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Dr. JLB
Dr. JLB, Ophthalmologist
Category: Eye
Satisfied Customers: 86
Experience:  General Ophthalmologist, Fellowship trained in Refractive Surgery
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i have chronic lyme disease and Postural Hypotension and i

Customer Question

i have chronic lyme disease and Postural Hypotension and i have recently been diagnosed with glaucomana and optic neuritis for whihc i received a 3 day IV home treatment of steroids and then followed up with prednisone pills which i am done with now, but vision is only getting worse, much worse since i started noticing changes 2 monts ago, vision has gotten worse so fast, i tried different eie drops but shockingly i had a violent, crippling, whole body spasming screaming crying headache, do you have any idea what would have caused this? i got this terrible reaction within a half hour of trying different eye drops, but the Xalatan and betoptic eye drops have not caused this reaction, so i am taking these, do you think these drops are suffiencient to lower eye pressure that is 35 in one eye and 24 in the left? so far, after a month, pressure has not come done at all, and my vision has only gotten more blurry and more darker, as the perssure goes down, will my vision get clearer and br
Submitted: 4 years ago.
Category: Eye
Expert:  Dr.S Riaz replied 4 years ago.

HelloCustomer

 

The headache that you are having is related to raised eye pressure. 35 mmHg is very high pressure and it needs to be brought down fast otherwise there will be damage to the optic nerve. Xalatan and Betoptic drops do not seem to be sufficient. You may require more pressure reducing drops or oral drugs for a short time like Acetazolamide. If pressure is not controlled on drugs, you may have to go for glaucome surgery. Some vision will return after the pressure is brought under control but the vsion loss due to optic nerve damage is not going to come back. The steroids that were given to you could be responsible for this raised pressure. You need to discuss it with your ophthalmologist. So, you need to see a glaucoma specialist fast to save the optic nerve and vision. Best wishes to you.

 

 

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Customer: replied 4 years ago.
thanks for your reply doctor, along with the xalatan and betoptic drops, i just started neptazame 3 times a day, the problem is that i am bedridden and cannto travel at all, i suffer major setbacks and it is jjust not possible, so surgery is out of the question, what i want to know is since i am on the drops and pills does that mean my vision will not get any darker and blurrier than it is right now and will thses symptoms get any better? and are there any other drops that you recomend that would might work faster that are not in the same group as azopt and alphagan because these are the 2 that gave me the think i am going to die sudden headaches, with intense sweating, do you have any idea why some of the drops gave this kind of headache and some didnt? thanks so much for any advice and input you can give me,
Expert:  Dr.S Riaz replied 4 years ago.

Hello Radha,

 

There are many drops avalable. You could have developed problems using prednisolone drops as prednisolone is a steroid and can cause increase in eye pressure. Every drop is associated with side effects in some individuals. I can understand that you can not travel and that is really unfortunate. In glaucoma treatment eye pressure has to be monitored and belive me it could be harmful for you to get an online prescription. An examination is very important. Neptazane will help to control the eye pressure but it can not be given for a long perio of time. As far as glaucoma surgery is concerned, it is done under local anesthesia and should not be such a problem. Your fitness will be assessed for this surgery before the procedure. You should discuss this with your ophthalmologist. Thanks.

 

 

Follow-up questions, if any, are welcome.

 

 

Unless you click the ACCEPT BUTTON I am not paid from your deposited amount. BONUS and a POSITIVE FEEDBACK will be welcomed.

Customer: replied 4 years ago.

i never said i had taken prednisone drops, and you have not given me direct answers to the questions i asked, so unless you can answer exactly what i have asked, i do not acdept this answer, sorry,

Radha

Expert:  Dr. JLB replied 4 years ago.
HiCustomer

I hope you don't mind, but I would like an opportunity to answer your concerns. The description of your recent decrease in vision after being placed on IV then oral steroids for optic neuritis associated with lyme disease is worrisome. IV and oral steroids have two common side effects in the eyes:

First, they can increase eye pressure, which you have already experienced. Typically, pressure must remain elevated for long periods in order to cause significant damage that would be noticeable to you as the patient. Glaucoma must be present for a long time before causing visual damage. In all likelyhood, the decreased vision you have recently noticed is not due to this increased pressure.

Second, steroids can lead to cataract formation. In my opinion, this is a more probable cause for the decreasing vision that you have recently noticed. There is only one solution to cataracts and that is cataract surgery. This is the most common surgery done in the United States and the techniques are such that you would likely be able to undergo this procedure with low risk of complications given your current medical ailments.

In terms of your current pressure readings, the drops you are using would be expected to lower your pressure 30 to 35% of their current reading. These drops, together with Neptazane should lower the pressure to less than 20. Over time, the effect of the steroids should wane and you may be able to decrease the meds you are currently using to keep the pressure low. Even if you had not stopped the steroids and were required to continue their use indefinitely, it is better to use them to treat the lyme disease and deal with the side effect of the steroids as they develop. Lyme disease can be quite debilitating whereas the steroid side effects can be managed.

In terms of your past side effects with Azopt and Alphagan, it is uncommon to have such severe side effects from eye drop use. However, the most likely of these two to cause the effects you described is Azopt. Azopt is called a carbonic anhydrase inhibitor and theoretically can cause side effects like the ones you have described. This is probably the reason you were not given Diamox (acetazolamide) which is an oral carbonic anhydrase inhibitor which can also cause side effects like the ones you described. Instead you were given neptazane which is the other oral alternative to lower eye pressure.

I have not examined your eyes and therefore cannot see if you are suffering from cataracts. Only your eye doctor can evaluate this.

There is yet one more possible explanation for your decreased vision. This is optic atrophy secondary to the recent episode of optic neuritis. During optic neuritis, retinal cells that course to the brain via the optic nerve can die off. These cells do not regenerate leading to optic atrophy and permanent loss of vision. This could also be a contributing factor to the loss of vision. Once again this possibility can only be assessed by the ophthalmologist that is currently caring for your eyes.

I wish you the best of luck and hope that these answers have shed some light....

God Bless,

Dr. JLB
Customer: replied 4 years ago.
thanks for your much more detailed reply, i didn't make myself clear because the high pressure, 35 in ight and 25 in left eye were measured before i had the IV treatment so the prednisone did not elevate the pressure and the doctor who came to my home and examined my eyes never mentioned cataracts, you did say that the eye drops and neptazane will lower the pressure but how long do you think approximately it will take? and in that time is it possible my eyes will get even more blury and more darker and possibly more lost completely or will the medicines stop any further vision loss and blurriness? my right is almost black and left is so so blurry and vision is so dark and dinned, you said i wasn't given diamox due to the violent, severe reaction to the eyedrops Azopt and Alphagan but i was first prescribed diamox and did not get the same reactino, but because of my choice and insistance, i was switched to neptazane since it seemed better, so it is still a mystery why i got the worst sudden screaming crying sweating headache of my life each time i used those drops. optic atrophy is a possibility since the doctor did say the back of my eye is almost completely white, and behind the other eye a blood vessel has ruptured and is leaking, what does that mean? i was only on the prednisone tablets for a few weeks and at the end not even daily and steroids are very bad for lyme disease and those tablets gave me too many side effects and made the lyme symptoms even worse so i was very glad when i stopped it, please please read this carefully and please give me a new assessment based on the new information i have provided, what are the chances of my vision getting back to as close to normal as possible? thanks so much Radha
Expert:  Dr. JLB replied 4 years ago.
Hi Radha,

Given the new information you have provided, it appears your glaucoma was in fact present prior to any steroid treatment. This would render you with a diagnosis of Primary Open Angle Glaucoma (POAG). POAG basically means that we do not know the cause but we do know the risk factors for the development of glaucoma. The major risk factors include:

1. high eye pressure (greater than 22)
2. having a family history
3. being of dark skin color
4. getting older

As you can see, the only one of these we can control is the pressure. The medication regimen you are on should lower the pressure within 1 to 2 days. So your pressure should already be normal, otherwise further measures should be explored. Once the pressure is controlled, the likelyhood of further visual loss due to glaucoma is greatly reduced.

As to the reason for the terrible side effects you experienced, I must admit, I have no explanation given your past use of Diamox. I would have expected the same symptoms while on Diamox.

Also, since cataracts have not been isolated as part of the problem, I am left to think that your visual loss is due to POAG, optic atrophy from lyme disease and finally from a branch retinal vein occlusion (BRVO, often seen in lyme disease) which is a type of stroke of the back of the eye. The visual damage from POAG and optic atrophy is usually permanent. In the case of BRVO, the leaking vessel can sometimes be treated with a laser that will aid in the reabsorption of the fluid accumulated in the retina and ultimately could provide some improvement in vision. I don't believe this improvement will take your vision back to normal but given the difficult clinical course you have experienced, you should strive to preserve your current vision and hope for some marginal improvement if the BRVO can be treated with laser

I sincerely XXXXX XXXXX prognosis I have shared with you was more positive, but ultimately I have to share with you my knowledge given the information you have provided. The vision that you have at this time should be protected at all cost, since the possibility of it worsening is real, especially if the pressure remains elevated.

Pressure control is the priority followed by laser treatment, if this is deemed to help with the BRVO by your ophthalmologist.

Good Luck and God Bless,

Dr. JLB

Edited by Dr. JLB on 12/26/2009 at 5:46 AM EST
Dr. JLB, Ophthalmologist
Category: Eye
Satisfied Customers: 86
Experience: General Ophthalmologist, Fellowship trained in Refractive Surgery
Dr. JLB and other Eye Specialists are ready to help you
Customer: replied 4 years ago.

thanks for sharing your knowledge and your honestly, i unfortuntaely cannot go for laser so will the eyedrops and pills be enough to control and even bring about some improvement in vision? and do you have any idea why i got elevated eye pressure in the first place at such a young age? i have clicked accept but i would appreciate it you could answer these final concerns, thanks alot,

Radha

Expert:  Dr. JLB replied 4 years ago.
Hi Radha,

It is possible that the laser you would need to treat the leaking from BRVO can be performed at the bedside, so dont give up on this alternative just yet. In my opinion, the eyedrops and pills should be sufficient to prevent further visual loss from glaucoma, as long as the pressure level remains around 18 or so. Unfortunately, usually the vision that has been lost cannot be recovered.

I cannot say why you got elevated pressure at your age, but glaucoma can begin as early as 18 years old in some cases.

Also, remember that the laser for BRVO can provide some improvement in your vision.

Best of luck to you!!!!

Dr. JLB
Customer: replied 4 years ago.

i am sorry for bothering you again Dr. but i have some more questinos and this is too important, and you seem more knowledgable than my own doctor, was i right in reading that laser can be done in the home by the bedside? can you do this? i know this is not the ideal or conventional method or preferred but since i dont have any other option can it possibly be done? money is not a problem and i would pay you for travel expenses and whatever else you asked for, i would not be using insurance, do you have any experience at all doing this? and yoou said the pressure should come down in a day or two, i thought it took months or longer, and i have no idea what the pressure is, i just bought a portable machine and it says 24 and 20 but i am not sure if it is right and vision is no different, , please please do not say no right away, other than laser, isi there anything else tha can be done to help te BRVO and how can i be positive i have that since it was never mentioned to me? if you think you can help me knowing i cannot leave my home, please come and see me, i am in New York, where are you and could you please give me your private email? i know it sounds strange that i cannot go to hospital or have any tests done like MRI, butany travel even with ambulance has caused too severe a setback in the past and i have to preserve whateve little independence i have left, thanks so much

Radha

Customer: replied 4 years ago.

please please reply to my last post, and please think about coming before saying no,r cr can please let me know what you decided and if laser can be dome in the home, if it is possible,

radha

Expert:  Dr. JLB replied 4 years ago.

HiCustomer

 

Yes, the laser can be done at your bedside. However, this is not a procedure that I perform since I am a refractive surgery specialist. This procedure must be performed by a retina specialist. There are excellent retina specialists in NY, but I am not sure if they would make the house call that you need. Most of the retina specialists I know work in Manhattan and the Bronx. You may want to consider calling The Retina Group on Pelham parkway in the Bronx.... They may be able to assist you better than I can. Please understand that I am not refusing to help you personally. I appreciate the confidence you have in me. Its just this is not my subspecialty and I am not qualified to perform the laser procedure that I believe may help you. Best of luck....

 

Dr. JLB

Customer: replied 4 years ago.

I am so sorry to be bothering you again and again, but is there anyone you knw personally, a friend maye who is this kind of specialist who you could maybe talke to and recommend, since i find total strangers are not willing to go out of their way to help someone they know nothihg about, i would be willing to pay any extra fees for taveling to see me, and i would feel more comfortable eing taken care of by someone who was recomended and was known for doing this even in the home, i could not find any info anywhere about any laser surgery being done in the home under any unusaly circumstances, i asked for your personal email so tha we wouldnt have to go thru just answer for every conmmunication, and again, please reply as soon as you can since this is such an important matter, and again i cannot thank you enough for all your input and replies, you said you knew some specialists in Manhattan, well mabye if you told them how badly i need a house call and need to have the surgery done in my home, maybe they might be more inclined to agree, pleaes, and i would compensate you for any part you plaed in this, eagerly await your reply,

radha

Expert:  Dr. JLB replied 4 years ago.
Hi Radha,

I am not sure of any colleagues by name that would be willing to make this house call. I will tell you that it may be possible to perform some of these lasers at the bedside but unfortunately this is not my subspecialty and I feel you would be better served by having a bedside consult by a Retina specialist.

There is an organization in Manhattan called Lighthouse international that may be able to facilitate such as service for you. They are accustomed to dealing with patients in need of low vision care on a daily basis. I can understand how frustrating this is for you and I appreciate your willingness to compensate me or any other that can come to your assistance. However, I feel that you may benefit from the aid of a social worker that may help facilitate in this time of need. There must be someone in your community that can start a chain of events that will provide you with social work help and possibly direct contact with the Lighthouse or a Retina specialist that will make this house call.

I do not feel comfortable sharing my personal e-mail via this forum but will be glad to continue to assist you in any way that I can via this Just Answer Blog.

Dr. JLB
Customer: replied 4 years ago.

hihi Dr. i have called many doctors in N.YC. and no one is willing to travel an dno one has any idea what i am talking about when i ask if they will do the laser in the home, and they are also wondering why i am asking for a retina specalist when glaucoma is in the back of the eye, so are you sure what i need is a retina specialist? and i dont meor does an to doubt you but are you sure the laser can be done in the home? if you are sure, then i asking you, please please give mesome specific names of doctors even if they are far away from me, who have the laser in the home, because i dont think i will be able to find sonmeone who will do it and i i need somdeone to come and do it right away, not months later, my mother and sister who is a lawyer have been making all the calls and typing alot of this for me, please give me some names and numbers, and if you can find me docror who will come and do the laser, iwould pay you wahtever you think is fair, and i also wanted to know if you have any idea why the betoptic drops and neptazane has not lowerded the eye pressure at all after weeks of treatment, or does it take longer? i pray at least no further damage is being done, please please reply and i am sorry foror does it take longer pressuring and bothering you and please do not give up on me,

radha

Expert:  Dr. JLB replied 4 years ago.

Hi Radha,

 

The laser that I am referring to is not meant to treat the glaucoma. It is meant to treat any possible swelling that may be present in the back of the eye due to the BRVO. It is important to remember that the visual loss from the glaucoma cannot be reversed but you may receive some marginal benefit if laser is performed to an area of swelling due to BRVO. I have seen retina doctors perform this procedure at the bedside using an indirect ophthalmoscope. Before you reach the point of having any laser treatment you need an evaluation to determine if such a procedure would help. I unfortunately do not know any doctors that perform house calls, but a place like Lighthouse International may be able to help. Their website is www.lighthouse.org.

 

In terms of the effect of Betoptic an Neptazane, they should prove effective within 1 to 2 days of use. You explain that the eye pressure is high, but I must caution you that the handheld tonometer is not as accurate as other instruments in measuring pressure and must be operated by someone skilled in its use.

 

Radha, please do not feel that I am holding out on giving you specific names. It is just that your circumstances are unique and require coordination with professionals willing to accomodate your needs. I don't know of any specific professionals that have done this in the past but other organizations may be able to assist. I strongly encourage you to contact the lighthouse and see where that leads.

 

Best of Luck!!!!

 

Dr. JLB

Customer: replied 4 years ago.

hi docgtor, you are saying the meter to measure pressuer might not be acurate, but if the pressure had come down then wouldnt i i had felt any difference in pain or vision improvement? and we did call the lighthouse international and they just help low vision lke eyeglasses and eye therapy, but not more compicated things like surgery, so i dont know how they could help me, i feel very bad constantly bothering you but since i am so secluded and canot get doctors to come and see me, i keep coming to you, and i eally need your help so tahnks for coniniuting to communicate with me, how can i be sure that i have this BRVO? just by looking and examing the eyes or can i only be positive i have it with an MRI? whihc i cannot have done , my parents think no doctor will do any laser or anything unless i can have all the ex-rays done, do you think a doctor might do the laser even without an MRI? i know i am asking too much, but i am asking again to please ask and find someone who would travel and do this laser for me, please, i dont know what else to do, please

Radha

Expert:  Dr. JLB replied 4 years ago.

Hi Radha,

 

AN MRI is not necessary to diagnose BRVO. This can be seen on a dilated eye exam that can easily be done at the bedside. Generally, increased eye pressure is not painful and therefore decreasing of the pressure would not feel different. Also, decreasing the pressure will not translate into improvement of the vision. It will only prevent further vision loss.

 

The only alternative to improve the vision will be an attempt at decreasing any swelling you may have in the retina associated with your BRVO. This is handled only by a retina specialist.

 

I'm sorry that the Lighthouse was not helpful. Have you tried to contact this retina specialist in your area?

Retina Associates-Binghamton: Sperber David E MD, 113 S Jensen Rd, Vestal -(NNN) NNN-NNNN/h4>

I checked their location and it appears to be about 45 minutes away from you in Vestal, NY. I do not know this doctor personally, but I hope that if you explain your situtation to his staff they would go the extra mile to try and meet your needs. I continue to wish for improvement in your case...

Dr. JLB

Customer: replied 4 years ago.

hi doctor, i was so so surprised and i am so grateful to you for all your help, more grateful than any words can say, i called the doctor you mentioned and he will not come and see hme anyone i call all sound shocked and and reply in a belittling and condescending tone that of course no treatment where something touches or goes into the eye can be done in the home, so i am begging you to please ask someone you know who has performed the procedure you are talking about to reduce the swelling, and ask him to come and do it for me, i would pay him and you as well, you are my only hope, my vision is getting slowly worse and i am so terrified, and i am ery sorry to pressure you and bother you, but please find me someone, because i seriously doubt i will find anyone, and definately no one to do any procedure in my home, please find me someone who knows about this procedure and is willing to do it in my home, it in the home, it doesnt matter how far away the doctor is, i will pay all traveling expenses as long as he helps me, i know i am asking too much of you, but i dont have anyone else to ask, please ask your colleagues if they will come and help me, and would having the BRVO be a reason why the eye pressure might not be coming down?

Radha

Expert:  Dr. JLB replied 4 years ago.

Hi Radha,

 

The BRVO is unlikely to have any relation to eye pressure. This is strictly related to the Glaucoma. I'm sorry to hear of your continued difficulties finding help. Can you explain to me why you absolutely and under no circumstances cannot leave the house? I have never known anyone that has done laser treatment at the bedside in a patients home. However, I have seen it performed at the bedside in a hospital setting. This means that such a treatment can be done at the bedside. It would be up to the doctor to decide if he is willing to do it outside a hospital setting.

 

Again, I am curious to know the obstacles to you visiting a doctors office? Is all of your medical care performed at the home?

 

Answer these questions for me so that I have a better idea of the entire situation. If you leave the home for a regular office visit at a doctor's office are you at risk of medical complications?

 

Thanks,

 

Dr. JLB

Customer: replied 4 years ago.

hi doctor, thanks so much for replying so fast, i was waiting for you to ask me why i am so adamant about not leaving the home, yes i have alot of other problems, i have severe Postural Hypotension and lyme disease and other infectionsgo thru pure helll when i try to eat anything due to low blood pressure, low blood volume, and low blood sugar fluctuations, so wheh i have tried to travel at all, or put any strain at all on my very very weakended body, i become a total vegetable, not even abloe to sit straigt on the bedpan, or feed myself, and gothru the hours of crushing pressure and adrenaline rushes i have every time i eat, and the daily fevers and chills and headaches i get daily from lyme and other infectinos, and i suffer too severe a setback, you will justhave to trust me when i say that travel is just not possible, if i could handle it do you think i would be begging you so much to come and see me?, i dont know what else to say to convince you of how desperately i need your helpi even if this is not your speciality, ,could you consider doing this procedre or finding someone who would do it in the home, plesase i am begging you, and do you have any ideas why the eye pressure might no thave come down after weeks on medication? my vision is very blurry and dimmed,and very dark like there is no light int he room, does this sound like glaucoma or BRVO? so it is not total vision loss i think, please give me the answer i am desperately waiting to hear from you, money is not a problem to save my eyesight and at the same time not put the rest of me in jeopardy either,

i have wonderfrul parents who will vouch for everything i have said,

Radha

Expert:  Dr. JLB replied 4 years ago.
Hi Radha,

Thanks for the explanation.... I understand how difficult it must be to travel. Do you have any doctors of any specialty that currently travel to your home? Also, remember that I cannot perform the procedure since this is not my area of sub-specialization

Thanks,

Dr. JLB
Customer: replied 4 years ago.

hi doctor, thanks again for replying quickly and for your understanding, there are still more reasons for my not being able to travel at all, but i i didnt want to go on and on and on, thanks for trusting me that it is nopossible in the condition i am in, a close friend of my dad's who is an internist is my doctor and he makes house calls and i keep in touch with yim thru email for any problems or concerns, but that is it, no other doctors of any speciality come to the home, that is why i am nagging you so much, becauv se i am in such desperate need of an eye doctor and you are realy my last hope, so what can i say or do to convince you to do this prodcedure which you sei bet you are thinking em to know alot about, or to find someone who will travel here and do it in the home? plase please do not say no, and again i am so sorry for continuiing to bother you when i am sure you already have more than enought of your own problems and too busy with your own life, but i really need your help, the sooner you can come or find someone who can come the better for my eyes, i know i am asking too too much from you but the fact]that you have continued to communicate with me and have gone way beyond the call of duty, shows the depth of character and your innate kindness, you didnt answer my question wny you thinkmaybe the eye pressure is not coming down,

Radham

Customer: replied 4 years ago.

i am very sorry for bohering you but since i havent heard from you i am getting nervous, please tell me that you didnt reply right away like you always do because youu are searching ans aking if anyone you know will travel here and see me, please do not give up on me,

with many many thanks

Radha

Expert:  Dr. JLB replied 4 years ago.
Hi Radha,

Sorry for the delay... I have been very busy lately. I really do not know anyone that I can ask if they would be willing to travel from my area to evaluate you and possibly treat you if this proved to be helpful. I honestly feel that your best options lie with the internist in charge of your care. This doctor should be able to present the specifics of your case to a retina practice that can then either examine you or refer someone that can examine you. Remember all my theories are strictly based on the information you have offered. There is no substitute for an eye exam where someone can see first hand if the treatments I have suggested would actually help. I can't imagine that your internist would not share your concern for the loss of vision and would look to assist in any way possible so that this retina consult could take place. I continue to wish for improvement in your condition.

God Bless,

Dr. JLB
Customer: replied 4 years ago.

hi doctor, thanks so so much for replyng and again i apologize for bothering you so much when i am sure you are very busy, my internist knows all about my eye problems and all he has to say is that he can refer me to an eye doctor or be admitted to the hospital, but that there is nothihng he can do, so i am asking again since you do not know anyone and i have called every eye doctor within an hour of me if you would come and see me and do the procedure, please seriously considerate it, i do not mean to insult or offend you in any way, but there must be asome monetary figure that mght influence you or maybe change your mind? and i know this is not your speciality but you are still a certified and qualified eye specialist so you can do the procedure and i trust that you willhelp me, please please come and help me, what can i say to convince you? thanks and eagerly waiting your reply,

Radha

Customer: replied 4 years ago.

please tell me that you are seriously considering coming to see me since i cannot get anyone to make a house call and defintaely no one to do any prodedure in the home, please i beg you,

Radha

Customer: replied 4 years ago.

hi doctor, i am sure you are surprised to hear from me again but i am very desperate and and i am asking you again to please reconsider coming and seeing me or tryjng to find someone you know to come and see me, i have tried and tried and no one will come to my hoe and no one has any idea what i am talking about when i tell them there is a procedure that can be done in the home for the BRVO, can you tell me the exact name of the procedure you have mentioned to me in previious messages and once again i am offering to pay any amount you ask if you come and help my vision, the eyedrops and neptazane are not helping and i dont know what else to do and vision is still getting worse and i know you understood why i couldnt travel to the hospital, i would if i could, please please reply,

Radha

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