How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8530
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
48069651
Type Your Eye Question Here...
Dr. Rick is online now
A new question is answered every 9 seconds

What is the exact status of the catarat in my right eye, when

Resolved Question:

What is the exact status of the catarat in my right eye, when should it be operated. Based on what is this decision normally done?

After the macular pucker operation in the left eye I started suffering from high blood pressure in my left eye, and I am using COSOPT to treat that. I never had blood pressure problems in the right eye. During my last visit to my ophthalmologist in December 2010 I discussed the problem that he had recommended me to change to another remedy for the blood pressure control, called Azarga, and he prescribed to use it in both eyes. I know from my own reading (e.g. internet, I am not a medical professional) that once you start using pressure control medicines for the eye, you will always have to keep on using it. So, I did not use Azarga in the period after the last visit in September 2010 and I kept using COSOPT in only the left eye. During the consultation of December 2010 my right eye blood pressure was good again (16) and the explanation my ophthalmologist gave me for using Azarga in the right eye could not convince me. I like to have a second opinion on this issue: is it recommended to start using blood pressure medicine in an eye that never had shown blood pressure problems? Whwn is it recommendable to change COSOPT for Azarga? Further comments are welcome, because I really have a problem with this issue.
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

are you available to chat?

Dr. Rick :

Hi. Cosopt and Azarga are very similar medicines. They both have the drug Timolol, a beta blocker, in combination with a carbonic anhydrase inhibitor. Cosopt has Dorzolamide and Azarga has brinzolamide. I would consider them almost the same in their ability to lower intraocular pressure.

Customer :

yes, I am now available to chat.

Dr. Rick :

good.

Dr. Rick :

In deciding when to start a patient on glaucoma medicine I look at many things: The eye pressure, the health and morphology of the optic nerve (called the "cup to disk ratio"), the health of the nerve fiber layer, the morphology of the outflow channels (called the angles, this is checked with gonioscopy), visual field changes, as well as the patients history, age and rate of change of the above parameters,

Dr. Rick :

Perhaps that is why your ophthalmologist wanted you to start drops in the right eye?

Customer :

The main point in my question was if it is recommendable to use a pressure lowering medicine in an eye with good pressure. Especially, if once the use of such medicine is started, the patient will probably will have to keep on using it for the rest of his life.

Dr. Rick :

That is correct about maybe having to use if for the rest of your life. As I pointed out before there are times when the pressure may be in the "normal" range and the optic nerve is still showing damage consistent with glaucoma. Perhaps this is what your ophthalmologist is noticing in your case ( I hope you are not trusting your glaucoma treatment to an optometrist!)

Dr. Rick :

As to why he would switch you from Cosopt to Azarga? I'm not sure. They would be expected to give the same level of eye pressure control. If more were needed I would add a drop such as Travatan to the cosopt.

Customer :

Is it true that once you start using pressure lowering medicine in the eye, you will probably have to keep on using it for therest of your life and that therefore you do not styart administering such a medicine till it is absolutely necessary.

Dr. Rick :

No. That is not exactly true. Drops can be started and stopped if they are found to not be working, surgery or laser can be used that make taking drops no longer necessary etc.

Dr. Rick :

One thing that is true, however, is that nerve tissue -- and the vision that goes along with it -- can never be restored or regained once it is gone. In that light, I would not be too quick to delay starting therapy to avoid a "lifetime of drop usage"

Customer :

In our system the optometrist is not supposed to give medication, so it is always the ophtamologist who is the one responsible for medicines..

Dr. Rick :

I wish it was like that in the States. I can' tell you the times I've had a patient finally come to me for treatment after an optometrist has been "treating" them for years while they slowly went irreversibly blind.

Dr. Rick :

Have we covered all the issues you wanted to review?

Customer :

What is the main factors on which a decision to operate a cataract is besed?

Customer :

orrection: What is the main factors on which a decision to operate a cataract is based?

Dr. Rick :
By how much the cataract is affecting your vision. A cutoff we use in the states is 20/50
Customer :

This is my last question.

Customer :

What is the interpretation of 20/50?

Dr. Rick :

At that level the risks of the surgery are much less then the expected benefit so it is worth it. This is also the level that the government and insurance companies use to pay for it so the patients don't have to

Customer :

Thank you dr. Rick.

Dr. Rick :

I'm not good at metric: 6/6 is the same as 20/20, Let me see if I can look it up quickly

Dr. Rick :

But if you are having a lot of glare issues from the cataract you could safely have it removed sooner....

Dr. Rick :

Got it. 20/50 is 6/15

Dr. Rick :







Snellen


20/10
20/15
20/20
20/25
20/30
20/40
20/50
20/100
20/200



Metric


6/3
6/4.5
6/6
6/7.5
6/9
6/12
6/15
6/30
6/60



 

Dr. Rick :

It has been my pleasure to help.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


I hope that this information was helpful for you. Please, allow me get credit for my time and effort in assisting you and press the ACCEPT button for this assist. I will be glad to answer additional questions until you are satisfied. Thank you very much.

Positive Feedback and/or Bonus is welcomed and appreciated.


 


 

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8530
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 3 years ago.
Have a good weekend.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C. Freshfield, Liverpool, UK
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex Los Angeles, CA
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP Hesperia, CA
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin Kernersville, NC
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther Woodstock, NY
  • Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know. Robin Elkton, Maryland
 
 
 

Meet The Experts:

 
 
 
  • Dr. Dan B.

    Board Certified Ophthalmologist

    Satisfied Customers:

    2903
    Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
< Last | Next >
  • http://ww2.justanswer.com/uploads/DoctorDanB/2010-6-7_6228_just_answer_profile_picture_60_pixels.jpg Dr. Dan B.'s Avatar

    Dr. Dan B.

    Board Certified Ophthalmologist

    Satisfied Customers:

    2903
    Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
  • http://ww2.justanswer.com/uploads/anupamadesai/2010-04-13_122313_Dr._A.S.Desai_new_photo.jpg Dr. A.S. Desai's Avatar

    Dr. A.S. Desai

    Ophthalmologist

    Satisfied Customers:

    1903
    MS Ophthalmology with 11 years of surgical expereince
  • http://ww2.justanswer.com/uploads/gsokoye/2009-10-28_181751_Dr._Stan.JPG Dr. Stan's Avatar

    Dr. Stan

    Ophthalmologist

    Satisfied Customers:

    895
    Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
  • http://ww2.justanswer.com/uploads/eyemd/2009-04-07_180315_pic.jpg Dr. Stevens's Avatar

    Dr. Stevens

    Ophthalmologist

    Satisfied Customers:

    629
    Board Certified Ophthalmologist
  • http://ww2.justanswer.com/uploads/CO/CorneaDoc/2012-2-18_0390_photo6.64x64.jpg Dr. Susan's Avatar

    Dr. Susan

    Ophthalmologist

    Satisfied Customers:

    217
    Board Certified & Fellowship trained eye surgeon.
  • http://ww2.justanswer.com/uploads/neuph94/2009-10-11_164729_gif_pic.GIF Dr. JP's Avatar

    Dr. JP

    Ophthalmology, Oculoplastic Surgery

    Satisfied Customers:

    28
    Harvard Medical School, Massachussetts Eye and Ear
  • http://ww2.justanswer.com/uploads/JA/JACUSTOMERjcufyksv/2012-3-13_44825_crop3.64x64.jpg Dr-Trace's Avatar

    Dr-Trace

    Board Certified Ophthalmologist

    Satisfied Customers:

    26
    Board Certified in General Ophthalmology
 
 
 
Chat Now With An Eye Doctor
Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5461 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest