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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I did go to see the eye Specialist on Friday and my pressure

Customer Question

I did go to see the eye Specialist on Friday and my pressure did not go down with the one eye drop called apo-brimonidine~ in fact it increased to 37 in each eye~I was very disappointed~ although she did say that there was no damage to my optic nerves and I just had high eye pressure~ not gluacoma~that was a relief~ she thus prescribed three drops to take and wants to see me again next week~ the drops were azopt op 1%or brinzolamide1%~combigan op DRP or Brimon tart/Timolol Mal~ each of these twice a day~ then Lumigan once before bed~.01%~ the first night I woke up with pain in my eyes and a headache~ but not the second night~ does this sound normal and also would I have to take these for Life~the last one is supposed to change the color of your eyes and grow eye lashes~ all this sounds rather scarey to me and yet I am Thankful to having healthy optic nerves so far~I would like your opinion on this treatment~Martha~
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Doctor DanB : Hello and thanks for your question. Martha, yes, Lumigan carries with it those risks. Most women don't mind the long, luxurious eyelashes, but thankfully the eye color change is much less common than the lash growth.
Doctor DanB : It is pretty normal to have a slate of abnormal symptoms for the first day or two on new drops, but ifbtheybhavecstopped that is encouraging.
Doctor DanB : If they have stopped that is encouragng
Doctor DanB : As far as taking these for life, most people generally do end up taking these for the rest of their life, but not always. There are always exceptions.
Doctor DanB : Does this make sense? Do you have any other questions about this?
Customer:

I am not sure what your comment means~IF they have stopped that is encouraging~your words sort of ran into one another and you typed it again on the next line~ I assume that you may mean the optic nerve damage is not done~I feel that this alone is a good sign~ but the reading of 37 seems very high to me~I was very relieved when she said this about my optic nerves~ she just calls it high eye pressure I think~ but in time would this not cause gluacoma and also do you think this reading is exceptionally high~especially when the Optomitrist prescribed drops~ were they not good ones maybe and with this problem can I still wear contacts~I need that thick one for my left eye where I had no implant with cataract surgery~ will the discomfort of burning sensation go a way in time and wll I always have to take three drops~ what about Laser surgery~

Doctor DanB : It is not exceptionally high, but definitely too high to let go untreated. I was saying if the headache from the first night on the drops stopped then that is encouraging that you likely won't have significant problems on those drops. You can wear contacts with this. Yes, laser surgery is also likely an option but you'd have to talk to your ophthalmologist to see if you would be a good candidate. This may allow you to get off of one or more drops for a few years.
Customer:

In your expert opinion does these drops sound like a good combination~years ago when I had high eye pressure the Doctor only prescribed one called Timinol and it worked~ the drop that the Optomitrist gave me~ what about that one and I wonder why it did not help at all~I felt safe knowing I was on drops from my previous experience~ the Specialist was only going to give me two and then the last minute she gave me the third~ I asked you will I feel normal after or always have some discomfort and could I drive~ do they make you tired~I guess I read too much on the Internet~:-)

Doctor DanB : These drops do seem like a good combination, especially if they control the pressure. We usually have no way of knowing why a person doesn't respond to one drop or another. Many times it's just that the person needs more than one drop to control the pressure. Most people get over the initial burning and don't go on to have it the rest of their lives. The irritation can make you want to close your eyes, but these drops dont make most people tired, though it's possible that they can.
Customer:

I always ask so many questions~ if this had gone on for some time and I did not see about it~ would damage have eventually been done to the optic nerves~or can some people have this and higher with no problems~in fact she said I did not have a baby cataract in one eye~ whereas the Optomitrist said I did~ also the first Specialist I saw a few years ago said my left optic nerve was shaped differently than the right and asked if I had had an accident in it~he said he never saw that before~ this Doctor said on Friday now they are the same~ do you know what this would be about~

Doctor DanB : It is likely a difference in opinion (the reason why the first dr said it was different and this one said not). If this had gone on untreated for many years I suspect it would've caused optc nerve damage.
Customer:

I promise one last question~ I have only started Friday night on these drops and today I feel a burning sensation~ but no headache~ it is annoying and hopefully it will go away~ also my sister had her eyes checked and there were extra blood vessals behind her left eye~ which had to be treated with needles~I never heard of this and what would cause that~ as I asked before~ would I be able to drive~I assume so since my eye sight seems okay~ my right eye has 20- 20 vision up close and the Optomitrist felt it was because of that so called cataract~ which the Specialist does not see~ or what she did see is very minimal~I assume an Optomitrist does not know nearly as much as you Specialists do~ she had me feel nervous and she seemed to think I had gluacoma~she thus would not prescribe new contacts for me until I saw this Doctor~Martha~

Doctor DanB : Your assumption about the optometrist is correct. And yes, you should be able to drive. I suspect it will go away but using some artificial tears regularly, 2-3x/day every day can help with that. The most common reason for those extra blood vessels is macular degeneration, but you would've been told about that if that were a problem for you.
Customer:

Many Thanks~ I agree that I would have been told~I have enough problems now without that~-)

Doctor DanB : Yes, indeed. I hope this has been helpful. Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3141
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Dr. Dan B. and other Eye Specialists are ready to help you
Customer: replied 1 year ago.


Hi Again~I just returned from the Eye Specialist and she was very pleased with how my medication worked~ four days after the readings of 37 in each eye they were 16 and 17 today~ I was so surprised that they worked that fast~ is this normal~ I must have applied them correctly ~she asked if I wanted Laser and then added that if so I would still need drops as well~she wants to only see me again in two or three months and I picked two~ plus continue my treatment~ would the pressure not go too low if it worked that fast~or does it remain stable at a certain level~the symptons that I mentioned my sister having~ is that serious and moreso than gluacoma~ as she spoke like it was nothing and the needles fixed it~I hope that I get you again~ since you were with me from the beginning~Martha~

Expert:  Dr. Dan B. replied 1 year ago.

Yes, this is normal that they work so fast. No the pressure wouldn't go too low just because it worked fast. Both eye problems you and your sister have are serious, but your sister's has the potential to take the sight much quicker and worse than yours.

 

I'm glad you're doing better. Good luck.

Customer: replied 1 year ago.


I guess I mean if continued~could it not go even lower~ as I assume she wants me to do~ will the eye pressure even go lower or stay stable I mean~ as she gave me 100 refills~in my case I do not have gluacoma~ but high eye pressure~is this not a good sign~in my sister's I am not famaliar with it nor have I heard of it before~

Expert:  Dr. Dan B. replied 1 year ago.
Yes, it's possible it could go lower, but it is virtually impossible for it to go too low. But hopefully as long as the pressure stays low, glaucoma damage will not develop.
Customer: replied 1 year ago.


Thanks for your responses and patience~ in your opinion then I am to continue taking these drops and the pressure will never go too low~I should have asked the Doctor this today~I wonder how she would know that even with laser I would still need drops~plus she was not in a big hurry to see me again~ she also said I could now get contacts~three drops seems to me like a lot~ but I am not a Doctor~Martha

Expert:  Dr. Dan B. replied 1 year ago.
Yes, that is correct. Experience is how she knows that, and I tend to agree with her assessment. Three eye drops are not alot considering you weren't even close to having your pressure controlled on one drop.
Customer: replied 1 year ago.

Hi I am back once again with yet another question~ I have been tired today and used my eyes for up close a lot~ both house work and computer~ anyway I see black floaters in my left eye~ they come and go~ I saw the Specialist twice in the last week and forgot to ask if these were serious~ could eye strain cause them~the pressure is normal now~ or I might think it was that~ hopefully the drops are not working too much and bringing the pressure too low~ although I have had these often through the years~ it is just now that these things tend to bother me moreso~worrying I guess that something serious is happening~ after the scare with such high eye pressure last week~ my sister said her Doctor stated that her eyes did not improve one bit with the needles and wants to send her to a Specialist in a larger Center~ she is not calling it macular degeneration and I don't like to say it to her~ can anything else be done~ she said the vision was very bad in that eye~

Expert:  Dr. Rick replied 1 year ago.
Hi. I'm online and happy to answer your question today. I see that your expert has opted out and is no longer available to assist you.

I am a retina specialist and, from what you have posted, the black floaters are nothing to worry about at this time.


You are likely experiencing a PVD or posterior vitreous detachment, a common event that happens in many people.

You have a thick gel material in the middle of your eyes called the vitreous. Over time as it liquefies, this gel material collapses on itself, forms little clumps that you can see as dots, lines or bugs. As these clumps form the vitreous pulls away from the wall of the eye. In the process it can stimulate the retina -- causing the flashes that you may see.

It is recommended that you see your ophthalmologist to look at the retina to make sure there are no problems such as a retinal hole or tear. In most cases, there are no problems, but this exam is precautionary and allows for preventative treatment of any lesions that are found.

If you notice a sudden increase in floaters, flashes of light (like a lightning storm), or a shadow/veil in the periphery of your vision, this can be worrisome for a retinal detachment. You would need to contact your ophthalmologist promptly in that case.

What can you do about the floaters? Well, floaters don't go away, and they don't really get worse. Over time they tend to "sink" out of your central vision and you brain "filters" them out so you don't notice them so much anymore. They almost never cause significant visual problems except, of course, if they cause a secondary retinal detachment as discussed above. The only way to decrease or remove the floaters is with a major surgery called a vitrectomy. As a retinal specialist for almost 2 decades I've only done this procedure to remove floaters in a handful of cases.

What you are experiencing is not caused by eye strain.

Concerning your eye pressure, as DrDan stated, it is almost impossible for your pressure to get too low from the use of glaucoma drops so no worries there.

If you could give me more information about what is going on with your sisters eyes, I would be happy to help you to better understand her situation.

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick MD FACS

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 1 year ago.

Hi Dr. Rick~Thanks for taking so much time to answer my question about floaters~I have had them on and off for many years~it is just now that ANY eye thing worries me~ I saw the Specialist twice in a week~ so if there was something serious I am sure she would have picked up on it~I assume you can read my comments about my eyes to Dr. Dan from the first to the end~I was so so relieved that no damage was done thus far and I was called just a suspect with high eye pressure~ I had neglected to go for some time and it would have been my fault~ the pressure did rise however and she got it down in four days~I continue to take the drops~is 37 dangerously high~


 


I am concerned about my sister~ Dr. Dan said it was macular degeneration when I told him her symptons~ she did not call it anything~ except that this was found in a routine eye exam~ a growth of blood vessels behind her left eye and he was treating her with needles to get rid of them~ after a few treatments in a month there was no improvement in her sight in that eye and he wants to refer to a retina specialist in a larger center~we both live in smaller centers~I wondered what else could be done~Dr. Dan said it was more likely that she would lose her sight than I would~if I continue my drops and keep seeing my Specialist~ am I pretty safe~ since thus far I am not called a glaucoma patient~ just IOP or some such word~I assume glaucoma would set in if left untreated~ since the pressure dropped so fast in four days~I thought it would maybe go too low if continued~but Dr. Dan said it was not possible~does keeping the drops in the fridge better~I read that some place~ thus one could feel the drop more if it goes in~ as they would be cool~Martha~Thanks~

Expert:  Dr. Rick replied 1 year ago.
Martha,

37 is high and defiantly is at the level that treatment is needed. That being said, as long as it has come down now, you should be OK.

As a retina specialist it does sound like macular degeneration from what you have posted (depending on your sisters age etc) If you could get me more information I'd be happy to help you to better understand what is going on with your sisters eye.

I'm not sure what your doctor is labeling you as but with an IOP of 37 before treatment I think you should consider yourself as a person who has glaucoma.

I agree with DrDan: You do not have to worry about the eye pressure getting too low on drops...this really is not possible.

I like to have patients keep their drops in the fridge so that they can feel the cold drop hit their eyeball and, as such, can easily tell if they got the drop in....just as you have been told.

Have a good day and let me know if I can do anything else to help you.

Dr Rick MD FACS
Customer: replied 1 year ago.


Hi Again~I just thought that if there was yet no damage to the optic nerves then it still was not glaucoma~you are just prone to having high pressure~is what I understood~ it started as 33 and 35 and with the one drop the Optomitrist gave me it actually went up to 37~ by the time I got to the Specialist~I moved from another Province and it took me longer to get all this in~I lost my husband suddenly is why I moved near my son~ so I have been under a lot of pressure~does marijuana help ~I had taken some in the past 10 years ~ but do not now~it appears that I have not lost any vision thus far~ 20- 20 up close for the right eye~I had cataract surgery in the left and have to wear a thick contact in it~ as back 30 years ago they would not do an Implant on a young person~as they were only supposed to last 20 years~ I need a new one~the Optomitrist would not give me one until I saw the Specialist~she was concerned about my high pressure and it is scary~now my sister is a different story~ would she eventually lose her sight~ she is age 62~would it eventually go to the other eye~it also sounds serious and I never heard of that disorder before~Martha

Expert:  Dr. Rick replied 1 year ago.
I'm glad that you do not have damage to your optic nerves at this point....but, with pressure of 37 I would label you as a person with glucoma...even without damage to your vision or nerve.

Marijuana really doesn't help much with glaucoma...but it doesn't hurt either.

You should be able to get a secondary intraocular lens implanted now so you don't have to wear a thick contact anymore....talk with an eye surgeon.

I would not let the optometrist manage your glaucoma...keep going to the ophthalmologist for that, even if the optometrist does your contacts.

Hard to tell what is going on with your sister. Let me know if you get anymore info...

Have a good weekend.
Customer: replied 1 year ago.

They do not seem to recommend an implant now~ with the trauma of high pressure~I had asked this question many times~ I don't see light flashes with the darn floaters and they seem to come and go every once in a while in my cataract eye~ then I do not have them for a while again~I agree about Optomitrist's~I only have to see the Specialist in two to three months~ so I picked two~ so she must be satisfied???~it is for the contact and glasses for my right eye ~ distance~ that I see the Optomitrist~ I do not think that they are even Doctors~should the needles have helped my sister I ask~yet they apparently did not~ she seems young at age 62~ to me anyway~:-) Sorry for so many questions~ funny now Dr. Dan said 37 was not exceptionally high~ but high enough for treatment~everyone must have different opinions~hopefully this shall be it~ except what happens after needles do not work for my sister with a retina specialist~ which she has to see~

Expert:  Dr. Rick replied 1 year ago.
Your high pressure/glaucoma really shouldn't completely rule out your chances for an intraocular lens....

Don't worry too much about the floaters....I've had them myself for 30+ years.

Sometimes the needles don't work....happens. But then laser might be an option.

Customer: replied 1 year ago.

Hi Again Dr. Rick~ I called my Ophthalmoligist today and she has me down as a Glaucoma Suspect~ not actually having it as such~ even with the original high pressure~I have to make sure that I take my drops however~Martha~ Have you heard of this before?

Expert:  Dr. Rick replied 1 year ago.
Martha,

Yes. That makes perfect sense to me. Like you said, whatever "title" your eye doctor has given you it is still necessary to use your drops.

From what you have posted I would bet that you caught the high pressure in your eye before any damage was done :-)

Have a great day.
Customer: replied 1 year ago.


Thanks and this gives me great comfort~ as it could easily have gone the opposite way~she did say I had NO damage yet~ she said I do not have what my sister has experienced either~to me hers sounds rather serious~ as can glaucoma as well~maybe hers has to be caught in the early stages also~ I had neglected mine~ is why I am so grateful~ years ago it was also high and I was on drops and then the Specialist went a way and I let it go~he did not call me back and I did not pursue it~I had taken some marijuana back then and that is why I asked you IF this may have helped ~ I know ~ as you said~ it did not hurt~ but after about 10 years of neglect and knowing I had high pressure~ this is either a Miracle or the marijuana helped~Martha~ :-) PS~ I was very stupid really to neglect something so vital~he was not a very nice man and I hated to go to him~

Expert:  Dr. Rick replied 1 year ago.
420 really doesn't lower eye pressure enough to be clinically helpful although it is true that it can make eye pressure a small amount lower....

I think we should go with a Miracle on this one lol!

Anytime you find that you don't like your doctor, go out and find another one -- there are tons of them ;-)

I'm glad you have not had any damage but never forget this: You will be on eye drops for pressure the rest of your life. Glaucoma is a silent, blinding disease if ignored....
Customer: replied 1 year ago.


Thank you~ as you are so nice and also have a sense of humour~I lived in a VERY small area and he was the only Specialist we had~ I now live in a larger Center and I see that there are many choices~ although I am happy with this one~ she seems very nice and my Optomitrist referred me~I guess I got lucky~ anyway I hate to keep asking questions~I hope that you get paid~ but once again is the outlook for my sister good~ thus far only her left eye is affected and the needles did not seem to help~ she could hardly read the letters on the second line of the chart~ he is thus referring her to a Specialist such as you are~ taking drops for life is not so bad~I see my drops vary on how to store then~ the fridge may be too low for one of them~although it sounds like a good idea~she said it depended on the drops~ 15C to 25C or 30 C I guess ~one is lower~I think my bathroom is okay~she said I must be doing things right~ to have it drop so fast~I hope this shall be my last question~Martha~I am concerned for my sister~ as she is still working~I am retired~

Expert:  Dr. Rick replied 1 year ago.
It is hard for me to say what the outlook for your sister is from what you have posted...if you could get more specific information I'm sure I could tell you much more....

You can store your glaucoma drops in your fridge as long as they don't freeze they will be OK. Being cold, it is easier to know when the drop gets into your eyeball so you don't waste as much and you are sure you are getting the medicine in.

I only get paid if you press the positive feedback button....so....if you want, you can mash it now (it is healthy and fun to press ;-)

Let me know what I can don for you in the future. Have a great day.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you

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