My mother and her parents had glaucoma. So for many years my ophthalmologist has had me taking latanoprost eye drops for my elevated pressure readings. She also arranges various testing / tracking. A friend mentioned that she also takes eyedrops related to glaucoma concerns. Got to thinking it may be common enough for CC’ers (or their aging parents) to start a thread.
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My H has had high pressure and a family history of glaucoma. He has been prescribed drops but is non-compliant in taking them, as he finds them very irritating.
So, he just had laser trabeculectomy performed on each eye last
Fall. So far, it seems to have worked. Pressure has remained lowered 
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I had a trebulectomy done on my left eye…and I wish it had insisted on the right one too. But it was deemed necessary because I was allergic to every eye drop tried…in my left eye…to sufficiently reduce the IOP. I use one drop of timolol daily in my right eye, and I had some surgery when I had my cataract done to do something for my glaucoma that can only be done during cataract surgery…whatever that was!
My son was diagnosed with glaucoma at age 20! He uses two different drops, timilol and something else.
All I can say is…thank goodness these drops are all now generics. They were NOT 20 years ago!
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My dad had glaucoma but wasn’t one for preventive care so by the time he had an eye exam and was diagnosed he had lost some vision. I always mention it at the optometrist’s
office and make sure my pressure is tested yearly. I also have another test to check my peripheral vision done about every 3 years.
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My Ophthamologist is pretty thorough & I believe she checks H & me out every visit (2x/year). So far so good, but H is being evaluated for when his eyes are ready for cataract surgery—he has to be off ALL contacts long enough.
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My mother was allergic to most of the glaucoma eyedrops she tried. Eventually she had a type that was very costly, tough on a low income. Even though my medical is a high deductible plan, I
still only pay $7 per 90 days for my latonoprost drops - no complaints there.
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MIGS - minimally invasive glaucoma surgery.
A small metal stent(s) are poked into the trabecular meshwork while the eye is open for cataract surgery.
It lowers IOP roughly an additional 3 mmHg.
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Interesting. Wonder if that is something that will be considered when I need cateract surgery someday.
With drops, my pressure readings are kept well under 20. Have had various testing done for years (well actually decades, first initiated by my prior ophthamologist who is now retired). The trend results have been inconsistent (I’m really bad at the testing) but still concern current my current ophthamologist. I tried doing a consult witha specialist. Unfortunately there was a glitch transmitting all my test data, and the specialist did a set of her own tests and said “seems fine”. So I went back to the regular place for the testing and my glasses in same place. Recently I had suggestion again to consult with specialist … or just transfer care - I may do it this time. Both places are quite convenient to home.
My ophthalmologist is a glaucoma specialist, and my son also goes to a glaucoma specialist.
Mine is in a very huge practice that has doctors specializing in just about everything…retina, optic nerve, cataract, ophthalmological plastic surgery. And they have three optometrists as well for those who don’t need an MD.
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The good news is that if it’s normal now, by definition it’s been normal prior. So your lost tests won’t be needed. 
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Part of the problem is that I’m horrible on the visual field test, so many of my responses get thrown out (although certain areas do seem worse over time, esp in one eye). Lots of practice has not made me any better. The ophthamologist also tries to look for trends on OCT scan (retina thickness), where there is some thinning over time. Forgive my layman translation.
I had a scary thing about a week ago, with 2 nights where I experience a few seconds of a sort of “whiteout” blindness after 8 or 10 steps on my way to the bathroom at night. I think it’s likely due to my low blood pressure, though I don’t recall feeling dizzy. (Since then I make sure to sit on the edge of the bed before getting up, take few deep breaths. No repeat of the issue.) Coincidentally I had an annual physical on Friday, and PCP agreed with me that it would be a good idea for me to consult the ophthamologist - I have an appt on Mon morn.
Seriously thinking about just switching to the specialist (who had no major concern at a consult a few years ago) and only getting glasses at my normal place. This was an option that had been suggested to me in the fall, when we had decided to defer decision.
White is generally not bad. Arterial occlusion, from any number of mechanisms, nerve swelling, also from any number of mechanisms, results in black, or rarely pink/purple vision.
As for visual field reliability, it’s hard for everyone. Fortunately, all the good machines, Humphrey/Zeiss and Octopus/Reichert, have catch trials. They’ll routinely test above and below threshold, to determine the reliability of a tester.
OCT, optical coherence tomography, in this case is used to section out a specific layer of the retina that shows retrograde damage when the nerve is injured, the nerve fibre layer. Anatomical changes as measured by OCT predate field changes. They are often equivocal though so most doctors wait for reliable, repeatable OCT changes, or just wait for field loss.
The good news is that you have to lose a LOT of field to be symptomatic.
Specialist, or sub specialist? Glaucoma Fellowship trained sub specialist? That would be overkill unless you had very atypical circumstances otherwise, like highly cupped small nerves, but normal field, exfoliation, etc. The only downside would be expense and time.
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Thanks, that’s good to know.
Honestly it did take me a while to calm down and realize that my “not able to see” panic moments were actually white. (I tried to find some logic about why all was ok when up at 1am, symptom at 4:30am wake-up… thought maybe due to early morn light through the blind.) My low blood pressure has made me prone to passing out a few times, though mostly when younger. Once at the eye doctor office, after dialation drops. That was embarrassing when the nice office staff arranged to drive me (and my car) home.
Orthostatic hypotension causes a temporary disruption in the occipital cortex of the brain where vision is processed. That’s almost certainly what caused your “whiteout” given your history. It’s benign…as long as you don’t fall and hurt yourself.
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REF - Ophthamologist (MD) vs Optometrist (OD) What Is an Ophthalmologist vs Optometrist? - American Academy of Ophthalmology
In my above posts mentioning “Dr Smith”, I erroneously said Ophthalmologist. I noticed today that she is actually is Doctor of Optometry.
I’m an optometrist, but I did a hospital based residency and was then the busiest provider in the largest ophthalmology practice in the region. I had a bigger glaucoma practice than all of the ophthalmologists except for my fellowship trained glaucoma specialist partner.
So, long story short, it depends on your optometrist. Are they residency trained? Do they have a decent sized glaucoma practice? Do you like them?
As a local endocrinologist told his diabetic patients when the asked him if it was ok to see me “You’re better off seeing an educated, interested optometrist than a disinterested ophthalmologist.”
The good news for primary open angle glaucoma is that it’s a very slow disease. It doesn’t go catastrophic rapidly…many years, not a few days. The typical optometrist tends to be more conservative and will turf you out the moment they’re feeling you are progressing.
In anyone hands glaucoma is a squishy disease. It relies on subject information that is arduous to obtain (visual fields) and anatomical markers that aren’t specific for the disease, and can vary visit to visit (OCT). IOP is mainly only a factor once you’re known to have glaucoma or if you have ocular hypertension, pressure over 21 mmHg.
So, you could change, but you might end up in worse hands. As one of my mentors used to say, the standard deviation is wider in optometry. You could already have great care. It’s hard to know from afar.
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Thanks for the helpful info, eyemgh. I had been confused by my simplistic assumption that “Dr xyz” meant ophthalmologist. (Didn’t realize optometry had a doctor designation.)
Due to strong family history of glaucoma, I’ve had tons of testing over the last decades. With my dismal visual fields test-taking skills (even mentioned in the report we looked at yesterday from 2022 glaucoma specialist consultation), sooo much testing.
My regular doc I’ve seen since 2013 has had me coming in 3 or 4 times a year. One annual visit is the regular exam for vision check / glasses and optimal. The other visits have been a pressure check and alternating tests (OCT, visual fields). There are possible small areas of loss indicated.
Yesterday, at an appt I set up when alarmed by the whiteout blip after getting out of bed at night, my eyes were OK as expected. (There was recommendation to talk with PCP or cardiologist). IOP was 16. We decided that instead of going back next week for next test appt, I’ll consult the glaucoma specialist again. She will hopefully again say no major concerns, advise whether I should switch to specialist office for testing because they are much more experienced with glaucoma patients.
3-4x/year testing is typically only the case in well documented, very fragile glaucoma. The glaucoma specialist will give you an idea of how “scary” your eyes look. High risk, they’ll hold onto you. Low concern, they’ll likely turf you back and maybe see you once a year, if again at all. It’ll be good know where you stand.
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Yeah, I’ve been taking some Rx that increase my risk of glaucoma so I am seen by ophthamologist 2x/yr. So far, no red flags. H also is seen 2x/yr and will be having cataract surgery soon.
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What med? Do you have narrow angles? The reason I ask is that most meds with a glaucoma warning are only applicable to people with a fairly uncommon anatomical configuration. People get worried when in reality, if they’re like most, the drug poses zero risk.