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Glaucoma: The Thief

I was diagnosed with Glaucoma last year and I thought it would be useful to others to provide a general education article on the subject, as well as provide some details of my experience. (This will not be a highly technical article. It is as much a description of my experience. I will provide some technical details and some an useful resources that go into more depth. I will add them here - to this web article..)

Glaucoma is an eye disease. It is the second leading cause of blindness in the United States. This disease is  called "the thief" because it robs sight in the "periphery" (the outer edges) of the;visual field. Because the vision loss is not central - the loss can go unnoticed.  Eventually the insidious loss of vision in the peripheral visual field works it's way inward toward the center of vision. By that time though, recovering the peripheral losses is impossible. But since early glaucoma can be detected nbsp;treated blindness can be averted. A routine Ophthalmologist visit insures early detection and treatment. But overall Glaucoma is an important topic to for me to write about, because I experienced it. By writing about it you are provided with the knowledge I did not have, or knowledge I did have but ignored. Then you can avoid the consequences I suffer daily..

This web page graphically depicts some of the visual changes that can occur when the peripheral vision is damaged, the tunneling effect: CLICK HERE

Glaucoma is about several things. Firstly: it is about a build up of pressure in the Vitreous Humor of the eye (a gelatinous watery substance that fills the eyeball) . Normally there is an equilibrium of fluid pressure in the eye  because the eye produces enough fluid to inflate the eye, and the excess comes out of a drainage channel near the cornea and iris called the trabecular mesh work. Glaucoma is a disturbance in the drainage system which results in increased intra ocular pressure. The increased pressure reduces blood flow in the  blood vessels feeding the optic nerve. That process results in  ischemia to that nerve, and ultimate death and blindness. The normal pressure inside of the eye 8-20 millimeters of mercury (mm hg) In Glaucoma pressures exceeding 20 mm hg causes the damage I described. That damage is permanent - but preventable, It is preventable by measuring the pressure in the aqueous humor ( Tonometry. Aqueous Humor is fluid that fills the outer parts of the eye such as the cornea and maintains it's convex shape. It also lubricates and supplies nutrients to the anterior parts of the eye and fluid to the Vitreous Humor.) It is recommended that everyone get that pressure checked every two years.

(Note: There is a type of glaucoma that does not involve high interior pressures, it is called "normal tension" glaucoma, but it is rare. Also, I have "open angle glaucoma," but there is also the "closed angle" type, which has a very sudden onset and is associated with quite a lot of eye pain due to a complete closure of the drainage system. It is considered a medical emergency. The signs of all types can be detected on exam and treated early.)

African Americans over ag

Risk factors for glaucoma are the following:

African Americans over age 40.

• Everyone over age 60, especially Mexican Americans.

• People with a family history of glaucoma.

Among African Americans, studies show that glaucoma is:

• Five times more likely to occur in African Americans than in Caucasians.

• About four times more likely to cause blindness in African Americans than in Caucasians.

• Fifteen times more likely to cause blindness in African Americans between the ages of 45-64 than in Caucasians of the same age group.

(Source: http://www.nei.nih.gov/health/glaucoma/glaucoma_facts.asp)

These criteria for "high risk" should not cause you to be oblivious to recommendations around frequency of eye exams. Falling into a high risk group only means the exams should be more frequent. For those in high risk groups, opthalmic visits should be annual. Also, Glaucoma can strike at any age, in any race, at anytime..I don't fall into any of those categories. Nobody in my family has been diagnosed with Glaucoma in three generations,when I researched both the maternal and .paternal sides of my family and so, despite a genetic component, there's no evidence anyone has or had the gene...

I did not get my eye pressures checked regularly and I am dealing with the consequences. I had no symptoms that were obvious until January 2008. The symptoms were coincident with an emotional trauma, which clouded the my interpretation of the symptoms as effects associated with a visual problem. And, there is evidence to suggest that the emotional event, and onset of noticeable symptoms were connected. Although, i don't think the emotional circumstances caused the disease. It is possible that a series of stress events triggered a genetic predisposition to the disease, d that the emotional trauma complicated the underlying disease. It was perhaps a number mechanisms that were involved in both the acute episode, and in the aggressiveness of the disease which normally insidious: higher blood pressure, and vasoconstriction, decreased immunity from stress, poor diet (I lost 30 pounds from anorexia associated with the depression.) Additionally, In February of 2008, I was actually diagnosed with symptoms of agitated depression and Post traumatic stress syndrome.

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In January 2008 I was talking to someone with whom I was involved on the telephone and discovered something shocking about that person that affected my sense of trust in my own instincts about people. I was emotionally traumatized by that person. And during that phone call I had two ocular symptoms: I saw my keys spinning on the floor, and then, a I saw a large black spot descended over my right visual field. I dismissed those symptoms as cognitive/emotional because they were transient, lasting only one hour. I was very upset and later saw the visual symptoms as part of the emotional trauma.

My involvement with this person led to life changing moves which affected many in my family. I knew that negative consequences would be forthcoming in the many months which would follow. This trauma followed one that had just occurred one week before - when my brother died. I felt somewhat responsible for his death. At that time, I was trusting that person, with that person, when there was another way to deal with our relationship that would not have compromised my brother. But because of the trust in that person's sincerity I was not there to help him and I lost him. If my brother had died when I was with her, and she was sincere, his death would at least have had some meaning. But on the phone, after a dramatic separation, I had much evidence to believe she was very insincere for the one whole year prior. She was playing games with a whole family and her own. The telephone call proved it. .Also, If she was sincere and we had not separated; then I would have been less confused by depression, and might have associated visual changes with an eye problem..(as it turned out, this woman was criminally inclined, and in the ensuing months, committed many crimes and violations of law..)

I sank into a severe life threatening depression which lasted months. In February of that year, I was in the supermarket, and I felt like I was in a fog, But another visual effect occurred: I saw people appearing and disappearing on my right side. Again, I thought the effect was cognitive/emotional. I wrongly assumed that the symptom was caused by inattention related to the depression. I found out the real cause later. I had already lost vision in my right visual field within one month of the initial symptoms.

I didn't know it, but the depression was obfuscating visual damage,

I wasn't convinced that the problem was visual until some months later while reading a book. I noticed my reading glasses weren't strong enough. I remembered the January experience and the supermarket episode, and decided to test my own vision in a crude way by closing my left eye while looking at the text with my right eye. The text was all fogged over. Alarmed I reversed the test. The text was much clearer looking at it with my left eye. I removed the glasses and tested my vision distant. The fog was still there and it was just as bad. I knew then something went very wrong with my vision, which has always been 20/15 in my right eye.

With a sense of urgency I flew out of the house and I drove to my daughter's ophthalmologist's office. He was the nearest eye doctor. I told the secretary about the symptoms, and she booked an appointment for August. I managed to convince her there was an emergent problem. I tried to convince her, that if my vision had gone this bad this quickly, the appointment could not wait. Luckily, the doctor overheard my complaints. He was focused on the January symptoms., and the associated visual changes and he took me right in..

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He checked y vision, and my eye pressures. The pressure readings were: 52 in the left eye, 56 in the right eye, nearly three times the acceptable outside limit of 8 - 20 mm hg. Then he dropped the bomb:

“ You have glaucoma. There is severe damage done to the right eye, minor to moderate damage to the left.. We will have to do a visual field test.”

He asked why I didn't come in January, the pressures could have been reduced by beta blocker eye drops... no damage would have been done, or perhaps, little, certainly far less. I told him about the emotional scene, and he seemed to understand, and then he apologized. There was no way to undo the damage. He said that by August, I'd be totally blind. The doctor gave me an oral anhydrase inhibitor: a pill called dimox and three drops: Lumigan, Cosopt, and Alphagan. The pill would reduce fluid production in the eye, and the drops would reduce inflammation and allow drainage from the interior of the eye.

When I went in the next day, the pressures dropped to a healthy 14 mm hg in the right eye, and 10 mm hg in the left. But the visual field test showed that I had lost all of my peripheral vision the right eye, with some central loss. The damage to the left eye was not quite as bad, but there was significant damage to the peripheral vision.


I went to see a specialist in Boston, Dr. Bellows of Mass Opthalmic Associates. He did optic nerve density test. This test determined how much viable optic nerve tissue was left in both eyes. The result was not very encouraging, The results showed I had very few optic nerve fibers left in the right eye, and even the left eye was badly damaged.

I was legally blind

As the summer of 2008 passed, while adjusting to this diagnosis, things were further complicated by a developing contact dermatitis from all three of the eye drops. The doctor gave me 2 variations of the earlier drops. Since allergy to so many different classes of medications is unusual, if not bizarre, the doctor thought it might be the preservatives common to all of them. So he prescribed versions of Alphagan and Lumigan that had different preservatives. Unfortunately, I got the same reaction, The eye lids became red and swollen, itching, and they drained a serous fluid which crusted over in the morning. From the total of 6 drops prescribed:and  two variations of Alphagan and Lumigan which had different preservatives, only Xalatan worked without producing allergy. But since the allergies took months to acquire, that drop may cause problems too.

On a recent visit to my primary Ophthalmologist, the pressure readings were too high on Xalatan alone. As a result my doctor suggested I meet with Dr. Bellows again to discuss surgical options. I met with him last Wednesday May 13. I was hoping Dr, Bellows would offer the laser surgery which is less invasive and poses the least risk. But he wants to do the filtering surgery called Trabeculectomy

With Trabeculectomy surgery, the surgeon uses a surgical tool to make an alternate drainage channel by incision into the sclera of the eye (the white part,) and then, into the vitreous humor. , If the procedure is successful there may be no need for the eye drops. The operation lasts 35-45 minutes on average, and it is done on an outpatient basis. There are still some associated risks. I was told there is a 3 % risk of trauma to the remaining nerves that are functional in my right eye. (He will do the right eye first.) There are also other risks that have the same rate of occurrence forming an overall risk rate of 3% for complications..: The pressure in the eye could drop too low, for example. Also, as with any surgery, the risk of infection is ever present.

Dr. Bellows wanted to do the surgery this Thursday May 21, 2009. But the surgery was postponed until the following Thursday May 28. I will eventually write on that experience once I know the results of the operation.

If there's a lesson to all about Glaucoma, it would be that the disease is very damaging and easily controlled with drops or surgery. Barriers of self defense against this kind of damage are: early detection, maintaining good over all health habits such as getting regular eye exams, and reducing stress.. There is some evidence to support an emotional trigger for glaucoma and acute episodes are often triggered by strong emotions. I experienced many of the symptoms of acute glaucoma in January of 2008...I have may have been close to a closed angle emergency, The research is ongoing in this area. Sometimes our experiences and resulting intuitions about things are way ahead of the research. And so, a stable emotional life is advised.

That emotional response I referred to earlier was my fault. Nobody should be allowed that kind of authority over my emotions nor should others allow anyone that kind of power. I supposed it is just sad that there were so many variables involved in me missing the signs that the problem was visual and not emotional.

As a nurse I should have followed my own advice. Certainly I should have recognized the “black spot” as a classic visual symptom. It usually means actual or threatened retinal detachment. But even my psychiatrist who was treating me for depression missed it, calling the visual effects: hallucinations. In addition, he should have known that visual hallucinations are very rare except in toxic states, or in organic brain syndromes - both of which are medical issues to be ruled out. My psychiatrist should have known that visual hallucinations are also more thematic - these were visual anomalies, not hallucinations. Ultimately he attributed the symptoms to medication called Chantix which is a nicotine antagonist used In smoking cessation. Indeed Chantix does have visual side effects .But I was well off of the Chatrix when I was in the supermarket one month later after my visit with him. I have no excuse for diagnosing myself...nor should you do the same, Get your eyes checked.

There are many useful web pages on the web related to Glaucoma found by running a search, but as for books Shields Text Book is very good.,

Thanks to Mike Zerger and Maria Claudia Faverio for editing suggestions on this article. There are still minor corrections to be made, and then this article, and And So it's The Piano , ,Man  a short story, will be published in the CGS Journal. Imhotep soon.