Sunday Musings on Glaucoma

Day 11 post-surgery

The more I read, the more questions I have. Most of the devices and procedures currently used to alleviate high IOP are for open-angle glaucoma. There are a surprising amount of glaucoma subsets that involve other diseases (such as diabetes). I have narrow-angle glaucoma, and the literature states that one has a greater disposition towards this type of glaucoma if one is Asian, and female. Ugh. Which of course makes me wonder what the standard treatments are for narrow-angle glaucoma, considering half the world's population is women, and there are billions of Asian people.

from National Taiwan University
Hospital glaucoma treatments

I narrow my search to Taiwan because 1) I'm looking for literature written in English and 2) there will be a greater likelihood of pertinent literature in an Asian country with high economic standards. So, that of course means, I'm not looking for research coming out of the People's Republic of China (because it'll probably all be in Mandarin), or Thailand (even thought they have a thriving medical tourism trade, among other types of infamous services, it's mostly cosmetic). What I find is not reassuring because there's no mention of MIGS (minimally invasive glaucoma surgery), which granted, is relatively new. There's lasering holes in the trabecular mesh work, shunt implantation, and finally, the drastic destruction (via laser) of the cells that produce eye fluid (called the ciliary body).  Nice to know what the other options are, right?

My eye looks nearly normal, with just a faint mesh of broken capillaries. I'm not sure if that's where the incisions were made to remove my lens and insert the iStent. A Femto laser was used because it is not only quicker, but more precise. Unfortunately, health insurance companies don'tsee it that way. (Seriously! They'll cover hand-made incisions but not the laser cuts!) This particular stent is meant to be positioned so that fluid drains into the normal meshwork of the eye via Schlemm's canal.

There is a new device, the mushroom-shaped iStent Inject, being tested that appears to be easier to install, and can implant multiple stents which, theoretically, will lead to a greater lowering of IOP. I could use that in my right eye since it has maintained a 3-4 point increase over the past year. While not at a critical level, it is alarming that having had laser iridotomy (first line of treatment for narrow-angle glaucoma after eye drops), and SLTs twice on both eyes, my eye pressures have never dropped to the "safe" level of <10 mmHg (millimeters of mercury). Last week my left eye measured 14, the same as it was prior to surgery, and my right eye maintained a pressure of 17.

There are more drastic devices that would lead to greater reduction in pressure, but those shunts also require blebs, or pockets under the surface of the sclera that can clog, become infected and suffer other serious malfunctions. I'm convinced that implanting a shunt will totally kill my gym rat days. That is unacceptable for me. It's not just vanity, but sanity that's at stake. If I can't work out, I really think that my mental health as well as physical well-being will suffer. Exercise is more than just stress-relief. It's also a mood enhancer, with the added benefit of preserving mental acuity. I can't give it up.

new iStent Inject

I seem to see just as well out of my left eye as my right, so that's reassuring and makes me less nervous about replacing my natural lens with an artificial one. I don't think my doctor has used the newer iStent Inject yet. It might be worth waiting for, depending on how the right eye progresses or maintains. According to a glaucoma specialist at Wills Eye Hospital in Philadelphia, this device is being tested in Armenia. (Admittedly, that's not a place I would expect to see in an article about new devices.) I see my doc tomorrow. Wednesday will be two weeks and I can stop using the antibiotic eye drops, which suggests (to me, but I'll double check) that I'll be able to shower without having to tape my eye shut. That will be such a relief!

I've added another treatment, as per my doc's instruction sheet: it's an OTC saline ointment (Muro 128) applied twice a day. It's suppose to reduce edemas, although I'm not sure I have any... and because it's basically salt in a greasy format, it stings a bit, makes my vision blurry and tends to goo up my lashes. It's also ridiculously expensive. I bought the store brand version, and it was still $22 for a tiny tube. (The cashier told me that they stopped carrying the name brand item because it was so pricey!) Luckily I had some coupons to knock the price down $5. But still! Ugh. And no matter what stent I have implanted in my right eye, I'll probably still have to do this routine again...

Day 12 post eye drops and goo