I told you Bill had to have another laser procedure and this one was different from the Laser Iridotomy last month which didn’t work. He’s had the Laser Trabeculoplasty procedure done 3 times now within a 9 year period plus the Iridotomy. He said this one really hurt and burned, they were going to put in 80 holes, but it got too bad and the contact popped out and he kept moving his head, they did reach 79 though before they quit.

This Laser Trabeculoplasty had to be done at the York Hospital instead of his office like the last one. It didn’t take very long after the drops to anesthetize and make the pupil smaller and we were required to go back to his office within an hour so he could check the pressure. An older lady had the procedure at the same time or rather right before Bill’s and she had to go have her pressure checked also. Hers went down to 14 and Bill’s went down to 20 which was great since it had been up around 33 and climbing.

Second week of August we go back to check the pressure again and I’m hoping it will be even lower. Below is the consent form we had to read and sign which explains what would be done and any complications that might be expected. His insurance isn’t the greatest and it costs a fortune to maintain, but at least it pays a portion of these surgeries and medications for his eyes. It really worries me that many people can’t afford insurance so what the hell do they do, go blind?

Of course I’m sure there are free clinics out there that help and will go by your income, but it sure would be nice if we had a national health system like Canada and other places. Well I’m closing this post now so have a great coming weekend if I don’t post tomorrow.

Consent To Perform Laser Trabeculoplasty

Purpose: The laser treatment that you will receive is being given as an alternative to surgery for open-angle glaucoma. The object is to re-open the microscopic channels that carry fluid (aqueous humor) from the interior of the eye by directing the laser beam into this portion of the eye. The published success rate of this type of therapy is about 75%, meaning in about 3 out of 4 cases there will be some lowering of intraocular pressure after the treatment. Generally the glaucoma drops that were being used prior to laser treatment will have to be continued after the laser treatment.

Method: The eye is anesthetized with a drop and a special contact lens is applied to the eye. From 40 to 100 applications of the laser will be made. depending upon the individual circumstances. These applications are generally given in one session, but sometimes a second treatment is required months to years later.

Complications: Minor complications that may occur include slight pain with the laser flashes, a foreign body sensation for a couple of days, and blurred vision lasting for up to a day. There is typically some redness and light sensitivity for several days. Potentially more serious are transient rises in pressure within the first few hours after the laser treatment that may require the temporary use of extra medication. In up to 3% of cases, there may actually be a permanent increase in eye pressure, rarely requiring surgical intervention. In some cases there may be a gradual loss of therapeutic effect or a rise in eye pressure over a period of months to years, requiring either a second laser treatment or other form of treatment like surgery.

Consent: I understand the reason for the proposed treatment, the chances of a successful outcome and the the risk of complications.

I really dislike being in the state of mind that seems to be overpowering me at the moment. I seem to be suspended somewhere outside myself, I can’t seem to make a connection to what I’m thinking or feeling so I am in limbo or so it feels. My body functions from day to day and I get through each one as it arises, but nothing really makes sense. Yes, I know it’s some form of depression, but for the moment I seem without power to help myself and sometimes I just don’t care.

I’m always amazed when I wake up and see that I’m still in the same body with the same familiar surroundings. Everyone seeks for the purpose and meaning of their life, many fulfill themselves through religion and God, others find truth in helping their fellow man and the reality of the earth they see before them by striving to save the planet. Many just seem to drift seeking, but never really finding, flitting from one illusion to another.

I think it’s great that each day brings choices and decisions that we must make that will affect our future life and even those around us. We have the power to make anything possible when we believe and what happens when we no longer believe or have hope of effecting a positive change? I don’t think I would ever commit suicide because I don’t understand the concept of ending it all, I don’t think anything is ever ended, I think that source of energy simply returns to the original source and is recycled into another channel.

Today I don’t know what I think or feel or even believe so I feel like I’m in limbo and I don’t like it, perhaps tomorrow I’ll snap out of it.

Bill’s Laser Iridotomy didn’t work, the pressure is still way too high, so in July the doctor is going to try something else. He told Bill that he wasn’t going to let him lose his sight. I don’t really think that’s something you can make a promise about, but he was trying to be reassuring. He sounds like he wants to try several different things before they do actual eye surgery.

He gave us a print out which I posted below for those that have glaucoma that might be facing this same type of surgery down the road. We hope it wont come to that, but you do what you have to. Have a great weekend.

Trabeculectomy & Sclerostomy  Filtering Microsurgery

What is filtering microsurgery? In glaucoma, the eye’s inner fluid pressure can build up and damage the optic nerve, the nerve that carries visual pictures to the brain. Damage to the optic nerve can lead to vision loss. When medicines and laser surgeries do not lower pressure enough, eye doctors may recommend a procedure called filtering microsurgery (sometimes called conventional or cutting surgery).

In filtering microsurgery, a tiny drainage hole is made in the sclera (the white part of the eye) in a procedure called a trabeculectomy or a sclerostomy. The new drainage hole allows fluid to flow out of the eye and helps lower the eye pressure. This prevents or reduces damage to the optic nerve.

How does the eye doctor determine if filtering surgery is needed? Often, laser surgery is recommended before filtering microsurgery, unless the eye pressure is very high or the optic nerve is badly damaged. During laser surgery, a tiny but powerful beam of light is used to make several small scars in the eye’s trabecular meshwork (the eye’s drainage system). The scars will help increase the flow of fluid out of the eye.

When laser surgery does not successfully lower eye pressure or the pressure lowering effects wear off, the doctor may recommend filtering rmcrosurgery . Is there pain during microsurgery? In most cases, there is no pain involved. The surgery is usually done with a local anesthetic and relaxing medications. Often a limited type of anesthesia, called intravenous (LV.) sedation, is used.

In addition, an injection is given around or behind the eye to prevent eye movement. This injection is not painful when LV. sedation is used first. The patient will be relaxed and drowsy and will not experience any pain during surgery. What is the success rate? Most of the related studies document follow-up for a one year period. In those reports, it shows that in older patients, glaucoma filtering surgery is successful in about 70-90% of cases, for at least one year.

Occasionally, the surgically-created drainage hole begins to close and the pressure rises again. This happens because the body tries to heal the new opening in the eye, as if the opening were an injury. This rapid healing occurs most often in younger people, because they have a stronger healing system. Anti-wound healing drugs, such as mitomycin-C and 5-FU help slow down the healing of the opening. If needed, glaucoma filtering surgery can be done a number of times in the same eye.

Is this an outpatient procedure or is an overnight stay in the hospital needed? Usually, filtering surgery is an outpatient procedure, requiring no overnight hospital stay. Within a few days after surgery, the eye doctor will need to check on the eye pressure. The doctor will also look for any signs of infection or increase in inflammation.

How long is the recovery time? For at least one week after surgery, patients are advised to keep water out of the eye. Most daily activities can be done, however, it is important to avoid driving, reading, bending, and doing any heavy lifting. Since each case is different, patients should check with their doctor for
specific advice.

How will the eye look after surgery? Is there a noticeable scar or redness? The eye will be red and irritated shortly after surgery, and there may be increased eye tearing or watering. The inner eye fluid flows through the surgically-created hole and forms a small blister-like bump called a bleb. The bleb, usually located on the upper surface of the eye, is covered by the eyelid, and is usually not visible.

Will vision be changed? Will glaucoma medications still need to be taken? There may be some vision changes, such as blurred vision, for about six weeks after the surgery. After that time, vision will usually return to the same level it was before surgery. Vision can sometimes improve after surgery in people who were previously using pilocarpine.

When pilocarpine drops are no longer taken, the pupil returns to normal size, allowing more light to enter the eye. In a few cases, the vision may be worse due to very low pressure. Cataracts or wrinkle in the macula area of the eye may develop. In terms of vision correction, a patient’s glasses or contact lenses may need to be changed after surgery.

Both gas permeable and soft contact lenses may be worn after glaucoma filtering surgery. There may be fitting problems due to the bleb. Special care is needed to avoid infection of the bleb. Contact lens users should discuss these problems with their eye doctor following surgery.

The Glaucoma Research Foundation acknowledges with appreciation Eve Higginbotham, MO, for her contributions to this information sheet. 490 Post Street, Suite 1427 • San Francisco, CA 94102 Telephone 415.986.3162 • Fax 415.986.3763 • www.glaucoma.org