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Medical Forum / Diseases and Disorders / Glaucoma / January 2004Random Questions
With the following as assumptions (so please don't challenge the assumptions--they are the given...even if you think they're unrealistic, stupid, whatever), 1. assuming no other medical impairments and no ophthalmological conditions other than glaucoma, would the visual acuity be affected by glaucoma? does glaucoma by itself usually only affect FOV? 2. assuming trab and other glaucoma surgery/procedures have not been undergone, and assuming further medications have reached the limit of their effectiveness (ie they have not lowered the pressures enough) and pressures remain relatively high, and lastly assuming a patient who for religious reasons or fear or whatever refuses any procedures and is unconcerned with going blind, would going off all meds then be something that could produce even worse effects? (if a drug/s are needed in this hypothetical, let's assume Xalatan, Cosopt and Alpha-gan P which are all widely used) 3. is the blindness that results from glaucoma a total no light perception (all darkness) blindness? Any anecdotal experiences welcomed. PF > refuses any procedures and is unconcerned with > going blind, Heather Replies: I would seriously consider sending this patient to a psychiatrist. Anyone who is 'unconcerned' with taking a course of action that leads to permanently losing their sight needs to have their competency to make that decision reviewed. That isn't to say that losing sight is the worst thing in the world, but after living 10 years without sight they might feel serious remorse that they failed to take a course of action that might have preserved their sight longer. > > refuses any procedures and is unconcerned with > > going blind, [quoted text clipped - 7 lines] > might feel serious remorse that they failed to take a course of action > that might have preserved their sight longer. This reply probably doesn't qualify as "spam" but it is exactly the response that is uncalled for, and moreover specifically not asked for. Nonetheless, the reply poster ignores the tautology in her response - who at this point can say any particular "course of action ... might have preserved their sight longer?" [if you're relying on "might," anything is within the realm of possibility--how about tomorrow scientists find a miracle cure for baldness, blindness and bad breath from a banana extract] No information was given as to what type of glaucoma the hypothetical patient suffers from, the profile of the patient or the extent of any effects from glaucoma. Perhaps, this reply poster was so affected by her glaucoma she didn't see the proviso at the beginning of the original post. If someone is unlike you and you cannot understand their reasoning, the first step is not to call in the shrink, but to try to understand where they're coming from. This board is very homogeneous in their thinking, and sad to say, makes little attempt to understand any diversity of thought. >> > refuses any procedures and is unconcerned with >> > going blind, [quoted text clipped - 9 lines] > >This reply probably doesn't qualify as "spam" No "probably" about it. The response to your post was just that, a response. Please note the definition of spam as it relates to Usenet, written by JDFalk: http://www.cybernothing.org/faqs/net-abuse-faq.html#2.1 >but it is exactly the response >that is uncalled for I disagree. I found it a logical response. To be "unconcerned" about going blind denotes deeper issues than glaucoma. Leigh -- If I want your opinion I'll beat it out of you. Have youu considered denial, sometimes a necessary coping response, at least initially? Caroyn >>>>refuses any procedures and is unconcerned with >>>>going blind, [quoted text clipped - 25 lines] > -- > If I want your opinion I'll beat it out of you.  SignatureA contented malcontent. http://www.equalizers.org >Have youu considered denial, sometimes a necessary coping response, at >least initially? Based on the hypothetical given (I'm assuming it was a hypothetical, anyway) it seemed that thought had been given to the issue so it wasn't an initial reaction to a diagnosis. Leigh -- If I want your opinion I'll beat it out of you. > Have youu considered denial, sometimes a necessary coping response, at > least initially? [quoted text clipped - 27 lines] >> >> Leigh How do you know the person actually is unconcerned. Maybe they are afraid... SignatureA contented malcontent. http://www.equalizers.org I'm not about to go to war on this. I was responding to what I percieve as a serious cluster of words, those being "unconcerned about going blind". That phrase concerns me, and that was all I expressed. > I'm not about to go to war on this. I was responding to what I percieve > as a serious cluster of words, those being "unconcerned about going > blind". That phrase concerns me, and that was all I expressed. Heather, Me neither. I just reread the originall scenario and noted that fear was one possibility mentioned. I'd just want to explore with the person the perception "unconcerned about going blind," because I too am concerned. SignatureA contented malcontent. http://www.equalizers.org > With the following as assumptions (so please don't challenge the > assumptions--they are the given...even if you think they're unrealistic, [quoted text clipped - 3 lines] > conditions other than glaucoma, would the visual acuity be affected by > glaucoma? does glaucoma by itself usually only affect FOV? Bare in mind these responss are from a glaucoma patient, not a doctor. There is a glaucoma specialist who often contributes here, so he would be able to give a more accurate response. Normally, glaucoma damages the optic nerve slowly over time. If uncontrolled, eventually the center portion of the field (which is what is generally used when acuity is measured) could be affected. > 2. assuming trab and other glaucoma surgery/procedures have not been > undergone, and assuming further medications have reached the limit of their [quoted text clipped - 4 lines] > even worse effects? (if a drug/s are needed in this hypothetical, let's > assume Xalatan, Cosopt and Alpha-gan P which are all widely used) Normally, higher pressures destroy optic nerve cells more quickly than lower (but still too high) pressures (note that too low of a pressure will also result in nerve damage; such a condition, while very rare, can happen). Assuming being on meds had lowered the pressure, I would say going off them would probably cause damage to occur more rapidly. > 3. is the blindness that results from glaucoma a total no light > perception (all darkness) blindness? In the areas of my FOV which have been severely affected by glaucoma, I can see nothing ("darkness" is a bit inaccurate since it still implies there is some sort of sight perception; instead, I often compare it with what you can see with your big toe, for example). I'm assuming that if my glaucoma were left to run amuck, out of control, the eventual result would be total blindness with no sight perception of any kind. > Any anecdotal experiences welcomed. > > PF > Assuming being on meds had lowered the pressure, I would >say going off them would probably cause damage to occur more rapidly. It's the spikes in pressures which cause the most damage, according to my opthamologist. (Noting that all degrees of damage are just that - damage.) Leigh -- If I want your opinion I'll beat it out of you. 1. assuming no other medical impairments and no ophthalmological > conditions other than glaucoma, would the visual acuity be affected by > glaucoma? does glaucoma by itself usually only affect FOV? > >Initially glaucoma usually affects only the mid-peripheral vision. By the time central vision is compromised and visual acuity starts to drop, one usually has greater than 95% damage to the optic nerve (a 0.95 cup to disc ratio). 2. assuming trab and other glaucoma surgery/procedures have not been > undergone, and assuming further medications have reached the limit of their > effectiveness (ie they have not lowered the pressures enough) and pressures [quoted text clipped - 5 lines] > >A prompt withdrawl from a regimen like this would cause a marked increase in IOP (often into the 40s or 50s). This would likely increase greatly the speed at which optic nerve axons die off. In addition the rapid rise in IOP could lead to moderate discomfort (usually an ache) and corneal edema (swelling) effecting vision. 3. is the blindness that results from glaucoma a total no light > perception (all darkness) blindness? > Yes, absolute glaucoma leads to loss of light perception (total blackness). Rick Cohn, MD Glaucoma specialist Winter Park, FL |
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