Stumbled upon this site about 4 months ago. Apologies for length - want to provide detailed history.
58yo male diagnosed with POAG in Sep 24 with no other health issues, no other medications, no known allergies.
HISTORY: Visual acuity exception for most of my life – 20/15 or better until mid-late 20s, 20/20 or better until mid-late 40s. Near vision remained 20/15 until late 40s when right eye went from 20/15 to 20/25 or worse in less than 3 months. Left eye remained 20/15 until early-50s and has slowly degraded to about 20/25-20/30 recently (since wearing readers regularly). Distant vision has remained fairly steady with right eye still 20/20 on good days and left about 20/25-20/30. Middle vision (30-60”) has remained 20/15 or better until very recently when right eye began to be slightly double-vision-ish, but still “crisp” if that makes any sense & left eye still better than 20/20.
For a few years prior to diagnosis, had occasional "blurry" spot that I could usually blink away and would present typically in the morning only. Initially thought it was just mucus as it didn’t seem in fixed location and I lived/worked on a small farm, so assumed some sort of infection. Antibiotic (neomycin) drops didn't seem to affect, but it only ever lasted an hour or two and always cleared up - no visual acuity effects. Being dumb and stubborn with a history of exceptional constitution where my body fixes everything (normally), I ignored it.
Over time, it got more frequent and larger areas of visual field. I tried neomycin + dexamethasone (steroid) with no change either. Eventually, for the few months prior to finally going to ophthalmologist, it was getting worse - entire field of view affected - looked "fogged" like when you walk out of AC into humid air with glasses. Almost always cleared within a couple hours with normal visual acuity following majority of the time.
Upon presenting to doctor - was having a "bad" eye day where it wasn't clearing and my IOP upon initial testing was 50mm/HG in right eye (left eye normal at 18mm/HG). Initial treatment in office was a pill, some drops & sent home with a script for Simbrinza 3xdaily. Follow up 5 days later and IOP in right eye still 24. Added Timolol drops and reduced both to 2xdaily. Follow up 3 days later and IOP now good around 18mm/HG. No visual field loss, but there is nerve damage. Further follow-ups remained the same over next 1-2 months. Doc decided everything was good, so scheduled next follow up for 4 months later.
I am very disciplined with my drops with reminders on my phone and I have never missed drops to date.
However, not happy with waiting that long between visits, I purchased an older Leica AT550 NCT so I could monitor myself. While the absolute calibration is unknown, I did "bracket" it by taking multiple readings before & after my next visit to my doc and determined it's reading about 2mm/HG low. Still good for relative measurements.
Patterning myself, I discovered that my IOP would be higher in the am (20-24mm/HG in right (18-20 left) – occasionally higher in right) shortly after waking, but after drops would come down to normal and stay normal well beyond my evening drop time. I began pushing my evening drops later and later while monitoring IOP and found no change in IOP even going up to 18hours between drops. So, while I still take my morning drops on time, I now take my evening drops prior to bed regardless of time in an effort to have more meds “on board” during the night.
Since my usual “normal” readings are mid-teens (13-17mm/HG) almost every day without any aggravating factors, I began simple experiments to see if I still needed both drops. Tried just Simbrinza for one week and just Timolol for one week – both seemed to adequately control pressures with Simbrinza being slightly more effective. This was not a well-regulated test where I measured regularly at same times, it was more of a ‘let’s just see how it goes’ sort of ad hoc daily measurements several times each day. I intend to do some thorough and more regimented tests in the near future now that I’m more aware of some of the aggravating factors (close work – see below).
About two months ago, a friend’s mother passed away who was also glaucoma patient and my friend gave me all of her left over medication – Latanaprost & Brimonidine. I have not experimented with the Latanaprost, but have used Brimonidine (since it’s half of Simbrinza) with good success as the sole medication as well.
OBSERVATIONS:
As far as patterning, I have noticed a significant increase in IOP if I spend a lot of time on “close” work such as reading or computer usage – only in the right eye. I began wearing readers regularly about a year ago. Within the past year (likely because I’m paying much closer attention) I have also noticed several accommodation dysfunctions in the right eye having all three types of dysfunction (insufficiency, infacility, & spasm). These are all aggravated with close work on computer or reading and only in right eye.
If I get on the computer for more than 30 minutes, IOP in right eye will increase 2-5mm/HG and will return to normal for the day (generally mid-low teens) with 30-60 minutes of rest (simply refraining from close work). If I do a lot of time on the computer, say 3-4 hours, my right eye will often spasm and not relax for distance focus at all. Sometimes, with several hours of rest, it will improve, but rarely back to 20/20. When it does this, pressures are elevated, but within the normal range – generally high teens.
Since discovering this correlation, when I do get on the computer or do any close work requiring readers/cheaters, I now close my left eye and try to get my work/reading at the optimal distance for perfect clarity in my right eye and then open my left eye to work/read. I do this to minimize the strain/effort on the right eye because of my findings. This seems to help a little bit. Quite often, if I don’t have a lot to do, I simply close my right eye and do my close work with only my left and this generally helps a little more.
I’m currently taking several supplements and have found Forskolin & Rutin to seem to be minimally helpful (1-2mm/HG) – many supplements overlap with blood pressure management and seem to all be vaso-dilators…
My hypothesis at this point is that my ciliary muscle is spasming due to some lens rigidity issue causing accommodative dysfunction, but also increasing aqueous humor production resulting in elevated IOP.
With all that said, my personal research has shown no correlation between accommodative dysfunction and IOP that doesn’t also involve cataracts – all references I can find to lens-induced glaucoma seem to involve cataracts. To my knowledge, I have no cataract development in either eye. However, given my observations that close work results in increased IOP in my right eye, and it seems to be directly correlated to near accommodation. My doctor has dismissed this without any consideration & has even told me not to look at the internet (I have other concerns about him and am looking for another doc).
QUESTIONS:
Is anyone aware of any type of lens-induced glaucoma that does not involve cataracts?
Unrelated to my specific condition, has anyone used DMSO to more effectively transport drops into the eye and noticed improvement with IOP (ie – more effective medication uptake)? Thanks for taking the time to read this long-winded rambling post! I appreciate the expertise and experience here and hope to contribute something of value in the future.