Glaucoma

[hashmodha]

Hello...I don't know where else to post this... Perhaps Thai Visa can open a Forum for this....I have Narrow Angle Glaucoma (hereditary)...I live here in Thailand and would like all who have Glaucoma to share, learn,and communicate and help eachother...I also am form a Glaucoma foundation and awareness amongst ExPat Community and Thai National as well...Thank you 

[Crossy]

Let's try this in the Health forum.

[James2020]

I'm a retired ophthalmologist from the US who now lives in BKK.  I have treated many patients with narrow angle glaucoma (open angle glaucoma is much more common) during my career, usually with an outpatient laser iridotomy.  Although no one can know for sure whether you will have a problem, the procedure to fix it is low risk, so most patients have it done.  A second opinion is always a good idea.

[gamini]

8 minutes ago, James2020 said:

I'm a retired ophthalmologist from the US who now lives in BKK.  I have treated many patients with narrow angle glaucoma (open angle glaucoma is much more common) during my career, usually with an outpatient laser iridotomy.  Although no one can know for sure whether you will have a problem, the procedure to fix it is low risk, so most patients have it done.  A second opinion is always a good idea.

Go to Rutinin hospital an internationally famous one, first class service and specialists. They will treat your glaucoma.

[Deerculler]

If you can go to the Rutnin Eye Hospital in Bangkok.

I had eye surgery for double vision. They fixed my problem. I cannot not recommend them high enough. 

[rocart]

Depends where you live. Dr Captain at Bangkok Hospital Phuket Bright Eyes Center is superb.

Edited June 24, 2018 by rocart

[shaurene]

Look it up on google, Narrow Angle Glaucoma.

it can be treated by laser if the eye drops do not work.interesting reading.

[hashmodha]

Great James.!.. Thanks for being here....I already had Laser Iridotomy 2 years ago,in the last few weeks my IOP is fluctuating....3 Different Goodmans,3 Tonometers....15/16...17/18......19/21...... monitoring closely... every 4 weeks or so...SLT on the way....I think...we see...Good of you to participate.... sometimes I feel so isolated here..

[Mansell]

Rutnin Eye Hospital in BKK is the way to go. Even if you don't live close it is worth the journey....I go every six months for my check up against getting glaucoma as I have the potential for this problem. I had some friends go to Bangkok Hospital Phuket and the guy there gave their baby the wrong kind of drops and nearly blinded the baby.......this pushed me to travel to BKK to Rutnin for their professionals.

[Stevemercer]

I have glaucoma and am currently using the local Mahasarakham hospital. The prescribed drops are the same I used to use in Australia and seem effective in keeping my pressure at an acceptable range. I have the usual 3 month check.

 

I'm covered by my wife's health insurance (former teacher) so the treatment and prescriptions are free. It cost me $90 a month back in Australia on Medicare.

 

It is good to have a thread in case I loose confidence in my current regime and/or need top shelf treatment.

 

 

[glamont002]

I have glaucoma and have been using Rutnin for the past 9 years (and I live in Hua Hin). First class and also inexpensive. Dr. Hathairat is a glaucoma specialist and she she speaks perfect English.

[hashmodha]

Good Steve,

                    If you need any help contact me,...I hope people come forward so I can organise something.

PS...we have some friends At Mahasarakan University,I think He is a Dean..

Edited June 24, 2018 by hashmodha

[Farang99]

If you even suspect you may have glaucoma, go to see an ophthalmologist at one of the major hospitals. I did not do this and went to my local ophthalmologist, complaining of restricted vision in my right eye, which was regarded  as trivial, and the same thing happened on a second check up a year later. When it was finally accepted that I had open angle glaucoma there had been so much damage to the retina that I am now effectively blind in one eye.

[James2020]

Books have been written about glaucoma, but I'll try to give some general information, learned over 30 years:

• There are two major types of glaucoma, open angle and closed angle.  Open angle is much more common (greater than 90%), is asymptomatic until the later stages, is a life long illness, and usually requires only eye drops for treatment.  It is usually diagnosed on a routine exam by measuring intraocular pressure, looking at the optic nerve, or by doing a visual field test.  Closed angle glaucoma can be very symptomatic, is determined by the shape of your eye (not visible to a layman), and is usually definitively treated with an emergency laser iridotomy.  It may be determined in advance that you are at risk for it, and a laser iridotomy can be prophylactic.
• Glaucoma is a common diagnosis for an ophthalmologist.  Most of us follow the same guidelines, so even if you're in a rural area in Thailand, you're probably getting good care.  A good option may be seeing a glaucoma specialist in a major city once a year, and seeing your general ophthalmologist every three or four months.
• Surgery for glaucoma is another matter.  Fewer than 10% of patients with glaucoma require surgery (I'm not referring to laser surgery) and there is no question that volume makes a difference.  Even the glaucoma specialist may not be doing enough surgery to have consistently good outcomes.  Do not take surgery for glaucoma lightly and always get another opinion.
• In my practice, most patients who lost some vision did so because their glaucoma was not diagnosed soon enough, or they did not take their eye drops.  There are a small number who seem to progress in spite of good treatment.  The chances of becoming blind in both eyes is very small - in my case, only two patients in 30 years of practice, and I saw patients with glaucoma every day.
• I've heard good things about Rutnin Eye Hospital, but have no direct knowledge.  I volunteered at Ramathibodi Hospital at Mahidol University, and can recommend their services.   

[Sheryl]

Rutnin is excellent.

[hashmodha]

Thank you kindly James!

Refreshing to read your contribution here..... Valuable information for awareness..I am monitoring my fluctuations closely as I write....

Farang 99....My Glaucoma Specialist is Associate Dr Prin Rojanapongpun at Sukumvit Hospital in Bangkok and at Bumrungrad Hospital...if you wish to be examined or need any help... Expect the best consultation.and truly loving care....I also have another Opthamologist for my support needs as I live quite far away from Bangkok...so sorry to about you...

[rumak]

On 6/25/2018 at 1:14 PM, Sheryl said:

Rutnin is excellent.

Which doctor or doctors would you recommend seeing in Chiangmai ?   I have recently been diagnosed with high pressure (IOD ? ).     Because of my age i would not want to travel to Bkk.    Thanks to anyone who might have a recommendation.    BTW:  i have just done a visual field test and another one that indicate

i am at risk.

[Sheryl]

Asst. Prof. Thidarat Leeungurasatien

 

Specializes specifically in glaucoma. US trained.

 

Can be seen at either CM Ram Hospital or Sripat

http://www.chiangmairam.com/searchdoctor1?major_id=133&doctor=118

 

[James2020]

14 hours ago, rumak said:

Which doctor or doctors would you recommend seeing in Chiangmai ?   I have recently been diagnosed with high pressure (IOD ? ).     Because of my age i would not want to travel to Bkk.    Thanks to anyone who might have a recommendation.    BTW:  i have just done a visual field test and another one that indicate

i am at risk.

I have no specific recommendation in Chiangmai, but elevated intraocular pressure or 'Ocular Hypertension' is a common diagnosis, and can be managed by most general ophthalmologists.  It does not cause symptoms, or require eye drops, so patients may not want to see their eye doctor several times a year, have visual fields done, etc., but it is important.  On average, patients with eye pressures over 21 or 22 mm Hg are at risk for developing glaucoma, but some with higher pressures never develop it, and some with lower pressures clearly have it, so if your doctor sees something that puts you at risk, it is best to always follow his/her advise.

[lopburi3]

15 minutes ago, James2020 said:

It does not cause symptoms, or require eye drops,

If he has or is at risk for glaucoma eye drops are first line of defense (to lower IOP) without surgery and likely to be for a lifetime.

[rumak]

23 minutes ago, lopburi3 said:

41 minutes ago, James2020 said:

It does not cause symptoms, or require eye drops,

If he has or is at risk for glaucoma eye drops are first line of defense (to lower IOP) without surgery and likely to be for a lifetime.

eye pressure one eye 20 other one 22     eight years ago (last time tested) around 10

visual field test now shows one eye "outside normal limits".....but not too bad

also had a machine take an analysis of optic disc cube,macular cube,  ...print out is confusing to me

but dr says one thing not so good (red)

she would have started me on drops but i chose to wait.  Looking at some reviews there are people that

really complain of side effects with drops ( xalatan,  travatan, (etc)

I am going to see one more (highly recommended) ophthamologist to get a second opinion.

 

[rumak]

14 hours ago, Sheryl said:

Asst. Prof. Thidarat Leeungurasatien

 

Specializes specifically in glaucoma. US trained.

 

Can be seen at either CM Ram Hospital or Sripat

http://www.chiangmairam.com/searchdoctor1?major_id=133&doctor=118

 

is Dr Rachada also a glaucoma specialist ?    Ophthalmology Orbital Diseases  ( I see her profile says )

but not sure if that includes glaucoma 

Edited November 3, 2018 by rumak

[Sheryl]

Dr. Rachada's sub specialty is in oculoplastics. She does not have a specialization in glaucoma per se. However all opthalmologists can and do treat glaucoma.

Prof. Thidarat on the other hand has a specific specialization in glaucoma and keen intetest in it including issues related to early detection/diagnosis. Hence the recommendation to see her based on what I understand of your situation.




Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[James2020]

2 hours ago, lopburi3 said:

If he has or is at risk for glaucoma eye drops are first line of defense (to lower IOP) without surgery and likely to be for a lifetime.

Like most things, it depends.  Most doctors do not diagnose 'glaucoma' until there is damage, as evidenced best by a Visual Field test.  But not everyone is a reliable tester, so someone with pressures of 26/27, with a suspicious optic nerve, and an unreliable VF, would probably be treated, whereas someone with pressures of 22/22, normal VF, and normal optic nerves would be followed without treatment.  While some ocular hypertensives can be treated, most are not.  Eye drops for treatment are expensive and can have ocular and systemic side effects, so the decision to commit someone to a lifetime of treatment is not to be taken lightly.  ALT, a type of laser treatment, is also a possibility for treatment that has increased in use in recent years, but doesn't work for everyone, is permanent, and may have to be done a number of times.  Conventional surgery is usually reserved only for those who don't respond to other treatment.

[rumak]

5 hours ago, Sheryl said:

Dr. Rachada's sub specialty is in oculoplastics. She does not have a specialization in glaucoma per se. However all opthalmologists can and do treat glaucoma.

Prof. Thidarat on the other hand has a specific specialization in glaucoma and keen intetest in it including issues related to early detection/diagnosis. Hence the recommendation to see her based on what I understand of your situation.




Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

 i did already make an appt with Prof. Thidarat.  Thanks always for your

assistance.  

Edited November 3, 2018 by rumak

[rumak]

On 11/3/2018 at 1:11 PM, James2020 said:

Like most things, it depends.  Most doctors do not diagnose 'glaucoma' until there is damage, as evidenced best by a Visual Field test.  But not everyone is a reliable tester, so someone with pressures of 26/27, with a suspicious optic nerve, and an unreliable VF, would probably be treated, whereas someone with pressures of 22/22, normal VF, and normal optic nerves would be followed without treatment.  While some ocular hypertensives can be treated, most are not.  Eye drops for treatment are expensive and can have ocular and systemic side effects, so the decision to commit someone to a lifetime of treatment is not to be taken lightly.  ALT, a type of laser treatment, is also a possibility for treatment that has increased in use in recent years, but doesn't work for everyone, is permanent, and may have to be done a number of times.  Conventional surgery is usually reserved only for those who don't respond to other treatment.

I did a visual field test which showed one eye outside (slightly) the normal limits.  But the biggie was the OCT photo which showed (according to one trusted opthalmologist and then one who has further training in Glaucoma )   well, they say that it shows there is already damage to the eyes (cornea, nerves?) Its a 5 page color printout and the color red is evident in a few places  ( 2 in my R eye RNFL  quadrant).  Anyway, having worked as an opthalmologist I think you know the analysis shown.   Since both doctors wanted to put me on drops right away I now have Xalatan which i will reluctantly start taking tonight.  I will further research the side effects as well as seeing first hand.  If you have any thoughts on my situation please

let me know.   As far as laser treatment they suggest i start on the drops ( i'm pretty sure to get the pressure down as soon as possible).  The specialist measured it manually and said it was 25 one eye and 29 another, quite a bit higher than the "puff machine" measurement.

[JAS21]

Because my mother had Glycoma and my pressures were a little high I was put on Xalatan when I was about 50 years old (am now 73). My pressures are somewhat less than 20 and my field of Vision I'm told is okay .. also told that I have beautiful eye lashes ... that would not be my opinion!!

[lopburi3]

1 hour ago, rumak said:

I did a visual field test which showed one eye outside (slightly) the normal limits.  But the biggie was the OCT photo which showed (according to one trusted opthalmologist and then one who has further training in Glaucoma )   well, they say that it shows there is already damage to the eyes (cornea, nerves?) Its a 5 page color printout and the color red is evident in a few places  ( 2 in my R eye RNFL  quadrant).  Anyway, having worked as an opthalmologist I think you know the analysis shown.   Since both doctors wanted to put me on drops right away I now have Xalatan which i will reluctantly start taking tonight.  I will further research the side effects as well as seeing first hand.  If you have any thoughts on my situation please

let me know.   As far as laser treatment they suggest i start on the drops ( i'm pretty sure to get the pressure down as soon as possible).  The specialist measured it manually and said it was 25 one eye and 29 another, quite a bit higher than the "puff machine" measurement.

In my case the air blast normally records the higher measurement.  Have been on Xalatan once a day and Cosopt twice a day for a few years now.  Xalatan is very sensitive to heat and is put on ice even for trip home from hospital.  

[James2020]

1 hour ago, rumak said:

I did a visual field test which showed one eye outside (slightly) the normal limits.  But the biggie was the OCT photo which showed (according to one trusted opthalmologist and then one who has further training in Glaucoma )   well, they say that it shows there is already damage to the eyes (cornea, nerves?) Its a 5 page color printout and the color red is evident in a few places  ( 2 in my R eye RNFL  quadrant).  Anyway, having worked as an opthalmologist I think you know the analysis shown.   Since both doctors wanted to put me on drops right away I now have Xalatan which i will reluctantly start taking tonight.  I will further research the side effects as well as seeing first hand.  If you have any thoughts on my situation please

let me know.   As far as laser treatment they suggest i start on the drops ( i'm pretty sure to get the pressure down as soon as possible).  The specialist measured it manually and said it was 25 one eye and 29 another, quite a bit higher than the "puff machine" measurement.

It seems that you do have optic nerve damage, so you have glaucoma, not just 'ocular hypertension', which can often be a precursor to glaucoma.  Xalatan is a good drug, one of the main stays of glaucoma therapy, with a low risk of side effects, but can be a bit pricey.

Sometimes patients need more than one drug to lower IOP.  I know of no ophthalmologist in the US who uses air puff tonometry to manage glaucoma patients.  They are used for screening only.  The 'gold standard' is Goldman Applanation Tonometry (the blue light...). 

 

[rumak]

7 minutes ago, James2020 said:

It seems that you do have optic nerve damage, so you have glaucoma, not just 'ocular hypertension', which can often be a precursor to glaucoma.  Xalatan is a good drug, one of the main stays of glaucoma therapy, with a low risk of side effects, but can be a bit pricey.

Sometimes patients need more than one drug to lower IOP.  I know of no ophthalmologist in the US who uses air puff tonometry to manage glaucoma patients.  They are used for screening only.  The 'gold standard' is Goldman Applanation Tonometry (the blue light...). 

 

specialist said i might need a second drug for my right eye..which is worse.   but starting me out with just Xalatan and will check in two weeks.  she also did the test with the blue light (but it was higher as i mentioned)  .  My main concern is side effects, hoping i am one of the lucky ones who manage ok.

Thanks again for the feedback.  oh, BTW....the name brand here (from sripat) is less than 500 baht !   a long way from the original prices in the states.

Edited November 7, 2018 by rumak