Forms of glaucoma. Note that the story and information here is not comprehensive for all forms of glaucoma. Nor is the consensus opinion of how I come to have ocular hypertension the only cause, there are many. Also, I am not medically trained in any way, so what follows is more of an anecdote than a medically accurate description for the disease or its effects.
See the link at the bottom of this page for better information than I am qualified to give.

Surgical and other procedures. That said, I will write the full story minute by minute of the experience of the surgical procedures that I have undergone and perhaps those will be valuable to someone who may also be in the position of needing an intervention to control their IOP.

Description: My condition is actually secondary glaucoma. That is, I don’t actually simply have glaucoma alone, but rather glaucoma is the end result from a condition that I do actrually have called pseudo exfoliation syndrome. What this means in simple terms is that the fluid in my eye contains particles of XFM, or exfoliation material. With all the wonderful medical research that goes on in these days, there is quite little known about this problem or what causes it. In fact, there is not much known about the actual composition of the material, except that it seems to come from within the anterior eye chamber itself and it causes drainage problems for the aqueous humor. This fluid is continuously produced and fed into the anterior eye chamber of the eye and is allowed to escape through the exit drain called the trabecular meshwork, the normal drainage system for the eyes. However, when there is a lot of XFM present, the drainage, or angle of the eye, becomes clogged, and so the intraocular pressure rises causing a glaucoma like problem threatening damage to the retina and optic nerve.

More information about types of glaucoma is here: https://glaucoma.org/types/secondary-glaucoma

The intraocular pressure is maintained in this way to be at the required pressure to maintain the form and shape of the front of the eye. What a miraculous mechanism we all have right there and generally we take it so much for granted. A lot like so many other of our normal bodily functions. All go on without us having to do anything but get on with our lives – right up until something happens to upset the balance.

Psudeo Exfoliation Syndrome is not the only issue that seemed to be present. I was informed by one opthamologist about a problem that was evident in my eye that is caused by pigment release within the eye which then deposits on the iris and also the trabecular meshwork, which compounds the problem. The production of fluid in the eye is not regulated – that is, it is just a continuous process, so any interruption to the correct drainage causes a rise in the pressure, that is, glaucoma. Glaucoma can also be caused by an excess production of fluid in the eye and this is called open angle glaucoma. The angle, or drainage is not interrupted, but the production of fluid for mostly unexplained reasons, goes into overdrive and then cannot be accommodated by the normal drainage ability.

From what I am able to learn from the many doctors that I have seen over the years, that does not seem to be the case for me. Glaucoma is a serious problem because high intraocular pressure is immediately transferred to the retina and causes compression of the optic arteries. Just like a tourniquet on an injured limb, there is a loss of blood supply to the retina and optic nerve. Without a blood supply, the optic nerves actually die and can never regenerate. This is the major threat of glaucoma, that once the damage is done, there is no going back, no cure, no fix for the problem. Once done, it is done for the life of the sufferer.

There are numerous highly developed techniques including transplants of cornea etc for eye problems but this is not one of them. It is just not possible to transplant the optic nerve with all the complex mechanisms that transfer the images from the retina to the brain. Another big problem with the condition is that it is sor many people so afflicted quite painless so most people don’t seek medical assistance until it is much too late to try to intervene medically or surgically. I would have been one of those except for the circumstances that I have recounted in my earlier posting "My "lucky" diagnosis".

UNANSWERED QUESTIONS

Questions that I have asked many times over the years but even today, in 2024, research is still unable to provide any conclusive answers.

1. Why did the problem only affect my right eye while my left eye was unaffected for over 30 years? (But did finally also have the same problem as predicted by the specialists.)

2. I suffered an accidental injury to my right eye about 5 years earlier, a sliver of steel became embedded in my eye that had to be removed at a doctor's surgery and it was starting to show signs of rust. Could that damage and perhaps contamination in my right eye have been a trigger that caused this life long problem later?

3. As you will read in later posts, my high IOP episodes were not constant, and for most of my life, not all that frequent. The IOP in my right eye could remain normal for months, then suddenly spike way up for no apparent reason. What does this? What is the trigger and could we find that and treat it and so not have to treat the result which is the hypertensive ocular pressure?

4 Diamox is the common name for a dieuretic that I was given the very first night I became aware that I had this problem. This drug knocks down the high IOP very fast but I have no idea of the mechanism that makes that work and have not found any explanation for why, but it does.

VERY FIRST EXPERIENCES

After my "lucky" diagnosis, my condition was not continuous, but the IOP did tend to be a little avove normal at most check ups. This was around 1990 and for all other considerations, my vision was perfect at all ranges. The only option available apart from anti glaucoma eye drops is an trabeculectomy (to be explained in detail in later posts) which is invasive eye surgery which doctors would only perform as a very last resort.

That last resort had to be exercised in Australia around 1996, details that far back for me are sketchy, but sufficient to say that this procedure made the glaucoma irrellevant for nearly the next 10 years.

Next post we go to in 2007 after my move to Thailand in 2001, and so my treatment in the Rutnin Eye Hospital in Bangkok.