It is 2007, I have been living and working in Thailand since 2001 and, no doubt thanks to the surgical procedure done in Australia about 15 years ago, I have not had any symptoms or reason to think that my glaucoma was going into relapse.

But it was... and I noted once again after all these years, the halos around the lights as described in the earlier post about my first experience and "lucky" diagnosis. By an ironic twist of fate, I was at the time living in an apartment almost across the road from the famous Rutnin Eye Hospital. Talk about a twist of unfortunate circumstance (relapse of occular hypertension) and corresponding fortunate circumstance, living right next to a world class facility dedicated to treatment for diseases of the eyes.

At first, the threat of another round of surgical intervention seemed a remote possibility. This hospital has a very good reputation and did turn out to be one of the best in the world, and I felt very fortunate that I was located so close to the place and that it was quite convenient for me to go there and receive treatment for this very serious condition. HRH The Queen of Thailand attended this very hospital for a detached retina only last year, so my attitude was that if this place is the choice of the Palace for the very highly revered Thai Queen, then I will be in good hands.

Upon arrival at the reception of the hospital I informed the staff that I had glaucoma and needed to see a specialist. They seemed skeptical that I should know what my problem was but did refer me to a doctor who, as I was to find out later, was one of the leading glaucoma specialists in the world.

My treatment went through all the normal phases. I was required to undergo the full range of tests and recording of my condition. This included retina photography, digital graph plotting of the retina thickness, field vision tests, and the normal intraocular pressure testing. All tests showed that my glaucoma was progressing, but seemed manageable with medication in the form of eye drops. This range of tests and diagnosis tools were quite new to me, and I was certainly impressed by the way that other technology, such as digital imaging, was applied to ophthalmology. The doctor can actually see in large photographic images the actual retina and nerves within the eye allowing complete assessment of the condition. Medication being the first line of treatment, I went onto the program and was monitored very regularly. It was just so fortunate that I was in Bangkok for this testing and treatment because the costs of such in Australia or (heaven forbid) in the United States, would have been quite prohibitive.

The Treatments Begins

The specialist I was seeing is very professional and knowledgeable so I was quite comfortable with his recommendations and advice. Additional medication in the form of more eye drops was prescribed and I conscientiously followed the instructions to the letter. In the short term, this seemed to work but soon showed to be inadequate as the disease was still progressing. Changes and additions to the medication also failed over time and it was obvious that something more radical was required to bring the problem under control. By this time, I had done a considerable amount of reading on the subject.

As mentioned, my problem is secondary glaucoma. That is, my glaucoma is caused by the presence of exfoliation material and pigment dispersion within the aqueous humor in the anterior chamber of my eye, causing blockages of the trabecular meshwork, or drainage facility of the eye, and so the intraocular pressure rises with the potential to permanently rob me of my sight. With my knowledge of the disease, I was able to discuss on a reasonably intelligent level with my specialist doctor what was happening and what alternatives were available.

So we started planning for the day of my second trabeculectomy (first one in Australia 15 years earlier and all but forgotten now) and I was about as prepared and informed as any patient could possibly be for such a dramatic event in their life. I knew full well what was considered to be causing the problem, what medications were available, why we had delayed to this point before resorting to a surgical intervention, and what are the potential complications and success rates. I knew that we really had exhausted all possible alternatives to what is, in the current medical arsenal of treatments before this, the final step.

Then came a suggestion that before we go to the full invasive surgical process of a trabeculectomy in the "normal" way, we should first try a new laser procedure to see if that may work sufficiently well to at least delay the need for full surgery with all the inherent risks and possible down sides.

Next post then, Lets try a Laser on this problem!