March 24, 2009 in Features

Dr. Gott: Ask doctor to explain glaucoma

Peter H. Gott, M.D.
 

Dear Dr. Gott: Last year, during my yearly eye examination, my doctor asked me if I had poked my eye with a stick (which I hadn’t), because I had a line in my eye, which was a first sign of glaucoma. He also noted that I had some pigment on both of my lenses.

Could you tell me if there is any treatment for this condition? My doctor didn’t tell me if anything could be done. Should I get a second opinion?

Dear Reader: Let me start by saying that if you don’t ask questions, your doctor can’t answer them. If there was something you didn’t understand or simply wanted to know more about, you should have said so. Doctors aren’t mind readers. Unless the patient says otherwise, the physician assumes the information has been understood. I have said time and again that people who take active roles in their health will usually get the best care.

Now, to your problem. Pigment is the substance that gives our eyes color. Sometimes, this pigment can flake off and land on other places, such as the lens. It often goes unnoticed, as it doesn’t cause symptoms.

I believe your doctor was referring to a rare form of glaucoma called pigmentary glaucoma. This condition results when pigment flakes off the iris and blocks the meshwork that allows for proper drainage within the eye. This increases the intraocular pressure, leading to damage to the optic nerve, better known as glaucoma.

If your eye pressures had been increased, you likely would have been told so and given steps or medications to take to reduce the pressure and prevent further damage. In your case, if the pigment is only on the lens, it is probably not blocking the meshwork. Return to your doctor and ask for clarification of the situation. If he or she refuses to elaborate, get a referral for a second opinion.

Dear Dr. Gott: Is there a way to cure “white coat” hypertension?

Dear Reader: “White coat” hypertension is a condition in which blood pressure rises to above normal just before and during a doctor’s appointment but returns to normal or below normal upon leaving the office.

This occurs because of the anxiety and stress related to seeing a doctor. It is not related to true hypertension, which is consistently high BP readings. There are steps that can reduce these feelings, as well as ways to achieve more accurate readings.

Establishing readings while at the doctor’s as well as at home in a more relaxed atmosphere will provides a basis for proper diagnosis between true and “white coat” hypertension. If home readings are at or below normal, then certain measures can be taken.

For example, relaxation techniques, such as deep breathing, can be done in the waiting room before an appointment. Having your BP checked at the end of the visit rather than the beginning will also allow for time to relax and adjust to the situation. If these steps fail, it may be necessary to purchase a blood pressure cuff for home use so levels can be sent to your physician on a regular basis.

To give you related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a check or money order for $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

If readers would like to contact Dr. Gott, they may send their mail directly to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.


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