Four questions regarding glaucoma

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FOUR QUESTIONS REGARDING GLAUCOMA Here are four relevant questions which I believe have never been answered. 1. What evidence is there that high IOP causes glaucoma? 2. If there is no evidence that it does -- why try to reduce IOP? 3. What physical, chemical or biological mechanism can explain how high IOP causes optic nerve degradation? 4. Why don't pearl divers and other free divers all go blind because of the pressure increase in their eyes when they are under water? (I am under the impression that any increase in IOP, can't adversely affect any cell within the eye -- since everything within the eye is essentially water-filled and the pressure would instantly equalize across all cell membranes.) Please consider the following -- I am an engineer by training and was diagnosed in 1999 by an ophthalmologist in Santa Barbara as being in danger of developing glaucoma. I considered the diagnosis to be a mistake that was based on a visit to the doctor where he measured my intraocular pressure (IOP) as about 20 mmhg. The doctor suggested treatment and I refused, based on my suspicion that the diagnosis was faulty. I subsequently investigated the subject of "glaucoma" and came to the general conclusion that glaucoma is often misdiagnosed because there is little evidence available as to what causes glaucoma. Along the way, I was thrown off a glaucoma listserve email group -- seemingly because I asked too many pointed questions that undermined the authority of doctors and "frightened" some young members of the email group. Robert Ritch, MD (ritch@inx.net) / Professor and Chief, Glaucoma Service / the New York Eye and Ear Infirmary / 310 East 14th Street, New York, NY 10003, was a member of the email group. He was quite helpful when I first started asking questions, but his patience wore thin over time when I suggested none of the information he proffered seemed to show that high IOP actually causes glaucoma. I think the email group was sponsored by The Glaucoma Foundation. Evidently, the email group has since been abandoned or changed its name. I consider the following 7 points to be provable facts: 1. Virtually all ophthalmologists and every glaucoma organization "know" and teach that glaucoma (progressive deterioration of optic nerve cells) and high intra-ocular-pressure (IOP) are often, but not always seen together. They say high IOP is a "risk factor" --- (they never say it is a symptom) 2. Glaucoma is often seen in low IOP individuals. 3. High IOP individuals sometimes do not have glaucoma. 4. I have asked authoritative sources if any tests or data or evidence prove that high IOP CAUSES glaucoma and that they are not both byproducts of some other factor, like aging. They hedge -- but generally answer, "no". 5. I have investigated the literature and can find no evidence of a cause and effect relationship. Some authorities have sent me technical papers supporting their theory that high IOP cause glaucoma -- but my reading of these papers tells me the papers do not show that at all. 6. Virtually all glaucoma treatments (eye drops, laser and knife surgery) are aimed at reducing IOP. 7. These treatments quite frequently have serious side effects. Martin R. Carbone. By the way -- it is now nine years after I was first advised to start treatment to ward off glaucoma. My eyesight is just about the same as it was then. Evidently I have not had significant degradation of the retina. I do have cataracts now, but my current eye doctor adivises against removing them because my sight is too good for the operation to be paid for under Medicare. Find out more about Glaucoma A variety of global patient advocacy organizations claim, in ads through Pfizer http://www.pfizeropthalmics.com , that they can provide a wealth of up-to-date information, support, and resources that will help you to protect your vision. Write to them and ask them what evidence they have that high Intra Ocular Pressure (IOP) causes glaucoma. Click on the links below to visit their individual Web sites and learn more about them. World Glaucoma Association http://www.globalaigs.org/ World Glaucoma Patient Association http://aigpo.org/ International Glaucoma Association http://www.glaucoma-association.com The Glaucoma Foundation http://www.glaucomafoundation.org/ Glaucoma Research Foundation http://glaucoma.org/ Glaucoma Australia http://www.glaucoma.org.au/ Glaucoma Friends Network http://www.gfnet.gr.jp	commercial messages to go in this column

FOUR QUESTIONS REGARDING GLAUCOMA

Here are four relevant questions which I believe have never been answered.
1. What evidence is there that high IOP causes glaucoma?
2. If there is no evidence that it does -- why try to reduce IOP?
3. What physical, chemical or biological mechanism can explain how high IOP causes optic nerve degradation?
4. Why don't pearl divers and other free divers all go blind because of the pressure increase in their eyes when they are under water? (I am under the impression that any increase in IOP, can't adversely affect any cell within the eye -- since everything within the eye is essentially water-filled and the pressure would instantly equalize across all cell membranes.)

Please consider the following -- I am an engineer by training and was diagnosed in 1999 by an ophthalmologist in Santa Barbara as being in danger of developing glaucoma. I considered the diagnosis to be a mistake that was based on a visit to the doctor where he measured my intraocular pressure (IOP) as about 20 mmhg. The doctor suggested treatment and I refused, based on my suspicion that the diagnosis was faulty.

I subsequently investigated the subject of "glaucoma" and came to the general conclusion that glaucoma is often misdiagnosed because there is little evidence available as to what causes glaucoma.

Along the way, I was thrown off a glaucoma listserve email group -- seemingly because I asked too many pointed questions that undermined the authority of doctors and "frightened" some young members of the email group. Robert Ritch, MD (ritch@inx.net) / Professor and Chief, Glaucoma Service / the New York Eye and Ear Infirmary / 310 East 14th Street, New York, NY 10003, was a member of the email group. He was quite helpful when I first started asking questions, but his patience wore thin over time when I suggested none of the information he proffered seemed to show that high IOP actually causes glaucoma. I think the email group was sponsored by The Glaucoma Foundation. Evidently, the email group has since been abandoned or changed its name.

I consider the following 7 points to be provable facts:

1. Virtually all ophthalmologists and every glaucoma organization "know" and teach that glaucoma (progressive deterioration of optic nerve cells) and high intra-ocular-pressure (IOP) are often, but not always seen together. They say high IOP is a "risk factor" --- (they never say it is a symptom)
2. Glaucoma is often seen in low IOP individuals.
3. High IOP individuals sometimes do not have glaucoma.
4. I have asked authoritative sources if any tests or data or evidence prove that high IOP CAUSES glaucoma and that they are not both byproducts of some other factor, like aging. They hedge -- but generally answer, "no".
5. I have investigated the literature and can find no evidence of a cause and effect relationship. Some authorities have sent me technical papers supporting their theory that high IOP cause glaucoma -- but my reading of these papers tells me the papers do not show that at all.
6. Virtually all glaucoma treatments (eye drops, laser and knife surgery) are aimed at reducing IOP.
7. These treatments quite frequently have serious side effects.

Martin R. Carbone.

By the way -- it is now nine years after I was first advised to start treatment to ward off glaucoma. My eyesight is just about the same as it was then. Evidently I have not had significant degradation of the retina. I do have cataracts now, but my current eye doctor adivises against removing them because my sight is too good for the operation to be paid for under Medicare.

Find out more about Glaucoma

A variety of global patient advocacy organizations claim, in ads through Pfizer http://www.pfizeropthalmics.com , that they can provide a wealth of up-to-date information, support, and resources that will help you to protect your vision.

Write to them and ask them what evidence they have that high Intra Ocular Pressure (IOP) causes glaucoma.

Click on the links below to visit their individual Web sites and learn more about them.

World Glaucoma Association
http://www.globalaigs.org/

World Glaucoma Patient Association
http://aigpo.org/

International Glaucoma Association
http://www.glaucoma-association.com

The Glaucoma Foundation
http://www.glaucomafoundation.org/

Glaucoma Research Foundation
http://glaucoma.org/

Glaucoma Australia
http://www.glaucoma.org.au/

Glaucoma Friends Network
http://www.gfnet.gr.jp

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