Worried about my aging dog...glaucoma

[Ambi]

Hi everyone,

I have an aging dog, she has multiple health issues. One of them is glaucoma that is worsening - she is blind in one eye, and the pressure is getting harder to control - the inflammatory process that is causing the glaucoma is worsening. I wanted to just have it removed, but her heart isn't strong enough to undergo anesthesia safely. The other option is something called ciliary body ablation - I think they kill off whatever creates aqueous humor in the eye, but it doesn't reduce the inflammation, of course (when I adopted her, she already had signs of a history of inflammation in that eye, not sure what it was due to - vets couldn't tell). So....what worries me is possible complications and side effects. If she could have gotten the eye out, it would have been done. With this, there's only an 80% success rate, and I'm worried it will somehow lead to more suffering if things don't resolve. I know I will probably just have to take the chance, not much other choice....but I am just worried. Ever since my mother suffered and died, with so much medical mismanagement happening, I have been very anxious about all of the things that can go wrong with medicine in general.

 

[kay]

Sorry about your dog. It's so hard dealing with them as they get older. Good luck with her, if you decide to go with the treatment I hope your girl is in the 80% successful.

 

[Gracey]

It is difficult to know what to do for the best.

The thought of having to say goodbye should the worst happen is also very difficult.

I can understand how worrying it is.
My loyal, old boy has some health issues too, one of which is DCM (common for his breed) this rules out any surgery.
I honestly think my next trip to the vets will be amongst his last.

If you have the time perhaps you could do some 'aspie-research'? (If you haven't already )
Explore the options?

As Kay says above, perhaps you're lady will be amongst the 80%?

 

[Ambi]

Thank you both for your kind replies I do need to do more Aspie research. I've been pulled in different directions by all of the different things I need to work out - different "projects" of sorts, all important for health or work. My usual mode of being able to focus entirely on one thing for a significant amount of time before switching to another is not possible now that I have found work....so then I feel like I've got all of these pots brewing in my mind and in my life, but unable to keep track of them, stir them, all at once. So this is one of those pots.....gotta get to it, though. You know, this leads me to realize - how amazing it would be if we could use our Aspie powers for all of the many pots we all may be stirring....maybe part of what makes me feel pulled apart is because I know the intensity with which I would want/need to address each issue/project, and knowing I simply don't have the time required. But that is a tangent. I did force myself to take the first step and set up a vet appointment to discuss concerns with the vet. From there I need to just keep juggling my leave and my paycheck and various bills to be sure I can pay for it.

 

[Mia]

Here are some of the options:

Lifetime Medical Therapy
Dogs and Cats: Topical (and sometimes oral) medication to control intraocular fluid production and increase fluid drainage. Lifetime regular intraocular pressure measurements/ophthalmic examinations
Dogs: Lifetime daily support with specific canine antioxidant vision supplementation; Control of stress; Use a harness attached to the leash instead of a neck collar.

Intravitreal Gentamicin Injection (“chemical ablation”, “pharmacologic ablation”)
The antibiotic gentamicin is injected into the eye, which kills the cells that produce fluid (aqueous humor), thereby permanently reducing the intraocular pressure in over 95% of patients. This usually causes the eye to become cloudy, and 50% will markedly decrease in size.

(Dogs only): Endolaser Cyclophotocoagulation/lens removal/artificial lens placement/ +/- drainage device placement, and afterwards follow ups.
Cells in the eye that produce fluid are killed by a laser beam, after first removing the lens. Then an artificial lens is inserted, followed sometimes by inserting an artificial glaucoma drainage device.

It will all depend on whether your dog has primary or secondary glaucoma. If secondary, most of these procedures can be performed. Endolaser will require anesthesia, and I don't know all that much about IG injection, which would likely require anesthesia as well. It seems that your only real option, with an older dog, would be medical therapy with ointments and antioxidants. And ensuring you always use a harness when walking your dog, as pressure on the jugular vein from collars does lead to eye difficulties in some types of dogs.

My own elderly dog was at different times treated with antioxidants, which usually consisted of fish oils, and I saw little difference in changes to her arthritis. Maybe beginning a course of fish oils, will help over the long term, with eye illnesses, although there is little in the way of long term studies on their efficacy in animals.

The other difficulty would be finding an animal ophthalmologist, as they are few and far between in regular vet practices. A large vet hospital or teaching practice would be the most likely place.

It is also important to know that if your dog loses vision in both eyes from glaucoma, that it is extremely likely that they will adjust very well to their vision loss, as long as the intraocular pressures are controlled so they do not have a headache and are comfortable.

Glaucoma @ Animal Eye Care

 

[Ambi]

Here are some of the options:

Lifetime Medical Therapy
Dogs and Cats: Topical (and sometimes oral) medication to control intraocular fluid production and increase fluid drainage. Lifetime regular intraocular pressure measurements/ophthalmic examinations
Dogs: Lifetime daily support with specific canine antioxidant vision supplementation; Control of stress; Use a harness attached to the leash instead of a neck collar.

Intravitreal Gentamicin Injection (“chemical ablation”, “pharmacologic ablation”)
The antibiotic gentamicin is injected into the eye, which kills the cells that produce fluid (aqueous humor), thereby permanently reducing the intraocular pressure in over 95% of patients. This usually causes the eye to become cloudy, and 50% will markedly decrease in size.

(Dogs only): Endolaser Cyclophotocoagulation/lens removal/artificial lens placement/ +/- drainage device placement, and afterwards follow ups.
Cells in the eye that produce fluid are killed by a laser beam, after first removing the lens. Then an artificial lens is inserted, followed sometimes by inserting an artificial glaucoma drainage device.

It will all depend on whether your dog has primary or secondary glaucoma. If secondary, most of these procedures can be performed. Endolaser will require anesthesia, and I don't know all that much about IG injection, which would likely require anesthesia as well. It seems that your only real option, with an older dog, would be medical therapy with ointments and antioxidants. And ensuring you always use a harness when walking your dog, as pressure on the jugular vein from collars does lead to eye difficulties in some types of dogs.

My own elderly dog was at different times treated with antioxidants, which usually consisted of fish oils, and I saw little difference in changes to her arthritis. Maybe beginning a course of fish oils, will help over the long term, with eye illnesses, although there is little in the way of long term studies on their efficacy in animals.

The other difficulty would be finding an animal ophthalmologist, as they are few and far between in regular vet practices. A large vet hospital or teaching practice would be the most likely place.

It is also important to know that if your dog loses vision in both eyes from glaucoma, that it is extremely likely that they will adjust very well to their vision loss, as long as the intraocular pressures are controlled so they do not have a headache and are comfortable.

Glaucoma @ Animal Eye Care

Thank you so much for researching and posting this! That was very, very kind of you I think it's the gentamicin injection that is being proposed - topical treatment just isn't working for her anymore....it's good to see they are projecting a higher success rate than I saw. I'm wondering if her eye shrinks if that would hurt and cause problems...one of the things I'm worried about. But that's something I can discuss with her vet - she does have an ophthalmologist, I'm very lucky to be near some very good ones. I know I just need to emotionally buck up and do this - usually it's not as hard, it's just a lot has been piling up over the past several years. It's very good to see that blind dogs can adjust well - as I am worried about her other eye. Though in her case, she is also deaf :-( :-( But I still would see if she could be happy and comfortable that way, as sad as that is to us humans anyway. I would trust her vet's input on that. And mentioning the headaches at the end of that info....yeah, I need to remember that. Right now, she probably does have a headache from it all, it's probably making her uncomfortable on top of all of her other health issues...

 

[Mia]

I'm wondering if her eye shrinks if that would hurt and cause problems...one of the things I'm worried about.

It will likely cause some pain, but perhaps less pain than the glaucoma? There are options though, and they do give dogs low doses of painkillers. You might indicate that they should do some 'pain management' for her. Your welcome for the research, I'm having eye difficulties myself, as in a recently begun cataract which caused me to do a lot of eye research So finding the eye treatment for dogs, is somewhat similar to human treatments.

 

[Ambi]

It will likely cause some pain, but perhaps less pain than the glaucoma? There are options though, and they do give dogs low doses of painkillers. You might indicate that they should do some 'pain management' for her. Your welcome for the research, I'm having eye difficulties myself, as in a recently begun cataract which caused me to do a lot of eye research So finding the eye treatment for dogs, is somewhat similar to human treatments.

Yes, maybe this is wishful thinking, but I was just thinking - well....her eye is a bit enlarged from the glaucoma, maybe it will just shrink back to normal size. Who knows? In any case, I'll paste below a passage from the link you posted that was very important/helpful for me to read:

"Note: If the eye is blind, controlling glaucoma with long-term medical and CAM treatment is usually not the best choice, because eventually the glaucoma WILL fail to be controlled, requiring surgery to relieve chronic discomfort. Medical treatment of a blind eye delays the inevitable, in most cases. Why commit to lifetime medical treatment for an eye that will never see again? Also, the cost of glaucoma medications and ophthalmic examinations is not cheap–usually this is a far greater expense than the cost of removing the blind eye. Do not be fooled into thinking that your pet’s blind, enlarged, glaucomatous eye is not bothering them. It is. Besides surgical eye removal, there are other surgical choices depending on the desired cosmetic outcome, cost, and the patient’s general health. For example if the pet is not in good general health, then a prolonged surgery under general anesthesia might not be possible. However, there is a very brief procedure (for dogs only) called intravitreal injection (or “chemical ablation”, or “pharmacologic ablation”) in which a drug that lowers the IOP is injected into the eye while the dog is briefly anesthetized."

As for your cataract....I used to actually work for an eye doctor. My advice if you decide to get surgery - be sure the doctor has a good success rate (I know you know that, but there were many shady opthalmologists we knew of, believe it or not!). Also, do your own Aspie research on the pros and cons of the various lenses they can replace your lens with. Several years ago when I was working with the eye doctor, multi-focal lenses could be great for some people, but did not work out for others - some people couldn't adjust to learning how to focus through them. I would just consider these things in case the doctors don't mention it....