re: David C. Spinney d.o.b.: 06-06-1938 A. Robert Bellows, M.D. Ophthalmic Consultants of Boston 50 Staniford Street Boston MA 02114 .sp 2 Dear Dr. Bellows, .PP Thank you for seeing Mr. David Spinney. Mr. Spinney has open angle glaucoma OU. In 1980 he had uncomplicated intracapsular cataract extraction OD with good anatomic and functional results. In 1984, when inspite of maximum medical treatment, perimetry showed incipient nasal constriction, he had posterior lip sclerectomy OS with the formation of a functioning bleb which lowered pressures to the high single digits. In September 2005, when there was as yet little if any loss of field, and tension OD on maximal medical treatment rose to 32, Mr. Spinney had implantation of a tube-shunt OD. This operation was successful to the extent that subsequently, on medication, pressure in OD reasonably well controlled. .nf OD OS OD OS OD OS 2-10-2000 12.0 10.0 8-16-2004 16.0 8.0 9- 4-2005 32.0 13.0 6- 8-2000 16.0 10.0 10- 1-2004 19.0 8.0 2-28-2007 13.5 -.-- 8-10-2000 14.0 13.0 11- 6-2004 19.0 8.0 3-14-2007 13.0 -.-- 11-21-2000 11.0 9.0 11-22-2004 18.5 8.0 3-28-2007 15.0 -.-- 2-20-2001 11.0 9.0 12- 3-2004 19.0 8.0 4-25-2007 15.0 -.-- 5-15-2001 13.0 9.0 12-10-2004 22.0 8.0 6-27-2007 12.0 -.-- 8-14-2001 13.0 9.0 12-23-2004 24.0 8.0 8- 7-2007 14.0 -.-- 11-15-2001 14.0 9.0 1-12-2005 12.5 8.0 10- 2-2007 16.5 -.-- 2- 7-2002 12.0 9.0 2-24-2005 16.0 8.0 10-30-2007 13.5 -.-- 5- 7-2002 12.5 9.0 5- 4-2005 20.0 8.0 11-27-2007 12.0 -.-- 8-19-2002 15.0 9.0 5- 8-2005 13.0 10.0 1- 8-2008 8.5 -.-- 11-19-2002 11.5 8.0 5-11-2005 21.0 8.0 2- 5-2008 13.5 -.-- 12-27-2002 13.5 9.0 6- 9-2005 24.0 10.0 3-11-2008 13.0 -.-- 1-16-2003 14.5 9.0 6-15-2005 11.5 8.0 4-18-2008 14.0 -.-- 2-11-2003 12.0 8.0 6-29-2005 17.0 11.0 7- 9-2008 14.0 -.-- 5- 8-2003 14.0 8.0 7-14-2005 20.0 13.0 9-10-2008 10.5 -.-- 7-31-2003 15.0 8.0 7-20-2005 20.0 15.0 11-11-2008 13.5 -.-- 11- 6-2003 14.0 8.0 8- 2-2005 16.5 16.0 1- 5-2009 15.0 -.-- 2- 5-2004 16.0 8.0 8-17-2005 13.5 11.0 2-11-2009 12.0 -.-- 5- 5-2004 11.0 8.0 8-26-2005 25.0 15.5 3-18-2009 15.0 -.-- 4-29-2009 11.5 -.-- .PP Shortly after the tube-shunt implantation OD, Mr. Spinney had cataract extraction OS complicated by bullous keratopathy which precluded subsequent meaningful applanation tonometry OS. Notwithstanding the relatively good pressure control OD, Mr. Spinney has continued to lose visual field in the upper quadrants. Mr. Spinney is presently taking timolol, brimonidine, trusopt and xalatan, all in the right eye only. .PP Pressure measurement in OD has been characterized by the circumstance that Mr. Spinney, when approached with a tonometer, exhibits a reflex tightening of the facial musculature, which factitiously elevates tension measurements OD. I believe it may be such spurious pressure elevations which have led to the recommendation - and scheduling of a second tube-shunt operation to OD. .PP My own preference however, is to postpone further surgery to OD, perhaps indefinitely, and to try to obtain lower pressures by adding pilocarpine, iopidine and or acetazolamide to the regimen. Mr. Spinney is caught in the predicament of conflicting advice by two physicians. He doesn't know what to do. He doesn't even know what to think. Please help us out with your advice. There is, of course, much more to the story which I will be glad to try to communicate by phone. If you think it would be helpful, please feel free to telephone me at any time (evenings and weekends included) at 617-484-8109. .PP Thank you for your help. .nf Sincerely, Ernst J. Meyer, M.D.