Trouble finding cataract help

Question
Hi Dana,

I just want to start off by saying that your contribution to the rabbit medicine on the internet is amazing and astounding.  I have a 13 year old mini Rex who went through GI stasis during her 6th year of life because I was ignorant and used clumping cat litter in her litter box.  If it wasn't for your contribution to rabbit medicine on the internet, my bunny, Babette, would not be alive today!  

I come to you with a question because I can't find a rabbit vet in Toronto that will listen and trust me on my observations.   I've read many of your past replies, especially regarding eye health.  

Unfortunately, I've had bad experiences with the exotic animal clinic in Toronto.  I've also tried several other vets and they all put me through hundreds of dollars of tests just to come to the same diagnosis that I insisted upon.  

My newest situation is that Babette (the mini rex) has developed a cataract and has glaucoma in her left eye about two months ago.  When I took her into the vet, they measured the eye pressure in both eyes, and asked for a "complete" blood test to check for any other abnormalities.  Her bloodwork was completely fine, as I suspected --her behaviour has been very normal.  I've seen her go through pain during her bout with GI stasis (she wasn't pooping for a week!), so I feel as if I understand what rabbit pain could be like.  The eye-pressure on her right eye was 16-18 (normal, no cataracts), and 22-29 for her left, and they confirmed that it was a cataract.  I intuitively knew that a reading of 22-29 is pretty high (and it's obvious by looking at her), but they were reluctant to treat her right away.  

I guess I am most upset at the fact that the vet bill was $500 -- when I instinctively knew the diagnosis without using quantitative tools.  It's quite obvious to see a bulging eye, a cataract, and to see that she doesn't have diabetes (which is often related).  They sent her home with "OcluVet" eye drops a few days later which I also think aren't helping.  A quick search on the internet shows that they are a cash-cow of eye drops.  They are a non-prescription eye drops that are labeled "nutritional/lubricant".  

I did some research on glaucoma, and about a week after I noticed the cataract, I saw a tiny pale vein develop in the cataract.  This makes me believe that she has the kind of glaucoma where she isn't getting enough blood to her eye (also a diagnosis made by my friend who is currently going through vet school).  I think the OcluVet eye drops are not helping --in fact I think her eye is getting worse --the cataract is more opaque than before.  I think Babette just needs the type of eye drops that promote fluids to her eye.  

Do you have any advice?  What do you think?  How do I get a vet to listen to me and not put me through more tests?  The last vet who prescribed OcluVet eye drops also mentioned that surgery maybe an option (she said this even before any of the tests results came back and didn't even mention other kinds of treatments available!) which makes me think the vet was not really thinking about the well-being of my rabbit.  I wouldn't put a 13 year old rabbit through non-vital surgery.  

I don't want to go back to the last vet but going to a new clinic usually means that I have to spend more on basic diagnostic tests.  Unfortunately I'm a student and cash is really tight!  I've considered asking my friends who are human doctors for the prescription but I don't know if all of the eye drops are safe for rabbits.  

Thank you for your time & help.
Stephanie

Answer
Dear Stephanie,

First, thanks for the warm fuzzies.  :)  But more importantly:  Babette.

Second:  Wait, what?  Surgery for glaucoma?  Excuse me?  Talk about cash cow!  Jeez!  Unless that vet was talking about enucleating (removing) the eye, I cannot imagine why he would recommend surgery.  Removing the lens would be pointless, since the high intraocular pressure of glaucoma is damaging her retina, and removing the lens would not likely restore vision.

There are two types of drops used to treat glaucoma. One type slows the flow of fluid into the eye (used when the ciliary body is over-producing the intraocular fluid), and the other type increases the outflow of the fluid from the intracular chambers (used when there is something slowing the exit of fluid from the eye).  

If I remember correctly, timolol is one of the former types of drug.  I can't immediately recall the name of the second type.  But there are also drops that combine both modes of action (more expensive, of course; but maybe cheaper in Canada than in the U.S.).

**Revision:  I just had a quick look on Google, and found this good explanation of the different types of eye drops used to treat glaucoma, and their modes of action:

http://www.allaboutvision.com/conditions/glaucoma-3-treatment.htm

If you can find a veterinary ophthalmologist, that would be your best bet.  I've noticed that many vets who are not board-certified ophthalmologists fancy themselves eye experts, and will sometimes prescribe inappropriate medications (as yours has!).  It's time to go to an expert.  A mammalian eye is pretty much a mammalian eye, so the vet doesn't have to be a rabbit expert.  Just someone who understands glaucoma and how to treat it.

If the eye becomes painful because of the pressure, then one relatively simple procedure would be to inject gentocin (an antibiotic) directly into the eye.  This will ablate/destroy the ciliary body, and fluid will stop flowing into the eye.  The eye will gradually recede and no longer work.  But unless you are able to stop the glaucoma with drops, she will lose the use of that eye, anyway.

Just a few options to consider.

I hope this helps!

Dana