Enlarged Optic Nerve w/Deterioration

A new optometrist took fundus photos today and showed them to me.  Both eyes have enlarged optic nerve heads with a little bit of deterioration around the edges and both optic nerves appear to be coming into the eye at a "different" angle.  I am 54, have correctable myopia (9.25 in both eyes), had retinal detachment surgery in both eyes (December 1990: scleral buckle in one eye, cryosurgery in the other, both stable but with vision loss), and a 20 year history of ophthalmic migraines in both eyes that has gotten progressively worse.  I never knew about the enlargement of the optic nerves or the angle or deterioration and never had a fundus photo before today.  Could that be related to the opthalmic migraines and the surgeries done back in the old days?  Should I be concerned or get further evaluation from a neuro-ophthalmologist since I'm having an increase in ophthalmic migraines?  I also have stage 2 cataracts.  If my eyes were cars I would call them "lemons", but for the sake of the public I have stopped driving.

Thanks

[Michael J Kutryb, MD]

Please go ahead and start seeing an ophthalmologist since you have a history of retinal detachments.  You can then have a complete glaucoma evaluation possibly with an optic nerve head scan like an OCT and possibly a visual field test.  You really haven't mentioned anything that sounded dangerous or terrible but rather some things that should be followed and an ophthalmologist should be able to do that.  I see no connection between your optic nerves and your migraines and if your doctor wants to mention all these things to you he should be prepared to tell what clinical significance, if any, that they have.

[GranGran55]

Thank you for those suggestions.  The optometrist said the enlarged nerve heads and tilted discs were within the normal range, but given my history (which I shared with her) I'm still unsure especially because she saw deterioration.  I'm also on Topamax for regular  migraines so I'm definitely going to take your advice and see an ophthalmologist in case further tests are warranted.