HRT III Exam for Glaucoma Suspects

[Station26]

Hello...I've been followed as a Glaucoma Suspect for the past couple of years and had baseline exams and followups (VF, Dilation, IOP & HRT etc)  Everything looked stable with the exception of the last HRT.  (IOP in the low to mid 20's, suspicious nerves (0.45 and 0.55) and fields).  The HRT baseline was WNL (p > .05).  However, after two additional followup HRT images taken within the last two years, it showed very subtle progression or change from baseline - a few red dots (don't know the specific measurements) but still WNL.  Could this indicate very early signs or perhaps pre-clinical glaucoma even if the HRT is still well within normal?  From what I understand, the values are taken from a normative database based on age & race.  There seem to be so much gray area in making a diagnosis.

[John C Hagan III, MD, FACS]

Making a diagnosis of glaucoma at the very earliest stage and determining who needs treatment at the very earliest stage is difficult and even highly qualified Eye MDs will differ on whom needs treatment and who needs observation. Overall the tendency (like treating blood pressure and cholesterol) is to treat at an earlier stage.

None of the data you cite is absolute indication to begin treatment and there are many other variables like your central corneal thickness, family history, age, race, even your reliability in keep your follow up appointments that must be take into account.

If you are seeing an Eye MD ophthalmologist that you trust go by what he/she recommends. If you are seeing a non-physician, non-MD, limited training optometrist then change over to an Eye MD.

JCH III MD

[John C Hagan III, MD, FACS]

I neglected to mention that optic nerve OCT may be preferred to HRT

JCH III MD

[Station26]

Thank you for your quick response.
I am followed by an eye MD.  I do not have a family history and have avg corneal thickness and in my late twenties.  However, I am moderately near-sighted. (-6 in both eyes)  Does that mean I would be a low risk GS?  I was told that due to my age, treatment is recommended.