Iridotomy- is it for me?

[fung]

Pls help,
A year ago I was diagnosed glaucoma ( my late grandfather had it too), did OCT and results were both my eyes had cup/disc area ratio  0,803 and 0,807. My pressure then was 17 and 19 and based on field analysis,my upper sight has already affected and its not good , suprisingly because I didnt feel any sighting problem before. It shocked me up.
Doctor prescribed me with 2 eye drops, azopt and timolol, and my eyes pressure became around 10 after this.  treatment. After 10 months , I went to another doctor for second opinion, and I was told to use only azopt for 1 month periode  to see how it went with my eye pressure and turned out my eye pressure rose  from 11/12 to 19/15 ( left/right). Now doctor recommends me to do laser  iridotomy although-after examined my inside eyes -my eyes form are not bad (I didnt understand exactly what doctor meant).

Could someone advise me what to do ? Do I really need laser surgery now ? I happened to read laser iridotomy can cause cataract ,among other things.

[John C Hagan III, MD, FACS, FAAO]

That is not a question I can answer since I don't know what the field looks like. Best discuss with your Eye MDs
JCH MD

[fung]

Thanks for your quick answer. Based on your experience, what would be the cause of my upper vision loss since I had never experienced head injury nor stroke. Would  tumor be the only answer or  glaucoma could be the cause?

[John C Hagan III, MD, FACS, FAAO]

If you were told that the visual field loss more resembles neurologic (stops at midline) rather than the glaucoma arcuate which crossed the midline then it is critically important to exclude a problem in the brain pathways causing the problem. Do follow their advice.
JCH MD

[fung]

Dear doc,
My last oct result ,done a year ago, was
     -cup/disc area ratio (OD 0,807 - OS 0,803 )
      - cup/disc hor ratio ( OD 0,932 - OS 0,947 )
     - cup/disc vert ratio ( OD 0,877 - OS 0,831 )
Humphrey single field analysis result my upper visual was almost black, both side
- right eyes MD -11.03 db P< 0,5% ,
                    PSD 13.92 db P< 0,5%
- left eyes MD -14,09 db
                 PSD 16,33 db
I went to another doc yesterday and done humphrey test again ,result
     -right eye MD -11,30 db
                     PSD 14,5 db
     - left eye MD -15,38 db
                    PSD 15,34 db
Eye pressure are 14 and 13 with eye drops .
According to doctor, my half upper visual field had affected badly, and said it was not usual type for glaucoma and could be caused by brain damage or tumor.So I was advised to check with neurological doctor for superior hemiosopsi diagnose.
Need your advise on this
      

[John C Hagan III, MD, FACS, FAAO]

=

[fung]

I really appreciate your explanation doc.
Thanks

[John C Hagan III, MD, FACS, FAAO]

You are farsighted, drops are not an acceptable treatment for angle closure glaucoma or mixed mechanism glaucoma. If you are not comfortable with the recommendation for an iridotomy then get a second opinion (find one near you at www.geteyesmart.org

JCH MD

[fung]

Thanks for your information.
I dont know what my glaucoma type is , All I know that my family has history in glaucoma. My eyes had no nearsighted nor anything before, never been wearing glasses,but when I turned 40 nature really took its course. Now I'm 48, its +2 and cannot read without them.
On my last eyes check up last year, I mentioned about this family "glaucoma" history to the doctor and the rest is history.
If I can keep my eyes pressure in normal range with these eye drops, like I'm doing now, do you think I still need iridotomy ?or  do iridotomy had  other purposes beside maintaining pressure?

[John C Hagan III, MD, FACS, FAAO]

There are different types of glaucoma  Azopt and timolol are for open angle glaucoma; laser iridotomy is for angle closure glaucoma. You can have both and its called "combined mechanism glaucoma" in that case the laser iridotomy is appropriate. Hopefully you are seeing an eye MD ophthalmoloigst. If you have any doubts you can always ask for a second opinion from another glaucoma specialist. angle closure glaucoma is more common in hyperopic or farsighted eyes.

JCH MD