Optic Nerve Thinning

Hi,

I have seen the same doctor for 4 years now and have
had field vision tests, OCT tests and  extensive exams
done each year and so far nothing has changed in
my eyes.  My concern is that even though there has
been no change my optic nerves are larger than
normal and are slightly different from each other
in size and one of them has two small spots where
some thinning has occurred.  My pressures are fine
and my field vision tests are fine.  My doctor says
since there hasnt been any change in over 4 years,
she does not think I actually have glaucoma, instead
I am just considered a suspect for it.  I did get a
2nd opinion who did not do all the tests but just
said based on the fact that there was no change
in 4 years it was probably just the way I was born
and not to worry.  Do you agree or should I
pursue another opinion?  I dont want them to be
wrong and suffer vision loss but I dont want to
be a chronic worrier either.  Please advise.

Thank you,
starr363

[Houman Vosoghi, MD]

As long as the doctor is an ophthalmologist with fellowship training in glaucoma, I would trust what they had to say.  Unfortunately, many optometrists and even some ophthalmologists don't check carefully enough for less likely glaucomas that present with normal pressures in clinic.  A glaucoma specialist should be able to perform gonioscopy to rule out intermittent angle closure glaucoma, pigment dispersion, pseudoexfoliation, normal tension glaucoma, and thin corneas leading to misreading of the pressures.  If your current doctor is not a glaucoma specialist MD, get a third opinion from one.  That being said, 4 years of stable exams is reassuring.

HV