Unilateral Progressive C:D ratio (increased in 13 months with 13%)

Dear doctors,

I'm under Glaucoma evaluation for 1.5 years now with still no diagnostic. I'm 29 years old caucasian male.
Those are the characteristics of my eyes:
     - physiologic asymetric papils(discs) right disk = 1.57 mm2 , left disk = 2.01 mm2 (measured by HRT)
     - Corneal thickness in both eyes = 570 > normal
     - IOP measured with "PUFF" devices: allways > 21 mm Hg. Maximum value 31 and 29.
     - IOP measured with Goldman allways <=20mm Hg. Average values 16-18 mm Hg.
     - After repeting the HRT after 13 months there ware some changes:
              - Left eye:
                          - Rim area decreased with 0.15 mm2 from 1.23 to 1.08           (13%)
                          - Cup area increased with 0.14 mm2 from 0.79 to 0.93 mm2
                          - Cup Volume increased with 0.16 mm3 from 0.13mm3 to 0.29 mm3
                          - Rim Volume increased with 0.01 mm3 from 0.22 to 0.23 mm3
                          - Cup/Disc Area Ratio  increased with 0.07 from 0.39 to 0.46
                          - Mean RNFL thickness remain constant at 0.16 mm
                          - Visual Field =  PSD= 1.22DB ; MD = -1.27 dB within normal limits
          - Right Eye:
                          - Cup area increased with 0.02 mm2 from 0.56 to 0.58 mm2
                          - Rim area decreased by 0.02 mm2 from 1.01 to 0.99 mm2
                          - Cup Volume = constant = 0.14 mm3
                          - Rim Volume decreased by 0.01 mm3 from 0.25 to 0.24
                          - Cup/Disc Area ratio increased with 0.01 from 0.36 to 0.37
                          - Mean RNFL Thickness decreased with 0.01 from 0.26 to 0.25 mm
                         - Visual Field =  PSD= 1.45DB ; MD = -1.57 dB within normal limits

My doctor concluded that for the moment everything is OK (main argument being the RNFL thickness being constant) and no treatment and come back in one year for reevaluation (HRT, visual field). In the meantime measure from 3 to 3 months the IOP using only Goldman, no puff. I will like a seccond opinion mainly beacuse my concerns regarding the C:D ratio in the left eye, asimetry between right and left, cupping progression in left eye.

QUESTIONS:
1. Please provide me with your views regarding my data from above.
2. Can errors occur in HRT measurement?
3. Is safe for me to wait 1 year without treatment for reevaluation?
4. Can there be other disease then glaucoma causing unilateral cupping (neurologic) ? In the pictures my optical nerve seems to be pink, is not swallen or pallor. I do not have headakes or disiness or nausea.
5. I am also concern about the small cupping in the right eye begause it has a smaller disc. Please provide input.
6. What do you advise?

Thanks,
Alex N.

[Ray T Oyakawa, MD]

You can see three doctors and end up with three different opinions on treatment.

Glaucoma is a very slow disease.  You can wait a year for your next exam.

Dr. O.

[AlexN82]

Dear Doctor Oyakawa,

Thank you for your fast reply.
Now I'm in the phase of determining if I have or not have glaucoma.
The next step is to get hostpitalized (as my current doctor sugested) one day for very frequent Goldman eye pressure measurements.Then I'll get the chance to ask her again about the reasoning behing left eye C:D ratio progression according to HRT.
My main concern is the C:D ratio progression in left eye which I hope to be partly due to HRT measurement error or operator error or something else that is physiological normal.
Thank you very  much again,
Alex