adaptation?

[melinda68]

I know that the brain learns to tune out unnecessary visual input. Is it true, conversely, that if you pay attention to visual anomalies and constantly check for them, you turn up the gain and your brain can't tune them out? So is it best to ignore them?

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

Yup

[melinda68]

One last question. Can people with narrow angles take SSRIs? Specifically Lexapro? Or is it just too risky?

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

If someone has narrow but not occludable angles its not a problem. If someone has occludable angles they need a laser peripheral iridectomy. So you would need to as your ophthalmologist who has done a test called gonioscopy to evaluate the angle. Risk of causing angle closure in that group is low.

[melinda68]

Thank you! I sent him an email, so will hopefully get clarification tomorrow.

[melinda68]

At the time he said, "Hmm, I don't think they're occludable" but then he re-did the pressure test after he put the dilation drops in, which makes me think he wasn't at all sure ...

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

If he thought they were occludable he wouldn't have dilated the eyes. Also just dilation in normal eye can raise IOP some

[melinda68]

He was an optometrist. I spoke to his office re the lexapro and they are now referring me to a glaucoma specialist. He said my angles were "modestly narrowed" and my pressures were high. 20/22 first visit, 22/24 second visit (where they were taken pre and post dilation).

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

That's 'passing the buck'  Go on in. It is likely you will be fine for the medicine.

[melinda68]

No kidding! That's exactly what I thought. At least a glaucoma specialist will be able to tell me whether I am just a suspect, or actually have the condition, I guess. That's a good thing.

[melinda68]

Does disk asymmetry refer to a difference in the cup size between the eyes? Mine are .4 and .45, but have been like that for 8 years apparently. Does that mean glaucoma is less likely and that it is just a physiological difference?

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

First of all cup disk size (known as C/D ratio) is notoriously subject with inablity to consistently rate to .1 degree and certainly not to 0.05    Just wait and see what the glaucoma Eye MD says. I suspect the news will be good all the way around.  

[melinda68]

Thank you, doctor. It's a bit nerve-wracking, on top of the other visual disturbance. Glaucoma is usually experienced as an absence of vision, isn't it? Not extra visual stuff that you see?

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

corrrect, usually loss of peripheral vision hard to detect in early stages.

[melinda68]

Argh, this is going to be a brutal six to eight weeks until I can see the specialist. The optometrist assures me I have no retinal tears, but I keep thinking, yeah, but he's not an eye doctor, and I doubt I have been checked properly, even though he did use one of those miner's hats and a handheld lens and took a long time

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

If you have trouble waiting perhaps ask the MD that prescribed the lexapro if maybe you might have something to use for anxiety, or try relaxation therapy, or cognitive behavior therapy.

[melinda68]

The GP would only prescribe propanol. I already have low BP. I don't need further dips overnight as a glaucoma suspect :(

Do you think I can stop worrying about a retinal tear or detachment or bleed in the meantime, if the optometrist says it's all OK per his examination?

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

I can't give that kind of assurances. No way for me to tell.

[melinda68]

Yes, of course, I realised as soon as I hit enter that you couldn't possibly. I just hope he was thorough ...

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

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