confusion

January has been a tough month for me. I am 57 years old and was diagnosed with thyroid cancer and narrow angles all in one month. I already have an inner ear condition where I must eat a low sodium diet, take an antihistamine every night and also some diuretics to prevent hearing loss and vertigo (don't have tinnitus).

My two main hobbies are scuba diving and bicycling. It seems to me that the things that I love most are at risk. Obviously I need my vision, hearing ,and overall health.

The thyroid cancer will be further assessed in March (I had 2 malfunctioning parathyroids removed and at the same time a thryoid nodule in which was found papillary cancer- I still have 1.5 lobes remaining- wish they had been taken out the first go round).

Now, about my narrow angles.

IOP was 17 OD, 16 OS by applanation tonometry. Slit lamp Exam was significant for lids w. meilomian glan inspissation and papillary reaction OU, corneas had pucntate epithelian erosions OU, anterio chamber was shallow OU. There was no cell/flare OU, iris was significan for no neovascularization OU, lens was clear OU. No dilated fundus exam due to risk of angle closure attack.

Do I get yag peripheral iridotomies, what are the chances of success, do I travel to the best specialist that I can find, how many iridotomies should they have performed to be an expert, how do I find the best surgeon for my condition, how long can I wait to find them and get an appointment ( how at risk am I now that I am using the pilocarpine drops TID), what about follow up if the surgeon is not local to me here in Texas?

I I guess I will never know how long I have had the narrow angles. I know the condition can come on slowly or develop over time.  Is the test for it a standard practice in a regular eye exam?
I found out last spring that my 88 year old dad has narrow angles ( they can't be corrected with surgery due to his parkinsons).

I have been taking xyzal, one of the newer antihistamines, to try to help save my hearing. Although my pharmacist saw nothing about abstaining from xyzal use for patients with glaucoma on the package insert, I have to wonder about taking it. Xyzal has been very helpful for my asthma as well as my vertigo, since my asthma is triggered by allergies. I clearly understand that I can' take benedryl, or for that matter bonine or scopalamine anymore (at least until my angles are more open). I am very sensitive to motion, which is obviously bad for my sport of scuba diving.

Actually I wonder if scuba diving is a risk right now because I have not had iridotomies yet? Is there a particular depth that is unsafe to go below because of the increased pressure? I am a technically deep dive certified diver.

Thanks for your input!!!!

[Ray T Oyakawa, MD]

Find an ophthalmologist who can do an anterior segment OCT to look at the exam amount of narrowing (RTvue with the anterior segment module). If below a certain point a YAG is indicated.  Complications are rare.

Dr. O.