glaucoma suspect

[melinda68]

Good afternoon Dr Hagen
I just had my biannual eye exam and i happened to mention to the doc that I am a migraine sufferer. Hearing this, the opthalmologist (whom I hadn't seen before) took a very keen interest in my optic nerves. He told me I was a glaucoma suspect due to asymmetry of my optic discs and a high cup-disc ratio. He took some photos to use as a baseline, as he hadn't seen me before and therefore couldn't be certain it wasn't a physiological issue specific to me. I am to have a follow-up in six months, at which time he will test my visual fields.

i last had my visual fields done 2 years ago and there were no problems. during that visit my cup-disc ratio was notated at .4 OD and .45 OS (from memory). The opthalmologist said i may have a problem with glaucoma "in 20 years". She didn't seem too concerned and did not mention any asymmetry.

I am 41 years old, take no meds, am 5'4" and weight 115 pounds. My BP is 115/70. I guess my question is, at what point does glaucoma suspect become a diagnosis? Or is there no clear boundary? My IOP (at 3pm) was 17 in both eyes. I will have a diurnal check next visit.

The doc mentioned normal-tension glaucoma - how is that treated? Do pressure-lowering drops have any relevance here? Are there any lifestyle measures I can take to prevent this progressing? Also, I read migraine prophylatics can cause glaucoma, so am hesitant to start that kind of regimen ...

I have done internet searches, but there is soo much conflicting information and I am overwhelmed.

Thank you in advance.
Melinda

[Ray T Oyakawa, MD]

A normal thickness only means the IOP is in the normal range of the general population.  It does mean it is normal for an individual.

I would not worry about the egg shaped nerves.  The important aspect is the nerve fiber layer.

Dr. O.

[melinda68]

thank you soo much, dr o. for you prompt reply (on a sunday, no less!)

i did have my corneal thickness measured and it was normal, which makes the IOP accurate? i had an OCT about four years ago, but i think it was of the macular, not the optic nerve.

i had a look at the images of my optic nerves and they looked like eggs instead of circles. eek. can they change like that over a two-year period? no other doctor has mentioned it, and i have had my eyes dilated about 10 times in the past five years.


i'm really curious about the pathology, and really appreciate your input.

thanks
melinda

[Ray T Oyakawa, MD]

See some one who can do an OCT(the newer SD is better) of the optic nerves.  This will pick early sign of glaucomatous damage before a visual field test.

Normal tension glaucoma refers to patients with IOPs in the normal range (<21).  However, the IOP depends on the corneal thickness.

In a complete glaucoma evaluation the following test should be done:

1)  corneal pachymetry.
2) IOP measurement
3) gonioscopy
4)OCT
5) Visual fields

I am not aware of which migraine prophylaxis can cause glaucoma.

Dr. O.