Glaucoma : Optometrist vs. Ophthalmologist

[Meljoanne]

I'm a 61 yr. old female and I have annual eye exams at my optometrist office. I've had excellent care there. They diagnosed a retinal tear several years ago and referred me to Ophthalmologist for laser treatment. This year's exam showed my IOP, which has usually been 18-19, was 25 in both eyes; optic nerve stable. Last week I had it checked again and it was 22-24. Optometrist suggested I go to Ophthalmologist for baseline and then just keep annual appts. My understanding is glaucoma is diagnosed when there has been some visual field loss and/or changes in optic nerve(?). I can't go by IOP alone. Do you think it would be better for me to see a regular eye M.D. for annual exam because of this? I'm just questioning who to see at this point, although the optometrist has been excellent. Your opinion is most coveted! Thank you.

[NightHawkGuy]

I also recommend going to an ophtalmologist ideally one that lists glaucoma maintenance as a speciality.  Thats what I have done since an optometrist diagnosed my glaucoma in my right eye about 4 years ago.

The glaucoma specialist I've been going to for nearly 4 years, has me come in three times annually to spread out the three procedures plus IOP checks each time (every 4 months): comprehensive eye exam, visual field test, and OCT.  With the eyedrops prescribed and these tests, my glaucoma has been stable and not gotten worse since diagnosed.

10 years ago with my old ophtalmologist, he had been monitoring the higher than normal IOP in my right eye back then (about 24) and had just started doing visual field tests and OCT but there was no optic nerve damage then.  Unfortunately he retired a year after that and I delayed finding a new eye doctor for a couple years more and by then apparently some optic nerve damage had occured.

So it sounds like you are at the point I was about 10 years ago, with only higher than normal IOP - so I'd recommend getting the regular glaucoma tests regularly now and perhaps starting a IOP lowering eyedrop early before optic nerve damage starts.  My eye doctor a year ago started me on that for my left eye as well now, though it has no optic nerve damage, but had started to consistently get over 23 IOP (previously 18 or so) about 2 years ago.

[JohnHaganMD]

Also remember there is new studies that indicate a great diet, rich in colorful vegetables may reduce not only the risk of macular degeneration but glaucoma as well.  Also in 2018 a new type of eye drop called a Rho Kinase inhibitor should be available in the US. Combined with latanoprost it will be a wonderful drop for many types of glaucoma.

[Meljoanne]

Thank you so much Dr. Hagan. Very appreciated.

[Meljoanne]

NightHawkGuy~ Thank you, also, for responding to my question. I had wondered about starting eyedrops even though there is no sign of optic nerve damage or loss of visual field. You have given me something to think about.

[JohnHaganMD]

That is a very difficult thing to calculate:  Beginning treatment before damage begins depends a lot on family history, cornea thickness, cup/disk ratio, age, reliability of the person (will they come in for regular tests). Certainly if there is a family history of glaucoma most ophthalmologists would probably begin RX with drops or laser.

[JohnHaganMD]

Yes I think you would be better served by seeing an ophthalmologist yearly.  A baseline is :   IOP, complete exam with assignment of cup/disk ration, corneal thickness, gonioscapy, visual field and nerve fiber layer OCT.

[JohnHaganMD]

cup/disk ratio

[Meljoanne]

Thank you! What a baseline entails was not explained to me. Now I know.