Glaucoma specialist did not dilate my eyes

[melinda68]

Hello Dr Hagen. I saw a glaucoma specialist yesterday and she didn't even dilate my eyes. How can she clear me of glaucoma and say I am still only a suspect if she didn't have a good look? I did a Humphrey visual field test and had an OCT. She also checked my angles and pressures and corneal thickness. Also, does an OCT check that the retina is OK as well as the optic nerve? Thank you!

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

In a referral practice many glaucoma specialists may not dilate the first visit because their patients have a much higher than rate of occludable angles.  So many will not dilate until after gonioscopy is done.  Most likely your will be dilated next visit but do ask about it.  OCT can be used to check for glaucoma and/or macular disease.

[melinda68]

I did ask, and she got her assistant to write on my notes:  patient requests dilation. That appointment is in three weeks. But she said there was no need as my OCT "couldn't be better". I was just expecting her to want to have a good look at my nerves, as they are asymmetric. She said .2 and .4, the OCT machine said .7 (she said she disregards that reading and relies on her own). Now I'm doubting the quality of the exam, which I shouldn't as she has a fellowship ...

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

So having a second appointment for dilation is not at all unusual.  Since they did OCT on your first visit no reason to do it at the second.  We usually do once/year on our glaucoma patients.

[melinda68]

OK, great! You've removed the doubt. I am a worrywart. She also said it was up to me whether to start latanoprost. My IOP was 19/21, which she said wasn't that high but the low nocturnal dips in my BP were concerning. And also the suspicious nerves. So I guess I ought to take the drops ...

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

The Early Glaucoma Treatment Study showed that beginning treatment early is better at 5 years than waiting till definite damage.

[melinda68]

Yes. Makes sense. I guess I'm reluctant to commit to a "drug for life" scenario, with the inevitable side effects. I am 50 and takes no meds at all. But I guess you've got to start somewhere ...

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

If you don't want to go on latanoprost once/day (it makes your eyelashes grow long and pretty, women love it) then talk to the glaucoma specialist about laser therapy (SLT) which would have about 75% chance of controlling your IOP without drops.

[melinda68]

I very much like that side effect, but I was also reading about it shrinking fat cells around the eyes, leading to a sunken appearance. Also ptosis and dark circles, which aren't so pretty. Vanity, I know, but still. So SLT, dose it basically turn your iris into a sieve?
I appreciate your input; thank you, Doctor Hagen

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

Latanoprost rarely causes that problem. Lumigan which is a brand name causes if very frequently.    SLT doesn't do anything to the iris, treatment is over the drainage angle (trabeculum) and makes the fluid drain out faster.

[melinda68]

Thank you so much, Dr Hagen! Very helpful information

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

UR Welcome