Glaucoma

[mohit_g1980]

Doctor, just to share with you, my wife had gone for her eye examination and Doctor told her that she has Glaucoma signs and is at very initial stage….I don’t know as there was no formal pressure test or field test done. But doctor recommended her eye drops for 45 days which we already started. It is now 5 days but after learning that Glaucoma is not normal in this age, I thought to take 2nd opinion for which I again visited to another Sr. doctor in Noida….who while eye examination didn’t tell of this but I in last told him that last doctor told us about Glaucoma. He said that medication should only start once you are confirmed that it is Glaucoma and he advised us to go for VFA and Pressure Tests.
We went for tests and VFA is said to be normal. Pressure test is done twice – in evening it was 17.5 and in morning it was 14.5 which again was normal.
Doctor suggested not to worry as there is no Glaucoma.

However additional information  I would like to share with you is Deep Cup, as doctor said that my wife has deep cup but still he said that there is no Glaucoma rather people suffering from minus number may develop deep cup.

Pls give your opinion and advice us what to do next.

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

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[TrapperV]

I'm not a doctor, but please let me add two things to the conversation.

There is a type of glaucoma called Normal Tension Glaucoma, where pressures fall well within the statistical normal range, but optic nerve damage can occur. It's more common than originally believed. Pressure tests alone are a poor indicator of glaucoma. As Doctor Hagan points out, complete tests are also needed to rule this and other types of of glaucoma out, and provide a benchmark for future comparison.

Having said that, let me also add that there also can be a genetic reason for the large cup to disc ratio. My siblings and I all share a very large cup to disc ratio. It's been that way for decades. I am the only one with any visual field damage. They show no signs of any optic nerve or other problems. I had additional risk factors and an incident that may have provoked mine.

Given the variables, it is wise to keep having things checked, as to catch any problems early.

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

Both doctors certainly recorded the cup to disk ratio. I think the latter eye doctor did the more complete evaluation and if you feel comfortable with him find out if he wants to see you once/year or once every 6 months.

JCH MD

[mohit_g1980]

Many thanks Doctor for your reply.

Does it mean that I again contact our Doctor and request him to do measure the cup-to-disk ratio. Later after 6 months, during routine checkup so that current cup-to-disk ratio can be compared later.

Pls suggest, if there is anything else that we need to do.

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

No way I can tell for sure but a "big cup" or "large cup-to-disk" ratio raises the possibility of glaucoma but does not in itself constitute glaucoma and other tests are necessary (such as visual field, optic nerve OCT, stereo disk photos, corneal thickness measurement, and assessment of risk factors such as age, family hx of glaucoma).

It is likely the the doctor that did visual field exam and measurement of IOP in AM and PM is more likely correct and that treatment is not indicated but careful follow up every 6-12 months with an ophthalmologist is appropriate and necessary.

JCH MD