Myopia and Glaucoma

[sophia35]

Dear Doctor,

I´ve got very severe myopia and astigmatism with previous retinal detachment in one eye and several
retinal tears treated with laser in both eyes, as well as myopic macular degeneration with previous  
haemorraging (?sp).which left scars and worsened my eyesight.I´ve got cataracts which at present
don´t affect my vision and I´m not even 40.

I'm scared to death of other complications
Is the dilated eye exam ( fundoscopy) enough to detect glaucoma even if it is associated with
normal or even low pressure?
Is there anything at all I can do to help prevent ever getting glaucoma?
I´ve heard of injections to prevent / control haemorraging.Could they possibly help my situation?

The only exam I do regularly is the fundoscopy. The doctor also measures the pressure in my eye.
Aren´t there other exams I could do regularly  to detect and treat problems at an early stage ?

I would really appreciate an answer. Frankly I haven´t had much luck with doctors.They are  either in a hurry to get me IOLs which I´ll pass because for now I do fine with gas permeable contacts and don't want to give invitation to further retinal detachments or they seem annoyed when I ask questions specially i f they show I've done research.

Thank you,

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

Thank you.

JCH III MD

[sophia35]

Dear Doctor,

Thank you once again. Enough praise can't be given to your dedicated and
complete responses. You have been  my " friendly expert voice" across the
Atlantic and have been of great help and comfort.

God bless you and all your loved ones.

Sophia

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

1.  Patients with high myopia often have thin corneas. Thin cornea can give falsely low IOP measurements.  What might be a reasonable course of action would be to have all the tests done once. Not necessarily all in one visit but perhaps spread out over 6 months. The corneal thickness and optic nerve OCT are the tests I find most informative.

2. The optic nerve photos are usually done every 2-4 years, the gonioscopy maybe every 3-5 years, the corneal thickness only once and the OCT or VF once/year. That will reduce the costs.

3. With your other problems you most likely will need to see an ophthalmologist at least every 6 months. Hopefully both the glaucoma and retina problems can be checked each visit.

4. Small area of neovascularization (NV) are sometimes difficult to see and if there is a high suspicion level a fluorscein angiogram or macular OCT may be necessary.

5. The prognosis for all types of macular and optic nerve NV has been dramatically improved by the VEGF inhibitors (Lucentis and Avastin) and intraocular steroids (macugen). Further research is turning up new medications each year.

JCH III MD

[sophia35]

Dear Doctor,

Thank you so much for you prompt reply.

I live in Portugal. ( If you enjoy beaches and golf Algarve is just the place).

I will definitely try to get all the exams you referred to done.
My mother is suspected of having glaucoma and I know I´'m at risk just because of
my high myopia  (22 and 17 diopters), so that got me worried.

Since all these exams may be expensive what would you advise me to do on a regular basis?
( my fear is glaucoma related to low or normal pressure). My blood pressure is actually on the "low "side.

I asked about the injections because I've had bleeding in my eyes which resulted in several scars and that's related to NV right?. Do fundus exams always detect bleeding and could injections help in my case or is all I can do  just hope no more bleeding and scarring will occur?

The sad truth is I feel my eyesight getting worse and its getting difficult to see small print even with my contacts and really close up.

Sorry, I realize many questions are hard to answer when you just have text information but I will really appreciate any more advice you can give me.

Wishing you and everyone the very  best,
Sophia

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

Hello Sophia 35 nice to hear from you again. Do I remember right that you live in Portugal or Spain?

1. A dilated fundus exam is not adequate to diagnose glaucoma in most circumstances. A glaucoma work up includes: a visual field exam, optic nerve stereo photographs, a corneal thickness measurement (pachymetry), optic nerve OCT, gonioscopy and a dilated complete eye exam.  This work-up would identify normal tension or low tension glaucoma.

2. You cannot prevent glaucoma of the most common type (primary open angle glaucoma POAG).

3. Most likely you are thinking of VEGF inhibitors used to treat macular neovasculariztion usually from age related macular degeneration, but also mypopic wet NV, ocular histoplasmosis and idiopathic NV.  These do NOT help glaucoma.

4. Unless you have a family history of glaucoma, your intra ocular pressure is high or borderline or your optic nerve looks suspicious you do not need all the tests listed in #1.

5. Its too bad your eye physicians feel this way. I find it easier to converse with patients that have done some research and have a basic understanding of their eye problems.

JCH III MD