Very early detection of Glaucoma possible?

[Van_Diemen]

Dear Sir,
I would like to ask a question regarding an issue that I have noticed for about half a year. First I would like to give you some additional information about myself: I'm a 21 year old male and on my father's side of the family glaucoma occurs. My grandfather especially has glaucoma and my father was treated earlier (about 10 years ago) by laser to relieve some of the pressure in his eyes. Apart from that his vision is still intact compared to the advanced vision loss of my grandfather. That's why I have always been very alert to any small changes in vision that might occur.
I'm under survey by an ophthalmologist for about 4 years now and nothing was discovered thus far. They do have measured a high eye pressure sometimes of about 23 mmHG and thus I need to be checked regularly (once every 2 years). However recently I myself discovered, about half a year ago, that when looking at an object (for example a piece of paper, pen or my own finger) very close and moving it a little up- and downwards in front of my eye, while keeping my eyes focus fixed on a white screen for example, I can see a black to grey line in the peripheral part of my right eye. This is beyond the natural blind spot and only appears if I check it myself, like I described using a close object. Normally I don't notice it. Now I do know a thing or two about eye symptoms and I can remember that peripheral scotomas are the first stage of developing glaucoma. Maybe the object causes your brains to be fooled and thus fill in the gap (of the scotoma) by making it black. However I also know that when using very close objects and moving them, for example by making a small hole in a piece of paper and looking in it while moving it slightly you can see the blood vessels in your eye (not very clear of course).
What do you think about my discovery and what is the most likely explanation. Also the last time I was checked by my ophthalmologist he did not find anything that I should be worried about.

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

From a statistical basis it would be rare for you to have had two ophthalmologists check you and a visual field without picking up trouble. Your youth also is a big protection.

JCH MD

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

You are welcome

JCH MD

[Van_Diemen]

Thank you very much for your advise and efforts on this forum.

[Van_Diemen]

I live in the Netherlands and here it is not as easy to switch. You need to make an appointment with your GP first. He/she then examines whether or not you need specialized help and allows you then depending on what he/she thinks of it to make an appointed with the specialist. In my case I got the appointment 4 years ago, because of the familiar risk of glaucoma.
Besides this it is to my knowledge highly irregular in the Netherlands to ask your specialist to do further tests. He/she will decide whether or not it is necessary to do additional tests. However yesterday I have fortunately been able to make an appointment with my other specialist to have a Visual Field test done in October. You see I had a second opinion in January this year and he decided that currently nothing was wrong with me and I had to come back in 2010 for another regular eye examination. However my first ophthalmologist (the one I have for about 4 years now) decided last year that I needed a Visual Field test in 2008, because the last one was done 4 years ago (came out fine). Thus I had this problem with having more or less two ophthalmologists with a totally different opinion in how often I need regular eye examinations. Here usually the last specialist you visit becomes your new regular specialist unless you have any objections. So, I told I would like to have my first opthalmologist back and they agreed. However I don't you how things go exactly in the USA, but I do know that here you cannot order a test to be done without the specialist's approval. Unless you go to some sort of private clinic and pay for it yourself. Even if you do I believe will the specialist decide whether or not further testing is necessary.

However besides routine what do you think in my case? Is it harmless and could glaucoma already have done minor damage without any of the ophalmologists having noticed it? I'm just 21 and it is the "normal" glaucoma that is prevalent in my family, not the juvenile one.

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

What country do you live in and why do you not have recourse to a different Eye MD with a different testing routine?

JCH MD

[Van_Diemen]

I would like to have it checked annually, but what if my last visit was half a year ago and they refuse to see me until about 2 years have passed? Also I believe that I cannot demand any tests by my Dr if he doesn't agree that they should be done. What do you think about this?

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

You should have your eyes checked annually by an ophthalmologist. I would also suggestg a baseline glaucoma work up: visual field, optic nerve OCT, gonioscopy, optic nerve stereo pictures and corneal thickness measurement.

JCH MD

[ginmill01]

I heard an opthalmologist talking on NPR radio last week.  They are working on a DNA test that will show the liklihood of getting glaucoma, but it is not yet perfected.  If I were you, I'd go more often than every two years for testing.  Annually would show you Dr a trend, and would probably give you more peace of mind.