post surgery tech. question

[zelmo]

Dear Dr.
I realize that my question may be inappropriate and best answered by my surgeon...but here goes anyway. Since aquiring my medical records, I noticed my linear cup disc ratio is .593 (change of .054 from base one year prior that} on my HRT 11 report less than one year prior to my surgery (7 on SLE exam at that time). It was given as .85 one day prior to my surgery one which I suffered snuff out, through SLE exam. Is such a discrepency usual and are HRT exams more or less acurate than SLE ? In general, do you have an opinion of validity of HRT exams ?
Thank you much for any insight.

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

estimating the cup/disk ration (c/d) is notriously inaccurate and is at best an estimate.  We don't get many people on this forum from the UK that are happy with the NHS.  If there is a mechanism to get a second opinion from a glaucoma specialist at a different institution that would be my suggestion.

JCH III MD

[zelmo]

Yes, that is what I meant by SLE; I assume it is the estimate of cup/disc ratio during the general exam whuch includes many other observations on the exam sheet.
The HRT exam, specific to the optic nerve olso had a summary title "Moorefields Classification: Within normal limits" as well. This all less than 7 months before my operation.
My eye MD had at that time classified me as "suspected glaucoma" and was treating me with eye drop meds.
I was never told until AFTER the operation for retinal detachment that I had "advanced glaucoma" which contributed to the "snuff out".
I assumed the HRT exam was more accuate than the estimate during the slit lamp exams. I'm getting no answers from my eye MDs as I continue the same protocol on my other eye, which by the way had a "higher" cup disc ratio on the HRT than the eye that was lost.
Thank you for your response Dr.

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

What do you mean by SLE  normally that means "slit lamp exam".

I do not use HRT. I use OCT.

JCH III MD

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

SLT is about the safest procedure I do. To date no serious complications. Close observation of the IOP in the first 24-48 hrs is important in severe glaucoma.

JCH III MD

[zelmo]

Thank you Dr. You've been very helpful. SLT is worth the effort to me as I'm on three types of drops, one 3 per day...every thing I've read said it was vary safe (do you concur ?) and Tuft's was where they stared it, which is where I have an appointment,,,,initially. I know everything has it's risks.
Thank you

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

SLT selective laser trabeculoplasty is roughly the equivalent of one medication. So if you are on 4 types of eye drops and the SLT worked (dropped the IOP on the average 3-4 pts) you might be able to stop one drop but it would not cure the glaucoma.

the ON damage and RD relationship would require speculation on my part and I can't answer.

My suggestion is to get a second opnion from a glaucoma specialst. Maybe at Mass Eye and Ear

JCH IIIMD

[zelmo]

Dear Dr.
I"m sorry if I gave you the impression I'm from UK...I do have an oppointment for Tuft's Eye Center and was concerned if the discrepency in the testing was a valid point to take up. Until I gat validation, I am extremely worried about my ability to maintain sight in my other eye.
I do 9 treatments a day with side affects and would like to consider SLT laser therapy to decrease my drop treatment. Your thoughts on safety of such treatment ? I just don't feel that ethically at the least, I was well informed during my initial treatment phase about my deteriorating condition.....I'm really worried feel I have to be more aggressive to keep from going blind.
Can the optic nerve be damage by a long term retinal detachment that was left untreated ? Another possibility ?