told I may have normal pressure glaucoma. am I waiting too long for further testing?

[summer22]

I went to my yearly eye exam with ophthamologist. My pressure was good/normal but the top test, the one where they take a picture with the bright flash showed my optic nerve was on the red line. Doctor said I might have low pressure glaucoma and wants me back in November. I am concerned that is too long of a wait. Should I be seen sooner for further testing. He said he will do additional tests to see if I have it. Cant they tell there is something wrong with the optic nerve with the dilated exam I had today? Which glaucoma is harder to treat? Pressure glaucoma or non pressure glaucoma? I am 60 and vision is okay with glasses. He said that I might be normal for this optic nerve decline? anyone else here have normal pressure glaucoma?

[JohnHaganMD]

If this an ophthalmologist you have seen for a long time? Or the first time?  Not sure what test you are talking about. Optic nerve photograph?  Nerve fiber layer OCT?  If you have no family history of glaucoma, your eye pressures normal and you are relatively healthy the chance of low pressure (also known as normal tension glaucoma) are very tiny.  NTG is much more common in Asians and in people with cardiovascular disease.  Other tests that might be necessary of your eyes for a complete glaucoma work up:  visual fields, gonioscopy, nerve fiber layer OCT and corneal thickness measurements (pachymetry).   You might discuss this with your Eye MD.   It might be worth moving your tests up to September to prevent you from worrying.

[summer22]

sorry I am not sure what the name of the test was they did. The tech girl did the test after dilation, and I looked at a little circle in the machine that went around, had to blink, saw a flash like a flash bulb. She seemed to be having an issue and had to retake it several times and seemed like she was not familiar with the machine. I am hoping the test was done correctly.
The doctor has checked my eyes two years ago, but did not do this test. He did dilate, and check with the hand scope.
He showed me a graph that showed where my optic nerves were at a low number for my age. But he said it may be normal for me and would do the additional tests you mentioned. I am 60, normal weight, no health issues, nor on any medications.
I feel like my peripheral vision is good. I did have a peripheral vision test done 4 years ago which was normal when I was having auras that turned out to be dx as non migraine auras from a neuro. This was a different eye doctor.

[JohnHaganMD]

The likelihood of you having glaucoma is small. You need to discuss with your Eye MD, ask the test. If you want to go through with the test move up so you don't fret so lont

[summer22]

thank you for the advice. I will try to move up the appt. I will try to get a sooner appt than 3months out

[JohnHaganMD]

Good plan.  Odds are you don't have it.

[summer22]

I went for my return check up on the Glaucoma Suspect with a different ophthamologist and she did a gonioscopy, OCT and pressure test. My peripheral was good, pressure 18 in both eyes but OCT was in the yellow/green range (red was considered bad) and also have start of cataracts. She said I am Suspect normal pressure glaucoma and will have me come back in 6 months for another peripheral test. I forgot to ask her what treatment would be used if it progressed to normal pressure glaucoma. Does normal pressure patients get drops and surgery as well even though there is no pressure to lower?
Also...do most suspect glaucoma patients usually end up with glaucoma down the road?

[JohnHaganMD]

Normal tension glaucoma is relatively rare. The exact cause is not know. Some people that develop it have been in shock due to massive blood loss (e.g. injury or childbirth complications) also people with cardiovascular disease risk factors (smokers, diabetics, hypertension, elevated cholesterol, heart attacks, strokes).  The treatment is to lower the normal pressure even lower with drops/laser/surgery.  Many people have thinking of nerve fiber layer on OCT but don't develop or have glaucoma. It is thinner in myopes, new finding may be thinner in patients with dementia (doesn't mean you have it or will get it).