how commonly do optometrists miss glaucoma?
gudrun17
vision was blurred. I asked if it could be glaucoma. My pressures were
17 and 18. I asked about normal tension glaucoma. She explained that
they look at three things to diaganose glaucoma: the pressures, the
optic nerve, and the visual field. I did a visual field test three
times but it was so inconsistent (even with my good eye) she said she
could not explain it. She did a dilated eye exam and told me my optic
nerves looked healthy but "large." She went through my records for the
past several years and noted there had been no change in the optic
nerve. I have high myopia so she explained that "large nerves"--I guess
she meant large cups--were typical with myopes. She said to show my
visual field tests to my retina specialist, which I did. He said the
test was so inconsistent it was meaningless and not to worry about
it--something about that kind of test not being sensitive enough for
high myopes.
Now my blurry peripheral vision has advanced considerably and I am
expecting, as my doctor now says is likely, a diagnosis of very
advanced glaucoma. My retina specialist, who also didn't notice any
optic nerve damage but finally had me do another visual field test,
says that sometimes optic nerve damage is subtle and easily missed.
Does that sound likely? If so, how do normal tension glaucoma patients
ever get diagnosed before it's almost too late? I have so much vision
loss now I think it's almost too late for that eye.
g.g...@agora.it
Discard your glasses and start the self-treatment under the supervision
of a person gifted with perfect sight: read the book by Dr. Bates. It
is a good book and explains very well why you have choosen the wrong
path of strain and effort to see.
It is 100% safe.
Wooly
Dom
there is no single "glaucoma test" that gives you a straight yes or no
diagnosis. Glaucoma is diagnosed by doing a number of tests (including
pressures, visual fields, and optic nerve evaluation, and others too), then
looking at the patient's age, family history, and forming an overall
opinion. Sometimes the information gathered makes it easy to say "yes you've
got it", but often the information is not conclusive and it's a bit of a
judgement call.
Optic nerve apperance varies between individuals, and some people are born
with a healthy optic nerve that has the appearance of a glaucomatous one.
Therefore a suspicious looking nerve is an indicator of possible glaucoma,
but certainly not definitive proof. Even the same test repeated over time
can give different results - eg. pressures can vary from day to day, and
within the day; and visual field tests can fluctuate from one test to the
next - only a consistent defect repeated over time is conclusive. Often
concentration or tiredness can create an inconsistent visual field result,
so a suspcious visual field is usually just repeated at some future date for
verification.
Normal-tension glaucoma is even harder to diagnose, as one of the main
indicators of glaucoma (raised intra-ocular pressure) is not present. And
the decision to diagnose glaucoma, and therefore put someone on daily
eyedrops for the rest of their life, is not taken likely. So the diagnosis
is not made on the basis of just one or two suspicious findings, but a more
complete pattern or some more definititive test results.
Having said all of this, if your glaucoma is advanced enough that you can
notice blurry peripheral vision yourself, then this should have been very,
very obvious on the visual field test. Usually computerised field tests pick
up defects years earlier than they are actually noticed by the person.
Hope this helps
Dom
"gudrun17" <yng...@aol.com> wrote in message news:1107554966.657858.98880@l4
1g2000cwc.googlegroups.com...
LarryDoc
"Dom" <NOmoad...@tpg.nospam.com.au> wrote:
Dom's reply was very well stated. I'd like to add a few things and draw
your attention to a couple of key points:
> the decision to diagnose glaucoma, and therefore put someone on daily
> eyedrops for the rest of their life, is not taken likely. So the diagnosis
> is not made on the basis of just one or two suspicious findings, but a more
> complete pattern or some more definititive test results.
This is very important, as once a patient is started on glaucoma
medication or surgical intervention, it is often impossible to
after-the-fact re-evaluate the original diagnosis.
>
> Having said all of this, if your glaucoma is advanced enough that you can
> notice blurry peripheral vision yourself, then this should have been very,
> very obvious on the visual field test. Usually computerised field tests pick
> up defects years earlier than they are actually noticed by the person.
Agreed. Additionally, there is now technology that can quantify the
degree of nerve fiber loss and monitor to progress of the disease, or
better, the efficacy of the treatment. Sometime pressure in the upper
range of normal is really higher than measured. This, too, is now
avoidable with current technology. Nevertheless, normal-tension
glaucoma and even elevated pressure glaucoma is not a simple diagnosis.
So, to answer your subject of your post, I think in 2005, it would be
very unusual for us to miss glaucomatous nerve damage. Not impossible,
but not very likely. We DO, on the other hand, as Dom wrote, like to be
pretty darn certain that the condition exists before beginning
treatment. That does not mean we "miss" detecting it, but it does
sometimes mean a delay in reaching a definitive diagnosis. (The "we"
referring to competent optometrists, general ophthalmologists and retina
specialists.)
You might want to ask about retina nerve fiber imaging and if that is
likewise inconclusive, having been to a retina specialist, I would think
the next referral would be to a neurologist.
Do let us know what happens.
--LB, O.D.
gudrun17
LarryDoc wrote:
> In article <42043314$1...@dnews.tpgi.com.au>,
> "Dom" <NOmoad...@tpg.nospam.com.au> wrote:
>
> Dom's reply was very well stated. I'd like to add a few things and
draw
> > Having said all of this, if your glaucoma is advanced enough that
you can
> > notice blurry peripheral vision yourself, then this should have
been very,
> > very obvious on the visual field test. Usually computerised field
tests pick
> > up defects years earlier than they are actually noticed by the
person.
The visual field test done by the optometrist showed gross
inconsistencies over three separate tests--in other words, an area that
showed came up black (this was the Humphrey frequency doubling test)
showed up white (normal) in the next text but there would be a
different defect (grey or black) in a different part of the eye that
before tested normal. There were more defects in the affected eye but
in one test but not in the other two, which showed more defects in my
good eye. The OD said she could not explain it, as I said, and told me
to show them to my retina specialist. He said they were too
inconsistent to mean anything. Actually he said I should wait until my
PVD "resolved" to have vision field testing, because I even asked about
having one done there. It wasn't actually until I showed him results of
an online visual field test that he decided I better have one done in
the office, and that's the one that showed "suspicion of glaucoma."
>
> Agreed. Additionally, there is now technology that can quantify the
> degree of nerve fiber loss and monitor to progress of the disease, or
> better, the efficacy of the treatment. Sometime pressure in the upper
> range of normal is really higher than measured. This, too, is now
> avoidable with current technology. Nevertheless, normal-tension
> glaucoma and even elevated pressure glaucoma is not a simple
diagnosis.
>
> So, to answer your subject of your post, I think in 2005, it would be
> very unusual for us to miss glaucomatous nerve damage. Not
impossible,
> but not very likely.
Okay, that's the part I'm wondering. I understand that with normal
pressures and with myopia, sometimes it can be harder to catch, but
over the past five months I've seen the OD, an ophtalmalogist, and my
retina specialist (who brought in a colleague to examine me as well)
and it's difficult for me to understand how they could all have missed
this. Meanwhile the blurry area kept extending closer to my central
vision, scaring me, but still my retina specialist said he could not
detect any optic nerve damage. I have seen him about five times during
this time period, and I asked him if he saw any changes in my optic
nerve, and he said no. He also said he had not thought it could be
glaucoma because I was complaining of rapid progression, and supposedly
glaucoma is slow.
We DO, on the other hand, as Dom wrote, like to be
> pretty darn certain that the condition exists before beginning
> treatment. That does not mean we "miss" detecting it, but it does
> sometimes mean a delay in reaching a definitive diagnosis. (The "we"
> referring to competent optometrists, general ophthalmologists and
retina
> specialists.)
Thank you. But it seems to me that if a patient is asking if it could
be glaucoma and complaining of loss of vision, surely the OD or the
ophtalmalogist or the retina specialist would, although hesitating to
make an actual diagnosis, consider the possibility? Or would they
normally take a look a the optic nerve, decide they see no damage and
take a wait and see approach? Everyone told me they didn't see anything
suspicious. Of course, I understand that retina specialists are
concentrating more on retinal tears--which is what they first thought
my symptoms indicated, but that was ruled out.
> You might want to ask about retina nerve fiber imaging and if that is
> likewise inconclusive, having been to a retina specialist, I would
think
> the next referral would be to a neurologist.
>
> Do let us know what happens.
>
> --LB, O.D.
Thanks for the suggestions. I'll see what the glaucoma specialist says.
I was just trying to understand how a group of eye care specialists
could be telling me my optic nerves look normal when I obviously have
advanced visual field loss. At this point most of my upper visual field
is blurred and dimmer, which is a big change from a few months ago when
I could only see the blurring in the far periphery. I am sure I will be
having an MRI. I will post back. The retina specialist said maybe it's
not glaucoma, but based on the field test he thought it likely is
although he could not explain why he had noticed no damage. Obviously I
am confused and distressed that this could not have been caught sooner
before I lost more vision--like I said, a couple months have made a
noticeable difference.
gudrun17
Dom wrote:
> In some ways glaucoma can be one of the most difficult things to test
for...
> there is no single "glaucoma test" that gives you a straight yes or
no
> diagnosis. Glaucoma is diagnosed by doing a number of tests
(including
> pressures, visual fields, and optic nerve evaluation, and others
too), then
> looking at the patient's age, family history, and forming an overall
> opinion. Sometimes the information gathered makes it easy to say "yes
you've
> got it", but often the information is not conclusive and it's a bit
of a
> judgement call.
>
> Optic nerve apperance varies between individuals, and some people are
born
> with a healthy optic nerve that has the appearance of a glaucomatous
one.
> Therefore a suspicious looking nerve is an indicator of possible
glaucoma,
> but certainly not definitive proof.
So are you saying that if a person has optic nerve appearance typical
of myopia, but complains of blurred peripheral vision, the OD could not
tell by looking at the optic nerve whether there was any damage? As I
noted, she did look back through my records (I am vigilant about having
yearly exams) and said there had not been any change in my optic nerves
over the past few years.
Even the same test repeated over time
> can give different results - eg. pressures can vary from day to day,
and
> within the day; and visual field tests can fluctuate from one test to
the
> next - only a consistent defect repeated over time is conclusive.
Often
> concentration or tiredness can create an inconsistent visual field
result,
> so a suspcious visual field is usually just repeated at some future
date for
> verification.
I understand, and that's what happened, but the fields were so
inconsistent from test to test she said she could not explain it. She
said the fields looked typical of someone with dense cataracts, which I
clearly don't have.
>
> Normal-tension glaucoma is even harder to diagnose, as one of the
main
> indicators of glaucoma (raised intra-ocular pressure) is not present.
And
> the decision to diagnose glaucoma, and therefore put someone on daily
> eyedrops for the rest of their life, is not taken likely. So the
diagnosis
> is not made on the basis of just one or two suspicious findings, but
a more
> complete pattern or some more definititive test results.
But I think you are talking about early glaucoma detection. It seems to
me that once a person is complaining of vision loss, starting treatment
to stop progression would be more important than waiting to be sure.
>
> Having said all of this, if your glaucoma is advanced enough that you
can
> notice blurry peripheral vision yourself, then this should have been
very,
> very obvious on the visual field test. Usually computerised field
tests pick
> up defects years earlier than they are actually noticed by the
person.
>
Is it likely that frequency doubling visual field tests are inaccurate
with high myopes? That's what I was told, since there were such wild
inconsistencies among the tests.
LarryDoc
"gudrun17" <yng...@aol.com> wrote:
As I read your latest post, one thing is clear: the whole picture is not
here. You keep adding more information (like the the fields test being
FDT, but not whether it was screening or threshold) and that you have
PVD and other little bits and pieces. It is not possible for anyone
here to give you a proper diagnosis or prognosis and my only reason for
commenting was to address the subject of your post.
Key points here are that you claim to have significant and rapid changes
in visual field loss---something that is hardly possible with normal
tension glaucoma. Glaucoma is known to be a slowly progressive condition
with the notable exception of extremely high rapid onset pressure.
> The visual field test done by the optometrist showed gross
> inconsistencies over three separate tests--in other words, an area that
> showed came up black (this was the Humphrey frequency doubling test)
The FDT has a number of testing modes. There are other methods of
measuring fields. Some people perform better with one or the other and
certainly, one would think that if there were poor results with one
technology that you would be tested with another.
> Actually he said I should wait until my
> PVD "resolved" to have vision field testing, because I even asked about
> having one done there. It wasn't actually until I showed him results of
> an online visual field test that he decided I better have one done in
> the office, and that's the one that showed "suspicion of glaucoma."
On-line test? Forget it. I should think that a $10K or $20K machine in
an office would be a bit more reliable.
> Meanwhile the blurry area kept extending closer to my central
> vision, scaring me, but still my retina specialist said he could not
> detect any optic nerve damage. I have seen him about five times during
> this time period, and I asked him if he saw any changes in my optic
> nerve, and he said no. He also said he had not thought it could be
> glaucoma because I was complaining of rapid progression, and supposedly
> glaucoma is slow.
As I said.
And as I started, we don't have all the data presented here and there is
nothing anyone "on-line" can do for you, except to encourage you to get
another opinion from a retina ophthalmologist and proceed rapidly with
other neurological testing including imaging studies---both of the
retina and brain.
I wish you well. Do let us know the outcome of your follow-ups.
--LB, O.D.
gudrun17
LarryDoc wrote:
> In article <1107617191.1...@f14g2000cwb.googlegroups.com>,
> "gudrun17" <yng...@aol.com> wrote:
>
> As I read your latest post, one thing is clear: the whole picture is
not
> here. You keep adding more information (like the the fields test
being
> FDT, but not whether it was screening or threshold) and that you have
> PVD and other little bits and pieces. It is not possible for anyone
> here to give you a proper diagnosis or prognosis and my only reason
for
> commenting was to address the subject of your post.
Thank you for your info. I understand; I'm not really looking for
diagnosis--, just trying to understand how reasonable it would be for
eye care professionals to detect advanced glaucoma-induced changes in
the optic nerve. The FDT test was for screeing, I'm sure. The
optometrist had only gotten it a few months earlier--they never had
offered visual field tests before. I'm not sure what difference the PVD
would make, except that that's what my RS thought was causing the loss
of vision at first.
>
> Key points here are that you claim to have significant and rapid
changes
> in visual field loss---something that is hardly possible with normal
> tension glaucoma. Glaucoma is known to be a slowly progressive
condition
> with the notable exception of extremely high rapid onset pressure.
Thank you, that's info that's important for me to know. I don't know
how slow is slow--whether there would be a noticeable loss over the
course of a few months (noticeable to the patient, I mean) or whether
it would normally take years.
>
>
> > The visual field test done by the optometrist showed gross
> > inconsistencies over three separate tests--in other words, an area
that
> > showed came up black (this was the Humphrey frequency doubling
test)
>
> The FDT has a number of testing modes. There are other methods of
> measuring fields. Some people perform better with one or the other
and
> certainly, one would think that if there were poor results with one
> technology that you would be tested with another.
I suspect since the FDT was a recent acquisition, the optometry
technicians may not have been well trained yet. I know they did not try
any other modes of testing, other than to have me do one with my
glasses and one with my contact lenses to see if it made a difference.
>
> > Actually he said I should wait until my
> > PVD "resolved" to have vision field testing, because I even asked
about
> > having one done there. It wasn't actually until I showed him
results of
> > an online visual field test that he decided I better have one done
in
> > the office, and that's the one that showed "suspicion of glaucoma."
>
> On-line test? Forget it. I should think that a $10K or $20K machine
in
> an office would be a bit more reliable.
Yes, of course, but if only I'd showed him the print-outs of the online
test a few months earlier, to document that I was missing more points
in the field, I think he would have taken the situation more seriously
and done a proper visual field test then, probably saving some of my
vision. The test showed defects within 20 degrees of fixation, which is
apparently what convinced him to order an office visual field test. I
didn't think he would take an online test seriously either, which is
why I didn't show it to him earlier. Now I obviously feel great remorse
that I didn't document my visual loss sooner rather than just try to
describe it to him and the other doctors I saw.
>
>
> > Meanwhile the blurry area kept extending closer to my central
> > vision, scaring me, but still my retina specialist said he could
not
> > detect any optic nerve damage. I have seen him about five times
during
> > this time period, and I asked him if he saw any changes in my optic
> > nerve, and he said no. He also said he had not thought it could be
> > glaucoma because I was complaining of rapid progression, and
supposedly
> > glaucoma is slow.
>
> As I said.
>
> And as I started, we don't have all the data presented here and there
is
> nothing anyone "on-line" can do for you, except to encourage you to
get
> another opinion from a retina ophthalmologist and proceed rapidly
with
> other neurological testing including imaging studies---both of the
> retina and brain.
Thank you. I am just trying to gather all the information I can, since
obviously I am baffled and scared. I have already scheduled a second
opinion appointment with another glaucoma specialist for later this
week. He seems to be willing to move a lot more quickly than my current
ophthalmalogists.
>
> I wish you well. Do let us know the outcome of your follow-ups.
>
> --LB, O.D.
Thank you, you've been very helpful. I look for information and
opinions online but I know very well that I must trust my doctors to
diagnose. Getting opinions online, however, helps me get a better
understanding of the situation so I can ask better questions of my
doctors. I wish I had delved into this a lot more a few months ago,
rather than just assuming my doctor's "wait and see--I think it will
resolve on its own" advice must be accurate, because I might have been
able to save more vision.
Dom
A "myopic" optic nerve isn't quite the same thing as a "glaucomatous"
optic nerve. But to answer your question, it is not always possible to
tell a nerve is damaged just by looking at it - myopic or otherwise. The
fact that your optic nerves had not changed suggests (but certainly
doesn't prove) that there is no glaucoma.
> Even the same test repeated over time
>
>>can give different results - eg. pressures can vary from day to day,
>
> and
>
>>within the day; and visual field tests can fluctuate from one test to
>
> the
>
>>next - only a consistent defect repeated over time is conclusive.
>
> Often
>
>>concentration or tiredness can create an inconsistent visual field
>
> result,
>
>>so a suspcious visual field is usually just repeated at some future
>
> date for
>
>>verification.
>
>
> I understand, and that's what happened, but the fields were so
> inconsistent from test to test she said she could not explain it. She
> said the fields looked typical of someone with dense cataracts, which I
> clearly don't have.
>
Glaucomatous visual fields have a distinctive pattern to them, which is
usually fairly easily recognised if it's advanced enough. If your fields
resembled those of someone with cataracts, then that's a different
pattern, and so no wonder your optometrist didn't immediately suspect
glaucoma. If you don't have cataracts, and your visual fields don't
resemble glaucoma, then you start to wonder what else may be causing
your peripheral blur... especially given its fairly rapid progression.
>>Normal-tension glaucoma is even harder to diagnose, as one of the
>
> main
>
>>indicators of glaucoma (raised intra-ocular pressure) is not present.
>
> And
>
>>the decision to diagnose glaucoma, and therefore put someone on daily
>>eyedrops for the rest of their life, is not taken likely. So the
>
> diagnosis
>
>>is not made on the basis of just one or two suspicious findings, but
>
> a more
>
>>complete pattern or some more definititive test results.
>
>
> But I think you are talking about early glaucoma detection. It seems to
> me that once a person is complaining of vision loss, starting treatment
> to stop progression would be more important than waiting to be sure.
>
Yes that's right -- *but* you have to be sure (1) the vision loss is
present and measureable, and (2) it is caused by glaucoma and not
something else, before you initate glaucoma treatment. Glaucoma is not
the only cause of peripheral vision loss. If they jumped in and started
you on glaucoma treatment earlier, but then your peripheral vision
continued to deteriorate because in fact it was caused by a brain tumour
and not glaucoma, then you'd be more than a little upset!
Have you actually formally been diagnosed with glaucoma, or was this
just one possiblity that has been suggested to you (or, have you done a
self-diagnosis over the internet)? Because your story is not totally
consistent for normal-tensive glaucoma. I don't mean to accuse you of
anything, I just wonder whether you have jumped to this conclusion
yourself when in fact there may be another cause.
>
>>Having said all of this, if your glaucoma is advanced enough that you
>
> can
>
>>notice blurry peripheral vision yourself, then this should have been
>
> very,
>
>>very obvious on the visual field test. Usually computerised field
>
> tests pick
>
>>up defects years earlier than they are actually noticed by the
>
> person.
>
> Is it likely that frequency doubling visual field tests are inaccurate
> with high myopes? That's what I was told, since there were such wild
> inconsistencies among the tests.
>
I'm no expert on FDT, but I think it's more accurate for high myopes and
hyperopes than traditional visual field testing. Anyway, if you wear
your contacts for the test it becomes irrelevant.
I agree with LarryDoc that everything doesn't quite "add up" here and
neurological testing might be a good idea. And beware of internet diagnoses!
Dom
Dom
> Here's a neat way to test for your field defects at home. Tune your
> television set to an unused channel so that all you see is "snow" (a
> gray background with shimmering white dots).
>
> Mark the center of the screen with a black dot. At a distance of about
> 2 feet, cover one eye and look at the dot. If you have a field defect
> it will appear very clearly as a solid gray area, i.e. with no dots.
> The size, shape and position of the defect will be perfectly clear, and
> much easier to perceive compared to a print-out from a static perimetry
> (Humphrey) test. The sensitivity and specificity are 93.2% and 96.9%,
> respectively, compared to standard perimetry.
>
> You can make a rough sketch of the field defects aand re-check
> periodically for changes. If you do this, I would like to know how it
> came out.
>
> --Rich
>
Interesting idea... but you'd have to control the distance from the TV
and the size of the screen to be consistent.
Where'd you get the % figure? I'd be interested to read this study.
Dom
Dr. Leukoma
An absolute glaucomatous scotoma would not be preceived as "blur." It
would not be perceived at all, because it would be a complete lack of
vision.
Something is rotten in Denmark.
DrG
gudrun17
Thank you. If I understand correctly, what you and LarryDoc are saying
is that a doctor can usually tell if an optic nerve looks suspicious,
but not always. So when the optometrist, the ophthalmologist, and the
retina specialist all say they didn't observe any damage, it's possible
they all just missed it.
My visual fields on the Humphrey FDT used by the optometrist resembled
someone with dense cataracts--so she said. But I was specifically
asking her to look for signs of glaucoma, so I was somewhat reassured
when she told me she saw no evidence of it. My visual field done at the
ophthalmology clinic--I don't know what kind it was, one of the ones
with lights on white background--did show a defect characteristic of
glaucoma. That's why my retina specialist is now telling me that's the
likely answer, although it might not be.
Yes, but I'm already upset that it wasn't detected earlier when I had
less vision loss. I suppose the reason there wasn't much sense of
urgency is that you are both saying glaucoma normally progresses
slowly--even in the advanced stage, I take it?
>
> Have you actually formally been diagnosed with glaucoma, or was this
> just one possiblity that has been suggested to you (or, have you done
a
> self-diagnosis over the internet)? Because your story is not totally
> consistent for normal-tensive glaucoma. I don't mean to accuse you of
> anything, I just wonder whether you have jumped to this conclusion
> yourself when in fact there may be another cause.
Okay, I will explain completely. I have not yet been formally
diagnosed. I see the glaucoma specialist in a couple of days. My retina
specialist referred me to him last week, saying that he no longer
thinks the vision loss is due to the PVD--because it should have
resolved by now-- and that normal tension glaucoma is the more likely
reason. As with most patients, the waiting to find out what's going on
is agony, and I am trying to find out all I can so that I can brace
myself for what is likely to be bad news no matter what. I am sure the
GS will test for other causes, given the rapid progression. I am
filling the time in waiting to learn as much as I can.
> >
> >>Having said all of this, if your glaucoma is advanced enough that
you
> >
> > can
> >
> >>notice blurry peripheral vision yourself, then this should have
been
> >
> > very,
> >
> >>very obvious on the visual field test. Usually computerised field
> >
> > tests pick
> >
> >>up defects years earlier than they are actually noticed by the
> >
> > person.
> >
> > Is it likely that frequency doubling visual field tests are
inaccurate
> > with high myopes? That's what I was told, since there were such
wild
> > inconsistencies among the tests.
> >
>
> I'm no expert on FDT, but I think it's more accurate for high myopes
and
> hyperopes than traditional visual field testing. Anyway, if you wear
> your contacts for the test it becomes irrelevant.
>
> I agree with LarryDoc that everything doesn't quite "add up" here and
> neurological testing might be a good idea. And beware of internet
diagnoses!
>
> Dom
I fully expect the GS to refer me to the ophthalmogy neurologist as
well. If he doesn't, I will be asking why not. I have also scheduled a
consult with another GS at another eye clinic, for later this week, so
I am certainly not relying on internet diagnoses. I just want to get an
idea of what the various diagnoses might be that I should expect--right
now advanced NTG seems the frontrunner, but having lost vision due to
not asking enough questions, I want to be better prepared now. I feel
pretty stupid believing for the last few months that my burred and
darkening vision was going to get better in time, because that's what
my RS and his colleague kept telling me. Now all of a sudden I am
learning that not only will it not improve, but more than likely keep
getting worse, so I do feel greatly compelled to ask a lot of questions
of a lot of people and not be so naive when it comes to accepting a
doctor's diagnosis.
gudrun17
Actually, this method was suggested on a glaucoma support board, so I
have tried it. I tried it with a 27 inch tv and a 12 inch tv. With the
twelve inch, I couldn't get close enough to see any scotomas. With the
27 inch, I could see my floaters very well, but no distinct scotomas. I
see some darker tendrils coming down from the top, one in the one
o'clock position where I know I have a defect, and a couple more in the
upper nasal quadrant. These are feathery and too indistinct for me to
really be able to sketch. I think my vision loss is too diffuse to show
up as distinct solid grey spots. I've read this does work very well for
lots of people, but I think it works better if you have scotomas,
defects surrounded by normal vision.
Also, I'd think the contrast settings or the way it displays "noise" on
your tv may have something to do with it. I don't get a white or light
grey snow pattern; on all our tvs it's white dots against black dots.
That might be another reason I can't see field defects very well this
way.
For those interested, I think this is called white noise campimetry and
here's the link I read:
http://webeye.ophth.uiowa.edu/ips/PerimetryHistory/White_Noise_Field_Campimetry.htm
gudrun17
Dr. Leukoma wrote:
>
> An absolute glaucomatous scotoma would not be preceived as "blur."
It
> would not be perceived at all, because it would be a complete lack of
> vision.
>
> Something is rotten in Denmark.
>
Aren't relative scotomas perceived as blur, or lack of resolution? One
person I asked described it as a fuzzy spot.
You know, one reason I believed my doctor that my increasingly blurred
upper vision must be from a collapsed vitreous and could not be
glaucoma is that the people I asked that I personally know who had
vision loss from glaucoma described the loss as a complete lack of
vision, as you say, a blind spot. I figured I could not have glaucoma
since I am not totally blind even in the densest part of my visual
loss--I can still perceive bright light in that spot, it's just blurred
and diffuse. The rest of my visual field loss is gradually less and
less blurry down to my central vision, which is still okay, although
barely. It is my understanding now that vision loss from glaucoma often
begins as areas of decreased resolution, as in a relative scotoma, and
then these areas gradually become absolute scotoma. Am I mistaken?
LarryDoc
"Dr. Leukoma" <d...@leukoma.com> wrote:
> An absolute glaucomatous scotoma would not be preceived as "blur." It
> would not be perceived at all, because it would be a complete lack of
> vision.
>
> Something is rotten in Denmark.
I'd say! Each time he posts there's a little more information. It is
difficult for me to understand how three competent practitioners in a
row could not come to a diagnosis or at least a protocol for finalizing
a diagnosis and then treatment plan. There's simply a limited number of
potential causes and a limited number of diagnostic tools to get there.
Comments on other posts:
I have no problem not completely trusting a doctor's judgment and
pursuing alternative opinions. Nor do I have a problem with "doing your
homework" and presenting a doctor with specific questions to be
addressed. If the practitioner fails to ask for information you think
might help in the diagnosis, feel free to add it! I've has occasion when
I diagnosis something and at the conclusion of the visit, he/she adds a
"by the way, it also happens when.......". And that little clue throws
out the first diagnosis.
Re: FDT. I don't think it correct to state that it is a superior field
testing device. Like all computer-assisted field testing devices, it has
its strengths and weaknesses. If one machine fails to provide reliable
data, we use another. Even if it does provide excellent quality data,
it's not unusual to re-test on a different machine with a different
protocol. (I use one all the time, every day.)
LB, O,D.
gudrun17
LarryDoc wrote:
> In article <1107660255.9...@c13g2000cwb.googlegroups.com>,
> "Dr. Leukoma" <d...@leukoma.com> wrote:
>
> > An absolute glaucomatous scotoma would not be preceived as "blur."
It
> > would not be perceived at all, because it would be a complete lack
of
> > vision.
> >
> > Something is rotten in Denmark.
>
> I'd say! Each time he posts there's a little more information.
You're right. I tried to simplify it in the first post--I couldn't very
well get every detail in one post.
It is
> difficult for me to understand how three competent practitioners in a
> row could not come to a diagnosis or at least a protocol for
finalizing
> a diagnosis and then treatment plan. There's simply a limited number
of
> potential causes and a limited number of diagnostic tools to get
there.
That's what I'm trying to understand too. The O.D. basically handed me
off to the retina specialist. My retina specialist is just now handing
me off to the glaucoma specialist. I don't know why he didn't think it
was worth testing my visual fields before now. He seemed to be thinking
all along that it was a vitreous problem.
>
> Comments on other posts:
>
> I have no problem not completely trusting a doctor's judgment and
> pursuing alternative opinions. Nor do I have a problem with "doing
your
> homework" and presenting a doctor with specific questions to be
> addressed. If the practitioner fails to ask for information you think
> might help in the diagnosis, feel free to add it! I've has occasion
when
> I diagnosis something and at the conclusion of the visit, he/she adds
a
> "by the way, it also happens when.......". And that little clue
throws
> out the first diagnosis.
I thought I was doing that, but I think some of what I was describing
was not taken seriously. Maybe it's because what I have always been
describing is blurred peripheral vision, not complete lack of it. I
described it as looking through a dark layer of vaseline. I don't know,
maybe that's not the way most people describe their sense of vision
loss.
Dr. Leukoma
the diagnosis hinges on the appearance of the optic nerve and the
visual fields. BTW, a large nerve has a large cup. Everybody has the
same number of nerves, and if they are densely packed, then the cup
will be small. If they are spread out, the cup will be large.
Do you have any other health issues, such as low blood pressure, or
migraine headaches?
DrG
Dr. Leukoma
notoriously unreliable. This is why there are now $50k instruments
available to measure the cup-to-disc ratio and the nerve fiber layer,
and those are hardly affordable except in the high volume glaucoma
practices.
There are other characteristic changes of the glaucomatous optic nerve
that are pressure-induced, such as vertical elongation, and thinning of
the rims where the nerve fibers are less dense. However, those
characteristics may not be present in a nerve that is undergoing damage
from a different mechanism. The mechanism for NTG is poorly
understood.
DrG
gudrun17
Dr. Leukoma wrote:
> NTG can be a very elusive diagnosis. Since the pressures are
"normal,"
> the diagnosis hinges on the appearance of the optic nerve and the
> visual fields. BTW, a large nerve has a large cup. Everybody has
the
> same number of nerves, and if they are densely packed, then the cup
> will be small. If they are spread out, the cup will be large.
I have been told many times over my lifetime that I have large
nerves/cups typical of myopia.
>
> Do you have any other health issues, such as low blood pressure, or
> migraine headaches?
>
Not that I know of. For the past two years, I've been on 12.5 mg.
hydrochlorothiazide for hypertension. My pressures had been reaching
140/90 prior to that, at least at the doctor's office, although 24 hour
ambulatory monitoring showed the pressure was usually normal throughout
the day. Now it's normally around 120/70. I get headaches sometimes
like everyone does, but I don't believe they are migraines.
gudrun17
Thank you. I think you are saying that a nerve undergoing damage from
NTG may look normal to OD's and ophthalmologists. That gives me some
idea why I have been told all along that my optic nerves look healthy
while I continue to lose more and more of my visual field. I am just
trying to understand how I have suddenly come to be in such a
terrifying condition.
RM
> Thank you. I think you are saying that a nerve undergoing damage from
> NTG may look normal to OD's and ophthalmologists. That gives me some
> idea why I have been told all along that my optic nerves look healthy
> while I continue to lose more and more of my visual field. I am just
> trying to understand how I have suddenly come to be in such a
> terrifying condition.
>
Sorry but I am going to chime in here at this late stage with a few remarks
that might seem a little pointed. I am not trying to offend anyone.
I do not understand what actually makes you so certain that you have
glaucoma. As others have told you the diagnosis is quite complicated.
After all, you have seen an OD and a retinal subspecialist multiple times
and despite their best efforts and testing they have never diagnosed you
with it. All that you seem to be able to present is that you notice
increasing amounts of peripheral blur that have come on rapidly. This is
not typical of glaucoma as you were already informed from your doctors. I
believe, as I think that others do in this forum as well, that the real
problem is probably something else.
While I commend you on your efforts to research information about your
health problems I think you have rushed to a diagnosis that is probably not
correct. To quote a cliche, "you know just enough information to be
dangerous." You seem to be wanting to assign blame to health care providers
that know more than you about this condition when you haven't even been
proven to have glaucoma.
I will warn you about this-- if you keep going around to eye doctors stating
your complaints and your convictions you will undoubtedly find one who will
tell you that you likely do have glaucoma and will treat you for it. After
all, it seems like thats what you want to hear. Also, its a difficult
diagnosis so somebody mighty just decide to err on the side of safety and
treat you for it anyway.
I suggest you go with an open mind to a glaucoma specialist, and possibly
also to a neurologist. Let them do the testing and the explaining and ask
all the questions you want. Try to be the patient, but not the doctor.
Give them information and a description of your symptoms but don't try to
interpret the test results for them.
I know this is scary for you but don't jump the gun on diagnosing yourself
and blaming others who have tried to help you.
PS-- IMHO, FDT measurements are not very reliable. While the technique is a
good screening tool for glaucoma (if you have glaucoma, you will almost
certainly give an abnormal FDT result) it also gives a very high rate of
false positives. MANY people with normal vision produce abnormal FDT
results due to binocular rivalry, cataracts, floaters, and god knows what
else. Nothing can bet a good old Humphrey 24-2 SITA coupled with retinal
tomography. And of course a careful optic nerve head evaluation
gudrun17
RM wrote:
>
> Sorry but I am going to chime in here at this late stage with a few
remarks
> that might seem a little pointed. I am not trying to offend anyone.
>
> I do not understand what actually makes you so certain that you have
> glaucoma. As others have told you the diagnosis is quite
complicated.
> After all, you have seen an OD and a retinal subspecialist multiple
times
> and despite their best efforts and testing they have never diagnosed
you
> with it. All that you seem to be able to present is that you notice
> increasing amounts of peripheral blur that have come on rapidly.
This is
> not typical of glaucoma as you were already informed from your
doctors. I
> believe, as I think that others do in this forum as well, that the
real
> problem is probably something else.
Thank you so much for your reply. What makes me pretty certain I have
glaucoma is that my retina specialist, after months of telling me my
visual loss was due to a collapsed vitreous, finally agreed to order a
visual field test (not the FDT kind I had at the OD's office. I already
knew I had significant field loss, but he said diagnosis depends on the
pattern of the loss. He called me the next day to tell me the test
showed field loss "suspicious of glaucoma" and that I should make an
appt. with the glaumoca specialist. You are right, he did explain why
he had not thought it could be glaucoma previously, and he did say
maybe it's not, but that it's the most likely cause of my vision loss.
Originally I saw increasing amounts of blur at the perpiphery and as
this progresed, the densest areas have become darker with less and less
perception of detail or light. Maybe my mistake has been describing
this as blur instead of an increasing loss of detail or a kind of
dimming.
>
> While I commend you on your efforts to research information about
your
> health problems I think you have rushed to a diagnosis that is
probably not
> correct. To quote a cliche, "you know just enough information to be
> dangerous." You seem to be wanting to assign blame to health care
providers
> that know more than you about this condition when you haven't even
been
> proven to have glaucoma.
No, I haven't, but I fully fear I will be tomorrow. If you are saying I
ought to expect a different diagnosis, in some ways I'm glad to hear
that. Maybe in relating all this, I have been stressing the details
that don't fit with the usual progression of glaucoma because I am
partly in denial. I would be very glad to find out that none of the
health care providers who examined me were mistaken.
>
> I will warn you about this-- if you keep going around to eye doctors
stating
> your complaints and your convictions you will undoubtedly find one
who will
> tell you that you likely do have glaucoma and will treat you for it.
After
> all, it seems like thats what you want to hear. Also, its a
difficult
> diagnosis so somebody mighty just decide to err on the side of safety
and
> treat you for it anyway.
Thank you, for making me aware of it. I've spent the past five months
believing my visual loss was *not* due to glaucoma, since my doctors
reassured me. It's not that I wanted to hear that it is--I certainly
didn't--but if what I'm experiencing is permanent vision loss, I want a
diagnosis right away that will stop the loss. Naturally. I've wasted
months losing vision thinking in time the situation would resolve on
its own, since that's what both my RS and another RS in the same
practice told me.
>
> I suggest you go with an open mind to a glaucoma specialist, and
possibly
> also to a neurologist. Let them do the testing and the explaining
and ask
> all the questions you want. Try to be the patient, but not the
doctor.
> Give them information and a description of your symptoms but don't
try to
> interpret the test results for them.
Thank you. I've really not even been tested for anything yet, just the
visual field tests. If the GS does not recommend I see the
ophthalmalogy neurologist there at the hospital, I will insist.
>
> I know this is scary for you but don't jump the gun on diagnosing
yourself
> and blaming others who have tried to help you.
Yes, I am diagnosing myself, in terms of wanting desperately to know
what to expect and what the ramifications are, and what the prognosis
will be to save what sight I have left. This is my way of dealing with
the agony of waiting to find out. I know waiting a week to see a
specialist is no big deal to the doctor, but it can be a mightly long
week to the patient.
>
> PS-- IMHO, FDT measurements are not very reliable. While the
technique is a
> good screening tool for glaucoma (if you have glaucoma, you will
almost
> certainly give an abnormal FDT result) it also gives a very high rate
of
> false positives. MANY people with normal vision produce abnormal FDT
> results due to binocular rivalry, cataracts, floaters, and god knows
what
> else. Nothing can bet a good old Humphrey 24-2 SITA coupled with
retinal
> tomography. And of course a careful optic nerve head evaluation.
I think the visual field test I had at the hospital may have been the
Humphrey 24-2. I think the one they are going to give me tomorrow may
be a threshold test. But since I can obviously see a lot of vision
loss, I already know I do not have normal fields. I think on the FDT,
the reasons I had such poor and inconsistent results were many that you
mentioned--large floaters in the affected eye, and binocular rivalry
because with my good eye covered, I can still percieve the floaters in
the other eye. And frequently the screen just goes dark when viewed
with my good eye, since my bad eye is dominant. I've been told that
shouldn't affect visual field testing, and neither should floaters, but
I have a large Weiss ring floater that tends to settle just beside my
point of fixation, so it's hard for me to believe that wouldn't show up
as a defect.
Thank you. I just hope I find out what's wrong soon, and that something
can be done to stop the loss of vision before it's too late.
reti...@hotmail.com
visual field result on at least two separate appointments to say that
visual field tests show you have glaucoma. Visual field results can be
irratic so they need to be replicated.
I agree that FDT is a screening tool only. If your FDT result was
normal I would think you were likely clear, but it is very common for
there to be false positive results.
You also agree that you need to get Retinal tomography testing. Either
Hiedelberg or GDX. Any glaucoma specialist worth their salt has one
of these apparatuses now. They are invaluable for diagnosing glaucoma.
Glaucoma is a tricky diagnosis. You basically have to weigh many test
results and risk factors to make a good diagnosis.
Have you been tested for MS? It sometimes gives blurry peripheral
vision. It can come on quite quickly as Optic Neuritis. This is
probably why the previous poster suggested you see a neurologist. You
would rather have glaucoma!
Rishi Giovanni Gatti
> <duck> QUACK QUACK QUACK QUACK </duck>
Idiots do exist.
I missed this one.
gudrun17
reti...@hotmail.com wrote:
> in my opinion you need a positive Humphrey 24-2 or 30-2 SITA Standard
> visual field result on at least two separate appointments to say that
> visual field tests show you have glaucoma. Visual field results can
be
> irratic so they need to be replicated.
Thank you. I'm having a second one today. I already know I have visual
field loss since it's advanced enough to be obvious to me even with
both eyes open, but I guess you are saying the second one might not
show a pattern typical of glaucoma.
>
> I agree that FDT is a screening tool only. If your FDT result was
> normal I would think you were likely clear, but it is very common for
> there to be false positive results.
>
> You also agree that you need to get Retinal tomography testing.
Either
> Hiedelberg or GDX. Any glaucoma specialist worth their salt has one
> of these apparatuses now. They are invaluable for diagnosing
glaucoma.
I assume the GS will do that.
>
> Glaucoma is a tricky diagnosis. You basically have to weigh many
test
> results and risk factors to make a good diagnosis.
>
> Have you been tested for MS? It sometimes gives blurry peripheral
> vision. It can come on quite quickly as Optic Neuritis. This is
> probably why the previous poster suggested you see a neurologist.
You
> would rather have glaucoma!
I've not been tested for MS, but I assume the GS will order an MRI
since it's normal tension glaucoma with rapid progression. But from
what I've read, optic neuritis would have resolved on its own by this
time--it's been five months since I noticed symptoms.
As for blurry peripheral vision, I'm still not sure because no actually
answered this question, but doesn't visual field loss from glaucoma
often start as areas of loss of acuity in the peripheral vision? That's
what I'm describing as blurred. I know you can also have blind spots,
but I'm wondering if my symptoms have been confused by the various eye
health professionals I've seen because I keep complaining of blurry
vision that is extending increasingly down into my central vision.
Maybe I've not been describing the visual loss properly.
Simon Dean
Awww. And I thought he captured your essence so perfectly.
Never mind. you can't win them all, eh Rishi my old friend?
Dr. Leukoma
office complaining of blurred peripheral vision. Nobody. Even
patients with demonstrable peripheral field loss have never said that
they noticed this. However, I do remember a gentleman with a superior
absolute scotoma just above the midline stating that he had begun to
notice that his golf ball disappeared after he hit it.
DrG
gudrun17
Dr. Leukoma wrote:
> I must admit that in over 20 years of practice, nobody has come into
my
> office complaining of blurred peripheral vision. Nobody. Even
> patients with demonstrable peripheral field loss have never said that
> they noticed this. However, I do remember a gentleman with a
superior
> absolute scotoma just above the midline stating that he had begun to
> notice that his golf ball disappeared after he hit it.
>
> DrG
>
I had today and he's not in until tomorrow. He mentioned something
about the optic nerve or rim looking "thin" so from what I've read,
that does indicate glaucoma. However, he said the visual field defect
(it was pretty much the same on both field tests)is not typical of
glaucoma. He also said that based on the field test I should not be
noticing so much visual disturbance as I am. The field test shows a
defect on the superior periphery from about the ten o'clock position to
the two o'clock position, with a little spur at the one o'clock
position. It doesn't show relative defects as close to the central
vision as I see them.
My IOP in the affected eye was 15, and 18 in the normal eye. I wonder
if it is common to have such a disparity of pressures between eyes. I
am also worried that if it is NTG, with a pressure of only 15 now
without treatment, it will be hard to get it low enough to stop
progression.
Dr. Leukoma
I think you need to sit down and take a deep breath. I agree with the
specialist regarding the visual field defect. However, if a thin rim
means glaucoma, then there are a lot of undiagnosed myopic glaucoma
patients walking around out there with normal visual fields. "Thin" is
a relative term, and no more signifies glaucoma than a C/D ratio of 0.6
means glaucoma.
>
> My IOP in the affected eye was 15, and 18 in the normal eye. I wonder
> if it is common to have such a disparity of pressures between eyes. I
> am also worried that if it is NTG, with a pressure of only 15 now
> without treatment, it will be hard to get it low enough to stop
> progression.
That much disparity, if repeatable, is somewhat uncommon, but what does
it mean, especially if the eye with the lower pressure has the field
defect? I mean, if you were a clinician looking at the available
evidence, would you say it all adds up to glaucoma? I wouldn't. It
appears as though you might be a conundrum.
DrG
gudrun17
Thank you. Of course I am panicky about this. Your advice is the best
I've gotten for days! I really do need to find a way to relax a little
about this--but it's hard at first when you think you might be going
blind.
I agree with the
> specialist regarding the visual field defect. However, if a thin rim
> means glaucoma, then there are a lot of undiagnosed myopic glaucoma
> patients walking around out there with normal visual fields. "Thin"
is
> a relative term, and no more signifies glaucoma than a C/D ratio of
0.6
> means glaucoma.
Thank you. My memory is getting a little jumbled now--I was obviously
stressed out at the time--but I thought the glaucoma specialist said
what he was seeing in the eye did not match what the visual field test
showed, and that's why he ordered the OCT and photos. I thought when he
said the rim looked thin, he must have meant compared to the other eye,
but the affected eye is also the most myopic one. The resident who
examined me first said that optic nerve looked pale, but the GS told
him it wasn't pale. Half of what I learned was from listening to the GS
educate the resident.
> >
> > My IOP in the affected eye was 15, and 18 in the normal eye. I
wonder
> > if it is common to have such a disparity of pressures between eyes.
I
> > am also worried that if it is NTG, with a pressure of only 15 now
> > without treatment, it will be hard to get it low enough to stop
> > progression.
>
> That much disparity, if repeatable, is somewhat uncommon, but what
does
> it mean, especially if the eye with the lower pressure has the field
> defect? I mean, if you were a clinician looking at the available
> evidence, would you say it all adds up to glaucoma? I wouldn't. It
> appears as though you might be a conundrum.
>
> DrG
Thanks. The way the GS left it with me is this: "You are a glaucoma
suspect but I need more information to make a diagnosis." So the next
step is to hear the results of the OCT. I assume that will tell a lot
about what kind of damage is going on.
Dr. Leukoma
physiological blind spot, with sudden onset of symptoms, and coinciding
with a peripheral vitreo-retinal event still makes me suspicious of a
vitreo-retinal cause.
DrG
gudrun17
defect, that would rule out a vitreo-retinal cause, right? Just found
out the results of the OCT. That is bad news, in my understanding--I
had just a little bit of hope left that my optic nerve was not too
damaged.
I am pretty depressed now.
Rishi Giovanni Gatti
>
> Never mind. you can't win them all, eh Rishi my old friend?
I missed you too.
Dr. Leukoma
gudrun17 wrote:
> Thank you. Since the OCT shows damage consistent with the visual
field
> defect, that would rule out a vitreo-retinal cause, right? Just found
> out the results of the OCT. That is bad news, in my understanding--I
> had just a little bit of hope left that my optic nerve was not too
> damaged.
> I am pretty depressed now.
Indeed, I am sorry to hear that. However, it still sounds like you are
fairly early in the progression, and with proper treatment, you should
do well.
Please keep us informed.
DrG
gudrun17
Dr. Leukoma wrote:
> gudrun17 wrote:
> > Thank you. Since the OCT shows damage consistent with the visual
> field
> > defect, that would rule out a vitreo-retinal cause, right? Just
found
> > out the results of the OCT. That is bad news, in my
understanding--I
> > had just a little bit of hope left that my optic nerve was not too
> > damaged.
> > I am pretty depressed now.
>
>
> Indeed, I am sorry to hear that. However, it still sounds like you
are
> fairly early in the progression, and with proper treatment, you
should
> do well.
>
> Please keep us informed.
>
> DrG
>
not in treatment yet. The GS said the next step is to measure my IOPs
throughout the day, and I'm doing that Monday. I realize there are
other reasons for optic nerve damage than glaucoma, so that's what he's
trying to determine. I wish he would order an MRI but I guess he needs
to check other things first. I just hope some kind of treatment to stop
progression will be started soon as I fear to keep waiting weeks and
weeks for a firm diagnosis.
In any case, thank you very much for all your input. I am getting a
consultation from another GS so who knows what he may say. I suppose I
need to stay hopeful.
Dr. Leukoma
Take presbyopia as an example. The regression is linear with respect
to age. Yet, most patients will insist that it came on suddenly, as if
overnight.
I have followed so many patients with glaucoma, including one or two
with NTG. Indeed, it does take many years for visual loss to develop.
On the other hand, visual field defects can develop rather quickly if
the pressure spikes suddenly. The lower pressure in the affected eye
may suggest a ciliary body/anterior uveitic mechanism.
DrG
Dr. Leukoma
may suggest a ciliary body mechanism.
DrG
gudrun17
Thank you, Dr. G. Yes, the vision loss is a lot more noticeable now
than it was a few months ago, because at that point with both eyes open
everything still looked normal. Now I can constantly see a difference,
as though the top of one lens of my glasses were smeared with vaseline.
It has definitely progressed towards my central vision, and that's
what's scaring me.
Are you talking about uveitis? I did mention to my doctor that the
affected eye is often painful, usually during the night when I sleep on
that side and when I wake up in the morning. Then the soreness
gradually goes away. He just said he would have to examine me when I
was feeling the pain.
Wouldn't the dilated eye exam show uveitis, or is there some other way
to test for it?
Dr. Leukoma
http://www.emedicine.com/oph/topic145.htm
As long as we are considering the atypical, sleep apnea has also been
linked to NTG. Anyhow, please keep us posted.
DrG
gudrun17
Thank you, Dr. G. I read the article. One thing I have been telling my
doctors all along is that the affected eye frequently hurts, but none
of them seem to think that was important. The sharpest pain is usually
first thing in the morning when I wake up although it also happens
during the night, enough to wake me up. Sometimes the eye aches all day
long, sometimes it's better during the day, although that could just be
because when it hurts I take aspirin, and then it often gets worse as
the day goes on. At its worst, it hurts a lot to look to either side.
The good eye does not hurt. I suppose the pain may be due to pressure
spikes so I may know more after they take my pressures all day long
Monday.
If that's the case, another possible reason my glaucoma has been missed
for years is that I always go for a dilated eye exam in the afternoon,
so that I could function in the morning. So my IOP's have always been
measured in the afternoon.
At this point I still don't have a firm diagnosis from one GS; the
other one basically said NTG pretty much just by looking at the visual
field tests. I am still hoping one of them will order an MRI.
BTW, I know you said NTG is slow and that many people don't notice
something different until it reaches a certain threshold, but if two
months ago, when I looked at the bottom of the computer screen and the
top of the screen was blurry, but now the top is blurry just when I
focus on the middle of the computer screen, it's obvious to me that
it's not just that I am noticing it more. My doctors don't seem to
believe me either, that it's been fast progressing, although I guess
there's nothing they can can do about it at this point. Actually my
retina specialist did believe me, and that's why he said he didn't
think it could be glaucoma. But I sure wish he would have felt a little
more urgency when a patient complains of decreasing vision.
Dr. Leukoma
Interesting case. I would tend not to dismiss someone who presented
with that level of self-observation and analysis.
Anyhow, it would seem that some kind of pressure-spiking was occurring.
DrG
gudrun17
>
> Interesting case. I would tend not to dismiss someone who presented
> with that level of self-observation and analysis.
>
> Anyhow, it would seem that some kind of pressure-spiking was
occurring.
>
> DrG
Thanks for your input. Was just told that my glaucoma is atypical--the
GS said that the appearance of the optic nerve does not in some ways
match the visual field defect. I don't know what that would mean--he
just said he's going to keep a closer eye on things than he normally
would. There might be pressure spiking but it must be occuring at night
because daylong monitoring showed pretty steady pressures. From what I
have read and has been posted here, I must be atypical in a number of
ways. The GS also said that with what is showing on the visual field
test, most people would not even notice a vision loss. I would like to
think maybe the damage is not so bad, but I suspect it's just that I am
possibly more observant of visual changes than most people and am
seeing the earliest changes that glaucoma causes, lack of resolution
and sensitivity. Or that's what I think after reading all the feeback
posted here, for which I give thanks to all.