Glaucoma Disease

How long will my vision last ?

Question:

William Stacy wrote: > Modern field testers are pretty good at picking up early damage, but > yes, once it shows up on field testing, significant damage has been > done. But since you have no field loss, I would still question the > diagnosis, not because I don’t believe your doctor, but because there is > no precise recipe for that diagnosis that everyone agrees on. I > personally believe that in some cases like yours, unless a change in the > optic nerve can be documented by photography or other optic nerve > imaging, the diagnosis may be premature. Ergo, the 2nd opinion, and if > they disagree, get a 3rd and go with the concensus.  You’ve got lots of > time.

Is it always true that there is significant damage once a visual field test shows a defect? In my case, if there weren’t a repeatable visual field defect (it is mild but widespread) I think I would still be considered a glaucoma suspect because with normal eye pressures and a deceptively healthy looking optic nerve, there wouldn’t be much else to go on, other than a borderline sector in HRT. Despite the visual field defect I was told my case is early or mild. I wish it could have been caught before there was any vision loss but as I said, with normal pressures and myopic disks I understand it can be hard to diagnose. -Gudrun

Response:

Glaucoma is a disease that is much less likely to take your sight when it is diagnosed early and managed well.  For example, when Kirby Puckett of the Minnesota Twins "suddenly" went blind from glaucoma, his pressure was over 50!  He now lectures young athletes all over the world about the dangers of being a glaucoma patient for years without being diagnosed or treated until a disaster occurs. Your doctor is being very cautious and being protective of your sight. Xalatan is a superior glaucoma drop in that it has been shown to not only lower the pressure on the optic nerve, but is has also shown an ability to protect the optic nerve from damage in the future by shielding the nerve from future damage.   This drug and others in its class are all less than 10 years old, so "old" studies of blindness from glaucoma are not as relevant because the nature of the disease and our ability to treat it has changed so much for the better.

Response:

The more you study the history of headache research and pain management, the more you realize how much we just don’t  know about this stuff.  A trigger for a migraine can be any other kind of pain.  I had a patient with visual migraines so bad that she would pull off the road and weep for hours until her aura would go away or she fell asleep.  After every test known to man to rule out a brain tumor, etc…she  accidentally found the trigger that started her migraines…at the dentist!!    She had an impacted wisdom tooth on one side that was so bad that the nerve pain in her jaw would go from her jaw back to the visual cortex, causing her the intense visual migraines.  Three months and two root canals later, she is pretty much migraine free. So, do I think that the two (LTG and migraine) can be related?  Yes, in the sense that all pain can be related because the body has an ability to transfer pain.  I can’t imagine your migraine as a "cause" of glaucoma, but I can more rationally see the glaucoma causing a migraine. Let’s not even touch that left brain/right brain stuff.  It gives me a migraine.

Response:

By definition, normal tension glaucoma is harder to diagnose and is often left untreated for extended periods of time because it is often undiagnosed for years.  So, your question is unfair in a certain way. For example, the recent statistics from the National Transportation Safety Board concluded that minivans had less crashes per thousand vehicles than any other kind of vehicle, and there were fewer fatalities per thousand vehicles.  Can you conclude from those statistics that minivans are the safest vehicle to drive?  No, you can only conclude that the KIND OF PERSON that drives a minivan is the least likely kind of person to crash and die.  So, since you are an early diagnosed LTG patient who is being watched closely with nerve-protecting prophylactic care, you are more likely to save your sight than the "average" LTG patient. – Hide quoted text — Show quoted text -buywhe…@hotmail.com wrote: > I am happy to know that Xalatan does more than lowering IOP, since I > read that for normal tension glaucoma there are some other mysterious > factors that contribute to optic nerve cells dying off, rather than > just high eye pressure. > If you are a clinician would you mind telling me if NTG are more > difficult to treat and has a higher rate of vision loss, even with > treatment, when compare with POAG ? > Thanks again for your time.

Response:

Oh and by the way, if the larger cup belongs to a larger nerve (disk), it is completely normal.  It’s more suggestive if the nerves are equal, and very suspicious if it is on a smaller nerve. – Hide quoted text — Show quoted text -> Asymetrical cups are always a red flag, but it is so common that by > itself it is just another relative risk factor. I’d be more suspicious > if there was a concurrent difference in i.o.p. > w.stacy, o.d.

Response:

I doubt it because pain is not a part of glaucoma except in very high pressures.  But I would look at the individual medications and any effect they might have on eye pressure could be significant. w.stacy, o.d. – Hide quoted text — Show quoted text -buywhe…@hotmail.com wrote: > Thanks for the analysis, I think what you have said is logical. I hope > you don’t mind if I ask another question: since I am a migraine > patient, do you think treating migraine itself will some how help my > glaucoma ? It is very interesting because when I have a migraine > attack, the pain is always on the right side of my head. And it is my > left eye which has glaucoma. From my very limited anatomy knowledge I > know the left eye is actually connected to the right brain. May be the > two conditions are somehow related ?

Response:

buywhe…@hotmail.com wrote: > Just to have an idea if someone with an earlier stage of glaucoma > receive no treatment at all, how long does it take for her to loss > peripherial vision, and how long to loss central vision ? Is there any > general trend in this ? I know every case is different, but is there > any concensus on the natural history of this illness ?

The disease has many different variables, knowns, unknowns, courses, and treatments.  And different experts will give you different opinions. Add to that the theories are changing as more is learned.  There are some things that are pretty well "concensus" but not all. It really does vary   from eye to eye. I know it sounds screwy, but there is a lot we don’t know about this disease. > I don’t know who is considered a glaucoma specialist, but I think more > than half of his patients see him for glaucoma. I was told I have > normal tension open angle glaucoma. Thanks for the suggestion I will > ask how it will affect my occupation.

Glaucoma specialists limit their practices to glaucoma cases.  Sounds like he might be a general ophthalmologist with a "special interest" in glaucoma. > No, none of my visual field test shows anything unusual, so my > diagnosis was based on the condition of my optic nerve. I was told that > it takes quite some damage to have an effect on visual field. Is that > correct ?

Modern field testers are pretty good at picking up early damage, but yes, once it shows up on field testing, significant damage has been done. But since you have no field loss, I would still question the diagnosis, not because I don’t believe your doctor, but because there is no precise recipe for that diagnosis that everyone agrees on. I personally believe that in some cases like yours, unless a change in the optic nerve can be documented by photography or other optic nerve imaging, the diagnosis may be premature. Ergo, the 2nd opinion, and if they disagree, get a 3rd and go with the concensus.  You’ve got lots of time. w.stacy, o.d.

Response:

Of course I will be second guessing your doc but I’m wondering a bit about the diagnosis.  Was it based on sequential HRT’s  or what?  Did he/she see any enlargment of the cups over time?  .6 and .4 are not particularly big cups for a myope with large discs, and 19 is not all that high for iop.  Sounds like you’ve got lots of nerve tissue there, and while nobody can predict with certainty, I’d be surprised if you were to become blind any time in your life, especially with all the advancements in the field that have and will take place. w.stacy, o.d. – Hide quoted text — Show quoted text -buywhe…@hotmail.com wrote: > I am 39 and was diagnosed with glaucoma in my left eye last week. My > doctor made the diagnosis after a HRT was done. My cup disk ratio is > 0.64 on my left eye, 0.45 on my right eye. My doctor said there was > some obvious damage in the left eye. My eye pressure are around 19 for > both eyes. I am myopic and my disks are very large to begin with (4 > mm), and I am also have migraine, and my doctor has called me a suspect > for two years. > I was put on Xalatan and my doctor said not to worry too much. He said > we will treat the other eye too. > My understanding is most glaucoma patients are elderly, and may be most > of them don’t live long enough to go blind anyway. My question is does > anybody know of any statistics of young patients going blind ? I still > have 36 years ahead if I can live to the age of 75. May be I won’t go > blind in the next 10 years. But what about 20 or 30 years later ? > I will appreciate if some of you can point me to any statistics/studies > or personal experience. I want to plan ahead if I know I am going to be > blind sometime down the road. > Thanks.

Response:

buywhe…@hotmail.com wrote: > Thanks for the suggestion. I will definitely go seek a second and third > opinion. But William, do you agree that most cupping in normal eyes are > symmetrical between the two eyes, no matter if they are small or large > ?

Asymetrical cups are always a red flag, but it is so common that by itself it is just another relative risk factor. I’d be more suspicious if there was a concurrent difference in i.o.p. w.stacy, o.d.

Response:

buywhe…@hotmail.com wrote: > Thank you for your kind words William, I chope what you have said will > come true. But since I have kids to take care of I need to be realistic > and plan ahead … (eg. start a new career which a low vision/blind > person can do, may be ?)

Most glaucomas are slow to take vision, usually affecting peripheral vision long before central vision goes, usually taking years to even be noticed by the patient. > To answer your question, no, my diagnosis was not based on sequential > HRTs. It was based on one single HRT. My doctor said based on his > experience the shape of my left nerve cup is definitely due to > glaucoma. He has been suspicious about my cupping for two years.

Maybe I’m not as sure about HRT as he is.  But again I’m second guessing.  Anyway, I’m suspicious enough to recommend a 2nd opinion by a glaucoma specialist.  After all, we are talking about a life sentence of eyedrops/what-have-you treatment and expensive monitoring.  If your doc is a glaucoma specialist, then fine, ask him how soon your type will/can cause you occupational problems.   I have heard some stories about people successful in maintaining > their eye sight for 20 or even 30 years. But I guess there must be a > lot of failure examples too.

Sure, most people do not outlive their glaucoma. BTW did you do visual fields?   Any demonstrable field defect? If so, I’ll yield to that, but if not, get that 2nd opinion and be sure to report back here. w.stacy, o.d.

Response:

Filed under: Glaucoma Treatment

Related Posts