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Medical Forum / Diseases and Disorders / Glaucoma / December 2003Will Appreciate a Reply
<reposting to google groups> Hello people, Wish we could have met under happier circumstances but very glod to have found this news group. I am 53 years old and am in India. I have reasonably normal vision (6/6 in both eyes) and am on drops for Glaucoma from 1997 (Optipres 0.5% (Betaxolol Hydrochloride), twice a day, until 15 days back when doctor changed it to Brimosun P (Brimonidine Tartarate), twice a day). I am highly myopic, power progressed as below. Age 10 yrs -5 in both eyes Age 16 years - 8 in both eyes Age 17 years - 10 in both eyes Age 22 years - 11.5 in both eyes From there, with onset of long sight etc, the power has stabilised at -10.5 sph, -1 cyl in both eyes till now (age 53 years). I was diagnosed glaucomid in right eye. At the time of diagnosis (1977), the pressure was RE 34, LE 18, but quickly came down to 17, 17 within two weeks on starting drops and is hovering between 14 and 17, by God's grace, in both eyes from then. It was 15, 15 when checked yesterday. ------------- The history of fields tests are 1997 ==== The report done at diagnosis of Glaucoma ( 1997) on a Octupus 123 using G1X program in yet another hospital said "RE : The mean sensitivity is slighly depressed (mean defect 2.5 db). There are no field defects. There are a few areas of depressed sensitivity in the arcute area. LE: The mean sensitivity is normal (Mean defect 1.5 DB). There are no field defects. Impression: Rt eye - border line field changes present Lt eye - Visual field appears normal" The print out said Rt Eye: Mean sensitivity 25.4 Mean defect 2.5 Corrected Loss Variance 4.9 Short term fluctuation 1.4 Reliability factor 4.5 left eye: Mean sensitivity 26.4 Mean defect 1.5 Corrected Loss variance 2.1 Short term fluctuation 1.6 Reliability factor 0.0 Vision: 6/6 both eyes, -10.5 sph, -1 cyl, both eyes 2001 === The previous fields was done 2 years back (2001) in another hospital, using Allergan Humphrey, Standard Goldman parameters. At that time it was, "Good pattern of reliability indices of patient's response to visual stimuli. Right eye: Bilnd spot is normal in size and shape. I very mild depression of retinal sensitivity is seen in the uppper field towards periphery. Left eye: Blind spot is normal in size and shape. I mild depression of retinal sensitivity is seen in the upper temporal arcute area. Impression: Both eyes show non specific changes. Clinical collaboration of findings is essential" Full threshold strategy Right eye: GHT - OUTSIDE normal limits MD - 2.72 dB PSD 4.29 dB, P < 5% SF 1.22 dB CPSD 4.07 dB, P < 2% Left Eye: GHT - Within normal limits MD -2.27 dB PSD 2.97 dB SF 1.09 dB CPSD 2.71 db P < 10% Vision: 6/6 both eyes, -10.5 sph, -1 cyl, both eyes 2003 (15 days back) =============== Fields report done on Humphrey 15 days back. "Test performance in both eyes is good. In RE there is a cluster of defects adjacent to blind spot (which may be due to presence of peripapillary atrophy). Rest of fields is normal. In the LE, there is a luster of defects inferior to disc in the periphery. Rest of fields is normal. Kindly correlate clinically" The print out said SITA Standard Strategy Right eye: GHT - Within normal limits MD - 3.02 dB, P < 2% PSD 1.84 dB Left Eye: GHT - Within normal limits MD -1.70 dB P < 10% PSD 2.08 dB -------------- To my untrained ears, the impressions seem to be getting harsher with time. (the last one talks of cluster of field defects while the first two did not). Unfortunately for me, all the three tests have been done in three different hospitals and the opinion is from different specialists each time so I cannot compare the style of writing. My doctor (ophthalmologist) says everything is under control, there are no problems, not to worry etc but he did change the medicine from Optipres to Brimosun P in the last visit. He says Brimosun is much more effective and the pressure did come down from about 17 to 15 in both eyes. I have been noticing a slight disturbance in vision in left eye (RIGHT was diagnosed as glaucomid) in the last month or so. When vision was checked yesterday, I did find that it was a little blurry with left eye and I did read a line less with left than with right (this has never happened before). Doctor said nothing to worry, no need to change power now glasses can still remain at -10.5 sph, -1 cyl both eyes. I am an engineer, not a doctor, but when I see the fields report of 15 days back I see a patch, same shape, size and density as blind spot in the RE mirrored above it. This was not there in the fields report of 2 years back or in the first test in 1997. The rest if the printout seems to be dots of <5% type with <2% type present towards the edges in a few places. My worries are =========== - Is the disease spreading to my left eye also - Is the right eye deteriorating - This talk of possible peripapillary atrophy scares me a lot Very sorry for this long and rambling letter but I AM a little scared and will be very thankful for any feed back. In any case I am extremely glad that I came across this news group, didn't know that it existed, it is comfort in the midst of all this worry. Regards surya nsurya0@<NOSPAM>lycos.com Surya- I do not know much about the data that you talk about below but I have noticed one thing. If you have high myopia, the optic nerve tend to be different and so many times doctors who do not have experience diagnose it as glaucoma. The high pressure is a good reason you may have it but again it is only 15. Stop using the medicine for some time and check the pressure again. Ask the doctor to interpret the results in lay man's terms. Since you are 53, there are normal loss of sensitivity in the eyes as well. I think you may not even have glaucoma, you are probably misdiagnosed owing to high myopia. Since you are in India get an appointment at Sankara Nethralaya in Chennai for this. They are pretty good. > <reposting to google groups> > Hello people, [quoted text clipped - 151 lines] > surya > nsurya0@<NOSPAM>lycos.com Hi, Thanks a lot for the response. I will be contacting Sankara Netralaya. Regards Surya > Surya- > [quoted text clipped - 181 lines] > > surya > > nsurya0@<NOSPAM>lycos.com Dr. Rick Cohn can give a good response. > Hi, > Thanks a lot for the response. I will be contacting Sankara Netralaya. [quoted text clipped - 197 lines] > > > surya > > > nsurya0@<NOSPAM>lycos.com Hello this is me again. I was going through the following site "http://www.agingeye.net/glaucoma/glaucomaeyeexam.php#" and realised that the data I have given about <5% and <2% points can give rise to very wrong impressions. Here are some clarifications 1. So far I have gone through 3 field tests as reported below - one on Octopus machine (1977) and two on Humphrey (2001 and 2003), the last one 15 days back. 2. The Humphrey tests were for Central 30-2 Threshhold test However, while the 2001 test was for full threshhold (Fovea - off) the 2003 one was for SITA-Standard (Fovea, RE 37 dB, LE 35dB). May be this is the reason the latter does not give the all important CPSD figure ? (Looks like I should get a Full Threshhold test done in the hospital where I got it done in 2001). One problem was, there it went on for nearly 15 minutes per eye, for some reason they used contact lenses instead of lenses as in the 2003 test. It was quite uncomfortable but after reading through the posts, I realise that I have endure it as you have done. 3. THE BIG MISTAKE: When I talked of <5% and <1% points, I realise now that this can be mistaken. Please see the snip below. (======= > > I am an engineer, not a doctor, but when I see the fields report of 15 > days [quoted text clipped - 4 lines] > > in the first test in 1997. The rest if the printout seems to be dots > > of <5% type with <2% type present towards the edges in a few places. ========) Here, I was really referring to the upper right hand figure where the graphical representation of the numbers on the upper left hand figures are shown. I DID NOT MEAN THE TOTAL DEVIATION OR PATTERN DEVIATION PLOTS. Shows how big a mistake an amateur can commit, does it not. Any way, In these plots most of the points are wide apart, wider than <5% pattern (meaning they are better than 5% and hence OK ?). - In Right eye there is one <0.5% and three <5% points in Pattern deviation plot. They are near the blind spot . - In left eye there is one <0.5%, two <2% and two <5% points all in the lower left edge. In both eyes, the total deviation plot shows a few more points (of < 2% type) than pattern deviation of < 2% type. All this makes me realise two things. 1. This posting has become really long and I am imposing on the reader by making him/her go through piecing it together. I am sorry for this and of course this makes the responses I receive all the more valuable. 2 It can be quite misleading if I assume that I will be able to verbally describe a crucial test result when I have no training in that. I have tried to make as good a job as possible (seeing that it is my eye !), please bear with me. Sorry for the mistakes, am looking forward to any responses, may be Dr. Rick Cohn can give his opinion ? Regards, Surya ====================================== > Surya- > [quoted text clipped - 181 lines] > > surya > > nsurya0@<NOSPAM>lycos.com Hi Surya, Just read your post...boy, you do sure sound like an engineer (my most difficult patients). Don't worry...it sounds like your doing fine. First of all, don't be upset by the description of "peripapillary atrophy." That means there is an absence of supportive choroidal tissue surrounding your optic nerve, a finding that is very common in almost EVERY high myope (very nearsighted individual) like you. It has no real bearing on glaucoma, except it can cause visual field changes around the optic nerve or blind spot. Secondly, regarding your visual field (VF) test: it certainly would be preferable to see one doctor at one office and have your fields repeated on the same machine (Humphrey's are the most widely used and accepted worldwide, and the 30-2 is the standard test, testing the central 30 degrees of your vision). Of course without seeing your fields it's hard for me to interpret, but you did offer one important tidbit of information, the MD or mean deviation. This gives the average decibels below normal across the whole field test (comparing you to age-matched normals). Well, you have had a very minimal change over the years, going from about -2.5 db to -3 db...that's nothing. Keep in mind that VF's have a practice effect...the more you do, the better you get...you should be taking one annually on the same machine. But really, don't worry...these changes sound minimal. Also, you find a center that offers computerized optic nerve head analysis with an HRT or GDx. These devices take numerous digital photos of your nerve and then send them to an attached computer for analysis of the cup size and volume. It also stores them on a hard drive for future annual comparison (the most important point, as this machine may pick up changes in the appearance of your nerve sooner than your doctor's naked eye). Keep in mind that high myopes often have funny-looking nerves that may be difficult to interpret. The disc may look "tilted" making difficult to tell the size of the cup in the nerve. Regarding your meds, don't stop them. The suggestion that you might not have glaucoma is unlikely if your IOP was over 30 before starting the drops. Brimonidine works well but has a rather high incidence of ocular allergies, so watch for the development of red, itchy eyes, even years after starting the drop. The problem with beta blockers like betaxolol (the weakest of them) is that one easily develops tachyphylaxis, or tolerance to the drug over time, making it less effective. The prostaglandin analogues, like Xalatan (latanaprost) or Lumigan (bimataprost) are a nice class of drugs because they are only used once a day and have few side effects. I don't know about their availability in India, but you may want to ask your doctor about them. Good luck to you...I hope this helped. Rick Cohn, MD Glaucoma Specialist Winter Park, FL Dear Dr Cohn, Thank you very much for your well thought out, clear and supportive response. It has really cleared a lot of my doubts and has reduced my worries considerably. I think I will try for HRD or GDx analysis. Thank you you once again for your response and Merry Christmas to all you people. With warm regards, surya > Hi Surya, > Just read your post...boy, you do sure sound like an engineer (my [quoted text clipped - 43 lines] > Glaucoma Specialist > Winter Park, FL Dr. Cohn, I rebooted and was able to open the messages on this thread. Thanks for a most helpful response, once again. I, too, had noted "peripapillary atrophy" in a report, so was glad to see your comments. Carolyn > Hi Surya, > Just read your post...boy, you do sure sound like an engineer (my [quoted text clipped - 43 lines] > Glaucoma Specialist > Winter Park, FL  SignatureA contented malcontent. http://www.equalizers.org THANK YOU DR. Cohn for spelling things out in layman's terms !!!!! > THANK YOU DR. Cohn for spelling things out in layman's terms !!!!! My Pleasure --Dr. C |
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