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Medical Forum / Diseases and Disorders / Glaucoma / February 2005questions about normal tension glaucoma
Since having a vitreous detachment four months ago I noticed diminished visual field in the affected eye. The upper peripheral vision in that eye is like looking through vaseline. I can see shapes and lights in that area but they shimmer. My retina specalist kept telling me a dense vitreous was causing it but he finally sent me to have a visual field test and now he said it shows a defect suspicious of glaucoma. I'm going to see the glaucoma specialist next week but from everything I've read, I've never seen anyone describe a visual field defect looking like this. My mother does have glaucoma (but she didn't develop it until she was in her 70s) and has a little loss of side vision, only because her doctor took her off her drops for a year, and she said she just can't see in that spot. Not blurry tendrils like I see. If I do have glaucoma it is in one eye only, normal tension (my IOP's are always 16-18) and my retina specialist said he has not seen any sign of optic nerve damage. At this point I'm just wondering if this is what loss of peripheral vision due to glaucoma looks like to the person who has it. All this time I thought what I was seeing in bright light--a pattern of slightly darker tendrils or swirls--was the structure of my vitreous but could this be compressed optic nerves or something I'm seeing? A compressed optic nerve generally looks swollen or pale, and glaucomatous visual field loss does not occur in the presence of a "normal-appearing nerve." I would wait to see if the glaucoma specialist concurs that your nerve looks healthy. If he/she is worried about compression of your nerve, then an MRI might be in order to check. If I were a betting man, I'd still bet your symptoms were from vitreous condensations in the periphery of your fundus (back of the eye). Let us know what the new doc says. Good luck, Rick Cohn, MD Glaucoma Specialist Winter Park, FL > A compressed optic nerve generally looks swollen or pale, and > glaucomatous visual field loss does not occur in the presence of a [quoted text clipped - 7 lines] > Glaucoma Specialist > Winter Park, FL Thank you, Dr. Cohn. That's somewhat encouraging. I asked my retina specialist how there could be significant visual field loss (I think it's significant, anyway) even though he had not observed any damage to the optic nerve and he said sometimes the signs can be subtle. In the past five months I've been examined by an opthalmalogist, my optometrist (who checked my records back five years to make sure no sign of change had ever been noted in my optic nerves), my retina specialist four times and by his colleages twice. Early on I asked about normal tension glaucoma and if that could be causing what I am seeing and was always assured that my optic nerves look normal or normal for someone myopic, I guess. Is it common that signs of optic nerve damage resulting in obvious vision loss (obvious to the patient, I mean)would be too subtle to be noticed by any opthalmalogist other than a glaucoma specialist? It sounds as though you are saying a compressed nerve would be hard to miss. Thank you for the information. I will post what the glaumoca specialist says next week. >> A compressed optic nerve generally looks swollen or pale, and >> glaucomatous visual field loss does not occur in the presence of a [quoted text clipped - 28 lines] >Thank you for the information. I will post what the glaumoca specialist >says next week. I have NTG with significant loss of field, particularly in one eye. However, I can't tell that I can't see in the area affected; it's not that something looks swirly or blurry. The way I was able to 'see' what I can't see was by focusing on a spot on the wall first with one eye then with the other. I see more area with the better eye. For example, if I look at an area of a wall that has a picture hanging above the spot focussed on, I can see the picture with one eye but not the other. So - unless you're clued in that the vision is missing I don't think you'd be aware it's not there, until it gets quite advanced. Hope this helps. Cheers, Ann To email: replace 'REMOVE' with 'b' in email address. > I have NTG with significant loss of field, particularly in one eye. > However, I can't tell that I can't see in the area affected; it's not [quoted text clipped - 8 lines] > > Hope this helps. Thanks. Yes, my mother said the same thing, that in her eye with field loss (hers is just a little bit near the nose) she just can't see anything there. But I am aware of a mismatch between the two eyes with both open; the affected one always has a couple of blurry areas in the upper periphery, like a smear on the top part of your glasses. Even in the far periphery where I guess I've lost the most vision, I noticed at the movie theater this week that I can still see lights there, but they're very blurred and things that aren't bright I don't see there. So if I focus on the wall, for example, and look down so that in my good eye I can just make out the shape of a picture in the very top of my peripheral vision, I don't see the top of it in the bad eye, but the bottom is a dark blurry shape. So either mine is very advanced--my doctor didn't say how bad the vision field test was--in which case I am astounded that he wouldn't have noticed damage to the optic nerve--or it's something else going on. Maybe the blur I see is closer to the point of fixation than where your field loss is and that's why I notice it more. >> I have NTG with significant loss of field, particularly in one eye. >> However, I can't tell that I can't see in the area affected; it's not [quoted text clipped - 27 lines] >point of fixation than where your field loss is and that's why I notice >it more. Good luck with the visit to the GS. Perhaps you should ask him (or her) the extent of vision loss that the field test shows, and whether it is attributable to Glaucoma. I would also be sure to mention your symptoms and his opinion if they are caused by glaucomatous changes to the optic nerve. If not, perhaps there's hope?? Cheers, Ann To email: replace 'REMOVE' with 'b' in email address. > Good luck with the visit to the GS. Perhaps you should ask him (or > her) the extent of vision loss that the field test shows, and whether > it is attributable to Glaucoma. I would also be sure to mention your > symptoms and his opinion if they are caused by glaucomatous changes to > the optic nerve. If not, perhaps there's hope?? Thank you, Ann. The GS' office called and he wants me to come in a little early to take another visual field test. I will definitely be asking a lot of questions. From what I've read, however, if there is enough field loss that I can notice it even with both eyes open, it must be pretty advanced. How were you diagnosed with NTG? You said you had significant field loss; is it under control with treatment? My worry is that with NTG, if that's what I have, it seems it can be harder to prevent more vision loss. Thanks again for your responses. > > Good luck with the visit to the GS. Perhaps you should ask him (or > > her) the extent of vision loss that the field test shows, and whether [quoted text clipped - 15 lines] > > Thanks again for your responses. Jumping in late... Your mother's description of her defect is pretty much how I'd describe mine. I don't notice the area of missing vision unless I close the other eye; then I become aware of parts of objects appearing and disappearing as they move in and out of the blind area. I also had a retinal hemorrhage about 10 years back that caused an initial defect that I would describe as appearing as though I had just had a flash go off in my face, but as it resolved, the vision in that area became a little blurry and wavy. Doesn't sound like your situation either, though. I was first diagnosed with NTG after my first diabetic ophthalmology exam; the doctor said I had no sign of diabetic complications in my eye, but that I had an unusually large optic nerve (0.99 cup to disk ratio, I believe), which made me suspect for glaucoma. My pressures were in the normal range, but a visual field showed a large peripheral defect in the upper nasal quadrant of the right eye. Hence the diagnosis. The treatment consists of lowering the pressure in the eye by 30%, which can sometimes be achieved with prescription eye drops. In my case, none of them were effective in lowering the pressure to my glaucoma specialist's satisfaction, and I had a trabeculectomy on the right eye in December, which has lowered the pressure to the acceptable range. There is no guarantee that it will prevent further vision loss for the rest of my life (I am only 43), but my GS seems confident that it will preserve my vision for some time. Of course, all of this is from my point of view as a patient, one of the doctors that post here I'm sure would have more insight. Best of luck with your exam, please let us all know how it turns out.  Signatureanka T2, dx'd 3/04 NTG, dx'd 7/04 Avandamet/Lipitor > Your mother's description of her defect is pretty much how I'd describe > mine. I don't notice the area of missing vision unless I close the other [quoted text clipped - 23 lines] > > Best of luck with your exam, please let us all know how it turns out. Thank you for your good wishes. After doing a lot of reading, which I wish I'd done a few months ago when there wasn't as much vison loss, I finally found a site that shows field loss more as progressive fuzziness and loss of detail rather than the increasing black circle around the center vision that a lot of the Web sites show. Since I can still see light through even the densest areas at the far periphery, I thought that meant it couldn't be glaucoma. I think my vision loss has become more noticeable because it's approaching my central vision--which is very bad, of course. And I have more loss than the upper nasal area; there's also darkening with a few long blurry tendrils coming down from the one-clock position. Of course, I could be wrong and I'm hoping the GS will tell me it's not as bad as I think, but from what I can tell by looking at sample vision field charts, it's advanced vision loss. I am just hoping, as we all, do, that something can be done now to stop or at least greatly slow down progression because as of now, I still have lower and central vision and some upper temporal vision in that eye and can function in my job, drive, etc. Unfortunately it's also progressed over just a few months--another reason my retina specialist said he didn't think it could be glaucoma, which he said is slow--and I know rapid progression is much harder to control. Thanks again. I hate even having to wait until Monday, although I guess he won't start treatment that minute. I think I'm going to call today and see if there's a cancellation and I could get in sooner before I lose any more vision. Otherwise this is going to be another horrible long weekend of being scared. >>Your mother's description of her defect is pretty much how I'd > [quoted text clipped - 108 lines] > lose any more vision. Otherwise this is going to be another horrible > long weekend of being scared. I;m thinking of you and hope the Dr. visit was able to give you some good news and hope.Please give us a report when you can. Best wishes, C. SignatureA contented malcontent. http://www.equalizers.org > I;m thinking of you and hope the Dr. visit was able to give you some > good news and hope.Please give us a report when you can. > Best wishes, > C. > -- Thank you for your good wishes. I don't have a diagnosis yet, although the GS suspects NTG. But he said the visual fields are not typical of glaucoma, so I'm waiting for results of the optic nerve fiber analysis. I think he said that the optic nerve looked "thin" so I believe that would indicate glaucoma, although he also said I'm seeing more visual disturbance than the test indicates. I just hope they can stop the loss. Thanks again. Thanks...contined good wishes to you! >>I;m thinking of you and hope the Dr. visit was able to give you some >>good news and hope.Please give us a report when you can. [quoted text clipped - 9 lines] > disturbance than the test indicates. I just hope they can stop the > loss. Thanks again. SignatureA contented malcontent. http://www.equalizers.org > Thanks...contined good wishes to you! > [quoted text clipped - 11 lines] > > disturbance than the test indicates. I just hope they can stop the > > loss. Thanks again. Well, I spoke to the GS today and all he would tell me about the OCT is that the damage is consistent with the loss of vision shown in the visual field test, but when I asked if that meant it was glaucoma he said it was just one piece in the puzzle and he isn't ready to make a diagnosis yet. I'm going in Monday to spend all day having my eye pressures measured and I guess meet with him again. I am getting a little upset with him that he seems irritated with my being frightened. I realize normal tension glaucoma is a tricky diagnosis but I've been in agony for almost two weeks now waiting to find out what is wrong and whether my vision loss can be stopped. >> Good luck with the visit to the GS. Perhaps you should ask him (or >> her) the extent of vision loss that the field test shows, and whether [quoted text clipped - 15 lines] > >Thanks again for your responses. I was diagnosed on a routine yearly visit to the opthamologist. However, 4 years prior I'd complained that I thought my peripheral vision wasn't as good as previously. I was given a visual field test that I was told was OK (later, I was told that test was unreliable). I assume the optic nerve looked normal at that time up till the diagnosis when it didn't look too good. Needless to say I was terribly upset, feeling I'd lost 4 years during which vision could've been saved. Not wanting to waste anymore time I searched out the best GS I could find in my area, went for a consult and am still with this GS. My vision has been stable for almost 2 years (about 6 months after starting treatment - I think). But I'm kept on a tight leash - monthly visits when I started, then every other month, then I graduated to quarterly visits. I was given frequent field tests in the beginning; now less so, with visits 4 months apart. I feel I'm getting the best care I possible could get, and I do my share by being religious about using my meds (and using them properly) and whatever else I can do to save my sight. Good luck !! Cheers, Ann To email: replace 'REMOVE' with 'b' in email address. > I was diagnosed on a routine yearly visit to the opthamologist. > However, 4 years prior I'd complained that I thought my peripheral [quoted text clipped - 18 lines] > Cheers, > Ann Thank you very much, Ann. I'm glad to hear your vision has been stable for the past 2 years. But do you mean it deteriorated within the first 6 months after starting treatment? This is scary to me because the blurry areas are already getting close to the center of my vision. When I look at the bottom of the computer screen, the top edge is blurrred so it's going to be hard to function if that gets any worse. I hope that treatment can begin immediately. How did you find the best glaucoma specialist in your area? The one I am seeing is the one in the same ophtalmology department as my retina specialist. This is at a major teaching university. I'm thinking no matter what this GS says, I should probably get a second opinion. All I know about this GS is he is listed with the American Glaucoma Society. Thanks again. >How did you find the best glaucoma specialist in your area? The one I >am seeing is the one in the same ophtalmology department as my retina [quoted text clipped - 3 lines] > >Thanks again. I'm sending a reply to this question to you via email. Cheers, Ann To email: replace 'REMOVE' with 'b' in email address. >>I have NTG with significant loss of field, particularly in one eye. >>However, I can't tell that I can't see in the area affected; it's not [quoted text clipped - 29 lines] > point of fixation than where your field loss is and that's why I notice > it more. Someone may have said this below, but you have a right to have a copy of your visual field printout and an explanation. I always get one for the records and tofollow over time. SignatureA contented malcontent. http://www.equalizers.org A compressed optic nerve generally looks swollen or pale, and glaucomatous visual field loss does not occur in the presence of a "normal-appearing nerve." I would wait to see if the glaucoma specialist concurs that your nerve looks healthy. If he/she is worried about compression of your nerve, then an MRI might be in order to check. If I were a betting man, I'd still bet your symptoms were from vitreous condensations in the periphery of your fundus (back of the eye). Let us know what the new doc says. Good luck, Rick Cohn, MD Glaucoma Specialist Winter Park, FL |
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