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Medical Forum / Diseases and Disorders / Glaucoma / December 2003

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The future

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sdf - 08 Dec 2003 06:01 GMT
I was referred for an unrelated problem, that turned out to be blepharitis.
As part of the examination, I had pressure taken and the optic nerve
examined. Vision was also tested (I'm 47, and vision was 20:20. I don't wear
glasses).

The IOP was 17, apparently within the normal range. More disconcerting was
that I have 70% cupping. Now, the doc said that doesn't necessarily mean
anything, and he said come back in a year for a vision field test. However,
when I went back to my general doctor, he said he had read the report and
that we need to keep an eye on it (pardon the pun!).

So, while 'm not panicking, any ideas as to prognosis? Should I worry at
all, and is there anything I need/should be doing?
Rick Cohn, M.D. - 08 Dec 2003 15:30 GMT
> I was referred for an unrelated problem, that turned out to be blepharitis.
> As part of the examination, I had pressure taken and the optic nerve
[quoted text clipped - 9 lines]
> So, while 'm not panicking, any ideas as to prognosis? Should I worry at
> all, and is there anything I need/should be doing?

If you have 70% cupping, or what we call a 0.7 cup to disc ratio, you
may simply be someone born with large cups, or you may have glaucoma.
You can't tell someone "You don't have glaucoma" just because he/she
has a normal pressure at one point in time.  We all have diurnal
variations...some of us have high IOPs early in the AM, some spike in
the late afternoon.  Maybe your doc just checked your IOP at your low
point of the day.  Also, some patients have "low-tension glaucoma" and
develop progressive optic nerve damage even with a normal pressure.
The only way to know is to observe for changes over time in both your
optic nerve appearance as well as a computerized visual field test.
Personally, I wouldn't have let you go for a full year.  I check most
of my glaucoma suspects every six months.  You should also have optic
nerve head photos or analysis done and measurements of your corneal
thickness.  If your doc doesn't have this technology in his office,
find someone who does, possibly a glaucoma specialist.  Good luck to
you.
--Rick Cohn, MD
Glaucoma specialist
Winter Park, FL
 
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