 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Vision / November 2005Different approach 2 eye doctors...
About: lasik, pigment dispersion syndrome, eye pressure, glaucoma, timolol, visual field test Doctor A (a total of 2 + 2 appointments) - eye doctor at private clinic - I went in, my eye pressure was measured several times with a tonometer: 28 - They eye was looked at with a gonioscope twice & slit lamp. - A visual field test was taken and the result was "within normal limits". - An optic nerve head analysis was taken which showed a "slight deteriorment" (something about cup to disc ratio, I'm no doctor), because of high eye pressure in the past. - Conclusion: pigment dispersion syndrome and was given timolol 0,5% twice a day (eye pressure drops). Because of her findings she recommended against doing the lasik eye surgery (which was the reason I went to that clinic in the first place) and that I should see my eye doctor at home to check eye pressure regulary. Doctor B (so far 2 appointments) - eye doctor at hospital (I gave him the optic nerve head analysis report and the result of the visual field test) - I went in, my eye pressure was measures using the "air"-method: 15 - I was taken off the drops for a week to check eye pressure again a week later. - A week later the eye pressure was 18, which is normal, so no need for medication. - To be certain he wants a visual field test, which will be done next week. I'm sure the visual field will turn out "within normal limits" and he won't recommend using timolol. I have the feeling he'd rather wait until it's more certain and visible that my visual field is deteriorating. The reasoning behind it is that he doesn't want me to start taking drops from now on twice a day for the rest of my life (I'm 26), because everything -he says- is just a borderline case. Now, I'm not a doctor... but shouldn't one _prevent_ sightloss and start with eye pressure drops as soon as possible rather than wait any longer untill my sight _really_ starts to deteriorate? I've been reading about this syndrome and it is usually detected between the ages of 20 and 40 years, which is younger than usual and that it doesn't follow the "normal glaucoma procedure". A website with a handbook states "... The "watch-and-wait" attitude that you might use with POAG is not suitable with cases of PG. Prompt, aggressive therapy is indicated as soon as the diagnosis is evident... " [1] Should I _again_ espress my concern and irritate the doctor for trying to be a know-it-all or can I assume he _does_ know the right approach? Am I just panicking? [2] Because it's also said that fewer than half of the patients will develop glaucoma (high eye pressure)... [3] Greetings, [1] http://www.revoptom.com/handbook/oct02_sec4_4.htm [2] http://www.krukenbergs-spindle.co.uk/What_can_be_done.htm [3] http://www.emedicine.com/oph/topic136.htm#section~treatment Interesting. Of course, IOP is often the first indication of risk, and also the single variable that is treated. In the absence of any other finding, a pressure of 28 will not necessarily result in treatment. The findings of the Ocular Hypertension Study do suggest that benefits of treatment outweigh the risks at elevated pressures. However, elevated pressure may be the result of a thicker than average cornea. LASIK results in a thinner cornea, hence the IOP must be adjusted following LASIK, depending on how much tissue is removed. Figure about 20% reduction. This reduction can obviously confound the diagnosis. Also, there is considerable pressure exerted on the optic nerve during the use of the suction ring. I think this bothers some glaucoma specialists who are, after all, trying to save nerve tissue. Anyhow, back to pressure. No matter what the pressure, if there is another positive finding, such as abnormal cupping, abnormally thin nerve fiber, abnormal visual field, then the diagnosis of glaucoma can be legitimately made. Also, of the various methods used to measure pressure, the standard seems to be Goldmann applanation or some other applanation technique such as the Tonopen. I am leaning towards the first diagnosis. Perhaps you should go for two out of three. DrG > I am leaning towards the first diagnosis. Perhaps you should go for > two out of three. > > DrG As am I and perhaps more consultation is in order. Dr #1 seems to have done a good work up, so perhaps she should be consulted again. If you have a good relationship and are willing to comply with a management plan as outlined below, that might be the reasonable course of action. I have a number of patients in my practice with "minor involvement" pigment dispersion syndrome whose individual pressures sometimes vary from 16 to 26 over the course of days or weeks. Most are not on medication, at least not yet. With PDS, it is important to get optic nerve stereo photos and OCT, HRT or GDx imaging, along with gonio and fields. If the patient is willing and able to afford to have Goldmann tonometry often (sometimes every 4 weeks or more) and nerve imaging every 4-6 months, it is sometimes reasonable to hold off medication. Sometimes the pigment exfoliation stops and the pressure stabilizes. Sometimes, of course, there that situation the system gets clogged for good and intervention is required. Certainly in situations where there is not careful patient monitoring, medication or surgery is the most appropriate option. If imaging studies show that your nerve health has already been compromised, that means your pressure has indeed spiked a lot higher than the 28 or has been up there for too long a time. (Normal fields does not mean the nerve fibers have not been damaged, only that not enough of them have been compromised to show up as visual loss.) In which case medication is required, even if your pressure on one reading appears normal. In any event, PDS may be quite variable and you, in consultation with your doctor need to decide how much risk you are willing to take and how much monitoring you are willing to do. Good luck with your decision and let us know what is decided. --LB, O.D> > Dr #1 seems to have done a good work up, so perhaps she should be > consulted again. Thanks for your informative response. I would if I could go back to her, but that was abroad, hehe. That's why she gave me the results (optic nerve photo and information) and told me to get in contact with my eye doctor at home to keep an eye on the IOP. [snip management plan: thanks] > In any event, PDS may be quite variable and you, in consultation with > your doctor need to decide how much risk you are willing to take and how > much monitoring you are willing to do. Monitoring is indeed the tricky part on how often one needs (or the doctor thinks it's needed) to check the eye pressure. I'll have to wait I guess at what my doctors says I suspect that after my visual field test doctor B will suggest to check it again in 6 months or so... I have no idea. I also don't think it would be wise to keep using eye drops against his suggestion (I have 4 bottles of 5 ml in stock with expiration date 2009). Thanks anyway :-) Greetings, > LASIK results in a thinner cornea, hence the IOP must be adjusted > following LASIK, depending on how much tissue is removed. Figure about > 20% reduction. Thanks for your informative response. I gave up on the idea of Lasik, the reason was that pressure measurement wouldn't be as precies after surgery and seeing my problem doctor A suggested better to take care of that. Her exact words were to live happily ever after with glasses. > Also, of the various methods used to measure pressure, the standard > seems to be Goldmann applanation. Perhaps you should go for > two out of three. Some websites indicate that applanation is more precise than the other method of a puff of air. Also the general impression of looking at my eye with that big lens (gonioscopy) and not wanting to do surgery on my eyes gave me confidence in her findings. After all, not letting me do the surgery directly affects the private clinic she worked at. My eye docter at home, doctor B, suggested that if I don't trust him he would give me permission to go to another hospital (Dutch insurance rules, you can't just keep hopping along). I didn't say "yes" ofcourse, after all he _is_ the doctor at the general hospital in the region and it's important to have a good relationship with the doctor. But still... his different approach isn't what I expected. Isn't it better to _prevent_ any vision loss and start with medication in stead of waiting untill the visual field test shows a vision loss? Thanks anyway :-) Greetings, > Isn't it better to _prevent_ any vision loss and start with medication in > stead of waiting untill the visual field test shows a vision loss? Thanks > anyway :-) It's a fundamental question with more than one answer. It's easy to say "yes" when the patient is young, when there's a strong family history, when there's good insurance. Even then, it's prudent to observe over time and look for changes over time, in the VF or optic nerve photos or OCT, HRT, GDx etc. Glaucoma is slow, compliance is difficult, and pressures in your range aren't very reliable for indicating glaucoma. Pressure measurements are crucial for determining the effectiveness of treatment, but many people with real glaucoma damage have "normal" pressures. Conversely, many people with pressures of 30 have no sign of glaucoma. Your pigment spindle by itself isn't very alarming. Gonioscopy is much better for determining your risk. -MT |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.