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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Concerned I might have glaucoma - any insight (ironic)

Resolved Question:

I am a 32 year male diagnosted 5 yrs ago with crohns, 8 year ago with diabetes 2, 6 months ago latent TB, and now I fear I am in the midst of a glaucoma diagnosis. I have repeatedly had elevated pressures (last one was 24 and 21), and so I saw an opthomologist who ran more exams. I do not have loss of visual field per the bowl/white dot test whatever you call it (I'm sure that's not the name:) However, he ordered a disk color photo (not the optomap which I've done before and it was fine). I did the stereo photos and the tech who took them showed them to me at my request. I asked him what they would look for, and, through his answer and my research, looks to be the following:

I couldn't tell the cup to disk ratio, but he was pointing out the jagged edges within the neoretinal rim on one eye, and the other eye looked like tis nueroretinal rim had a big gulge in it. I'm waiting for the doctor's report but panicked in the meantime. Does this mean I have damage to my optic nerve already? Do I have glaucoma?
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

Hello and thank you for your question.


A higher pressure reading does not necessarily mean you have glaucoma now if you didn't before. However, it does mean that this particular part of the glaucoma puzzle is abnormal and it may lead to a glaucoma diagnosis in the future. Unless there is damage to the optic nerve or damage to the peripheral vision or imminent damage to such, then your doctor may just closely observe. Damage can be detected by: 1. the visual field test you took (the white bowl test), which shows the doctor if you've lost any peripheral vision, 2. by the way the optic disc looks on examination (how big the cup-to-disc ratio is and if the rim of the optic disc (the area on the outside of the cup in the center) has notches or areas that are selectively thinned out, and/or 3. A scan of your optic nerve called an optical coherence tomography scan (OCT).


So with a normal visual field test, it is unlikely you have glaucoma, but that is just one part of the puzzle, albeit a very important part of the puzzle. Glaucoma can sometimes be a murky diagnosis. There is, unfortunately, not one single test that can be performed that will allow an ophthalmologist to diagnose it. It is diagnosed after a handful of tests are performed and the preponderance of evidence points to it.


Even if you were diagnosed with glaucoma, for the vast majority of people who keep up with their doctor visits and drops schedule, vision loss is unlikely. It is just a diagnosis to keep on top of. The fact that you don't have any on your visual field is very encouraging. Even still, if it were happening, glaucoma damage usually happens very slowly, so don't get too panicked while waiting to talk to your doctor. The signs seem to be okay so far, from what you're telling me.


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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must be examined by your doctor.


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