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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10893
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I developed glaucoma in one year following my regular opthamalogical eye exam. Intrao

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I developed glaucoma in one year following my regular opthamalogical eye exam. Intraocular pressure which was 25 is now under control with eye drops but my doctor is shocked at how quickly the optic nerve got so thin. The visual field test showed I lost most of my peripheral vision in one eye and much of it in the other. What is the likelihood of blindness even though pressure is down to 12; and what else could be causing damage to the optic nerve.

Dr. Rick :

Hi. I can help you today.

Dr. Rick :

Do you know what he called the cup to disk ratio in your eye?

Dr. Rick :

Is the person treating your glaucoma an ophthalmologist?

Customer:

I'm concerned that my glaucoma will lead to blindness even though the intraocular pressure is down to 10 because of the speed with which I've already lost vision. What else could be causing damage to the optic nerve

Customer:

Yes, he is an ophthalmologist. I do not know the cup to disk ratio

Dr. Rick :

When your pressure was first noticed to be 25 did the doctor do "baseline" visual field tests, optic nerve head pictures and/or OCT measurements?

Dr. Rick :

If she did, are you saying that you have lost significant visual field from baseline as well as had continued significant damage to your optic nerve structure even with the pressures at 12?

Dr. Rick :

When treating glaucoma I first like to try and get a 30% reduction in baseline (presenting) pressure. Being at 10 mmhg is almost a 40% reduction.

Customer:

This was just detected a month ago and the visual field test was done yesterday. He did take optic nerve head pictures which showed deterioration in the nerve since my last eye exam 14months ago. Since this was the first visual field test I don't know for sure that I did not lose vision years ago, although the optic nerve looked normal at my last exam. The 12 reading is a result of drops I used over the last month.

Dr. Rick :

You are correct to be concerned. Glaucoma is the number one silent cause of blindness. In order to help you know how much you need to be concerned I would have to have more information on the cup to disk ratio of your nerve, it's color etc and how your visual fields look today as well as how much they have changed over time. I wish he had done a visual field test 14 months ago.....

Dr. Rick :

In things as important as your vision, and given the amount of damage you have been told you have I think I would sleep better if you got copies of your records, visual fields and nerve photos and obtained a second opinion by a fellowship trained glaucoma specialist.

Dr. Rick :

Your treating ophthalmologist should understand and not feel the least bit slighted by your request for a second opinion....I know I never am.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

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Customer: replied 6 years ago.
Don't know what happened but I suspect there is not much more you can do at this point. My concern was whether there is something else causing the damage. He asked me to get an MRI, a 24 hour blood pressure monitor and a carotid Doppler test.
As long as you have vision I would not give up hope. Those tests make sense. If you blood pressure is going low at night it can cause nerve damage even with low eye pressure. Also, blockage seen on MRI or carotid doppler can find unseen problems.

I still think a consultation by an glaucoma expert is indicated in your case.