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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
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Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Last August, at my eye exam with the optometrist, I was told

Resolved Question:

Last August, at my eye exam with the optometrist, I was told that I was at risk for acute angle closure glaucoma. After reading about this particular type of glaucoma, I'm not sure how one suddenly becomes 'at risk'. Isn't this something that should have been seen in prior exams? Or, is it age-related? My IOP was normal at that time, but she did say that I might consider laser peripheral iridotomy as a preventative measure.

While I don't feel that I'm currently experiencing any symptoms, I have had an odd issue with my right eye over the last few days. It's difficult to describe, but it happens at night while I'm awake and I think I notice it more when I blink. I don't know if the eye is dry, but it's rather like the eye doesn't seem to fit. I recently had a very bad cold for about three weeks with severe congestion and still have a bit, so I wonder if there is a residual effect.

I don't know if there is enough concern that I should see a specialist or if I'm just overthinking it all.

Other details --
49 yo female.
I have a paternal family history of macular degeneration (father, grandmother).
I wear orthokeratology lenses at night (8 years).
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Customer:

Hi Dr. Rick.

Dr. Rick :

Picking up your risk for angle closure glaucoma is not something that would always be picked up on a routine eye exam, especially by an optometrist.

Dr. Rick :

The best way to evaluate you for this risk is by having a special exam at the slit lamp called gonioscopy. Once again, it is my opinion that optometrists do not have enough training to do this evaluation. That being said, there are other clues at the slit lamp etc that may make your optometrist concerned that you may be at risk.

Dr. Rick :

The cold and feelings of your eye "not fitting" are not something that would be expected to be related to this possible diagnosis. One thing, however, is that if you are at risk for an angle closure glaucoma attack I would not recommend doing orthokeratology until after your had laser iridotomies.

Dr. Rick :

I suggest you have a complete eye exam by an ophthalmologist, making sure to tell the doctor about your optometrists concerns about narrow angles. This way the ophthalmologist will examine your angles by gonioscopy and let you know if, indeed, you have anything to worry about.

Dr. Rick :

Does this make sense to you?

Customer:

It does, yes. I've been wearing the orthok lenses for 8 years now -- is there any reason to believe that could have contributed to the change in angle of my cornea?

Dr. Rick :

Also, your IOP need not be elevated for you to be at risk for angle closure.

Customer:

I"m sorry -- the lenses I'm wearing now -- could that affect this condition?

Dr. Rick :

I do not think that it is a big risk but if you are deforming your cornea every night and, let's say for arguments sake, your angles are very, very, very narrow and on the verge of closing there could be a small chance that mashing your cornea into a new shape could cause problems. In reality I think this is more of a theoretical then a real risk......but better safe then sorry, if you get what I mean.

Customer:

I do! So, it wouldn't be an overreaction to just be seen by an opthamologist to check things out? Or, is having a preventative iridotomy something that should be done - or does that depend on the severity of the risk?

Dr. Rick :

I think you should go to an ophthalmologist and tell him you would like to have a gonioscopy exam (it is quick, painless and done at the slit lamp) as you've been told you might have narrow angles. If that ophthalmologist says you, indeed, do have narrow angles and you are at risk for an angle closure attack, you should have the (very safe, easy and (mostly) painless) peripheral laser iridotomy. Once that is done you never have to worry about this anymore.

Dr. Rick :

I've done thousands of then and not even once did I experience any pain at all lol!

Customer:

Okay, that's what I'll do. I should look for an opthalmologist who treats corneal diseases or is that any opthalmologist?

Customer:

I have to say -- I'm really a bit skeevy about anything done to my eyes -- hence the orthok instead of lasik. LOL

Dr. Rick :

Any ophthalmologist can do this for you. It is a basic skill that every eye MD has

Dr. Rick :

I can understand that....but angle closure can snuff out your vision in about an hour.....not something you want to happen while you are on vacation backpacking in the Andies.

Customer:

Point taken! I'll make an appt today. Thanks very much for all the information. I feel a lot better!

Dr. Rick :

My pleasure. Have a great day and don't worry ;)

Dr. Rick :

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Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8486
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 2 years ago.
Let me know if there is anything else you would like to discuss pertaining to this issue.

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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5443 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest