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Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2165
Experience:  MS Ophthalmology with 11 years of surgical expereince
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Brief history Father born 1936 Unknown if true but his

Resolved Question:

Brief history

Father born 1936
Unknown if true but his mother always told him that he had a sigma in right eye due to having scarlet fever during the war.

Late 30 - started wearing bifocals - has always had relatively stable eye-site and has had the same lenses for the last 6 years.

Two months ago, his right eye went a little blurred. This went away in about 30 mins. It happened again 2 weeks later - got better within an hour. On the 19th of this month he felt that his right eye went cloudy (as though looking though a steamed up bottle), got a bit better then worse again but within three hours it had gone and it has not happened since. With reference to this last time he was quite stressed as he was getting ready to fly back home and this may have something to do with it.

He when to see an eye specialist (he is now in Thailand) on the 20th and the specialist said that she wanted to operate urgently (within three days) for glaucoma. She did not give him a written diagnosis or copy of any exams. He went back to her on the 22nd saying that he wanted a diagnosis and a copy of the tests that she had taken. She did another series of tests and this time gave him the results which can be seen here:

https://www.dropbox.com/sh/b5o2fmg2whyitgb/dGZ5i5Isgw/130522%20Eye%20exam%20results

but no diagnosis other then that on 20 May the pressure in his eyes were:

left eye 28
right eye 25

and on 22 May they were:

left eye 18
right eye 20

Having completed the tests she said that as long as it does not happen again he did not need to see him until 22 June... hence we would love an opinion as to if it could be glaucoma and or one would expect cataracts. Any further tests that you would suggest or questions that should be asked.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 1 year ago.

Dr. A.S. Desai :

Hello, Thank you for the question.I am Dr.A.S.Desai and I look forward to assisting you .

Dr. A.S. Desai :

Please give me a moment to type my answer.

Dr. A.S. Desai :

To begin with, cataracts would not have been the cause of the blurring of vision.

Dr. A.S. Desai :

If the IOP was high, it is likely to be due to glaucoma.

Dr. A.S. Desai :

But it would be important to identify the type of glaucoma such as primary or secondary.

Dr. A.S. Desai :

Further it is to be identified If it is due to angle closure or not. The angle closure type og glaucoma causes corneal edema and cloudiness of vision.

Dr. A.S. Desai :

There to some problem with the chat system. I will be switching over to the Q &A mode. Please bear with me.

Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2165
Experience: MS Ophthalmology with 11 years of surgical expereince
Dr. A.S. Desai and other Eye Specialists are ready to help you
Expert:  Dr. A.S. Desai replied 1 year ago.
Hello James,

I did go through the reports sent and it does look like there has been glaucoma for quite sometime now as there are visual field defects seen. However the fine details of the fundus picture are not clear on magnification. With high iop the cornea can become edematous. I guess your ophthalmologist is right in deciding the further course of action. If medical line of treatment is unable to keep the iop under control, surgery can be tried such as trabeculectomy. The decision would solely depend on the ophthalmologist and the result of the initial treatment. I wish him well.

Please feel free to ask follow up questions if any.

Thank you and best wishes. It was a pleasure to have answered this question.

Kindly rate the answer, if you do not have any more questions to ask
Customer: replied 1 year ago.

Dear Dr. Desai,

 

Thank you for your reply and I am sorry your chat system failed us.

 

> But it would be important to identify the type of glaucoma such as primary or secondary.

 

Is that information not available in the reports?

 

> Further it is to be identified If it is due to angle closure or not. The angle closure type og glaucoma causes corneal edema and cloudiness of vision.

 

Again is that information here. Is it due to angle closure?

 

> I did go through the reports sent and it does look like there has been glaucoma for quite sometime now as there are visual field defects seen.

 

That is interesting to know. Are you able to say how quickly this problem needs to be tackled as I understand gloucoma can result in blindness if not dealt with quickly.

 

> However the fine details of the fundus picture are not clear on magnification

 

Can you confirm which image this is and I will resent in greater detail.

 

> If medical line of treatment is unable

 

May I ask what you mean by this? Is there an alternative to surgery?

 

> The decision would solely depend on the ophthalmologist and the result of the initial treatment.

 

What initial treatment would you expect to be prescribed here?

 

Could I also ask you to comment on the following numbers:

 

but no diagnosis other then that on 20 May the pressure in his eyes were:

left eye 28
right eye 25

and on 22 May they were:

left eye 18
right eye 20

 

are they high? on the border... normal?

 

Many thanks, James

Expert:  Dr. A.S. Desai replied 1 year ago.
It would help to see the magnified image of the fundus photograph as the optic nerve head changes are not clear.

The iop on 20 May was definitely high. Normally the cut off is 21 mm of hg. The iop on 22 May was found to be normal. The initial line of treatment is medical in the form of ee drops (aniglaucom). If the drops fail to keep IOP under control even after 3 months of continous use, laser treatment is considered suh as argon trabeculoplasty. If his also fails then surgery can be considered. Though the images do show crowding of the angle of the anterior chamber, I was wondering how your father never had symptoms which are otherwise very typical of angle closure glaucoma (PACG) such as acute pain in the eye/redness/watering/photophobia apart from the clouding of vision.Has he ever mentioned these symptoms?
Customer: replied 1 year ago.

Thank you very much Dr. Desai, I will get hold of a better scan for you + ask the questions and return to you on Monday. Much appreciated and will be acknowledged when I close this consultation out!

Expert:  Dr. A.S. Desai replied 1 year ago.
Hello James,

Sorry for the delay in replying and the spelling mistakes ( now that I got to see them) . I was replying on the move from my tablet and it was a bit cumbersome to do so. I am going through the details of the question and images sent once again .

I need to get a few facts to your notice here.
1) The oculus pentacam showing the angle of the anterior chamber shows shallowing but not closure. However a single frame is not conclusive as there can be something called as creeping angle wherein there are different grades of the angle within the same eye. The report of the examining doctor would thus throw more light.
2) The corneal thickness is normal in both eyes ( presently no edema)
3) The optic nerve head( ONH and RFNL OU analysis) seems to show symmetrical cupping in both eyes ( normal is 0.3 and his is 0.4 to 0.5 in both eyes) which is marginally more than normal.
4) The visual field shows peripheral constriction in the right eye ( an early sign of glaucoma).

Having said all this, we need to keep in mind that glaucoma cannot be diagnosed on a single visit or 2 visits 2 days apart. We have to observe consistently progressive signs suggestive of glaucoma such as a progress in cupping or other signs of glaucoma, corresponding changes in the visual fields and IOP. Normal tension glaucoma (NTG) is another type of glaucoma where the pressures are never above 21 mm of hg but optic nerve and visual field changes are consistent of glaucoma. I beleive that your father would need to be observed after a month again to look for the above mentioned changes.For blindness to occur due to glaucoma it would take years to decades. Except acute episode of angle closure glaucoma ( characterised by sudden onset of severe eye pain, headache, nausea, vomiting, cloudy vision, redness, watering, photophobia) which can lead to irreversible cloudiness of the cornea if the IOP is not controlled immediatley.

I don't see any role for immediate surgery in his case . He would rather need to get the investigations repeated after a month ( to see the ophthalmologist immediately if the cloudy vision occurs). If the repeat tests show a progress with raised IOP then it would be better to start with anti-glaucoma eye drops.

I'll wait for your reply on monday morning. Have a good weekend!
Customer: replied 1 year ago.

Dear Dr. Desai,


 


Thank you very much for your detailed reply; much appreciated. I have obtained a better copy of the fundus photographs as requested


 


https://dl.dropboxusercontent.com/u/5624744/130522%20Eye%20exam%20results/CCI24052013_00005%20High%20Res.jpg


 


and look forward to your comments. As to your question:


 


> I was wondering how your father never had symptoms which


> are otherwise very typical of angle closure glaucoma (PACG)


> such as acute pain in the eye/redness/watering/photophobia


> apart from the clouding of vision.Has he ever mentioned these


> symptoms?


 


His initial response is no. However he did say that he has never used Optrex before but about 6 months ago bought a bottle (no 1/4 left) which he has used on an off since - he says this to illustrate that something must have changed as he never felt the need to use it before. If he pushes the eye he says it does feel a painful and probably more so than previously.


 


I am assuming that you would be happy for him to wait until 22 June to repeat the exams before taking any further action.


 


Thank you for your time in this matter.


 


Kind regards, James

Expert:  Dr. A.S. Desai replied 1 year ago.
Hello James,

Thank you for the reply and the additional information which I had seeked.

The fundus picture sent this time is magnified but again does not show the details of the cupping which we look for in glaucoma. However I got the informatiom from the other test done and it shows cupping to be 0.4 to 0.5 ( considered as early cupping). Yes, I do feel that it is appropriate for him to wait and get the repest tests done on 22nd June 2013( unless he gets another episode of sudden clouding of vision in between for which he needs to contact the doctor ASAP).

I thank you for giving me a positive rating and the bonus. I would love to hear from you again after your father undergoes all the tests again. You just need to open this page using its URL- http://www.justanswer.com/eye-health/7s2m2-brief-history-father-born-1936-unknown-true.html. You will not be charged for following up with the same page anytime later.

Have a good day! I wish your father well!

Regards

Dr.A.S.Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2165
Experience: MS Ophthalmology with 11 years of surgical expereince
Dr. A.S. Desai and other Eye Specialists are ready to help you
Expert:  Dr. A.S. Desai replied 1 year ago.
Sorry but I need to bring this to your kind notice that having given a positive rating once, you need not give another positive rating for the same again( I am afraid you will be charged for each positive rating). You just need to continue with the interaction and view the replies henceforth.

Thank you
Customer: replied 1 year ago.

Thank you Dr. Desai. At worst I have paid in advance for your kind authority in a months time! Kind regards, James

Expert:  Dr. A.S. Desai replied 1 year ago.
That is a very kind gesture. Thank you. I hope to be kept briefed up with your father's follow up.( please do not rate the answer again ;)......)

Regards

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MS Ophthalmology with 11 years of surgical expereince