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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8065
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My eye doctor told me one year ago that I have deep optic cupping.

Customer Question

My eye doctor told me one year ago that I have deep optic cupping. I understand that this can be physiological rather than pathological. He didn't do a field vision test at that time, but he measured the C/D ratios at 0.7 in both eyes. I went in recently--one year later--and we did a field vision test. I don't know what the C/D ratio was this time (it looks in the notes as if it was 0.5 for the right eye & 0.8 (hard to read that number) for the right eye, but that’s not entirely clear and that doesn't seem to make a lot of sense, so I'm just not sure.

The results of the visual field test for the left eye are: nothing to note on the TD or PD; GHT within normal limits; MD -1.14 DB; PSD 1.21 DB).

The right eye, however, is a little different. In addition to general deterioration of vision in that eye over the past year, the results of the visual field test were this: quite a few markings on the TD (I’m not sure how to properly convey those to you in this format—but 3 in the <.5% marking, 7 in the <1% marking, 9 in the <2% marking, 16 in the <5% marking; these are generally in the middle bottom & to the left; the PD has 1 in the <2% marking and 1 in the <5% marking). The GHT is “General Reduction of Sensitivity”, MD -3.91 DB P<1%, PSD 1.47 DB.

I understand that you’re not able to make a diagnosis based on this data alone over the internet, but I just want to get a general sense of what this means. I like as much info & straight-talk as I can get because I can deal with that—feeling uncertain & uninformed is upsetting to me whereas real info is...at least real & something I can learn more about. The opthamologist told me that it is nothing but it seems to me that it might be, that it could be early glaucoma. I recognize that we might not be able to know much more until some time has passed and we do another field vision test, but my question is more about what it might mean in general, if I should see him sooner than 6 months from now and if I should consider meeting with a specialist.

Sorry this is so long! Thanks for any input you can provide!
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. My name isXXXXX and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Customer:

Great, thanks. I laid it out in my original message. Two additional notes--on the visual field test, the fixation losses were 0/14, 2% false positives & 0% false negatives. Don't know my corneal thickness. IOP is 15.Not sure if it matters or not, but I've noticed an increased sensitivity to light in recent years.

Dr. Rick :

hi.

Dr. Rick :

Are you still there?

Dr. Rick :

Was your eye doctor an optometrist or an ophthalmologist (eye MD who does surgery)?

Customer:

Hi, I'm still here. This was an opthalmologist.

Dr. Rick :

I've never reviewed an visual field test using the stats and a general description before -- thanks for the new experience :)

Customer:

:) I try.

Dr. Rick :

Well, after reviewing the data you have posted, it doesn't seem like you have damage from glaucoma at this point....however....

Dr. Rick :

if you really have a .5 cup on one eye and a .8 cup on the other that is very suspicious.

Customer:

Yes, I know those are supposed to be the same. I have to find out what the other number is. It definitely doesn't look like the .5 (which is very clear), but .5 & .8 would be a huge difference, right? Also, I meant to say it was .5 for the left. The right is the one I'm not able to decipher.

Dr. Rick :

Also, if the highest your IOP has ever been measured at, your gonioscopic and nerve fiber layer analysis is normal you would -- if you had any type of glaucoma-- have low (also called normal) tension glaucoma.....

Dr. Rick :

Yes .3 difference is significant....although no comment seems to have been made about the morphology of the cup, which is an important data point.

Dr. Rick :

Two things that are obvious to me from your post:

Dr. Rick :

1. you are concerned.

Dr. Rick :

2. You are well informed. :)

Dr. Rick :

Normal tension glaucoma can be difficult to diagnose, even for the most experienced ophthalmologist......

Dr. Rick :

If I were in your place, I would make an appointment with a fellowship-trained glaucoma specialist, bring your clinical notes, have a complete exam and see what she has to say.

Customer:

I'm trying to be well-informed and, with that, trying not to be concerned. Like I say, if it appears that there is a potential for glaucoma, that's fine, I'd rather know that & start dealing with it, maybe see a specialist, etc. But I also don't want to be hypochondriac, so I'm trying to be MORE informed. So, I'd appreciate if you could let me know your overall opinion.... Oh, you answered that while I was typing. That's what I was thinking but didn't want to be an alarmist either.

Customer:

Thanks so much--I'll do that. Anything else you think I should know/ask/look into...?

Dr. Rick :

I do not think that this is an emergency, nor do I feel that your eye care to date has been substandard. I only suggest this course of action as a way to make sure that nothing is being missed and to put your concerns to rest.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

You are not being an alarmist :)

Customer:

Ok, thanks. That works. :)

Dr. Rick :

My pleasure. Have a good weekend.

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8065
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 1 year ago.
Hi Christina,

I was just thinking about you and wondering if you have had a chance to see a glaucoma specialist. I hope everything is going well and she said you do not have glaucoma.

Take care and let me know if there is anything else I can do for you.

Dr Rick MD FACS
Customer: replied 1 year ago.

Nice of you to follow up. I'm scheduled to see a specialist tomorrow morning. I did find out that the doctor lists the C/D ratios as the same in both eyes (he says both are .5, even though he said both were .7 last year...weird....). But knowing that the C/D ratios are allegedly the same has been a bit calming too. So, fingers crossed for tomorrow. :)


 


Thanks,


Christina

Expert:  Dr. Rick replied 1 year ago.
Christina,

That is good news.

If you want to upload a copy of tomorrows clinical note and any test results I would be happy to go over them in detail with you and answer any questions you might have.

I am currently driving to Texas and, as such, will not be online much but I will try to check my messages at least once a day.

Good luck tomorrow -- I'll keep my fingers crossed too!

Dr. Rick

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