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Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2063
Experience:  MS Ophthalmology with 11 years of surgical expereince
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43 year old male had a CRVO approx 18 months ago. Received

Resolved Question:

43 year old male had a CRVO approx 18 months ago. Received a steroid injection which seemed to clear up the edema, but resulted in steroid induced glaucoma. Had a trabeclectomy with a mini shunt approx a year ago. Pressure remains good. Have been regulalry checked by a retina specialist and glaucoma specialist. I also had a physical workup and blood workup done to make sure there are no underlying medical conditions that caused this.

Visual field is not so good. This unfortunately happened in my dominant eye and visual disturbances persist. Have suffered pretty severe depression and anxiety from this. Vision seems "splotchy". pretty good in some areas, not so good in others. When I close my eyes the areas of visual disturbances appear to be white clouds. Is it possible that the vision disturbances are caused by residual debris / hemohorrage? Is there any hope at all of recovery of vision? Should I be seeing a different type of doctor?
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 :

Are you available for chat now?

Dr. A.S. Desai :

Prior to 18 months, did you ever have any episode of raised intraocular pressure (IOP) or were you diagnosed with glaucoma suspect?

Customer:

No. The glaucoma was steroid induced.

Dr. A.S. Desai :

When you said that you were diagnosed with steroid induced glaucoma, were visual field tests done before and after trabeculectomy?

Customer:

Yes. The original visual field test was done following the CRVO event. The raised IOP occurred following the steroid injection. Visual field test was also done approx 4 months following the trab. It showed some improvement.

Dr. A.S. Desai :

It is to be noted that within 6 months of being diagnosed with steroid induced glaucoma , you underwent trabeculectomy with shunt surgery. This shows that the IOP was on the rise and probably not kep under control with eye drops alone. The fact that you needed surgery for the treatment of glaucoma shows that there was significant optic nerve damage ( glaucoma causes irreversible damage to the optic nerve) and surgery alone could have arrested the progress.

Dr. A.S. Desai :

Such glaucoma are called refractory glaucoma ( which finally require a shunt surgery). The subtle improvement in the visual fields after trabeculectomy is unlikely to be due to any improvement in the optic nerve status but rather due to improvement in the macular edema. Your present complaints regarding not so good visual field could be more to do with the glaucomatous optic nerve changes.

Dr. A.S. Desai :

The areas of visual field with not so good vision are probably scotomas ( non-seeing areas in the visual field).

Dr. A.S. Desai :

These scotomas are seen in glaucoma and they remain the same and do not progress if the IOP is well controlled.

Dr. A.S. Desai :

I must say that you are in good hands of your retina and glaucoma specialists and they are doing the best which can be done in your case. I don't think you need any other kind of specialist at this stage.

Customer:

Ok... So for the areas of scotomas - Is there chance for improvement or is this something I have to learn to cope with?

Dr. A.S. Desai :

If the scotoma ( these are seen in fixed areas of the visual field and they move the movement of the eye in the same direction) is definitely due to glaucoma, then they do not improve as they are due to irreversible damage to the optic nerve fibres as a result of raised IOP. However these scotomas canbe prevented from extending by keeping the IOP within the normal range ( 10 to 20 mm of hg). In your case trabeculectomy and shunt surgery have already been done to keep the IOP under control, so it is unlikely that the scotomas should worsen any further.

Customer:

Ok... So now I just need to figure out how to cope with this. Unfortunately the visual field disturbances seem to override the good vision in my non-dominant eye. Any information on coping techniques / resources would be appreciated. Thank you

Dr. A.S. Desai :

I have a small question here- do you feel that the not so good vision areas of the visual filed keep floating just like floaters? Or are they pretty fixed and are always seen in the same spot ?

Customer:

They have the appearance of floaters but I think they are pretty much in fixed locations. If they are indeed floaters they move so slowly that it is impossible for me to tell. If I look at an amsler grid, just above the center dot is missing, the top / right hand side is missing (not black - more greyed out) there are several little spots disbursed throughout the grid, and the lines are all wavy.

Dr. A.S. Desai :

Well this could possibly point towards persistent macular edema ( but I cannot be very certain about this) as glaucoma tends to start around the physiological blind spot and not at the fixation point. Morever wavy lines on amsler grid are indicative of retinal problem and not glaucoma. Your visual problems are probably multifactorial rather than due to a single cause. Glaucomatous visual field defects and persistent macular edema are the likely causes.

Customer:

Ok... Thanks. I guess its a "wait and see" type of scenario. This has been extremely difficult to deal with.

Dr. A.S. Desai :

I can understand your difficulty and I guess you do need to wait and observe and follow the advise of your eye specialists. I wish you well.

Dr. A.S. Desai :

Is there anything else that I can answer for you ?

Customer:

No. Thank you for your help.

Dr. A.S. Desai :

You are most welcome.

Dr. A.S. Desai :

If you need more help, please use the reply tab to continue our conversation. If you do not require further assistance, kindly rate my service.



Thank you and best wishes.



It was a pleasure to have answered this question.

Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist


Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2063
Experience: MS Ophthalmology with 11 years of surgical expereince
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