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Confused about my condition

I went to see an eye doctor ( OD).After doing dilated eye exam he told me your optic nerve looks suspicious and you might have Glaucoma. He told  me your eye pressure is high 20 mm Hg in both eye and C/D is 0.7 in both eye. I was very very afraid... i could not sleep that day...Next day i went to see an famous eye  MD in my area. She did a dilated eye exam+Slit lamp exam+GDx. She told i do not have glaucoma. Then i asked her they why other doctor told me that i might have glaucoma. She explaied me following:-

1. Higher C/D ( 0.7) does not say that you have glaucoma. She told your optic nerve looks very good and healthy. There is no damage. Then i asked her can i do GDx image...but she was so confident that she told me you do not have Glaucoma and do not need to do GDx. But i wanted to do that. Then she told me if you want then she will do it.

2. GDx shows  your RNFL index is 14. For glaucoma cut off value is >39. Also, your  grapghs fall within the normal value.

3. You angle between iris and corea is wide open ...so you can not have closed angle Glaucoma

4. She told me there is no range or limit for eye pressure. It depends on eye to eye. Today your eye pressure is 19/19 mm Hg and cornea thickness is 525 micron. So,  your cornea is not thin and what ever your eye pressure that is correct.

She told me you do not have glaucoma...go home and sleep...,

Now i am very confused...what should i do...Who is correct?  

Could you please help.

3 Responses
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Avatar universal
Hello VSQ.  I would believe the "famous eye MD", for two reasons. First the Eye MD has many years more training than the limited eye care provider optometrist (OD) and sees a lot more complicated and serious eye pathology. Second the ophthalmologist has done more testing.

When I see someone with .7 cup/disk ration (C/D) I explain what this means, show them a picture I have that shows all C/D from 0.0 to 1.0.  I tell them this is important information to give anyone that checks them in the future.

Depending on the age of the patient, the family history I will often do a baseline evaluation that would consist of: 1. measurement of corneal thickness  (a thick cornea is good, a think cornea is bad. If the cornea is thick the eye pressure (IOP) will be lower than the tonometry reading, if the cornea is thin it will be higher and if the cornea is "average" the IOP is the same as the tomometry).  2. Stereo photographs of the optic nerve.   3. OCT (optical coherence tomography) of the optic nerves. This is a newer test than the GDX and more accurate but the GDX is still a good test.   If there are other risk factors then I will do a visual field and a gonioscopy (the test done to see if the angles are opten).  Depending on the results I may see the patient once per year or if something is suspicious every six months.

I would stop worrying unless something changes and go back in a year to the famous EyeMD for a regualr annual examination.

JCH EYE MD  ophthalmologist
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Avatar universal

Thank you very much for your help. I think i will be able to sleep in night now. Couple of questions:-

1. Is 525 is a thin or thick cornea?

2. Is it possible to measure angle between corea and  iris using slit lamp  ( in my case EyeMD used a special lens between slit lamp and my eye. She did not put the lens inside my eye)

3. famoues EyeMD--- i said this because she is from Massachusetts Eye and Ear Infirmary, Harvard
    Medical School+many years of experience+ a  fellowship training  in glaucoma. But not sure if
    she is a glaucoma specilist. Do you think in my case do i need to see a EyeMD, who is
    specialist in glaucoma?

Thanks a  again

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Avatar universal
1.  Average cornea thickness is 555 microns. Worrisome thinness would be less than 500 microns.
2. Yes you can get an estimate of the angle width with the slit lamd using the width of the anterior chamber vs. the width of the anterior chamber (Herrick's test). However to see the base of the angle of the eye you need to use a gonioscopic lens which rests against the cornea.
3. Fellowship in glaucoma = glaucoma specialist.   You've been to a very find institution and seen a highly qualified ophthalmologist. I would take her word on it and just have a yearly examination, ideally with the same Eye MD each year.

JCH MD  Ophthalmologist
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