GLAUCOMA TESTS

[msmeabc]

Hello All....I am 31 years old Male...I was diagnosedwith Type 2 diabetes in May 2019....In June 2019 i felt that my vision has been changing and i was feeling photophobic..So I checked with a doctor and he performed Diabetic retinopathy on dilated eyes and said that everything is ok...The problem he told was Conjuctivitis...In september 2019 again i went to a doctor and she performed dilated eye exam.and said that eyes are normal...Symptoms started getting severe...Photophobia...Red eyes...Heavy eyes...Heaviness in head...These symptoms kep.9n increasing...So.I.went to.another doctor.in Dec 2019...He started treatment and gave me.CMC...FML...KETROLAC ed...I used these 3 ed for almost 10 momths as in March lockdown was imposed and i was unable to visit any doctor...Few days back I went to another doctor and she diagnosed Eye pressure increased to 24 and 30 R/l resp...She gave me a drop.for.reducing pressure twice a day...in 2 days the pressure came down to 13,14.7 resp...So.she asked me to stop it...In her Diagnosis...She wrote "Allergic conjuctivitis , mibolitis and steroid induced OHT...She performed thorough dilated eye exam.and ruled.out the possibility of cataract...I didnt asked about Glaucoma then as i.was not aware of this problem.....She suggested 2 tests....HSv...and OCT RSNL...I came to.know.about Glaucoma after reading about these tests...as these tests are used to diagnose Glaucoma...But in the prescription she nowhere wrote GLAUCOMA SIGNS OR ANYTHING...Clear Media...Clear lens...and all other parameters are normal

My Question is..

1) Is this possible that Glaucoma left diagnosed in previous exams even in diabetic retinopathy and dilated eyes check up.three times

2) What are the chances of Glaucoma bynusing those e/d for 10 months

Note''My symptoms have started improving and in 4 days 60% of my symptoms were resolved by the anti bacterial.medicine she gave to.me apart from that eye pressure e/d

[JohnHaganMD]

The most important thing is what type of "doctor' you are seeing.  As a diabetic and potential glaucoma patient you should be under the care of an EYE MD also called ophthalmologist. You should not be under the care of a non-physician optometrist ( OD degree)   so 1. be sure you are under the care of EYE MD.  If not get in to see one immediately.  If you are under the care of an Eye MD I would get a second opinion from an Eye MD that specializes in glaucoma.  You were on steroid eye drops for a long time. We normally don't like to do that as about 8% of people develop increased intra ocular pressure (IOP) also known as steroid glaucoma.  FML is a steroid and normally we would not put anyone one on chronic FLM therapy for allergic conjunctivitis or dry eye.  I don't know what CMC is abbreviation for so please tell me, perhaps it also is a steroid.   Your 'doctor' is thinking along the same lines as steroid OHT (ocular hypertension) means the pressure is up because of chronic steroid use.  The tests that were suggested are to see if you have permanent damage (side vision test, and measurement of nerve fiber layer by OCT).   re-read this several times. Get with an EYE MD, if you are get a second opinion.  I am making an assumption you DO NOT wear contacts. If you do they should be discontinued.  If you have heavy duty dry eyes (unusual in young male) and not get relief with artificial tears 2-4 times/day then you might be a candidate for restasis or cequa which will not raise pressure in your eyes.

[msmeabc]

Sir CMC is Carboxy methyl cellulose..The doctor i seen are all MD Sir...

Sir I wear glasses of power -1.75 and -2 in R/L.eyes

Sir...What I can understand by ur explaination is that these 2 tests are to check the damage done by high OHT...I want 2 know that do i have glaucoma as per my above information or not...As after Dilated eye exam she said that catarct is nt there...And there is nothing 2 worry about...My doctor is out off town and will be available after 10 days...I.am spending sleepless nights of thinking Glaucoma...

[msmeabc]

Also....I dnt have any problem in side view sir....Apart from a little blurry vision (That too has improved a lot in 4 days treatment of antibiotic paste)

[JohnHaganMD]

You understand I cannot make an exact diagnosis and these are generalizations.   1. The most likely cause of your elevated IOP is chronic use of FML especially if you were using it daily or every other day.  2. The doctor should have known better but now that the doctor and you know you are a 'steroid responder"  steroids need to be used with great caution.  3. Please confirm you do not have a family history of glaucoma, if not the IOP should return to normal weeks to months after you stop the steroids and you should be able to go off your 'glaucoma eyedrops"

[JohnHaganMD]

QUESTION: WHAT DROP ARE YOU ON KNOW FOR HIGH PRESSURE?

[msmeabc]

Sir I Dnt have any Family history if Glaucoma...And R8 now I am nt using any E/D for Pressure....The day I was diagnosed with High OCT...Doctor gave me Timolol...I used those drops for 2 days and pressure came back to 13,14 in both eyes....So she asked me yo stop Timolol...This is 3 days back....Azithrozome and Genital are other drop and paste she gave me...one for Conjuctivitis and other one i dnt know...

[JohnHaganMD]

Sorry, I didn't read your post correctly and thought you were still on drops. I think you don't have to worry about glaucoma and that the tests, which should be done, will be normal, your chart should be marked 'STEROID RESPONSER"  and if you eyes are still uncomfortable ask your EYE MD to refer you to an EYE MD that specializes in cornea and external eye diseases.

[JohnHaganMD]

RESPONDER

[msmeabc]

Thnku for ur Kind Help Sir....One more question from my side sir....Is there any way to.check eye pressure without equipment....Or by which we can get any idea about the preasure of eyes

[JohnHaganMD]

Nothing that is practical. For people with bad glaucoma there is a home IOP measuring device but it is expensive, hard to use and not indicated in your case.

[msmeabc]

Ok Sir

Thanks

[JohnHaganMD]

You are welcome, best of luck

[msmeabc]

Hello sir...I tried chacking my vision in a dim lighted room using a laser gun with bright red light...Along with a friend of normal vision without spectacles...I am able to see the light at all the corners of the room...At some places  behind me i am able to see the bright red light and at others places just behind me i am able to identify the appearance too...I tried this in almost every places...In open...In small rooms and in large rooms...In large rooms my friend is able to see a little more backward than me...in close we both have same

[JohnHaganMD]

Not a very exact test. Field of vision varies some based on deep set eyes, droopy eyelid, etc.

[msmeabc]

Sir...Does eye and shoulder exercises raise OHT..

[msmeabc]

And Mobile and laptop.use??

[JohnHaganMD]

Rubbing on the eye dramatically raises the pressure in the eye. Other eye exercise (usually not helpful) don't. Shoulder and computer screens no.  IOP varies over day like the tide called 'diurnal curve"

[msmeabc]

Sir One last question....my optic nerve is nt danaged till date...So If I have glaucoma...Is it possible to stop further damage so that my vision remain unaffected stopping further damage...As I know hat damage done is nt recoverable

And What r the furture hope...Like cataract is their any hope of reviving lost vision in near future

[JohnHaganMD]

Your elevation of IOP was due to inappropriate long term steroid use. Now you have stopped and IOP is normal. You no longer have steroid "intraocular hypertension"   You don't have glaucoma, if you stay off steroids your change of regular glaucoma is about 2% for the rest of your life like everyone else.  If the steroids had caused cataracts your doctor would be able to see them. If not present not likely to develop in future again if you stay off steroids (oral, eye drops, nasal spray, injections into joints).

[msmeabc]

asir can i have ur email.id for sharing my reports test dome yday

[msmeabc]

Neuro Retinal Rim thickness
OU Sample;122
Od--440,Os-962

RNFL.THICKNESS
OU SAMPLE--60
OD--86
OS--98

[msmeabc]

HFV is Normal Sir

[msmeabc]

Sir....One Last help Required...Please Guide

[JohnHaganMD]

So your baseline glaucoma testing is normal.  My previous answers still stand, now confirmed.  1. You don't have glaucoma.  2. You are a steroid responder.

[msmeabc]

Thnku very much Sir...Just want 2 know one more thing...That These specific OCT results are normal??

In My OCT report RNFL SYMMETRY is 52% and is the only red shade area...Plz tell me about this and
Neuro Retinal Rim thickness
OU Sample;122
Od--440,Os-962

RNFL.THICKNESS
OU SAMPLE--60
OD--86
OS--98
.For one last time...This will be my final.comment

[JohnHaganMD]

Because the cup/disk ratio varies widely over populations, being smaller in hyperopes and larger in myopes a variety of tests, not a single one, is needed to make diagnosis of glaucoma.  You are young, you don't have a family hx of glaucoma, your visual field is normal. Your NFL OCT is not especially suggestive of glaucoma, your IOP was up when on steroids for an unacceptably long time and returned to normal when they were stopped.  If you are myopic and or have a larger than normal C/D ration some thinning of NFL is common.  Move on.

[msmeabc]

Ok sir.,..Thnku Very Much for ur kind help

[msmeabc]

NCT 18,15

F/U/C Steroid INDUCED OHT, pt is not on anti glaucomous e/d

O/E NSNR

Adv--Bepos e/d one month

-----------

Sir, This is my doctors diagnosis as of 2day

[msmeabc]

Srry To Disturb u again Sir...Just One more doubt...Kindly guide

In my r8 eye...The quadrants in OCT..

S---112(GREEN) N--64(GREEN).....I--99(YELLOW) and T--2(RED)

And The Picture of eye in OCT shows redness in T part....Kindly tell me what that T-- 2 means...Does it means that the nerves of that part has been damaged....Or that red part in T--2 is bcause if the redness caused by Conjuctivitis....

And After this information does ur previous stand still stands confirmed

Left one is all in green shades

Kindly Respond one last time If Possible Sir

Will Not Disturb u again

I promise

[JohnHaganMD]

No more, I will not indulge your obsessions at this point.

[msmeabc]

One Last Time Sir

Plz

[JohnHaganMD]

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[JohnHaganMD]

Ask your ophthalmologist to discuss this. I have told you all I can over the internet

[msmeabc]

Yes Sir..U have helped me a lot..Will remain grateful to u for that..Your words are giving relief thats why I was disturbing u again and again...I am extremely Sorry for that

Thnku for ur help sir

[JohnHaganMD]

you are welcome. I think it likely you will be fine

[msmeabc]

Thnku Sir

I am taking ur last Suggestion as my final diagnosis

[JohnHaganMD]

Go in peace (of mind)

[msmeabc]

Yes Sir...Peace is what I am looking for

[msmeabc]

Hello Sir..My Recent eye pressures are 18 17..do i still considered as a suspect?

[John C Hagan III, MD, FACS, FAAO]

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