On a recent trip to the opticians, my wife (56) was referred to our local eye clinic with narrow drainage angles. Her ocular pressure is ok and there are no other abnormalities.
The referral was quick and she had an appointment at the clinic within a few weeks. After the prerequisite tests, she was seen and examined by the specialist ophthalmologist. Again, no specific abnormalities but she has narrow angles - how narrow was an unknown at this point.
Now, this is where it gets tricky. Is my wife a primary angle closure suspect? She has no other risk factors. Apparently, pre Covid, they would have recommended a laser peripheral iridotomy. However, the NICE guidelines have changed following the Singapore ANA LIS Trial. The overall risk of progression from narrow angles to primary angle closure is low. The initial prognosis was to leave it and just monitor the situation.
He elected to conduct one final ‘scan’ taking a complete image of the eyes - front to back. This was then discussed with the consultant ophthalmologist. Following the review with the consultant, he then pulled up data from the Singapore study. He pointed out that some my wife’s scan stats were lower than the 3rd group in the study indicating she has narrow, narrow angles or very narrow. Given this information, the recommendation was changed and a prophylactic laser iridotomy should be conducted.
Gauging individual risk is difficult. Has anyone else encountered this situation? My wife is squeamish about her eyes and doesn’t relish the treatment unless it is necessary.
Thanks
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Hi - just a fairly quick response as my case is very similar to that of your wife . My optician contacted my doctor , and I then had a hospital referral for Suspected angle closure ( narrow angles ) . They checked my eyes using gonioscopy ( which didn’t hurt at all), and then I was offered YAG - iridotomy. My eye pressures were on the high side of normal . All I can say is that the laser treatment was fast, pain free and with no side effects . I was happy to err on the side of caution, whatever multiple studies were saying/ concluding… I think the main thing is to keep getting your eyes checked and monitored, but as someone who is very squeamish, I had no problems with the laser iridotomy .
I was diagnosed the same two years ago , my pressures were slightly up at 23/4 when opticians referred me .
I had the basic checks done by a virtual clinic , so just the technicians , no consultant , had to wait for results ,which was a angle closure suspect .
Next appt was a gonioscopy , where I too was told they no longer do iridotomy as routine . Mine would have been monitored, but as diabetic which requires yearly pupil dilation for my retina screen , ( dilation is not good for narrow angles ) that it was in my interest to have one done on both eyes at same time.
It was ok, though took longer , as one eye he struggled with and had to use another laser . I did have a bleed , but he just pressed on my eyeball and it stopped .
Recovery was fine, no issues .
Had follow up and discharged back into the care of opticians . Just warned about angle closure symptoms and if I got these to go to A&E ( dreading that as look at the state of A&E and the huge wait )
My pressures were raised a bit though when I was checked last year 23/4/5/6 at opticians , she did them again , telling me to relax and them came down a wee bit , also had a OCT scan. Opticians was happy with this and said I didn’t need re referral.
Due again in Jan , just hoping my pressures are not up 🤞🏻
Hi, I was also offered a laser iridotomy last week. Currently, my pressure is normal and i have no sign of glaucoma. But, I am having headache, nausea and eye pain everyday. Did you have any headaches or any symptoms leading up to your appointment with your optician? Thanks
None whatsoever. I was really shocked to be referred as didn’t have a clue about narrow angles. Was also worried re the glaucoma side too. I didn't have it , but at risk of developing it as narrow angles can cause pressure rises and I have a half sibling with glaucoma .
It took me awhile to not think about it and get on with life.
But when my yearly opticians is due it brings it all back and I worry about my pressure and if any changes .
I have the diabetic retina screening in Jan too , same month . I dread that as they dilute pupils , I just pray it doesn’t bring on an attack .
Being diabetic we have to worry about retinopathy too, another that causes blindness .
Hi, I was diagnosed with closed angle at a routine visit to optician. Referred to hospital where I was told I needed laser treatment. Like your wife I am squeamish about my eyes. When I said I couldn't say yes to this (literally I could not say yes, so scared) he said he would see me in 2 months and see what I had decided. I decided after thinking about it nonstop that I should have it done. I went back to consultant, and he discharged me, just like that! I went back to optician who referred me to another hospital, advising that laser treatment should be done. This time I was told by consultant that they no longer referred everyone for laser treatment, preferring to monitor the situation in some cases. That meant in my case "yearly" check ups! But it does seem that there really is not enough time taken to explain things to patients. It also seems that the preference now is to not do laser surgery if pressures are not high. It is a decision that only your wife can make, going on the advice of her consultant. I wish her well and I'm sure she is braver than she thinks.
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