I have “normal pressure glaucoma” AND as a bonus l, narrow angles

[SkinNBones]

Hi everyone. - this was first noticed on an oct scan (i went for a macula scan and they did the wrong obe!) that i had retinal nerve fiber layer (rnfl) thinning especially left eye. Also in that eye , optic nerve “cupping”. Pressures at lower end of normal When i close each eye, bith brightnesses and color are different.

But i feel like i am being sent down the wrong rabbit hole. Glaucoma experts seem to mostky know about increased pressure glaucoms. And because i have many other symptoms, both visual and otherwise, i wonder about ischemia secondary to an artery issue, either inflammation ir spasm and id guess artery back of head (basalar?) but perhaps others Ive described the other visual symptoms eksewhere. I guess i can here too but they sure do not seem like glaucoma symptoms to ne. Perhaps am wrong so i will look thru everyones posts for any odd visual symptoms. The neuroopthalmologisr is mostly blowing me off. Says well there are rare things - as if that means i csnt possibly have them! And says just go to a glaucoma specialist. I have but Long story

Anyway looking to connect with otgers wo also have a diagnosiis of normal pressure glsucoka to read about yiyr journry and treatment choices. Right now i am on no nedication for it.

i have refused a gonoscope and have asked for another visual field test since my last one was before the pandemic Long list of med issues so right now going to a different specialist for each body part is very difficult.

[Beecalmed]

Hi SkinNBones!

I’m not clear from your post sorry! You either have narrow angles or you don’t, I’d have thought. If you have narrow angles then you would receive a treatment of laser and possibly pressure lowering drops. Narrow angles are more likely to create an emergency situation, so the guidance has always been to treat proactively usually with laser. Unless that protocol has changed recently?

If you have NTG you may need very low IOPs to attempt to stop progress. The focus will still be on eye pressure just much lower than general open angle. Regular OCTs will check for retinal bleeds, which often accompany NTG and thought to be a precursor in some to vision loss near to the site of the bleed. This has happened to me .

I can’t advise you on your thoughts about ischemia as I have no experience of this. Have you considered seeing a private consultant for glaucoma? If they suspect ischemia I’d have thought they’d refer you to a specialist for that.

Lastly it could be a systemic issue as you say. I have similar thoughts about my glaucoma, that it’s part of a bigger issue in my body related to blood perfusion. But you must get glaucoma treated in the traditional manner whilst you look for other possibilities and solutions. Don’t not treat the glaucoma! I was diagnosed late and lost vision. If you don’t have treatment and you have glaucoma you could be risking your eyesight. I’m trying all sorts of things but I stick rigorously to my consultants treatment plan for me too. 👍🏻

[SkinNBones in reply to Beecalmed]

Very helpful, thank you. To clarify, I have been told I have thin angles but apparently not the cause of the optic nerve cupping abd rnlf thinning.

until the pandemic, i was getting octs regularly which started because of a partak thicckness macular hole- another mystery. So far no bleeds that i know of but its been a while. The last time i had not only octs of mscukar and nerve fiver layer but also the extensicmvevone thst looks at the vlood vessels. But after all that or perhaps from a dilating drop (which i almostv never get) it aggravated some nerve i think trigeminal and i really dont want sny more octs for a while

I had heard that too- thst even tho not caused by increase pressure, they still reduce pressures and its the only treatment available.

Interesting you suspect a general issue also, in yiur case perfusion.

Curious how often you get a visual field test and if you got side effects from the drops i react very badly to meds so its one of the big obstacles Does your glaucoma expert seem knowledgable to you about your type of glsucoma?

Thanks again for your help i see theres one other reppky. Today is day 3 of a migraine i dont usually get so has to wait (tho not surprised if somethibg going on in nerves on left side of face has something to do with the NTG

[Trish_GlaucomaUK Partner]

Hello.

Thinning of the nerve fiber layer happens as we get older plus it is associated to glaucoma. Your Neuro Ophthalmologist can only deal with the neurological side of things. Some neurological problems can affect your vision as you are probably aware. They were correct in referring you to see a glaucoma specialist.

You mention you are not on any medication, which doesn't make sense as you say there are signs of cupping, which can indicate glaucoma damage. Very rarely it could be physiological cupping where the optic nerve looks damaged, but isn't. It is just the way the optic nerve has developed from childhood.

The only reason a consultant would not offer treatment for glaucoma, would be if they felt the patient is a glaucoma suspect and want to monitor them closely before offering any treatment. Another reason would be if the patient declines treatment. The consultant cannot force a person to have treatment but they make them aware of the risks to their vision if they don't, but will still want to monitor them.

A person can have narrow angles with an eye pressure well within the normal range which is 10mmHg-21mmHg

If they feel an MRI is necessary for further investigation they will arrange this.

Everyone with glaucoma is different. There are no two people the same.