do I even have glaucoma???

[KitMcG]

Having had elevated IOP since at least the mid-nineties, I was referred to the Glaucoma service in 2020, and diagnosed with glaucoma in my right eye in 2022. Raised pressure at my last appointment in August caused a bit of concern, though I still haven’t had an appointment to review medication.

I arranged to see my optician for some reassurance and at one point he said I was a ‘glaucoma suspect’ but the diagnosis of glaucoma might be premature. I found this fascinating, since he was the one who referred me in the first place, but didn’t have time to explore it in detail. On his recommendation I booked a private appointment at NewMedica to see Nick Wride. He also said some thing interesting…. ‘Is it glaucoma, or is it myopia?’

I’ve since done some research about this and it seems the more we find out about Glaucoma, the less we know!

[Trish_GlaucomaUK Partner]

Hello. Sometimes a diagnosis of glaucoma is not straight forward. A person may have a tilted disc or physiological cupping where it looks as though there is damage to the optic nerve, but it is just the way it has developed as a baby, although this is not common.

When you were seen at the eye clinic in 2022 the consultant acted correctly by I would imagine prescribing eyedrops to help lower the IOP and to monitor you. If a person is a glaucoma suspect they are either monitored closely without any treatment or they are prescribed eyedrops straight away if the consultant feels there is a risk of glaucoma. More commonly, since Jan 2023 due to new NICE guidelines, laser is offered.

Visual field tests done within this time would have shown if there were signs or possible signs of glaucoma by the results. The comment of ‘Is it glaucoma, or is it myopia?’ is unusual to say the least. Myopia can increase the risk of developing glaucoma, so this may be the reason why he mentioned it.

I would contact the eye secretary with your concerns and ask for clarification as to whether you have glaucoma or are classed as a glaucoma suspect.

[KitMcG in reply to Trish_GlaucomaUK]

There’s some more recent (though not that recent) research that shows a more confusing picture of myopia vs glaucoma, as unusual-looking optic discs and a similar pattern of visual field defects in some with myopia can mimic glaucoma. Check it out Trish.

Unfortunately, correct or not, letter to my gp indicates glaucoma in both eyes, so I’ve had to inform DVLA

No help ringing the eye Secretary, the line is seldom in use, hence me going private.

[Beechdown in reply to KitMcG]

I am very high myopic -15. My consultant said it was difficult to tease glaucoma and myopia apart in it's early stages. My letter says glaucoma suspect in bad eye. I have family history but different risk factors and high IOP.

[swiftsummer]

I too wonder if I actually have glaucoma. I've been diagnosed and a normal tension glaucoma suspect. I take drops to try and reduce pressure and have regular checks. But for the purpose of a travel insurance form do I or don't I have glaucoma? And for I need to report being a glaucoma suspect to DVLA when driving license renewal comes up?

[KitMcG in reply to swiftsummer]

As I understand it, if a written diagnosis of glaucoma in both eyes, you are required to inform the DVLA. I don’t actually have any glaucomatous changes visible in my left eye, but here we are.

[Eahldt]

Very interesting. I was referred by my optician to the eye clinic over 15 years ago. The consultant spent a year trying to make a diagnosis, came to the conclusion I had a weak optic nerve in my right eye which I was probably born with and was about to discharge me. (I had also always been very short sighted in that eye.) Then the field test showed signs of change and I was referred to the glaucoma consultant who diagnosed glaucoma in my right eye. My sight in that eye has certainly deteriorated over the years inspite of a trabeculectomy, cataract removal and use of drops. I was optimistic my left eye was ok as the optic nerve is normal and I couldn’t detect any signs of deterioration over the years. However, I was told at some point I had glaucoma in that eye, had a trabeculectomy and cataract removal since which I think the vision in that eye is slightly worse. Of course I had to go down the DVLA route but fortunately passed the test, My optician told me recently my eyesight has been stable in both eyes for the past two years which is good news. I go the glaucoma clinic annually but don’t hear anything so assume that’s good news. However I do still wonder about my diagnosis especially the left eye. This post got me thinking again but I guess we’re all defined by the times in which we live and knowledge of and treatment for glaucoma has improved since my diagnosis.

[KitMcG in reply to Eahldt]

I agree. As I said, the more we know the less we understand. I think there are big changes on the horizon for the diagnosis and treatment of glaucoma, but I suspect they will come from new ideas rather than perceived wisdom.

[Eahldt in reply to KitMcG]

When I had the trabeculectomy in my left eye the pressure in my right eye came down to match it and has stayed that way ever since. I had a conversation with my then consultant who referred to research into how the brain reacts. Also interesting.

[KitMcG in reply to Eahldt]

I think this is one of the fascinating things. Actually my eye pressures were quite unequal befire I started medication. Now both eyes have almost equal raised pressures. When we identify what mechanisms are going on, hopefully it will be the beginning of the end to putting horrible substances into our eyes!

[Sorshup]

An interesting conversation. The saying "the more you look the more you find" may apply. Within the past 20 years we optometrists have had the use of equipment that has enabled us to find suspicious IOPs, odd VF losses, and nerve head anomalies that indicate referral for a medical opinion. Often to the perplexity of the consultants ! I feel that glaucoma-type damage is as " normal" in the ageing process as so much esle that starts to fail. The successful control of these changes is not necessarily achievable if old Father Time has the ultimate sway ! We go back to the frustration that as much as we wish for neuroprotective medication and reliable, controllable, filtration surgery this is a continuing task for research and surgeons.

[KitMcG in reply to Sorshup]

It’s interesting that you say some changes may be age related, something I’ve wondered about. The glaucoma practitioner nearly had a conniption when I suggested as much when I was last at the hospital! This is why I feel, like many other areas of research, we may have to let go of some long-held beliefs about the disease before we can make progress in treating it.