Can an optician see if I have GCA during routine eye test ?

[Tiny_Tim]

I have been on steroids since March when I was first diagnosed with PMR .I am currently tapering over a month down from 9 mg to 8 mg . I have noticed that my sight is quite blurry ( I already had a small cataract in my right eye ) I am a migraine sufferer and have always had some muscular problems in my neck , so I am getting confused as to whether pain in the neck and shoulder ( left side only ) could be GCA . I have booked to see an optician ..can she see if there is a problem during the test ?

On another matter I am still feeling extremely weak ...not a great deal of pain, but if walking out and about I get quite frightened as it feels as though my blood sugar is low ( had recent tests for various things including diabetes and bone density but this did not show any problems ) it is not exactly fatigue , but extreme weak and wobbly symptoms .Has anyone had the same problem ?

Tiny_ tim

[Celtic PMRGCAuk volunteer]

Tiny_Tim, blurred vision can be caused by the steroids themselves as well as the cataract you mention. Providing the optician is a good one who uses the appropriate equipment to look at the back of the eye (ie not one who just dispenses specs), s/he should be able to see the optic nerve and rule out any sort of halo appearance suggestive of GCA affecting the temporal artery. I had the back of my eyes checked by a good and caring optician fairly regularly in the early days with GCA just for reassurance when the blurriness was at its peak.

It is quite usual to feel "weak and wobbly" both prior to PMR diagnosis and in the early days of treatment. Certainly, my legs were at their wobbliest, feeling as though they might give way, during my days of undiagnosed, therefore untreated, PMR, and this continued at the high steroid doses but was not so much of a problem at the lower doses. I would hazard a guess that you are on slightly too low a dose for you at this moment. Have you tried increasing back up slightly for a week or two to see if there is a difference in your symptoms?

[SheffieldJane]

Hi Tiny-Tim,

A well equipped Optician can see a lot more than your GP but again with this condition the most reliable diagnosis is made by your symptoms I believe.

I have been through phases of "weak and wobbly " sensations with PMR. I feel much stronger now on a lower dose of Pred and following a measured walking programme. I can even hop up on to my sofa to reach my blinds.

Pred can cause anxiety amongst other delights, try to go with it and nod it past knowing that it is not you, just the drug. I was worried about this symptom limiting me further but it hasn't.

This too will pass.

[PMRpro Ambassador]

Lots of people feel weak and wobbly - partly PMR, partly pred sometimes both. Some people found that taking their pred at night allowed that phase to pass while they were asleep and when they got up they were fine. Using a walking stick may make you feel more confident.

As Celtic has explained, it depends on the test. If they put drops in your eyes to be able to examine the back of the eye, so they can see the retina and the place where the optic nerve joins it, then they MAY see changes in the appearance of the optic nerve. But that is a longer term effect of reduced blood flow and may not always be present. If it is there it needs further investigation as there are other causes besides GCA. But not being there isn't a total rule out.

If your only real complaint is shoulder and neck pain on one side I'd suspect it is muscular and not GCA - if you have a cataract that will cause blurry vision too. And someone this week has mentioned her optometrist thinks that her double vision is due to PMR affecting the eye muscles.

[englishrose417]

I am on 20 mgms Prednisone coming down from 60 mgms in March. I have blurred and double vision for most of the day. I had cataracts removed 10 years ago. I saw my optician 2 weeks ago had a visual field test which was OK. My pupils were dilated and he did a really good examination of my eyes and found everything OK and put the problem down to Prednisone. I see my Rheumatologist tomorrow. He is a believer in Methotrexate I have been on 15mgms each week since March. Having read some comments here I am skeptical and even more so when he tells me he will have me off Prednisone in a year. Again having read others experience on getting off Pred one of us is in cloud cuckoo land and it's not me. I will take a copy of the slow method of cutting down on Pred and see his reaction.

[PMRpro Ambassador in reply to englishrose417]

If he really has all his patients off pred in a year - I wish he'd write a paper with facts and figures. Because frankly - I don't believe him.

[HeronNS in reply to englishrose417]

Englishrose, I looked up side effects of mtx, and one of the less common ones can be blurred vision.

[englishrose417 in reply to HeronNS]

Thank you for that piece of info, never thought to research it just put it down to the Pred.

[jinasc in reply to englishrose417]

Go to your in box I have sent something to help you with your Rheumy, it will be published in the Summer 2017 Newsletter of PMR&GCAuk North East Support. It is at the printers and hopefully it will be distributed within the next two weeks.

It is an article re reduction plans and a bit from a Lead Researcher for PMR & GCA.

[englishrose417]

Having found this forum a couple of months ago I have said I am skeptical about his time line. I am sure I will be around this site for more then a year and we will see how long it takes me to get off Pred. I see him tomorrow so I will up date you.

[Mary63]

You mentioned that you had concerns that your blood sugar was low. The routine diabetes (blood sugar) tests check whether your blood sugar is HIGH.

Low blood sugar levels can occur even if you are not diabetic, And these symptoms are common....dizziness, irritability, shaky, possibly headache, ...best way to keep blood sugar levels steady is to massively reduce sugar and carbs, and look at GI content of foods. You can get an app, or read a book. Hope this helps, but obviously your symptoms may be down to what other people have mentioned above.

[1602]

Hi Tiny Tim

a good optician can see a lot during the tests - it was my optician who found my symptoms and referred me immediately to an eye consultant. Good Luck

[S4ndy]

Hi Tiny Tim, my optician takes a digital image of the back of the eyes including the optic nerve. He then compares and looks for changes or anything amiss. No changes so far I do get visual disturbances and dry eyes but gp and optician both think its drug side effects. Again I am lucky in that my optician knows about PMR/GCA and has been keeping my gp up to date with eye pressures etc. I've been seeing him for many years too so he has been with me before and during my PMR journey. Wishing you well.