As I did not feel my eyes were quite right, I went back to the GP and asked for the dose to be put up. She arranged an emergency appointment with the eye doctor at the hospital. They performed all the test and decided it was just the cataracts being disturbed. The eye specialist there also checked the pulse in the arteries. He said there was no sign on any inflammation there and my symptoms were not bad enough for GCA. My dose will not have to go up. I will however be called back for more eye tests and blood test in the next couple of months I am quite happy with this outcome.
My main point is, Should all people with PMR be screened for eyes the same as diabetics?
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keepfitdoll
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I think many of us do frequent the opticians as sight does alter with pred. Mine deteriorated during the first two years, now is apparently heading back in the other direction! Plus I have new cataracts, but no one will commit to saying they are pred induced as I ‘might have got them anyway at my age’.
I get my opticians to check my eyes thoroughly because of PMR & pred, and they have a THOROUGH check of my retinas and it’s health. Plus pressures and field of vision in case I have any blind spots.
I was worried about a new headache a couple of months back, specifically around my left temple with lightning shooting pains. I went to my optician under the NHS MEC (minor eye condition) scheme, they did a full exam for free, then sent a note to my GP suggesting check ESR. My GP did nothing, but that’s another story! (Headache cleared and was likely due to low oestrogen)
It is important to check your ESR levels. How do you know if your inflammation is building up otherwise. Do keep asking the GP otherwise some of them don't bother Mine were quite good.
I’m one of the 20% that never had raised inflammatory markers. So fairly pointless. My rheumie checks them each visit, but results are not something I can rely on.
It is not in the protocol and it should be. I have initiated my own with a very well equipped Ophthalmologist locally, every few months. I’d rather be proactive than reactive, because of the potential for accelerating the development of cataracts, if nothing else.
Everybody on pred should have an annual eye screen - it was provided for in the past but now it is 2-yearly. Here I have to go to the hospital eye clinic - but there has been no change in anything at all in the 9 years I have been on pred. My pressures are still mid teens and there is no sign whatsoever of cataracts (less pleased about that - would like to get rid of one lot of specs!!!
I am curious PMRpro can an ophthalmologist 'decide' there is no GCA because they cannot observe sufficient 'inflammation' and/or by just checking the 'pulse' in the arteries - wouldn't this amount to another kind of diagnostic 'tool' for GCA ?
If there has been long term reduced arterial blood flow to the optic nerve they should be able to see the effects of that - but that doesn't identify GCA in any other place besides the blood supply to the optic nerve.
What worries me about that though - ie. the effects of a 'long term reduced arterial blood flow' is that it would only be relevant if someone had had GCA for a 'while' at least and maybe not very evident in initial stages. When I first had several classic GCA symptoms an ophthalmologist I saw was dismissive of even the possibility I had GCA as he said my optic nerve looked 'OK'. This seems crazy to me as we shouldn't have to get to a damaged optic nerve stage before a diagnosis - as well as the fact (as you mentioned) that GCA can exist in 'other places'
You aren't going to see the effects of a "stroke-like" blockage until it happens - but you MIGHT see the effects of "angina-like" reduced blood flow and that was what he meant. Reduced blood flow like that leads to the optic nerve paling and swelling a bit - but it requires luck in being there at the right time.
There simply isn't the technology without doing a biopsy - but even then, you have to know where and you can't do them on large vessels or in the brain except in the context of a major operation.
They seam to wait until things are really bad before they do anything. Does seam the wrong way to go about it.
I’m pleased it wasn’t issues with GCA & well done your GP for taking prompt action in referring you.
A lot of us complain about changes to our vision, mainly caused by the Pred. I had my eyes tested more often & actually had a pair of middle distance glasses made up as l could see well enough in the distance, read OK without my specs but anything hand distance away was very blurry & also my eyes had to adapt after l’d been reading if l wanted to look at the TV but it passed after l reduced the dose.
My eyes have been all over the shop regards focus and adapting quickly to change in field depth. But unlike my GCA eye symptoms. I’ve had my pressures checked every 3 months and the whole lot checked every 6 months for the first 18 months but now annually. It has all improved with lowering of dose and especially below 10mg.
I suspect blood sugar up and downing impacted on eyes. I certainly suffered blurred vision at 10mg & above. I waited 2 years to gets eyes tested, though i did have my diabetes checks and photos taken.
I was diagnosed borderline Type 2 Diabetic in 2014 and have controlled my blood sugar levels (as measured by HbA1c tests) by diet alone since then. However, the diagnosis did mean that I was invited every year for a free retinopathy exam at the local hospital eye unit, on top of my annual eye tests at my local opticians and 6-monthly checks just for my contact lenses. I was therefore having regular checks anyway for cataract, glaucoma, field of view etc.
Following a new diagnosis of PMR in March this year, and Pred at 15mg a day, I have talked things over with my optician, He suggests more regular eye checks, at least 6-monthly, while I am on Pred. I, too, have noticed some blurring especially at low light levels and when driving at night. Worrying, but a new test at the opticians (3D OCT screening) which I have to pay for has set my mind at rest about macular degeneration, glaucoma, vitreous detachments, macular holes, as well as cataracts which can develop faster when you're on Pred, especially if already diabetic.
GP's won't usually mention any of this. Even if you do not wear glasses or lenses and don't see an optician regularly, I think it's vital to start 6-month checks as soon as you are diagnosed with PMR and put on Pred. I simply can't imagine living without sight - I'd rather suffer pain than blindness any day !!
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