Q. Does nerve fiber and ganglion cell thinning in OCT indicates angle-closure glaucoma?

Answered by
Dr. Vaibhev Mittal
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on May 26, 2019

Hello doctor,

I concern that I have angle-closure glaucoma. I took a strong sleeping pill called Trazodone one night and woke up with a decreased vision in the right eye. My left eye became bad three weeks later. It has now been three months with no improvement. Fundus and other clinical examinations are normal. However, an OCT showed nerve fiber thinning and ganglion cell thinning.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome to icliniq.com.

I reviewed your reports with patience. OCT (optical coherence tomography) of optic nerve head is normal. Your vision, color vision, visual field, and intraocular pressure are normal. I do not think you have any glaucoma. Please feel free to ask your queries.


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Thank you doctor,

Do you have any ideas to what has caused my decrease in vision? Everything has gone dim. It is like mild blurring. I have been told that my optical fibers are thinning so would it make sense that I had an attack of angle closure? Should I get gonioscopy done? I am concerned and confused.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome back to icliniq.com.

The thinning is insignificant. Glaucoma in the early stages does not blur the vision, but it affects the visual field. Gonioscopy is not required as the diagnosis of glaucoma is not confirmed. This blurring could be due to dryness. I hope this will help you.


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Thank you doctor,

I am worried having found information on glaucoma saying it can affect central vision. I have been getting headaches and feeling a lot of pressure in my eyes. I am concerned the drug I took caused mydriasis during my sleep, which blocked the angle. Is it worth getting the test to see if my angles are narrow? Or is there any other tests that I have to do? My eyes did not show any dryness.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome back to icliniq.com.

a. Mydriasis (dilation of pupils) alone does not cause angle closure in all patients.

b. Central vision is affected in the late stages of glaucoma and not in the early stage.

c. 21 mm Hg pressure usually does not cause a feeling of pressure in the eye. The headache could be due to stress, lack of sleep, or other systemic condition and not necessarily due to an eye problem.

d. I do not see any need for gonioscopy, but you can get it done for your satisfaction.


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Thank you doctor,

I think I am left with some other kind of optic neuropathy if not glaucoma. Does all optic atrophy cause blindness? Or is it possible that I have done some damage, but it would not progress.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome back to icliniq.com.

Your pupillary reflexes are normal. Visual field, color vision, OCT, and optic nerve head is normal. These suggest that there is no optic neuropathy. At the most, you can get visual field evaluation done using Humphrey visual field. This will prove beyond doubt that there is no neuropathy. I hope this will help you.


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Thank you doctor,

Is it abnormal at my age?

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome back to icliniq.com.

I reviewed the OCT reports (attachment removed to protect patient identity). Two of them are of right and left optic nerve head, and both of them are normal. One of them is of the fovea, which is also normal. There is nothing unusual or abnormal in these reports. I hope this will help you.


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Thank you doctor,

My ophthalmologist said that my report shows slight abnormalities in the nerve fibers and ganglion cells. Is this the reason why my vision is like this? I am so confused.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome back to icliniq.com.

Abnormalities on OCT are not significant. Like I mentioned earlier, you can get a Humphery visual field test done, which will rule out all optic nerve abnormalities.


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