Dr. Manjunath Natarajan
Ophthalmology (Eye Care)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My ophthalmologist said I had arteriovenous nicking in two spots in my left eye. He also said to check my blood pressure. An extensive heart test (ECG, EKG) came back normal with blood pressure measurement of 110/70. I also have checked my blood pressure consistently over the past five years and came back normal. Is there something I should worry about?
Hello,
Welcome to icliniq.com.
The arteriovenous nicking or AV crossing changes you mentioned, although present, seem quite harmless in the fundus photos you have sent me. Please do not worry about these, as they are not associated with other precursor changes of hypertensive retinopathy. I am also happy with the fact that your blood pressure and heart tests are normal. This matter of AV nicking would need nothing but periodic monitoring per se, probably once a year. I also have a responsibility as a doctor to tell you that in the photos that you have attached, the disc is asymmetric. What I mean to say is, in your photos (attachment removed to protect patient identity), there is a green computer generated circle in the center of each eye. Inside of this green circle is the dark circular optic disc and inside the optic disc is a grey or white color optic cup. The size of the optic cup is different in your eyes indicating asymmetry (also mentioned in your photo and the top center of the photo). This could be due to a variety of reasons including your refractive error, optic nerve disease or glaucoma. Kindly share with me all your previous records if your doctor has not informed you about this.
The Probable causes
Investigations to be done
Differential diagnosis
Probable diagnosis
Treatment plan
Patient's Query
Thank you doctor,
I have been tested for glaucoma using OCT and visual fields, with a negative result (ocular pressure is also normal). I have a bit of strabismus, amblyopia and double vision due to Duane's syndrome as well as astigmatism. Could these be the reasons for the asymmetry? I have also attached the full picture of the OCT that shows no abnormal nerve.
Hi,
Welcome back to icliniq.com.
I feel that the asymmetry could be congenital (from birth), rather than being due to astigmatism or amblyopia or Duanes. I feel that considering your present state, regular six monthly monitoring for the following are warranted. Refractive error assessment (for astigmatism).Strabismus evaluation for deviations in the primary position. Eye pressure (tonometry). Dilated fundus exam (for glaucoma and AV crossing changes). Visual fields test (30-2 perimetry). These are very simple and painless tests which tell us a great deal about your eye health. I am afraid there are no home remedies or preventive measures available, but just a simple monitoring of the above will suffice and will help with early detection and early treatment. I would like to see your OCT (optical coherence tomography) optic nerve head reports whenever you can send them.
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Ophthalmology (Eye Care)
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