Dr. Souhad Abdulhalim Lawand
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,
Please see below a report of my interactions with eye doctors in the last 21 months. This piece also includes further information under preambles, and questions, under the problem. Before two years, my optometrist advised that I see an ophthalmologist after examining the back of my eyes. He said my eye pressure was high, and I think 14 or 15. I also told him I had been seeing tiny flashes on waking up since about one month or two. The ophthalmologist, after examining me said my eye pressure was okay, I think it was 12, and he was comfortable with the back of my eyes. He asked me to do a CVF (copy attached). He said the CVF report is ok, the few black spots are nothing to worry about, they may also be false. He put me on Ivyxolotl (Betaxolol hydrochloride) and asked me to come back in six months. Last year I told the ophthalmologist that the flashes had stopped. My eyes were examined, I was asked to call in in 6 months again, and to continue using Ivyxolotl. He said I am a glaucoma suspect. The CVF was repeated. (The copy is attached). Before three months in the same hospital, a different doctor said I have glaucoma as the back of my eyes is cupped. Asked me to repeat CVF, and should continue using Ivyxollol. My eye pressure was 10.Before two months, I did the CVF test but now started to consider getting another hospitals opinion, since it appears this hospital is giving me contradictory opinions. 1st doc says I am not a glaucoma patient but gives me glaucoma meds, 2nd doc says I am a glaucoma patient. (Same hospital). Before two months I sought the opinion of another ophthalmologist in another hospital; After back- of- eyes examination and OCT, he told me, you do not have glaucoma and stop using Ivyxolotl in the meantime. Last month I woke up with a feeling that there is a shaded area in my vision. Second hospital doctor checked for retinal detachment, was convinced that was not happening, asked me to come back in three months. It is reiterated that I do not have glaucoma. Still the opinion that there is a shaded part of my vision, I saw the first doctor, who also reiterated that I am a glaucoma suspect, not a patient. He advised me to continue using Ivyxollol. Eye pressure was 12. Could not communicate to him that I would have stopped using Ivyxolotl, about two months earlier, before the session ended. A grandfather and his brother lost their visions in their old age, and two uncles have also been having problems with their visions. They are in their late 70s. A tennis ball hit me very hard on one eye about 20 years ago. I saw an ophthalmologist then and never had any problem with it since. The problem now is not knowing what to do with Ivyxollol since I now have two differing advice from two ophthalmologists. Wanting to be sure that what I feel I see from the corners of my eyes when I roll my eyes one way, and the other is normal. Is there a site, or a write-up that can take one through a total spectrum of what is normal for a perfect eye to see? Wanting to know if there are other tests I should be doing now since the general advice about eye health and vision is that most problems can be prevented if detected earlier Wanting to know for sure the lifestyle steps or changes I might need to take now to enhance my eye-health at this point. What are your recommendations?
Hello,
Welcome to icliniq.com.
Unfortunately, I was not able to see any attachments, but I understand your frustration about your diagnosis and recommendations. To start with, all the eye pressure measurements were within normal values but that might be insignificant in case they suspect normal tension glaucoma. The main problem is that suspecting glaucoma in a patient is the best way to treat it if detected before it does irreversible damage to the optic nerve. However and to suspect it, the patient must undergo a set of diagnostic tests, visual field tests, gonioscopy, and the primary test is optical coherence tomography along with measurements of the eye pressure twice a day within three days. The only way I could assist you with proper advice would be to see those tests. As for Betaxolol, I would have monitored you and your eye pressure before prescribing it. The only way to know whether it was effective is to do an OCT while using them now, stop them for three months and do another OCT for comparison.
Patient's Query
Thank you doctor,
Thank you for your reply. I planned to send the reports with the query. I believe I left the question as a draft so I could attach the test reports, but was glad to get a fast response from you. The results are now attached. I hope you get them. The attachment includes a most recent CVF, done yesterday, and it seems to me that these reports have much less dark spots than the earlier CVF results. What is the implication of this? Could you please explain what the OTC result means. Unlike the first doctor who has wanted me to be on the drops ever since, the other doctor does not want me to use any drops until my next appointment with him, late next month. What is the benefit of staying off the drops now? In your opinion, does the benefit outweigh the risk? I do hope your response will help clarify matters better. After drafting this reply to you I could not send it immediately, however, right now I am experiencing something on my left eye. It is twitching, since yesterday night. Before it appeared, I was having some scale type of thing on it, but now, is twitching. I also have a feeling that some part of my vision is shaded.
Hello,
Welcome back to icliniq.com.
I went through your reports and to tell you the truth, and it does not look like glaucoma to me. The visual fields that were done before two years are not that dependable, and the following reports show no significant changes characteristic to glaucoma. At last, the confirmation was in the optic nerve scan, which showed good symmetry in shape and form of the optic nerves without any damage to essential tissues emerging from it and that further diminishes the diagnosis. I would continue with the doctor that wants you off the drops and don't worry about you not being on eye pressure lowering agent. No significant damage should happen. The doctor wants to confirm whether the eye can withstand and deal with the current pressure on its own and without help, and two to four weeks should be enough time. Once he confirms that the pressure has not shown any adverse effect, then he will start monitoring you once a year and conduct the same tests and compare accurately. As for the eye twitch, there are many reasons for it but mainly is due to lack of sleep. In addition to that, the use of eye drops that have preservatives may cause dryness of the eyes, and that will lead to dryness of the eyes. Try using artificial tears four times daily for ten days, and if you feel that you have dealt with the situation, then continue. Do not use artificial tears before going to sleep. Please describe the shaded vision continuous, short-term, in one or two eyes, does it move and if yes in the same direction of your gaze or it follows it? Are you on other systemic medications and for what illnesses?
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Ophthalmology (Eye Care)
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