Q. Can you compare two images of fundus and tell me if there is progression?

Answered by
Dr. Rahul Vaswani
and medically reviewed by Dr.Lekshmipriya B
This is a premium question & answer published on May 25, 2018 and last reviewed on: Jan 29, 2022

Hello doctor,

I need a comparison analysis of two fundus photos to check whether they show signs of progression or not. Patient is on Xalatan, Timolol, and Dortas. Kindly help.



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I had gone through the photographs (attachments removed to protect patient identity). There seems to be a very slight progression. But to conclude based on fundus photographs alone would be incorrect. One of the most accurate ways to judge progression is field analysis done on Humphrey field analyzer. All the known patients with glaucoma need to get their intraocular pressure (IOP) checked every two weeks, and their target IOP is maintained then. The fields should be done yearly, at least. In conclusion, there is a very slight increase in the cup-disc ratio from the above pictures, but more information is needed to conclude. Please do get the latest fields done and send them to me.

Hi doctor,

Thank you for the reply.

Kindly let me know the difference between the eye pressure of the normal eye and one with glaucoma has to be in what range? Her pressures are normal. I have a home tonometer to check, but diurnal fluctuations are high.



Welcome back to

The pressure of a normal eye ranges between 10 mmHg to up to 21 mmHg with an average of 16 mmHg. In a patient with glaucoma, the treating doctor decides a target pressure (defined as a pressure where progression stops) which is usually kept in lower teens, for example, 12 or 14 mmHg. But, that is very subjective. Some may need to lower their IOP to as low as 10. We judge by serial fields examination when we start the medicines and decide the target pressure. The following are the tips to reduce pressure fluctuations:

1. The timing of the drugs: Xalatan (Latanoprost) 9 PM always, Timolol 7 AM and 7 PM, and Dortas (Dorzolamide) 8 AM, 2 PM, and 10 PM. After instilling the drugs, do not squeeze the eyes; just close them gently. Hold the junction of the eye and nose with fingers for one minute after instilling the drug so as to increase the contact time of the drug with the eyes.

2. Your future option: If the IOP is not controlled by three drugs even after taking all the measures I had mentioned, then one has to think about going for surgery to achieve the IOP.

What is her IOP?

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