Q. What does glaucoma suspected patient mean?

Answered by
Dr. Vaibhev Mittal
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 10, 2018 and last reviewed on: Oct 09, 2018

Hi doctor,

I had eye checkup nine months back as I had light pain in right eye. The doctor advised me to get OCT and CCT. With the test reports he said that I have glaucoma. He advised me to take an eye drop named Lumigan one drop daily at night in both eyes. I am not satisfied with his opinion and so went to another doctor. He said no glaucoma and advised to take vitamin tablet daily. After a week consulted another doctor and he said that the OCT report is normal and no need to take any eye drop. After a week I went to a famous eye hospital and consulted there. Again took an OCT and reported to have glaucoma and advised to take Brimosun 0.15% drops twice daily with a gap of 12 hours. A month later went to another hospital and the doctor said he is in confused state and asked me to check my eye regularly and take OCT for every six months. Then two months later I visited a glaucoma expert and he examined my eye deeply and done another OCT. After all tests he said I am a glaucoma suspect patient and advised to take eye drop Timolast 0.5% or Timolet od every morning one drop in both eyes. My eye pressure is always between 20 and 24 in both eyes. My first and second time CCT reports are 502-503 and 533-534 respectively. My OCT reports showed 10% area in red figure and balance in green figure in the left eye and 10% area in yellow and balance in green in the right eye. Is it necessary to take glaucoma drop? If yes, which one to take from the above? Is Timolet a highly concentrated one in comparison of Brimosun 0.15%? My mother suffered with glaucoma. I am taking Thyronorm 75 daily. Please advise me in detail. Thank you.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hi,

Welcome to icliniq.com.

First of all please relax. There is nothing to worry. All the doctors are correct. Now let me explain you.

Glaucoma is a very slowly progressive disease. You are glaucoma suspect means you are at risk of glaucoma or have many predisposing factors for glaucoma, but there is no conclusive evidence to diagnose glaucoma.

Predisposing factors present in you are as follows:

  • Family history of glaucoma (your mother).
  • Borderline high IOP - intraocular pressure (20-24 mmHg).
  • Little thin CCT - central corneal thickness (low CCT underestimates pressure meaning your actual IOP is 1 mm more than is recorded by machines).
  • Borderline OCT - optical coherence tomography (10% red in right eye and 10% yellow in left eye).

All these factors make you susceptible for glaucoma, but it is not conclusive. You should not worry about glaucoma or loss of eye sight. Having said that you can use Timolast eye drop (Timolol) or Timolet eye drop twice a day, there is no harm in using this eye drop. Some doctors give Lumigan (Bimatoprost) and some give Brimosun (Brimonidine). There is no harm in using any of these eye drops, but please use only one of these.

  • Timolast is the cheapest and best for initial stage. You can use it just for prophylaxis and just get yourself examined every six months to rule out progression.
  • One more advice is to ask for perimetry test next time. After six months, get OCT from same machine as it is very difficult to compare OCT reports from two different machines.

For further information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist


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Hi doctor,

I am really sorry to say that I had forgotten to write about my perimetry test. I also submit my field test report here. Right eye report:- Fixation target -  central. fixation losses 4/15 xx, false positive errors 4%, false negative errors 0%, visual acuity 6/6, RX + 2.5, DS DC - X. Left eye report:- Fixation target - central, fixation losses 0/0, false positive errors 4%, false negative errors 3%, visual acuity 6/6, RX + 2.50, DS DC - X. This test was done seven months back.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hi,

Welcome back to icliniq.com.

  • You have reported only reliable parameters of perimetry which shows that your perimetry report is trustworthy, but the results of perimetry will be known only if you scan them and attach them with your message.
  • Once it is done, I will interpret them and discuss that with you.

Revert back with complete perimetry report to an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist


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Hello,

As you asked, I am attaching scanned copy of my OCT reports. OCT was done from the same machine in the same hospital. I have not taken any medicine or eye drops till now. You had also asked for perimetry test reports. I asked about it from the hospital and they told me that OCT is a modern technique and when OCT is available, perimetry test is not required. I do not know what is correct. please take a look at these reports and let me know what do you think about my case. Also, I have three specific questions that I want your opinion on:

1. How is the progress of glaucoma in my eye? Is it increasing rapidly or slowly? Should I start taking medicines or eye drops? Looking at the glaucoma progress in last one year, what can happen if I do not take eye drops for another few years?

2. I have been told that glaucoma eye drops are lifelong once I start it, I cannot stop it and cannot even miss taking drops for few days. Once after I start taking drops and then I miss taking for few days. Will it harm my eyes?

3. What will harm my eyes (particular to my case) more: (a) Start taking drops and then missing for few days or (b) Not taking drops at all for next few years.

Dr. Vaibhev Mittal

Ophthalmology (Eye Care)
#

Hello,

Welcome back to icliniq.com.

You are glaucoma suspect person as I said earlier. In glaucoma suspects, it becomes difficult to say with 100% confirmation that the patient has glaucoma and so we start prophylactic antiglaucoma medicines and keep the patient under regular follow-up. I reviewed your reports and my conclusions are as follows.

A. Perimetry is the most sensitive test for glaucoma. OCT supplements the findings of perimetry but it can never replace perimetry. So next time,try to get perimetry test done also.

B. Both the OCT reports are same (attachment removed to protect patient identity). There is no progression of glaucoma in last one year.

C. OCT of right eye suggests glaucoma suspect which means that the damage due to glaucoma is not there. In left eye, yes, there is damage to optic nerve due to glaucoma but that damage is stable and has not progressed over last one year.

D. As I suggested, Timolol is a very safe and cheap medicine. In my opinion, you should start Timolast twice daily.

E. Yes, glaucoma eyedrops are for lifetime usage. If during your follow-up, we understand that you do not have glaucoma then we can stop it. But like I said earlier, left eye is more suspicious so in my opinion you should start Timolast. It is a very cheap and safe medicine. Moreover,you have positive family history, so you should start.

F. If you do not want to use medicine then you should be under regular follow up. I think not starting eyedrop will do more harm than starting eyedrop and missing the dosage.

Last of all, please do not worry. You are alright. Do not be afraid of glaucoma. You will not lose your eyesight. I hope this will answer your query.


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