Dr. Asha Juliet Barboza
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
Hi doctor,
I am a 31-year-old male. I was referred to an optometrist when my eye pressure was high during the eye examination. The optometrist conducted a variety of tests such as visual field test, dilated eye exam, and took photographs of the back of my eye. In the end, she concluded that everything is fine but the appearance of the right eye's optic nerve is unusual. She asked me whether I have done any brain scans. I told that it was done before 14 years. I do not have its full report. But I have some images and I have attached them.
Hi,
Welcome to icliniq.com.
I have gone through the reports (attachment removed to protect patient identity). Please mention your intraocular pressure. The reports suggest that you have a large cup to disc ratio in both the eyes and it indicates glaucoma. It is also seen in normal circumstances called physiological cupping. If the eye pressure is above 21 mmHg, then you can have ocular hypertension. Retinal nerve fiber analysis also indicates an early loss. Glaucoma is diagnosed based on many factors such as high intraocular pressure, large C D ratio (cup to disc ratio), loss of RNFL (retinal nerve fiber layer), and visual fields. In your case, the visual field looks normal and they are not typical of glaucoma. Repeat visual fields and OCT (optical coherence tomography) after six months. If it is glaucoma, the pressure is controlled by taking medications as there are many types available to control it.
Patient's Query
Thank you doctor,
I do not know the intraocular pressure measured at the optometrist's office. But I have noted it. The intraocular pressure was R23 and L29 measured with an NCT. At the age of 23, when I was getting contacts, my eye pressure was high. After that, I did several tests. The ophthalmologist told me that I do not have glaucoma at that time. I am trying to retrieve the results. Gonioscopy was done this time and I have attached it. My optometrist told me that she does not believe that I do not have glaucoma as there was some greyness noticed in my right eye's optic nerve. Is there anything that helps to determine glaucoma by an ophthalmologist? Do you suspect any issues in the brain?
Hi,
Welcome back to icliniq.com.
Having an IOP (intraocular pressure) of 23 and 29 is high. I went through the attached report again. There is a difference present between the right eye and the left eye. An ophthalmologist is a correct person to diagnose glaucoma. If your IOP is high from 23 years of age, then you should start using anti-glaucoma eye drops for ocular hypertension. The thin line present between glaucoma and ocular hypertension is visual field loss. For brain involvement, MRI (magnetic resonance imaging) can be done. I have seen similar looking optic nerve in people who had head trauma in the past. But there will be a profound visual loss. I presume that your vision is perfectly fine. A high IOP with optic nerve issue occurs most often due to a local issue rather than the brain. Have immediate appointment with a glaucoma specialist to treat it.
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Ophthalmology (Eye Care)
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