Optic disc was smaller than normal. Is a visual field test necessary?

Question

Hello doctor,

I am a 70 year old male. I just moved to a new area and found a new ophthalmologist, and he said my optic disc was smaller than normal, and he recommended a visual field test, to get a baseline, should it be needed for the future. I called my ophthalmologist for the previous two decades, and he said he never bothered to look at my optic disc. From what I can find on the internet, a field vision test is used to check the progression of glaucoma, among other things, but not to diagnose it. My new ophthalmologist gave a diagnosis of low tension glaucoma, stage unspecified. He did not start treating me for it. When I questioned the diagnosis, he explained that the visual field test is the only way to diagnose it. I hate testing for the sake of testing. I am finding some articles on the internet that support the idea that a field vision test can be overused and a waste of time for a variety of reasons, including the management of glaucoma. My peripheral vision, as best I can tell is fine. I can certainly look straight ahead, cover one eye and see an object at 90 degrees. The doctor did no vision testing in his office. He only saw what he thought was a smaller than normal optic disc. He admitted this could be perfectly normal for me. My manual and online computer tests show no loss of peripheral vision. Do I really need this test?

Answer 1

Hello,

Welcome to icliniq.com.

The spectrum of the disc and the cup size is hugely variable in people. The size of the optic disc is not the only determining factor. The size of the cup, average rim size and pattern, nerve fiber pattern, and intraocular pressure, are together taken into consideration before conclusively making a diagnosis of glaucoma. A confrontation test is a very crude way of field analysis and will only be positive if a significant damage is done. Glaucoma changes are irreversible and you do not want to be misdiagnosed. Often patients feel they are being exploited, which is common for patients having glaucoma as there are no symptoms. But again glaucoma is a silent thief of sight. So a field testing will do no harm and will conclusively prove if any glaucoma damage is present. Better have a negative test and live in peace than to actually have a disease and not get diagnosed. If the internet could answer all questions, then the world would stop producing doctors.

Answer 2

Hello,

Welcome back to icliniq.com.

Thank you for your kind words.