Glaucoma: Key Questions and Concerns for Patients

Q: Glaucoma: Key Questions and Concerns for Patients

Hello Mr. Wang： 1. Visual field (VF) testing is a passive examination. In addition to optic nerve disorders, cataracts can sometimes also affect the results. Optical coherence tomography (OCT) is a subjective method of examination that can reveal the condition

Questions about glaucoma?

Dear Doctor,
My father experienced blurred vision in his left eye about six months ago and initially visited a local clinic.
The doctor diagnosed him with cataracts, but stated that it had not progressed to the point of requiring surgery, so my father only used eye drops during this period.
However, his condition did not improve.
He returned to the same clinic for follow-up visits, and the doctor continued to diagnose cataracts.
Eventually, feeling that something was wrong, he sought a second opinion at another clinic, where dilation revealed potential issues with his optic nerve.
The doctor recommended further examination at a larger hospital.
After being referred to Chiayi Christian Hospital, it was discovered that he has severe glaucoma in his left eye and also has glaucoma in his right eye.
At the larger hospital, visual field (V.F.) testing and optical coherence tomography (OCT) were performed, and the doctor informed us that he has almost no vision in the upper part of his left eye, while his right eye has 25% damage.
It was surprising that the previous clinic did not investigate other potential causes, as the diagnosis had solely been cataracts for the past six months.
I would like to ask the following questions:
1.
Is there a possibility of misinterpretation with V.F.
and OCT results? We have already scheduled my father for another examination at a different large hospital next month; would it be advisable to conduct another round of tests?
2.
Since my father does not typically have elevated intraocular pressure that causes swelling, other examinations were not promptly arranged.
He is currently using some eye drops to lower his eye pressure, but will his glaucoma condition continue to worsen?
3.
Is there a treatment available for glaucoma? If surgery is required, will it yield better outcomes for his eyes? I am concerned about the long-term use of eye drops and whether they may cause other side effects.
4.
In daily life, are there additional precautions my father should take regarding his glaucoma?
Thank you for your responses.

Wang, 50~59 year old female. Ask Date: 2020/10/07

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
Wang:
1.
Visual field (VF) testing is a passive examination.
In addition to optic nerve disorders, cataracts can sometimes also affect the results.
Optical coherence tomography (OCT) is a subjective method of examination that can reveal the condition of the optic nerve.
If further testing is necessary, I believe the hospital will arrange it.
2.
Glaucoma is a progressive disease, and appropriate treatment can slow its progression.
Regular follow-up examinations are essential.
3.
Surgery is indicated for patients whose intraocular pressure cannot be controlled.
If medication can manage the pressure, surgery is not required.
4.
It is important to adhere to a regular medication schedule, maintain a relaxed mindset, ensure adequate sleep, avoid excessive smoking and alcohol, limit prolonged work in dimly lit environments, and engage in moderate exercise.
For reference, you can visit: https://bit.ly/3jFshcV.
The ophthalmology department at Puzi Hospital in Taiwan operates on the following schedule: Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 2:00 PM to 4:30 PM.
Please note that online responses should only be used as a reference; it is necessary to seek care at a medical facility.
I hope to have the opportunity to serve you.
Sincerely,
Gao Pilin

Reply Date: 2020/10/07

More Info

Understanding glaucoma is crucial for patients, especially those who have been diagnosed or are at risk. Glaucoma is a group of eye conditions that damage the optic nerve, often due to high intraocular pressure (IOP). It is one of the leading causes of blindness worldwide, and early detection and treatment are vital to prevent vision loss.

1. Accuracy of Visual Field (V.F.) and Optical Coherence Tomography (OCT): Both V.F. and OCT are essential diagnostic tools in assessing glaucoma. V.F. tests measure peripheral vision and can indicate damage to the optic nerve. OCT provides detailed images of the retina and optic nerve head, allowing for the assessment of nerve fiber layer thickness. While these tests are generally reliable, false positives or negatives can occur due to various factors, including patient cooperation, the presence of other eye conditions, or even technical issues. It is advisable to have follow-up tests, especially if there are concerns about the accuracy of previous results. A second opinion from a different specialist can also provide clarity.

2. Progression of Glaucoma: Glaucoma can progress silently, often without noticeable symptoms until significant damage has occurred. The absence of elevated eye pressure does not rule out glaucoma, as some patients can have normal-tension glaucoma. Regular monitoring is essential, and if your father is currently using eye drops to lower IOP, it is crucial to adhere to the prescribed regimen. However, glaucoma can still progress despite treatment, so ongoing assessments are necessary to adjust treatment plans as needed.

3. Treatment Options for Glaucoma: While glaucoma cannot be cured, it can be managed effectively. Treatment typically involves lowering IOP through medications (eye drops), laser treatments, or surgery. Surgical options, such as trabeculectomy or glaucoma drainage devices, can create a new drainage pathway for fluid, thereby reducing IOP. The decision to proceed with surgery depends on the severity of the glaucoma, the effectiveness of current treatments, and the patient's overall health. Surgery can lead to better outcomes for some patients, but it also carries risks, including infection and complications that could affect vision.

4. Lifestyle Considerations for Glaucoma Patients: Patients with glaucoma should be mindful of their lifestyle choices. Regular eye examinations are crucial for monitoring the condition. Patients should also adhere to their medication regimen and report any changes in vision to their healthcare provider immediately. Additionally, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking, can support overall eye health. It is also advisable to manage systemic health conditions, such as diabetes and hypertension, as they can impact eye health.

In conclusion, your father's situation highlights the importance of thorough and ongoing eye examinations, especially when symptoms persist or worsen. Glaucoma management is a collaborative effort between the patient and healthcare providers, and staying informed about the condition can empower patients to make better decisions regarding their eye health. If there are any concerns about treatment efficacy or side effects, discussing these with the ophthalmologist is essential to ensure the best possible outcomes.

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