Suspected Early Glaucoma and Vision Loss: Key Insights

Q: Suspected Early Glaucoma and Vision Loss: Key Insights

Hello： Since I have not examined you in person, my response is for reference only. <br>Please consult your ophthalmologist for specific treatment recommendations. <br><br>1. <br>It appears that your fundus examination results show some changes, including the structure of the opti

Glaucoma and Visual Field Loss: The Gray Area Between Presence and Absence

Hello, Director.
Recently, during a routine eye examination (which included intraocular pressure, fundus examination, OCT, and visual field tests), the physician determined that there was some visual field loss and indicated a "suspected" early stage of glaucoma (however, when discussing the type of glaucoma, he mentioned that "my condition is at the threshold, but based on his experience and my various conditions, he feels I should have glaucoma").
Therefore, he prescribed the glaucoma eye drop Karteol 2% for pressure reduction (although my intraocular pressure was normal both previously and during this visit, below 20 mmHg), and I was advised to return for a follow-up in one month.
Although the visual field report indicated a high reliability for this test (False Positive Error was 0/10, and False Negative Error was Off), there are also claims that visual field testing may be affected by the patient's mood, concentration, and cooperation, and that one test may not definitively determine whether glaucoma is present; additionally, I subjectively felt that my performance during the test was not ideal (I seemed to be overly cautious when pressing the visual field test button and experienced some eye fatigue).
Below are the results of the various vision tests: Right eye visual field test GHT: outside normal limits (MD: -4.26dB P <1%, PSD: 2.32dB P <2%) Left eye visual field test GHT: outside normal limits (MD: -5.42dB P <1%, PSD: 4.63dB P <0.5%), with slight nasal step in the right eye.

Optic Nerve Head Analysis Results for the right eye: Rim Area: 0.56 mm², Cup Area: 0.390 mm², Disk Area: 1.45 mm², Cup/disk Avg.
Ratio: 0.78, Cup/Disk Vert.
Ratio: 0.76, Average RNFL thickness: 86 µm.

Optic Nerve Head Analysis Results for the left eye: Rim Area: 0.54 mm², Cup Area: 0.266 mm², Disk Area: 1.25 mm², Cup/disk Avg.
Ratio: 0.74, Cup/Disk Vert.
Ratio: 0.64, Average RNFL thickness: 84 µm.

I would like to ask the director a few questions:
1.
Prior fundus examination results mostly indicated "vitreous opacities, retinal pallor, elongated axial length due to high myopia, and optic nerve atrophy." I would like to know if my condition is related to these existing vision degradations, or does long-term optic nerve atrophy inevitably lead to glaucoma?
2.
Why did the physician use a very cautious term to describe my eyes as "suspected early glaucoma" but also mention "at the threshold"? Given this situation, do I have glaucoma or not?
3.
Should I seek a second opinion and undergo another OCT and visual field test? If so, how long should I wait before retesting?
4.
Compared to traditional glaucoma medications, how severe are the side effects of Karteol? If used long-term, could it harm vision, other structures and tissues, or the shape and color of the eyes (I have heard that some glaucoma medications can have such adverse reactions)?
5.
I have heard that glaucoma patients often need to use pressure-lowering eye drops for life to control vision and prevent deterioration.
If I am in the early stages of glaucoma, is there a chance that I could stop using pressure-lowering drops after treatment reaches a certain level, or am I destined to be lifelong companions with glaucoma and eye drops? I have heard that when diagnosed with glaucoma, one often feels blank in the mind; I kindly ask for your help with my eyes! Thank you very much!

Zhenhe, 30~39 year old female. Ask Date: 2024/01/24

Dr. Gao Pilin reply Ophthalmology

Hello: Since I have not examined you in person, my response is for reference only.
Please consult your ophthalmologist for specific treatment recommendations.

1.
It appears that your fundus examination results show some changes, including the structure of the optic nerve head.
Optic nerve atrophy can result from various ocular diseases, not just glaucoma.
Factors such as visual deterioration and high myopia may affect the results of the fundus examination, but a more detailed evaluation is necessary for a specific situation.
2.
The physician's use of terms like "suspected early glaucoma" and "at the threshold" may indicate that the examination results show some abnormalities, but they may not be sufficient to definitively diagnose glaucoma.
This may require further monitoring and testing to confirm the diagnosis.
3.
If you have concerns, you may seek a second opinion from another ophthalmologist for a more detailed examination and assessment.
The interval for repeating OCT and visual field tests should be determined by the new physician.
4.
Regarding the side effects and potency of Carteol eye drops, generally, side effects are not very common.
However, different eye drops may elicit different reactions in different individuals, so your physician will assess their suitability for you.
As for vision, the shape and color of the eyes will not change.
5.
The treatment for glaucoma depends on individual circumstances; some patients may need to use intraocular pressure-lowering medications for life, while others may only require short-term use.
The prognosis of treatment outcomes depends on multiple factors, including the severity of the disease and the patient's response.
It is advisable to discuss these issues in depth with your ophthalmologist to understand a more specific treatment plan.

Reply Date: 2024/01/24

More Info

Understanding suspected early glaucoma and vision loss is crucial for managing your eye health effectively. Based on your description, it appears that you have undergone a comprehensive eye examination, including tests for intraocular pressure (IOP), optical coherence tomography (OCT), and visual field assessments. The findings suggest some visual field loss, which has raised concerns about the possibility of early glaucoma.

1. Connection Between Existing Conditions and Glaucoma
Your previous eye examinations indicated issues such as vitreous opacities, retinal whitening, and optic nerve atrophy, which can be associated with high myopia. High myopia can lead to structural changes in the eye, increasing the risk of glaucoma. The optic nerve atrophy you mentioned could be a contributing factor to your current visual field loss. While optic nerve damage can occur due to glaucoma, it can also result from other conditions, including chronic high myopia. Therefore, it is essential to consider all these factors when evaluating your risk for glaucoma.

2. Understanding the Diagnosis of "Suspected Early Glaucoma"
The term "suspected early glaucoma" indicates that your test results are borderline and may not definitively confirm the diagnosis. Your doctor’s cautious approach reflects the complexity of diagnosing glaucoma, as it often requires multiple assessments over time to establish a clear diagnosis. Factors such as your emotional state, focus, and fatigue during the visual field test can indeed affect the results. It is not uncommon for patients to have fluctuating results, especially if they are anxious or tired during testing.

3. Seeking a Second Opinion
If you have concerns about your diagnosis or treatment plan, seeking a second opinion is a reasonable step. It is advisable to wait at least a few weeks to a couple of months before repeating the OCT and visual field tests, allowing time for any potential changes in your condition to manifest. A second opinion can provide additional insights and reassurance regarding your diagnosis and management plan.

4. Side Effects of Karteol
Karteol (carteolol) is a beta-blocker used to lower intraocular pressure in glaucoma patients. While it is generally well-tolerated, potential side effects can include ocular discomfort, dry eyes, and systemic effects like fatigue or bradycardia. Long-term use of any glaucoma medication should be monitored by your eye care provider to ensure that it does not adversely affect your vision or eye health. It is essential to communicate any side effects you experience to your doctor.

5. Long-term Management of Glaucoma
Glaucoma is often a chronic condition requiring lifelong management. While some patients may achieve stable IOP levels and maintain their vision with treatment, others may need to continue medication indefinitely. The goal of treatment is to prevent further damage to the optic nerve and preserve vision. Your doctor will monitor your condition closely and may adjust your treatment plan based on your response to therapy and any changes in your visual field or optic nerve status.

In conclusion, it is vital to maintain open communication with your eye care provider, adhere to follow-up appointments, and report any changes in your vision. Understanding your condition and the rationale behind your treatment plan can empower you to take an active role in managing your eye health. If you have further questions or concerns, do not hesitate to reach out to your healthcare provider for clarification and support.

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