Glaucoma or Night Blindness: Your Eye Condition

Q: Glaucoma or Night Blindness: Your Eye Condition

Dear Confused Individual： Due to the complexity of your condition, it is difficult to provide a recommendation. <br>I suggest you go directly to a medical center for an examination, as you may receive a more accurate diagnosis. <br>Dr. <br>He Jianxian, Department of Ophthalmology

Is it glaucoma or night blindness?

Hello doctor, I was diagnosed with macular degeneration during my health check-up in January this year.
Subsequent follow-up examinations revealed that I have low-tension glaucoma (my eye pressure was approximately 10-15 before using eye drops).
I have consulted two or three different doctors at major hospitals, and my eye conditions are as follows:
1.
The doctors mentioned that there is atrophy and folds in the macula, but there is also edema, which means that my macula is still flat and my vision is not distorted.
2.
My myopia is -5.50 in one eye and -6.50 in the other, with approximately 50 degrees of astigmatism.
After correction, my vision is close to 1.0.
3.
Regarding glaucoma, my mean deviation (MD) from the visual field test is approximately -7 dB, and the visual field index (VFI) is around 64%-76%.
4.
The pattern of my visual field loss is unusual; typically, glaucoma causes peripheral vision loss, but my loss is primarily concentrated in the upper central area and the outer ring near the center, presenting a somewhat irregular shape.
5.
According to the visual field test results, I should almost have no vision in the central area, but in reality, I can see perfectly well.
6.
My parents do not have glaucoma or night blindness.
7.
Currently, I have been using Bausch + Lomb's Vistadrop eye drops for two months, and my eye pressure is around 11-13.
8.
I usually have cold hands and feet and slightly low blood pressure, with systolic pressure ranging from 110 to the 90s.
9.
The conditions in both of my eyes regarding glaucoma and the macula are quite similar.
10.
One doctor mentioned that some photoreceptor cells in my retina have died, while another said my condition is glaucoma.
Some doctors noted that my case is somewhat unique, but recently another doctor suggested that I might not have glaucoma but rather night blindness.
I have been scheduled for an electroretinogram and a visual evoked potential test, but I do not yet know the results.
However, I have no issues with night vision when driving in the dark.
Could I possibly have night blindness instead of glaucoma? Or are there cases where individuals unfortunately have both glaucoma and night blindness? If it is not glaucoma and I continue using eye drops, I am quite concerned about the long-term side effects.
Additionally, could you recommend any further examinations I should undergo? Thank you.

Mi Wang De Ren, 40~49 year old female. Ask Date: 2024/04/25

Dr. He Jianxian reply Ophthalmology

Dear Confused Individual: Due to the complexity of your condition, it is difficult to provide a recommendation.
I suggest you go directly to a medical center for an examination, as you may receive a more accurate diagnosis.
Dr.
He Jianxian, Department of Ophthalmology, Nantou Hospital.

Reply Date: 2024/04/25

More Info

Your situation is indeed complex, and it’s understandable that you have concerns regarding your eye health, especially with the diagnosis of low-tension glaucoma and the potential for night blindness. Let’s break down the information you provided and clarify your concerns.

Understanding Your Conditions
1. Low-Tension Glaucoma: This type of glaucoma occurs when the optic nerve is damaged despite normal intraocular pressure (IOP). Your IOP readings of 10-15 mmHg are within the normal range, yet the damage to your optic nerve and visual field loss indicates that there is an underlying issue. The visual field loss you describe, particularly in the upper central area, is atypical for classic glaucoma, which usually presents with peripheral vision loss first. This could suggest that your condition is more complex than standard glaucoma.

2. Macular Degeneration: The presence of macular changes, including atrophy and edema, can affect your central vision. The fact that your central vision remains intact despite the visual field loss is noteworthy. This could indicate that your brain is compensating for the loss in a way that allows you to maintain functional vision.

3. Night Blindness: Night blindness, or nyctalopia, is typically associated with conditions that affect the rod photoreceptors in the retina, which are responsible for vision in low-light conditions. Given that you have not experienced issues with night driving, it raises questions about whether you truly have night blindness. However, it’s important to note that night blindness can sometimes coexist with other conditions, including glaucoma.

Diagnostic Considerations
Given the complexity of your symptoms and the conflicting opinions from different specialists, further diagnostic testing is warranted. Here are some suggestions:
- Electrophysiological Tests: The electroretinogram (ERG) and visual evoked potential (VEP) tests can provide insights into the function of the retina and the optic nerve. These tests can help differentiate between retinal diseases and optic nerve issues.

- Optical Coherence Tomography (OCT): This imaging test can provide detailed images of the retina and optic nerve, helping to assess the extent of damage and any structural changes.

- Visual Field Testing: Regular visual field tests can help monitor any changes over time, providing a clearer picture of your visual field status.

Management and Treatment
1. Medication: If you are diagnosed with glaucoma, continuing your prescribed eye drops is crucial to manage intraocular pressure and protect your optic nerve. Discuss any concerns about side effects with your ophthalmologist, as they can provide alternatives if necessary.

2. Lifestyle Adjustments: Maintaining a healthy lifestyle, including a balanced diet rich in antioxidants (like lutein and zeaxanthin), can support eye health. Regular check-ups with your eye care provider are essential for monitoring your conditions.

3. Follow-Up: Given the complexity of your case, consider seeking a second opinion from a glaucoma specialist or a retinal specialist who can provide a comprehensive evaluation of both your glaucoma and macular conditions.

Conclusion
In summary, while it is possible to have both glaucoma and night blindness, the atypical presentation of your visual field loss suggests that further investigation is necessary to clarify your diagnosis. It is essential to continue monitoring your eye health closely and to communicate openly with your healthcare providers about your concerns and symptoms. Regular follow-ups and appropriate testing will help ensure that any changes in your condition are addressed promptly.

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