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Mama Deb
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Mama Deb [userpic]

Good thing I'm a touch-typist, because I can barely see at the moment. I have the font for my browser cranked up to 10 - not quite 11. That's because I just came from the opthamalogist and they dilated my eyes.

So forgive any typos - I can't see them.

I went because 1. I't's been a couple of years since my last exam and 2, wiith my diabetes kicking in like this, I need to get a baseline exam before things go wrong. And it needed to be done by an opthalmologist, not an optometrist.

My eyes are basically fine - no sign of diabetic retinapathy or macular degeneration, no sign of cataracts or glaucoma. I *am* a bit more nearsighted, but not enough to get a new prescription. Also, he believe that as my blood sugar levels improve, so will my eyesight. Thus, no need to get new glasses. Since this change is very recent, I'm inclined to go along with that. I made an appointment for next year.

There was one odd bit - he said my optic nerves looked like I had glaucoma, but I don't. And he took a picture of them for the record because of this. I never got the chance to ask him why - Jonathan called and then I needed the picture.

Does anyone here have any idea what that would mean? My grandmother a"h had glaucoma.

After googling: Okay. My optic nerves apparently have a larger than normal "cup" at the ends, which would indicate glaucoma if there was also other indications - being very thin or sloped - but not in my case. However, he took the pictures for future reference, in case it changes. Okay. That makes sense. Human variation vs. diagnosis.


I think I can answer this, having both glaucoma and a medical background.

It's entirely possible for your optic nerves to show signs (cupping, it's called) of glaucoma, but for your intraocular pressure to be within normal range at the time of your exam. The pressures are typically highest when you first wake up and again in the late afternoon. Your eye doc might want to take your eye pressure readings at different times, as well as do tests such as corneal thickness and visual fields to see exactly where you stand. If your corneas are thick, your eye doc can knock off one whole point per pressure reading per eye. If your visual fields show deficits, then that would confirm glaucoma but with normal pressure readings it would be a very slow progressing form of open angle glaucoma. It's easily treated with either drops or pills, and definitely best to catch it *now*.

I have glaucoma (and not a medical background). My opthamologist prefers that I make my appointments at a consistent time of day so the readings can be directly compared; she's less concerned about when that time is. Last year for the first time she measured the thickness of my corneas; turns out they're thick so my pressure isn't as bad as we thought it was (though it's borderline anyway -- usually measures 20).

For decades (I was diagnoed when I was a child) I thought glaucoma was defined as high pressure in the eyes. More recently she told me that no, the definition is in terms of the damage to the optic nerve, which is caused by the high pressure (usually). (Does that track with you, or have I misunderstood what she said?)

I've been taking eyedrops for this since I was 11 and the numbers have stayed pretty consistent, so if you do develop this, mamadeb, it shouldn't be hard to deal with. More impact to your wallet than to anything else, and you do get used to putting drops in your eyes without flinching after not too long.

I'm not especially worried, since he didn't seem to be, and my next appointment is next year.

Eye drops also not a problem. I used to wear contacts, after all. But at this point, there's no indication that I'll need them.

I didn't mean to suggest that you should worry. It sounds like things are well in hand. And even if you do end up with that diagnosis, it's controllable. No worries.

In re: the time of day, it only really matters initially and with patients like mamadeb who a doctor might have concern with or is trying to diagnose. Once a diagnosis is received, a consistent time to check the readings is best.

The doctor who diagnosed me had me come in at 9am to check my intraocular pressure since I had initially come to see him at 1pm and my readings were high-normal at that time, but I had severe cupping. The readings were, as he expected, sky high when I woke up, high-normal at 1pm. The readings can also dictate what meds and how the doc prescribes them; i.e. - drops at bedtime or pills in the morning, etc.

Since mamadeb's readings weren't of concern when she went in, it is possible her doctor will want to check the readings first thing in the morning or possibly late in the afternoon (the two times readings are highest in most glaucoma patients) to compare the readings. It's just one more method of diagnosis.

In re: the pressure issue, I've heard both actually, having had four different eye docs over the years. I was diagnosed in '91. Initially, thanks to my asthma and the meds I take for that, there was no effective glaucoma medication for me to take. I was on iopidine for almost 10 years which kept my pressures at very high normal (the best I could get). The eye docs had told me that unless and until new meds were developed, I'd keep losing vision. :-( There are new eye drops now, though, for asthmatics to take, and thanks to two different new ones, my pressures have been steady and there has been zero progression for the last five years. :)

He didn't say anything except that "your optic nerves look like you have glaucoma but you don't, and I'm taking images. See you next year."

Oy. The very kind of eye doc that gives mine fits. :) I won't tell him if you won't!

Given that he doesn't want to see me again until NEXT May, I'm guessing that the pressure was well within normal range.

So I'm not terribly worried.

You shouldn't worry in gen'l, as even if it is glaucoma, it's treatable. It does sound like your doc is a lot less conservative than the ones I've seen, though. :)

The pressure reading depends on what time of day your appointment was. If your appointment was in the early morning or the late afternoon (the times the readings are highest in most glaucoma patients), then the readings are of less concern. However, just because the pressure was in normal range at the time does not mean the pressures are *always* normal. If they were, you wouldn't have signs of cupping which is caused by high intraocular or intracranial pressure. There are other things besides glaucoma that can cause high intracranial or intraocular pressure and which can cause that cupping, such as ocular histoplasmosis or, as with our joint-friend, Liv in MS, pseudo-tumour cerebri. The most common cause, though, is glaucoma.

I got the impression from the websites I've seen that someone can have cupping without it meaning anything besides normal human variation - that there are other signs besides pressure that the doctor will look for to confirm this. However, he did take those images, so I assume that next year, he'll compare things. He also didn't specify a time of day.

Yeah, even doctors differ in re: how to best approach things. Get six doctors in a room with one patient who has one specific thing wrong and each will likely have different meds to prescribe or tests to run, some won't run any tests and some won't prescribe and each will also likely read the tests results differently, too.

Your doctor sounds a lot more relaxed about the issue than mine would be. My current glaucoma specialist has fits when he hears other eye docs have 'wait and see' attitudes about pressures & signs of cupping. He has new stories to tell almost each time we go in for our eye exams.

I feel for you. I've been to the opthamalogist today as well, and it's been hours and only now my vision is approaching normal again. But good to hear that your eyes are okay. Since I've been getting checked quite often the last year I noticed that diabetes certainly seems to be the most common thing why people get such eye exams, like often in a group of people waiting for an eye exam there's very few besides me not there for diabetes related checks or problems, and then those usually have cataracts because of age.

Diabetes is a cause for a number of eye problems, all of which need to be caught as early as possible.

Not a fun condition.

I had my eyes done yesterday! And I actually had to get new glasses after my blood sugar levels dropped because my eyesight improved a bit.