Mombu 2009-03-29 10:35:44
I am 39 and was diagnosed with glaucoma in my left eye last week. My
doctor made the diagnosis after a HRT was done. My cup disk ratio is
0.64 on my left eye, 0.45 on my right eye. My doctor said there was
some obvious damage in the left eye. My eye pressure are around 19 for
both eyes. I am myopic and my disks are very large to begin with (4
mm), and I am also have migraine, and my doctor has called me a suspect
for two years.
I was put on Xalatan and my doctor said not to worry too much. He said
we will treat the other eye too.
My understanding is most glaucoma patients are elderly, and may be most
of them don’t live long enough to go blind anyway. My question is does
anybody know of any statistics of young patients going blind ? I still
have 36 years ahead if I can live to the age of 75. May be I won’t go
blind in the next 10 years. But what about 20 or 30 years later ?
I will appreciate if some of you can point me to any statistics/studies
or personal experience. I want to plan ahead if I know I am going to be
blind sometime down the road.
William stacy 2009-03-29 10:35:47
Of course I will be second guessing your doc but I’m wondering a bit
about the diagnosis. Was it based on sequential HRT’s or what? Did
he/she see any enlargment of the cups over time? .6 and .4 are not
particularly big cups for a myope with large discs, and 19 is not all
that high for iop. Sounds like you’ve got lots of nerve tissue there,
and while nobody can predict with certainty, I’d be surprised if you
were to become blind any time in your life, especially with all the
advancements in the field that have and will take place.
Mombu 2009-03-29 10:35:53
Thank you for your kind words William, I chope what you have said will
come true. But since I have kids to take care of I need to be realistic
and plan ahead … (eg. start a new career which a low vision/blind
person can do, may be ?)
To answer your question, no, my diagnosis was not based on sequential
HRTs. It was based on one single HRT. My doctor said based on his
experience the shape of my left nerve cup is definitely due to
glaucoma. He has been suspicious about my cupping for two years. In the
past because I do not have a family history of glaucoma, am relatively
young, with not too high IOP, he did not think I have it, but he was
very suspicious because of what he saw using traditional equipments
(forgot the names) … this year he decided a HRT test had to be done
and that was that.
If there is no statistics of young patients going blind I would like to
hear from clinicans like yourself, or from patients, what are the odds
for someone like me to loss useful vision and how long that will likely
take. I have heard some stories about people successful in maintaining
their eye sight for 20 or even 30 years. But I guess there must be a
lot of failure examples too.
Thanks for your input anyway.
Doctor_my_eye 2009-03-29 10:35:56
Glaucoma is a disease that is much less likely to take your sight when
it is diagnosed early and managed well. For example, when Kirby
Puckett of the Minnesota Twins “suddenly” went blind from glaucoma, his
pressure was over 50! He now lectures young athletes all over the
world about the dangers of being a glaucoma patient for years without
being diagnosed or treated until a disaster occurs.
Your doctor is being very cautious and being protective of your sight.
Xalatan is a superior glaucoma drop in that it has been shown to not
only lower the pressure on the optic nerve, but is has also shown an
ability to protect the optic nerve from damage in the future by
shielding the nerve from future damage. This drug and others in its
class are all less than 10 years old, so “old” studies of blindness
from glaucoma are not as relevant because the nature of the disease and
our ability to treat it has changed so much for the better.
William stacy 2009-03-29 10:35:59
Most glaucomas are slow to take vision, usually affecting peripheral
vision long before central vision goes, usually taking years to even be
noticed by the patient.
Maybe I’m not as sure about HRT as he is. But again I’m second
guessing. Anyway, I’m suspicious enough to recommend a 2nd opinion by a
glaucoma specialist. After all, we are talking about a life sentence of
eyedrops/what-have-you treatment and expensive monitoring. If your doc
is a glaucoma specialist, then fine, ask him how soon your type will/can
cause you occupational problems.
I have heard some stories about people successful in maintaining
Sure, most people do not outlive their glaucoma. BTW did you do visual
fields? Any demonstrable field defect? If so, I’ll yield to that, but
if not, get that 2nd opinion and be sure to report back here.
Mombu 2009-03-29 10:36:02
I am happy to know that Xalatan does more than lowering IOP, since I
read that for normal tension glaucoma there are some other mysterious
factors that contribute to optic nerve cells dying off, rather than
just high eye pressure.
If you are a clinician would you mind telling me if NTG are more
difficult to treat and has a higher rate of vision loss, even with
treatment, when compare with POAG ?
Thanks again for your time.
Mombu 2009-03-29 10:36:05
Thanks again for responding.
Just to have an idea if someone with an earlier stage of glaucoma
receive no treatment at all, how long does it take for her to loss
peripherial vision, and how long to loss central vision ? Is there any
general trend in this ? I know every case is different, but is there
any concensus on the natural history of this illness ?
I don’t know who is considered a glaucoma specialist, but I think more
than half of his patients see him for glaucoma. I was told I have
normal tension open angle glaucoma. Thanks for the suggestion I will
ask how it will affect my occupation.
No, none of my visual field test shows anything unusual, so my
diagnosis was based on the condition of my optic nerve. I was told that
it takes quite some damage to have an effect on visual field. Is that
Thanks for your time.
William stacy 2009-03-29 10:36:08
The disease has many different variables, knowns, unknowns, courses, and
treatments. And different experts will give you different opinions. Add
to that the theories are changing as more is learned. There are some
things that are pretty well “concensus” but not all. It really does vary
from eye to eye. I know it sounds screwy, but there is a lot we don’t
know about this disease.
Glaucoma specialists limit their practices to glaucoma cases. Sounds
like he might be a general ophthalmologist with a “special interest” in glaucoma.
Modern field testers are pretty good at picking up early damage, but
yes, once it shows up on field testing, significant damage has been
done. But since you have no field loss, I would still question the
diagnosis, not because I don’t believe your doctor, but because there is
no precise recipe for that diagnosis that everyone agrees on. I
personally believe that in some cases like yours, unless a change in the
optic nerve can be documented by photography or other optic nerve
imaging, the diagnosis may be premature. Ergo, the 2nd opinion, and if
they disagree, get a 3rd and go with the concensus. You’ve got lots of
Doctor_my_eye 2009-03-29 10:36:10
By definition, normal tension glaucoma is harder to diagnose and is
often left untreated for extended periods of time because it is often
undiagnosed for years. So, your question is unfair in a certain way.
For example, the recent statistics from the National Transportation
Safety Board concluded that minivans had less crashes per thousand
vehicles than any other kind of vehicle, and there were fewer
fatalities per thousand vehicles. Can you conclude from those
statistics that minivans are the safest vehicle to drive? No, you can
only conclude that the KIND OF PERSON that drives a minivan is the
least likely kind of person to crash and die. So, since you are an
early diagnosed LTG patient who is being watched closely with
nerve-protecting prophylactic care, you are more likely to save your
sight than the “average” LTG patient.
Gudrun17 2009-03-29 16:21:39
Is it always true that there is significant damage once a visual field
test shows a defect? In my case, if there weren’t a repeatable visual
field defect (it is mild but widespread) I think I would still be
considered a glaucoma suspect because with normal eye pressures and a
deceptively healthy looking optic nerve, there wouldn’t be much else to
go on, other than a borderline sector in HRT. Despite the visual field
defect I was told my case is early or mild. I wish it could have been
caught before there was any vision loss but as I said, with normal
pressures and myopic disks I understand it can be hard to diagnose.
Mombu 2009-03-29 16:21:51
Thanks for sharing this with me.
Thanks for the suggestion. I will definitely go seek a second and third
opinion. But William, do you agree that most cupping in normal eyes are
symmetrical between the two eyes, no matter if they are small or large
Mombu 2009-03-29 16:21:55
Thanks for the analysis, I think what you have said is logical. I hope
you don’t mind if I ask another question: since I am a migraine
patient, do you think treating migraine itself will some how help my
glaucoma ? It is very interesting because when I have a migraine
attack, the pain is always on the right side of my head. And it is my
left eye which has glaucoma. From my very limited anatomy knowledge I
know the left eye is actually connected to the right brain. May be the
two conditions are somehow related ?
Doctor_my_eye 2009-03-29 16:22:02
The more you study the history of headache research and pain
management, the more you realize how much we just don’t know about
this stuff. A trigger for a migraine can be any other kind of pain. I
had a patient with visual migraines so bad that she would pull off the
road and weep for hours until her aura would go away or she fell
asleep. After every test known to man to rule out a brain tumor,
etc…she accidentally found the trigger that started her
migraines…at the dentist!! She had an impacted wisdom tooth on one
side that was so bad that the nerve pain in her jaw would go from her
jaw back to the visual cortex, causing her the intense visual
migraines. Three months and two root canals later, she is pretty much
So, do I think that the two (LTG and migraine) can be related? Yes, in
the sense that all pain can be related because the body has an ability
to transfer pain. I can’t imagine your migraine as a “cause” of
glaucoma, but I can more rationally see the glaucoma causing a
Let’s not even touch that left brain/right brain stuff. 😉 It gives me
William stacy 2009-03-29 16:22:06
I doubt it because pain is not a part of glaucoma except in very high
pressures. But I would look at the individual medications and any
effect they might have on eye pressure could be significant.
William stacy 2009-03-29 16:22:10
Asymetrical cups are always a red flag, but it is so common that by
itself it is just another relative risk factor. I’d be more suspicious
if there was a concurrent difference in i.o.p.
William stacy 2009-03-29 16:22:14
Oh and by the way, if the larger cup belongs to a larger nerve (disk),
it is completely normal. It’s more suggestive if the nerves are equal,
and very suspicious if it is on a smaller nerve.
Mombu 2009-03-29 16:22:18
Yeah in my case both disks are about 4 square mm each, but the cupping
on my left eye is more serious than my right eye (.65 and .44