recent glaucoma diagnosis

[NC2PA]

Hi,

I'm a 23 year old dental student and have recently been diagnosed with glaucoma. I was wondering if anyone could point me toward any good websites or journals/articles regarding treatment, or for that matter, any information regarding treatment success in young patients.

A little background on my condition: my eye pressures have been monitored for the last 6 years and have increased from 17 to 27 in the left and 15 to 24 in the right eye. My opthalmologist tested for corneal thickness, but ultimately determined my diagnosis after doing an HRT scan last week. Luckily, I haven't had any loss of peripheral vision thus far. I wear corrective glasses for an astigmatism in my left eye during lectures and for reading occasionally.

I was determined to be high risk for glaucoma after my mother was found to have high pressures, but her HRT scan turned out negative and her eye pressure eventually stabilized and decreased. My grandfather on my father's side also underwent glaucoma treatment several years ago.

I won't be able to meet with my opthalmologist to discuss treatment options for a couple of months because i'll be away at school, but i'd like to read up as much as possible.

Any help is greatly appreciated.

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[Andrew_Doan]

23 y.o. is a young for the diagnosis of glaucoma, but it can occur in young individuals.

Glaucoma is a disease where high eye pressure is a risk factor, but is diagnosed by change in optic nerve cupping and loss of visual field with time. HRT may be helpful in demonstrating change of the nerve fiber layer thickness over time, but cannot diagnose glaucoma with only one scan. There are also other things asides from the classic primary open angle glaucoma that causes high eye pressure, such as pigment dispersion syndrome.

It's difficult to say what you have without an exam. Let's assume you don't have any of the other causes of high eye pressure, e.g. pigment dispersion syndrome, plateau iris, closed angle glaucomas, etc... With a 'normal' exam (other than the high eye pressure), you are placed in the glaucoma suspect category. If you don't have other signs of glaucoma (optic nerve appears healthy without cupping and no visual field loss), then you're placed in the category of ocular hypertension.

According to the OHTS study, individuals with ocular hypertension have a 10% chance of developing glaucoma over a 5 year period. If treated with eye drops to lower the intraocular pressure, then the risk is reduced to 5% (cuts your risk by 50%).

This data is controversial because we have to treat 100 people to benefit 5. It's not clear if we should treat everyone with high pressure (remember according to the study 90% do not develop glaucoma over 5 years of follow-up), or should we monitor those with high pressures closely until there are other signs of glaucoma before initiating treatment. With your young age, I'd be more aggressive because you have many more years left to develop glaucoma. The disadvantage of following a patient with optic nerve exams, visual field testing, and HRT/OCT is that glaucoma can become advanced before there are detectable losses of the nerve fiber layer. For instance, visual field changes occur after more than 50% of the nerve fiber layer has been lossed.

This study also showed that corneal thickness plays a factor in eye pressure measurements. Thicker corneas will translate into falsely high eye pressures and thinner corneas will translate into falsely low eye pressures. The average corneal thickness is ~550 microns; thus, if you have thicker corneas than this, then your true eye pressure is lower than measured; and if you have thinner corneas than 550 microns, then your true eye pressure is higher than measured.

For more information, consider:

http://ohts.wustl.edu/results.html

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12698045

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12049575

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11755836

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10326953

 

[mdkurt]

Hi,

I'm a 23 year old dental student and have recently been diagnosed with glaucoma. I was wondering if anyone could point me toward any good websites or journals/articles regarding treatment, or for that matter, any information regarding treatment success in young patients.

A little background on my condition: my eye pressures have been monitored for the last 6 years and have increased from 17 to 27 in the left and 15 to 24 in the right eye. My opthalmologist tested for corneal thickness, but ultimately determined my diagnosis after doing an HRT scan last week. Luckily, I haven't had any loss of peripheral vision thus far. I wear corrective glasses for an astigmatism in my left eye during lectures and for reading occasionally.

I was determined to be high risk for glaucoma after my mother was found to have high pressures, but her HRT scan turned out negative and her eye pressure eventually stabilized and decreased. My grandfather on my father's side also underwent glaucoma treatment several years ago.

I won't be able to meet with my opthalmologist to discuss treatment options for a couple of months because i'll be away at school, but i'd like to read up as much as possible.

Any help is greatly appreciated.

I don't think anybody can go into any specifics regarding your situation without actually examining you, but from what you posted I'd say that you had your glaucoma diagnosed at exactly the right time--when the diagnosis is difficult to make and before any functional loss has occurred. If you're tied into this site, you probably already did an internet search for glaucoma. One web site that is a good resource is the Wills glaucoma service. Do a Google search for "Wills glaucoma" and it should be one of the first few hits. This site has forums where glaucoma patients can discuss their diagnosis with doctors and each other.

As far as treatment options are concerned, you may want to make time to meet w/your ophthalmologist before you go away, becuase some of the more common medications to start with take several weeks to reach their maximal effect. If you're going to see him/her again in a couple months, that would be an excellent time to check your response.

At some point, it may be worthwhile to solicit the opinion of a glaucoma specialist. This does not have to happen before you start treatment, and I'm sure your ophthalmologist would welcome the input.

Hope this helps,
Kurt

 

[JennyW]

23 y.o. is a young for the diagnosis of glaucoma, but it can occur in young individuals.

Glaucoma is a disease where high eye pressure is a risk factor, but is diagnosed by change in optic nerve cupping and loss of visual field with time. HRT may be helpful in demonstrating change of the nerve fiber layer thickness over time, but cannot diagnose glaucoma with only one scan. There are also other things asides from the classic primary open angle glaucoma that causes high eye pressure, such as pigment dispersion syndrome.
]

Is there any literature on the incidence of POAG in the 18-45 cohort?
One specialist that I consulted with said that he has never seen a true case of POAG in this age group. THoughts on that??

Jenny

 

[Andrew_Doan]

There's not much literature on the incidence of POAG in the 18-45 cohort. If glaucoma presents in this age group, then it's considered junvenile glaucoma. Here is one paper I found.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2909022

Juvenile glaucoma, race, and refraction.

Lotufo D, Ritch R, Szmyd L Jr, Burris JE.

Department of Ophthalmology, New York Eye and Ear Infirmary, NY 10003.

Of 68 patients who presented between the ages of 10 and 35 years with elevated intraocular pressure, 25 were classified as juvenile ocular hypertension and 43 as juvenile primary open-angle glaucoma. Blacks constituted a greater proportion of the primary open-angle glaucoma patients (47%) than of the ocular hypertensives (20%) and in both groups presented at younger ages than did whites. Myopia was present in 59% of the ocular hypertensives and 73% of the primary open-angle glaucoma patients, of whom 39% had more than 6 diopters of myopia. All eyes of black patients with more than 3 diopters of myopia had glaucomatous defects compared with 52% of such eyes of white patients. Our data suggest that myopia is strongly associated with juvenile open-angle glaucoma and that young black patients with elevated intraocular pressure, especially when myopic, are more susceptible to glaucomatous damage than are whites.

 

[NC2PA]

Thanks for the quick responses.

My doctor did check my corneal thickness and determined both to be normal. He also did a couple other tests, but i'm not sure exactly what he did.

Unfortunately, school starts tomorrow morning, so meeting with him won't be an option for a little while. But I think i'll try to meet with an opthalmologist or glaucoma specialist here. Luckily, I live right up the street from the Wills Eye Hospital.

Until then, i'm just gonna hope for the best.