18 months ago

Ricky • 0

@ricky

Hi Everyone, I am Ricky, 30 years old and looking for suggestion from fiteyes community. In April 2022, while I had gone for a regular eye checkup, my IOP was around 20 in one eye and 24 in another. The clinic was using icare ic100 to measure pressures. My optometrist told me that I had similar pressure last year as well and suggested Visual field test and OCT. Visual field test and OCT came out clean. The OCT also had inbuilt pachymetry and my CCT was around 555. I had no damage and he classified it as ocular hypertension and glaucoma suspect and asked me to come next year. I started reading about glaucoma and decided to go visit an ophthalmologist. Ophthalmologist took my eye pressure and it was 26 and 24 using ic100 again. He dilated my eyes and looked inside with different lenses and stuff and told me my eyes were healthy and there was no damage and repeated the same thing that I was glaucoma suspect. Still anxious, I decided to get a home 2 tonometer to measure my own eye pressure. Based on the readings, every morning immediately after I wake up my eye pressure is in mid to upper 30s (as high as 39) and when I measure again after 15 mins of waking up it comes down to around 24 25 level and stays there, sometimes dropping to 20/21 in evening and staying there until I go to bed. I decided to go visit a glaucoma specialist. Glaucoma specialist again did an OCT, visual field test which came out clean and without any damage. The pachymetry this time however was from a pen shaped device and my CCT was around 585 for both eyes. Also the doctors assistant measured my pressure using Goldmann aplantation tonometre and told me my pressure as 22 and 24.However, when the GS measured my pressure again, he told me it was 16 and 18. On asking the GS, that his assistant told me it was 22 and 24 10 mins back, he said "he took it wrong, that's why I took it again". GS did see the data I had collected and said he doesn't think any treatment is required and that 30s fluctuation might only be for some time and if it would have been there for long, he would have seen any damage. Also GS saw inside my eyes, using some machine which felt very wierd. GS never dilated my eyes. GS told me the same thing that I should check every 6 months with my optometrist for pressure and 1 year for OCT. He wrote in my summary that no treatment required, pressure in normal range.

I am now not sure what should my next steps be. Should I show it to another doctor? Is it possible that because of my high CCT, home 2 readings are not right? I have never seen a reading of 16 or 18 using my icare home 2, from around 150 readings that I have taken. Also I don't wear any glasses and otherwise have good vision. My family thinks I am just anxious and have no eye issues.

22 months ago

david 4.2k

@david_fe

My family thinks I am just anxious and have no eye issues.

You said your IOP has been measured at 22 and 24 via Goldmann aplantation tonometry. Those values are above normal. You mentioned that it has also been measured above normal by the IC-100 tonometer multiple times and those measurements were conducted by professionals (e.g., you ophthalmologist). Based on what you have shared, I feel you are being wise and prudent. Your steps could be crucial to protecting your vision.

You don't need to make yourself anxious about it, but continue your steps until you have satisfactory answers. You will be thankful you did. Don't worry, but do take action, as you are. Your family should commend you, in my opinion. Take comfort with the fact that you are being proactive. This should help you feel relaxed. I would only be worried or anxious if I were doing nothing about the potential risk. Since you are doing the best you can, you can now give yourself permission to relax and carry forward without any anxiety.

For many glaucoma suspects, it is normal to be on glaucoma eye drops as a preventative measure. Starting an eye drop as a preventative measure might be warranted in your case. (You would need your doctor's prescription, of course.)

The "wait and see" approach is not always ideal because, by definition, it means you have suffered the loss of some optic nerve fibers before treatment is even started. A proactive approach might suit you better.

Also the doctors assistant measured my pressure using Goldmann aplantation tonometre and told me my pressure as 22 and 24.However, when the GS measured my pressure again, he told me it was 16 and 18. On asking the GS, that his assistant told me it was 22 and 24 10 mins back, he said "he took it wrong, that's why I took it again".

This is, unfortunately, a common response, in my experience. I don't agree with the attitude of dismissing IOP data with a wave of the hand ("he took it wrong, that's why I took it again").

From a scientific perspective, it is not a good practice to dismiss data. The entire glaucoma medical profession can only treat one thing: intraocular pressure. That one thing is the most important risk factor for the disease this specialty treats. Given that fact, having a cavalier attitude toward IOP is not warranted, in my opinion.

Until proven otherwise, we should assume these other IOP measurements you mentioned are in fact valid & correct.

what should my next steps be?

Please see this related question and my answer:

My Home Tonometer Does Not Agree Exactly With My Doctor's Eye Pressure Measurement. What Should I Do? | Ask FitEyes

I believe your next steps should be to have an exam with a Reichert Ocular Response Analyzer (ORA). See the answer there, and follow those steps as closely as you can.

It will be ideal if you can do the recommended side-by-side comparison between your iCare and the ORA, as explained in that answer. If you decide to do that, please reach out to me and I'll speak to you over the phone (or VoIP).

Also, get copies of your OCT results and keep them for reference. (Keep copies of all your medical records.)

Do you have records of all your IOP measurements in the doctor's office along with the type of tonometer used? If you want to share more details, I may be able to offer more thoughts / advice.

20 months ago

BrianB • 250

@brianb

I was first diagnosed, maybe 12-13 years ago now, with high pressure and as a "glaucoma suspect". My doctor said she wasn't concerned, but I started on Latanaprost as a precaution. Over the next 10 years she never gave any indication of there being a problem. But I came to learn that I did in fact have visual field loss and evidence of optic nerve damage. She was never up-front with me on this, and in hindsight I believe she was not proactive enough in keeping my pressure in a lower range. I ended up having a trabeculectomy on one eye in 2021.

I have since switched doctors, since 2020. I would, as suggested above, look to see another glaucoma specialist for another opinion.