Question
My question concerns my 8 y/o son with POAG diagnosis. Diagnosis in Dec '06, followed by a regime of drops. Pressures seemed to be controlled ou. OS IOP at onset was ~40 mmHg, OD ~ 25mmHg. Post trtmnt with Alphagan P BID ou, Azopt BID os pressures were ~15 ou. Last week os iop spiked to 50 (od ~ 16). Diamox , timoptic xe, travatan were added ( Azopt stopped). All exams show clear corneas, open angles, normal vf, corrected vision 20/20 od, 20/30 os, c/d ratio slightly worse in os (can't recall what they were)---otherwise healthy kid. Next step would presumably be surgery. I would like to exhaust all other options before sx. Could the unilateral nature of this be indicative of some sort of something (venous flow problem)? In the abscence of any systemic issues (sturge-weber, others typically seen with glauc)) or other ocular issues are there other avenues to diagnose and/or rule out. Would an MRI or MRA tell us anything? Could there be some sort of -oma lurking in there somewhere? We are recieving excellent care and advice form our OD and Ophthalmologist, but would like to get additional input.
Any resources or advice you can offer is appreciated
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Answer
'Could the unilateral nature of this be indicative of some sort of something (venous flow problem)'
probably not. glaucoma is always described as 'bilateral but asymmetric', meaning that almost every glaucoma patient has one eye with higher pressures. this phenomenon is poorly understood by the profession.
'Would an MRI or MRA tell us anything?'
unlikely to, no.
'Could there be some sort of -oma lurking in there somewhere?'
highly, high;y unlikely b/c both eyes have high pressure. a tumor would be pretty obvious and have a lot of other signs/symptoms, and would be really unlikely to affect the iop in BOTH eyes. this is much, much more likely to be POAG than anything else.
surgery is probably your best option IMO. most glaucoma surgeries are laser-based and not so bad, and the alternative is 75+ years of expensive eyedrops and trying to be compliant. very difficult to achieve, even in patients/parents with the best of intentions.
