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Normal tension glaucoma and PMR?
When my opthalmologist learned I have PMR he did a visual field test and found an area of field loss which has persisted. My intraocular pressure is normal. He has now put me on drops to reduce the already-normal pressure and thinks there may be a connection to the PMR. Has anyone experienced this?
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Although I have not had personal experience with this, since going back on prednisone for steroid withdrawal/SAI, I have been reading whatever I could find in the medical literature about glaucoma and prednisone. (I have doctoral level training in public health and was the one always tasked with researching the background literature for publications, so I am comfortable with how to do this). Although my focus has been on increased intraocular pressure (IOP), I have come across this in the literature. Go to PubMed and search for prednisone and glaucoma; prednisone and intraocular pressure; and glaucoma and normal IOP. I am dealing with increased IOP in my better eye and requested more frequent monitoring. I also currently take drops for corneal rejection, and it is all but impossible to get an eye doctor to understand the effects of oral prednisone when combined with daily ocular steroid drops. They are scared to counsel patients to discontinue the oral drug because that is what they consider helpful, so the approach I have encountered in the past is to discontinue the oral prednisone. No way, because I really really don't want to suffer the sequalae of SAI. Moral of this story is you have to be well informed and be your own advocate. Trust the medical literature and dot org sites on glaucoma. Do not just rely on the AI summary that pops up at the top of internet searches these days.
Hi,
Thanks for your response. You're probably right that the "normal tension glaucoma" is related to exposure to prednisone. I am currently on Kevzara and have been off prednisone for almost a year but the visual field cut (not noticeable to me but discovered on testing) began when I was on prednisone and has persisted over the year, although stable. My ophthalmologist is very conscientious and attuned to potential eye issues associated with PMR. Also, I'm a doctor and we medical professionals do (unfortunately, though fortunately for us) get taken more seriously by colleagues. He's having me come back in a month after starting me on timolol and wants my normal intraocular pressure to be even lower than the current normal reading.
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https://glaucoma.org/types/normal-tension-glaucoma
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Just to create more confusion I will share my experience with increased intraocular pressure (IOP).
IOP was a side effect that I experienced while on oral Prednisone. I currently have IOP on steroid eye drops too which are being used for a problem with my cornea. I have been off oral prednisone for 5 years so that isn't contributing to my IOP.
My past treatment for IOP has been Cosopt drops whenever I was taking any corticosteroid be it steroid eye drops or oral prednisone. I was called a "steroid responder" which is a confusing terminology in ophthalmology. While a responder sounds like a positive thing, in ophthalmology, it is actually a warning about my side effect.
In the technical sense, I didn't have glaucoma but I have a side effect from prednisone. The way my ophthalmologist differentiated it was by calling it prednisone induced glaucoma or secondary glaucoma.
Primary glaucoma wasn't my problem until recently. Now my condition is being called "glaucoma suspect" which means I don't have glaucoma yet but my optic nerve has a shape that suggests glaucoma.
I think "glaucoma suspect" will be upgraded to glaucoma soon. My ophhtalmologist wanted me to hold my steroid high drops and cosopt drops to see what my IOP was without any medications. My untreated IOP was 30 mmHg with my target being less than 20. At 30 mmHg, my eye pressure is significantly elevated, which puts extra stress on my optic nerve.
As soon as I told my optometrist about my diagnosis and meds, he did baseline testing and started carefully watching me. Fast forward 4 years later and I developed glaucoma and a cataract in one eye. I'm very grateful for his knowledge and early intervention. The glaucoma is under control with the drops.
This is interesting, I have developed Macular Degeneration in the last year, I wonder if there is a connection. I have had Poly for 11 years. I have to get shots in my eye every month, I will ask about a possible connection.
@margedoc Oh, good. As a doctor, you too probably started by researching your problem in the literature, AND you can be taken more seriously by colleagues. As a PhD, I am sometimes dismissed, but I have found that good doctors respect an informed and educated patient who doesn’t consult “Dr. Google.” If they are dismissive, well, that’s a sign that maybe I need to move on. This whole issue of prednisone withdrawal and SAI is very complex, and not every ophthalmologist is familiar with the complexities. For that reason, I will probably be taking my own advice. Please share how your recovery goes.