Case Study: Pigmentary DS vs Pig GLC

[Idocanesthesia]

I am a 36 yo WM OTW , -5.00 SPH OU , wears CLs, no recent complaints, history only moderate myopia, mother w history NT GLC
IOP 29,31
OCT some abnormalities w line mild dips into "yellow" OU
VF 30-2 some inferior defects
Pachymetry ~ 480s OU
Gonio 3-4 pigment
+ Kruks spindle w 3+ iris transillumination defects
C/D 0.4, 0.5

any feedback is greatly appreciated.

---

Members don't see this ad.

 

[KHE]

Patient is 36 yo WM OTW comes in for routine GE, -5.00 SPH OU , wears CLs, no recent complaints, history only moderate myope, mother w history NT GLC
IOP 29,31
OCT some abnormalities w line mild dips into "yellow" OU
VF 30-2 some inferior defects
Pachymetry ~ 480s OU
Gonio 3-4 pigment
+ Kruks spindle w 3+ iris transillumination defects


How do you proceed?

any feedback is greatly appreciated.

Is this a serious question? How do you THINK you proceed?

 

[Idocanesthesia]

I am absolutely serious......maybe I worded it too simply/easy etc. Obviously this is Pig GLC, my questions are, do u proceed w 1 or 2 GLC meds, how quickly do you go to surgical/ laser intervention and what is your prognosis estimates?

 

[Meibomian SxN]

I am absolutely serious......maybe I worded it too simply/easy etc. Obviously this is Pig GLC, my questions are, do u proceed w 1 or 2 GLC meds, how quickly do you go to surgical/ laser intervention and what is your prognosis estimates?

My treatment would depend on what setting I was working in:

1) If I was in a group OD/MD practice, I would start with SLT followed by a beta-blocker.

2) If I was in a practice that did not have access to a laser, I would start with a beta-blocker. Once daily regimen, most patient's are adherent with that.

 

[Meibomian SxN]

My treatment would depend on what setting I was working in:

1) If I was in a group OD/MD practice, I would start with SLT followed by a beta-blocker.

2) If I was in a practice that did not have access to a laser, I would start with a beta-blocker. Once daily regimen, most patient's are adherent with that.

After seeing the same post in the ophthalmology forum, I wish I could have retracted my response.

I agree with KHE. Especially since you said you were a little "freaked out"??? Sounds like you need to quit your job and do a residency to strengthen your diagnosis & treatment skills.

 

[Idocanesthesia]

After seeing the same post in the ophthalmology forum, I wish I could have retracted my response.

I agree with KHE. Especially since you said you were a little "freaked out"??? Sounds like you need to quit your job and do a residency to strengthen your diagnosis & treatment skills.

well u arrogant POS , my diagnosis and treatment skills are just fine but as this has happened to ME and not some random patient, I am leaving no stone unturned as to other opinions, options, and insight into anything I am leaving out. I hope if you ever have a sight threatening situation happen to YOU that someone will treat you w such arrogance and disdain. I am sure you are the best eye doc that has ever lived and never ever seek the advice of others.

 

[Meibomian SxN]

well u arrogant POS , my diagnosis and treatment skills are just fine but as this has happened to ME and not some random patient, I am leaving no stone unturned as to other opinions, options, and insight into anything I am leaving out. I hope if you ever have a sight threatening situation happen to YOU that someone will treat you w such arrogance and disdain. I am sure you are the best eye doc that has ever lived and never ever seek the advice of others.

Lol. Your last statement is true though.

Since its a slow Wednesday for me, tell us what treatment options were you presented with? There's always medical marijuana also!

 

[Idocanesthesia]

Lol. Your last statement is true though.

Since its a slow Wednesday for me, tell us what treatment options were you presented with? There's always medical marijuana also!

As obviously you have nothing to add to this discussion other than diatribe and immaturity I will say nothing else but may Karma smile on you and your family someday. My 3 and 6 yo children would not think highly of you nor I can imagine anyone else w any sense of humanity.

 

[Meibomian SxN]

As obviously you have nothing to add to this discussion other than diatribe and immaturity I will say nothing else but may Karma smile on you and your family someday. My 3 and 6 yo children would not think highly of you nor I can imagine anyone else w any sense of humanity.

Riiiiight. Have fun getting an 7th & 8th opinion.

I hear Dr. House, MD may be able to help you; call him!

 

[Hoffy]

Sorry starting this thread and berating the subsequent replied is absurd for what should be obvious reasons. Consulting your colleagues directly seems to be the most logical option.

P.S. Karma won't get you for calling someone a POS. Interesting how it works both ways!

 

[4Eyes]

This is really just a medical advice thread under the guise of a case study thread....

 

[ABaverage]

This is a serious question and I intend no offense. Are you an optometrist?

 

[Idocanesthesia]

This is a serious question and I intend no offense. Are you an optometrist?

Yes I have been out for 8 years working in a MD/OD ( retina and K specialist). The point of this thread was to leave no stone unturned as to my treatment options other than the usual obvious drops/SLT regimen. I dont presume and nor do my colleagues that we know everything about eyes on the planet ( apparently there are some are here that do) and since there are eye docs (OD and MD ) on here from everywhere I wanted to see if I was missing anything as far as new and possibly ways to go about treating pig GLC. Yes this may seem straightforward but maybe someone on here works at a GLC cutting edge program that is privy to info that I am not. I have never posted on here before and maybe I went about seeking info the wrong way BUT I never thought I would run into so many internet tough guy know-it-alls. Amazing... at the scorn you get for asking a question about seemingly simple case.

 

[PBEA]

I think the treatment is pretty straightforward, so not much to offer there. I will add one often overlooked aspect and that is your lifestyle, and/or IOP increase with increased body heat. I would definitely have yours measured after exercise, etc to see how much you are spiking. Some of those spikes are surprising, and as such may lead you give up marathon running or other intense exercise.

 

[Idocanesthesia]

I think the treatment is pretty straightforward, so not much to offer there. I will add one often overlooked aspect and that is your lifestyle, and/or IOP increase with increased body heat. I would definitely have yours measured after exercise, etc to see how much you are spiking. Some of those spikes are surprising, and as such may lead you give up marathon running or other intense exercise.

appreciate the feedback....yeah have quit jogging, havent played BBall in a year anyway so no problem there. Have been much more cognizant when working out about valsalva, head position etc and just doing cardio via the bike. What do you know about caffiene and how big a no, no it really is. Have read something about not more than 50 mg per sitting ( seems like a lot ) and may change IOP around 1 mmhg . But also read that for every 1 mmhg change is +- 13% risk factors. Thanks again for the info.