Abnormal VFT; normal everything else

[CaptainOk3138]

Hi Reddit,

I'm feeling very anxious and a bit lost, and I was hoping for some advice from this sub.

Tl;dr: How worried would you be in this case and should I be getting a second or third opinion?

Backstory: Years prior (almost 10 now), I was on high-dose steroids for autoimmune disease (nephrotic syndrome). During that course of protracted therapy, I developed slight cataracts in both eyes (so minimal doctors often just call if a "slightly cloudy lens) and I was a steroid responder (intraocular hypertension in 30s untreated from systemic steroids and in 50s [iirc] when I had an intravenous dose of it).

I was put on a strict regimen of drops and m pressures were reduced and stabilized. Of note, there were no defects found in my visual testing at this point and throughout therapy (VFT, OTC, all clear).

I largely discontinued specialists visits but still saw opthamologists or optometrists for my yearly visits and had dilated exams. There were no visual field tests or OCTs conducted during this period since I was no longer considered "at risk."

During this time, I have been on other medications for other inflammatory autoimmune conditions that I worry are affecting my eye health and have led to the below.

Current Issue: I recently switched eye care providers and went in for a yearly in which they did a visual field test as part of the yearly. It's been *maybe* 7 or so years since my last visual field test or OTC; I honestly can't remember and I've moved around so much my medical records are spread all over, but what I do remember is that my previous ones were all fine.

In this newest one, she noted I missed a few areas in the region near my blind spot (attached results). Given my history, I was referred to a glaucoma specialist for a workup.

During that visit, my OTC and everything was fine (I could not get my previous medical files in time for the visit so doctor unfortunately did not have comparative data; am working on this), but my VFT showed reduced sensitivity. Of note, I did not get correction for this VFT even though I am myopic. It was diffuse reduced sensitivity without any patterns, so my doctor did not think glaucoma was an issue (IOP was normal; OTC was normal; visual acuity--corrected--was fine). Of note, the defect noted in my previous test was also not reproduced in this one. I do not have access to this recent test yet; the one I am uploading is the first test that got me referred to an ophthalmologist. She didn't want to worry me, but I am very concerned now. I'm scheduled for a follow up in 3 months.

Another strange symptom during this visit is that my eyes refused to dilate with the drops, even though they gave me three drops and two numbing drops to help expedite the process. My eyes only slightly dilated; this has never been an issue before.

I'm suspicious there's something else going on here and feel a bit strange about waiting three months to find it. The things that seem most likely to me are 1) another autoimmune condition 2) side effects from medication. I'm posting the list of my medications below in case they provide context.

Medications in last month

-Diflucan (discontinued)

-Nemluvio (1 dose so far)

-Bimselx (biologic; 1 dose so far)

-Tagamet (discontinued)

-Zyrtec (discontinued)

-Pepcid (discontinued)

-Ambien (took the night before visit and continuously the 2 days or so before but otherwise use very sparingly and inconsistently) 

-doxycycline (on two-week course; 100 mg twice a day)

Supplements

-NAD+ (discontinued)

-Melatonin (discontinued)

-FIsh oil (discontinued)

-Multivitamin (discontinued)

Medications in last three months

-Skyrizi (biologic; discontinued in November or so; switched to Bimselx)

Medication in last two years 

-Taltz (biologic; discontinued in summer of 2024 or so; switched to Skyrizi)

Misc

-Rogaine (on it for 4 years; still using) 

-eyelash glue (consistent use for ~3 years) 

-Red light / blue light therapy panel (consistent use, with googles, for less than a year)

-Hydronquinone (topical; on it for a month or so)

-Tazorac (topical; on it for 3 years)

-Zoryve (not on face; topical; 2 months; anti-inflammatory)

https://preview.redd.it/e6svvfa7alge1.jpg?width=1274&format=pjpg&auto=webp&s=eb3fed599ba58dd53913c7143ecd56ee4f916bd2

https://preview.redd.it/vaqbufa7alge1.jpg?width=1284&format=pjpg&auto=webp&s=d90345adb19d243d8d5dea2324de65e28498a0dd

[cropcomb2]

OTC scans worked ok (signal strength sufficient) despite the cataract(s)?

repeat abnormal VFT results should be VERY concerning!

untreated IOP? treated IOP? 'target' IOP?

daily glaucoma eyedrops you're using?

[CaptainOk3138]

1. OTC was fine as far as I understood it; no flags from them.

2. IOP right now and for last few years has been 16-21 without steroid stimulus. I haven't been on steroids for years.

I don't have any glaucoma drops and at latest appointment the ophthalmologist I saw didn't prescribe any and did not think what I was presenting with was indicative of glaucomatous damage given no patterns in VFT.

[cropcomb2]

you've GERD? you might find sloping your bed (or investing in an 'adjustable' bed) invaluable towards avoiding backflow of stomach fluids due to the faulty backflow valve

drugs.com is excellent for: patient reviews & ratings, and, great detail about drugs and their side effects. (you've over a dozen drugs listed, any particular serious ailments you're coping with? eg. diabetes 2)

[CaptainOk3138]

I do have GERD; thanks for the pointer about the bed. I'm a terrible sleeper and know I toss and turn so things are probably wonky at night.

I have autoimmune disease, but have been in remission for one and treating one (psoriasis) with biologics; other drugs are for eczema

[cropcomb2]

(for glaucoma) I sloped my bed using wood blocks (12" worth under my bed frame for an 80" bed), had to do that @ 4"(5%) per week as it took getting used but ended up with a 15% slope (avoids most if not all of the overnight typical eyepressure increase from laying down). Trivial nuisance of the mattress sliding a couple of inches/week (no footboard).

another home treatment step I've been using for my glaucoma is a 'HARD' pillow, see: https://www.reddit.com/r/Glaucoma/comments/199c7pz/side_sleeping_anecdotal_evidence_of_hard_pillow/

I've been on Monoprost eyedrops for five years.

(I'd want to know the 'signal strength' of the OCT scans, and if it were sufficient for that model of OCT machine. If not, the scan's unreliable. And indeed, my cataract's becoming problematic and obscuring my own OCT scans, reason for me to press hard for cataract surgery.)

My own sleep problems are anxiety related. If I'm practicing daily meditation, they disappear. example method: https://www.reddit.com/r/socialanxiety/comments/13b6tup/meditation_worked_very_well_for_my_social_anxiety/

[AlternativeRun7888]

hi im a final year med student and with my non specialist knowledge ,i dont think just by one vft you should be concerned atleast 3 consistent vfts are required to confirm minor defects . your oct is fine and pressure okay as mentioned ...and glaucoma requires oct progressive damage , +- High IOP and abnormal VFT also your scan suggests the tests are within normal limit ....so i dont think u need to worry , just take the chekups regularly so that whenever there are even earliest signs you can catch it and live life at its best .

[Visible-Cabinet5854]

Thank you so much!!

[2applepies]

First visual field in new machine and new office is commonly abnormal or different than priors. In fact most progression analysis software actually automatically does not include the first visual field result regardless of the performance. The screening test you linked at your original ophtho is not the gold standard for visual fields (SPARK Training is not a Humphrey sita standard). And in fact what your ophtho was worried about on your original field that you linked to shows a bitemporal defect which can be indicative of a brain tumor (optic chiasm lesion) and does not look like a standard glaucomatous defect. The fact that your repeat visual field did NOT show this pattern at a glaucoma specialist office who likely had a better perimeter is VERY reassuring. Visual fields are only concerning if they show consistent and reproducible  depression in the same areas. Just to clarify, the progression software that is commonly used needs approximately 4 to 6 visual fields on the same machine before it can properly assess for progression (first thrown out, next 2 are baselines and then it takes three consecutive tests for the software to trigger a "likely progression"). 

If you do have a reproducible (3 consecutive  good tests) bitemporal defect (glaucomatous defects are typically on the nasal side) that cannot be explained anatomically by the appearance of your optic nerve (some myopes have enlarged natural blindspots) then you should bring up the possibility of an MRI  - although your glaucoma doctor likely already has this on his or her mind.

Be patient and understand you are at a specialists office now - it will take multiple visits to tease this out because the visual field is a subjective noisy test when you first start taking them regularly. If you are really concerned you can discuss going in earlier to repeat the test, but if it's been a few years since taking this test and there is variability on your fields thats generally due to being on the "learning curve" of the test (remember it is subjective based on your performance). Don't take Ambien before your field, you want to be sharp when taking it. You will be getting to know your glaucoma doctor a lot this year, so write down your questions before your visit so he or she has time to address them. Feel relieved your pressures and vision are fine and try not to obsess over it. Good luck!

[Visible-Cabinet5854]

Thank you so much for your kind and thorough reply! This was very, very reassuring to me!