I’m 26 yo, and I am writing to kindly request a second opinion regarding my glaucoma diagnosis and recent progression.
I have a history of elevated intraocular pressure (IOP) starting from the age of 14, when it was first recorded at 23 mmHg. Since then, the IOP has fluctuated, with the highest reading being 29 mmHg and the lowest around 23 mmHg.
I have been diagnosed with high iris insertion, and since 2021, early changes began to appear on OCT scans. Unfortunately, I only managed to see a glaucoma specialist in 2025, by which time structural changes had already become visible on both the OCT and visual field tests.
On April 8th of this year, I started treatment with Ecbirio (a combination of timolol and bimatoprost). On May 20th, I had a repeat OCT and underwent MLT (Micropulse Laser Trabeculoplasty) laser treatment on the same day. At that time, my IOP was 19 mmHg left eye, 18 right eye. One month after the laser procedure, my IOP ranged between 15 and 16.5 mmHg in both eyes.
At my next check-up, I had a visual field test on June 24th, and then on July 30th, I repeated both the OCT and visual field. Unfortunately, both tests showed further progression of nerve fiber loss and visual field deterioration, despite apparently controlled IOP (14mmHg right eye, 16 mmHg left eye - with pahimetry correlated).
Following this, my treatment was changed to Azopt (brinzolamide).
I would deeply appreciate your expert opinion on the following questions:
What more can I do at this point to prevent further loss of nerve fibers and visual field?
Why have new changes appeared in the macular area between the two recent OCTs, just two months apart, even with IOP between 15 and 16.5 mmHg?
Is it possible that another neuro-ophthalmological condition (such as ischemia) may be contributing to this progression?