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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Cupping Of 0.7 In Both Eyes. Advised Not Due To Glaucoma. Higher Risk Of Developing Glaucoma Than An Average Person?

Hi,

I have a question regarding congenital cupping. I have a cupping of 0.7 in both eyes, which two ophthalmologist assured me it's congenital and not due to glaucoma(this was established on follow-ups spanning two years with all tests: tonometry - constant pressure of 12, OCT,visual field test, CCT).
My question is if I'm at a higher risk of developing glaucoma than the average person. One doctor told me that absolutely not since this is normal for me, the other said that I have a predisposition for this disease, even without family history. Searching through the net I have seen some sites mention this as a risk factor, but most don't, so I'm really confused.

Thanks a lot,
Michael
Mon, 13 May 2013
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Ophthalmologist 's  Response
Hi Michael,

Thanks for your detailed question. In glaucoma one of the recognized features is an increased cup to disc ratio. In your case you have a cup:disc ratio of 0.7 in both eyes. However, the finding of cupping needs to be taken in the context of all your other measurements and investigations. Cupping alone can be a completely normal finding.

From what you have described the most likely diagnosis is "physiological cupping" which means that there is unlikely to be anything wrong. This is supported by the fact that the cupping is the same in both your eyes. As long as there is no progression of the cupping this is likely to be normal for you and will stay that way for the rest of your life.

It is unlikely that you have glaucoma as your intraocular pressure is normal at 12 and your visual field test has been normal as you have already recognized.

In terms of your question, your risk of developing glaucoma is no greater than anyone else your age. However, I would still recommend that you see your optician annually for an eyetest and pressure measurement. The opticians may also take pictures of the back of your eye which can help to monitor any progression of cupping.

I hope that has helped to reassure you and clarify this finding.

Regards
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Cupping Of 0.7 In Both Eyes. Advised Not Due To Glaucoma. Higher Risk Of Developing Glaucoma Than An Average Person?

Hi Michael, Thanks for your detailed question. In glaucoma one of the recognized features is an increased cup to disc ratio. In your case you have a cup:disc ratio of 0.7 in both eyes. However, the finding of cupping needs to be taken in the context of all your other measurements and investigations. Cupping alone can be a completely normal finding. From what you have described the most likely diagnosis is physiological cupping which means that there is unlikely to be anything wrong. This is supported by the fact that the cupping is the same in both your eyes. As long as there is no progression of the cupping this is likely to be normal for you and will stay that way for the rest of your life. It is unlikely that you have glaucoma as your intraocular pressure is normal at 12 and your visual field test has been normal as you have already recognized. In terms of your question, your risk of developing glaucoma is no greater than anyone else your age. However, I would still recommend that you see your optician annually for an eyetest and pressure measurement. The opticians may also take pictures of the back of your eye which can help to monitor any progression of cupping. I hope that has helped to reassure you and clarify this finding. Regards