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You have glaucoma in your left eye.

A few months ago I had a routine eye test at our local opticians in Tetbury, part of which was the normal visual field test. I stared into the eyepiece, waiting for the machine to whirr and flash a series of tiny pinpricks of light, to which I would respond by clicking a button whenever they appeared. All-so-normal, until it seemed my left eye wasn’t quite so good at noticing the dots. This was unexpected, and very different from just 12 months earlier, so the optician asked me to repeat the tests. The results were the same.

I can still sense the whirring of the machine as it flashes lights that I ought to be able to see. There’s a rhythm to it that I can recognise. With my right eye there’s a regularity to the button clicks as the lights register in my brain. For my left eye there are gaping silences where clicks should be. I’m staring, squinting, aching to see something that means I can click. I’m tempted to cheat. The test takes longer as the machine gives me more chances, makes the lights brighter, trying to understand what’s there and what’s not there for me. And while I know it’s only minutes it feels much longer. I sense the nurse knows what the silences mean: this isn’t normal.

Visual Field Tests Glaucoma

This isn’t mine… but it’s sort of similar

 

And so last week, after further tests, a precautionary MRI scan and a couple of months of eye drops, I sat with the consultant as he confirmed the inevitable, and talked about my glaucoma.

There are fairly significant differences in the visual field tests in your left eye, notable damage to and thinning of the optic nerve…

…but your IOP (intra-ocular pressure) is normal, much lower than often is the case with glaucoma…

…you’re really quite a lot younger than the typical progression, a bit of an outlier on that graph…

…nothing on the MRI scan, so we can definitely rule out anything like a tumour pressing on the nerve…

…there’s no increase in your pressures since taking the drops, no real progression since the last tests (3 months ago), so that’s pleasing…

…you probably won’t notice anything different, until you do bump into something (joke)…

…playing a wind instrument like an oboe or French Horn can cause spikes in IOP, although I’m loathed to tell someone who loves playing music to stop…

So the long and the short of it is that I’m now taking daily eye drops (painless, no hassle at all), and will have repeated tests every 6 months. And that’s it.

Except…

The following day, at my regular orchestra rehearsal, I was acutely conscious of sensations of ‘pressure’ when playing, especially loud and high notes. We’re playing Tchaikovsky’s 4th Symphony, which has plenty of loud and plenty of high, especially for 1st/3rd horn. In fact there’s mostly a lot of notes that are both loud and high, in rapid succession, in violently percussive chords and fanfares. In exercise terms it’s high impact, like running up and down stairs. I could feel the impact inside my head, around my eyes, behind my eyes, in ways I’ve never actively noticed before. And all the time I was thinking

Should I be doing this? Am I risking my sight?

There were moments when I wanted to play quieter, or stop. There were moments when I didn’t want to play my Horn any more, at all, ever again.

Apparently the mean time for progression from early diagnosis to loss of vision is more than 20 years: for normal tension glaucoma and for younger (under 60) patients it’s even slower than that. So I’m probably being over-sensitive. But if the visual field loss starts in my right eye, I’ll have to tell the DVLA. And then I’ll have to be reassessed for driving.

So.

I’ll take the drops every morning, and play 4th horn instead.

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