Glaucoma: Navigating Eye Pressure Concerns and Treatments

The issue of glaucoma is very troubling?

Hello, Director: My eyes have been a bit dry and red lately, so I went to the ophthalmology department at the municipal hospital for a consultation.
That day, my intraocular pressure was measured at 21 and 22, which is slightly elevated.
The doctor also had me look at a cross-shaped light to check my optic nerve and performed a slit lamp examination.
Afterward, he diagnosed me with glaucoma and prescribed eye drops for it.
However, I was very concerned and went to Chang Gung Memorial Hospital for further examination, which included corneal assessment, visual field testing, and fundus photography.
That day, my eye pressure was around 22 and 23.
The ophthalmologist at Chang Gung reviewed my results and said there was no significant issue and that I was not at the level of glaucoma, just that my eye pressure was slightly elevated.
He prescribed me Metipranolol eye drops to use once a day and advised me to return for a follow-up in three months.
However, I continued to use the eye drops from the municipal hospital and have not started the ones from Chang Gung yet.
The municipal hospital has me returning for follow-ups every month, and my eye pressure has consistently been around 19 to 21.
The doctor then added a nighttime drop of Brimonidine 0.004% to my regimen.
After using it, my eyes feel very uncomfortable and red.
So, I am unsure whether to trust the first doctor’s diagnosis.
If I do not have glaucoma and continue using the pressure-lowering eye drops, could there be side effects? I am very worried, which is why I am reaching out to you for your advice.
I apologize for bothering you during your busy schedule.
Thank you!

Niming, 30~39 year old female. Ask Date: 2018/03/31

Dr. He Jianxian reply Ophthalmology

The use of stress-relief medication can cause vasodilation, which may result in red eyes; this is a normal phenomenon.
Elevated intraocular pressure does not necessarily indicate glaucoma; additional information is required for a proper assessment, such as visual field testing.
If your visual field test at Chang Gung Hospital is normal, I recommend following up in three months, and it is not mandatory to start medication immediately.

Reply Date: 2018/03/31

More Info

Understanding glaucoma and managing elevated intraocular pressure (IOP) can be quite complex, especially when faced with conflicting medical opinions. Your situation highlights the importance of thorough evaluation and individualized treatment plans. Here’s a comprehensive overview of glaucoma, its implications, and treatment considerations based on your concerns.

Understanding Glaucoma and Eye Pressure
Glaucoma is a group of eye conditions that damage the optic nerve, often due to high intraocular pressure. It's crucial to understand that not everyone with elevated eye pressure will develop glaucoma. The condition can be classified into different types, with primary open-angle glaucoma (POAG) being the most common. In your case, the readings of 21-23 mmHg indicate elevated IOP, but whether this translates to glaucoma depends on additional factors, including optic nerve health and visual field tests.

Diagnostic Procedures
The tests you underwent, including visual field testing, optical coherence tomography (OCT), and slit-lamp examination, are essential in diagnosing glaucoma. The OCT can provide detailed images of the optic nerve and help assess any thinning that may indicate glaucoma. If your optic nerve appears healthy and visual fields are intact, it may suggest that you do not have glaucoma, despite elevated IOP.

Treatment Options
1. Medications: The medications prescribed by both hospitals aim to lower IOP. Common classes include prostaglandin analogs (like Travatan), beta-blockers (like Timolol), and alpha agonists. While these medications can effectively reduce IOP, they may also cause side effects, such as redness, dryness, or discomfort, which you have experienced.

2. Monitoring: Regular follow-ups are crucial. If your IOP remains stable and your optic nerve health is intact, your doctor may recommend a watchful waiting approach rather than aggressive treatment. This is particularly relevant if there are no signs of glaucoma progression.

3. Lifestyle Considerations: Managing stress, maintaining a healthy diet, and staying hydrated can also contribute to eye health. Additionally, ensure you are getting adequate sleep, as fatigue can exacerbate symptoms like dryness and discomfort.

Concerns About Long-Term Medication Use
Your concern about the long-term use of IOP-lowering medications is valid. Prolonged use can lead to side effects, and in some cases, patients may develop a tolerance, necessitating higher doses or additional medications. However, if you do not have glaucoma, the risks of unnecessary medication may outweigh the benefits.

Seeking a Second Opinion
Given the conflicting opinions from the two medical facilities, it may be beneficial to seek a third opinion from a glaucoma specialist. This specialist can provide a more focused evaluation of your optic nerve and IOP, and help clarify whether you truly have glaucoma or if your condition can be managed with observation and lifestyle adjustments.

Conclusion
In summary, while elevated IOP is a concern, it does not automatically mean you have glaucoma. The health of your optic nerve and visual fields are critical in making this determination. If your current treatment is causing discomfort, it’s essential to communicate this with your healthcare provider. They may adjust your medication or suggest alternative therapies. Regular monitoring and open communication with your eye care team are key to managing your eye health effectively.
Always remember, your comfort and quality of life are paramount, and finding a treatment plan that aligns with your needs is essential.

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