the Use of Eyedrops for Glaucoma: A Patient's Concern

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Hello Doctor,
I am 24 years old and have severe myopia, with both eyes at -800 diopters.
Earlier this year, I had an examination at a hospital in the northern part of Taiwan, where the doctor informed me that I might have glaucoma, as my intraocular pressure (IOP) was around 23-25 mmHg.
Following that, I underwent further tests.
The visual field test results indicated no significant issues, but the doctor noted that my optic nerve appeared weaker and required monitoring.
After returning home for the winter break, I consulted two other doctors.
One doctor mentioned that my elevated IOP could be due to my thick corneas, and that the cup-to-disc ratio was abnormal.
He explained that the weakness of my optic nerve was likely a result of my high myopia.
The other doctor stated that everything looked fine and recommended regular follow-ups.
During this time, I became anxious about the possibility of glaucoma, so I tried to maintain a routine of going to bed early and waking up early.
I also visited the ophthalmologist approximately every two weeks, and since February, my IOP readings have consistently ranged from 14 to 20 mmHg, which seems to fall within the normal range according to my online research.
Today (March 26), I returned to the northern hospital, where my IOP was measured at 18 and 20 mmHg.
The doctor mentioned that my optic nerve still appeared weak and showed signs of redness, so he prescribed me Brimonidine eye drops.
However, I am confused as to why I need to use Brimonidine if my IOP is within normal limits.
I found out that this medication is typically used to lower IOP, but since my readings are normal, I wonder if I actually have glaucoma.
Could it be that the doctor is withholding information to avoid causing me anxiety, especially since he knows I have been struggling with appetite and sleep since being informed of the potential glaucoma?
Additionally, I would like to ask about an incident on February 28, when I experienced abnormal flashes of light in my vision.
I consulted four ophthalmologists, all of whom confirmed that my fundus, macula, and retina appeared normal, with no signs of tears or detachment.
However, the flashes continue to occur intermittently, resembling the reflective tiles on sidewalks at night, with different locations each time and no way to predict when they will appear.
I also underwent a CT scan and MRI of my brain, which showed no issues with my cranial nerves.
Could you advise if there are any other tests I should consider, or if there are other conditions that might be affecting my eye health?
Thank you for taking the time to read my message.
I apologize for the length of this note.
The temperature has been fluctuating significantly these days, so please take care to stay warm.
I look forward to your response.
Thank you, Doctor.

K, 20~29 year old female. Ask Date: 2019/03/26

Dr. He Jianxian reply Ophthalmology

If you have concerns about glaucoma, it is advisable to consult with an ophthalmologist for a more definitive assessment, as I do not have the necessary information to make a clear determination.
Regarding astigmatism-related visual disturbances, if you have already seen four ophthalmologists and undergone dilation examinations, it is likely that there should be no issues.

Reply Date: 2019/03/26

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your eye health and the use of eyedrops for glaucoma. I understand that you have been experiencing anxiety about your eye condition, especially after being informed of a potential glaucoma diagnosis. Let’s address your questions and concerns systematically.

1. Understanding Your Diagnosis: You mentioned that your eye pressure readings have been fluctuating between 14-20 mmHg, which is generally considered within the normal range. However, the fact that your optic nerve appears weak and has a reddish appearance is a significant factor. In glaucoma, the health of the optic nerve is crucial, and even if the intraocular pressure (IOP) is normal, damage to the optic nerve can still occur. This condition is known as Normal Tension Glaucoma (NTG). Your doctors may be proactive in prescribing medication like "艾弗明" (which I assume is a pressure-lowering medication) to protect your optic nerve from potential damage, even if your current pressures are within normal limits. This is a common practice to prevent further deterioration.

2. Medication Use: The prescription of eye drops like "艾弗明" is often a precautionary measure. It’s not uncommon for doctors to prescribe IOP-lowering medications to patients with risk factors for glaucoma, such as a family history of the disease, optic nerve appearance, or even high myopia (which you have). The goal is to maintain the health of your optic nerve and prevent any future vision loss. If you have concerns about the necessity of this medication, it is essential to discuss them with your ophthalmologist. They can provide clarity on the rationale behind the prescription.

3. Flashing Lights: The intermittent flashing lights you are experiencing can be concerning. While you have been evaluated by multiple ophthalmologists and have undergone imaging studies that ruled out retinal tears or detachment, it is still important to monitor this symptom. Flashes can sometimes be related to vitreous changes in the eye, especially in individuals with high myopia. If the flashes persist or worsen, further evaluation by a retina specialist may be warranted to rule out any underlying issues.

4. Anxiety and Follow-Up: It’s understandable to feel anxious about your eye health, especially with the potential diagnosis of glaucoma. Regular follow-ups are crucial, and it’s good that you are proactive about your eye care. If you feel that your anxiety is impacting your daily life, consider discussing this with your healthcare provider. They may suggest coping strategies or refer you to a mental health professional who can help you manage your anxiety.

5. Further Investigations: If the flashing lights continue and are bothersome, you might want to ask your doctor about additional tests, such as a visual field test or optical coherence tomography (OCT), which can provide more detailed information about the health of your retina and optic nerve.

In conclusion, while your current eye pressures are within normal limits, the health of your optic nerve and the presence of flashing lights warrant careful monitoring and possibly preventive treatment. It’s crucial to maintain open communication with your healthcare providers about your concerns and treatment plan. If you have any further questions or if your symptoms change, do not hesitate to seek medical advice promptly.

Wishing you the best in your eye health journey.

Sincerely,
Doctor Q&A Teams

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