Eye Pressure: Concerns and Management for Glaucoma - Ophthalmology

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Intraocular pressure issues?


Hello, I apologize for the lengthy message.
On July 12, I went to a general clinic for a retinal examination and found my intraocular pressure (IOP) to be 24 and 25 mmHg (after 5 air puffs).
The doctor suspected glaucoma.
Two weeks later, on July 18, I went to a larger hospital for further examination, and my IOP was 21/21 mmHg after some medication.
The doctor advised me to stop the medication to see how high my IOP would rise.
On July 19, I underwent a visual field test; the doctor did not mention the IOP, but it was on the higher side.
On July 25, I reviewed the test results, which showed an IOP of 22/23 mmHg, and my corneal thickness was measured at 604/610 micrometers, which the doctor considered normal.
On August 22, during a fundus examination, my IOP was again 24/25 mmHg (after 4-5 air puffs).
The doctor then administered anesthetic drops and used a contact tonometer, measuring 18/23 mmHg, which was also normal (I suspect the initial higher reading in my right eye was due to sudden anxiety, as I was more relaxed when the left eye was measured).
On October 10, during a second visual field test, my IOP was 22/23 mmHg, which was normal.
Despite multiple tests showing no significant issues, on October 18, I felt an increase in floaters and went to an unfamiliar hospital for an examination, where my IOP was measured at 31/28 mmHg (by a novice optometrist).
Two hours later, after receiving anesthetic drops, the IOP was around 27 mmHg (measured by a different person).
I find this hard to believe since my previous hospital consistently showed normal IOP readings, and my original doctor advised me not to worry, suggesting annual visual field and retinal examinations.
However, the readings from this new hospital raised concerns (the nurse and doctor were quite rough when cleaning up the anesthetic that had leaked out, which caused some discomfort).
After half an hour, I rushed to another eye clinic where my IOP was 24/25 mmHg, corrected to about 21/22 mmHg, which was slightly elevated.
The experience at the third clinic was quite disheartening, as the numbers varied significantly from the first and second clinics.

1.
Since my fundus, optic nerve, and visual field tests show no issues, should I measure my IOP monthly at the same clinic and have visual field tests every six months?
2.
Is there a discrepancy due to different machines at different clinics? I understand that timing matters, but with so many measurements taken at different times, the IOP readings should not vary significantly between morning and afternoon.
Should I consistently go to the same clinic with the same equipment for more accurate and comparable results? (I also trust that clinic more.)
3.
The doctor at the clinic with the higher readings mentioned that if I have glaucoma in the coming years, I could go blind by age 50.
Since I am young and my optic nerve is currently fine, is there a high probability of developing glaucoma? If I do develop glaucoma, wouldn’t it be challenging to manage it with the right medications to avoid blindness?
4.
Given my situation, am I at risk for developing glaucoma? My prescription is 625/700.
5.
I feel very anxious every time I measure my IOP.
Is this a form of white coat syndrome? Would my IOP readings be higher than at home?
6.
I know that higher IOP is more dangerous; what does my current IOP indicate? Should I be concerned about developing glaucoma in a few years?
7.
Should I be treated for high IOP with medication?
8.
Can long-term monitoring help prevent glaucoma? I am really anxious; since visiting that clinic on October 18, I have been extremely worried and cried on October 19.
9.
In three days, on October 21 (Saturday), I have another appointment at my usual clinic to measure my IOP for follow-up, but I am very worried, so I came online to ask.
Thank you, doctor, for taking the time to read my lengthy message and answer my questions.

Feichang Konghuan Zhe, 10~19 year old female. Ask Date: 2022/10/19

Dr. Gao Pilin reply Ophthalmology


Hello: 1.
It is beneficial to have follow-ups at the same clinic.
This allows the physician to monitor your changes effectively.
2.
The difference measured by a properly functioning machine should not be significant.
You can go to a clinic you trust.
3.
If managed properly, it is unlikely to lead to blindness.
There's no need to worry too much.
4.
Not necessarily.
5.
Anxiety can potentially increase intraocular pressure.
6.
7.
8.
9.
With long-term follow-up and appropriate treatment, even glaucoma can be well-controlled.
Moreover, since your fundus, optic nerve, and visual field are all normal, it does not necessarily mean you will develop glaucoma.
You can have your examination in three days and wait with peace of mind.

Reply Date: 2022/10/19

More Info


Understanding eye pressure and its implications for glaucoma is crucial, especially for individuals with a history of high eye pressure readings. Your concerns are valid, and it’s important to address them comprehensively.

1. Eye Pressure Readings: Your eye pressure readings of 24-25 mmHg are indeed above the normal range, which is typically considered to be between 10 and 21 mmHg. However, it’s essential to note that a single high reading does not automatically indicate glaucoma. Glaucoma is diagnosed based on a combination of factors, including eye pressure, the appearance of the optic nerve, and visual field tests. Since your optic nerve and visual fields have been reported as normal, this is a positive sign.

2. Variability in Measurements: Different machines and techniques can yield varying results. Factors such as the technician’s experience, the time of day, and even your level of anxiety during the measurement can influence the readings. It’s advisable to have your eye pressure measured at the same clinic and preferably with the same equipment for consistency. This will help you and your doctor track any changes more accurately.

3. Anxiety and Eye Pressure: Your anxiety during eye pressure measurements can indeed lead to higher readings, a phenomenon often referred to as "white coat syndrome." It’s not uncommon for patients to experience elevated pressure due to stress. Practicing relaxation techniques before your appointment may help mitigate this effect.

4. Risk Factors for Glaucoma: While high myopia (nearsightedness) is a risk factor for glaucoma, it does not guarantee that you will develop the condition. Regular monitoring is key. Your current eye pressure readings, while concerning, should be interpreted in the context of your overall eye health, including the condition of your optic nerve and visual fields.

5. Management and Follow-Up: Given your fluctuating eye pressure readings, it’s wise to follow your doctor’s advice regarding regular check-ups. Monthly pressure checks and semi-annual visual field tests can help establish a clearer picture of your eye health over time. If your eye pressure remains consistently high or if there are changes in your optic nerve or visual fields, your doctor may recommend treatment options, including medication.

6. Treatment for High Eye Pressure: If your eye pressure readings remain elevated, your doctor may consider prescribing medication to lower it. The goal of treatment is to prevent damage to the optic nerve, which can lead to vision loss. Early intervention is crucial in managing glaucoma effectively.

7. Long-term Monitoring: Regular follow-ups are essential in preventing glaucoma-related damage. Even if your eye pressure readings are currently manageable, continued monitoring will help catch any changes early.
8. Coping with Anxiety: It’s understandable to feel anxious about your eye health, especially with the potential implications of glaucoma. Consider discussing your anxiety with your healthcare provider, who may suggest strategies to help you cope, such as mindfulness techniques or counseling.

9. Conclusion: While your situation may seem daunting, it’s important to remember that many individuals with high eye pressure do not develop glaucoma, especially with regular monitoring and appropriate management. Stay proactive about your eye health, maintain open communication with your eye care provider, and focus on managing your anxiety.
In summary, while your eye pressure readings are a concern, they do not definitively indicate glaucoma, especially given the normal findings in your optic nerve and visual fields. Regular monitoring and a good relationship with your eye care provider will be your best strategies moving forward.

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