Managing Intermediate Open-Angle Glaucoma: Key Concerns and Solutions

Intermediate glaucoma

Hello Director He:
I was diagnosed with moderate open-angle glaucoma in August last year, with a visual field test showing an MD of -9 in both eyes.
Currently, I am using fixed-dose eye drops to control my intraocular pressure.
For the past six months, I have been feeling anxious every day, especially when working on the computer, which has significantly affected my work and daily life.
I would like to ask:
1.
Does work-related stress and the amount of time spent using my eyes affect intraocular pressure? Should I consider changing jobs to reduce eye strain?
2.
I found online information stating that the risk of blindness from glaucoma can be as high as 25%.
Is this figure accurate?
3.
My doctor is currently using only a single medication for treatment, and my intraocular pressure is around 16-17 (previously around 22-24 before medication).
Should I seek more aggressive laser surgery to ensure my visual field does not continue to deteriorate?
4.
Is it possible to maintain proper control of moderate glaucoma and avoid blindness for a lifetime?
5.
Does smoking affect the control of intraocular pressure?
Thank you for taking the time to answer my questions.

Jimmy, 40~49 year old female. Ask Date: 2023/01/17

Dr. He Jianxian reply Ophthalmology

1.
There is no clear research on the correlation between work-related stress, eye strain, and intraocular pressure; however, moderate exercise and stress relief can indeed lower intraocular pressure.
2.
It should not be that high.
3.
If intraocular pressure can be ideally controlled with medication and visual field tests show no significant deterioration, there is no definite need for laser surgery.
4.
If well-controlled, the risk of blindness is quite low.
5.
Smoking affects blood flow and circulation; even if it does not impact intraocular pressure, it should still have a negative effect on the overall health of the eye.
Dr.
He Jianxian, Ophthalmology Department, Nantou Hospital.

Reply Date: 2023/01/17

More Info

Managing intermediate open-angle glaucoma can be a challenging journey, especially when dealing with the anxiety and uncertainty that often accompany a diagnosis. Your concerns are valid, and it's important to address them comprehensively.

1. Impact of Work Stress and Eye Strain on Intraocular Pressure (IOP): Stress and prolonged screen time can indeed affect your overall eye health, but the direct impact on IOP is less clear. While stress can lead to physiological changes in the body that might indirectly influence IOP, the primary factors affecting IOP are related to the production and drainage of aqueous humor in the eye. However, reducing eye strain by taking regular breaks, using proper lighting, and maintaining a comfortable distance from screens can help alleviate discomfort and potentially improve your overall eye health. If your job requires extensive screen time, consider discussing with your employer about ergonomics and breaks to minimize eye fatigue.

2. Risk of Vision Loss in Glaucoma: The statistic that glaucoma can lead to blindness in up to 25% of patients is concerning but varies widely based on several factors, including the type of glaucoma, how well it is managed, and individual patient factors. Early detection and consistent treatment are crucial in preventing vision loss. Regular follow-ups with your ophthalmologist and adherence to prescribed treatments can significantly reduce the risk of progression.

3. Current Treatment and Need for More Aggressive Options: If your current treatment with a single medication is keeping your IOP within a safe range (16-17 mmHg), it may be adequate for now. However, if you are experiencing anxiety about your condition or if your visual field is deteriorating, it may be worth discussing additional treatment options with your doctor. Laser treatments, such as selective laser trabeculoplasty (SLT), can be effective in lowering IOP and may be considered if medications alone are insufficient. Your ophthalmologist can provide guidance based on your specific situation and the stability of your condition.

4. Long-term Management of Intermediate Glaucoma: With proper management, many patients with intermediate open-angle glaucoma can maintain their vision throughout their lives. This involves regular monitoring, adherence to medication, and lifestyle adjustments. The goal is to keep IOP within a target range that minimizes the risk of optic nerve damage. Regular visual field tests and OCT scans can help track any changes in your condition.

5. Effect of Smoking on Eye Pressure: Smoking has been associated with various eye diseases, including glaucoma. While the direct impact of smoking on IOP is still being studied, it is generally advisable to avoid smoking due to its harmful effects on overall health. Quitting smoking can improve your general health and may positively influence your eye health as well.

In summary, managing intermediate open-angle glaucoma requires a proactive approach that includes regular monitoring, adherence to treatment, and lifestyle adjustments. If you have ongoing concerns about your treatment plan or the progression of your condition, seeking a second opinion or discussing your anxiety with your healthcare provider can be beneficial. Remember, you are not alone in this journey, and there are resources and support available to help you manage your condition effectively.

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