High Eye Pressure and Optic Nerve Health: Key Concerns

Q: High Eye Pressure and Optic Nerve Health: Key Concerns

Hello： (1) Based on your description, your intraocular pressure is currently stable in the range of 21-22 mmHg, and your visual field test results are normal, with no abnormalities in the fundus. <br>This may indicate that your condition is currently stable and may only be classi

Optic nerve-related

Currently, I would like to briefly describe my situation.
I was diagnosed with elevated intraocular pressure and slightly larger optic nerve cupping at the age of 18.
I have been undergoing regular visual field tests and fundus examinations for the past five years.
On July 25 of this year, my visual field test results were similar to previous years, showing normal vision with no damage.
My fundus examination showed a normal retina.
My intraocular pressure, which was originally between 25-27 mmHg, is now stable at 21-22 mmHg, rising to 23 mmHg when fatigued.
I have not been using any pressure-lowering eye drops (I usually use maintenance drops and dilate my pupils before bed).
The optic nerve cupping has not increased, measuring approximately 0.4 in the left eye and 0.5 in the right eye.
My refractive error is -3.20 diopters with astigmatism of -1.50 in the left eye, and -4.25 diopters with astigmatism of -1.25 in the right eye.
I would like to ask the following questions to my doctor:
1.
Does my current condition only classify as elevated intraocular pressure, and is it stable?
2.
Could the optic nerve cupping be congenital or caused by myopia and astigmatism?
3.
Is it possible that my intraocular pressure is elevated due to excessive eye strain or staying up late?
4.
Does weight training negatively affect intraocular pressure? (I try to avoid holding my breath and breathe normally.)
Additionally, over the past few years, I have noticed a small area of darker coloration in the fundus of my right eye, described by my doctor as orange-red.
There are no tears or bleeding, and the blood vessels appear healthy.
The discoloration has been gradually fading.
The doctor mentioned it could be simple pigment deposition (not related to night blindness) or stretching caused by myopia and astigmatism.
I would like to know your opinion on this.
Finally, today my doctor mentioned scheduling an optical coherence tomography (OCT) scan in six months to check for any thinning of my optic nerve fibers.
I would like to ask: if there are changes in the optic nerve fibers, but my visual field is normal, intraocular pressure is stable, and optic nerve cupping has not increased, would this still be classified as glaucoma, or would it be considered early-stage? If it is classified as early-stage, should I start using medication? I am a bit concerned that after these five years, I may be approaching the mid-stage of visual field damage.
The doctor said that visual field testing is too time-consuming, which is why he switched to this method, but I am still a bit anxious and worried.
I apologize for having so many questions, and I appreciate your help.
Thank you.

Yan, 20~29 year old female. Ask Date: 2023/09/30

Dr. Gao Pilin reply Ophthalmology

Hello: (1) Based on your description, your intraocular pressure is currently stable in the range of 21-22 mmHg, and your visual field test results are normal, with no abnormalities in the fundus.
This may indicate that your condition is currently stable and may only be classified as ocular hypertension.
However, it is important to note that elevated intraocular pressure itself can be a risk factor for glaucoma, so regular check-ups are still necessary to ensure stability.
(2) The optic nerve cupping may be congenital or influenced by factors such as myopia and astigmatism.
These factors may increase the risk of developing glaucoma.
However, your current optic nerve cupping does not appear to have worsened significantly, so it is important to continue regular examinations to monitor for changes.
(3) The increase in intraocular pressure may be related to eye strain and late nights, but this is usually temporary.
Your current intraocular pressure level is relatively stable, and in the future, you can focus on rest and maintaining a proper lifestyle to ensure stability.
(4) Weight training typically does not adversely affect intraocular pressure, as long as you maintain normal breathing and avoid excessive straining; this should not be a primary cause of elevated intraocular pressure.
Regarding the small dark area in the fundus of your right eye, the doctor's preliminary assessment suggests it may be due to pigment deposition or other causes.
Since it is gradually fading and no more serious issues have arisen, you can continue regular check-ups to monitor the situation.
Finally, optical coherence tomography (OCT) is a tool used to assess the optic nerve fibers.
If there are changes in your optic nerve fibers but your visual field is normal and intraocular pressure is stable, this may indicate that you are in the early stages of glaucoma.
In this case, the physician may consider initiating treatment to prevent potential visual field damage.

Reply Date: 2023/09/30

More Info

Understanding high eye pressure and its implications for optic nerve health is crucial, especially for individuals with a history of ocular issues such as high eye pressure and myopia. Based on your detailed description, let's address your concerns systematically.

1. Current Status of High Eye Pressure: Your eye pressure readings of 21-22 mmHg, while elevated compared to the normal range (typically 10-21 mmHg), are stable and not currently requiring treatment. The fact that your visual fields remain normal and there is no progression in optic nerve cupping suggests that you are not experiencing glaucomatous damage at this time. This condition is often referred to as "ocular hypertension." Regular monitoring is essential, as it helps to ensure that any changes can be detected early.

2. Optic Nerve Cupping: The degree of optic nerve cupping you describe (0.4 in the left eye and 0.5 in the right) can indeed be influenced by factors such as myopia and astigmatism. High myopia is associated with structural changes in the eye, which can lead to a greater likelihood of optic nerve changes. However, the cupping you observe does not necessarily indicate glaucoma, especially since your visual fields are intact.

3. Causes of Elevated Eye Pressure: Elevated eye pressure can be influenced by various factors, including prolonged screen time, lack of sleep, and overall eye fatigue. These factors can lead to transient increases in intraocular pressure (IOP). However, it is essential to differentiate between temporary spikes in pressure and chronic high eye pressure, which could lead to optic nerve damage over time.

4. Impact of Weight Training on Eye Pressure: Engaging in weight training can potentially affect eye pressure, particularly if there is significant straining involved (such as holding your breath during heavy lifts). It is advisable to maintain proper breathing techniques and avoid excessive straining to minimize any potential impact on your eye pressure.

5. Observation of Retinal Changes: The presence of a small area of deeper pigmentation in your retina, described as orange-red, is likely benign and could be attributed to pigmentary changes associated with myopia or other non-pathological factors. The fact that it is gradually fading is a positive sign, indicating that it may not be a cause for concern.

6. Future Monitoring and Treatment: The upcoming optical coherence tomography (OCT) scan is an excellent step to assess the health of your optic nerve fibers. If there are changes in the nerve fiber layer but your visual fields remain normal, this does not automatically classify you as having glaucoma. It may indicate a need for closer monitoring. If your optic nerve fibers show thinning, but your visual fields are intact and your eye pressure is stable, it may suggest early changes that warrant observation rather than immediate treatment.

In conclusion, while your concerns are valid given your history of high eye pressure and myopia, the current evidence suggests that you are stable at this time. Regular follow-ups with your eye care provider, adherence to prescribed monitoring protocols, and maintaining a healthy lifestyle will be crucial in managing your eye health. If you experience any new symptoms or changes in your vision, do not hesitate to seek medical advice sooner than your scheduled appointments. Remember, proactive management is key in preserving your vision and overall ocular health.

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