Managing High Eye Pressure: Should You Stop Medication Before Follow-Up?

Q: Managing High Eye Pressure: Should You Stop Medication Before Follow-Up?

Hello： 1. <br>Timing for discontinuing medication： If your intraocular pressure has significantly decreased after using eye drops, and you plan to undergo a visual field test, the doctor may recommend stopping the medication, believing that your current examination situation does

In cases of elevated intraocular pressure, if the follow-up diagnostic appointment is scheduled too far in the future, should the medication be paused first?

Hello Doctor, I spontaneously decided to visit a nearby ophthalmology clinic on Monday evening for an eye examination, as I hadn't had one in over ten years.
I found that my intraocular pressure (IOP) was 28 in one eye and 26 in the other, but I had no discomfort.
The doctor prescribed Xalatan and Safrin eye drops, which I used once in the morning and once at night until this morning (Wednesday).
At the larger hospital, my IOP dropped from 28 to 22, but the 26 seemed unchanged.
I was too eager to ask and forgot to inquire whether this measurement accounted for corneal thickness or not.
When I entered the examination room, I glanced at the IOP readings, which appeared to be 20 and 22.
I noticed that one eye had a corneal thickness of 595 micrometers.
I suspect that the equipment at the old clinic may not have adjusted for corneal thickness, leading to elevated readings.
Additionally, I underwent an OCT examination, and I saw that the data was quite good, with everything in the green range.
However, the eye that initially had an IOP of 26 had a vertical cup-to-disc ratio of 0.69, indicated in yellow (this eye was injured by a ruler in childhood, and I have higher myopia; I'm not sure if this affects the measurements).
The cup volume was 0.353 mm, which was in the green range.
The RNFL thickness was also in the good range, all green.
The doctor advised me to stop the medication and scheduled a visual field test, but the appointment is a month away.
I'm unsure if it is appropriate to stop the medication at this point or if I should continue using it until the test.
Should I consider finding a smaller clinic to monitor my IOP in the meantime? Thank you, Doctor.

Niu, 30~39 year old female. Ask Date: 2024/01/17

Dr. Gao Pilin reply Ophthalmology

Hello: 1.
Timing for discontinuing medication: If your intraocular pressure has significantly decreased after using eye drops, and you plan to undergo a visual field test, the doctor may recommend stopping the medication, believing that your current examination situation does not require the use of drops.
After completing the visual field test, you can reconsider whether to continue medication.
The physician's recommendation to stop the medication indicates that it is acceptable to have a follow-up examination in a month.
2.
Monitoring intraocular pressure: If you are concerned about the accuracy of your intraocular pressure readings, you might consider having multiple measurements taken at different clinics to verify the consistency of the results.
Additionally, it may be challenging to frequently measure intraocular pressure at large hospitals, so it is advisable to have several measurements taken at a clinic to ensure that the intraocular pressure is stable.

Reply Date: 2024/01/17

More Info

Managing high eye pressure is a critical aspect of eye health, especially for individuals with a history of elevated intraocular pressure (IOP) or conditions such as glaucoma. In your case, it appears that you have experienced fluctuating eye pressure readings, with initial measurements of 28 mmHg and 26 mmHg, which are indeed above the normal range (typically considered to be between 10 and 21 mmHg). After starting treatment with eye drops, your pressure decreased to 22 mmHg, while the other eye remained unchanged.

Should You Stop Medication Before Follow-Up?
Based on the information provided, your doctor has advised you to stop the medication and schedule a follow-up visual field test in a month. This recommendation is likely based on the following considerations:
1. Significant Reduction in Eye Pressure: If your eye pressure has decreased significantly after starting the medication, it may indicate that the treatment is effective. Your doctor may feel that continuing the medication is unnecessary at this point, especially if your pressure is now closer to the normal range.

2. Monitoring and Follow-Up: The decision to stop medication before a follow-up test can be a strategic one. Your doctor may want to assess your eye pressure without the influence of medication to get a clearer picture of your baseline IOP. This can help in determining whether you need ongoing treatment or if your elevated pressure was a temporary issue.

3. Visual Field Testing: The visual field test is crucial in assessing the health of your optic nerve and determining if there has been any damage due to elevated eye pressure. If your doctor believes that your current eye pressure is stable and not causing immediate harm, they may prioritize this test before making further treatment decisions.

Should You Continue Monitoring Eye Pressure?
While your doctor has suggested stopping the medication, it is essential to remain vigilant about your eye health. Here are some recommendations:
- Regular Monitoring: If you are concerned about your eye pressure, consider visiting a local clinic or eye care provider for regular monitoring. This can help ensure that your eye pressure remains stable and that any fluctuations are addressed promptly.

- Understanding Equipment Variability: You mentioned concerns about the accuracy of the equipment used in the initial clinic. It is not uncommon for different devices to yield slightly different results, especially if they do not account for corneal thickness. If you have access to a reputable eye care facility, it may be beneficial to have your pressure checked there for consistency.

- Symptoms to Watch For: Although you are currently asymptomatic, be aware of any changes in your vision, headaches, or discomfort around your eyes. If you experience any of these symptoms, it may warrant an earlier visit to your eye care provider.

Conclusion
In summary, stopping the medication before your follow-up visual field test seems reasonable given your recent eye pressure reduction. However, it is crucial to remain proactive about your eye health by monitoring your pressure regularly and being aware of any symptoms. If you have any doubts or experience changes in your condition, do not hesitate to reach out to your eye care provider for further evaluation. Your eye health is paramount, and staying informed and engaged in your care will help ensure the best outcomes.

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