Thinning of the Optic Nerve Fibers and Glaucoma Risks

Q: Thinning of the Optic Nerve Fibers and Glaucoma Risks

Hello： Based on your description, your intraocular pressure has increased from 18 and 19 to 26 and 27 over the past six years, with thinning of the optic nerve fibers. <br>The OCT examination shows abnormalities in the inferior quadrant of the left eye, but the visual field test

Optic nerve fiber thinning

Hello, Doctor~~ Over the past six years, my intraocular pressure has increased from an initial 18-19 to 26-27 this year, and I was subsequently diagnosed with suspected glaucoma! The doctor noted that my optic nerve fibers have thinned, and after performing an OCT (Optical Coherence Tomography) scan, he pointed to the pie chart indicating that the lower half of my left eye was entirely red, which is concerning.
Later, I underwent a visual field test, and the doctor said my visual fields are still okay, advising me to return for check-ups every six months.
I haven't been prescribed any eye drops or medications.
(Additional information: I have dry eye syndrome due to oil and water deficiency, congenital amblyopia, hyperopia in both eyes approximately +400, astigmatism of -500 and -275, and visual acuity of 0.8 each.) I have a few questions: 1.
Does thinning of the optic nerve fibers not indicate early-stage glaucoma? (I really want to know this.) I ask this because a colleague of mine has a similar condition, but the doctor at the hospital said he has early-stage glaucoma that can be well controlled.
2.
Could keratoconus lead to further thinning of the cornea, potentially causing glaucoma due to elevated intraocular pressure? 3.
Should I undergo other retinal examinations, or is the OCT sufficient? Thank you very much, Doctor, for taking the time to answer my questions!

Tracy, 30~39 year old female. Ask Date: 2024/03/26

Dr. Gao Pilin reply Ophthalmology

Hello: Based on your description, your intraocular pressure has increased from 18 and 19 to 26 and 27 over the past six years, with thinning of the optic nerve fibers.
The OCT examination shows abnormalities in the inferior quadrant of the left eye, but the visual field test is normal.

1.
Thinning of the optic nerve fibers: The optic nerve fibers are part of the optic nerve, responsible for transmitting visual information from the retina to the brain.
Thinning of the optic nerve fibers may be an early sign of glaucoma, but it does not necessarily indicate glaucoma.
Other conditions, such as optic neuritis and optic atrophy, can also lead to thinning of the optic nerve fibers.
Therefore, whether thinning of the optic nerve fibers signifies early glaucoma needs to be assessed in conjunction with other examination results.
In your case, the elevated intraocular pressure also supports the diagnosis of glaucoma.
2.
Keratoconus: Keratoconus and glaucoma are two distinct ocular conditions.
Keratoconus is a visual problem caused by an irregular shape of the cornea, while glaucoma is a disease characterized by damage to the optic nerve due to elevated intraocular pressure.
Although both conditions may coexist in the same individual, their relationship is not as direct as you might be concerned about.
However, some corneal diseases may affect the measurement of intraocular pressure, so this should be taken into account when measuring eye pressure.
3.
Retinal examination: Given that you have already undergone an OCT retinal scan and the physician has not indicated the need for additional retinal examinations, OCT retinal scans typically provide detailed information about retinal structure, which aids in assessing glaucoma and other ocular conditions.
However, if you have specific concerns about the retina or if other symptoms arise, you may consult with your physician regarding the necessity of further retinal examinations.

Reply Date: 2024/03/26

More Info

Hello! Thank you for your questions regarding the thinning of the optic nerve fibers and the associated risks of glaucoma. It’s understandable to feel concerned about your eye health, especially with the changes you’ve described. Let’s address your questions one by one.

1. Is thinning of the optic nerve fibers an early sign of glaucoma?
Yes, thinning of the optic nerve fibers can indeed be an early indicator of glaucoma. The optic nerve is crucial for transmitting visual information from the eye to the brain, and any damage or thinning can suggest that the nerve is under stress, often due to elevated intraocular pressure (IOP). In your case, the increase in eye pressure from 18-19 mmHg to 26-27 mmHg is significant, as normal IOP typically ranges from 10 to 21 mmHg. The fact that your doctor noted areas of concern in the OCT scan, particularly in the lower half of your left eye, aligns with the potential for glaucoma. However, the absence of visual field loss at this stage is a positive sign, as it indicates that your vision has not yet been affected. Regular monitoring is essential, as glaucoma can progress silently.

2. Can keratoconus lead to thinner corneas and subsequently increase the risk of glaucoma due to high eye pressure?
Keratoconus is a condition where the cornea thins and bulges into a cone shape, which can lead to various visual distortions. While keratoconus primarily affects the cornea, it does not directly cause glaucoma. However, if the cornea becomes significantly thin, it can affect the accuracy of IOP measurements, potentially leading to misdiagnosis or underestimation of the risk for glaucoma. Additionally, if the cornea becomes too thin, it may complicate surgical options for treating glaucoma if it becomes necessary in the future. Therefore, while keratoconus itself does not cause glaucoma, the changes in corneal thickness can influence the overall assessment of eye health.

3. Should I undergo other retinal examinations, or is the OCT sufficient?
The OCT (Optical Coherence Tomography) is a valuable tool for assessing the health of the optic nerve and the retina. It provides detailed images of the retinal layers and can detect thinning of the nerve fiber layer, which is crucial for glaucoma assessment. However, depending on your specific situation and the findings from your current examinations, your eye doctor may recommend additional tests. These could include visual field tests to monitor for any changes in peripheral vision, or other imaging techniques like fundus photography or fluorescein angiography to evaluate the retina and optic nerve head more comprehensively. It’s essential to have an open dialogue with your eye care provider about any additional tests that may be beneficial for your condition.

In summary, while thinning of the optic nerve fibers is a concern and can indicate early glaucoma, the absence of visual field loss is reassuring. Regular follow-ups and monitoring of your eye pressure and optic nerve health are crucial. Additionally, while keratoconus does not directly cause glaucoma, it can complicate the assessment of eye health. Always feel free to discuss any concerns with your eye care provider, as they can provide personalized recommendations based on your specific condition. Thank you for reaching out, and I wish you the best in managing your eye health!

Similar Q&A

Understanding Low Optic Nerve Fiber Thickness and Its Implications for Glaucoma

Hello, doctor. Last week, I went to an optical shop for an OCT examination, and it showed that my optic nerve fibers are low, with measurements of 72 and 69 for each eye. My intraocular pressure was normal except for the low optic nerve fiber count. They suggested that I visit a ...

Dr. Liang Ce reply Ophthalmology
We recommend that you: 1. Discuss the above situation further with your attending physician. 2. Consider consulting another ophthalmology clinic for a second opinion. Wishing you good health. Thank you!

Understanding Glaucoma: Eye Pressure, Nerve Health, and Safety Concerns

Hello, doctor. Recently, I've been experiencing eye strain and some discomfort in the back of my head. I'm concerned it might be glaucoma, so I went to the hospital for an examination. I have high myopia, approximately -7.00 diopters. My intraocular pressure was 17 mmHg...

Dr. He Jianxian reply Ophthalmology
1. In high myopia, the optic nerve itself can undergo changes, making it difficult to determine if there are any pathological alterations. If your doctor suspects you may have glaucoma, they will likely schedule a visual field test for you. 2. The fundus examination typically doe...

Understanding Thin Optic Nerve Fibers: Risks and Protection Strategies

I have high myopia with -7.50/-2.50 in the left eye and -9.25/-1.25 in the right eye. After undergoing optical nerve fiber examination, the doctor mentioned that the nerve fiber thickness is very thin and weak, likely due to high myopia causing unhealthy nerves. The average thick...

Dr. Wang Zhishun reply Ophthalmology
In cases of high myopia, optical coherence tomography (OCT) reveals that the nerve fiber layer thickness is already reduced due to the thinning of the retina. Currently, there are no methods available to increase this thickness.

Understanding Optic Nerve and Retina Thinning in High Myopia

Hello Doctor: I have high myopia (550, 600). Yesterday, I underwent a routine dilated eye exam (showing retinal thinning, non-patterned degeneration) and also had a fundus scan. The report indicated that the optic nerves in both eyes are thinning, and I need to undergo a visual f...

Dr. Gao Pilin reply Ophthalmology
Hello May: The thinning of the optic nerve can sometimes be congenital, so a visual field test is necessary to determine if there are any abnormalities. High myopia can lead to thinning of the peripheral retina, but it does not necessarily result in holes or retinal detachment. T...