Eye Flashes and Nerve Cupping in High Myopia

Q: Eye Flashes and Nerve Cupping in High Myopia

Hello： Floaters refer to the appearance of black dots, dust, or small insects in your line of sight, usually caused by floating debris in the vitreous body. <br>If the symptoms of flashes change significantly and persist, it is advisable to seek medical evaluation promptly. <br>I

Flashes of light; optic nerve cupping?

Hello Doctor: A few months ago, I discovered floaters in my vision, and after undergoing dilation, no issues were found at that time.
Over the past few months, I have intermittently experienced flashes of light (similar to a light bulb flickering, lasting less than a second).
Sometimes, I go weeks without any symptoms, while other times, I may experience them 4-5 times in a week.
Yesterday, after dilation, no problems were detected; however, the doctor mentioned that these brief flashes in my vision are not significant and that dilation would not provide any useful information.
He stated that due to my high myopia (nearly 1000 degrees in both eyes) and already poor vision, unless I experience shadows or blurriness, I should not be concerned about the flashes.
I thought that online educational resources suggest that any changes or frequent symptoms warrant an examination, right? I also noticed that the occurrence of these flashes does not seem to correlate with my eye usage; sometimes, even on days when I do not use my eyes much, I still experience the flickering.

Another issue is that I visited a clinic to check for glaucoma, as my eye pressure has consistently been on the higher side (around 18-22).
Additionally, my cornea is relatively thick (580-600), which may bring my measurements into the normal range.
The OCT measurements indicated that my optic nerve is somewhat thin (the doctor mentioned that while the average is around 100, mine is in the 80s), and my cup-to-disc ratio is approximately 0.5-0.6.
However, the glaucoma specialist at the hospital indicated that my condition resembles degeneration due to high myopia (with a thickness in the 80s), while the clinic doctor warned that if my eye pressure remains high, I will likely develop glaucoma by middle age.

I would like to ask, is it possible that the degree of optic nerve cupping could be attributed to degeneration from high myopia? The opinions from the two doctors are inconsistent, and the glaucoma specialist has not prescribed any medication yet, stating that I have not been diagnosed but has arranged for regular follow-ups.
Thank you, Doctor.

Hong, 20~29 year old female. Ask Date: 2024/04/27

Dr. Gao Pilin reply Ophthalmology

Hello: Floaters refer to the appearance of black dots, dust, or small insects in your line of sight, usually caused by floating debris in the vitreous body.
If the symptoms of flashes change significantly and persist, it is advisable to seek medical evaluation promptly.
If they are intermittent, you may monitor them.
However, if you have concerns, undergoing several examinations can provide reassurance.

As for glaucoma, it is a condition that can lead to damage to the optic nerve.
The optic nerve transmits visual information from the eye to the brain, and once damaged, it may result in vision loss.
Risk factors for glaucoma include elevated intraocular pressure, family history, advanced age, and myopia.
Your elevated intraocular pressure, combined with high myopia, places you in a high-risk group for glaucoma.
Although considering corneal thickness, it is still prudent to be cautious.
A visual field test may be necessary.

Optic nerve cupping is one of the common symptoms of glaucoma.
It refers to the degree of depression of the optic disc (the area where the optic nerve enters the eye).
In normal individuals, the cup-to-disc ratio (the ratio of the area of the optic nerve cup to the area of the optic nerve head) is approximately 0.3-0.4.
Your cup-to-disc ratio is 0.5-0.6, indicating mild cupping.
However, high myopia can also lead to optic nerve cupping.
Therefore, the degree of optic nerve cupping alone cannot determine the presence of glaucoma, and a visual field test may still be required.

Your glaucoma specialist believes that your current condition may be due to the degeneration associated with high myopia, but regular follow-up is still necessary.
It is recommended that you follow your doctor's instructions, undergo regular ophthalmic examinations, and pay attention to controlling your intraocular pressure.
I hope this information is helpful to you.

Reply Date: 2024/04/27

More Info

Understanding eye flashes and nerve cupping in individuals with high myopia is crucial, especially given the complexities associated with this condition. High myopia, defined as a refractive error of -6.00 diopters or more, can lead to various ocular complications, including retinal detachment, glaucoma, and changes in the optic nerve head, often referred to as nerve cupping.

Eye Flashes
The phenomenon of experiencing flashes of light, particularly in the context of high myopia, is often associated with changes in the vitreous body of the eye. As individuals age or as the vitreous gel undergoes liquefaction, it can pull away from the retina, leading to what is known as posterior vitreous detachment (PVD). This detachment can stimulate the retina, causing the perception of flashes of light, which may appear as brief, bright spots or streaks in the visual field.
In your case, the intermittent nature of these flashes—occurring sporadically over weeks—suggests that they may be related to the ongoing changes in the vitreous rather than an acute retinal issue. However, it is essential to monitor these symptoms closely. If the flashes become more frequent, or if you notice new floaters or a shadow in your vision, it is crucial to seek immediate medical attention, as these could indicate a retinal tear or detachment.

Nerve Cupping and High Myopia
Regarding the optic nerve cupping you mentioned, it is indeed possible for high myopia to lead to changes in the optic nerve head. In high myopia, the elongation of the eyeball can cause stretching of the optic nerve, leading to a characteristic appearance of nerve cupping. The cup-to-disc ratio you provided (0.5-0.6) is significant, especially in the context of your elevated intraocular pressure (IOP) readings. While a normal cup-to-disc ratio is typically around 0.3, values above this can indicate potential glaucomatous changes, particularly when combined with high IOP.

The discrepancy between the two doctors' opinions regarding the cause of your optic nerve changes is not uncommon in clinical practice. One doctor may emphasize the degenerative changes associated with high myopia, while another may focus on the potential for glaucoma given your elevated IOP and the observed cupping. It is essential to consider both perspectives, as high myopia can indeed lead to nerve changes that mimic those seen in glaucoma, and elevated IOP is a significant risk factor for developing glaucoma.

Recommendations
1. Regular Monitoring: Given your history of high myopia and the presence of both flashes and nerve cupping, regular follow-ups with an ophthalmologist are critical. This should include comprehensive eye exams, visual field tests, and OCT imaging to monitor any changes in the optic nerve and retina.

2. Manage Eye Pressure: Since your IOP readings are on the higher side, it is essential to monitor this closely. Even if you have not been prescribed medication yet, maintaining regular check-ups will help in early detection of any potential glaucoma development.

3. Lifestyle Adjustments: Reducing eye strain through proper ergonomics, taking regular breaks from screens, and ensuring adequate lighting can help manage symptoms. Additionally, managing stress and anxiety, which you mentioned, can also have a positive impact on your overall eye health.

4. Seek a Second Opinion: If you feel uncertain about the differing opinions from your doctors, seeking a second opinion from a glaucoma specialist or a retinal specialist may provide further clarity on your condition.

In conclusion, while the symptoms you are experiencing can be concerning, they are not uncommon in individuals with high myopia. Continuous monitoring and proactive management of your eye health are essential to mitigate potential complications. Always trust your instincts; if something feels off, do not hesitate to seek further evaluation.

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