High Eye Pressure: Insights on Diagnosis and Treatment

Q: High Eye Pressure: Insights on Diagnosis and Treatment

Hello： Based on the detailed information you provided, here are my recommendations and explanations：<br>1. <br>Should you continue using eye drops? Given your high myopia and elevated intraocular pressure, you belong to a high-risk group for glaucoma, making the preventive use of

Ocular hypertension

Hello, Dr.
Gao.
Due to high myopia, with prescriptions of -800 and -700 diopters, my tonometry readings have reached a maximum of 24 mmHg, mostly ranging between 21 and 22 mmHg.
When using a handheld tonometer, the readings are around 18 and 17 mmHg.
I have consulted three glaucoma specialists and undergone OCT scans.
Due to my high myopia, my optic nerve is somewhat thin.
I have had visual field tests three times, all within the normal range, with MD values ranging from 0.08 to 0.8.
A slit-lamp examination showed no damage to the optic nerve.
The diagnoses from the three clinics are as follows:
Clinic A: High intraocular pressure, suspected glaucoma, recommended medication, and intraocular pressure must be reduced to below 18 mmHg.

Clinic B: Primary open-angle glaucoma (POAG), mild; I am currently being monitored at this clinic, and after using Timolol, my intraocular pressure was 19 and 18 mmHg.

Clinic C: High intraocular pressure, no medication needed, but due to being in a high-risk group, monitoring is required.
I have the following questions for you, Dr.
Gao:
1.
Do you recommend starting medication?
2.
If medication is necessary, does using Timolol achieve the target intraocular pressure?
3.
The definition of early glaucoma is an MD value of -3 or lower; Clinic B's diagnosis of POAG, mild, indicates mild glaucoma.
Is this different from the definition of early glaucoma?
4.
If it is confirmed to be high intraocular pressure, will stopping medication lead to the development of true glaucoma? I have been on medication for a year and a half.
Thank you for your response.

Lisa, 50~59 year old female. Ask Date: 2024/06/26

Dr. Gao Pilin reply Ophthalmology

Hello: Based on the detailed information you provided, here are my recommendations and explanations:
1.
Should you continue using eye drops? Given your high myopia and elevated intraocular pressure, you belong to a high-risk group for glaucoma, making the preventive use of intraocular pressure-lowering medications a reasonable choice.
Two out of three hospitals recommended medication, indicating the importance of controlling intraocular pressure.
Although your visual field test results are currently normal, persistently high intraocular pressure may lead to optic nerve damage.
Therefore, I recommend continuing the eye drops to maintain intraocular pressure within a safe range.
2.
If you are using eye drops, does using Timolol achieve the target intraocular pressure? After using Timolol, your intraocular pressure decreased to 19 and 18.
According to Hospital A's recommendation, the target intraocular pressure should be below 18.
While your current intraocular pressure is close to the target, it occasionally exceeds 18, so it may be necessary to consider adjusting the dosage or adding other medications to ensure stable intraocular pressure below 18.
This should be further discussed with your ophthalmologist to assess the most suitable treatment plan for you.
3.
The definition of early glaucoma is an MD value below -3.
Does the diagnosis of POAG, mild at Hospital B mean mild glaucoma? Is it different from early glaucoma? The MD value (mean deviation) is used to quantify visual field loss.
Early glaucoma typically refers to an MD value within -6 dB, while below -3 dB is considered very mild loss.
Therefore, the diagnosis of POAG mild (primary open-angle glaucoma, mild) at Hospital B does not contradict the concept of early glaucoma; it is simply a different way of describing it.
Mild glaucoma usually refers to cases with minimal visual field loss, consistent with your current MD value range.
4.
If it is confirmed that you have ocular hypertension, will stopping medication lead to actual glaucoma? Currently, having ocular hypertension for a year and a half does not necessarily progress to glaucoma, but it is a risk factor.
If intraocular pressure rises again after stopping medication, maintaining high intraocular pressure over the long term may increase the risk of optic nerve damage, potentially leading to glaucoma.
Therefore, the decision to stop medication should be made cautiously.
If you gradually taper off the medication under your doctor's supervision and continue to monitor intraocular pressure and optic nerve status, you can reduce the risk.
It is advisable to discuss with your ophthalmologist the possibility of stopping medication and risk management in detail.
In summary, considering your situation, continuing the use of intraocular pressure-lowering medications and regular follow-up is the safer choice.
I hope these recommendations are helpful to you.
If you have further questions, it is advisable to have an eye examination to obtain a treatment plan suitable for you.

Reply Date: 2024/06/26

More Info

Understanding high eye pressure, especially in the context of myopia (high nearsightedness), is crucial for preventing potential complications like glaucoma. Your situation, characterized by high myopia (800 and 700 degrees) and fluctuating intraocular pressure (IOP) readings between 21-24 mmHg, raises several important considerations regarding diagnosis and treatment.

1. Should you use medication? Given your history of high eye pressure and the fact that you have been evaluated by multiple specialists, the decision to start medication should be based on a comprehensive assessment of your risk factors. High myopia is indeed associated with an increased risk of glaucoma, particularly open-angle glaucoma (POAG). The recommendation from one of the clinics to lower your IOP to below 18 mmHg is a common guideline, as lower pressures can reduce the risk of optic nerve damage. If your current readings are consistently above this threshold, and considering your myopic status, it may be prudent to continue with the prescribed medication.

2. Is the current medication effective? You mentioned using a medication called "美特朗" (likely referring to a prostaglandin analog). This class of medication is generally effective in lowering IOP and can help achieve target pressures. If your IOP readings have dropped to 19 and 18 mmHg while on this medication, it suggests that it is working to some extent. However, the effectiveness can vary among individuals, and regular monitoring is essential to ensure that your IOP remains within a safe range.

3. Understanding early glaucoma and classifications: The term "early glaucoma" can indeed vary in definition among practitioners. The MD value (mean deviation) you mentioned is a critical factor in assessing visual field loss. An MD value of -3 or lower typically indicates some degree of visual field loss associated with glaucoma. The classification of "mild POAG" suggests that while there may be some early changes, it may not yet be significant enough to warrant immediate concern. It's essential to have a clear understanding of your specific condition and how it relates to the broader category of glaucoma.

4. Risk of developing glaucoma after stopping medication: If you are diagnosed with high eye pressure, discontinuing medication could potentially lead to an increase in IOP, which might increase the risk of developing glaucoma, especially given your myopic background. Regular monitoring of your eye pressure and visual fields is crucial. If you stop medication, it is advisable to have more frequent follow-ups to catch any changes early.

In summary, managing high eye pressure in the context of high myopia requires a proactive approach. Regular follow-ups with your eye care specialist, adherence to prescribed medications, and understanding the implications of your eye health are vital. If you have concerns about your treatment plan or the need for medication, discussing these with your ophthalmologist can provide clarity and reassurance. Remember, early detection and management are key in preventing vision loss associated with glaucoma.

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