Optic Nerve Issues in High Myopia: A Patient's Dilemma - Ophthalmology

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Hello, thank you for sharing your concerns regarding your eye health, particularly in relation to high myopia and optic nerve issues. It’s understandable to feel anxious when faced with conflicting medical opinions and potential vision problems. Let’s break down your situation and address your questions.


Understanding Your Condition
High myopia, or severe nearsightedness, can lead to various complications, including changes in the optic nerve and retina. The thinning of the optic nerve and retina, as noted by your doctors, is a common concern in individuals with high myopia. This thinning can increase the risk of developing glaucoma, a condition characterized by increased intraocular pressure (IOP) that can damage the optic nerve and lead to vision loss.


Eye Pressure and Optic Nerve Health
You mentioned that your eye pressure has fluctuated but has generally remained below 20 mmHg, which is considered within the normal range. However, the fact that you have experienced episodes of elevated pressure in the past, combined with your high myopia, makes it essential to monitor your eye health closely. Elevated IOP can lead to optic nerve damage, even if the pressure is not consistently high.


Visual Field Loss
The visual field loss you described, particularly the complete loss of the left half of your vision in the left eye and some defects in the right eye, is concerning. While your doctors have indicated that the optic nerve appears normal, significant visual field defects can suggest underlying issues that may not be immediately apparent through standard examinations. The use of simpler equipment for visual field testing can indeed yield different results compared to more advanced testing methods, which may explain some discrepancies in your findings.


Medication and Treatment Options
Regarding the use of pressure-lowering medications, it’s a nuanced decision. If your doctors are divided on whether to start treatment, it may be beneficial to consider a few factors:
1. Risk Assessment: Given your age and the presence of high myopia, the risk of developing glaucoma or further optic nerve damage is a valid concern. Starting treatment early may help prevent potential damage.

2. Monitoring: If you choose not to start medication immediately, ensure that you have a robust follow-up plan in place. Regular eye exams, including IOP measurements and visual field tests, are crucial.

3. Lifestyle Modifications: Reducing screen time, taking regular breaks, and ensuring proper lighting while reading or using screens can help alleviate eye strain. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can support overall eye health.


Conclusion
In summary, while your current IOP readings are within normal limits, your history of high myopia and visual field defects necessitates careful monitoring and possibly proactive treatment. It’s essential to have open discussions with your eye care professionals about your concerns and the potential benefits and risks of starting medication. If you feel uncertain, seeking a second opinion from a specialist in glaucoma or a neuro-ophthalmologist may provide further clarity.

Remember, early intervention is often key in preventing vision loss, especially in individuals with high myopia. Stay proactive about your eye health, and don’t hesitate to advocate for your needs during medical consultations. Your vision is invaluable, and taking steps to protect it is crucial.