Optic Nerve Cupping: Signs, Risks, and Eye Care Tips

Q: Optic Nerve Cupping: Signs, Risks, and Eye Care Tips

Hello, Big Eyes：<br>1. <br>Disc cupping refers to the excavation of the optic nerve head. <br>When the optic disc is affected by intraocular pressure, it may initially lead to an increase in the cupping of the optic nerve head. <br>Therefore, an increase in disc cupping can be co

Optic nerve and cupping issues?

Dear Dr.
Gao/Director,
Happy Lunar New Year! I am currently abroad and today I went to an ophthalmologist for a routine vision health check.
My visual acuity was measured (it hasn't worsened compared to last year), and my intraocular pressure was normal.
At my request, they checked my tear film distribution (which was normal) and measured some other terms I didn't recognize.
In the end, the doctor administered dilating drops and after a while, examined my optic nerve.
He measured it by having me look at a bright light while he used a magnifying instrument to examine my pupils.
After the examination, he mentioned that there was a slight issue with my right eye.
He pointed to a poster on the wall explaining glaucoma and indicated that my right eye resembled one of the images, showing some optic nerve cupping near the edge of the optic disc.
He said it was uncertain whether this was a congenital condition or indicative of a problem.
He also examined the thickness of my retina or something similar (I forgot the exact term) and said that my thickness and intraocular pressure were okay, suggesting that I should follow up next year.
This left me feeling quite anxious.
At that moment, I didn't know what further questions to ask, and since the clinic hours were over, I left.

I would like to ask:
1.
Is it possible that this could be a precursor to glaucoma, given that he mentioned my cupping occurs at the edge of the disc?
2.
Besides waiting for next year's check-up, what can I do to protect my eyes so that this cupping does not worsen?
3.
What is the Chinese term for cupping? How do you refer to the optic disc?
4.
Is there any connection between this and the occasional eye fatigue and dryness I experience, which leads me to press on my eyes? (Could I have caused damage to my eyes, resulting in elevated pressure?)
Additionally, I would like to mention that my father has macular degeneration and high myopia.
I have a right eye prescription of -7.50 to -7.75 and a left eye of -6.00 to -6.25 with astigmatism.
Without my glasses, I see lights (such as car headlights and traffic lights) appearing distorted and lacking a center, with only the periphery being visible.

I appreciate your professional insights on these matters.
Thank you in advance for your response.

Da Yan Jing, 20~29 year old female. Ask Date: 2014/02/04

Dr. Gao Pilin reply Ophthalmology

Hello, Big Eyes:
1.
Disc cupping refers to the excavation of the optic nerve head.
When the optic disc is affected by intraocular pressure, it may initially lead to an increase in the cupping of the optic nerve head.
Therefore, an increase in disc cupping can be considered an indicator of glaucoma; however, some individuals may naturally have larger optic discs, so monitoring is necessary to determine the situation.
2.
In addition to optic nerve cupping, intraocular pressure and visual fields are also important indicators.
Regular outpatient visits to measure intraocular pressure and arrange for visual field testing are recommended.
If both are normal, there is generally no need for excessive concern.
3.
Disc cupping is the excavation of the optic nerve head, and the optic disc is the optic nerve head.
4.
Pressing on the eyes can sometimes cause a temporary increase in intraocular pressure.
If done too frequently or with excessive force, it may have an impact.
However, it is rare for someone to develop glaucoma solely from pressing on their eyes.
5.
Your myopia is not mild.
The progression of myopia is similar to that of glaucoma: the optic nerve head may tilt towards the temporal side, resulting in cupping on the temporal side and the formation of crescent-shaped lesions, which can interfere with the diagnosis of glaucoma.
Generally, the changes in the optic nerve head in myopic eyes are sloped, while glaucoma not caused by myopia presents with a more pronounced excavation.
This difference can lead to varying interpretations among physicians, which is why some patients may be diagnosed with glaucoma by one doctor and not by another.
Therefore, monitoring intraocular pressure and visual fields is essential for establishing a diagnosis.
6.
Seeing halos around lights is related to your myopia and astigmatism, particularly the astigmatism, and there is no need for concern.
Puzih Hospital Ophthalmology Department: Monday to Friday from 8:00 AM to 12:00 PM and Wednesday from 1:00 PM to 4:30 PM.
We hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2014/02/04

More Info

Understanding optic nerve cupping is essential for maintaining eye health, especially when there are concerns about conditions like glaucoma. Based on your description, it seems you have undergone a thorough examination, and while your eye pressure and retina thickness are normal, the presence of optic nerve cupping near the optic disc raises some questions.

1. Is optic nerve cupping a sign of glaucoma?
Optic nerve cupping occurs when there is damage to the optic nerve, often due to increased intraocular pressure (IOP), which is a hallmark of glaucoma. However, not everyone with cupping has glaucoma; some individuals may have a naturally larger optic nerve head. The fact that your cupping is at the edge of the optic disc and your eye pressure is currently normal is reassuring, but it does warrant monitoring. Regular follow-ups are crucial, as glaucoma can develop silently. Your eye care professional may recommend visual field tests and additional imaging to monitor any changes over time.

2. What can I do to protect my eyes and prevent cupping from worsening?
While you await your next appointment, there are several proactive measures you can take:
- Regular Eye Exams: Continue with regular eye check-ups, especially since you have a family history of eye conditions.

- Healthy Lifestyle Choices: Maintain a balanced diet rich in antioxidants (like leafy greens and fish), stay hydrated, and exercise regularly. These factors can contribute to overall eye health.

- Manage Eye Strain: If you experience eye fatigue or dryness, take breaks when using screens (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds). Consider using artificial tears if dryness is a persistent issue.

- Protective Eyewear: If you play sports or engage in activities that could lead to eye injury, wear protective eyewear.

3. What are the Chinese terms for cupping and optic disc?
In Chinese, "cupping" is referred to as "杯盤比" (bēi pán bǐ), and "optic disc" is "視神經盤" (shì shén jīng pán). Understanding these terms can help you communicate more effectively with healthcare providers.

4. Does pressing on my eyes relate to my symptoms?
Pressing on your eyes can temporarily increase intraocular pressure, but it is unlikely to cause permanent damage or lead to glaucoma. However, frequent or forceful pressure could potentially exacerbate existing conditions. If you experience discomfort or persistent symptoms, it’s best to avoid this habit and consult with your eye care provider.

Given your family history of macular degeneration and your high myopia, it’s essential to stay vigilant about your eye health. High myopia can lead to changes in the optic nerve and increase the risk of glaucoma. The visual disturbances you describe, such as seeing lights in a distorted manner, may be related to your refractive error and should be discussed with your eye doctor.

In summary, while optic nerve cupping can be a sign of glaucoma, it is not definitive without further testing. Regular monitoring, a healthy lifestyle, and protective measures can help safeguard your vision. If you have any further concerns or notice changes in your vision, do not hesitate to reach out to your eye care professional. Your proactive approach to understanding and managing your eye health is commendable, and staying informed will empower you to make the best decisions for your vision.

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