Normal-Tension Glaucoma: Diagnosis, Treatment, and Lifestyle Impact - Ophthalmology

More Info

---

Normal-tension glaucoma (NTG) is a type of glaucoma where optic nerve damage occurs despite having normal intraocular pressure (IOP). This condition can be particularly challenging to diagnose and manage, as patients often do not exhibit the typical high eye pressure associated with other forms of glaucoma. Your situation, with a history of myopia and recent findings of visual field defects and thinning of the nerve fiber layer, raises several important considerations.

1. Further Investigations: Given your symptoms and the findings of a thinner nerve fiber layer, it is indeed prudent to consider additional tests to rule out other potential causes of your condition. High myopia can lead to structural changes in the eye, including elongation of the eyeball and potential damage to the optic nerve. Tests such as optical coherence tomography (OCT) can provide detailed images of the retina and optic nerve, while visual field tests can help assess the extent of any peripheral vision loss. Additionally, tests for retinal blood flow or imaging studies to evaluate for ischemic changes in the optic nerve may be warranted.

2. Types of Glaucoma: To determine whether you have open-angle or angle-closure glaucoma, a comprehensive eye examination is necessary. This typically includes gonioscopy, which allows the doctor to visualize the drainage angle of the eye. This is crucial, as the management strategies differ significantly between the two types.

3. Gonioscopy: The anterior chamber angle examination (gonioscopy) is indeed an important test in glaucoma evaluation. It helps to assess the drainage angle of the eye and can provide insight into the type of glaucoma present. If your doctor has not yet performed this test, it would be advisable to discuss its necessity.

4. Integrating Traditional and Western Medicine: Combining traditional Chinese medicine (TCM) with Western medical treatments can be beneficial for some patients, but it is essential to ensure that both approaches do not interfere with each other. Always inform both your ophthalmologist and TCM practitioner about the treatments you are receiving to avoid any potential interactions.

5. Exercise and Eye Drops: After applying your eye drops, it is generally safe to engage in light to moderate exercise, such as jogging. However, it is advisable to wait a few minutes after instilling the drops to allow for proper absorption and to minimize systemic absorption.

6. Heat and Massage: Warm compresses and gentle eye massage can provide relief from eye strain but should be approached cautiously. While they may not directly affect IOP, they can help alleviate discomfort associated with prolonged screen time. However, avoid excessive pressure, as this could potentially harm the optic nerve.

7. Impact of Movies and Sunglasses: Watching movies or wearing sunglasses should not significantly impact your eye pressure. However, prolonged screen time can lead to eye strain and discomfort, which might exacerbate symptoms. It is advisable to take regular breaks using the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds.

8. Screen Time and Eye Pressure: Extended use of computers and mobile devices can lead to digital eye strain, which may not directly affect IOP but can contribute to discomfort and visual fatigue. It is essential to maintain good ergonomic practices and take regular breaks to reduce strain.

In summary, managing normal-tension glaucoma involves a comprehensive approach that includes regular monitoring, potential additional testing, and lifestyle modifications. It is crucial to maintain open communication with your healthcare providers to ensure that all aspects of your health are being addressed. If you have further concerns or questions, do not hesitate to reach out to your ophthalmologist for personalized advice and treatment options.