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Elevated Intraocular Pressure In Both Eyes, Choroidal Nevus Present. Family History Of Glaucoma. Chances Of Having Glaucoma?
Question: My ophthalomologist consistently finds my intraocular pressure at between 21 to 24 in both eyes for several years. He tells me it could correlate with being overweight and glucose numbers, which are not that bad, i.e. 117 and A1C of 6.1%. I don't have any immediate family with glaucoma, and perhaps there are people whose "normal" is above the usual range of below 21. The eye doctor says I am classified as "borderline," but is not worried now, and says I could have these numbers my whole life without getting glaucoma. Please let me know what you think about this. Thank you.
I also have a choroidal nevus at the back of one eye that was only discovered a couple of years ago. It may have been there my whole life. Thankfully it never changes. It's about one inch in size. It's near the macula. What are the chances at my stage in life (age 55) that this will develop into something worse? My doctor says there is always a chance, but that it is rather remote. Thanks.
Hello XXXXXXX
Sorry for delay in responding your query.
Do not get panic.
Your IOP (Intra ocular pressure) is 21-24 for several years and if you have no family history of glaucoma then no need to worry about it.But you have not mentioned about any visual fied test HFA (Humphrey field analyzer),OCT ( 3 D SCAN ie OPTICAL COHERENCE TOMOGRAPHY),fundus examination {ONH( optic nerve head ) Evaluation }whether have been done or not.
Definitely your IOP is on higher side ,you can be classified as patient of OCULAR HYPERTENSION if your visual field examination,optic nerve head examination,( cup disc ratio,fundus status) and central corneal thickness are with in normal limit.
At present you need only periodical check up 6 or 12 monthly with glaucoma specialist.
Glaucoma can be classified as OPEN AND CLOSED ANGLE GLAUCOMA.
OPEN ANGLE GLAUCOMA can again be classified as
1OCULAR HYPERTENSION
2.PRIMARY OPEN ANGLE GLAUCOMA SUSPECT
3.PRIMARY OPEN ANGLE GLAUCOMA.
OCULAR HYPERTENSION include patients with raised IOP (>21MM Hg) with normal optic nerve head examination and normal visual field.So PRESENTLY this condition requires observation and periodical check up.
As you have described about choroidal nevus which is in macula and its status is same as far as you have mentioned ,it's just like hyperpigmentation so it need not require intervention currently.
Chances of some changes can be expected but that require only yearly fundus examination.
I hope i have solved your query to some extent ,if you have any doubt regarding anything you can ask any time.
Take care
Dr XXXXXXX pawar
Sorry for delay in responding your query.
Do not get panic.
Your IOP (Intra ocular pressure) is 21-24 for several years and if you have no family history of glaucoma then no need to worry about it.But you have not mentioned about any visual fied test HFA (Humphrey field analyzer),OCT ( 3 D SCAN ie OPTICAL COHERENCE TOMOGRAPHY),fundus examination {ONH( optic nerve head ) Evaluation }whether have been done or not.
Definitely your IOP is on higher side ,you can be classified as patient of OCULAR HYPERTENSION if your visual field examination,optic nerve head examination,( cup disc ratio,fundus status) and central corneal thickness are with in normal limit.
At present you need only periodical check up 6 or 12 monthly with glaucoma specialist.
Glaucoma can be classified as OPEN AND CLOSED ANGLE GLAUCOMA.
OPEN ANGLE GLAUCOMA can again be classified as
1OCULAR HYPERTENSION
2.PRIMARY OPEN ANGLE GLAUCOMA SUSPECT
3.PRIMARY OPEN ANGLE GLAUCOMA.
OCULAR HYPERTENSION include patients with raised IOP (>21MM Hg) with normal optic nerve head examination and normal visual field.So PRESENTLY this condition requires observation and periodical check up.
As you have described about choroidal nevus which is in macula and its status is same as far as you have mentioned ,it's just like hyperpigmentation so it need not require intervention currently.
Chances of some changes can be expected but that require only yearly fundus examination.
I hope i have solved your query to some extent ,if you have any doubt regarding anything you can ask any time.
Take care
Dr XXXXXXX pawar
Above answer was peer-reviewed by :
Dr. Radhika
Thank you kindly for your reply. I did forget to mention that thankfully my optic nerves are fine, and I did have the field vision tests several times and they were within normal limits. Now how common is it for people to be above the ranges of the pressure tests and still be considered to have "normal" pressure?
And physiologically, how can it be that pressure could be 22 to 24 and not affect the optic nerve, which is so sensitive to pressure? Is there anything I can do with my lifestyle or supplements to reduce the pressure down under 20?
With regard to the nevus, my mother's brother has a small one, and it has never changed. So maybe in this regard there is some genetic element.
And physiologically, how can it be that pressure could be 22 to 24 and not affect the optic nerve, which is so sensitive to pressure? Is there anything I can do with my lifestyle or supplements to reduce the pressure down under 20?
With regard to the nevus, my mother's brother has a small one, and it has never changed. So maybe in this regard there is some genetic element.
Hello again XXXXXXX
Its good to hear that your all field test and optic nerve head examination are within normal limit.
Glaucoma is a chronic progressive optic neuropathy in which there is loss of cells of optic nerve and retina nerve fibre layer and IOP is a risk factor only.
There are cases of glaucoma in which even with low tension people develop optic nerve damage.
There are a number of factors along with increased Intra-Ocular Pressure which can cause glaucoma.
This pressure of 22-24 could be XXXXXXX to those people who have family history of glaucoma, who are myopic or blood pressure related problems. That is why we set a target pressure which will vary from individual to individual according to his ocular status.
Eat healthy foods, drink lots of water, go for regular check up with glaucoma specialists and follow his instruction. IOP can vary from time to time so i cannot comment that it will decrease or increase.
It would be better to discuss with your treating doctor for the same.
Wishing you good health.
Take care
Its good to hear that your all field test and optic nerve head examination are within normal limit.
Glaucoma is a chronic progressive optic neuropathy in which there is loss of cells of optic nerve and retina nerve fibre layer and IOP is a risk factor only.
There are cases of glaucoma in which even with low tension people develop optic nerve damage.
There are a number of factors along with increased Intra-Ocular Pressure which can cause glaucoma.
This pressure of 22-24 could be XXXXXXX to those people who have family history of glaucoma, who are myopic or blood pressure related problems. That is why we set a target pressure which will vary from individual to individual according to his ocular status.
Eat healthy foods, drink lots of water, go for regular check up with glaucoma specialists and follow his instruction. IOP can vary from time to time so i cannot comment that it will decrease or increase.
It would be better to discuss with your treating doctor for the same.
Wishing you good health.
Take care
Above answer was peer-reviewed by :
Dr. Yogesh D
So you mean that the higher pressure in and of itself is not necessarily the decisive factor for risks to the optic nerve, but depends on other factors? Then how high is it theoretically possible to go without risk of glaucoma and optic nerve damage beyond the usual limit of 21?
Does the same situation exist for blood pressure whereby a higher pressure could still be "normal "?
Does the same situation exist for blood pressure whereby a higher pressure could still be "normal "?
hello XXXXXXX
Thank you again for the follow up.
You have mistaken my words. I DO NOT mean to say that IOP is just a MINOR FACTOR.
I have given you an example that even a low pressure (less percentage of cases) can cause glaucoma which is known as normal tension glaucoma, in which glaucomatous damage occur in spite of low tension.
Increased IOP is a major factor for causing glaucoma in most of cases.
Glaucoma doesnot mean only increased pressure, it includes optic nerve changes and changes in visual field along with increased pressure.
you are having no visual field changes, your optic disc is fine. Only Intra-ocular pressure is slightly raised thats why you are only ocular hypertensive. ( IF IOP raises above 25-26, it will be a matter of concern).
YOU CANNOT CORRELATE IT WITH BLOOD PRESSURE. HIGH BLOOD PRESSURE CAN NOT BE LABELLED AS NORMAL.
YOU CAN NOT CORRELATE BLOOD PRESSURE WITH EYE PRESSURE.
Hope things are clear to you.
Wishing you a healthy life.
Dr XXXXXXX
Thank you again for the follow up.
You have mistaken my words. I DO NOT mean to say that IOP is just a MINOR FACTOR.
I have given you an example that even a low pressure (less percentage of cases) can cause glaucoma which is known as normal tension glaucoma, in which glaucomatous damage occur in spite of low tension.
Increased IOP is a major factor for causing glaucoma in most of cases.
Glaucoma doesnot mean only increased pressure, it includes optic nerve changes and changes in visual field along with increased pressure.
you are having no visual field changes, your optic disc is fine. Only Intra-ocular pressure is slightly raised thats why you are only ocular hypertensive. ( IF IOP raises above 25-26, it will be a matter of concern).
YOU CANNOT CORRELATE IT WITH BLOOD PRESSURE. HIGH BLOOD PRESSURE CAN NOT BE LABELLED AS NORMAL.
YOU CAN NOT CORRELATE BLOOD PRESSURE WITH EYE PRESSURE.
Hope things are clear to you.
Wishing you a healthy life.
Dr XXXXXXX
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you very much for all your clarifications! I appreciate it greatly.
Hello.
Thanks for having patience for listening my advice.
Wish you good health.
Regards.
Dr XXXXXXX PAWAR
Thanks for having patience for listening my advice.
Wish you good health.
Regards.
Dr XXXXXXX PAWAR
Above answer was peer-reviewed by :
Dr. Jyoti Patil
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