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Ophthalmology & Optometry/Question About My Father's Eye Pressure


Hello Dr.Dovie,

Thank you for answering my question!

My father was diagnosed with Glaucoma in 2001 and has been receiving treatment ever since. His eye pressures had gone up (between 20- 25 mm Hg)in 2011. After adding a third eye drop and changing from a general ophthalmologist to a Glaucoma specialist (GS), his pressures have been in the range of 6-10 mm Hg ever since. He sees his Glaucoma specialist every 2-3 months.

When he went for a visit today, he was told by his GS that the eye pressure in both his eyes are 5 mm Hg. The GS advised my father that the lower the values, the better. He will see him again in January 2015.

The last visual field test was done in June 2013. At that time, the GS had advised my father that his visual field loss had slightly increased when compared to the test that was done in Feb 2012, but the overall pattern was the same and that my father's treatment with three drops and   would ensure that his current vision would be maintained. The GS did not administer the visual field test on his visit today.

My father has not felt any differences in his vision and has no symptoms.

Quick Background about my father:
My father is 78 years old, 5 ft 3 inches in height and weighs 125 lbs with a waist size of 36.3 inches inches and lives alone in Goa,India.  He walks about an hour in the morning and about 45 minutes in the evening and uses the exercise bike for about 15-30 minutes after his morning walk. His diet is brown rice, wheat bread, fruits, nuts and vegetables.

a) Generally speaking, in your view,  are these eye pressures of 5mm Hg  in both eyes too low and a cause for concern? Is this a case of over treatment?

b) In your opinion, is an annual visual field test an absolute  requirement for treating patients with Glaucoma? Is it fine if my father  asks for this test in Jan 2015 (after 1.5 years from the previous test)?

Thank you!!

Thanks for your question, and all of the information you provided.
In very general terms, with glaucoma, the lower pressure is better.  There is an area of concern, though, once it gets under 6.  We need fluid pressure in the eye to help maintain it's structure and function.
The term 'hypotony' means that the pressure in the eye is not high enough, and this can lead to it's own problems.  The definition for hypotony is pressure under 6.5, which is three standard deviations away from the 'normal' eye pressure.  A pressure of 5 is lower than this threshold, and is cause for at least a discussion about "what is too low for my father?"
The standard of care for glaucoma testing is visual fields every year to help the doctor evaluate how he's doing - the pressure may be good, but if there's progression in field loss, he may want to change his methods.  That being said, you can't get the eye pressure any lower without causing risking serious harm to the eye.  Glaucoma is a progressive disease, and it will progress over time.  The medication is there to slow it down as much as we can - but we can't really "stop" it.  So if he is on max medical therapy, and his eye pressure is at the absolute lowest we can get without harm, he's at his end-game.  I would still suggest visual fields, but waiting a few extra months should pose no problem.
It sounds like your father is doing everything he can - he gets exercise, eats well, uses his medications, and goes to his appointments.  I am glad he is getting good care, but I have slight concern over pressures under 6mmHg.  I would bring this up to his doctor, and if in doubt, get a second opinion.
Good Luck!

link to more information on hypotony:

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John M. Dovie, OD, FAAO


As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.


Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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