Eye Pressure Comes Full Circle

Nearly four weeks ago I wrote the blog post about my intraocular pressure reaching a record low of 6.7 mmHg as measured by the Reichert Ocular Response Analyzer.

After that post, I had one measurement that was even lower - 6.5 mmHg. It seemed like week after week and day after day my intraocular pressure continued to go lower and lower. By this time, I had already been enjoying record low eye pressure levels for several months and during those months I continued to monitor my intraocular pressure many times per day with some of the best professional tonometers available, so there is no question that the results are reliable.

I arrived at these good eye pressure results by following my plan of managing stress, emotions and my thoughts, while also eating well, taking supplements and exercising as I normally do. Everything seemed to be working exceptionally well.

However, things were going so well that I had a passing thought as to whether anyone would believe that it was my efforts that were producing these low intraocular pressure results. Would people assume something fundamentally changed in regard to my condition? As I said, it was just a passing thought: my attention was more fully focused on continuing to do the things that have been bringing me such good results. Because I am working to change some lifelong habits, it requires will power and discipline. It is not always easy, but I do have to say that it is always satisfying. The results are wonderful in all areas of my life and that keeps me motivated. Even so, those old habits are not always easy to break. One tends to fall back into old patterns during challenging periods.

This is exactly what happened about a week after this new record low of 6.5 mmHg. I had a few days of slightly higher eye pressure readings. I could tell I wasn't "on the program" as well as I had been. I was very, very busy with work -- and that seems to be my weakness. When it is crunch time, I have the habit of pushing myself to deliver the results even if I have to ignore my health. I believe that particular habit is not unrelated to my development of glaucoma.

However, I am a different person than I was a couple years ago, thanks to the blessing of glaucoma. With my greater awareness now, I don't do nearly the same level of damage to my physiology when I fall into my workaholic patterns. I catch myself earlier and I maintain better balance almost all the time. And, as a consequence, my intraocular pressure remained pretty good even though it wasn't at my record low levels. Therefore, I did not become too concerned.

The next week, however, my intraocular pressure rose slightly again (on average). And the next week, which was just last week, my eye pressure was again higher. I had no readings under 10 mmHg - even at the lowest point in my diurnal curve. Overall, my intraocular pressure was about 4 or 5 mm Hg higher at all times of the day compared to the best period of about three to four weeks earlier.

However, even though the average was "only" up by about 4 to 5 mmHg, I had a few really high eye pressure measurements last week -- in the high 20's! This really got my attention. This was like the bad old days!

Those of you who read my blog regularly know that my whole focus is on a fact-based, data-driven approach to intraocular pressure monitoring and management. I have always relied upon my extensive database of IOP readings to help me figure out what works and what doesn't work. This time I once again went back over everything I had been doing. I got back on track with my program of managing my thoughts and emotions and I immediately started seeing lower intraocular pressure readings.

I am relying extensively on the Pascal Dynamic Contour Tonometer for intraocular pressure readings in the mornings very soon after I wake up. Those readings are usually the high point of my diurnal curve. These readings mean a lot more to me than the readings at the low point of my diurnal curve (which are the ones I have been quoting above and in prior articles).

I only had a couple days where my early morning Pascal Dynamic Contour Tonometer IOP values were above the threshold my doctors target. (I'll talk more about the exact levels in another blog post because I need to discuss the difference between Goldmann-correlated IOP values and the "corrected" intraocular pressure values reported by the Reichert Ocular Response Analyzer and the Pascal Dynamic Contour Tonometer. So far I am reporting only Goldmann-correlated IOP values because that is what everyone is familiar with.) Back to my story now.

By making a few changes in my lifestyle, I was able to get the critical early-morning IOP values back to acceptable levels. However, even after getting back on my program I could not get the evening values back down near my record low levels. I thought I was doing the things I needed to do, and my IOP values were generally pretty good, but they were still about 3mmHg higher than my best readings in the evenings. For some people, 3mmHg can make a huge difference.

After some additional research, I found out that my use of lubricant artificial tears (such as Thera Tears with 0.25% methylcellulose) in the evenings was the factor responsible for my higher IOP.

After three days of not using the lubricant artificial tears, I am once again seeing the really low eye pressure values in the evening. Tonight, after my walk, my intraocular pressure was 7.0 mmHg. It has been almost four weeks since I had a reading that low. I have come full circle and in the process I have learned valuable information.

I believe the most important factor in this whole episode is my management of my thoughts and emotions. The few days where I really got off track with that were the only days when my intraocular pressure reached levels that would concern my doctors. When I got back on my program, my IOP returned to safe levels. However, my use of lubricant artificial tears emerged as an interesting confounding factor and it took a bit of detective work for me to track down the culprit.

I do not believe lubricant artificial tears themselves are always a problem. However, in addition to using them several times a day, I had gotten into the habit of using them in the hour before taking my glaucoma medications at night - and this was definitely the problem. I don't have all the answers about when I might be able to use the artificial tears and when I cannot because I stopped using them completely. In the future we may design a study to look into this a bit further. For now, this has been an experiment with a population size of one - actually, it's been a case study, not an experiment. However, the results I am reporting are based on a lot of data; I feel there is not much question that my use of artificial tears in the hour prior to using my glaucoma medications was the responsible factor in raising my intraocular pressure about 3 mmHg on average.