The Puff Of Air, And Nothing Else

You go for the eye test every couple of years. The chin rest, the letters, the puff of air that makes you flinch.

Someone says everything looks fine and hands you a new prescription.

Nobody said the word pressure. Nobody mentioned your age, your ovaries, or your mother.

Here is what makes this one different from everything else in this newsletter. There is no sensation to describe. No stiffness, no burn, no flutter at two in the morning.

You feel nothing, which is precisely how it gets years of head start.

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Your Eye Is A Pressurized Chamber

Fluid is produced continuously inside the front of your eye and drains out through a mesh of tissue at the angle where the iris meets the cornea.

Pressure is the balance between what goes in and what gets out.

Push that pressure up and hold it there, and it damages the optic nerve at the back. Slowly, painlessly, and starting at the edges of your vision rather than the centre.

Your brain fills in missing edges without telling you. That is its job. Which is why people lose a substantial amount of peripheral vision before they notice anything at all.

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One And A Half To Three And A Half

A 2023 review by Douglass, Dattilo and Feola in Cellular and Molecular Neurobiology examined menopause as a risk factor for glaucoma.

Postmenopausal women had intraocular pressure between 1.5 and 3.5 mmHg higher than premenopausal women of the same age.

Read that again. Same age. The difference was menopause status, not years lived.

Women on estrogen-containing hormone therapy had pressures 0.5 to 3 mmHg lower.

And women who went through early menopause, or surgical menopause, carried higher risk than women who transitioned naturally.

Estrogen receptors are present in ocular tissue, and estrogen appears to influence both drainage and blood flow at the optic nerve head. Your eyes were on the list the whole time.

A Sight Test Is Not A Glaucoma Assessment

Do this. Book a full eye examination and ask for three things by name.

Intraocular pressure. A dilated examination of the optic nerve head, or retinal imaging of it. And a visual field test.

If all you got was the air puff and a prescription, you were not assessed for glaucoma. You were sold glasses.

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Put Your Ovaries In Your Eye Notes

Tell the optometrist your menopause history directly. Say whether you have had your ovaries removed, and whether your periods stopped before 45.

Both raise risk and neither will ever appear in your eye record unless you say it out loud in that chair.

Also tell them about family history, and know that high short-sightedness and African or Caribbean ancestry raise risk too.

Then get tested every two years from 40, and annually if any of those apply to you. Ask what interval they are putting you on and why.

You were never someone who ignored her body. This is the one thing your body cannot tell you.

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