The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving

Sang Moon Jeoung; Sung Gil Kim; Jeong Do Kwon

doi:10.3341/jkos.2010.51.12.1598

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Jeoung, Kim, and Kwon: The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving

Original Article

J Korean Ophthalmol Soc 2010;51(12):1598-1605.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.12.1598

The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving

Sang Moon Jeoung, MD¹, Sung Gil Kim², Jeong Do Kwon, MD¹

¹Department of Ophthalmology, Wallace Memorial Baptist Hospital, Busan, Korea

²Department of Ocean Physical Education, Korea Maritime University, Busan, Korea

Address reprint requests to Jeong Do Kwon, MD Department of Ophthalmology, Wallace Memorial Baptist Hospital #374-75 Namsan-dong, Kumjung-gu, Busan 609-340, Korea Tel: 82-51-580-1359, Fax: 82-51-512-1354, E-mail: kjdeye@naver.com

Received 9 April 2010 Accepted 7 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To examine how SCUBA diving activities in high-pressure underwater environment affect their intraocular pressure (IOP), visual field (VF), retinal nerve fiber layer (RNFL), and the shape of optic disc.

Methods

We performed visual acuity and refractory test, IOP test, VF test, RNFL photography, optical coherent tomography, and 3D optic disc photography for a group of 32 people and a control group of 32 non-divers, and analyzed the differences between the two groups. For the diver group, we conducted a questionnaire survey on the patterns of diving and diving experience, and analyzed their correlation with results of test.

Results

Compared to the Control, the diver group showed significant difference in the mean IOP (diver group: 15.71 ± 2.54 mmHg, control group: 14.23 ± 2.15 mmHg, p = 0.019), and abnormal visual field (diver group: 7 eyes (11.3%), control group: 0 eye (0%), p = 0.006). 85.7% of abnormal visual field belonged to early defect. The diver group did not showed significant difference in the shape of optic disc (p = 0.546), but the optic nerve atrophy in shape of optic disc test field (diver group: 8 eyes (12.9%), control group: 2 eyes (3.1%), p=0.042) was significantly different.

Conclusions

Divers who did SCUBA diving activities need to have a glaucoma test regularly. Additional research and large cross or longitudinal study are needed to evaluate causes that scuba diving activities affect.

Keywords: Intraocular pressure, Optic nerve, SCUBA diving, Visual field

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Table 1.

Nerve Fiber Layer Grading system Features

Nerve Fiber Layer Feature	Grade D0^*	Grade D1^†	Grade D2^‡	Grade D3^§
Brightness	Bright	Less bright	Minimally bright	Dark
Texture	Coarse and fine striations	Fine striations	Bsrely detectable striations	No texture
Blood vessels				
Large	Clear or blurred	Clear	Clear	Clear
Medium	Blurred	Less blurred	Clear	Clear
Small	Very blurred	Still blurred	Clear	Clear

^* D0 = diffuse atrophy of retinal nerve fiber layer 0

^† D1 = diffuse atrophy of retinal nerve fiber layer 1

^‡ D2 = diffuse atrophy of retinal nerve fiber layer 2

^§ D3 = diffuse atrophy of retinal nerve fiber layer 3.

Table 2.

Diving pattern of scuba divers (N = 62)

	Mean^*	Range
Diving years	15.18 ± 7.23	10∼35
Working hours / day	1.92 ± 0.89	1∼4
Diving hours / 1 time	0.69 ± 0.32	0.5∼2
Diving depth (m)	18.47 ± 6.64	5∼30

^* Values are given as a mean ± standard deviation.

Table 3.

Characteristics of the study groups

	Diver eyes (N = 62)	Control eyes (N = 64)	P value
Age (yr)	42.48 ± 8^*	42.53 ± 8.37^*	0.974^†
Hypertension (%)	3.2	0	0.148^‡
IOP (mmHg)^§	15.71 ± 2.54^*	14.23 ± 2.15^*	0.019^Π
BCVA (logMAR)^＃	0.03 ± 0.06^*	0.02 ± 0.04^*	0.776^Π
Mean deviation (dB)	1.77 ± 1.61^*	1.24 ± 1.07^*	0.048^Π
Pattern Standard deviation (dB)	1.67 ± 1.47^*	1.34 ± 0.23^*	0.124^Π
Visual field defect (%)	11.3	0	0.006^‡
Red free defect (%)	12.9	3.1	0.042^‡

^* Values are given as a mean ± standard deviation

^† Statistical significance by student t-test, p < 0.05

^‡ Statistical significance by Chi-square test

^§ IOP = intraocular pressure

^Π Statistical significance by General linear model

^＃ BCVA = best corrected visual activity.

Table 4.

Comparison of OCT parameters between diver eyes and control eyes

	Diver eyes (N = 62) Mean ± SD	Control eyes (N = 64) Mean ± SD	P value^*
Optic disc parameters			
Disc area (mm²)	2.60 ± 0.4	2.67 ± 0.49	0.525
VIRA (mm²)^†	0.33 ± 0.17	0.38 ± 0.27	0.366
HIRW (mm²)^‡	1.68 ± 0.27	1.7 ± 0.24	0.710
Cup area (mm²)	1 ± 0.47	0.98 ± 0.48	0.860
Rim area (mm²)	1.6 ± 0.42	1.71 ± 0.46	0.346
Horizontal C/D^§ ratio	0.67 ± 0.15	0.64 ± 0.16	0.489
Vertical C/D^§ ratio	0.54 ± 0.11	0.53 ± 0.12	0.724
RNFL^Π thickness parameters			
Superior quadrant	130.26 ± 22.76	147.7 ± 76.86	0.090
Temporal quadrant	85.56 ± 14.43	86.59 ± 14.58	0.657
Inferior quadrant	136.55 ± 18.92	137.2 ± 12.75	0.764
Nasal quadrant	81.39 ± 13.38	84.23 ± 14.5	0.232

^* P value based on General linear model

^† VIRA = vertical integrated rim area

^‡ HIRW = horizontal integrated rim width

^§ C/D = Cup to disc ratio

^Π RNFL = retinal nerve fiber layer.

Table 5.

Correlation of between IOP, VF, RF, OCT parameters and diving patterns in diver eyes

	Diving years P value (R)^*	Diving hours / day P value (R)^*	Diving seconds / 1 time P value (R)^*	Diving depth (m) P value (R)^*
IOP^† (mmHg)	< 0.05 (0.306)	0.270 (0.142)	0.562 (0.075)	0.253 (0.147)
Visual field defect	0.242 (−0.151)	0.630 (0.062)	0.297 (−0.135)	0.579 (−0.072)
Red free defect	0.701 (−0.050)	0.890 (−0.018)	0.244 (0.150)	0.489 (0.090)
MD^‡ (dB)	0.819 (−0.030)	0.182 (0.172)	0.587 (0.070)	0.517 (0.084)
PSD^§ (dB)	0.373 (−0.115)	0.808 (−0.031)	0.363 (−0.117)	0.915 (0.014)
Disc area (mm²)	0.156 (−0.182)	0.545 (0.078)	0.859 (0.023)	< 0.05 (−0.293)
VIRA^Π (mm²)	0.352 (−0.120)	0.338 (−0.124)	0.412 (−0.106)	< 0.05 (−0.352)
HIRW^＃ (mm²)	0.071 (−0.231)	0.423 (−0.104)	0.757 (−0.040)	< 0.05 (−0.288)
Cup area (mm²)	0.764 (−0.039)	0.589 (0.070)	0.798 (0.033)	0.381 (0.113)
Rim area (mm²)	0.300 (−0.134)	0.980 (−0.003)	0.859 (−0.023)	<0.05 (−0.405)
Horizontal C/D ratio	0.743 (0.042)	0.797 (−0.033)	0.565 (0.075)	<0.05 (0.330)
Vertical C/D ratio	0.985 (−0.002)	0.234 (0.153)	0.505 (−0.086)	0.080 (0.224)
Superior quadrant	0.809 (−0.031)	0.350 (0.121)	0.975 (0.004)	0.936 (−0.010)
Temporal quadrant	0.246 (−0.150)	0.853 (−0.024)	0.076 (−0.227)	0.560 (−0.075)
Inferior quadrant	0.532 (−0.081)	0.356 (−0.119)	0.810 (−0.031)	0.847 (−0.025)
Nasal quadrant	0.518 (−0.084)	0.204 (−0.164)	0.228 (−0.155)	0.869 (−0.021)

^* Values are number of P value (R). P = Pearson's correlation, R = Pearson's correlation coefficient

^† IOP = intraocular pressure

^‡ MD = mean deviation

^§ PSD = pattern standard deviation

^Π VIRA = vertical integrated rim area

^＃ HIRW = horizontal integrated rim width.

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