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Increased Intraocular Pressure and Visual Field Defects in High Resistance Wind Instrument Players


Copyright 2017, Mark Alan Wade

Primary Author: Schuman, J.
Journal Title: Ophthalmology
Date Published: Jan-00
Language: English
Category: Vision Problems
Key Words: wind instrument performance resistance eye visual
Full Citation: Schuman, J. S., et al. Increased Intraocular Pressure and Visual Field Defects in High Resistance Wind Instrument Players. Ophthalmology 107, no. 1 (January 2000): 127-133.
Full Abstract: Joel S. Shuman, MD, Emma C. Massicotte, MD, Shannon Connolly, BA, Ellen Hertzmark, MS, Bhaskar Mukherji, MD, and Mandi Kunen, MD investigate a correlation between intraocular pressure (IOP) and high resistance wind instruments. Both high and low resistance wind musicians experience a transient rise in their IOP while playing. The magnitude of the IOP increase is indeed higher among high resistance wind players. Furthermore, these pressures cause visual field loss, glaucoma damage, and uveal thickening due to life-hours of long term intermittent IOP. The measured change in the visual function among high pressure wind players is small and unlikely to be significant except in a minority of professional musicians. When a trumpet player plays softly, the IOP rises at .88mmHg/sec. When playing at high pitches and loud dynamics, the IOP rises at 1.8mmHg/Sec. The IOP of the case study at rest is 16mmHg compared to 46mmHg when playing high notes and loudly. In short, the force of blowing and the pitch sounded determine the rate of IOP change. While there is conjecture among researchers, evidence shows that the IOP elevation results from an increase in uveal volume via the Valsalva maneuver caused by high-resistance wind instrument playing. A Valsalva maneuver (the inflating of the inner ear caused by closing the mouth and nose and blowing) causes a rise in intrathoracic pressure and compression of the intrathoracic venous system. This rise in venous pressure results in an increase in IOP transferred through the jugular, orbital, and vortex veins to the choroids. IOP is also elevated by venous pressure rises in the episcleral veins, but at a slower and somewhat insignificant rate. High resistance wind players show high incidences of minor glaucomatous damage compared to other musicians. The cumulative effects of long-term high resistance wind instrument playing IOP elevations may be sufficient enough to cause eye damage. Because of this research, this condition is now classified as intermittent high pressure glaucoma, which previously would have been diagnosed as normal tension glaucoma.