Pigment Dispersion Syndrome: First Contact
The first time I ever heard the words "pigment dispersion syndrome" was during an initial eye test. It was merely a test at my local optician's office to check whether or not I needed glasses. Little did I know that this day would see the beginning of a twenty-year treatment routine to combat this little-known eye condition.
What Is Pigment Dispersion Syndrome?
Pigment dispersion syndrome (PDS) is a condition that results from flakes of pigment, which, when eroded from the back of the iris (coloured part of the eye), are then introduced into the fluid of the eye (aqueous humor).
Occasionally, these fragments of pigment end up as debris that clogs the eye's drainage canals; this, in turn, raises eye pressure.
Symptoms Associated With PDS
Sadly, not everyone who has this condition will display symptoms. They may be blissfully unaware of a problem until a stage where lasting eye damage has occurred.
For those who do experience symptoms, these may include:
- Blurred vision
- Mild ocular pain
- Halos (usually coloured) around lights
First Visit to the Opticians
The suggestion that I may have this unusual eye condition came during the first routine eye test I had booked at my local optician's. It was twenty years ago, and at that time, I was 43 years of age. I had been experiencing eye strain and mild but persistent headaches for a few months. I suspected that I might need glasses.
The optometrist performed the usual visual checks and suggested that I was a little short-sighted and that I did indeed need to wear glasses. During the eye test, he also checked my eye pressure, which was higher than expected.
He stepped out of the room and asked a fellow optometrist to take a look. They discussed my results for a few moments, seeming to enjoy finding something novel with my eyes.
At the end of the consultation, the optician told me he believed that I might have an eye condition called pigment dispersion syndrome (PDS) and that he would issue me a letter to take to my local general practitioner.
The eye doctor also seemed amused as he told me the condition meant that it was highly likely that I had a family link to Viking descent. I remember being intrigued and a little pumped by this revelation. Although, I later learned that while it is true that there is a sturdy Scandinavian link, the condition also exists in many other countries and cultures.
What Causes Flaking of Eye Pigment?
Within the eye, fibres that support the lens sometimes rub against the rear of the iris, causing the pigment to break away.
Why Is Increased Eye Pressure a Problem?
The resulting increase in eye pressure can lead to damage of the optic nerve. This damage may have the consequence of causing glaucoma. At this stage, (PDS) becomes a condition known as pigmentary glaucoma.
It is essential to understand that the damage this causes to the optic nerve is irreversible and permanent. Hence, it is vital to recognise and treat this condition early.
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What Signifies a High-Pressure Eye Reading?
The unit of measure for determining eye pressures is mmHg (millimetres of mercury).
A reading of 21 mmHg or above would signal a high reading. The term given to increased pressures within the eye is ocular hypertension.
In my case, the first eye pressure readings recorded were 25 mmHg (left eye) and 23 mmHg (right eye). Over the years, these have generally been maintained within expected tolerances. However, the readings have spiked from time to time, usually resulting in a greater frequency of outpatient appointments and testing.
My Experience With This Eye Condition
The follow-up appointment with my local general practitioner resulted in a referral to an eye specialist.
Never having heard of this condition before, I was a little unnerved to think about what might lie ahead; after all, no one likes the thought of having their eyes messed about with, right?
However, in my case, I can safely say that the diagnosis and treatment of this unusual eye complaint are straightforward and not at all intrusive. Although I am aware that should this condition be left uncontrolled and develop into pigmentary glaucoma, potential treatments are likely to become more invasive.
How PDS Is Diagnosed
The diagnosis of PDS involves an examination of the eyes.
The ophthalmologist will look for increased signs of pigment in the eye's drainage angle and on the inner lining of the cornea. They will also look for evidence of a thinning of the iris due to rubbing or chaffing and pigment release.
Imaging of the optic nerve at the back of the eye is likely to be performed to be able to assess potential damage.
Ahead of the above examination, you are likely to be asked to carry out a Field Vision Test, a sight test, and an eye pressure test.
It is worth saying that none of the above were intrusive or painful. Apart from the administering of a few eye drops (which may sting for a couple of seconds), the whole examination is surprisingly straightforward.
Interestingly, when first diagnosed, I had been advised against taking vigorous exercise. At that time, I was a keen jogger, having taken part in several half-marathons. Such activity can increase the risk of pigment breaking away from the iris.
Appointments During Covid-19 Crisis
Earlier this month (October 2020), I attended a routine four-monthly check-up at my local hospital. As expected, coronavirus precautions were very evident. The aspect of the eye checks that took me a little by surprise was the fact the equipment used to carry out the Field Vision Test, the Eye Pressure Test and the Retinal Screening had been changed in appearance and did not require the administration of any eye drops. The new routine made the whole experience very easy and a lot quicker to run through, so much so, that I hope that these amended routines are to be continued post covid.
Optician, Optometrist and Ophthalmologist: Who Does What?
Like many people, I was at first confused by the various terms used to describe the role of people who were involved in the multiple stages of identification and treatment of pigment dispersion.
- Optician: a technician trained to fit and design eyeglasses and frames. They are not permitted to diagnose or prescribe medications.
- Optometrist: Often referred to as a Doctor of Optometry, they are licensed to provide vision tests and eye exams and prescribe corrective lenses, detect eye anomalies, and prescribe some medications.
- Ophthalmologist: a medical doctor who specialises in eye and vision care. They are licensed to practice medicine and surgery .
What Is a Field Vision Test?
As part of my ongoing treatment for PDS, I have four monthly checks on my eyesight. A key part of these routine checks involves a field vision test.
This test is to assess your central and peripheral (side vision). The test itself is straightforward, taking only a few minutes to complete.
Sitting in front of a test machine, with one eye covered, you stare straight ahead at a small central light. After a few seconds delay, in what appears a random distribution, varying bright pin-pricks of light appear against the white background. You then press a buzzer each time you see one of these lights appear.
A chart is then printed out detailing the results and is used to determine the range of your vision.
In my case, treatment was simple and effective. Initially, I was issued a prescription of Timolol eye drops (0.25%) to be administered twice daily to both eyes. Timolol is a class of drug known as a beta-blocker. This treatment works by lowering the pressure in the eye. It achieves this by decreasing the amount of fluid within the eye.
The treatment was to be long term and to continue for the foreseeable future. I remained on this treatment for the next fifteen years.
Circumstances can change somewhat over such a timespan. Life moves on, and my wife suffered strokes and developed vascular dementia at all too young an age. My new additional role as a carer took some adjusting to, and, for a while, I struggled to maintain my twice-daily routine of eye drops. The next review of my eye pressure demonstrated this only too well as they had risen sharply. The ophthalmologist was extremely understanding of my changed circumstances, and over the next few weeks, I was taken off Timolol and placed on Latanoprost.
For the last five years, I have been administering Latanoprost (0.005%) eye drops once per day in the evening and, although it might seem a little strange, this simple change to routine made things so much easier, and I have kept to the practice rigidly ever since.
Potential Side Effects
In my experience, the side effects were limited to blurred vision and itchiness around the eye. Fortunately, these quickly passed, and after a few weeks, I soon settled into a daily morning and evening routine of administering the eye drops.
For some people, side effects can include dizziness, eye pain, irregular heartbeat, swelling, muscle weakness, numbness, and even mood changes. Anyone experiencing these should, of course, consult their doctor without delay.
Again, I had an initial reaction to the new medication. This time I was pre-warned that I might experience some redness and soreness of the eyes for a few weeks but that I should try to persist with the treatment as this usually settled down after a short time.
The eye specialist was correct, and this reaction is what I experienced. The soreness was a little worse than the first treatment and lasted for a couple of weeks. It did, however, settle down, and I have had no issues since then.
Common side effects of Latanoprost use consist of:
- Redness of the eye
- Eye infection
- Sensitivity to light
- Changes to your eyelashes (grow longer or thicker)
- Change in eye colour
Severe side effects:
- Breathing difficulties
Anyone suffering from any associated side effects must, of course, consult the doctor immediately.
There are many different variant brands of drugs used to combat this condition—the majority work in a similar way in that they aim to reduce pressures within the eye.
- Gender: Men and women seem to develop PDS at equal rates. There is research taking place into why men are about three times as likely to go on and develop pigmentary glaucoma .
- Age: Men are also far more likely to develop PDS at a younger age than many women.
- Pre-existing eye conditions: Men with nearsightedness (Myopia) are also at increased risk.
- Exercise: There is evidence that vigorous exercise can worsen this condition by releasing more pigment from the iris .
The lifetime risk of PDS developing into pigmentary glaucoma is between 35 to 50% .
Current Status of My Eye Condition
During the last year, reviews and testing are now carried out by the glaucoma monitoring unit at my local hospital. I suspect that this is the result of slightly further deterioration in vision. It is worth noting, however, that the main difference in assessment from my time at the eye outpatients department is that the frequency of appointments has moved from six months to every three months. I also now have digital retinal imagery on each visit.
The key to successfully managing impacts of pigment dispersion on the health of your eyes and sight is early diagnosis and treatment.
Treatment is prolonged and, at times, somewhat tedious. I cannot stress enough the need to settle into a regular daily routine with the administering of your eye drops. It can be all too easy to be distracted by daily chores and activities and skip a dose or two. It can also become a bit laborious having to continually re-order the next prescription. Eye drops tend to come in small vials or bottles that, once opened, must be used or discarded after 30 days.
In my case, the most challenging aspect was establishing this daily routine; after all, there is no immediately apparent impact from forgetting a dose here and there. But the reality is that when you have your next assessment, the high eye pressure readings will almost certainly reveal that you have not been as methodical as you need to be.
PDS is a condition that you can successfully manage. Doctors and optometrists can advise you. But ultimately, the daily routine of administering your medication is down to you. You can, at the very least, extend the time that your vision can be maintained. Your overriding aim should be to avoid the development of glaucoma and potential loss of sight. There can surely be no further need for increased motivation than this.
The video below is a detailed medical examination of pigment dispersion syndrome and pigmentary glaucoma. For those interested in the technicalities of this condition, it is a riveting view.
- Difference between an Ophthalmologist, Optometrist and Optician - American Association for Pediatric
. The role of the various professionals in the treatment of eye disorders.
- Pigmentary Glaucoma and Pigment Dispersion Syndrome
. Risk factors associated with Pigmentary Dispersion Syndrome.
- Pigment Dispersion Syndrome and Pigmentary Glaucoma | Glaucoma Research Foundation
. Vigorous exercise and Pigmentary Dispersion Syndrome.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.