Increased intraocular pressure and visual field defects in high resistancewind instrument players

Objective: In this twofold study, part 1 aimed to determine whether the pla ying of high resistance wind instruments elevates intraocular pressure (IOP ) and if so, to investigate the mechanism of IOP elevation and whether its magnitude differs while playing high resistance versus low resistance instr uments. The purpose of part 2 was to evaluate whether high resistance playe rs have a greater incidence of glaucomatous changes than other musicians. Design: Three case reports and a cross-sectional study. Participants: Two players of high resistance instruments and one player of high and low resistance wind instruments participated in part 1 of the stud y. Nine high resistance wind players, 12 low resistance wind players, and 2 4 nonwind players were recruited among professional musicians in the Boston area to participate in part 2. Intervention: In part 1, IOP and uveal thickness changes were measured by p neumatonometry and ultrasound biomicroscopy in two participants playing the ir high resistance wind instruments (trumpet and oboe) and in a third parti cipant playing both high (trumpet) and low (clarinet and saxaphone) resista nce instruments. Each musician in part 2 underwent medical and musical hist ory, measurement of IOP, Humphrey visual field testing, slit-lamp examinati on, gonioscopy, and dilated examination. Main Outcome Measures: Intraocular pressure and uveal thickness changes, an d visual field loss and optic nerve head appearance were the main parameter s measured in part 1 and part 2, respectively. Results: In part 1, pneumatonometry showed IOP elevation dependent on the f orce of blowing, and ultrasound biomicroscopy revealed uveal thickening ass ociated with IOP elevation. The magnitude of IOP elevation was dependent on the amount of expiratory resistance provided by the particular instrument. Part 2 showed that life hours of high resistance wind instrument playing h ad a significant relationship to abnormal visual field (P = 0.03) and corre cted pattern standard deviation (CPSD) scores (P = 0.007) in univariate log istic regression and univariate linear regression, respectively. A 0.011-un it increase in CPSD for each 1000 life hours of high resistance wind playin g was found. Conclusions: High and low resistance wind musicians experience a transient rise in their IOP while playing their instruments as a result least in part of uveal engorgement. The magnitude of IOP increase is greater in high res istance wind players versus low resistance wind players. High resistance wi nd musicians had a small but significantly greater incidence of visual fiel d loss (abnormal fields and increased CPSD scores) than other musicians, wh ich was related to life hours of playing. The cumulative effects of long-te rm intermittent IOP elevation during high resistance wind instrument playin g may result in glaucomatous damage, which could be misdiagnosed as normal- tension glaucoma. Ophthalmology 2000;107:127-133 (C) 2000 by the American A cademy of Ophthalmology.