The importance of early eye examinations: A case study on asymptomatic Idiopathic Intracranial Hypertension

 

With three in four Australians considering their sight to be their most valued sense, it is crucial to prioritise initiatives aimed at preserving and improving eye health.¹ The National Eye Health Survey (2020) projects a 39% increase in the absolute number of Australians experiencing vision loss between 2020 and 2030, a rate substantially higher than the 14–20% increase expected in subsequent decades.² Despite this alarming trend, 90% of cases of blindness and vision impairment in Australia could be prevented or treated through early detection.³

A 2020 study by Jonas and Baird emphasises the importance of regular eye examinations, stating that, “Regular eye examinations in combination with the provision of appropriate glasses is the most effective, economical and safest of measures to minimise vision loss in the Australian population.”⁴

Further research suggests that individuals who are unaware of their eye diseases are at particularly high risk of vision loss. Consequently, improving eye disease literacy and the frequency of eye examinations may improve disease awareness and treatment, thereby reducing Australia’s burden of vision impairment and blindness.⁵

A routine eye examination uncovers asymptomatic Idiopathic Intracranial Hypertension (IIH)

Optometry Australia recently interviewed Hayley, a South Australian optometrist, and 21-year-old patient, Emily, about their experiences during a seemingly inconspicuous routine eye test.

Emily, a regular contact lens wearer, had visited her local optometrist, Hayley, for an annual check-up. Emily reported no symptoms and felt all was going well. Hayley performed all the usual tests, progressing from the front of the eye to the back. Everything seemed normal until Hayley reached three-quarters of the way through the consultation. When it was time to assess Emily’s optic nerves, Hayley unexpectedly discovered something of concern: ‘Her optic nerves were swollen, despite absolutely no symptoms,’ she said.

In surprise of this unusual presentation, Hayley referred Emily to Flinders’ Medical Centre with a tentative diagnosis of Idiopathic Intracranial Hypertension (IIH); a condition that usually causes “persistent headaches, that do not subside.”

The Flinders medical team were astounded that Emily had remained asymptomatic despite the severity of her swollen optic nerves. According to her medical team, Emily stated that her presentation was considered ‘really rare, especially since I wasn’t showing any symptoms.’

A lumbar puncture confirmed suspicions of IIH, revealing a cerebrospinal fluid (CSF) pressure of 35cmH₂O. Considering the normal range for intracranial pressure in adults is 6 to 25cmH₂O, Emily’s pressure reading was significantly higher than expected. ⁶

Emily was prescribed Diamox, a medication used to reduce the amount of CSF in the brain and provided with additional general health recommendations. A follow up optometric examination confirmed complete resolution of the nerve swelling.

Emily expressed her relief in being diagnosed early: ‘I was lucky [the IIH] was found when it was – it could be easily managed. I didn’t want to [end up] being on 1000 tablets or in hospital.’

Through her story, Emily emphasised the importance of not delaying care: ‘Don’t put stuff off, as the implications could be really bad – like losing your eyesight or going blind. Our eyes are really important.’

A call for action: Reinforcing the importance of regular eye checks

Emily’s story serves as a powerful reminder of the importance of regular eye checks. Conditions like IIH carry serious risks that can have life-changing consequences. Emily’s optometrist, Hayley, reiterated: ‘IIH can lead to permanent vision loss, or even blindness in severe enough cases. I often hear the statement: “I don’t need an eye test – I know my eyes, there’s nothing wrong” but there are so many silent eye conditions that can be actively taking your sight.

Hayley reflected on the importance of regular Medicare subsidised eye tests. ‘Detecting eye conditions sooner makes a huge difference! We optometrists can find cancers, leukaemia, diabetes… all significant conditions that people don’t know about,’ she said.

‘People still want to prioritise their eye health, but in a day and age where people are tossing up between the cost of so many things, the cost of eye care definitely factors in. The idea that it is only once you hit 65 that you need to be worried about your eye health is not accurate. The evidence supports two yearly checks which reduces the burden on an already over-run healthcare system.’

Emily also shared her perspective on the importance of Medicare-subsidised eye tests, stating: ‘Even if nothing is found, it is peace of mind knowing nothing is wrong.’

Reflecting on the financial barriers to accessing healthcare, Emily reiterated, ‘I often put off [seeing a specialist] due to the cost. People [are] struggling with money in the current economic climate… it is harder to pay for things. I probably would not have gone when I did [to see the optometrist] if it was not subsidised.’

As Emily’s story demonstrates, regular eye checks are not just about preventing blindness – they provide invaluable peace of mind and the opportunity for timely intervention.

All Australians aged under 65 stand to benefit from being able to access Medicare-subsidised eye examinations once every two years rather than once every three years.

Read more about Optometry Australia’s Federal Election campaign, ‘Eyes on Medicare,’ here.

References

1. Optometry Australia. (2022). 2022 Vision Index Report. Retrieved March 2025 from https://www.optometry.org.au/wp-content/uploads/GVFL/Vision_Index/2022-Vision-Index-Report.pdf.
2. Foreman, J., Keel, S., McGuiness, M., Liew, D., van Wijngaarden, P., Taylor, H. R., & Dirani, M. (2020). Future burden of vision loss in Australia: Projections from the National Eye Health Survey. Clinical & Experimental Ophthalmology, 48(6), 730–738. https://doi.org/10.1111/ceo.13776.
3. Vision 2020 Australia. (2022). 2022–2023 Pre-Budget Submission, Vision 2020. Retrieved 2025 from https://www.vision2020australia.org.au/resources/2022-23-pre-budget-submission/
4. Baird, P. N., & Jonas, J. B. (2020). Uncorrected refractive error in the Australian National Eye Health Survey. Clinical & Experimental Ophthalmology, 48(1), 9–11. https://doi.org/10.1111/ceo.13698.
5. Foreman, J., et al. (2017). The validity of self-report of eye diseases in participants with vision loss in the National Eye Health Survey. Scientific Reports. 7(1): p. 8757.
6. Lee, S. C. M., & Lueck, C. J. (2014). Cerebrospinal fluid pressure in adults. Journal of Neuro-Ophthalmology, 34(3), 278–283. https://doi.org/10.1097/WNO.0000000000000155.
7. Subramaniam, S., & Fletcher, W. A. (2017). Obesity and weight loss in idiopathic intracranial hypertension: A narrative review. Journal of Neuro-Ophthalmology, 37(2), 197–205. https://doi.org/10.1097/WNO.0000000000000448.