A new glaucoma diagnosis can feel disorienting, but with the right knowledge and care, your vision can often be preserved for many years. Here, Dr. Tosin Smith, of the Glaucoma Associates of Texas, breaks down what glaucoma is, how it progresses, and what steps can be taken to manage it. Think of this as your starting point—one that helps you ask better questions, make informed decisions, and take control of your glaucoma journey.*

What Glaucoma Is and Isn’t

Glaucoma isn’t just about eye pressure; it’s an optic nerve disease. At its core, glaucoma is damage to the optic nerve, usually caused by increased internal eye pressure, also called intraocular pressure (IOP). That pressure builds when the eye’s internal fluid drainage system malfunctions.

“Glaucoma is not one disease,” Dr. Smith says. There are several types:

• Open-angle, 
• Angle-closure and narrow-angle, and 
• Congenital. 

The most common, primary open-angle glaucoma involves a problem with the eye’s “plumbing,” where fluid can reach the drain but isn’t exiting properly. “I like to describe the trabecular meshwork as the strainer over your kitchen sink,” Smith explains. When the drain clogs, pressure builds, damaging the optic nerve—particularly at its weakest point, where nerve fibers exit the eye.

Over time, this pressure leads to what’s called “cupping” of the optic nerve—visible loss of nerve fiber tissue. “You’ll see a normal optic nerve on one side, and on the other, an area where the nerve fiber layer has been lost.”

Why Regular Testing Matters

Glaucoma is sneaky and often causes no noticeable symptoms until vision loss is significant. That’s why early diagnosis and consistent monitoring are critical. Comprehensive testing includes:

• Measuring eye pressure, 
• Examining the optic nerve, 
• Checking your visual field, and 
• Using imaging to monitor nerve fiber thickness.

“Visual field loss creeps up on you,” says Smith. Many patients don’t realize how much they’ve lost until it affects their daily life. The goal of testing is to detect changes early enough to prevent or slow further loss. “We try to decide what test is best for you,” he says, “to keep the vision that you have left.”

Home monitoring is also emerging as a new frontier, with tools like portable tonometers and virtual reality visual field tests, so you can take more responsibility for certain aspects of your eye care. 

Treatment & Living Your Life

Glaucoma treatment aims to lower IOP and stabilize vision. While there’s currently no cure, effective treatments include:

• Eye drops,
• Laser therapy, and 
• Surgery.  

“It’s all about plumbing,” Smith says. “Either reduce fluid production, improve the drainage system, or create a new one.”

Today, he continues, treatment is highly personalized. “There’s a number for everybody… that pressure at which you don’t get worse.” You’ll work with your doctor to find that pressure and track it over time.

Living with glaucoma also means staying engaged in your care: keep appointments, report any vision changes, use medications as prescribed, and ask questions. “Keep a notebook,” Smith urges. “We can’t remember everything.” 

*Glaucoma Research Foundation Videos. (2025, July 24). Tosin Smith, MD – Understanding and Living With Glaucoma [Video file]. Retrieved from https://www.youtube.com/watch?v=0HK_qNtXcjw

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