Open-angle glaucoma (OAG) is one of the leading causes of blindness, affecting roughly 3 million Americans. It’s important to understand how glaucoma leads to disability so as to learn how to best support people with glaucoma, specifically elderly patients.* 

What tasks reflect a glaucoma-related disability?

There are several tasks that a person with glaucoma may no longer be able to efficiently perform as someone without glaucoma. This is especially likely in those with bilateral disease, which is glaucoma that impacts both eyes. Light sensitivity to both low and extremely bright light (in particular) affects one’s ability to perform tasks. Some of these tasks include reading, walking, keeping your balance, driving, and having social interactions.

Reading

Difficulty reading is one of the most common complaints in glaucoma patients. People with advanced glaucoma are five times more likely to report difficulty doing tasks requiring near vision than those without glaucoma.

Resources to help: Enlarged print on digital devices and magnifiers are available for assistance with reading. Mobile phones allow a sense of touch if one’s sense of sight is impaired and allow people to be able to dial phone numbers. Talking devices, such as watches, digital readers, and GPS can also assist glaucoma patients, as can learning braille in low-vision patients when communicating with others in person.

Walking and balance

People with glaucoma walk more slowly than people of the same age without glaucoma. Patients with bilateral disease walked more slowly and bumped into things more frequently. They may also sway more, and the sway is wider when the visual field loss is greater. 

Elderly people who have trouble walking are more likely to be in nursing homes or assisted living facilities. Their innate fear of falling leads to decreased quality of life, higher morbidity, and higher mortality.

Resources to help: Walking canes and walkers can help provide a safer environment, as can non-slip bath mats, portable bathtubs, and bedside handles.

Driving

Patients with bilateral (not unilateral) glaucoma were found to be more likely to stop driving than those without glaucoma. When an elderly person stops driving, they are likely to:

• Transition into a long-term care facility
• Have higher rates of depression
• Have a reduced quality of life

Glaucoma is also associated with more motor vehicle accidents (MVA), as well. Those with advanced glaucoma having 3.5 times increased odds of being in an MVA. Having an impaired Useful Field of View (UFOV) was the strongest risk factor for being involved in an MVA. 

Lastly, after performing an on-road performance test, glaucoma patients with slight to moderate visual field impairment were successful in completing a driving course but were six times more likely to require instructor help.

Resources to help: Taxi services, public transit, and door-to-door and paratransit services are just a few ways to access transportation safely.

Social interaction

People with glaucoma have difficulty in recognizing faces. This can impact their ability to engage in social interactions and maintain relationships, which in turn significantly impacts one’s quality of life.

Diagnostic tools to gauge disability

Since glaucoma can affect many areas of life, it’s important to evaluate its broader impact. Several glaucoma-related scales allow ophthalmologists to understand how glaucoma is affecting a person’s everyday tasks and quality of life. 

The following are some of these tests:

• National Eye Institute Visual Function Questionnaire (NEI-VFQ)
• Glaucoma Symptom Scale (GSS)
• VF-14
• Glaucoma Quality of Life – 15 (GQL-15)/Glaucoma Activity Limitation (GAL-9)
• Assessment of Disability Related to Vision (ADREV)
• Useful Field of View (UFOV)

These diagnostic tools are reliant on self-reports and directly-reported outcomes, and they allow the provider to effectively treat the patient and provide them with a comprehensive treatment plan. If a person with glaucoma has been diagnosed with legal blindness (defined as visual acuity of 20/200 or less in the better eye and/or a visual field of 20 degrees or less), they may be eligible to receive disability benefits from the U.S. government.

*Thomas, A. (2019, June 11). Disability In Glaucoma. EyeWiki (American Academy of Ophthalmology). https://eyewiki.org/Disability_In_Glaucoma

Any sources from outside of Prevent Blindness do not imply an endorsement from Prevent Blindness. The contents of the material used are the responsibility of the authoring organization, Responsum Health.