For people living with glaucoma, becoming educated about the chronic, and currently incurable, disease can help achieve better outcomes. The annual Glaucoma Research Foundation (GRF) Patient Summit is designed for this purpose. In this presentation from the 2022 GRF Patient Summit, Dr.  Anjali Hawkins, M.D., Ph.D. of Rush University Medical Center explains in simple terms how glaucoma occurs, the different forms it can take, and how it’s generally treated.*

What is glaucoma and how many people have it? (1:21)

Glaucoma is “a disease of the optic nerve which gets damaged slowly and progressively, but painlessly, due to high pressure inside the eye,” Hawkins says. Right now, in the U.S.:

• Three million people have glaucoma.
• One million people don’t know they have it.
• 80,000 people are blind from it.

Glaucoma is currently the second leading cause of vision loss in older adults, but blindness can usually be avoided through early detection and appropriate treatment.

Who is at risk for glaucoma? (3:08)

Hawkins outlines six risk factors for the most common form of glaucoma in the U.S. 

• Over 65 years of age
• High intraocular (internal eye) pressure, or IOP
• First-degree relatives who had glaucoma (e.g., father or mother)
• Nearsightedness
• Diabetes
• African descent

Types of glaucoma (5:15)

There are several types of glaucoma, the most common being primary open-angle glaucoma (POAG), and angle-closure glaucoma (see below). Less common forms include congenital (from birth) glaucoma, and secondary glaucoma, which can be caused by a separate issue such as:

• Eye trauma
• Uveitis 
• Prolonged steroid use
• Diabetic retinopathy
• Eye vein blockage 

Treatment for such conditions can also lead to glaucoma, Hawkins warns. Doctors should discuss such risks with their patients.

Primary open-angle glaucoma (6:03)

POAG is the most common type of glaucoma in adults, and has the following traits:

• Affects both eyes, though damage may occur faster in one eye
• Shows clear optic nerve damage 
• The eye’s structural angle for fluid drainage is “open” or wide

Since the eye’s structure is wide enough for drainage, the cause of pressure buildup is usually an obstruction by the opening or overproduction of fluid. POAG has no early symptoms, so patients often don’t see a doctor until the disease is advanced and noticeable peripheral (side) vision loss has occurred. 

Visual field measurement (10:00)

Aside from tonometry, which measures eye pressure, visual field measurement is “the single most important test that we do,” says Hawkins. It’s the only way doctors can know how much vision has been lost and the rate of that loss. Vision loss can occur at both very high pressures and very low pressures.

Treatment (12:13)

The most important modifiable risk factor for glaucoma is IOP. If IOP is not controlled, optic nerve damage will progress and vision will continue to decline. Common treatment options to lower IOP include:

• Medications, in the form of eye drops and/or drugs to lower blood pressure
• Laser therapy
• Surgery, such as trabeculectomy, to remove obstructions or create a new drainage

Patient compliance (12:36)

Using your eye drops diligently every day is critical for preventing further vision loss. Hawkins says it’s common for patients to be more diligent with their eye drops right before doctor appointments—like flossing more before a dental appointment, but that’s not enough. 

She finds that patients who have “taken ownership” of their glaucoma and are more engaged in their treatment are the ones she can help the most. 

Angle-closure glaucoma (14:02)

Angle-closure glaucoma is less common than POAG in the U.S., and occurs when the eye’s drainage angle is too narrow, or “closed,” causing a rapid backup of fluid and rise in pressure. Angle-closure glaucoma can quickly result in blindness without emergency medical treatment. 

Risk factors for angle-closure include:

• Older age, especially if female 
• Farsightedness
• Family history
• Asian and/or Inuit descent

Common symptoms can include:

• Nausea
• Sudden, sometimes prolonged, eye pain
• Severe headaches

Treatment is typically laser surgery. If done early, the surgery is usually sufficient, and no eye drops are needed afterward.

*Glaucoma Research Foundation. (2022, August 16). Glaucoma Overview: What You Need to Know [Video file]. Retrieved from https://www.youtube.com/watch?v=hHhskLPHkf8&t=11s