Neovascular glaucoma (NVG) is a form of secondary glaucoma that commonly arises in the elderly, and can cause significant vision loss if not identified and treated early. To prevent irreversible loss of sight, MedicalNewsToday outlines what you need to know about NVG.*

What is NVG?

NVG happens when abnormal blood vessels form over the iris (colored part of the eye) and front eye chamber. Two ways in which eye pressure can rise (and permanently damage the optic nerve) are:

• The new vessels can block fluid from draining out of the eye, and 
• The vessels can bleed/leak.

While NVG isn’t life-threatening, it’s associated with a poor outlook for one’s vision. Disease outcomes can be improved with early diagnosis and treatment.

How does NVG happen?

As a secondary form of glaucoma, NVG commonly arises from underlying conditions such as:

• Diabetic retinopathy
• Ocular ischemic syndrome (reduced blood to the eye from a severe carotid arterial blockage)
• Ischemic central retinal vein occlusion (blockage of the vein carrying blood from the retina)

When the retina doesn’t get adequate oxygen, it releases a signal protein called VEGF (vascular endothelial growth factor) that spurs growth of new blood vessels in a hasty attempt to restore oxygen flow to retinal tissues. These new vessels can leak and block eye fluid drainage.

What are symptoms of NVG?

Symptoms appear gradually in NVG, so there may be no early indications that anything is amiss. Eventual symptoms may include:

• Blurred vision and light sensitivity (frequently first symptoms to appear)
• Eye pain
• Eye redness
• Reduced vision

Redness and pain may be less pronounced, especially in younger people.

How is NVG diagnosed?

A comprehensive eye exam is needed to determine:

• Eye pressure
• Optic nerve and frontal eye chamber health
• Drainage angle health (where eye fluid exits the eye)
• Visual field

In addition, imaging tests may be needed to help identify and then monitor disease progression.

• NVG’s underlying cause needs to be determined for the disease to be effectively treated.
• This may require a medical history to identify any NVG risk factors, and additional tests to confirm conditions like diabetes.

How is NVG treated?

NVG is treated by addressing the underlying cause, along with reducing eye pressure to protect the optic nerve. Generally, treatment is aimed at:

• Managing retinal blood flow
• Reducing new blood vessel formation

Managing retinal blood flow and new blood vessels can be accomplished by:

• Laser treatment to lower VEGF production
• Injecting anti-VEGF medications into the eye

Lowering eye pressure can be accomplished by:

• Eye drops or oral medications, followed by laser therapy if needed
• Tube shunt surgery, if eye drops and laser therapy are unsuccessful

For those with low vision, a less-invasive laser procedure that neutralizes the ciliary body (the part of the eye that makes eye fluid) may instead be advised.

The treatment team will involve:

• Ophthalmologists (physicians who diagnose and treat eye disease)
• Glaucoma and retina specialists
• Primary care physicians

They’ll work in partnership with you to ensure optimal eye care, while minimizing your risk of total vision loss.

*Sherrell, Z. (2023, May 18). Neovascular glaucoma: What to know. MedicalNewsToday. https://www.medicalnewstoday.com/articles/neovascular-glaucoma