Glaucoma is a general name for a group of eye diseases that damage the optic nerve and the retinal nerve fiber layer of the eye.  Often associated with gradual increases in pressure within the eyeball itself, glaucoma can result in partial or total blindness over time.  The damage caused by glaucoma is irreversible, and it is currently the second-leading cause of blindness in Americans over age 40 in the United States.

Glaucoma Statistics

Currently, 2.7 million people ages 40 and older have open-angle glaucoma. And while anyone can develop glaucoma, the disease is most common in people over age 40, particularly people with an African ethnicity.
In addition, people with a family history of glaucoma stand at a higher risk to develop the disease, and anyone over age 60, particularly Hispanic persons, faces an increased risk of developing glaucoma.

Normal Intraocular Pressure

Elevated intraocular pressure is a risk factor for developing glaucoma.

The measurement of intraocular pressure is a way to determine the amount of aqueous fluid in the front of the eye. Normal intraocular pressure requires a balance between aqueous fluid production and fluid drainage, and in people with glaucoma, this mechanism becomes unbalanced.

Early detection is key

No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma.  People at high risk for developing glaucoma due to elevated intraocular pressure, a family history of glaucoma, advanced age or an unusual optic nerve appearance may need more frequent visits to the office.

Glaucoma Risk Factors

Your risk of having glaucoma is determined by the number of positive risk factors that you have.

A person may be classified as having no risk for developing glaucoma if they have no risk factors.

  • Risk Factor 1 – Positive family history
  • Risk Factor 2 – Black or Hispanic race
  • Risk Factor 3 – Elevated intraocular pressure
  • Risk Factor 4 – Abnormal optic disc appearance
  • Risk Factor 5 – Thin central corneal thickness

A person may be classified as a low-risk for developing glaucoma if one or two risk factors were identified during the patient history and clinical examination.

Alternatively, a person may be classified as a high-risk for developing glaucoma if three or more risk factors are present.

Open-Angle Glaucoma


  • generally painless
  • no obvious symptoms

Narrow-Angle Glaucoma

Risk Factors

  • Farsighted vision
  • Age
  • Asian race
  • Cataracts

Clinical Pathology

  • iris bows forward
  • obstruction to drainage angle
  • fluid backs up
  • intraocular pressure rises

Diagnostic Tests for Glaucoma

  • ophthalmoscopic evaluation of the optic nerve
  • fundus photographs of the optic nerve
  • tonometry to measure the intraocular pressure
  • corneal thickness measurements
  • visual  field examination
  • retinal laser scans
  • pupillary examination
  • electrodiagnostic examination
  • gonioscopy, anterior segment imaging, or ophthalmic ultrasound to evaluate the internal structures of the eye
An abnormally high IOP reading indicates a problem with the amount of fluid inside the eye.  Either the eye is producing too much fluid, or it’s not draining properly.
Another method for detecting or monitoring glaucoma is the use of instruments to create images of the eye’s optic nerve and then repeating this imaging over time to see if changes to the optic nerve are taking place, which might indicate progressive glaucoma damage.  Instruments used for this purpose include scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy.
Visual field testing is another way to monitor whether blind spots are developing in your field of vision from glaucoma damage to the optic nerve.  Visual field testing involves staring straight ahead into an instrument and pushing a button when you see a blinking light in your visual field. The test may be repeated at regular intervals so your eye doctor can determine if there is progressive vision loss.
Anterior segment imaging or ultrasound biomicroscopy may be used to evaluate how well fluids flow through the eye’s internal structures.  Gonioscopy is the use of special lenses that allow your eye doctor to visually inspect internal eye structures that control fluid drainage.

Treatment of Glaucoma

Depending on the severity of the disease, treatment for glaucoma can involve the use of medications, laser surgery, or intraocular surgery.  Medicated eye drops aimed at lowering intraocular pressure are usually tried first to treat glaucoma.

Because glaucoma is often painless, people may become careless about the regular use of eye drops that can decrease eye pressure and help prevent permanent eye damage.  In fact, non-compliance with a program of prescribed glaucoma medication is a major risk factor that contributes to people going blind from glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

All glaucoma surgery procedures (whether laser or non-laser) are designed to accomplish one of two basic results: decrease the production of intraocular fluid or increase the outflow (drainage) of this same fluid.  Occasionally, a procedure will accomplish both.

Currently the goal of glaucoma surgery and other glaucoma therapy is to reduce or stabilize intraocular pressure.  When this goal is accomplished, damage to ocular structures – especially the optic nerve – may be prevented.

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