Glaucoma is a group of eye diseases that damage the optic nerve. It often affects both eyes, usually to varying degrees. As most cases won’t have any symptoms, one of the best ways to detect glaucoma is during a routine eye test – that’s why it’s so important to have one regularly.
Risk factors of glaucoma
Anyone can develop glaucoma, but there are several risk factors which make developing it more likely.
- You have at least a four-times higher risk of developing glaucoma if you have a close blood relative who has it
- Age plays a big part; chronic glaucoma affects up to two in every 100 people over 40 and around five in every 100 people over 80
- Higher levels of short sightedness are linked to the chronic form of glaucoma and long-sighted people to the acute form
- Consistently raised pressure in the eye is a warning sign, this is called ocular hypertension (OHT)
- People of African-Caribbean origin have about a four-times higher risk of chronic forms of glaucoma compared to those of European origin
- Acute glaucoma is much less common; however, people of Asian origin are more at risk of getting this type of glaucoma compared with those from other ethnic groups
- People with diabetes may be at higher risk of developing glaucoma
- Very high blood pressure can lead to an increase in intraocular pressure.
- Low blood pressure can lead to insufficient blood supply to the optic nerve which can also cause problems
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The types of glaucoma
The main types of glaucoma are as follows, but you’ll find much more in our guide to glaucoma diagnosis.
Chronic open-angle glaucoma/primary open angle glaucoma
Chronic or primary open-angle glaucoma is the most common type of glaucoma. It develops gradually and painlessly, so an eye test is usually the only way to detect it.
Primary angle-closure glaucoma
Sometimes known as acute glaucoma, primary angle-closure glaucoma is usually treated as a medical emergency.
Unlike chronic open-angle glaucoma, primary angle-closure glaucoma happens quickly due to a sudden rise in eye pressure and can lead to sight loss if not treated quickly.
Anyone over 40 who has a close relative with glaucoma is entitled to an NHS-funded eye test every year in England. There is at least a four-times higher risk of developing glaucoma if you have a close blood relative who has it.
Congenital means a condition is present at birth and it does affect a very small number of babies.
Traumatic glaucoma can develop after an eye injury to the eye – either a blunt trauma or something that penetrates the eye. It can happen at the time of the injury or later.
What are the symptoms of glaucoma?
There are various types of glaucoma and symptoms will differ depending on which type you have.
If you have chronic glaucoma, you might not realise you have it because it’s painless and affects your peripheral (outer) vision. Without regular checks you may not notice there’s a problem until your start to lose your more central vision.
Acute glaucoma develops much faster as a result of sudden pressure build-up in the eye. Although rare, it is usually painful and is often accompanied by:
- Blurred vision
- Haloes around lights
- A red eye
If you get these symptoms, it is important to seek immediate assistance. Contact your optician or local accident and emergency department.
Even if the symptoms go away you should contact your optician as soon as possible as repeat episodes can cause damage to your eyesight.
Glaucoma will usually be diagnosed during a normal eye test. As well as looking at the overall health of your eye and the structures within it, you’ll also have a series of quick and painless tests that help to spot any signs of glaucoma.
Tests for glaucoma
Eye pressure test (tonometry)
An instrument called a tonometer is used to measure the pressure inside your eye – intraocular pressure.
Tonometry can be useful to identify ocular hypertension (OHT – raised pressure in the eye), which is a risk factor for chronic open-angle glaucoma.
Visual field test
You will be shown a sequence of light spots and asked which ones you can see. Some dots will appear in your peripheral vision, which is where glaucoma begins.
If you can’t see the spots in your peripheral vision, it may indicate the glaucoma has damaged your vision.
Optic nerve assessment
Your optic nerve connects your eye to your brain. This can be assessed in a variety of ways during your examination and it is also photographed using a retinal camera. Digital retinal photography (DRP) captures an image of your optic nerve which can be used as reference for future visits and to track any changes that may occur over time.
OCT (Optical Coherence Tomography)
OCT scans are similar to MRI and ultrasound scans and can help our opticians detect signs of glaucoma and other conditions up to four years earlier than more traditional imaging methods. The scan produces a 3D-like image that allows us to see the structures of your eye in even greater detail. Over time, your optician will be able to spot the changes that indicate the start of glaucoma. Ask your local store if they offer OCT and you can add it to your eye test.
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For Alan, it was during his normal eye test at Specsavers that his opticians spotted the early signs of glaucoma.
Now, after a quick referral, he can manage his glaucoma and protect his sight with some daily eye drops.
Glaucoma can be treated but early detection is important. If left untreated, glaucoma can cause visual impairment and damage that cannot be reversed. But if it’s detected and treated early enough, further damage to vision can be minimised or prevented.
So regular eye tests are essential. You should have an eye test at least every two years or more frequently if advised by your optometrist. For example, they may suggest you have more frequent eye tests if you have a close relative with glaucoma, such as a parent, brother or sister.
If your optometrist suspects glaucoma, you will be referred to an ophthalmologist for further tests. If the ophthalmologist confirms a diagnosis of glaucoma, they will also be able to explain:
- How far the condition has developed
- How much damage the glaucoma has had on your eyes
- What may have caused the glaucoma
They will then be able to advise on treatment which in most cases is simply an eye drop used on a daily basis coupled with regular follow-up appointments.
Drops may be used to examine your eyes in a glaucoma appointment – these can temporarily affect your vision. Please check when making the appointment if you will be able to drive immediately after the appointment.
The purpose of the eye drops is to lower the eye pressure either by reducing the amount of fluid (aqueous humour) that is produced or helping it to drain better from the eye.
Depending on the type of glaucoma, different types of laser treatment could be used. In an acute case, a procedure called an iridotomy is often used to quickly relieve the pressure and keep it lower. In non-acute cases, a selective laser trabeculoplasty (SLT) can be used to help lower the pressure, it is especially useful for people with open-angle glaucoma that hasn’t got any better using eye drops to lower the pressure.
Eye drops will often be the first treatment to try, but surgery is an option. Trabeculectomy surgery helps to slow the development of glaucoma and lower eye pressure, many other procedures may be used dependent on the stage and type of glaucoma.
Future treatment options
There are new treatments in the pipeline for glaucoma. These include a tiny stainless-steel device which allows fluid to drain out of the eye, a little probe which travels through a tiny incision and uses thermal energy to improve drainage, and a treatment called canaloplasty which uses an extremely fine catheter to enlarge the eye’s natural drainage canal and relieve pressure inside the eyes. The benefits of all these treatments include the fact that they are minimally invasive, thereby reducing pain and side effects.
Researchers are also looking at new ways to combine eye drops to make them work better and easier to use. In the longer term, research is being done into treating brain and nerve tissue to help it regenerate, as well as investigating how stem cells can help protect the optic nerve.
For more information on understanding how glaucoma is treated, head across to our dedicated treatment hub where you can learn more about eye drops, as well as other treatment options.
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