From the Guidelines
The primary risk factors for glaucoma, from highest to lowest risk, are advanced age, high intraocular pressure, family history of glaucoma, African or Hispanic ancestry, thin corneas, and severe myopia. These risk factors are identified based on recent studies, including 1, 1, and 1, which highlight the importance of older age, African race or Latino/Hispanic ethnicity, elevated intraocular pressure (IOP), family history of glaucoma, lower ocular perfusion pressure, type 2 diabetes mellitus, and thin central cornea as key risk factors for primary open-angle glaucoma (POAG). Some of the key points to consider include:
- Age is a significant risk factor, with the risk increasing substantially after age 60, as noted in 1 and 1.
- Elevated intraocular pressure (above 21 mmHg) directly damages the optic nerve over time, as discussed in 1.
- Genetic factors play a major role, with first-degree relatives of glaucoma patients having a higher risk, as mentioned in 1 and 1.
- African Americans have a risk about six times higher than Caucasians and tend to develop the disease earlier, according to 1 and 1. Additional significant risk factors include diabetes, hypertension, prolonged corticosteroid use, previous eye injury or surgery, and conditions affecting blood flow such as migraines or Raynaud's phenomenon, as discussed in 1. Regular comprehensive eye exams are essential for early detection, particularly for those with multiple risk factors, as glaucoma often develops without noticeable symptoms until significant vision loss has occurred, as emphasized in 1, 1, and 1.
From the FDA Drug Label
Elevated IOP presents a major risk factor in glaucomatous field loss. The higher the level of IOP, the greater the likelihood of optic nerve damage and visual field loss Elevated intraocular pressure is a major risk factor in the pathogenesis of glaucomatous visual field loss The higher the level of intraocular pressure, the greater the likelihood of glaucomatous visual field loss and optic nerve damage.
The main risk factor for glaucoma is elevated intraocular pressure (IOP). The higher the level of IOP, the greater the likelihood of optic nerve damage and visual field loss. However, the FDA drug label does not provide a list of risk factors from highest to lowest. 2 3
From the Research
Risk Factors for Glaucoma
The risk factors for glaucoma can be listed from highest to lowest based on the available evidence. The following are the key risk factors:
- Elevated intraocular pressure (IOP) 4, 5, 6, 7, 8
- Older age 4, 5, 6, 7, 8
- Family history of glaucoma 4, 5, 6, 7, 8
- Nonwhite race, including black race and Asian descent 4, 5, 6
- Hispanic origin 4
- Female sex, particularly for primary angle-closure glaucoma 4
- Diabetes mellitus 4, 7
- Thinner central corneal thickness 7
- Higher cup-to-disk ratios of the optic disc 7
- Higher pattern standard deviation values on the Humphrey automated perimeter at baseline 7
- Certain systemic medical conditions, such as those requiring corticosteroids, anticholinergics, certain antidepressants, and topiramate 6
Ranking of Risk Factors
While the exact ranking of risk factors may vary depending on the specific study and population, the following general hierarchy can be established:
- Elevated IOP: consistently identified as a major risk factor across all studies 4, 5, 6, 7, 8
- Older age: a significant risk factor in all studies, with increasing age associated with higher risk 4, 5, 6, 7, 8
- Family history of glaucoma: a strong risk factor, particularly for primary open-angle glaucoma 4, 5, 6, 7, 8
- Nonwhite race: a significant risk factor, particularly for black race and Asian descent 4, 5, 6
- Other risk factors, such as diabetes mellitus, thinner central corneal thickness, and certain systemic medical conditions, may also contribute to the development and progression of glaucoma 4, 6, 7