Prognosis for Glaucoma
The prognosis for glaucoma is highly variable and depends critically on disease severity at diagnosis, patient demographics, and treatment adherence—ranging from minimal impact on vision in slowly progressive cases to irreversible blindness in untreated or rapidly progressive disease. 1, 2
Natural History and Disease Progression
The natural history of glaucoma is heterogeneous and poorly defined, making individual prognosis difficult to predict. 1
Key prognostic patterns include:
In some patients, primary open-angle glaucoma (POAG) does not progress or progresses so slowly that it never meaningfully affects vision—the size of this subgroup is uncertain but may depend on ethnicity, age, and initial ophthalmologic findings. 1
Other patients experience more rapid progression characterized by accelerating optic nerve damage, visual field defects, and development of visual impairment. 1
Whether early glaucoma will progress to visual impairment cannot be precisely predicted, and whether the rate of visual field progression remains uniform throughout the disease course is unknown. 1
High-Risk Populations with Worse Prognosis
Older adults and African Americans have significantly increased risk and more rapid disease progression. 1
African Americans have approximately 3 times higher age-adjusted prevalence compared to whites (overall U.S. prevalence 1.9%). 1
Hispanics also demonstrate elevated risk, with prevalence of 4.7% in those older than 40 years. 1
Additional risk factors associated with worse outcomes include elevated intraocular pressure (IOP), family history, lower ocular perfusion pressure, type 2 diabetes, myopia, and thin central cornea. 2, 3
Prognosis with Treatment
Treatment with IOP-lowering medications, laser therapy, and surgery effectively reduces the development and progression of small visual field defects as assessed by clinical examination. 1
Medical treatment demonstrates a significant protective effect on incident worsening of visual field measurements compared to placebo (odds ratio 0.62,95% CI 0.47-0.81). 1
Combined medical and/or surgical treatment reduces progression of visual field loss and optic disc damage (hazard ratio 0.56,95% CI 0.39-0.81). 1
However, the magnitude of effectiveness in reducing patient-reported vision-related function impairment, including development of blindness, remains uncertain. 1
Prognosis for Angle-Closure Glaucoma
Acute angle-closure glaucoma has a particularly poor prognosis if untreated, with 18% of eyes becoming blind and 48% developing glaucomatous optic neuropathy within 4-10 years following untreated acute angle closure. 2
This represents a medical emergency requiring immediate intervention to prevent permanent vision loss. 2, 4
With prompt treatment (laser peripheral iridotomy or surgical intervention), prognosis improves substantially. 2
Critical Prognostic Considerations
Persons with short life expectancy probably have little to gain from glaucoma screening, given the slowly progressive nature of most cases. 1
The proportion of currently unidentified persons who will develop vision problems from screening-detected disease is unknown. 1
Overdiagnosis and overtreatment are possible because not all diagnosed and treated patients progress to visual impairment—the magnitude of this phenomenon is unknown. 1
Treatment-Related Factors Affecting Prognosis
Medication adherence is critical for optimal outcomes, as glaucoma requires lifelong treatment. 5, 6
Treatment harms include cataract formation (from medications and surgery), eye redness (2-21% depending on medication), eye pain and burning (1-3%), and surgical complications including hypotony, hyphema, and choroidal detachment. 1
Up to one-half of patients with POAG remain undiagnosed because diagnosis often requires monitoring over years to document progressive changes, contributing to worse overall population prognosis. 3