From the Guidelines
Glaucoma often presents with no symptoms in its early stages, which is why it's called the "silent thief of sight." The most common symptoms include gradual loss of peripheral vision, seeing halos around lights, eye pain, headache, blurred vision, redness in the eye, and nausea or vomiting (particularly in acute angle-closure glaucoma) 1. Some patients may also experience difficulty adjusting to dark rooms, decreased contrast sensitivity, and difficulty focusing on near objects. In advanced cases, tunnel vision may develop as peripheral vision continues to deteriorate. Acute angle-closure glaucoma is a medical emergency that presents with sudden severe eye pain, headache, nausea, vomiting, and rapidly blurred vision. Regular eye examinations are crucial for early detection since vision loss from glaucoma is irreversible. The damage occurs because increased intraocular pressure damages the optic nerve fibers, leading to progressive vision loss. People over 60, those with a family history of glaucoma, individuals with certain medical conditions like diabetes, and those of African, Hispanic, or Asian descent are at higher risk and should be particularly vigilant about regular eye screenings 1. Key risk factors for primary open-angle glaucoma (POAG) include 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 1. Screening for glaucoma in the general population is not cost-effective, but targeted screening in high-risk populations can be beneficial 1. The most effective method for screening is still debated, but assessing the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) using techniques like optical coherence tomography (OCT) shows promise 1. Regular eye examinations, particularly for those at high risk, are essential for early detection and prevention of vision loss from glaucoma. It is estimated that 53 million people worldwide have POAG, with a prevalence of 3.0% in the population aged 40 to 80 years 1. Given the asymptomatic nature of glaucoma in its early stages and the irreversible vision loss it can cause, early detection through regular eye exams is critical for maintaining quality of life and preventing morbidity and mortality associated with glaucoma.
From the Research
Symptoms of Glaucoma
- Glaucoma is often characterized by a lack of warning signs or symptoms, with extensive and permanent optic nerve damage occurring before the patient is aware of visual field loss 2
- The progressive loss of peripheral vision in glaucoma can lead to difficulty with driving, particularly at night, and increase the risk of falls and subsequent fractures 2
- Primary angle closure glaucoma (PACG) has relative structural preservation and worse functional loss inferiorly, while primary open angle glaucoma (POAG) has more pronounced inferior retinal nerve fiber layer thinning 3
- Patients with PACG tend to have thicker global retinal nerve fiber layer, smaller cup volume, smaller cup-to-disc ratio, and larger rim area than patients with POAG 3
- Acute angle-closure glaucoma (AACG) and open-angle glaucoma (OAG) have different optic nerve head structures, with AACG showing higher global Bruch's membrane opening-minimum rim width and total Bruch's membrane opening-minimum rim area than OAG 4
Key Differences Between Glaucoma Subtypes
- POAG is associated with superior paracentral loss, while PACG is associated with inferior field loss 3
- AACG with optic nerve head swelling is associated with significantly thinner global retinal nerve fiber layer compared to AACG without optic nerve head swelling 4
- The mechanisms of optic nerve damage in POAG and AACG are different, suggesting distinct pathophysiological processes 4