Who is at highest risk for glaucoma and the importance of annual eye exams in diagnosing and treating the disorder.

Q. What is glaucoma, and how many people does it affect?
A. Glaucoma is a vision-threatening eye disorder that usually occurs when excessive pressure inside the eye damages the retina, optic nerve or both. Glaucoma affects 3 million Americans, and about 120,000 are legally blind because of it. Left untreated, glaucoma can lead to blindness in three to 15 years, depending on its severity.

Q. Who is at greatest risk?
A. Glaucoma most often occurs in people over age 40. People with a family history of glaucoma and those who are very nearsighted or diabetic also are at a higher risk. Research shows black Americans are about seven times more likely to develop glaucoma. It is the leading cause of blindness among black Americans. Hispanics also face an elevated risk.

Q. What causes glaucoma?
A. Your eyes produce an internal fluid designed to help the eyeball keep its shape. This fluid is constantly draining out of the eye. If too much fluid is made or if the “drain” backs up, which is usually what happens in glaucoma, pressure begins to build inside the eye like air in an overinflated tire. The extra pressure damages sensitive nerve tissues. The result in most cases is chronic glaucoma that slowly worsens over time. There’s also a type of glaucoma in which damage occurs without elevated pressure, but we don’t often see this low-pressure glaucoma.

Q. What are the symptoms of glaucoma?
A. Usually the first stages have no symptoms. That’s why it’s so important to get a yearly eye exam to detect the condition early. A glaucoma “puff test” is a standard part of a comprehensive eye exam. There’s also an acute form of glaucoma in which the “drain” shuts down rapidly. This condition is rare but extremely painful, so there’s no mistaking it. Acute glaucoma requires immediate attention in a hospital emergency room.

Q. Is there hope for glaucoma patients?
A. We’ve seen the development of several powerful new medications that can be quite effective at slowing down or even halting the progression of glaucoma. These new medicines often are used along with laser surgery to improve drainage in the eye and thus reduce pressure. Glaucoma often is very treatable with early detection.

Q. How do your patients feel when you detect their glaucoma early and save their eyesight with treatment?
A. Many older patients have told me how relieved they are that they still have good vision after many years of glaucoma. For example, a good friend told me a few years ago her eyes felt funny. I gave her a thorough eye exam, found she had low-pressure glaucoma and sent her to a specialist. She hasn’t lost any additional vision at all, and her eyesight has improved thanks to medication and surgery.