What is glaucoma?

Fundus photography showing the retina and optic disc of a human eye, indicating signs of glaucoma, an eye condition.

Glaucoma is the "silent thief of sight"

Glaucoma is the leading cause of irreversible blindness. It was estimated to affect 4 million in the US and 80 million world-wide in 2020. The overall prevalence within the US is 2.1% and 3.54% globally. It is estimated that 3.36 million people 40 years and older in the US have open-angle glaucoma. This disease is on the rise and expected to reach 111.8 million globally by 2040.

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Glaucoma is a group of eye diseases that damage the optic nerve and result in vision loss. The two most common types are primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). 90% of US glaucoma patients have POAG. There are typically no early warning signs or symptoms for POAG which is why it is known as the “silent thief of sight”. Consequently, routine eye exams are critical to diagnosis. No cure for glaucoma has been discovered yet and the only clinically proven way to modify disease progression is to lower the pressure inside the eye. Current treatments cannot reverse vision loss but are designed to slow disease progression, thereby preventing further vision loss.

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Everyone is at risk for developing glaucoma, but certain groups have a higher risk. All people over the age of 60 are 6x more likely to develop a type of glaucoma. Those with diabetes are 2x more likely to develop a type of glaucoma. Prevalence also varies with race. People of African-Caribbean and African American descent over the age of 40 are 8x more likely to develop POAG.

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Today, the national economic impact of glaucoma takes up the majority of $5.8 billion spent on treatment and management of optic nerve disorders. Ten million doctor visits occur each year for glaucoma resulting in $2.5 billion in annual healthcare costs. The burden of these costs on the US healthcare system is expected to significantly rise as the number of patients increases. Only 50% of people with glaucoma are diagnosed. The other 50% are unaware of their disease. Additionally, it is projected that the number of people affected by glaucoma will increase two folds by 2050.

Glaucoma is the leading cause of irreversible blindness in the world and currently has no cure. In glaucoma patients, excess fluid within the eye builds up and puts pressure on the optic nerve. This pressure leads to irreversible vision loss. Glaucoma is a group of diseases, the two most common being primary open-angle glaucoma and angle-closure glaucoma.

Primary open-angle glaucoma (POAG) is the most common type of glaucoma. There are typically no early warning signs or symptoms. In POAG, the drainage system (trabecular meshwork) within the front of the eye is clogged. Fluid is unable to cycle and drain as normal, thus leading to increased pressure within the eye. If POAG is not diagnosed and treated, it can cause gradual blindness over many years. POAG usually responds well to medication, especially if diagnosed and treated early.

A woman undergoing an eye examination for glaucoma treatment using specialized ophthalmic equipment.

Angle-closure glaucoma occurs when the iris is very close to the drainage angle in the eye, blocking the drainage angle. When the drainage angle is blocked in this way, eye pressure will rise very quickly in an “acute attack.” Symptoms of an acute angle-closure glaucoma attack include severe eye pain and sudden blurry vision. Consult an ophthalmologist for more information. Most people with angle-closure glaucoma develop it slowly, with no symptoms prior to an acute attack. Angle-closure glaucoma can result in blindness if not treated.

The current treatment algorithm for open-angle glaucoma begins with eye drop medications and laser procedures (laser trabeculoplasty) before proceeding to minimally-invasive glaucoma surgery. If these minimally-invasive treatments fail to reduce pressure sufficiently, more invasive surgical treatment options are used such as gold-standard manual surgery (trabeculectomy) and tube shunt implants; however, the currently available options involve significant risks (such as infection, scarring, clogging, etc.) so the need for a safer alternative solution remains.

An eye doctor conducting an examination for potential glaucoma using a slit lamp biomicroscope on a female patient.

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