Glaucoma: the ‘silent’ eye disease that can happen at any age

This story first appeared in the April 2024 edition of Healthy You, a quarterly health publication and Gazette special section.

Glaucoma is a common eye disease that affects people mostly over 60. However, it can happen at any age, according to the Iowa Glaucoma Center at the Carver College of Medicine in Iowa City.

“Glaucoma is much more common as people age, and most patients we see are 60 years and older,” said Dr. Erin Boese, an ophthalmologist at the Iowa Glaucoma Center. However, she adds, there are types of glaucoma that can affect people at any age. Babies and infants can develop glaucoma as well, which is typically more aggressive than adult-onset glaucoma.

She said one of the most predictive factors of developing glaucoma is having a close relative, like a sibling or parent, with the disease. Glaucoma causes damage to the optic nerve, the cable that sends all visual information from your eye to your brain. This damage gradually causes the peripheral vision to be lost first, and if it goes untreated, can lead to total blindness.

“Although there are many risk factors for glaucoma, including a family history, the only risk factor we can control is the pressure within the eye by lowering it,” Boese said.

Common signs, symptoms and treatments

Most cases of glaucoma are found on routine exams and don’t have symptoms until late in the disease. The most common type of glaucoma, open angle glaucoma, often results from an eye pressure that is too high and causes a very gradual loss of vision over years, which may go unnoticed, according to Boese.

“In angle closure glaucoma, which is much less common, people have a sudden increase in eye pressure which may result in a sudden blurring of vision, severe headache, nausea and red eye,” she said.

While there are treatments for glaucoma, there’s unfortunately no way to undo damage that has already been done. However, further vision loss can be prevented. “It’s like driving a car with brakes but no reverse gear,” Boese said.

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“We typically treat glaucoma by lowering the eye pressure to a point that is healthy for each individual eye (which can vary between people). Typically, most people start by using medicated eye drops,” she added. “We have many different classes of these, which can work in combination with each other. There are also lasers and a range of different eye surgeries that can be done as well.”

Advancements

In addition to treatments, Boese explained that there are recent advancements with glaucoma, including some new surgical options.

“Glaucoma surgery used to be reserved for cases when all other options were not enough. Now, we have minimally invasive glaucoma surgery options, small surgeries that are safer and quick to recover from. This allows us to safely offer a small surgery earlier, sometimes combined with a routine cataract surgery,” she said.

This is especially appealing for people who dislike drops or need just a little bit more control.

Ocular health can also affect your general health, she added, and glaucoma is the leading cause of irreversible blindness worldwide, affecting approximately 2 percent of the population. If left untreated, it can cause loss of peripheral vision and eventually blindness. Not having any peripheral vision can cause problems with motility and day-to-day life.

“Most types of glaucoma are thankfully isolated to the eye itself, and rarely affect the rest of the body,” Boese said.

To detect “silent” eye diseases like glaucoma, Boese said, it is important to get regular eye examinations, even if you don’t need glasses or contact lenses.

“The good news is that, if treated appropriately, the vast majority of glaucoma patients have functional vision their entire lives,” she said.

Dr. Erin Boese is a clinical assistant professor in Ophthalmology and Visual Sciences at the University of Iowa Hospitals and Clinics; a member of the American Board of Ophthalmology, and has her M.D. from the University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City.