Glaucoma

What it is

Glaucoma is a group of eye diseases that damage the optic nerve, the cable that carries sight from the eye to the brain. In the common form, fluid in the eye cannot drain fast enough, and the pressure that builds pushes on the optic nerve [2].

Why this guide is written for Black patients

Glaucoma is almost three times as common in African Americans as in white Americans [3]. In United States data, the prevalence of glaucoma is 3.4 percent in African Americans, 1.7 percent in Caucasians and 1.5 percent in Hispanics [4]. Primary open-angle glaucoma is also more likely to result in vision loss and blindness in African Americans than in other populations in the US [4].

The National Eye Institute lists being African American and over age 40 as a risk factor for glaucoma [1].

There is a piece of good news attached to those numbers. In the Ocular Hypertension Treatment Study, daily pressure-lowering eye drops reduced the development of primary open-angle glaucoma in African Americans by almost 50 percent: 8.4 percent of those treated developed glaucoma, against 16.1 percent of the African American participants who did not receive the drops [3].

What to ask a clinician

• Given my age and family history, how often should I have a comprehensive dilated eye exam?
• What was my eye pressure, and what does that number mean for me?
• Did you look at my optic nerve, and did you photograph it so we can compare next time?
• Have I had a visual field test, and when is the next one?
• If I need drops, what happens if I miss doses, and what do I do about side effects rather than just stopping?

What good care looks like

At first, glaucoma does not usually have any symptoms [1]. That is the entire problem, and it is why care is scheduled rather than triggered. If you are at higher risk, you need a comprehensive dilated eye exam every 1 to 2 years [1].

A comprehensive dilated exam is not the same as a vision test for glasses, and it is not the same as the puff of air on its own. Ask for the dilated exam by name, and expect the appointment to include eye pressure, a look at the optic nerve, and, if there is any concern, a visual field test.

Open-angle glaucoma is the most common type in the United States, where 9 in 10 people with glaucoma have it, and many people have no symptoms until they start to lose vision [2]. Sight already lost to glaucoma does not come back, so all treatment is aimed at protecting what remains. That makes taking the drops every day the whole of the treatment, and a clinician who asks how you are actually managing with them is doing the job properly.

When it is urgent

Angle-closure glaucoma, also called narrow-angle or acute glaucoma, is a medical emergency [2]. The symptoms are intense eye pain, an upset stomach or nausea, a red eye and blurry vision [2]. If it is not treated, angle-closure glaucoma can cause blindness in just a few days [2].

Do not wait for an optometrist appointment for those symptoms. Go to an emergency department or emergency eye care the same hour. Sudden loss of vision in one eye, seeing halos around lights with pain, or a curtain coming across the vision also needs emergency assessment.

What to do next

If you are Black and over 40, book a comprehensive dilated eye exam even if your sight seems fine, and ask how often you should come back [1].

An optometrist can do the exam and start the conversation, and an ophthalmologist manages treatment and surgery. Find Black optometrists and Black ophthalmologists. Ask whoever you see whether anyone in your family has glaucoma, then tell your siblings the answer, because the exam schedule changes for them too.