Glaucoma is often referred to as the “sneak thief of sight” because of the disease’s slow progression and minimal symptoms. Those at greatest risk for developing irreversible blindness from glaucoma may not be getting the regular eye exams that are critical for early detection. For Glaucoma Awareness Month, the Albert and Diane Kaneb Chair in Ophthalmology and Co-Director of Harvard Medical School's Glaucoma Center of Excellence, Dr. David S. Friedman shared his insight into this debilitating disease.
“Glaucoma is asymptomatic. Because patients lose eye sight slowly they are often unaware of vision loss over time,” he explained. “It’s a very slow, painless loss of function. We don’t recognize the small worsening of eye sight from one day to the next.”
The Glaucoma Research Foundation estimates that three million Americans have glaucoma. Older adults are six times more likely to develop glaucoma after age 60 and are at an even higher risk if they have a sibling or a parent with the disease. Furthermore, glaucoma affects certain groups disproportionally. For example, African Americans and Hispanic Americans have higher rates of glaucoma and are at greater risk as they age. In African Americans, glaucoma progresses faster, blindness from glaucoma is more common, and the disease occurs about 10 years earlier in life than in other populations.
Glaucoma screening and treatment in higher-risk populations is aimed at early diagnosis and treatment to prevent vision loss. “Glaucoma screening is not simple,” Dr. Friedman said. “Ideally, you would measure eye pressure and look at the optic nerve to determine if further evaluation is warranted.” Dr. Friedman said primary care providers can start by asking if the patient’s eyes have recently been examined, if they have ever been treated or are currently being treated for glaucoma, and if there is a family history of glaucoma.
Some patients with glaucoma struggle with insurance coverage of necessary treatment to slow the disease’s progression. Dr. Friedman explained that some patients being treated for glaucoma drop out of care due to financial reasons, while those with good insurance tend to stay in care. But because of the higher prevalence of glaucoma observed in African American and Hispanic American populations, Medicare Part B covers glaucoma tests once every 12 months for African Americans 50 and older and Hispanic Americans 65 and older.
“While we understand a lot of the pathology at the basic science level, almost no major environmental factors have been identified that are associated with glaucoma,” he said. “One risk factor is chronic steroid use.” Steroids can be prescribed for treatment of chronic diseases and conditions, such as COPD. According to the GRF, chronic steroid use causes increased eye pressure, and 90% of patients with open-angle glaucoma develop a steroid response. If unrecognized, the steroid response can develop into steroid-induced glaucoma and cause permanent optic nerve damage.
Dr. Friedman believes that raising awareness of glaucoma can help patients, in general, and those belonging to high-risk populations with early detection of the disease. Given the higher risk of developing glaucoma in first-degree relatives, Dr. Friedman recommends that clinicians encourage their patients with glaucoma to tell their siblings to get an eye exam.