Early detection matters: Spotting the first signs of glaucoma

Imagine a world without colours, shapes, and the faces of loved ones – a world dimmed by a condition that silently steals your sight without you even noticing.

This condition is called glaucoma, a complex eye disease that affects more than 3% of people over the age of 70. Although glaucoma can be detected early through routine eye exams, at least half of glaucoma cases go undetected across every region of the globe. According to Glaucoma UK, an estimated 350,000 people in the UK are unaware they have glaucoma.

If left untreated, glaucoma can lead to sight loss and even blindness. Irreversible damage can occur long before any noticeable symptoms develop, which is why regular eye exams as we get older are such an essential defence against this silent menace.

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What exactly is glaucoma?

Glaucoma is an eye disease usually associated with abnormally high pressure within your eye (known medically as intraocular pressure). As the pressure rises, it causes progressive damage to the eye’s structures, including the optic nerve, which transmits visual information between the brain and the eye.

There are several types of glaucoma, the most common being primary open-angle glaucoma. This type of glaucoma becomes more common with age, affecting around 2% of people over the age of 40, and over 1 in 20 people over the age of 80.

In primary open-angle glaucoma, the drainage system in the eye doesn’t work properly, leading to a gradual increase in pressure inside the eye that progressively damages the optic nerve. As the nerve gets damaged, your vision can become weaker over time. The problem is that you’re unlikely to realise it’s happening until a significant amount of damage has occurred – unless it is picked up in a routine eye exam.

Other less common types of glaucoma include angle-closure glaucoma and normal-tension glaucoma. Angle-closure glaucoma happens when there is a sudden or gradual blockage of your eye’s drainage angle, causing a rapid rise in eye pressure and severe eye pain, redness, and blurred vision. Normal-tension glaucoma is different in that the optic nerve gets damaged even though eye pressure is normal.

Know the risk factors

While anyone can develop glaucoma, there are certain risk factors that increase the likelihood of it developing.  For example, if a close blood relative in your family has had angle-closure glaucoma,  you can have up to a 10-fold increase in risk of developing it compared to someone with no family history of the disease.  

If you have one or more of these risk factors, it’s even more important to prioritise regular eye exams:

  • Age (especially over 60)
  • Family history of glaucoma
  • African or Asian descent
  • Previous eye injury or surgery
  • Diabetes
  • High blood pressure
  • Being short- or long-sighted
  • Cardiovascular disease

Having one or more of these risk factors doesn’t necessarily mean you will go on to develop glaucoma, but being aware of them can help you and your eye care professional stay vigilant and catch any potential problems before they lead to serious vision issues.

Why early detection for glaucoma matters

Glaucoma is a silent condition that can lead to irreversible blindness if it isn’t detected and treated early (hence why it is often referred to as “the silent thief of sight”).

In its most common form, it is often symptomless and causes no pain as it gradually develops over time. Only when the disease becomes more advanced might someone suddenly notice a shadowy patch in their vision or start to see things less clearly. In people with advanced disease and severe damage in one eye, the unaffected or ‘better’ eye can often also mask the problem further.

This is why early detection through routine eye examinations is so critical. An optometrist or optician can carry out a few painless tests and look for changes or abnormalities in the pressure inside your eye. If the optician suspects you might have glaucoma, they will refer you to an ophthalmologist for further evaluation and treatment.

Be warned however – NHS eye care services still face a huge backlog since the pandemic as well as a growing demand for care (the Royal College of Ophthalmologists anticipates a 44% increase in demand for glaucoma services by 2035).  Glaucoma waiting lists are long and you may have to wait several months to see an ophthalmologist on the NHS following a referral or follow up appointment. Even more incentive to waste no time in booking your next eye exam.

Spotting the signs of glaucoma

What is usually the first sign of glaucoma? The first signs depend on what type of glaucoma you have. In primary open-angle glaucoma, there are usually no obvious signs or symptoms in the early stages.

Acute-angle closure glaucoma, on the other hand, does have early symptoms you can spot, including:

  • Eye pain or redness
  • Blurred or hazy vision
  • Severe headache
  • Nausea and vomiting (acute cases)
  • Halos or rainbow-coloured rings around lights

Anyone experiencing these symptoms should seek immediate medical attention.

If you’re caring for an elder parent or relative, and they have not had an eye exam for a good few years, signs that could indicate advanced primary open-angle glaucoma include:  

  • Trouble distinguishing colours (especially in low light)
  • Difficulty seeing things to the side of them / being startled when you approach them from the side
  • Complaining of blurry vision and needing more light
  • Frequently bumping into objects
  • Increased number of falls.

Regardless of whether they are showing these signs or not, if they haven’t been for an eye exam for a long time you should encourage them to make an appointment with an optician.

Encouraging regular eye exams in the elderly

People often think that eye tests are just about checking you have the correct glasses, but eye tests are so much more than this and can help detect a number of important health and visual issues, including diabetes, high blood pressure, macular degeneration and glaucoma.

The NHS recommends that people should get their eyes tested at least every two years, and that people aged 70 and over should have theirs tested once a year. Going for a regular eye exam should be a fundamental part of an elderly person’s yearly healthcare routine, alongside trips to the dentist and other general health checks.

As well as picking up on the early signs of glaucoma and other potential health issues, regular eye checks will of course help ensure they have the right glasses prescription and maintain good vision – which is important for mobility, independence, and quality of life. Poor vision can put older people at risk of falls, driving accidents and making mistakes with medications.

However, despite the benefits, there can be many reasons why older people don’t keep up with regular eye exams. Failing memories can make it difficult to remember when their last appointment was, other health issues may take priority, or they could be apprehensive about costs and ‘hard sells’ on expensive eyewear.  Other times, they may simply be unaware of the risks of eye disease and the full purpose of eye exams.

Convincing an elderly parent or relative who hasn’t been to the optician in a long time to get an eye exam is not always easy, but try using some of these tips if they resist the idea:

  1. Express your concerns: Talk to your parents about your concerns for their eye health in a loving and non-confrontational manner.
  2. Educate: Share information about the risks of eye diseases like glaucoma and how early detection can make a significant difference.
  3. Accompany them: Offer to go with them to their appointments, which can make the process less intimidating.
  4. Make it convenient: Help to schedule the appointment and arrange transportation. If they have issues with mobility or mental health, they may also be entitled to a mobile sight test from the NHS, where an optometrist will come to visit them at home.
  5. Clarify costs: If they are over 60, they will be eligible for free NHS eye tests, which lots of opticians provide. You can find opticians that offer NHS sight tests near you here.
  6. Discuss the benefits: Explain how they can maintain their independence and quality of life through better vision.

Treating glaucoma

There is no cure for glaucoma, but treatments make it possible to live with the condition and slow its progression. Treatment involves either medication or surgery to prevent further damage to the optic nerve. The type of treatment you receive depends on the severity of the glaucoma and individual factors.

Eye drops to reduce eye pressure are usually the first line of defence. Sometimes, oral medications or laser therapies might be recommended to complement the drops. If this isn’t successful, or in more advanced cases, surgery can be undertaken to reduce pressure by improving fluid drainage. If someone has acute angle-closure glaucoma, immediate medical treatment involving a laser procedure is required.

In summary

The impact of early detection for glaucoma cannot be overstated. When caught in its early stages, glaucoma progression can often be slowed or halted through treatments such as eye drops, oral medications, or surgical procedures. However, once vision is lost due to glaucoma, it cannot be fully restored.

Don’t rely on spotting symptoms yourself before going to see a specialist as the most common type of glaucoma develops slowly and is often symptomless until it is already advanced.  Schedule and attend regular eye appointments instead.

Common questions

What is usually the first sign of glaucoma?

There are different types of glaucoma with different sets of symptoms. The most common form (primary open-angle glaucoma) is often symptomless in the early stages.  However, acute-angle closure glaucoma does have early symptoms which include eye pain or redness, blurred or hazy vision, halos or rainbow-coloured rings around lights, nausea and vomiting.

Can you live well with glaucoma?

Yes, it is possible to live well with glaucoma if you detect it and treat it early, and continue to monitor it with regular eye checks. Depending on its severity, you may need to limit or modify certain activities. A doctor can determine what is safe and appropriate.

Can you tell if someone has glaucoma?

Only a proper medical evaluation can determine if someone has glaucoma.

Do UK pensioners get free eye tests?

Yes. People aged 60 and over are eligible for free NHS eye tests every two years.

What can I do to prevent glaucoma?

Regular eye exams every 1-2 years are the best protection against glaucoma as you get older. While eye exams can’t prevent you from getting glaucoma, they can help you detect it early and get treatment prevent it progressing and causing significant damage or blindness.

Disclaimer: The information provided in this article is intended for general informational purposes only and should not be considered as professional medical advice. If you have any specific medical concerns or questions about glaucoma or any other medical condition, it is recommended that you seek advice from a qualified medical professional or healthcare provider.

While we strive to ensure the accuracy and timeliness of the information, medical knowledge is constantly evolving, and new information may emerge that could affect the accuracy or relevance of the information provided in the article.

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