The older you are, the greater you are at risk (especially if you are over 60 years old). African Americans are at a greater risk at a younger age starting at age 40 and older.

African-Americans age 40 and over are 4-5 times more likely to have glaucoma than others. Hispanics are also at increased risk for glaucoma as they age. Those of Asian and Native American descent are at increased risk for angle closure glaucoma.

If you have a parent, brother or sister with glaucoma, you are more likely to get glaucoma. If you have glaucoma, inform your family members to get complete eye exams.

You are at risk if you have a history of high pressure in your eyes, previous eye injury, long term steroid use, or nearsightedness.

This self-assessment will help you determine whether you are at risk for age-related eye disease.

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The doctor will place a few drops in your eye to open or dilate the pupil. This allows the doctor a clearer view to inspect the optic nerve at the back of the eye.

Photography or Optic Nerve and Retinal Imaging or laser scanning may be used to show the appearance of the optic nerve inside your eye. This may also involve dilating your eye.

Tonometry measures pressure in the eye. Medicine drops are used to numb the eye. An instrument gently presses on the outside of your eye. Pressure is shown as a number followed by the abbreviation “mm Hg.” This stands for “millimeters of mercury,” a standard measure for pressure. An average pressure is about 16 mm Hg. Still, a higher than average number doesn’t always mean you have glaucoma. Since the thickness of the cornea (the front window of the eye) may affect the pressure reading and the risk of glaucoma progression, your doctor may measure this as well. Pressure can also be measured by non-contact tonometry, also known as the air puff test.

Perimetry evaluates your visual field. This tests your vision all around your field of view to see if any areas are missing. It usually involves staring straight ahead at a light and trying to see lights that appear around the sides of your view. This is generally done with a computerized system.

Gonioscopy After numbing the eye, the doctor gently places a special lens on the surface to examine the area in the front of the eye that drains fluid. Gonioscopy allows a more accurate diagnosis of the type of glaucoma.

This self-assessment will help you determine whether you are at risk for age-related eye disease.

Learn More

Laser trabeculoplasty or selective laser trabeculoplasty improves the outflow of aqueous fluid. A laser is used to make from 50 to 100 tiny burns in the trabecular meshwork. The procedure opens up the mesh-like outflow pathway to improve draining of fluids from the eye. Sometimes your doctor may perform this procedure over two visits. The benefit of the treatment may last for a few years, but it is not a cure. More than half the people who have this surgery need additional treatment within five years. Repeat laser trabeculoplasty may be used to treat patients who had a good first effect with laser treatment, but over time have lost some of the pressure-lowering response. Treatment beyond a second laser treatment is most often not effective.

A peripheral iridotomy is most often used to treat narrow angle or angle closure glaucoma. The laser beam creates a tiny hole in the colored part of the eye (the iris). This lets the pressure in front of the iris become the same as the pressure behind the iris. As a result, the iris moves away from the drainage angle and the aqueous fluid can resume draining normally.

People usually don’t feel any pain with these procedures, although some report a slight stinging. Most patients take it easy the day of their treatment, but go back to their normal routine the following day.

Many people need to keep taking medicines even after laser surgery.

Laser surgery is usually successful, but there are some risks. These include a temporary, generally short-term increase in eye pressure, temporary inflammation of the eye, and possibly a slightly increased risk of developing cataracts.

Filtering surgery creates a new path through the eye’s tissues to let fluid drain from the eye.

In the most common filtering surgery, called a trabeculectomy or a sclerostomy, the surgeon makes a small opening in the white part of the eye (the sclera) to create a new outflow path. The fluid then flows through the new opening and creates a bleb, which is like a small bubble or reservoir on the surface of the eye. The bleb holds the fluid while it is slowly absorbed into the surrounding tissue. The upper eyelid usually hides the bleb, so it’s not noticeable to you or others.

Most people who have this procedure no longer need medicine after surgery. Some people treated still need medicine, but they have better pressure control after the surgery. About 15 percent do not benefit from filtering surgery.

An alternative type of glaucoma surgery may occasionally be performed in which the tissues over the drainage area are thinned but not fully penetrated. This procedure may produce fewer complicatons than trabeculectomy, but also may be less effective in achieving low intraocular pressures.

Drainage implant surgery is sometimes performed when a person is not suited for filtering surgery or when earlier filtering surgery has failed. Depending on the kind of implant used, the surgery is called valve, shunt or seton surgery.

In these procedures, the surgeon inserts a tiny tube through the sclera into the front part of the eye behind the iris. This tube becomes a path for fluid to drain away. The other end of the tube is attached to a tiny reservoir that acts like the bleb to hold fluid until it is absorbed into the surrounding tissue. The reservoir is placed on the surface of the eye, back between the eye muscles, so it is not visible.

Right after filtering or drainage implant surgery, a person may have a temporary decrease of vision. Vision usually improves over several weeks to its previous level. It also takes time to recuperate from either form of surgery. For example, in the weeks after surgery, people often must avoid getting water into their eyes, reading, bending, lifting heavy objects and driving.

Canaloplasty is a newer procedure to lower pressure that is performed within the eye wall but that does not actually pentrate the eye. While this procedure is safer that filtering surgery, it does not provide as profound a reduction in IOP.

Minimal Invasive Glaucoma Surgeries are a set of newer FDA approved procedures that lower pressure. These approaches currently include Trabectome and the iStent. Both of these approaches work by bypassing the blockage in the drain of the eye to help fluid flow through the natural drain and do not require “artifical” pathways for fluid drainage to areas outside the eye. Like canaloplasty, the procedures are less risky than filtering surgery but do not provide as profound a reduction in IOP. More long-term data is needed to determine how well they work beyond the first few years. Use of Minimal Invasive Glaucoma Surgeries is still being debated among glaucoma specialists but may have application is specific patients.

Laser Cyclophotocoagulation is used for severe cases of glaucoma. It eliminates tiny areas of the ciliary body that make aqueous fluid. This “turns down the faucet.” Laser cyclophotocoagulation requires a numbing block to the eye to prevent pain with the procedure

Glaucoma surgeries have some possible risks, such as:

• A higher chance of getting cataracts
• Infection or leaking of the incision
• Too low pressure
• Hemorrhages inside the eye

Unfortunately, the new drainage path can close, causing pressure in the eye to rise again. Filtering surgery can be repeated with good results. Also, drainage implants are often successful in patients whose filtering surgery has failed. The medicines that reduce inflammation and control scar formation after surgery have helped increase the success of glaucoma surgeries.