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Interviewer: It causes blindness and the damage is so gradual you might not even realize that you have it until it's too late. What you'll learn about glaucoma could save your vision.

Dr. Norm Zabriskie is a glaucoma expert at the Moran Eye Center. Doctor, I don't think I realized glaucoma was so serious that it could take your eyesight and so sneaky as well.

What Exactly is Glaucoma?

Dr. Zabriskie: Glaucoma is indeed a blinding disease that is traditionally chronic and kind of insidious. By definition, glaucoma is a disease that damages the optic nerve of the eye, the nerve that connects the eye to the brain, that nerve that is fundamental for vision as we know it. Glaucoma is a slowly progressive disease that gradually damages the optic nerve.

Interviewer: So with glaucoma, does it always result in visual loss ultimately?

Dr. Zabriskie: If not treated, yes, it does. And the thing about the damage caused by glaucoma is that it is irreversible. That is one very, very important aspect of glaucoma. When we talk about treating glaucoma, we only talk about preventing further loss, as unfortunate as that might be. We can't talk about reversing the damage that has already been done. So in glaucoma, early diagnosis is critical because once the damage is done, it is done, and with today's technology we can't bring it back.

High Percentage of Undiagnosed Glaucoma Cases

Interviewer: And would you say that a lot of people that have it, is that true, don't realize that they have it?

Dr. Zabriskie: It has been estimated that as many as 50% of the people with glaucoma do not realize they have glaucoma.

Interviewer: And how far along, how much damage is done by the time the average person kind of realizes?

Dr. Zabriskie: Well, it varies depending on when it is diagnosed. To use your question there, if a person notices their own glaucoma, it is almost for sure already very advanced. We tell people. We tell patients. We never want you to diagnose your own glaucoma. We want it picked up by an eye care professional or even one of your primary care physicians well before you even know you have any issue whatsoever.

Interviewer: Yeah. I'm going to ask eventually what you should do about it. I think I'm starting to get a handle on what the answer to that question will be, but . . . So the gradual thing really scares me.

Dr. Zabriskie: Yeah.

Am I at Risk of Glaucoma?

Interviewer: Are there certain people that should be more worried about it than others?

Dr. Zabriskie: Absolutely. I think certainly people with a family history of glaucoma. It is a familial disease. The genetics of glaucoma have not been totally delineated, but it is clearly a familial disease. So those with a family history of glaucoma certainly need to be aware of it and be getting regular eye exams.

In other population groups, African-Americans for example, or any individual of African descent, we know that glaucoma amongst African-Americans and those of African descent is not only more common, which it absolutely is, but it tends to be more aggressive and more severe, and more difficult to treat. So that is one population group that should take particular note.

Others are it has been shown that in the Hispanic population, it is also quite prevalent and perhaps even more severe. So those are the ones that we watch out for the most carefully.

Signs and Symptoms of Glaucoma

Interviewer: All right. So you said yourself that you don't ever want somebody to self-diagnose their glaucoma, but we probably should talk about symptoms anyway, just in case somebody is noticing it. They can get in as quickly as possible.

Dr. Zabriskie: Sure. Fundamentally, it's vision loss. People would notice a blind spot or a dark area or something like a shadow or something like that that is in their vision. Glaucoma traditionally and most commonly affects the peripheral vision before it affects the central vision, and that's why it can go so unnoticed. For some people, though, when they have glaucoma, the very earliest visual field defect is somewhat central. But more commonly it's peripherally and that's why it can sneak up on you. But if someone were to notice their own glaucoma, it would be a blind spot or an area where they become aware that they just don't see as well.

Interviewer: They would get in immediately at that point.

Dr. Zabriskie: Yeah. It would be something to look at right away.

Preventing Glaucoma

Interviewer: So I don't want to go blind. What should I do? How can I prevent this from happening?

Dr. Zabriskie: Well, I think the key to preventing glaucoma or diagnosing it early is just an eye examination. It really can't be diagnosed in any other way, and that eye examination would need to be one where the pressure is checked. Now, we haven't even talked about pressure and glaucoma, but most people, but certainly not everyone, most people that have glaucoma have a higher than normal eye pressure, and that's a specific measurement that's made with instruments designed to measure the eye pressure.

So an examination to evaluate glaucoma would consist of having your eye pressure checked, but also very importantly, it would involve having the optic nerve examined. When a person has glaucoma, as I said, it damages the optic nerve, and that optic nerve then changes in a very characteristic way that we can recognize as being glaucomatous or suspicious for glaucoma. So a screening exam for glaucoma would involve a pressure check as well as a careful optic nerve examination.

The Importance of Annual Eye Exams

Interviewer: Am I getting that in my annual eye exam?

Dr. Zabriskie: Most of the time. Most of the time, if you go to an eye care professional, an optometrist or an ophthalmologist, it would involve a pressure check and an evaluation of the optic nerve.

Interviewer: So that's another great reason why you should really see an eye doctor every year.

Dr. Zabriskie: Absolutely. I think especially once a person gets, say, to the age of 60, then I would say definitely a yearly eye exam would be advisable. Glaucoma, like many other diseases, is more prevalent as we get older. So that's another group that needs to be on the lookout for glaucoma. Just those of us that are older, 60 and above definitely, I think, in my opinion, should be getting a yearly eye exam. For those who have a family history of glaucoma, I think that yearly eye exams should start quite a bit earlier, maybe in their 40s or something like that.

Interviewer: How about everybody else? How often should you be going in?

Dr. Zabriskie: That's a really good question. For someone who has no problems, and no family history, probably every couple of years would be fine.

Interviewer: Okay. Is the glaucoma test that I get that little puff of air? Is that what that is?

Dr. Zabriskie: Yes. That's one way . . .

Interviewer: Is that the pressure?

Dr. Zabriskie: . . . of measuring pressure. Yeah. It might not be the gold standard, but it's still a good way. But again, that by itself is not an adequate test. Now, I don't want to criticize anything, anybody that sets up a shop in the mall and measures pressure to do screenings at like a health fair something, but that's not sufficient, and the reason is fully 25%, maybe even 30% of people with glaucoma never have high pressure.

So the danger of that is to get your pressure checked and it turns out to be normal, say, at a health screening or something like that and you're told "Oh, you're pressure is fine," and so you automatically think, "Well, I don't have glaucoma." But unless that pressure check is combined with a look at the optic nerve, a full screening has not taken place.

updated: May 25, 2023
originally published: January 12, 2015