Managing your risk of glaucoma: When to seek help

The health issues that affect over-60s are varied and many, but there is one area of health that almost all people need to address as they age: vision.

Our vision accuracy naturally deteriorates over time, which is why most of us find ourselves reaching for our glasses multiple times a day. Aside from weakening vision though there are specific eye diseases and conditions that become more common with age and that need to be addressed early to prevent them from doing more harm to our vision further down the track. One of the most common eye issues over-60s face is glaucoma.

About 300,000 Australians live with glaucoma, a term used to describe a series of eye diseases where vision is lost due to damage to the optic nerve. When there is irregular pressure in the eye, it causes the nerves at the back of the eye to become damaged.

“The optic nerve sends all the information for your vision from your eye to your brain, so it is important,” Ben Hamlyn, Member Support and Policy Advisor for Optometry Australia, tells Starts at 60. “There are a few types of glaucoma, however the damage to the nerve is usually gradual, and affects the peripheral vision first. If it is not picked up it can cause blindness.”

Around 11.1 million people worldwide are expected to go blind as a result of glaucoma by 2020, but worryingly there are no early warning signs or ways of detecting glaucoma in the early stages with a self-check, highlighting the significance of regular eye check-ups. Half of all people with glaucoma have not yet been diagnosed.

“You can actually lose up to 40 per cent of the vision outside without realising,” Meagan Anderson, Orthoptist with Vision Australia, tells Starts at 60. “You have certain channels around the edge of the iris, the colour part at the front of the eye. When those channels get blocked, the pressure builds and unless it’s a very high pressure, you won’t notice it happening within your eye. That’s when people really are at risk of having consequential nerve damage at the same time.”

While people can be impacted by different types of glaucoma including acute angle closure glaucoma (where the drainage of the eye becomes blocked and raises eye pressure quickly), secondary glaucoma (caused by other eye conditions) and congenital glaucoma (glaucoma that develops in childhood), primary open angle glaucoma is the biggest cause of concern for over-60s. This type of glaucoma, which accounts for 90 per cent of all glaucoma cases in Australia, develops slowly over years when the drainage channels in the eye become blocked over time.

Certain people are also more at risk, including those with a family history of the disease, people over the age of 40, people from Asian or African backgrounds, those with irregular blood pressure or diabetes and even people who are short-sighted.

“The pressure that causes damage varies between people. Some people have high pressures in their eyes, and no damage occurs, while others have normal pressures and their optic nerves become damaged through glaucoma,” Hamlyn says. “To assess for glaucoma, the pressure of the fluid in someone’s eye will be checked, but more importantly the health of the optic nerve and sometimes the peripheral vision is assessed.”

Sadly, there is no cure for glaucoma and damage caused can’t be reversed. It typically causes changes to the peripheral vision first, which isn’t needed for reading and recognising faces. Having said that, early detection is key as treatments are available to halt any damage before vision loss occurs. It’s best to visit an optometrist at least once every two years, where they will perform a number of tests as part of a regular check-up, including glaucoma checks.

“Glaucoma is not simple to diagnose and requires a number of factors about the patient to be taken together to decide if the person has the condition,” Hamlyn says. “An examination of the vision, health of the optic nerve and eye pressure is required to assess for glaucoma. Often the diagnosis also requires assessment over time, to see if there is any change to the health of the optic nerve or the peripheral vision.”

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Tonometry is used to detect pressure in the eye, while ophthalmoscopy is used to examine the optic nerve. A visual field test can measure peripheral vision loss, gonioscopy determines if high eye pressure is being caused by a blocked drainage angle, while corneal pachymetry measures the thickness of the cornea, which can impact pressure in the eye.

For many people, eye drops will be prescribed by a glaucoma specialist to regulate the pressure within the eye, which should delay the nerves becoming damaged.

“If the drops don’t help the pressure, there are additional treatments to assist including laser treatments just to help regulate the pressure a little bit more, or surgery, which also aims to do the same,” Anderson says.

Laser treatment works by prompting fluids to flow better in the eye to reduce pressure, while surgery can open pathways within the eye to better allow fluid to drain.

“The chosen treatment depends on all of the variables of the patient and the treating eye care practitioner is in the best position to discuss this with the person,” Hamlyn says. “Some surgeries aim to reduce the production of fluid in the eye, however most are aimed at increasing the drainage of the fluid from the eye. Generally, surgery is used when drops and laser was not effective, or the glaucoma is quite advanced.”

It’s important to know that treatments don’t reverse any damage that’s already been done, so early detection through regular eye check-ups is still important. Most eye tests in Australia are covered by Medicare and can be booked at your local optometrist.

“Older people need to know that the condition is common and about half of those with the disease do not know that they have it. This is because in the early stages of the disease there are no symptoms,” Hamlyn concludes. “The best way to avoid losing vision from glaucoma is to get our eyes examined with an eye care professional.”

Read more: From ageing eyes to glaucoma: Signs you need to see an optometrist

When was the last time you had your eyes tested? Have you been impacted by glaucoma?