Glaucoma
Living with Glaucoma
Glaucoma is a chronic disease associated with elevated intraocular pressure (IOP). In glaucoma, the field of vision shrinks gradually, while more central areas of the field of vision often remain unaffected longer.
Based on the results of a 2001 prospective study questionnaire completed by 308 patients with glaucoma in the US, more than half of patients experienced no ocular symptoms at the time of glaucoma diagnosis.1
In this study the glaucoma patients were asked questions about the visit at which their glaucoma was diagnosed (N=308).1
About 300 000 people in Sweden live with primary open-angle glaucoma, POAG (the most common type of glaucoma.)2 The global incidence of POAG was estimated in 2020 at 75.5 million people, a figure that is expected to increase to 111 million by 2040.3 Around half of all people living with glaucoma are undiagnosed and untreated, and are therefore at risk of losing their vision.4 Ten years after diagnosis, 27% of patients are blind in one eye.5
We know that the burden of glaucoma is increasing as the world’s population ages6
There will be a predicted 111 million OAG patients by 20406
Half of people living with glaucoma are undiagnosed, untreated and at risk of losing their sight4
59% of patients experience progression despite treatment7
27% of patients will lose their sight in one eye within 10 years of diagnosis5
For many people, vision is the most important of the five senses
Loss of vision affects many aspects of life, such as the ability to walk, drive, work and read.
Greater risk of depression/anxiety10,11
Patients with glaucoma are at increased risk of experiencing negative emotions such as anxiety and depression. Being aware of the possibility of these conditions is important in supporting your patients.10,11
A glaucoma diagnosis often cause anxiety, especially among younger patients. 64% of patients below the age of 60 reporting feeling anxious in a self-administered questionnaire to 589 glaucoma patients in Norway over 4 weeks in 1997.11
More than 80% of the patients reported negative emotions on learning they had glaucoma.11
Another study shows that patients worry about becoming a burden to friends and family, or are embarrassed about needing help in public 12
Greater risk of falls8,13,14
Patients with glaucoma are reported to be at a higher risk of falling compared to those without the disease13
Compared to the general population, glaucoma patients were three times more likely to have been fallen in the previous year. 13
Exercise has been linked to a reduction in IOP, as it may increase the facility of eye channels outflow which could decrease obstruction of the aqueous outflow pathways.14
In individuals with and without glaucoma, exercise temporarily reduced IOP, and variations in percentage reduction are dependent on the duration and type of exercise amongst other factors.14
Higher risk of car accident9
A study which evaluated the risk of falls and motor vehicle collisions in patients with glaucoma (N=48) showed that compared with the general population, glaucoma patients were six times more likely to have been involved in a car accident the last five years. 10,11
(vs. age-matched normal control subjects (N=47). The above analysis included 11 patients with glaucoma and 4 control patients.10,11)
In multiple studies, patients with moderate and severe glaucoma were reported to be more likely to stop driving than those without the disease. 3, 15-17
The visual field is shrinking gradually
Certain systemic medications may increase the risk of developing glaucoma in some patients18
While elevated IOP is the only modifiable risk factor for glaucoma, some patients still experience progressive vision loss despite having low IOP – suggesting other factors besides IOP may influence the course of disease.18
And as more patients are developing more chronic diseases that require treatment with medication, considerations about the associations between different systemic medications and the risk of developing glaucoma or experiencing disease progression must be taken into account.18
With polypharmacy – defined as the use of ≥5 prescription medicines at any one time – becoming more prevalent, there is an unmet need to understand the effects of medications on glaucoma development and progression.18
Several classes of systemic medications are known to or suspected to modulate the risk of OAG or ACG.
Systemic medications that may increase the risk of OAG:18
corticosteroids
Exposure to corticosteroids is believed to increase resistance of aqueous outflow through the trabecular meshwork, and based on a few studies, approximately 1 in 4 to 1 in 3 patients developed elevated IOP from corticosteroids, and this risk increased if the patient had a known history of glaucoma or a family history of the disease.18
Systemic medications that may increase the risk of ACG and/or acute angle-closure crisis:18
anticholinergics
adrenergics
cholinergics
sulfonamides
anticoagulants
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References and abbreviations
1. Quigley HA and Jampel HD. How Are Glaucoma Patients Identified? J Glaucoma 2003; 12(6): 451–455.
2. https://glaukomforbundet.se/om-glaukom/fakta-om-glaukom/ accessed 4th July 2024
3. Allison K, Patel, Alabi. Epidemiology of Glaucoma: The Past, Present, and Predictions for the Future. Cureus 2020 Nov; 12(11): e11686. Published online 2020 Nov 24. doi: 10.7759/cureus.11686.
4. The Consequences of Undiagnosed Glaucoma and How to Avoid Them. Glaucoma Research Foundation. Available at: https://glaucoma.org/articles/the-consequences-of-undiagnosed-glaucoma-and-how-to-avoid-them Accessed July 2024.
5. Peters D, Bengtsson, Heijl. Lifetime risk of blindness in open-angle glaucoma. Am J Ophthalmol. 2013: 156(4): 724–730.
6. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Am Acad Ophthalmol. 2014;121(11):2081–2089.
7. Leske C. Heijl A, Hyman L, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology 2007;114(11):1965-1972.
8. Baig S, Diniz-Filho, Wu et al. Association of Fast Visual Field Loss With Risk of Falling in Patients With Glaucoma. JAMA Ophthalmol 2016; 134: 880–6.
9. McGwin G Jr, Huisingh, Jain et al. Binocular visual field impairment in glaucoma and at-fault motor vehicle collisions J Glaucoma 2015; 24: 138–43.
10. Zhang X, Olson, Lin et al. The Association Between Glaucoma, Anxiety, and Depression in a Large Population. Am J Ophthalmol 2017; 183: 37–41.
11. Odberg T, Jacobsen, Hultgren et al. The impact of glaucoma on the quality of life of patients in Norway. I. Results from a self-administered questionnaire. Acta Ophthalmol Scand 2001; 79: 116–120.
12. Shu YH, Wu, Luong et al. Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Health Care System. J Glaucoma 2021; 30: 1047–1055.
13. Haymes S, Leblanc, Nicolela et al. Risk of falls and motor vehicle collisions in glaucoma. Invest Ophthalmol Vis Sci 2007; 48(3): 1149–1155.
14. Coleman AL and Kodjebacheva G. Risk Factors for Glaucoma Needing More Attention. Open Ophthalmol 2009; 3: 38–42.
15. Ramulu P, West, Munoz et al. Driving Cessation and Driving Limitation in Glaucoma: The Salisbury Eye Evaluation Project. Ophthalmology 2009; 116(10) 1846–1853.
16. Gilhotra J, Mitchell, Ivers et al. Impaired vision and other factors associated with driving cessation in the elderly: the Blue Mountains Eye Study. Clin Exp Ophthalmol 2001; 29: 104–107.
17. van Landingham S, Hochberg, Massof et al. Driving patterns in older adults with glaucoma. BMC Ophthalmol 2013; 13: 4.
18. Wu A, Khawaja, Pasquale et al. A review of systemic medications that may modulate the risk of glaucoma. Eye (Lond) 2020; 34(1): 12–28.
ACG, angle-closure glaucoma; IOP, intraocular pressure; OAG, open-angle glaucoma.
SE-OPHTHG-240003 v1.0 July 2024
