Glaucoma: risk factors, early detection, and what monitoring involves

Glaucoma is often described as the silent thief of sight, because it typically causes no symptoms until a significant amount of peripheral vision has already been lost. Early detection depends on regular examination, and the examination needs to include the right tests. This article explains what we look for, why family history matters, and what happens if we find something worth monitoring.

Who is at higher risk ¶

The main risk factors for glaucoma are age, family history, raised intraocular pressure, and certain structural features of the optic nerve. Having a first-degree relative with glaucoma roughly doubles the risk. People of African or Caribbean heritage have a higher prevalence of primary open-angle glaucoma and tend to develop it at a younger age.

Patients with raised intraocular pressure but no other signs of glaucoma are described as ocular hypertensives. Not all of them will develop glaucoma, but they warrant closer monitoring than the general population.

What we measure at each examination ¶

At Cedar Vision Works, every adult examination includes intraocular pressure measurement using non-contact tonometry, assessment of the optic nerve head, and OCT imaging of the nerve fibre layer. The OCT is particularly useful for glaucoma monitoring because it can detect thinning of the nerve fibre layer before any change is visible on a standard examination.

We also record the central corneal thickness for patients with raised pressure, as a thinner cornea can cause tonometry to underestimate the true pressure.

What happens if we find something ¶

If we find raised pressure, a suspicious optic nerve, or thinning on OCT, we discuss the findings with the patient and decide on the appropriate next step. For some patients, this means a referral to the glaucoma clinic at the local hospital for a full visual field test and specialist assessment. For others, it means a shorter review interval at the practice.

We write referral letters the same day and follow up to make sure the appointment has been received. We do not leave patients to navigate the referral process alone.

If you have a family history of glaucoma and have not had an eye test in the past year, it is worth booking in. The examination includes everything needed to assess your current risk and set an appropriate monitoring plan.