Addressing Glaucoma in Seniors: What to Expect

Despite glaucoma being one of the leading causes of irreversible blindness worldwide, it often develops without obvious symptoms in its early stages.

If you’re a senior in Singapore, understanding the condition and its risk factors can help you recognise when an eye examination may be appropriate. Early detection and treatment can help slow or prevent further vision loss before significant damage occurs.

This guide explains what glaucoma is, why the risk increases with age, how it is detected and what glaucoma treatment may involve.

Explaining Glaucoma

Glaucoma refers to a group of eye conditions that damage the optic nerve, the bundle of nerve fibres that carries visual information from the eye to the brain.

In many forms of glaucoma, damage is associated with increased intraocular pressure (IOP), although glaucoma can also develop when eye pressure is within the normal range. High eye pressure occurs when fluid inside the eye does not drain properly, causing pressure to build up.

Over time, glaucoma can damage the optic nerve and lead to permanent vision loss. Vision that has already been lost because of glaucoma generally cannot be restored.

The encouraging news is that early detection and appropriate treatment can often slow or prevent further damage. This is why regular eye examinations are particularly important for people at higher risk.

Why Are Seniors More at Risk?

Age is one of the most important risk factors for glaucoma. The risk generally increases as people get older, particularly after the age of 60.

Glaucoma is also relatively common in Singapore. Other recognised risk factors include having a family history of glaucoma, diabetes, high myopia (short-sightedness), and certain anatomical characteristics of the eye, including a thinner cornea.

Studies in Singapore have also found differences in glaucoma prevalence between ethnic groups. This is one reason why an individual's overall risk should be assessed based on their age, medical and family history, ethnicity and eye health rather than age alone.

The Symptoms of Glaucoma in Seniors

Primary open-angle glaucoma is the most common form of glaucoma in many populations. It usually develops gradually and often causes no pain or obvious symptoms in its early stages.

When vision is affected, glaucoma often damages peripheral (side) vision first. Because the changes can be gradual, a person may not realise that their field of vision has narrowed until the disease has progressed significantly.

Difficulty noticing objects to the side or repeatedly bumping into things may sometimes occur when peripheral vision has been affected. However, these symptoms can have many other causes and should not be used to diagnose glaucoma.

Another form, acute angle-closure glaucoma, can develop suddenly and requires emergency medical attention. Symptoms may include severe eye pain, a red eye, blurred vision, halos around lights, headache, nausea or vomiting.

If these symptoms develop suddenly, seek emergency medical attention immediately, as untreated acute angle-closure glaucoma can cause rapid and permanent vision loss.

Screening Seniors for Glaucoma

A glaucoma assessment usually involves several tests rather than relying on eye pressure alone. Depending on the individual's circumstances, an ophthalmologist may perform:

• Tonometry, which measures intraocular pressure

• Optic nerve examination, which allows the doctor to assess the appearance of the optic nerve

• Visual field testing, which checks for areas of reduced or missing peripheral vision

• Gonioscopy, which examines the drainage angle of the eye and can help determine whether the angle is open or narrow

• Optical coherence tomography (OCT), which can provide detailed images and measurements of the optic nerve and retinal structures

The appropriate tests and frequency of follow-up depend on a person's age, risk factors and examination findings. There is no single screening schedule that is suitable for everyone, so your eye specialist can advise you on how often you should be assessed.

What Does Glaucoma Treatment Involve?

There is currently no cure for glaucoma, and treatment cannot restore optic nerve damage or vision that has already been lost. However, glaucoma treatment can reduce the risk of further damage by lowering or controlling intraocular pressure.

Depending on the type and severity of glaucoma, treatment may include prescription eye drops, laser treatment or surgery. Eye drops that lower eye pressure are commonly used as an initial treatment for many people with glaucoma.

If eye drops do not lower the pressure sufficiently, or if the glaucoma is progressing, an ophthalmologist may recommend laser treatment or surgery. The appropriate approach depends on the type of glaucoma, the level of eye pressure, the extent of optic nerve damage and other individual factors.

Because glaucoma is generally a long-term condition, ongoing monitoring and treatment are often necessary. Following the prescribed treatment plan and attending regular follow-up appointments can help your ophthalmologist monitor the condition and adjust treatment when needed.

For seniors and others with glaucoma risk factors, regular eye examinations can help detect the disease before significant vision loss occurs. If glaucoma is identified, starting appropriate treatment early can give you a better opportunity to protect the vision you still have.