Open-angle glaucoma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Glaucoma is the main cause of irreversible blindness in the world; open-angle glaucoma is the most common type.
Frequently presents asymptomatically and can be identified on routine ophthalmic examination.
Intraocular pressure is most often elevated, but it may be normal.
Optic disk cupping is diagnostic.
Untreated glaucoma may lead to irreversible loss of peripheral vision and, later, of central vision if untreated.

Photograph showing optic disk cupping. An increase in cup-to-disk ratio over time may indicate glaucoma.

Collection of Robert B. Avery, MD, PhD

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

The progressive journey from normal vision to blindness in glaucoma. There is a transition over time from normal visual function to blindness in patients with glaucoma. (A) Clinical examination or fundus photography can demonstrate and document the progression of optic disk cupping and neuroretinal rim thinning over time, that develops secondary to retinal ganglion cell loss. (B) Optical coherence tomography imaging quantifies changes in the thickness of the innermost layer of the retina around the optic disk and macula region, which comprise retinal ganglion cells and their axons, and can compare these measurements to normative databases. This enables detection and monitoring of structural changes at the optic nerve head and macula that might have developed due to glaucomatous injury. Structural changes often precede deficits in visual function and therefore optical coherence tomography imaging facilitates the detection of glaucoma at an early stage of disease. (C) Visual field testing allows for the detection and monitoring of impairment of visual function during the disease course. Early glaucoma is often asymptomatic as there is a threshold of retinal ganglion cell loss below which functional damage might not be detectable. (D) Even in the presence of substantial visual field defects, patients with glaucoma might remain asymptomatic as the brain can fill in the perceived picture using saccades and sensory inputs from the fellow eye. This means that patients might feel that their vision is normal until the very late stages of disease
Fundus photograph of normal optic nerve head
Photograph showing optic disk cupping. An increase in cup-to-disk ratio over time may indicate glaucoma.

Citations

Key Articles

Weinreb RN, Leung CK, Crowston JG, et al. Primary open-angle glaucoma. Nat Rev Dis Primers. 2016 Sep 22;2:16067.[Abstract]
International Council of Ophthalmology. ICO guidelines for glaucoma eye care. Feb 2016 [internet publication].[Full Text]
American Academy of Ophthalmology. Primary open-angle glaucoma preferred practice pattern. Nov 2020 [internet publication].[Full Text]
American Academy of Ophthalmology. Primary open-angle glaucoma suspect preferred practice pattern. Nov 2020 [internet publication].[Full Text]
National Institute for Health and Care Excellence. Glaucoma: diagnosis and management. Jan 2022 [internet publication].[Full Text]

Other Online Resources

JAMA: what is glaucoma?

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