Glaucoma doesn’t have to end in blindness

Glaucoma doesn't necessarily lead to blindness, according to two studies published in the journal Ophthalmology. The first found that traditional glaucoma surgery gives better results than a glaucoma drainage device; the second found that glaucoma can be treated successfully even in its late stages.

The first study compared complications of traditional surgery with those of implanting a device that drains fluid from the eye. "We found more complications with drainage devices than with surgery," says Dr Frank, "but both rarely cause bad outcomes, so doctors should weigh the risks and benefits when choosing."

Dr Frank and colleagues collected data on 14,491 glaucoma patients who had one of three operations: primary trabeculectomy (PT), trabeculectomy after scarring from earlier surgery or injury (TS), or a glaucoma drainage device (GDD). All improve fluid drainage and lower the pressure inside the eye: trabeculectomy removes part of the drainage tissue so fluid flows more easily, while GDD implants a tiny tube that redirects the flow. All had few side effects: loss of vision or blindness occurred in 2.6% after GDD, 1% after PT and 1.3% after TS, so PT caused the least blindness and is the preferred first choice.

In the second study, Dr Jason and colleagues reviewed the charts of 64 patients with end-stage glaucoma, all considered almost blind at the start. All had laser trabeculoplasty or trabeculectomy. Although their vision was impaired, they didn't go blind, so blindness isn't inevitable with treatment: patients can keep enough sight for years to manage daily tasks, read and enjoy their hobbies. "This contradicts earlier studies saying that treating end-stage glaucoma doesn't work because it makes patients lose their sight," Dr Jason says.

Glaucoma is a disease of the optic nerve that leads to blindness if untreated. High pressure inside the eye (above 21 mmHg) is its main risk factor, although glaucoma can also occur with normal pressure, so diagnosis needs an eye examination of the optic nerve and field of vision. The most common type in the US is primary open-angle glaucoma, and many Americans have raised eye pressure that puts them at risk.