Glaucoma: Facts & Figures

More than 3 million Americans are living with glaucoma, 2.7 million of whom (aged 40 and older) are affected by its most common form, open-angle glaucoma. Get the facts about glaucoma.

Glaucoma is a group of eye disorders that have few symptoms in their early stages but eventually lead to damage of the optic nerve (the bundle of nerve fibers that carries information from the eye to the brain), which can then lead to vision loss or complete blindness.

Glaucoma is a leading cause of irreversible blindness in the United States and the world.^{1, 2}

• More than three million Americans are living with glaucoma, 2.7 million of whom—aged 40 and older—are affected by its most common form, open-angle glaucoma.^3-6
• Blindness or low vision affects 3.3 million Americans age 40 and over.
• There are 80 million people worldwide with glaucoma, and this number is expected to increase to over 111 million by 2040.⁷

Glaucoma costs the U.S. economy $2.86 billion every year in direct costs and productivity losses.⁸

Glaucoma is a leading cause of blindness among African Americans and Hispanics in the U.S.^4-6

• Open-angle glaucoma is three to four times more common in African Americans than in non-Hispanic whites.^9-18
• The prevalence of glaucoma rises rapidly in Hispanics over age 65.²²

High eye pressure does not cause glaucoma; it is only a risk factor.

Optic nerve damage usually occurs in the presence of high eye (intraocular) pressure. However, glaucoma can be diagnosed with normal or even lower than normal eye pressure.

There are two main forms of glaucoma: open-angle (most common) and angle-closure.

• Open-angle is the most common form and affects approximately 95% of individuals.
• Open-angle glaucoma initially has no symptoms. At some point, side (peripheral) vision is lost and without treatment, an individual can become totally blind.
• In the United States, the major type of glaucoma, called open-angle glaucoma, strikes African Americans and Hispanics at higher rates than other ethnic groups.²¹

Angle-closure glaucoma comes in two forms: acute or chronic.

• Acute angle-closure glaucoma occurs when the normal flow of aqueous humor between the iris and the lens is suddenly blocked. Symptoms may include severe pain, nausea, vomiting, blurred vision, and a rainbow halo appearing around lights. Acute angle-closure glaucoma is a medical emergency that must be treated immediately or blindness can result in one or two days.
• Chronic angle-closure glaucoma progresses slowly and can produce damage without symptoms, similar to open-angle glaucoma.

Regular eye exams are needed for a proper diagnosis and to prevent damage to the optic nerve.

• Eye doctors use several tests to detect glaucoma including: visual acuity test, visual field test, dilated eye exam, tonometry, pachymetry, ophthalmoscopy, gonioscopy, and optic nerve imaging.
• Individuals at high risk for glaucoma should have a dilated pupil eye examination, including a visual field test, at least every one to two years years or as directed by a doctor.
• Some studies have shown that perhaps half of people living with glaucoma aren't even aware they have the disease.^20-23

There are also several other forms of glaucoma, including normal-tension, congenital, juvenile, and secondary.

Secondary glaucoma can be open-angle or closed-angle and results from another medical condition in the eye or body. Examples of secondary glaucoma include pseudoexfoliation syndrome, neovascular, pigmentary, and iridocorneal endothelial syndrome (ICE syndrome).

Strong risk factors for open-angle glaucoma include:

• High eye pressure
• Family history of glaucoma
• Age 40 and older for African Americans
• Age 60 and older for the general population, especially Mexican Americans
• Thin cornea
• Suspicious optic nerve appearance with increased cupping (size of cup, the space at the center of optic nerve, is larger than normal)

Potential risk factors for open-angle glaucoma include:

• High myopia (very severe nearsightedness)
• Diabetes
• Eye surgery or injury
• High blood pressure
• Use of corticosteroids (for example, eye drops, pills, inhalers, and creams)
• Prescription eye drops could cut African Americans' risk of getting glaucoma in half.²⁴

Currently, there is no cure for glaucoma; however, through early diagnosis and treatment, the disease can be controlled before vision loss or blindness occurs.

• Treatments for open-angle glaucoma include: medications, usually eye drops, to help eye fluid drain more effectively or lessen fluid production; laser surgery; and conventional surgery.
• New treatment research is focused on lowering pressure inside the eye, finding medications to protect and preserve the optic nerve from the damage that causes vision loss, and the role of genetic factors.
• Approximately 5.6 million prescriptions were filled for glaucoma patients in 2001.²⁵
• The average direct cost of glaucoma treatment ranges from $623 per year for patients with early-stage glaucoma to $2,511 per year for end stage patients.²⁶

Sources

1. Don’t Lose Sight of Glaucoma – Information for People at Risk. NIH Publication No. 12-3251 (revised 2012).
2. VISION 2020 Global Initiative for the Elimination of Avoidable Blindness: Action plan 2006-2011. World Health Organization, 2007
3. The 2012 Fifth Edition of Vision Problems in the U.S.: Funding for the 2012 Fifth Edition of Vision Problems in the U.S., was provided by the National Eye Institute and the BrightFocus Foundation. Research described in this report was conducted by dozens of scientists from all over the world. We gratefully acknowledge the invaluable contribution of data from their work. Prevalence estimates for Vision Problems in the U.S. were created under a grant to Johns Hopkins University. We offer our appreciation to the investigators: Principal Investigator: David S. Friedman, MD, MPH, Professor of Ophthalmology, Wilmer Eye Institute, Director, Dana Center for Preventive Ophthalmology, Johns Hopkins University; Prevalence Estimates Based on 2010 U.S. Census Data: Benita J. O'Colmain, MPH, PhD, Fellow/Technical Director, ICF International; Database Development: Ilona Mestril, MPH
4. Citations and Abstracts from April 2004 Archives of Ophthalmology: Several papers describing the meta-analysis used to obtain the prevalence data contained in the Vision Problems in the U.S. report published in 2002 have published in a themed issue of the April 2004 Archives of Ophthalmology. This NEI-supported research provides an in-depth description of the data analysis and includes projections for the year 2020 regarding the prevalence of four diseases (age-related macular degeneration, cataracts, diabetic retinopathy, and glaucoma) and disorders among Whites, African-Americans, and Hispanics.
5. “Blindness and Visual Impairment-A Public Health Issue for the Future as Well as Today (editorial),” Archives of Ophthalmology 2004; 122:451-452
6. “Prevalence of Open-Angle Glaucoma Among Adults in the United States,” Archives of Ophthalmology 2004; 122:532-53
7. "Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040", Ophthalmology 2014; 121:2081-2090
8. “The Economic Burden of Major Adult Visual Disorders in the United States,” David B. Rein, PhD; Ping Zhang, PhD; Kathleen E. Wirth, BA; Paul P. Lee, MD, JD; Thomas J. Hoerger, PhD; Nancy McCall, ScD; Ronald Klein, MD, MPH; James M. Tielsch, PhD; Sandeep Vijan, MD, MS; Jinan Saaddine, MD, MPH, Arch Ophthalmol. 2006;124:1754-1760
9. From “Glaucoma: Our Role in Reducing the Burden of Blindness,” Lenworth N. Johnson, MD, NMA Chairman, JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 94, NO. 10, OCTOBER 2002; Original sources:
10. Tielsh JM, Sommer A, Katz J, et al. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991;266:369-74.
11. Marshall EC. Racial differences in the presentation of chronic open-angle glaucoma. J Am Optom Assoc. 1989;60:760-7.
12. Sommer A, Tielsh JM, Katz J, et al. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991;109:1090-5.
13. Leske MC, Connell AMD, Schachat AP, Hyman L. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994;1 12:821-9.
14. Mason RP, Kosoko 0, Wilson MR, et al. National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings. Ophthalmology. 1989;96:1363-8.
15. Weih LM, Nanjan M, McCarty CA, Taylor HR. Prevalence and predictors of open-angle glaucoma. Results from the Visual Impairment Project. Ophthalmolog. 2001;108:1966-72.
16. Klein BEK, Klein R, Sponsel WE, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992;99: 1499-1504.
17. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The Blue Mountain Eye Study. Ophthalmology. 1996;103:1661-9.
18. Dielmans I, Vingerling JR, Wolfs RCW, et al. The prevalence of primary open-angle glaucoma in a population-based study in the Netherlands. The Rotterdam Study. Ophthalmolog. 1994;101:1851-5.
19. Vision Loss from Eye Diseases Will Increase as Americans Age. National Eye Institute (NEI), 2004
20. Quigley, H. A., Broman, A. T., “The number of people with glaucoma worldwide in 2010 and 2020,” British Journal of Ophthalmology (2006); 90:262–267. doi: 10.1136/bjo.2005.081224
21. Friedman, David S., Roger C.W. Wolfs, Benita J. O'Colmain, Barbara E. Klein, Hugh R. Taylor, Sheila West, M. Cristina Leske, Paul Mitchell, Nathan G. Congdon, and John Kempen. "Prevalence of Open-Angle Glaucoma Among Adults in the United States". Archives of Ophthalmology. 2004 Vol. 122, No. 4, pp. 532-8
22. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma: the Baltimore Eye Survey. JAMA. 1991;266:369–374
23. Wensor MD, McCarty CA, Stanislavsky YL, Livingston PM, Taylor HR. The prevalence of glaucoma in the Melbourne Visual Impairment Project. Ophthalmology. 1998;105:733–739
24. Original paper: Higginbotham, et al. 2004, The Ocular Hypertension Treatment Study. Arch Ophthalmol. 2004 Jun;122(6):813-20. 
25. Rein et al. 2006, The Economic Burden of Major Adult Visual Disorders in the United States. (Original Source) [ No. of patients in---- Outpatient: 2,033,082 ---Inpatient: 263 –Prescription drugs, vitamins, and other medications: 1,482,941// Cost per patient (SE), $ Outp: 276 (2)--- Inp: 2270 (471) ---Prescr: 806 (11).
26. Lee et al. 2006, A Multicenter, Retrospective Pilot Study of Resource Use and Costs Associated with Severity of Disease in Glaucoma.