As clearly stated in our mission, Evergreen Eye Consultants exists to promote the prevention of vision loss from glaucoma. This raises an important question: In the 21st century, how do people still go blind from glaucoma — especially given all our scientific advancements in health care?
The fact remains that glaucoma is one of the leading causes of irreversible vision loss worldwide — and, depending on which study you cite, the most common cause. This is all the more striking considering glaucoma itself is not a common condition.
The worldwide overall prevalence of primary open-angle glaucoma (POAG) is 2.4% (95% CI 2.0–2.8%), and prevalence increases with age.¹ Even though that may seem like a small percentage, a small percentage of 8.3 billion people still represents a staggering number of individuals affected by this disease.
Understanding the Disease
Glaucoma is an optic neuropathy — a disease of the optic nerve. It is the most common form of optic neuropathy, though not the only one. The optic nerve functions as a cable of over a million nerve fibers carrying visual information from the eye to the brain. When it becomes damaged, vision loss occurs.
Open-angle glaucoma, the most prevalent type, is painless and slowly progressive. This means most patients have no symptoms until very late in the disease, when significant and irreversible vision loss has already occurred. The good news is that with timely diagnosis and appropriate treatment, optic nerve damage can usually be slowed — or even stopped — before it causes visual disability.
When I trained in the early 1980s, it was conventional wisdom that no matter how well a glaucoma patient was managed, if they lived long enough they would eventually go blind. Many clinicians likely still hold some version of this belief.
Progress Through Time
Although glaucoma was recognized in antiquity, effective diagnosis and treatment tools did not emerge until the mid-19th century — barely 170 years ago. Progress since then was gradual until the late 20th and early 21st centuries, when two breakthroughs transformed glaucoma care:
- Prostaglandin analogues (PGAs), introduced in the 1990s, which safely and effectively lower intraocular pressure .
- Optical Coherence Tomography (OCT), developed in the 1990s and refined over the following decades, which allows detailed, quantitative imaging of the optic nerve and retinal nerve fiber layer .
Together, these advances revolutionized both diagnosis and management, making it possible to detect and treat glaucoma earlier and more effectively than ever before. In my view, blindness from glaucoma should no longer be considered inevitable.
Why Do People Still Go Blind?
In 1982, an influential article in Ophthalmology asked, “Why do some people go blind from glaucoma?” . Over three decades later, a follow-up piece — “Why Do People (Still) Go Blind from Glaucoma?” — revisited the same question . Both identified three persistent causes:
- Underdiagnosis– too many cases remain undetected until late in the disease.
- Improper treatment– failure to achieve or maintain target pressure.
- Non-adherence– patients not using prescribed therapy consistently.
Forty-three years after the original publication, these same barriers continue to challenge us.
Looking Ahead
Over the next several articles, I’ll explore each of these issues — underdiagnosis, treatment gaps, and adherence — drawing on current data, practical experience, and clinical insight.
Knowledge is power. Whether you are a clinician, a patient, or a family member, understanding why vision loss still occurs is the first step toward ensuring it doesn’t.
Stay tuned.
— J.J. O’Donnell, OD, FAAO (Dipl. Glaucoma)
Evergreen Eye Consultants
Citations
- Zhang, N., Wang, J., Li, Y. et al. Prevalence of primary open angle glaucoma in the last 20 years: a meta-analysis and systematic review.Sci Rep 11, 13762 (2021). https://doi.org/10.1038/s41598-021-92971-w
- Tham, Y.C. et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040.Ophthalmology. 2014;121(11):2081–2090.
- Quigley, H.A., Broman, A.T. The number of people with glaucoma worldwide in 2010 and 2020.Br J Ophthalmol. 2006;90(3):262–267.
- Weinreb, R.N., et al. The pathophysiology and treatment of glaucoma: A review. 2014;311(18):1901–1911.
- Alm, A., Stjernschantz, J. Effects on intraocular pressure and side effects of latanoprost and timolol in patients with ocular hypertension and glaucoma. 1995;102(12):1743–1752.
- Huang, D. et al. Optical coherence tomography. 1991;254(5035):1178–1181.
- Kolker, A.E. Why do some people go blind from glaucoma? 1982;89(9):991–998.
- Weinreb, R.N., et al. Why Do People (Still) Go Blind from Glaucoma?Trans Am Ophthalmol Soc. 2015;113:T8.