Glaucoma risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]

Common risk factors include a positive family history, increased age, myopia, diabetes mellitus, hypertension, sleep apnea, thyroid disorders, hypercholesterolemia, migraine, raynaud phenomenon.

Common risk factors

• Age:
  • The risk increases with the increase in age.
  • The visual field defects are 7 times more likely to progress in patients above the age 60 years in comparison to those younger than 40 years.
  • Although an increase in lOP with age has been observed in many populations.
  • Several studies in Japan have shown a relationship between glaucoma and age even with no increase in lOP in the population.^[1]
• Race:
  • The prevalence of POAG is 3-4 times greater in black persons and Hispanic persons as compared to non-Hispanic Caucasian individuals.
  • The loss of vision as a consequence of glaucoma is at least 4 times more common in blacks than in Caucasian population.
  • The Baltimore Eye Survey found that the prevalence of glaucoma increases dramatically with age, particularly among black persons, exceeding 11% in those aged 80 years or older.^[2]
• Family History:
  • A positive family history is a risk factor for POAG. The relative risk of POAG is increased by 3.7-fold for individuals who have a sibling with diagnosed POAG.^[3]
• Myopia:
  • The concurrence of POAG and myopia cause difficulty in diagnosis and management of POAG.
  • There is an increased difficulty in evaluation of the optic disc is particularly complicated in highly myopic eyes that have tilted discs.
  • Myopia-related retinal abnormalities can cause visual field defects along with glaucoma.
  • A high refractive error may also make it difficult to perform accurate perimetric measurement and to interpret visual field abnormalities.
• Diabetes Mellitus:
  • The role of diabetes mellitus in causing POAG is still not clear.
  • Though some studies have found diabetes plays a significant role in the disease, other studies have not found any corelation.^[4]
• Hypertension:
  • The systemic hypertension is associated with a low risk of the presence of glaucoma in younger patients and with an increased risk in patients above 65 years of age.
  • With advancing age, the adverse effects of chronic hypertension on the optic nerve microcirculation may lead to the nerve’s susceptibility to the development of glaucomatous optic neuropathy.
  • Some studeis demonstrate that lower ocular perfusion pressure is a strong risk factor for the development of glaucoma, independent of lOP alone.
  • The overtreatment of systemic hypertension may be a contributing factor to glaucoma progression in some cases and hence, should be avoided.^[4]
• Retinal vein occlusion:
  • The patients with central retinal vein occlusion may lead to an elevated lOP and subsequentlu glaucoma.
  • In some case, there may be presentation of preexisting POAG or other types of glaucoma. After CRVO, patients may develop angle-closure glaucoma or, at a later stage, neovascular glaucoma.
• Sleep apnea
• Thyroid disorders
• Hypercholesterolemia
• Migraine
• Raynaud Phenomenon

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