Detecting and managing blindness risk in glaucoma

Summary Glaucoma patients are sometimes described as a homogeneous disease group, with the implication that the ‘a priori’ lifetime risk of visual impairment is similar for all patients, or that predicting the eventual risk of visual impairment is problematic. This is an oversimplification of the true situation. The risk of eventual visual impairment can be substantially different between individual patients, with these differences being evident at the first visit to the glaucoma clinic: a diagnosis of secondary glaucoma e.g. PXF , or angle closure glaucoma, is a an important adverse risk factor, as is the initial severity of visual field loss, height of presenting IOP , and, perhaps most important of all, the age of the patient at presentation. The risk of eventual significant visual loss for patients presenting as OHT is low, though, research work, notably the OHTS study, has highlighted risk factors evident at diagnosis which aid more accurate estimation of the visual prognosis. The prognostic importance of the initial findings at diagnosis, and a review of the literature is presented: including new insights from a recent UK audit of a countywide clinical population detailing the annualised relative risk of individual glaucoma patients requiring glaucoma surgery, segregated by presenting diagnosis.