Elderly people can have glaucoma and not know it, says study – 09/28/2023 – Equilíbrio

Many elderly people may have glaucoma without knowing it, according to a new Swedish study carried out by the University of Gothenburg and published in the journal Acta Ophtalmologica. Of the patients evaluated, 4.8% had the disease, with more than half of them (56%) unaware of their diagnosis. Glaucoma is the leading cause of irreversible blindness in the world.

“The importance of this study is that it evaluates a population over 70 years old and in a developed, Scandinavian country, but half were unaware of their diagnosis”, says ophthalmologist Augusto Paranhos, from Hospital Israelita Albert Einstein.

According to the specialist, although there is not much specific data on underdiagnosed cases, a survey conducted by the Brazilian Glaucoma Society revealed that patients only seek out an ophthalmologist when they have a complaint, and not as a form of prevention.

“It should be something routine, as happens with other specialties, as many serious diseases, such as glaucoma, have no symptoms at the beginning. And delays can lead to loss of vision”, says the specialist.

The Swedish work evaluated more than a thousand elderly people from the Gothenburg H70 Birth Cohort Studies program, which has been carrying out population epidemiological studies in the country for 50 years. In this case, those born in 1944 were selected, recruited between 2014 and 2016. They answered questionnaires about their eye health history and family history of glaucoma, as well as assessments about diabetes and high blood pressure. Half also underwent detailed eye exams.

The prevalence found in the study was slightly higher than expected, which is between 2% and 3% of the population. However, as it increases with age, this may explain a higher rate in the elderly. Worldwide, at least 3.6 million people are blind, and 4.1 million suffer from moderate to severe visual impairment due to glaucoma. In Brazil, a study estimated the prevalence at around 2.4% over the age of 40, which is equivalent to approximately 1.5 million Brazilians, according to data from the Brazilian Glaucoma Society.

What is glaucoma?

The disease progresses silently and causes the death of the cells that connect the eye and the brain, called retinal ganglion cells. The loss of field of vision is gradual and usually goes unnoticed. Normally, it affects both eyes, but if one of them is more severe, the other can compensate, making this perception even more difficult.

“When the person notices, it is because it is in an advanced state. As it is not possible to recover the lost cells, we cannot reverse the damage, but with the correct treatment we can stop or, at least, slow down the process”, says Paranhos. Without treatment, it leads to irreversible blindness. Hence, early diagnosis is essential.

In the most common type of glaucoma, primary open-angle glaucoma, intraocular pressure is normally elevated. However, there are cases of the disease in which this pressure is normal, as was observed in the majority (67%) of those newly diagnosed in the Swedish study.

“For this reason, we do not just take into account the measurement of intraocular pressure”, explains the specialist. A complete examination, including evaluation of the fundus, is necessary to check for possible damage. Sometimes, there are several consultations and follow-up before finalizing the diagnosis. “Doubt is a good sign because it means that, if there is something, it is at the beginning. But when we look and we are sure of the disease, it gives the impression that we were late, that the diagnosis should have been made earlier.”

In the early stages, it is possible to prevent damage and blindness. The more advanced it is, the more difficult and aggressive the treatment. Therefore, it is essential to have periodic exams, especially over 40 years of age. Those who have risk factors, such as family history, high intraocular pressure, myopia, hyperopia and African descent, should see a doctor sooner and more regularly.

First-degree relatives of people with glaucoma have ten times the risk of developing the disease. “Children and young people should also see an ophthalmologist. He is the one who will define the frequency of appointments for each patient”, recalls the doctor. Although rarer, pediatric glaucoma also exists.

Currently, the first treatment option for primary open-angle glaucoma is laser. But, depending on the case and the response, eye drops and surgeries may also be indicated to reduce intraocular pressure.