Open-Angle Glaucoma - Physiological, Psychological, and Social Challenges - Research Paper Example

? Open-Angle Glaucoma: Physiological, Psychological, and Social Challenges Open-Angle Glaucoma: Physiological, Psychological, and Social Challenges Introduction About three million people in the USA have glaucoma, an incurable disease, which leads to blindness (11). Eighty thousand Americans are blind, due to glaucoma (4). A sizable number of glaucoma sufferers do not even know they have it. Regular screenings for glaucoma used to be highly encouraged, until scientists began to question whether the benefits were worth the risks of the screening. Screening was found to irritate the eyes and increase the risk of cataracts. Subsequently, screening became far less common. Now, again, scientists are recommending screening (11). There are severe outcomes for untreated glaucoma. It results in loss of peripheral vision, damage to the optic nerve, elevated intraocular pressure (11), a life constrained by medications, which have side effects, and the disease can lead to a complexity of psychological symptoms and social effects. This paper aims to discuss the physiological, psychological, and social reality of glaucoma, with a strong focus on open-angle glaucoma. The author of this paper was motivated to take up this topic, due to a personal diagnosis of this disorder, ten months ago. At first, emphasis was placed on the psychosocial expectations of glaucoma (lifestyle changes necessitated by possible oncoming blindness, anticipated changes in social activities, increased dependence on others, loss of self-confidence, and emotional responses). Now the author is motivated to focus on the scientific understanding of glaucoma, also, as a way to become empowered, through information, to minimize risk and delay unfortunate outcomes. Furthermore, personal empowerment can potentially help others. Helping others is a good way to help one’s self. Body Glaucoma gradually takes away vision, leaving blind spots in the peripheral vision, along the way. With open-angle glaucoma, there is a gradual increase in eye pressure, over time, which pushes on the optic nerve. This nerve passes visual information from the retina to the brain and becomes damaged. The pressure is caused by fluid in the eye (11). The eye is normally fairly hollow, with fluid flowing throughout the inside (4). With open-angle glaucoma, the junction of the cornea and the iris is open, as it should be, but the canals that should drain fluid become clogged. That is what causes the pressure to increase, complicating further drainage (5). Segmental atrophy of the optic disk (known as cupping) then occurs. Open angle glaucoma is bilateral, but it can be asymmetrical (4). Below is an illustration of how the disease progresses. The first picture (4) shows a normal presentation of the optic head. It looks like a donut. The hole in the center (optic cup) is where the nerves turn and begin to spread out. As glaucoma develops, the donut hole becomes enlarged as there is progressive degeneration and erosion of the nerve. The final two pictures show advanced glaucoma. FIGURE 1 There are different types of glaucoma. With open-angle glaucoma, irrespective of how much peripheral vision loss occurs, central vision remains. With absolute glaucoma, central vision also degenerates, along with peripheral vision, including perception of light (8). Glaucoma can strike anyone, anywhere. There are, however, special risk factors. The risk factors for developing open-angle glaucoma include advancing age (six time more likely after age 60), African American (six to eight times more likely) or Latino ethnicity, diabetes, cardiovascular disease, family history (four to nine times more likely to develop open-angle glaucoma), large doses of steroid use for asthma (40% increase), and history of eye injury (especially with blunt trauma or penetrative injury such as caused in sports), as well as nearsightedness, high blood pressure, and a thin cornea (less than 5 mm) (8). Family history of open-angle glaucoma has been mapped to a gene mutation. It is a gene that is responsible for encoding a trabecular meshwork protein (TIGR). In a study of 13 open-angle glaucoma patients, one of three mutations was found in each subject, as well as in a control group subject (12). In a study of 54 families with inherited POAG (open angle glaucoma), researchers identified the gene that caused it on chromosome 10p 14. It is called it OPTN (optineurin). Optineurin has a protective role, and in expressed in travecular meshwork, non-pigmented ciliary epithelium, retina, and brain (10). Open-angle glaucoma is the most common type of the disorder. About 2.2 million Americans have been diagnosed with open-angle glaucoma, and most of them are over 40 years of age, with another 2.2 million cases as yet undiagnosed (13). In most cases, there is no pain involved, and the changes in vision are so gradual that people do not at first notice them. Worldwide, about 33 million people suffer from open-angle glaucoma (6). A research study was done to determine the probability of developing legal blindness in one or both eyes, following diagnosis and the implementation of treatment. The subjects for this study were 295 people, diagnosed with open-angle glaucoma. Legal blindness is defined as corrected vision at 20/200 or worse, and/or visual field constriction at 20% or more. These research subjects were followed for 20 years, and it was found that the probability of blindness in one eye was 27%, and the probability of blindness in both eyes was 9% (6). The researchers concluded that this is a considerable probability. Although there is as yet no cure, early treatment is critical, so that the progression of glaucoma damage can be slowed down and vision loss can be delayed as long as possible. A major treatment is eye drops/ Reducing the pressure in the eyes by a mere 20% was found by researchers to cut the occurrence of glaucoma in half (13). However, since eye drops can have negative effects, they are not right for every case (13). Surgery alone or in combination with medication administered during surgery is another treatment of open-angle glaucoma. The most common operative surgery is a trabeculectomy. This involves the removal of some of the trabecular meshwork and some surrounding structure. This is useful in allowing fluid to drain, thereby lessening the pressure in the eye (7). FIGURE 2 (4) Trabeculectomy can be made more effective by applying mitomycin once, for five minutes, during the surgery. If too low a dosage is given (0.02 mg), the intraocular pressure is not sufficiently relieved. On the other hand, at a large dose (0.2 mg), there is risk of transient hypotony maculopathy (18%) and cataract progression (18%), among other complications. The dose must be given very precisely, in the middle range between 0.02 mg and 0.2 mg, for best results (7). Another surgical technique used with glaucoma is trabeculoplasty, in which a laser opens the drain to assist fluid flow. This technique is used with open-angle glaucoma. In angle-closure glaucoma, the laser makes a hole in the iris, to help the fluid reach the drain. This is called an iridotomy. In pseudoexfoliative glaucoma, the most successful treatment is argon laser trabeculoplasty (4). These surgical techniques are used to lower the pressure in the eye. Oddly enough, however, not all glaucoma patients have elevated eye fluid pressure. It used to be thought that they all did, but recently a number of glaucoma patients have been identified, who do not have elevated pressure. These patients are referred to as having low-tension glaucoma (4). This is changing the way we must view glaucoma, since the degeneration of glaucoma is not solely based on pressure. Although there has been a lot of research done on glaucoma, and multiple theories have resulted, the full picture is not yet understood. It seems that blood flow in the optic nerve, mechanical factors in and around it, and biochemical factors are also part of that picture. Glaucoma is a very complex disease (4). This paper has summarized the mechanisms, risks, and treatment of glaucoma, with an emphasis on reviewing the scientific literature. Now we turn attention to the social and psychological considerations of glaucoma. Understanding the science involved in a disease is important and necessary, but it is also important to recognize the person behind the diagnosis. Glaucoma patients need to be educated about the disease and treatment options, in order to maximize cooperation (2). One example is eye drops. Eye drops need to be taken regularly, on-schedule (4). Many people have lifestyles that are not conducive to a rigid schedule, If they understand why, rather than simply being told to do it, a patient is more likely to comply. Research indicates that people generally respond to a glaucoma diagnosis with anxiety (2). They worry about becoming blind and how they will meet their current responsibilities without good eyesight. Other people react with anger, that a little gene mutation would have so much power over them. Some people turn their anger inward and react with depression (2). A glaucoma diagnosis represents change, and this change is occurring in one or both eyes. Eyes are the main way we collect information about the world around us. Knowing that this main channel of independence is under threat can be overwhelming. The glaucoma patient may feel betrayed by their body and may worry about becoming dependent on others. For a person who can see, the idea of becoming blind is very frightening. This is especially true for elderly people, a group already struggling with economic and health threats to their independence, Without being educated about the facts of glaucoma, the person might react by feeling helpless and hopeless. By educating the patient, they can become engaged in decision-making and the details of glaucoma management (2). This empowers the individual, and an empowered individual is more likely to follow instructions and be careful, alert and communicative about anything encountered. A research study was conducted with 100 primary open-angle glaucoma patients in Greece (9). The purpose of the study was to evaluate the connection between personality traits and psychological distress, and compliance or noncompliance with glaucoma treatment instructions. Fully 42% of the patients were found to be non-compliers, meaning that they missed more than two medication doses per week (9). It was found that the glaucoma symptoms of non-compliers were more severe. Non-compliers were far more likely to be depressed and also to take an immature defensive position, with respect to compliance, which then increased non-compliance. The researchers concluded that psychotherapy for depressed and personality-disordered glaucoma patients would likely increase compliance, thereby reducing the severity of glaucoma symptoms (9). This is an important study because glaucoma cannot be treated only as diseased eyes. There is a person behind those diseased eyes, and that person has emotions and peculiar ways of reacting to fear and anger and depression. Those reactions need to be considered in the treatment plan. If they are not, the best medicine and surgical techniques in the world cannot succeed. Education should include information about the disease process, the logic behind interventions, possible side effects of treatment options. the truth about their own condition, and the pros and cons of alternative intervention options. For example, implanting a multifocal intraocular lens carries with it the risk of reduced contrast sensitivity (2). The patient who sees meaning, and helps to create it, will support good disease management. If they see their doctor as a partner in management, they will be more likely to report changes and side effects. There are a number of side effects occurring from the various medications used in treating glaucoma. Some are merely mildly annoying, while others are painful and disorienting. This makes it especially important that glaucoma patients feel they are participants in their own glaucoma management, rather than being helpless victims of it. Table 1 reviews the side effects for common glaucoma medications. TABLE 1 Pharmacologic options and side effects for patients with open-angle glaucoma (adapted from a more complex table) (4) Medication(SOR) Side effects Beta-blockers (A), non-selective (timolol, carteolol, levobunolol, metipranolol) and selective (betaxolol) Bradycardia, hypotension, bronchospasm (timolol, carteolol, levobunolol, metipranolol) Prostaglandin analogues (A) (latanoprost, travoprost, unoprostone) Increased eyelash growth, iris pigmentation, muscle and joint pain Alpha adrenergic drugs (A) (apraclonidine, brimonidine) Dry nose, dry mouth, follicular conjunctivitis, hypotension (brimonidine) Topical carbonic anhydrase inhibitors (A) (brinzolamide, dorzolamide) GI disturbances, headache, local irritation, redness, sulfa allergies Cholinergic agonists (A) (pilocarpine, carbachol) Small, fixed pupils, induced myopia, cataracts Glaucoma affects vision, and low vision is a threat to quality of life. The patient may be concerned about job loss, insurance loss, loss of options to drive or read a book or watch television as ways of unwinding. The individual with glaucoma may wonder how this will impact their desirability as a romantic partner, how it will impact the balance of power in marriage or in child-rearing. A sports fan may feel that loss of the ability to engage in or to watch a favorite sport and discuss it with friends is a truly tremendous loss (2). Counseling can be quite beneficial (2), since this represents a time of great change for the patient. The counselor can help the patient to focus on what is possible and less on what is not. The counselor can also help the patient to grieve about loss and move forward with new goals. A support group can be helpful (2) in terms of getting the person to talk about what they are feeling, to others who are currently or formerly feeling something similar; A support group provides role models for people who are dealing with certain aspects better than the patient, and also provides the opportunity to give help and inspiration to those who need a bit more support. Helping others is a wonderful way to improve one’s own outlook. The patient who is becoming blind needs to be educated about available rehabilitative technology (2), such as talking clocks, powerful magnifying lenses, and hobbies that can be done through touch and hearing,. They should also be informed about classes that teach how to organize the kitchen, simplify the material context of his/her life, use a cane or a guide dog, count steps to the bus stop, strengthen balance, ask for the help actually needed and politely discourage “helpers” who remove self-responsibility and personal decision-making. These skills will boost self-confidence and relieve feelings of anxiety, Some patients might not seek these services out, thinking they will be expensive or perhaps not knowing they exist. So, part of patient education should include information and referrals for social services and community organizations that will support them in the life changes they are going through (2) Not only are there personal emotional costs to patients with open-angle glaucoma, but there are costs also to society. The National Eye Institute claims that 120,000Americans are blind due to glaucoma. This costs the US government $1.5 billion every year in Social Security payments, lost income tax, and health care expenses (3). Because it especially targets older people, it cuts short their productive years and loses their expertise prematurely. Furthermore, glaucoma targets Black and Hispanic people out of ratio to Whites (2). This adds to the social marginalization of these minority groups, further complicating the lives of people already struggling to survive. Summary/Discussion This paper has discussed the mechanisms, risks, and treatment of glaucoma from both a physiological and psychological viewpoint, and has emphasized the importance of educating the patient in order to involve their full cooperation with treatment. At this point, it might be helpful to consider an actual case of a person living with open-angle glaucoma. In this way, the facts and issues described in this paper, can be reviewed, personalized and seen in application, through this case that is presented by three medical doctors. A 22 year old young woman was found to have abnormally high intraocular pressure, when she was 16 years old. She was placed on medication, which reduced the pressure, until the medication stopped helping at age 22. The young woman was diagnosed with juvenile open-angle glaucoma. Primary open-angle glaucoma has its onset after age 40, while juvenile open-angle glaucoma has an onset between ages 3-40 (1). The young woman had evidence of an enlarged optic cup, and degenerating peripheral vision. This was the case in both left and right eyes. The cause of juvenile open-angle glaucoma is generally found to be a mutation in the myocilin gene. This mutation is passed down through families. This was the case with the young woman (1). She had no history of eye trauma, nor was there anything about her social history that might have reasonably contributed to her glaucoma risk. However, she did have a family history of early onset open-angle glaucoma. Her mother, her grandmother. and her brother were diagnosed with it, and altogether more than 25 relatives were identified who had it. Screening was done on her extended family, in order to identify who else might be at high risk for developing juvenile open-angle glaucoma, in the future, due to the specific mutation involved (1). There are a variety of medicinal and laser therapies for primary open-angle glaucoma, but these interventions are not very successful with the management of JOAG. Surgery is often required. In her case, this was true and so she had trabeculectomies done in each eye. These procedures were successful in reducing intraocular pressure (1). The report on her case does not indicate anything about her psychological and social outcomes of this disease. There seems to be a bias, in medicine, to stick to the physiological facts. Yet mind and body are connected, so this bias needs to be addressed. We can only speculate on the role psychological and social implications played in this young woman’s life. To be diagnosed with such a severe disease, at a time in life when a person is deciding who they are and who they will be, can only be confusing. She must have wondered why life is being unfair, and why this happened to her. Perhaps she had faith in the doctor, that he or she would give the right medication and the problem would no longer be a problem. She must have felt anxiety when, at age 22, the medications no longer worked, and her eyesight was again deteriorating (enlarged optic cup, elevated pressure, and reduced peripheral vision), as discussed in this paper. At an age where living in the present is usually the case, this young woman had to wonder whether and when she would go blind and how she would manage with low vision. Who would love her, with such a defect? How would she support herself? Would her friends still be there for her when she became increasingly dependent? Would her parents interfere more in her life than did the parents of her friends? Would she need more surgery? How would she afford to pay for the medical care she will need? It is possible to speculate also on the social and psychological factors at work in her family. Perhaps her mother and grandmother feel terrible about passing on this disease to the young woman and her brother. Maybe the extended family wonders if they are cursed, with this rare form of the disease affecting so many family members. There must be a lot of anxiety felt at the birth of a new family member. They must wonder if that child also will succumb to glaucoma. Perhaps they consider not having children at all. Speaking with a counselor or participating in a support group would likely be beneficial. Unless the family is extremely wealthy, it must be a struggle to finance tests and treatment for glaucoma. Ordinarily, when one family member has a medical challenge, help can be requested from extended family members. In this case, however, more than 25 family members have the disease and others are at risk for developing it. Finances for medical support must be stretched very thin. In this young woman’s family, the mother and brother also have glaucoma, and early onset glaucoma is especially difficult to treat with medications, generally requiring surgeries (2). This is potentially very expensive. Finances for continuing education, clothing, hobbies, concerts, vacations, and other enrichment avenues of life are no doubt compromised, as well. Finances would be primarily directed toward obtaining necessary medical care and rehabilitative support. There may not be much money left over for life enrichment. This might also further depression and anxiety reactions. This case reviews the mechanisms, risks, and treatment of open-angle glaucoma. We speculated on the psychological and social challenges, based on the research summarized in this paper. The case illustrates the importance of early screening, the physiological description of the disease (elevated intraocular pressure, enlarged optic cup, decreasing peripheral vision), the risk of developing glaucoma (which in this case was strong family history of genetic mutation), problems with medication and necessity, in this case, for surgery. This paper has speculated on psychological reactions, such as depression, anxiety, and guilt, and social challenges, such as finances, career concerns, dependency issues, with respect to this case, and the lessening of social activities made necessary by the expenses of treating glaucoma. It was not mentioned, in this case, whether the patient was well-informed about the disease and the need for treatment compliance. It may be that, with a patient so young, the parents were informed more carefully than the patient. They have probably taken responsibility in encouraging compliance, assuming, that is, that they value compliance. This is particularly likely with a mother and brother who also must use medication and surgical treatments, and with an extended family who also suffers with the disease. It was mentioned, in the introduction to this paper, that the author was diagnosed with open-angle glaucoma, 10 months ago. The physiological, psychological, and social implications of this disease are now quite clear to the author and this will empower not only eyesight protection, but also an optimal quality of life. Furthermore, the author is now in a position to educate others about the disease, whether those others are reacting to the author’s situation or wondering about their own situation, or that of a friend or family member. Open-angle glaucoma is a depressing and anxiety-producing, complex, debilitating disease but, armed with the proper information and attitude, it can be managed. References 1. Alward, G. D.; W. I Lively and J. B. Fingert. September 17, 2008. Juvenile open-angle glaucoma. University of Iowa Health Care: Ophthalmology and Visual Sciences. 19 October 2012. http://webeye.ophth.uiowa.edu/eyeforum/cases/87-myocilin-juvenile-open-angle-glaucoma.htm, 2. American Academy of Ophthalmology. October 2010. Preferred practice pattern guidelines. ONE Network. 18 October 23012. http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=93019a87-4649-4130-8f94-b6a9b19144d2 3. Aref, A. A. and B. P. Schmitt. February 2005. Open-angle glaucoma: Tips for earlier detection and treatment selection. J of Family Practice: 54(2). 4. Arffa, R. C. Common eye disorder: Glaucoma. nd. Robert C. Arffa, M.D.18 October 2012. http://www.drarffa.com/disorders/glaucoma.html. 5. Glaucoma Research Foundation. January 13, 2011. Symptoms of open-angle glaucoma. Glaucoma Research Foundation. 17 October 2012. http://www.glaucoma.org/glaucoma/symptoms-of-primary-open-angle-glaucoma.php 6. Hattenhauer, M. G.; D. H. Johnson.; H. H. Ing; D. C. Herman; D. O. Hodge; P. Varbara; I. Butterfield; C. Inda; Gray, T. Darryl. November 1998. The probabiliity of blindness from open-angle glaucoma. Ophthalmology: 105(11): 2099-2104. 7. Kitazawa, Y.; H. Suemori-Matsushita; T. Yamamoto; K. Kawase. 1993. Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology: 100(11): 1624-1628.. 8. McGraw-Hill. 2010. Current diagnosis & treatment: Surgery, 13e. Access Medicine. 18 October 2012. http://accessmedicine.com/content.aspx?aid=5312174 9. Pappa, C.; T. Hyphantis; S. Pappa, M. Aspiotis; M. Stefaniotou; G. Kitsos; K. Psilas; V. Mavreas. 2006. Psychiatric manifestations and personality traits associated with compliance with glaucoma treatment. J of Psychosomatic Research: 61(5):609-617.. 10. Rezale, T.; A. Child; R. Hitchinge; G. Rice; L. Miller; M. Coca-Prados; E. Heon; T. Krupin;R. Ritch; D. Kreutzer; R. P. Crick; M. Sarfarazi. February 2002. Adult-Onset primary open-angle Glaucoma caused by mutations in optineurin. Science. 295(5557):1077-1079.. 11. Snyder, Alison. January 17, 2006. Turning a blind eye. Scientific American.. 17 October 2012. 12. Stone, E. M.; J. H. Alward; W. L. M. Fingert; T. D. Nguyen; S. Polansky; L. F. Sara; R. Jon; D. Nishimura; A. F. Clark; A. Nystuen; B. F. Nichols; D. A. Mackey; J. W. Kalenak; E. Craven; S. Randy; C. I. January 1997. Identuification of a gene that causes primary open angle glaucoma. Science: 275(5300):668-670.. 13. Wong, Kate. June 17, 2002. Eyedrops delay onset of glaucoma. Scientific American. 17 October 2012. Appendix 3 first pages of significant sources used. University of Iowa Health Care Ophthalmology and Visual Sciences 22 year-old Caucasian female referred in 1990 for evaluation of elevated intraocular pressure (IOP) Geoffrey D. Lively, MD, W.L. Alward, MD, and John H. Fingert, MD, PhD September 17, 2008 Chief Complaint: 22 year-old Caucasian female referred in 1990 for evaluation of elevated intraocular pressure (IOP) that was initially controlled with medicines. History of Present Illness: High IOP was incidentally detected in both eyes at age 16 and was effectively controlled until 6 months ago, when IOPs reached the mid-50's OU. Ocular History: No previous ocular trauma or surgery. Medical History: Unremarkable. Medications: Acetazolamide 500mg orally BID Timolol 0.5% OU BID Dipivefrin OU BID Social History: Noncontributory. Family History: mother, grandmother, and brother have glaucoma. Ocular Exam: Best corrected visual acuities: 20/20 -1 OD, 20/20 -1 OS mRx: -0.75 sph OD, -1.25 +0.5 x 134 OS EOM: full Pupils: no RAPD Gonio: Wide-open angles OU. (D40f) IOP: 45 mmHg OD, 44 mmHg OS SLE: Normal OU DFE: Normal OU The probability of blindness from open-angle glaucoma. Hattenhauer MG, Johnson DH, Ing HH, Herman DC, Hodge DO, Yawn BP, Butterfield LC, Gray DT. Source Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. Abstract OBJECTIVE: This study aimed to determine the probability of a patient developing legal blindness in either one or both eyes from newly diagnosed and treated open-angle glaucoma (OAG) after starting medical or surgical therapy or both. DESIGN: The study design was a retrospective, community-based descriptive study. PARTICIPANTS: Two hundred ninety-five residents of Olmsted County, Minnesota, newly diagnosed with, and treated for, OAG between 1965 and 1980 with a mean follow-up of 15 years (standard deviation +/- 8 years) participated. INTERVENTION: Kaplan-Meier cumulative probability of blindness was estimated for patients treated and followed for OAG. MAIN OUTCOME MEASURES: Legal blindness, defined as a corrected visual acuity of 20/200 or worse, and/or visual field constricted to 20 degrees or less in its widest diameter with the Goldmann 1114e test object or its equivalent on automated perimetry, secondary to glaucomatous loss, was measured. RESULTS: At 20-years' follow-up, the Kaplan-Meier cumulative probability of glaucoma-related blindness in at least one eye was estimated to be 27% (95% confidence interval, 20%-33%), and for both eyes, it was estimated to be 9% (95% confidence interval, 5%-14%). At the time of diagnosis, 15 patients were blind in at least 1 eye from OAG. CONCLUSION: Turning a Blind Eye Proponents fire back after a report questions glaucoma screening By Alison Snyder In revamping Medicare, one of the first preventive practices President George W. Bush put under the national health care policy was glaucoma testing, beginning in 2002. After all, screening people at high risk of developing the chronic eye disease had been common practice for decades. Then, in 2005, a government-sponsored panel of experts found that it could not make any definitive recommendation about glaucoma screening. The surprising conclusion sparked a debate over the risks and benefits of screening for the disorder. Now new evidence, some researchers and policymakers say, tips the balance in favor of the benefits. Glaucoma affects about three million people in the U.S. and is a leading cause of blindness. It occurs when fluid pressure inside the eyes rises, irreversibly damaging the optic nerve that carries visual information from the retina to the brain. Blind spots begin to form on the periphery of people’s vision and can progress to tunnel vision that, left untreated, can then narrow to blindness. As many as half of those with glaucoma in the U.S. do not know that they have the disease, according to the National Eye Institute. “There are no symptoms or signs. The disease is essentially picked up through screening,” explains Rohit Varma, an ophthalmology professor at the University of Southern California. Such screening typically involves checking a patient’s peripheral vision, examining the retina and optic nerve for damage and measuring the fluid pressure in the patient’s eye. Testing is important because a loss of vision cannot be reversed. Prescription eyedrops or surgery, or both, however, can halt its progression. The National Eye Institute and other government agencies, professional societies and consumer groups recommend regular glaucoma screening for people at high risk, such as individuals with a family history of the disease, African-Americans older than 40, and everyone older than 60, especially Latinos. But in 2005 the U.S. Preventive Services Task Force (USPSTF), a panel of primary and preventive care experts sponsored by the U.S. Department of Health and Human Services, evaluated the scientific literature regarding testing and “found insufficient evidence to recommend for or against screening adults for glaucoma.” In reviewing 13 studies, the task force saw evidence that screening can detect increased fluid pressure and early glaucoma in adults and that timely treatment for fluid pressure reduces the number of people who lose their vision from the disease. But it did not find enough evidence to determine whether screening and early detection lead to improved quality of life for glaucoma patients. Moreover, the task force cited eye irritation from screening and an increased risk for developing cataracts after glaucoma treatment as associated risks. So the panel did not recommend for or against screening. The apparently neutral stance effectively states that “the benefits don’t outweigh the risks,” comments Dennis McBride, academic president of the Potomac Institute for Policy Studies, a nonprofit public policy research group. Read More