The Silent Thief of Sight: What You Need to Know About Glaucoma

Let's start with a statistic that still gets me every time I say it out loud.

Around 300,000 Australians are living with glaucoma right now. And approximately half of them have absolutely no idea.

Not because they haven't been paying attention. Not because they've been ignoring symptoms. But because glaucoma, in its most common form, has no symptoms at all, not in the early stages, not in the middle stages, and sometimes not until a significant amount of vision has already been lost.

This is why I talk about glaucoma with almost every patient I see. Not to alarm people. Just because it's genuinely one of the most important things a regular eye examination picks up and one of the most common things that gets missed without one.

Around 300,000 Australians are living with glaucoma. Approximately half don't know it.

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So what exactly is glaucoma?

Glaucoma is a group of eye conditions that damage the optic nerve - the nerve that carries visual information from the eye to the brain. In most cases, this damage is caused by increased pressure inside the eye, though it can also occur when eye pressure is within the normal range (this is called normal tension glaucoma, and it's more common than people realise).

The optic nerve is made up of around 1.2 million nerve fibres. Glaucoma damages these fibres gradually and progressively, and once they're gone, they can't be restored. This is why early detection matters so much, we can't reverse the damage, but we can absolutely slow or stop it from progressing.

The most common type is called primary open-angle glaucoma. It develops slowly, affects both eyes (usually unevenly), and starts by eroding peripheral vision - the vision at the edges of your visual field. By the time central vision is affected, the disease is already well advanced.

Why doesn't it hurt?

This is the part that surprises most people. With many health conditions, your body gives you a signal that something is wrong. Pain, discomfort, a change you can't ignore. Glaucoma rarely works that way.

The optic nerve itself has no pain receptors. The gradual loss of peripheral vision is so slow that the brain compensates without you noticing, it fills in the gaps, so to speak. By the time vision loss becomes obvious to you in everyday life, significant and irreversible damage has already occurred.

This is exactly why "I can see fine" is not the same as "My eyes are healthy." The two things are not the same, and glaucoma is one of the best examples of why.

Who is at risk?

Anyone can develop glaucoma, but some factors significantly increase your risk. You should be particularly vigilant about regular eye examinations if you have:

• A family history of glaucoma. This is one of the strongest risk factors. If a parent or sibling has glaucoma, your risk is significantly elevated. Please tell us about your family history if you haven't already.
• Elevated eye pressure (intraocular pressure). Higher pressure inside the eye puts greater stress on the optic nerve. We measure this at every comprehensive eye examination.
• Age over 50. The risk of glaucoma increases significantly with age, though it can occur at any age.
• Short-sightedness (myopia). Particularly high myopia is associated with increased glaucoma risk.
• Thin corneas. A thinner central cornea can be associated with higher risk and can also affect how we interpret eye pressure readings.
• Previous eye injuries. Trauma to the eye can affect the drainage of fluid and increase pressure over time.
• Long-term use of corticosteroids. Steroid eye drops or prolonged systemic steroid use can raise eye pressure in some people.
• Diabetes or cardiovascular disease. These conditions can affect blood flow to the optic nerve.

It's also worth knowing that glaucoma can affect anyone at any age, including children, though this is rare.

How do we detect it?

This is where I genuinely love what we can do at Outlook Eye Centre.

A proper glaucoma assessment isn't just one test, it's a picture built from several pieces of information together. At a comprehensive eye examination, we assess:

• Intraocular pressure (IOP). We measure the pressure inside your eye using a technique called contact tonometry.
• The optic nerve head. We examine the optic disc, the point where the optic nerve enters the eye - for signs of structural change, including changes to the cup-to-disc ratio and the health of the surrounding rim tissue.
• OCT imaging. This is where things have changed dramatically in the last decade. We use an Optopol Revo 60 OCT (Optical Coherence Tomography), an advanced imaging tool that lets us measure the thickness of the retinal nerve fibre layer and the ganglion cell complex with extraordinary precision. These are the layers of the retina that are affected earliest in glaucoma, often before any change is visible to the naked eye or shows up on a visual field test. OCT allows us to detect structural changes earlier than we ever could before.
• Visual field testing. For patients where glaucoma is suspected or confirmed, we perform visual field testing to map any loss of peripheral vision. This helps us understand how the condition is affecting function and track changes over time.
• Corneal thickness (pachymetry). Because corneal thickness affects how we interpret pressure readings, this measurement helps us get a more accurate picture of true eye pressure.

No single measurement tells the whole story. It's the combination of these findings, tracked over time, that gives us the clearest picture of what's happening.

OCT imaging lets us detect structural changes to the optic nerve earlier than we ever could before - sometimes years before any vision loss is detectable.

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What happens if glaucoma is detected?

The first thing I want people to know is that a diagnosis of glaucoma is not a death sentence for your vision. When detected early, the condition is very manageable. The goal of treatment is to lower eye pressure (even if it's already in the normal range) to reduce the stress on the optic nerve and slow or stop further damage.

Treatment options include:

• Prescription eye drops. Usually the first line of treatment. These reduce eye pressure either by decreasing the production of fluid inside the eye or by improving its drainage.
• Laser treatment. Certain types of glaucoma respond well to laser procedures that improve fluid drainage. This is typically performed by an ophthalmologist.
• Surgery. In more advanced cases or where other treatments aren't sufficient, surgical options can create new drainage pathways for fluid.

At Outlook Eye Centre, we work closely with specialist ophthalmologists in Toowoomba in a co-management model. This means we monitor your glaucoma carefully using our OCT and visual field equipment, manage the day-to-day aspects of your care, and refer to an ophthalmologist when surgical or specialist input is needed. You get continuity of care from someone who knows you and your eyes, with the specialist expertise brought in when it matters.

The bottom line

Glaucoma is common, serious, and largely preventable from causing significant vision loss, but only if it's caught. The window between when we can detect it and when you would notice something is wrong yourself is the window where we can make the biggest difference.

If you're over 50, have a family history of glaucoma, or simply haven't had a comprehensive eye examination in the last two years, please book an appointment. Not because something is definitely wrong. But because finding out when everything is fine is exactly how we keep it that way.

Concerned about glaucoma, or due for your next eye examination? Call us on 07 4635 8844 or email andrew@outlookeyecentre.com.au to book an appointment at Outlook Eye Centre in Toowoomba. We're open Monday to Friday, 8:30am to 5:00pm.

Shannon Smith | Optometrist | Outlook Eye Centre | 65 High Street, Rangeville, Toowoomba QLD 4350