Risk and risk factors for blindness from glaucoma.

PURPOSE OF REVIEW: Estimates of blindness from glaucoma and risk factors for blindness remain of interest for all ophthalmologists. RECENT
FINDINGS: Long-term retrospective studies of patients with open-angle glaucoma in developed countries have noted that progression to bilateral blindness among treated patients is relatively uncommon. Risk factors for development of blindness include advanced visual field loss at presentation and noncompliance with the treatment regimen. Age is a risk factor in some studies. Many of those with blindness are blind at presentation. Untreated rates of blindness are higher. Population-based studies of glaucoma in developing countries have highlighted the obstacles to prevention of blindness in such settings, with astonishingly high rates of blindness noted.
SUMMARY: The risk of blindness from glaucoma is very high among patients in developing countries, the vast majority of whom do not know they are afflicted. When considering all glaucoma worldwide, the greatest risk factor for blindness is almost certainly being an average citizen of a developing country. Among those with open-angle glaucoma in developed countries, more advanced visual field loss at presentation and noncompliance are risk factors for development of blindness, as well as advanced age. Effective public education about glaucoma and targeted screening of those most likely to have glaucoma are necessary if the number of blind from glaucoma is to be reduced worldwide. Better treatment options for those in developing countries must also be developed.