Walter Reed National Military Medical Center, BETHESDA, MD  –  
Glaucoma is a leading cause of irreversible blindness in the United States. It is an umbrella term for diseases characterized by a common end state of optic nerve loss. Optic nerve fibers create a “highway,” sending visual input from the eye to the brain and when “lanes” on the highway close, you get glaucoma. The disease usually starts by closing the highway’s outer lanes, leading to loss of peripheral vision. Over time, it can work its way toward the center lane, causing permanent loss of the center of the visual field.

“Fortunately, the body has developed redundancies in the highway, so that many lanes can be damaged before any vision is lost. Our goal with glaucoma management is to prevent the disease from causing vision loss,” said U.S. Navy Lt. Cmdr. (Dr.) Carli Deitel, staff ophthalmologist at Walter Reed.

Ultimately, glaucoma leads to permanent vision loss. The two main types of glaucoma, open-angle and closed-angle, are defined by the anatomy of the drainage pathway for fluid inside the eye. The most common type in the United States is open angle. The good news is that this type usually progresses slowly, over many years. The bad news is that it often does so silently, without symptoms, hence it is often called the “silent thief of sight.”

“The lanes on the highway close from peripheral to central. When the peripheral vision is affected, it is often not noticeable because the central vision remains intact, and the other eye can compensate at first when both eyes are open,” said Deitel. “However, by the time visual field loss is noticeable, the disease is often in the advanced stage, affecting the central vision. In closed angle glaucoma, the disease may progress silently as well, or it may occur with a sudden development of pain, blurry vision, and nausea.”

The best way to prevent vision loss from glaucoma is to obtain regular eye exams, including an assessment of the optic nerve. Caught early, glaucoma is treated by lowering eye pressure with prescription eye drops or an in-office laser procedure. For more advanced stages, surgery can be performed. Glaucoma treatment surgery may include laser techniques (YAG, diode, and argon lasers), anti-metabolite assisted surgery, glaucoma shunts, and cyclophotocoagulation.

“At the Walter Reed Eye Institute, we perform all steps on the glaucoma continuum: routine eye exams, medical management with eye drops, and procedural management with laser procedures, advanced surgeries, and revision surgeries,” said Deitel.

According to Deitel’s research, in 2024, approximately 4.22 million adults in the United States have glaucoma, and more than 1.4 million already experiencing vision loss from the disease. Globally, the disease affects an estimated 80 million people, a number expected to rise as populations age. Risk factors include but are not limited to a glaucoma family history, African, Hispanic, or Asian heritage, prior eye trauma, long-term medical steroid use, and high eye pressure.

At Walter Reed, ophthalmologists like Deitel are committed to providing comprehensive, world-class care by using the latest, state-of-the-art equipment and procedures.

For more information on Walter Reed ophthalmology services, visit https://walterreed.tricare.mil/Health-Services/Vision/Ophthalmology.