What happens if Glaucoma is left untreated?

Untreated glaucoma is a serious eye condition in which elevated pressure inside the eye (intraocular pressure, or IOP) or other factors damage the optic nerve over time. Because nerve fibers do not regenerate, this damage is permanent. Here’s what you need to know if glaucoma goes untreated.

What Is Glaucoma?
Glaucoma refers to a group of eye diseases characterized by progressive optic nerve damage. The most common form, primary open-angle glaucoma, often develops slowly and painlessly. A less common form, normal-tension glaucoma, causes similar nerve damage even when IOP is in the “normal” range.

Why Early Treatment Matters
• Glaucoma is often called the “silent thief of sight” because you usually won’t notice vision loss until it’s advanced.
• Once optic nerve fibers die, lost vision cannot be restored.
• Clinical trials (Early Manifest Glaucoma Trial, EMGT; Collaborative Normal-Tension Glaucoma Study) show that lowering IOP—even in normal-tension cases—significantly slows progression.

What Happens If Glaucoma Is Left Untreated?

1. Progressive Optic Nerve Damage

   • Elevated or fluctuating IOP damages the optic nerve head.
   • Nerve fiber loss begins at the periphery and moves inward.
   • Damage accumulates silently over months or years.

2. Gradual Peripheral Vision Loss

   • Initial loss often affects side (peripheral) vision.
   • You may not notice until “tunnel vision” develops.
   • Everyday tasks—driving, walking in crowds, navigating stairs—become hazardous.

3. Central Vision Threatened

   • Without treatment, peripheral loss eventually encroaches on central vision.
   • Reading, recognizing faces and colors, and detailed tasks become difficult.

4. Increased Risk of Blindness

   • The EMGT found untreated patients had a 62% risk of measurable visual field progression within six years; treatment roughly halved that risk.
   • The Collaborative Normal-Tension Glaucoma Study showed even small IOP reductions in normal-tension glaucoma patients cut progression rates by about 30–40%.

5. Impact on Quality of Life

   • Reduced independence: difficulty driving, reading, cooking.
   • Higher fall risk due to limited peripheral awareness.
   • Emotional toll: frustration, anxiety, potential social isolation.

6. Long-Term Health and Safety Concerns

   • Vision loss can contribute to depression and cognitive decline in older adults.
   • Severe visual impairment increases dependency on caregivers or assisted living.

How Fast Does Glaucoma Progress?
Progression varies widely:
• Risk factors for faster decline include higher baseline IOP, thinner central corneal thickness, older age, optic disc hemorrhages and poor blood flow to the optic nerve. (Leske et al., 2003)
• Some people lose vision slowly over decades; others progress rapidly within a few years.
• Even “normal-tension” glaucoma can advance if left untreated—IOP isn’t the only driver.

Signs and Symptoms You Might Notice
Because early glaucoma is painless, symptoms often appear only in advanced stages:
• Blurred vision or hazy appearance
• Patchy blind spots in peripheral or central vision
• Difficulty adapting to low light, especially at night
• Tunnel vision in late stages

Given this subtlety, regular eye exams are the best defense. If you have any risk factors—family history of glaucoma, high IOP, African or Hispanic ancestry, diabetes, high blood pressure—be sure to schedule comprehensive eye checks.

What You Can Do Now
• Get a dilated eye exam at least once every 1–2 years (more often if you’re high-risk).
• Monitor any changes in vision and report them to your eye specialist immediately.
• Consider doing a free, online symptom check for if you notice visual changes.

Treatment Options (Brief Overview)
Although this article focuses on what happens when glaucoma is untreated, it’s important to know that effective treatments exist:
• Prescription eye drops (first-line therapy to lower IOP)
• Laser therapy (e.g., selective laser trabeculoplasty)
• Minimally invasive glaucoma surgery (MIGS) and traditional filtering surgeries

All these aim to preserve your remaining vision; none can restore lost nerve fibers. That’s why early intervention is so critical.

Key Takeaways

• Untreated glaucoma leads to irreversible optic nerve damage and progressive vision loss, often starting with peripheral fields.
• Clinical studies show that lowering IOP—even modestly—significantly slows disease progression.
• You may not notice early vision changes, so routine eye exams are essential.
• If you detect any visual symptoms or have risk factors, act promptly: consider a symptom check for and speak to your eye care provider.

This information is intended to help you understand the risks of untreated glaucoma. Always speak to a doctor about any concerns—only a qualified professional can assess your individual situation and recommend appropriate care.