Glaucoma usually has no symptoms in its early stages. By the time a patient notices something is wrong, significant and irreversible nerve damage has often already occurred. This is why knowing your risk matters, and why a proactive eye check can protect your vision before any loss begins.
Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care.
Who is at risk for glaucoma?
Everyone has some risk of glaucoma, which is why ophthalmologists recommend regular eye checks for all adults. But certain factors significantly raise that risk. Understanding your personal risk profile is the first step toward protecting your vision.
Age
Glaucoma can affect any age, including newborn children (congenital glaucoma). Risk increases meaningfully from the 40s onwards. The risk of angle closure glaucoma rises in the 40s. Open angle glaucoma risk peaks in the 60s. Because glaucoma involves progressive loss of optic nerve cells, a process that accelerates with age, it is sometimes called the Alzheimer’s disease of the eye.
Family history
A family history of glaucoma is one of the strongest individual risk factors. If a parent or sibling has primary open angle glaucoma (POAG), your risk can be three to thirteen times higher than that of the general population. The risk is even greater if the affected relative is a sibling rather than a parent. If glaucoma runs in your family, do not wait for symptoms. Get screened now.
Ethnicity and Indian-specific risk
South Asians, including Indians, have a significantly higher risk of angle closure glaucoma. This is due to anatomically shallower anterior chambers and narrower drainage angles, which are more common in this population. Indians also tend to present at a younger age and at more advanced stages of disease. Angle closure can cause sudden, severe pressure spikes and rapid vision loss if not detected and treated early.
People of African-Caribbean descent have a higher risk of open angle glaucoma, which tends to be more severe and aggressive. Hispanic populations also carry elevated risk. Japanese individuals have a higher risk of normal tension glaucoma.
If you are Indian and have a family history of glaucoma, narrow angles, or high myopia, your risk is compounded. Early screening is especially important.
Eye pressure
Raised intraocular pressure (IOP) is the only modifiable risk factor for glaucoma. High eye pressure does not cause symptoms. It is detected only on examination. Not everyone with high IOP develops glaucoma, but elevated pressure significantly increases the risk, and lowering it is the foundation of all glaucoma treatment. Regular eye pressure checks are essential if you are at risk.
Optic nerve structure
The appearance of the optic nerve can indicate glaucoma risk even before pressure rises or vision is affected. A large cup-to-disc ratio, disc asymmetry between the two eyes, thinning of the retinal nerve fibre layer, and disc haemorrhages are all findings that warrant closer monitoring. These are assessed using slit-lamp examination and OCT imaging.
Gender
Women have a higher risk of angle closure glaucoma and normal tension glaucoma (NTG). Hormonal factors and anatomical differences in the eye contribute to this. Women should not assume glaucoma is primarily a male disease.
Refractive error
High myopia (short-sightedness) increases the risk of open angle glaucoma. High hypermetropia (long-sightedness) increases the risk of angle closure glaucoma. If you have a strong glasses prescription, ask your eye doctor to assess your glaucoma risk at your next visit.
Structural features of the eye
Narrow drainage angles, a shallow anterior chamber, a thicker or more anteriorly positioned lens, and a short axial length all predispose to angle closure glaucoma. These features are more common in South Asian eyes. Pseudoexfoliation, a condition where protein deposits accumulate in the eye, significantly raises the risk of a specific and often aggressive form of glaucoma called pseudoexfoliative glaucoma.
Thin central cornea
A central corneal thickness below 520 microns increases glaucoma risk in two ways. First, it causes IOP readings to appear falsely lower than they are. Second, thinner corneas may reflect weaker structural support around the optic nerve, making it more vulnerable to pressure-related damage. Corneal thickness is measured once as part of a full glaucoma risk assessment.
Diabetes and systemic diseases
People with diabetes have a significantly higher risk of glaucoma. High blood pressure, low blood pressure at night, migraine, Raynaud’s phenomenon, and thyroid disease have all been associated with increased glaucoma risk. Vasospastic diseases — conditions where blood vessels constrict intermittently — are particularly linked to normal tension glaucoma, where optic nerve damage occurs despite normal IOP.
Steroid use
Steroids in any form: eye drops, skin creams, nasal sprays, inhalers, or oral tablets, can raise eye pressure and trigger steroid-induced glaucoma. This risk is present even with short-term use of topical steroids around the eyes. If you use steroids regularly in any form, tell your eye doctor. Other medications associated with glaucoma risk include certain antidepressants, anticonvulsants, drugs for Parkinsonism, and some migraine medications.
Eye trauma and previous eye surgery
A history of eye injury or multiple eye surgeries increases the risk of secondary glaucoma. Post-traumatic glaucoma, uveitic glaucoma, and glaucoma following vitreoretinal surgery are well-recognised clinical entities. If you have had significant eye trauma or surgery in the past, ensure your IOP and optic nerve are assessed regularly.
Genetic predisposition
Several genes associated with glaucoma have been identified. However, most glaucoma cases are polygenic, meaning no single gene is responsible. Gene-environment interactions are thought to be more important than any individual genetic variant. A family history remains the most clinically useful indicator of genetic risk.
What the major clinical trials tell us
Large clinical trials have defined the most important risk factors with precision.
The Ocular Hypertension Treatment Study (OHTS) identified older age, higher IOP, thinner central cornea, and a larger vertical cup-to-disc ratio as the key risk factors for developing POAG.
The Collaborative Normal Tension Glaucoma Study (CNTGS) found that female gender, recurrent disc haemorrhages, and a history of migraine predicted faster progression in NTG.
The Early Manifest Glaucoma Treatment Trial (EMGT) showed that higher IOP, pseudoexfoliation, older age, bilateral disease, and disc haemorrhages all drove faster progression.
These findings underpin how glaucoma specialists assess and manage risk in clinical practice today.
What to do if you are at risk
If you have one or more of the risk factors above, do not wait for symptoms. Glaucoma rarely announces itself. Schedule a comprehensive glaucoma assessment that includes IOP measurement, optic nerve evaluation, OCT, visual field testing, and gonioscopy.
If you have already been diagnosed elsewhere and want an independent review of your risk or treatment plan, a glaucoma second opinion is a straightforward and sensible step.
Book a consultation at Marengo Asia Hospitals, Gurugram or upload your reports for a second opinion.
Frequently Asked Questions
Who is most at risk for glaucoma?
People with a family history of glaucoma, raised eye pressure, thin corneas, high myopia, diabetes, or South Asian ethnicity are at higher risk. Age over 40 adds to this. No single factor determines outcome. Risk assessment requires looking at the full picture.
Can glaucoma run in families?
Yes. A first-degree relative with primary open angle glaucoma raises your personal risk three to thirteen times. The risk is higher if the affected relative is a sibling. If glaucoma runs in your family, get a formal screening examination, do not rely on self-assessment.
Are Indians at higher risk of glaucoma?
Yes. South Asians, including Indians, have a higher prevalence of angle closure glaucoma due to anatomically narrower drainage angles. Indians also tend to present at more advanced stages. Early screening is particularly important for Indians with a family history, high myopia, or shallow anterior chambers.
Does high eye pressure always mean glaucoma?
No. High eye pressure (ocular hypertension) is a risk factor, not a diagnosis. Many people with elevated IOP never develop glaucoma. Conversely, glaucoma can occur with normal IOP, this is called normal tension glaucoma. A full assessment is needed to determine actual risk.
Can steroids cause glaucoma?
Yes. Steroids in any form: eye drops, skin creams, nasal sprays, inhalers, or tablets, can raise IOP and trigger steroid-induced glaucoma. This risk applies even with short-term use around the eyes. Always inform your eye doctor if you use steroids regularly.
Does myopia increase glaucoma risk?
Yes. High short-sightedness (myopia) is associated with a higher risk of open angle glaucoma. The structural changes in a myopic eye, including a larger, more vulnerable optic disc, contribute to this risk. People with high myopia should have regular glaucoma assessments.
What is normal tension glaucoma and who is at risk?
Normal tension glaucoma (NTG) is glaucoma that occurs despite normal eye pressure. It is linked to impaired blood flow to the optic nerve. Women, people with migraine, those with low nocturnal blood pressure, and individuals of Japanese descent are at higher risk. It is underdiagnosed because IOP appears normal on routine checks.
At what age should I start getting checked for glaucoma?
Anyone with a risk factor: family history, diabetes, myopia, steroid use, or South Asian ethnicity, should begin regular glaucoma checks by their 40s, or earlier if risk is high. All adults over 60 should have routine screening regardless of risk factors.
Where can I get a glaucoma risk assessment in Gurgaon?
Dr Shibal Bhartiya offers comprehensive glaucoma risk assessments at Marengo Asia Hospitals, Sector 56, Gurugram. Assessment includes IOP, optic nerve evaluation, OCT, visual fields, corneal thickness, gonioscopy and quality of life assessments. Call +91 88826 38735 or visit drshibalbhartiya.com.
Read the research articles
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. This article was edited in April 2026.
She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
Her work can be accessed on Pubmed, Google Scholar, ResearchGate and ORCID.
Dr Shibal Bhartiya
Glaucoma • Second Opinion • Advanced Care
www.drshibalbhartiya.com
+91 88826 38735
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