Rare disease treatment is characterized by its numerous challenges, stemming from an overall lack of awareness across the healthcare landscape. This issue becomes a waterfall, trickling down and affecting crucial nodes of the healthcare value chain, such as regulations, existing healthcare infrastructure, and affordability, before it can even potentially reach patients. Hence, the cooperation of the public and private sectors with a firm basis in knowledge sharing and education is required to alleviate these multifaceted challenges brought from a lack of awareness.

The Root of Awareness  

Rare diseases are defined by their generally low population impact, with many markets agreeing to a ratioed figure, such as one patient per every 2,000 in a population. The rarity of such diseases results in a lack of awareness among both the general public and the healthcare practitioner community. This awareness gap translates into a significant challenge in patients receiving an accurate diagnosis. Combined with the relatively few specialized medical personnel for such diseases, this can lead to misdiagnosis or delayed referrals, resulting in an average time to receive a final diagnosis of up to 5 years. By this time, some rare diseases can cause significant distress, such as Leber hereditary optic neuropathy (LHON), which can cause vision loss in a matter of months if left untreated.

Patients face a journey of medical uncertainty, fiscal difficulties, and personal challenges. These issues are often exacerbated by healthcare systems that struggle to accurately and promptly diagnose such rare conditions.

Point-to-Point Hurdles in Medication Access

Across markets, the rare disease medication issue also has to contend with more tangible and operational concerns stemming from the lack of awareness. From a regulatory standpoint, the lack of rare disease understanding can lead to regulations being under equipped to address medication access. This is doubly so for more challenging regulatory landscapes, such as across APAC’s complex and fragmented market environment, where general healthcare accessibility can already prove to be a hurdle due to a combination of socioeconomic and geopolitical factors. This can lead rare diseases and their medications to be an underserved area, while more widely common health concerns are prioritized.

A key driver of healthcare access is the underlying infrastructure powering the supply chain, ensuring the distribution of medication to patients. Similar to regulations, supply chain systems can vary vastly in complexity, particularly when across challenging geography and when specialised logistics, such as cold chain solutions, are needed to handle sensitive medication. These can culminate in much-needed investment into supply chain infrastructure. For example, in APAC markets, such as Thailand, DKSH has established a network of satellite distribution centers that can provide last-mile delivery of sensitive medications to underserved areas in a short period of time.

Regulatory complexities and supply chain infrastructure aside, the barrier to rare disease medication accessibility most often felt by patients is the affordability of treatments. The high cost of rare disease treatment options is critical, with some reaching over a million dollars for annual or one-time treatment. The issue of cost is more amplified in regions like APAC, where many markets have less robust public health insurance or social support systems, placing a financial strain on patients, even when access is just within reach.

This collection of barriers to accessing rare disease medications can be daunting from the outset. As a challenge of global concern, addressing it requires a unified approach that combines in-market and industry expertise, all in service of bringing medication to underserved patients.

The Power of Collaboration

The unique challenges of rare diseases are too great for any single entity to tackle alone. Bridging this gap through collaboration is paving the way forward, with public-private partnerships (PPPs) emerging as a core means for success. These partnerships bring together government agencies, pharmaceutical companies, academic institutions, and patient advocacy groups to share expertise, resources, and risk. For instance, in the APAC region, initiatives like the APEC Action Plan on Rare Diseases have provided a framework for member economies to accelerate efforts in this area, including the promotion of multisectoral collaborations. Regional alliances, such as the Asia Pacific Alliance for Rare Disease Organizations (APARDO), have done valuable work in collaborating with advocacy groups to raise awareness about these conditions. On an organizational level, there are also healthcare partners, such as DKSH, who work with firms, such as Kyowa Kirin, to bring rare disease medications to markets by utilizing in-market and regulatory expertise. Moreover, DKSH’s local teams have strong market knowledge, enabling them to offer clients and customers expert advice on local regulation.

This collaborative approach is crucial for streamlining the regulatory process for rare disease medications, also known as orphan drugs. Governments, including many in Asia, have introduced specific regulations and incentives to encourage the development of rare disease medication. These include Orphan Drug Designations (ODD) that provide much-needed support, such as tax credits for clinical research. Beyond these incentives, regulatory bodies are considering a greater reliance on evidence from expanded access programs. This allows for the use of data from a smaller patient pool, which is often the only available source of information for such rare conditions, thereby accelerating the review and approval process.

From a patient perspective, financial aid is of vital importance and an area where collaboration is key. The high cost of treatments for rare diseases necessitates innovative funding models beyond traditional public insurance. One effective model gaining traction in APAC is the establishment of dedicated funds, supported by a combination of public and private contributions. Singapore’s Rare Disease Fund (RDF) is a prime example, where community donations are matched by the government at a significant ratio. This model provides long-term financial support for patients, while encouraging a sense of shared responsibility across society. Similarly, patient access schemes and managed access programs are being implemented to ensure affordability and controlled access to therapies before full reimbursement is in place. These schemes can be tailored to individual patient needs and help bridge the gap between regulatory approval and widespread access.

Ultimately, the future of rare disease medication accessibility rests on a unified, multi-stakeholder ecosystem. By building on collaborative frameworks, optimizing regulatory pathways, and pioneering innovative funding mechanisms, the healthcare landscape can be transformed. Beyond raising awareness, there is an opportunity to create a robust, equitable, and sustainable system that ensures no patient is left behind, regardless of the rarity of their condition.

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Early Detection Poses Challenge

Glaucoma may strike individuals of any age, but it is most prevalent in people over the age of 60. For Black Americans, the rate of prevalence ticks up much earlier, at about 40 years of age, and people with diabetes or a family history of the condition are also more susceptible. Because glaucoma is asymptomatic in initial stages, early diagnosis is challenging.

The disease occurs when the optic nerve and the retinal ganglion cells — which relay visual inputs to the central nervous system — are damaged; elevated pressure in the eye, or intraocular pressure, is the main culprit. When fluid accumulates in the eye, such as from overproduction or improper drainage, it increases intraocular pressure and also the risk of developing glaucoma. Symptoms appear slowly, with changes in peripheral vision occurring before forward-facing vision becomes compromised.

Comprehensive eye exams can catch glaucoma in earlier stages, as these screenings involve optic nerve examination, intraocular pressure measurement, visual field testing and risk factor assessment. Patients must be proactive about regular screenings because once vision is lost, it cannot be repaired or restored. Available therapies can stop glaucoma’s progression and generally focus on alleviating intraocular pressure, but early diagnosis remains key.

Building on Existing Diagnostic Tools

Advances in diagnostic tools can give clinicians more and better information for treating glaucoma. Optical coherence tomography (OCT), for instance, uses light-wave imaging to help assess the optic nerve’s structural integrity. More recently, OCT angiography (OCTA) has been adopted to consider the optic nerve’s support system, such as blood supply. Functional imaging may be the next wave, as it should enable clinicians to identify cells under oxidative stress and take corrective action before irreversible damage is done.

Understanding a patient’s visual field is critical to identifying ocular diseases, and virtual reality goggles are emerging as a user-friendly, portable device. Doheny Eye Institute, dedicated to vision science, is investigating VR to enhance existing field vision testing and foresees future assessments that could bypass patient response. With its predictive powers, AI should also have a diagnostic role; AI may identify factors that clinicians could overlook when determining the risk of disease, progression, and aggressiveness so that patients can be treated early and accordingly.

Treatment Options Keep Evolving

Patients have various treatment options for glaucoma and generally take one of three paths: medication, laser or surgery. In the past five years, two new medications have surfaced, each with a novel mechanism of action that is additive to clinicians’ arsenals. The rho kinase inhibitor works to lower intraocular pressure, while a nitric oxide medication has dual action, reducing pressure and improving blood flow and oxygen to the optic nerve head. Research organizations like Doheny Eye Institute are also investing in the drug delivery arena, seeking ways to reduce patient error in medication administration and improve outcomes.

Laser treatment is nothing new in treating glaucoma, but techniques and instruments are constantly being refined. Laser trabeculoplasty has gained more acceptance, and as a minimally invasive procedure, it provides relief by reducing intraocular pressure. A more recent introduction, micropulse transscleral laser therapy also relieves intraocular pressure but by delivering energy in short pulses, which appears to minimize collateral tissue damage.

Should patients be beyond medication or non-invasive procedures, incisional surgery remains an option to improve natural drainage of the eye or insert an implant to create an accessory drainage pathway. Advances in surgical procedures, implants and devices continue to be sought after in research circles.

The Future Lies in Neuroprotection

Glaucoma research is a dynamic field, and an emergent focus is neuroprotection, where treatment extends beyond decreasing intraocular pressure to intervention in the chemical pathways that lead to the death of retinal ganglion cells. This exciting area considers protective effects, such as a drug therapy that could prevent cells from dying. It also explores how cells could be resuscitated, or what interventions could return damaged cells to their full functionality. Ultimately, this field of study is working toward neuro regeneration, where neural pathways may be fully restored so that lost vision may be regained.

With continued advances in glaucoma-related research and development across the board — from diagnostics and devices to pharmaceuticals and drug delivery to laser and surgical procedures — the future for patients is looking brighter. Maintaining momentum will be key for researchers to achieve the ultimate goal and find a cure for existing and future glaucoma patients.

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Not all cases of AMD are created equal

AMD takes on one of two forms: wet AMD or dry AMD. Wet AMD, or choroidal neovascularization, is less prevalent but also treatable. It is characterized by abnormal blood vessel growth into the retina, and that intrusion and leakage of blood into the retina disrupt the photoreceptors, which causes a disruption to vision. Patients may notice that once straight lines appear wavy, or they could have a blank spot in their central vision. The onset of symptoms is relatively rapid, but treatments can effectively promote a regression of blood vessels and help restore vision. Only about 10% of patients with AMD have this treatable form.

Dry AMD, on the other hand, occurs in more than 80% of patients and no time-tested treatments exist. This slow progressing disease involves the death of the retinal pigment epithelium (RPE), cells that support the health of the light-sensing photoreceptors by serving as a conduit for nutrients and oxygen from the outer retinal blood supply. Importantly, the RPE cells have no regenerative potential, so once this critical support system is lost, photoreceptors are prone to damage and loss.

Typically, patients learn they have the condition at regular eye exams, where an ophthalmologist may identify drusen (tiny bits of debris in the back of the eye), or when they begin experiencing impaired vision, at which point they are often in an advanced stage, or geographic atrophy (GA). The FDA has only recently approved two therapies intended for dry AMD, but their efficacy for a broad patient population has not yet been determined.

Identifying pathways is key

Both new therapies for dry AMD target the complement pathway. Part of the immune system and present in all tissues, the complement pathway surveys for invading pathogens and removes them, which is a good thing. It can go into overdrive or behave erratically, however, which can result in the destruction of good tissue. New treatments are formulated to keep the complement pathway in check and inhibit it from destroying cells in the eye, as this destruction is a mechanism for dry AMD.

While the new therapies are promising, they target just one of potentially many mechanisms for the condition. Researchers have successfully used genetics to identify specific pathways that appear to increase the risks of developing dry AMD, with dozens of different genes found to be potential culprits. In just the past decade or so, at least six different pathways that could contribute to the onset of dry AMD have also been uncovered.

One relatively recent development includes the discovery that the mitochondria, the cell’s center for generating energy, is compromised in the RPE cells early in the disease, which could indicate a potential pathological event contributing to dry AMD onset. Cell culture models are replicating the findings, and further investigation points to a specific population that carries the complement factor H risk allele and appears more susceptible to mitochondrial disruption.

In addition to exploring the mitochondrial factor, researchers are working to understand other risk alleles and the biology behind them. By understanding the biological processes that go awry early on in dry AMD, investigators should be able to develop more targeted therapies. Further, coupling scientific research with the frontline experience of ophthalmologists can help to identify and understand which pathway is impacting a particular patient so that treatment can be tailored to achieve the best possible outcome. Even with wet AMD, the available treatments are not effective in all patients, which suggests that the remedies are overlooking a key mechanism in some individuals.

Research progresses amidst challenges

The scientific community has persisted in advancing dry AMD research, although this particular disease presents some challenges. Genetics is only one piece of the puzzle. Environmental factors also play a role for individuals, as a history of smoking or poor diet, for instance, can elevate the danger of developing dry AMD. And because AMD is an age-onset disease, it may be near impossible to pinpoint what, in a 50- or 60-year lifetime, set an individual on their path to disease.

Animal models representative of the human condition are highly valuable in medical research, but AMD researchers are hard-pressed to find a close approximation due to the unique features of the human eye and the contribution of aging. To maintain momentum in their field, AMD researchers are turning to different types of cultured cells. Induced pluripotent stem cells (iPSCs) are a somewhat recent innovation and have shown considerable potential.

Mature cells are taken from an adult, and those cells have their development reversed to the point at which they become like a fetal cell. At that juncture, they can be differentiated into any cell in the body, including RPE cells, and be studied in a dish to learn AMD’s underlying pathophysiology and identify potential treatments. Future progress with iPSCs include using patient-specific cells to identify the optimal treatment for each patient, possibly opening the door to personalized medicine — the Holy Grail of medicine by some estimations. 

For AMD researchers, one of the most valuable sources for IPSCs are eye banks, where people have donated their eyes to medical research. Scientists have made major discoveries from accessing and comparing eyes of those individuals with AMD to those without the disease. In addition to studying the tissues itself, researchers can generate critical iPSCs from the donations, furthering the impact of the donation and moving investigators closer to new, effective therapies.

Pressing ahead with intention

Recent FDA approval of dry AMD therapies is encouraging, but the work is not done. Considering the genetic and environmental variations in the millions of patients currently and potentially coping with the disease, more than a one-size-fits-all approach will be needed to transform lives for the better. Researchers must continue to ask critical questions about cellular changes associated with aging, factors that influence pathology, cellular responses to disease, and the potential to protect against pathologic changes. As such mysteries are unraveled, the scientific community will move closer to discovering groundbreaking therapies for this widespread, life-altering condition.

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AI builds on earlier computer vision efforts

Earlier efforts of applying computer vision techniques to analyze images involved creating a hard-coded algorithm containing rules that machines should follow in their search. While this method has worked well in many cases, where it fails is in cases that are outliers or are presented in a manner inconsistent with what models have been told to seek. To capture those types of instances, it would be necessary to revise the algorithm by writing new sets of rules as scenarios arise — an arduous and time-consuming process.

With AI-based approaches, researchers can feed thousands upon thousands of images to a system that will review and sort all the data it comes across, allowing it to detect patterns and to generalize. It is not foolproof, as encountering a not-yet-seen image will require some intervention to confirm whether that image should be added to a database, but this adjustment is relatively simple and allows AI to refine its learning quickly and serve as a more valuable, timely resource with compelling potential for patient care.

Medical AI algorithm offers clarity

Already, one of the first FDA-cleared medical AI algorithms is making a life-changing impact for patients around the world. A collaboration between Doheny Eye Institute and Eyenuk, leveraging NIH-sponsored grants, has resulted in a new screening system to detect diabetic retinopathy, a condition that can result in vision loss and blindness in people with diabetes. Screening is vitally important because 90% of diabetic blindness is preventable with timely detection and treatment.

For the AI screening tool, experts in image reading participated in algorithm development and training by furnishing annotated images of cases ranging from mild, non-proliferative retinopathy to the most severe stage of proliferative retinopathy. With the data input, the algorithm was trained to identify whether patients exhibited retinopathy that warranted a visit to an ophthalmologist to avoid future vision loss.

In the case of diabetic retinopathy, early stages of the condition may go unnoticed, or if the symptoms appear manageable, patients may postpone a visit to their physician. An AI screening tool offers the possibility of garnering greater compliance with recommendations for regular assessment. Capturing an image of the eye at a primary care physician’s office or even on a smartphone at home and sharing it with AI in the cloud for an immediate diagnosis could promote early detection and, hopefully, prevent blindness.

Similar work is being conducted in the area of age-related macular degeneration (AMD). Algorithms are being developed to detect features in patients with AMD to help physicians identify those who may be at high risk of progression to more advanced stages. The information can assist doctors in closer monitoring of at-risk individuals and in developing a treatment course.

Adding another tool to the toolbox

The advent of AI has ushered in countless conversations about the technology’s impact — good and bad — and the medical field has certainly not been immune to the debates. For one, AI is not perfect, and it can and will make mistakes. It’s necessary to consider the output of large language models that have generated hearsay or misinformation, and human experts must approach any output with a healthy dose of skepticism and be unafraid to challenge results.

Additionally, the application of any new technology, like AI, may result in unintended consequences. Should medical AI models become widely available, there is a risk that those without proper credentials may try to use them to make decisions, or to question decisions, which are best left to licensed medical professionals. AI models can provide actionable knowledge, but they will lack the broader context of a patient’s circumstances, values and conditions that their physicians should understand and consider in a holistic treatment plan.

If harnessed with care, AI has the ability to provide medical professionals with another tool to elevate patient care. Each case is unique and deserves a personalized approach, and AI may help doctors optimize their selection of treatment options. Physicians could leverage information furnished by AI, such as from clinical trials, and compare it alongside an individual’s characteristics to arrive at a care approach with the best chance for success.

AI is poised to be instrumental in the decision-making process for physicians, but ultimately, it cannot replace the human element. Medicine is much more than determining a diagnosis, and tough discussions and difficult decisions require empathy that only another human being can provide. With AI as an assistive tool, it opens the door for physicians to access more information and context to aid in making treatment recommendations and ultimately help improve their patients’ outcomes.

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Approximately 45 million individuals in the United States wear contact lenses. Two out of three people using contact lenses are female. In the USA, contact lenses are medical devices regulated by the Food and Drug Administration (FDA) through the Federal Food, Drug, and Cosmetic Act.

What Are “Forever Chemicals?”

PFAS, or per- and polyfluoroalkyl substances, are a group of artificial chemicals used in various products for decades. They are known for their water- and stain-resistance and are in products like nonstick cookware, stain-resistant fabrics, carpets, firefighting foam, and food packaging.

PFAS are very persistent in the environment, meaning they do not break down easily and can accumulate in the body over time. Exposure to PFAS has been linked to several health problems, including cancer, thyroid disease, reproductive problems, and immune system suppression.

In recent years, there has been growing concern about the health risks of PFAS. In 2016, the United States Environmental Protection Agency (EPA) issued a health advisory for PFOA and PFOS, two of the most common PFAS chemicals. The advisory set a limit of 70 parts per trillion (ppt) for PFOA and PFOS in drinking water.

Regulating PFAS

Since then, many states have taken steps to regulate PFAS. In 2020, New York became the first state to ban PFAS in food packaging. Other states, such as California and Minnesota, have set limits on the levels of PFAS in consumer products.

The EPA is currently developing a national strategy for addressing PFAS contamination. The agency is expected to release a draft plan in 2023.

If you are concerned about your exposure to PFAS, you can take steps to reduce your risk. These steps include:

• Avoiding products that contain PFAS, such as nonstick cookware and stain-resistant fabrics.
• Drinking filtered water, especially if you live near a Superfund site or other area where PFAS contamination is known to exist.
• Eat organic foods, as PFAS are often used in conventional farming practices.
• Getting your blood tested for PFAS levels.

PFAS are “forever chemicals” because they don‘t naturally break down.

Contact Lenses and Cancer: New Research

American researchers tested 18 pairs of soft contact lenses to see if they contained PFAS. More than half were daily lenses. The tests looked for traces of organic fluorine in lenses by brands Acuvue, Alcon, and Coopervision. Let’s look at the disturbing results:

Researchers detected fluorine levels (in contact lenses) between 105 parts per million (ppm) to 20,700 ppm. All tested contact lenses exceeded 100 ppm, equivalent to 100,000,000 ppt, or 50,000 times higher than the maximum level deemed safe in drinking water by the US Environmental Protection Agency.

Here are the lenses with the highest amounts of organic fluorine: Alcon Air Optix (No Hydraglide) for Astigmatism (20,000ppm), Alcon Air Optix Colors with Smartshield Technology (20,700ppm), and Alcon Total30 Contact Lenses for Daily Wear (20,400ppm).

Key Points — Contact Lenses and Cancer: Is There a Connection?

Question. Do contact lenses contain dangerous substances?

Findings. Fluoropolymers are described as PFAS or “forever chemicals,” and some contact lenses are found to have extremely high levels of organic flueronic, a marker of PFAS, in each.

Meaning. Fluoropolymers are PFAS or “forever chemicals.” Some contact lenses have extremely high levels of organic flueronic, a marker of PFAS. Still, we cannot leap to say that the high levels of the substance influence the health of contact lens wearers. The study authors present no evidence of harm. I look forward to epidemiologic studies.

I want to remind the reader that not having good contact lens hygiene increases the risk of serious eye infections. Serious eye infections that can lead to blindness affect up to one out of every 500 contact lens users annually.

This number should get your attention: Upwards of 40 to 90 percent of contact lens wearers do not follow the care instructions for their contact lenses. Moreover, 99 percent of users report one or more contact lens hygiene behavior previously associated with an increased risk of eye infection or inflammation.

The forever chemical data raises concerns, but proper contact lens hygiene is immediately actionable. To my knowledge, there is no high-level evidence linking contact lens use to cancer.

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In summary, those with AMD have a higher risk for COVID-19 infection and severe disease. This increased risk has a genetic basis.

What is macular degeneration?

Age-related macular degeneration (AMD) is an eye condition that can worsen over time. AMD is the leading cause of severe, permanent vision loss in older individuals.

The macula wears down in AMD. The retina is the nerve tissue — at the back of the eye — that senses light.

AMD occurs when the small central portion of your retina, the macula, wears down. The retina is the nerve tissue that senses light and is at the back of your eye.

Below are fundus photographs of the right eye (top image) and left eye (bottom image), seen from the front so that the left in each image is to the person’s right. The gaze is on the camera, so the macula is in the center of the image in each picture. The optic disc is towards the nose.

Because AMD occurs with increasing age, it is often called age-related macular degeneration. While AMD doesn’t usually cause blindness, it might cause severe visual loss.

Another macular degeneration form (Stargardt disease or juvenile macular degeneration) affects children and young adults.

COVID-19 and macular degeneration

Scientists have discovered a genetic link between COVID-19 infection and age-related macular degeneration.

COVID-19 and AMD are associated with variations in the PDGFB gene. This gene has a role in new blood vessel formation (and is linked to abnormal blood vessel changes that occur with age-related macular degeneration).

Researchers analyzed genetic data from over 16,000 individuals with age-related macular degeneration, more than 50,000 people with COVID, and control groups. Here is Boston Univerity researcher Lindsay Farrer, Ph.D., chief of biomedical genetics, speaking in a news release:

“Our analysis lends credence to previously reported clinical studies that found those with AMD have a higher risk for COVID-19 infection and severe disease, and that this increased risk may have a genetic basis.”

Prior research showed that those with AMD have a 1.25 times increased risk of respiratory failure or death due to COVID, which is higher than other well-known risk factors such as type 2 diabetes (21 percent) or obesity (13 percent), according to the current researchers.

Reducing your AMD risk

I want to end with something actionable. How can you reduce your risk of getting age-related macular degeneration? The US Centers for Disease Control offers some tips:

• Tell your eye doctor about your family history.
• Get regular eye exams.
• Don’t smoke.
• Have a good cholesterol level

The Age-Related Disease Studies found that getting certain vitamins and minerals every day may slow the progression of the disease from the early or middle stages to the later stages. Specifically, combinations of the following vitamins can reduce the risk of late AMD by one quarter (25 percent):

• Vitamin C
• Vitamin E
• Beta-carotene
• Zinc
• Copper

Green, leafy vegetables contain large amounts of many of these vitamins. For those with AMD progression to later stages, therapeutic interventions may include laser treatment or injections.

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Glaucoma is a group of optic nerve-damaging eye conditions. The optic nerve transmits visual information from your eye to the brain. Optic nerve damage is often associated with high pressure in the eye (as is often the case with glaucoma). Still, glaucoma can occur even if you have normal eye pressure.

While glaucoma can occur at any age, it is more common among older adults. The disease is a leading cause of blindness for people over age 60.

Today we explore a United Kingdom study that explores the relationship between insufficient sleep and glaucoma risk.

Glaucoma basics

Glaucoma worsens over time and tends to run in families. Glaucoma can lead to permanent vision loss or blindness within a few years if the damage worsens.

Most individuals have no early symptoms (such as pain or visual loss). By regularly visiting your eye doctor, you are more likely to diagnose and manage glaucoma before you have a long-term visual loss.

Once the vision is lost, you cannot recover it. However, lowering eye pressure may help you keep the vision you have. Fortunately, most individuals with glaucoma who are diligent about regular eye examinations and follow their treatment plan will retain their vision.

Glaucoma causes

Normally, our eye’s fluid (or aqueous humor) flows out of the eye through a mesh-like channel. The fluid can build up if the channel is blocked (or if the eye produces too much fluid). Unfortunately, we don’t know the cause of the blockage, but one can inherit risk.

Less common causes of glaucoma include:

• Eye injury (such as from a chemical or blunt trauma; uncommonly from eye surgery for another condition)
• Eye infection, severe
• Blood vessel blockage in the eye
• Inflammatory conditions
• Steroid medicines

Glaucoma typically affects both eyes but may be worse in one than the other.

Glaucoma types

According to WebMD, there are two main forms of the condition: open-angle and angle-closure glaucoma. Open-angle (wide-angle) glaucoma is the most common type. The eye’s drain structure (trabecular meshwork) looks normal, but the fluid doesn’t flow out as it should.

With acute or chronic angle-closure (narrow-angle) glaucoma, the eye doesn’t drain properly because the drainage space between your iris and cornea is too narrow. The result? A sudden buildup of pressure within the eye. Angle-closure glaucoma is associated with cataracts and farsightedness.

Less common types include normal-tension glaucoma, a condition with visual blind spots. Alternatively, the optic nerve is damaged, even though the intraocular pressure is normal. Some view it as a form of open-angle glaucoma.

Finally, pigmentary glaucoma involves very small pigment pieces from your iris (the colored portion of your eye) getting into the eye fluid and clogging the drainage canals.

Glaucoma risk factors

While glaucoma most commonly affects adults over 40, one can suffer from the disease at any age. African-Americans are more likely to suffer from the condition at a younger age and with more vision loss.

After cataracts, glaucoma is the leading cause of blindness in African Americans. The Glaucoma Research Foundation explains that many people are unaware that:

Glaucoma strikes earlier and progresses faster in African Americans. The glaucoma risk is 1.2-times higher if the condition runs in the family. Other factors putting African Americans at even greater risk include age over 40, extreme nearsightedness, high blood pressure, diabetes, and prolonged steroid use.

Glaucoma is five times more common among African Americans. Glaucoma-related blindness is roughly six times more common. Glaucoma often occurs at an earlier age in African Americans — on average, about ten years earlier than in other ethnic populations.

We don’t know why African Americans have a higher risk, but inherited genetics plays a role.

Other glaucoma risk factors include:

• African American, Russian, Irish, Japanese, Hispanic, Scandanavian, or Inuit ancestry
• Age over 40
• A family history of glaucoma
• You are nearsighted or farsighted.
• Poor vision
• Diabetes
• Steroid medications such as prednisone
• Certain bladder control or seizure drugs. Select over-the-counter cold medicines may raise the risk.
• Eye injury
• Corneas that are thinner than usual
• Hypertension, heart disease, diabetes, or sickle cell anemia
• High eye pressure

Glaucoma symptoms and diagnosis

Symptoms

Most individuals who have open-angle glaucoma do not have symptoms (unless the disease is late in its progression). The primary symptom is a loss of peripheral (side) vision.

Angle-closure glaucoma symptoms typically come on more rapidly and are more apparent. Because damage can quickly occur, if you have any of the following symptoms, please seek medical care: Visual loss; seeing halos around lights; eye redness; eye pain; an upset stomach or vomiting; a hazy-appearing eye (especially in infants).

Glaucoma diagnosis

Many have glaucoma and don’t know it. Regular eye exams are critical to catching glaucoma or other eye problems. Clinicians may perform a dilated eye exam to widen pupils and view the optic nerve at the back of the eyes.

Genioscopy involves an examination of the angle where the cornea and the iris meet. An ocular pressure test (tonometry) measures eye pressure, while optical coherence tomography (OCT) searches for changes in the optic nerve.

Other approaches include pachymetry to measure corneal thickness and a visual acuity test (eye chart) to look for vision loss. A slit lamp exam examines the inside of your eye with a special microscope known as a slit lamp. Finally, a visual field test (perimetry) looks for peripheral vision changes.

Sleep insufficiency and glaucoma

A new research study illustrates an association between poor sleep and glaucoma. The study drew on a database of over 400,000 individuals (in the UK Biobank) to explore links between sleep and vision loss.

The study looked at sleep behavior, including too much, too little, insomnia, daytime sleepiness, snoring, and being a “morning lark” or “night owl.” The study defined normal sleep duration as seven to nine hours. After tracking the health and lifespan of the participants until the first diagnosis of glaucoma, death, emigration, or end of monitoring in 2021, researchers identified 8,690 glaucoma cases.

Here are the results:

Frequent daytime sleepiness was associated with a 1.2-fold higher risk for glaucoma. The risk rose 1.12-times with insomnia and 1.08-times with short or long sleep duration. Snoring was associated with a 1.04-fold higher risk.

Compared with those without glaucoma, participants with the condition tended to be male and older, and have high blood pressure, diabetes, or smoking history.

The risk increases associated with insufficient sleep appear to be relatively small. In addition, the researchers do not establish causality.

The researchers note that glaucoma might influence sleep patterns rather than vice versa. They also offer some possible biological explanations for the association. The internal pressure of the eye rises when we lie down or when sleep hormones are off (as happens with insomnia).

Furthermore, anxiety and depression (sometimes associated with insomnia) may increase eye pressure, possibly due to dysregulated cortisol stress hormone production.

Alternatively, repeated episodes of low oxygen secondary to sleep apnea may also damage the optic nerve.

I want to use this new research as a springboard to talking about glaucoma. Here are some steps from the Mayo Clinic that may allow you to detect and manage glaucoma early, hopefully preventing visual loss (or slowing its pace).

• Get regular eye examinations. Generally, the American Academy of Ophthalmology suggests an eye exam every five to 10 years if you are under age 40; every two to four years if you are 40 to 54; every one to three years if you are 55 to 64, and every year or two if you’re older than 65.
• You’ll need more frequent screening if you have a higher risk of glaucoma. Ask your healthcare provider to guide you to an appropriate screening program.
• Know your family’s eye health history. Glaucoma tends to run in families.
• Wear eye protection. Serious eye injuries can cause glaucoma. Please wear appropriate eye protection when you play sports or use power tools.
• Take prescribed eye drops regularly, as directed (even if you have no symptoms).

Other tips

Finally, don’t smoke, and watch your caffeine intake. The latter can increase your eye pressure. Elevate your head when you sleep, for example, with a wedge pillow to lower eye pressure.

Learn more here about glaucoma:

Glaucoma

Glaucoma is a condition that damages your eye’s optic nerve. It gets worse over time. It’s often linked to a buildup of…

www.webmd.com.

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