Glaucoma Risk Factors: Who Is Most at Risk and What to Do Next

You came here to answer one thing: am I likely to get glaucoma? Fair question. Glaucoma steals sight quietly, and by the time you notice, damage is baked in. The good news: most of the risk comes from a handful of clear patterns-age, family background, eye pressure, and certain meds. This guide gives you the short list, helps you judge your own risk today, and tells you exactly when to book an eye test and which tests matter.

• Big risks: getting older (especially 40+), a parent or sibling with glaucoma, African or Caribbean heritage (open-angle), and East or Southeast Asian heritage (angle-closure).
• Medical flags: raised eye pressure, thin corneas, high myopia (short-sighted), narrow angles, diabetes, long-term steroid use, or past eye injury.
• Action now: if you’re 40+, get a baseline eye exam and repeat every 1-2 years; go yearly if you’re high risk.
• UK perk: in England, NHS sight tests are free if you’re 60+, have glaucoma, are 40+ with a first-degree relative affected, or have been told you’re at risk. Scotland provides free eye exams for all residents.
• Tests that matter: eye pressure (tonometry), optic nerve imaging (OCT), visual field testing, corneal thickness (pachymetry), and angle check (gonioscopy).

What actually raises your risk (and by how much)

Here’s the straight answer backed by the strongest evidence from the American Academy of Ophthalmology (Preferred Practice Pattern), NICE guideline NG81 on glaucoma (UK), the Ocular Hypertension Treatment Study, and The Royal College of Ophthalmologists. When people talk about glaucoma risk factors, they mean the mix below.

Age: risk climbs with each decade after 40. By 75, about 1 in 10 people in the UK have glaucoma or suspected glaucoma. The World Health Organization flags glaucoma as a leading cause of irreversible blindness worldwide, with cases rising as populations age.

Family history: a first-degree relative (parent, brother, sister, or child) roughly triples your odds for primary open-angle glaucoma. If a close relative was diagnosed early (before 50), consider yourself in a higher bracket.

Ethnicity and ancestry:

• African or Caribbean heritage: higher and earlier risk of primary open-angle glaucoma, and it can be more aggressive. Eye exams should start earlier and be more frequent.
• East and Southeast Asian heritage (including Chinese): higher risk of angle-closure glaucoma due to naturally narrower angles.
• South Asian heritage: risk sits between White and East Asian groups; watch both open-angle and angle-closure, especially with advancing age.

Eye pressure (IOP): higher pressure is the strongest modifiable risk. The Ocular Hypertension Treatment Study showed that people with raised pressure and thin corneas had the highest chance of developing glaucoma, and that lowering pressure cut that risk substantially.

Corneal thickness (CCT): thinner corneas (often defined around 555 microns or less) mean higher risk and make pressure readings look lower than they truly are. This is one reason pachymetry matters.

Refractive status:

• High myopia (strong short-sightedness, often −6.00 D or worse): linked with higher open-angle risk and can make optic nerve assessment trickier.
• Hyperopia (long-sightedness): more likely to have narrow angles, which raises angle-closure risk.

Eye anatomy and conditions:

• Narrow or occludable angles (your optometrist can tell you): risk of sudden angle closure.
• Pseudoexfoliation syndrome and pigment dispersion: both raise open-angle risk.
• Past eye injury (blunt trauma) or certain surgeries: can trigger secondary glaucoma months or years later.

Medical conditions:

• Diabetes: mild to moderate increase in open-angle risk; AAO and NICE flag it as relevant even if the link isn’t as strong as age or family history.
• Obstructive sleep apnoea: associated with glaucoma in several cohort studies; consider more frequent checks if you have OSA.
• Vascular dysregulation (e.g., migraine, Raynaud-type symptoms): possible increased vulnerability of the optic nerve.
• Low nocturnal blood pressure dips (often from aggressive BP treatment at night): linked in studies with progression-don’t change meds on your own, just discuss timing with your GP.

Medications and substances:

• Corticosteroids (tablets, inhalers, skin creams, joint injections, and especially eye drops): can raise eye pressure; the risk rises with dose and duration, plus personal steroid responsiveness.
• Topiramate (for migraines or seizures): rare but notable risk of secondary angle closure, especially early in treatment.
• Anticholinergics and adrenergic agents (some decongestants, motion-sickness meds, urinary spasm drugs) can precipitate angle closure if your angles are narrow.
• Chronic cannabis: not a treatment. Any pressure drop is short-lived and comes with side effects; AAO advises against using it for glaucoma.

What doesn’t seem to drive risk in a big way? Long hours on screens, reading, or wearing contact lenses. Those don’t cause glaucoma.

Judge your risk in five minutes (step-by-step)

Use this quick self-check. It’s not a diagnosis. It’s a prompt to book the right exam at the right time.

1. Age and ancestry check
   Are you 40 or older? If yes, you’re in the age band where screening matters. If you have African/Caribbean heritage, start exams by 40. If you have East or Southeast Asian heritage, ask specifically for an angle assessment.
2. Family history check
   Any parent, brother, sister, or child with glaucoma? That puts you in a higher bracket. If they were diagnosed young, push your first proper exam earlier.
3. Eye background
   Do you have strong glasses (very short- or long-sighted)? Ever told you have high pressure, thin corneas, narrow angles, pigment dispersion, or pseudoexfoliation? Have you had an eye injury? If yes to any, get an exam at least yearly.
4. Medical and meds check
   Diabetes? Sleep apnoea? Heavy night-time blood pressure drops? On steroids (inhalers, tablets, creams, injections) for more than a few weeks? On topiramate? These need closer monitoring.
5. Symptom check (don’t rely on this)
   Open-angle glaucoma usually has no early symptoms. Angle-closure can be dramatic: sudden eye pain, headache, blurry vision, haloes around lights, nausea. That’s A&E territory-go now.

Note: The UK National Screening Committee doesn’t run a population glaucoma screening programme (accuracy would be too variable), so regular eye exams are the route. NICE NG81 and The Royal College of Ophthalmologists recommend targeted testing with tonometry, optic nerve assessment, OCT and visual fields, pachymetry, and gonioscopy where indicated.

What to expect at the eye exam (and which tests matter)

Good care follows a simple pattern: measure pressure, look at the optic nerve, map your visual field, and understand your anatomy.

• Tonometry: measures eye pressure. It’s one piece of the puzzle, not the whole story.
• Optic nerve assessment: your optometrist or ophthalmologist looks at the nerve head for thinning or notching.
• OCT (optical coherence tomography): scans the nerve fibre layers and ganglion cells for early loss before you notice vision changes.
• Visual fields (perimetry): checks for the classic blind spots that creep in from the side.
• Pachymetry: measures corneal thickness to help interpret pressure readings and risk.
• Gonioscopy or anterior segment imaging: checks if your angles are open or narrow. Crucial if you’re East/Southeast Asian, hyperopic, or have symptoms suggestive of angle issues.

How often to test?

• Low to moderate risk: every 1-2 years after 40, sooner if your optometrist advises.
• High risk or on steroids: yearly at minimum; sometimes every 6-12 months.
• Known ocular hypertension or early glaucoma: follow the plan from your clinic; pressure targets are individual.

UK specifics in 2025:

• England: NHS sight tests are free if you’re 60+, have glaucoma, are 40+ with a close relative with glaucoma, have diabetes, or have been advised by an ophthalmologist. Otherwise, it’s a private fee at the optician.
• Scotland: eye examinations are free for all residents at set intervals; frequency increases if risk is higher.
• Wales and Northern Ireland: enhanced eye care schemes exist; many high-risk patients qualify for NHS-funded exams-ask your local optician.

What you can change (and what you can’t)

You can’t change your age, ancestry, or family history. You can reduce avoidable risks and catch problems early.

• Review steroids: if you’re on long-term steroids (inhaled for asthma, creams for eczema, joint injections, eye drops), ask your GP or specialist if the dose can be minimised and arrange regular eye pressure checks.
• Know your angles: if you’re told you have narrow angles, learn the red-flag symptoms of angle closure and ask whether preventive laser (iridotomy) makes sense for you.
• Exercise: regular aerobic activity is linked with slightly lower eye pressure and better vascular health. Aim for brisk walking most days unless told otherwise by your doctor.
• Blood pressure timing: if you feel woozy at night and have progressive glaucoma despite good daytime pressure, speak to your GP. Night-time dosing might be worth reviewing.
• Sleep apnoea: if you snore, wake unrefreshed, or stop breathing at night (a partner often spots this), get assessed. Treating OSA helps general health and may help your eyes.
• Caffeine and hydration: very large caffeine hits can bump pressure transiently. Spread your coffee out and avoid big fluid chugs in one go if you have known glaucoma.
• Cannabis: not a treatment path. Effects are short, and the downsides outweigh the brief pressure dip according to AAO.

Red flags that need urgent care now (same day): sudden severe eye pain, headache, blurred vision, haloes around lights, nausea or vomiting, or a red hard eye with worsening vision. That’s angle-closure territory-go to urgent eye care or A&E.

Real-world scenarios and action plans

Scenario 1: You’re 28, very short-sighted (−7.00 D), no family history. Your move: book a full eye exam every 1-2 years and make sure the optometrist does OCT and visual fields at least periodically. Flag your myopia as a risk.

Scenario 2: You’re 52, of Black Caribbean heritage, and your mother has glaucoma. Your move: go yearly. You qualify for an NHS sight test in England given family history at 40+, and you should have OCT, visual fields, pachymetry, and a careful optic nerve check. If pressure is borderline, don’t wait-consider referral to a glaucoma clinic.

Scenario 3: You’re 67, White British, told you have thin corneas and “pressure a bit high.” Your move: you’re high risk. Expect regular OCT and visual fields and probably a pressure target set by a clinic. Treatment to lower pressure (drops, laser) reduces the chance of damage.

Scenario 4: You’re 45 with moderate eczema using potent steroid creams most days, plus a steroid inhaler for asthma. Your move: keep the steroids you need, but schedule eye pressure checks every 6-12 months. Ask if you can pulse or step down the steroid strength without flares.

Scenario 5: You’re 35, started topiramate two weeks ago for migraines, and now have blurred vision and haloes. Your move: urgent eye care today. This can be a drug-induced angle closure. Don’t wait for it to pass.

Scenario 6: You’re 74 with type 2 diabetes, no eye symptoms. Your move: you’re eligible for NHS sight tests and diabetic eye screening, but remember, diabetic screening photos aren’t glaucoma tests. Keep separate glaucoma checks yearly.

FAQ

Is glaucoma preventable? You can’t change your baseline risk, but you can lower pressure if it’s high and catch damage before it affects daily life. That’s what exams are for.

Can I tell at home if I’m getting glaucoma? Not reliably. Open-angle glaucoma is silent early. Home tonometers and phone apps aren’t a replacement for OCT, fields, and a trained look at the nerve.

Do blue-light glasses help? No effect on glaucoma risk.

Does LASIK cause glaucoma? LASIK doesn’t cause glaucoma, but it thins the cornea flap, which can make pressure readings look lower. If you’ve had LASIK, tell your optometrist so they interpret IOP correctly.

Do blood pressure tablets worsen glaucoma? Not directly. Very low night-time blood pressure can be an issue in some patients. Don’t change doses yourself-discuss timing with your GP.

Are children at risk? Childhood glaucoma exists but is rare. If there’s a strong family history of early-onset disease, paediatric referral is appropriate.

How strong is the diabetes link? Modest compared to age, family history, and pressure, but enough that guidelines list it as a risk. Keep up both diabetic screening and glaucoma checks.

What about migraine? It’s a possible vascular risk signal, especially with cold hands/feet patterns, but it’s not a primary driver like high pressure.

Next steps

• If you’re 40-59 with no clear risk: book a comprehensive eye exam every 1-2 years. Ask for pressure measurement, optic nerve assessment, and, if available, OCT.
• If you’re 60+: plan yearly exams. In England, you’re eligible for an NHS sight test.
• If you have a first-degree relative with glaucoma or you’re of African/Caribbean heritage: go yearly from age 40, sooner if advised.
• If you have East or Southeast Asian heritage or you’re long-sighted: ask specifically for an angle assessment (gonioscopy). Learn angle-closure red flags.
• If you’re on long-term steroids or topiramate: tell your optometrist and arrange regular pressure checks. Seek urgent care for sudden pain, blurred vision, or haloes.
• If you’ve been told you have raised pressure or thin corneas: stick to follow-up plans; lowering pressure reduces risk of vision loss.

Sources behind the guidance: AAO Preferred Practice Pattern for Primary Open-Angle Glaucoma; NICE NG81: Glaucoma: diagnosis and management; The Royal College of Ophthalmologists clinical statements; Ocular Hypertension Treatment Study and the European Glaucoma Prevention Study; UK National Screening Committee statements on glaucoma; WHO World Report on Vision. These bodies align on who’s at risk and the tests that matter.