Glaucoma in the Fraser Valley: Symptoms, Risks & When to See a Specialist

Glaucoma is one of the leading causes of irreversible blindness worldwide — and yet, for the majority of people who have it, there are no symptoms until a meaningful amount of vision has already been permanently lost. In the Fraser Valley, where a large and growing South Asian community faces elevated glaucoma risk, understanding this disease and accessing specialist care early is critically important. This article explains what glaucoma is, who is most at risk, and what you should do if you're concerned.

What Is Glaucoma?

Glaucoma is a group of eye diseases in which the optic nerve — the cable that transmits visual information from the eye to the brain — is progressively damaged over time. In most cases, this damage is caused or worsened by elevated pressure inside the eye (intraocular pressure, or IOP). The optic nerve contains over a million nerve fibres, and once damaged, they cannot regenerate.

The most common form in adults is primary open-angle glaucoma (POAG). The "angle" refers to the drainage angle of the eye, where fluid produced inside the eye (aqueous humour) flows out. In open-angle glaucoma, this drainage system functions but works inefficiently, causing pressure to build gradually. There is no pain, no redness, and initially no change in central vision. The damage begins in the peripheral visual field — the outer edges of sight — and slowly encroaches inward. By the time most patients notice anything is wrong, a significant portion of optic nerve fibres may already be gone.

Who Is at Risk?

While glaucoma can affect anyone, certain factors significantly increase your likelihood of developing it. Understanding your personal risk profile is the first step toward appropriate screening:

• Age: The risk of glaucoma increases substantially after age 40 and continues to rise with each decade. Regular eye exams are particularly important for older adults.
• Family history: Having a first-degree relative (parent, sibling) with glaucoma increases your risk three to nine times. If someone in your immediate family has been diagnosed, you should be screened proactively.
• Elevated intraocular pressure (IOP): The most important modifiable risk factor. Higher eye pressure increases the likelihood of optic nerve damage, though it is important to note that some people develop glaucoma at normal pressure levels (normal-tension glaucoma), and some people have elevated pressure without glaucoma (ocular hypertension).
• South Asian ethnicity: This is especially relevant for Fraser Valley patients. Research consistently shows that individuals of South Asian descent have an elevated prevalence of primary open-angle glaucoma and normal-tension glaucoma compared to the general European-descent population. Studies have found that South Asian individuals may also develop glaucoma at lower intraocular pressures, meaning standard pressure-based screening thresholds may be less reliable for this community. The Fraser Valley has one of the largest South Asian populations in British Columbia — patients of South Asian background should discuss glaucoma screening with their family doctor earlier than standard population guidelines suggest.
• African descent: Individuals of African ancestry have a significantly higher prevalence and earlier onset of primary open-angle glaucoma, often with more aggressive progression.
• High myopia (nearsightedness): People with moderate to severe myopia (short-sightedness) have a structurally thinner optic nerve head that is more vulnerable to pressure-related damage.
• Thin corneas: Central corneal thickness (CCT) affects how accurately intraocular pressure is measured. Thinner corneas are associated with higher glaucoma risk independently of measured IOP.
• Diabetes and cardiovascular disease: Both conditions affect blood flow to the optic nerve and are associated with elevated glaucoma risk.
• Long-term corticosteroid use: Steroid eye drops, inhaled steroids, and oral steroids can all cause steroid-induced elevation of eye pressure in susceptible individuals.

Symptoms to Watch For

The honest answer is that primary open-angle glaucoma — the most common type — typically causes no symptoms in its early and moderate stages. This is what makes it so dangerous. By the time patients notice their peripheral vision is impaired, the optic nerve damage is already advanced.

That said, there are some warning signs worth knowing:

• Gradual loss of peripheral (side) vision, usually in both eyes
• Tunnel vision in advanced stages — a sense that you can only see straight ahead
• Halos around lights, particularly at night (more typical of angle-closure glaucoma)
• Eye pain and sudden blurred vision (hallmarks of acute angle-closure glaucoma — a medical emergency)

Acute angle-closure glaucoma is less common but is a true emergency. It occurs when the drainage angle becomes suddenly blocked, causing a rapid and severe spike in eye pressure. Symptoms include sudden, severe eye pain, nausea, vomiting, sudden blurred vision, and coloured halos around lights. If you experience these symptoms, go to a hospital emergency department immediately.

When to Ask for a Referral

Given that glaucoma is typically asymptomatic, the most important trigger for a referral is not waiting for symptoms — it's acting on risk factors and screening findings. You should ask your GP or optometrist for a referral to an ophthalmologist if:

• Your optometrist has noted elevated intraocular pressure (above 21 mmHg) at any routine exam
• Your optometrist suspects optic nerve cupping or a suspicious-looking optic disc
• You have a first-degree family member with glaucoma
• You are of South Asian or African descent and have not had a glaucoma assessment after age 40
• You have been on long-term steroid medications
• You experience any of the acute symptoms described above

What Happens at Your Ophthalmology Appointment

When you see Dr. Sundaram for a glaucoma assessment, the examination is more comprehensive than a standard eye test at an optometrist's office. It typically includes:

• Intraocular pressure measurement (tonometry): Usually performed with a Goldmann applanation tonometer, the gold standard for accuracy.
• Optic nerve evaluation: The optic disc is examined at the slit lamp with a special lens. Dr. Sundaram will assess the cup-to-disc ratio and look for signs of nerve fibre layer loss or disc haemorrhages.
• OCT (Optical Coherence Tomography): A non-invasive laser scan that maps the thickness of the retinal nerve fibre layer (RNFL) and the ganglion cell layer with high precision. This is one of the most sensitive tools for detecting early glaucomatous damage and for tracking progression over time.
• Visual field testing (perimetry): Automated perimetry maps the sensitivity of your visual field, detecting areas of loss that correspond to optic nerve damage. Even subtle changes can be detected before you notice them subjectively.
• Gonioscopy: An examination using a special contact lens to directly view the drainage angle and classify the type of glaucoma.
• Central corneal thickness (pachymetry): Measures corneal thickness, which affects IOP readings and independently influences glaucoma risk.

Treatment Options Available Locally

The cornerstone of glaucoma management is reducing intraocular pressure — even in normal-tension glaucoma, lowering IOP further slows disease progression. Treatment options include:

Eye Drops

Pressure-lowering eye drops are the most common first-line treatment. Several classes are available, including prostaglandin analogues (the most commonly used), beta-blockers, alpha agonists, and carbonic anhydrase inhibitors. Drops must be used consistently — typically once or twice daily — and adherence is critical. Forgetting doses allows pressure to fluctuate and accelerates nerve damage.

Laser Treatment (SLT)

Selective Laser Trabeculoplasty (SLT) is a quick, painless office procedure that improves aqueous drainage from the eye, reducing pressure. It is increasingly used as a first-line treatment and can reduce or eliminate the need for drops in many patients. The effect lasts for several years and can be repeated. Dr. Sundaram offers SLT for eligible glaucoma patients.

Minimally Invasive Glaucoma Surgery (MIGS)

A range of micro-surgical devices and procedures can lower eye pressure with a lower risk profile than traditional glaucoma surgery. Many MIGS procedures can be combined with cataract surgery, offering an efficient option for patients who have both conditions.

Trabeculectomy and Tube Shunts

For advanced glaucoma not adequately controlled with drops or laser, surgical procedures that create new drainage pathways or implant pressure-regulating devices may be recommended. These are performed in a hospital operating theatre and require close post-operative monitoring.

For physicians in the Fraser Valley looking to refer patients for glaucoma assessment or management, please visit our For Physicians page for referral details.