Glaucoma screening

Screening in primary care. USPSTF's I statement covers adults 40 or older seen in primary care with no signs or symptoms of open-angle glaucoma, and leaves the decision to the clinician for each patient. It names who is at higher risk: "Risk factors for POAG include older age, family history, and Black or Hispanic/Latino race or ethnicity." Even so, it "did not find adequate evidence on screening in these higher-risk groups," so the I statement applies to them as well.

An eye exam by an ophthalmologist. AAO recommends a baseline comprehensive medical eye evaluation at 40 for adults without signs of eye disease or risk factors for it who have not had one. After that, with no risk factors: every 2 to 4 years from 40 to 54, every 1 to 3 years from 55 to 64, and every 1 to 2 years from 65. With risk factors for glaucoma, AAO sets every 1 to 3 years from 40 to 54 and every 1 to 2 years from 55: shorter than the standard schedule before 65, and the same from 65. AAO's two 2025 guidelines name those risk factors in lists that do not match. The eye-exam guideline lists diabetes, older age, family history, Black race and Latino/Hispanic ethnicity. The glaucoma guideline's groups for targeted screening are older adults, people with a first-degree relative with glaucoma, Black or Hispanic individuals, and people whose social and economic circumstances limit their access to care; it does not name diabetes. If you have diabetes, the same AAO eye-exam table sets a separate yearly diabetic eye exam, starting at diagnosis for type 2 diabetes and 5 years after onset for type 1.

Do not wait for a schedule if you have symptoms. USPSTF's statement does not apply to adults who have reported signs and symptoms of vision loss. AAO's patient site says open-angle glaucoma gives no warning signs early, and that blind spots develop in side vision as it progresses. Angle-closure glaucoma is different. AAO lists the signs of an attack as severe pain in the eye or forehead, eye redness, decreased or blurred vision, seeing rainbows or halos, headache, nausea and vomiting, calls it "a true eye emergency," and says to call your ophthalmologist right away.

Medicare covers glaucoma screenings "Once every 12 months" for people it counts as high risk: diabetes, a family history of glaucoma, African American and 50 or older, or Hispanic and 65 or older. That is a coverage rule; neither body on this page uses those ages as screening ages.

The exam AAO recommends is an office visit with an ophthalmologist, not a single test. Among the parts its 2025 eye-exam guideline lists are a visual acuity check with your current glasses or contacts, an eye pressure measurement, for which it calls a contact applanation method, typically a Goldmann tonometer, the most accurate, and an examination of the retina and optic nerve. It says the structures behind the iris are best examined through a dilated pupil.

AAO's patient site lists the parts of a complete glaucoma exam in plain terms: measuring eye pressure, inspecting the eye's drainage angle, examining the optic nerve for damage, testing side vision, taking a picture or computer measurement of the optic nerve, and measuring the thickness of the cornea.

On screening methods, AAO's glaucoma guideline says measuring pressure is not an effective way to screen populations, and that pairing a structural assessment of the optic nerve with visual field testing likely gives better sensitivity and specificity. One visit is often not the end. AAO notes that a person suspected of glaucoma at one visit may return for more pressure readings, gonioscopy, corneal thickness measurement, visual field testing and imaging of the optic nerve and retina before the diagnosis is confirmed.

Two labels can follow an abnormal finding. The first is glaucoma suspect. AAO's 2025 Primary Open-Angle Glaucoma Suspect guideline gives that label to someone with consistently elevated eye pressure (ocular hypertension), a suspicious-looking optic nerve, thinning of the nerve fiber or ganglion cell layers on imaging, or a visual field defect that looks suspicious, in either eye or both. Not every suspect is treated: AAO says the decision depends on the pressure level and other risk factors, and that for a suspect who does start treatment a reasonable first target is a 20% reduction in eye pressure, based on the Ocular Hypertension Treatment Study.

The second is primary open-angle glaucoma itself. AAO states that clinical trials show lowering eye pressure reduces the risk of developing the disease and slows its progression, and that laser, medication and incisional surgery are all effective ways to lower it. Its reasonable initial goal is a pressure 20% to 30% below the starting level. USPSTF describes the same aim: treatment starts by lowering pressure, even in people whose pressure was not elevated.

Treatment protects the vision that is left. AAO's patient site says glaucoma damage is permanent, and that once you take glaucoma medication you can expect to see your ophthalmologist about every 3 to 6 months, varying with your treatment needs. A diagnosis also carries the cost USPSTF lists among the harms of screening: some people diagnosed and treated would never have progressed to visual impairment.