Glaucoma remains the main cause of irreversible blindness in Brazil

Glaucoma is still the main cause of irreversible blindness in Brazil. Approximately 350,000 Brazilians treat the disease annually with eye drops distributed by the Unified Health System (SUS), according to the Brazilian Council of Ophthalmology (CBO). Combined with surgical procedures, treatment has advanced, but challenges persist and keep the condition as a threat to eye health.

It is a progressive disease, caused in most cases by increased intraocular pressure when there are changes in circulation or blockages in the ocular fluid drainage channels. Over time, these processes damage the optic nerve and compromise vision. Although there is no cure, glaucoma is controllable if the diagnosis and medical follow-up are carried out correctly.

But reality shows that control is complex. A study conducted by researchers at Einstein Hospital Israelita and published in April in the scientific journal Clinical Epidemiology and Global Health analyzed data on glaucoma surgery in the SUS. The investigation identified that the number of procedures jumped from 18,500 in 2009 to 45,200 in 2024, an increase of 144%.

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This growth, however, is uneven. "Covering national demand still presents significant challenges", says ophthalmologist Carolina Engelbrecht, one of the authors of the article and researcher at the Center for the Study and Promotion of Health Policies (CEPPS), at Einstein. "Our study shows that the regional distribution of procedures is uneven, with the Southeast and North presenting higher proportional volumes of care than other regions."

In addition, there are deficits from a technological point of view. "We see the persistence of a considerable number of trabeculectomies, conventional surgery, which increased from 10,600 in 2009 to 18,600 in 2024", notes Engelbrecht. Today, however, there are methods that allow minimally invasive procedures.

"In developed countries, what we have seen is a reduction in the volume of trabeculectomies and an increase in minimally invasive procedures, which present less risk of complications", reports the ophthalmologist.

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In addition to surgery, recent advances have changed the treatment profile. There are eye drops, for example, designed to cause less eye irritation and combine more than one treatment component in the same solution.

Laser methods have also changed the dynamics of combating the disease by allowing treatment with less invasive procedures, which can be carried out in the office.

"Compared to 20 years ago, current techniques and treatments are more effective and safer. Adherence to treatment, however, remains a central challenge for health professionals", says the doctor and CEPPS researcher.

Gradually, however, Brazil is advancing. According to the CBO, the total number of glaucoma exams performed in the country jumped from 1.37 million in 2019 to 2.26 million in 2025, an increase of 65%. However, the evolution was not homogeneous: the Southeast led with an increase of 115%, while the Northeast recorded the lowest growth in the last five years, 36%. The disparities are so great that Pernambuco records 7,000 tests for every 100,000 inhabitants, while in the Federal District there are only 265 tests.

"The most common form of glaucoma occurs slowly and gradually. In these cases, the patient normally has no symptoms and this does not make them seek ophthalmological care", points out ophthalmologist Diego Monteiro Verginassi, also from Einstein. "In a country with inequalities in access to medical services and specialists, diagnosis often comes late."

For the president of the CBO, ophthalmologist Maria Auxiliadora Frazão, changing this panorama should involve authorities, managers, doctors and opinion makers. "It is not enough to raise awareness about the risk, we need to provide access to tests.

And not just access; It is necessary, after diagnosis, to form a network that offers treatment at the right time and with the correct monitoring", he emphasizes.

Risk factors and prevention
The ideal is, after the age of 40, to include investigation for glaucoma in routine exams. The risk is increased for people who have a family history of the disease, advanced age, high eye pressure, high myopia or who have used corticosteroids for a long time.

One of the least known risk factors is African ancestry. "In the black population, primary open-angle glaucoma is more prevalent, its onset is earlier, and the progression of the disease is faster and more resistant to treatments", indicates Verginassi. In these cases, it is even more important to maintain a regular check-up schedule.

The sooner the diagnosis is made, the greater the chance of total preservation of vision. "Assessing ocular pressure and the fundus are tests that provide us with important information. The key is to do your tests", advises the doctor.

Glaucoma: the danger that steals vision without warning and can be avoided

Source: CNN