Glaucoma
Glaucoma does not hurt. That is the problem.
Glaucoma takes sight from the outside in — so slowly that the brain fills in the gaps until it is too late. Lost visual field does not come back. Glaucoma that is found can almost always be halted. The difference is screening.
Three questions about glaucoma — and which one is yours right now
Glaucoma is not one question but a series of them, and they come in order: does this concern me at all? What is actually examined? And once the diagnosis has been made — what follows from it? This page answers the first two in full and, for the third, tells you where the complete answer lives. It is deliberately the way in rather than the whole text: if you already have a diagnosis, you should be one click from the right page, not ten paragraphs deep in this one.
Here without any symptoms? Then your question is from what age and how often an examination makes sense — the section below answers it briefly, and in more detail the page on the screening examination that finds glaucoma early. If the diagnosis has already been made, feel free to skip this page: how glaucoma is treated — with drops, with the SLT laser and with surgical pressure lowering — is set out with every intermediate step and side effect on its own sub-page.
Two confusions cost time regularly. The first is in the name: in German, glaucoma and cataract are both called 'Star', yet they are two different diseases. What a cataract is, and why its operation really can improve sight, you can read there — because with glaucoma exactly that does not hold. The second is in the measurement: a raised eye pressure is not yet a diagnosis. Why not, and what decides it instead, is further down this page.
And what is deliberately not here: a recommendation for a particular preparation or procedure. Which step is right for your eye is decided by the findings at the optic nerve and the anterior chamber angle — that conversation belongs in the consulting room. A suddenly hard, painful, red eye, incidentally, is something entirely different from slow-moving glaucoma; see the red box below.
Who should come for screening — and when
- Every two years from 40, annually from 60 — even with no symptoms at all.
- Earlier and more frequently if a parent or sibling has glaucoma: the risk is then markedly increased.
- With marked short-sightedness, diabetes or long-term steroid treatment — talk to us and we will set your interval.
What we examine
A serious glaucoma screening is more than a pressure measurement. We combine four findings into one judgement: intraocular pressure, the optic nerve head and retinal nerve fibre layer on high-resolution OCT imaging, the anterior chamber angle and — where indicated — the visual field. Only that whole picture separates reliably: healthy, needs monitoring, or needs treatment. The eye screening page tells you from what age and at what intervals that makes sense — along with the uncomfortable part: what early detection makes visible at the optic nerve, and what it can no longer bring back. If your optic nerve has never been assessed, book your glaucoma screening appointment online.
When treatment is needed
Treatment lowers the pressure in the eye — with drops, and in suitable cases with a gentle laser treatment, selective laser trabeculoplasty (SLT). If drops and laser are not enough, we discuss surgical options — and we also tell you when a procedure is better handled elsewhere. We do not begin lifelong treatment 'on suspicion': only when your optic nerve genuinely demands treatment do we demand it of you. After that: consistent monitoring against cleanly documented baseline findings — because with glaucoma the course is the diagnosis. What that monitoring uses, and how often it is needed, is set out on the overview page: OCT, visual field and the other eye examinations.
Acute angle-closure glaucoma:A suddenly hard, painful, red eye with loss of vision, often with headache and nausea — that is an emergency. Call us immediately:+41 44 500 69 00. If we suspect it, we see you the same day.
Eye pressure is not glaucoma — and why the difference matters
Two processes keep the eye in shape: supply and drainage. Aqueous humour forms without pause, and just as continuously it has to leave the eye again through the anterior chamber angle. If the drainage stalls, the pressure rises — and the optic nerve head does not withstand that added load in the long run. That is why pressure is the most important risk factor for glaucoma and at the same time the only lever a treatment has to pull. What it is not is the disease itself.
Finding and reading come apart in both directions. Where the value sits above the statistical norm while the optic nerve and the visual field stay unremarkable, this is called 'ocular hypertension': a risk that belongs under observation, and not a disease — monitoring can be the right decision here. The reverse case exists just as much: glaucoma can develop with unremarkable pressure readings too, so-called normal-tension glaucoma. Knowing the number alone therefore does not yet tell you where you stand.
On top of that, the number itself is a matter of interpretation. It fluctuates over the day, and the thickness of your cornea influences what the instrument shows. 'Normal' is therefore not a fixed value but a range set for your eye — depending on the starting pressure, the state of the optic nerve and the stage. That individual target pressure only becomes important once treatment begins: how a target pressure is set and the treatment measured against it is described on the treatment sub-page.
And because with glaucoma the course is the diagnosis, a single measurement counts for less than the series anyway. The first appointment lays down the baseline findings against which every later examination is compared; what is recorded then, and what you should bring for it, is under 'Your first appointment here' below.
How glaucoma relates to the other eye diagnoses
The German name misleads: 'Grüner Star' (glaucoma) and 'Grauer Star' (cataract) have nothing in common but the word. In a cataract the lens of the eye clouds over and sight goes dull — and the operation with an artificial lens really can improve visual acuity again; how a cataract makes itself felt and when it is operated on — all of that is on its own page. In glaucoma, by contrast, nerve fibres in the optic nerve are lost, and that tissue does not grow back. The two often occur in the same eye, and in selected cases they can even be dealt with in one sitting — whether that comes into question is decided by the chamber angle, the stage and the amount of pressure reduction needed. Who carries out the combined procedure, and where, we discuss with you beforehand.
Other diagnoses do not change the disease, but they do change your risk and with it your monitoring interval. Marked short-sightedness is one of them — from what point a myopia counts as high and what lies behind it is set out there. A narrow anterior chamber angle, more common in long-sighted eyes, is the anatomy on which an acute angle-closure attack becomes possible in the first place; what a narrow chamber angle means and why it should be assessed once is on the long-sightedness page. And steroids in any form — eye drops, ointments, nasal and asthma sprays, tablets — can raise the pressure inside the eye: tell us, and we monitor more closely instead of guessing.
Glaucoma is also not the only eye disease that stays silent at the start. A screening examination therefore does not ask how well you see, but what can be seen at the eye pressure, the optic nerve and the retina — glaucoma is only one of the findings that can turn up. The centre of the retina, for one, changes independently of whether anything is happening at the optic nerve; how age-related macular degeneration makes itself felt is on the AMD page — centre and edge do not exclude one another. With diabetes in turn, the finest retinal vessels change over years, without pain and often without any loss of sight: why the retina stays silent in diabetes and what the annual check finds is described on that page. And anyone who suddenly notices flashes, a shower of floaters or a shadow in the field of vision is asking a different question altogether: these signs belong in an examination the same day — not the weekend after. What is looked for then is set out in an overview of the warning signs at the retina and vitreous.
Finally, this risk belongs in a family conversation. Anyone with a parent or sibling who has glaucoma carries a markedly higher risk and should be examined earlier and more regularly — that is the only point on this page that helps somebody other than you. If the family history also touches children in your family, we work out with you what makes sense at what age; how children's eyes are examined at all is described in paediatric ophthalmology, with its own examination routes.
Your first appointment here: what to bring, and what is settled afterwards
A first glaucoma appointment is not a procedure and not a decision — it is a stocktake. Expect forty-five to ninety minutes if the pupil is to be dilated — and longer if additional examinations such as a visual field or an OCT scan of the optic nerve are added; the time goes on the measurements and on the conversation afterwards. What stands at the end is not a sales pitch but an assessment — and, where needed, an interval. Four things are worth packing or planning for:
- Earlier findings, if there are any. Visual fields and OCT scans of the optic nerve from other practices are worth more for the comparison than any new single measurement.
- All your eye drops in the original bottles, including those prescribed by other doctors. That way we see what is actually in the bathroom cabinet.
- Your other medicines and diagnoses. Heart, circulatory and asthma diagnoses help decide which class of pressure-lowering agent comes into question at all.
- A little time in reserve — and a way home that is not your own car. Whether the pupil has to be dilated is decided at the appointment; afterwards you see blurred at close range for several hours and are sensitive to glare. Very rarely, in an eye with a very narrow anterior chamber angle, dilation triggers an acute glaucoma attack: what to watch for in the hours afterwards and when to call at once is set out on the screening page.
One expectation we will clear up straight away: a sight test is not a glaucoma examination. It establishes how sharply you see — a pleasing number, but not a certificate of health. Glaucoma begins at the edge of the visual field and often leaves central acuity alone well into advanced stages; what a sight test measures and what it precisely does not show is on its own page.
What is settled afterwards: whether there is anything to see, whether we monitor or treat — and if we treat, with what aim. We do not begin lifelong treatment 'on suspicion'. And if you would like a second opinion on a proposal from elsewhere, that is a sensible request and not a delicate one: bring the earlier findings and we will assess it together — at one of our three sites in Zurich, Wetzikon and Meilen.
Costs & health insurance
What does the insurer pay for — and what not?
Glaucoma treatment is covered by insurance. And screening is cheaper than a glaucoma found too late, by orders of magnitude.
| Service | Coverage | What this means for you |
|---|---|---|
Assessment on suspicion / with symptoms | Basic insurance (OKP) | Fully covered. |
Follow-up checks & treatment | Basic insurance (OKP) | Drop treatment and medically indicated laser treatment are covered. |
Screening alone, with no symptoms | Partly self-pay depending on your model | We tell you before the appointment what to expect. |
Our promise:Before any treatment you receive a complete, itemised cost breakdown in writing — before you decide. Nothing is added to it afterwards.
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Medically reviewed by PD Dr. med. Andrea von Rückmann · Last reviewed
Frequently asked questions
- Because that is exactly what glaucoma counts on. The optic nerve dies gradually and painlessly; the brain fills in the growing gaps in the visual field until large parts are missing. What is lost does not come back. A screening examination from 40 — earlier with a family history — is the only way to find glaucoma before it finds you.
- We measure the pressure inside the eye, assess the optic nerve head and the retinal nerve fibre layer with high-resolution OCT imaging, examine the anterior chamber angle and — where needed — the visual field. Unremarkable? Then depending on your risk profile a check every one to two years is enough.
- Not necessarily. Raised pressure is the most important risk factor, but it is not a verdict: some people tolerate higher readings without harm, others develop glaucoma at normal pressure. What decides it is the state of the optic nerve — and that is exactly what we assess before beginning lifelong treatment.
- Often yes — and that is the uncomfortable truth we will not spare you: the treatment only works if it happens daily. If drops are not tolerated or are not enough, we discuss alternatives such as laser treatment openly. What we will not do is sell you a treatment your findings do not call for.
- No — but in the great majority of cases it can be controlled. The aim of treatment is to lower the pressure far enough that the optic nerve takes no further damage. With consistent treatment and regular monitoring, most people keep usable sight for life.
- In early and well-controlled stages, usually yes — what decides it is the visual field. We check the requirements relevant to driving at your follow-up and raise it openly, before the road traffic office does.
- Assessment on suspicion, follow-up checks and treatment are covered by basic health insurance. A screening examination on its own, with no symptoms, is partly self-pay depending on your insurance model — we tell you before the appointment what to expect.
- If what matters to you is whether you are affected at all, you are in the right place: this page describes who should come for screening and when, and what is examined. If the paper already says 'glaucoma' and your question is what happens now, the way leads to our treatment sub-page — drops, the SLT laser and the surgical procedures with their limits. If it says 'ocular hypertension', or shows only a raised pressure reading with no finding at the optic nerve, the section 'Eye pressure is not glaucoma' above is the way in.
- Nothing but the German word they share: both are called 'Star'. They sit in different places in the eye. A cataract sits in the lens: over the years it turns cloudy, the picture loses its clarity, and because a cloudy lens can be replaced, visual acuity afterwards is as a rule better again. Glaucoma sits in the optic nerve: its fibres are lost, first at the edge of the visual field where nobody notices — and lost fibres do not grow back. So the expectation 'after the operation I will see better' is justified with a cataract and wrong with glaucoma. What adds to the confusion is that the two often occur in the same eye — and then both need treating.
- Yes, and it is the rule rather than the exception: the commonest eye diseases affect the same age group. Glaucoma and cataract often occur together and can, in selected cases, even be dealt with in one sitting; who carries out the combined procedure, and where, we discuss with you beforehand. Diabetes changes the retina independently of whether anything can be seen at the optic nerve. And macular degeneration affects the centre of the retina while glaucoma works in from the edge — the two do not exclude one another. For you that means: an examination does not assess 'the glaucoma', it assesses the eye; and what we notice alongside, we tell you.
- We do not start from scratch. Earlier visual fields and OCT scans of the optic nerve are worth more for the assessment than any new single measurement, because with glaucoma the course is the diagnosis — so bring them, even when they come from elsewhere. What we promise is not a better number but a reasoning you can follow: a single high reading does not put you on long-term treatment here, and we do not change a treatment that is running without a reason to.
- Paper and bottles, above all — and both follow from what the appointment is for. Earlier visual fields and OCT scans of the optic nerve are the yardstick a course can be read against at all; without them the series starts again from the beginning here. Your eye drops are best brought as they stand at home, in the original bottles and unsorted: a preparation name recalled from memory rarely turns out to be the right one. And think of anything containing a steroid — nasal and asthma sprays, ointments and tablets included. It seldom appears on an eye list, and it can raise the pressure inside the eye.
Turned 40? Family history?
A glaucoma screening takes just under an hour and gives you certainty for years. Your optic nerve does not get a second chance — give it the first.
Or call us: +41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30