Age and sex are major factors associated with almost all indicators of glaucoma severity, according to a report published in Glaucoma. The study, conducted by the Italian Primary Open Angle Glaucoma Study, shows that males and older patients bear the brunt of the disease’s impact. Other significant variables include employment, profession and marital status.

The investigators employed the Glaucoma Symptom Scale (GSS) questionnaire—which measures the functional impact of the disease—to rank the condition’s severity. The study reviewed the records of 3,227 patients and found that the scores went up for each 10-year increase in patient age. It also found that anxiety and depression can add to glaucoma severity.

Additionally, the research helps confirm prior studies that show women are more likely than men to report symptoms earlier on—perhaps leading to earlier diagnoses and contributing to the reduced severity. The report also identifies that estrogen enhances ocular blood flow and may have a neuroprotective effect on retinal ganglion cells.