A nurse is caring for a male older adult client who has a new diagnosis for glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease? Select all that apply.

Choice A rationale Hypertension is a known risk factor for the development of glaucoma because high systemic blood pressure can damage the delicate microvasculature of the optic nerve. Impaired blood flow or high vascular resistance within the eye contributes to the progression of optic neuropathy. Maintaining a blood pressure within the normal range of less than 120/80 mmHg is essential for ocular health. Chronic vascular stress increases the vulnerability of the eye to pressure changes. Choice B rationale Glaucoma is characterized by an increase in intraocular pressure, not a decrease. Normal intraocular pressure ranges from 10 to 21 mmHg. When the drainage of aqueous humor is obstructed, the pressure rises, which compresses the retinal ganglion cells and the optic nerve. A sudden decrease in pressure is not a typical risk factor for glaucoma; rather, elevated or fluctuating high pressure is the primary mechanism that leads to the loss of peripheral vision. Choice C rationale Genetic predisposition plays a significant role in the etiology of glaucoma. Individuals with a positive family history of the disease have a much higher risk of developing it themselves. Specific genetic mutations can affect the structural integrity of the trabecular meshwork or the sensitivity of the optic nerve to pressure. Understanding family medical history allows for earlier screening and intervention, which is crucial because the vision loss associated with glaucoma is irreversible. Choice D rationale Advancing age is one of the most significant risk factors for glaucoma. As individuals get older, the efficiency of the aqueous humor drainage system often declines, leading to a gradual increase in intraocular pressure. This is especially true for individuals over the age of 60. Changes in the collagen structure of the eye and cumulative oxidative stress over decades make the optic nerve more susceptible to damage from even moderate pressure elevations. Choice E rationale Diabetes mellitus is a systemic metabolic disorder that increases the risk of primary open-angle glaucoma. High blood glucose levels over time can cause damage to the blood vessels in the retina and may lead to the growth of abnormal new blood vessels that block the drainage angles of the eye. This is known as neovascular glaucoma. Diabetics must undergo regular comprehensive eye exams to monitor for both retinopathy and elevations in intraocular pressure.