OBJECTIVES: We measured increased non-vision cost for progression to visual loss due to glaucoma. METHODS: We analyzed a random 5% sample of Medicare beneficiaries (1999-2003). Presence the ICD-9 code, 365.xx, in a 1999 claim was considered evidence of glaucoma. Inclusion required survival from 1999-2003. Moderate visual loss was defined as severe impairment in the worst seeing eye (ICD-9 > 369.60). Severe visual loss was defined as severe impairment in best seeing eye (ICD-9 369.10 to 369.41). Blindness was defined as near total to profound impairment in both eyes (ICD-9 369.0 to 369.09). We identified those who reported depression, injury and living in long-term care settings. We report the mean total medical costs for each group and the increased risk of depression or injury, and living in an institutional setting associated with progression. RESULTS: In total, 57,664 beneficiaries were reported as having glaucoma. 54,596 did not experience severe impairment in either eye, while 3,068 beneficiaries (5.3%) reported severe impairment in at least one eye during the five year period. Increased visual impairment was associated with higher overall medical costs in 2003. Those who were blind had the highest cost of those who did not progress ($11,568). Those who progressed from glaucoma to blindness had the highest overall cost ($16,109) . Among those who progressed to vision loss, progression to blindness had the highest incremental cost ($5,510). Those who progressed to any vision loss were more likely to be diagnosed with depression or injury, or to be in long-term care or skilled nursing facility than those who did not, including those who had visual impairment at the beginning of the period. CONCLUSION: Among people with glaucoma, progression to loss of visual function in even a single eye leads to higher medical costs during progression. A substantial portion of this cost is associated with avoidable conditions and institutionalization.