Overview
Primary open-angle glaucoma (POAG) is a progressive optic neuropathy characterized by characteristic visual field defects and optic nerve damage 1. It is a leading cause of irreversible blindness worldwide 1.Diagnosis
Diagnosis is based on characteristic optic nerve damage and visual field loss, in the absence of other identifiable causes 1.
Recommended evaluations include visual acuity, intraocular pressure (IOP) measurement, gonioscopy, optic nerve head examination, and visual field testing 1.
Anterior segment optical coherence tomography (OCT) and optic nerve head OCT can provide objective structural measurements 1.Management
The primary goal of treatment is to lower IOP to prevent further optic nerve damage 1.
First-line medical therapy typically involves topical prostaglandin analogs, beta-blockers, or alpha-adrenergic agonists 1.
Adjunctive medical therapies include miotics and carbonic anhydrase inhibitors 1.
Laser therapy, such as selective laser trabeculoplasty (SLT), can be used as a first-line or adjunctive treatment 1.
Surgical interventions, including trabeculectomy and tube shunt surgery, are considered when medical or laser therapy is insufficient 1.Key Recommendations
Lowering intraocular pressure is the cornerstone of managing primary open-angle glaucoma 1. (Evidence: Strong)
Regular optic nerve head and visual field examinations are essential for monitoring disease progression 1. (Evidence: Strong)
Topical prostaglandin analogs are often considered a first-line medical therapy option 1. (Evidence: Moderate)References
1 Prum BE, Rosenberg LF, Gedde SJ, Mansberger SL, Stein JD, Moroi SE et al.. Primary Open-Angle Glaucoma Preferred Practice Pattern(®) Guidelines. Ophthalmology 2016. link