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PRIMARY OPEN-ANGLE GLAUCOMA
Primary open-angle glaucoma (POAG) is a chronic, progressive, usually bilateral disease of the eye with an insidious onset.
It is most often characterized by optic nerve damage, defects in the retinal fiber layer and subsequent visual field loss in the absence of underlying ocular disease or congenital abnormalities.
It is generally asymptomatic until it has caused a significant loss of visual field.
Occasionally, patients with very high intraocular pressure may complain of nonspecific headache, discomfort, intermittent blurring of vision or even halos caused by corneal edema.

Follow Up

  • Primary open-angle glaucoma (POAG) patients require lifetime therapy & monitoring of intraocular pressure (IOP), visual fields & optic disc
  • Follow-up visits are usually at least 2x a year but frequency may depend on extent of damage, presence of progression, stability of IOP control & patient compliance
  • Measure visual acuity, IOP & perform slit-lamp biomicroscopy
  • Gonioscopy may be performed every 1-5 years but is warranted in cases of unexplained IOP changes or if w/ suspicion of anterior chamber abnormalities
  • Indications for therapy adjustments include:
    • Failure to achieve target IOP
    • Progressive optic nerve damage despite achieving target IOP
    • Medication intolerance or patient has developed contraindications to the medications
    • Poor patient compliance 
  • Poor control of IOP warrants adjustment of therapy for which a patient may be seen every 2-4 weeks
  • Consider increasing target IOP if the patient has been stable & either requires or desires less medication
  • Consider decreasing target IOP in the presence of visual field deterioration or progressive optic disc damage

Expert Referral

  • Consultation or referral to an ophthalmologist w/ special training or experience in glaucoma management
  • Patients w/ significant or progressive loss of vision may be referred for vision rehabilitation & social services
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