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primary%20open-angle%20glaucoma
PRIMARY OPEN-ANGLE GLAUCOMA
Treatment Guideline Chart
Primary open-angle glaucoma (POAG) is a chronic, progressive, irreversible, 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.

Primary%20open-angle%20glaucoma Management

Vision Rehabilitation

  • Improves visual function with the use of optical and non-optical devices and includes occupational, vocational and independent living counseling services
  • Has been found to significantly improve vision-related quality of life of patients with glaucoma

Expert Referral

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

Follow Up

  • POAG patients require lifetime therapy and monitoring of IOP, visual fields and optic disc
    • ONH, RNFL and macular imaging should also be monitored to determine progressive damage
  • Patients who underwent laser surgery should be evaluated within 30 minutes-2 hours post-surgery and follow-up done within 6 weeks after surgery
  • Patients who underwent incisional glaucoma surgery must be evaluated after 12-36 hours post-surgery and at least once during the first 1-2 weeks to assess IOP, visual acuity and status of the anterior segment
    • Follow-up is done after 3 months in patients without postoperative complications to evaluate IOP, visual acuity and anterior segment status
    • Patients with postoperative complications require more frequent visits
  • Follow-up visits are usually at least 2 times a year but frequency may depend on extent of damage, presence of progression, stability of IOP control and patient compliance
  • Measure visual acuity, IOP and perform slit-lamp biomicroscopy
  • Gonioscopy may be performed every 1-5 years but is warranted in cases of unexplained IOP changes or if with suspicion of angle-closure component or 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 2-8 weeks
  • Consider increasing target IOP if the patient has been stable and either requires or desires less medication
  • Consider decreasing target IOP in the presence of visual field deterioration or progressive optic disc damage
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