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Primary%20open-angle%20glaucoma Management
Follow Up
- Primary open-angle glaucoma (POAG) patients require lifetime therapy and monitoring of intraocular pressure (IOP), visual fields and optic disc
- 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
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
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
