Open-angle glaucoma: Treatment
- Deborah S Jacobs, MD
Deborah S Jacobs, MD
- Associate Professor of Ophthalmology, Part-Time
- Harvard Medical School
Glaucoma is a group of eye diseases traditionally characterized by elevated intraocular pressure (IOP). However, glaucoma is more accurately defined as an optic neuropathy involving a characteristic atrophy of the optic nerve head, which may or may not be accompanied by elevated IOP. In open-angle glaucoma, optic nerve damage results in a progressive loss of retinal ganglion cell axons, which is manifested initially as visual field loss and, ultimately, irreversible blindness if left untreated .
This topic will focus on the treatment of primary open-angle glaucoma, where the etiology is unknown. Treatment of known causes (eg, uveitis, trauma, glucocorticoid therapy), in addition to lowering IOP, should be considered in patients with secondary open-angle glaucoma. (See "Uveitis: Treatment" and "Major side effects of systemic glucocorticoids", section on 'Eye'.)
Glaucoma in children, angle-closure glaucoma, and epidemiology and diagnosis of open-angle glaucoma are discussed elsewhere. (See "Overview of glaucoma in infants and children" and "Angle-closure glaucoma" and "Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis".)
GOALS OF THERAPY
Lowering intraocular pressure (IOP) has been shown to reduce the risk of glaucomatous progression of visual field loss and/or optic disc changes and is the primary goal of therapy [2,3]. In a meta-analysis of two randomized trials of patients with open-angle glaucoma, those randomly assigned to IOP-lowering treatment were less likely to have progression of visual field and/or optic disc deterioration compared with those randomly assigned to placebo (hazard ratio [HR] 0.65, 95% CI 0.49-0.87) .
Other factors such as blood supply, nerve metabolism, and extracellular matrix likely play a role in the progressive optic neuropathy of glaucoma . However, treatment targeting these other factors in patients with open-angle glaucoma has not been well studied .
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