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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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