Prognosis and Therapy
Most patients with POAG retain useful vision for their entire lives. The patients at greatest risk of blindness are those who present with visual field loss at the time of diagnosis. In a single-institution study, the cumulative risk of unilateral and bilateral blindness in patients with OAG was 7.4% and 3.4%, respectively, within 10 years of diagnosis, and 13.5% and 4.3%, respectively, within 20 years of diagnosis.
Treatment with topical medication, laser surgery, and incisional surgery to lower IOP has been shown to significantly reduce the risk of glaucomatous progression (see the Clinical Trials at the end of this chapter). Patients with symptomatically decreased visual function (eg, visual acuity worse than 20/40, severe visual field damage, decreased contrast sensitivity), can be referred to a vision rehabilitation specialist. These specialists can help improve visual function by optimizing lighting, enhancing contrast, reducing glare, and providing adaptations to enhance activities of daily living. Orientation and mobility specialists can be consulted and vision substitution strategies (eg, talking books, watches) used to improve daily function and quality of life for these patients. The American Academy of Ophthalmology’s Initiative in Vision Rehabilitation page on the ONE Network (www.aao.org/low-vision-and-vision-rehab) provides resources for low vision management, including patient handouts and information about additional vision rehabilitation opportunities beyond those provided by the ophthalmologist. See also BCSC Section 3, Clinical Optics, for in-depth discussion of low vision aids.
American Academy of Ophthalmology Vision Rehabilitation Committee, Hoskins Center for Quality Eye Care. Preferred Practice Pattern® Guidelines. Vision Rehabilitation—2017. American Academy of Ophthalmology; 2017. www.aao.org/ppp
Boland MV, Ervin AM, Friedman DS, et al. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2013;158(4):271–279.
Malihi M, Moura Filho ER, Hodge DO, Sit AJ. Long-term trends in glaucoma-related blindness in Olmsted County, Minnesota. Ophthalmology. 2014;121(1):134–141.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.