By the American Academy of Ophthalmology Preferred Practice Pattern Glaucoma Committee: Steven J. Gedde, MD,1 Kateki Vinod, MD,2 Martha M. Wright, MD,3 Kelly W. Muir, MD,4 John T. Lind, MD,5 Philip P. Chen, MD,6 Tianjing Li, MD, MHS, PhD,7 Steven L. Mansberger, MD, MPH8
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1Bascom Palmer Eye Institute, Miami, Florida
2Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, New York
3Minneapolis VA Medical Center, Minneapolis, Minnesota
4Duke University School of Medicine, Department of Ophthalmology, Durham, North Carolina
5Indiana University School of Medicine, Department of Ophthalmology, Indianapolis, Indiana
6Professor and Grace E. Hill Chair, Department of Ophthalmology, University of Washington, Chief of Ophthalmology, UW Medicine Eye Institute, Seattle, Washington
7Associate Professor, Department of Ophthalmology, School of Medicine, Department of Epidemiology, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
8Legacy Devers Eye Institute, Portland, Oregon
Highlighted Findings and Recommendations for Care
Established risk factors for primary open-angle glaucoma (POAG) include older age, African race or Latino/Hispanic ethnicity, elevated intraocular pressure (IOP), family history of glaucoma, low ocular perfusion pressure, type 2 diabetes mellitus, myopia, and thin central cornea.
Primary open-angle glaucoma patients often have untreated IOP consistently within the normal range (i.e., normal tension glaucoma). Lowering pressure in these patients is beneficial.
Characteristic clinical features of POAG include an open angle on gonioscopy, and glaucomatous optic nerve head (ONH) and retinal nerve fiber layer (RNFL)/macula imaging changes that are usually associated with typical glaucomatous visual field defects.
Computer-based imaging and stereoscopic photography provide different and complementary information about optic nerve status.
Adjusting computerized visual field programs (24 degrees, 30 degrees, 10 degrees) and stimulus size (III, V) can aid in detecting and monitoring progressive visual field loss.
Clinical trials have shown that lowering IOP reduces the risk of developing POAG and slows the progression of POAG. Effective medical, laser, and incisional surgical approaches exist for lowering IOP.
A reasonable initial treatment goal in a POAG patient is to reduce the IOP 20% or 30% below baseline and to adjust up or down as indicated by disease course and severity.