Î Established and important risk factors for primary open-angle
glaucoma (POAG) include age, race/ethnicity, level of intraocular
pressure (IOP), family history of glaucoma, low ocular perfusion
pressure, type 2 diabetes mellitus, myopia, and thin central cornea.
Î POAG with consistently normal IOP is common, especially in certain
populations. Lowering pressure in these patients can be beneficial.
Î Characteristic clinical features of POAG include an open angle on
gonioscopy, and glaucomatous optic nerve head (ONH) and retinal
nerve fiber layer (RNFL) changes that usually are associated with
typical glaucomatous visual field defects.
Î Computer-based imaging and stereoscopic photography provide
different and complementary information about optic nerve status and
are useful adjuncts to a good clinical examination.
Î Adjusting computerized visual field programs (24°, 30°, 10°) and
varying stimulus size for patients with advanced glaucoma aid in
detecting and monitoring progressive visual field loss.
Î Clinical trials have shown that lowering IOP reduces the risk of
developing POAG and slows the progression of POAG, including
normal-tension open angle glaucoma (OAG).
Î Effective medical, laser, and incisional surgical approaches exist for
lowering IOP.
Î A reasonable initial treatment in a POAG patient is to reduce IOP
20%–30% below baseline and to adjust up or down as indicated by
disease course and severity.
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