Management
Î Eye care providers can lower IOP with medications, laser therapy, or
incisional glaucoma surgery. Results from randomized controlled trials
and other studies provide evidence that these treatments reduce IOP
and decrease the rate and incidence of progressive of POAG. (I++, G, S)
Î The diagnosis, severity of the disease, prognosis and management
plan, and likelihood of long-term therapy should be discussed with the
patient. (G, S)
Î When deciding to treat a glaucoma suspect patient, it is important to
remember that the goal of treatment is to maintain the IOP in a range
at which visual field loss is unlikely to significantly reduce a patient's
health-related quality of life over his or her lifetime. (II+, M, D)
Î The target pressure should be individualized and may need adjustment
further down or even up during the course of the disease . (III, In, D)
Î Prostaglandin analogs are the most frequently prescribed initial eye
drops for lowering IOP in patients with glaucoma because they are
most efficacious, well-tolerated, and instilled once daily. They are also
relatively safe. They are, therefore, often considered as initial medical
therapy unless other considerations, such as contraindications, cost,
side effects, intolerance, or patient refusal preclude this. (I+, G, S)
Î A better way to assess IOP-lowering response is to compare the effect in
one eye with multiple baseline measurements in the same eye, but the
number of necessary baseline measurements will vary among patients.
(II+, M, D)
Î The ophthalmologist should assess the patient for local ocular and
systemic side effects, toxicity (interactions with other medications), and
potential life-threatening adverse reactions. (G, S)
Î Before changing glaucoma treatment, repeat and confirmatory
visual field examinations are recommended for test results that are
unreliable or show a new glaucomatous defect. (II++, G, S)
Î If a single medication is effective in lowering IOP but the target
pressure is not reached, combination therapy or switching to an
alternative therapy may be appropriate.
Î To reduce systemic absorption, patients should be educated about
eyelid closure or nasolacrimal duct occlusion when applying topical
medications. (III, G, S)
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