Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach

ABSTRACT

Glaucoma is the leading cause of irreversible blindness worldwide. As a chronic disease, glaucoma presents a significant burden to the individual, health‐care provider and the health‐care system. Currently, strategies for treating glaucoma are focused on lowering intraocular pressure, which is aimed at slowing or arresting disease progression over time. This is the only current accepted therapeutic strategy for glaucoma, and can be achieved using topical drugs, laser trabeculoplasty, filtration surgery or cyclodestructive techniques. The lowering of intraocular pressure has been well‐supported by numerous large‐scale seminal clinical trials in primary open‐angle glaucoma, in both its early and advanced stages. Although such guidance remains current, in the last 10-years, there has been a significant evolution in preferred first‐line therapies in the treatment of open‐angle glaucoma with a resultant shift in practice patterns, particularly early in the course of the disease. These changes reflect both from the perspective of the doctor – in titrating the most effective and least risky treatment modality – and the perspective of the patient, in consenting to a treatment that preserves vision and results in minimal negative impact on quality of life. In this review, the most recent evidence regarding treatment modalities for early primary open‐angle glaucoma is presented and an updated framework for management guidance is proposed.

KEYWORDS:

• Beta‐blockers
• normal‐tension glaucoma
• ocular hypertension
• primary open‐angle glaucoma
• prostaglandin analogues
• selective laser trabeculoplasty

Acknowledgements

Guide Dogs NSW/ACT provides salary support for Jack Phu, Henrietta Wang and Michael Kalloniatis. Guide Dogs NSW/ACT also provides support for clinical service delivery at the Centre for Eye Health, from which the clinical data was derived. The funding body had no role in the conception or design of the study.

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Supporting information

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Figure S1. Optical coherence tomography (Cirrus OCT, retinal nerve fibre layer/optic nerve head and ganglion cell analysis) results for the left eye for the patient presented in Case 3. Thickness (‘heat’) maps and deviation maps are presented at each time point (up to eight shown for reference). Humphrey Field Analyser pattern deviation maps and global indices are also shown. The red box indicates the visit at which glaucomatous structural progression was noted. However, following that visit, a further monitoring plan (no treatment) showed arrest of progression as part of the natural history of pigment dispersion syndrome.

Additional information

Funding

Guide Dogs NSW/ACT provides salary support for Jack Phu, Henrietta Wang and Michael Kalloniatis. Guide Dogs NSW/ACT also provides support for clinical service delivery at Centre for Eye Health, from which the clinical data were derived. The funding body had no role in the conception or design of the study.