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  • image Primary open-angle glaucoma (POAG) or ocular hypertension is more prevalent outside Asia than closed- or narrow-angle glaucoma.
  • image In any form of glaucoma, reduction of intraocular pressure (IOP) is essential.
  • image IOP is a very important risk factor for glaucoma, but the most important considerations are progression of glaucomatous changes in the back of the eye (optic disk and nerve fiber layer) and visual field changes when diagnosing and monitoring for POAG or ocular hypertension.
  • image Optic nerve changes often occur before visual field changes are exhibited.
  • image Recent studies demonstrate that reduction in IOP prevents progression or even onset of glaucoma.
  • image Newer medications simplify treatment regimens for patients. Prostaglandin analogs are considered the most potent topical medications for reducing IOP and flattening diurnal variations in IOP.
  • image Local adverse events are common with topical glaucoma medications, but patient education and reinforcing adherence are essential to prevent glaucoma progression.

On completion of the chapter, the reader will be able to:

  1. Describe the incidence of open-angle glaucoma.

  2. Describe the symptoms of open-angle glaucoma.

  3. Differentiate between open-angle and closed-angle glaucoma.

  4. Discuss the optic disc changes commonly seen in glaucoma.

  5. Describe the production and outflow of aqueous humor.

  6. Describe the effect of glaucoma medications on aqueous humor production and outflow.

  7. Discuss the relationship between intraocular pressure and visual field loss in glaucoma.

  8. Discuss the therapeutic goals of glaucoma therapy.

  9. List the medications considered “first line” for open-angle glaucoma.

  10. Describe the common systemic side effects of ophthalmic β-blockers.

  11. Describe the use of combination therapies in glaucoma.

  12. Describe the proper method for administration of ophthalmic medications.

  13. Describe the technique and purpose of nasolacrimal occlusion.

  14. Describe the therapeutic approach to the acute angle-closure glaucoma.

  15. Describe the importance of patient adherence to the success of glaucoma therapy.

  16. List medications with high risk for exacerbation of open-angle glaucoma.

  17. List medications with high risk for exacerbation of closed-angle glaucoma.

The glaucomas are a group of ocular disorders that lead to an optic neuropathy characterized by changes in the optic nerve head (optic disk) that is associated with loss of visual sensitivity and field. Increased intraocular pressure (IOP), a traditional diagnostic criterion for glaucoma, is thought to play an important role in the pathogenesis of glaucoma, but it is no longer a diagnostic criterion for glaucoma.110 Two major types of glaucoma have been identified: open angle and closed angle. Open-angle glaucoma accounts for the great majority of cases in North America, while closed-angle glaucoma (CAG) is more prevalent in Asia. Either type can be a primary inherited disorder, congenital, or secondary to disease, trauma, or drugs and can lead to serious complications.1,1116 Both primary and secondary glaucomas may be caused by a combination of open-angle and closed-angle mechanisms (Table 75-1).

Table 75-1 General Classification of Glaucoma

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