Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Open-angle glaucoma

Key sources
The following summarized guidelines for the evaluation and management of open-angle glaucoma are prepared by our editorial team based on guidelines from the Japan Glaucoma Society (JGS 2023), the European Society of Hypertension (ESH 2023), the U.S. Preventive Services Task Force (USPSTF 2022), the European Glaucoma Society (EGS 2021), the American Academy of Ophthalmology (AAO 2021), the American College of Radiology (ACR 2018), the American Academy of Family Physicians (AAFP 2016), the American College of Endocrinology (ACE/AACE 2016), and the The Scottish Intercollegiate Guidelines Network (SIGN 2015).
1
2
3
4
5
6
7
8
9

Guidelines

1.Screening and diagnosis

Indications for screening, general population, USPSTF: insufficient evidence to assess the balance of benefits and harms of screening for primary open-angle glaucoma in adults.
I
Create free account

More topics in this section

  • Indications for screening (patients with hypertension)

2.Classification and risk stratification

Risk factors: as per JGS 2023 guidelines, recognize that the following are risk factors for developing primary open-angle glaucoma from ocular hypertension:
older age
large vertical cup-to-disc ratio
high intraocular pressure
large PSD
thin central corneal thickness
optic nerve disc hemorrhage.
B

3.Diagnostic investigations

Initial assessment: as per EGS 2021 guidelines, obtain the following in the initial evaluation of glaucoma:
visual acuity and refractive error
B
slit lamp examination
B
gonioscopy
B
tonometry
B
central corneal thickness; consider using central corneal thickness for baseline risk profiling
B
; do not use central corneal thickness-adjusted intraocular pressure values
B
visual field testing
B
clinical assessment of the optic nerve head, retinal nerve fiber layer, and macula; prefer binocular examination under pupil dilatation, except in angle closure; consider using optic disc and retinal nerve fiber layer photography.
B
Show 3 more

More topics in this section

  • Diagnostic imaging

4.Medical management

Indications for treatment
As per JGS 2023 guidelines:
Initiate treatment for ocular hypertension in patients with risk factors for developing primary open-angle glaucoma from ocular hypertension (older age, large vertical cup-to-disc ratio, high intraocular, large PSD, thin central corneal thickness, and occurrence of optic nerve disc hemorrhage).
B
Consider initiating treatment for preperimetric glaucoma with normal intraocular pressure alongside careful clinical follow-up and evaluation of risk factors.
C

More topics in this section

  • Prostaglandin analogs

5.Perioperative care

Perioperative management
As per JGS 2023 guidelines:
Administer topical corticosteroids for intraocular pressure control after trabeculectomy for primary open-angle glaucoma.
B
Administer antibiotic instillation and ointment application after trabeculectomy. Continue antibiotic instillation and ointment application as appropriate according to the risk of bleb-related infection.
B

6.Surgical interventions

Indications for surgery: as per JGS 2023 guidelines, consider performing trabeculectomy in patients with progressive visual field impairment despite intraocular pressure in the low 10 mmHg range under topical ophthalmic treatment.
C
Show 2 more

More topics in this section

  • Concomitant cataract surgery

7.Specific circumstances

Patients with obesity
Prefer liraglutide 3 mg, orlistat, or lorcaserin in patients with a history, or at risk of, glaucoma.
B
Be cautious when using naltrexone ER/bupropion ER. Avoid using phentermine/topiramate ER in patients with glaucoma.
B

More topics in this section

  • Patients with arterial hypertension

8.Follow-up and surveillance

Follow-up: as per EGS 2021 guidelines, obtain the following tests for monitoring of patients with glaucoma:
visual acuity assessment
B
visual field testing; use the same instrument and strategy for follow-up tests; use software-based progression analyses use a visual field to monitor progression
B
clinical examination of the optic disc and retinal nerve fiber layer
B
tonometry
B
optical coherence tomography of the disc/retinal nerve fiber layer/macula; consider using the same instrument with the software-based analysis; do not use optical coherence tomography progression analysis to replace visual field progression analysis
B
repeat gonioscopy in some circumstances.
B