Primary open-angle glaucoma is a syndrome of optic nerve damage associated with an open anterior chamber angle and an elevated or sometimes average intraocular pressure (IOP). Symptoms are a result of visual field loss. Diagnosis is by ophthalmoscopy, gonioscopy, visual field examination, and measurement of central corneal thickness and IOP. Treatment includes topical drugs (eg, prostaglandin analogs, beta-blockers) and often requires laser or incisional surgery to increase aqueous drainage.

Risk factors for primary open-angle glaucoma include

• Older age
• Positive family history
• African ethnicity
• Thinner central corneal thickness
• Systemic hypertension
• Diabetes
• Myopia

 Symptoms and Signs

Early primary open-angle glaucoma symptoms are uncommon. Usually, the patient becomes aware of visual field loss only when optic nerve atrophy is marked; the typically asymmetric deficits contribute to delay in recognition. However, some patients have complaints, such as missing stairs if their inferior visual field has been lost, noticing portions of words missing when reading, or having difficulty with driving earlier in the course of the disease.

Characteristic optic nerve changes include

• Increased cup:disk ratio (particularly an increasing ratio over time)
• Thinning of the neurosensory rim
• Pitting or notching of the rim
• Nerve fiber layer hemorrhage that crosses the disk margin (ie, Drance hemorrhage or splinter hemorrhages)
• Vertical elongation of the cup
• Quick angulations in the course of the exiting blood vessels (called bayoneting)

Visual field changes caused by lesions of the optic nerve include

• Nasal step defects (which do not cross the horizontal meridian—an imaginary horizontal line between the upper and lower parts of the visual field)
• Arcuate (arc-shaped) scotomata extending nasally from the blind spot
• Temporal wedge defects
• Paracentral scotomata

Diagnosis

• Visual field testing
• Ophthalmoscopy
• Measurement of central corneal thickness and IOP
• Exclusion of other optic neuropathies

Treatment

• Decreasing intraocular pressure (IOP) 20 to 40%
• Initially, drugs (eg, prostaglandin analogs such as latanoprost or tafluprost, beta-blockers such as timolol)
• Sometimes surgery, such as laser trabeculoplasty or guarded filtration procedure.

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Media Contact
Sarah Rose
Journal Manager
The Ophthalmologist: Clinical and Therapeutic Journal
Email: ophthalmologist@eclinicalsci.com