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 wellsupported 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.

Comparison of 10-2 and 24-2C Test Grids for Identifying Central Visual Field Defects in Glaucoma and Suspect Patients

“…Since the 24-2C can in most cases identify the presence of central visual field defects -but not necessarily "clusters", when might the 10-2 be clinically useful for the individual patient as part of a personalised management plan? 51,52 Three representative examples of subjects used in the present study are shown in Figure 5, describing the diverse possible outcomes of glaucomatous visual field defects, which despite instances of mutually identified or suspected defects. Therefore, identification of central visual field defects on 24-2 or 24-2C could provide an indication for conducting the 10-2 to confirm or fully characterise the defect.…”

The Frontloading Fields Study (FFS): Detecting Changes in Mean Deviation in Glaucoma Using Multiple Visual Field Tests Per Clinical Visit

“…Current management paradigms for glaucoma, a leading cause of irreversible blindness worldwide, emphasize two main goals: first, to preserve vision and prevent irreversible vision loss, and, second, to preserve quality of life by balancing treatment decisions against the potential impact of disease. 1 – 3 Individualizing the glaucoma treatment plan involves interpreting the clinical findings to understand the individual's disease trajectory. Disease progression in glaucoma is often quantified using visual field testing over time, as perimetry results have been strongly correlated with an individual's functionality and quality of life.…”

Cannabidiol Signaling in the Eye and Its Potential as an Ocular Therapeutic Agent

“…An estimated 3 million Americans have glaucoma, a major cause of irreversible blindness with no cure [ 59 , 60 ]. Even with therapeutic intervention, approximately 10% of those diagnosed still experience vision loss [ 59 , 60 ].…”

“…An estimated 3 million Americans have glaucoma, a major cause of irreversible blindness with no cure [ 59 , 60 ]. Even with therapeutic intervention, approximately 10% of those diagnosed still experience vision loss [ 59 , 60 ]. Although not always elevated, intraocular pressure (IOP) is currently the only treatable factor of the disease.…”