First-line treatment in open-angle glaucoma: an update

This review paper sets out to evaluate the evidence for different modalities as first-line treatments for primary open-angle glaucoma. In current practice, initial treatment is commonly with medical therapy, whereas laser, or incisional surgery, is performed if medical therapy does not satisfactorily reduce initial intra-ocular pressure and/or prevent visual field progression. However, medical therapy is not without adverse effects, and poor compliance with treatment means that in some cases another primary therapy might be preferable. Glaucoma is a common, chronic disease requiring life-long care in order to prevent progressive optic nerve head atrophy and blindness. Demographic changes in the developed world are resulting in a growing treated population: issues concerning acceptability, efficiency and cost–effectiveness of initial glaucoma treatment will become increasingly important.