Glaucoma management in adults: an update

This is the authors' abstract. We don't add key points for this paper.

Glaucoma is a group of progressive optic neuropathies that cause optic nerve damage and visual field defects.It is typically asymptomatic until irreversible vision loss has occurred.Early detection relies on regular comprehensive eye examinations, with targeted case finding particularly important for people at increased risk.Lowering intraocular pressure is the only proven strategy to slow disease progression, and treatment should be individualised.Topical prostaglandin analogues (eye drops) are commonly used as first-line medical therapy, with once-daily dosing associated with improved adherence.Topical beta blockers may be added if the target intraocular pressure is not achieved or disease progression occurs.Patient adherence, eye drop technique and adverse effects should be reviewed regularly.Selective laser trabeculoplasty (a laser treatment that helps fluid drain out of the eye, thereby lowering intraocular pressure) is an effective first-line alternative to eye drops.Urgent referral to an ophthalmologist or emergency department is required for a suspected acute angle-closure attack.Symptoms include severe eye pain, headache, blurred vision, halos around lights, nausea and vomiting.This article provides an update on glaucoma management in adults, focusing on pharmacological therapy and primary care management. Types of glaucomaGlaucoma is broadly classified into primary and secondary types. Primary glaucomaPrimary open-angle glaucoma is the most common form of glaucoma.It is characterised by a structurally open anterior chamber angle and progressive optic neuropathy, leading to characteristic visual field loss.This condition is typically chronic, painless and asymptomatic in its early stages, with visual impairment often developing only in advanced disease.IOP may be elevated or remain within the population reference range.1,2 A subtype, often referred to as normal-tension glaucoma, occurs despite IOP measurements within the 'normal' range, a statistical construct defined as 2 standard deviations from the mean IOP in large population-based surveys.This subtype has been associated with vascular risk factors such as migraine, Raynaud phenomenon, systemic hypotension and obstructive sleep apnoea, and may be more prevalent in some Asian populations.1,