Care of the Patient with Primary Open-Angle Glaucoma
Publication Date: October 28, 2024
Last Updated: November 1, 2024
Summary of Recommendations
The examination of a person suspected of having primary open-angle glaucoma (POAG) should include all aspects of a comprehensive eye and vision examination, with emphasis on the evaluation of the anterior chamber angle, optic nerve head (ONH), peripapillary retinal nerve fiber layer (RNFL), macula and visual fields (VF), and measurement of intraocular pressure (IOP) and central corneal thickness (CCT). (B, Recommendation)
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The use of prostaglandin analogs (PGAs) should be considered as an initial therapy in patients with ocular hypertension (OH) or primary open-angle glaucoma (POAG), unless contraindicated. (A, Strong Recommendation)
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Patients prescribed topical intraocular pressure (IOP) lowering therapy may experience decreased tear film stability and elevated tear osmolarity and should be evaluated for ocular surface disease (OSD). (C, Recommendation)
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Pharmacological treatment of primary open-angle glaucoma (POAG) should be used with caution during pregnancy and lactation. (, Consensus Statement)
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Selective laser trabeculoplasty (SLT) should be considered as an initial/alternative or additive therapy to medication for achieving intraocular pressure (IOP) control in patients with ocular hypertension (OH) or primary open-angle glaucoma (POAG). (A, Strong Recommendation)
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The frequency and scope of follow-up examinations of persons diagnosed with primary open-angle glaucoma (POAG) should be individualized based on the severity and stability of their disease and should occur at regular intervals to monitor progression and treatment efficacy. (, Consensus Statement)
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Progress examinations of patients with primary open-angle glaucoma (POAG) should include, but are not limited to, an interval history, measurement of visual acuity and intraocular pressure (IOP), and evaluation of the optic nerve head (ONH), with periodic gonioscopy, retinal nerve fiber layer (RNFL) evaluation and visual field (VF) testing. (, Consensus Statement)
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Patient self-monitoring of intraocular pressures (IOP) should be considered to help support the diagnosis and/or management of patients at risk for or diagnosed with primary open-angle glaucoma (POAG). (C, Recommendation)
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Early medical treatment should be considered for individuals with ocular hypertension (OH) who are at moderate or high risk of developing primary open-angle glaucoma (POAG). (A, Strong Recommendation)
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Eye doctors should be persistent in providing education and training to patients with primary open-angle glaucoma (POAG) to improve adherence/compliance with recommended therapy. (B, Recommendation)
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Patients with primary open-angle glaucoma (POAG) who are prescribed pharmacological treatment should receive instructions on eyedrop instillation. (B, Recommendation)
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Ocular telehealth programs can provide increased access to care but should not be used alone or for the assessment or management of moderate or advanced disease in patients with primary open-angle glaucoma (POAG). (B, Strong Recommendation)
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Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Care of the Patient with Primary Open-Angle Glaucoma
Authoring Organization
American Optometric Association
Publication Month/Year
October 28, 2024
Last Updated Month/Year
November 1, 2024
Document Type
Guideline
Country of Publication
US
Document Objectives
This Evidence-based Clinical Practice Guideline on Care of the Patient with Primary Open-Angle Glaucoma provides examination, treatment and management recommendations designed to help preserve vision and maintain vision related quality of life in persons with POAG.
Target Patient Population
Patients with primary open angle glaucoma
Target Provider Population
Optometrists, ophthalmologists, and other eye doctors or other clinicians caring for patients with primary open angle glaucoma
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, optometrist, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Management
Diseases/Conditions (MeSH)
D005901 - Glaucoma, D005902 - Glaucoma, Open-Angle
Keywords
open-angle glaucoma, glaucoma, POAG