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Upon completion of the chapter, the reader will be able to:

  1. Identify risk factors for the development of primary open-angle glaucoma (POAG) and acute angle-closure glaucoma.

  2. Recommend a frequency for glaucoma screening based on patient-specific risk factors.

  3. Compare and contrast the pathophysiologic mechanisms responsible for open-angle glaucoma and acute angle-closure glaucoma.

  4. Compare and contrast the clinical presentation of chronic open-angle glaucoma and acute angle-closure glaucoma.

  5. List the goals of treatment for patients with POAG suspect, POAG, and acute angle-closure glaucoma.

  6. Choose the most appropriate therapy based on patient-specific data for open-angle glaucoma, glaucoma suspect, and acute angle-closure glaucoma.

  7. Develop a monitoring plan for patients on specific pharmacologic regimens.

  8. Counsel patients about glaucoma, drug therapy options, ophthalmic administration techniques, and the importance of adherence to the prescribed regimen.




  • Image not available. Practitioners can play an important role in eye care by assessing patients for risk factors and referring to an ophthalmologist for appropriate screening and evaluation.

  • Image not available. Acute angle-closure crisis is a medical emergency and requires laser or surgical intervention.

  • Image not available. Patients with POAG typically have a slow, insidious loss of vision. This is contrasted by the course of acute angle-closure crisis, which can lead to rapid vision loss that develops over hours to days. There are exceptions in the rate of progression for both disease subtypes, and there can be mixed subtypes whereby patients exhibit features of both diseases, so-called "combined mechanism glaucoma."

  • Image not available. The goals of therapy are to prevent further loss of visual function; minimize adverse effects of therapy and impact on the patient's vision, general health, and quality of life; maintain IOP at or below a pressure at which further optic nerve damage is unlikely to occur; and educate and involve the patient in the management of their disease.

  • Image not available. Current therapy is directed at altering the flow and production of aqueous humor, which is the major determinant of IOP.

  • Image not available. Because POAG is a chronic, often asymptomatic condition, the decision of when and how to treat patients is difficult because the treatment modalities are often expensive and have potential adverse effects or complications. Therefore, the clinician should evaluate the potential effectiveness, toxicity, and the likelihood of patient adherence for each therapeutic modality.

  • Image not available. An initial target IOP should be set at least 25% lower than the patient's baseline IOP. The target IOP can be set lower (30% to 50% of baseline IOP) for patients who already have severe disease, risk factors for disease progression, or normal-tension glaucoma (NTG).

  • Image not available. Target IOP should be revised based on the course of the disease and rate of progression.




Glaucoma refers to a spectrum of ophthalmic disorders characterized by neuropathy of the optic nerve and loss of retinal ganglion cells, which leads to permanent deterioration of the visual field and potentially total vision loss. It is often, but not always, eye pressure related. Glaucoma can be classified ...

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