Manual

Primary open-angle glaucoma

Glaucoma

Primary open-angle glaucoma

Chronic progressive optic neuropathy.

  • Risk factors: IOP, age, African or Hispanic ancestry, family history, thin CCT, myopia, low ocular perfusion pressure.
  • Diagnosis: characteristic disc/RNFL change + corresponding field defect, open angle on gonioscopy.
  • Target IOP: typically 20–30% reduction from baseline (more for advanced disease).
Stage (ICD-10)Visual field (24-2)
MildOptic nerve change, normal field
ModerateField loss in one hemifield, not within 5° of fixation
SevereLoss in both hemifields and/or within 5° of fixation

First-line: prostaglandin analogue or SLT (LiGHT trial: SLT as good as drops with fewer surgeries). Escalate: add drops, MIGS, trabeculectomy, tube shunt.

NextGonioscopy & angle grading

Educational summary — follow local protocols and current guidelines.