The Pathophysiology and Treatment of Glaucoma: A Review | Genetics and Genomics | JAMA Network
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Review
May 14, 2014

The Pathophysiology and Treatment of Glaucoma: A Review

Author Affiliations
  • 1Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, La Jolla
  • 2Singapore National Eye Center, Singapore, Singapore
  • 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore
JAMA. 2014;311(18):1901-1911. doi:10.1001/jama.2014.3192
Abstract

Importance  Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition.

Objective  To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma.

Evidence Review  A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians.

Findings  The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression.

Conclusions and Relevance  Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.

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