Primary Open Angle Glaucoma (POAG)

Clinical Description

Glaucoma with a normal (open) anterior chamber angle and raised intraocular pressure (IOP)

Signs and Symptoms

• Gradual loss of vision, Narrowed field of vision

Treatment

• Prostaglandin analogues - the first line treatment (avoid in uveitis)
• Travopost 0.004% (Travatan) every day
• Latanoprost 0.005% (Xalatan) every day
• Bimatroprost 0.03% Lumigan
• Beta adrenergic antagonists, contraindicated in Asthma
• Selective a-1 antagonists
• Betaxolol 0.5% 12 hourly
• Non-Selective B antagonists
• Timolol 0.5% 12 hourly
• Alpha 2 adrenergic agonists
• Brimonidine 0.2% 8 hourly
• Carbonic anhydrase inhibitors
• Systemic
• Acetazolamide 125 - 250mg 6 hourly
• Topical
• Brinzolamide 1% (Azopt)every 12 hourly
• Dorzolamide 2% (Trusopt) every 8 hourly
• Parasympathomimetic (Cholinergics)
• Pilocarpine 2%, 4% 6 hourly gel or drops
• Surgical Treatment
• Trabeculectomy - when maximal medical treatment is suboptimal in IOP control
• Consider transcleral cyclophotocoagulation in eye with poor visual potential
• Consider argon laser trabeculoplasty (ALT)/selective laser trabeculoplasty (SLT) if not possible to perform trabeculectomy
• Minimally Invasive Glaucoma Surgery (MIGS)
• Shunt devices
• The medical and surgical treatment of POAG is also applicable to pseudo exfoliative glaucoma and pigmentary glaucoma.