Primary Open-Angle Glaucoma Preferred Practice Pattern®

Primary Open-Angle Glaucoma Preferred Practice Pattern®

Background: Primary open-angle glaucoma (POAG) is a chronic, progressive ocular disease causing loss of the optic nerve rim and retinal nerve fiber layer (RNFL) with associated visual field defects. The anterior chamber angle is open, and the disease is generally bilateral. Risk factors for POAG include older age, African race or Latino/Hispanic ethnicity, elevated intraocular pressure (IOP), family history of glaucoma, lower ocular perfusion pressure, type 2 diabetes mellitus, and thin central cornea. It is estimated that 53 million people in the world have POAG in 2020 with a prevalence of 3.0% in the population aged 40 to 80 years.

Rationale for Treatment: Clinical trials have shown that lowering IOP reduces the risk of developing POAG and slows the progression of the disease. Medical, laser, and incisional surgical approaches exist to effectively lower IOP. Early diagnosis and treatment generally prevent visual disability.

Care Process: The goals of managing patients with POAG are to control IOP in a target range and to prevent progressive visual field and optic nerve/RNFL damage in order to preserve visual function and quality of life. The initial glaucoma evaluation includes all components of the comprehensive adult medical evaluation focusing on those elements that specifically pertain to the diagnosis and management of POAG. Important diagnostic testing includes central corneal thickness measurement, visual field evaluation, and imaging of the optic nerve head, RNFL and macula. The relative risks and benefits of treatment with medications, laser therapy, or incisional surgery should be discussed with the patient prior to its initiation. The adequacy of treatment is determined during follow-up by regular assessment of the optic nerve appearance and quantitative evaluation with visual field testing and imaging of the optic nerve head, RNFL and macula.


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