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Glaucoma is a multifactorial optic neuropathy involving progressive optic nerve damage associated with loss of visual function and often with elevated intraocular pressure (IOP).1 ,2
It is the second most important cause of world blindness after cataracts. It has been estimated that 79.6 million people will suffer from glaucoma in 2020, and of these, 74% will have open-angle glaucoma.3 Elevated IOP has been recognised as the major risk factor for the development of glaucoma and consistently demonstrated to be associated with its progression.4 Among the treatment goals of glaucoma therapy, IOP control is the mainstay. In established open-angle glaucoma, lowering IOP is effective and always advised, regardless of whether IOP is abnormal.5
Topical medical treatment, laser procedures and surgery are various options available to treat glaucoma. All of these modalities act by reducing IOP and, in this way, protect the optic nerve from direct mechanical and/or indirect vascular insult.2 Progression of glaucoma can be stopped if IOP is lowered to a normative value, which may be set as a ‘target-IOP’.6 ,7 However, optimal glaucoma therapy should involve IOP control throughout the 24-h period; in the face of this fact, not all therapies are equally efficacious at all times of the day and night.
Initial treatment for glaucoma typically involves lowering and subsequent control of IOP with pharmacological therapy.8 The first line of glaucoma treatment consists of topical IOP-lowering medications, usually initiated as monotherapy.9 Drug therapies effective for IOP reduction include both agents that decrease aqueous humour production (β-blockers and carbonic anhydrase inhibitors) and agents that increase the trabecular and uveo-scleral outflow facility (prostaglandin analogues and cholinergic agents). β-Blockers, once the gold standard of care, are now being replaced by prostaglandin analogues, which have revolutionised the medical treatment of glaucoma as …
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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