13th February 2025

Primary open-angle glaucoma

Clinical findings in open-angle glaucoma

The prevalence of primary open-angle glaucoma increases with age, though is equally common in males and females. Family history is a risk factor, as is afro-caribbean heritage. It is often asymptomatic until relatively advanced disease at which point there may be painless visual loss.

Typical examination findings include a normal appearance of the sclera and cornea (in contrast to acute closed-angle glaucoma). Peripheral visual field loss may be present in advanced disease.

Management of open-angle glaucoma

Management of open-angle glaucoma aims to reduce intraocular pressure. February 2023 NICE guidelines suggest the following:

• First line:
  • Laser trabeculoplasty, during which a laser is used to improve drainage of aqueous humour through the trabecular meshwork
  • If trabeculoplasty is not available or the patient prefers medical therapy, a generic prostaglandin analogue (PGA) should be prescribed, such as bimatoprost or latanoprost
• Second line:
  • An alternative PGA
  • Topical beta blockers, such as timolol
  • Other topical medications including miotics, sympathomimetics, or carbonic anhydrase inhibitors

Note that topical non-selective beta blockers have been shown to increase asthma morbidity and should therefore be avoided in asthmatic patients.