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Survey of Ophthalmology 2022Juvenile-onset open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma that is diagnosed before 40 years of age. The disease may be familial or... (Review)
Review
Juvenile-onset open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma that is diagnosed before 40 years of age. The disease may be familial or non-familial, with proportions varying among different populations. Myocilin mutations are the most commonly associated. JOAG is characterized by high intraocular pressures (IOP), with many patients needing surgery. The mean age at diagnosis is in the 3 decade, with a male preponderance. Myopia is a common association. The pathophysiology underlying the disease is immaturity of the conventional outflow pathways, which may or may not be observed on gonioscopy and anterior segment optical coherence tomography. The unique optic nerve head features include large discs with deep, steep cupping associated with high IOP-induced damage. Progression rates among JOAG patients are comparable to adult primary glaucomas, but as the disease affects younger patients, the projected disability from this disease is higher. Early diagnosis, prompt management, and life-long monitoring play an important role in preventing disease progression. Gene-based therapies currently under investigation offer future hope.
Topics: Adult; Eye Proteins; Glaucoma; Glaucoma, Open-Angle; Gonioscopy; Humans; Intraocular Pressure; Male; Mutation; Optic Disk
PubMed: 34536459
DOI: 10.1016/j.survophthal.2021.09.001 -
La Revue de Medecine Interne Jul 2019Primary open-angle glaucoma is a progressive chronic optic neuropathy, typically bilateral, that occurs after the age of 40 years. It is the second leading cause of... (Review)
Review
Primary open-angle glaucoma is a progressive chronic optic neuropathy, typically bilateral, that occurs after the age of 40 years. It is the second leading cause of irreversible blindness in the world. Primary open-angle glaucoma corresponds to a progressive loss of retinal ganglion cell characterized by an excavation of the optic disc associated with typical visual field defects. Elevated intraocular pressure is the main risk factor of primary open-angle glaucoma. Diagnosis and monitoring of primary open-angle glaucoma arebased on both analysis of structural alteration, by clinical examination of optic disc completed by imaging tests (Ocular Coherence Tomography), and functional alterations, by visual field tests. The only effective treatment to slow primary open-angle glaucoma progression is the reduction of the intraocular pressure with anti-glaucomatous eye drops, laser or surgical treatments.
Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Diagnosis, Differential; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Middle Aged; Monitoring, Physiologic; Ophthalmic Solutions; Tomography, Optical Coherence; Vision Disorders; Visual Field Tests
PubMed: 30594326
DOI: 10.1016/j.revmed.2018.12.001 -
Lancet (London, England) May 2004Primary open-angle glaucoma is a progressive optic neuropathy and, perhaps, the most common form of glaucoma. Because the disease is treatable, and because the visual... (Review)
Review
Primary open-angle glaucoma is a progressive optic neuropathy and, perhaps, the most common form of glaucoma. Because the disease is treatable, and because the visual impairment caused by glaucoma is irreversible, early detection is essential. Early diagnosis depends on examination of the optic disc, retinal nerve fibre layer, and visual field. New imaging and psychophysical tests can improve both detection and monitoring of the progression of the disease. Recently completed long-term clinical trials provide convincing evidence that lowering intraocular pressure prevents progression at both the early and late stages of the disease. The degree of protection is related to the degree to which intraocular pressure is lowered. Improvements in therapy consist of more effective and better-tolerated drugs to lower intraocular pressure, and more effective surgical procedures. New treatments to directly treat and protect the retinal ganglion cells that are damaged in glaucoma are also in development.
Topics: Animals; Glaucoma, Open-Angle; Humans; Optic Disk; Risk Factors; Visual Fields
PubMed: 15158634
DOI: 10.1016/S0140-6736(04)16257-0 -
Der Ophthalmologe : Zeitschrift Der... Jul 2021Open-angle glaucomas are a group of chronic progressive optic nerve neuropathies with a gonioscopic open anterior chamber angle. They are one of the main causes of... (Review)
Review
Open-angle glaucomas are a group of chronic progressive optic nerve neuropathies with a gonioscopic open anterior chamber angle. They are one of the main causes of visual impairment and blindness in industrialized countries. The aim of this article is to discuss and evaluate the epidemiology and risk factors for the development of open-angle glaucoma and to present the screening procedure for open-angle glaucoma according to the recently published S2e guidelines of the Association of the Scientific Medical Societies in Germany (AWMF).
Topics: Germany; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Optic Nerve Diseases; Risk Factors
PubMed: 33881589
DOI: 10.1007/s00347-021-01378-5 -
JAMA May 2014Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A... (Review)
Review
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.
Topics: Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Primary Health Care
PubMed: 24825645
DOI: 10.1001/jama.2014.3192 -
American Family Physician May 2003Glaucoma is the second most common cause of legal blindness in the United States. Open-angle glaucoma is an asymptomatic, progressive optic neuropathy characterized by... (Review)
Review
Glaucoma is the second most common cause of legal blindness in the United States. Open-angle glaucoma is an asymptomatic, progressive optic neuropathy characterized by enlarging optic disc cupping and visual field loss. Patients at increased risk for open-angle glaucoma include blacks older than 40 years, whites older than 65 years, and persons with a family history of glaucoma or a personal history of diabetes or severe myopia. Elevated intraocular pressure is a strong, modifiable risk factor for open-angle glaucoma, but it is not diagnostic. Some patients with glaucoma have normal intraocular pressure (i.e., normal-pressure glaucoma), and many patients with elevated intraocular pressure do not have glaucoma (i.e., glaucoma suspects). Routine measurement of intraocular pressure by primary care physicians to screen patients for glaucoma is not recommended. Open-angle glaucoma usually is discovered during an adult eye evaluation performed for other indications. Final diagnosis and treatment occur in collaboration with ophthalmologists and optometrists. Formal visual field testing (perimetry) is a mainstay of glaucoma diagnosis and management. Eye drops, commonly nonspecific beta-blocker or prostaglandin analog drops, generally are the first-line treatment to reduce intraocular pressure. Laser treatment and surgery usually are reserved for patients in whom medical treatment has failed. Without treatment, open-angle glaucoma can end in irreversible vision loss.
Topics: Adrenergic alpha-Agonists; Adrenergic beta-Antagonists; Blindness; Glaucoma, Open-Angle; Humans; Mass Screening; Ophthalmic Solutions
PubMed: 12751655
DOI: No ID Found -
The Consultant Pharmacist : the Journal... Aug 2018Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG). (Review)
Review
OBJECTIVE
Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG).
DATA SOURCES
Articles indexed in PubMed, Scopus, and Cochrane Library in the last 10 years using the key words "glaucoma," "open-angle glaucoma," and "'open-angle glaucoma' AND 'treatment.'" Primary sources were used to locate additional resources. ClinicalTrials. gov was used to locate unpublished studies.
STUDY SELECTION AND DATA EXTRACTION
Eighty-one publications were reviewed and criteria supporting the primary objective were used to identify useful resources.
DATA SYNTHESIS
The literature included practice guidelines, review articles, original research articles, and product prescribing information for POAG.
CONCLUSION
The POAG optic neuropathies result in optic disk damage and visual field loss. Ophthalmic medication therapy retards glaucoma progression, but many older patients require multiple medications to preserve vision and quality of life. An agent from the ophthalmic prostaglandin analog class is used as initial therapy in current practice because of the convenience of once-a-day administration and lower incidence of systemic side effects and slightly increased efficacy compared with other available ophthalmic medication classes. The other ophthalmic medication classes used in clinical practice include the beta-adrenergic blocking agents, the alpha-2 adrenergic agonists, and the carbonic anhydrase inhibitors. Proper ophthalmic eye-drop administration and medication adherence are imperative for preserving vision in POAG. Selective laser trabeculoplasty is a viable alternative to ophthalmic medications either initially or if a patient experiences ocular or systemic side effects from medication therapy. A modified prostaglandin analog was approved by the Food and Drug Administration in November 2017; its role in clinical practice is still evolving.
Topics: Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ophthalmic Solutions; Trabeculectomy
PubMed: 30068436
DOI: 10.4140/TCP.n.2018.432 -
Indian Journal of Ophthalmology Apr 2018Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering... (Review)
Review
Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. "Target" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a "Target" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
Topics: Antihypertensive Agents; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Iridectomy
PubMed: 29582808
DOI: 10.4103/ijo.IJO_1130_17 -
Current Opinion in Ophthalmology Mar 2022The aim of this article is to summarize up-to-date research on the diagnosis and management of juvenile open-angle glaucoma (JOAG). (Review)
Review
PURPOSE OF REVIEW
The aim of this article is to summarize up-to-date research on the diagnosis and management of juvenile open-angle glaucoma (JOAG).
RECENT FINDINGS
JOAG can be subclassified into four clinical phenotypes, and faster myopic shift is a risk factor for disease progression. Vessel density is associated with structural damage and worsening visual acuity in JOAG and can be monitored with optical coherence tomography angiography. Genetic studies have revealed molecular causes of JOAG including variants in CPAMD8, MYOC, and CYP1B1. Tube shunt surgeries as well as gonioscopy-assisted transluminal trabeculotomy have been shown to be successful in JOAG.
SUMMARY
Although genetic advances may improve future screening, intraocular pressure monitoring and fundoscopic exam remain the current mainstay of diagnosis. Medical treatment alone for JOAG is typically insufficient with patients requiring surgical management. Selective laser trabeculoplasty may delay or decrease the need for surgery. Trabeculectomy has traditionally been shown to be effective in JOAG, but tube shunt surgery and microinvasive glaucoma surgery are effective alternatives.
Topics: Follow-Up Studies; Glaucoma; Glaucoma, Open-Angle; Gonioscopy; Humans; Intraocular Pressure; Retrospective Studies; Trabeculectomy
PubMed: 34698671
DOI: 10.1097/ICU.0000000000000813 -
The New England Journal of Medicine Apr 1993
Review
Topics: Glaucoma, Open-Angle; Gonioscopy; Humans; Risk Factors; Tonometry, Ocular; Visual Fields
PubMed: 8455668
DOI: 10.1056/NEJM199304153281507