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Glaucoma

Glaucoma in Adults—Screening, Diagnosis, and ManagementA Review

Educational Objective
To review the clinical management of glaucoma.
1 Credit CME
JAMA
January 12, 2021
Review
Joshua D. Stein, MD, MS1,2,3;
Anthony P. Khawaja, MBBS, PhD4;
Jennifer S. Weizer, MD1
Author Affiliations
  • 1W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
  • 2Center for Eye Policy and Innovation, University of Michigan, Ann Arbor
  • 3Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
  • 4NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Glaucoma Diagnosis and Treatment
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Abstract

Importance  Glaucoma is the most common cause of irreversible blindness worldwide. Many patients with glaucoma are asymptomatic early in the disease course. Primary care clinicians should know which patients to refer to an eye care professional for a complete eye examination to check for signs of glaucoma and to determine what systemic conditions or medications can increase a patient’s risk of glaucoma. Open-angle and narrow-angle forms of glaucoma are reviewed, including a description of the pathophysiology, risk factors, screening, disease monitoring, and treatment options.

Observations  Glaucoma is a chronic progressive optic neuropathy, characterized by damage to the optic nerve and retinal nerve fiber layer, that can lead to permanent loss of peripheral or central vision. Intraocular pressure is the only known modifiable risk factor. Other important risk factors include older age, nonwhite race, and a family history of glaucoma. Several systemic medical conditions and medications including corticosteroids, anticholinergics, certain antidepressants, and topiramate may predispose patients to glaucoma. There are 2 broad categories of glaucoma, open-angle and angle-closure glaucoma. Diagnostic testing to assess for glaucoma and to monitor for disease progression includes measurement of intraocular pressure, perimetry, and optical coherence tomography. Treatment of glaucoma involves lowering intraocular pressure. This can be achieved with various classes of glaucoma medications as well as laser and incisional surgical procedures.

Conclusions and Relevance  Vision loss from glaucoma can be minimized by recognizing systemic conditions and medications that increase a patient’s risk of glaucoma and referring high-risk patients for a complete ophthalmologic examination. Clinicians should ensure that patients remain adherent with taking glaucoma medications and should monitor for adverse events from medical or surgical interventions used to treat glaucoma.

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Article Information

Corresponding Author: Joshua D. Stein, MD, MS, Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105 (jdstein@med.umich.edu).

Accepted for Publication: October 19, 2020.

Author Contributions: Dr Stein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Weizer.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Khawaja, Weizer.

Administrative, technical, or material support: Khawaja, Weizer.

Supervision: Weizer.

Conflict of Interest Disclosures: Dr Stein reported receipt of grants from the National Eye Institute, the Lighthouse Guild, and Research to Prevent Blindness during the conduct of the study. Dr Khawaja reported receipt of personal fees from Allergan, Novartis, Thea, Aerie, Santen, and from Google Health outside the submitted work. No other disclosures were reported.

Funding/Support: The Lighthouse Guild, National Eye Institute (1R01EY026641-01A1), and Dr Beverley and Gerson Geltner Fund (Dr Stein); Research to Prevent Blindness (Drs Stein and Weizer); Moorfields Eye Charity Career Development Fellowship (Dr Khawaja).

Role of the Funder/Sponsor: None of the funders or sponsors had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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