Management and outcomes of primary open-angle glaucoma

Area of Science:

• Ophthalmology
• Clinical Medicine
• Evidence-Based Medicine

Background:

• Primary open angle glaucoma (POAG) is a major cause of irreversible blindness.
• POAG is characterized by optic nerve damage and often elevated intraocular pressure (IOP).
• Current POAG treatments include medical therapy, surgery, or combination approaches.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials (RCTs) on POAG management.
• To compare the efficacy of medical, surgical, and combination therapies for POAG.
• To evaluate IOP reduction, visual field maintenance, and adverse effects of different POAG treatments.

Main Methods:

• Systematic review and meta-analysis of 80 RCTs.
• Inclusion of studies on medical (e.g., prostaglandin analogs, beta blockers), surgical (e.g., trabeculectomy, minimally invasive glaucoma surgery), and combination treatments.
• Primary outcomes: ≥20% IOP reduction and visual field progression; secondary outcomes: disease progression, quality of life, satisfaction, and side effects.

Main Results:

• No statistically significant difference in IOP lowering efficacy (P=0.5301) or mean IOP reduction (P=0.8493) among medical, surgical, and combination groups.
• All treatment modalities achieved substantial IOP reduction in a significant proportion of patients.
• Adverse effects like ocular pain, hyperemia, and blurred vision were common across all treatment groups.

Conclusions:

• Medical, surgical, and combination therapies are effective for managing POAG, lowering IOP, and preserving visual fields.
• No single treatment modality demonstrated clear superiority in mean IOP reduction.
• Individualized treatment selection based on patient characteristics, disease severity, and risk factors is crucial for optimizing outcomes.