Management and outcomes of primary open-angle glaucoma

Primary open angle glaucoma (POAG) is a leading cause of irreversible blindness, characterized by progressive optic nerve damage often associated with elevated intraocular pressure (IOP). Treatment for POAG currently includes medical treatment, surgical intervention, or their combination. The goal of this study is to evaluate and contrast the efficacy of these several treatment methods through a systematic review and meta analysis of randomized controlled trials (RCTs) focusing on IOP reduction, visual field maintenance, and treatment related adverse effects. Studies published on POAG management were reviewed and meta analysis was done using a systematic method. Eighty RCTs in all involving patients who had either medical treatment (e.g., prostaglandin analogs, beta blockers), surgical intervention (e.g., trabeculectomy, minimally invasive glaucoma surgery), or their combination. While secondary outcomes included disease progression, quality of life, treatment satisfaction, and side effects, the primary outcomes were IOP reduction (≥20%) and visual field progression. Regarding IOP reduction and the mean IOP reduction, the meta analysis evaluated the variations between the treatment arms. The research comprised diverse patient groups, therapy methods, and follow up periods. Although a substantial proportion of patients across medical, surgical, and combination achieved ≥ 20% IOP reduction, no statistically significant difference was observed among the groups considering IOP lowering efficacy (P = 0.5301). Surgical procedures displayed the greatest mean IOP decrease, followed by medical and combination approaches, but the difference between treatment groups was not statistically significant (P = 0.8493). Adverse effects were common across all treatments, most frequently ocular pain, hyperemia, and blurred vision. In managing POAG, this study demonstrates that medical, surgical, and combination therapies are all effective in lowering IOP and preserving visual fields. Among the therapeutic approaches, no clear superiority was identified among treatment modalities regarding mean IOP reduction. Since side effects are present among all treatments, therapy should be individualized based on patient characteristics, disease severity, and risk factors to optimize outcomes.