What Is the Initial Treatment of Open-Angle Glaucoma?
Managing open-angle glaucoma starts with prompt intraocular pressure (IOP) reduction. The first treatment step is guided by a structured evidence-based protocol with a clear, measurable pressure target.
Clinical Goal
First-line therapy aims to achieve a sustained, clinically significant reduction in IOP:
Reduce IOP 20–30% below baseline
Initial Therapy — Partial Overview
First-line options include a class of topical IOP-lowering eye drops — selected for efficacy, tolerability, and dosing convenience — as well as a laser surgical alternative. Specific agent selection, sequencing, and the full decision framework are contained in the complete structured protocol.
References
DOI: 10.1016/j.ophtha.2025.12.029
- Topical medical therapy is currently the most common initial intervention to lower IOP (see Table 4 for an overview of options available).
- Prostaglandin analogs are the most frequently prescribed eye drops for lowering IOP in patients with glaucoma because they are most efficacious and well tolerated, and they need to be instilled only once daily.
- Therefore, prostaglandin analogs are often selected as initial medical therapy unless other considerations, such as contraindications, cost, side effects, intolerance, or patient refusal preclude this.
- Laser trabeculoplasty surgery may be used as initial or adjunctive therapy in patients with POAG.
- A reasonable initial treatment goal in a patient with POAG is to reduce IOP 20% to 30% below baseline and to adjust up or down as indicated by disease course and severity.
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