Managing Primary Open-angle Glaucoma – Ocular Tolerability, Compliance, Persistence and Patient Outcomes

Abstract

Primary open-angle glaucoma (POAG) is a progressive optic neuropathy that, left untreated, can lead to irreversible damage to the optic nerve and permanent vision loss. To date, intraocular pressure (IOP) is the only modifiable risk factor for disease progression, and topical eye-drops are currently used as the leading non-surgical glaucoma therapy. Despite the efficacy of pharmacotherapy in lowering IOP, success is ultimately defined by patient compliance and patient persistence. Ocular tolerability is a crucial factor in patient compliance and persistence; non-adherence owing to adverse effects can lead to poor control of IOP and treatment failure. Prostaglandin analogues are currently the first-line antiglaucoma agents, with a good tolerability profile and a better IOP-lowering effect compared with β-blockers. Combination therapies have also shown greater efficacy in lowering IOP compared with the individual constituents, with fewer adverse effects. Treatment should be tailored to the individual patient, with a focus on ocular tolerability and its role in adherence, compliance and vision preservation.