Optic Disc Damage Research Articles

Application of transcranial magnetotherapy in the treatment of glaucoma

The term "glaucoma" unites a large group of eye diseases with a characteristic pathogenesis and clinical picture, but different aetiology. Modern classifications group the different forms of glaucoma according to origin, age of the patient, mechanism of intraocular pressure increase and its level, degree of optic disc damage and course of the disease. The disease is a significant medical and social problem, as it affects large population groups worldwide and is the leading cause of irreversible blindness. Every year the number of glaucoma patients of working age increases, and the presence of concomitant diseases in patients complements and complicates the clinical picture and course of the main pathological process. To date, high therapeutic effectiveness of electromagnetic fields in glaucoma treatment has been determined and proved, specific methods of procedures have been developed, and the list of indications for their prescription is expanding. The purpose of the review is to present the possibilities of using transcranial magnetic therapy in the treatment of glaucoma. The authors, based on available scientific data and their own clinical observations, summarizes information regarding the use of transcranial magnetic therapy for glaucoma. Indications and contraindications for transcranial magnetic therapy are outlined. The principles of prescribing various methods of transcranial magnetic therapy are covered in detail. The characteristics of the equipment used for transcranial magnetic therapy procedures are given. In general, physical therapeutic factors play an important role in the overall complex of therapeutic and preventive measures in the treatment of eye diseases. As methods of external influence they have a direct impact on etiological and pathogenetic mechanisms, as well as on the symptoms of the disease.

Changes in Iridotrabecular Contact and Intraocular Pressure after Phacoemulsification in Primary Angle-Closure Disease Spectrum.

To compare changes in the swept-source (SS) anterior-segment optical coherence tomography (AS-OCT) parameters and intraocular pressure (IOP) control after lens extraction in various spectra of primary angle-closure disease (PACD). A total 92 eyes from 92 patients with PACD who underwent lens extraction were included in the study. All patients underwent IOP measurement preoperatively and at 1 day, 1 week, and 1, 3, and 6 months postoperatively. SS AS-OCT was performed in all subjects preoperatively and 1 month postoperatively. All participants were divided into two groups depending on the presence of glaucomatous optic disc or visual field damage (group A, PAC suspect or PAC; group B, PAC glaucoma). The changes in IOP and anterior chamber angle parameters of SS AS-OCT of each group were compared. Regression analysis was performed to find factors associated with the degree of IOP reduction after lens extraction. Preoperatively, there was no significant difference in IOP between the two groups (16.3 ± 2.5 mmHg vs. 16.9 ± 3.2 mmHg, p = 0.297), but the number of glaucoma medications used was greater in group B (0.6 ± 1.0 vs. 2.0 ± 0.9, p < 0.001). Postoperatively, IOP was not significantly different, but the number of medications used was greater in group B (0.2 ± 0.7 vs. 0.9 ± 0.8, p < 0.001). Anterior chamber angle parameters including angle opening distance and trabecular-iris angle had a greater increase in group B after lens extraction. However, the residual iridotrabecular contact (ITC) index was significantly greater in group B (5.6 ± 7.0 vs 10.7 ± 12.1, p = 0.014). A greater change in the ITC index was related to a greater degree of IOP reduction (β coefficient, 0.429; p < 0.001). Eyes with PAC glaucoma had a greater residual ITC index after lens extraction compared with eyes of other PACD spectrum and required a greater number of glaucoma medications to maintain a similar level of IOP.

Glaucoma Disease Classification by using Fundus images

Optic Disc (OD) and Optic Cup (OC) damage is caused by the eye condition glaucoma. OD is the morphological structure that is apparent in the cross-sectional view of the optic nerve connecting to the retina, while OC is the core region of OD. The morphological changes in the optic disc (OD) and optic cup (OC) often happen before visual field issues when glaucoma begins. Optic nerve head damage caused by glaucoma is permanent. Glaucoma is the greatest global cause of irreversible blindness, according to data from the World Health Organization (WHO). Only 10 to 50 percent of glaucoma patients, according to population-level surveys, are aware that they have the condition. As a result, glaucoma early identification is crucial for preventing irreversible eye damage. Glaucoma is a vision disorder that frequently affects older people and renders them permanently blind. Glaucoma affects 2.5% of people of all ages and 4.8% of people over the age of 75. Using MobileNetV2, this study suggests a unique deep transfer learning model for categorizing glaucoma. With regard to the error, with the least amount of expense, MobileNetV2 is a framework that optimizes memory consumption and execution speed. To increase the dataset and MobileNetV2's precision, data augmentation techniques were used. Using the HRF dataset, the suggested deep learning model's effectiveness is assessed. Results from the suggested procedure are accurate to 98%. Medical professionals can find the optimum course of treatment for their patients with the help of automated glaucoma classification.

Outcomes of lensectomy with glued intraocular lens and factors associated with failure in eyes with spherophakia and glaucoma.

To evaluate the outcomes of lensectomy with a glued intraocular lens (IOL) in spherophakic eyes with secondary glaucoma and assess factors associated with failure. We prospectively evaluated outcomes of lensectomy with glued IOL in 19 eyes with spherophakia and secondary glaucoma (intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage) between 2016 and 2018. The vision, refractive error, IOP, antiglaucoma medications (AGMs), optic disc changes, need for glaucoma surgery, and complications were assessed. Success was defined as complete when IOP was ≥5 and ≤21 mmHg without AGMs; qualified success as similar IOP with up to 3 AGM; the need for >3AGM/additional surgery for IOP control was considered a failure. Preoperatively, the median (interquartile range: IQR) age was 18 (13.5-30) years. IOP was 16 (14-22.5) mmHg on a median of 3 (2,3) AGMs. Median postoperative follow up was 27.7 months (11.9, 39.7). Postsurgery, most patients achieved emmetropia, with significantly decreased refractive error from a median spherical equivalent of -12.5D to + 0.5D, P < 0.0002. The complete success probability was 47% (95% confidence intervals (CIs): 29-76%) at 3 months and was 21% (8 - 50%) at 1 year and 3 years. The qualified success probability was 93% (82-100%) at 1 year, which reduced to 79% (60-100%) in 3 years. None of the eyes had any retinal complications. The higher number of preoperative AGM was found to be a significant risk factor (p < 0.02) for the failure of complete success. One-third of the eyes had IOP control without the need for AGM postlensectomy with glued IOL. Surgery resulted in significant improvement in visual acuity. The higher number of preoperative AGM was associated with poor glaucoma control after glued IOL surgery.

Association between Myopia and Glaucoma; A Cross-sectional Study

Myopia is a major cause of worldwide avoidable blindness and its prevalence increasing rapidly. Objective: To investigate the prevalence of glaucomatous optic nerve damage with various myopia levels as well as the relationship between myopia and glaucoma. Methods: A multi-centered cross-sectional study was conducted from January 2022 to July 2022. 250 individuals between the ages of 40 and 65 were recruited using non-probability purposive sampling technique. Mild, moderate and severe degree of myopia who had never had any surgery were included. All subjects underwent refraction and the optic disc ratio was assessed by slit lamp biomicroscopy, perimetry was performed to evaluate the visual field defects and IOP was determined using air puff tonometer. Frequency of glaucoma indicated by presence of visual field defects, glaucomatous optic disc. SPSS software was used for data analysis. Results: 145 (58%) of the 250 total subjects were female and 105(42%) were male. 67 (26.8%) people had refractive errors of mild myopia up to 3D. While 85 (34%) had a severe degree of myopia (refractive error greater than 6D) and 98 (39.2%) had a moderate degree. No intragroup's intraocular pressure showed a significantly distinct configuration. Age-related VF anomalies (a larger blind region, a vertical cup to disc ratio, and an unjustified defect) were associated with both glaucoma and high myopia. Findings from the study indicated that glaucoma risk increased for those with high myopia (p=0.001). Conclusion: High myopia is strongly associated with glaucomatous changes and a high prevalence of optic disc damage.

RARE CASE OF SPONTANEOUS SUB-RETINAL HAEMORRHAGE ASSOCIATED WITH IDOPATHIC INTRACRANIAL HYPERTENSION

Introduction: Idiopathic Intracranial Hypertension (IIH)is defined as increase in intracranial pressure due to unspecified causes leading to headache, papilledema, and transient vision loss. Usually the patients present with mild visual loss but about 25% may develop permanent visual loss due to irreversible optic disc damage. One rare cause of severe visual loss is subretinal hemorrhage (SRH) due to underlying Subretinal Neovascular membrane.&#x0D; Case Report: We report a case of a 36-year-old man diagnosed with IIH and papilloedema with sudden onset profound visual loss in his right eye. On examination, there was a large peripapillary SRH superior to the disc and involving the macula.We stress the importance of recognizing this uncommon complication of papilledema and discuss the possible causes for developing SRH, its most common outcome and the diagnostic as well as treatment modalities available.&#x0D; Discussion: We stress the importance of recognizing this uncommon complication of papilledema and discuss the possible causes for developing SRH, its most common outcome and the diagnostic as well as current treatment modalities available.&#x0D; Conclusion: This report highlights a rare case of spontaneous sub retinal haemorrhage in a patient with IIH. Measurement of optic nerve sheath diameter can be a vital tool for the diagnosis of raised intracranial pressure in this setting.

Longitudinal Choriocapillaris Vascular Density Changes in Different Types of Primary Open-Angle Glaucoma.

To evaluate longitudinal changes in choriocapillaris perfusion in patients with glaucoma with four phenotypes of optic disc damage and to explore associated factors with decreased choriocapillaris vessel density (CVD). This prospective longitudinal study included 96 eyes of 96 patients with primary open-angle glaucoma (POAG). Patients with POAG was differentiated into the optic disc phenotypes of focal ischemic type (FI), myopic type (MY), senile sclerotic type (SS), and generalized enlargement type (GE). Patients were followed up every three months. Simple linear regression was used to investigate the factors associated with a reduction in CVD. The median follow-up time was 2.5 years (range, 2.0-3.0 years). Choriocapillaris perfusion tended to decrease over time, with CVD decreasing significantly faster in the FI type than in the other three types (P < 0.001). The percentage decrease in the FI type was 7.85%, 10.89%, and 8.88% faster than MY, SS and GE, respectively, after correcting for age, gender, axial length, intraocular pressure, mean deviation, retinal nerve fiber layer (RNFL), and image quality score. In multivariate regression, decreased CVD was independently associated with the rate of RNFL thinning. FI type had the fastest rate of CVD decline in the four phenotypes of optic disc damage, and decreased CVD was positively correlated with the rate of RNFL thinning. The role of the choriocapillaris in the pathogenesis and therapeutic potential of glaucoma require further attention to facilitate better management of glaucoma patients.

RimNet: A Deep Neural Network Pipeline for Automated Identification of the Optic Disc Rim

Accurate neural rim measurement based on optic disc imaging is important to glaucoma severity grading and often performed by trained glaucoma specialists. We aim to improve upon existing automated tools by building a fully automated system (RimNet) for direct rim identification in glaucomatous eyes and measurement of the minimum rim-to-disc ratio (mRDR) in intact rims, the angle of absent rim width (ARW) in incomplete rims, and the rim-to-disc-area ratio (RDAR) with the goal of optic disc damage grading. Retrospective cross sectional study. One thousand and twenty-eight optic disc photographs with evidence of glaucomatous optic nerve damage from 1021 eyes of 903 patients with any form of primary glaucoma were included. The mean age was 63.7 (± 14.9) yrs. The average mean deviation of visual fields was-8.03 (± 8.59). The images were required to be of adequate quality, have signs of glaucomatous damage, and be free of significant concurrent pathology as independently determined by glaucoma specialists. Rim and optic cup masks for each image were manually delineated by glaucoma specialists. The database was randomly split into 80/10/10 for training, validation, and testing, respectively. RimNet consists of a deep learning rim and cup segmentation model, a computer vision mRDR measurement tool for intact rims, and an ARW measurement tool for incomplete rims. The mRDR is calculated at the thinnest rim section while ARW is calculated in regions of total rim loss. The RDAR was also calculated. Evaluation on the Drishti-GS dataset provided external validation (Sivaswamy 2015). Median Absolute Error (MAE) between glaucoma specialists and RimNet for mRDR and ARW. On the test set, RimNet achieved a mRDR MAE of 0.03 (0.05), ARW MAE of 31 (89)°, and an RDAR MAE of 0.09 (0.10). On the Drishti-GS dataset, an mRDR MAE of 0.03 (0.04) and an mRDAR MAE of 0.09 (0.10) was observed. RimNet demonstrated acceptably accurate rim segmentation and mRDR and ARW measurements. The fully automated algorithm presented here would be a valuable component in an automated mRDR-based glaucoma grading system. Further improvements could be made by improving identification and segmentation performance on incomplete rims and expanding the number and variety of glaucomatous training images.

Glaucoma in Dogs

Glaucoma is a group of diseases commonly defined by an increased intraocular pressure (IOP) which interferes with normal function of the optic nerve and retina. Characteristic changes of glaucoma include reduced axoplasmic flow in the optic nerve head, retinal ganglion cells death, cupping of the optic disc and visual damage or blindness due to retinal and optic nerve atrophy. &#x0D; Glaucoma with a normal intraocular pressure (normotensive glaucoma) has been described in human patients, however not in animals so far.

Case report on delayed presentation of primary congenital glaucoma

An asymptomatic 5 year old child presented to OPD with corneal haze, megalocornea and raised intraocular pressure. On fundus examination there was bilateral advanced optic disc damage. Surgical interventions done included Trabeculotomy and Trabeculectomy in the left eye and Trabeculectomy alone was done in the right eye. As in this case asymptomatic nature of the disease led to it’s late presentation which itself is a cause for advanced disc damage. Therefore awareness towards the subclinical subtle signs of congenital glaucoma makes it a point of concern for pediatricians to do proper screening and referral.

Clinical correlation of glaucoma with systemic hypertension and its effect on visual morbidity

Glaucoma and hypertension share a common pathophysiology of altered sodium transport in the renal and ciliary epithelium and can co exist. High blood pressure is a significant risk factor for glaucoma progression due to intraocular pressure spikes.This study was performed to evaluate the association of hypertension with glaucoma and to assess the extent of optic disc damage, the role of anti hypertensive medications and visual morbidity.This is a prospective, multidisciplinary study performed on a cohort of118 hypertensive patients over 1 year. Ophthalmic examination, ancillary ocular investigations, systemic tests and multi speciality referrals were obtained for all patients.Among 118 hypertensive patients, 64 (54.8%) had glaucoma. 65 patients (55.1%) were female and 53 patients (44.1%) male. Age group most frequently affected was between 60 and 70 years. There was increased incidence of ocular hypertension which was statistically significant (p value of 0.02). The range of IOP in those on anti hypertensive medications was 10-16 mmHg which was statistically significant (p value = 0. 03).Risk of glaucoma in hypertension was higher in women. An elevation of diastolic blood pressure is more significant than systolic BP in raising IOP. Decreased IOP was highest among patients taking calcium channel blockers.: Hypertension can cause both reduction and elevation in IOP. Treatment of hypertension does lower the IOP and prevent further progression of glaucoma and prevent any visual loss.

Assessment of Cerebral Vasomotor Reactivity in Patients With Primary Open-angle Glaucoma and Ocular Hypertension Using the Breath-Holding Index.

Patients with ocular hypertension (OHT) do not show impaired cerebral vasodilation responses to hypercapnia but patients with primary open-angle glaucoma (POAG) do. Impaired vasoreactivity in patients with POAG may have neuronal or vascular origins and increase stroke risk. To investigate changes in cerebral blood flow and cerebral vasomotor reactivity using the breath-holding index in patients with POAG and OHT, to examine whether these parameters contribute to the risk of ischemic stroke. Thirty patients with POAG, 30 patients with OHT, and 30 age- and sex-matched healthy control subjects were included in this university hospital-based, cross-sectional, and observational study. Eyes with a greater degree of visual field loss and/or more severe optic disc damage were selected for the study in patients with POAG, whereas in patients with OHT and controls, the study eye was chosen randomly. The mean blood flow velocity and breath-holding index were measured in the middle cerebral artery ipsilaterally in patient and control groups, by using transcranial Doppler ultrasonography. The mean blood flow velocity and breath-holding indexes were significantly lower in patients with POAG than in the control group (all P<0.05). In the OHT group, the mean blood flow velocity and breath-holding indexes were not different from those in the control group. Patients with POAG have impaired vasodilation response to hypercapnia. Presumably, the neuronal changes and deterioration of the endothelium-mediated vasodilatation in patients with glaucoma may disrupt the regulation of arteries and potentially present functional insufficiency on vasoreactivity. Moreover, impaired cerebral vascular regulation may contribute to the increased risk of stroke in patients with POAG.

Acupuncture for glaucoma.

Acupuncture for glaucoma.

A case report of late presentation of asymptomatic primary congenital glaucoma

An asymptomatic 3-year-old child presented with megalocornea, mild corneal haze, high intraocular pressure, and advanced optic disc damage in both eyes. The child was taken up for trabeculectomy and trabeculotomy in the right eye and trabeculectomy alone in the left eye. Due to the failure of the procedure in the right eye, Aurolab aqueous drainage implant was placed. The asymptomatic nature of the child led to the late presentation with advanced disc damage. Therefore, awareness of subtle signs of congenital glaucoma is crucial among the pediatricians for proper screening and referral.

A Canadian Cost-Utility Analysis of 2 Trabecular Microbypass Stents at Time of Cataract Surgery in Patients with Mild to Moderate Open-Angle Glaucoma

To assess, from the Canadian public payer perspective, the cost-utility of implanting iStent Inject trabecular bypass stent (TBS) devices in conjunction with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma (OAG) and visually significant cataract. Cost-utility analysis using efficacy and safety results of pivotal randomized clinical trial. Modeled cohort of patients with OAG (83.1% with mild disease, 16.9% with moderate disease) and visually significant cataract. Open-angle glaucoma treatment costs and effects were projected over a 15-year time horizon using a Markov model with Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, severe or blind) and death as health states. Patients in the mild or moderate OAG health states received implantation of iStent Inject during cataract surgery versus cataract surgery alone. On worsening of visual field defect and optic disc damage, patients could receive selective laser trabeculoplasty and trabeculectomy. We measured treatment effect as reduction in intraocular pressure (IOP) and mean medication use and estimated transition probabilities based on efficacy-adjusted visual field mean deviation decline per month. Healthcare resource utilization and utility scores were obtained from the literature. Cost inputs (2017 Canadian dollars [C$]) were derived using the Ontario Health Insurance Plan, expert opinion, medication claims datasets, and Ontario Drug Benefit Formulary medication consumption costs. We conducted deterministic and probabilistic sensitivity analyses to examine the impact of alternative model input values on results. Incremental cost per quality-adjusted life year (QALY) gained. Compared with cataract surgery alone, TBS plus cataract surgery showed a 99% probability of being more effective (+0.023 QALYs; 95% confidence interval [CI], 0.004 to 0.044) and a 73.7% probability of being cost-saving (net cost, -C$389.00; 95% CI, -C$1712.00 to C$850.70). In 95% of all simulations, TBS plus cataract surgery showed a cost per QALY of C$62 366 or less. Results were robust in additional sensitivity and scenario analyses. iStent Inject TBS implantation during cataract surgery seems to be cost effective for reducing IOP in patients with mild to moderate OAG versus cataract surgery alone.

Comparison of the retinal nerve fiber layer and ganglion cell complex thickness in Korean patients with unilateral exfoliation syndrome and healthy subjects.

PurposeTo compare retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness in patients with unilateral exfoliation syndrome (XFS) and age-matched controls using spectral domain-optical coherence tomography (SD-OCT).Materials and methodsThis prospective case–control study included 54 eyes (the XFS-affected and the fellow eyes) of 27 unilateral XFS patients and 27 eyes of 27 age-matched control subjects. The RNFL and GCC thicknesses were measured using SD-OCT (RT-Vue 100, Optovue, Fremont, CA) after pupillary dilation. RNFL and GCC thicknesses were compared between case and control groups.ResultsThe mean age of XFS patients was 73.3 years and that of age-matched controls was 74.3 years. Both groups demonstrated a male preponderance. Superior RNFL thickness of XFS-affected eyes were significantly thinner than those of the healthy age-matched controls (P = 0.002 by ANOVA). There were no statistically significant differences in the RNFL thickness between both eyes of unilateral XFS patients. Moreover, superior GCC thickness of both eyes in unilateral XFS patients were thinner than those in controls (P = 0.002 by ANOVA).ConclusionsThinner RNFL and GCC thicknesses were observed in unilateral XFS patients without visual field defects. These findings imply that XFS itself might be a risk factor for development of glaucomatous optic disc and RNFL damage.

Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis

PurposeTo report the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma in vernal keratoconjunctivitis (VKC).Materials and methodsRecords of patients with VKC, who visited our tertiary centre from 1992...

Oral Memantine for the Treatment of Glaucoma: Design and Results of 2 Randomized, Placebo-Controlled, Phase 3 Studies

To evaluate the effectiveness and safety of oral memantine as a potential neuroprotective agent in open-angle glaucoma (OAG) at risk for progression. Two randomized, double-masked, placebo-controlled, parallel-group, multicenter, 48-month studies identically designed, initiated 1 year apart, and completed in 2006. Protocol amendments included a 1-year extension (first study) and change in primary endpoint and analysis (second study). Patients (2298 total) with bilateral OAG; glaucomatous optic disc damage and visual field loss in 1 eye; glaucomatous optic disc damage and/or visual field loss in the contralateral eye (at screening), topically treated or untreated intraocular pressure (IOP) of 21 mmHg or less (at baseline); and at risk of glaucomatous progression (per prespecified criteria). Patients were randomized 3:2:2 to receive memantine 20 mg, memantine 10 mg, or placebo tablets daily. Glaucomatous progression was assessed in the intent-to-treat population by full-threshold standard automated perimetry (SAP), frequency doubling technology (FDT), and stereoscopic optic disc photographs, standardized by quality control assessment at centralized reading centers. Safety evaluations included adverse events (AEs), best-corrected visual acuity, biomicroscopy, IOP, and ophthalmoscopy. Efficacy data from each study were analyzed per protocol. Pooled analyses of efficacy and safety data were also performed. The predefined primary efficacy measure was glaucomatous visual field progression, as measured by SAP. Additional efficacy measures included glaucomatous progression of visual field (FDT) and optic nerve damage (stereoscopic optic disc photographs). The proportion of patients who completed the studies was similar among groups (80%-83%). Compared with placebo, daily treatment with memantine 10 mg or 20 mg for 48 months did not delay glaucomatous progression significantly in the individual studies and pooled analyses. The pooled risk reduction ratio (95% confidence interval) assessed by SAP was-0.13 (-0.40, 0.09) and-0.17 (-0.46, 0.07) for memantine 10 mg and 20 mg, respectively. Results were similar per FDT and stereoscopic optic disc photographs. The most common AEs leading to treatment discontinuations were dizziness, headache, fatigue, and nausea. With technologies available when the studies were conducted, daily treatment with memantine over 48 months was not shown to prevent glaucomatous progression in this patient population.

COMPARISON OF mfERG WITH VEP IN NAION PATIENTS AND HEALTHY PEOPLE

Purpose : Comparison of mfERG (multifocal electroretinography )with VEP( vizual evoked potential )in NAION( Nonarteritic ischemic optic neuropathy ) patients and healthy people Materials and methods: 44 NAION patients were included in the study.The patients were 23 woman, 21 male. The average age was 60-83 in NAION group.The patients underwent mfERG and VEP. 35 healthy people formed the control group. In the control group was 19 woman, 17 male. The average age was 57-89 in control group. Results : Mean VEP amplitude 1.89 * 0, 95mV and latency 123,6 * 18,70 msec in NAION group . In healthy group VEP amplitude was 4.92 * 1, 02mV and latency was 103,01 * 7.02 msec. There was no obvious pathology in mfERG in patients with NAION and in the control group . Conclusion: In NAION patients, significant changes can be seen in VEP amplitude and VEP latency. This was also found in our work. Ganglion cell and optic disc damage does not change in the mfERG , so abnormal mfERG is probably a reporter of an external retinal lesion. Key words: mfERG, VEP , NAION

Therapy for Open-Angle Glaucoma.

Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG). Articles indexed in PubMed, Scopus, and Cochrane Library in the last 10 years using the key words "glaucoma," "open-angle glaucoma," and "'open-angle glaucoma' AND 'treatment.'" Primary sources were used to locate additional resources. ClinicalTrials. gov was used to locate unpublished studies. Eighty-one publications were reviewed and criteria supporting the primary objective were used to identify useful resources. The literature included practice guidelines, review articles, original research articles, and product prescribing information for POAG. The POAG optic neuropathies result in optic disk damage and visual field loss. Ophthalmic medication therapy retards glaucoma progression, but many older patients require multiple medications to preserve vision and quality of life. An agent from the ophthalmic prostaglandin analog class is used as initial therapy in current practice because of the convenience of once-a-day administration and lower incidence of systemic side effects and slightly increased efficacy compared with other available ophthalmic medication classes. The other ophthalmic medication classes used in clinical practice include the beta-adrenergic blocking agents, the alpha-2 adrenergic agonists, and the carbonic anhydrase inhibitors. Proper ophthalmic eye-drop administration and medication adherence are imperative for preserving vision in POAG. Selective laser trabeculoplasty is a viable alternative to ophthalmic medications either initially or if a patient experiences ocular or systemic side effects from medication therapy. A modified prostaglandin analog was approved by the Food and Drug Administration in November 2017; its role in clinical practice is still evolving.