CLINICAL EVALUATION AND MANAGEMENT STRATEGIES FOR PRIMARY OPEN-ANGLE GLAUCOMA

Аннотация

Primary open-angle glaucoma (POAG) is a progressive optic neuropathy characterized by irreversible loss of retinal ganglion cells and visual field defects. It is one of the leading causes of blindness globally, often developing insidiously and remaining asymptomatic until advanced stages. This article investigates the clinical presentation, diagnostic challenges, and therapeutic interventions for POAG through a structured clinical study. The methodology involved comprehensive ocular examinations, intraocular pressure (IOP) monitoring, optical coherence tomography (OCT), and visual field analysis in patients diagnosed with POAG. The analysis emphasizes the correlation between early detection and preserved visual function. Findings highlight the importance of lifelong monitoring and patient-specific treatment regimens, including pharmacologic and surgical options. The study advocates for proactive screening and individualized care plans to prevent vision loss from POAG. Key words:Primary Open-Angle Glaucoma, Glaucoma Diagnosis, Intraocular Pressure (IOP), Optic Nerve Damage, Visual Field Testing, Tonometry, Gonioscopy, Optical Coherence Tomography (OCT), Glaucoma Management, Medical Therapy, Prostaglandin Analogs, Beta-Blockers. Introduction Glaucoma, particularly primary open-angle glaucoma (POAG), is a chronic optic neuropathy that affects millions of people worldwide. As of recent estimates, over 70 million individuals globally are affected by glaucoma, with POAG comprising the majority of these cases. Despite its high prevalence and potential for irreversible blindness, POAG remains underdiagnosed due to its asymptomatic progression during the early stages. By the time visual symptoms become noticeable, substantial optic nerve damage has usually occurred, often making intervention less effective. The hallmark of POAG is progressive loss of retinal ganglion cells, leading to characteristic changes in the optic disc and corresponding visual field defects. Although elevated intraocular pressure (IOP) is a major risk factor, it is not the sole determinant of disease onset or progression. Other contributory factors include genetic predisposition, age, race (with increased prevalence in individuals of African descent), corneal thickness, and vascular dysregulation. Diagnosing POAG requires a multifaceted approach. Clinical examination typically reveals an open anterior chamber angle on gonioscopy, increased cup-to-disc ratio on fundoscopy, and https://scientific-jl.com/wsrj 8 1 Volume-39_Issue-2_May-2025 World scientific research journal elevated IOP in many cases. However, a subset of patients with normal-tension glaucoma (NTG) exhibits characteristic glaucomatous changes without elevated IOP, complicating the diagnostic process. Recent advancements in imaging modalities such as OCT have enhanced the ability to detect early structural damage, particularly thinning of the retinal nerve fiber layer (RNFL) and ganglion cell complex. These changes often precede visual field defects detectable by standard automated perimetry, emphasizing the importance of structural assessments in early diagnosis. The primary goal in managing POAG is to halt or significantly slow disease progression by lowering IOP, even in cases where baseline IOP is within the statistically normal range. Treatment options include topical medications (e.g., prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors), laser trabeculoplasty, and various surgical interventions such as trabeculectomy or minimally invasive glaucoma surgeries (MIGS). This article presents a comprehensive analysis of POAG through a prospective clinical study, focusing on diagnostic accuracy, treatment efficacy, and long-term outcomes. It aims to reinforce the critical need for early intervention and tailored management in preventing irreversible visual loss. Methodology This prospective clinical study was conducted over a 24-month period at a university-affiliated ophthalmology center. A total of 120 patients aged between 40 and 75 years who were newly diagnosed with primary open-angle glaucoma were enrolled. The inclusion criteria consisted of open iridocorneal angles on gonioscopy, evidence of glaucomatous optic disc changes, and reproducible visual field defects consistent with glaucoma. Patients with secondary glaucoma, angle- closure glaucoma, or other optic neuropathies were excluded. All participants underwent a thorough ophthalmic evaluation at baseline, including best-corrected visual acuity (BCVA), slit-lamp examination, applanation tonometry for IOP measurement, gonioscopy, dilated fundus examination, OCT of the optic nerve head and macula, and automated visual field testing using the Humphrey Field Analyzer (24-2 SITA Standard protocol). Patients were stratified into three groups based on disease severity: early-stage, moderate-stage, and advanced-stage POAG. Treatment regimens were assigned accordingly: Early-stage patients were prescribed monothera