Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, La Jolla.
Singapore National Eye Center, Singapore, Singapore3Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
JAMA. 2014 May 14;311(18):1901-11. doi: 10.1001/jama.2014.3192.
Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition.
To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma.
A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians.
The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression.
Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
青光眼是全球范围内导致不可逆视力丧失的主要原因。由于它在相对较晚的阶段才可能出现症状，因此诊断经常被延误。对疾病的病理生理学、诊断和治疗有一个普遍的了解，可以帮助初级保健医生将高风险患者转介到全面的眼科检查，并更积极地参与治疗受这种情况影响的患者。
描述开角型青光眼和闭角型青光眼的病理生理学和治疗的当前证据。
使用 MEDLINE、Cochrane 图书馆和手稿参考文献，对 2000 年 1 月至 2013 年 9 月期间以开角型青光眼和闭角型青光眼为主题发表的英文研究进行了文献检索。从筛选出的 4334 篇摘要中，选择了 210 篇包含与初级保健医生相关的病理生理学和治疗信息的文章。
青光眼是一组进行性视神经病变，其特征为视网膜神经节细胞的退化以及视神经头部的相应变化。神经节细胞的丧失与眼内压水平有关，但其他因素也可能起作用。降低眼内压是治疗这种疾病的唯一被证实的方法。尽管治疗通常是从眼部降压滴液开始，但也可以使用激光小梁成形术和手术来减缓疾病的进展。
初级保健医生可以通过将有阳性家族史或可疑视神经头部发现的患者转介到全面的眼科检查，在青光眼的诊断中发挥重要作用。他们可以通过强调药物依从性和持久性的重要性，以及认识到青光眼药物和手术的不良反应，来改善治疗结果。
