Am J Manag Care. 2017 Sep;23(15 Suppl):S279-S292.
Primary open angle glaucoma (POAG) is the most common type of glaucoma, and is responsible for approximately 90% of glaucoma cases in North America. POAG is characterized by an asymptomatic onset, where patients do not present with symptoms until significant visual loss occurs in late stages of the disease. Importantly, while glaucoma is associated with several risk factors that contribute to damage and disease progression, intraocular pressure (IOP) is the only proven modifiable risk factor at this time. Treatments for POAG include use of pharmacologic and surgical interventions. As of this writing, available pharmacologic options reduce IOP through reduction of aqueous humor production or by facilitating aqueous humor drainage through the uveoscleral outflow pathway (the unconventional pathway). Although cholinergic agonists (eg, pilocarpine) indirectly targets aqueous humor draining through the trabecular meshwork/Schlemm's canal (the conventional outflow pathway), cholinergic agonists are not frequently used, and as of this writing, no agents are currently available that target both the conventional and unconventional outflow pathways. Therapies in late-stage development include trabodenoson, netardsudil, and latanoprostene bunod.
原发性开角型青光眼（POAG）是最常见的青光眼类型，约占北美青光眼病例的 90%。POAG 的特点是无症状起病，患者在疾病晚期出现明显视力丧失之前没有出现症状。重要的是，虽然青光眼与导致损伤和疾病进展的几个风险因素有关，但目前眼压（IOP）是唯一已证实可改变的风险因素。POAG 的治疗包括药物和手术干预。在撰写本文时，可用的药物治疗方案通过减少房水生成或通过促进房水通过葡萄膜巩膜流出途径（非传统途径）来降低眼压。尽管胆碱能激动剂（如毛果芸香碱）间接靶向通过小梁网/施莱姆氏管（传统流出途径）排出的房水，但胆碱能激动剂并不常用，而且在撰写本文时，尚无同时靶向传统和非传统流出途径的药物。晚期开发的疗法包括 trabodenoson、netardsudil 和 latanoprostene bunod。
