Centre for Eye Health, The University of New South Wales, Sydney, Australia.
School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia.
Clin Exp Optom. 2021 Apr;104(3):367-384. doi: 10.1111/cxo.13114. Epub 2021 Mar 29.
Glaucoma is the leading cause of irreversible blindness worldwide. As a chronic disease, glaucoma presents a significant burden to the individual, health-care provider and the health-care system. Currently, strategies for treating glaucoma are focused on lowering intraocular pressure, which is aimed at slowing or arresting disease progression over time. This is the only current accepted therapeutic strategy for glaucoma, and can be achieved using topical drugs, laser trabeculoplasty, filtration surgery or cyclodestructive techniques. The lowering of intraocular pressure has been well-supported by numerous large-scale seminal clinical trials in primary open-angle glaucoma, in both its early and advanced stages. Although such guidance remains current, in the last 10-years, there has been a significant evolution in preferred first-line therapies in the treatment of open-angle glaucoma with a resultant shift in practice patterns, particularly early in the course of the disease. These changes reflect both from the perspective of the doctor - in titrating the most effective and least risky treatment modality - and the perspective of the patient, in consenting to a treatment that preserves vision and results in minimal negative impact on quality of life. In this review, the most recent evidence regarding treatment modalities for early primary open-angle glaucoma is presented and an updated framework for management guidance is proposed.
青光眼是全球范围内导致不可逆性失明的主要原因。作为一种慢性病，青光眼给患者、医疗服务提供者和医疗保健系统带来了巨大的负担。目前，治疗青光眼的策略主要集中在降低眼内压上，这旨在随着时间的推移减缓或阻止疾病的进展。这是目前唯一被接受的青光眼治疗策略，可以通过局部药物治疗、激光小梁成形术、滤过性手术或破坏性手术来实现。在原发性开角型青光眼的早期和晚期，大量大规模的开创性临床试验都很好地支持了降低眼内压的方法。尽管这种指导仍然是目前的主流，但在过去的 10 年中，开角型青光眼的首选一线治疗方法发生了重大变化，治疗模式也发生了转变，尤其是在疾病早期。这些变化反映了医生在选择最有效和风险最小的治疗方式方面的观点，也反映了患者在同意一种既能保持视力又能将对生活质量的负面影响降至最低的治疗方法方面的观点。在这篇综述中，介绍了早期原发性开角型青光眼治疗方法的最新证据，并提出了更新的管理指导框架。
