W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
Center for Eye Policy and Innovation, University of Michigan, Ann Arbor.
JAMA. 2021 Jan 12;325(2):164-174. doi: 10.1001/jama.2020.21899.
Glaucoma is the most common cause of irreversible blindness worldwide. Many patients with glaucoma are asymptomatic early in the disease course. Primary care clinicians should know which patients to refer to an eye care professional for a complete eye examination to check for signs of glaucoma and to determine what systemic conditions or medications can increase a patient's risk of glaucoma. Open-angle and narrow-angle forms of glaucoma are reviewed, including a description of the pathophysiology, risk factors, screening, disease monitoring, and treatment options.
Glaucoma is a chronic progressive optic neuropathy, characterized by damage to the optic nerve and retinal nerve fiber layer, that can lead to permanent loss of peripheral or central vision. Intraocular pressure is the only known modifiable risk factor. Other important risk factors include older age, nonwhite race, and a family history of glaucoma. Several systemic medical conditions and medications including corticosteroids, anticholinergics, certain antidepressants, and topiramate may predispose patients to glaucoma. There are 2 broad categories of glaucoma, open-angle and angle-closure glaucoma. Diagnostic testing to assess for glaucoma and to monitor for disease progression includes measurement of intraocular pressure, perimetry, and optical coherence tomography. Treatment of glaucoma involves lowering intraocular pressure. This can be achieved with various classes of glaucoma medications as well as laser and incisional surgical procedures.
Vision loss from glaucoma can be minimized by recognizing systemic conditions and medications that increase a patient's risk of glaucoma and referring high-risk patients for a complete ophthalmologic examination. Clinicians should ensure that patients remain adherent with taking glaucoma medications and should monitor for adverse events from medical or surgical interventions used to treat glaucoma.
青光眼是全球最常见的不可逆性失明原因。许多青光眼患者在疾病早期无症状。初级保健临床医生应了解哪些患者需要转介到眼科专业医生进行全面的眼部检查，以检查是否有青光眼迹象，并确定哪些全身状况或药物会增加患者患青光眼的风险。本文回顾了开角型和窄角型青光眼，包括其病理生理学、危险因素、筛查、疾病监测和治疗选择的描述。
青光眼是一种慢性进行性视神经病变，其特征是视神经和视网膜神经纤维层损伤，可导致周边或中央视力永久性丧失。眼内压是唯一已知的可改变的危险因素。其他重要的危险因素包括年龄较大、非白种人以及青光眼家族史。几种全身疾病和药物，包括皮质类固醇、抗胆碱能药物、某些抗抑郁药和托吡酯，可能使患者易患青光眼。青光眼有 2 大类，开角型和闭角型青光眼。用于评估青光眼和监测疾病进展的诊断测试包括眼压测量、视野检查和光学相干断层扫描。青光眼的治疗包括降低眼压。这可以通过各种类型的青光眼药物以及激光和手术治疗来实现。
通过识别增加患者患青光眼风险的全身状况和药物，并将高风险患者转介进行全面眼科检查，可以最大限度地减少青光眼引起的视力丧失。临床医生应确保患者坚持使用青光眼药物，并监测用于治疗青光眼的药物或手术干预的不良反应。
