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LancetSeptember 20230 citations

Glaucoma: now and beyond.

Jayaram Hari, Kolko Miriam, Friedman David S, Gazzard Gus


AI Summary

Glaucoma causes irreversible vision loss, primarily managed by lowering intraocular pressure. While effective, challenges include late diagnosis and limited evidence for many new treatments, highlighting the need for future neuroprotective and personalized therapies.

Abstract

The glaucomas are a group of conditions leading to irreversible sight loss and characterised by progressive loss of retinal ganglion cells. Although not always elevated, intraocular pressure is the only modifiable risk factor demonstrated by large clinical trials. It remains the leading cause of irreversible blindness, but timely treatment to lower intraocular pressure is effective at slowing the rate of vision loss from glaucoma. Methods for lowering intraocular pressure include laser treatments, topical medications, and surgery. Although modern surgical innovations aim to be less invasive, many have been introduced with little supporting evidence from randomised controlled trials. Many cases remain undiagnosed until the advanced stages of disease due to the limitations of screening and poor access to opportunistic case finding. Future research aims to generate evidence for intraocular pressure-independent neuroprotective treatments, personalised treatment through genetic risk profiling, and exploration of potential advanced cellular and gene therapies.


MeSH Terms

HumansGlaucoma, Open-AngleGlaucomaIntraocular PressureBlindnessVision Disorders

Key Concepts6

Intraocular pressure (IOP) is the only modifiable risk factor for glaucoma demonstrated by large clinical trials, although it is not always elevated.

TreatmentReviewn=Not applicableCh3Ch10Ch28

Timely treatment to lower intraocular pressure is effective at slowing the rate of vision loss from glaucoma.

TreatmentReviewn=Not applicableCh28Ch29

Many modern surgical innovations for glaucoma have been introduced with little supporting evidence from randomised controlled trials.

TreatmentReviewn=Not applicableCh37Ch40

Many glaucoma cases remain undiagnosed until the advanced stages of disease due to limitations of screening and poor access to opportunistic case finding.

DiagnosisReviewn=Not applicableCh10Ch11

Glaucomas are a group of conditions that lead to irreversible sight loss and are characterized by progressive loss of retinal ganglion cells.

PrognosisReviewn=Not applicableCh1Ch7

Methods for lowering intraocular pressure include laser treatments, topical medications, and surgery.

TreatmentReviewn=Not applicableCh28Ch29Ch37Ch40

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