Patient handout

Primary open-angle glaucoma (POAG)

PRODUCTION

1. Your condition

This handout is for primary open-angle glaucoma (poag). Your care team identified this based on: asymptomatic patient with cupped optic disc, elevated iop, rnfl thinning on oct, or unreliable visual field — poag is typically silent until late, so most entries are screening-detected (aao ppp poag 2025).

Other reasons your team may use this plan: first-degree family history of glaucoma, black or hispanic ancestry, age >60, high myopia, diabetes, or thin central cornea — high-risk asymptomatic screening cohort (aao ppp poag 2025); patient-reported peripheral vision loss, missed steps, near-misses while driving — already moderate-to-advanced disease at presentation (hodapp-anderson-parrish staging); chronic topical, intra-ocular, inhaled, intra-articular, or systemic corticosteroid user with iop elevation — steroid-induced secondary oag must be unmasked (aao ppp poag 2025).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
selective_laser_trabeculoplasty_first_line	—	—	—	LiGHT (Gazzard Lancet 2019 PMID 30862377): SLT first-line was non-inferior on HRQoL, 74.2% drop-free at 3 y, 0 vs 11 glaucoma-surgery patients, more time within target IOP (93.0% vs 91.3% of visits), and cost-effective. 6-year extension (Montesano/Gazzard Ophthalmology 2025 PMID 41043781) showed slower VF MD progression -0.26 vs -0.37 dB/y (P=0.007).

Plan: POAG — SLT-first then stepwise IOP-lowering pharmacotherapy + surgery (AAO PPP POAG 2025; LiGHT)

3. When to call your provider

Contact your care team if any of the following happen:

Documented structural OR functional progression at IOP target → re-set lower IOP target (drop another 20-30%) and step up the ladder (AAO PPP POAG 2025)
Disc haemorrhage (Drance) at any visit → strong progression signal, lower target
Acute angle-closure features (high IOP, cloudy cornea, mid-dilated fixed pupil) → route to ophtho.acute-angle-closure-glaucoma.core.v1

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Hodapp-Anderson-Parrish ADVANCED stage (mean deviation worse than -12 dB or split fixation) at presentation or progression
Documented OCT-RNFL or Humphrey VF progression while at the previously-set IOP target
Asthma / severe COPD / sinus bradycardia / 2nd-3rd degree AV block in a patient on or considered for topical timolol
Glaucoma in a child under age 2 considered for α2-agonist
Acute IOP spike with fixed mid-dilated pupil + cloudy cornea + pain + haloes(life-threatening)

5. Follow-up

Lifelong therapy with stage-appropriate cadence. Escalate IOP target or step up the ladder if progression detected on OCT or VF despite hitting IOP target. Drop-burden reduction via SLT re-treatment or MIGS is appropriate in stable patients with adherence struggles. Co-manage steroid-induced OAG by taper/switch of the offending steroid in collaboration with the prescribing service. Counsel patients on driving-vision regulations, fall-risk in advanced disease, low-vision rehabilitation (AAO PPP POAG 2025).

6. Sources

Guideline: AAO Preferred Practice Pattern (PPP) Primary Open-Angle Glaucoma 2025 cycle + LiGHT primary RCT (Gazzard Lancet 2019, PMID 30862377) + LiGHT 6-year visual-field-progression extension (Montesano/Gazzard Ophthalmology 2025, PMID 41043781)