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Primary open-angle glaucoma
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Primary open-angle glaucoma

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Contributors: D. Chimene Richa MD, Deepak Sobti MD
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Synopsis

Primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States. It is a chronic, progressive optic neuropathy in which the angle of the anterior chamber is open, there is loss of optic nerve tissues, also called cupping, and there are no other explanations for the nerve damage, such as trauma, uveitis, chronic steroid use, etc. It is often bilateral but can be asymmetric.

Typically asymptomatic, it is classically characterized by painless, gradual peripheral visual field loss followed by central visual field loss and eventually irreversible blindness, often with elevated intraocular pressure (IOP). However, 40% of cases are associated with normal IOP (see also normal tension glaucoma).

In the United States, POAG is the leading cause of blindness in black individuals, and there is a threefold-higher incidence in black patients as compared to non-Hispanic white patients; Hispanic patients have a comparable high prevalence rate to black patients.

Risk factors for development of POAG include:
  • Elevated IOP
  • Age over 50 years
  • Family history of glaucoma, especially in first-degree relative
  • African descent or Latin / Hispanic ethnicity
  • Thinner central cornea
  • Diabetes mellitus type 2
  • Myopia (nearsightedness)
  • Disc hemorrhage
  • Increased cup-to-disc ratio
  • Changes on peripheral visual fields
Management involves lowering IOP to slow disease progression and prevent vision loss, most commonly by pharmacotherapy, laser therapy, or surgery.

Codes

ICD10CM:
H40.1190 – Primary open-angle glaucoma, unspecified eye, stage unspecified

SNOMEDCT:
77075001 – Primary open angle glaucoma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Other diseases associated with optic disc damage or visual field abnormalities should be considered prior to accepting the diagnosis of glaucoma. These include:

Optic disc abnormalities:
Retinal abnormalities:
Central nervous system abnormalities:
  • Compressive optic neuropathy
  • Demyelination from multiple sclerosis
  • Nutritional optic neuropathy
  • Dominant optic atrophy
Also, secondary causes of glaucoma must be ruled out prior to diagnosing a patient with POAG.

Secondary causes of glaucoma:

Best Tests

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Therapy

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References

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Last Reviewed: 07/05/2017
Last Updated: 07/26/2017
Copyright © 2019 VisualDx®. All rights reserved.
Primary open-angle glaucoma
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Primary open-angle glaucoma : Bilateral, Vision loss, Elevated intraocular pressure
Copyright © 2019 VisualDx®. All rights reserved.