Primary Open-Angle Glaucoma (POAG)
Primary Open-Angle Glaucoma (POAG)
The most common form — painless, gradual optic nerve damage. This patient-education article is written by the glaucoma service at Suraj Eye Institute, Nagpur.
Primary Open-Angle Glaucoma (POAG)
IOP Management and Treatment Pyramid
The management of POAG follows a stepwise pyramid approach, beginning with the least invasive and most cost-effective options:
1. Topical IOP-Lowering Medications
Prostaglandin analogues (latanoprost, bimatoprost, travoprost, tafluprost) are first-line agents, reducing IOP by 25–35%. These are typically instilled once daily in the evening. Other classes include beta-blockers, alpha-2 agonists, carbonic anhydrase inhibitors, and newer ROCK inhibitors. Target IOP is individualised — typically a 20–30% reduction from baseline, or lower in advanced cases.
2. Selective Laser Trabeculoplasty (SLT)
SLT is a non-invasive laser procedure that improves trabecular meshwork function by selective stimulation, reducing IOP by 15–25% as a bridge between medications and surgery, or as monotherapy in select cases.
3. Surgical Options
Trabeculectomy with mitomycin C (MMC) and minimally invasive glaucoma surgery (MIGS) procedures including gonioscopy-assisted transluminal trabeculotomy (GATT) and Kahook Dual Blade (KDB) trabeculectomy are options for IOP inadequately controlled by drops and laser.
Monitoring and Follow-up
Regular monitoring is essential to detect progression early. Each visit should include intraocular pressure measurement by Goldmann applanation tonometry, optic disc evaluation (preferably with photography for comparison), and periodic visual field testing (automated 24-2 perimetry) and OCT of the retinal nerve fibre layer (RNFL). At Suraj Eye Institute, our glaucoma team uses state-of-the-art diagnostic equipment to detect disease early and personalise treatment for each patient.
Suraj Eye Institute is a NABH-accredited eye hospital in Nagpur with a dedicated glaucoma department staffed by experienced specialists. We employ advanced diagnostic technology including Humphrey visual field analysers, optical coherence tomography (OCT), and gonioscopy to diagnose glaucoma at its earliest stages. Our treatment options range from medical management to laser and surgical interventions, personalised to each patient’s needs and target IOP requirements. We prioritise early detection in at-risk populations and provide comprehensive long-term follow-up to preserve vision and quality of life.