Treatment of POAG

Question 1

Goals of treating POAG

Answer 1

1. prevent further loss visual function
2. minimize adverse effects + impact patients vision
3. general health
4. QOL
5. maintain IOP/ below pressure
6. educate + involve patient in management of their disease
   current therapy = altering flow + production aq humour

Question 2

General approach to treat POAG

Answer 2

1. lower IOP reduce visual field loss
   2, clinician evaulated effectiveness toxicity , patient adherence
2. ideal therapeutic regimen - maximal effectivness + patient tolerance = achieve desired therapeutic response
3. reach a target IOP slow progression optic neuropathy

Question 3

RF for progression POAG

Answer 3

• high IOP
• older age
• haemorrhage optic disc
• large cup-to-disc ratio- thinner CCT
• established glacuomatous progression

Question 4

How can initial IOP control be achieved?

Answer 4

medical, laser, surgical/ combination

- medical + laser trabeculoplasty preffered

Question 5

What is the most common treatment in POAG?

Answer 5

• medical treatment with antihyperttensive - [low]
• 1st line agents = effective lowering IOP peak + trough
• lack systemic se
• dosed once daily

Question 6

IF monotherapy alone lowers IOP but does not reach target pressure than what can be used?

Answer 6

• combination therapy/ switching to another appropriate agent
• 2nd line agent from another class additive effect in IOP

Question 7

What are 2nd line agents?

Answer 7

• ocular hypotensive lipids
• timolol
• carbonic anhydrase inihibtors
• brimonidine

Question 8

What do combination eye drops reduce?

Answer 8

the number of drops to be administered

Question 9

What adverse effects can bensalkonium chloride cause - common preservative

Answer 9

• superficial punctate keratitis
• corneal erosion
• conjunctival allergy
• intolerance to preservative - resolved changing to preservative fre eye drop