Glaucoma is one of the leading causes of blindness in the general population, and open-angle glaucoma is the most common form [1] [2] [3]. Numerous risk factors for this disorder have been identified, including older age, genetic factors (a seven-fold increased risk is confirmed in the setting of a positive family history), trauma, use of corticosteroids (either topical or systemic), black race, and high intraocular pressure, which is considered to be the main event in the pathogenesis [3] [4] [5]. Unfortunately, one of the most prominent clinical features of glaucoma is that its symptoms appear only when substantial damage to the optic nerve and disk occurs [3] [4]. In fact, open-angle glaucoma is usually diagnosed incidentally, when examination of the eye is performed due to other causes [5]. Studies have shown that loss of more than 40% of optic nerve fibers is necessary to produce symptoms [5], and patients report a gradual loss of peripheral vision that is often perceived as tunnel vision [5] [6]. In most patients, open- angle glaucoma appears bilaterally, and inability to perform daily activities, such as driving and newspaper reading is often a consequence of the reduced visual field, while some patients report missing stairs as well [4]. Glaucoma invariably causes irreversible blindness in the absence of a timely diagnosis and an early appearance of vision-related symptoms must be taken seriously for that reason.

• Mediastinal Lymphadenopathy

  Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure. [ncbi.nlm.nih.gov]

• High Arched Palate

  Systemic examination showed hyperextensible skin and joints, acrogeria, hypodontia, high arched palate, and varicose veins. [ncbi.nlm.nih.gov]

• Acrogeria

  Systemic examination showed hyperextensible skin and joints, acrogeria, hypodontia, high arched palate, and varicose veins. [ncbi.nlm.nih.gov]

• Blurred Vision

  Peak IOP was associated with temporary blurring of vision and mild corneal edema in 1 patient (case 1). [ncbi.nlm.nih.gov]

  Acute Angle Closure Glaucoma is characterized by this sudden rise in pressure which will cause pain, redness, light sensitivity, colored haloes around lights, nausea or vomiting, and blurred vision, and if left untreated permanent loss of vision. [bweyecenter.com]

  There is great risk of vision loss if an angle closure attack occurs. The symptoms of an angle closure attack are red painful eye, blurred vision, nausea, vomiting, and headache. [sightmd.com]

• Visual Acuity Decreased

  Patient V.1, a female born in 1967, first had a decrease in visual acuity at the age of 12. At age 18, visual acuity was 4/10 in each eye. [jmg.bmj.com]

• Blue Sclera

  Ocular findings include blue sclera, low ocular rigidity, and thin corneal thickness. However, there are no documented cases linking OI and primary open angle glaucoma (POAG). [ncbi.nlm.nih.gov]

• Chronic Progressive External Ophthalmoplegia

  Kearns-Sayre syndrome is characterized by chronic progressive external ophthalmoplegia, tapetoretinal degeneration and severe generalized myopathy. We report on a 82-year-old male patient with Kearns-Sayre syndrome with open angle glaucoma. [ncbi.nlm.nih.gov]

The diagnostic workup of patients reporting vision impairment must start with a thorough patient history that can reveal the presence of risk factors and assess the course and progression of symptoms. A positive family history, previous eye-related disorders and potential use of corticosteroids must be noted. A physical examination including visual field examination should be performed. As symptoms may be absent in the early stages, direct ophthalmoscopy is also recommended as a mandatory part of primary practice [3] [4] [5]. A more detailed ophthalmoscopic examination, however, is required to confirm glaucoma and various non-invasive procedures and these may be [4] [5] [7]:

• Perimetry - Because of its ability to provide a direct view of the patient's visual fields, this computer-based procedure is considered to be the mainstay in diagnosis and management of glaucoma [5].
• Optical coherence tomography (OCT) - Used to assess the optic nerve head and the retina by creating cross-sectional images [7], OCT is also frequently implemented in glaucoma workup. A more advanced form possessing an increased resolution and faster scanning speed, spectral domain (SD)-OCT, was recently introduced in ophthalmology, providing an even better view of the damaged structures [7].
• Scanning laser polarimetry and ophthalmoscopy - Measurement of the optic nerve fiber thickness and quantitative detection of viable retinal cells is achieved by these methods, respectively, which may be quite useful when the disease is in its initial stages.

• Gliosis

  […] with the increased incidence of nonrhegmatogenous retinal detachment, and also with strabismus, afferent pupillary defect, visual field defects, presence of hyaloids artery remnants, ciliary body cyst, congenital cataract, lid hemangioma and preretinal gliosis [ncbi.nlm.nih.gov]

Treatment of atopic eyelid disease with topical tacrolimus, following corticosteroid discontinuation in a steroid responder patient with open-angle glaucoma, seems to be an effective alternative treatment to corticosteroids without the risk of IOP increase [ncbi.nlm.nih.gov]

We did identify some border line evidence for a positive influence of treatment on VF prognosis (OR 0.67, 95% CI 0.45 to 1.00) for the beta-blockers . [cochrane.org]

What Is the Prognosis for Primary Open-Angle Glaucoma? The prognosis is generally good for people with primary open-angle glaucoma. [emedicinehealth.com]

(GRADE*: Level of evidence=low, Strength of recommendation=strong) Offer people the opportunity to discuss their diagnosis, referral, prognosis, treatment and discharge, and provide them with relevant information in an accessible format at initial and [college-optometrists.org]

Treatment & Prognosis If glaucoma is detected early, you can prevent or lessen serious symptoms, such as vision loss. Damage caused by glaucoma is irreparable. Treatment only helps to control the condition and prevent further damage. [nvisioncenters.com]

The present report suggests that visual field defects atypical for glaucoma should be carefully scrutinized for other etiologies. [ncbi.nlm.nih.gov]

Etiology/Risk factors Pathophysiology Clinical features Diagnostics Treatment [amboss.com]

Etiology The final common pathway for all potential etiologies of POAG is optic nerve head damage. This is thought to be secondary to primarily ganglion cell axon loss, although loss of blood vessels and glial cells has also been observed. [eyewiki.aao.org]

Blasco Ibáñez 15, 46010 Valencia, Spain. [email protected] 5 CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Calle Sinesio Delgado, 3, 28029 Madrid, Spain. [email protected] 6 Genetic & Molecular Epidemiology [ncbi.nlm.nih.gov]

Abstract Objective: To evaluate the clinical and epidemiological profile of patients with primary open-angle glaucoma. [scielo.br]

BACKGROUND: The pathophysiological changes occurring in the trabecular meshwork in primary open angle glaucoma are poorly understood, but are thought to include increased extracellular matrix deposition, trabecular meshwork cell apoptosis, inflammation [ncbi.nlm.nih.gov]

Etiology/Risk factors Pathophysiology Clinical features Diagnostics Treatment [amboss.com]

Glaucoma Pathophysiology Glaucoma Causes Glaucoma Diagnosis [news-medical.net]

Early detection prevents major vision loss While you can’t prevent glaucoma, you can prevent major vision loss from this disease with early detection and treatment. Vision Loss from Glaucoma [nweyes.com]

Author information 1 Genetic & Molecular Epidemiology Unit, Department of Preventive Medicine & Public Health, School of Medicine, University of Valencia, Avenida Vicente Blasco Ibáñez 15, 46010 Valencia, Spain. [email protected] 2 CIBER Fisiopatología [ncbi.nlm.nih.gov]

Prevention Is Easy When it comes to preventing glaucoma, the best thing you can do is get regular eye examinations and glaucoma screenings from Eye and Lasik Center. [eyeandlasik.com]

It needs to be filled and drained consistently to prevent blockages or excess pressure. [nvisioncenters.com]

1. Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363:1711–1720.
2. Beidoe G, Mousa SA. Current primary open-angle glaucoma treatments and future directions. Clin Ophthalmol. 2012;6:1699-1707.
3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
4. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;14;311(18):1901-1111.
5. Distelhorst JS, Hughes GM. Open-Angle Glaucoma. Am Fam Physician. 2003;67:1937–44.
6. Hu CX, Zangalli C, Hsieh M, et al. What Do Patients With Glaucoma See? Visual Symptoms Reported by Patients With Glaucoma. Am J Med Sci. 2014;348(5):403-409.
7. Bussel II, Wollstein G, Schuman JS. OCT for glaucoma diagnosis, screening and detection of glaucoma progression. Br J Ophthalmol. 2014;98(2):ii15-ii19.