Chronic open-angle glaucoma. Review for primary care physicians

Introduction: Chronic open-angle glaucoma (COAG) is a leading cause of irreversible blindness worldwide, including in Canada. It presents a challenge in diagnosis, as disease often progresses without symptoms; an estimated 50% of cases are undetected. Sources of information: MEDLINE searches, reference lists of articles, and expert knowledge from one of the authors (K.F.D.), a glaucoma specialist, were used. Main message: A casefinding approach using early referral to optometrists and ophthalmologists for early detection of COAG is helpful for patients with risk factors such as age above 50, a positive family history, black race, and myopia. Moderate evidence for referral also exists for the following risk factors: hypertension, type 2 diabetes mellitus, hypothyroidism, and sleep apnea. Treatment with intraocular pressure-lowering medication can arrest or slow the course of the disease, permitting patients to retain good visual function. Family physicians should be aware that some intraocular pressure-lowering medications, particularly topical beta-blockers, can pose iatrogenic harm to patients and result in or exacerbate such conditions as asthma, cardiovascular disturbances, depression, and sexual dysfunction. Conclusion: Appropriate referral patterns and an understanding of common as well as serious side effects of glaucoma medications are important in optimizing management of patients at risk of developing, or who have, COAG.