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Primary open angle glaucoma is the most frequently diagnosed of the glaucoma syndromes. Patients are usually asymptomatic until the later stages of their disease, unless a paracentral scotoma is present. In the absence of other neurological reasons for the visual impairment, the diagnosis is made by a triad of clinical signs:

•Open angles gonioscopically.

•Glaucomatous damage to the optic nerve with corresponding field defect.

•Raised intraocular pressure (>21 mmHg).

The clinical signs and resulting visual field defects are discussed in more detail in later chapters.

Treatment is aimed at reducing the intraocular pressure either medically (drops), by laser (SLT/ALT), or surgically (e.g. trabeculectomy or aqueous shunt device). Reducing the IOP has been shown to reduce progression of glaucomatous field defects.

Prognosis is important to discuss with the patient when first diagnosing the condition and may be the source of concerns at future visits. Most POAG patients will not go blind within their lifetime due to glaucoma if the condition is optimally managed.