gms | German Medical Science

Open angle glaucoma (POAG) is a chronic progressive optic neuropathy associated with retinal ganglion cell and visual field loss. The goal of glaucoma therapy is to maintain the patients visual function and the related quality of life. The key risk factors for the development of glaucoma are higher intraocular pressure (IOP), higher age, more baseline damage, optic disc hemorrhages, thinner central corneal thickness, pseudoexfoliation syndrome and low blood pressure (normal tension glaucoma). The only risk factor that can be influenced at the moment is the IOP. Other possible treatment areas have been evaluated such as ocular blood flow and neuroprotection, but there is no conclusive evidence to date.

Most forms of open angle glaucoma are initially treated with topical and occasionally orally administered agents that can either act on the reduction of aqueous humour production or on the enhancement of the aqueous outflow or on both. Several substances are considered first line as monotherapy. When patients fail to achieve their target IOP, a combination of agents of different classes can be employed next.

Since glaucoma is a chronic disease, topical therapy has to be given for many years up to decades. Several problems are associated with this long-term glaucoma medication: cost intensiveness, lack of patient cooperation and cause and/or exacerbation of ocular surface disease.

New routes of drug administration, i.e. with extended release implants are needed to overcome these problems in the future.