Management

Most eye units now run special clinics for dealing with glaucoma patients. From what has been said, it should be clear that patients with glaucoma require much time and attention. Initially, the nature of the disease must be explained and patients must realise that the treatment is to arrest the progress of the condition and not to cure it. Furthermore, any visual loss that occurs is irretrievable, so that regular follow-up visits are essential for checking the intraocular pressure and carefully assessing the visual fields.

The initial treatment is a single topical agent - usually a prostaglandin analogue. The second-line treatments of choice are beta-blockers, brimonidine or dorzolamide. Commonly, patients with glaucoma require several different medications to control intraocular pressure effectively.

Increasingly, optometrists are providing specialist care for patients with glaucoma. Some optometrists work alongside hospital consultant-led teams, others work in the community to "refine referrals" and reduce the number of false-positive referrals to a specialist glaucoma clinic.

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