Treatment choices for newly diagnosed primary open angle and ocular hypertension patients


Despite advances in our knowledge of the aetiology and pathophysiology of glaucoma, the sole proven, effective intervention for treating primary open-angle glaucoma (POAG) and ocular hypertension (OHT) remains lowering of intraocular pressure (IOP) to prevent further progression and visual loss. The purpose of this review is to evaluate the treatment choices available to newly diagnosed POAG and OHT patients. We review the existing literature on treatments currently available to newly diagnosed POAG and OHT patients and discuss their role in the treatment paradigm of POAG and OHT. We consider different factors that may be important when offering a choice of treatment to newly diagnosed POAG and OHT patients as well as describing new glaucoma treatments in development and future directions for treatment.


尽管我们对青光眼的病因与病理生理学的认识有所提高, 但目前针对原发性开角型青光眼(POAG)和高眼压(OHT)的治疗, 为防止病情进展和视力丧失, 唯一有效的干预措施仍是降低眼内压(IOP)。本文旨在对新诊断的POAG和OHT患者现有的治疗方式进行评估。我们针对新诊断的POAG和OHT患者现有的治疗方式进行了文献回顾, 并讨论了它们在POAG和OHT治疗模式中的作用。我们也考虑了其他因素在治疗新诊断的POAG和OHT中的重要作用。本文也阐述了青光眼治疗方法的新进展以及未来的治疗方向。

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Garway-Heath DF, Crabb DP, Bunce C, Lascaratos G, Amalfitano F, Anand N, et al. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. Lancet (Lond, Engl). 2015;385:1295–304.

    CAS  Google Scholar 

  3. 3.

    Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol (Chic, Ill : 1960). 2002;120:701–13.

    Google Scholar 

  4. 4.

    Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol (Chic, Ill : 1960). 2002;120:1268–79.

    Google Scholar 

  5. 5.

    Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol (Chic, Ill : 1960). 2003;121:48–56.

    Google Scholar 

  6. 6.

    Collaborative Normal-Tension Glaucoma Study Group. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol. 1998;126:487–97.

    Google Scholar 

  7. 7.

    Damji KF, Behki R, Wang L. Canadian perspectives in glaucoma management: setting target intraocular pressure range. Can J Ophthalmol J Canadien d'ophtalmologie. 2003;38:189–97.

    Google Scholar 

  8. 8.

    Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311:1901–11.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 363:1711–20.

    Google Scholar 

  10. 10.

    Pietrucha-Dutczak M, Amadio M, Govoni S, Lewin-Kowalik J, Smedowski A. The role of endogenous neuroprotective mechanisms in the prevention of retinal ganglion cells degeneration. Front Neurosci. 2018;12:834.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ (Clin Res ed). 1996;312:71–2.

    CAS  Google Scholar 

  12. 12.

    Osterberg L, Blaschke T. Adherence to medication. New Engl J Med. 2005;353:487–97.

    CAS  Google Scholar 

  13. 13.

    Wang F, Javitt JC, Tielsch JM. Racial variations in treatment for glaucoma and cataract among Medicare recipients. Ophthalmic Epidemiol. 1997;4:89–100.

    CAS  Google Scholar 

  14. 14.

    Stein JD, Talwar N, Laverne AM, Nan B, Lichter PR. Racial disparities in the use of ancillary testing to evaluate individuals with open-angle glaucoma. Arch Ophthalmol (Chic, Ill : 1960). 2012;130:1579–88.

    Google Scholar 

  15. 15.

    Jones L, Garway-Heath DF, Azuara-Blanco A, Crabb DP. Are patient self-reported outcome measures sensitive enough to be used as end points in clinical trials?: evidence from the United Kingdom Glaucoma Treatment Study. Ophthalmology. 2019;126:682–89.

    Google Scholar 

  16. 16.

    Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet (Lond, Engl). 2016;388:1389–97.

    Google Scholar 

  17. 17.

    Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. (London, England). 2019;393:1505–16.

    Google Scholar 

  18. 18.

    Hee OK, Thng ZX, Zhu HY, Lamoureux EL. Usage of glaucoma-specific patient-reported outcome measures (PROMs) in the Singapore context: a qualitative scoping exercise. BMC Ophthalmol. 2018;18:197.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Dirani M, Crowston JG, Taylor PS, Moore PT, Rogers S, Pezzullo ML, et al. Economic impact of primary open-angle glaucoma in Australia. Clin Exp Ophthalmol. 2011;39:623–32.

    Google Scholar 

  20. 20.

    Taylor HR. Glaucoma: where to now? Ophthalmology. 2009;116:821–2.

    Google Scholar 

  21. 21.

    Lee R, Hutnik CM. Projected cost comparison of selective laser trabeculoplasty versus glaucoma medication in the Ontario Health Insurance Plan. Can J Ophthalmol J Canadien d'ophtalmologie. 2006;41:449–56.

    Google Scholar 

  22. 22.

    Guedes RA, Guedes VM, Gomes CE, Chaoubah A. Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity. Medicine. 2016;95:e5745.

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Cantor LB, Katz LJ, Cheng JW, Chen E, Tong KB, Peabody JW. Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US. Curr Med Res Opin. 2008;24:2905–18.

    Google Scholar 

  24. 24.

    Kaplan RI, De Moraes CG, Cioffi GA, Al-Aswad LA, Blumberg DM. Comparative Cost-effectiveness of the Baerveldt implant, trabeculectomy with mitomycin, and medical treatment. JAMA Ophthalmol. 2015;133:560–7.

    Google Scholar 

  25. 25.

    Berdahl JP, Khatana AK, Katz LJ, Herndon L, Layton AJ, Yu TM, et al. Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma. J Med Econ. 2017;20:760–6.

    Google Scholar 

  26. 26.

    Patel V, Ahmed I, Podbielski D, Falvey H, Murray J, Goeree R. Cost-effectiveness analysis of standalone trabecular micro-bypass stents in patients with mild-to-moderate open-angle glaucoma in Canada. J Med Econ. 2019;22:390-401.

    Google Scholar 

  27. 27.

    Owen CG, Carey IM, De Wilde S, Whincup PH, Wormald R, Cook DG. The epidemiology of medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994 to 2003. Br J Ophthalmol. 2006;90:861–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Weinreb RN, Toris CB, Gabelt BT, Lindsey JD, Kaufman PL. Effects of prostaglandins on the aqueous humor outflow pathways. Surv Ophthalmol. 2002;47(Suppl 1):S53–64.

    Google Scholar 

  29. 29.

    Weinreb RN, Kashiwagi K, Kashiwagi F, Tsukahara S, Lindsey JD. Prostaglandins increase matrix metalloproteinase release from human ciliary smooth muscle cells. Investigative Ophthalmol Vis Sci. 1997;38:2772–80.

    CAS  Google Scholar 

  30. 30.

    Prum BE, Jr., Rosenberg LF, Gedde SJ, Mansberger SL, Stein JD, Moroi SE, et al. Primary open-angle glaucoma preferred practice pattern((R)) guidelines. Ophthalmology. 2016;123:P41–111.

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, et al. Comparative effectiveness of first-line medications for primary open-angle glaucoma: a systematic review and network meta-analysis. Ophthalmology. 2016;123:129–40.

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Grierson I, Pfeiffer N, Cracknell KP, Appleton P. Histology and fine structure of the iris and outflow system following latanoprost therapy. Surv Ophthalmol. 2002;47(Suppl 1):S176–84.

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Kirwan JF, Nightingale JA, Bunce C, Wormald R. Beta blockers for glaucoma and excess risk of airways obstruction: population based cohort study. BMJ (Clin Res ed). 2002;325:1396–7.

    Google Scholar 

  34. 34.

    Toris CB, Camras CB, Yablonski ME. Acute versus chronic effects of brimonidine on aqueous humor dynamics in ocular hypertensive patients. Am J Ophthalmol. 1999;128:8–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Schmier JK, Hulme-Lowe CK, Covert DW. Adjunctive therapy patterns in glaucoma patients using prostaglandin analogs. Clinical ophthalmology (Auckland, NZ). 2014;8:1097–104.

  36. 36.

    Higginbotham EJ. Considerations in glaucoma therapy: fixed combinations versus their component medications. Clin Ophthalmol (Auckland, NZ). 2010;4:1–9.

  37. 37.

    Webers CA, Beckers HJ, Zeegers MP, Nuijts RM, Hendrikse F, Schouten JS. The intraocular pressure-lowering effect of prostaglandin analogs combined with topical beta-blocker therapy: a systematic review and meta-analysis. Ophthalmology. 2010;117:2067-74.e1-6.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Robin AL, Novack GD, Covert DW, Crockett RS, Marcic TS. Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol. 2007;144:533–40.

    Google Scholar 

  39. 39.

    Tsai JC. A comprehensive perspective on patient adherence to topical glaucoma therapy. Ophthalmology. 2009;116(11 Suppl):S30–6.

    Google Scholar 

  40. 40.

    Tsai JC, McClure CA, Ramos SE, Schlundt DG, Pichert JW. Compliance barriers in glaucoma: a systematic classification. J Glaucoma. 2003;12:393–8.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Tsai JC. Medication adherence in glaucoma: approaches for optimizing patient compliance. Curr Opin Ophthalmol. 2006;17:190–5.

    PubMed  PubMed Central  Google Scholar 

  42. 42.

    Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005;140:598–606.

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    Balkrishnan R, Bond JB, Byerly WG, Camacho FT, Anderson RT. Medication-related predictors of health-related quality of life in glaucoma patients enrolled in a medicare health maintenance organization. Am J Geriatr Pharmacother. 2003;1:75–81.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Rahman MQ, Montgomery DM, Lazaridou MN. Surveillance of glaucoma medical therapy in a Glasgow teaching hospital: 26 years' experience. Br J Ophthalmol. 2009;93:1572–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Broadway D, Grierson I, Hitchings R. Adverse effects of topical antiglaucomatous medications on the conjunctiva. Br J Ophthalmol. 1993;77:590–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Broadway DC, Grierson I, O'Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol (Chic, Ill: 1960). 1994;112:1446–54.

    CAS  Google Scholar 

  47. 47.

    Li G, Torrejon KY, Unser AM, Ahmed F, Navarro ID, Baumgartner RA, et al. trabodenoson, an adenosine mimetic with a1 receptor selectivity lowers intraocular pressure by increasing conventional outflow facility in mice. Investigative Ophthalmol Vis Sci. 2018;59:383–92.

    CAS  Google Scholar 

  48. 48.

    Myers JS, Sall KN, DuBiner H, Slomowitz N, McVicar W, Rich CC, et al. A Dose-escalation study to evaluate the safety, tolerability, pharmacokinetics, and efficacy of 2 and 4 weeks of twice-daily ocular trabodenoson in adults with ocular hypertension or primary open-angle glaucoma. J Ocul Pharmacol Therapeutics: Off J Assoc Ocul Pharmacol Therapeutics. 2016;32:555–62.

    CAS  Google Scholar 

  49. 49.

    Liebmann JM, Lee JK. Current therapeutic options and treatments in development for the management of primary open-angle glaucoma. Am J Managed Care. 2017;23(15 Suppl):S279–s92.

    Google Scholar 

  50. 50.

    Ren R, Li G, Le TD, Kopczynski C, Stamer WD, Gong H. Netarsudil increases outflow facility in human eyes through multiple mechanisms. Investigative Ophthalmol Vis Sci. 2016;57:6197–209.

    CAS  Google Scholar 

  51. 51.

    Wang RF, Williamson JE, Kopczynski C, Serle JB. Effect of 0.04% AR-13324, a ROCK, and norepinephrine transporter inhibitor, on aqueous humor dynamics in normotensive monkey eyes. J Glaucoma. 2015;24:51–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Kiel JW, Kopczynski CC. Effect of AR-13324 on episcleral venous pressure in Dutch belted rabbits. J Ocul Pharmacol Therapeutics : Off J Assoc Ocul Pharmacol Therapeutics. 2015;31:146–51.

    CAS  Google Scholar 

  53. 53.

    Serle JB, Katz LJ, McLaurin E, Heah T, Ramirez-Davis N, Usner DW, et al. Two phase 3 clinical trials comparing the safety and efficacy of netarsudil to timolol in patients with elevated intraocular pressure: rho kinase elevated iop treatment trial 1 and 2 (ROCKET-1 and ROCKET-2). Am J Ophthalmol. 2018;186:116–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Lewis RA, Levy B, Ramirez N, Kopczynski CC, Usner DW, Novack GD. Fixed-dose combination of AR-13324 and latanoprost: a double-masked, 28-day, randomised, controlled study in patients with open-angle glaucoma or ocular hypertension. Br J Ophthalmol. 2016;100:339–44.

    PubMed  PubMed Central  Google Scholar 

  55. 55.

    Garcia GA, Ngai P, Mosaed S, Lin KY. Critical evaluation of latanoprostene bunod in the treatment of glaucoma. Clin Ophthalmol (Auckland, NZ). 2016;10:2035–50.

    Google Scholar 

  56. 56.

    Cavet ME, Vittitow JL, Impagnatiello F, Ongini E, Bastia E. Nitric oxide (NO): an emerging target for the treatment of glaucoma. Investigative Ophthalmol Vis Sci. 2014;55:5005–15.

    CAS  Google Scholar 

  57. 57.

    Weinreb RN, Scassellati Sforzolini B, Vittitow J, Liebmann J. Latanoprostene bunod 0.024% versus timolol maleate 0.5% in subjects with open-angle glaucoma or ocular hypertension: the APOLLO study. Ophthalmology. 2016;123:965–73.

    PubMed  PubMed Central  Google Scholar 

  58. 58.

    Medeiros FA, Martin KR, Peace J, Scassellati Sforzolini B, Vittitow JL, Weinreb RN. Comparison of latanoprostene bunod 0.024% and TiMolol Maleate 0.5% in open-angle glaucoma or ocular hypertension: the LUNAR study. Am J Ophthalmol. 2016;168:250–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Kawase K, Vittitow JL, Weinreb RN, Araie M. Long-term safety and efficacy of latanoprostene bunod 0.024% in Japanese subjects with open-angle glaucoma or ocular hypertension: the JUPITER study. Adv Ther. 2016;33:1612–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Wise JB, Witter SL. Argon laser therapy for open-angle glaucoma. A pilot study. Arch Ophthalmol (Chic, Ill : 1960). 1979;97:319–22.

    CAS  Google Scholar 

  61. 61.

    Thomas JV, Simmons RJ, Belcher CD 3rd. Argon laser trabeculoplasty in the presurgical glaucoma patient. Ophthalmology. 1982;89:187–97.

    CAS  Google Scholar 

  62. 62.

    Brubaker RF, Liesegang TJ. Effect of trabecular photocoagulation on the aqueous humor dynamics of the human eye. Am J Ophthalmol. 1983;96:139–47.

    CAS  Google Scholar 

  63. 63.

    Latina MA, Park C. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res. 1995;60:359–71.

    CAS  Google Scholar 

  64. 64.

    Beltran-Agullo L, Alaghband P, Obi A, Husain R, Lim KS. The effect of selective laser trabeculoplasty on aqueous humor dynamics in patients with ocular hypertension and primary open-angle glaucoma. J Glaucoma. 2013;22:746–9.

    Google Scholar 

  65. 65.

    Goyal S, Beltran-Agullo L, Rashid S, Shah SP, Nath R, Obi A, et al. Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial. Br J Ophthalmol. 2010;94:1443–7.

    Google Scholar 

  66. 66.

    Gulati V, Fan S, Gardner BJ, Havens SJ, Schaaf MT, Neely DG, et al. Mechanism of action of selective laser trabeculoplasty and predictors of response. Investigative Ophthalmol Vis Sci. 2017;58:1462–8.

    Google Scholar 

  67. 67.

    Bradley JM, Anderssohn AM, Colvis CM, Parshley DE, Zhu XH, Ruddat MS, et al. Mediation of laser trabeculoplasty-induced matrix metalloproteinase expression by IL-1beta and TNFalpha. Investigative Ophthalmol Vis Sci. 2000;41:422–30.

    CAS  Google Scholar 

  68. 68.

    Lee JY, Kagan DB, Roumeliotis G, Liu H, Hutnik CM. Secretion of matrix metalloproteinase-3 by co-cultured pigmented and non-pigmented human trabecular meshwork cells following selective laser trabeculoplasty. Clin Exp Ophthalmol. 2016;44:33–42.

    Google Scholar 

  69. 69.

    Izzotti A, Longobardi M, Cartiglia C, Rathschuler F, Sacca SC. Trabecular meshwork gene expression after selective laser trabeculoplasty. PLoS ONE. 2011;6:e20110.

    CAS  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Alvarado JA, Katz LJ, Trivedi S, Shifera AS. Monocyte modulation of aqueous outflow and recruitment to the trabecular meshwork following selective laser trabeculoplasty. Arch Ophthalmol (Chic, Ill : 1960). 2010;128:731–7.

    Google Scholar 

  71. 71.

    Kramer TR, Noecker RJ. Comparison of the morphologic changes after selective laser trabeculoplasty and argon laser trabeculoplasty in human eye bank eyes. Ophthalmology. 2001;108:773–9.

    CAS  Google Scholar 

  72. 72.

    Arora KS, Robin AL, Corcoran KJ, Corcoran SL, Ramulu PY. Use of various glaucoma surgeries and procedures in medicare beneficiaries from 1994 to 2012. Ophthalmology. 2015;122:1615–24.

    Google Scholar 

  73. 73.

    Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol (Chic, Ill : 1960). 2003;121:957–60.

    Google Scholar 

  74. 74.

    Nagar M, Ogunyomade A, O'Brart DP, Howes F, Marshall J. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol. 2005;89:1413–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  75. 75.

    McIlraith I, Strasfeld M, Colev G, Hutnik CM. Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma. 2006;15:124–30.

    Google Scholar 

  76. 76.

    Katz LJ, Steinmann WC, Kabir A, Molineaux J, Wizov SS, Marcellino G. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma. 2012;21:460–8.

    Google Scholar 

  77. 77.

    Weinand FS, Althen F. Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma. Eur J Ophthalmol. 2006;16:100–4.

    CAS  Google Scholar 

  78. 78.

    Woo DM, Healey PR, Graham SL, Goldberg I. Intraocular pressure-lowering medications and long-term outcomes of selective laser trabeculoplasty. Clin Exp Ophthalmol. 2015;43:320–7.

    Google Scholar 

  79. 79.

    McAlinden C. Selective laser trabeculoplasty (SLT) vs. other treatment modalities for glaucoma: systematic review. Eye (Lond, Engl). 2014;28:249–58.

    CAS  Google Scholar 

  80. 80.

    Nagar M, Luhishi E, Shah N. Intraocular pressure control and fluctuation: the effect of treatment with selective laser trabeculoplasty. Br J Ophthalmol. 2009;93:497–501.

    CAS  Google Scholar 

  81. 81.

    Li X, Wang W, Zhang X. Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma. BMC Ophthalmol. 2015;15:107.

    CAS  PubMed  PubMed Central  Google Scholar 

  82. 82.

    Ayala M. Intraocular pressure reduction after initial failure of selective laser trabeculoplasty (SLT). Graefe's Arch Clin Exp Ophthalmol=Albrecht von Graefes Arch fur klinische und experimentelle Ophthalmologie. 2014;252:315–20.

    Google Scholar 

  83. 83.

    Francis BA, Loewen N, Hong B, Dustin L, Kaplowitz K, Kinast R, et al. Repeatability of selective laser trabeculoplasty for open-angle glaucoma. BMC Ophthalmol. 2016;16:128.

    PubMed  PubMed Central  Google Scholar 

  84. 84.

    Hong BK, Winer JC, Martone JF, Wand M, Altman B, Shields B. Repeat selective laser trabeculoplasty. J Glaucoma. 2009;18:180–3.

    PubMed  PubMed Central  Google Scholar 

  85. 85.

    Polat J, Grantham L, Mitchell K, Realini T. Repeatability of selective laser trabeculoplasty. Br J Ophthalmol. 2016;100:1437–41.

    Google Scholar 

  86. 86.

    Khouri AS, Lin J, Berezina TL, Maltzman B, Fechtner RD. Repeat selective laser trabeculoplasty can be effective in eyes with initial modest response. Middle East Afr J Ophthalmol. 2014;21:205–9.

    PubMed  PubMed Central  Google Scholar 

  87. 87.

    Khouri AS, Lari HB, Berezina TL, Maltzman B, Fechtner RD. Long term efficacy of repeat selective laser trabeculoplasty. J ophthalmic Vis Res. 2014;9:444–8.

    PubMed  PubMed Central  Google Scholar 

  88. 88.

    Avery N, Ang GS, Nicholas S, Wells A. Repeatability of primary selective laser trabeculoplasty in patients with primary open-angle glaucoma. Int Ophthalmol. 2013;33:501–6.

    Google Scholar 

  89. 89.

    Song J. Complications of selective laser trabeculoplasty: a review. Clin Ophthalmol (Auckland, NZ). 2016;10:137–43.

  90. 90.

    Kennedy JB, SooHoo JR, Kahook MY, Seibold LK. Selective laser trabeculoplasty: an update. Asia-Pacific J Ophthalmol (Philadelphia, Pa). 2016;5:63–9.

    Google Scholar 

  91. 91.

    White AJ, Mukherjee A, Hanspal I, Sarkies NJ, Martin KR, Shah P. Acute transient corneal endothelial changes following selective laser trabeculoplasty. Clin Exp Ophthalmol. 2013;41:435–41.

    Google Scholar 

  92. 92.

    Regina M, Bunya VY, Orlin SE, Ansari H. Corneal edema and haze after selective laser trabeculoplasty. J Glaucoma. 2011;20:327–9.

    Google Scholar 

  93. 93.

    Ha JH, Bowling B, Chen SD. Cystoid macular oedema following selective laser trabeculoplasty in a diabetic patient. Clin Exp Ophthalmol. 2014;42:200–1.

    Google Scholar 

  94. 94.

    Wechsler DZ, Wechsler IB. Cystoid macular oedema after selective laser trabeculoplasty. Eye (Lond, Engl). 2010;24:1113.

    CAS  Google Scholar 

  95. 95.

    Wu ZQ, Huang J, Sadda S. Selective laser trabeculoplasty complicated by cystoid macular edema: report of two cases. Eye Sci. 2012;27:193–7.

    Google Scholar 

  96. 96.

    Phillis CA, Bourke RD. Bilateral subretinal fluid mimicking subretinal neovascularization within 24 hours after selective laser trabeculoplasty. J Glaucoma. 2016;25:e110–4.

    Google Scholar 

  97. 97.

    Kim DY, Singh A. Severe iritis and choroidal effusion following selective laser trabeculoplasty. Ophthalmic Surg, lasers Imaging : Off J Int Soc Imaging Eye. 2008;39:409–11.

    Google Scholar 

  98. 98.

    Hernandez Pardines F, Molina Martin JC, Fernandez Montalvo L, Aguirre Balsalobre F. Bilateral choroidal effusion after selective laser trabeculoplasty. Archivos de la Sociedad Espanola de. Oftalmologia. 2017;92:295–8.

    CAS  Google Scholar 

  99. 99.

    Wong MO, Lee JW, Choy BN, Chan JC, Lai JS. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol. 2015;60:36–50.

    Google Scholar 

  100. 100.

    Baser EF, Akbulut D. Significant peripheral anterior synechiae after repeat selective laser trabeculoplasty. Can J Ophthalmol J canadien d'ophtalmologie. 2015;50:e36–8.

    Google Scholar 

  101. 101.

    Bovell AM, Damji KF, Hodge WG, Rock WJ, Buhrmann RR, Pan YI. Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty? Can J Ophthalmol J Canadien d'ophtalmologie. 2011;46:408–13.

    Google Scholar 

  102. 102.

    Rolim de Moura C, Paranhos A, Jr., Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database Syst Rev. 2007: Cd003919.

  103. 103.

    Ekici F, Waisbourd M, Katz LJ. Current and future of laser therapy in the management of glaucoma open. Ophthalmol J. 2016;10:56–67.

    Google Scholar 

  104. 104.

    Rantala E, Valimaki J. Micropulse diode laser trabeculoplasty—180-degree treatment. Acta Ophthalmologica. 2012;90:441–4.

    Google Scholar 

  105. 105.

    Fea AM, Bosone A, Rolle T, Brogliatti B, Grignolo FM. Micropulse diode laser trabeculoplasty (MDLT): A phase II clinical study with 12 months follow-up. Clin Ophthalmol (Auckland, NZ). 2008;2:247–52.

  106. 106.

    Lee JW, Yau GS, Yick DW, Yuen CY. Micropulse laser trabeculoplasty for the treatment of open-angle glaucoma. Medicine. 2015;94:e2075.

    PubMed  PubMed Central  Google Scholar 

  107. 107.

    Abramowitz B, Chadha N, Kouchouk A, Alhabshan R, Belyea DA, Lamba T. Selective laser trabeculoplasty vs. micropulse laser trabeculoplasty in open-angle glaucoma. Clin Ophthalmol (Auckland, NZ). 2018;12:1599–604.

    Google Scholar 

  108. 108.

    Goldenfeld M, Melamed S, Simon G, Ben Simon GJ. Titanium:sapphire laser trabeculoplasty versus argon laser trabeculoplasty in patients with open-angle glaucoma. Ophthalmic Surg, lasers Imaging : Off J Int Soc Imaging Eye. 2009;40:264–9.

    Google Scholar 

  109. 109.

    Kaplowitz K, Wang S, Bilonick R, Oatts JT, Grippo T, Loewen NA. Randomized controlled comparison of titanium-sapphire versus standard Q-switched Nd: YAG laser trabeculoplasty. J Glaucoma. 2016;25:e663–7.

    Google Scholar 

  110. 110.

    Mansouri K, Shaarawy T. Comparing pattern scanning laser trabeculoplasty to selective laser trabeculoplasty: a randomized controlled trial. Acta Ophthalmologica. 2017;95:e361–e5.

    Google Scholar 

  111. 111.

    Belkin M, Geffen N, Ofir S, Kaplan Messas A, Barkana Y, Belkin A, et al. Direct trans-scleral selective laser trabeculoplasty (SLT) without a gonioscopy lens. Investigative Ophthalmol Vis Sci. 2014;55:819.

    Google Scholar 

  112. 112.

    Geffen N, Ofir S, Belkin A, Segev F, Barkana Y, Kaplan Messas A, et al. Transscleral selective laser trabeculoplasty without a gonioscopy lens. J Glaucoma. 2017;26:201–7.

    Google Scholar 

  113. 113.

    Zhang ML, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. Cochrane Database Syst Rev. 2015: Cd008671.

  114. 114.

    Burr J, Azuara-Blanco A, Avenell A, Tuulonen A. Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev. 2012:Cd004399.

  115. 115.

    King AJ, Fernie G, Azuara-Blanco A, Burr JM, Garway-Heath T, Sparrow JM, et al. Treatment of advanced glaucoma study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol. Br J Ophthalmol. 2018;102:922–8.

    Google Scholar 

  116. 116.

    Watson PG, Barnett F. Effectiveness of trabeculectomy in glaucoma. Am J Ophthalmol. 1975;79:831–45.

    CAS  Google Scholar 

  117. 117.

    Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789–803.e2.

    PubMed  PubMed Central  Google Scholar 

  118. 118.

    Gedde SJ, Feuer WJ, Shi W, Lim KS, Barton K, Goyal S, et al. Treatment outcomes in the primary tube versus trabeculectomy study after 1 year of follow-up. Ophthalmology. 2018;125:650–63.

    Google Scholar 

  119. 119.

    Budenz DL, Barton K, Gedde SJ, Feuer WJ, Schiffman J, Costa VP, et al. Five-Year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology. 2015;122:308–16.

    Google Scholar 

  120. 120.

    O'Brart DPS, Rowlands E, Islam N, Noury AMS. A randomised, prospective study comparing trabeculectomy augmented with antimetabolites with a viscocanalostomy technique for the management of open angle glaucoma uncontrolled by medical therapy. Br J Ophthalmol. 2002;86:748–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  121. 121.

    Gilmour DF, Manners TD, Devonport H, Varga Z, Solebo AL, Miles J. Viscocanalostomy versus trabeculectomy for primary open angle glaucoma: 4-year prospective randomized clinical trial. Eye (Lond, Engl). 2009;23:1802–7.

    CAS  Google Scholar 

  122. 122.

    Jonescu-Cuypers C, Jacobi P, Konen W, Krieglstein G. Primary viscocanalostomy versus trabeculectomy in white patients with open-angle glaucoma: a randomized clinical trial. Ophthalmology. 2001;108:254–8.

    CAS  Google Scholar 

  123. 123.

    Samuelson TW, Sarkisian SR Jr., Lubeck DM, Stiles MC, Duh YJ, Romo EA, et al. Prospective, randomized, controlled pivotal trial of an Ab interno implanted trabecular micro-bypass in primary open-angle glaucoma and cataract: two-year results. Ophthalmology. 2019;126:811–21.

    Google Scholar 

  124. 124.

    Samuelson TW, Chang DF, Marquis R, Flowers B, Lim KS, Ahmed IIK, et al. A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: The HORIZON Study. Ophthalmology. 2019;126:29–37.

    Google Scholar 

  125. 125.

    Vold S, Ahmed II, Craven ER, Mattox C, Stamper R, Packer M, et al. Two-Year COMPASS trial results: supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts. Ophthalmology. 2016;123:2103–12.

    Google Scholar 

  126. 126.

    Chatzara A, Chronopoulou I, Theodossiadis G, Theodossiadis P, Chatziralli I. XEN implant for glaucoma treatment: a review of the literature. Semin Ophthalmol. 2019;34:93–7.

    Google Scholar 

  127. 127.

    Brandao LM, Grieshaber MC. Update on minimally invasive glaucomasurgery (MIGS) and new implants. J Ophthalmol. 2013;2013:705915.

    PubMed  PubMed Central  Google Scholar 

  128. 128.

    Almasieh M, Levin LA. Neuroprotection in glaucoma: animal models and clinical trials. Annu Rev Vis Sci. 2017;3:91–120.

    Google Scholar 

  129. 129.

    Levin LA, Danesh-Meyer HV. Lost in translation: bumps in the road between bench and bedside. JAMA. 2010;303:1533–4.

    CAS  Google Scholar 

  130. 130.

    Prum BE Jr., Lim MC, Mansberger SL, Stein JD, Moroi SE, Gedde SJ, et al. Primary open-angle glaucoma suspect preferred practice pattern((R)) guidelines. Ophthalmology. 2016;123:P112–51.

    Google Scholar 

  131. 131.

    NICE. National Institute for Health and Clinical Excellence. NICE: Guidance on Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension: DoH; 2010. 2010.

  132. 132.

    European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th edn—Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol. 2017;101:130–95.

Download references


The authors have received financial research support that contributes to their ongoing research work from the following organisations: Anurag Garg: Fight For Sight Charity; International Glaucoma Association/Royal College of Ophthalmologists. Gus Gazzard: National Institute for Health Research, Health and Technology Assessment Programme; Moorfields Eye Charity; BCPB.

Author information



Corresponding author

Correspondence to Gus Gazzard.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Garg, A., Gazzard, G. Treatment choices for newly diagnosed primary open angle and ocular hypertension patients. Eye 34, 60–71 (2020).

Download citation


Quick links