Glaucoma: pharmacological management and iatrogenic causes

Glaucoma is the most common cause of irreversible visual loss worldwide (Sun et al, 2022). There are several types of glaucoma, ranging from primary congenital glaucoma, which occurs once in every 12 000 to 18 000 births, to chronic open-angle glaucoma (COAG), the most common variety, which affects about 480 000 people in England (European Glaucoma Society, 2017; Greener, 2019). COAG is about seven times more common than closed-angle (also called angle-closure) glaucoma, which is the next most frequent type (Gupta and Chen, 2016). Guidelines from the European Glaucoma Society (2017) provide full definitions of the various types.

Early diagnosis and rapid treatment are essential to preserve sight (Hamid et al, 2022). Intraocular pressure (IOP) is the only modifiable risk factor for glaucoma and reducing IOP is currently the only treatment strategy (Ho et al, 2017; Storgaard et al, 2021), although other targets are being explored that could result in new treatments (Greener, 2019). This article briefly introduces the pharmacological classes that reduce IOP and explores some factors that healthcare professionals (HCPs) should consider when using drugs to prevent sight loss, in particular emphasising the importance of concordance (adherence). The article also highlights the need for vigilance by all HCPs for side effects, such as iatrogenic glaucoma, which can arise from several commonly prescribed drugs (Table 1).