Algorithm for choosing treatment tactics for patients with primary open-angle glaucoma in outpatient practice

Relevance One of the main factors in the development of glaucomatous optic neuropathy is elevated intraocular pressure (IOP) [1]. To reduce it, an ophthalmologist has medications, laser procedures, and antiglaucoma surgeries (AGO) [2, 3]. The timing of the intervention can be delayed due to incorrectly defined treatment tactics [4, 5]. Objective Development of an algorithm that can quickly assess the degree of POAG compensation in a patient and decide on further tactics. Material and methods The study involved 30 patients aged 30 to 86 years with a diagnosis of primary open-angle glaucoma or suspected glaucoma. All patients underwent a standard ophthalmological examination. The study assessed the stage of glaucoma in points: suspected glaucoma - 1 point; Stage I - 2 points; II - 4 points; III – 6 points. IOP level: normal – 0 points; borderline – 1 point; moderately elevated – 3 points; high – 5 points. Progression according to perimetry data: not detected – 0 points; insufficient data in the absence of 3 studies – 3 points; decrease within a year of VFI < 1% and MD < 0.3 dB – 2 points; decrease within a year of VFI 1–3% and MD by 0.3–1 dB – 4 points; decrease within a year of VFI > 3% and MD > 1 dB – 8 points. Antihypertensive regimen: without antihypertensive agents – 0 points; monotherapy or SLT – 1 point; enhanced therapy – 3 points; combination therapy – 4; maximum therapy – 8 points. Tolerability of therapy: good – 0 points; poor – 2 points. Presence of risk factors for glaucoma development and progression: absence or one of the risk factors – 0 points; 2 or more risk factors – 2 points. Based on the total score, the algorithm suggests further patient management tactics: 0–6 points – dynamic observation without treatment; 7–10 points – antihypertensive monotherapy or SLT; 11–13 points – enhanced therapy or SLT; 14–16 points – combination therapy, informing the patient about the need for AGO in the future; 17–19 points – maximum therapy, informing the patient about the need for AGO in the future; > 19 points – AGO prescription. Results The expert’s choice of treatment tactics coincided with the treatment proposed by the algorithm in 90% of cases. Conclusion This algorithm can be used in outpatient settings. However, the final decision requires a critical assessment by a specialist. Key words: primary open-angle glaucoma; glaucoma treatment; monitoring of glaucoma patients; antiglaucoma therapy; antiglaucoma surgery