A Scoping Literature Review of Glaucoma Management: Pharmacological, Surgical, and Laser Interventions

Abstract Glaucoma is a leading cause of irreversible blindness worldwide and comprises a group of optic neuropathies characterized by progressive optic nerve damage, commonly associated with elevated intraocular pressure (IOP). The primary goal of glaucoma management is to reduce IOP, slow disease progression, and preserve visual function. This scoping review mapped existing and emerging management strategies for glaucoma, including pharmacological therapy, surgical interventions, laser procedures, and novel approaches such as gene therapy and neuroprotective agents. A comprehensive literature search of PubMed, Scopus, and Google Scholar was conducted for studies published between 2000 and 2025, including clinical trials, observational studies, and systematic reviews that examined the efficacy, safety, and outcomes of various glaucoma treatments, in line with PRISMA-ScR guidelines. Twenty studies met the inclusion criteria. Pharmacological therapy, particularly prostaglandin analogs, emerged as the most effective first-line treatment, providing substantial IOP reduction, although long-term adherence remains problematic due to side effects. Surgical options such as trabeculectomy demonstrated high effectiveness in IOP control, while minimally invasive glaucoma surgery offered improved safety profiles but comparatively reduced efficacy in advanced disease. Laser therapies, including selective laser trabeculoplasty and laser peripheral iridotomy, were shown to be effective alternatives, with selective laser trabeculoplasty producing outcomes comparable to first-line medications. Emerging strategies, notably gene therapy and neuroprotective agents, show promise in targeting the underlying disease mechanisms rather than solely reducing IOP, though their clinical application remains under investigation. Overall, glaucoma management remains complex and requires individualized treatment decisions based on disease severity, patient characteristics, and treatment tolerance. While current modalities effectively control IOP, persistent challenges underscore the need for continued research into innovative, long-term therapeutic solutions to improve outcomes and prevent vision loss. Keywords: Glaucoma, Intraocular pressure, Pharmacological treatments, Surgery, Laser therapy,