Glaucoma is a chronic disorder that cannot be cured. Open-angle glaucoma often can be treated safely and effectively with medication or surgery, though lifelong therapy is almost always necessary. Decisions on when to start treatment are based on evidence of optic nerve damage, visual field loss, and risk factors (such as elevated intraocular pressure, or IOP, increasing age, and African-American or Hispanic background). The overall aim in the treatment of glaucoma is to prevent damage to the optic nerve by lowering IOP and maintaining it at a level that is unlikely to cause further nerve damage. The appropriate target for IOP is generally 25 percent below the IOP level at the time of diagnosis. If progressive damage is detected at the target IOP, a lower target is selected. Unfortunately, treatment cannot reverse optic nerve damage or improve vision.
Acute closed-angle glaucoma is a medical emergency. During an acute attack of closed-angle glaucoma, IOP may be high enough to damage the optic nerve or obstruct one of the blood vessels carrying blood and oxygen to the retina. Unless IOP is lowered promptly, blindness can occur within one or two days. The goals of treatment are to protect the optic nerve and prevent a future attack in the other eye. IOP in the affected eye is lowered with medication followed by surgery, either laser (iridotomy) or conventional (iridectomy). In both cases, surgery involves making a tiny hole in the iris to allow a path for the flow of aqueous humor. Surgery is almost always successful, and repeat treatment is rarely necessary. A preventive iridotomy or iridectomy in the other eye is usually performed because of the high likelihood of a future acute attack in that eye.
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