Intended for healthcare professionals

Clinical Review


BMJ 2013; 346 doi: (Published 11 June 2013) Cite this as: BMJ 2013;346:f3518
  1. Anthony King, consultant ophthalmic surgeon and honorary associate professor clinical ophthalmology1,
  2. Augusto Azuara-Blanco, professor of clinical ophthalmology and honorary consultant ophthalmologist2,
  3. Anja Tuulonen, professor of ophthalmology3
  1. 1Nottingham University Hospital and University of Nottingham, Nottingham NG7 2UH, UK
  2. 2Centre for Vision and Vascular Science, Queens University Belfast, Belfast, UK
  3. 3Tays Eye Centre, Tampere University Hospital, Tampere, Finland
  1. Correspondence to: A King anthony.king{at}

Summary points

  • The treatment of glaucoma can prevent or slow visual loss

  • A large proportion of people with glaucoma remain undiagnosed

  • Patients with advanced glaucoma at diagnosis are at greatest risk of blindness

  • The only treatment strategy with supporting evidence is the lowering of intraocular pressure

  • Non-adherence to glaucoma treatment drops may contribute to disease progression

Glaucoma is one of the most common ophthalmic conditions encountered in primary and secondary care. The World Health Organization estimated that in 2010 glaucoma accounted for 2% of visual impairment and 8% of global blindness.1 Disability adjusted life years attributable to glaucoma more than doubled between 1990 and 2010 due to the worldwide increase in the number of older people.2 Glaucoma is the leading cause of irreversible blindness in the world. In the United Kingdom, the management of patients with glaucoma constitutes a major part of ophthalmologists’ workload, accounting for 23% of all follow-up attendances to the UK hospital eye service.3 In the NHS there are more than one million glaucoma related visits per year. The social and economic burden is likely to increase in the future because of longer life expectancy and an ageing population.4 5 In the UK, glaucoma is the second most common cause for registration of visual impairment, accounting for 9-12% of registrations in people over the age of 65 years.6

Sources and selection criteria

This review focuses mainly on the diagnosis and current treatment options for primary open angle glaucoma, which is the most prevalent form in the United Kingdom. We searched Medline, the Cochrane Database of Systemic Reviews, and Clinical Evidence online using the search terms “glaucoma”, “glaucoma diagnosis”, “glaucoma medications”, and “glaucoma surgery”. We limited our studies to those conducted in adults and focused on systematic reviews, meta-analyses, and high quality randomised trials when available.

What is glaucoma?

Glaucoma refers …

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