Glaucoma · Medical vs Laser vs Surgery

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Type + control status
   Open-angle/angle-closure? IOP control status?
   • Open-angle, treatment-naive → Open-angle naive → drops ± SLT
   • Acute angle-closure (angle closed, sudden IOP rise) → Acute angle-closure → urgent lowering + iridotomy
   • Poorly controlled/progressing on maximal tolerated medical therapy → Progression → filtration/drainage/MIGS
2. [End] Open-angle naive → drops ± SLT
   Open-angle treatment-naive → IOP-lowering drops (prostaglandin analog first-line) ± SLT selective laser trabeculoplasty (can be first-line, supported by the LiGHT trial); periodic visual field/OCT follow-up.
3. [End] Acute angle-closure → urgent lowering + iridotomy
   Acute angle-closure → urgent IOP lowering (medical) + laser peripheral iridotomy to relieve pupillary block; prophylactic iridotomy of the fellow eye.
4. [End] Progression → filtration/drainage/MIGS
   Poorly controlled/progressing on maximal tolerated medical therapy → surgery: trabeculectomy, glaucoma drainage device (tube), or MIGS (minimally invasive, mild-moderate ± combined with cataract).

Source guidelines & references

• Glaucoma management (AAO glaucoma PPP; LiGHT trial SLT)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways