The feasibility of adopting «stepwise» initial approaches in treatment of patients with different stages of glaucoma

The “classical” scheme of prescribing regimens to patients with newly diagnosed primary open-angle glaucoma (POAG) implies initial monotherapy treatment, which is practiced in patients with any stage of the disease. This in turn implies a consistent strengthening of regimes.
Thus, the “modern” clinical algorithm practically excludes the possibility of initial treatment with combined medicines, laser treatment or conventional surgery. At the same time, differentiated («stepwise») approache used in other disciplines makes it possible to achieve control over the disease with the use of the smallest, but sufficient amount of medicines (regimens), depending on the stage of treatment, intraocular pressure (IOP) compensation and stabilization of the glaucomatous optic neuropathy.

Significant research in the field of permissible IOP-level values, which against the background of the ongoing treatment would not lead to rapid negative morphofunctional changes of the visual analyzer, is still few. The analysis of the clinical and epidemiological results of the studies given in the review, the established hypotensive efficacy of different treatment regimens and the predicted terms of the active substance tolerance violation convincingly prove the feasibility of using differentiated schemes of initial treatment. «Stepwise» approach, including the choice
of monotherapy with the use of a prostaglandin analogues at the «start» of treatment in patients with a newly identified mild glaucoma, mandatory use of combinations (preferably fixed) in patients with moderate stage of the disease and a minimum of triple therapy with a predicted transition to rapid surgical treatment in patients with advanced stage is another rational variant of using a limited amount of resources with which we can achieve the final result.

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