Speaking about primary prevention when it comes to glaucoma is not easy. Primary prevention refers to behavior or actions conducted directly on the environment to prevent the onset of the disease. The reason is soon said: glaucoma itself is not preventable, but in the majority of cases, the progression of damage and blindness are preventable. Since the disease is asymptomatic until the late stages, when a significant and irreversible functional impairment has already appeared, an early diagnosis is indispensable to promptly initiate therapy that stops the progression of damage.

Open-angle glaucoma, or as previously mentioned, chronic simple glaucoma, is a insidious condition because the damage is not perceived by the patient until the late stages, when there has already been a significant and irreversible loss of visual capacity. For this reason, early diagnosis is indispensable, which can only be achieved through regular check-ups, essential for relatives of glaucomatous individuals and which must be intensified as age progresses.

For this reason, it is essential to undergo regular eye examinations, at least every 4 years up to the age of 40, then every two years, increasing the frequency in subjects at risk. Only in this way is it possible to detect even slight alterations that may suggest the onset of glaucoma.

• Family history
• High intraocular pressure Age (risk increases with age)
• Race (higher frequency and severity in patients of color)
• Corneal thickness (low corneal thickness is a risk factor)
• Vascular diseases, arterial hypertension, diabetes mellitus
• Use of specific medications (corticosteroids, psychotropic drugs)

Eye drops generally constitute the first-choice treatment (unless laser treatment is possible) and include 4 groups of drugs:

• Beta-blockers,
• Prostaglandin analogues,
• Carbonic anhydrase inhibitors,
• Sympathomimetics.

These can also be used in combination to enhance their hypotensive effect. The choice of a specific eye drop is made based on effectiveness, tolerability, and any contraindications. It is crucial that the therapy is administered regularly. However, it is estimated that about 50% of glaucoma patients do not correctly adhere to the therapy (due to difficulties in instillation, discomfort, or because there is no perceived immediate benefit in undergoing the therapy).

Surgery is considered the last resort due to the possibility of complications or failures in reducing pressure, which can occur even when the procedure is performed correctly. In recent years, there have been significant advancements aimed at improving the effectiveness and safety of traditional operations and introducing minimally invasive surgical techniques.

These techniques can be performed on an outpatient basis and, if necessary, simultaneously with cataract surgery. Unfortunately, they do not have the same efficacy as traditional techniques in lowering intraocular pressure. For this reason, they are reserved for cases of glaucoma that are not highly advanced, where a modest reduction in intraocular pressure is sufficient. It can be safely stated that generally, the more effective a surgery is in lowering intraocular pressure, the higher the risks of complications associated with it.

Each type of surgical intervention is characterized by a mean postoperative pressure (obtained from the average postoperative pressures in a large group of patients), which is the pressure we can expect after that type of surgery. The choice is therefore determined by the pressure value we want to achieve in a particular patient (target pressure): obviously, the intervention is chosen in which the results are compatible with the desired level of pressure, and, all other things being equal, the least risky one is chosen. Therefore, the intervention that predicts a postoperative pressure lower than the target pressure with the lowest risk will be chosen.