PRIMARY OPEN-ANGLE GLAUCOMA: FAILURES IN SCREENING AND TREATMENT ADHERENCE AS DETERMINANTS OF THE RISK OF VISUAL LOSS

Abstract

Primary open-angle glaucoma (POAG) causes progressive and irreversible optic nerve damage, often remaining asymptomatic until relevant visual field loss has occurred. This narrative review analyzes how failures in early detection and inadequate treatment adherence contribute to preventable visual loss, while distinguishing population screening from risk-based case finding. Searches were conducted in 2026 in PubMed/MEDLINE, SciELO, and official guideline and evidence-review sources, prioritizing clinical guidelines, systematic reviews, randomized trials, longitudinal studies, and Brazilian evidence published mainly from 2000 to 2026. The literature shows that a substantial proportion of glaucoma remains undiagnosed, including in Brazil, and that strategies based only on intraocular pressure miss patients with pressure values within the statistically normal range. At the same time, medication adherence is limited by forgetfulness, complex regimens, poor understanding of an asymptomatic disease, difficulties with drop instillation, access barriers, and weak continuity of care. Longitudinal evidence associates lower adherence with faster visual field deterioration. Multicomponent educational strategies, simplified treatment, structured follow-up, and selective laser trabeculoplasty can reduce modifiable barriers. Preventing visual loss therefore requires an integrated care pathway that combines targeted detection, accurate diagnosis, individualized pressure reduction, adherence support, and continuous monitoring of structural and functional progression.