New trends in the treatment of open-angle glaucoma: a critical review.

Purpose: This critical review explores current and emerging strategies for the management of open-angle glaucoma (OAG), highlighting pharmacological, laser-based, and surgical innovations. It aims to synthesize recent evidence, assess real-world applicability, and evaluate future directions in personalized glaucoma care.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases for English-language publications between January 2000 and May 2025. Studies on first-line therapies, combination treatments, microinvasive glaucoma surgery (MIGS), laser modalities, and novel drug delivery systems were included. The review presents an overview of significant advancements and future directions in glaucoma treatment.

Results: Prostaglandin analogs remain the cornerstone of medical therapy, while fixed combinations and sustained-release implants improve adherence. Selective laser trabeculoplasty (SLT) has gained traction as a first-line treatment in mild OAG, though its effectiveness in advanced stages is limited. MIGS procedures are increasingly used as safer alternatives to traditional surgery, especially when combined with cataract extraction. Affordable goniotomy techniques and suprachoroidal approaches offer promising solutions in resource-constrained settings. Neuroprotection, vascular modulation, and caspase inhibition represent future adjunctive strategies. In Romania, glaucoma remains a major public health challenge, with limited treatment coverage and delayed diagnoses due to systemic gaps in education and screening.

Conclusions: Management of OAG is shifting toward patient-centered interventions that balance efficacy, safety, and accessibility. Continued integration of novel therapies, surgical innovation, and real-world cost-effectiveness data is essential for optimizing treatment algorithms, particularly in under-resourced health systems.