Primary open angle glaucoma(POAG)is a chronic, progressive optic neuropathy characterized by pathologically elevated intraocular pressure(IOP), which is the main high-risk factor, although the etiology is still unclear. Due to the insidious onset, many patients are already in the intermediate or advanced stages at the first presentation. At these stages, optic nerve damage is often severe, the target IOP requirement is stringent(below 12 mmHg), with poor tolerance to treatment, which necessitates comprehensive treatment approaches to control disease progression. This review systematically summarizes recent advances in the clinical management of advanced POAG, including medications, laser therapy, trabeculectomy, glaucoma drainage device implantation, minimally invasive glaucoma surgery and other emerging therapies. It elaborates on the mechanisms of action, efficacy, safety, suitable populations, and indications for switching treatments. Incorporating the latest clinical research data up to 2025, the analysis evaluates the impact of different treatment approaches on clinical practice and explores the future development trends, aiming to provide comprehensive references for individualized treatment strategies to maximize preservation of visual function in patients with advanced POAG.