Glaucoma is a disease characterized by “a progressive, chronic optic neuropathy in adults where IOP [intraocular pressure] and other unknown factors contribute to damage and which in the absence of other identifiable causes, there is characteristic acquired atrophy of the optic nerve and loss of retinal ganglion cells (RGCs).”[1] The progressive loss of RGCs and their axons produces characteristic damage of optic nerve (e.g., disc cupping and/or retinal nerve fiber layer defects) and corresponding visual field defects. Based upon its definition of a multifactorial optic neuropathy, glaucoma is diagnosed based on structural and functional criteria rather than the IOP level (Box 23.1). A recently proposed “glaucoma continuum” hypothesis characterizes patients along a path from undetectable disease to early mildly symptomatic disease to profound functional impairment.[2]
Box 23.1| Glaucoma is a complex multifactorial disease of later age onset |
Glaucoma is likely caused by several or more contributing risk factors, not all of which will be present to the same degree in every patient. While our current definition of open-angle glaucoma is no longer synonymous with “elevated intraocular pressure,” multiple randomized prospective clinical studies conducted across the glaucoma continuum have demonstrated the pressure-associated nature of the disease |
In the majority of cases, primary open-angle …
