Clinical evaluation of the optic nerve head
There are several practical consequences of discarding intraocular pressure (IOP) as central to the definition of glaucoma. One is that the clinician must become proficient at examining the optic nerve…
OPHTHALMOLOGY
Primary angle closure glaucoma
HISTORICAL REVIEW AND CLASSIFICATIONS The Hippocratic aphorisms include two mentions of blindness, one of which may refer to glaucoma: ‘When headache develops in cases of ophthalmia and accompanies it for…
Optic nerve anatomy and pathophysiology
In the past decades, two significant changes have impacted how we contextualize the pathogenic mechanisms of primary open-angle glaucoma. The first change is clinically relevant: the elimination of intraocular pressure…
Cholinergic drugs
The cholinergic drugs are the oldest effective medical treatment for glaucoma. More than 100 years ago, Laqueur used physostigmine (eserine), an extract from the Calabar or ordeal bean, for the…
Prostaglandins
The prostaglandins burst on the clinical scene in the 1990s and have become one of the mainstays of glaucoma treatment around the world. As a class, they are very potent…
Medical treatment of glaucoma: general principles
The ultimate goal of glaucoma treatment is to preserve enough vision during the patient’s lifetime to meet their functional needs; ideally, treatment should also delay, stop, and sometimes reverse the…
The adrenergic system and adrenergic agonists
Adrenergic agonists have been used as ocular hypotensive agents since 1900 when Darier treated glaucoma patients with subconjunctival injections of epinephrine. Two decades later, Hamburger applied epinephrine topically to reduce…
Carbonic anhydrase inhibitors
Carbonic anhydrase inhibitors (CAIs) continue to be the only systemic agents used for the long-term treatment of glaucoma, if only occasionally. A topical version introduced more than 40 years after…
Adrenergic antagonists
In 1967 Phillips and co-workers reported that an intravenous injection of propranolol, a β-adrenergic antagonist, lowered intraocular pressure (IOP) in humans. Within a short time, other investigators found that oral…
Genetics of glaucoma
INTRODUCTION That primary open-angle glaucoma (POAG) and, especially, glaucoma occurring in childhood or associated with other developmental anomalies had familial characteristics has been known since the mid nineteenth century. Von…
