We systematically searched MEDLINE with terminology relating to primary open-angle glaucoma discussed in this review. Keywords used were glaucoma, open-angle glaucoma, primary open-angle glaucoma, glaucoma blindness, ocular hypertension. Articles were reviewed up to June, 2003, and studies reported in full and in abstract form have been reported.
SeminarPrimary open-angle glaucoma
Section snippets
Epidemiology
It is estimated that glaucoma affects more than 66 million individuals worldwide with at least 6·8 million bilaterally blind.1 Vision loss caused by glaucoma is irreversible, and glaucoma is the second leading cause of blindness in the world. Of the many types of glaucoma, primary open-angle glaucoma is perhaps the most common, particularly in populations of European and African ancestry.2, 3 The disease is the leading cause of blindness in African-Americans.
In the USA, more than 7 million
Aqueous humour secretion and drainage
Intraocular pressure is regulated by a balance between the secretion and drainage of aqueous humour (figure 1). This fluid is secreted posterior to the iris by the ciliary body and then flows anteriorly to the anterior chamber. Aqueous humour provides nutrients to the iris, lens, and cornea. It exits the eye into the venous circulation via the trabecular meshwork and independently through the uveoscleral outflow pathway.
The optic nerve and inner retina
Axons of retinal ganglion cells comprise the retinal nerve fibre layer, the
Pathophysiology
Glaucoma is a neurodegenerative disease characterised by the slow, progressive degeneration of retinal ganglion cells.5 With glaucoma, the width of the neuroretinal rim decreases with concomitant enlargement of the cup. Other optic neuropathies usually result in pallor of the optic nerve head but, for unknown reasons, rarely show enlargement of the optic disc cup. Glaucomatous neuronal death is not limited to changes in the retinal ganglion cell axons, soma, and dendrites;6 neurons in the
Diagnosis
Primary open-angle glaucoma is a chronic, generally bilateral, but often asymmetrical, disease that is characterised by progressive damage of the optic nerve as shown by changes in the optic disc, retinal nerve fibre layer, or visual field. The disease has an adult onset, with open anterior chamber angles of normal appearance and an absence of other known explanations for the change in the optic nerve. If detected early, disease progression can frequently be arrested or slowed with medical and
Goals of glaucoma management
As described in the Preferred Practice Patterns of the American Academy of Ophthalmology70 and other guidelines, glaucoma care aims to enhance the patient's health and quality of life by preserving visual function without causing untoward effects from treatment. Specific goals are: (1) to document the status of optic nerve on presentation and during follow-up by assessment of the appearance of the optic disc, retinal nerve fibre layer, or both, and assessment of the visual field; (2) estimation
Conclusion
The worldwide prevalence of primary open-angle glaucoma is increasing. Although the pathophysiology of glaucoma is still not well understood, results of large-scale long-term clinical trials have shown that reduction of intraocular pressure prevents the progression of early and late glaucoma. These findings clearly show the importance of early diagnosis to initiate pressure-lowering treatment and early detection of progression to advance this treatment.
Search strategy and selection criteria
References (124)
- et al.
The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey
Ophthalmology
(1996) - et al.
Mechanisms of optic nerve damage in primary open angle glaucoma
Surv Ophthalmol
(1994) - et al.
Effects of retinal ganglion cell loss on magno-, parvo-, koniocellular pathways in the lateral geniculate nucleus and visual cortex in glaucoma
Prog Retin Eye Res
(2003) Possible role for memantine in protecting retinal ganglion cells from glaucomatous damage
Surv Ophthalmol
(2003)- et al.
A rat model of chronic pressure-induced optic nerve damage
Exp Eye Res
(1997) - et al.
Twenty-four-hour pattern of mouse intraocular pressure
Exp Eye Res
(2003) - et al.
Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma
Am J Ophthalmol
(1989) - et al.
An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage
Ophthalmology
(1992) - et al.
Effect of corneal polarization axis on assessment of retinal nerve fiber layer thickness by scanning laser polarimetry
Am J Ophthalmol
(2000) - et al.
A comparison of optical coherence tomography and retinal nerve fiber layer photography for detection of nerve fiber layer damage in glaucoma
Ophthalmology
(2000)
Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes
Ophthalmology
Short-wavelength automated perimetry: its role in the clinic and for understanding ganglion cell function
Prog Retin Eye Res
Predictive value of short-wavelength automated perimetry: a 3–year follow-up study
Ophthalmology
Prevalence of open-angle glaucoma in Australia: the Blue Mountains eye study
Ophthalmology
Myocilin glaucoma
Surv Ophthalmol
Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery
Ophthalmology
Prostaglandin F2 alpha increases uveoscleral outflow in the cynomolgus monkey
Exp Eye Res
Effects of prostaglandins on the aqueous humor outflow pathways
Surv Ophthalmol
The incidence and time-course of latanoprost-induced iridial pigmentation as a function of eye color
Surv Ophthalmol
Histology and fine structure of the iris and outflow system following latanoprost therapy
Surv Ophthalmol
Hypertrichosis and increased pigmentation of eyelashes and adjacent hair in the region of the ipsilateral eyelids of patients treated with unilateral topical latanoprost
Am J Ophthalmol
Acute versus chronic effects of brimonidine on aqueous humor dynamics in ocular hypertensive patients
Am J Ophthalmol
Meta-analysis of the effect of latanoprost and brimonidine on intraocular pressure in the treatment of glaucoma
Clin Ther
Safety and efficacy of brimonidine in children with glaucoma
J AAPOS
Number of people with glaucoma worldwide
Br J Ophthalmol
Models of open-angle glaucoma prevalence and incidence in the United States
Invest Ophthalmol Vis Sci
Preparing for managed competition: utilization of ophthalmologic services varies by state
Arch Ophthalmol
Experimental glaucoma and cell size, density, and number in the primate lateral geniculate nucleus
Invest Ophthalmol Vis Sci
Loss of neurons in magnocellular and parvocellular layers of the lateral geniculate nucleus in glaucoma
Arch Ophthalmol
Atrophy of relay neurons in magno- and parvocellular layers in the lateral geniculate nucleus in experimental glaucoma
Invest Ophthalmol Vis Sci
Experimental glaucoma in primates: changes in cytochrome oxidase blobs in VI cortex
Invest Ophthalmol Vis Sci
Visual function-specific perimetry for indirect comparison of different ganglion cell populations in glaucoma
Invest Ophthalmol Vis Sci
Increased elastin expression in astrocytes of the lamina cribrosa in response to elevated intraocular pressure
Invest Ophthalmol Vis Sci
Immunohistologic evidence for retinal glial cell changes in human glaucoma
Invest Ophthalmol Vis Sci
Deformation of the lamina cribrosa and anterior scleral canal wall in early experimental glaucoma
Invest Ophthalmol Vis Sci
Retrograde axonal transport of BDNF in retinal ganglion cells is blocked by acute IOP elevation in rats
Invest Ophthalmol Vis Sci
Optic nerve blood flow
Elevated glutamate levels in the vitreous body of humans and monkeys with glaucoma
Arch Ophthalmol
Elevation of intraocular glutamate levels in rats with partial lesion of the optic nerve
Arch Ophthalmol
Nitric oxide synthase-2 in human optic nerve head astrocytes induced by elevated pressure in vitro
Arch Ophthalmol
Matrix metalloproteinases and tumor necrosis factor alpha in glaucomatous optic nerve head
Arch Ophthalmol
Neurodegeneration and neuroprotection in glaucoma: development of a therapeutic neuroprotective vaccine—the Friedenwald lecture
Invest Ophthalmol Vis Sci
Serum autoantibodies to optic nerve head glycosaminoglycans in patients with glaucoma
Arch Ophthalmol
Mouse genetics: a tool to help unlock the mechanisms of glaucoma
J Glaucoma
Ocular hypertension in mice with a targeted type I collagen mutation
Invest Ophthalmol Vis Sci
Quantitative analysis of retinal ganglion cell (RGC) loss in aging DBA/2NNia glaucomatous mice: comparison with RGC loss in aging C57/BL6 mice
Invest Ophthalmol Vis Sci
Experimental mouse ocular hypertension: establishment of the model
Invest Ophthalmol Vis Sci
Optic nerve damage in experimental mouse ocular hypertension
Invest Ophthalmol Vis Sci
Patterns of intraocular pressure elevation after aqueous humor outflow obstruction in rats
Invest Ophthalmol Vis Sci
Aqueous humor dynamics in mice
Invest Ophthalmol Vis Sci
Cited by (1649)
Investigation into the usefulness of cynomolgus monkeys with spontaneously elevated intraocular pressure as a model for glaucoma treatment research
2024, Journal of Pharmacological SciencesCrocin supplementation in primary open angle glaucoma: A randomized, triple-blind, placebo-controlled clinical trial
2024, Medicine in Drug DiscoveryCorneal biomechanics and diagnostics: a review
2024, International OphthalmologyAutomated vertical cup-to-disc ratio determination from fundus images for glaucoma detection
2024, Scientific ReportsChitosan as a promising materials for the construction of nanocarriers for diabetic retinopathy: an updated review
2024, Journal of Biological Engineering