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DAVID A. LEE, M.D., is Pawek-Vallotton Endowed Chair for Biomedical Engineering in Ophthalmology, Professor of Ophthalmology, and Director of the Glaucoma Service, Storm Eye Institute, Medical University of South Carolina, Charleston. EVE J. HIGGINBOTHAM, M.D., is Professor of Ophthalmology and Chair, Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore.

Address correspondence to Dr. Lee at the Storm Eye Institute, Medical University of South Carolina, 167 Ashley Avenue, Room 506, P.O. Box 250676, Charleston, SC 29425 (leedav{at}musc.edu).

Purpose. A review of glaucoma and its treatment is presented. Summary. Glaucoma is a common eye disease that can cause irreversible blindness if left undiagnosed and untreated. Glaucoma is a leading cause of blindness in the United States and other industrialized countries. In most cases, the symptoms of early-stage glaucoma are minimal or nonexistent. There are several different types of glaucoma, and they have been classically divided into the categories of primary or secondary open-angle or angle-closure glaucoma. Secondary forms of glaucoma are caused by various ocular or systemic diseases. Every available treatment to prevent progressive glaucomatous optic neuropathy has potential adverse effects and involves a certain amount of risk and financial expense. Conventional first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective ß-blocker or a topical prostaglandin analog. Second-line drugs of choice include -agonists and topical carbonic anhydrase inhibitors. Parasympathomimetic agents, most commonly pilocarpine, are considered third-line treatment options. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are further methods that can be used to lower intraocular pressure. The results of clinical trials have reaffirmed the utility of antiglaucoma medications in slowing the progression of the disease. Conclusion. Glaucoma is a common eye disease that is usually associated with an elevated intraocular pressure. Treatment options for patients with glaucoma include medications, laser therapy, and incisional surgery. The risks and benefits of each type of treatment must be carefully considered to maximize the treatment’s benefits while minimizing adverse effects. Index terms: Carbonic anhydrase inhibitors; Costs; Glaucoma; Lasers; Miotics; Optic nerve diseases; Parasympathomimetic agents; Pilocarpine; Prostaglandins; Surgery; Sympatholytic agents; Toxicity

 

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