Unpredictability of glaucoma progression

ABSTRACT

Background: Glaucoma is a chronic, progressive ocular neuropathy that leads to the loss of retinal ganglion cells and varying degrees of visual impairment or blindness.

Management: There are three major factors to consider in the management of patients with glaucoma. First, extensive damage to retinal ganglion cells often can occur before the appearance of any functional deficits is detected by perimetry. Second, the rate of glaucoma progression varies considerably among different patients and even for the same patient at different times. Third, the lack of correspondence between structural and functional change may reflect the limitations of current assays in measuring each. Given the variability of disease progression, early detection and continued vigilance of both structure and function in the form of regular patient monitoring are essential.

Conclusion: This review presents six case histories that demonstrate the differing rates of progression that may be observed in the clinic and the importance of early detection and treatment in controlling the disease. In addition, major lessons from randomised clinical trials are summarised, including the likelihood of progression from diagnosed ocular hypertension to the development of glaucoma, the risks of progression of established glaucoma and the effectiveness of therapy.

Keywords: :

• Glaucoma
• Ocular hypertension
• Progression
• Risk factors

Transparency

Declaration of funding

This study and editorial support for this article were funded by Pfizer Inc.

Declaration of financial/other relationships

R.S. has disclosed that he received an educational grant from Pfizer for the development of a presentation which was the basis for the content of this manuscript.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she is on the speakers’ bureau of Carl Zeiss Meditec (Humphrey Visual Field). Peer Reviewer 2 has disclosed that he/she has no relevant financial relationships.

Acknowledgment

The author thanks Christine Zucker of Zola Associates, Englewood Cliffs, NJ, USA, for editorial support, including contributing to the literature review, manuscript development and styling the paper for journal submission. That support was funded by Pfizer.