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Currently, glaucoma is recognised as an optic neuropathy and defined as “ocular” Alzheimer disease (AD); it is a chronic neurodegeneration of the optic nerve, the second cause, after cataract, of world blindness and of major public health importance.123 Selective death of retinal ganglion cells (RGC) is the hallmark of glaucoma, also associated with structural changes in the optic nerve head; death of RGC after axonal injury can be induced by a variety of different stimuli.4 The process of RGC death is thought to be biphasic: a primary injury responsible for initiation of damage followed by a slower secondary degeneration related to noxious environment surrounding the degenerating cells. A working knowledge of the environmental risk factors for the induction and progression of the disease is essential to our clinical practices and helps those patients at greater risk of disease progression and blindness; a major priority is to achieve a better understanding of the risk factors, likely to involve gene–environment interactions.
Evidence for the possibility of an infectious agent comes from reports in younger patients with exfoliative glaucoma (XFG) after intraocular surgery or trauma with iris surgery in infancy and childhood or after penetrating keratoplasty from elderly donors.5 Moreover, in the middle Norway eye-screening study, the prevalence of XFG in both members of married couples is significantly higher than expected,5 thereby suggesting a common environmental (probably infectious) agent, which may be of aetiological significance for the XFG development.6 In this respect, Koch’s postulates regarding a causal association with a disease seem to apply in glaucoma,7 but until recently, no one had associated any micro-organisms with glaucoma. Specifically, although degenerative diseases, including glaucoma or AD, have an increasingly high impact on aged population, their association with Helicobacter pylori infection (Hp-I) has not been thoroughly …
Competing interests None.
Provenance and Peer review Commissioned; not externally peer reviewed.