Elsevier

The Lancet

Volume 354, Issue 9192, 20 November 1999, Pages 1803-1810
The Lancet

Seminar
Glaucoma

https://doi.org/10.1016/S0140-6736(99)04240-3Get rights and content

Summary

In 2000 an estimated 66·8 million people worldwide will have glaucoma, 6·7 million of whom will be bilaterally blind from irreversible optic-nerve damage. Yet even in developed countries with public educational programmes that target glaucoma, half of the individuals with glaucoma remain undiagnosed. Patients with even mild visual impairment secondary to glaucoma may have difficulties with mobility, driving, and social interactions. Although glaucoma may be associated with increased eye pressures, its diagnosis does not rely on a specific level of eye pressure. Diagnosis of glaucoma often relies on examination of the optic disc and assessment of the visual field. The two most common types of glaucoma—primary open-angle glaucoma and primary angle-closure glaucoma—have different risk factors. Although similar medications can be used to treat these two types of glaucoma, the overall management of patients differs in important ways. Until recently, there were no randomised clinical trials that showed the effectiveness of lowering eye pressures with medications or surgery in patients with glaucoma. However, in 1998 a randomised clinical trial showed the benefit of lowering eye pressure in patients with glaucoma who had eye pressures of 24 mm Hg or less. Because glaucoma is treatable, and because the visual impairment from glaucoma is irreversible, early detection of the disease is critically important.

Section snippets

Definition and diagnosis

POAG has an adult onset, is usually bilateral, and has no noticeable symptoms in most patients until the later stages of the disease when patients lose their central vision.11, 12 In the USA, POAG has an age-adjusted prevalence of 1·55%.13 Although POAG has conventionally been characterised as a disease of raised eye pressures, it is currently defined as a group of ocular diseases that may cause characteristic, progressive changes in the optic nerve head, visual field loss, or both.11 These

Diagnosis and epidemiology

Patients with PACG may present with acute raised eye pressures, a mid-dilated pupil, a red eye, or nausea and vomiting, whereas in other cases they may have no complaints or may complain of a non-specific headache, eye pain, or halos around lights.67 The diagnosis of PACG requires an assessment of the anterior chamber angle to find out if the trabecular meshwork is blocked by the peripheral iris. If a skilled observer, slit-lamp, and gonioscopy lens are not available, a presumptive diagnosis of

Conclusion

If current trends prevail, the worldwide prevalences of POAG and PACG will continue to increase. Attempts to reduce substantially the visual impairment and blindness associated with glaucoma will need more aggressive detection, so that more people with glaucoma are aware that they have this disease. Also needed is more careful management of POAG and PACG that incorporates lessons learned from current research. Because of the health, social, and economic consequences of blindness, the burden of

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