I searched the PubMed and Google Scholar databases up to August, 2010, and the International Glaucoma Review Abstracts (2005 to 2010), with the following search terms: “glaucoma”, “angle closure”, “open angle”, “pathogenesis”, “diagnosis”, “treatment”, “laser”, “surgery”, “genetics”, “childhood”, “secondary”, and “neovascular”, both alone and in combinations. I mostly selected publications from the past 5 years, but did not exclude important older publications. I also searched the reference
SeminarGlaucoma
Section snippets
Clinical definitions
In 2002, an international consensus panel published definitions of open-angle glaucoma and angle-closure glaucoma that are now widely accepted.1, 2 For both disorders, glaucoma is now recognised to be an optic neuropathy and is thought to be present only when at least one eye has both typical structural and functional defects (optic disc damage and visual field loss). This combination of damage has to be sufficiently characteristic to indicate the death of a substantial number of retinal
Clinical features and risk factors
Open-angle glaucoma is distinguished from other optic neuropathies by slow progression over months to years.11 The clinical appearance of this form of glaucoma is distinguishable from ischaemic optic neuropathy12 or chiasmal tumour-induced neuropathy by the excavation or abnormal structural deepening of optic-disc connective tissue. Of retinal neurons, glaucoma affects only retinal ganglion cells13, 14—a loss that occurs selectively more rapidly in axons that pass through the upper and lower
Clinical features, risk factors, and pathogenesis
Although angle-closure glaucoma is often related to an acute, painful crisis associated with blurred vision, more than 75% of patients do not have an acute attack,80 instead they have an asymptomatic course with progressive loss of the visual field similar to that in patients with open-angle glaucoma. Worldwide, a third of patients with primary glaucoma have angle-closure glaucoma.1 The proportionate vision loss in angle-closure glaucoma might be as much as twice as great as open-angle
Other forms of glaucoma
Glaucoma is uncommon in children, with an estimated prevalence in the USA of fewer than three per 100 000 for all forms of glaucoma in those younger than 20 years.100 Many of these cases are primary childhood-onset glaucoma, which presents during the first year of life with symptoms of tearing and photophobia and signs of enlarged and cloudy corneas. There is substantial heritability, and three genetic loci have been identified for childhood glaucoma, with one gene clearly associated with the
Conclusions
Both open-angle and angle-closure glaucoma are commonly present in older people and, with the ageing of world populations, the number with both forms of glaucoma will substantially increase in the next decade.1 The diagnosis of glaucoma of each type requires a detailed eye examination, with tests of both structure and function of the eye. New developments in diagnostic testing might soon make this process more efficient. Therapy that lowers intraocular pressure slows the progress of open-angle
Search strategy and selection criteria
References (106)
- et al.
The optic nerve head as a biomechanical structure: a new paradigm for understanding the role of IOP-related stress and strain in the pathophysiology of glaucomatous optic nerve head damage
Prog Retin Eye Res
(2005) - et al.
Risk factors for open-angle glaucoma in a Japanese population: the Tajimi study
Ophthalmology
(2006) - et al.
Natural history of open-angle glaucoma
Ophthalmology
(2009) - et al.
Five-year incidence of open-angle glaucoma: the visual impairment project
Ophthalmology
(2002) - et al.
Primary open-angle glaucoma in Blacks: a review
Surv Ophthalmol
(2003) - et al.
Risk of glaucoma in ocular hypertension with and without pseudoexfoliation
Ophthalmology
(2005) Central corneal thickness—tonometry artifact, or something more?
Ophthalmology
(2007)- et al.
Predictors of long-term progression in the Early Manifest Glaucoma Trial
Ophthalmology
(2007) - et al.
Mouse genetic models: an ideal system for understanding glaucomatous neurodegeneration and neuroprotection
Prog Brain Res
(2008) - et al.
Biomechanics of the optic nerve head
Exp Eye Res
(2009)