Unpredictability of glaucoma progression.
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.


RESULTS
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.


CONCLUSIONS
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.
Susanna
Remo
R
University of São Paulo, São Paulo, Brazil. rsusanna@terra.com.br
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D018450:Disease Progression; D005901:Glaucoma / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D011379:Prognosis; D016896:Treatment Outcome; D014794:Visual Fields / Q000502:physiology
D000959:Antihypertensive Agents