Glaucomatous optic neuropathy: mechanisms of disease.

The optic neuropathy of glaucoma appears to be multifactorial in etiology. Both mechanical and vasogenic theories remain viable explanations for the observed nerve damage and the destructive effect of trophic withdrawal could be espoused by either theory. Each theory feeds into the final common pathway of cell death; even the immune system may kill cells in glaucoma by apoptosis. This knowledge has led to the hope that glaucomatous nerve damage can be curtailed or even prevented with the use of neuroprotective agents. Indeed, there are many intriguing new therapeutic possibilities on the horizon. Until evidence from clinical trials demonstrates the effectiveness of these agents however, control of IOP will remain the mainstay of treatment for glaucoma.