Glaucoma update: epidemiology and new approaches to medical management.

Glaucoma describes a group of ocular conditions which involve progressive optic nerve damage associated with loss of visual function and, frequently, with elevated intraocular pressure. Recent estimates of worldwide prevalence predict that 67 million people will suffer from glaucoma by the year 2000. Although the clinical features of glaucoma are reasonably well described, the pathogenesis of optic nerve damage remains unclear. Intraocular pressure (IOP) is accepted as an important risk factor; however, it is clear that other factors play a role in the pathogenesis of the disease, and such factors may interact with IOP to greatly enhance its harmful effects. Many of the new therapeutic approaches to the stabilisation and potential cure of glaucoma attempt to address these non-IOP factors. The aim of the following paper is to consider the implications of new estimates of disease prevalence, discuss theories related to optic nerve damage and outline new and future approaches to the medical management of the disease.