A new management system for glaucoma based on improvement of the appearance of the optic disc or visual field.

GLAUCOMA IS A DISEASE OF THE NEURONS EXTENDING FROM THE RETINAL GANglion cells to the geniculate body. The major risk factor for glaucomatous damage is intraocular pressure. Other factors also play important roles. One satisfactory definition of glaucoma is that it is a disease due to intraocular pressure higher than the eye can tolerate. In primary open-angle glaucoma, or other glaucomas in which there is permanent interference with aqueous outflow, the process responsible for the intraocular pressure which is higher than the eye can tolerate is a continuing one; the process persists for the life of the patient. Therefore, the course of the disease is one of relentless deterioration (Fig 1). The rate of descent and the shape of the course vary from patient to patient (Figs 2 and 3), but the final destination of the journey is pitifully sure-loss of sight. Some believe that once the optic nerve has become severely cupped, then prevention of continued worsening is difficult, or even impossible. That this should be so in certain cases is not surprising when the pathology of glaucomatous optic nerve damage is considered.`5 The neurons become compressed by the distorted, posteriorly-bowed lamina and lose

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