The causes of glaucoma are complex and so are its treatment regimens. It is almost as if glaucoma were several separate diseases. Controlling intraocular pressure (IOP) in the anterior segment is certainly a prime consideration, but the pathologic endpoint of glaucoma is the death of the retinal ganglion cell in the posterior segment. The disease itself is probably best called an optic neuropathy, one of many diseases that can affect neuronal cells. However, it is unique as to the cell affected (the ganglion cell) and the endpoints of the disease process. Biologically and physically, glaucoma is characterized by changes in the optic disc, optic nerve, and brain and by ganglion cell death. Functionally, the changes lead to visual impairment, as best exemplified by a decrease in visual field. Thus, developing methods of preserving ganglion cell function and lifespan are the ultimate goals in maintaining vision in glaucoma. One way to achieve preservation is through neuroprotection—the use of neuron-survival (neurotrophic) agents.
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