CHAPTER I INTRODUCTION

Glaucoma is a condition that involves distinctive changes in the optic nerve and visual field. It is marked by functional and structural abnormalities in the eye in which optic nerve damage can ordinarily be alleviated and inhibited by sufficiently reducing intraocular pressure (IOP). Glaucoma, found in approximately 5.8% of persons aged 40 and older, is a disease that causes a severe impairment of visual function and leads to blindness if untreated. In todays aging society, glaucoma is the second-leading cause of acquired blindness, and the question of how to appropriately diagnose, treat, and manage the disease is of vital importance not only in maintaining patients quality of life, but also in stemming the increasing burden on society imposed by the disease.1 Glaucoma can be classified into primary glaucoma, in which there is no other cause of elevated IOP, secondary glaucoma, in which the elevation in IOP results from other ocular disease, systemic disease, or drug use, and developmental glaucoma, in which the elevation in IOP results from developmental anomalies in the anterior chamber angle occurring during the embryonic period. Primary glaucoma is divided into primary open angle glaucoma (broad definition) (a disease concept that encompasses both conventional primary open-angle glaucoma and normal-tension glaucoma) and primary angle-closure glaucoma.1 About 60 million people have glaucoma. An estimated 3 million Americans are affected, and of these cases, about 50% are undiagnosed. About 6 million people are blind from glaucoma, including approximately 100,000 Americans, making it the leading cause of preventable blindness in the United States. Primary open-angle glaucoma, the most common form among blacks and whites, causes insidious asymptomatic progressive bilateral visual loss that is often not detected until 1

extensive field loss has already occurred. Blacks are at greater risk than whites for early onset, delayed diagnosis, and severe visual loss. Angle-closure glaucoma accounts for 1015% of cases in whites. This percentage is much higher in Asians and in Inuit. Primary angle-closure glaucoma may account for over 90% of bilateral blindness due to glaucoma in China.2 The mechanism of raised intraocular pressure in glaucoma is impaired outflow of aqueous resulting from abnormalities within the drainage system of the anterior chamber angle (open-angle glaucoma) or impaired access of aqueous to the drainage system (angle-closure glaucoma). Treatment is directed toward reducing the intraocular pressure and, when possible, correcting the underlying cause. Although in normal-tension glaucoma intraocular pressure is within the normal range, reduction of intraocular pressure may still be beneficial.2