Intended for healthcare professionals


Towards better treatment of glaucoma

BMJ 2000; 320 doi: (Published 17 June 2000) Cite this as: BMJ 2000;320:1619

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Recent advances could have a major impact on preventing damage worldwide

  1. P T Khaw, professor of glaucoma and wound healing (,
  2. M F Cordeiro, Wellcome Trust fellow (
  1. Institute of Ophthalmology and Moorfields Eye Hospital, London EC1V 9EL

    The glaucomas are characterised by a specific type of optic nerve damage and visual field loss. This group of diseases is the most important cause of irreversible blindness worldwide: an estimated 66.8 million people have glaucoma, 6.7 million of whom are bilaterally blind.1

    The ability to detect the development and progression of glaucoma has been improved by the use of high resolution laser scanning to detect damage to the head of the optic nerve and by advanced computerised visual field assessment which detects defects in the visual field. Thus, treatment may now be offered before too much irreversible damage has occurred.2

    Treatments for glaucoma work to lower intraocular pressure, which is still the major risk factor for the disease. Glaucoma can be treated medically, surgically, or with lasers. Recently, large scale clinical trials have shown that lowering intraocular pressure can slow disease progression, even in patients with intraocular pressure that is statistically “normal” (so called normal tension glaucoma).3

    The mainstays of topical medical treatment have until recently been cholinergic agonists such as pilocarpine, which increase outflow of the aqueous humour but have serious ocular side …

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