Glaucoma continues to be a major public health problem. It is the second leading cause of blindness worldwide after cataracts. In the United States, primary open-angle glaucoma is the most common form of glaucoma and is the leading cause of irreversible blindness in African Americans. This disease is typically asymptomatic until advanced visual field loss occurs. Some of the risk factors for primary open-angle glaucoma have been extensively described and studied, including elevated intraocular pressure, advancing age, family history, African ancestry, myopia, and perhaps presence of certain systemic diseases, such as diabetes and hypertension. The precise mechanism of increased resistance to aqueous outflow remains unclear and is currently an active focus of research. At present, all our treatment strategies are directed at lowering intraocular pressure. Initial treatment is usually started with topical or oral medications. However, with progressive damage, laser trabeculoplasty may be considered as an adjunctive therapy, followed by incisional glaucoma surgery, either with trabeculectomy or glaucoma drainage implant.
