/n the latter part of the nineteenth century, effective medical treatment for glaucoma was championed by physicians who had studied under Albrecht von Graefe. In 1876, Ludwig Laqueur, a professor in Strasbourg, France, recommended the use of an extract of the calabar bean, the seed of an African vine that is a source of physostigmine. At about the same time, Adolf Weber, a practicing ophthalmologist in Darmstadt, Germany, advocated the use of an extract of jaborandi, a South American shrub that contains pilocarpine. Although these drugs did not treat the underlying cause of glaucoma, they successfully controlled intraocular pressure in many patients. Miosis-inducing parasympathomimetic drugs remained the mainstay of medical therapy for glaucoma for the next 75 years, until the introduction of oral acetazolamide and topical epinephrine in the 1950s, followed by topical ophthalmic beta blockers in the 1970s.

In recent years, a large number of drugs have been developed for the treatment of glaucoma. With the increasing choices of alternative medications, miotic drugs, acetazolamide, and epinephrine are now less frequently used to treat chronic glaucoma. Prostaglandin analogs, topical carbonic anhydrase inhibitors, and adrenergic agonists have played an increasingly important role in the medical therapy of glaucoma. While naturally available substances provided the earliest glaucoma medications, new drugs are now developed through computational and synthetic chemical techniques. Currently available glaucoma medications have been approved for clinical use based upon their ability to lower intraocular pressure, although medications are being considered with other primary mechanisms of action that are thought to be potentially beneficial in glaucoma therapy. The clinical use of drugs for glaucoma therapy has evolved, adapting with the advent of each new drug.

Clinicians need to understand, synthesize, and use data about medications that have specific benefits and risks for their glaucoma patients.

An ideal drug would have no side effects, would be effortless to administer, would cost nothing, and would be 100% effective in controlling or eliminating the problem. Currently, the ideal drug for glaucoma does not exist. Nonetheless, investigators continually strive to improve glaucoma medical therapy, which will likely continue to improve in the future. New experimental and clinical investigations are promising and may open new therapeutic targets for treatment of glaucoma in the future. The focus of this book is the current art and science of clinically available drugs for medical therapy of glaucoma. The contributors have attempted to provide evidence-based information about the topic, while providing perspective from clinical experience.

This is a peer-reviewed, edited, multiauthor book, with chapters contributed by individuals with expertise in the medical therapy of glaucoma. The book is intended to provide information about glaucoma medical therapy for practicing ophthalmologists and ophthalmologists in training. Other practitioners who have clinical contact with glaucoma patients also may find the content of this monograph valuable. The material in this book on the medical management of glaucoma complements the surgical orientation of the second edition of Glaucoma Surgery: Principles and Techniques, edited by Robert N. Weinreb, MD, and Richard P. Mills, MD, and published by the American Academy of Ophthalmology and Oxford University Press.

In the second edition of this book, all chapters have been thoroughly revised and updated, and new chapters regarding fixed-combination drugs and medical treatment in pregnancy and pediatric patients have been added. Some chapters have required addition of extensive new material because of the changes in medical therapy of glaucoma since the publication of the first edition of the book in 1999. In 2005, Robert C. Allen, MD, co-editor for the first edition, succumbed to the complications of uveal melanoma. He was an esteemed clinical colleague and investigator, prolific academic, respected department chair, devoted family man, and cherished friend.

The contributors to this edition of Glaucoma Medical Therapy have dedicated their efforts to the memory of Dr. Robert C. Allen (1950-2005).

Peter A. Netland, MD, PhD

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