ROBERT RITCH, YANIV BARKANA, and JEFFREY M. LIEBMANN
Certain discrete glaucomas and difficult clinical problems require the use of multiple medications or require medications to be used in conjunction with laser treatment or filtration surgery. The specific medications used may differ from those used in primary open-angle glaucoma. Directed therapy, when applicable, should be a strong consideration in treatment.
Directed therapy is conceptually simple. It merely means devising specific treatments for specific diseases. This fundamental tenet of medicine has been applied infrequently in the treatment of glaucoma.
The simplification of glaucoma into congenital, open-angle, and angle-closure glaucoma has led us to focus on glaucoma as the disease and intraocular pressure (IOP) as its treatable aspect. Specific glaucomas, however, lead to trabecular dysfunction by specific series of events. In theory, intervention could be applied at each of these steps. Little emphasis has been placed on preventive treatment or disease-specific therapy, and more could be done even with our present knowledge. Other potentially damaging abnormalities bypass the meshwork and affect the optic nerve head directly. These include disorders affecting ocular perfusion, the extracellular matrix of the optic nerve head and lamina cribrosa, and perhaps factors within the central nervous system. These other risk factors are also potentially treatable, now or in the future.
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