The two main types of glaucoma are open angle glaucoma, or primary open angle glaucoma (POAG), and angle closure glaucoma. Currently, there is no cure for glaucoma. Glaucoma is a chronic disease that must be treated for life. However, much is happening in research that makes us hopeful a cure may be realized in our lifetime.
There is exciting work being conducted by scientists all over the world in the areas of genetics, neuroprotection and neuroregeneration. These areas of study deal with the origins and pathology of glaucoma as opposed to managing symptoms. A cure is on the way. Glaucoma over the Age of Forty in the United StatesThe term “glaucoma” encompasses a group of eye diseases, not a single entity. Glaucoma is described broadly in terms of aqueous fluid drainage through the trabecular meshwork, the major outflow pathway.
There are two main types: angle closure glaucoma and open angle glaucoma. Open angle glaucoma is far more common in the United States. The American Academy of Ophthalmology defines primary angle closure glaucoma as “An appositional or synechial closure of the anterior chamber angle caused by relative pupillary block in the absence of other causes of angle closure”. The American Academy of Ophthalmology defines primary open angle glaucoma as a “Multifactorial optic neuropathy in which there is a characteristic acquired loss of optic nerve fibers”. Classifying glaucoma broadly into angle closure glaucoma or open angle glaucoma is helpful from both a diagnostic and pathophysiological perspective.
Problem StatementIn the United States, approximately 2. 2 million people age 40 and older have glaucoma, and of these, as many as 120,000 are blind due to the disease. The number of Americans with glaucoma is estimated to increase to 3. 3 million by the year 2020. Each year, there are more than 300,000 new cases of glaucoma and approximately 5,400 people suffer complete blindness. Glaucoma is a leading cause of blindness among African Americans and Hispanics in the United States.
African Americans experience glaucoma at a rate of three times that of Whites and experience blindness six times more frequently. Between the ages of 40 and 64, glaucoma is fifteen times more likely to cause blindness in African Americans than in Whites. Vision experts estimate that half of those affected may not know they have glaucoma because symptoms may not occur during the early stages of the disease. By the time the patient notices something is wrong, the disease has already caused considerable damage. Unfortunately, the vision lost to glaucoma is gone forever.
Medications and surgery can help slow the progression of the disease, but there is no cure. Importance of the StudyThe fact that glaucoma is the second leading cause of blindness in the United States renders this study as extremely important. There is no known treatment for glaucoma, so every little bit of information we can obtain is very important. Natural History of GlaucomaMosby’s dictionary (Anderson, 1998) defines glaucoma as “an abnormal condition of elevated pressure within the eye caused by obstruction of the outflow of aqueous humor”. Several types of glaucoma have been identified; however, the most common are Primary Open Angle Glaucoma (POAG), which has a slow insidious onset, and Angle Closure Glaucoma (ACG), which is less common and more acute in nature (World Health Organization, 2005).
It is noted that POAG is a significant public health problem. POAG is an important cause of blindness and more frequently found to cause nonreversible blindness in African Americans (American Academy of Ophthalmology, 2004). POAG is manageable and because the visual impairment caused by glaucoma is irreversible, early detection is essential. In the United States more than seven million office visits are made per