Glaucoma is a sight-threatening optic nerve disease often related to increased intraocular pressure (IOP), but may also be due to vascular insufficiency. These factors can lead to optic nerve damage, visual field loss, and, if left untreated, blindness. Glaucoma is known to affect between 2.5 and 3 million Americans and it is estimated that there are at least another 1 million undiagnosed individuals. It is the second leading cause of blindness in the United States and the leading cause of legal blindness among African-Americans. About 80,000 Americans are legally blind as the result of glaucoma. In the United States in 1990, the disease accounted for more than 7 million office visits. Primary open-angle glaucoma (POAG) accounts for the largest portion of the total number of patients treated for glaucoma.

	Who is at risk?
	Primary open-angle glaucoma generally occurs in people over age 40 and risks for developing this disease increase with age. Approximately two-thirds of Americans with glaucoma are over age 65. A family history of glaucoma also plays an important role in increasing the risk of developing glaucoma. African-Americans tend to have an earlier onset and a more rapid progression of the disease than do whites. Other risk factors include elevated pressure in the eye, a history of diabetes, or a high degree of nearsightedness.
	What can be done about glaucoma?
	Detection is challenging because, until the disease is advanced, POAG is asymptomatic and the field of vision that is lost is usually peripheral. Identifying people with risk factors permits the effective use of techniques that detect glaucoma in its early stages. Although glaucoma cannot be cured and the lost vision cannot be restored, effective treatment can arrest progression of the condition. Thus, the challenges for ophthalmologists, optometrists, and primary care providers are to recognize the disease early and to individualize therapy in order to achieve the goals of long-term compliance and prevention of blindness. Medical therapy is generally the first line of treatment for glaucoma. Surgical procedures may be considered for patients in whom medical therapy is ineffective or unsuitable. Procedures include argon laser trabecular surgery (ALT), filtering surgery, cyclodestructive surgery, and drainage device surgery. However, with the exception of ALT, ocular risks are greater with surgical procedures than with medications. Medical Therapy for Glaucoma Currently, five classes of drug are available for use in patients with glaucoma or elevated intraocular pressure. No perfect medicine has been developed - all have some side-effects. Moreover, in some patients, medication fails to reduce IOP adequately. It is important therefore to balance efficacy, tolerability and side effects on a patient-by-patient basis. The treatment program can change over the many years that glaucoma is treated. In some cases the change is necessary because of an unwanted side effect from the medication. In other cases, prescribing a stronger drug or adding another medication is necessary to maintain control of the eye pressure. The most frequently used medical therapies include: Ophthalmic Beta-Blockers lower pressure in the eye by reducing aqueous production. These drugs are divided into two classes: 1) nonselective beta-blockers (timolol, levobunolol, metipranolol, carteolol); and 2) beta-1 selective (betaxolol). Alcon products in this class are BETOPTIC� S (betaxolol HCl) ophthalmic suspension 0.25% and BETOPTIC� (betaxolol HCl) ophthalmic solution 0.5%. Carbonic Anhydrase Inhibitors also lower pressure in the eye by decreasing aqueous production. Carbonic anhydrase inhibitors are available as topically TRUSOPT�  (dorzolamide) and AZOPTTM (brinzolamide) or orally (acetazolamide, methazolamide). The topical forms are associated with fewer systemic side-effects than the oral forms and are better tolerated by many patients. Alpha-Agonists are still another class of medicine that lower pressure primarily by reducing the aqueous production. In addition, they also may have an effect on increasing the rate at which the fluid drains from the eye. The most frequently prescribed drugs in this class are the relatively selective alpha 2 agonists (apraclonidine, brimonidine) IOPIDINE� 0.5% (apraclonidine) ophthalmic solution is manufactured by Alcon. Miotics have been used for over 100 years to lower eye pressure. Miotics decrease IOP by increasing aqueous outflow through the trabecular meshwork. However, because of their ocular adverse effects (increased myopia, eye and brow pain, decreased vision and retinal problems), the use of miotics is declining. Examples of miotics include pilocarpine and carbachol. Alcon brands include ISOPTO� CARPINE (pilocarpine HCl) ophtalmic solution, PILOPINE HS� (pilocarpine HCl) gel and ISOPTO� CARBACHOL (carbachol) ophthalmic solution. Prostaglandin analogs work by increasing the uveoscleral outflow. Four brands are currently available in the US. RESCULA� is administered twice a day. XALATAN�, TRAVATAN� and LUMIGAN� are administered once a day.Prostaglandins are our most effective glaucoma medications.. However, some patients experience an irreversible change in iris color and the long-term significance of this effect is currently unknown.