All that glitters is not glaucoma

ABSTRACT

The twentieth century has witnessed great strides in the understanding and management of the major ophthalmic conditions. For example, the surgical treatment of cataract is being honed to perfection with only the goal of accommodative restoration remaining to complement visual clarity. Understanding of the mode of transmission of Chlamydia trachomaitis, plus the new macrolide antimicrobial, azithromycin, which can cure 80 percent of acute trachoma, offers hope in managing this infection. Similarly, the control of the vector Simulium and the microfilariacidal, Ivermectin, promise to eradicate onchocerciasis volvolus. Increasing understanding of the pathogenesis of the microangiopathy of diabetic retinopathy and the recent trials - Diabetic Control and Complication Trial and the European Prospective Study - have paved the way for the control of this condition. However, our understanding and management of chronic open angle glaucoma remains frustratingly elusive. Problems related to the early detection and monitoring progression remain imprecise and sometimes non-specific and misleading. Two cases are presented to illustrate the limitations of the visual field test and underline the fact that it should never be viewed in isolation. Further treatment modalities will dictate more precise objective tests for monitoring optic nerve function, focusing on early diagnosis and small degrees of progression.(AU)