The Pathophysiology and Treatment of Glaucoma

Dear Colleagues,

Glaucoma is a continuous enigma.

It was already known in ancient Greece: "Glaucosis" was first mentioned in Hippocratic writings as a blinding disease most often occurring in the elderly.

Glaucoma is a multifactorial disease that is the leading cause of irreversible vision loss worldwide. The damage it causes is not restricted to the optic nerve; it also spreads to the brain.

One would expect that after 2500 years we would have a comprehensive understanding of the normal physiology and pathophysiology of glaucoma. That is not the case; even our understanding and data on the most important risk factor, intraocular pressure, are incomplete. We do not know why or what causes intraocular pressure to rise at night to levels that are considered above-normal during the day. Why do these high intraocular pressure levels not cause damage? The discrepancy between functional tests (such as perimetry) and anatomical measurement (such as nerve fiber thickness) in many patients is not understood. In many cases, the diagnosis of glaucoma is like a puzzle that you have put together correctly.

It is incredible that the only way to treat glaucoma till now has been to reduce the intraocular pressure, which is only a risk factor of developing glaucoma.

Over the years, Many surgical technics and various implants have been introduced in the last thirty years. Nevertheless, the success rate, meaning the number of patients not losing sight, has been relatively stable in recent decades.

Creating and analyzing big data with artificial intelligence will hopefully bring new insights to this complex disease.

New insights into the causes, early diagnosis, biomarkers, and treatment methods to resolve the stalemate that we are in are welcomed.

Dr. Aharon Wegner
Prof. Dr. Alon Harris
Guest Editors

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• pathophysiology
• diurnal changes
• intraocular pressure
• perimetry
• nerve fiber thickness
• OCT-A
• treatment strategies
• sustained release therapies
• laser treatment
• biomarkers
• microinvasive glaucoma surgery (MIGS)
• artificial intelligence