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Controversies in the Vascular Mechanisms of Glaucomatous Optic Nerve Disease 

Authors: Syed Shoeb Ahmad, Ophthalmology Department, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia

Research on a micro- and macro-level is being performed in institutions across the globe, all targeting glaucoma in some way. But despite quantum leaps in our understanding of this disease, management of glaucoma still flounders around a perfect way to just control intra-ocular pressure. That is the only controllable risk factor identified after millions of dollars spent on research and development.

At this moment in time, the two pertinent questions which every patient probably wants to ask are:

1. Why does glaucoma occur? (mechanisms)
2. Where can we find a treatment to stop visual deterioration or better still, to recover visual loss? (neuroprotection and neuroregeneration)

Unfortunately, we are still unable to answer even these two questions. My own interest in glaucoma revolves around these two questions. I want to know why glaucoma occurs and if there is any way to stop its damaging effects? Saying that multifactorial mechanisms are at work is just an easy way out to escape our responsibility in delving deeper into the etiology and mechanisms of glaucoma causation. A parent who loses a young son or daughter in a car accident cannot be soothed by an explanation that the car was driven at 200mph, it was raining, the driver was distracted by a phone call and the road was poorly lit. The parent wants to know what could have been done to avoid this accident and what steps are being taken to prevent such accidents in the future. Glaucoma is a similar situation for patients who suffer from this cruel disease. What answer do we have for patients who come with advanced disease, hoping for their problems to be solved by a simple drug or operation? 

A few years back I researched into the biochemical mechanisms of glaucoma. It was such a painful conclusion to know that there are possibly hundreds of mediators of glaucomatous optic nerve degeneration (GOND) in our bodies and the environment. It raised the questions, how will we ever tackle all of them?

Now, I am looking into the vascular mechanisms. The result is equally distressing. I feel a bitter anguish that we still do not have enough solid evidence to introduce this aspect of the disease in our management protocols. Calcium channel blockers are being explored in certain groups of patients but the results are still inconclusive.

I recently published an article,1 which I hope will stimulate researchers into working on the vascular mechanisms of GOND and one day down the line we might be able to really control glaucoma.

Dr Syed Shoeb Ahmad publishes a regular glaucoma blog (Glog) Glaucoma Specialty Club

Disclosures: Dr Syed Shoeb Ahmad has nothing to disclose in relation to this article.

1. Shoeb Ahmad S, Controversies in the vascular theory of glaucomatous optic nerve degeneration, Taiwan Journal of Ophthalmology, 2016; In Press. Available at: 

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