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Glaucoma: changing concepts and future directions.

Important concepts about glaucoma have evolved during the past few decades. Glaucoma is a family of diseases not defined by a specific intraocular pressure but rather as an optic neuropathy that can occur at any intraocular pressure depending on the optic nerve susceptibility of the individual person. Increased risk factors for idiopathic open-angle glaucoma include advancing age, black race, a family history of glaucoma, and increased intraocular pressure. The primary-care physician is in the prominent position of recognizing patients with increased risk factors or suspicious eye findings who should be referred to an ophthalmologist. Topically applied ophthalmic medications have systemic side effects that must be recognized and monitored by the primary-care physician. In the United States, glaucoma is usually treated with topically applied medications; laser or surgical therapy is done if medical treatment fails. The National Eye Institute is conducting multicenter studies to confirm whether this is still the most appropriate strategy for this common disease.

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