Glaucoma is a debilitating disease affecting mainly the elderly, often times limiting mobility (eg. Walking, driving, societal mobility) and if untreated, can cause complete blindness. It is simply described as the build up of intraocular pressure (IOP) or pressure within the eyeball. The main reason for loss of vision is due to damage to the optic nerve, caused by the pressure build up. In glaucoma, it has been estimated that up to "50% of the retinal ganglion cells at any particular location can be lost before a visual field defect is detectable using currently available clinical methods" (Morgan, 1999). Consequently, if we rely on tests of visual acuity or visual field, significant retinal damage may have already occurred by the time that disease is detected, leading to a poorer visual prognosis. Glaucoma has many repercussions to the aging population, but mainly in the loss of mobility.

Glaucoma is now defined as a group of ocular diseases characterized by elevated intraocular pressure that causes progressive damage to the optic nerve, resulting in optic nerve atrophy and blindness. The two primary types of disease, open-angle glaucoma and angle-closure glaucoma, are classified

There is a source of hope for those affected by such a debilitating disease, because with proper treatment and adjustments in lifestyle living they can learn to live again. There are many different techniques that can be learned that will help in keeping mobile, even in the face of complete blindness. Many blind or visually impaired people learn to use their sense of touch almost unconsciously. Others need reminders that their hands can be a helpful guide in getting around and a reliable form of protection from bumps and bruises.

The most interesting new class of topical medication is the prostaglandin agonists, such as latanoprost. This drug lowers intraocular pressure by opening up an alternative pathway for aqueous outflow (the uveoscleral pathway) by altering the resistance of the extracellular matrix. This has a greater effect on lowering pressure than Beta-blockers. This drug is also given once a day and has few systemic side effects; however, it may occassionally cause some unusual side effects such as an increase in eyelash growth and an irreversible darkening of the iris.

There are a number of different techniques used to help one get around with the help of others with good vision. The Grip is when the blind or visually impaired person takes the guide's arm just above the elbow with four fingers on the inside and the thumb on the outside of the arm. The grip must be firm enough for the person to maintain it while walking, but not so tight as to cause discomfort to the guide. A Variation of Grip the elderly person who needs more support, may grasp the guide's upper forearm from the inside. The guiding arm is held close to the body for additional support to the elderly person. The Narrow Passage Technique is useful when negotiating any area where it is difficult to walk two abreast, such as aisles, doorways or crowded spaces. The guide moves the guiding arm backwards and positions it diagonally across the back. The blind or visually impaired person responds by straightening the gripping arm and stepping behind the guide; thus they are in singl!

Oral carbonic anhydrase inhibitors, such as acetazolamide, reduce aqueous secretion and are effective in lowering pressure. Unfortunately, the systemic side effects, which include lassitude, paraesthesia, and rarer complications such as renal stones, have limited their long-term use. Topical formulations of these inhibitors, such as dorzolamide, are a useful addition to available treatments, although they are not as effective as the oral forms.

------------------------------------------------------------------------

Large prospective studies are now under way to determine whether these agents should be used in all patients undergoing glaucoma surgery. This is particularly important since filtration surgery is the only practical treatment for glaucoma in many countries.

The use of relatively inexpensive anticancer agents such as fluorouracil and mitomycin at the time of surgery has revolutionised these procedures, particularly in patients at a high risk of failure due to scarring. In this group of patients (for example, those with previous attempts at filtration surgery that have failed or previous intraocular surgery such as cataract surgery), these agents have halved the failure rate. However, their use may be associated with a new series of complications such as infection and vision impairment caused by low pressures. Choosing the appropriate agent for different populations of patients may minimize complications (Singh, Egbert & Byrd, 1997).

Advances in treatment and therapy have aided in the battle with glaucoma. Surgical techniques, drug therapies and alternative therapies have be developed over the past few years, that make living with glaucoma much less cumbersome than before. Treatments for glaucoma work to lower intraocular pressure, which is still the major risk factor for the disease. Glaucoma can be treated medically, surgically, or with lasers

Some common words found in the essay are:
Butler Campbell, Vaughan Riordan, Hospital Wales, Passage Technique, Combination Glaucoma, Tsai Sharma, Diggory Franks, Egbert Byrd, Nd YAG, Campbell Gaasterland, intraocular pressure, optic nerve, visual acuity, angle-closure glaucoma, visual field, visually impaired, blind visually impaired, blind visually, open-angle glaucoma, damage optic, damage optic nerve, safe driving, visually impaired person, anterior chamber angle, visual acuity risk,
Approximate Word count = 3312
Approximate Pages = 13 (250 words per page double spaced)