Transitions of the Understanding and Definition of Primary Glaucoma.

Si-An LIU; Zhen-Ni ZHAO; Nan-Nan SUN; Ying HAN; Jeremy CHEN; Zhi-Gang FAN

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Transitions of the Understanding and Definition of Primary Glaucoma.

Author: Si-An LIU ¹ ; Zhen-Ni ZHAO ¹ ; Nan-Nan SUN ¹ ; Ying HAN ² ; Jeremy CHEN ² ; Zhi-Gang FAN ¹
Author Information

1. Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong 510060, China.
2. Department of Ophthalmology, UCSF Medical Center, University of California at San Francisco, San Francisco 94010, USA.
Publication Type:Journal Article
Keywords: Central Nervous System Degenerative Disease; Intraocular Pressure; Ocular-Cranial Pressure Gradient; Optic Neuropathy; Primary Glaucoma
MeSH: China; Glaucoma; diagnosis; physiopathology; Glaucoma, Angle-Closure; diagnosis; physiopathology; Glaucoma, Open-Angle; diagnosis; physiopathology; Humans; Intraocular Pressure; physiology; Ophthalmology; methods
From: Chinese Medical Journal 2018;131(23):2852-2859
CountryChina
Language:English
Abstract: Objective:In previous decades, glaucoma has been primarily attributed to elevated intraocular pressure (IOP), but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries. However, there still remain strong controversies in the definition of glaucoma in China. In this current review, we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries. Furthermore, we will briefly describe the "ocular-cranial pressure gradient" theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS) in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma.
Data Sources:We performed a comprehensive search in both PubMed and SinoMed using the following keywords: (a) "primary glaucoma" and "guideline," (b) "ocular-cranial pressure gradient," and (c) "glaucoma," "Alzheimer's disease," and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date.
Study Selection:The primary references were Chinese and English articles including (a) original guidelines and expert consensuses of primary glaucoma, (b) reviews focusing on the differences between various versions of these guidelines and consensuses, and (c) papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases.
Results:The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines. Chinese definitions and classifications put more emphasis on the IOP, while international guidelines put more emphasis on the presence of optic neuropathy. The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma.
Conclusions:As regards the definition and classification of primary glaucoma, we find that there are still some discrepancies between Chinese expert consensuses and international guidelines. Glaucoma is a disease with complex etiologies, while its common characteristic is a specific optic neuropathy. The current definition and understanding of glaucoma is an ongoing and evolving process, reflecting our latest available evidence on its pathogenesis. Chinese ophthalmology community may need to update our guidelines, accommodating these latest developments.