Ocular surfaces in the treatment of glaucoma

The ultimate goal of glaucoma therapy is to prevent ganglion cell death and progression of glaucoma. So far glaucoma has been treated by lowering the intraocular pressure. Although this strategy has been successful in many cases there is a great need to understand the overall benefits, risk factors and adverse reactions of the various existing and new treatment modalities to further improve the success of medical and surgical glaucoma therapies. Ocular surfaces are the most important pathway for the topical glaucoma drugs and thus most vulnerable to the topical adverse reactions. In the aging population the risk for the topical adverse reactions is high and they may jeopardize the success of glaucoma therapy by decreasing the adherence to the treatment or by affecting the outcome of the glaucoma surgery. The cause of these problems might lie in the individual vulnerability, in the active or adjunctive compounds of the medical drugs, in the surgical techniques or biomaterial used in the glaucoma surgery. Therefore the identification of the existing risk factors for these reactions are of great importance for the successful glaucoma therapy.