Back to the Future – Has Medical Treatment of Glaucoma Improved?

These proceedings are based on a symposium that were presented at the European Society of Ophthalmology 2015 Congress in Vienna, Austria on 8 June 2015. The symposium was arranged to bring together leaders in ophthalmology to explore advances in the medical treatment of glaucoma. Many patients with glaucoma require combination therapy. Fixed-dose combinations represent a significant improvement in the medical treatment of glaucoma, being advantageous in terms of their association with good compliance and elimination of the wash-out effect. While preservatives are a historic necessity, their use is associated with increased ocular surface disease and higher indirect cost. The novel preservative-free tafluprost/timolol fixed-dose combination provides mean diurnal intraocular pressure (IOP) lowering of up to 40 % from baseline and demonstrates similar efficacy with other prostaglandin/timolol fixed-dose combinations, is superior to its individual components and non-inferior to its individual components given concomitantly. The tafluprost/timolol fixed-dose combination is well-tolerated with low prevalence of hyperaemia. It is generally accepted that function loss follows structural damage and that normal-pressure glaucoma (NPG) and high-pressure glaucoma (HPG) represent that same disease, separated by an arbitrary pressure level. However, functional damage (pattern electroretinogram) is detectable prior to structural damage and NPG patients show less retinal nerve fibre layer and visual field loss compared with the same optic nerve head morphology HPG patients. NPG patients seem to lose connective tissue first whereas, in HPG, patients seem to lose retinal nerve fibres first. Thus, whether NPG and HPG are the same disease is an open question.