Why Do Patients with Controlled Glaucoma Continue to Lose Their Vision?

The question why patients with controlled glaucoma continue to lose their vision and may end with blindness was raised at the conference last year, but no answer was provided. This presentation will address some of the possible clinical causes such as supine position during sleep and sleeping on the affected eye(s). Antihypertensive drugs at bedtime increase the risk of anterior ischemic optic neuropathy, which is a challenge to diagnose in advanced glaucoma. Basic causes include the continuation of neuronal apoptosis despite controlled intraocular pressure. To prevent further visual loss in these patients, practical steps such as sleeping at 20–30° head-up position, avoiding sleeping on the affected eye(s), avoiding taking antihypertensive drugs at bedtime, and developing antiapoptotic drugs such as antibodies are essential.