Abstract
Anterior segment glaucoma clinical care and research has recently gained new focus because of novel imaging modalities and the advent of angle-based surgical treatments. Traditional investigation drawn to the trabecular meshwork now emphasizes the entire conventional aqueous humor outflow (AHO) pathway from the anterior chamber to the episcleral vein. AHO investigation can be divided into structural and functional assessments using different methods. The historical basis for studying the anterior segment of the eye and AHO in glaucoma is discussed. Structural studies of AHO are reviewed and include traditional pathological approaches to modern tools such as multi-model two-photon microscopy and optical coherence tomography. Functional assessment focuses on visualizing AHO itself through a variety of non-real-time and real-time techniques such as aqueous angiography. Implications of distal outflow resistance and segmental AHO are discussed with an emphasis on melding bench-side research to viable clinical applications. Through the development of an improved structure: function relationship for AHO in the anterior segment of the normal and diseased eye, a better understanding of the eye with improved therapeutics may be developed.
Highlights
Introduction and HistoryGlaucoma can result in irreversible vision loss
intraocular pressure (IOP) is elevated in glaucoma due to increased
The importance of furthering our understanding of how aqueous humor exits from the eye is of increasing interest
Summary
Glaucoma can result in irreversible vision loss. At this time, the only proven treatment is lowering intraocular pressure (IOP) [1,2]. IOP is elevated in glaucoma due to increased resistance to fluid outflow from the eye [3,4]. A new category of glaucoma surgery, Minimally Invasive Glaucoma Surgeries (MIGS) [5,6], is of great interest. MIGS offer a small wound, safe, and fast surgical approach to enhance aqueous humor outflow (AHO) drainage. The importance of furthering our understanding of how aqueous humor exits from the eye is of increasing interest. Using new and emerging technologies, AHO structure and function is being re-examined with a goal of improving current and enhancing future therapeutics
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