This first volume of the New Concepts in Glaucoma series was conceived as a platform to express new ideas and approaches to understanding and solving primary open-angle glaucoma. The authors have attempted to expand levels of knowledge, present new ideas and challenge existing theories. Although the authors have painted a broad picture, the central theme of the book is to ask the right questions and seek the answers for patients with primary open-angle glaucoma.

Foreword Volume 2 of our serial publication continues our desire to address glaucoma with a combination of science and speculation. As science expands, the emphasis is on data, interpretation, and dogma. We disagree; open minds open new approaches. Using methodologies that are primarily molecular and genetic, we seek to refine the causes of glaucoma as well as how it is best treated, especially incorporating thoughts and hypotheses about new methods of treatment. Glaucoma is a complex disease, and genetics proves that a variety of proteins are culpable at one level. At another level, however, there are likely final common pathways and numerous feedback loops which have defied explanations to date. The search for answers goes on in basic science researcher’s laboratories and clinical ophthalmologist’s offices and operating rooms. We are all well-served by understanding that glaucoma is a neurodegenerative disease. Current attempts to solve the disease have focused on two strategic arenas: the trabecular meshwork function and its impact on intraocular pressure as a major risk factor for the disease; and the optic nerve dysfunction leading to visual loss. Genetic mutations have yielded puzzling clues to the cause, but without resolution. For example, mutations in myocilin and optineurin genes are closely connected to the phenotype, but how do they cause the disease? In the next two years, priority areas of research are signaling pathway discoveries, biomarker panels, epigenetic factors, and continued genomic studies to yield answers to the common final pathways of the disease. The final pathways are complex and redundant, such that the overlap of bio-informatics will be challenging. Current promising leads suggest the innate immune system holds important clues to both trabecular meshwork and optic nerve pathophysiology. When the primary open-angle glaucoma disease pathways are unraveled, drug discoveries and new treatment modalities will be available for better regulation of intraocular pressure and neuroprotection for the optic nerve. This volume discusses the glaucoma pipeline from several perspectives as well as future candidate classes. As always, the authors herein are urged to speculate on how the cure of glaucomatous optic nerve damage will yield to new treatments. John R. Samples Clinical Professor, Elson S. Floyd College of Medicine, Washington State University School of Medicine www.glaucomaconcepts.com Paul A. Knepper Associate Professor of Ophthalmology, Feinberg School of Medicine, Northwestern University Medical School Research Scientist, University of Illinois at Chicago

Successful interventional glaucoma remains a sought-after goal for the glaucoma clinician for many reasons. Medical costs, compliance, and adherence remain major barriers for the treatment of our patients. A truly definitive treatment for glaucoma is most likely to be largely surgical, as it is doubtful that patients will continue to use glaucoma drugs in the future for anything other than transient lowering of intraocular pressure. In the coming era, it seems probable that neuroprotection and neurorestoration will be combined with MIGS to lower pressure. The different types of MIGS are increasing in proportion to their efficacy. To date, there are no fewer than 12 choices available to glaucoma specialists. Choice of procedure depends on the underlying anatomy as well as the patient’s individual characteristics. Truthfully, the number of available surgeries depends upon their taxonomy. Most are based on the outflow system and the canal, as illustrated in this book.

Handbook of Basic and Clinical Ocular Pharmacology and Therapeutics provides a review of the basic anatomy, physiology, biochemistry and pathology of the eye with a focus drug therapy, drug delivery and use of therapeutic medical miniature devices. An understanding of the pharmacological actions of drugs acting on the eye requires the student and health care practitioner to learn additional principles in basic and clinical sciences that are unique to this organ. As a sensory organ, the eye is relatively inaccessible to the systemic circulation due to the blood-vitreous, blood-aqueous and blood-retinal barriers. Consequently, the administration of drugs for therapeutic effects in the eye necessitates an understanding of physico-chemical properties of the molecules and pharmacokinetic principles involved in the access to its site of action via topical, intracameral and intravitreal administration. This book includes information on the general principles of pharmacokinetics and pharmacodynamics of drugs as it pertains to the eye and in combating ocular disorders and diseases. Using a disease-themed approach, the book discusses basic and clinical pharmacological principles involved in the therapy of these diseases including the ocular side effect of systemically-administered drugs, drugs used in ophthalmic surgery and miscellaneous agents, the therapeutic utility of biologics, drug conjugates, combination products, gene and cellular therapy are also covered. Handbook of Basic and Clinical Ocular Pharmacology and Therapeutics is useful as a primary and secondary source of reference for up-to-date information about the pharmacological mechanisms of action, pharmacokinetics, side effects, drug-drug interactions and therapeutic indications of drugs for pharmacologists, pharmaceutical scientists, students in the health care disciplines (nursing, pharmacy, optometry, medical), and practitioners in optometry and ophthalmology. - Explains the mechanisms of action, side-effects and therapeutic uses of drugs, biologics, miniature devices, gene and cellular therapies for the eye - Provides a comprehensive review of the anatomy, physiology, biochemistry, pharmacology, microbiology, genetics and pathology of parts of the eye involved in drug therapy to combat eye disorders and diseases - Explores the pharmacological and clinical basis of drugs, drug conjugates, combination products used in the treatment of anterior and posterior segment diseases