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    POAG: Enigmatic group of heterogenous diseases?

    Recognition of differences among subtypes may facilitate diagnosis, management

    He described the case of a patient who presented with an apoplectic inferior altitudinal visual field loss in the left eye. However, IOP was relatively normal. The referring physician inquired if the patient had sustained a sudden ischemia or retinal embolic event, had newly discovered normal-tension glaucoma, or non-arteritic ischemic optic neuropathy.

    This case illustrates the quandary in which ophthalmologists find themselves.

    “How long have we been confused about POAG?” Dr. Pasquale asked. “The answer is: A really long time."

    “The term is a misnomer,” he added. “The definition in the dictionary is pale blue or grayish green. The Latin root means ‘waterfall,’ which probably referred to patients who were functionally blind from a mature cataract.”

    It was not until the invention of the ophthalmoscope that patients with clear media also were found to have excavated totally cupped optic nerves, which explained the blindness, Dr. Pasquale noted.

    However, confusion about the disease persisted, and the terminology used might have actually confounded the confusion about the etiology of POAG, he said.

    Redefining POAG

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