On the choice of effective strategy and tactics in early diagnosis, prevention and treatment of open-angle glaucoma

Discussion aspects of the pathogenesis of open - angle glaucoma (OAG) were considered in view of the pathophysiological processes occurring in the fibrous layer of the eye (FOG) in this disease. The new medical technology of early diagnosis prevention and treatment of OAG, tested in the clinic was described, using the following author's techniques: - Evaluation of functional stability of the scleral lamina cribrosa deflection (CPF); Evaluation of the functional state of FOG according of levels rigidity and scleral fluctuations; - Evaluation of the eyes belonging to the area with low, medium or high rates of IOP; - Determination of the IOP values of the patient in the elderly and in young age; - Methods to reduce stiffness of FOG and to restore the functional capacity of the sclera to the fluctuations with hypotensive gentle therapeutic effects of a new generation of non - invasive laser - hypotensive sclerotomy (LNGS). Using a modified by authors the measurement platform of the pneumoanalizator ORA the functional regulatory features of the fluctuations of the sclera in healthy and glaucoma eyes were revealed and described, and it was found also that the level of rigidity FOG uniquely identifies the current level of the average IOP in the eye (p < 0,001). The problems of metrological assurance of IOP accuracy of IOP measurement were ex - amined. It was revealed relatively low instrumental accuracy of IOP measurement using any of the conventional methods. The low quality of the elaboration of GOSTR ISO 8612-2010 ?Ophthalmic Instruments? Tonometers? was marked, which legally allows to apply in Russia even ophthalmomanometers with unacceptably high level of relative error (more 70 %). The conclusion about the absolute necessity of accelerated development of the in - ternational standard of measurement accuracy of IOP and adequate program of certification of ophthalmomanometers was made. It was revealed partial contradictions in pathogenetic validity of recommendations of the European Society Glaucoma for reducing of IOP level at 20, 30 or 40 % as a way to stop the progression of glaucoma. It is noted that such recommendations to achieve target pressure (CD) in the traditional sense, lead to a deterioration of the metabolism and accelerate the growth of FOG rigidity, and therefore IOP. We examine the uncertainty and inconsistency of the concept of ?target pressure? (CD). It was found that while there are no full - fledged independent pathogenetic criteria for CSDs, and physiological basis of the comparison as reliably worked norms / standards for healthy IOP or glaucoma eyes. These facts, and the lack in the eye of the mechanism of physiological control of level of IOP and relatively low instrumental accuracy of IOP measurements in any of the traditional ways, has led the authors to the conclusion about the lack of reliable criteria for ?IOT level? and the ?target pressure? at this stage. As prognostic criteria for early diagnosis and effective treatment of OAG authors suggest to use not so only the level of IOP, but to use more pathogenetically based criteria: as rigidity FOG and the fluctuation of the sclera, the stability of the CPF to deflection gradually expanding, if possible, its use in clinical practice. In the prevention and treatment of OAG authors recommend direct efforts to preserve visual function by simultaneously restoring function of the scleral fluctuations, reduce stiffness of FOG and increase resistance of CPF to deflection.