Objective To determine the longitudinal trends in the probability of blindness due to open-angle glaucoma (OAG) in Olmsted County, Minnesota from 1965 to 2009. Design Retrospective, population-based cohort study. Participants All residents of Olmsted County, Minnesota (40 years of age and over) who were diagnosed with OAG between January 1, 1965 to December 31, 2000. Methods All available medical records of every incident case of OAG were reviewed until December 31, 2009 to identify progression to blindness, defined as visual acuity of 20/200 or worse, and/or visual field constriction to 20° or less. Kaplan–Meier analysis was used to estimate the cumulative probability of glaucoma-related blindness. Population incidence of blindness within 10 years of diagnosis was calculated using United States Census data. Rates for subjects diagnosed in the period 1965–1980 were compared with rates for subjects diagnosed in the period 1981–2000 using logrank tests and Poisson regression models. Main Outcome Measures Cumulative probability of OAG-related blindness, and population incidence of blindness within 10 years of diagnosis. Results Probability of glaucoma-related blindness in at least one eye at 20 years decreased from 25.8 % (95% Confidence interval [CI]: 18.5–32.5) for subjects diagnosed in 1965–1980, to 13.5% (95% CI: 8.8–17.9) for subjects diagnosed in 1981–2000 (P=0.01). The population incidence of blindness within 10 years of the diagnosis decreased from 8.7 per 100,000 (95% CI: 5.9–11.5) for subjects diagnosed in 1965–1980, to 5.5 per 100,000 (95% CI: 3.9–7.2) for subjects diagnosed in 1981–2000 (P=0.02). Higher age at diagnosis was associated with increased risk of progression to blindness (P< 0.001). Conclusions The 20-year probability and the population incidence of blindness due to OAG in at least one eye have decreased over a 45 year period from 1965 to 2009. However, a significant proportion of patients still progress to blindness despite recent diagnostic and therapeutic advancements.

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Despite being introduced over 50 years ago, the current gold standard for glaucoma surgery is still trabeculectomy. However, significant complications can occur with the procedure and, consequently, recent developments in glaucoma surgery have focused on improving safety and reliability. These developments can be categorized into three main areas: advances in filtering surgery, angle surgery and uveoscleral shunts. Each of these approaches has advantages and disadvantages, which are discussed in this review. In general, angle surgery and uveoscleral shunts do not appear to offer as low an intraocular pressure as filtering surgery, but appear to have fewer serious complications than filtering surgery. However, clinical data for these newer approaches are still limited in many cases, and further research is required to determine the role of new surgical options in glaucoma management.