Primary Open Angle Glaucoma (POAG, COAG) – the diagnosis and our understanding behind the pathogenesis and pathophysiology continues to evolve from our previous emphasis primarily on elevated pressure producing optic nerve damage and visual field loss toward new concepts that emphasize nerve damage, early detection, and the risk for future nerve damage.  The question in 1981 was “is the pressure too high for that nerve.”  In 2011 the question has become, ” is the nerve healthy enough for that pressure”?  The AAO (American Academy of Ophthalmology) removed pressure from the diagnosis of glaucoma nearly 10 years ago.  I wonder where the emphasis will be 10 years from now?  What initiates the first step in the process?  We are too content in medicine to settle for problem treatments when we need to find problem cures and problem prevention!  This is the only mechanism by which health care reform can deliver higher quality, better access, and improved economics.