Glaucoma: classification and structural assessment in determining the stage of the disease. Critical notes and proposals

The staff of the Academic Department of Ophthalmology of the Military Medical Academy made a significant contribution to the creation of glaucoma classification. In 1948, B.L. Polyak developed a dynamic classification of glaucoma, which reflected both the staging of the disease — based on the degree of visual field constriction, and the threat of its further progression — based on the degree of intraocular pressure compensation; this classification was approved by the Ministry of Health of the USSR in 1952 and served as the national glaucoma classification for nearly 25 years. Subsequently, an improved and updated version of primary glaucoma classification by A.P. Nesterov and A.Ya. Bunin was approved in 1975 at the 3rd All-Russian Congress of Ophthalmologists and remains the official classification to this day. Since 2003, in accordance with international standards, the diagnosis of glaucoma has been based primarily on the identification of structural changes in the optic nerve heard (ONH) characteristic of glaucoma and the associated functional changes in the visual field. The concept of glaucoma 

based on the disruption of the transmembrane gradient between intraocular and intracranial pressure, and has contributed to the development of a structural and functional approach to its diagnosis long before the international standards were established. The results of studies performed at the department in the late 20th century, including morphometric analysis of the ONH, were incorporated into the classification of primary open-angle glaucoma developed by V.V. Volkov.

In light of the above, we propose refining the classification scheme of glaucoma stages presented in the current Ministry of Health of the Russian Federation guidelines, "Clinical Guidelines: Primary Open-Angle Glaucoma — 2024", by providing structural and functional diagnostic criteria for glaucomatous optic neuropathy with not only qualitative but also quantitative parameters, taking into account the developments in this field achieved in Russia.

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