The birth of ocular pharmacology in the 20th century

Nineteenth century ophthalmology, characterized by significant gains in dia gnostic techniques, provided the basis for great advancements in treatment during the 20th century. Drug therapy at the turn of the century was empiri c, palliative, and often toxic. The development of ocular pharmacology duri ng the 20th century provided the basis for a rational therapeutic approach to ocular disease. Foremost among the therapeutic developments were antibio tics, due to their potential to cure conditions that frequently resulted in blindness. Second, other therapeutic classes provided palliative therapy f or chronic diseases, and thus decreased morbidity. For example, drugs speci fically targeting many different aspects of glaucoma have had remarkable su ccess controlling intraocular pressure and forestalling development of blin dness. In addition, other new approaches provided palliative therapy for no nblinding conditions and effective adjuncts to surgical procedures. Antiall ergy and anti-inflammatory drugs greatly increased patient comfort and faci litated treatment of allergic and inflammatory reactions. Local anesthetics and analgesia reduced patient discomfort during surgery. Other adjunct dru gs improved surgical outcomes by reducing inflammation and infectious compl ications. The 21st century will undoubtedly provide navel approaches to add ress many of today's therapeutic dilemmas. Photodynamic therapy,growth fact ors, antisense technology, and genetic-based therapies all show great promi se. Many of the conditions that are only treated palliatively today will be curable in the next century using many of these pharmacological advances. (C)2000 the American College of Clinical Pharmacology.