Worldwide, it is estimated that there are nearly 67 million people with glaucoma, 6.7 million of whom eventually go blind due to glaucoma. In recent years, some scholars have projected that there are as many as 9.4 million glaucoma patients in the population over 40 years of age in China, of which 5.2 million are blind, a number much larger than we originally estimated. Current problems in glaucoma treatment In China, the treatment of glaucoma is still mainly surgical, with most patients receiving filtering surgery. In order to increase the success rate of surgery, some antimetabolic drugs such as 5-Fu and mitomycin have been used in these procedures, resulting in an increase in the success rate of IOP control on the one hand, but an increase in the incidence of thin-walled follicles on the other hand, especially due to a series of complications caused by thin-walled follicles, which affect the visual function and quality of life of patients. Therefore, as we enter the 21st century, the goal of glaucoma treatment poses a challenge – is the goal simply to control IOP? Or is it to preserve visual function? The shift in the treatment paradigm of glaucoma in the 21st century: 1. Drug therapy: The long-standing cardiopulmonary side effects of beta-blockers have caused much discomfort and even life-threatening problems for patients treated with glaucoma drugs. Recently, a new generation of anti-glaucoma drugs, prostaglandin derivatives, has been developed. The characteristics of these anti-glaucoma drugs are different from those of traditional drugs in that they can promote the discharge of atrial fluid through another channel: the uveoscleral channel, so the effect of lowering IOP is stronger. In addition, because they are FP agonists, they increase atrial aqueous discharge by degrading the extracellular matrix of the uveoscleral channel, so they have no cardiopulmonary side effects, thus bringing benefits to patients treated with glaucoma medications. Such drugs that have been used clinically include Latanoprot, rescula, travartan, lumingan, etc. In addition, the protection of the optic nerve in glaucoma patients is also the key to glaucoma treatment. It is undeniable that ideal control of IOP is currently an important tool for optic nerve protection, but protection against optic nerve damage due to non-IOP factors still cannot be neglected. It is currently believed that new anti-glaucoma drugs, such as selective β1 receptor blockers, tulipramine, and receptor agonists, have optic neuroprotective effects. However, multicenter randomized clinical trials have confirmed that none of the various drugs currently on the market have a positive effect, so the study of optic nerve protection is still an important topic of glaucoma research in this century. Another important issue in the field of glaucoma drug therapy is how to evaluate the effect of drug therapy. The current proposal to control IOP at the “target IOP” level is only a concept, and in fact we do not yet have an effective method to determine the target IOP level for each individual. The monitoring of glaucomatous optic nerve damage is another time-consuming and costly task, and even the most sensitive visual field meters are not adequate for monitoring the progression of existing visual impairment. For example, when the retinal ganglion cells are lost by 20%, the visual field meter only shows a loss of 5 db, so the short-term evaluation of the effect of glaucoma drug therapy is still an unsolved problem. Therefore, in glaucoma drug therapy, nowadays, not only the control of IOP at the “target IOP” level is emphasized, but also the control of IOP at night and the control of IOP daytime fluctuation has become the monitoring standard for IOP control. The search for highly sensitive and specific monitoring tools is also a very important issue in the field of drug efficacy evaluation. 2.Surgical treatment: At present, the classical trabeculectomy is still the mainstream procedure. However, there is a trend that many scholars are looking for a non-filter bubble-dependent surgical approach, such as deep sclerectomy, viscoelastic agent Schlemm “s canal dilation, non-penetrating trabeculectomy, and closed-angle glaucoma atrial angle adhesion separation. These procedures have been found to have comparable early and mid-term results to trabecular surgery with reduced complications in current clinical application studies, but their long-term results need to be further investigated, and long-term multicenter randomized controlled studies are not yet available. Excimer laser and endoscopic systems provide new tools for glaucoma surgery, and there have been reports on excimer laser-assisted nonpenetrating trabecular surgery and endoscopically guided trabecular perforation ciliary photocoagulation, and these techniques may play a role in the surgical treatment of glaucoma in this century. The development of novel atrial drainage devices will likely provide new materials for the treatment of refractory glaucoma, especially in complex cases of refractory glaucoma. As the widely used anti-scaroproliferative drugs mitomycin and 5-Fu have brought many problems in glaucoma surgery use, the search for a new anti-fibroproliferative drug with safe, low toxic side effects and anti-scaroproliferative effect is also an important issue in glaucoma surgery treatment research in this century. 3, glaucoma low vision problem: Although we can not do much for the protection and regeneration of glaucoma optic nerve damage, but for glaucoma patients with low vision, especially small vision patients, optical or non-optical visual aids can be used to enhance and improve their visual space, so as to improve their ability to take care of themselves and reduce their dependence on others. This work is also an important part of glaucoma rehabilitation in this century, a work that has not yet been carried out in China. With the economic development and population aging, the rehabilitation of glaucoma patients with low vision will become an important task for ophthalmologists and optometrists in China in this century.