Illustrate and explain clinically observable manifestations of axonal transport. To our knowledge suppression of axonal transport and thinning of the nerve fiber layer have not previously been correlated with fundus changes as indicated in Figure 1. Improvement in disc contours is well known especially following IOP reduction in pediatric glaucoma and visual field improvement after IOP lowering has been well documented in adults, Figure 2. These pre-OCT observations are incentives for early recognition and therapy of adult glaucoma and will hopefully stimulate pre- and post-operative measurements of the nerve fiber layer in young glaucoma patients by OCT.

We believe that the explanation for disc and visual field recovery in some glaucoma patients after intraocular pressure (IOP) lowering by trabeculectomy is recovery of suppressed axonal transport by high IOP. To our knowledge, this concept has not been previously expressed and represents a useful addition to the clinical care of glaucoma patients.