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Racial factor has been identified as a risk factor of glaucoma. African derived population is at higher risk of developing primary open angle glaucoma (POAG). African Americans were found to be at greater risk for open-angle glaucoma (Tielsch et al, 1991). The prevalence of OAG in populations of African descent was 7-fold greater than in Caucasians age 40–49, but due to the steeper increase of OAG in Caucasians at older age, the difference between the 2 populations dropped to 2.5-fold in the 80–89 year-old age bracket (Quigley et al, 1999). Although the prevalence of OAG in Caucasians and Asians aged 40–49 are similar, Caucasians as a whole demonstrate a greater prevalence. On the other hand, Asians are more predisposed to angle closure glaucoma. African derived population is believed to have more severe and progress faster than Caucasian with higher rate of blindness (Sommers et al, 1991a; Sommers et al, 1991b). Angle closure glaucoma (ACG) behaved differently in Asian population. ACG is responsible in more blindness in Asian than in Caucasian population. Laser peripheral iridotomy do not confer strong protection in prevention of progression to glaucoma post acute angle closure in Asians (Ang and Ang, 2008). African derived population response differently to medical and surgical intervention. Racial influence does not only affect susceptibility to glaucoma but also response to glaucoma treatment. In addition, individual variation has also exerted its effect to management of glaucoma patient. Individual variation in drug response poses a significant clinical problem, ranging from failure to respond to a drug to life threatening adverse drug reactions. The causative factors are genetic, physiological, pathophysiological, and environmental. Quantification of pharmacokinetics and pharmacodynamics of topical ophthalmic drugs is technically more difficult as compared to systemic drugs. It is considered quite difficult and dangerous to obtain aqueous or any ocular fluid sample sequentially to determine the concentration of drug in human. Tracer such as technetium makes it possible. Ophthalmic drug once given topically is absorbed to systemic circulation directly by passing hepatic first pass effect. Low availability of ophthalmic drug in the target tissue may cause the needs for higher concentration of the drug and higher likelihood for systemic side effects. The concentration of ophthalmic drug in the blood circulation is certainly not reflective the actual concentration at the target tissue. The pharmacokinetic of the ophthalmic drug is affected by the absorption at the corneal and conjunctiva, rate of blinking, tears concentration and

Topical Pressure Lowering Drug: Racial Respond Variation and Pharmacogenetics