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Primary open-angle glaucoma is not yet fully understood in terms of its pathophysiologic mechanisms. However, they are being addressed more completely in the recent literature. To the list of known risk factors associated with this disease, systemic influences are now being added. Primary open-angle glaucoma is becoming a much more complex disease as research uncovers associations and relationships that were previously unknown. Without knowledge of these mechanisms, the clinician is unable to adequately diagnose and treat the problem. Advances in computer-based diagnostic tools have been made, and we are now beginning to understand their value and limitations. However, whatever technology has to offer, we must always remember that the ultimate decision on initial diagnosis and further deterioration remains a clinical one.