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Joseph Panarelli, MD, and Arsham Sheybani, MD, discuss the Primary Trabeculectomy for Advanced Glaucoma: Pragmatic Multicentre Randomized Controlled Trial, or TAGS trial, and how this can apply to real world situation. This multicenter randomized controlled trial evaluated whether primary trabeculectomy or primary medical treatment leads to improved outcomes in terms of quality of life, clinical effectiveness, and safety.