Glaucoma: Treat all? Aggressively?


Although the rate of glaucoma progression varies widely between patients, and prognostic factors to identify patients at higher risk for faster progression have been identified, the answer to the question of whether there are certain subgroups of patients who should be treated more aggressively than others is "no."

Dr. Wilson's statement was based on information about the natural history of glaucoma showing there is a high probability of blindness in untreated disease and that when it comes to individual patients, the predictive value of progression risk factors and the ability to predict progression rate is very poor.

"The question of 'Who should be treated for glaucoma?' can be disposed of quickly, because with rare exceptions, the answer is that all patients with bona fide disease should be treated," said Dr. Wilson, chancellor emeritus and professor of ophthalmology, University of Colorado School of Medicine, Denver.

"Then, patients should be monitored and treatment modified based on data received over time," he continued. "The approach to treatment of glaucoma is still an art, and it should not be based a priori on risk factors identified prior to treatment initiation."

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