Medical treatment as the initial therapy for open-angle glaucoma.

Abstract

HE GOALS OF THERAPY in the treatT ment of open-angle glaucoma are threefold. First, we strive to prevent the progression of damage to the visual system. This has conventionally been assessed in terms of the ophthalmoscopic appearance of the optic nervehead and the fullness of the visual field. Currently, numerous other measures of both anatomic and functional integrity are also being vigorously investigated. Second, we endeavor to achieve a lowering of intraocular pressure (IOP). This goal has become an accepted short-term focus of therapy even in the absence of signs of progressive damage. The third goal of therapy is to minimize side effects and complications. As in any medical field, in planning therapy for glaucoma we must always be thinking of the least invasive and least risky intervention that is likely to achieve the desired level of protection or cure. This last goal is far from trivial. Consider, as an example, that this is the reason we do not perform cyclodestructive procedures on all newly diagnosed ocular hypertensive patients, although we would likely lower pressure and prevent some visual loss in some patients. In other words, the goals of preserving sight and lowering pressure must always be conducted in a context of minimizing the hazard, inconvenience, and cost of therapy.