Treatment options in advanced disease

Abstract

AbstractGlaucoma is still the second cause of blindness worldwide. One of the main reasons is that since glaucoma is a symptom‐free disease, at least 50% of glaucoma patients are not aware of their disease. Therefore it is not uncommon to see at the consultation advanced glaucoma cases even in the Western world. The management of these advanced cases is very challenging because if at best the treatment can stop the loss of retinal ganglion cells (RGCs) while lowering intraocular pressure (IOP), it will not prevent from the natural age‐related loss of RGCs. Therefore many of these patients will go blind even with a “successful” treatment. The modalities of the treatment are controversial because when surgery is indicated, the fear of the so‐called whipe‐out syndrome is well known among glaucoma surgeons. Recent papers have highlighted that this complication may occur but may be at a lower rate that previously thought. In any case the treatment has to be customised according to the life‐expectancy of the patient, the local and systemic tolerance of IOP‐lowering drugs and the status of the other eye. A fair information given to the patients by the ophthalmologist is probably at least important that the suggested treatments for a given patient.