ABSTRACT
The newly diagnosed glaucoma patients in the collaborative initial glaucoma study trial had similar rates of progression, whether in the surgical treatment arm with intraocular pressure (IOP) ranging from 14 to 15 mmHg or in the medical treatment arm with IOP ranging from 17 to 18 mmHg. When initiating therapy for a newly diagnosed glaucoma patient, consideration is given to starting with medical therapy or to beginning treatment with laser trabeculoplasty or, much less commonly, performing surgery as an initial treatment. A medical regimen should be designed to attain a target IOP with the fewest associated side effects, which the patient can administer on a regular basis. Because glaucoma is usually an asymptomatic disease, patients may have difficulty accepting the diagnosis and the need for life-long medication, particularly when vision is unaffected and they are asymptomatic. Compliance is one of the major obstacles to medical management of diseases.
