Can the treatments be worse than the disease?

Take Home Points

A primary rule of medicine is “First, do no harm.” We must continuously be thinking about whether things that are recommended as treatments are, on balance, better than doing nothing. Resident doctors in training like to joke that Dr. Quigley takes as many patients off eye drops as he puts on them. By this, they mean that he often will try a unilateral stop trial (stopping the drops in one eye), just to see if they are really doing enough for the patient. You don’t want to take things every day that aren’t helping.

In recent research into who actually benefits from glaucoma treatment, our colleague, Dr. Michael Boland, made the strong case that many persons over age 70 who are open angle glaucoma suspects could be followed without eye drops—and lose no significant vision during the rest of their lives. So, it is not true as patients sometimes tell me: “once I start the eye drops I guess I’ll always have to use them, right?” No, you can try them and if they’re not right for you, you can stop, under certain conditions. And as mentioned above, we’re expecting sustained delivery of glaucoma medications to occur in the near future to replace drops.

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