What treatments are the right ones? Drops, scissors, laser

Take Home Points

In this section, we’ll talk about the present mainline therapy for glaucoma, lowering the eye pressure. With due respect to the old game of rocks, scissors, paper, each has advantages over the other, but also each has a downside or two. The 3 methods are: daily eye drops, laser treatment to the angle, or various forms of surgery. Which method to lower eye pressure is best for you to start with? This discussion applies whether you have open angle glaucoma, or you are an open angle suspect who chooses therapy, or if you have angle closure or angle closure glaucoma after iridotomy, and even for others with secondary forms of glaucoma (see section Secondary glaucoma).

Clinician scientists know that all three treatments have been tested in big studies and that they all work. You wouldn’t be wrong to start with drops, with laser or with surgery. The big organization that eye surgeons belong to, the American Academy of Ophthalmology, has guidelines called preferred practice patterns. These are written by committees that put together the best information for doctors to present to patients. The practice pattern says that every new glaucoma patient should be told the upsides and downsides of each of these methods, and that it’s fine to start with any one of the three. Every new patient in our practice runs through the following discussion with us before the mutual decision about how to start treatment is made. So, what’s the good news and the bad news?

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