How early should glaucoma treatment begin?
Because treatment will cause symptomatology and entail a cost, before starting treatment, one must be fairly sure that a patient who has no symptoms will develop them if medical or surgical therapy is not employed. Specifically, will this individual develop either glaucomatous damage or another problem such as a retinal vein occlusion? If the patient has a narrow anterior chamber angle, one must determine the likelihood of occlusion. With an asymptomatic individual who has an open angle, the question is whether he will develop vascular occlusion or damage from primary open-angle glaucoma that will interfere with his life. Although we do not know much about the former, anecdotal evidence suggests that patients with higher IOPs are more likely to develop retinal vein occlusion. If patients have IOPs of 30 mm Hg (my own magic number) or higher, I begin pressure-lowering treatment. I am particularly concerned when such a patient also has a predisposing factor such as diabetes. Regarding gl
