The dilemma in glaucoma: To treat or not to treat?

Glaucoma is a common cause of blindness worldwide and the decision to initiate glaucoma therapy can, in some instances, be very challenging. The disease is often slowly progressive, affecting peripheral vision in the early stages. Therefore, most patients are unaware that they have the disease and frequently their quality of life is unaffected. In addition, many patients die before going blind from the disease. Also, the available therapies have potential side effects and their cost is a frequent problem. Data from major prospective clinical studies are now available that can guide us in our decision-making process to treat glaucoma. In addition, certain risk factors have been identified that can increase the predictive power of determining who will develop glaucoma. In this review we examine both sides of the dilemma. It is our opinion that in cases where such a quandary exists, one should consider using the data from the major clinical trials, tailor them to an individual patient and then make decisions regarding treatment.