Review of Optometry
In the United States, medicine is the standard first-line treatment. In Europe, surgery often comes first. New studies raise questions about this sequence.
As surgical techniques continue to become safer and more effective in treating glaucoma, the option of surgery first is becoming an earlier consideration for some patients.
This trend of surgery as first-line treatment is already prevalent in Europe, as it is considerably less expensive to perform surgery A gonioscopic view of the anterior pigmented trabecular meshwork, where argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT) is applied.
Studies have concluded that diurnal variations of IOP appear to be better controlled with surgery than with medicines, yet final control of POAG appeared to be equal between the two groups. If cost factors and IOP factors are removed from the equation, quality of life seems to be better within the medically-treated glaucoma patients compared with the surgically-treated glaucoma patients.
Surgical treatment renders no additional neuroprotection except for the control of IOP. Complication rates appear to be greater with surgical treatment than medical treatment. It appears that the U.S. model—medical treatment followed by laser treatment, then surgical treatment in patients whose glaucoma is either not adequately controlled, who cannot afford or are non-compliant with medicines, or who have presented with side effects from the medicines—fits within good medical practices.