To treat or not to treat?

This patient was NOT started on IOP-lowering medications and instead monitored more frequently. The patient was scheduled to return in 1 month to repeat the visual field to confirm progression and to check the IOP. If progression on the visual field was confirmed, IOP-lowering medication would be initiated. The patient has since been lost to follow up.

There is no right or wrong answer to initiate treatment or not on this patient. Below are some reasons to either start treatment or not.

To treat:

  • Younger patient and is monocular
  • IOP fluctuation with a spike at one visit to 23 mmHg
  • Low CH and corneal thickness
  • Possible progression on visual field

Not to treat (close monitoring):

  • No family history of glaucoma
  • “Normative” IOP
  • Possible myopic visual fields with questionable progression
  • Initiation of treatment comes at a cost financially and emotionally
  • Visually significant damage will not occur in 1 month