Fast glaucoma progression requires aggressive treatment

Roberto Carassa

PARIS — In patients with rapid glaucoma progression, aggressive treatment may be required, according to one speaker here.

"Filtering surgery is usually the way, and we should not be afraid of doing it whenever necessary," Roberto Carassa, MD, said at the World Glaucoma Congress.

Progression rate is highly variable among glaucoma patients and depends on both IOP and non-IOP related factors. Nevertheless, the basic of glaucoma treatment is lowering IOP.

"IOP reduction has been demonstrated to be significantly related to maintaining visual function and, consequently, quality of life. Studies have shown that 1 mm Hg of IOP reduction is associated with a difference of 0.31% per year in the rate of visual field loss. Other studies have shown that a 35% IOP reduction is necessary to bring visual field changes close to 0," Dr. Carassa said.

How reduction should be obtained depends on the individual clinical case. Young patients with rapidly progressing disease need aggressive surgical treatment to prevent blindness, while in older patients with a shorter life expectancy, a more gentle approach with medications might be sufficient.

"Surgery, filtering surgery in particular, is undoubtedly very effective in decreasing the rate of visual field progression. It is important, nevertheless, to consider the benefits-risk ratio of intervention, taking into account factors such as stage of the disease, life expectancy, patient preference, and potential side effects or complications," Dr. Carassa said.

Disclosures: Dr. Carassa has no relevant financial disclosures.