Is the Patient Getting Worse?

Glaucoma care today is often simplified into all or nothing terms with the assumption that if the patient’s intraocular pressure (IOP) is above a certain level, glaucomatous disease will progress and when the IOP is lowered to below a threshold, no further progression will occur. This dogma is largely the result of limitations in the resolution of tools currently available to judge progression. Glaucoma is a neurodegenerative disease and, as with all degenerative diseases, progression continues to occur, albeit at slower rates, with appropriate treatment. In the future, as our tools to assess structural and functional optic nerve change become more precise, we will no longer think of glaucoma as being stable or progressive but rather speak in terms of rates of progression.