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Controversies
February 1998

Initial Treatment for Open-Angle Glaucoma—Medical, Laser, or Surgical?Medication Is the Treatment of Choice for Chronic Open-Angle Glaucoma

Arch Ophthalmol. 1998;116(2):239-240. doi:10-1001/pubs.Ophthalmol.-ISSN-0003-9950-116-2-esa7375a

WITHIN THE LAST 20 years several new, effective, and well-tolerated glaucoma medications have been introduced. No longer is the clinician limited to pilocarpine and other cholinergic agents, epinephrine, and systemic carbonic anhydrase inhibitors. Every medication we prescribe has its own list of adverse effects; however, many of the older medications are associated with effects that are problematic for many of our patients. Therefore, early surgery would have been my choice 25 years ago. Even 10 years ago, when an adrenergic antagonist was the primary therapeutic choice and laser trabeculoplasty was commonly performed, one could argue for laser therapy as an initial approach given the systemic adverse effects associated with β-blockers. Today, clinicians and patients have a wider range of choices, which generally are associated with fewer adverse effects and require less frequent administration. Medical therapy can now be defended as an initial approach to treatment.

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