We read with great interest the article by Schuman et al1 that reported the 1-year outcomes of patients with glaucoma or ocular hypertension after treatment with brimonidine tartate twice daily and compared these results with those obtained from patients treated with timolol maleate.
Our understanding of glaucoma recently has changed. Whereas glaucoma was previously thought to be a disease related to intraocular pressure (IOP), it is now known that elevated IOP is only one extremely important aspect of a complicated process that results in optic nerve compromise and visual field loss.2 The presence of glaucomatous damage of the optic nerve in the absence of elevated IOP has brought into question the role of IOP as a causative factor in the development of the disease.
Burnstein Y, Robin AL. Pressure or Progression?. Arch Ophthalmol. 1999;117(3):417-418. doi: