The present system of glaucoma management is typically one of trial and error. Intraocular pressure is lowered a specific amount and, if deterioration continues despite this reduction, treatment is increased; if deterioration still continues, treatment is again increased, etc. Since no one has yet established the amount of pressure reduction required to halt worsening visual field, and since no one wishes to overtreat, progression of the disease is virtually guaranteed.
See also p 1599.
In this issue, Shin and colleagues1 report results of a study that may signal a more effective approach to the management of glaucoma. They demonstrated a mean decrease of 0.7 cup-disc units (14% ) in the eyes of 13 adults with primary open angle glaucoma in which intraocular pressure had been markedly reduced by medical treatment. The decrease in cupping was directly related to the amount of intraocular pressure reduction. In the five eyes in which changes were able to
Spaeth GL. Reversibility of Optic Disc CuppingA Phenomenon That May Change the Management of Glaucoma. Arch Ophthalmol. 1989;107(11):1583-1584. doi:10.1001/archopht.1989.01070020661022