We, as clinicians, appreciate on a daily basis that the diagnosis of glaucoma can be challenging because of the inherent differences in optic nerve head appearances among individuals. Even more challenging during the initial visits is to make the determination a priori about which patients are at the greatest risk of progression in the long term, thus adding uncertainty about potential for undertreatment vs overtreatment. Objective measurements of circumpapillary retinal nerve fiber layer (RNFL) measurements and macular ganglion cell complex (GCC) thickness using optical coherence tomography (OCT) have proven effective in glaucoma evaluation and progression, especially in cases of mild to moderate glaucoma. Because structural loss typically precedes functional damage, it is crucial to detect structural decline, which can be associated with subsequent visual field (VF) loss. Attenuation of RNFL thickness is associated with future field loss.1 Furthermore, a more rapid RNFL thickness loss in the initial follow-up period is associated with a more rapid future VF decline in the subsequent follow-up period.2