Description

Until recently, the rationale for the treatment of ocular hypertension and glaucoma could legitimately have been criticised for being based mainly on indirect and circumstantial evidence. Although there have been many studies demonstrating the association between intraocular pressure and the risk of glaucoma, the benefit of pressure lowering had not been convincingly demonstrated. Over the last few years, landmark clinical trials have finally provided an evidence base for glaucoma treatment. Recently published large-scale, prospective, controlled clinical trials include the Ocular Hypertension Treatment Study, the Collaborative Normal Tension Glaucoma Study, the Early Manifest Glaucoma Study, the Collaborative Initial Glaucoma Treatment Study and the Advanced Glaucoma Intervention Study. These trials have demonstrated beyond reasonable doubt that lowering intraocular pressure is benefical, both in reducing conversion from ocular hypertension to glaucoma, and in reducing glaucomatous progression in eyes with established manifest glaucoma. The aim of the current review was to consider the impact of these trials on everyday clinical decisions about which patients need treatment and how best to manage such individuals.