Glaucoma treatment can be a gamble

Among the many factors to keep in mind when assessing how to treat a patient who presents with glaucoma is the patient’s own view of whether the risks of treatment outweigh the risk of non-treatment, said Norbert Pfeiffer MD, University of Mainz, Mainz, Germany. 

While the aim of treatment in such cases to prevent vision loss in the longer term, in the shorter term, treatment can have negative effects on a patients quality of life, Dr Pfeiffer told the European Society Congress in Nice.

 “We must look at the options but obviously we must also analyse the side effects of treatment. For example, with medication there are medication risks, this patient has hyperaemia, there may be allergy for example. T there may even be systemic allergy from medication, “he added.

Sometimes a patient can have a very severe reaction to medication, he said, citing the example of a glaucoma patient who developed a third degree atrioventricular block while receiving a topical beta-blocker . Other ways medical treatment can affect a patient’s quality of life are its time-consuming nature, a possible stigma, and the way it serves as a daily reminder to the patient that they have a disease.

Surgical treatment also carries risks, including that of such devastating complications like expulsive haemorrhage Dr Pfeiffer noted. Even when the surgery  has the desired clinical outcome, the patient may be unhappy, as was the case with a patient of his in whom a bleb formed at the junction the iris and the sclera.

“You have to keep weighing the risks and please keep in mind that your risk assessment may be greatly different from your patients risk assessment and their quality-of-life is not ours,” he concluded.