The role of medical therapy in the rank order of glaucoma treatment.

There is no consensus as to how treatment of open-angle glaucoma should be initiated. Medical therapy, laser trabeculoplasty, and filtration surgery each have their advocates as the best modality for initial treatment. The advantages and disadvantages of these three options are discussed here. It is pointed out that there may not be a single answer as to how to begin treatment. Patient factors such as age, general health, and stage of glaucoma as well as various socioeconomic and technologic factors may lead to different recommendations for different patients. At present, most patients with open-angle glaucoma are started on medical therapy. beta-Blockers are used most commonly as the initial drug of choice, but latanoprost and brimonidine are now being recommended by many as alternate first-line therapy.