A review of the choice of therapy in primary open angle glaucoma.

We are in the midst of a therapeutic revolution and the choice of therapy in the management of glaucoma can no longer be based on long-held beliefs. The choice between medical, surgical and argon laser trabeculoplasty as primary therapy for glaucoma has been a matter of debate and research for many years. Arguments are based mainly on 3 factors: efficacy, safety and cost. In Africa, other factors that must be considered include acceptability of surgery, compliance with medical therapy, scarcity and expense of modern drugs, absence of laser facilities among others. It is generally accepted that trabeculectomy surgery is the most acceptable form of therapy in Africans mainly because of its efficacy, late presentation and problems encountered during medical therapy. However many African patients are reluctant to have surgery for glaucoma mainly because of fear and the fact that there will be no visual improvement after the surgery. There are now several potent modern drugs, which though expensive have acceptable safety profile, and fewer problems with compliance. The decision on the choice of therapy should be individualized and not be based on long-held beliefs.