Conclusions

When prescribing multiple medications in the treatment of glaucoma, the clinician considers the mechanism of action of various drugs, the patient's general health, and the patient's lifestyle and ability to comply with medical therapy. In general, when a patient does not have adequate glaucoma control or suffers disease progression while on maximal medical therapy, a surgical procedure should be performed. LTP (argon or selective) is generally an appropriate first choice after failing medical treatment. If adequate IOP reduction does not occur, then trabeculectomy or shunt placement should be considered. It is the clinician's responsibility to make sure that the patient with glaucoma understands the disease, treatment options, and potential for visual loss both with and without adequate therapy.

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