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Glaucoma
Management of the Progressing Glaucoma Patient
Marco Centofanti
1,2
and Francesco Oddone
2
1. Aggregate Professor, Department of Ophthalmology, University of Tor Vergata, Rome; 2. IRCCS – Fondazione GB Bietti per la Ricerca in Oftalmologia, Rome
Abstract
The objective of glaucoma therapy is to preserve the patient’s vision at moderate cost. Life expectancy, stage of disease and progression rate,
jointly, are considered the pivotal standard of assessment of the glaucoma patient, and correct therapeutic management is fundamental.
Decreasing the progression rate of functional damage is the only strategy to reach the therapy objective in glaucoma today. From this point
of view, ocular hypotensive therapy represents the only available instrument to reduce the risk of progression, minimising the risk of visual
loss for each patient. Decreasing intraocular pressure should be considered the instrument by which the clinician can reduce the speed of a
patient’s disease progression. The choice of aggressive or less aggressive treatment can be made on a case-by-case basis to slow down the
progression rate of the disease to a secure level for the patient’s individual risk profile. In conclusion, the management of the glaucoma patient
should be based on perimetric data, which should be considered as the way to judge the efficacy of the ocular hypotensive therapy.
Keywords
Glaucoma, ocular hypotensive therapy, prostaglandin analogues, progression rate
Disclosure: Marco Centofanti is a consultant advisor to Allergan, Alcon and Merck, and has received lecture fees from Allergan, Alcon and Pfizer and grant support from Allergan,
Alcon and Merck. Francesco Oddone is a consultant advisor to Allergan, and has received lecture fees from Allergan and Pfizer and grant support from Allergan and Merck.
Received: 1 October 2009 Accepted: 12 October 2009
Correspondence: Marco Centofanti, Aggregate Professor, Department of Ophthalmology, University of Rome ‘Tor Vergata’, Head of Glaucoma Research, Fondazione Bietti –
IRCCS, Via di Trasone, 6, 00199 Rome, Italy. E: marco.centofanti@fastwebnet.it
The objective of glaucoma therapy is to preserve the patient’s vision life (see Figure 1). The risk of developing serious visual impairment,
at moderate cost.
1
It is a common perception that glaucoma  has a starting with the same age and same stage of functional damage,
slowly progressing pathology and that the visual function of the increases with the acceleration of disease progression. In other
patient suffering from glaucoma deteriorates symptomatically only words, a young patient with an advanced stage of the disease but
towards the terminal stage of the disease. In fact, scientific proof with slow progression has an overall lower risk of visual impairment
exists demonstrating how progression rate can be very variable from than a patient of the same age and similar disease stage whose
patient to patient.
2
At an unexpectedly early stage of the disease the disease progression is very rapid (see Figure 2).
glaucoma patient can experience such a loss of vision that his or her
quality of life changes. This is reflected in an increase in accidental Life expectancy, stage of disease and progression rate are considered
slips and falls
3
and road accidents
4
observed in elderly glaucoma the pivotal standard of assessment of the glaucoma patient. This
patients compared with persons of the same age without glaucoma. assessment is fundamental in ensuring  correct therapeutic
Currently, the  correct clinical management and therapeutic management of the condition. Preserving a patient’s visual function is
approach for the newly diagnosed patient cannot disregard an initial the objective of glaucoma therapy. However, decreasing the
assessment of the individual’s lifetime risk of developing perimetric progression rate of functional damage is the only strategy by which to
damage that will compromise quality of life. reach such an  objective today. From this point of view, ocular
hypotensive therapy represents the only available instrument by
Risk assessment is based on some fundamental elements, among which to reduce the risk of progression,
5–9
minimising the risk of visual
which stage of pathology at the moment of diagnosis and age of the loss for each patient. The novelty, in terms of concept, is to consider
patient (and his/her life expectancy) play a primary role. The younger the decrease of progression in functional damage as a measure of
the patient presenting with advanced glaucoma at first diagnosis, the efficacy for the ocular hypotensive therapy, rather than relying on the
bigger the risk that progression of the disease will  lead to serious associated value resulting from the tonometric value.
visual impairment. By contrast, advanced age and the presence of
damage at an initial stage can be considered, under this point of view, Intraocular pressure (IOP)  should therefore  be considered the
to be elements of a low risk profile. instrument by which a clinician can judge the speed of progression of a
patient’s disease. The choice of aggressive or less aggressive treatment
The third and most important factor to be considered, next to age and can be made  on a case-by-case  basis in order  to slow down the
damage stage, is the progression rate of the disease during a patient’s progression rate of the disease to a secure level for the patient’s
© TOUCH BRIEFINGS 2009 37
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