title: Seven steps to assure the best possible treatment of persons with glaucoma or suspected of having glaucoma.
abstract: Glaucoma causes more blindness and disability than any other eye disease except for cataract. Cataract surgery is highly successful, even intracapsular cataract surgery. The major problem, then, with regard to relieving or preventing disability related to cataract is one of access to care. Though access to care is a major problem with glaucoma, it is by no means the only problem. Many patients with glaucoma get worse, even when they are being treated. Additionally, it is not only glaucoma itself that causes disability. In the recent past, far more damage was caused by treatment for glaucoma than by glaucoma itself. To repeat, summarized slightly differently, glaucoma and its treatment damage health more than any other eye disease except cataract, and the medical profession is responsible for a major part of that problem. How can it be that glaucoma and its treatment still cause so much disability? In the first place, care is unavailable in many areas, and, second, care is not utilized even where available, and third, care is often inappropriate even where available. The first two issues are of great importance but are not the subject of this discussion. It is my belief that the major explanation for why care is often poor is because the goals of care are often wrong. Specifically, the goals of care are to lower intraocular pressure, or to prevent visual field loss. These may be appropriate intermediary steps on the way to achieving the appropriate goal, but they are not the goal itself.
authors.affiliation: Wills Eye Hospital/Jefferson Medical College, Philadelphia, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Spaeth
mesh_terms: D018450:Disease Progression; D005901:Glaucoma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017408:Guidelines as Topic; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D009901:Optic Nerve Diseases / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D012307:Risk Factors; D014794:Visual Fields