Medical treatment of glaucoma--a reappraisal of the risks.

There has been an accumulation of evidence in recent years to demonstrate that surgical treatment is more effective than eyedrops at lowering intraocular pressure and preserving the visual field in primary open angle glaucoma.' 2 The argument against primary surgery for glaucoma has been the risk to the eye of performing an intraocular operation. The risks of topical medical therapy to general health, particularly that of elderly people, have been underestimated and surgery is likely to be both a safer and a more effective option for patients requiring treatment for glaucoma. The only therapeutic approach to have proved effective in glaucoma is lowering intraocular pressure. Eyedrops are the mainstay of glaucoma treatment and, because they are excellent ocular hypotensives with few local side effects, topical 1 antagonists are the class of drug most often prescribed.3 Therapy is life long and many people of extreme old age receive treatment. Ophthalmologists and geriatricians have many patients in common. Open angle glaucoma is predominantly a disease of old age, affecting up to 5% of the population by 65 years and becoming even more common in older age.4 5 Respiratory and cardiovascular disease are also common in this age group and both may be affected by eyedrops prescribed for glaucoma.