Treatment Initiation in Glaucoma Suspects

Abstract

The decision to initiate treatment in glaucoma suspects is challenging because it requires the clinician to synthesize multiple risk factors for progression and predicting which patients will most likely develop glaucoma. Because clinicians may tend to underestimate risk, clinical tools including the Scoring Tool for Assessing Risk (STAR) and the RAND-UCLA Appropriateness Method (RAM) have been developed to help clinicians integrate the numerous risk factors for glaucoma and stratify a glaucoma suspect into low, intermediate, or high risk. Some glaucoma suspects may lie further along the continuum towards glaucoma than others and, in addition to these tools, nerve imaging is useful in aiding the decision to treat. All of this objective information can help customize a discussion with patients in terms of the advantages of therapy versus observation, but they must be weighed against the costs of treatment in terms of a patient’s quality of life.