Challenges in conventional management of chronic glaucoma: evidence based call to revisit assumptions

Physicians of the years prior to 1952 had significant insight into an ailing client’s ocular and bodily pathology by way of personal examination at the other end of an ophthalmoscope and a stethoscope. In the domain of glaucoma diagnostics, optic nerve evaluation came first, and later came the testing of eye pressure at the cornea. The older tests for visual field perimetry, although simple, were reasonably effective, many years prior to computers. The standard of care for Board Certified Ophthalmologists since 1981, has been LASER treatment of the posterior corneal periphery, enlarging “holes” of the trabecular meshwork. Optometrists, however, limit their practice to pharmaceutical agents, applied to the ocular surface. Not to deny the datasets obtained from multi-center, multi-million dollar investigations, much toleration and waiting is required of the client suffering from chronic glaucoma. Ambitions set forth as goals sponsored by the World Health Organization under the leadership of the International Association for the Prevention of Blindness and the World Council of Optometry [collectively termed as the VISION 2020 Initiative] have achieved modestly. Technology as a modality for empowering doctors has great value. The astute consumer of medical consultations, however, must exercise their doubting Thomas. In simplified, but not simplistic terms, the present synthesis is an attempt to bring forth some of the salient features of diagnosing and treating glaucoma that are cause for concern. It is intended by the authors, that any critical remarks presented here, be construed as making good the promise of the Hippocratic Oath, and the tenets of the Declaration of Helsinki.