Probability of filtration surgery in patients with open-angle glaucoma.

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Abstract
AS A WORLDWIDE cause of blindness, glaucoma ranks among the top permanent visually debilitating diseases.1 While there is no cure for open-angle glaucoma (OAG), there are various treatment options that lower intraocular pressure (IOP) and may, therefore, slow the progressive loss of visual field associated with the disease. Topical and systemic medications, laser trabeculoplasty, and filtration surgery are common methods used in an attempt to lower IOP. The role and timing of these therapeutic options often vary based on the clinician's training and experience, as well as the severity of the disease. Traditionally, ophthalmologists in the United States have followed a stepwise approach in the management of OAG, with extensive use of topical ocular hypotensive medications, followed by laser trabeculoplasty, and then filtration surgery. European clinicians have been more aggressive in their treatment of OAG, with filtration surgery recommended either as initial therapy or after a trial of a topical medication fails to control IOP or the progression of visual field loss.2,3 The reevaluation of treatment strategy in the United States has led to several large multicentered studies, including the Collaborative Initial Glaucoma Treatment Study4 and the Glaucoma Laser Trial,5 that compare surgical intervention with medical therapy in the treatment of OAG.

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