I BELIEVE THAT GLAUCOMA can never be false, it is either there or not because currently there are many sophisticated tonometers  for measurement,mild ones that are very slow progressing   may be observed by watchful waiting. 

Hi, George, thank you for your answer. I agree with you, but there are many patients who do not have glaucoma, but they are still in therapy. The diagnosis of glaucoma is the composition of a puzzle, and every element is a piece of this mosaic (family history, patient's age, morphology of the optic disc etc.), but very often patients are put on treatment without waiting for the main test, ie the progression of damage that is the real key to understanding. Are you agree with me?

Alberto , There can be glaucoma,yet discopathy may yet  be involved , therefore ,

intra-ocular  pressure measurement is very important.

Dear Alberto,

I think this issue is critical. Published literature shows that around half of glaucoma patients are using medication when they don't need to or are overtreated (sometimes for many years which makes it harder to explain). Dealing with this is as important as finding a solution for the half that is not diagnosed. 

thanks joao, you have centered the problem. my question was provocative, because it is clear that there are overtreated, but the problem is almost ignored, perhaps because the multinational drug companies have no interest.

I really met many cases taking antiglaucoma meidcations without true evidence of glaucoma just ,, patient with large optic cup , IOP around 20 , chronic headache, non specific field changes are given beta blocker eye drops ,,,  

I think a matter of big debate is the existence of " normotensive glaucoma" ,,, It may be a separate disease entity that should be separated totally from ocular hypertensive optic neuropathy which is the actual glaucoma and its acute form (ACG)

in my clinical practice for the last 8/10yrs or so, I met approx 20-25%pts who actually doesn't require antiglaucoma medications (who are on medications),except close follow up. Several cases are there where I stopped medications, and followed/following pts with Applanation,perimetry,retinal nerve fibre thickness,disc redfree and colored photograph documentation. Can anyone provide few published literature on such interesting topic?

Dear Dr Alberto. A few years ago we did an audit of our case files and found a lot of patients actually did not need therapy. We have tried weaning them away from treatment. Some were hesitant to stop, afraid that they would go blind. While there were others who were ecstatic to know that they did not have a potentially blinding condition. For example, one patient who had 0.9 C:D R in both eyes; IOPs were always normal. VFs in RE showed a sort of quadrantanopia while LE was absolutely normal. He was on Xalatan and Timolol for many years. We got a CT scan done which showed an old orbital injury in RE, explaining the VF defect.

Dear colleagues, I am happy that the discussion is growing and I expect it will rise again. This topic is little discussed, but I think today's experience serves not so much to make a diagnosis, but to have the courage and honesty to stop a useless therapy.

Dear all,

  Greetings !

Glaucoma is condition which is very much over treated

and reason being 

a. Fear of not treating or missing a blinding disease ( among patients and doctors )

b. Wrong  diagnostic criteria

Diagnosis 

IOP is not good enough for diagnosis of glaucoma as almost 50 % of cases present with normal IOPs at presentation 

Persistantly high IOP is diagnostic of glaucoma

The ultimate key in diagnosis of glaucoma rests in binocular dilated stereoscopic biomicroscopic examination of optic nerve heads

in which evaluation of NeuroRetinalRim and Nerve Fibre Layer is the most important

Loss of NRR/NFL or Drance heme is to be noted

Final and the most important is to document a progression in the Disc changes

which is ultimate in the diagnosis of glaucoma 

Depending solely on the test results and not knowing the use and limitations of various gluacoma diagnostic gadgets is one of the main reason for overdiagnosis

If you have a Disc suspect in front of you, It is always better to closely follow up the patient for a documented change in disc (with structure function correlation ) rather than jumping on to treatment especially if IOPs are normal 

I agree dear Sunil: final and the most important is to document a progression in the Disc changes which is ultimate in the diagnosis of glaucoma, but in your clinical practice, by what percentage do you decide to stop glaucoma therapy? 

Thanks for your opinion!

Dear Dr Alberto,

Good morning !

I don't have any data on that 

May be around 10 -20 %