Treatment of Glaucoma with or without Medications Lowering Intraocular Pressure: Options and Relevant General Health Issues

The etiology of glaucoma is multifactorial. Intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Currently, based on evidence-based glaucoma therapy, the only approach proven to be efficient in preserving visual function is lowering IOP. Lowering IOP by 20-40% has been shown to reduce the rate of progressive visual field loss by half. Despite the fact that IOP-lowering interventions reduce the risk of progression and delay the onset of glaucoma, its pathogenesis is controversial and not completely understood. In this matter, non-IOP-dependent risk factors appear to be responsible for around 50% of glaucoma cases. New drugs are now entering the clinic, along with new ways to deliver them. There is growing consensus that the future of glaucoma management will be based more on the optic nerve pathway from the retina to the visual cortex and will not be strictly limited to improving outflow or reducing inflow. But still, many future IOP-lowering options will be developed, including neuroprotective strategies aiming to directly prevent or significantly hinder neuronal cell damage. The goal of glaucoma treatment is to maintain the patient's visual function and related quality of life at a sustainable cost. The cost of treatment in terms of inconvenience and side effects as well as financial implications for the individual and society requires careful evaluation. In conclusion, IOP lowering is the only proven therapy for glaucoma at present. Neuroprotection may be clinically useful (based on one trial), but this needs to be confirmed. So far, we have no evidence of potential therapies related to ocular blood flow and glaucoma care, and evidence to support the use of acupuncture, vitamins, minerals, or herbal medicines such as marijuana for treating glaucoma is insufficient.