To proceed with glaucoma surgery must include an evaluation of risk factors

The decision to proceed with glaucoma surgery must include an evaluation of risk factors other than IOP alone. Table 1.1 lists the risk factors for glaucoma progression other than IOP that were found in the major recent randomized controlled trials of glaucoma treatment. In addition, factors that were assessed and found to be noncontributory,and factors that were found to be protective are listed. All of these factors should be considered prior to proceeding to surgery.


Normal-tension glaucoma appears to have different risk factors than other types of glaucoma (5). Among the studies of elevated-pressure glaucoma, age is the only factor identified universally. Note that none of the studies found family history to be a significant factor for progression, and only the Collaborative Initial Glaucoma Treatment Study (CIGTS) identified race as a factor (6). This is likely a result of the high prevalence of the disease, but seems to contradict population surveys that clearly show race and family history to be associated with the presence of glaucoma. Race is clearly an important


factor may be more useful in glaucoma that occurs at a younger age. Central corneal thickness may also be an important independent risk factor for progression (8). Advanced disease is generally considered to be more susceptible to further glaucomatous damage than early disease. This is supported by the EMGT (9), CIGTS (6), and OHTS (10), which examined early glaucoma and ocular hypertension. However, the opposite result was found with AGIS (11) which examined advanced glaucoma and found that patients with better baseline visual fields were more likely to demonstrate progression. The investigators suggested that this might be due to greater difficulty in detecting visual field changes in advanced disease when compared with early disease.