What’s your threshold for initiating treatment in patients with optic nerve cupping but normal IOP, normal visual fields, and borderline OCT findings?  

My answer relies on the appearance of the OCT findings, the patient's and family history, and the progression over time. A Borderline OCT finding is broad. Patients who have a myopic fundus, or just a displacement of the retinal vessels near the optic nerve, do not worry me, and I choose to wait. I...

After 40 years+ of practice, I am much more aggressive, because I have followed patients for 20-40 years. I almost always eventually regretted waiting and watching. Glaucoma is like slow-growing cancers- treatment should be proportional to lifespan, but not an assumed algorithmic life span, but ba...