Pierach has raised several important issues regarding the detection, treatment, and prevention of glaucomatous vision loss. Glaucoma is a very important cause of irreversible blindness worldwide, and the leading cause of irreversible blindness in African American patients. It is particularly important to underscore the irreversible nature of glaucomatous vision loss. Many patients have far-advanced vision loss at the time of diagnosis.
Late diagnosis is common, due to the lack of early symptoms in the majority of the glaucomas.
Additionally, Dr Pierach appropriately notes that the merit of intraocular pressure reduction in ocular hypertensives is in question. However, few would argue against lowering IOP in patients with manifest glaucoma. Indeed, the recently published findings of the Low Tension Treatment Trial found that lowering IOP is indeed beneficial, even in patients in whom the IOP is not particularly high. Dr Pierach correctly states that IOP is not the sine qua non in the diagnosis of glaucoma. Indeed, IOP is simply a risk factor.