Glaucoma is a potentially blinding disease. The best way to prevent glaucoma is early detection and the mitigation of risk factors (ie, be sure there is no narrow angle, avoid and treat diabetes, do not smoke).
Drops used to be the first line of treatment but the preservatives of these drops can cause severe dry eye issues in patients which can at decrease quality of life scores more than the glaucoma.
Selective laser trabeculoplasty (SLT) is sage and effective and can be repeated if needed with little if any damage to the inner eye drain (ie trabecular meshwork). I would choose SLT over using drops daily as a first line agent.
Likely the limiting factor with be insurance companies: will they make patients try drops first before approving SLT?
Maybe some will see the cost savings and Quality of Life Improvement route with SLT (which can be once in a lifetime procedure or repeated every year to 2-3x/per year) compared to the expense of drops and dry eye care.
Sandra Lora Cremers, MD, FACS
British Medical Journal of Ophthalmology