If a 60-year-old patient in good health has severe glaucoma, what is the likely treatment approach?

• A. No treatment needed
• B. Eye drops only
• C. Likely needs aggressive IOP lowering to preserve vision and QoL
• D. Referral only

Answer: (C)

The idea being tested is that treatment intensity in glaucoma is guided by how severe the disease is and the goal of preventing vision loss over time. In severe glaucoma, especially in a 60-year-old with many years ahead in which vision preservation matters for quality of life, the plan is to lower intraocular pressure as aggressively as possible within safety limits. This often means moving beyond a single daily eye drop to a stronger, multi-modal approach—adding additional medications, considering laser therapy, or even surgical options if needed—to reach a lower target pressure and reduce the risk of further optic nerve damage. Simply doing nothing or relying on eye drops alone is unlikely to be sufficient in severe disease, and a stance of “referral only” would delay crucial treatment.