If an 85-year-old patient in poor health has mild glaucoma with few risk factors, would they likely require treatment?

• A. Yes, aggressive therapy
• B. Observation only
• C. Immediate surgery
• D. No, they may not need treatment to preserve vision and QOL

Answer: (D)

The main idea is balancing the potential benefit of treatment against its burden for someone with limited life expectancy and mild disease. In glaucoma, lowering eye pressure helps slow vision loss, but the advantage of starting therapy depends on how likely the disease is to progress during the patient’s remaining years and how burdensome the treatment would be.

For an 85-year-old in poor health with mild glaucoma and few risk factors, the expected benefit of aggressive or ongoing treatment is small in the face of limited life expectancy. Daily eye drops, possible side effects, ongoing monitoring, and the overall impact on quality of life may outweigh any marginal chance of preserving vision. In such cases, observation with regular follow-up is a reasonable approach, and treatment can be reconsidered if progression or new risk factors arise. This is why the option reflects that they may not need treatment to preserve vision and quality of life.