Which scenario is an exception to treating glaucomatous disease?

• A. Stable NTG, mild disease in the very elderly
• B. Severe POAG in young adults
• C. New-onset high IOP with optic neuropathy
• D. Moderate NTG in middle-aged

Answer: (A)

The main idea is that glaucoma treatment is guided by balancing the benefit of lowering pressure against the burden and risks of therapy, and by how likely the disease is to progress within the patient’s lifetime. In an elderly person with stable, mild normal-tension glaucoma, the disease is not actively progressing and life expectancy is limited. The gain from more aggressive treatment is small, while ongoing therapy brings daily burdens, potential side effects, and adherence challenges. Because of that, observation without escalating treatment is reasonable, making this scenario the exception to treating glaucomatous disease.

In the other scenarios, treatment is clearly warranted: severe glaucoma in a young adult means a long horizon for potential vision loss, so reducing risk is important; new-onset high intraocular pressure with optic neuropathy indicates active damage that needs intervention; moderate normal-tension glaucoma in a middle-aged patient carries a meaningful risk of progression that justifies treatment to protect vision.