Are we over prescribing in Glaucoma?

The current cultural and legal environments exert tremendous pressure to do more. To choose to do nothing seems to be more open to criticism, rather than to take action, despite the risk that action might later prove to be harmful. It is well-known for decades that high resource allocation does not necessarily lead to measurable benefits to the patients.

Prescribing diagnostic tests and treatments are indicated when they provide benefits and outcomes that are important to patients, i.e. when interventions improve patients’ well-being in every-day life. More frequent testing leads to more diagnoses with newly detected cases being in general milder and non-optimal specificities of diagnostic tests falsely classifying non-glaucoma cases having glaucoma. Thus, outcomes will seem to improve, which stimulates to do even more.

When we have evidence of treatment effectiveness, does it automatically imply that treatment should be administered to every patient? When e.g. the total costs of glaucoma medications increase five-fold in 5 years, and one country treats 30% more patients with glaucoma compared to its neighbor, which patients are under- or over-treated? Very different conclusions may result from the same evidence.