Proposed Language of New Definition of Refractory Glaucoma to Share with ANSI / FDA

Glaucoma is a progressive optic neuropathy that is characterized by sectoral or generalized morphologic loss of neural tissue at the optic nerve head as well as within the retinal cell layers. Such permanent loss of neural tissue eventually causes loss of sensitivity in the visual field. Glaucoma progression can be reduced by lowering the intraocular pressure, which is the only modifiable risk factor for glaucoma. Due to multiple factors, the effectiveness of glaucoma control by the addition of sequential medications is reduced as the number of medications is increased. Given these factors, the AGS and ASCRS consider glaucoma to be "refractory" when the intraocular pressure remains above target numbers designed to slow or halt the disease, despite the use of 3 or more classes of medications, or fewer than 3 medications when tolerability or effectiveness limits the use of other drug classes.