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[When should the anti-glaucoma treatment start?].

The decision to start a glaucoma treatment in a newly diagnosed patient is easy when the disease is clearly identified with typical optic nerve cupping, visual field defect, and elevated intraocular pressure. However it often appears more complicated, especially in young patients for whom a careful analysis of the fundus and an examination of nerve fiber layers should be assessed to detect an early sign of glaucoma before any visual field change. If glaucoma is present, patients with intraocular pressure above 14 mmHg should be treated, as in such cases there is always a "pressure risk factor". In case of isolated elevated ocular pressure, in France it is usually considered that a pressure above 25 mmHg should be reduced, with a target pressure at least of--20% from baseline. Other factors should also be considered such as quality of life and cost of the treatment. The psychological profile of the patient should also be taken in to account and clear information concerning the risks and potential severity of the disease should be given before the onset of treatment.