Glaucoma is a chronic disease that often requires lifelong monitoring and treatment decisions that affect patients for decades. Ethical glaucoma care therefore goes beyond prescribing eye drops or recommending glaucoma surgery or procedures. It requires transparent communication, thoughtful risk assessment, and shared decision-making with patients.
Because glaucoma damage is irreversible, treatment decisions must carefully balance preventing vision loss while avoiding unnecessary treatment burden. This is why ethics matter in glaucoma treatment beyond just commercial ethics.
Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.
What is ethical glaucoma care?
Ethical glaucoma care means managing glaucoma in a way that prioritises patient safety, informed decision-making, and long-term visual outcomes.
In practice, ethical glaucoma care involves:
• making an accurate diagnosis before starting long-term treatment
• explaining test results clearly to patients
• discussing all reasonable treatment options, including second opinions and referral to higher centres, if needed
• balancing treatment benefits against potential side effects
• respecting patient preferences and concerns
• focusing on long-term vision protection rather than unnecessary interventions
Because glaucoma progresses slowly in many patients, treatment decisions must consider the patient’s lifetime risk of vision loss rather than only short-term test results.
Challenges in Ethical glaucoma treatment
Several ethical questions arise frequently in glaucoma management.
Treatment decisions with uncertainty
In early glaucoma, tests may not always give clear answers. Doctors and patients often need to make decisions under uncertainty, balancing the risks of overtreatment against the risk of irreversible vision loss.
Lifelong treatment burden
Many glaucoma patients use medications for decades. Ethical care requires discussing:
• long-term medication use
• potential side effects
• financial costs
• impact on daily life
Patients should understand why treatment is recommended and what alternatives exist.
Avoiding unnecessary treatment
In some situations, aggressive treatment may not improve long-term outcomes. Ethical glaucoma practice requires careful evaluation of:
• disease severity
• rate of progression
• age and general health
• individual risk factors
The goal is always protecting vision while minimising unnecessary treatment burden.
Clear communication with patients
Ethical care requires that patients understand:
• what glaucoma is
• how it may progress
• what treatment can realistically achieve
• why monitoring is important
Shared decision-making allows patients to participate actively in choosing the management plan.
Ethical responsibility to refer or suggest a second opinion
Ethical glaucoma care also includes recognising when a patient may benefit from additional expertise or an independent second opinion.
Glaucoma can be a complex disease, and treatment decisions—especially those involving long-term medications, laser procedures, or surgery—can have lasting consequences for a patient’s vision and quality of life.
In certain situations, responsible care may involve:
• referring the patient to a glaucoma specialist for further evaluation
• recommending additional diagnostic testing
• encouraging the patient to seek a second opinion before major treatment decisions
Seeking another opinion is not a sign of doubt or failure. In many cases, it helps patients feel more confident and informed about their treatment choices.
When doctors support transparent discussion and independent evaluation, it strengthens trust, patient autonomy, and long-term clinical outcomes.
Research on ethics in glaucoma practice
Dr Shibal Bhartiya has published peer-reviewed research examining ethical decision-making in glaucoma care, focusing on how clinicians balance clinical evidence with patient autonomy and long-term risk.
Her work explores themes such as:
• balancing early treatment with the risks of overtreatment
• maintaining patient autonomy in chronic disease management
• transparent communication about prognosis and uncertainty
• ethical considerations in surgical and medical glaucoma interventions
This research reflects a broader commitment to responsible, patient-centred glaucoma care.
Frequently asked questions about ethical glaucoma care
Can glaucoma be overtreated?
Yes. In some patients, treatment is started too early, continued longer than necessary, or escalated without clear evidence of progression. Ethical glaucoma care requires honest assessment of whether treatment is genuinely protecting your vision, or simply adding burden without meaningful benefit. If you have been on the same medications for years without a clear explanation of why, that is a reasonable question to raise with your doctor or to explore through a second opinion.
How do I know if my glaucoma doctor is trustworthy?
A trustworthy glaucoma specialist explains your diagnosis clearly, shows you your test results, tells you what your target pressure is and why, and discusses all treatment options including the option of watchful waiting where appropriate. They welcome questions and do not discourage you from seeking a second opinion. If your doctor cannot explain why a particular treatment is necessary in terms you understand, that is worth paying attention to.
Should I get a second opinion for glaucoma?
Yes, in any of these situations: surgery has been recommended, multiple medications have been prescribed and you are not sure why, your glaucoma continues to progress despite treatment, your diagnosis is uncertain, or you simply do not feel confident in the current plan. Seeking another opinion is not disloyal to your doctor. It is a responsible part of managing a lifelong condition.
My glaucoma is not progressing. Do I still need eye drops?
This depends on your individual risk profile, your baseline pressure, the degree of optic nerve damage, your age, and other factors. Some patients with very early or stable disease can be monitored without immediate treatment. Others with higher risk need drops even when progression is not yet visible. The answer should be explained to you specifically, not assumed. If it has never been discussed, ask.
What happens if glaucoma is diagnosed incorrectly?
Glaucoma diagnosis requires multiple tests interpreted together, eye pressure alone is not enough. Misdiagnosis can lead to years of unnecessary medication, unnecessary anxiety, and unnecessary expense. If your diagnosis was based on a single test or a single visit, or if you have never had an OCT scan or visual field test, a second opinion is worth considering.
Can I refuse glaucoma treatment?
Yes. You have the right to make informed decisions about your own care, including the right to decline treatment. What matters is that your decision is truly informed, that you understand the realistic risk of not treating, what progression might look like, and what monitoring would be needed if you choose to wait. A good glaucoma specialist will support your decision-making rather than pressure you.
Questions to ask your glaucoma doctor before agreeing to surgery?
These five questions will help you evaluate any surgical recommendation clearly. Ask: What is my current target pressure, and why is surgery needed to reach it? What happens if I do not have surgery now: what is the realistic risk over the next one to two years? What are the alternatives to this specific procedure? What is your personal experience with this surgery and what outcomes do your patients typically achieve? Would you recommend I get a second opinion before deciding?
A surgeon who answers all five questions clearly and without defensiveness is one you can trust. One who discourages you from asking is not.
How do I find a real glaucoma specialist in India?
Look for a fellowship-trained glaucoma specialist, not a general ophthalmologist who also treats glaucoma. Check for peer-reviewed publications, which indicate someone engaged with the current evidence. Look for a doctor who offers second opinions, because a specialist confident in their own work welcomes scrutiny. And look for someone who explains their reasoning rather than simply issuing instructions.
Five questions every glaucoma patient should ask their doctor
These questions apply at any stage of glaucoma, whether you have just been diagnosed, have been on treatment for years, or are being asked to consider surgery.
1. What is my target eye pressure, and how did you arrive at that number?
Your target pressure should be individualised to your disease severity, your age, and your rate of progression. If your doctor cannot name a specific number and explain the reasoning, that is a gap worth addressing.
2. Is my glaucoma actually progressing, or are we treating a risk?
These are two different situations requiring different levels of urgency. Treating confirmed progression is non-negotiable. Treating a risk factor requires a more nuanced conversation about benefit versus burden.
3. What are the realistic consequences of delaying or modifying this treatment?
You deserve an honest answer about what happens over one year, five years, and ten years under different treatment scenarios, not just a general warning about blindness.
4. Have you considered my quality of life in this treatment plan?
Eye drops have side effects. Surgery has recovery times. Lifelong treatment has financial and psychological costs. A complete treatment plan accounts for all of these, not just the IOP number.
5. Would a second opinion change anything here?
The answer to this question tells you a great deal. A confident, ethical glaucoma specialist will say: possibly, and here is how to get one. That response reflects security in their own assessment and respect for your right to verify it.
If any of these questions are met with evasion, dismissal, or discomfort, that is information worth acting on.
Read the research articles
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine. This article was updated in April 2026.
She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
Her published research on ethics in glaucoma practice includes:
Ethical Considerations in Glaucoma Surgery: Balancing Clinical Evidence and Patient Autonomy examines how surgeons should approach surgical decisions when evidence is uncertain and patient preferences vary. Available on PubMed.
Shared Decision-Making in Chronic Glaucoma Management — explores how transparent communication and patient involvement improve long-term treatment adherence and outcomes. Available on PubMed.
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
Access her work on Pubmed, Google Scholar, ResearchGate and ORCID.
Dr Shibal Bhartiya
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