The risk of blindness in your glaucoma patients may be higher than you think, even though you�re treating the disease.

Researchers at the Mayo Clinic reviewed the medical histories of nearly 300 open-angle glaucoma patients from 1965 to 1980. They found that 20 years after diagnosis and initiation of treatment, the probability for glaucoma-related blindness in at least one eye was about 27% � 9% for both eyes. Risk was especially high among patients whose glaucoma went undetected until nerve head damage had already occurred. The "classic glaucoma" patient had a 54% probability of blindness in at least one eye and a 22% probability in both eyes.

These findings contradict the results of other studies saying glaucoma rarely leads to blindness. The Mayo Clinic authors point out, however, that some of the most effective treatments only entered practice in the 1980s, so future risk estimates of blindness may be lower than these findings.

Managed care�s cost-cutting has long been frustrating for everyone. Now one study suggests the system for determining cataract surgery eligibility could discriminate against older women.

Medicare weighs visual impairments associated with activities of daily life, employment and driving more heavily than recreational limitations when deciding who to cover for cataract procedures. However, a study by Tobacman, Zimmerman and Lee found that men are likelier to be affected by inability to work or drive, and women were likelier to have problems in activities of daily life or recreation. Younger cataract patients had more problems in work activities than older patients, who were more likely to have trouble performing recreational activities. This creates inherent prejudice against women and older patients.

"These implications are potentially of crucial importance, if rationing of cataract surgery is contemplated, for the findings suggest adoption of a hierarchy of visual impairments may result in a gender and age bias in the determination of who receives cataract surgery," the authors state. They suggest that quality of life be considered instead.