The paper presents current problems associated with advanced glaucoma treatment and new trends in therapeutic management. Evaluation of the disease progression with only visual field testing may not be sufficient in such cases. Sensitive indicator of the deterioration is visual acuity reduction, which may also be a parameter used in surgery results estimation. Treatment of advanced glaucoma should concentrate on surgical methods because of more effective IOP control and its fluctuations. After surgery there is a risk of sudden visual loss without visible pathology explaining this deterioration called wipe-out or snuff-out phenomenon. However advanced glaucoma doesn’t aggravate safety of antiglaucoma surgery. Wipe-out phenomenon occurs extremely rare and refers to very advanced glaucoma or cases accompanied with ischemia. Patients after surgery have much more chance of preserving remaining visual field, if central vision isn’t lost during operation, whereas progression in visual field analysis is rare provided that surgery ensures good IOP control.
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