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This review summarizes the key findings from the Collaborative Initial Glaucoma Treatment Study (CIGTS), which was designed to evaluate whether medical therapy or trabeculectomy is the better initial treatment for patients with open-angle glaucoma (OAG). In addition to examining effects on visual field progression, intraocular pressure control, and visual acuity, the study also examined the effects of medical and surgical treatments on quality of life.The 4+-year interim outcomes noted no significant difference in visual field loss between the medically and surgically treated patients. Patients assigned to trabeculectomy had lower intraocular pressures, but demonstrated a greater risk for significant loss of visual acuity and a threefold increased rate of cataract progression. Most quality-of-life measurements were similar in the two treatment arms, except local eye symptoms, which were reported more frequently by the surgically treated patients.Results from CIGTS do not support altering current treatment practices in the initial management of patients with primary open-angle glaucoma.