**1. Introduction**

Glaucoma is a neurodegenerative disease that causes a reduction of chromatic and contrast sensitivity, early alteration of light adaption, and the progressive development of characteristic visual field defects and optic disc damage [1–4]. This condition can lead to difficulties in performing daily activities such as reading, walking, or driving, limiting patients' independence [5,6]. Moreover, the psychological impact can be fairly relevant: the loss of autonomy, together with the fear of going blind, may lead to depression, anxiety, and loneliness [7–9].

The main goal of glaucoma management is to preserve visual function (VF) and quality of life (QoL) [10]. QoL in glaucoma is assuming a leading role in healthcare, representing a significant index of glaucoma impact on patients and of health interventions' effectiveness.

Glaucoma therapeutic options include medical and surgical treatment. Topical medical therapy (TMT) is generally the first approach in reducing intraocular pressure (IOP). However, it can lead to annoying local side effects such as irritation, burning, foreign body sensation, fatigue, blurred vision, dryness, photophobia, dry eye syndrome, allergies, and blepharitis [5,11]. Patients may also have difficulty applying eye drops and following complex treatment regimens. These issues can undermine patients' satisfaction and their compliance with therapy [12,13]. Surgical therapy can reduce the incidence of these side effects; nevertheless, it is associated with specific unpleasant complications. Trabeculectomy

**Citation:** Pastore, M.R.; Milan, S.; Agolini, R.; Egidi, L.; Agostini, T.; Belfanti, L.; Cirigliano, G.; Tognetto, D. How Could Medical and Surgical Treatment Affect the Quality of Life in Glaucoma Patients? A Cross-Sectional Study. *J. Clin. Med.* **2022**, *11*, 7301. https://doi.org/ 10.3390/jcm11247301

Academic Editors: Kyung Chul Yoon and Monica M. Jablonski

Received: 14 November 2022 Accepted: 6 December 2022 Published: 8 December 2022

**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

(TB) represents the gold standard in glaucoma surgery, being the most effective surgical procedure for reducing IOP [13]. However, since it implies the creation of a communication between the anterior chamber and the subconjunctival space, it is burdened by numerous intraoperative and postoperative problems such as hypotony, bleb leakage, cataract development, choroidal hemorrhage, and infections [14–16]. Canaloplasty (CP) is a minimally invasive procedure requiring visco-dilatation of the Schlemm's canal and the placement of an intracanalicular tension suture [17]. It has several advantages compared with TB, such as the absence of the filtering bleb and its complications, easier postoperative management, and faster recovery; however, a lower efficacy in reducing IOP was reported [15].

This study aimed to evaluate and compare the VF and the QoL in glaucoma patients treated with TMT, CP, and TB and to correlate it with anatomical and functional optic nerve alterations.
