The current glaucoma treatment paradigm starts with topical medications, which made sense in the era of argon laser trabeculoplasty and trabeculectomy. Does it still make sense in the era of selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery? This presentation from Glaucoma Subspecialty Day 2023 looks at the limitations of a medication-first approach, and why an SLT-first approach may make more sense.