I would argue that the earlier treatment and diagnosis is being done by the generalists. I am a generalist and I typically refer if I cannot control IOP on meds/lasers or if the glaucoma progresses on MMT. Perhaps, we (generalists) are holding onto these patients too long. Or, perhaps my view is skewed by the mainly academic exposure to the glaucoma service.
IMO, as minimally invasive glaucoma procedures improve, the spectrum of disease will shift further - meaning the glaucoma specialists will be consulted for severely progressed glaucoma (pts who need a trab/tube).
In most cases, glaucoma progresses so slowly, I think it is difficult for patients to appreciate the benefit of IOP lowering surgery unless they have already lost vision in one eye. But then again, I don't usually follow these patients.