OBJECTIVES The purpose of this study is to review the epidemiology and the treatment paradigm of German glaucoma population and to assess the frequency of switches from monotherapy to second- or third line combination therapy in primary open angle glaucoma (POAG) patients. Glaucoma is the second leading cause of blindness globally. The newly published EGS guidelines state that if the first choice monotherapy is well tolerated and has effective intra ocular pressure (IOP) lowering but has not succeeded in reaching the target pressure, the addition of a second drug should be considered. METHODS German patient databases were searched in the following areas: glaucoma prevalence and incidence studies in German population as well as treatment paradigm in glaucoma patients. RESULTS Our analysis underlines the high number of glaucoma patients in Germany and the relevance of this disease for the German healthcare system. The study also demonstrates that a considerable number of glaucoma patients do not reach IOP target under monotherapy and have to be treated with a combination therapy. In general, treatment with a combination of agents of different classes is associated with superior IOP lowering efficacy. With an increasing number of available fixed dose combination products, more options become available for combination therapy of glaucoma patients. CONCLUSIONS Glaucoma care needs to be given high priority in public health programs. Especially treatment options for glaucoma patients in need for a combination therapy should be in the focus of healthcare system decision makers as well as further research in glaucoma clinical trials and clinical care.