OBJECTIVES: To investigate treatment patterns of glaucoma and persistence to therapy in a large health organization (HMO) in Israel. METHODS: A retrospective cohort study, conducted using the electronic medical databases of Maccabi Healthcare Services, a 2 million member HMO in Israel. The study population consisted of all patients who were newly diagnosed with glaucoma between 2003 and 2010 at MHS. Collected data included personal characteristics and demographics, relevant surgical procedures, prescribed and dispensed anti-glaucoma medications, and caregiver characteristics. We investigated quality of care indices including routine ophthalmologist follow up, performance of tonometry tests, as well as persistence to treatment by drug type. Persistence was analyzed by proportion of days covered by drugs during follow up time, ignoring overlaps due to overuse and simultaneous combination of several types of eye drops. RESULTS:  A total of 11,512 incident glaucoma patients, who were diagnosed between 2003 and 2010 were identified. One quarter of these patients remained naïve through the follow-up period, additional 20% were non-adherent with therapy (covered less than 20% of the follow up time), and only 13% exhibited high persistence (covered at least 80% of the follow-up period). The most common physician was ophthalmologist both at treatment initiation (70% of initial prescriptions were ophthalmologist vs. 7% by general practitioner) and ongoing prescriptions (48% ophthalmologist vs. 22% by general practitioner). CONCLUSIONS:  The current study demonstrates the potential use of automated medical databases to characterize treatment patterns of glaucoma, illustrate the great variety of drug therapies, and describe adherence to treatment in the community. The increased comorbidity and mortality among these patients has important implication for health authorities for prevention and delivery of health-care services.