OBJECTIVES: Develop a health economic model to measure the standard of care costs associated with progression of primary open angle glaucoma. METHODS: We used Monte Carlo techniques to model the cost of a simulated cohort of 600 patients with Mean Deviation (MD) score progression over four years. MD scores were used to estimate resource utilization for the cohort using regression equations from an analysis of the relationship between resources and MD score in the worst eye from a U.S. chart review of glaucoma patients (N = 161, mean age 66.3, minimum follow-up of four years). Both medical (number of office visits, visual field exams, trabeculoplasties and trabeculectomies) and pharmacy resources (number of glaucoma medications) were included in the model. Unit costs were applied to the resource utilization estimates. MD scores were also used to predict utility scores based on a regression analysis of utility scores among glaucoma patients; the quality-adjusted-life years (QALYs) over four years was modeled. RESULTS: The four-year cost for the cohort was $3957 per patient ($598 in pharmacy costs and $3359 in medical costs) with 2.96 QALYs accumulated over four years. CONCLUSION: Glaucoma progression as evidenced by worsening MD scores is associated with a loss in quality of life and substantial costs over four years of follow-up. Advances in understanding the economic burden of glaucoma progression may help to guide strategies for preventing and delaying onset of this disease and lead to cost savings by slowing disease progression.