Early treatment trial results impact glaucoma management

ANAHEIM, Calif. — With results from the Early Management Glaucoma Trial showing that long-term vision changes are sensitive to small changes in intraocular pressure, Roger Hitchings, FRCS, advised physicians to alter their methods for treating primary open-angle glaucoma.

“EMGT shows that if I reduce pressure by just over 5 mm Hg there was detectable protection by standard automated perimetry,” said Mr. Hitchings, of Moorfields Eye Hospital in London, here at the American Academy of Ophthalmology meeting. “We can also identify risk factors that increase the risk of progression.”

Mr. Hitchings said the results of this long-term study “give us the necessary confirmatory evidence that pressure reduction certainly helps.”

Mr. Hitchings said the results of the EMGT have impacted his treatment approach to POAG. He said he now considers it crucial to accurately measure baseline pressure and to pay scrupulous attention to continual maintenance of the target pressure.

“[The EMGT] really made me want to know that I had an accurate estimation of baseline pressure. I know that if I’m going to reduce my IOP, I have the baseline to go with, so I can then say I have reduced my pressure by a certain amount. It’s insufficient just to have occasional sampling for this. Otherwise I’m going to miss out and my patients are going to as well.”

Mr. Hitchings said the study found the rate of visual field loss progression in untreated eyes varied widely. “You can detect it through standard automated perimetry in 10% [of patients] within 1 year but you could not detect it in one-third within 5 years. We notice this 10% risk reduction for each millimeter fall with IOP.”

Mr. Hitchings noted that medical treatment is not without hazard, as the EMGT showed treatment may cause an increase in the development of nuclear sclerosis. Since glaucoma is a long-term disease, Mr. Hitchings concluded that further studies on this same group of patients could modify these conclusions.