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Glaucoma surgery reverses optic disc cupping in some patients
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CANCUN, Mexico — An analysis of 5-year data of patients in the Collaborative Initial Glaucoma Treatment Study found that 14% of patients treated surgically experienced a "reversal of cupping" compared with just 1% of patients treated medically, according to a surgeon speaking here.
Richard K. Parrish II, MD, presented the data at the Pan-American Association of Ophthalmology meeting during the American Journal of Ophthalmology lecture. This is the first time the data has been presented, he said.
Investigators in the Collaborative Initial Glaucoma Treatment Study (CIGTS) initially obtained optic disc photos of 607 open-angle glaucoma patients. Of these, 346 patients had follow-up photos of adequate quality obtained close enough to the 5-year mark to be considered for this analysis, Dr. Parrish said.
Two independent investigators read the photos, with Dr. Parrish acting as the adjudicator in cases of disagreement.
Overall, 61 eyes were deemed to have a change in the optic disc over 5 years and were sent to the CIGTS Optic Disc Endpoint Committee, which affirmed 45 of the 61 readings.
Surprisingly, 25 eyes showed a reversal in optic disc cupping rather than the expected progression.
Due to the unexpected nature of the finding, the CIGTS committee confirmed the results multiple times, Dr. Parrish noted.
"Progression was more likely to occur in the medicine group and reversal of cupping to have been seen in the group of patients [randomly assigned] to surgical treatment," he said.
"Was this real? Did it occur?" he said he had asked himself during the data analysis process.
"I believe that it did. There were no fewer than six independent observers who agreed on what change was," he said.