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Immediate glaucoma treatment helps delay disease progression

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MALMO, Sweden — Immediately treating people with early stages of primary open-angle glaucoma can delay disease progression, according to a study sponsored by the National Eye Institute.

The Early Manifest Glaucoma Trial followed 255 patients between 50 and 80 years of age who had early stage glaucoma in at least one eye. Approximately half the were randomized to immediate pressure-lowering treatment with medicines and laser, while the other half were left untreated as controls. Follow-up was 6 years, with patients screened every 3 months for the follow-up time. Patients in the control group that showed signs of glaucoma progression at any visit were immediately offered treatment.

At the end of 6 years of follow-up, progression was less frequent and occurred significantly later in the treatment group than in untreated patients. Sixty-two percent of patients in the control group had disease progression compared with 45% in the treated group. The treated group had an IOP decrease of 25% on average.

Paul Sieving, MD, PhD, director of the NEI, noted that the study confirms beliefs that were widely held by physicians but never scientifically studied. Most patients in whom glaucoma is detected are treated immediately, so little is known about the natural history of the untreated disease. “Future reports from the study will add further important information on glaucoma progression and its risk factors,” Dr. Sieving said.

Initial study results also indicated that many of the patients remained stable over time, even those in the control group. “Despite the clear effect of treatment, glaucoma progressed in as many as 30% of treated patients after 4 years,” said Anders Heijl MD, PhD, with Sweden’s Malmö University Hospital. (The study was co-sponsored by the Swedish Research Council.)

Dr. Heijl added that in patients with rapidly progressing glaucoma, “the treatment used in this study was insufficient to halt progression of the disease.”

Results of the study appear in the October 2002 issue of Archives of Ophthalmology.