Meds, surgery equally effective as initial glaucoma treatments, says CIGTS

THOROFARE, N.J. — Topical medications and filtering surgery are equally effective as initial treatments for newly diagnosed open-angle glaucoma, according to up to 5 years of follow-up data from the Collaborative Initial Glaucoma Treatment Study.

“Five years of follow-up are not adequate for making conclusive treatment recommendations in a chronic disease like glaucoma,” said Paul Lichter, MD, first author of one of the CIGTS reports. Therefore, this interim report does not support changing current approaches to treating open-angle glaucoma, Dr. Lichter said. The CIGTS researchers are continuing to study more than 90% of the 607 enrolled patients, he added.

Dr. Lichter's report focused on the effectiveness of initial therapy with medication and initial therapy with filtering surgery. Primary outcome variables are visual field loss, with secondary outcomes including quality of life, visual acuity, intraocular pressure and cataract development.

Most participants were diagnosed with primary open-angle glaucoma. Average age for the participants was 57.5 years, and average IOP was 27 mm Hg. A greater decrease in IOP was seen in the surgery group, with IOP dropping from an average 27 mm Hg to 14 to 15 mm Hg. In the medication group, average baseline IOP was 28 mm Hg, dropping to 17 to 18 mm Hg with treatment.

Clinically substantial visual field loss was seen at some point in 10.7% of the medical group and in 13.5% of the surgical group. Visual field outcomes between both groups is about the same, despite lower IOPs in the surgical group, noted Richard Lewis, MD.

“The message is clear. Aggressively achieving a predetermined target IOP is important in reducing visual field loss in our patients with glaucoma,” Dr. Lewis said.

More about the interim results report will be published in the June print issue of Ocular Surgery News Europe/Asia-Pacific edition.