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Recent glaucoma research should be applied in patient care

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KOLOA, Hawaii — Clinicians should learn to apply newly published clinical information to their daily care of glaucoma patients, according to one clinician.

“The practice of evidence-based medicine is something we all should do,” Anne L. Coleman, MD, said at Hawaii 2004: the Royal Hawaiian Eye Meeting.

Dr. Coleman said physicians should consider the findings of the Ocular Hypertension Treatment Study (OHTS) and the Early Manifest Glaucoma Trial (EMGT) in treating their patients. She explained that evidence-based medicine can help physicians calculate risk-benefit ratios, such as the number needed to treat (NNT) and the number needed to harm (NNH). She said that the NNT takes into account the baseline risk of an outcome in a population, and the NNT may be helpful when a clinician is deciding whether to treat an individual patient. She said it is easy to compare the NNT with the NNH from the same study.

For example, following the results of OHTS, she said, “If you treat 96 patients with ocular hypertension for an average of 5 years, you will prevent glaucomatous optic nerve damage in 6 patients and cause 2 patients to have cataract surgery.”

In another example, Dr. Coleman said, “if you treat 18 patients similar to those in the EMGT for an average of 6 years, then you will prevent glaucomatous optic nerve progression in 6 patients and cause 3 patients to have cataract surgery.”

Furthermore, OHTS found that for each 1 mm Hg higher IOP at baseline, there was an approximate 10% increased risk of glaucomatous progression. In the EGMT, a decrease in the average IOP of 1 mm Hg was associated with approximately a 10% decreased risk of glaucomatous progression.

These studies show that “lowering IOP is important and can be expected to decrease risk of glaucomatous progression,” Dr. Coleman said. “It just takes your clinical judgement.”