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Surgery may delay or halt glaucomatous optic disc progression more than medication

Am J Ophthalmol. 2009. 147(4):717-724.

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Surgery reversed progression of optic disc cupping more often than medication, according to 5-year data from the Collaborative Initial Glaucoma Treatment Study.

"Surgery prevents or delays glaucomatous progression as measured by optic disc criteria in patients with early [open-angle glaucoma]," the study authors said. "Reversal is associated with lower IOP, but is not associated with improved visual function."

The masked, randomized clinical trial included 348 eyes assigned to undergo medical treatment or surgery for open-angle glaucoma.

Data showed that 303 eyes (87.1%) had no optic disc changes; 22 eyes (6.3%) had enlargement of the cup and glaucomatous progression; and 23 eyes (6.6%) had reduction in the cup.

In the medication group, 18 of 185 eyes (10%) had optic disc progression; in the surgery group, four of 163 patients (3%) had optic disc progression. The difference was statistically significant (P = .007).

Reversal of cupping was more frequent in the surgical group (21 of 163 patients, 13%) than in the medication group (two of 185 patients, 1%). This difference was also statistically significant (P < .001).