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Visual field loss seen in some glaucoma patients 8 years after trabeculectomy or medication
Ophthalmology. 2009:116(2):200-207.
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An intervention protocol reduced IOP for an extended period in most glaucoma patients, but visual field loss was seen in more than 20% of patients. Diabetic patients showed poor long-term outcomes.
The randomized clinical trial included 607 newly diagnosed glaucoma patients participating in the Collaborative Initial Glaucoma Treatment Study. Patients were treated with medication or underwent trabeculectomy. All patients underwent clinical evaluation every 6 months.
Primary outcome measures included worsening of visual fields, defined by mean deviation decreasing by 3 dB or more from baseline at each follow-up, the study authors said.
There were minimal changes from baseline in both groups' average mean deviation throughout the follow-up period. However, 21.3% of patients in the trabeculectomy group and 25.5% of patients in the medication group experienced substantial worsening of mean deviation at 8-year follow-up.
Surgery resulted in less visual field progression than medication in patients with advanced visual field loss at baseline. However, diabetic patients who underwent surgery showed more visual field loss over time, the study authors said.
"The findings regarding initial surgery being beneficial for subjects with more advanced [visual field] loss at presentation, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation," they said.