EAGLE trial: Lens extraction superior to iridotomy in patients with angle-closure glaucoma

PRAGUE — Lens extraction in angle-closure glaucoma is associated with better clinical outcomes and patient-reported outcomes than laser peripheral iridotomy and appears to be cost-effective, according to the results of the 3-year EAGLE trial.

“With 5.3 million people affected worldwide, angle-closure is also a leading cause of blindness. Yet, there is a disproportion in the number of trials as compared with open-angle, and little is known on the efficacy of treatments,” Augusto Azuara-Blanco, MD, PhD, said at the European Glaucoma Society Congress.

Augusto Azuara-Blanco

The EAGLE trial was a team effort involving 400 patients from 31 sites in the U.K., East Asia and Australia and was funded by the U.K. Medical Research Council. Lens extraction and the gold standard of laser peripheral iridotomy plus topical medications were compared in patients with angle-closure, high IOP, and early or moderate glaucoma damage. Patient-centered outcomes (health status measured by EQ-5D score), clinical outcomes (IOP) and economic outcomes (incremental cost per quality-adjusted life-year) were evaluated.

Lens extraction resulted in significantly better EQ-5D scores. IOP was comparable in both groups, but 60% of patients in the lens extraction group were controlled without medications as compared with 21% of patients in the iridotomy group. Additional glaucoma surgery was performed in 24 patients in the iridotomy group and one patient in the lens extraction group.

“This is compelling evidence that lens extraction controls the glaucoma better,” Azuara-Blanco said.

Visual acuity, visual acuity loss and complications were similar in the two groups, as was the number of complications.

Subgroup analysis showed no difference in outcomes related to ethnicity, “but there might be a difference we were not able to detect,” Azuara-Blanco said.

“From point of view of NHS, lens extraction is very likely to be a cost-effective intervention,” he said.

However, the procedure “is not without risk of complications,” he said, and the choice must be made with the patient discussing the risks and potential benefits. – by Michela Cimberle

Reference:

Azuara-Blanco A. The EAGLE trial: Implications for the management of angle closure. Presented at: European Glaucoma Society Congress; June 19-22, 2016; Prague.

Disclosure: Azuara-Blanco reports no relevant financial disclosures.