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Early treatment reduced glaucoma progression risk by half
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STONY BROOK, N.Y. — Glaucoma patients treated with laser and medical therapy reduced by half their risk of disease progression compared to untreated patients, according to a long-term study. The magnitude of initial intraocular pressure reduction was a major factor influencing progression.
Disease progression in the trial also increased with a higher baseline intraocular pressure, exfoliation, bilateral disease, worse mean deviation and older age.
Christina Leske, MD, MPH, and others here at Stony Brook University School of Medicine analyzed data from the Early Manifest Glaucoma Trial, which was conducted in Sweden and included mainly white participants. The study analyzed 255 open-angle glaucoma patients randomized to argon laser trabeculoplasty plus topical betaxolol (129 patients) or no immediate treatment (126 patients). Follow-up was every 3 months.
Perimetric and photographic optic disc information was used to assess disease progression.
After 6 years, 53% of patients progressed. The progression risk was halved by treatment. Predictive baseline factors included higher IOP, exfoliation and having both eyes eligible for the study. Each millimeter of mercury decrease from baseline IOP measurement to first follow-up yielded about a 10% decrease in risk of disease progression.
At baseline, 12% to 13% of patients had disc hemorrhages. As a patient’s percentage of visits with disc hemorrhages increased, the patient’s risk of progression increased as well. Frequent disc hemorrhages at follow-up were confirmed as an important sign and conferred a worse prognosis, the study authors reported in the January issue of Archives of Ophthalmology.