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Visual field preserved significantly longer in patients treated with latanoprost
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Open-angle glaucoma patients who lowered their intraocular pressure with latanoprost demonstrated more visual field preservation than a placebo group, researchers reported in a study recently published in The Lancet.
Garway-Heath and colleagues conducted a randomized, triple-masked, placebo-controlled trial to evaluate the preservation of visual function in patients treated with latanoprost.
Researchers divided 516 participants into an intervention and a control group. The intervention group received latanoprost 0.005%, and the control group received placebo eye drops; both drops were administered from identical bottles, and participants received them once each day in both eyes. To analyze vision preservation, researchers evaluated the participants after 24 months.
Results showed that participants in the latanoprost group had a mean intraocular pressure of 19.6 mm Hg at baseline and a mean reduction in pressure of 3.8 mm Hg. Participants in the placebo group had a mean intraocular pressure of 20.1 mm Hg at baseline and a mean reduction in pressure of 0.9 mm Hg.
Researchers also reported that visual field preservation was significantly shorter in the placebo group than in the latanoprost group.
"To our knowledge, the United Kingdom Glaucoma Treatment Study is the first randomized, triple-masked, placebo-controlled trial to assess the benefit of topical medical treatment (eye drops) for reduction of loss of vision in patients with open-angle glaucoma," the authors concluded. "Our findings provide strong evidence for the vision-preserving benefit of lowering of intraocular pressure, supporting evidence from previous randomized trials that were not masked or placebo-controlled.
The study also provides evidence of the vision-preserving benefits of topical prostaglandin analogs,” they continued. “The trial design meant a fairly short observation period was needed to show treatment effects on vision, with the difference between treatment groups evident at just 12 months compared with typical observation periods of roughly 5 years in previous trials. The short trial duration will have a major beneficial effect on development and assessment of new treatments, increasing the likelihood of these treatments being made available for patient benefit."
Disclosures: Garway-Heath has received unrestricted research funding from Allergan and Pfizer and equipment loans from Carl Zeiss Meditec, Heidelberg Engineering and OptoVue; has had advisory roles (compensated) with Alcon, Alimera, Allergan, Bausch + Lomb, Forsight, GlaxoSmithKline, Merck and Quark; and has received honoraria for lecturing from Allergan, Bausch + Lomb and Merck.
Perspective
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Scott Anthony, OD, FAAO
Although lowering IOP has been shown to improve visual field preservation, it is still unclear if the means by which we lower IOP (medical, surgical or a combination thereof) influences this outcome.
Although many clinicians (including myself) assumed latanoprost was effective at preserving the visual field by proxy of its IOP-lowering effects, surprisingly, no study has ever verified this with a placebo control group. This trial not only precisely demonstrated the effectiveness of latanoprost monotherapy for preserving visual field, but did so in a 2-year span of time, a remarkable feat for a study of this nature.
In some ways, this study appears to be a platform for demonstrating the importance of efficient study design. In using guided progression analysis (GPA) software and clustering the visual field testing at the beginning and end of the trial period, Garway-Heath and colleagues were able to detect progression quickly.
Although many clinicians cluster visual field testing at the start of their GPA, this study reinforces the need to periodically cluster testing during the follow-up period. This is a departure from the traditional thinking that one follow-up test per year is adequate in patients who are thought to have stable glaucoma.
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