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Trabeculectomy may improve visual function in glaucoma
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Researchers have found that trabeculectomy significantly slows the rate of perimetric decay from glaucoma, according to a retrospective review in Ophthalmology.
Caprioli and colleagues stated that their study results “provide evidence of sustained, long-term improvement of retinal ganglion cell (RGC) function in glaucoma” and that “these findings suggest the possibility of the reversal of RGC dysfunction from glaucoma.”
Their study included 74 eyes from 64 patients who underwent trabeculectomy and a comparison group with 71 eyes from 65 patients with unoperated glaucoma.
Researchers found the mean rate of change for all visual field locations slowed from -2.5/year before surgery to -0.10/year after surgery. In the comparison group, the mean rate of decay was -1.4/year during the first half of follow-up and -1.7/year during the second half.
Preoperatively, 70% of locations decayed in the trabeculectomy group, and 30% improved, they reported. Postoperatively, 56% decayed and 44% improved. Furthermore, at least 10 visual field locations improved postoperatively in the trabeculectomy group.
The proportion of eyes in the trab group with five or more test locations improving postoperatively was 80% and with 10 or more locations improving postoperatively was 57%, according to researchers.
“We postulate that RGCs that are damaged but not yet dead remain dysfunctional for some time...Their functionality can sometimes be restored by the reduction of stress related to IOP,” the researchers wrote. “The sensitivities of individual test locations of the visual field frequently show improvement after IOP reduction with trabeculectomy; this improvement is sustained and continues over time.”
The researchers also suggested challenging the traditional goal of treating glaucoma merely to maintain stability.
“Long-term improvement of visual function may be a reasonable and attainable goal in some patients,” they concluded. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Glaucoma is generally thought to result in irreversible visual field loss, sometimes despite glaucoma treatments. Typically, if visual fields improve in our glaucoma patients, we attribute it to a learning curve effect or test variability.
This study challenges our conventional thinking and reminds us that visual field improvement can occur with sustained lowering of intraocular pressure. It is a reassuring point that we can pass along to our patients when discussing the importance of treatments. Not only are we trying to prevent their glaucoma from worsening, but we are aiming to modestly improve their vision in some cases, which this study has shown.
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