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Reversal of visual field loss may become future paradigm in glaucoma treatment
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FORT LAUDERDALE, Fla. — Reversal of visual field loss should be a goal of glaucoma treatment, according to a speaker here.
That goal challenges conventional wisdom and would represent a paradigm shift in glaucoma treatment, Anne L. Coleman, MD, PhD, said at the American Glaucoma Society meeting, where she delivered the annual AGS Lecture, “How Do We Define Success?”
Anne L. Coleman
Citing a study she co-authored in Ophthalmology that measured visual field rate of change after IOP reduction with trabeculectomy in patients with glaucoma, Coleman said the implications of the study findings are that “robust IOP reductions can possibly reverse glaucomatous visual field loss.”
“The hypothesis is that there are retinal ganglion cells that are sick but they’re not quite dead yet. So this gives us an opportunity for intervention in a lot of our patients,” she said. “In addition, we found that regional indices are more meaningful than the global indices when used as treatment outcome measures.”
In another challenge of conventional wisdom — that unresolved hypotony is a treatment failure — Coleman and colleagues at UCLA Stein Eye Institute undertook a case control study comparing incidence of vision loss in cases vs. controls. Of 3,659 eyes that underwent trabeculectomy with mitomycin C between 1990 and 2014, 65 case eyes with hypotony after trabeculectomy and 132 control eyes without hypotony after trabeculectomy were studied. Definition of hypotony was IOP of 5 mm Hg or less on three or more visits 3 months or longer after trabeculectomy, without bleb leak.
Implications of this work were that there was a slightly higher crude incidence of postoperative vision loss in patients with hypotony after trabeculectomy.
Considering results adjusted for covariates, Coleman said, “Differences in vision loss in patients with vs. without hypotony were not statistically significant, but it is intriguing. So, hypotony may not be a failure. We might want to start rethinking the definition of a success rate when we look at trabeculectomies.”
Another area to rethink the definition of failure is in the publication rate of studies with negative results, she said. Often, there is a publication bias against studies that yield negative or null results, but their conclusions are still relevant and “may advance science and patient care.” – by Patricia Nale, ELS
References:
Caprioli J, et al. Ophthalmology. 2016; doi:10.1016/j.ophtha.2015.09.027.
Coleman AL. 26th Annual AGS Lecture: How do we define success? Presented at: American Glaucoma Society 26th Annual Meeting; March 3-6, 2016; Fort Lauderdale, Fla.
Disclosure: Coleman reports no relevant financial disclosures.