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Rate of visual field progression similar for trabeculectomy, topical therapy
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Most patients after trabeculectomy demonstrate relatively slow rates of visual field progression, similar to those treated medically, according to research published in the British Journal of Ophthalmology.
The retrospective study included 180 surgical patients with five or more 24-2 visual field examinations post trabeculectomy matched with 180 medically treated patients (topical therapy), followed for about 7 years.
The mean deviation (MD) slopes were -0.22 dB/year and -0.08 dB/year in the surgically and medically treated patients, respectively, which was not deemed statistically significant.
Researchers discovered faster progression rates in the surgical group than the medical group.
In the surgical group, patients were using 2.5 topical medications prior to surgery, which dropped to 0.9 at the last follow-up visit postsurgically. Mean IOP before surgery was 19.8 mm Hg, which decreased to 12.0 mm Hg at the last follow-up post procedure.
The researchers concluded that despite adequate surgical IOP control, more patients in the surgical group showed faster progression compared to the medical group, which may suggest other factors contribute to visual field progression in this patient subset. –by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Glaucoma progression is inevitable, even when your patient doggedly adheres to their treatment plan.
In treating this incurable disease, our goal is to slow its progression to an acceptable rate. In talking with optometrists, I occasionally find an attitude that trabeculectomy is tantamount to a cure.
This study’s findings fly in the face of this mistaken belief by finding that glaucoma progresses more quickly after trabeculectomy when compared with a medication-taking group of similar disease severity. Perhaps the trabeculectomy group had faster advancing glaucoma? Perhaps there are important non-IOP related factors that we are unaware of? Perhaps lowering IOP beyond a certain level conveys no additional benefit? There is much we don’t know and, as they say, more studies are certainly indicated.
What do we know? Medications are powerful tools in our fight against glaucoma, and filtering surgery is not a treatment panacea. I wish we knew more.
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