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Effectiveness of IOP lowering in glaucoma

Näytönastekatsaus | Julkaistu: 28.03.2023 Tulosta
Glaucoma Working Group

Effectiveness of IOP lowering in glaucoma

Näytönastekatsaukset
Glaucoma Working Group
28.3.2023

Level of evidence: B

Lowering of IOP seems to delay the progression of glaucomatous abnormalities in open angle glaucoma.

Systematic review

Systematic review searched for systematic reviews published by March 2011 as well primary studies without imposed language, sample size, or date restrictions up to 30 July 2012:

  • Treatments currently used for OAG, including medical, laser, and incisional surgery were examined in studies with participants aged ≥ 40 years who had primary or suspected OAG.
  • Evidence from additional primary studies that were published after the date of the last search conducted for systematic reviews.

The risk of bias, consistency, directness, and precision of the body of evidence was assessed. The search found 11 258 publications, of which 379 were eligible. Also 169 systematic reviews were identified, of which 23 remained eligible for inclusion after screening. These systematic reviews also included all but 86 of the primary studies identified. Because of appreciable variability in interventions, follow-up intervals, or assessments of outcomes, the focus was on qualitative rather than quantitative synthesis.

High-level evidence suggests that medical, laser, and surgical treatments decrease intraocular pressure and that medical treatment and trabeculectomy reduce the risk for optic nerve damage and visual field loss compared with no treatment.

No systematic reviews of medical or surgical interventions for OAG were identified directly addressing visual impairment. Primary studies that met inclusion criteria were identified. However, none were of sufficient duration or size to identify outcomes that plausibly could be related to visual impairment due to glaucoma

The limitations included heterogeneous outcome definitions and measurements among the included studies; exclusion of many treatment studies that did not stratify results by glaucoma type.

Medical and surgical treatments for open-angle glaucoma lower intraocular pressure and reduce the risk for optic nerve damage over the short to medium term. Which treatments best prevent visual disability and improve patient-reported outcomes is unclear «Boland MV, Ervin AM, Friedman DS ym. Comparative e...»1.

References

  1. Boland MV, Ervin AM, Friedman DS ym. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013;158:271-9 «PMID: 23420235»PubMed
  2. Leske MC, Heijl A, Hyman L ym. Early Manifest Glaucoma Trial: design and baseline data. Ophthalmology 1999;106:2144-53 «PMID: 10571351»PubMed
  3. Heijl A, Leske MC, Bengtsson B ym. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 2002;120:1268-79 «PMID: 12365904»PubMed
  4. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol 1998;126:487-97 «PMID: 9780093»PubMed
  5. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol 1998;126:498-505 «PMID: 9780094»PubMed
  6. Schulzer M. Errors in the diagnosis of visual field progression in normal-tension glaucoma. Ophthalmology 1994;101:1589-94; discussion 1595 «PMID: 8090461»PubMed
  7. The Glaucoma Laser Trial (GLT): 6. Treatment group differences in visual field changes. Glaucoma Laser Trial Research Group. Am J Ophthalmol 1995;120:10-22 «PMID: 7611312»PubMed
  8. Ederer F, Gaasterland DE, Sullivan EK ym. The Advanced Glaucoma Intervention Study (AGIS): 1. Study design and methods and baseline characteristics of study patients. Control Clin Trials 1994;15:299-325 «PMID: 7956270»PubMed
  9. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol 2000;130:429-40 «PMID: 11024415»PubMed
  10. Kass MA, Gordon MO. Intraocular pressure and visual field progression in open-angle glaucoma. Am J Ophthalmol 2000;130:490-1 «PMID: 11024422»PubMed
  11. The Advanced Glaucoma Intervention Study (AGIS): 4. Comparison of treatment outcomes within race. Seven-year results. Ophthalmology 1998;105:1146-64 «PMID: 9663215»PubMed
  12. Leske MC, Hyman L, Hussein M ym. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol 1999;127:625-6 «PMID: 10334369»PubMed
  13. Musch DC, Lichter PR, Guire KE ym. The Collaborative Initial Glaucoma Treatment Study: study design, methods, and baseline characteristics of enrolled patients. Ophthalmology 1999;106:653-62 «PMID: 10201583»PubMed
  14. Gordon MO, Kass MA. The Ocular Hypertension Treatment Study: design and baseline description of the participants. Arch Ophthalmol 1999;117:573-83 «PMID: 10326953»PubMed
  15. Keltner JL, Johnson CA, Quigg JM ym. Confirmation of visual field abnormalities in the Ocular Hypertension Treatment Study. Ocular Hypertension Treatment Study Group. Arch Ophthalmol 2000;118:1187-94 «PMID: 10980763»PubMed
  16. Anderson DR, Drance SM, Schulzer M ym. Natural history of normal-tension glaucoma. Ophthalmology 2001;108:247-53 «PMID: 11158794»PubMed
  17. Bohn RL, Gurwitz JH, Yeomans SM ym. Which patients are treated for glaucoma? An observational analysis. J Glaucoma 2000;9:38-44 «PMID: 10708230»PubMed
Article ID: nak09697 (037.030)
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