Takaisin

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

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