Initial study results indicate that medication or surgery may be equally effective treatments for newly diagnosed open-angle glaucoma

(San Francisco)—After five years of follow-up, either medications or surgery appear to be equally effective treatments for newly diagnosed open-angle glaucoma, reducing intraocular pressure and preventing vision loss. These findings, part of the Collaborative Initial Glaucoma Treatment Study, appear in the November 2001 issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology.

Glaucoma is a group of diseases that without treatment can damage the optic nerve and cause irreversible vision loss. Intraocular pressure is an important risk factor in causing the optic nerve damage. Currently, more than two million people in the United States have glaucoma.
There has been some debate in the medical community about whether to first use medications or to first use surgery to treat newly diagnosed glaucoma. Current treatment in the United States usually involves treating patients with eye drops to reduce intraocular pressure. When the drops fail, surgery is performed. However, some earlier British studies showed early surgery worked better than medication in saving vision. The Collaborative Initial Glaucoma Treatment Study was conducted to determine which approach is better.

In this randomized, controlled clinical trial, 607 newly diagnosed glaucoma patients from 14 clinical centers were divided into two groups—307 taking medicine and 300 treated surgically. In addition to measuring visual function, researchers also used a standardized questionnaire to measure the impact of glaucoma and its treatment on the patients’ quality of life. Both groups were followed for five years and both groups had their intraocular pressure reduced substantially. Surgery patients had the lowest pressure, however.

Surgery patients required cataract surgery more frequently than patients treated with medicines. With regard to health-related quality of life, both the medicine and surgery groups are doing well after five years of treatment. There were not many reports of serious side effects or problems with vision. While the surgery group reported more local eye symptoms than did the medicine group, both groups reported less symptoms and side effects as the study progressed.

" Our study shows that medications or surgery are effective treatments for newly diagnosed open-angle glaucoma," said study chairman, Paul R. Lichter, M.D., Professor and Chair of Ophthalmology and Visual Sciences at the University of Michigan's Kellogg Eye Center in Ann Arbor. " While we do not recommend any changes to the usual treatment approaches at this time, it is important to emphasize that five-year findings are not the definitive answer in a chronic disease like glaucoma. Findings from longer term follow-up of the CIGTS patients will provide a much better basis on which to base recommendations on the best approach to initial glaucoma treatment," Lichter said.

The American Academy of Ophthalmology is the largest association of eye physicians and surgeons—Eye MDs—with more than 27,000 members. For more information about the Academy, visit the Academy’s website at www.aao.org. For more information about glaucoma, visit the Academy’s partner website, www.medem.com.