Early treatment of glaucoma recommended
Reducing intraocular pressure in people who have early stage glaucoma
could slow the rate of disease progression in some patients, according
to the results of a trial.
Researchers randomised 255 people aged 50–80 years, who had early
glaucoma, visual field defects and a median intraocular pressure (IOP)
of 20mmHg, to laser treatment plus topical betaxolol hydrochloride (n=129),
or no initial treatment (n=126). They found that treatment reduced IOP
by a quarter (5.1mmHg) and that this reduction was maintained over a six-year
follow-up period.
Furthermore, disease progression was less frequent in the treated group
(45 per cent) than in the control group (62 per cent, P=0.007) and occurred
later. However, treatment was associated with an increase in cataracts
(P=0.002).
Dr Paul Sieving, director of the United States National Eye Institute,
which co-sponsored the study, said: “These results strongly support
the body of evidence suggesting that immediate treatment of early stage,
open-angle glaucoma will slow the disease progression.”
However, lead researcher and chairman of the ophthalmology department
at Malms University Hospital, Sweden, Dr Anders Heijl, said the results
should be kept in perspective: “. . . despite the clear effect of
treatment, glaucoma progressed in as many as 30 per cent of treated patients
after four years.” Dr Heijl said time to progression varied and was
sometimes short, even for treated patients. “This shows that in many
patients with rapidly progressing glaucoma, the treatment used in this
study was insufficient to halt progression of the disease.”
He stressed that treatment for early, newly diagnosed glaucoma should
be individualised and carefully balanced (Archives of Ophthalmology 2002;120:1268).
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