advertisement
Abstract #15971 Published in IGR 2-3
Intraocular pressure and visual field progression in open-angle glaucoma
Kass MA; Gordon MOAmerican Journal of Ophthalmology 2000; 130: 490-491
In this editorial the authors comment on a recent paper with results from the AGIS study. As the reader know the AGIS study involves patients with open angle glaucoma who are uncontrolled on maximum medical therapy. These patients either receive Argon laser trabeculoplasty first or trabeculectomy first. This paper presents a predictive analysis and an associative analysis. In the predictive analysis it was found that the level of intraocular pressure in the early period after the operation predicted the amount of visual field progression in the subsequent years. This relationship seems to follow a dose response dose characteristic. In the second analysis the authors analyze the percentage of intra ocular pressure measurements that were under 18 mmHg. In this part of the study it was shown that those eyes in which intra-ocular pressure was less than 18 mmHg a 100% of the visits have little chance of visual field deterioration. The differences between groups were particularly significant beyond five years of follow-up and the effect was greater with increasing follow-up. In the associative analysis there was a group with a mean intra-ocular pressure of 12.3 mmHg. In this group some 14% of the eyes showed worsening whereas some 18% of eyes showed improvement of the visual field resulting in an overall no progression. No doubt part of the worsening and improvement is due to long-term fluctuation noise. Even though the analyses were designed post-hoc the study has major strength: it concerns a large sample of patients that was systematically studied for a minimum of six years. We learned that lowering intraocular pressure indeed reduces the rate of visual field loss. Lower pressures seems to be more protective than higher pressures. Interestingly the protective effect becomes more pronounced with time. Finally pressure levels in the low teens are associated with very little progression. These authors feel that the fact that there is still some progression at low pressure levels points to a nice future for neuroprotective drugs.
MA Kass, Dep of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 South Euclid Avenue-Campus Box 8096, St. Louis, Missouri 63110, USA. Fax. (314)747-2851 E-mail: kass@vision.wustl.edu
Classification:
6.1 Intraocular pressure measurement; factors affecting IOP (Part of: 6 Clinical examination methods)
12.4 Laser trabeculoplasty and other laser treatment of the angle (Part of: 12 Surgical treatment)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
