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Editors Selection IGR 9-4

Clinical Glaucoma: Progression and CCT

Comment by Paul Healey on:

19584 Corneal thickness measurement in the management of primary open-angle glaucoma: a report by the American Academy of Ophthalmology, Dueker DK; Singh K; Lin SC et al., Ophthalmology, 2007; 114: 1779-1787

See also comment(s) by Gábor Holló •

Find related abstracts

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This paper by Dueker et al. (835) attempts to systematically review studies exploring the relationship between central corneal thickness (CCT) and glaucoma. After a lucid and thorough discussion of CCT and IOP, the authors pose three specific questions:

1. Is CCT a risk factor for progression of ocular hypertension to glaucomatous optic neuropathy?
2. Is CCT a risk factor for the presence of glaucomatous optic neuropathy?
3. Is CCT a risk factor for progression of damage in POAG?

A Pubmed literature search of English-language articles was conducted in November 2004. Of the 195 articles retrieved, 57 were chosen for review. A further 81 reports were identified during manuscript preparation of which 37 were chosen for review. Chosen articles were assessed for the methodological strength and outcome. Only five studies examining the relationship between CCT and progression of ocular hypertension to glaucoma were identified. Three of these used the same clinic-based patient cohort to recruit the study sample. All five studies reported that CCT was a risk factor for the progression of ocular hypertension to glaucoma. Twenty-one identified papers were split equally as to the role of CCT in prevalent glaucoma. Of five population-based studies, three did not demonstrate a relationship between CCT and glaucoma. Seven papers examined the relationship between CCT and glaucoma progression, most notably the Early Manifest Glaucoma Study. Like most of the papers, it did not find a relationship between CCT and glaucoma progression. So like papers on which it was based, the outcome of this review appears inconsistent. CCT is a strong risk factor for the progression of ocular hypertension to glaucoma but not at all for progression of that glaucoma nor prevalent disease. Whether this is methodological or biological is not clear.

CCT is a strong risk factor for the progression of ocular hypertension to glaucoma but not at all for progression of that glaucoma nor prevalent disease

Nevertheless the authors endorse the current AAO preferred practice pattern which advocates an important role for CCT measurement in glaucoma assessment.

A systematic review is only as good as the papers it includes. While the current review contains important population-based studies and large well-conducted randomized controlled trials, a pubmed search in October 2007 using the same search criteria retrieved 400 articles. There is clearly much ongoing research interest in this field. Hopefully this research will help clarify the role of CTT in glaucoma.

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