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Flashcards in Trials Deck (11):
0

What was the main conclusion of the Collaborative Initial Glaucoma Treatment Study (CIGTS)?

Initial medical and initial surgical therapy resulted in similar visual field outcomes after 5 years of follow-up.

As mentioned ad nauseum on this website, the main conclusions of the Collaborative Normal Tension Glaucoma Study (CNTGS) were:

There was a decrease from 35 to 12% in visual field progression in eyes whose IOPs were lowered by at least 30%.

12% of eyes progressed regardless if the IOP was lowered by at least 30%.

65% of untreated eyes showed no visual field progression.

2

What was the main conclusion of the Collaborative Initial Glaucoma Treatment Study (CIGTS)?

Collaborative Normal Tension Glaucoma Study (CNTGS)
30% decrease in IOP reduced VF progression

12% of eyes progressed regardless if the IOP was lowered by at least 30%.

65% of untreated eyes showed no visual field progression

Initial medical and initial surgical therapy resulted in similar visual field outcomes after 5 years of follow-up.

2

According to the Early Manifest Glaucoma Trial (EMGT) final data analysis, which of the following was a risk factor for the progression of glaucoma?

The EMGT studied the effect of lowering intraocular pressure (IOP) vs. observation in patients newly diagnosed with glaucoma. This study randomized these patients to either: (a) IOP lowering with betaxolol + laser trabeculoplasty; or (b) observation.

The initial report1 found that progression on visual fields occurred in 62% of untreated patients and 45% of treated patients at a median of 6 years of follow-up. The treatment group had their IOPs reduced by an average of 25% and also experienced progression at a significantly later timepoint.

Analysis from the final EMGT dataset2 (median follow-up of 8 years) found the following risk factors for progression:


higher baseline IOP and higher IOPs at follow-up visits
presence of exfoliation
bilateral disease
older age
lower ocular perfusion pressure (all patients)
cardiovascular disease history (in patients with higher baseline IOP)
lower systolic blood pressure (in patients with lower baseline IOP)
disc hemorrhages
thinner central corneal thickness (in patients with higher baseline IOP).

3

Primary Open Angle Glaucoma
Risk factors?

FHx (4x risk)
AA race (3-4x risk)
Age>50
Low CCT
DM, myopia (controversial)
RD
CRVO

If h/o POAG, risk in other eye?
75%

4

ABC (Ahmed Baerveldt Comparison) study

- looked at the outcomes for Ahmed or Baerveldt
-on MMT w/IOP greater than 18 mmHg

The main results of this study were:

(1) IOPs of the Ahmed group were slightly (but significantly) higher than the Baerveldt group at 1 year. (15.4 vs 13.2)
(2) More patients in the Baerveldt group experienced early post-op complications and experienced "serious complications" ( >2 Snellen line VA loss)

There were no significant differences in the number of glaucoma medications required or "treatment failures" (i.e. lowering IOP by a specific percentage) between the two groups.

5

OHTN study risk factors for POAG

African American;
sex (male)
increased pattern standard deviation
increased horizontal cup-to-disc ratio (in addition to vertical c/d ratio)
heart disease
increased intraocular pressure.

6

Normal Tension Glaucoma

VF defects more focal, deeper, closer to fixation than POAG
More likely to have splinter hemorrhages


7

Glaucoma Laser Trial

ALT alone as effective as timolol alone
50% need drops by 2 years

8

TVTS (Tube vs. Traeculectomy Study)

Similar IOP ctrl, but trab needs >meds
Tube better for IOP ctrl, avoid hypotony, re-op, VA loss, post-op complications

9

CIGTS (Collaborative Initial Glc Tx Study)

Newly diagnosed POAG
Surgery vs. medical tx similar in VA+VF
Early surgery more likely to lose VA+VF, but converge with time
IOP reduction greater with surgery

10

AGIS (Adv Glaucoma Intervention Study)

Advanced OAG
Keeping IOP<18; shows no VF loss
ALT first for blacks; Trab first for whites