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Does Treatment of Elevated Intraocular Pressure Prevent Glaucoma?

Topical ocular hypotensive drugs reduced intraocular pressures and were associated with less optic disc deterioration.

Patients with elevated intraocular pressure (IOP) are at increased risk for primary open-angle glaucoma. However, the extent to which treatment of elevated IOP prevents or delays glaucoma is unclear. Researchers attempted to clarify this issue in a partially industry-sponsored, multicenter, U.S. study, which an editorialist described as a landmark trial.

A total of 1636 patients with IOPs between 24 mm Hg and 32 mm Hg and with no evidence of glaucomatous damage were randomized to receive either topical ocular hypotensive agents (goal, IOP reduction of 20%, to reach IOP <24 mm Hg) or no treatment. The primary outcome was development of a visual field abnormality or optic disc deterioration. At 5 years, the probability of reaching this outcome was significantly lower in the treatment group than in the control group (4.4% vs. 9.5%). In a multivariate analysis presented in a companion article, several baseline factors predicted development of glaucoma, including older age, higher IOP, and thinner corneas.

Comment: The 5% absolute difference in outcomes reported in this study suggests that 1 of 20 patients would benefit during 5 years of treatment. The editorialist hopes that information from this study will be combined with data from other trials, in such a way as to help us select those patients most likely to benefit from early treatment of elevated IOP. At the time of publication, the full text for 2 of these articles was available at http://archopht.ama-assn.org/issues/current/rfull/ecs20045.html and http://archopht.ama-assn.org/issues/current/ffull/eed20002.html free of charge.

— Allan S. Brett, MD

Published in Journal Watch General Medicine July 9, 2002

Citation(s):

Kass MA et al. The Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002 Jun; 120:701-13.

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• Medline abstract (Free)

Gordon MO et al. The Ocular Hypertension Treatment Study: Baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002 Jun; 120:714-20.

• Original article (Subscription may be required)
• Medline abstract (Free)

Palmberg P. Answers from the ocular hypertension treatment study. Arch Ophthalmol 2002 Jun; 120:829-30.

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• Medline abstract (Free)