Glaucoma laser trial follow up study

Study record managers: refer to the Data Element Definitions if submitting registration or results information. During the last decade, argon laser trabeculoplasty ALT has often been used instead of surgery as the treatment of choice in cases of open-angle glaucoma that could not be controlled by drugs.

ALT treatment consists of tiny laser burns evenly spaced around the trabecular meshwork. It sometimes has been found to be effective in controlling glaucoma, although many eyes still require some medical treatment. The Glaucoma Laser Trial GLT , a randomized, controlled clinical trial, was conducted to determine whether ALT is effective in patients with newly diagnosed, primary, open-angle glaucoma. Each of the patients in the trial received argon laser treatment in one eye and standard topical medication in the other eye.

The eye to be started on medicine and the eye that would get the laser treatment were randomly selected. By the close of the Glaucoma Laser Trial Followup Study, median duration of followup since diagnosis of primary, open-angle glaucoma was 7 years maximum, 9 years.

The argon laser treatment was done in two sessions 1 month apart, with one-half of the trabecular meshwork treated with 45 to 55 laser burns in each session. Patients were seen for a followup visit 3 months after the first laser treatment and every 3 months thereafter for a period of at least 2 years. At each visit, examination of the eyes included a check of intraocular pressure and visual acuity. Visual field examinations were performed 3, 6, and 12 months after randomization and annually thereafter.

Disc stereo photographs were taken 6 and 12 months after randomization and annually thereafter. The results of these examinations determined whether treatment should be changed. If the pressure in either eye had not been reduced to the desired level, the physician changed the medication in the eye treated with drops or started the use of drops in the laser-treated eye according to a standardized procedure being used in the trial.

If intraocular pressure was still not successfully reduced, surgery or further laser treatment may have been required.

Wolfe St. N2 - PURPOSE: To determine differences between the two treatment groups of the Glaucoma Laser Trial with respect to intraocular pressure, visual fields, optic disk cupping, and therapy for primary open-angle glaucoma. Results J. Overview Fingerprint. Abstract PURPOSE: To determine differences between the two treatment groups of the Glaucoma Laser Trial with respect to intraocular pressure, visual fields, optic disk cupping, and therapy for primary open-angle glaucoma.

Access to Document Link to publication in Scopus. Together they form a unique fingerprint. View full fingerprint. American Journal of Ophthalmology , 6 , Krug, J. In: American Journal of Ophthalmology. Krug and M. Chiavelli and G. Borawski and M. Devaney and D. Epstein and F. Berson and M. Additionally, in patients with extremely elevated IOP, the superior early IOP reduction from the Ahmed valve may help reduce the risk of glaucomatous vision loss early.

Compare eye drops versus selective laser trabeculoplasty SLT as the first line therapy for ocular hypertension and primary open angle glaucoma. This was an observer-masked randomized control trial in which patients were randomly assigned to receive either eye drops patients or SLT patients.

First line eye drops were prostaglandin analogues, second line were beta blockers, third and fourth line treatment were topical carbonic anhydrase inhibitors and alpha agonists. Primary outcome measure was patient quality of life, secondary outcomes were visual acuity, IOP, cost, disease progression and need for glaucoma surgery.

Patient demographics and ocular characteristics were similar between the two groups. There was no difference in quality of life scores between the eye drops and SLT groups. Visual acuity and IOP outcomes were similar between the two groups. In the eye drop group 11 patients required incisional glaucoma surgery to lower IOP compared to zero patients in the SLT group. Cost analysis showed that the SLT was more cost effective than eye drops.

This study utilized a treat-to-target design that does not provide clear IOP reduction parameters. Drop adherence was not measured in the eye drop group. SLT is both a clinically effective and cost effective option for first line treatment for primary open angle and ocular hypertensive patients.

It may spare patients eye drops and reduce the risk of future glaucoma surgery. The Low-Pressure Glaucoma Treatment Study LoGTS evaluates the visual field stability in low-pressure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice daily brimonidine tartrate 0. This study wanted to test if topical brimonidine in NTG has a neuroprotective benefit, comparing to timolol which has similar IOP-lowering effect. Randomized, multicenter, double-masked clinical trial.

Low-pressure glaucoma patients 30 years of age or older were identified. Exclusion criteria included an untreated pressure of more than 21 mmHg, advanced visual field loss, and contraindications to study medications. Interventions randomization of both eyes to double-masked monotherapy with brimonidine or timolol. Follow-up visits included Humphrey full-threshold perimetry, tonometry every 4 months, and annual optic disc photography. Mean age was Visual field mean deviation for all eyes was Mean vertical cup-to-disc ratio for all eyes was 0.

Unilateral field loss patients had a larger cup-to-disc ratio in the field loss eye 0. Disc hemorrhage was present at baseline in 29 patients 32 eyes. Brimonidine has a higher risk of ocular allergy, systemic adverse events and non-compliance compared with timolol. The goal of GLT is to determine the safety and efficacy argon laser trabeculoplasty ALT compared with topical medication timolol as initial treatment for primary open-angle glaucoma POAG.

A multicenter, randomized clinical trial designed to assess the efficacy and safety of argon laser trabeculoplasty ALT as an alternative to treatment with timolol for controlling intraocular pressure IOP in patients with newly diagnosed, previously untreated primary open-angle glaucoma POAG. Each patient had one eye randomly assigned to ALT and the other eye assigned to timolol maleate 0.

ALT was applied in two sessions of degrees burns, mW to blanch or barely form a bubble separated by four weeks. Primary endpoint: IOP. Secondary endpoints: Visual field and disc changes, VA. Follow-up: Two years minim, to nine years. There were no major differences between the two treatment approaches with respect to changes in visual acuity or visual field over the 2 years of follow-up.

The enrolment criteria, limiting previously untreated phakic patients, make the generalization of the findings of this study to other patient groups difficult.

The medications available to the s s were limited. Initial treatment with ALT resulted in fewer medications and slightly lower IOP at three years compared to initial treatment with timolol 0. ALT laser has comparable results to timolol 0. The second goal was to determine if LE or standard care is more cost-effective in the medium term.

LE is a definitive cure for angle closure, nevertheless, surgery has risks to consider, especially in patients with good vision and no significant cataract. Laser iridotomy and medication followed by glaucoma surgery when necessary result in more follow-up visits, more medication, and potentially more complicated surgery later.

From , to , patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment.

Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. It was not possible to mask interventions. The gonioscopy reporting was incomplete. The economic analysis was only in the UK setting, and it may not be generalizable. The Glaucoma Laser Trial: 4. Contralateral effects of timolol on the intraocular pressure of eyes treated with ALT. GLT Research Group. Ophthalmic Surg.

Subgroup differences at enrollment. Treatment group differences in visual field changes. Am J Ophthalmol.