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Medical treatment or surgery are both effective first-line glaucoma treatments

WESTPORT, CT (Reuters Health) – Medical treatment or surgery can lower
intraocular pressure and reduce visual field loss, and both are effective as first-line treatments for glaucoma, according to interim outcome study data released on Wednesday at the annual meeting of the American Academy of Ophthalmology in New Orleans.

"In the US, medications are used as initial treatment, and [then] surgery is used if medications are not effective," Dr. Paul R. Lichter, of the University of Michigan Kellogg Eye Center in Ann Arbor, told Reuters Health.

Dr. Lichter and colleagues analyzed outcomes in 307 patients treated with standard glaucoma eye drops or oral medications and 300 patients who underwent trabeculectomy. The multicenter trial included patients who were newly diagnosed with open-angle glaucoma.

After 5 years of follow-up, Dr. Lichter reports that both groups had an effective lowering of intraocular pressure from an average baseline of 28 mm Hg to 17-18 mm Hg in the medication group, and an average baseline of 27 mm Hg to 14-15 mm Hg in the surgical group.

At some point during follow-up, 13.5% of surgical patients had a substantial loss of visual field, compared with 10.7% of medically treated patients, Dr. Lichter said. In the surgically treated patients, a clinically substantial loss of visual acuity, which the investigators defined as equal to three lines on an eye chart, was seen during 7.2% of the visits. A loss of visual acuity in the medically treated patients was observed during 3.9% of the visits.

Dr. Lichter also reported that 19% of the surgical cohort required cataract surgery during the follow-up period compared with 8% of the medically treated patients.

It is important to remember that glaucoma and its treatment affect not only the patient's eyes but the patient's quality of life, Dr. Lichter said, noting that "both groups on average were satisfied with treatment."

"Small differences in visual acuity and visual field, detected in an intensive study, may not affect patient's quality of life," Dr. Lichter told Reuters Health. He believes that a "longer follow-up is needed prior to recommending a change in the usual treatment for glaucoma in the US."

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