Faculty Collaboration Database

Five-year follow-up optic disc findings of the Collaborative Initial Glaucoma Treatment Study. Am J Ophthalmol 2009 Apr;147(4):717-724.e1

Date

01/21/2009

Pubmed ID

19152871

Pubmed Central ID

PMC2714658

DOI

10.1016/j.ajo.2008.10.007

Scopus ID

2-s2.0-62649097711 (requires institutional sign-in at Scopus site)   83 Citations

Abstract

PURPOSE: To determine the effect of intraocular pressure (IOP) lowering on the optic disc in patients of the Collaborative Initial Glaucoma Treatment Study (CIGTS) after 5 years.

DESIGN: Randomized clinical trial.

METHODS: The baseline and 5-year stereoscopic optic disc photographs of 348 eyes (patients) randomized to medical or surgical treatment of open-angle glaucoma (OAG) were assessed by 2 independent readers for change in a masked side-by-side comparison, and confirmed by an independent committee.

RESULTS: Three hundred and three (87.1%) eyes showed no change, 22 (6.3%) showed enlargement of the cup along any meridian (progression), and 23 (6.6%) showed a reduction in the cup along any meridian (reversal of cupping). Incidence of optic disc progression was higher (P = .007) in the medicine group, 18/185 (10%) than in the surgical group 4/163 (3%); and the incidence of reversal of cupping was higher (P < .001) in the surgical group, 21/163 (13%), than the medicine group, 2/185 (1%), (P < .001). Visual field (VF) worsening (mean deviation) was significantly associated with progression of optic disc cupping (P < .001). Reversal of cupping was also associated with lower postoperative IOP (P < .001). Reversal of cupping was not associated with improvement of either visual acuity or central VFs.

CONCLUSIONS: Surgery prevents or delays glaucomatous progression as measured by optic disc criteria in patients with early OAG. Reversal of cupping occurs more frequently in the surgical group than in the medical treatment group. Reversal is associated with lower IOP, but is not associated with improved visual function.

Author List

Parrish RK 2nd, Feuer WJ, Schiffman JC, Lichter PR, Musch DC, CIGTS Optic Disc Study Group

Author

Dale Heuer MD Emeritus Professor in the Ophthalmology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antihypertensive Agents
Disease Progression
Double-Blind Method
Female
Follow-Up Studies
Glaucoma, Open-Angle
Humans
Incidence
Intraocular Pressure
Male
Middle Aged
Optic Disk
Optic Nerve Diseases
Photography
Risk Factors
Trabeculectomy
Vision Disorders
Visual Fields