Immediate Treatment Helps Delay Progression Of Glaucoma

Researchers have found that immediately treating people who
have early stage glaucoma can delay progression of the
disease. This finding supports the medical community's
emerging consensus that treatment to lower pressure inside
the eye can slow glaucoma damage and subsequent vision
loss. These results are reported in the October 2002 issue
of "Archives of Ophthalmology."

Scientists found that immediate treatment of newly-
discovered primary open-angle glaucoma, the most common
form of glaucoma and one of the nation's leading causes of
vision loss, led to a slower rate of disease progression.
The findings from this study reinforce accumulating medical
evidence that lowering eye pressure in glaucoma's early
stages slows progression of the disease.

"These results strongly support the body of evidence
suggesting that immediate treatment of early stage, open-
angle glaucoma will slow the disease progression," said
Paul Sieving, M.D., Ph.D., director of the National Eye
Institute (NEI), one of the Federal government's National
Institutes of Health and co-sponsor of the study.
"Unfortunately, glaucoma has no early warning signs, and
many affected patients are unaware they have the disease
until it has advanced. Once people have lost vision from
glaucoma, it cannot be regained. However, early detection
and timely treatment would help to save the vision of
thousands of people each year."

Dr. Sieving also notes that the study results provide
important new medical knowledge on the course of the
disease, both among treated and untreated patients.
"Because most people are treated for glaucoma as soon as
they are diagnosed, little is known about the natural
history of the disease," he said. "Future reports from the
study will add further important information on glaucoma
progression and its risk factors."

The study -- called the Early Manifest Glaucoma Trial --
followed 255 patients, aged 50-80 years, with early stage
glaucoma in at least one eye. Most patients were identified
in a population screening. The average age of the patients
at the beginning of the study was 68 years. One group (129
patients) was treated immediately with medicines and laser
to lower eye pressure, and the other group (126 patients) -

the control group -- was left untreated. Both groups were
followed carefully and monitored every three months for
early signs of advancing disease, using indicators that are
extremely sensitive for detecting glaucoma progression. Any
patient in the control group whose glaucoma progressed was
immediately offered treatment.

After six years of followup, scientists found that
progression was less frequent in the treated group (45
percent) than in the control group (62 percent), and
occurred significantly later in treated patients. Treatment
effects were also evident in patients with different
characteristics, such as age, initial eye pressure levels,
and degree of glaucoma damage. In the treated group, eye
pressure was lowered by an average of 25 percent.

The study was a collaborative effort involving the
University of Lund, Sweden, with centers in Malm?,
Helsingborg, and Lund, Sweden, as well as Stony Brook
University, Stony Brook, New York.

These results should be put into perspective, according to
Anders Heijl, M.D., Ph.D., chairman of the Department of
Ophthalmology at Sweden's Malm? University Hospital and
first author of the report. "Although the study closely
checked for possible glaucoma progression, many of the
patients remained stable over time, even those in the
control group," Dr. Heijl said. "On the other hand, despite
the clear effect of treatment, glaucoma progressed in as
many as 30 percent of treated patients after four years."

Dr. Heijl said that the time it took for glaucoma to
progress varied greatly among patients and was sometimes
rather short, even in treated patients. "This shows that in
many patients with rapidly progressing glaucoma, the
treatment used in this study was insufficient to halt
progression of the disease," Dr. Heijl said.

Dr. Heijl emphasized that treatment for early, newly
diagnosed glaucoma should be individualized and carefully
balanced. Before deciding on the best treatment option, eye
care professionals should consider several unique patient
factors, such as age, eye pressure levels, and disease
severity. "The study findings support the medical
community's growing contention that glaucoma treatment
should be tailored to the individual needs of the patient,"
Dr. Heijl said. "One option could include no initial
treatment, but subsequent treatment if the disease
progresses. Many glaucoma medicines have side effects, so
the decision not to treat the disease in its early stage --
but closely monitor patients -- can postpone or obviate the
need for medications."

Although the study results confirm the belief that reducing
eye pressure is beneficial, "they do not prove that
elevated eye pressure in itself is the primary cause of
glaucoma," said M. Cristina Leske, M.D., chair of the
Department of Preventive Medicine at Stony Brook University
and a study co-author. "However, because reducing eye
pressure slows the progression of glaucoma, eye pressure
levels are important in the course of the disease."

Dr. Leske said that the study treatment had few side
effects. The most important was an increase in nuclear
opacities, a type of cataract, but the number of related
cataract surgeries in the treated group was small.

Open-angle glaucoma affects about 2.2 million Americans age
40 and over; another two million may have the disease and
don't know it. Glaucoma occurs when the optic nerve is
damaged. In most cases, increased pressure in the eye is a
risk factor for this damage. The damage to the optic nerve
causes loss of peripheral (side) vision, although people
are often unaware that they have glaucoma. As the disease
worsens, the field of vision gradually narrows and
blindness can result. However, if detected early through a
comprehensive eye exam, glaucoma can usually be controlled
and serious vision loss prevented.

The Early Manifest Glaucoma Trial was co-sponsored by the
Swedish Research Council. A list of EMGT study centers and
principal investigators is attached.

The National Eye Institute is part of the National
Institutes of Health (NIH) and is the Federal government's
lead agency for vision research that leads to sight-saving
treatments and plays a key role in reducing visual
impairment and blindness. The NIH is an agency of the U.S.
Department of Health and Human Services.

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