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Abstract #10504 Published in IGR 6-1
Interventions for normal tension glaucoma
Sycha T; Vass C; Findl O; Bauer P; Groke I; Schmetterer L; Eichler HCochrane Database of Systematic Reviews 2003; 4: CD002222
BACKGROUND: Normal tension glaucoma is a clinical condition in which the optic nerve is pathologically excavated and the visual field is disturbed. Nevertheless it has been assumed that intraocular pressure (IOP) plays a role in the progression of visual field defects in this disease, but other, mainly vascular factors, have been discussed as well. OBJECTIVES: To assess the effects of medical and surgical treatments for normal tension glaucoma. SEARCH STRATEGY: Trials were identified from the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group trials register), MEDLINE, EMBASE and BIOSIS Previews. Bibliographies of identified trials were searched to find additional trials. In addition, investigators and pharmaceutical companies were contacted. Date of last search: January 2001. SELECTION CRITERIA: This review includes randomized controlled trials in which medical or surgical interventions were compared to no treatment, placebo or other treatment in people with normal tension glaucoma. Two reviewers independently assessed the full text copies of the possibly relevant trials. Trial quality was assessed according to the methods set out in Section 6 of the Cochrane Reviewers' Handbook (Clarke 2000). DATA COLLECTION AND ANALYSIS Data were extracted by two reviewers and results were compared for differences. Discrepancies were resolved by discussion. The heterogeneity of interventions, follow-up periods and outcomes did not allow for statistical combinations of the study results. MAIN RESULTS: According to the selection criteria on visual field loss, eight studies were included in this review. Only three studies focused on patient relevant outcomes. In one trial a beneficial effect of lowering IOP was found, but only if data were corrected for cataract development. In two small studies a beneficial effect on visual field loss of brovincamine, a calcium antagonist was reported. REVIEWER'S CONCLUSIONS: In one study, the effect of IOP lowering on visual field outcome was only significant when data were corrected for cataract development. The results for calcium antagonists are promising, but larger trials have to be performed. Studies that focused on reduction of IOP or hemodynamic variables are not necessarily relevant for the outcome in people with normal tension glaucoma.
Dr. T. Sycha, Department of Clinical Pharmacology, University of Vienna, Medical School, Allgemeines Krankenhaus Wien, Wahringer-Gurtel 18-20, Vienna, A-1090, Austria
Classification:
9.2.4 Normal pressure glaucoma (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)
