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Abstract #8461 Published in IGR 5-1
Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial
Leske MC; Heijl A; Hussein M; Bengtsson B; Hyman L; Komaroff E; Early Manifest Glaucoma Trial GroupArchives of Ophthalmology 2003; 121: 48-56
OBJECTIVE: To assess factors for progression in the Early Manifest Glaucoma Trial (EMGT), including the effect of EMGT treatment. SETTING/PARTICIPANTS: Two hundred and fifty-five open-angle glaucoma patients randomized to argon laser trabeculoplasty plus topical betaxolol or no immediate treatment (129 treated; 126 controls) and followed up every three months. METHODS: Progression was determined by perimetric and photographic optic disc criteria. Patient-based risk of progression was evaluated using Cox proportional hazard regression models and was expressed as hazard ratios (HR) with 95% confidence intervals (95% CI). RESULTS: After six years, 53% of patients had progressed. In multivariate analyses, progression risk was halved by treatment (HR = 0.50; 95% CI, 0.35-0.71). Predictive baseline factors were higher intraocular pressure (IOP) (i.e., the higher the baseline IOP, the higher the risk), exfoliation, and having both eyes eligible (each of the latter two factors doubled the risk), as well as worse mean deviation and older age. Progression risk decreased by about 10% with each millimeter of mercury of IOP reduction from baseline to the first follow-up visit (HR = 0.90 per mm of mercury decrease; 95% CI, 0.86-0.94). The first IOP at that visit (three months' follow-up) was also related to progression (HR = 1.11 per mm of mercury higher; 95% CI, 1.06-1.17), as was the mean IOP at follow-up (HR = 1.13 per mm of mercury higher; 95% CI, 1.07-1.19). The percent of patient follow-up visits with disc hemorrhages was also related to progression (HR = 1.02 per percent higher; 95% CI, 1.01-1.03). No other factors were identified. CONCLUSIONS: Patients treated in the EMGT had half the progression risk of control patients. The magnitude of initial IOP reduction was a major factor influencing outcome. Progression was also increased with higher baseline IOP, exfoliation, bilateral disease, worse mean deviation, and older age, as well as frequent disc hemorrhages during follow-up. Each higher (or lower) millimeter of mercury of IOP on follow-up was associated with an approximate 10% increased (or decreased) risk of progression.
Dr. M.C. Leske, Department of Preventive Medicine, Stony Brook University School of Medicine, Health Sciences Center, L3 086, Stony Brook, NY 11794-8036, USA. cleske@notes.cc.sunysb.edu
Classification:
9.2.2 Other risk factors for glaucoma (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)
