Quantifying the effect of intraocular pressure reduction on the occurrence of glaucoma

Abstract

ABSTRACT.Purpose: To estimate the effect of reducing intraocular pressure (IOP) on: (i) the incidence of primary open-angle glaucoma (POAG) in patients with ocular hypertension (OH), and (ii) the progression of glaucoma. Methods: A meta-analysis of relevant randomized controlled trials was conducted. A literature search was performed to identify trials with: a randomized comparison of IOP-lowering intervention versus placebo or no treatment; visual field loss or optic disc changes as outcome; and follow-up >6 months. A pooled relative risk (RR) was calculated by a random effects model. Risk reduction of glaucoma conversion per mmHg of IOP reduction was quantified in a meta-regression model. Results: We identified nine OH and one POAG trials. A meta-analysis of OH trials gives a pooled RR of 0.61 [95% confidence interval (CI) 0.45-0.83]. A meta-regression shows a decrease of the RR of glaucoma conversion by 14% with each mmHg extra IOP reduction (P = 0.045). No meta-analysis of POAG trials was performed because only one study has been identified. Conclusion: There is sufficient evidence that OH therapy reduces the risk of conversion to glaucoma. This risk reduction increases with greater IOP reduction.

The relationship between visual field loss in glaucoma and health-related quality-of-life

“…More relevant, however, is the fact that visual field loss is related to vision and health-related quality-oflife (HRQOL), which directly reflect patients' experiences. [1][2][3][4][5] Ultimately the aim of glaucoma treatment is to prevent HRQOL loss, and knowledge about the relationship between visual field loss and HRQOL should have a function in treatment decisions. Several aspects of this relationship are clinically relevant.…”

A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy

“…6,14 However, our systematic review shows that still a considerable number of glaucoma patients become blind or visually impaired at the end of their life. Factors associated with end-of-life visual disability in glaucoma patients are advanced VF loss at diagnosis, 11,12,14 progression of VF loss, 14 noncompliance with treatment, 11 fluctuation of IOP during treatment, 11 higher IOP, 14 presence of PEXG, 11 longer duration of the disease (longer life expectancy), 14 and other eye diseases.…”

“…1,2,5 Nerve fiber loss and related VF loss are irreversible but lowering the intraocular pressure (IOP) reduces progression and risk of blindness. 1,6 The goal of eye care is to prevent visual loss and impairment in quality of life. Severe visual loss and blindness have a large impact on patients, health care providers, and society.…”

Glaucoma-Induced Degeneration of Retinal Ganglion Cells Prevented by Hypoxic Preconditioning: A Model of Glaucoma Tolerance

“…Yanli Zhu, 1 Lihong Zhang, 1 Jimena F Schmidt, 2 and Jeffrey M Gidday Like all cells, neurons adapt to stress by transient alterations in phenotype, an epigenetic response that forms the basis for preconditioning against acute ischemic injury in the central nervous system. We recently showed that a modified repetitive hypoxic preconditioning (RHP) regimen significantly extends the window of ischemic tolerance to acute retinal ischemic injury from days to months.…”

“…Current pharmacological treatments designed to lower intraocular pressure (IOP) in primary open-angle glaucoma have shown some efficacy in delaying or preventing the onset of disease (2), but many eligible patients do not receive regular treatment or derive significant benefit from this approach, and many individuals develop glaucoma in the absence of significant intraocular hypertension. Thus, neuroprotective-based therapeutic approaches to prevent or slow the progressive loss of retinal ganglion cells (RGCs) that characterize this neuropathy have received considerable attention (3,4).…”