Medical versus surgical interventions for open angle glaucoma.

Area of Science:

• Ophthalmology
• Glaucoma Research
• Clinical Trials

Background:

• Open-angle glaucoma (OAG) is a leading cause of irreversible blindness globally.
• Understanding the comparative effectiveness of OAG treatments is crucial for patient care.

Purpose of the Study:

• To compare the efficacy and safety of medical versus surgical treatments for open-angle glaucoma (OAG).

Main Methods:

• Systematic review of randomized controlled trials comparing OAG medications to surgical interventions.
• Searched multiple databases (Cochrane, MEDLINE, EMBASE) and contacted researchers.
• Independent assessment of trial quality and data extraction by two authors.

Main Results:

• For mild OAG, no significant difference in visual field (VF) loss between medication and trabeculectomy over five years.
• Trabeculectomy was associated with higher risks of vision reduction, cataracts, and patient discomfort compared to medication.
• For moderate to advanced OAG, medication (pilocarpine) showed more VF loss and less intraocular pressure (IOP) reduction than surgery.
• Long-term data indicated a significantly higher risk of treatment failure with medication compared to trabeculectomy.

Conclusions:

• Mild OAG: VF deterioration is comparable between medication and trabeculectomy, but surgery poses higher risks.
• Severe OAG: Early medication (pilocarpine) linked to greater VF loss than surgery; surgery generally lowers IOP more effectively.
• Effectiveness of modern medications versus surgery for severe OAG and specific ethnic groups remains unproven.
• Further research is needed to evaluate contemporary treatments for OAG.