Medical interventions for primary open angle glaucoma and ocular hypertension

Area of Science:

• Ophthalmology
• Pharmacology
• Clinical Trials

Background:

• Primary open-angle glaucoma (POAG) is a progressive optic neuropathy characterized by elevated intraocular pressure (IOP), optic nerve damage, and visual field (VF) loss.
• Ocular hypertension (OHT) presents with elevated IOP but without optic nerve or VF pathology, yet it is a significant risk factor for POAG development.

Purpose of the Study:

• To evaluate and compare the efficacy of topical pharmacological treatments in preventing the onset or progression of glaucomatous optic neuropathy in patients with POAG or OHT.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
• Searches included CENTRAL, MEDLINE, and EMBASE databases, supplemented by bibliographical reviews and expert consultations.
• Data from 26 RCTs involving 4979 participants were analyzed, focusing on treatment duration of at least one year.

Main Results:

• Meta-analysis of 10 trials demonstrated a significant reduction in the onset of VF defects in treated OHT patients (OR 0.62).
• No single drug class showed statistically significant VF protection compared to placebo or untreated controls.
• Weak evidence suggested a potential VF protective effect for beta-blockers (OR 0.67).

Conclusions:

• Medical IOP-lowering treatment demonstrates a clear visual field protective effect in OHT.
• While beta-blockers show some promise, direct comparisons for newer agents like prostaglandins or brimonidine against placebo are lacking.
• Treatment decisions should be individualized based on patient-specific factors such as IOP level, existing damage, and age.