Glaucoma management reconsidered: insights from LiGHT, ZAP, TAGS, PTVT, and EAGLE

Several high-quality prospective clinical trials have emerged in recent years that have provided evidence to support changes in management of glaucoma. This article reviews results from five recent landmark studies and discusses how they may impact clinical practice.

Five multicenter trials - LiGHT, ZAP, EAGLE, TAGS, and PTVT - have reshaped glaucoma management strategies. LiGHT demonstrated that selective laser therapy is a well tolerated and effective first-line therapy for open-angle glaucoma. ZAP investigated routine use of prophylactic laser peripheral iridotomy, emphasizing the importance of risk stratification in primary angle closure suspects. EAGLE established clear-lens exchange as a viable alternative to conventional treatment in select patients with angle closure anatomy. TAGS showed that primary trabeculectomy provides better intraocular pressure (IOP) control and reduced visual field progression in advanced disease. Finally, PTVT highlighted that both trabeculectomy and tube shunt surgeries remain appropriate initial surgeries, with procedure choice best guided by baseline IOP, risk tolerance, and patient goals.

Improvements in laser and surgical technology, increased understanding of the natural history of glaucoma, and evidence regarding the importance of early intervention in disease have led to fundamental changes in glaucoma practice. The five clinical trials reviewed in this article support these shifts and provide frameworks to guide clinical practice.