Best Glaucoma Treatments Still a Puzzle, Task Force Reports

By Maureen Salamon

HealthDay Reporter

MONDAY, Feb. 18 (HealthDay News) -- Drugs and surgery can lower the hallmark inner-eye pressure characteristic of glaucoma -- the second-leading cause of blindness in the United States. But research still hasn't identified the best ways to prevent significant vision loss and improve patient satisfaction, according to a prominent government medical group.

The U.S. Preventive Services Task Force (USPSTF) reviewed dozens of studies and collective reviews on open-angle glaucoma, which accounts for about 90 percent of all cases, concluding there's inadequate evidence to directly compare the effectiveness of medical, surgical or laser treatments.

The task force, comprised of 16 independent experts in prevention and evidence-based medicine, also said it couldn't determine whether glaucoma screening for adults without previous vision problems prevents blindness or enhances long-term health.

"We know that treatments are effective, but we don't know enough to say treatment A is definitely better than treatment B," said task force co-vice chair Dr. Albert Siu, director of geriatric research, education and the clinical center at James J. Peters VA Medical Center in the Bronx, N.Y. "What we do know is that these treatments are effective in reducing the development and progression in small losses of [peripheral vision]. What isn't clear is how this translates into reducing vision problems or vision quality of life."

The task force report is published Feb. 19 in Annals of Internal Medicine.

Open-angle glaucoma affects about 2.5 million Americans, primarily seniors, older blacks and those with a family history, the task force said. Often symptomless, the condition is diagnosed with a combination of tests that show degenerative changes in the optic nerve head and a loss of peripheral vision.

Complicating diagnosis, however, is the fact that many people with open-angle glaucoma don't suffer from characteristically increased pressure in the inner eye (called intraocular pressure), and not all with elevated pressure go on to develop glaucoma. The condition develops over years and has a highly variable course, with some people never progressing to visual problems.

The dozens of collective reviews and studies on glaucoma treatments analyzed by the USPSTF reported mixed results. Some evidence suggested surgical treatment was slightly more effective than drugs at decreasing intraocular pressure and protecting against worsening peripheral vision loss. Treatment side effects -- such as eye redness from topical medications -- were common, and surgery can raise the risk of adverse effects such as cataracts, infections and bleeding.

One expert not associated with the study gave his reaction.

"We could say for sure there are interventions for lowering intraocular pressure . . . but that had better be true. We didn't need this study to tell us that lowering intraocular pressure tends to slow the progression of disease," said Dr. Louis Pasquale, co-director of the glaucoma center at Massachusetts Eye and Ear Infirmary, in Boston. "What this study is saying is there are many ways of lowering eye pressure and we don't know which one is best for minimizing visual disability and maximizing patient happiness while they're being treated for glaucoma."

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New Eye Test May Help Predict Risk of Glaucoma

Jan. 4, 2013 -- A new study from Australia may offer a new way of identifying people at risk of glaucoma years before vision loss happens.

Glaucoma is a leading cause of blindness. But because vision damage often occurs gradually, most people with the eye disease do not realize they have it until a good deal of their sight has been lost. If caught early, though, there are medications and procedures that may help treat glaucoma.

In the study, researchers were able to predict who was at increased risk of developing the eye disease with some accuracy by measuring blood vessel thickness in the retinas of study participants using a computer-based imaging tool.

Those with the narrowest vessels at the beginning of the study were four times more likely to have developed glaucoma a decade later.

About 3 million Americans and 60 million people worldwide have glaucoma, and the numbers are projected to rise over the next few decades as the population ages.

The disease involves damage to the optic nerve, which relays images from the retina to the brain.

Early detection is key, but without regular eye exams, most people don’t know they have a problem, says ophthalmologist Andrew Iwach, MD. He is the executive director of the Glaucoma Center of San Francisco and an associate clinical professor of opthalmology at the University of California, San Francisco.

“We call this disease a ‘thief of vision’ because most people with it have no idea that they have lost sight until it is too late to bring it back,” Iwach says.

In the study, researchers from the University of Sydney followed nearly 2,500 adults, aged 49 and older, for 10 years.

None of the participants had glaucoma when they entered the study.

Compared with the group as a whole, those people who were diagnosed with the eye disease during the following decade were older, had higher blood pressure, and were more likely to be female.

The researchers concluded that measuring retinal-vessel narrowing could help identify people at risk for glaucoma. But they added that blood pressure and other factors that can contribute to vessel size would need to be considered.

The study appears in the latest issue of the journal Ophthalmology.

The researchers say that the findings also highlight the importance of having regular eye exams as people age.

The American Optometric Association recommends eye exams for adults aged 18 to 60 every two years, every year for adults 61 and older, or as recommended by their eye doctor.

In addition to glaucoma, regular exams can detect other eye diseases associated with aging, including macular degeneration and cataracts, Iwach says.

Eye surgeon Mark Fromer, MD, of Lenox Hill Hospital in New York City, agrees that having regular eye exams is the best protection against vision loss associated with aging.

“It remains to be seen if this approach will help us identify people at risk for glaucoma sooner,” he says. “We have a number of tools now to help us do that, but we’ve got to get people in our offices to use them.”

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