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Priya Patel, Nicole Pritz, Robert Fechtner, Albert Khouri; Assessment of Intervisit IOP Control in Eyes with Advanced Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5634.
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The Advanced Glaucoma Intervention Study (AGIS) provided evidence more than a decade ago that low intraocular pressure (IOP) was associated with reduced progression of visual field defects. The aim of this study was to evaluate the extent of intervisit control of IOP with current treatments of patients with advanced glaucoma.
Medical records of consecutive patients with a diagnosis of advanced primary open angle glaucoma (POAG) at New Jersey Medical School between 06/2012 and 11/2012 were reviewed. Inclusion: POAG with documented cup-to-disc ratio ≥ 0.8 and visual field abnormalities in both hemifields and/or loss within 5° of fixation in at least one hemifield as tested with standard automated perimetry, >9 office visits. Exclusion: Glaucoma other than POAG, mild to moderate POAG, <9 office visits. Data on IOP, ocular medications, lens status, and ophthalmic surgeries (incisional and laser) were collected. IOP was categorized into one of four groups (Excellent <14, Good 14-17.5, Fair 18-21, Poor >21mmHg; consistent with AGIS). Effect of lens status and glaucoma surgery was analyzed. Percentages, means, paired t-tests, and chi-square analyses were used.
493 time points were collected for 50 eyes (28 patients). Mean age was 65 years (range: 46 to 88 years). The numbers of time points that fell within the various categories were: Excellent 173/493 (35%), Good 179/493 (36%), Fair 75/493 (15%), Poor 66/493 (13%). When further grouped into time points < or ≥ 18 mmHg, glaucoma surgery and lower mean number of medications were statistically significantly higher in time points with IOP <18 mmHg. The number of time points < 18 mmHg was higher for pseudophakic eyes, but this did not reach statistical significance (Table 1).
In eyes with advanced POAG, IOP control below 18 mmHg was achieved in about 70% of office visits, and was more often seen in eyes after glaucoma surgery. Rigorous IOP control remains a challenge in advanced POAG more than a decade after AGIS recommendations.
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