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M. P. Villegas-Perez, J. Calzado-Hinojosa, A. Ortiz-Gomariz, J. Miralles de Imperial; Overtreatment of Glaucoma: The Murcia Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5585.
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To investigate the clinical characteristics of the patients receiving monotherapy for ocular hypertension (OH) or primary open angle glaucoma (POAG) in our health area and to evaluate the sensitivity and specificity of the Moorfields Regression Analysis (MRA) Classification of the Heidelberg II Retina Tomograph (HRT II).
Ninety six patients receiving monotherapy for OH or POAG were recruited from our clinic and followed for one year. The treatment was interrupted three weeks before the first visit and the patients were examined five times during the study: in the first or recruiting visit, and 1, 3, 6 and 12 months thereafter. Central corneal thickness and gonioscopy were evaluated in the first visit; examination of the anterior segment, optic disk and intraocular pressure (Perkins applanation tonometry) were carried out in every visit; and examination of contrast sensitivity, visual fields (SITA fast 30-2) and optic disk topography (HRT II) were carried out in the first, fourth and fifth visit. The patients that presented intraocular pressures equal or superior to 23 mm of Hg in any of the visits were treated again with one of the following substances: timolol, latanoprost or brimonidine, at the standard clinical dose. Seventy patients completed the study and received a clinical diagnosis based mainly in three parameters: intraocular pressure, optic disk morphology and visual field evaluation and a second diagnosis by the MRA Classification.
At the end of the study, only 31 patients (44.3%) needed treatment because of OH or POAG. The three ocular hypotensive drugs showed similar efficacy. Thirty-nine patients (55.7%) did not require treatment. Of these, 7 patients (10%) were suspicious of normotensive glaucoma and 32 patients (45.7%) were considered normal.
We concluded that around 50% of the patients receiving monotherapy for glaucoma or ocular hypertension in our health area do not need treatment. The MRA Classification showed a sensitivity between 79.3 and 83.3% and a specificity between 83.7 and 87.9%.
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