May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Does Initial Treatment Approach Matter for Newly–Diagnosed Open–Angle Glaucoma? The Differential Role of Baseline Visual Field Severity in Subsequent Loss.
Author Affiliations & Notes
  • D.C. Musch
    Ophthalmology & Visual Sciences, and Epidemiology,
    Univ of MI Kellogg Eye Center, Ann Arbor, MI
  • B.W. Gillespie
    Biostatistics, Univ of MI, Ann Arbor, MI
  • P.R. Lichter
    Ophthalmology & Visual Sciences,
    Univ of MI Kellogg Eye Center, Ann Arbor, MI
  • R. Varma
    Ophthalmology, USC Doheny Eye Institute, Los Angeles, CA
  • G.L. Skuta
    Ophthalmology, Univ of OK Dean A. McGee Eye Institute, Oklahoma City, OK
  • K.E. Guire
    Biostatistics, Univ of MI, Ann Arbor, MI
  • CIGTS Study Group
    Univ of MI Kellogg Eye Center, Ann Arbor, MI
  • Footnotes
    Commercial Relationships  D.C. Musch, Allergan, Inc. F; B.W. Gillespie, Allergan, Inc. F; P.R. Lichter, Allergan, Inc. F; R. Varma, Allergan, Inc. F; G.L. Skuta, Pfizer, Inc. C, R; Allergan, Inc. F, R; Alcon, Inc. C, R; Merck, Inc. C, R; K.E. Guire, Allergan, Inc. F.
  • Footnotes
    Support  NIH Grant EY09148; Allergan, Inc.
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 969. doi:
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      D.C. Musch, B.W. Gillespie, P.R. Lichter, R. Varma, G.L. Skuta, K.E. Guire, CIGTS Study Group; Does Initial Treatment Approach Matter for Newly–Diagnosed Open–Angle Glaucoma? The Differential Role of Baseline Visual Field Severity in Subsequent Loss. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):969.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Abstract: : Purpose: To evaluate the impact of baseline visual field (VF) severity on subsequent VF loss and the relative impact of initial treatment choice on this association. Methods: 607 patients with newly–diagnosed open–angle glaucoma were randomly assigned to receive initial medications or initial trabeculectomy for treating their condition. These patients were examined at six month intervals by standardized testing including Humphrey 24–2 full threshold VF tests. VF severity was assessed by a score (ranging from 0 to 20) based on the total deviation probability plot, as well as by the mean deviation. Longitudinal repeated measures modeling analyses were conducted using SAS Proc Mixed and SAS Proc Genmod (the latter with GEE adjustment), to evaluate progression in VF loss over time. Analyses included follow–up data extending through 7 years post–randomization, and adjusted for other influential factors (e.g., age, race, and time). Results: For analyses treating progression in VF loss as a continuous variable, baseline VF severity showed a strong positive association with progressive VF loss in a nearly linear relation (P=0.0001). An interaction with initial treatment was also detected (P=0.037). For analyses treating progression in VF loss as a categorical variable, a similar interaction was observed (P=0.016). Patients with minimal VF loss at baseline (CIGTS VF score = 0; MD ≈ 0) had an increased risk of subsequent progressive VF loss if treated with initial surgery (OR=1.87; 95% CI: 1.17, 2.99), whereas patients with more advanced VF loss at baseline (CIGTS VF score = 16; MD ≈ –20) had a decreased risk of subsequent loss if treated with initial surgery (OR=0.51; 95% CI: 0.24, 1.09). Conclusions: The choice of initial treatment for newly–diagnosed open–angle glaucoma does appear to matter. Within the limitations of our follow–up (up to 7 years), medical treatment may be a more effective approach for those with minimal or mild VF loss, whereas surgical treatment may be a more effective approach for those with more advanced VF loss.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • visual impairment: neuro–ophthalmological disease 
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