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Glaucoma > Landmark Trials > Flashcards

Landmark Trials Flashcards

1
Q

Objective of the European Glaucoma Prevention Study

A

To evaluate the efficacy of IOP reduction by dorzolamide in preventing or delaying the development of POAG in patients with OHT

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2
Q

Sample in European Glaucoma Prevention Study

A

OHT

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3
Q

Treatment groups in European Glaucoma Prevention Study

A

Dorzolamide

Placebo

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4
Q

Dorzolamide vs Placebo in preventing or delaying the development of POAG in patients with OHT

A

No difference (EGPS)

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5
Q

Risk factors for conversion of OHT to POAG

A 
Both EGPS and OHTS:
Older age
Larger vertical cup–disc ratio
Worse PSD (pattern standard deviation)
Reduced CCT (central corneal thickness)

EGPS only:
Greater vertical cup–disc asymmetry

OHTS only:
Higher IOP

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6
Q

Objective of Ocular Hypertension Treatment Study

A

To evaluate the safety and efficacy of topical glaucoma medications in preventing or delaying the onset of POAG in patients with OHT

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7
Q

Sample in OHTS

A

IOP of 24–32 in one eye, 21–32 in the other eye, without evidence of glaucomatous damage (normal VF, normal discs)

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8
Q

Treatment groups in OHTS

A

Treatment (topical glaucoma medications to reduce IOP 20% and ≤ 24 mm Hg)

Observation

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9
Q

Ocular hypertension: Treat or observe?

A

EGPS: Observe.
OHTS: Observe low-risk, treat high-risk.

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10
Q

OHTS results

A

Treatment delays onset of glaucoma

Treating abnormally elevated intraocular pressure (IOP) with topical medications delays or prevents the onset of glaucomatous damage

Higher probability of glaucomatous conversion in observation group

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11
Q

Risk categories for OHT

A

Low Moderate High
IOP (mmHg) <23.75 23.75-25.75 >25.75
CCT (uM) >588 555-588 <555
Vertical C/D <0.30 0.30-0.50 >0.50

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12
Q

How to treat OHT in terms of risk

A

High risk = close follow-up and some from early treatment

Low-risk = less frequent follow-up and may not need early treatment.

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13
Q

When do you consider observation in OHT patients?

A

Consider observation before treatment in some patients (e.g. low-risk patients).

Only 10 or 20 percent of people with ocular hypertension eventually develop glaucoma

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14
Q

Aim of Collaborative Normal-Tension Glaucoma Study (CNTGS)

A

To determine whether reducing IOP favorably influenced the course of normal-tension glaucoma (NTG)

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15
Q

NTG: Treat or observe?

A

Treat

Lowering IOP is an effective treatment for NTG.
Glaucoma progression was slower in the treated group than in the untreated group

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16
Q

Treatment groups in CNTGS

A

Treatment (glaucoma medications, laser, and/or surgery to reduce IOP by 30%)
Observation

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17
Q

Risk factors for NTG progression

A

Female gender
Non-Asian race
Disc hemorrhages
Migraines

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18
Q

Aim of Early Manifest Glaucoma Trial (EMGT)

A

To evaluate the effectiveness of reducing IOP in patients with open-angle glaucoma

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19
Q

Sample of Early Manifest Glaucoma Trial (EMGT)

A

Newly-diagnosed OAG

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20
Q

Treament groups of Early Manifest Glaucoma Trial (EMGT)

A

Treatment (ALT and betaxolol)

Observation (left untreated until signs of progression appeared)

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21
Q

OAG: Treat or observe?

A

Treat

Treat IOP early. Lowering IOP is effective in decreasing the rate of progression in patients with newly diagnosed open-angle glaucoma (EMGT)

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22
Q

According to EMGT, every 1 mmHg of IOP reduction was associated with a risk reduction of ___%

A

10%

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23
Q

Risk factors for progression of OAG

A

BI-MODE

Bilateral disease
IOP, higher at baseline
MD, worse
Older age
Disc hemorrhages, recurrent
Exfoliation syndrome
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24
Q

An important pressure-independent risk factor for progression of OAG according to EMGT

A

Exfoliation syndrome

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25
Q

Aim of Collaborative Initial Glaucoma Treatment Study (CIGTS)

A

Trabeculectomy vs. drugs for initial therapy of OAG

26
Q

OAG: Meds or Trab?

A

Offer meds in early OAG.
• IOP significantly reduced at baseline
• VF change similar to surgery
Consider surgery first in patients with moderate or advanced disease.

27
Q

Treatment group in Collaborative Initial Glaucoma Treatment Study (CIGTS)

A 
Medical therapy (stepped topical medication)
Trabeculectomy
28
Q

When to use meds over trab in OAG according to CIGTS?

A

Low-risk

DM and African-American

29
Q

Surgery is associated with ______ according to CIGTS

A

Cataract

30
Q

Measured QOL as part of its outcomes

A

CIGTS

31
Q

Aim of Glaucoma Laser Trial

A

To assess the efficacy and safety of ALT as an alternative to medical treatment for newly diagnosed POAG

32
Q

OAG: Meds first or Laser first?

A

Laser first

ALT is a safe and effective treatment to lower IOP in patients with newly diagnosed POAG (GLT)

33
Q

Treatment groups in GLT

A
  • Laser first (LF)
    • 360° ALT followed by stepped medication regimen
  • Medication first (MF)
    • stepped medication regimen (timolol as initial drug)
34
Q

Sample in GLT

A

Newly diagnosed POAG

35
Q

Aim of Advanced Glaucoma Intervention Study

A

Compare clinical course of 2 surgical treatment sequences

36
Q

OAG: Laser first or surgery first?

A

It depends on the race. Laser first in Black, surgery first in White.

Higher rate of VA (visual acuity) loss in black patients with TAT sequence
Higher rate of VF (visual field) loss in white patients with ATT sequence

37
Q

Treatment groups in AGIS

A

ATT (ALT then trab)

TAT (Trab then ALT)

38
Q

Factors associated with trabeculectomy failure according to AGIS

A

Diabetes

Postoperative complication

39
Q

“There is dose-response relationship between IOP and risk of glaucoma”

A

AGIS

40
Q

Factors associated with both trabeculectomy AND ALT failure according to AGIS

A

Younger age

Higher IOP

41
Q

Aim of Tube Versus Trabeculectomy (TVT)

A

To compare the safety and efficacy of tube shunt surgery and trabeculectomy with MMC in eyes with previous ocular surgery

42
Q

Sample in TVT

A

Patients who had undergone cataract extraction with intraocular lens implantation and/or failed filtering surgery

43
Q

Post-surgical eyes: Tube or Trab?

A

No clear winner.

44
Q

Treatment groups in TVT

A

Tube: Baerveldt glaucoma implant
Trab: Trabeculectomy with mitomycin C

45
Q

Aim of Ahmed Baerveldt Comparison
(ABC) Study and Ahmed Versus
Baerveldt (AVB) Study

A

Compare surgical outcomes of two glaucoma shunt devices

46
Q

Treatment groups in ABC and AVB

A
  • Ahmed glaucoma valve

* Baerveldt glaucoma implant

47
Q

Refractory glau: Ahmed or Baerveldt?

A

It depends.

Ahmed is desirable in:

  1. Patients at higher risk of postoperative hypotony (eg, uveitic glaucoma or prior cyclodestruction)
  2. Setting of markedly elevated IOP

Baerveldt is preferred

  1. When low IOP is needed
  2. Tolerance of glaucoma medications is limited.
48
Q

Ahmed valve desirable in

A
  1. Patients at higher risk of postoperative hypotony (eg, uveitic glaucoma or prior cyclodestruction)
  2. Setting of markedly elevated IOP

Due to the following reasons:
Lower rate of serious postoperative complications
Lower hypotony-related vision-threatening complications
Greater IOP reduction during the first few weeks postoperatively

49
Q

Baerveldt valve desirable in

A

Baerveldt is preferred when low IOP is needed and/or tolerance of glaucoma medications is limited.

Greater long-term IOP reduction
Fewer glaucoma meds

50
Q

Why is Baerveldt more effective in reducing IOP in the long term?

A

The larger plate of the Baerveldt implant likely explains its greater efficacy, as the larger surface area plate is associated with greater pressure reduction.

51
Q

Why is Ahmed more effective in preventing hypotony?

A

Ahmed valve’s mechanism appears to provide an additional level of safety by minimizing the risk of hypotony in the early postoperative period

52
Q

EGPS

A

European
Glaucoma
Prevention
Study

OHT: Treat or observe?

53
Q

OHTS

A

Ocular
Hypertension
Treatment
Study

OHT: Treat or observe?

54
Q

CNTGS

A

Collaborative
Normal-Tension
Glaucoma
Study

NTG: Treat or observe?

55
Q

EMGT

A

Early
Manifest
Glaucoma
Trial

OAG: Treat or observe?

56
Q

CIGTS

A 
Collaborative 
Initial 
Glaucoma 
Treatment 
Study

OAG: Meds or Trab?

57
Q

GLT

A

Glaucoma
Laser
Trial

OAG: Meds first or Laser first?

58
Q

AGIS

A

Advanced
Glaucoma
Intervention
Study

OAG: Laser first or surgery first? ATT vs TAT?

59
Q

TVT

A

Tube
Versus
Trabeculectomy

Post-surgical eyes: Tube or Trab?

60
Q

ABC

A

Ahmed
Baerveldt
Comparison

Refractory glau: Ahmed or Baerveldt?

61
Q

AVB

A

Ahmed
Versus
Baerveldt

Refractory glau: Ahmed or Baerveldt?

Glaucoma (1 decks)

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