Trials Flashcards
What does OHTS stand for?
Results?
Ocular Hypertension Treatment Study 1996
20% reduction in IOP halves risk of progression to POAG
Identified RF
In OHTS - how much was the IOP lowered?
How much did medication reduce the risk
20%
half from 9.5% to 4.4%
OHTS Risk Factors
- Higher IOP
- Older Age
- Large Cup-Disc Ration
- Reduced CCT
- Increased PSD (Pattern std deviation)
OHTS 4 Implications
- Tx of mod-High risk pt e.g. IOP>26 % CCT <555 = 36% progress at 5 years.
IOP at 24 - only 12% - Need for multiple VF
- Pachymetry is important.
- Phaco & IOL can achieve IOP reduction.
What does EMGT stand for?
What did it compare?
Early Manifest Glaucoma Trial 1997
Compared beta blocker +/- laser Vs Observation.
EMGT Results?
reduction of 25% IOP
Progression Tx = 45% vs Control 65%
Each 1mmHg drop = 10% less risk of progression.
EMGT Risk Factors, Baseline and post Tx
Baseline: IOP>20, PSD>4, bilateral disease PXF
Post Tx: Disc Haemorrhage, less reuduction in IOP, higher mean IOP.
EMGT Implications
First study to show that decreasing IOP reduced progression.
Each 1 mmHG is associated with lower risk of progression.
CNTGS?
Aim?
Collaborative Normal Tension Glaucoma Study 1998
Does aggressive lowering of IOP reduce or prevent VF progression & Nerve damage in NTG?
CNTGS Method & how much was IOP lowered
two groups, one treated with medication (laser or surgery) the other had no treatment.
30% reduction.
CNTGS Results
Progression
Treated = 12% vs Untreated = 35%
Reduction of 66%
CNTGS Vascular regulation factors.
Disc Haemorrhage
Migraine
Female
Nocturnal Hypotension - 24 hr BP monitoring.
*Important to exclude other causes of optic neuropathy.
NTG - Classic Patient
Middle Aged female - migraine.
CIGTS what does it stand for?
Aim?
Collaborative Initial Glaucoma Treatment Study 1997
Compare long term effects of medication vs surgery in newly diagnosed POAG.
CIGTS Method
Follow up duration
- Medical -> ALT -> Surgery
- Surgery -> ALT -> Medical
5 Year follow up.
