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Study Supports Early Glaucoma Treatment

Finds commonly used practice delays progression of vision loss

WEDNESDAY, Oct. 16, 2002 (HealthDayNews) -- The eye disease glaucoma should be treated in the early stages to delay progression of vision loss, a new study suggests.

The conclusion, reported in the October issue of the Archives of Ophthalmology, lends support to what most eye specialists are already doing and is lauded by one expert as validation of what has become standard practice.

The researchers, from Sweden's Malmo University Hospital and the State University of New York at Stony Brook, followed 255 patients, aged 50 to 80, with early-stage glaucoma in at least one eye. Each had the type of glaucoma known as primary open angle, the most common type, in which the drainage canals in the eye become clogged over time, leading to higher pressure within the eye as fluid builds up.

Open angle glaucoma affects about 2.2 million Americans, according to the National Eye Institute, and another 2 million may have it and not know it.

In the study, one group of 129 patients was treated immediately after diagnosis with eyedrop medication and laser surgery to help fluid drain, while another group of 126 was untreated. However, both groups were followed closely and any control group patient whose disease showed signs of progressing was offered treatment.

After six years of follow-up, 62 percent of the untreated control group had progression, but only 45 percent of the treatment group did.

The study results point to the wisdom of early treatment, but they do not necessarily mean everyone should be treated to the full extent, cautions study author Dr. Anders Heijl, chairman of the department of ophthalmology at Sweden's Malmo University Hospital. That may sound contradictory, but Heijl explains that the most surprising finding was that patients' disease course varied greatly, "much more than I would have guessed after 25 years as a glaucoma clinician."

While the standard treatment in the study was beneficial, he says, it was "quite insufficient in some rapidly progressing patients, while at the same time some patients without treatment remain perfectly stable after six to eight years. The consequence of that [finding], in my opinion, is that patients with newly detected glaucoma, should probably be monitored for disease progression more frequently than what is now common." That close monitoring will help the eye specialist decide how much treatment is ideal.

"This may require careful follow-up, particularly during the first years after the disease detection, and follow-up may then be less frequent if the patient proves to be relatively or entirely stable," Heijl says.

The study is "confirmation of standard practice," says Dr. Richard Bensinger, chairman of the eye department at Swedish Hospital in Seattle and a spokesman for the American Academy of Ophthalmology. "This is everyone's seat-of-the-pants idea [that early treatment is best]."

"Ophthalmologists will look at this study and say, 'Isn't this terrific, what I am doing all my life actually does work.' It will be well-received," Bensinger says.

"Glaucoma of this type usually has no symptoms," Bensinger adds. For that reason, it's important to be checked by an eye specialist regularly for glaucoma.

What To Do

For more information on glaucoma, try the National Eye Institute or the Glaucoma Foundation.

SOURCES: Anders Heijl, M.D., Ph.D., chairman, Department of Ophthalmology, Malmo University Hospital, Malmo, Sweden; Richard Bensinger, M.D., spokesman, American Academy of Ophthalmology and chair, Eye Department, Swedish Hospital, Seattle; October 2002 Archives of Ophthalmology
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