Glaucoma
Screening
Glaucoma is among the leading causes of blindness in the U.S., and
it is the leading cause of blindness among African Americans. There
are presently no consistent guidelines in the U.S. or internationally
for treating patients with "ocular hypertension" - those
who have pressures between 24 and 32 mm Hg, when the ophthalmic examination
is normal in other aspects. In Great Britain, surgery is advocated
at the first evidence of glaucoma. Previous studies are inconsistent:
they are often flawed methodologically, the definition of glaucoma
differs from one study to another, sample size is often small, and
follow-up
periods are variable. As a result, great confusion exists in the ophthalmic
community regarding the need to treat patients with elevated intraocular
pressure but otherwise normal ocular examinations. |
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Evaluating
Glaucoma Risk.
If we can define precisely which patients are at greatest
risk of developing glaucoma, we will be able to initiate reasonable
treatment for the greatest number of patients. I am principal investigator
for a randomized prospective
multicenter trial that we have designed to evaluate the relative
risk of developing glaucomatous visual field loss for patients who
have pressures between 24 and 32 mm Hg, and who do not presently
have glaucoma. This study will be important in determining whether
we should expose these patients to a lifetime of expensive medications
or surgery, or if they are better off if we follow them until glaucomatous
visual loss appears.
This study will closely follow selected patients with ocular hypertension,
between 40 and 80 years of age, in order to determine whether treatment
will change the rates at which these patients develop glaucoma.
Patients are randomly assigned to a treatment group or to a nontreatment
group; patients in both treatment and nontreatment groups will be
followed every six months, but patients in the treatment group will
have intraocular pressure lowered 20% or more, using topical antiglaucoma
drops. Because of the increased evidence of glaucoma among African-Americans,
30% of patients will be African-American. If any patient
progresses to glaucamatous loss, they will be treated fully for
glaucoma in a standard fashion.
This study is designed in a way that it should be successful in
determining in a scientific fashion the relative risk of developing
glaucomatous visual field loss for patients with pressures between
24 and 32 mm Hg. This new data will help in directing practice patterns.
The Glaucoma Service at UCSF boasts an international reputation
for excellence in glaucoma research, diagnosis and care. In the
last decade, I have participated in numerous multi-center collaborative
trials at UCSF that have focused on glaucoma. I have also served
on the NIH/NEI Panel that reviews multi-center collaborative glaucoma
studies.
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