Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2005 Jul 16;331(7509):134.
doi: 10.1136/bmj.38506.594977.E0. Epub 2005 Jul 1.

Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials

Philip C Maier  1 , Jens Funk, Guido Schwarzer, Gerd Antes, Yngve T Falck-Ytter
Affiliations
Review

Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials

Philip C Maier et al. BMJ. .

Abstract

Objective: Open angle glaucoma is one of the most common causes of blindness in industrialised nations. Treatments to lower ocular pressure are widely used in glaucoma prevention and treatment, despite conflicting evidence.

Design: We performed meta-analyses to reassess the effectiveness of pressure lowering treatment to delay the development of glaucoma in ocular hypertension, as well as progression of manifest open angle glaucoma.

Data sources: Medline, Embase, and the Cochrane Library.

Selection of studies: Eligible studies were randomised controlled trials with a concurrent untreated control group and information on time to glaucomatous changes to visual field and optic disc. Trial reports were reviewed independently by two investigators in an unblinded standardised manner.

Results: Meta-analysis of trials in ocular hypertension showed a significant preventive effect of reducing intraocular pressure on progression to glaucoma (hazard ratio 0.56, 95% confidence interval 0.39 to 0.81, P = 0.01; number needed to treat 12). Pooled data of studies in manifest glaucoma showed a significant delay of visual field deterioration (0.65, 0.49 to 0.87, P = 0.003; NNT = 7), with subgroup analysis showing a larger effect in patients with raised pressure and a reduced effect in normal tension glaucoma (subgroup comparison: not significant).

Conclusions: Lowering intraocular pressure in patients with ocular hypertension or manifest glaucoma is beneficial in reducing the risk of visual field loss in the long term.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Trial flow shows the number of trials screened, retrieved for evaluation, and included in the analysis
Fig 2
Fig 2
Visual field loss or deterioration of optic disc, or both, among patients randomised to pressure lowering treatment v no treatment in ocular hypertension. Hazard ratios of less than 1.0 favour pressure lowering treatment. Boxed area is proportional to weight given to each trial in the statistical model. Heterogeneity: χ2 = 6.2 (P=0.185); I2 = 35.4% (95% confidence interval 0 to 75.8%)
Fig 3
Fig 3
Visual field loss or deterioration of optic disc, or both, among patients randomised to pressure lowering treatment v no treatment in open angle glaucoma (panel A). Panel B shows subgroup analysis of data in normal tension glaucoma. Hazard ratios of less than 1.0 favour pressure lowering treatment. Boxed area is proportional to weight given to each trial in the statistical model. Heterogeneity: χ2 = 0.13 (P=0.72) for open angle glaucoma and χ2 = 0.001 (P=0.97) for normal tension glaucoma
See this image and copyright information in PMC

Comment in

  • Preventing blindness from glaucoma.
    Henson DB, Thampy R. Henson DB, et al. BMJ. 2005 Jul 16;331(7509):120-1. doi: 10.1136/bmj.331.7509.120. BMJ. 2005. PMID: 16020831 Free PMC article. No abstract available.

References

    1. Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol 1996;80: 389-93. - PMC - PubMed
    1. Dielemans I, Vingerling JR, Wolfs RC, Hofman A, Grobbee DE, de Jong PT. The prevalence of primary open-angle glaucoma in a population-based study in the Netherlands. The Rotterdam study. Ophthalmology 1994;101: 1851-5. - PubMed
    1. Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, et al. The ocular hypertension treatment study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120: 714-20. - PubMed
    1. Kitazawa Y, Horie T, Aoki S, Suzuki M, Nishioka K. Untreated ocular hypertension. A long-term prospective study. Arch Ophthalmol 1977;95: 1180-4. - PubMed
    1. Rossetti L, Marchetti I, Orzalesi N, Scorpiglione N, Torri V, Liberati A. Randomized clinical trials on medical treatment of glaucoma. Are they appropriate to guide clinical practice? Arch Ophthalmol 1993;111: 96-103. - PubMed

MeSH terms