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Randomized Controlled Trial
. 2018 Sep;96(6):567-572.
doi: 10.1111/aos.13790. Epub 2018 Sep 21.

Initial intraocular pressure reduction by mono- versus multi-therapy in patients with open-angle glaucoma: results from the Glaucoma Intensive Treatment Study

Christina Lindén  1 , Anders Heijl  2 , Gauti Jóhannesson  1   3 , Johan Aspberg  2 , Sabina Andersson Geimer  2 , Boel Bengtsson  2
Affiliations
Randomized Controlled Trial

Initial intraocular pressure reduction by mono- versus multi-therapy in patients with open-angle glaucoma: results from the Glaucoma Intensive Treatment Study

Christina Lindén et al. Acta Ophthalmol. 2018 Sep.

Abstract

Purpose: To study newly diagnosed glaucoma patients given mono- or multi-therapy regarding differences in initial intraocular pressure (IOP) reduction, target IOP levels reached and influence of untreated baseline IOP on IOP reduction.

Methods: Patients newly diagnosed with manifest primary open-angle glaucoma and included in the Glaucoma Intensive Treatment Study (GITS) were randomized to immediate intensive treatment with any of three different IOP-lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single-drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment.

Results: One hundred eighteen patients (143 eyes) received mono-therapy and 122 patients (152 eyes) multi-therapy. Median baseline IOP was 24.0 (min: 9.7, max: 56.0) mmHg in mono-therapy eyes and 24.0 (min: 12.3, max: 48.5) mmHg in multi-therapy eyes (p = 0.56). After 1 month in the two groups, respectively, values for median IOP reduction were 6.3 (range: -5.3-31.0) and 11.0 (range: 0.7-34.5) mmHg, and for mean relative decline 26.8 (range: -32.0-55.4) and 46.0 (range: 4.6-81.6) % (p = 0.000). A larger proportion of the multi-therapy patients reached each target IOP level (p = 0.000). The higher the baseline IOP, the larger the observed pressure reduction, considering both absolute and relative figures. The effect was more pronounced in eyes with multi-therapy than in those with mono-therapy (p = 0.000). For every mmHg higher IOP at baseline, the IOP was reduced by an additional 0.56 (mono-therapy) or 0.84 (multi-therapy) mmHg.

Conclusion: Intensive treatment led to considerably greater IOP reduction than mono-therapy. Among patients with IOP ≥30 mmHg at diagnosis an IOP of <16 was reached in 2/3 of those with multi-therapy but in none with mono-therapy. The IOP reduction was highly dependent on the untreated IOP level.

Keywords: baseline pressure; intraocular pressure; multi-therapy; open-angle glaucoma; target pressure; therapy.

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Figures

Figure 1
Figure 1
Change in intraocular pressure between baseline and 1‐month visit in eyes randomized to mono‐therapy (n = 143, A) or multi‐therapy (n = 152, B).
Figure 2
Figure 2
Relationship between untreated intraocular pressure (IOP) and the reduction in IOP after 1 month of treatment in eyes receiving mono‐therapy (open circles) or multi‐therapy (filled circles).
See this image and copyright information in PMC

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