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Review
. 2021 Sep-Oct;4(5):454-462.
doi: 10.1016/j.ogla.2021.01.007. Epub 2021 Feb 9.

What Do We Really Know about the Effectiveness of Glaucoma Interventions?: An Overview of Systematic Reviews

Riaz Qureshi  1 , Augusto Azuara-Blanco  2 , Manuele Michelessi  3 , Gianni Virgili  4 , João Barbosa Breda  5 , Carlo Alberto Cutolo  6 , Marta Pazos  7 , Andreas Katsanos  8 , Gerhard Garhöfer  9 , Miriam Kolko  10 , Verena Prokosch-Willing  11 , Ali Ahmed Al Rajhi  12 , Flora Lum  12 , David Musch  13 , Steven Gedde  14 , Tianjing Li  15
Affiliations
Review

What Do We Really Know about the Effectiveness of Glaucoma Interventions?: An Overview of Systematic Reviews

Riaz Qureshi et al. Ophthalmol Glaucoma. 2021 Sep-Oct.

Abstract

Purpose: To identify systematic reviews of interventions for glaucoma conditions and to assess their reliability, thereby generating a list of potentially reliable reviews for updating glaucoma practice guidelines.

Design: Cross-sectional study.

Participants: Systematic reviews of interventions for glaucoma conditions.

Methods: We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United States Satellite. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7, 2019, and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1, 2014, and August 7, 2019.

Main outcome measures: We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable.

Results: Of the 4451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (IOP; 43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinders the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps to prevent glaucoma and its progression, prostaglandin analogs are the most effective medical treatment for lowering IOP, laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP, the use of IOP-lowering medications in the perioperative or postoperative periods to accompany laser (e.g., trabeculoplasty) reduces the risk of postoperative IOP spikes, conventional surgery (i.e., trabeculectomy) is more effective than medications in reducing IOP, and antimetabolites and β-radiation improve IOP control after trabeculectomy. The evidence is weak regarding the effectiveness of minimally invasive glaucoma surgeries.

Conclusions: Most systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, important limitations exist in the value of information because of the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.

Keywords: Evidence-based medicine; Glaucoma; Guideline development; Systematic reviews.

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Conflict of interest statement

Conflict of interest disclosures: No conflicting relationship exists for any author

Figures

Figure.
Figure.
Study flow chart
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