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Five-Year Visual Field Outcomes of the HORIZON Trial

Montesano, Giovanni; Ometto, Giovanni; Ahmed, Iqbal Ike K; Ramulu, Pradeep Y; Chang, David F; Crabb, David P; Gazzard, Gus; (2023) Five-Year Visual Field Outcomes of the HORIZON Trial. American Journal of Ophthalmology , 251 (7) pp. 143-155. 10.1016/j.ajo.2023.02.008. Green open access

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Abstract

PURPOSE: To compare visual field (VF) progression between glaucoma patients receiving cataract surgery alone (CS) or with a Hydrus microstent (CS-HMS). DESIGN: Post hoc analysis of VF data from the HORIZON multicenter randomized controlled trial. METHODS: A total of 556 patients with glaucoma and cataract were randomized 2:1 to either CS-HMS (369) or CS (187) and followed up for 5 years. VF was performed at 6 months and then every year after surgery. We analyzed data for all participants with at least 3 reliable VFs (false positives < 15%). Average between-group difference in rate of progression (RoP) was tested using a Bayesian mixed model and a 2-sided Bayesian P value <.05 (main outcome). A multivariable model measured the effect of intraocular pressure (IOP). A survival analysis compared the probability of global VF sensitivity dropping by predefined cutoffs (2.5, 3.5, 4.5, and 5.5 dB) from baseline. RESULTS: Data from 352 eyes in the CS-HMS arm and 165 in the CS arm were analyzed (2966 VFs). The mean RoP was -0.26 dB/y (95% credible interval -0.36, -0.16) for CS-HMS and -0.49 dB/y (95% credible interval -0.63, -0.34) for CS. This difference was significant (P = .0138). The difference in IOP only explained 17% of the effect (P < .0001). Five-year survival analysis showed an increased probability of VF worsening by 5.5 dB (P = .0170), indicating a greater proportion of fast progressors in the CS arm. CONCLUSIONS: CS-HMS has a significant effect on VF preservation in glaucoma patients compared with CS alone, reducing the proportion of fast progressors.

Type: Article
Title: Five-Year Visual Field Outcomes of the HORIZON Trial
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ajo.2023.02.008
Publisher version: https://doi.org/10.1016/j.ajo.2023.02.008
Language: English
Additional information: © 2023 THE AUTHOR(S). PUBLISHED BY ELSEVIER INC. THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY LICENSE (HTTP://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/)
Keywords: CLINICAL-TRIALS, CONTRAST SENSITIVITY, INTRAOCULAR-PRESSURE, Life Sciences & Biomedicine, NEUROPROTECTION TRIALS, OCULAR HYPERTENSION, OPEN-ANGLE GLAUCOMA, Ophthalmology, PROGRESSION, QUALITY-OF-LIFE, RANDOMIZED-TRIAL, SCHLEMMS CANAL MICROSTENT, Science & Technology
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10171949
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