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Evaluating primary treatment for people presenting with advanced glaucoma: 5-year results of the Treatment of Advanced Glaucoma Study

King, Anthony J; Hudson, Jemma; Azuara-Blanco, Augusto; Burr, Jennifer; Kernohant, Ashleigh; Homer, Tara; Shabaninejad, Hosein; ... TAGS Study Group; + view all (2024) Evaluating primary treatment for people presenting with advanced glaucoma: 5-year results of the Treatment of Advanced Glaucoma Study. Ophthalmology 10.1016/j.ophtha.2024.01.007. (In press).

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Abstract

Purpose: to determine whether primary trabeculectomy or medical treatment produces better outcomes in term of quality of life (QoL), clinical effectiveness and safety in patients presenting with advanced glaucoma. // Design: multicentre randomised controlled trial // Participants: between June 3, 2014 and May 31, 2017, 453 adults presenting with newly diagnosed advanced open angle glaucoma in at least one eye (Hodapp Classification) were recruited from 27 secondary care glaucoma departments in the UK, 227 were allocated to trabeculectomy and 226 to medical management. // Methods: participants were randomised on a 1:1 basis to have either mitomycin C augmented trabeculectomy or escalating medical management with intraocular pressure reducing drops as their primary intervention and followed up for 5 years. ISRCTN registry: ISRCTN56878850. // Main Outcome Measures: The primary outcome was vision-specific quality of life measured with Visual Function Questionnaire-25 (VFQ-25) at 5-years. Secondary outcomes: general health status, glaucoma related QoL, clinical effectiveness [intraocular pressure (IOP), visual field (VF), visual acuity (VA)] and safety. // Results: At 5 years the mean VFQ-25 in the trabeculectomy and medication arms were 83.3 (SD 15.5) and 81.3 (SD 17.5) respectively, mean difference 1.01, (95% CI -1.99 to 4.00); p=0.51. Mean IOPs were 12.07 ( 5.18) mmHg and 14.76 (4.14) mmHg respectively, mean difference -2.56 (95% CI -3.80 to -1.32); p<0.001. Glaucoma severity measured with visual field mean deviation were -14.30 (7.14) and -16.74 (6.78) dB respectively, mean difference 1.87 (95% CI 0.87 to 2.87) dB, p<0.001. Safety events occurred in 115 (52.2%) in the trabeculectomy arm and 124 (57.9%) in the medication arm, relative risk 0.92 (95% CI 0.72 to 1.19); p=0.54. Serious adverse events were rare. // Conclusion: At 5 years TAGS has demonstrated that primary trabeculectomy surgery is more effective in lowering IOP and preventing disease progression than primary medical treatment in patients presenting with advanced disease and has a similar safety profile // Trial registration: Health Technology Assessment (NIHR-HTA) Programme (Project number: 12/35/38). ISRCTN registry: ISRCTN56878850.

Type: Article
Title: Evaluating primary treatment for people presenting with advanced glaucoma: 5-year results of the Treatment of Advanced Glaucoma Study
Location: United States
DOI: 10.1016/j.ophtha.2024.01.007
Publisher version: http://dx.doi.org/10.1016/j.ophtha.2024.01.007
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Open angle glaucoma, randomised controlled trial, quality of life, intraocular pressure, visual field loss
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/10185622
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