At the 2021 virtual American Glaucoma Society (AGS) annual meeting, Henry Jampel, M.D., shared that research on the effectiveness of treatments on early glaucoma patients found effectiveness to be only modest.* Therefore, doctors will oftentimes delay treatment until it may be more effective. 

What does the research say?

This research includes:

• The Early Manifest Glaucoma Trial (EMGT) found that at six years, 49% of the treated group worsened versus 63% of the untreated group. 
• The EMGT study also showed that quality of life was similar in untreated and treated patients, and that cataract onset or progression was higher in the treated group compared with the control group, showing that side effects of treatment could negatively impact early glaucoma patients.
• In another study known as the United Kingdom Glaucoma Treatment Study (UKGTS), participants were given either latanoprost eye drops or a placebo option. Researchers found that at two years, 15% of the treated group worsened compared with 25% of the untreated group.
• Research from a 2008 study published in Investigative Ophthalmology and Visual Science showed most patients with early glaucoma do not live long enough to end up losing sight altogether. For Black patients, the average time from glaucoma diagnosis until death was 15 years. Other ethnicities typically had less than 15 years, according to Dr. Jampel.

Takeaways from the studies

In summary, there is time to treat glaucoma later as the treatment effect is modest, and “there is no evidence that treatment affects quality of life, most patients won’t live long enough to lose important vision, and treatment has side effects,” explained Dr. Jampel.

It’s important to note, though, that there are exceptions to the rule. For example, if a patient’s intraocular eye pressure (IOP) is very elevated and the patient is worsening, they should be treated, he said.

Doctors should conduct a risk-benefit analysis to see if it is necessary to pursue treatment for early glaucoma patients by looking at their individual experiences. The EMGT and UKGTS studies show that there is a slight benefit in treating patients, but weighing this modest benefit against risks, such as side effects of treatment, will be key.

Dr. Jampel reminds doctors to always include patients in the decision-making process.

*Linnehan, R. (2021, Mar. 8). Treatment may be delayed for patients with early glaucoma. Ocular Surgery News. https://www.healio.com/news/ophthalmology/20210308/treatment-may-be-delayed-for-patients-with-early-glaucoma

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