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Laser Surgery Is Safe And Effective First Treatment For Glaucoma

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Laser therapy is a safe and effective alternative to eyedrops as afirst-line treatment for patients with newly diagnosed primaryopen-angle glaucoma, according to research results released today.

The finding comes from a followup study of patients in thenationwide Glaucoma Laser Trial (GLT), sponsored by the National EyeInstitute of the National Institutes of Health. The study was done tolearn if early laser treatment is safe and whether it offers anymedical advantages over eyedrops for newly diagnosed open-angleglaucoma.

After some 7 years of followup, all measures used to evaluate thetwo treatments showed that the “laser first” eyes and the “medicationfirst” eyes had a similar status on all measures used to evaluatethe two treatments. Researchers assessed changes in the patient’svisual field, visual acuity (sharpness), intraocular pressure, andoptic nerve.

“Our results suggest that initial treatment with laser is atleast as effective as initial treatment with eyedrops,” said HughBeckman, M.D. of Sinai Hospital in Detroit, the study’s chairman.

However, researchers cautioned that neither treatment method is a “magicbullet” for long-term control of glaucoma. They noted that twoyears after the start of treatment, 56 percent of “laser first”eyes and 70 percent of “medication first” eyes needed new orextra medications to control pressure inside the eye.

Carl Kupfer, M.D., director of the National Eye Institute, statedthat whichever first treatment is chosen for newly diagnosed glaucoma,”the disease is a long-term, chronic illness that must becontrolled over the patient’s lifetime in order to save vision.”

About 3 million Americans have open-angle glaucoma, the most commonform of glaucoma in the U.S. For unknown reasons, small changes withinthe eye gradually interfere with the normal flow of fluids that feedtissues in the front of the eye. If these fluids do not drainproperly, the resulting higher pressure inside the eye can damage theoptic nerve and narrow the field of vision. This change happens soslowly that many people are not diagnosed with glaucoma until theyhave significant loss of vision.

A total of 271 patients were enrolled in the initial GLT. Eachpatient had laser treatment in one eye and medication in the othereye. The final results on 203 patients who were followed for anaverage of 7 years after treatment were reported in today’s AmericanJournal of Ophthalmology.

Researchers noted that both treatments caused side effects. However,the side effects of laser treatment were temporary or made no apparentdifference in the long run, while the side effects of eyedrops weretroublesome for some patients for as long as the drops were used.Eyedrops used for glaucoma treatment can cause discomfort in the eye,blurry vision, headaches, and fast or slow heartbeat.

In 34 percent of “laser first” eyes the laser treatmentcaused a temporary jump in intraocular pressure for the first few daysafter treatment. Also, some 30 percent of the “laser first”eyes developed peripheral anterior synechiae–adhesions that form whenthe iris sticks to part of the cornea. However, on all clinicalmeasures the eyes with adhesions were the same as eyes with noadhesions.

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  • The Glaucoma Laser Trial (GLT) and Glaucoma Laser Trial Follow-Up Study: 7. Results. Glaucoma Laser Trial Research Group. Am J Ophthalmol. 1995 Dec. PubMed

June 2001