The Glaucoma Intensive Treatment Study compared the effects of intensive and standard intraocular pressure-lowering treatments on visual field progression in patients with open-angle glaucoma over 5 years. Based on baseline pressure levels, the results provided insights into personalized management strategies for glaucoma patients.
The study, recently published in the American Journal of Ophthalmology, was a prospective, randomized, two-center clinical trial of 242 patients aged 40 to 78 years conducted in Sweden. Participants had newly diagnosed, untreated primary open-angle glaucoma or pseudoexfoliation glaucoma, and were randomized into mono-treatment or multi-treatment groups. Baseline untreated intraocular pressure (IOP) was 24 mm Hg for both groups. High adherence was reported in both groups, with 98% of participants following prescribed regimens.
The multi-treatment group demonstrated a 5.5-fold slower rate of progression than the mono-treatment group (-0.20% vs. -1.10% per year). The median progression rate was -0.25% per year (multi-treatment) vs. -0.65% per year (mono-treatment). The End-of-life Visual Field Index was 79.3% for the mono-treatment group and 87.1% for the multi-treatment group. The difference was more pronounced among patients with higher baseline IOP (≥24 mm Hg; 74.1% vs. 85.8%).
Median IOP reduction was greater in the multi-treatment group (12 mm Hg vs. 7 mm Hg for mono-treatment). In comparison, median IOP over the follow-up period was 17 mm Hg for mono-treatment and 14 mm Hg for multi-treatment.
Regarding progression events, 21% of mono-treatment participants experienced a progression event compared to 11% in the multi-treatment group. Again, differences were more significant in patients with higher baseline IOP (27% mono vs. 4% multi-treatment). Most adverse events (AEs) were mild, and serious adverse events were rare and unrelated to study medications. Still, AEs were more frequent in the multi-treatment group (36%) compared to the mono-treatment group (25%).
“Initial intensive treatment may be considered in glaucoma patients with high untreated IOP at diagnosis, whereas we have found no evidence that multi-therapy should be given routinely to all glaucoma patients,” the investigators concluded.
While multi-treatment incurs higher initial costs and risks, its long-term benefits in high-IOP patients could outweigh these factors by reducing disease progression and associated healthcare costs. However, mono-treatment remains sufficient for patients with lower baseline IOP because of its lower risk of AEs and maintained comparable outcomes.
The study population consisted predominantly of European patients, limiting generalizability to other ethnic groups.
A full list of author disclosures can be found in the published research
