UK: A type of surgery called trabeculectomy for people with advanced glaucoma reduces intraocular pressure (IOP) more effectively than eye drops, reveals a recent study published in The BMJ. The study also found the surgery to be likely more cost-effective than eye drops over the person's lifetime.
A glaucoma is a group of eye conditions with substantial and detrimental effects on many aspects of daily living. Effective treatment can control the disease, prevent further sight loss, and prevents blindness. The only proven effective treatment for glaucoma is reducing intraocular pressure. Controlling IOP at the initial stage following diagnosis reduces the risk of further progression.

Anthony J King, Department of Ophthalmology, Nottingham University Hospital, Nottingham, UK, and colleagues conducted the study with an aim to determine whether primary trabeculectomy or the primary medical treatment produces better outcomes with regard to the quality of life, clinical effectiveness, and safety in patients presenting with advanced glaucoma in a pragmatic multicentre randomised controlled trial.
The study was conducted across 27 secondary care glaucoma departments in the UK. It included 453 adults presenting with newly diagnosed advanced open-angle glaucoma in at least one eye (Hodapp classification) between 3 June 2014 and 31 May 2017. 227 were given mitomycin C augmented trabeculectomy and 226 were given escalating medical management with intraocular pressure reducing drops.
Vision-specific quality of life measured with Visual Function Questionnaire-25 (VFQ-25) at 24 months was the primary outcome. Secondary outcomes included general health status, clinical effectiveness (intraocular pressure, visual field, visual acuity), glaucoma-related quality of life, and safety.
Based on the study, the researchers reported the following:
At 24 months, the mean VFQ-25 scores in the trabeculectomy and medical arms were 85.4 and 84.5, respectively.
Mean intraocular pressure was 12.4 (SD 4.7) mm Hg for trabeculectomy and 15.1 (4.8) mm Hg for medical management (mean difference −2.8 mm Hg).
Adverse events occurred in 88 (39%) patients in the trabeculectomy arm and 100 (44%) in the medical management arm (relative risk 0.88). Serious side effects were rare.
Patients who underwent primary trabeculectomy had similar quality of life and safety outcomes and achieved a lower IOP compared with primary medication.
"Our study provides the first direct evidence of the outcomes of interventions for patients presenting with advanced glaucoma," the authors wrote in their study. "These results will inform clinicians and patients in making treatment choices."
Reference:
King A J, Hudson J, Fernie G, Kernohan A, Azuara-Blanco A, Burr J et al. Primary trabeculectomy for advanced glaucoma: pragmatic multicentre randomised controlled trial (TAGS) BMJ 2021; 373 :n1014 doi:10.1136/bmj.n1014