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Abstract
Abstract
Changing Concepts in Glaucoma Therapy - Consequences from Recent Randomised Controlled Trials
Hitchings R.
Moorfields Eye Hospital, London
For many years ophthalmologists believed that glaucoma is a disease of the optic nerve induced by elevated intraocular pressure. This concept advanced, following the recognition that the eye pressure did not need to be above the upper limit of normal, to one where glaucoma was seen as a disease of the optic nerve with elevated intraocular pressure as a risk factor. Even with this down-grading of the role of intraocular pressure, treatment for chronic glaucoma is still to reduce intraocular pressure. Until recently there had been no hard evidence to support this approach. In the last few years, however, there have been a number of thorough long term randomised controlled trials that demonstrated the beneficial effects of lowering intraocular pressure. These trials involved therapy versus placebo or different levels of intraocular pressure reduction.
From these trials, it became clear that even when untreated the progress of the disease was slow for many patients, and with treatment, progress could be slowed further but frequently not halted altogether. These randomised controlled trials have given new insights as to the causation of chronic glaucoma, noting that factors other that elevated intraocular pressure clearly have a part to play. Secondly, they have demonstrated the limits of current hypotensive therapy noting that we could only offer the patients so much protection by this route. For many patients, alternative treatments also need to be consi