Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials

doi:10.1136/bmj.38506.594977.E0

BMJ 2005;331:134 (16 July), doi:10.1136/bmj.38506.594977.E0 (published 1 July 2005)

Paper

Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials

Philip C Maier, fellow in ophthalmology¹, Jens Funk, professor of ophthalmology¹, Guido Schwarzer, senior statistician², Gerd Antes, director, German Cochrane Centre², Yngve T Falck-Ytter, assistant professor of medicine³

¹ Department of Ophthalmology, University Hospital Freiburg, Killianstr 5, D-79106 Freiburg, Germany, ² Institute of Medical Biometry and Medical Informatics, University Hospital Freiburg, ³ Louis Stokes VA Medical Center, Case Western Reserve University, 10701 East Blvd, Cleveland, OH 44106, USA

Correspondence to: P Maier maierphi{at}aug.ukl.uni-freiburg.de

Objective Open angle glaucoma is one of the most common causesof blindness in industrialised nations. Treatments to lowerocular pressure are widely used in glaucoma prevention and treatment,despite conflicting evidence.

Design We performed meta-analyses to reassess the effectivenessof pressure lowering treatment to delay the development of glaucomain ocular hypertension, as well as progression of manifest openangle glaucoma.

Data sources Medline, Embase, and the Cochrane Library.

Selection of studies Eligible studies were randomised controlledtrials with a concurrent untreated control group and informationon time to glaucomatous changes to visual field and optic disc.Trial reports were reviewed independently by two investigatorsin an unblinded standardised manner.

Results Meta-analysis of trials in ocular hypertension showeda significant preventive effect of reducing intraocular pressureon progression to glaucoma (hazard ratio 0.56, 95% confidenceinterval 0.39 to 0.81, P = 0.01; number needed to treat 12).Pooled data of studies in manifest glaucoma showed a significantdelay of visual field deterioration (0.65, 0.49 to 0.87, P =0.003; NNT = 7), with subgroup analysis showing a larger effectin patients with raised pressure and a reduced effect in normaltension glaucoma (subgroup comparison: not significant).

Conclusions Lowering intraocular pressure in patients with ocularhypertension or manifest glaucoma is beneficial in reducingthe risk of visual field loss in the long term.

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