The sight test fee Effectiveness for treatment for glaucoma remains unproved

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6965.1369b (Published 19 November 1994) Cite this as: BMJ 1994;309:1369
  1. L Clearkin
  1. Arrowe Park Hospital, Upton, Wirral, Merseyside L49 5PE

    EDITOR, - D A H Laidlaw and colleagues are concerned that the prevalence of blindness due to glaucoma may increase because of reduced uptake of screening since the introduction of the sight test fee.1 Their implication is that treatment improves outcome. Unfortunately, the effectiveness of treatment for glaucoma remains unproved. Eddy and Billings, in a comprehensive review of the literature, found “not a single book, chapter or paper that systematically reviewed the evidence on the effectiveness of [glaucoma] treatment.”2 A 20 year follow up of the outcome of surgery for glaucoma (trabeculectomy) was unable to show field stability irrespective of the intraocular pressure.3 Holmin et al, in a small trial of medical treatment versus no treatment, found no significant difference in field decay between the groups.4 The authors of this study ironically noted, “that a very high pressure tends to impair the circulation and lead to atrophy of the optic nerve head is undeniable. The idea of extrapolating this fact to be valid even in the lowest pressure range may appear logical and even so seductive that testing of the hypothesis is found unnecessary.”

    Adequate proof of the benefit of treatment for glaucoma is long overdue.


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