Document Detail


Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study.
MedLine Citation:
PMID:  17964655     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate, both at initial glaucoma diagnosis and during treatment, the role of demographic and clinical factors on intraocular pressure (IOP). DESIGN: Cohort study of patients enrolled in a randomized clinical trial. PARTICIPANTS: Six hundred seven patients with newly diagnosed open-angle glaucoma (OAG) were enrolled at 14 centers in the United States. METHODS: After randomization to initial surgery or medications, patients were followed at 6-month intervals. Intraocular pressure was measured by Goldmann applanation tonometry. Predictive factors for IOP at baseline and during follow-up were analyzed using linear mixed models. MAIN OUTCOME MEASURE: Intraocular pressure at baseline and during follow-up. RESULTS: The mean baseline IOP was 27.5 mmHg (standard deviation, 5.6 mmHg). Predictive factors for higher baseline IOP included younger age (0.7 mmHg per 10 years), male gender (2.4 mmHg higher than females), pseudoexfoliative glaucoma (5.4 mmHg higher than primary OAG), and pupillary defect (2.2 mmHg higher than those without a defect). During 9 years of follow-up, both surgery and medications dramatically reduced IOP from baseline levels, but the extent of IOP reduction was consistently greater in the surgery group. Over follow-up years 2 through 9, mean IOP was 15.0 versus 17.2 mmHg for surgery versus medicine, respectively. Predictive associations with higher IOP during follow-up included higher baseline IOP (P<0.0001), worse baseline visual field (mean deviation; P<0.0001), and lower level of education (P = 0.0019). Treatment effect was modified by smoking status: nonsmokers treated surgically had lower IOP than smokers treated surgically (14.6 vs. 16.7 mmHg, respectively; P = 0.0013). Clinical center effects were significant (P<0.0001) in both the baseline and follow-up models. CONCLUSIONS: In this large cohort of newly diagnosed glaucoma patients, predictors of pretreatment IOP and IOP measurements over 9 years of follow-up were identified. Our findings lend credence to the postulate that sociodemographic, economic, compliance, or other environmental influences play a role in IOP control during treatment.
Authors:
David C Musch; Brenda W Gillespie; Leslie M Niziol; L Frank Cashwell; Paul R Lichter;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2007-10-26
Journal Detail:
Title:  Ophthalmology     Volume:  115     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-06-12     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  927-33     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan 48105, USA.
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use
Cohort Studies
Exfoliation Syndrome / therapy
Female
Follow-Up Studies
Glaucoma, Open-Angle / physiopathology*,  therapy*
Humans
Intraocular Pressure / physiology*
Male
Middle Aged
Risk Factors
Tonometry, Ocular
Trabeculectomy / methods
Grant Support
ID/Acronym/Agency:
EY015860/EY/NEI NIH HHS; EY09148/EY/NEI NIH HHS; R03 EY015860-01/EY/NEI NIH HHS; R03 EY015860-02/EY/NEI NIH HHS; R21 EY018690-01A1/EY/NEI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections

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