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Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors . PURPOSE To evaluate factors associated with visual field ( VF ) progression , using all available follow-up through 9 years after treatment initiation , in the Collaborative Initial Glaucoma Treatment Study ( CIGTS ) . DESIGN Longitudinal follow-up of participants enrolled in a randomized clinical trial . PARTICIPANTS Six hundred seven newly diagnosed glaucoma patients . METHODS In a randomized clinical trial , 607 subjects with newly diagnosed open-angle glaucoma initially were treated with either medication or trabeculectomy . After treatment initiation and early follow-up , subjects were evaluated clinically at 6-month intervals . Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure ( IOP ) to a level at or below a predetermined , eye-specific target pressure . Visual field progression was analyzed using repeated measures models . MAIN OUTCOME MEASURES Visual field progression , measured by Humphrey 24-2 full-threshold testing and assessed by the change in the mean deviation ( MD ) , and an indicator of substantial worsening of the VF ( MD decrease of > or =3 dB from baseline ) , assessed at each follow-up visit . RESULTS Follow-up indicated minimal change from baseline in each initial treatment group 's average MD . However , at the 8-year follow-up examination , substantial worsening ( > or =3 dB ) of MD from baseline was found in 21.3 % and 25.5 % of the initial surgery and initial medicine groups , respectively . The effect of initial treatment on subsequent VF loss was modified by time ( P < 0.0001 ) , baseline MD ( P = 0.03 ) , and diabetes ( P = 0.01 ) . Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline , whereas subjects with diabetes had more VF loss over time if treated initially with surgery . CONCLUSIONS The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both treatment groups . Progression in VF loss was seen in a subset , increasing to more than 20 % of the subjects . The findings regarding initial surgery being beneficial for subjects with more advanced VF loss at presentation , but detrimental for patients with diabetes , are noteworthy and warrant independent confirmation . FINANCIAL DISCLOSURE ( S ) The author ( s ) have no proprietary or commercial interest in any materials discussed in this article .
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Intervention_Pharmacological
treated with either medication or trabeculectomy
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Intervention_Physical
treated aggressively in an effort to reduce intraocular pressure ( IOP ) to a level at or below a predetermined , eye-specific target pressure . Visual field progression was analyzed using repeated measures models
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Intervention_Surgical
Initial surgery
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Intervention_Pharmacological
initial medicine
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Outcome_Physical
visual field ( VF ) progression
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Outcome_Physical
reduce intraocular pressure ( IOP )
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Outcome_Physical
Visual field progression , measured by Humphrey 24-2 full-threshold testing and assessed by the change in the mean deviation ( MD )
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Outcome_Physical
an indicator of substantial worsening of the VF
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Outcome_Physical
MD
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Outcome_Physical
worsening ( > or =3 dB ) of MD
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Outcome_Physical
VF loss
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Outcome_Physical
VF progression
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Outcome_Physical
VF loss
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Outcome_Physical
lowering of IOP
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Outcome_Physical
VF loss
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Participant_Condition
Collaborative Initial Glaucoma Treatment Study
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Participant_Condition
607 subjects with newly diagnosed open-angle glaucoma
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Participant_Condition
subjects with advanced VF loss at baseline
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Participant_Condition
subjects with more advanced VF loss at presentation
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Participant_Condition
patients with diabetes