By Paul R. Lichter, MD
    Subspecialty Day 2011: Glaucoma

    The Collaborative Initial Glaucoma Treatment Study (CIGTS) randomized 607 patients with open-angle glaucoma to receive initial treatment with topical medications or trabeculectomy. Fourteen clinical centers took part in the study to assess whether there was a difference in visual field outcome and quality of life depending on initial treatment.

    Dr. Paul Lichter discusses how interim study outcomes have influenced his practice.

    • The CIGTS found that patients had a significant fear of blindness at the time they were given their diagnosis. Dr. Lichter now reassures patients that with appropriate management, glaucoma can be managed and blindness will not likely ensue.
    • Earlier surgical intervention may be indicated by multiple findings in the CIGTS, particularly for white patients with moderate to extensive visual field (VF) loss, and because topical medication may promote IOP variability and lead to further VF damage.
    • Serious complications associated with initial trabeculectomy were few and all resolved without sequelae. These results confirmed Dr. Lichter's clinical impressions and validate decisions to intervene surgically in some patients.
    • On the other hand, the CIGTS showed that African Americans and patients with diabetes do not fare as well with initial surgery, and Dr. Lichter believes this significantly impacts how therapy should be decided for these populations.