Skip to main content

  • Fellow-Eye Treatment of Open-Angle Glaucoma: CIGTS Results

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors
    Add to My Bookmarks

    Journal Highlights

    JAMA Ophthalmology, October 2018

    Download PDF

    Once it’s clear that a patient requires unilateral treatment for open-angle glaucoma (OAG), it may help to know which traits portend disease progres­sion and need for eventual treatment in the fellow eye (FE). In a post hoc analysis of data from the Collabo­rative Initial Glaucoma Treatment Study (CIGTS), Niziol et al. estimated the time between initial treatment of the study eye (SE) and the need for treatment of the FE. They found that by 7 years after OAG treatment of the SE, roughly two-thirds of patients had undergone treatment of the FE.

    In CIGTS, 607 participants with newly diagnosed OAG in at least 1 eye were assigned randomly to receive topical medication or trabeculectomy. FEs were treated when eligible or at the physician’s discretion. Data were col­lected for up to 11 years. Survival anal­ysis was used to estimate the probabili­ty of FE treatment over time and to test potential baseline and time-dependent predictors of treatment need. Using linear regression, disease trajectory was calculated as the eye-specific slopes of mean deviation (MD) and intraocular pressure (IOP) over time. In addition, correlations between SE and FE tra­jectories also were calculated. Main outcomes were time to FE treatment and the slopes over time (MD and IOP) for SEs and FEs.

    Among the FEs, 291 (47.9%) were treated at baseline along with SEs, 123 (20.3%) were treated eventually, and 193 (31.8%) did not receive treatment. The probability of FE treatment for OAG was 0.57 by year 1 and 0.68 by year 7 after SE randomization. Cor­relations in IOP slopes were 0.57, 0.24, and 0, respectively. The similarity of slopes observed for SEs and treated FEs implies that SE change is a harbinger of FE change and, therefore, warrants close surveillance. Two variables that predict FE intervention are modifiable: hypertension and IOP. Proper attention to these factors may reduce the need for FE treatment. (Also see related commen­tary in the same issue by Rohit Varma, MD, MPH, and Xuejuan Jiang, PhD.)

    The original article can be found here.