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Original-artiklen fra The Lancet


Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two.

In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at (ISRCTN32038223).

Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI −0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3–78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained.

Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.

Practical recommendations for measuring rates of visual field change in glaucoma

Chauhan BC, Garway-Heath DF, Goñi FJ, Rossetti L, Bengtsson B, Viswanathan AC, Heijl A.

Department of Ophthalmology and Visual Sciences, Dalhousie University, 2nd Floor Centennial Building, Queen Elizabeth II Health Sciences Centre, Halifax, Canada. Denne e-mail adresse bliver beskyttet mod spambots. Du skal have JavaScript aktiveret for at vise den.

To date, there has been a lack of evidence-based guidance on the frequency of visual field examinations required to identify clinically meaningful rates of change in glaucoma. The objective of this perspective is to provide practical recommendations for this purpose. The primary emphasis is on the period of time and number of examinations required to measure various rates of change in mean deviation (MD) with adequate statistical power. Empirical data were used to obtain variability estimates of MD while statistical modeling techniques derived the required time periods to detect change with various degrees of visual field variability. We provide the frequency of examinations per year required to detect different amounts of change in 2, 3 and 5 years. For instance, three examinations per year are required to identify an overall change in MD of 4 dB over 2 years in a patient with average visual field variability. Recommendations on other issues such as examination type, strategy, and quality are also made.

Br J Ophthalmol 2008;92:569-573

Artiklen giver evidensbaserede rekommandationer for, hvor hyppigt perimetri bør foretages, hvis man inden for en rimelig tidsperiode skal kunne diagnosticere progression hos en glaukompatient.

  • Diagnostik af statistisk signifikant progression afhænger af variabilitet af synsfelter samt antallet af synsfelter.
  • Med 3 synsfelter pr. år vil hurtig progression (-2 dB/år) kunne verificeres i løbet af 2 år og langsom progression (-0.5 dB/år) i løbet af 4 år hos patienter med moderat variabilitet af synsfelter.

Baseret på ovenstående anbefales 6 synsfelter de første 2 år som basis (progressionsprofil) for fortsat follow-up og behandling.

S. Krag

Emne: Guidelines for Glakomdiagnostik- og behandling

Terminology and Guidelines for Glaucoma (4th Edition)
European Glaucoma Society (EGS) (

- Guidelines fra EGS er distribueret til danske øjenlæger takket være et sponsorat fra Alcon, Allergan, Pfizer og Santen.
Hvis man ikke har modtaget guidelines kan man kontakte et af firmaerne.

Download EGS_Guidelines_4_English.pdf

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