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More Than 1 Million Americans At Risk For Losing Their Vision To Glaucoma
January 8, 2002

(San Francisco)-As we mark this year's observance of Glaucoma Awareness Month, there are still far too many Americans at risk for losing their vision to glaucoma simply because they don t know they have the disease.

About 1 million people in America today are at risk of losing their vision because glaucoma usually has no symptoms. Unfortunately, if left untreated, it can lead to vision loss.

That's why the American Academy of Ophthalmology is urging Americans to get an eye exam, especially if you are at risk for developing glaucoma. The good news is that there is no better time to be treated for glaucoma. New advances in medical research are helping Eye M.D.s (ophthalmologists) treat glaucoma more effectively and with fewer side effects, said Andrew Iwach, MD, a spokesperson for the American Academy of Ophthalmology.

But the key to treatment is early diagnosis, said Dr. Iwach. The earlier glaucoma is diagnosed, the easier it is to treat, and the more likely you are to retain your vision.

The federal government recently acknowledged the key role early detection plays in the successful treatment of glaucoma when it approved new Medicare legislation calling for coverage of eye exams for those at a higher risk of developing glaucoma.

The Academy worked for three years to get this benefit approved, and we expect it to help save the sight of thousands of seniors.

In addition, The Foundation of the American Academy of Ophthalmology will later this month launch The Glaucoma Project through its national public service program, EyeCare AmericaTM, to provide glaucoma information and referral for qualified people at increased risk for developing glaucoma.

Individuals who call the toll-free help line at 800/391-EYES (3937) are screened for glaucoma risk factors. Eligible callers at increased risk are matched with a nearby volunteer Eye M.D. who will provide a glaucoma eye examination and initiate necessary treatment. To be eligible, callers must be U.S. citizens/legal residents; not have had an eye exam in the past 12 months; and not belong to a doctor-restricted HMO plan or receive VA eye care benefits. The help line is accessible 24 hours a day, seven days a week.

African-Americans are at a higher risk of developing glaucoma than other racial groups. Also, anyone with a close relative who has it -- a father, mother or sibling -- is at risk. Older people, those with diabetes and people who have been taking steroid medication for a long time are also at risk. If you fall into any of these categories, talk to your Eye M.D. about how often you should have your eyes examined.

Glaucoma is a group of diseases typically associated with elevated pressure inside the eye, which can damage the optic nerve and cause vision loss.

While there are usually no warning signs, some symptoms may occur in the later stages of the disease, such as loss of peripheral vision, difficulty focusing on close work, seeing halos around lights and frequent changes of prescription glasses. But by the time you realize you re losing your vision, the vision you've lost is gone forever.

Glaucoma has blinded 80,000 Americans. Don't become a statistic. Know your risk and have your eyes examined regularly. A pressure check alone is insufficient to detect glaucoma. It's important you receive an appropriate evaluation from an Eye M.D. if you are at a higher risk of developing glaucoma.
AAO


NATIONAL INSTITUTES OF HEALTH
National Eye Institute
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Immediate Treatment Helps Delay Progression of Glaucoma

Researchers have found that immediately treating people who have early stage glaucoma can delay progression of the disease. This finding supports the medical community's emerging consensus that treatment to lower pressure inside the eye can slow glaucoma damage and subsequent vision loss. These results are reported in the October 2002 issue of Archives of Ophthalmology.

Scientists found that immediate treatment of newly-discovered primary open-angle glaucoma, the most common form of glaucoma and one of the nation's leading causes of vision loss, led to a slower rate of disease progression. The findings from this study reinforce accumulating medical evidence that lowering eye pressure in glaucoma's early stages slows progression of the disease.

"These results strongly support the body of evidence suggesting that immediate treatment of early stage, open-angle glaucoma will slow the disease progression," said Paul Sieving, M.D., Ph.D., director of the National Eye Institute (NEI), one of the Federal government's National Institutes of Health and co-sponsor of the study. "Unfortunately, glaucoma has no early warning signs, and many affected patients are unaware they have the disease until it has advanced. Once people have lost vision from glaucoma, it cannot be regained. However, early detection and timely treatment would help to save the vision of thousands of people each year."

Dr. Sieving also notes that the study results provide important new medical knowledge on the course of the disease, both among treated and untreated patients. "Because most people are treated for glaucoma as soon as they are diagnosed, little is known about the natural history of the disease," he said. "Future reports from the study will add further important information on glaucoma progression and its risk factors."

The study called the "Early Manifest Glaucoma Trial" followed 255 patients, aged 50-80 years, with early stage glaucoma in at least one eye. Most patients were identified in a population screening. The average age of the patients at the beginning of the study was 68 years. One group (129 patients) was treated immediately with medicines and laser to lower eye pressure, and the other group (126 patients-the control group)was left untreated. Both groups were followed carefully and monitored every three months for early signs of advancing disease, using indicators that are extremely sensitive for detecting glaucoma progression. Any patient in the control group whose glaucoma progressed was immediately offered treatment.

After six years of followup, scientists found that progression was less frequent in the treated group (45 percent) than in the control group (62 percent), and occurred significantly later in treated patients. Treatment effects were also evident in patients with different characteristics, such as age, initial eye pressure levels, and degree of glaucoma damage. In the treated group, eye pressure was lowered by an average of 25 percent.

The study was a collaborative effort involving the University of Lund, Sweden, with centers in Malmö, Helsingborg, and Lund, Sweden, as well as Stony Brook University, Stony Brook, New York.

These results should be put into perspective, according to Anders Heijl, M.D., Ph.D., chairman of the Department of Ophthalmology at Sweden's Malmö University Hospital and first author of the report. "Although the study closely checked for possible glaucoma progression, many of the patients remained stable over time, even those in the control group," Dr. Heijl said. "On the other hand, despite the clear effect of treatment, glaucoma progressed in as many as 30 percent of treated patients after four years."

Dr. Heijl said that the time it took for glaucoma to progress varied greatly among patients and was sometimes rather short, even in treated patients. "This shows that in many patients with rapidly progressing glaucoma, the treatment used in this study was insufficient to halt progression of the disease," Dr. Heijl said.

Dr. Heijl emphasized that treatment for early, newly diagnosed glaucoma should be individualized and carefully balanced. Before deciding on the best treatment option, eye care professionals should consider several unique patient factors, such as age, eye pressure levels, and disease severity. "The study findings support the medical community's growing contention that glaucoma treatment should be tailored to the individual needs of the patient," Dr. Heijl said. "One option could include no initial treatment, but subsequent treatment if the disease progresses. Many glaucoma medicines have side effects, so the decision not to treat the disease in its early stage (but closely monitor patients) can postpone or obviate the need for medications."

Although the study results confirm the belief that reducing eye pressure is beneficial, "they do not prove that elevated eye pressure in itself is the primary cause of glaucoma," said M. Cristina Leske, M.D., chair of the Department of Preventive Medicine at Stony Brook University and a study co-author. "However, because reducing eye pressure slows the progression of glaucoma, eye pressure levels are important in the course of the disease."

Dr. Leske said that the study treatment had few side effects. The most important was an increase in nuclear opacities, a type of cataract, but the number of related cataract surgeries in the treated group was small.

Open-angle glaucoma affects about 2.2 million Americans age 40 and over; another two million may have the disease and don't know it. Glaucoma occurs when the optic nerve is damaged. In most cases, increased pressure in the eye is a risk factor for this damage. The damage to the optic nerve causes loss of peripheral (side) vision, although people are often unaware that they have glaucoma. As the disease worsens, the field of vision gradually narrows and blindness can result. However, if detected early through a comprehensive eye exam, glaucoma can usually be controlled and serious vision loss prevented.

The National Eye Institute is part of the National Institutes of Health (NIH) and is the Federal government's lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness. The NIH is an agency of the U.S. Department of Health and Human Services.
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News from the AAO: Initial Study Results Indicate That Medication or Surgery May Be Equally Effective Treatments for Newly Diagnosed Open-Angle Glaucoma

November 14, 2001: After five years of follow-up, either medications or surgery appear to be equally effective treatments for newly diagnosed open-angle glaucoma, reducing intraocular pressure and preventing vision loss. These findings, part of the Collaborative Initial Glaucoma Treatment Study, appear in the November 2001 issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology.

Glaucoma is a group of diseases that without treatment can damage the optic nerve and cause irreversible vision loss. Intraocular pressure is an important risk factor in causing the optic nerve damage. Currently, more than two million people in the United States have glaucoma.

There has been some debate in the medical community about whether to first use medications or to first use surgery to treat newly diagnosed glaucoma. Current treatment in the United States usually involves treating patients with eye drops to reduce intraocular pressure. When the drops fail, surgery is performed. However, some earlier British studies showed early surgery worked better than medication in saving vision. The Collaborative Initial Glaucoma Treatment Study was conducted to determine which approach is better.

In this randomized, controlled clinical trial, 607 newly diagnosed glaucoma patients from 14 clinical centers were divided into two groups: 307 taking medicine and 300 treated surgically. In addition to measuring visual function, researchers also used a standardized questionnaire to measure the impact of glaucoma and its treatment on the patients' quality of life. Both groups were followed for five years and both groups had their intraocular pressure reduced substantially. Surgery patients had the lowest pressure, however.

Surgery patients required cataract surgery more frequently than patients treated with medicines. With regard to health-related quality of life, both the medicine and surgery groups are doing well after five years of treatment. There were not many reports of serious side effects or problems with vision. While the surgery group reported more local eye symptoms than did the medicine group, both groups reported less symptoms and side effects as the study progressed.

"Our study shows that medications or surgery are effective treatments for newly diagnosed open-angle glaucoma," said study chairman, Paul R. Lichter, M.D., professor and chair of Ophthalmology and Visual Sciences at the University of Michigan's Kellogg Eye Center in Ann Arbor. " While we do not recommend any changes to the usual treatment approaches at this time, it is important to emphasize that five-year findings are not the definitive answer in a chronic disease like glaucoma. Findings from longer-term follow-up of the CIGTS patients will provide a much better basis on which to base recommendations on the best approach to initial glaucoma treatment