International Multicenter Glaucoma Research

The review paper presents the results of large-scale international multicenter research of glaucoma. The research has a considerable impact on today’s understanding of strategies of glaucoma diagnosis and treatment. The conclusions made by the authors of this research are heavily cited in ophthalmological literature but its structure, vital for proper interpretation of research details and results, is often disregarded. Randomized clinical studies are extremely important for the selection of correct management of patients with glaucoma or ocular hypertension. The reviewed research showed, for the first time, that IOP reduction definitely slows the progression of glaucoma and reduces the probability that ocular hypertension develops into glaucoma. IOP reduction slows down the progression of glaucoma even if its level is conditionally normal, and the risk of progression is reduced drastically (by some estimates, this risk drops about 10 % per 1 mmHg of IOP reduction). It is noted that various surgical interventions (argon laser trabeculoplasty, trabeculectomy) increase the degree and duration of IOP compensation, but the risk of complications may be different for different operations. The research identifies the major risk factors of glaucoma progression (advanced age, increased IOP, optic disc hemorrhages) and of transition of ocular hypertension to glaucoma (increased IOP, age, lower central corneal thickness and optic disc hemorrhages). The progression rate has been found to depend on the intraocular pressure level as measured at the moment of the detection of the disease, and on the stage of the disease. Besides, the study suggests a differentiated approach to the choice of patient management tactics, including the choice of “wait-and-see” tactics under adequate monitoring of the key parameters of progression, especially of perimeter indices and the condition of the optic nerve. The results of randomized clinical studies permit to achieve a more targeted and effective glaucomatous therapy and to form an evidence-based management of patients in different clinical situations // Russian Ophthalmological Journal, 2016; 2: 96-101 . doi: 10.21516/2072-0076-2016-9-2-96-101