Original articleNatural History of Open-Angle Glaucoma
Section snippets
Design Overview
The study design of EMGT (National Institutes of Health ClinicalTrials.gov identifier NCT00000132. Date of registration: September 23, 1999) has been described in detail.2 Briefly, EMGT included patients with newly diagnosed and untreated glaucoma with early to moderate damage. Most patients were identified in a large population-based screening of 44,000 citizens in Malmö and Helsingborg, Sweden, aged 50 to 80 years. The study was approved by the Ethics Committee of the University of Lund,
Results
Baseline characteristics of all study patients and of those in each category are shown in Table 1. Intraocular pressure was naturally higher in patients with HTG than in those with NTG, whereas IOP of patients with PEXG was slightly lower than in those with HTG. Patient age was similar among the 3 diagnostic groups. Attrition was minimal; only 4 patients were lost to follow-up, except for deaths.
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Rate of progression
Table 2 presents both median and mean rates of progression, which followed the
Discussion
We studied the natural history of glaucomatous visual field progression in a large group of patients with open-angle glaucoma who had been randomized to no initial treatment in EMGT. After a follow-up time of 6 years, 80 of 118 patients (68%) had shown definite visual field progression. Progression rate and thus time to progression varied considerably among HTG, NTG, and PEXG groups, and among patients within each group. Rates of progression were considerably higher in patients with HTG than
References (38)
- et al.
Early Manifest Glaucoma Trial design and baseline data
Ophthalmology
(1999) - et al.
Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease
Am J Ophthalmol
(2006) - et al.
A comparison of visual field progression criteria of 3 major glaucoma trials in Early Manifest Glaucoma Trial patients
Ophthalmology
(2008) - et al.
Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study
Ophthalmology
(2004) - et al.
Predictors of long-term progression in the early manifest glaucoma trial
Ophthalmology
(2007) - et al.
The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study
Ophthalmology
(2004) - et al.
Effect of patient experience on the results of automated perimetry in clinically stable glaucoma patients
Ophthalmology
(1988) - et al.
The probability of blindness from open-angle glaucoma
Ophthalmology
(1998) - et al.
Rate of visual field loss and long-term visual outcome in primary open-angle glaucoma
Am J Ophthalmol
(2001) - et al.
Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies
Am J Ophthalmol
(2002)
The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands, the Rotterdam Study
Ophthalmology
Prevalence of open-angle glaucoma in Australia, the Blue Mountains Eye Study
Ophthalmology
Prevalence of glaucoma and intraocular pressure distribution in a defined population, the Egna-Neumarkt Study
Ophthalmology
Prevalence and predictors of open-angle glaucoma: results from the visual impairment project
Ophthalmology
Natural history of normal-tension glaucoma
Ophthalmology
American Academy of Ophthalmology: Preferred Practice PatternPrimary Open-Angle Glaucoma
Exfoliation syndrome
Curr Opin Ophthalmol
Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial
Arch Ophthalmol
The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma
Arch Ophthalmol
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2023, Survey of OphthalmologyCitation Excerpt :In most studies, a large variability was found, which indicates different rates of progression among NTG patients.[26], [42], [45], [55] This implies that there are many people who show a very slow progression, but also some patients who display a very high rate of progression, which leads to a considerable difference between mean and median rates of progression, with the mean being skewed to a worse value than the median.[26] Because of different follow-up and study design, it is challenging to compare the different studies.
Manuscript no. 2008-1396.
Financial Disclosure(s): The author(s) have made the following disclosure(s): The National Eye Institute and the Swedish Research Council participated in the design of the Early Manifest Glaucoma Trial. The other sponsors had no role in the design or conduct of this research.
Supported by the Swedish Research Council K2005-74X-10426-13A, National Eye Institute, Bethesda, Maryland, grants no U10EY10260 and U10EY10261, the Järnhardt Foundation, and unrestricted grants from Alcon Research Ltd., Fort Worth, Texas, Allergan Inc., Irvine, California, and Santen Oy, Tampere, Finland. Zhongming Yang, PhD, provided statistical assistance.
Available online: October 26, 2009.