Glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide. Over the last 3 decades, a series of landmark randomized controlled trials have revealed answers regarding how glaucoma develops, progresses, and is treated. In this chapter, we start with reviewing the Ocular Hypertension Treatment Study, which clarified risk factors for glaucoma development and the role of lowering eye pressure. The Early Manifest Glaucoma Trial and the Collaborative Initial Glaucoma Treatment Study, studied patients with newly diagnosed glaucoma and showed how these patients fare both with and without therapy. The Collaborative Normal Tension Glaucoma Study is a pivotal trial that showed patients with intraocular pressures in the normal range benefit from additional eye pressure lowering. The Advanced Glaucoma Intervention Study evaluated the treatment effect on patients with advanced/severe disease. The final set of clinical trials influenced the techniques of glaucoma intervention. The Glaucoma Laser Trial helped define the role of laser trabeculoplasty in glaucoma treatment. The Fluorouracil Filtering Surgery Study elucidated the benefits and risks of using antimetabolites in trabeculectomy surgery. The Tube Versus Trabeculectomy Study compared the two primary forms of glaucoma surgeries head-to-head and teased out the pros and cons of each. As tube shunt surgery becomes increasingly popular, results from the Ahmed versus Baerveldt and Ahmed Baerveldt Comparison studies allow clinicians to make informed choices regarding which of the two most popular tube shunts to use.