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 -------------------------------------------------------------------------------------------------------------------- EMBARGOED BY JOURNAL Monday, October 14, 2002 12:01 a.m. ET Contact: Michael Coogan NEI Information Office (301) 496-5248
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. --------------------------------------------------------------------------------------------------------------------
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
