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Delaying treatment of ocular hypertension: the ocular hypertension treatment study.
Arch Ophthalmol 2010; 128(3):276-87AO

Abstract

OBJECTIVE

To compare the safety and efficacy of earlier vs later treatment in preventing primary open-angle glaucoma (POAG) in individuals with ocular hypertension.

METHODS

One thousand six hundred thirty-six individuals with intraocular pressure (IOP) from 24 to 32 mm Hg in 1 eye and 21 to 32 mm Hg in the fellow eye were randomized to observation or to topical ocular hypotensive medication. Median time of treatment in the medication group was 13.0 years. After a median of 7.5 years without treatment, the observation group received medication for a median of 5.5 years. To determine if there is a penalty for delaying treatment, we compared the cumulative proportions of participants who developed POAG at a median follow-up of 13 years in the original observation group and in the original medication group.

MAIN OUTCOME MEASURES

Cumulative proportion of participants who developed POAG.

RESULTS

The cumulative proportion of participants in the original observation group who developed POAG at 13 years was 0.22 (95% confidence interval [CI], 0.19-0.25), vs 0.16 (95% CI, 0.13-0.19) in the original medication group (P = .009). Among participants at the highest third of baseline risk of developing POAG, the cumulative proportion who developed POAG was 0.40 (95% CI, 0.33-0.46) in the original observation group and 0.28 (95% CI, 0.22-0.34) in the original medication group. There was little evidence of increased adverse events associated with medication.

APPLICATION TO CLINICAL PRACTICE

Absolute reduction was greatest among participants at the highest baseline risk of developing POAG. Individuals at high risk of developing POAG may benefit from more frequent examinations and early preventive treatment.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00000125.

Authors+Show Affiliations

Ocular Hypertension Treatment Study Coordinating Center, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8203, 660 S Euclid Ave, St Louis, MO 63110, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase I
Clinical Trial, Phase II
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20212196

Citation

Kass, Michael A., et al. "Delaying Treatment of Ocular Hypertension: the Ocular Hypertension Treatment Study." Archives of Ophthalmology (Chicago, Ill. : 1960), vol. 128, no. 3, 2010, pp. 276-87.
Kass MA, Gordon MO, Gao F, et al. Delaying treatment of ocular hypertension: the ocular hypertension treatment study. Arch Ophthalmol. 2010;128(3):276-87.
Kass, M. A., Gordon, M. O., Gao, F., Heuer, D. K., Higginbotham, E. J., Johnson, C. A., ... Wilson, M. R. (2010). Delaying treatment of ocular hypertension: the ocular hypertension treatment study. Archives of Ophthalmology (Chicago, Ill. : 1960), 128(3), pp. 276-87. doi:10.1001/archophthalmol.2010.20.
Kass MA, et al. Delaying Treatment of Ocular Hypertension: the Ocular Hypertension Treatment Study. Arch Ophthalmol. 2010;128(3):276-87. PubMed PMID: 20212196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delaying treatment of ocular hypertension: the ocular hypertension treatment study. AU - Kass,Michael A, AU - Gordon,Mae O, AU - Gao,Feng, AU - Heuer,Dale K, AU - Higginbotham,Eve J, AU - Johnson,Chris A, AU - Keltner,John K, AU - Miller,J Philip, AU - Parrish,Richard K, AU - Wilson,M Roy, AU - ,, PY - 2010/3/10/entrez PY - 2010/3/10/pubmed PY - 2010/4/2/medline SP - 276 EP - 87 JF - Archives of ophthalmology (Chicago, Ill. : 1960) JO - Arch. Ophthalmol. VL - 128 IS - 3 N2 - OBJECTIVE: To compare the safety and efficacy of earlier vs later treatment in preventing primary open-angle glaucoma (POAG) in individuals with ocular hypertension. METHODS: One thousand six hundred thirty-six individuals with intraocular pressure (IOP) from 24 to 32 mm Hg in 1 eye and 21 to 32 mm Hg in the fellow eye were randomized to observation or to topical ocular hypotensive medication. Median time of treatment in the medication group was 13.0 years. After a median of 7.5 years without treatment, the observation group received medication for a median of 5.5 years. To determine if there is a penalty for delaying treatment, we compared the cumulative proportions of participants who developed POAG at a median follow-up of 13 years in the original observation group and in the original medication group. MAIN OUTCOME MEASURES: Cumulative proportion of participants who developed POAG. RESULTS: The cumulative proportion of participants in the original observation group who developed POAG at 13 years was 0.22 (95% confidence interval [CI], 0.19-0.25), vs 0.16 (95% CI, 0.13-0.19) in the original medication group (P = .009). Among participants at the highest third of baseline risk of developing POAG, the cumulative proportion who developed POAG was 0.40 (95% CI, 0.33-0.46) in the original observation group and 0.28 (95% CI, 0.22-0.34) in the original medication group. There was little evidence of increased adverse events associated with medication. APPLICATION TO CLINICAL PRACTICE: Absolute reduction was greatest among participants at the highest baseline risk of developing POAG. Individuals at high risk of developing POAG may benefit from more frequent examinations and early preventive treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000125. SN - 1538-3601 UR - https://www.unboundmedicine.com/medline/citation/20212196/Delaying_treatment_of_ocular_hypertension:_the_ocular_hypertension_treatment_study_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/archophthalmol.2010.20 DB - PRIME DP - Unbound Medicine ER -