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Glaucoma study calls into question preventative laser therapy

An Australian researcher has recommended against a preventative laser treatment for primary angle closure glaucoma, following an extensive study involving 900 Chinese patients.

Professor Mingguang He, from the Centre for Eye Research Australia and University of Melbourne, led one of the world’s largest studies into laser peripheral iridotomy – a common preventative treatment for people at risk of developing the severe form of glaucoma.

In findings recently published in The Lancet journal, He discovered the treatment – used worldwide since the 1970s – resulted in “only modest benefits” for patients. Instead, He said patients would benefit more from a greater phasis on early detection, and intensive treatment for those most at-risk.

The study tracked almost 900 patients for six years aged 50 to 70 suspected of having the disease at an eye clinic in Guangzhou, China. Patients received laser treatment in one randomly-selected eye, while the other was left untreated.

Researchers then monitored both eyes over the ensuing years to determine the impact the treatment had on preventing further development of the disease.

According to the study, final results donstrated that although there was a small, statistically significant improvement in eyes that were treated – overall the benefits were “limited”, and the majority of patients did not develop any glaucoma symptoms in their untreated eye.

In analysing the results, He recommended against the widespread treatment of all people at risk of developing the condition as a public health measure.

“Given our results, widespread use of preventative laser treatment is not the best use of health care resources, which could instead by redirected to providing more intensive treatment to those most at risk of blindness and to identifying glaucoma earlier,’’ He said.

It is anticipated the findings could have major implications for public health in China, where 28 million people are at risk of primary angle closure glaucoma.

“In the past these patients could have been considered eligible candidates for laser treatment, but this new evidence shows that many do not need treatment,’’ He said.

“A change in practice from routine preventative laser could save considerable time, money and unnecessary medical interventions.’’

He’s study was conducted in partnership with Zhongshan Ophthalmic Centre, Sun Yat-Sen University, China; the National Institute for Health Research and Biomedical Research Centre, Moorfields Eye Health Hospital, London; UCL Institute of Ophthalmology, London; Dana Centre for Preventative Ophthalmology, Wilmer Eye Institute and Department of International Health, Johns Hopkins School Bloomberg School of Public Health, US and National University of Singapore.

Headshot image credit: Anna Carlile