Glaucoma protocol under fire

Key Points

Washington, DC-Two reports issued by a federal health-care agency, claiming that screening and treatment of glaucoma have been ineffective, ignore more than 30 years of evidence to the contrary, according to the American Academy of Ophthalmology (AAO) and American Glaucoma Society (AGS).

The Agency for Healthcare Research and Quality (AHRQ)'s draft reviews, released in September, reported no direct or indirect links between glaucoma screening and visual field loss, visual impairment, optic nerve damage, IOP, and patient-reported outcomes.

Similarly, the agency said it did not find evidence of direct or indirect links between glaucoma treatment and visual impairment or patient-reported outcomes.

The groups have filed joint comments disputing the reports' findings. A final report is expected within 4 to 6 months, said Jean Slutzky, director of AHRQ's Center for Outcomes and Evidence.

"The National Institutes of Health funded a series of large clinical trials that absolutely put to rest and proved beyond any shadow of a doubt that treatment for glaucoma can slow or arrest the progressive loss of vision which is inherent in the disease," Dr. Caprioli said. "These documents don't give proper credence or credit to (those studies)."

While screening of the general population has not proved effective, screening of highrisk groups can be highly useful in identifying patients with asymptomatic glaucoma, which can be treated to avert vision loss, he added. In addition, glaucoma treatment cannot be the same for every patient; treatment must be individualized to maintain vision stability.

"One of the things they propose, which is just incredible, is that there should be in future research a randomized trial between those with treatment and no treatment," Dr. Caprioli said. "The efficacy of treatment is so well established scientifically and clinically that there's no way that study would ever pass IRB (international review board) approval in the United States.

"The people who prepared this (review) were not well informed, not well prepared, not well read, and weren't familiar with all the scientific and clinical literature that's out there," he said. "That's the most puzzling thing to me about that document."