Glau Hour 01-22-24 Powerpoint Presentation

Glaucoma Hour

1. PREPARED BY: Dr. Lovely Keziah c. flores & dr. Ahnna Patrizia dp . Agustin DEPARTMENT OF OPHTHALMOLOGY Ilocos Training and Regional Medical Center Parian, San Fernando City, La Union 2500 GLAUCOMA HOUR JANUARY 22, 2024

2. objectives To provide a brief discussion on the Effectiveness of Early Lens Extraction for the Treatment of Primary Primary Angle Closure Glaucoma (EAGLE): A Randomized Controlled Trial

3. introduction WHO ranked Glaucoma as the leading cause of IRREVERSIBLE blindness By 2040, 34 million will be affected (5.3 million → Blindness) Highest prevalence of PACG → East Asia Early stage of PAC: high IOP without visual loss → LI and medical treatment → Trabeculectomy Alternative management for PACG: Cataract Surgery Hypothesis: “Initial clear lens extraction would be associated with better quality of life, lower intraocular pressure, and less need for glaucoma surgery at 36 months than standard care.”

4. Clear lens extraction vs. standard care Clinical Dilemma:

5. Methods Definition of Terms: PAC: iridotrabecular contact (appositional or synechial ) of at least 180 deg on gonioscopy PACG: glaucomatous visual field defects OR glaucomatous optic neuropathy, OR BOTH, and IOP (> 21 on at least 1 occasion)

6. Methods (Study design & participants) Randomized Control Trial in 30 Hospitals in 5 countries: Australia (1), Mainland China (1), Malaysia (2), SG (2), and UK (22) Inclusion Criteria: Phakic 50y/o or older Newly diagnosed PAC with IOP 30 or PACG Exclusion Criteria: Symptomatic cataract Advanced Glaucoma (MD worse than -15 dB or CDR > 0.9 Previous Acute Angle Closure Attack

7. Methods (procedure) Target IOP: 15-20mmHg (baseline) Standard Care (LI and Topical Anti-Glaucoma Meds): Topical meds started at the time of diagnosis and interventions done within 60 days Clear Lens Extraction: Phacoemulsificiation with monofocal intraocular lens (with synechiolysis ) While awaiting surgery: eye drops Treatment Failure: if Glaucoma Surgery is needed Standard Care pxs – can undergo Lens Extraction if with reduced vision

8. Methods (Assessment) European Quality of Life-5 Dimensions (EQ-5D) Questionnaire National Eye Institute Visual Function Questionniare – 25 Glaucoma Utility Index BCVA – using ETDRS charts Gonioscopy Visual Fields (Humphrey SITA 24-2 Test) - 2 tests at baseline then at 6, 12, 24, and 36 months IOP by Goldmann Tonometry Average of 2 readings following masking protocol Assessed at baseline, 6, 12, 24, and 36 months

9. results 805 patients were assessed 250 did not meet the inclusion criteria 136 declined 419 were recruited (Jan. 8, 2009 to December 28, 2011) 208 – Clear Lens Extraction 211 – receive Standard Care 155 (37%) – had PAC 263 (67%) – had PACG

10. results EQ-5D Scores and IOP at 36mons – favored Clear Lens Extraction NEI-VFQ-25 and Glaucoma Utility Index at 36mons – higher in Clear Lens Extraction Visual Field Severity at 36mons – similar in both groups 24 participants – Clear Lens Extraction Group (worsened) 30 participants – Standard Care Group (worsened)

11. Results (Complications) Clear Lens Extraction Irreversible Loss of Vision (ETDRS Chart) – 1 px PCR – 2 pxs Transient Corneal Edema Malignant Glaucoma Standard Care Irreversible Loss of Vision (ETDRS Chart) – 3 pxs

12. Discussion Initial treatment with clear lens extraction was SUPERIOR to laser peripheral iridotomy plus topical treatment Relevance of changes reported by patients is hard to quantify but overall health status resulted to improvement: Reduced need for Glaucoma medications Surgery after intervention Improvement of Visual function Correction of refractive error Better VA than standard care group by 3 ETDRS letters Better IOP by 1mmHg lower at 3 years (21% in clear lens group needed meds while 61% in standard care group)

13. Conclusion Clear-lens extraction should be considered the initial treatment for primary angle-closure glaucoma and primary angle closure with increased intraocular pressure.