Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study.
OBJECTIVE
To evaluate, both at initial glaucoma diagnosis and during treatment, the role of demographic and clinical factors on intraocular pressure (IOP).


METHODS
Cohort study of patients enrolled in a randomized clinical trial.


METHODS
Six hundred seven patients with newly diagnosed open-angle glaucoma (OAG) were enrolled at 14 centers in the United States.


METHODS
After randomization to initial surgery or medications, patients were followed at 6-month intervals. Intraocular pressure was measured by Goldmann applanation tonometry. Predictive factors for IOP at baseline and during follow-up were analyzed using linear mixed models.


METHODS
Intraocular pressure at baseline and during follow-up.


RESULTS
The mean baseline IOP was 27.5 mmHg (standard deviation, 5.6 mmHg). Predictive factors for higher baseline IOP included younger age (0.7 mmHg per 10 years), male gender (2.4 mmHg higher than females), pseudoexfoliative glaucoma (5.4 mmHg higher than primary OAG), and pupillary defect (2.2 mmHg higher than those without a defect). During 9 years of follow-up, both surgery and medications dramatically reduced IOP from baseline levels, but the extent of IOP reduction was consistently greater in the surgery group. Over follow-up years 2 through 9, mean IOP was 15.0 versus 17.2 mmHg for surgery versus medicine, respectively. Predictive associations with higher IOP during follow-up included higher baseline IOP (P<0.0001), worse baseline visual field (mean deviation; P<0.0001), and lower level of education (P = 0.0019). Treatment effect was modified by smoking status: nonsmokers treated surgically had lower IOP than smokers treated surgically (14.6 vs. 16.7 mmHg, respectively; P = 0.0013). Clinical center effects were significant (P<0.0001) in both the baseline and follow-up models.


CONCLUSIONS
In this large cohort of newly diagnosed glaucoma patients, predictors of pretreatment IOP and IOP measurements over 9 years of follow-up were identified. Our findings lend credence to the postulate that sociodemographic, economic, compliance, or other environmental influences play a role in IOP control during treatment.
Musch
David C
DC
Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan 48105, USA.
Gillespie
Brenda W
BW
Niziol
Leslie M
LM
Cashwell
L Frank
LF
Lichter
Paul R
PR
D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017889:Exfoliation Syndrome / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods
D000959:Antihypertensive Agents