title: Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  Glaucoma is an acquired degeneration of the optic nerve and a leading cause of blindness worldwide. Medical and surgical treatments that decrease intraocular pressure may prevent visual impairment and blindness.
  
  
  OBJECTIVE
  To compare the effectiveness of medical, laser, and surgical treatments in adults with open-angle glaucoma with regard to decreasing intraocular pressure and preventing optic nerve damage, vision loss, and visual impairment.
  
  
  METHODS
  MEDLINE, CENTRAL, and an existing database for systematic reviews (through 2 March 2011); MEDLINE, EMBASE, LILACS, and CENTRAL for primary studies (through 30 July 2012).
  
  
  METHODS
  English-language systematic reviews; randomized, controlled trials; and quasi-randomized, controlled trials for most outcomes and observational studies for quality of life and harms.
  
  
  METHODS
  Two investigators abstracted or checked information about study design, participants, and outcomes and assessed risk of bias and strength of evidence.
  
  
  RESULTS
  High-level evidence suggests that medical, laser, and surgical treatments decrease intraocular pressure and that medical treatment and trabeculectomy reduce the risk for optic nerve damage and visual field loss compared with no treatment. The direct effect of treatments on visual impairment and the comparative efficacy of different treatments are not clear. Harms of medical treatment are primarily local (ocular redness, irritation); surgical treatment carries a small risk for more serious complications.
  
  
  CONCLUSIONS
  Heterogeneous outcome definitions and measurements among the included studies; exclusion of many treatment studies that did not stratify results by glaucoma type.
  
  
  CONCLUSIONS
  Medical and surgical treatments for open-angle glaucoma lower intraocular pressure and reduce the risk for optic nerve damage over the short to medium term. Which treatments best prevent visual disability and improve patient-reported outcomes is unclear.
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Michael V
authors: MV
authors: Boland
authors: Ann-Margret
authors: AM
authors: Ervin
authors: David S
authors: DS
authors: Friedman
authors: Henry D
authors: HD
authors: Jampel
authors: Barbara S
authors: BS
authors: Hawkins
authors: Daniela
authors: D
authors: Vollenweider
authors: Yohalakshmi
authors: Y
authors: Chelladurai
authors: Darcy
authors: D
authors: Ward
authors: Catalina
authors: C
authors: Suarez-Cuervo
authors: Karen A
authors: KA
authors: Robinson
mesh_terms: D057186:Comparative Effectiveness Research; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D053685:Laser Therapy; D009900:Optic Nerve / Q000473:pathology; D011453:Prostaglandins / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014130:Trabeculectomy; D014786:Vision Disorders / Q000517:prevention & control; D014794:Visual Fields / Q000187:drug effects
chemical_list: D011453:Prostaglandins