Advanced Glaucoma Intervention Study (AGIS)

Advanced Glaucoma Intervention Study (AGIS)

Purpose: To evaluate the outcomes of sequences of interventions involving trabeculectomy and ALT in eyes that have failed medical treatment for glaucoma


–       To provide assessment of the long range outcomes of medical and surgical management in advanced glaucoma using visual function status for comparison

–       789 eyes (ages 35-80) with advanced glaucoma was enrolled and patients were followed for a minimum of 5 yrs

–       Eyes were randomly assigned to one of two intervention sequences; supplemented by medical therapy as needed

1.  Trab then ALT if trab fails, then 2nd trab if ALT fails (trab/ALT/trab)

2.  ALT, then trab if ALT fails, then 2nd trab if 1st trab fails (ALT/trab/trab)

(If the eyes fail the above sequences, then individualized therapy)

–       Primary outcome is decrease of vision, secondary outcomes include sustained decrease of vision, failure of interventions, number of prescribed glaucoma medications and level of intraocular pressure.


–       Followup at 7yrs, revealed that the vision in the eyes of black patients with advanced glaucoma were better preserved in the program that started with ALT

–       Initially (1st 4yrs), vision in the eyes of white patients tended to be better preserved however, over 7yr f/u, the reverse is true.


–        It is recommended that black patients with advanced glaucoma start a therapy program with laser surgery, while whites without life threatening health problems should begin with trabeculectomy