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
Description:
– 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.
Results:
– 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.
Conclusions:
– 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
