Blind World


June 14, 2002.

BY Deborah L. Shelton,
St. Louis Post-Dispatch.

A national study led by researchers at Washington University School of Medicine found that eyedrops that lower pressure in the eye can delay, or even prevent, the most common type of glaucoma.

In Missouri, more than 46,000 people have glaucoma, an eye disease that can lead to blindness. In Illinois, more than 99,000 people have it. It affects about 2.2 million people nationwide.

Because glaucoma rarely has early symptoms, most people already have significant, irreversible damage by the time they experience vision problems.

The Ocular Hypertension Treatment Study, which involved 1,636 people nationwide -- 41 in St. Louis - found that treatment with pressure-lowering eyedrops reduced the onset of open-angle glaucoma by more than 50 percent. Open-angle glaucoma is the most common form of the disease.

Nationwide, up to 6 million Americans have elevated eye pressure that increases their chances of developing open-angle glaucoma.

Other factors that put people at risk include a thinning cornea, old age, African-American ancestry or a family history of glaucoma.

"When we started the study, it wasn't clear what you should do to prevent it," said Dr. Michael A. Kass, national chair of the 22-center study and head of the Department of Ophthalmology and Visual Sciences at Washington University School of Medicine. "There had been a number of small studies conducted, but none of them were big enough or rigorous enough to come to a real conclusion."

The Ocular Hypertension Treatment Study appears in this month's issue of Archives of Ophthalmology.

Brenda Scarpace joined the study because glaucoma runs on her father's side of her family. She began to experience high pressure in her eyes in her early 30s.

"My father and uncle started developing problems in their 50s. I started when I was 32," said Scarpace, 48, a resident of south St. Louis County. "I had night blindness. I was seeing halos and spots and it affected my peripheral vision."

The eyedrops, however, have made a huge difference, she said. "I think it's wonderful."

Judy Ruffus of Creve Coeur volunteered for the study, but wasn't one of those who got treatment. Her father lost the sight in his left eye to glaucoma and is losing it in his right eye. She plans to start taking the drops next month.

Study's methods

Under normal circumstances, fluid regularly flows in and out of the eye. High pressure results when that fluid drains too slowly.

Half of the study participants were randomly selected to get a single type of eyedrops or a combination of drops each day for at least five years. The others didn't get medication but were closely monitored by eye specialists. The eyedrops, of which there are about a half-dozen, are currently available by prescription and are not experimental.

The drops reduced eye pressure by about 20 percent, which was enough to make the difference, Kass said.

At the end of five years, 4.4 percent of people treated with eyedrops that lower eye pressure developed glaucoma compared to 9.5 percent of those who did not get the drops.

The study findings support the concept that people at high risk for developing glaucoma should get early, preventive treatment, Kass said.

"The good news about all of these risk factors is that they are all relatively simple to measure," Kass said. "They can be ascertained in an eye exam."

The next phase of the study will look at who makes the best candidate for such preventive treatment. Potential downsides, including costs and side-effects, make treatment ill-advised for those with relatively low eye pressure, Kass said. Depending on the type of eyedrops, side-effects can range from burning sensation in the eyes to worsening of asthma symptoms to harm to a developing fetus.

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