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June 1994

Randomized Clinical Trials on Medical Treatment of Glaucoma: Are They Appropriate to Guide Clinical Practice?

Author Affiliations

Irvine, Calif
Baltimore, Md

Arch Ophthalmol. 1994;112(6):726. doi:10.1001/archopht.1994.01090180024002

We were interested in the meta-analysis of medical treatment of glaucoma trials by Rossetti et al.1 The topic of intraocular pressure as a risk factor for visual field loss has been discussed by others.2 As the coauthors of over 20% of the published studies reviewed in this meta-analysis, we feel it is appropriate to respond to some of the authors' conclusions.

The article's authors conclude that only a few of the studies of medical therapy (16 of 102) addressed the question of the efficacy of medical therapy compared with no therapy, only three studies provided data on visual field changes, and there was little coherence and consistency among the studies.

We agree that few modern reports evaluate the absolute efficacy of medical therapy in long-term trials. Ethical standards today limit such long-term studies to patients without visual field damage (ie, ocular hypertensives). However, few of the studies were