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TAGS: Eye drops or surgery for advanced glaucoma?

BACKGROUND

The Nottingham TAGS Team:  Anthony King, Cons Ophthalmologist, Patrick Cox, Research Nurse and Lauren Tarr, Research Practitioner

The Nottingham TAGS Team: Anthony King, Cons Ophthalmologist, Patrick Cox, Research Nurse and Lauren Tarr, Research Practitioner

Glaucoma is a potentially sight threatening condition and is the second most common cause for blindness in the UK. It is estimated to affect around 2% of the UK population over the age of 40 years. This percentage increases with age so as many as 10% of people in their 80’s may be affected. In England in the NHS there are over 1 million glaucoma-related visits per year.

Glaucoma refers to a group of conditions which are characterised by damage to the optic nerve at the back of the eye. These conditions occur because the pressure within the eye (intraocular pressure) is too high. The optic nerve damage results in permanent loss of vision, however with early treatment this vision loss can be minimised. Unfortunately, many patients with glaucoma are not aware that they have the condition or that their vision has been affected as it develops gradually and may only affect one eye to begin with. As people are often unaware they have glaucoma the condition may be very advanced before they notice it. Once diagnosed, treatment for advanced glaucoma aims to reduce and stabilise the high pressure in the eye and prevent any further loss of vision.

Visual field tests showing mild glaucoma visual field damage

Visual field tests showing mild glaucoma visual field damage

Currently there are two different ways to treat patients who have advanced glaucoma, eye drops and surgery; both treatments are effective at reducing eye pressure and are successfully used in the NHS, but no one knows which works best in patients with advanced glaucoma.

Mr Anthony King, one of the Consultant Ophthalmologist at Nottingham University Hospitals NHS Trust(NUH) is the Chief investigator for a multi-centre study to investigate which treatment option is better for patients with advanced glaucoma. This study is funded by the National Institute for Health Research’s (NIHR) Health Technology Assessment (HTA) Programme and is now open and will be recruiting at around 20 sites in the UK. NUH is both the lead site and sponsor.

TRIAL OBJECTIVES
  • Patient Reported Outcome – to determine how treatment with eye drops and surgery affect quality of life and whether this differs between treatment options.
  • Clinical outcomes – to determine which treatment is most successful in the long term in preserving patients’ eyesight by reducing pressure and preventing further visual field loss
  • Economic outcome – to determine which treatment is most cost effective in prevention of further vision loss

Both treatments are currently being used in the NHS and at NUH and the study is not trialling anything new or untested. Participants who agree to take part will not receive any treatments that are not currently used successfully every day in the NHS.

PATIENT RECRUITMENT

The study is designed to find out which treatment for advanced glaucoma patients prefer, in terms of their quality of life; we will, therefore, ask patients who agree to take part questions relating to:

  • what they think about their treatment,
  • what their experiences of the treatments are,
  • how their vision is after treatment.

Participants will be asked to complete questionnaires five times over two years as well as attending regular appointments at the eye clinic.

Patients who agree to take part in the study will have the treatment they receive randomly chosen. As we are comparing the two successfully used treatments currently used in the NHS this means there is a 50:50 chance of being treated with eye drops or treated with surgery.

Patients will be approached via the eye clinic at NUH, during their routine appointments. If they are eligible, they will be given the opportunity to discuss the trial with the Consultant and a research nurse, and consent will be taken.

If you are suffering from Glaucoma and are a patient at NUH, please speak to your Dr at your next appointment who will let you know if the trial is suitable for you. A copy of the Participant Information Sheet is also available to download and will give you more specific information on the study and whether or not this might be suitable for you.

FURTHER INFORMATION

Additional information on TAGS, including a list of sites participating in this study, can be found by visiting the dedicated website

To contact the study team please email TAGS

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