Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty?

OBJECTIVE: Selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) are used to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). We report long-term follow-up data comparing SLT to ALT. DESIGN: Follow-up of prospective randomized clinical trial. PARTICIPANTS: Patients with glaucoma from the practices of three ophthalmologists at the University of Ottawa. METHODS: We randomized 176 eyes of 152 patients with uncontrolled IOP on maximal tolerated medical therapy (MTMT, with or without previous ALT) to undergo either SLT or ALT. Data were available for 142 eyes at 3 years, 134 eyes at 4 years, and 120 eyes at 5 years. The primary outcome was change in IOP from pretreatment baseline. RESULTS: Comparison of baseline parameters was similar in the two groups. Lowering of IOP were similar at 3 years (SLT -6.7 ± 7.1 vs ALT -6.1 ± 5.1); at 4 years (SLT 7.0 ± 7.7 vs ALT -6.3 ± 5.0); and at 5 years (SLT -7.4 ± 7.3 vs ALT -6.7 ± 6.6). There was no statistically significant change in IOP in either of the two groups. Medication changes were equivalent in each group. A number of interventions were required in both groups, cumulatively, over the 5-year follow-up period (49 SLT and 33 ALT). Survival analysis indicated that the time to 50% failure in each group was approximately 2 years. CONCLUSIONS: The IOP-lowering effect of SLT and ALT was similar over 5 years in this group of patients with open-angle glaucoma on MTMT.

The evidence for efficacy of omega-3 fatty acids in preventing or slowing the progression of retinitis pigmentosa: a systematic review.

BACKGROUND: Studies in preterm and term human infants have suggested that a dietary supply of omega-3 fatty acids is essential for optimal visual development. Several basic science studies support the hypothesis that omega-3 fatty acids may be useful therapeutic agents for pathologies of the retina and lens. As part of a systematic review of the effect of omega-3 fatty acids on eye health, the purpose of this study was to conduct a systematic review of the scientific-medical literature to appraise and synthesize the evidence for the effects of omega-3 fatty acids in preventing the development or progression of retinitis pigmentosa. METHODS: A comprehensive search was undertaken in MEDLINE, PREMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Global Health, and Dissertation Abstracts. Unpublished literature was sought through manual searches of reference lists of included studies and key review articles and from the files of content experts. Searches were not restricted by language of publication, publication type, or study design. Eligibility criteria were applied to screen eligible studies on two levels. Data extraction and quality assessment were performed. RESULTS: Six studies published between 1995 and 2004 met eligibility criteria in investigating the question of the possible value of omega-3 fatty acids in slowing the progression of retinitis pigmentosa. Meta-analysis was not performed because there was not enough available information for formal quantitative analysis. INTERPRETATION: There are trends in improvement of some retinitis pigmentosa outcomes with omega-3 fatty acids in the higher quality studies. Clinical research is preliminary in this field, however. Accordingly, definitive answers will require significantly more observational and interventional clinical research.