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OHTS 3 study

Researchers at Washington University School of Medicine in St. Louis have received almost $12 million in grants to resume the landmark Ocular Hypertension Treatment Study (OHTS), which concluded that lowering pressure in the eye prevents or delays glaucoma in some patients at high risk for the disease. Washington University researchers led the original study 20 years ago and found that patients at the highest risk for glaucoma needed treatment with pressure-lowering drops. But the scientists also concluded that many with elevated pressure but no additional symptoms probably did not need treatment. Twenty years later, the same researchers are leading a follow-up study to see how their original conclusions have held up.

VISION SCIENTISTS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS HAVE RECEIVED GRANTS, TOTALING ALMOST 12 MILLION DOLLARS, TO CHECK IN WITH MORE THAN 1500 PATIENTS AND LEARN ABOUT HOW LOWERING ELEVATED PRESSURE IN THEIR EYES AFFECTED THEIR LONG-TERM RISK FOR GLAUCOMA. JIM DRYDEN HAS THE STORY…

IT’S THE THIRD PHASE OF THE OCULAR HYPERTENSION TREATMENT STUDY. WHEN THAT STUDY BEGAN IN THE EARLY 1990s, THE GOAL WAS TO LEARN WHETHER USING DROPS TO LOWER PRESSURE IN THE EYE REALLY COULD PREVENT OR DELAY THE ONSET OF GLAUCOMA. ACCORDING TO WASHINGTON UNIVERSITY GLAUCOMA SPECIALIST MICHAEL KASS, THE ORIGINAL GOAL WAS TO BETTER UNDERSTAND THE RELATIONSHIP BETWEEN ELEVATED PRESSURE AND RISK FOR GLAUCOMA.

(act) :19 o/c developing glaucoma

The first was, once and for all, to answer the question, “Is early

treatment effective?” And the second goal was, can we identify at

baseline certain demographic, or clinical, features that would allow

us to predict which patients are at high risk and which ones are at

low risk for developing glaucoma?

THAT UNDERSTANDING COULD ALLOW VISION SPECIALISTS TO TREAT THE PEOPLE AT HIGH RISK WHILE ONLY CAREFULLY WATCHING THOSE WHO AREN’T. NOW, IN THIS THIRD PHASE OF THE STUDY, THE RESEARCHERS WILL REVISIT AS MANY OF THE ORIGINAL STUDY PATIENTS AS THEY CAN FIND TO SEE WHAT HAPPENED OVER THE INTERVENING TWO DECADES.

(act) :23 o/c these people

There aren’t very many prospective, 20-year studies done in vision

research. It’s hard to do, so we wanted to try to get as many of

these people back as possible and do full eye examinations on them

and try to determine what is their status now? How many people

developed glaucoma over 20 years? How severe is the glaucoma in

these people?

KASS, AND FELLOW RESEARCHER MAE GORDON EXPECT THAT IT’LL BE KIND OF TOUGH TO FIND EVERYONE AFTER 20 YEARS, BUT GORDON SAYS THAT IN PREPARING FOR THE STUDY, THEY HAVE NOT ONLY BEEN ABLE TO FIND MOST OF THE PATIENTS THEY SEARCHED FOR. SHE SAYS THEY’VE ALSO GOTTEN AGREEMENTS FROM THOSE PATIENTS TO PARTICIPATE IN THIS NEW PHASE OF THE RESEARCH.

(act) :17 o/c a visit

We did a survey two-and-a-half years ago and were able to

track 80 percent of the presumed survivors, which is very

good. Contacted them, and 85 percent indicated willingness

to return for a visit.

IN CASES WHERE PATIENTS ALREADY HAVE DIED, THE RESEARCHERS WILL OBTAIN THEIR VISION RECORDS. IN THE ORIGINAL STUDY, GORDON AND KASS SAY THEY FOUND THAT LOWERING PRESSURE COULD HELP PREVENT OR DELAY GLAUCOMA IN MANY PATIENTS, BUT THEY ALSO FOUND THAT SOME PEOPLE WITH OCULAR HYPERTENSION DID FINE WITHOUT THE PRESSURE-LOWERING DROPS. MEANWHILE, THEY SAY SOME, PARTICULARY AFRICAN-AMERICAN PATIENTS, STILL WERE AT HIGH RISK EVEN IF THEY USED THE PRESSURE-LOWERING DROPS.

(act) :13 o/c developed glaucoma

They had a higher rate of conversion to glaucoma despite the fact

that they had the same level of pressure, the same kind of treatment,

were followed in the same way. So they did worse in the study. More

of them developed glaucoma.

AFTER 20 YEARS GORDON AND KASS SAY THIS VERY LONG-TERM FOLLOW UP STUDY SHOULD HELP VISION SCIENTISTS LEARN WHAT COMBINATIONS OF RISK FACTORS MAKE PEOPLE LIKELY TO DEVELOP GLAUCOMA AND TO LOSE VISION SO THAT CLINICIANS CAN DISTINGUISH MORE CLEARY WHO IS LIKELY TO RAPIDLY PROGRESS TO VISION LOSS, AS WELL AS WHICH PATIENTS ARE LIKELY TO PROGRESS MORE SLOWLY. I’M JIM DRYDEN…

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