Landmark clinical trials in glaucoma: Questions and answers

摘要

Over the past two decades, several clinical trials in glaucoma have provided support for IOF lowering therapy for both ocular hypertensive and primary open angle glaucoma patients that was lacking in prior generations. No clinical trial is perfect and the impact and limitations of these studies should be kept in mind when incorporating the recommendations of study investigators into clinical practice.Under the best of circumstances, there is no more powerful study design than the prospective randomized multicenter clinical trial. Such studies provide the highest quality of evidence in support of, or against, a particular hypothesis evaluating new or existing therapy.1 Randomized clinical trial results are often considered 'credible', even when there are limitations in the study hypothesis, design, conduct and interpretation. Such studies form the cornerstone for 'evidence based medicine', which is a concept that is increasingly considered important in guiding virtually every treatment decision. While some and perhaps the majority of practitioners believe that our glaucoma practice patterns in the 21st century are more 'precise' or 'evidence based' than those of our predecessors, the benefit to our patients from these studies has been limited and is open to debate. Further, the potential for systematic error or misinterpretation is certainly not eliminated when one conducts a randomized clinical trial.