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Predictors of long-term intraocular pressure control after lens extraction in primary angle closure glaucoma: results from the EAGLE trial
  1. William G Mitchell1,
  2. Augusto Azuara-Blanco2,3,
  3. Paul J Foster4,
  4. Omar Halawa5,6,
  5. Jennifer Burr7,
  6. Craig R Ramsay8,
  7. David Cooper9,
  8. Claire Cochran8,
  9. John Norrie10,
  10. David Friedman11,
  11. Dolly Chang12
  1. 1Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  2. 2Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
  3. 3Queen's University Belfast, Centre for Public Health, Belfast, UK
  4. 4NIHR Biomedical Research Centre, Moorfields Eye Hospital, Institute of Ophthalmology, University College London, London, UK
  5. 5Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  6. 6Harvard Medical School, Harvard University, Boston, Massachusetts, USA
  7. 7School of Medicine, University of St Andrews, St Andrews, Fife, UK
  8. 8Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  9. 9Health Services Research Unit, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
  10. 10Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
  11. 11Ophthalmology, Harvard University, Cambridge, Massachusetts, USA
  12. 12Early Clinical Development, Genentech Inc, South San Francisco, California, USA
  1. Correspondence to Professor David Friedman, Ophthalmology, Harvard University, Cambridge, Massachusetts, USA; david_friedman{at}


Background/aims To assess baseline ocular parameters in the prediction of long-term intraocular pressure (IOP) control after clear lens extraction (CLE) or laser peripheral iridotomy (LPI) in patients with primary angle closure (PAC) disease using data from the Effectiveness of Early Lens Extraction for the treatment of primary angle-closure glaucoma (EAGLE) tria.

Methods This study is a secondary analysis of EAGLE data where we define the primary outcome of ‘good responders’ as those with IOP<21 mm Hg without requiring additional surgery and ‘optimal responders’ as those who in addition were medication free, at 36-month follow-up. Primary analysis was conducted using a multivariate logistic regression model to assess how randomised interventions and ocular parameters predict treatment response.

Results A total of 369 patients (182 in CLE arm and 187 in LPI arm) completed the 36-month follow-up examination. After CLE, 90% met our predefined ‘good response’ criterion compared with 67% in the LPI arm, and 66% met ‘optimal response’ criterion compared with 18% in the LPI arm, with significantly longer drops/surgery-free survival time (p<0.05 for all). Patients randomised to CLE (OR=10.1 (6.1 to 16.8)), Chinese (OR=2.3 (1.3 to 3.9)), and those who had not previously used glaucoma drops (OR=2.8 (1.6 to 4.8)) were more likely to maintain long-term optimal IOP response over 36 months.

Conclusion Patients with primary angle closure glaucoma/PAC are 10 times more likely to maintain drop-free good IOP control with initial CLE surgery than LPI. Non-Chinese ethnicity, higher baseline IOP and using glaucoma drops prior to randomisation are predictors of worse long-term IOP response.

  • Glaucoma

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • DF and DC are joint senior authors.

  • Twitter @oahalawa

  • Contributors WGM, DF and DSC were responsible for conceptualisation and methodology and were responsible for initial manuscript composition. AA-B, PJF, JB, CRR, DC, CC and JN were responsible for the original investigation and data curation. DSC was responsible for data analyses and validation. DF is guarantor.

  • Funding Medical Research Council, United Kingdom. DSC is an employee of Genentech, Inc but all work was performed outside the realm of her employment relationship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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