Pitt, WVU doctors join forces for glaucoma trial
Courtesy of Metro Creative
All adults over age 50 are encouraged to have an eye exam once a year.
Courtesy of West Virginia University
Dr. Tony Realini, professor of ophthalmology and glaucoma specialist at West Virginia University, will be the principal investigator of a $15.2 million study on how a treatment called selective laser trabeculoplasty (SLT) can be better used to treat glaucoma. Realini performs a laser procedure on a patient in a photo taken before the COVID-19 pandemic.
Tony Realini
While alumni and fans of the University of Pittsburgh and West Virginia University may never see eye to eye, doctors from both institutions are joining forces to battle the world’s leading cause of irreversible blindness.
Glaucoma causes damage to the optic nerve resulting in a slow, painless loss of vision over time. For years, patients have been able to avoid blindness by using drops to lower the elevated eye pressure that causes the damage. Now, the researchers will study whether laser treatment can accomplish the same goal.
The National Eye Institute, which is part of the National Institutes of Health, has awarded both universities $15.2 million to study whether the laser eye treatment called selective laser trabeculoplasty (SLT) can be better used to treat glaucoma.
“Our hope is that a brief low-energy laser procedure performed in the office once a year will effectively lower eye pressure without the hassle, expense and side effects of daily medical therapy,” said Dr. Tony Realini, professor of ophthalmology/visual sciences and glaucoma specialist at West Virginia University, who is the study’s principal investigator.
What causes glaucoma?
“We don’t know what causes glaucoma,” Realini said. “It is hereditary – it runs in families – so there is clearly a genetic component. Glaucoma causes damage to the optic nerve which connects the eye to the brain and tells the brain what we’re seeing.”
That damage causes a gradual and painless loss of peripheral vision that can progress to tunnel vision and blindness if not treated. All glaucoma treatments – whether eye drop medications, laser, or surgery – all work in various ways to lower eye pressure and prevent further glaucoma damage.
“We cannot cure glaucoma and we cannot reverse vision loss once it occurs,” he said. “Glaucoma has no symptoms until the very late stages when significant irreversible damage to vision has already occurred. You won’t know if you have glaucoma until it’s too late.”
The only way to detect glaucoma is through an eye exam. All adults over age 50 should have an eye exam once a year and high-risk individuals, including those with a family history of glaucoma and those of African or Hispanic descent, should begin annual screenings at age 40.
Why not stick with the eye drops that have been proven to work?
Because using them presents challenges like having to faithfully adhere to a daily schedule of several doses, high cost and side effects like irritation, stinging and redness. Those issues lead many patients to quit using them or to not get the desired effectiveness. The SLT procedure accomplishes the same goal of the eye drops, but the procedure may only need to be performed once a year which would be much less burdomesome on patients.
Researchers plan to enroll more than 600 patients to receive treatment at up to 20 research centers including West Virginia University. The WVU Eye Institute team will oversee the clinical sites while the University of Pittsburgh team will be the trial’s data coordinating center. The research team also includes doctors at Washington University in St. Louis, University College London and the doctor at Tufts University who invented SLT.
“Mounting evidence suggests that laser may be a better first-line therapy for glaucoma than medications,” Realini said. “Our study seeks to identify the best way to use laser to ensure maximum clinical benefit.”
Realini has had a long collaboration with the team at Pitt’s Epidemiology Center and this is their third NIH-funded research project.
How does SLT work?
The goal of glaucoma therapy is to lower eye pressure. The laser treatment does this by unclogging the drain of the eye so fluid can leave and relieve high pressure.
The study will take place in two parts.
In the first phase, participants will be assigned to receive either standard SLT or low energy SLT.
“The goal of the first part is to see if we can achieve comparable outcomes if we turn the energy down,” Realini said.
In the second part, the same participants will be reassigned into two groups after a year. One group will receive another round of SLT when effects from the first treatment diminish. The other group will get treatment with low-energy SLT annually regardless of eye pressure.
“We believe that we can accomplish better clinical outcomes using low energy SLT performed more often rather than standard energy SLT performed only as needed,” Realini said.
The full study will take seven years with participants spending spending four years in the trial.
Realini said he hopes results will show the new procedure is a real option for glaucoma patients.
“Eye drops have many limitations and most patients do not take them every day for a variety of reasons,” he said. “If a five minute, painless laser procedure performed in the office can help patients avoid the need for eye drop medications, we believe patients will have better vision in the long run and have a better quality of life.”