- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02375009
Glaucoma Management in the African-Derived Developing World Using Trabeculoplasty
June 17, 2021 updated by: Anthony Realini, West Virginia University
This proposal aims to evaluate selective laser trabeculoplasty (SLT) as a safe and effective therapy to control open-angle glaucoma and reduce the risk of progression to visual dysfunction or blindness in the African-derived developing world.
If funded, this work will complete the characterization of SLT's safety and efficacy profile as a means of long-term disease control in this population.
This work will support the translation of SLT into a structured public health initiative to reduce glaucoma-related vision loss throughout the African-derived developing world.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Glaucoma is a leading cause of blindness in the African-derived developing world and represents a significant public health challenge as the disease burden is substantial.
In Ghana, the prevalence of open-angle glaucoma over age 40 is 8.5%.
In Barbados, the prevalence is 7.0%.
In neighboring St. Lucia, the prevalence has been estimated at 8.8% with a 16% ten-year incidence of glaucoma-related blindness in one or both eyes.
(In contrast, the prevalence in US adults is 1.9%.)
The burden of glaucoma-related visual dysfunction is also substantial in the developing world.
Because the application of medical and surgical therapies is limited by issues such as cost, availability, and limited regional surgical expertise, undertreatment is pervasive.
Also, there is little access to low vision or vision rehabilitation services and minimal social support for the visually impaired.
Laser trabeculoplasty may be a part of the solution to the developing world's burgeoning glaucoma burden.
The treatment is fast, safe, minimally invasive and requires minimal post-treatment care; the equipment is portable; and the incremental cost of trabeculoplasty treatment is small once the equipment and expertise are on-site.
Our recent study in St. Lucia demonstrated that laser trabeculoplasty lowers IOP by an amount likely to favorably alter the clinical course of glaucoma (versus no treatment) and has the potential to bend the glaucoma-related blindness curve in the African-derived developing world.
Our long-term goal is to translate this finding through a public health initiative by establishing a pan-Caribbean glaucoma laser program to provide safe, effective, and cost-effective therapy for glaucoma in this underserved and overburdened region.
Before this can happen, several important research questions remain unanswered regarding SLT in this population and comprise the specific aims of this proposal.
What is the long-term efficacy of SLT in this population?
Is repeat SLT effective once the IOP reduction of initial SLT wanes?
Are the results obtained in St. Lucia generalizable to other developing nations populated by people of African descent?
In this application, we propose a prospective cohort study in St. Lucia in which qualifying subjects with open-angle glaucoma will receive bilateral selective laser trabeculoplasty, will be followed to failure of initial SLT, and will undergo repeat SLT and again be followed to failure.
The long-term safety and efficacy of both initial and repeat SLT in glaucoma patients of African descent will thus be established.
Further, we will replicate the cohort study in Dominica to confirm external validity of the St. Lucia outcomes.
This proposal is designed to answer the questions posed above and thus to complete the research phase of this project and facilitate translation of the research findings into the public health space.
Considering the population of the African-derived developing world, the prevalence of glaucoma in this population, and the observed preliminary benefits of laser therapy, this project's output could ultimately reduce the risk of glaucoma-related visual dysfunction in hundreds of thousands of individuals throughout the developing world.
Study Type
Interventional
Enrollment (Actual)
129
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
West Virginia
-
Morgantown, West Virginia, United States, 26505
- West Virginia University Eye Institute
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
30 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Afro-Caribbean ancestry
- Ages 30 and above
- Open-angle glaucoma (ISGEO criteria)
- CDR≥0.7 or CDR asymmetry ≥0.2 or rim width ≤0.1 CDR with typical VF loss; or
- CDR≥0.8 or CDR asymmetry ≥0.3 (if unable to get VF); or
- VA <20/400 and IOP ≥ 32 mmHg (if unable to get VF or CDR)
- Receiving ≤2 topical IOP-lowering medications
- IOP between 17-35 mmHg in both eyes after 30-day washout
Exclusion Criteria:
- Any glaucoma other than open-angle glaucoma
- Advanced glaucoma (CDR > 0.9 or field loss in central 10º)
- History of:
- Prior glaucoma laser or surgery
- Ocular inflammation within 3 months
- Ocular trauma or intraocular surgery within 6 months
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment Cohort
All subjects will receive bilateral 360 degree Selective Laser Trabeculoplasty therapy in a single session, but will be randomized to one of three treatment sessions at times 0, Month 3 and Month 6. Subjects will be washed out of current IOP-lowering therapy 4-6 weeks pre-SLT.
Subjects continuing on meds beyond time 0 will provide a comparator to early SLT to quantify regression to the mean.
|
laser therapy to trabecular outflow pathway of the eye to lower intraocular pressure, delivered to 360 degrees of both eyes in a single session
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Probability of 12-month success (Proportion of subjects with 20% or greater IOP reduction 12 months following SLT)
Time Frame: 12 months
|
Proportion of subjects with 20% or greater IOP reduction 12 months following SLT
|
12 months
|
Repeat probability of 12-month success (Proportion of subjects with 20% or greater IOP reduction from baseline 12 months after repeat SLT)
Time Frame: 12 months after as-needed repeat SLT
|
12 months after as-needed repeat SLT
|
|
Generalizability of IOP-lowering efficacy to populations other than St. Lucia (significance of a site term in a predictive model of IOP reduction)
Time Frame: 12 months
|
Evaluate significance of a site term in a predictive model of IOP reduction following SLT to determine if response to IOP is site dependent
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Median survival time following initial SLT (Time from initial SLT to when 50% of subjects no longer manifest a 20% or greater reduction in IOP from baseline)
Time Frame: Through up to five years of follow-up
|
Time from initial SLT to when 50% of subjects no longer manifest a 20% or greater reduction in IOP from baseline
|
Through up to five years of follow-up
|
Mean IOP reduction (Descriptive analysis of mean (+/- SD) IOP reductions from baseline)
Time Frame: through up to five years of follow-up
|
Descriptive analysis of mean (+/- SD) IOP reductions from baseline at each 12-month period following initial and repeat SLT, separately
|
through up to five years of follow-up
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Tony Realini, MD, MPH, West Virginia University Eye Institute
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. Clinical outcomes following selective laser trabeculoplasty in Afro-Caribbean patients with glaucoma at high risk for progression. Br J Ophthalmol. 2022 Sep;106(9):1235-1239. doi: 10.1136/bjophthalmol-2020-317117. Epub 2021 Apr 9.
- Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. West Indies Glaucoma Laser Study (WIGLS)-2: Predictors of Selective Laser Trabeculoplasty Efficacy in Afro-Caribbeans With Glaucoma. J Glaucoma. 2018 Oct;27(10):845-848. doi: 10.1097/IJG.0000000000001018.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 1, 2015
Primary Completion (Actual)
September 1, 2018
Study Completion (Actual)
September 1, 2018
Study Registration Dates
First Submitted
January 26, 2015
First Submitted That Met QC Criteria
February 23, 2015
First Posted (Estimate)
March 2, 2015
Study Record Updates
Last Update Posted (Actual)
June 18, 2021
Last Update Submitted That Met QC Criteria
June 17, 2021
Last Verified
June 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1411505682
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Glaucoma
-
Centre hospitalier de l'Université de Montréal...CompletedGlaucoma | Glaucoma, Open-Angle | Glaucoma, Neovascular | Glaucoma Eye | Glaucoma and Ocular Hypertension | Glaucoma, Uncompensated | Glaucoma SecondaryCanada
-
Pro Top & Mediking Company LimitedCompletedOpen Angle Glaucoma | Neovascular Glaucoma | Angle Closure Glaucoma | Uveitis Glaucoma | Young Age Glaucoma | High Risk PatientEstonia
-
Imperial College Healthcare NHS TrustIRIDEX CorporationNot yet recruitingGlaucoma | Glaucoma, Open-Angle | Glaucoma, Angle-Closure | Glaucoma, Neovascular | Glaucoma Eye | Glaucoma Secondary | Glaucoma Traumatic | Glaucoma Uveitic
-
Wills EyeIOP OphthalmicsTerminatedPrimary Open Angle Glaucoma | Neovascular Glaucoma | Uveitic Glaucoma | Pseudoexfoliation Glaucoma | Primary Angle Closure Glaucoma | Pigmentary Glaucoma | Traumatic GlaucomaUnited States
-
Sanoculis LtdCompletedPrimary Open Angle Glaucoma | Pigmentary Glaucoma | Pseudoexfoliative GlaucomaIsrael
-
Bausch & Lomb IncorporatedNicOx Inc.CompletedPrimary Open Angle Glaucoma | Ocular Hypertension | Pigmentary Glaucoma | Pseudoexfoliative GlaucomaUnited States
-
Sensimed AGCompletedPrimary Open Angle Glaucoma | Pigmentary Glaucoma | Pseudoexfoliative GlaucomaFrance
-
Ivantis, Inc.CompletedPrimary Open Angle Glaucoma | Pigmentary Glaucoma | Pseudoexfoliative GlaucomaUnited States
-
University of California, San FranciscoUniversity of Colorado, Denver; University of Maryland; Zhongshan Ophthalmic... and other collaboratorsCompletedPrimary Open Angle Glaucoma | Glaucoma | Neovascular Glaucoma | Secondary GlaucomaUnited States, China, India, Mexico
-
Wills EyeOptovueCompletedPrimary Open-angle Glaucoma | Normal Tension Glaucoma | Glaucoma; DrugsUnited States
Clinical Trials on Selective laser trabeculoplasty
-
Belkin Laser Ltd.CompletedOpen Angle GlaucomaGeorgia
-
Western University, CanadaCompletedOcular Hypertension | Intraocular Pressure | Primary Open Angle Glaucoma of Both EyesCanada
-
Queen's UniversityTerminated
-
University of ZurichCompletedOcular Hypertension | Cataract | Open Angle GlaucomaSwitzerland
-
University Hospital, GenevaTerminatedGlaucoma and Ocular HypertensionSwitzerland
-
Sunnybrook Health Sciences CentreCompleted
-
Jayme ViannaGlaucoma Research Society of Canada; Canadian Glaucoma SocietyNot yet recruitingPseudoexfoliation Glaucoma
-
University of TorontoUniversity of Western Ontario, CanadaUnknown
-
Glaucoma Research & Education GroupPharmaLogic Development, Inc.UnknownPrimary Open Angle Glaucoma | Ocular Hypertension | Pigment Dispersion Glaucoma | Pseudo-Exfoliative GlaucomaUnited States
-
Northeastern State UniversityActive, not recruitingOcular Hypertension | Primary Open-Angle Glaucoma, Unspecified EyeUnited States