- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02955849
A Trial of China Laser and Surgery Study Glaucoma in Rural China
The China Laser and Surgery Study : A Mixed Methods Study With an Random Control Trial Comparing Outcomes From Selective Laser Trabeculoplasty Versus Surgical Treatment (Trabeculectomy) for Glaucoma in Rural China .
Aims and Objectives (Quantitative) Aim: To compare the effectiveness of selective laser trabeculoplasty with trabeculoplasty in lowering the intraocular pressure in patients with medically uncontrolled open angle glaucoma in rural China, taking into account the impact of patient acceptance of each type of treatment
Hypothesis: Mean intraocular pressure after treatment with selective laser trabeculoplasty will be lower than with surgery due to higher acceptance rates among patients randomized to receive this treatment and therefore treatment provided at an earlier stage of disease progression.
Study Overview
Detailed Description
Glaucoma is one of the three leading causes of blindness in China. Although this condition can be controlled with medication to lower intraocular pressure , such treatment must continue over a patient's lifetime. This is not practical in resource-poor settings due to cost and inconvenience for patients. Trabeculectomy is the standard treatment offered in rural China but is rarely used because of the following issues:
- need for hospitalization, which increases patient expense and inconvenience
- high refusal rates by patients for all ocular surgery
- high rates of infection due to poor quality instruments and material
- need for multiple follow-up visits post-surgery (our earlier work shows a return rate of only 30% 1 month post-surgery among rural patients in China).
A viable alternative for patients in rural China is selective laser trabeculoplasty , based on the following advantages:
- simplicity (done as a 5-minute out-patient procedure requiring only topical anaesthesia)
- effectiveness (18-32% reduction in intraocular pressure, which is comparable to medication)
- safety (complications are rare and do not include serious infectious as with trabeculotemy)
- convenience (minimal follow-up, with one visit within 6 weeks post-surgery)
- cost-effectiveness (compared to other glaucoma therapies in many settings)
- acceptability to patients (due to low-cost out-patient care with easy follow-up).
Study Design (Quantitative) This phase of the proposed China Laser and Surgery Study research project is a multi-centre open-label pragmatic randomised controlled trial.
Expected timeline:
- Enrolment: 12 months
- Follow-up: 12 months
- Data analysis: 4 months
Patient Population and Setting: Patients presenting with glaucoma at rural hospitals (n=4) in Guangdong province, China, all of whom are currently capable of performing trabeculectomy surgery, and have been provided an selective laser trabeculoplasty machine and training in its use.
Sample Size: One hundred ninety patients (95 in each group) will be needed to obtain a power of 0.90, with a two-sided alpha of 0.05. Patients are the unit of randomization. Expected IOP difference between groups of 3.0 mm Hg + 4.0 mmg HG, and a correlation of 0.30 between baseline and final intraocular pressure, allowing for loss to follow up of 30%.
Baseline Data:
aseline data (to be collected prior to determination of eligibility and randomization but after obtaining informed consent) include the following:
- Presence or absence of relevant pre-existing health conditions (i.e., hypertension, diabetes, cardiovascular disease)
Ophthamologic test results
- Best corrected visual acuity and presenting visual acuity in both eyes
- Intraocular pressure in both eyes
- Cup to disk ratio in both eyes
- presence or absence of visually significant cataract in both eyes; if cataract present in study eye, whether cataract surgery has already been performed
- degrees of visible Trabecular Meshwork in the study eye on gonioscopy without "dynamic gonioscopy"
- score on glaucoma knowledge test using a simple, previously validated questionnaire
Demographic data
- date of birth or self-reported age in years
- sex
Contact information
- Address
- mobile phone number where can be reached (own or neighbours, etc.)
Socioeconomic status
- completed education in years
- wealth, as measured by ownership of items on a pre-determined list of 13 common household devices in China
- job title/description
Level of difficulty traveling to hospital with eye clinic
- distance traveled
- time spent traveling
- direct or out-of-pocket costs for travel, meals, etc.
Main analyses:
- Following requirements for intention-to-treat analyses, we will measure mean intraocular pressure at 12 months comparing the two groups and adjusting for baseline intraocular pressure, including all subjects who accepted and refused treatment (primary analysis, unadjusted). We will also measure intraocular pressure as above, adjusting for cataract surgery, age, gender, prior use of medication, degrees of open angle in study eye at baseline, and severity of glaucoma (Cup to disk ratio) in study eye at baseline (primary analysis, adjusted). Both of the above analyses will be repeated using a per protocol approach (including only patients who accepted their assigned therapy, or secondary analysis).
- We will test for differences in baseline characteristics by study group with t-tests (for continuous variables) and Chi-square tests (for categorical variables). We will use generalized linear models with Poisson regression (for variables with binary outcomes) and linear regression (for variables with continuous outcomes) to estimate the relative risk for the intervention arm. Multiple imputation in Stata 13.1 (StataCorp, College Station, TX, USA) will be used to address missing data. All statistical analysis will be performed using Stata 13.1. A two-tailed P-value of <0.05 will be considered statistically significant.
Study Type
Enrollment (Anticipated)
Phase
- Early Phase 1
Contacts and Locations
Study Locations
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Guangdong
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Guangzhou, Guangdong, China, 510060
- Blindness Preventment and Treatment Department
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- diagnosis of glaucoma (Cup to disk ratio, or CDR > 0.6 with optic nerve appearance and/or visual field findings consistent with glaucoma in the study eye)
- angle configuration > 180° of trabecular meshwork visible in the study eye
- no previous ocular incisional surgery or ocular laser treatment except refractive or cataract surgery in the study eye
- Best corrected visual acuity > 6/60 metres in both eyes
Exclusion Criteria:
- Intraocular pressure > 35 in the study eye
- Cup to disk ratio > 0.9 in the study eye
- Inability to give informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: SLT laser group
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Patients will be offered initial SLT laser by doctors
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No Intervention: Standard care group
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No Intervention: Drug treatment group
Patients not accepting the offered treatment for the study eye within 3 months will receive topical Timolol 0.5% bid at the usual price, with the prescription to be refilled per usual practice at the hospital (usually monthly).
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Intraocular pressure
Time Frame: 12 months
|
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12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Visual quality of life
Time Frame: 12 months
|
use the scale "NEI-VQ 25" to assess the patient's visual quality of life
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12 months
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Satisfaction score
Time Frame: 12 months
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Using a Surgical Satisfaction Questionnaire previously validated in rural China
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12 months
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Cataract surgery
Time Frame: 12 months
|
Cataract surgery performed in conjunction with allocated treatment (Yes/No)
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12 months
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Allocated treatment
Time Frame: 12 months
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use acceptance questionnaire form to calculate surgical receiving rate
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12 months
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Nathan G Congdon, MD,MPH, Zhongshan Ophthalmic Center, Sun Yat-sen University
Publications and helpful links
General Publications
- Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ, Duan XR, Yang XH, Wang FH, Zhou Q, Wang NL; Handan Eye Study Group. Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study. Ophthalmology. 2008 Nov;115(11):1965-72. doi: 10.1016/j.ophtha.2008.05.030. Epub 2008 Aug 5.
- Zhang XJ, Liang YB, Liu YP, Jhanji V, Musch DC, Peng Y, Zheng CR, Zhang HX, Chen P, Tang X, Lam DS. Implementation of a free cataract surgery program in rural China: a community-based randomized interventional study. Ophthalmology. 2013 Feb;120(2):260-5. doi: 10.1016/j.ophtha.2012.07.087. Epub 2012 Oct 27.
- Ang GS, Varga Z, Shaarawy T. Postoperative infection in penetrating versus non-penetrating glaucoma surgery. Br J Ophthalmol. 2010 Dec;94(12):1571-6. doi: 10.1136/bjo.2009.163923. Epub 2009 Nov 5.
- Liu T, Congdon N, Yan X, Jin L, Wu Y, Friedman D, He M. A randomized, controlled trial of an intervention promoting cataract surgery acceptance in rural China: the Guangzhou Uptake of Surgery Trial (GUSTO). Invest Ophthalmol Vis Sci. 2012 Aug 13;53(9):5271-8. doi: 10.1167/iovs.12-9798.
- Wittenborn JS, Rein DB. Cost-effectiveness of glaucoma interventions in Barbados and Ghana. Optom Vis Sci. 2011 Jan;88(1):155-63. doi: 10.1097/OPX.0b013e3181fc30f3.
- Narayanaswamy A, Leung CK, Istiantoro DV, Perera SA, Ho CL, Nongpiur ME, Baskaran M, Htoon HM, Wong TT, Goh D, Su DH, Belkin M, Aung T. Efficacy of selective laser trabeculoplasty in primary angle-closure glaucoma: a randomized clinical trial. JAMA Ophthalmol. 2015 Feb;133(2):206-12. doi: 10.1001/jamaophthalmol.2014.4893.
- Realini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol. 2013 Mar;131(3):321-7. doi: 10.1001/jamaophthalmol.2013.1706.
- Adekoya BJ, Akinsola FB, Balogun BG, Balogun MM, Ibidapo OO. Patient refusal of glaucoma surgery and associated factors in Lagos, Nigeria. Middle East Afr J Ophthalmol. 2013 Apr-Jun;20(2):168-73. doi: 10.4103/0974-9233.110612.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- SLT in rural China
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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