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The EGS Fellowship Syllabus

This document is a comprehensive list of topics and represents the requested standard of knowledge set by the EGS to be acquired during the EGS accredited fellowship.

The document is based on the EGS Guidelines (5th edition 2020). However, more in-depth reading of landmark book chapters, review articles, and randomised clinical trials (RCTs) is highly recommended. The last section of the syllabus is dedicated to the relevant glaucoma literature. While relatively exhaustive, this list is not complete but represents a basis for the understanding of modern glaucoma management.

A prerequisite knowledge is mandatory prior to starting the fellowship (chapter A. 1-4). Knowledge of most cited topics is mandatory; however, depending on the availability of some tools/instruments, some are listed as “Recommended” (R) but their theoretical comprehension is mandatory.

Medical fellowship (as per EGS definition): Surgical skills are not part of this fellowship; however, full theoretical knowledge on indications, various techniques, postoperative care, complications, and their management is mandatory.

Medical fellowship with surgical training (as per EGS definition): In addition to the mandatory knowledge on indications, various techniques, postoperative care, complications, and their management, the fellow should be able to perform several surgical techniques which represent mandatory surgical training. This document does not set minimal numbers of procedures to be performed as this is dependent on the training institution, the trainers, and the trainees.

A. Pre-requisite Knowledge (all mandatory)

Items 1-4 represent general knowledge acquired during residency and tested, when available, within the national European specialty exam or within supranational exams such as the EBO/ICO exam. This knowledge is a prerequisite before entering the fellowship.

1. Anatomy and Physiology

  • Embryology and anatomy of the eye (anterior and posterior segment)
  • Anatomy of the visual pathway
  • Physiology of aqueous humour

2. Epidemiology and Statistics

  • Clinical epidemiology (prevalence, incidence, geographic distribution)
  • Basic statistics relevant to ophthalmic practice

3. Genetics

  • Molecular genetics background, glaucoma-related loci and genes, patterns of inheritance
  • Role of the clinician in genetic studies, consultation with patients and family, and appropriate referrals for genetic counselling

4. Glaucoma Classification

4.1 Childhood Glaucoma
  • Primary childhood glaucoma
    • Primary congenital glaucoma (PCG) from birth to the first years of life
    • Late-onset childhood OAG with onset from more than two years of age to puberty
  • Secondary childhood glaucoma
    • Glaucoma associated with non-acquired anomalies
      • Aniridia
      • Axenfeld-Rieger anomaly
      • Congenital ectropion uveae
      • Congenital iris hypoplasia
      • Ectopia lentis
      • Microcornea
      • Microphthalmos
      • Oculodermal melanocytosis
      • Persistent fetal vasculature
      • Peters anomaly
      • Posterior polymorphous dystrophy
    • Glaucoma associated with non-acquired systemic disease or syndrome
      • Chromosomal disorders (e.g., Down syndrome)
      • Connective tissue disorders (Marfan, Weill-Marchesani, Stickler syndromes)
      • Metabolic disorders (homocystinuria, Lowe syndrome, Mucopolysaccharidoses)
      • Phacomatoses (Neurofibromatosis, Sturge-Weber syndrome)
    • Glaucoma associated with acquired conditions
      • Uveitis
      • Traumatism (hyphaema, angle recession, ectopia lentis)
      • Steroid-induced
      • Tumours (benign/malignant, ocular/orbital)
      • Retinopathy of prematurity
    • Glaucoma following cataract surgery
4.2 Adult Glaucoma
  • Open angle disease
    • Ocular hypertension
    • Primary open angle glaucoma (POAG)
      • Risk factors for the onset of POAG
      • Primary open angle glaucoma suspect
      • Risk factors for progression of POAG
    • Primary late-onset juvenile open angle glaucoma
      • Myocilin mutations
  • Angle closure disease
    • Block mechanisms
      • Pupillary
      • Ciliary
      • Lens
      • Vitreous and choroid
    • Clinical presentations
      • Primary angle closure suspect (PACS)
      • Primary angle closure (PAC)
      • Primary angle closure glaucoma (PACG)
  • Secondary glaucomas
    • Secondary open angle glaucoma (pigmentary, exfoliative, lens-induced, corticoid-induced, haemorrhage-induced, uveitic, associated with increased episcleral venous pressure, intraocular tumours, trauma, iatrogenic/surgery/laser induced)
    • Secondary angle closure glaucoma (neovascular, lens/IOL-induced, uveitic, traumatic, aqueous misdirection, ICE syndrome, post-trauma or ocular surgery)

B. Knowledge to Be Acquired/Improved

For each type of glaucoma, there should be adequate understanding of the following aspects:

  • Epidemiology
  • Pathophysiology
  • Diagnosis
  • Treatments (medical, surgical, laser procedures)
  • Side effects and complications of treatments
  • Follow-up
  • Critical evaluation of literature (evidence-based medicine), including health economics

All items are regarded as mandatory knowledge, except those labelled with R (recommended) for which in-depth theoretical knowledge is required.

1. Glaucoma Clinical Evaluation

Goal: The fellow is expected to be able to perform or order and analyze results of all the mandatory examinations, decide on follow-up visits (according to disease stage, life expectancy, type of glaucoma, systemic diseases, etc.), evaluate the patients’ rate of progression, and adjust the clinical management based on evidence-based practice and patient perspectives.

  • 1.1 Intraocular pressure (IOP) measurement techniques
    • Goldmann applanation tonometry
    • Dynamic contour tonometry (Pascal) R
    • Air-puff
    • Ocular Response Analyser R
    • Tono-pen R
    • Rebound tonometry (i-Care) R
  • 1.2 Pachymetry
  • 1.3 Gonioscopy
    • Indirect gonioscopy (Goldmann 3-2-1 mirror lenses)
    • Direct gonioscopy (Koeppe lens) R
    • Dynamic gonioscopy (Zeiss, Posner, Sussmann lens)
  • 1.4 Fundoscopy
    • Evaluation of optic disc, retinal nerve fibre layer (RNFL), and relevant retinal changes
  • 1.5 Tests of visual function
    • Standard automated perimetry (SAP): Humphrey and/or Octopus
      • Theoretical knowledge on the basics of automatic perimetry
      • Practical knowledge on interpretation of data
    • Goldmann static perimetry R
    • Microperimetry R
    • Electrophysiology R
  • 1.6 Imaging
    • Theoretical knowledge on the basics of each device
    • Practical knowledge on interpretation of data
    • 1.6.1 Anterior segment
      • Anterior segment OCT
      • UBM
    • 1.6.2 Posterior segment
      • Retinography: assessment of disc and RNFL
      • OCT, OCT-angiography
        • Evaluation and interpretation of optic nerve head parameters, including Bruch’s Membrane-Minimum Rim Width (BMO-MRW), retinal nerve fibre layer (RNFL) thickness, and macular parameters comprising the ganglion cells, such as ganglion cell layer (GCL), ganglion cell plus inner plexiform layer (GCIPL), or ganglion cell complex (GCC)
  • 1.7 Other tests relevant to patient pathology and presentation
    • Blood tests
    • 24-hour blood pressure monitoring
    • Central nervous system imaging

2. Glaucoma Management

Goal: The fellow is expected to be able to manage medically or with laser therapy different conditions according to the type and stage of glaucoma, patient’s life expectancy, and possible systemic diseases. They should be familiar with side effects and limitations of medical and laser therapy and able to adjust management. Indications for surgery should be recognized accordingly, and the most appropriate surgical management suggested for the given condition and patient. The fellow is expected to know theoretically all techniques cited in the list below. For Clinical Fellowships with surgery, surgical techniques are requested practically, and among them, certain ones are considered mandatory. Decisions on the choice of surgical techniques should be based on evidence-based practice and patients’ perspectives and expectations.

  • 2.1 Medical Treatment
    • 2.1.1 Drug Categories
      • Prostaglandin analogues
      • Beta-receptor antagonists
      • Alpha-agonists
      • Carbonic anhydrase inhibitors (topical and systemic)
      • Parasympathomimetics
      • Osmotic agents
      • New molecules
    • 2.1.2 Understanding Required for Each Drug Category
      • Mechanism of action
      • Indications
      • Posology
      • Limitations
      • Side effects
      • Financial impact
      • Potential impact on quality of life (QoL)
  • 2.2 Surgical Management
    • 2.2.1 Laser Procedures
      • Trabeculoplasty (Argon and/or SLT)
      • Nd:YAG iridotomy
      • Peripheral iridoplasty
      • Laser suture lysis
      • Nd:YAG capsulotomy
    • 2.2.2 Surgical Procedures
      • Cataract surgery*
      • Trabeculectomy*
      • Aqueous shunts (non-valved and valved)*
      • Non-penetrating procedures (canaloplasty, viscocanaloplasty, and deep sclerectomy)**
      • Minimally Invasive Glaucoma Surgery (MIGS)**
      • Cyclo destruction/modulation procedures*
      • Combined cataract-glaucoma procedures**
      • For children
        • Examination under general anaesthesia*
        • Trabeculotomy**
        • Goniotomy**

Mandatory techniques: These are to be learned during fellowship with surgical training. A certain number of cataract surgeries (n=80) is a prerequisite for admittance to the fellowship with surgical training.

Recommended techniques: These should be learned if available. Theoretical knowledge is mandatory.

2.2.3 Anti-Scarring Agents in Glaucoma Surgery
  • Knowledge of options:
    • Antifibrotics (MMC, 5-FU)
    • Anti-VEGF agents
    • Implants
  • Knowledge on indications based on available evidence, practical use, and potential complications and side effects of anti-scarring agent usage
2.2.4 Complications of Glaucoma Surgery
  • 2.2.4.1 Knowledge of Commonest Complications (Physiopathology and Rates):
    • Hypotony (early, late) and related complications
    • Bleb leak
    • Tube exposure
    • Aqueous misdirection
    • Suprachoroidal haemorrhage
    • Blebitis
    • Endophthalmitis
    • Hyphema
  • 2.2.4.2 Management of Complications:
    • Medical treatment
    • Anterior chamber reformation
    • Removal of internal blockage (e.g., laser for iris incarceration or device obstruction)
    • Compression sutures
    • Bleb revision
    • Infection management
    • Further glaucoma surgery
    • Choroidal drainage
2.2.5 Bleb Failure (Diagnosis and Management)
  • Needling of failing/cystic filtering blebs
  • Bleb revision
  • Indication and use of antifibrotics
  • YAG laser goniopuncture (after non-penetrating surgery)
2.3 Post-Operative Follow-Up
  • Drug regimen (antibiotics, corticosteroids, others)
  • Follow-up visits
  • Suture removal at the slit lamp
  • Adjustment of medical therapy according to target IOP and rate of progression

3. Health Economics

Goal: The fellow should be able to understand the basic concept and terminology of health economics and analyze the cost-effectiveness of glaucoma management (from diagnosis to medical and surgical management). The fellow should also be able to evaluate cost-effectiveness studies.

4. Quality of Life

Goal: The fellow should be able to adapt glaucoma management to personalized care, taking into account the patient’s perspective.

In addition to the clinical/surgical training during the fellowship, it is expected that the fellow takes active part in various research activities, not exceeding 20% of the work time (epidemiology studies, clinical research including clinical trials, basic research, critical review of the current literature, manuscript preparation, oral presentations, and attendance at major glaucoma meetings).

C. Suggested Readings

Guidelines

Books

  • BCSC - 10. Glaucoma. Edition 2020-21. American Academy of Ophthalmology 2020
  • Shields Textbook of Glaucoma. 7th Edition. R. Rand Allingham, Karim F. Damji, Sayoko E. Moroi, Douglas J. Rhee, Sharon F. Freedman, Sanjay G. Asrani, Christopher C. Teng. Lippincott Williams & Wilkins 2020
  • Glaucoma, A Colour Manual of Diagnosis and Treatment. 3rd Edition. John F. Salmon, Jack J. Kanski. Butterworth-Heinemann 2004
  • The Glaucoma Book, A Practical, Evidence-Based Approach to Patient Care. Paul N. Schacknow, John R. Samplers. Springer Science and Business Media LLC 2010
  • The Glaucomas. Robert Ritch, M. Bruce Shields, Theodore Krupin. Mosby 1996
  • Evidence Based Medicine, How to Practice and Teach EBM. 5th Edition. Sharon Straus, Paul Glasziou, W. Scott Richardson, R. Brian Haynes. Elsevier 2018
  • Glaucoma. 2nd Edition. Tarek Shaarawy, Marc Sherwood, Roger Hitchings, Jonathan Crowston. Saunders Ltd 2014
  • Atlas of Glaucoma. 3rd Edition. Neil T. Choplin and Carlo E. Traverso. CRC Press, Taylor & Francis Group 2014
  • Color Atlas of Gonioscopy. 2nd Edition. Wallace L. M. Alward & Reid A. Longmuir MD. American Academy of Ophthalmology 2008

Published Peer-Reviewed Publications

Access to the main journals published in the field of Ophthalmology is strongly recommended.

A. Reviews
  • The 39 Cochrane reviews dealing with glaucoma (available in 2021) should be consulted for the fellowship program.
  • Wormald, R., Virgili, G., & Azuara-Blanco, A. Systematic reviews and randomized controlled trials on open angle glaucoma. Eye, 34, 161–167 (2020). https://doi.org/10.1038/s41433-019-0687-5
B. Relevant Randomised Controlled Clinical Trials
  • CNTGS 40, 41
  • LoTGS 42
  • AGIS 43-53
  • CIGTS 54-58
  • EMGT 59-63
  • OHTS 64-73
  • EGPS 74, 75
  • UKGTS 76-78
  • EAGLE 79-81
  • ZAP 82
  • LiGHT 83, 84
  • TVT 85-87
  • PTVT 88-91
C. Major Epidemiological Studies
  • Baltimore Eye Survey 92-98
  • Blue Mountains Eye Study 99-102
  • Rotterdam Eye Study 103, 104
  • Thessaloniki Eye Study 105-116
  • Santa Lucia Eye Study 117
  • Beijing Eye Study 118-121
  • The Singapore Epidemiology of Eye Diseases Study 122-125

References

A. Cochrane database systematic review on glaucoma management
1. Wilkins M, Indar A, Wormald R. Intraoperative Mitomycin C for glaucoma surgery. Cochrane Database of Systematic Reviews 2005.
2. Hatt SR, Wormald R, Burr J. Screening for prevention of optic nerve damage due to chronic open angle glaucoma. Cochrane Database of Systematic Reviews 2006.
3. Rolim de Moura CR, Paranhos Jr A, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database of Systematic Reviews 2007.
4. Vass C, Hirn C, Sycha T, et al. Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database of Systematic Reviews 2007.
5. Sycha T, Vass C, Findl O, et al. Interventions for normal tension glaucoma. Cochrane Database of Systematic Reviews 2010.
6. Bochmann F, Azuara‐Blanco A. Interventions for late trabeculectomy bleb leak. Cochrane Database of Systematic Reviews 2012.
7. Burr J, Azuara‐Blanco A, Avenell A, Tuulonen A. Medical versus surgical interventions for open angle glaucoma. Cochrane Database of Systematic Reviews 2012.
8. Feyi‐Waboso A, Ejere HOD. Needling for encapsulated trabeculectomy filtering blebs. Cochrane Database of Systematic Reviews 2012.
9. Kirwan JF, Rennie C, Evans JR. Beta radiation for glaucoma surgery. Cochrane Database of Systematic Reviews 2012.
10. Waterman H, Evans JR, Gray TA, Henson D, Harper R. Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database of Systematic Reviews 2013.
11. Eldaly MA, Bunce C, ElSheikha OZ, Wormald R. Non‐penetrating filtration surgery versus trabeculectomy for open‐angle glaucoma. Cochrane Database of Systematic Reviews 2014.
12. Green E, Wilkins M, Bunce C, Wormald R. 5‐Fluorouracil for glaucoma surgery. Cochrane Database of Systematic Reviews 2014.
13. Thomas RE, Crichton A, Thomas BC. Antimetabolites in cataract surgery to prevent failure of a previous trabeculectomy. Cochrane Database of Systematic Reviews 2014.
14. Al‐Haddad C, Abdulaal M, Al‐Moujahed A, Ervin AM. Fornix‐based versus limbal‐based conjunctival trabeculectomy flaps for glaucoma. Cochrane Database of Systematic Reviews 2015.
15. Cabourne E, Clarke JCK, Schlottmann PG, Evans JR. Mitomycin C versus 5‐Fluorouracil for wound healing in glaucoma surgery. Cochrane Database of Systematic Reviews 2015.
16. Michelessi M, Lucenteforte E, Oddone F, et al. Optic nerve head and fibre layer imaging for diagnosing glaucoma. Cochrane Database of Systematic Reviews 2015.
17. Wang X, Khan R, Coleman A. Device‐modified trabeculectomy for glaucoma. Cochrane Database of Systematic Reviews 2015.
18. Zhang ML, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. Cochrane Database of Systematic Reviews 2015.
19. Cheng JW, Cheng SW, Wei RL, Lu GC. Anti‐vascular endothelial growth factor for control of wound healing in glaucoma surgery. Cochrane Database of Systematic Reviews 2016.
20. Michelessi M, Lindsley K. Peripheral iridotomy for pigmentary glaucoma. Cochrane Database of Systematic Reviews 2016.
21. Sena DF, Lindsley K. Neuroprotection for treatment of glaucoma in adults. Cochrane Database of Systematic Reviews 2017.
22. Tseng VL, Coleman AL, Chang MY, Caprioli J. Aqueous shunts for glaucoma. Cochrane Database of Systematic Reviews 2017.
23. Xu L, Wang X, Wu M. Topical medication instillation techniques for glaucoma. Cochrane Database of Systematic Reviews 2017.
24. Zhang L, Weizer JS, Musch DC. Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty. Cochrane Database of Systematic Reviews 2017.
25. King AJ, Shah A, Nikita E, et al. Subconjunctival draining minimally‐invasive glaucoma devices for medically uncontrolled glaucoma. Cochrane Database of Systematic Reviews 2018.
26. Le JT, Rouse B, Gazzard G. Iridotomy to slow progression of visual field loss in angle‐closure glaucoma. Cochrane Database of Systematic Reviews 2018.
27. Michelessi M, Bicket AK, Lindsley K. Cyclodestructive procedures for non‐refractory glaucoma. Cochrane Database of Systematic Reviews 2018.
28. Chen MF, Kim CH, Coleman AL. Cyclodestructive procedures for refractory glaucoma. Cochrane Database of Systematic Reviews 2019.
29. Foo VHX, Htoon HM, Welsbie DS, Perera SA. Aqueous shunts with mitomycin C versus aqueous shunts alone for glaucoma. Cochrane Database of Systematic Reviews 2019.
30. Le JT, Bicket AK, Wang L, Li T. Ab interno trabecular bypass surgery with iStent for open‐angle glaucoma. Cochrane Database of Systematic Reviews 2019.
31. Tóth M, Shah A, Hu K, Bunce C, Gazzard G. Endoscopic cyclophotocoagulation (ECP) for open angle glaucoma and primary angle closure. Cochrane Database of Systematic Reviews 2019.
32. Gagrani M, Garg I, Ghate D. Surgical interventions for primary congenital glaucoma. Cochrane Database of Systematic Reviews 2020.
33. Jindal A, Ctori I, Virgili G, Lucenteforte E, Lawrenson JG. Non‐contact tests for identifying people at risk of primary angle closure glaucoma. Cochrane Database of Systematic Reviews 2020.
34. Law SK, Wang L, Li T. Acupuncture for glaucoma. Cochrane Database of Systematic Reviews 2020.
35. Otarola F, Virgili G, Shah A, Hu K, Bunce C, Gazzard G. Ab interno trabecular bypass surgery with Schlemm´s canal microstent (Hydrus) for open angle glaucoma. Cochrane Database of Systematic Reviews 2020.
36. Simha A, Aziz K, Braganza A, Abraham L, Samuel P, Lindsley KB. Anti‐vascular endothelial growth factor for neovascular glaucoma. Cochrane Database of Systematic Reviews 2020.
37. Bayliss JM, Ng WS, Waugh N, Azuara-Blanco A. Laser peripheral iridoplasty for chronic angle closure. Cochrane Database of Systematic Reviews 2021.
38. Hu K, Shah A, Virgili G, Bunce C, Gazzard G. Ab interno trabecular bypass surgery with Trabectome for open‐angle glaucoma. Cochrane Database of Systematic Reviews 2021.
39. Ong AY, Ng SM, Vedula SS, Friedman DS. Lens extraction for chronic angle‐closure glaucoma. Cochrane Database of Systematic Reviews 2021.

B. Randomised controlled clinical trials
- The Collaborative Normal Tension Glaucoma Study (CNTGS)
40. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol 1998;126:487-497.
41. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol 1998;126:498-505.

- The Low-Pressure Glaucoma Treatment Study
42. Krupin T, Liebmann JM, Greenfield DS, Ritch R, Gardiner S, Low-Pressure Glaucoma Study G. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol 2011;151:671-681.

- The Advanced Glaucoma Intervention Study (AGIS)
43. The Advanced Glaucoma Intervention Study (AGIS): 4. Comparison of treatment outcomes within race. Seven-year results. Ophthalmology 1998;105:1146-1164.
44. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol 2000;130:429-440.
45. The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators. Arch Ophthalmol 2000;118:1639-1652.
46. Caprioli J, Coleman AL. Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study. Ophthalmology 2008;115:1123-1129 e1123.
47. Ederer F, Gaasterland DA, Dally LG, et al. The Advanced Glaucoma Intervention Study (AGIS): 13. Comparison of treatment outcomes within race: 10-year results. Ophthalmology 2004;111:651-664.
48. Investigators A. The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups. Am J Ophthalmol 2001;132:311-320.
49. Investigators A. The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol 2002;134:481-498.
50. Investigators A. The Advanced Glaucoma Intervention Study (AGIS): 12. Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma. Am J Ophthalmol 2002;134:499-512.
51. Kim J, Dally LG, Ederer F, et al. The Advanced Glaucoma Intervention Study (AGIS): 14. Distinguishing progression of glaucoma from visual field fluctuations. Ophthalmology 2004;111:2109-2116.
52. Nouri-Mahdavi K, Hoffman D, Coleman AL, et al. Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology 2004;111:1627-1635.
53. Schwartz AL, Van Veldhuisen PC, Gaasterland DE, Ederer F, Sullivan EK, Cyrlin MN. The Advanced Glaucoma Intervention Study (AGIS): 5. Encapsulated bleb after initial trabeculectomy. Am J Ophthalmol 1999;127:8-19.

- The Collaborative Initial Glaucoma Treatement Study (CIGTS)
54. Musch DC, Gillespie BW, Niziol LM, et al. Cataract extraction in the collaborative initial glaucoma treatment study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes. Arch Ophthalmol 2006;124:1694-1700.
55. Musch DC, Lichter PR, Guire KE, Standardi CL. The Collaborative Initial Glaucoma Treatment Study: study design, methods, and baseline characteristics of enrolled patients. Ophthalmology 1999;106:653-662.
56. Musch DC, Gillespie BW, Niziol LM, Cashwell LF, Lichter PR, Collaborative Initial Glaucoma Treatment Study G. Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 2008;115:927-933.
57. Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001;108:1943-1953.
58. Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK, Investigators CS. Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors. Ophthalmology 2009;116:200-207.

- The Early Manifest Glaucoma Trial (EMGT)
59. Leske MC, Heijl A, Hyman L, Bengtsson B. Early manifest glaucoma trial. Ophthalmology 1999;106:2144-2153.
60. Leske MC, Heijl A, Hussein M, et al. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol 2003;121:48-56.
61. Heijl A, Bengtsson B, Hyman L, Leske MC, Early Manifest Glaucoma Trial G. Natural history of open-angle glaucoma. Ophthalmology 2009;116:2271-2276.
62. Leske MC, Heijl A, Hyman L, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology 2007;114:1965-1972.
63. Heijl A, Leske MC, Bengtsson B, et al. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 2002;120:1268-1279.

- The Ocular Hypertension Treatment Study (OHTS)
64. Brandt JD, Gordon MO, Beiser JA, et al. Changes in central corneal thickness over time: the ocular hypertension treatment study. Ophthalmology 2008;115:1550-1556, 1556 e1551.
65. Budenz DL, Anderson DR, Feuer WJ, et al. Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study. Ophthalmology 2006;113:2137-2143.
66. De Moraes CG, Demirel S, Gardiner SK, et al. Rate of visual field progression in eyes with optic disc hemorrhages in the ocular hypertension treatment study. Arch Ophthalmol 2012;130:1541-1546.
67. Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120:714-720; discussion 829-730.
68. Herman DC, Gordon MO, Beiser JA, et al. Topical ocular hypotensive medication and lens opacification: evidence from the ocular hypertension treatment study. Am J Ophthalmol 2006;142:800-810.
69. Kass MA, Gordon MO, Gao F, et al. Delaying treatment of ocular hypertension: the ocular hypertension treatment study. Arch Ophthalmol 2010;128:276-287.
70. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120:701-713; discussion 829-730.
71. Mansberger SL, Gordon MO, Jampel H, et al. Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology 2012;119:1826-1831.
72. Mansberger SL, Hughes BA, Gordon MO, et al. Comparison of initial intraocular pressure response with topical beta-adrenergic antagonists and prostaglandin analogues in African American and white individuals in the Ocular Hypertension Treatment Study. Arch Ophthalmol 2007;125:454-459.
73. Scheetz TE, Faga B, Ortega L, et al. Glaucoma Risk Alleles in the Ocular Hypertension Treatment Study. Ophthalmology 2016;123:2527-2536.

- The European Glaucoma Prevention Study (EGPS)
74. European Glaucoma Prevention Study G, Miglior S, Pfeiffer N, et al. Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. Ophthalmology 2007;114:3-9.
75. Miglior S, Zeyen T, Pfeiffer N, et al. Results of the European Glaucoma Prevention Study. Ophthalmology 2005;112:366-375.

- The United Kingdom Glaucoma Treatment Study (UKGTS)
76. Garway-Heath DF, Crabb DP, Bunce C, et al. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. Lancet 2015;385:1295-1304.
77. Founti P, Bunce C, Khawaja AP, et al. Risk Factors for Visual Field Deterioration in the United Kingdom Glaucoma Treatment Study. Ophthalmology 2020;127:1642-1651.
78. Jones L, Garway-Heath DF, Azuara-Blanco A, Crabb DP, United Kingdom Glaucoma Treatment Study I. Are Patient Self-Reported Outcome Measures Sensitive Enough to Be Used as End Points in Clinical Trials?: Evidence from the United Kingdom Glaucoma Treatment Study. Ophthalmology 2019;126:682-689.

- Effectiveness in Angle Closure Glaucoma of Lens Extraction (EAGLE)
79. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet 2016;388:1389-1397.
80. Day AC, Cooper D, Burr J, et al. Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort. Br J Ophthalmol 2018;102:1658-1662.
81. Javanbakht M, Azuara-Blanco A, Burr JM, et al. Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial. BMJ Open 2017;7:e013254.

- The Zhongshan Angle Closure Prevention Trial (ZAP)
82. He M, Jiang Y, Huang S, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. Lancet 2019;393:1609-1618.

- The Laser in Glaucoma and Ocular Hypertension Trial (LIGHT)
83. Garg A, Vickerstaff V, Nathwani N, et al. Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial. Ophthalmology 2020;127:467-476.
84. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019;393:1505-1516.

- The Tube Versus Trabeculectomy Study (TVT)
85. Saheb H, Gedde SJ, Schiffman JC, Feuer WJ, Tube Versus Trabeculectomy Study G. Outcomes of glaucoma reoperations in the Tube Versus Trabeculectomy (TVT) Study. Am J Ophthalmol 2014;157:1179-1189 e1172.
86. Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012;153:804-814 e801.
87. Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012;153:789-803 e782.

- The Primary Tube Versus Trabeculectomy Study (PTVT)
88. Gedde SJ, Feuer WJ, Chen PP, et al. Comparing Treatment Outcomes from the Tube Versus Trabeculectomy and Primary Tube Versus Trabeculectomy Studies. Ophthalmology 2021;128:324-326.
89. Gedde SJ, Feuer WJ, Lim KS, et al. Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 3 Years of Follow-up. Ophthalmology 2020;127:333-345.
90. Gedde SJ, Feuer WJ, Shi W, et al. Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up. Ophthalmology 2018;125:650-663.
91. Gedde SJ, Chen PP, Heuer DK, et al. The Primary Tube Versus Trabeculectomy Study: Methodology of a Multicenter Randomized Clinical Trial Comparing Tube Shunt Surgery and Trabeculectomy with Mitomycin C. Ophthalmology 2018;125:774-781.

C. Major epidemiological studies
- The Baltimore Eye Survey
92. Patel KH, Javitt JC, Tielsch JM, et al. Incidence of acute angle-closure glaucoma after pharmacologic mydriasis. Am J Ophthalmol 1995;120:709-717.
93. Quigley HA, Tielsch JM, Katz J, Sommer A. Rate of progression in open-angle glaucoma estimated from cross-sectional prevalence of visual field damage. Am J Ophthalmol 1996;122:355-363.
94. Quigley HA, Varma R, Tielsch JM, Katz J, Sommer A, Gilbert DL. The relationship between optic disc area and open-angle glaucoma: the Baltimore Eye Survey. J Glaucoma 1999;8:347-352.
95. Sommer A. Glaucoma risk factors observed in the Baltimore Eye Survey. Curr Opin Ophthalmol 1996;7:93-98.
96. Tielsch JM, Katz J, Quigley HA, Javitt JC, Sommer A. Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey. Ophthalmology 1995;102:48-53.
97. Tielsch JM, Katz J, Sommer A, Quigley HA, Javitt JC. Family history and risk of primary open angle glaucoma. The Baltimore Eye Survey. Arch Ophthalmol 1994;112:69-73.
98. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA 1991;266:369-374.

- The Blue Mountains Eye Study
99. Mitchell P, Hourihan F, Sandbach J, Wang JJ. The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology 1999;106:2010-2015.
100. Mitchell P, Lee AJ, Rochtchina E, Wang JJ. Open-angle glaucoma and systemic hypertension: the blue mountains eye study. J Glaucoma 2004;13:319-326.
101. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. Ophthalmology 1996;103:1661-1669.
102. Mitchell P, Smith W, Chey T, Healey PR. Open-angle glaucoma and diabetes: the Blue Mountains eye study, Australia. Ophthalmology 1997;104:712-718.

- The Rotterdam Study
103. Dielemans I, Vingerling JR, Wolfs RC, Hofman A, Grobbee DE, de Jong PT. The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study. Ophthalmology 1994;101:1851-1855.
104. Springelkamp H, Wolfs RC, Ramdas WD, et al. Incidence of glaucomatous visual field loss after two decades of follow-up: the Rotterdam Study. Eur J Epidemiol 2017;32:691-699.

- The Thessaloniki Eye Study
105. Anastasopoulos E, Coleman AL, Wilson MR, et al. Association of LOXL1 polymorphisms with pseudoexfoliation, glaucoma, intraocular pressure, and systemic diseases in a Greek population. The Thessaloniki eye study. Invest Ophthalmol Vis Sci 2014;55:4238-4243.
106. Anastasopoulos E, Topouzis F, Wilson MR, et al. Characteristics of pseudoexfoliation in the Thessaloniki Eye Study. J Glaucoma 2011;20:160-166.
107. Founti P, Coleman AL, Wilson MR, et al. Overdiagnosis of open-angle glaucoma in the general population: the Thessaloniki Eye Study. Acta Ophthalmol 2018;96:e859-e864.
108. Harris A, Topouzis F, Wilson MR, et al. Association of the optic disc structure with the use of antihypertensive medications: the Thessaloniki eye study. J Glaucoma 2013;22:526-531.
109. Topouzis F, Coleman AL, Harris A, et al. Association of blood pressure status with the optic disk structure in non-glaucoma subjects: the Thessaloniki eye study. Am J Ophthalmol 2006;142:60-67.
110. Topouzis F, Coleman AL, Harris A, et al. Factors associated with undiagnosed open-angle glaucoma: the Thessaloniki Eye Study. Am J Ophthalmol 2008;145:327-335.
111. Topouzis F, Coleman AL, Yu F, et al. Sensitivity and specificity of the 76-suprathreshold visual field test to detect eyes with visual field defect by Humphrey threshold testing in a population-based setting: the Thessaloniki eye study. Am J Ophthalmol 2004;137:420-425.
112. Topouzis F, Founti P, Yu F, Wilson MR, Coleman AL. Twelve-Year Incidence and Baseline Risk Factors for Pseudoexfoliation: The Thessaloniki Eye Study (An American Ophthalmological Society Thesis). Am J Ophthalmol 2019;206:192-214.
113. Topouzis F, Harris A, Wilson MR, et al. Increased likelihood of glaucoma at the same screening intraocular pressure in subjects with pseudoexfoliation: the Thessaloniki Eye Study. Am J Ophthalmol 2009;148:606-613 e601.
114. Topouzis F, Wilson MR, Harris A, et al. Prevalence of open-angle glaucoma in Greece: the Thessaloniki Eye Study. Am J Ophthalmol 2007;144:511-519.
115. Topouzis F, Wilson MR, Harris A, et al. Risk factors for primary open-angle glaucoma and pseudoexfoliative glaucoma in the Thessaloniki eye study. Am J Ophthalmol 2011;152:219-228 e211.
116. Topouzis F, Wilson MR, Harris A, et al. Association of open-angle glaucoma with perfusion pressure status in the Thessaloniki Eye Study. Am J Ophthalmol 2013;155:843-851.
117. Wilson MR, Kosoko O, Cowan CL, Jr., et al. Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies. Am J Ophthalmol 2002;134:399-405.

- The Beijing Eye Study
118. Jonas JB, Xu L, Wang YX. The Beijing Eye Study. Acta Ophthalmol 2009;87:247-261.
119. Wang YX, Xu L, Yang H, Jonas JB. Prevalence of glaucoma in North China: the Beijing Eye Study. Am J Ophthalmol 2010;150:917-924.
120. Xu L, Wang Y, Wang S, Wang Y, Jonas JB. High myopia and glaucoma susceptibility the Beijing Eye Study. Ophthalmology 2007;114:216-220.
121. Xu L, Wang YX, Jonas JB. Glaucoma and mortality in the Beijing Eye Study. Eye (Lond) 2008;22:434-438.

- The Singapore Epidemiology of Eye Diseases Study
122. Chua J, Tham YC, Liao J, et al. Ethnic differences of intraocular pressure and central corneal thickness: the Singapore Epidemiology of Eye Diseases study. Ophthalmology 2014;121:2013-2022.
123. Ho H, Shi Y, Chua J, et al. Association of Systemic Medication Use With Intraocular Pressure in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study. JAMA Ophthalmol 2017;135:196-202.
124. Luo XY, Tan NYQ, Chee ML, et al. Direct and Indirect Associations Between Diabetes and Intraocular Pressure: The Singapore Epidemiology of Eye Diseases Study. Invest Ophthalmol Vis Sci 2018;59:2205-2211.
125. Tham YC, Lim SH, Gupta P, Aung T, Wong TY, Cheng CY. Inter-relationship between ocular perfusion pressure, blood pressure, intraocular pressure profiles and primary open-angle glaucoma: the Singapore Epidemiology of Eye Diseases study. Br J Ophthalmol 2018;102:1402-1406.