***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To provide the results of the Early Manifest Glaucoma Trial , which compared the effect of immediately lowering the intraocular pressure ( IOP ) , vs no treatment or later treatment , on the progression of newly detected open-angle glaucoma . DESIGN R and omized clinical trial . PARTICIPANTS Two hundred fifty-five patients aged 50 to 80 years ( median , 68 years ) with early glaucoma , visual field defects ( median mean deviation , -4 dB ) , and a median IOP of 20 mm Hg , mainly identified through a population screening . Patients with an IOP greater than 30 mm Hg or advanced visual field loss were ineligible . INTERVENTIONS Patients were r and omized to either laser trabeculoplasty plus topical betaxolol hydrochloride ( n = 129 ) or no initial treatment ( n = 126 ) . Study visits included Humphrey Full Threshold 30 - 2 visual field tests and tonometry every 3 months , and optic disc photography every 6 months . Decisions regarding treatment were made jointly with the patient when progression occurred and thereafter . MAIN OUTCOME MEASURES Glaucoma progression was defined by specific visual field and optic disc outcomes . Criteria for perimetric progression were computer based and defined as the same 3 or more test point locations showing significant deterioration from baseline in glaucoma change probability maps from 3 consecutive tests . Optic disc progression was determined by masked grade rs using flicker chronoscopy plus side-by-side photogradings . RESULTS After a median follow-up period of 6 years ( range , 51 - 102 months ) , retention was excellent , with only 6 patients lost to follow-up for reasons other than death . On average , treatment reduced the IOP by 5.1 mm Hg or 25 % , a reduction maintained throughout follow-up . Progression was less frequent in the treatment group ( 58/129 ; 45 % ) than in controls ( 78/126 ; 62 % ) ( P = .007 ) and occurred significantly later in treated patients . Treatment effects were also evident when stratifying patients by median IOP , mean deviation , and age as well as exfoliation status . Although patients reported few systemic or ocular conditions , increases in clinical nuclear lens opacity gradings were associated with treatment ( P = .002 ) . CONCLUSIONS The Early Manifest Glaucoma Trial is the first adequately powered r and omized trial with an untreated control arm to evaluate the effects of IOP reduction in patients with open-angle glaucoma who have elevated and normal IOP . Its intent-to-treat analysis showed considerable beneficial effects of treatment that significantly delayed progression . Whereas progression varied across patient categories , treatment effects were present in both older and younger patients , high- and normal-tension glaucoma , and eyes with less and greater visual field loss PURPOSE To identify risk factors for poor adherence to topical once daily therapy for glaucoma . DESIGN Prospect i ve , observational cohort study . PARTICIPANTS A total of 196 patients with glaucoma who were being treated with a prostagl and in analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007 . METHODS Demographics , ocular history , and responses to interview questions about glaucoma knowledge , health beliefs , and drop-taking behaviors were obtained from each patient . All patients used the Travatan Dosing Aid ( DA ; Alcon Laboratories Inc. , Fort Worth , TX ) to administer travoprost as prescribed . Devices were collected at 3 months , and the data of drop use were downloaded using software provided with the DA . Patients taking < or=75 % doses during the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit were compared with those taking > 75 % of doses . MAIN OUTCOME MEASURES Risk factors for poor adherence . RESULTS Eighty-seven patients ( 44.4 % of the 196 subjects with evaluable data at 3 months ) used the DA on 75 % or less of the monitored days . In univariate analysis , poorer adherers were more likely to be < 50 or > or=80 years of age , to be African American , to report less than excellent health , to report higher amounts of depression , to have lower income , and to be treated at the Scheie Eye Institute . Multivariate analysis ( adjusting for education and income ) found that age , race/ethnicity , and less than excellent health were associated with poor adherence . CONCLUSIONS Those who failed to take more than 75 % of eyedrop doses were more likely to be African American and to report poor health . Those in the youngest and oldest age groups were less adherent , although this finding was not always statistically significant . Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted . FINANCIAL DISCLOSURE(S ) Proprietary or commercial disclosure may be found after the references Purpose To evaluate the efficacy and safety of endoscopic cyclophotocoagulation ( ECP ) in the treatment of uncontrolled glaucoma with a prior aqueous tube shunt . Methods A prospect i ve , nonr and omized , interventional clinical trial with up to 2 years of follow up included 25 eyes of 25 consecutive glaucoma patients with a previous tube shunt and uncontrolled intraocular pressure ( IOP ) despite medical therapy . Patients had IOP greater than 21 mm Hg on maximal medications or IOP ⩽21 mm Hg but intolerant to medications or using an oral carbonic anhydrase inhibitor . Application of ECP over 360 degrees was performed and subjects were followed for 6 months minimum . Main outcome measures were mean reduction in IOP and medications at 12 months . Success was defined as reduction in IOP of 3 mm Hg and discontinuation of nontolerated glaucoma medications . A failure was defined as continued uncontrolled IOP , vision loss to no light perception , or additional medications or glaucoma surgery required . Results At 12 months , the mean IOP dropped from 24.02 to 15.36 mm Hg . The mean of the differences was −7.77 mm Hg ( −30.8 % ) . The mean number of medications was 3.2 before laser and 1.5 at 12 months ( P<0.001 ) . The success rate at 12 months ( n=18 ) was 88 % and remained at that level until the end of the follow-up period of 2 years ( n=11 , P<0.00005 ) . There were no serious complications . Conclusions ECP seems to be a safe and effective treatment in patients with uncontrolled IOP with a prior aqueous tube shunt , and is a reasonable option in this group of refractory glaucoma patients PURPOSE To assess patient adherence and behaviors with topical once-daily therapy for glaucoma . DESIGN Prospect i ve , observational cohort study . PARTICIPANTS One hundred ninety-six patients with glaucoma who were being treated with a prostagl and in analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007 . METHODS Detailed medical history was obtained from each patient . All subjects used the Travatan Dosing Aid ( DA ; Alcon , Fort Worth , TX ) to administer travoprost as prescribed . Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid . Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit . MAIN OUTCOME MEASURES Assessment of adherence and patterns of drop usage as indicated by the DA . RESULTS A total of 282 subjects consented to be in the study and 86 ( 30 % ) withdrew before study completion or had device errors , leaving 196 subjects ( 70 % ) with evaluable data at 3 months . The overall mean ( + /-st and ard deviation ) adherence rate was 0.71 ( + /-0.24 ) , ranging from 0.02 to 0.97 . One hundred nine of these patients ( 55.6 % ) took greater than 75 % of the expected doses . Those with adherence of less than 50 % of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months ( P = 0.03 ) . The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95 , respectively . The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases ( intraclass correlation coefficient , 0.09 ; 95 % confidence interval , 0.00 - 0.19 ) . CONCLUSIONS Nearly 45 % of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75 % of the time . Patients reported far higher medication use than their actual behavior . The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor . FINANCIAL DISCLOSURE(S ) Proprietary or commercial disclosure may be found after the references BACKGROUND Primary open-angle glaucoma ( POAG ) is one of the leading causes of blindness in the United States and worldwide . Three to 6 million people in the United States are at increased risk for developing POAG because of elevated intraocular pressure ( IOP ) , or ocular hypertension . There is no consensus on the efficacy of medical treatment in delaying or preventing the onset of POAG in individuals with elevated IOP . Therefore , we design ed a r and omized clinical trial , the Ocular Hypertension Treatment Study . OBJECTIVE To determine the safety and efficacy of topical ocular hypotensive medication in delaying or preventing the onset of POAG . METHODS A total of 1636 participants with no evidence of glaucomatous damage , aged 40 to 80 years , and with an IOP between 24 mm Hg and 32 mm Hg in one eye and between 21 mm Hg and 32 mm Hg in the other eye were r and omized to either observation or treatment with commercially available topical ocular hypotensive medication . The goal in the medication group was to reduce the IOP by 20 % or more and to reach an IOP of 24 mm Hg or less . MAIN OUTCOME MEASURES The primary outcome was the development of reproducible visual field abnormality or reproducible optic disc deterioration attributed to POAG . Abnormalities were determined by masked certified readers at the reading centers , and attribution to POAG was decided by the masked Endpoint Committee . RESULTS During the course of the study , the mean + /- SD reduction in IOP in the medication group was 22.5 % + /- 9.9 % . The IOP declined by 4.0 % + /- 11.6 % in the observation group . At 60 months , the cumulative probability of developing POAG was 4.4 % in the medication group and 9.5 % in the observation group ( hazard ratio , 0.40 ; 95 % confidence interval , 0.27 - 0.59 ; P<.0001 ) . There was little evidence of increased systemic or ocular risk associated with ocular hypotensive medication . CONCLUSIONS Topical ocular hypotensive medication was effective in delaying or preventing the onset of POAG in individuals with elevated IOP . Although this does not imply that all patients with borderline or elevated IOP should receive medication , clinicians should consider initiating treatment for individuals with ocular hypertension who are at moderate or high risk for developing POAG PURPOSE To report interim outcome data , using all available follow-up through 5 years after treatment initiation , in the Collaborative Initial Glaucoma Treatment Study ( CIGTS ) . DESIGN R and omized clinical trial . PARTICIPANTS Six hundred seven newly diagnosed glaucoma patients . METHODS In a r and omized clinical trial , 607 patients with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy ( with or without 5-fluorouracil ) . After treatment onset and early follow-up , patients were evaluated clinical ly at 6-month intervals . In addition , quality of life telephone interviews were conducted at similar frequency to the clinical visits . Patients in both arms of CIGTS were treated aggressively in an effort to reduce intraocular pressure ( IOP ) to a level at or below a predetermined target pressure specific for each individual eye .  Visual field ( VF ) scores were analyzed by time-specific comparisons and by repeated measures models . MAIN OUTCOME MEASURES VF loss was the primary outcome variable in CIGTS . Secondary outcomes of visual acuity ( VA ) , IOP , and cataract were also studied . RESULTS On the basis of completed follow-up through 4 years and partially completed through 5 years , VF loss did not differ significantly by initial treatment . Over the entire period of follow-up , surgical patients had a greater risk of substantial VA loss compared with medical patients . However , by 4 years after treatment , the average VA in the two groups was about equal . Over the course of follow-up , IOP in the medicine group has averaged 17 to 18 mmHg , whereas that in the surgery group averaged 14 to 15 mmHg . The rate of cataract requiring removal was greater in the surgically treated group . CONCLUSIONS Both initial medical or initial surgical therapy result in about the same VF outcome after up to 5 years of follow-up . VA loss was greater in the surgery group , but the differences between groups seem to be converging as follow-up continues . When aggressive treatment aim ed at substantial reduction in IOP from baseline is used , loss of VF can be seen to be minimal in general . Because 4 to 5 years of follow-up 
    Output:
    
There is currently no high- quality evidence for the effects of ECP for OAG and primary angle closure .