Surgeons are testing whether removing the eye’s lens—standard cataract surgery—can prevent blindness in people with primary angle closure glaucoma (PACG) who do not yet have cataracts. PACG is a leading cause of irreversible blindness worldwide. The eye’s drainage system becomes blocked, pressure builds up, and the optic nerve is damaged. Current treatment uses laser to open drainage channels, followed by eye drops, and finally invasive surgery if those fail. But these approaches often require lifelong medication and do not always preserve vision. No high-quality trial has tested whether early lens removal, which physically opens up the eye’s drainage angle, works better than standard care. This international trial randomly assigns participants to either early lens extraction or conventional treatment, then measures quality of life, vision, and costs after three years. If lens extraction proves superior, it could become the new standard of care for PACG—reducing or eliminating the need for daily eye drops, preserving sight longer, and lowering the long-term burden on patients and healthcare systems. For a disease that blinds millions, even a modest improvement in treatment effectiveness would have a large global impact.
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The purpose of this study is to test which treatment is best for people with an eye condition called primary angle closure glaucoma (PACG). PACG is a leading cause of irreversible blindness worldwide. In PACG the eye’s ability to drain is damaged leading to an elevation of the pressure within the eye. High pressure leads to visual loss and, if untreated, blindness. The risk of blindness is greatly reduced by lowering this pressure. Current treatment is to use a laser to open the drainage pathways, eye drops to reduce the eye pressure and, if these fail, drainage surgery within the eye. It is thought that PACG might be more successfully treated by removing the lens of the eye and replacing it with a plastic lens (commonly known as cataract surgery). Early lens extraction, potentially, could reduce the number of eye drops required and overall improve vision compared with current treatments. As there is no high quality research assessing whether removing the lens at an early stage, i.e. when there is no cataract, is better than standard treatment, this international study will randomly allocate participants to either treatment and assess the quality of life, vision and associated costs three years later.
Augusto Azuara-Blanco (Principal Investigator)Catherine Lui (Co-Investigator)Craig Ramsay (Co-Investigator)Da-Wen Lu (Co-Investigator)David Friedman (Co-Investigator)David Wong (Co-Investigator)Jennifer Burr (Co-Investigator)Jimmy Lai (Co-Investigator)John Norrie (Co-Investigator)Jovina See (Co-Investigator)Luke Vale (Co-Investigator)Paul Foster (Co-Investigator)Tin Aung (Co-Investigator)Winifred Nolan (Co-Investigator)
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