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Trial now finished

The full paper is now published and is available to view here

Section A
EAGLE is an international multi-centre pragmatic randomised controlled trial (RCT) to establish whether removal of the lens of the eye (lens extraction) for newly diagnosed Primary Angle Closure Glaucoma results in better patient reported health, vision, lower IOP and other outcomes compared with standard management
Who funds EAGLE?
EAGLE is a Medical Research Council (MRC) funded study
Background to the problem
The World Health Organization ranks glaucoma as the second most common cause of blindness after cataract, and as the leading cause of irreversible blindness. There are two types of glaucoma: open angle and angle-closure. Although primary open angle glaucoma is the more common, primary angle-closure glaucoma (PACG) is the more severe (more likely to result in irreversible blindness if not properly treated). By 2020 PACG will affect 20 million people, and 5.3 million will be blind. In the UK, PACG affects between 50,000 and 100,000 people, but is estimated to cause 1000 people to suffer irreversible blindness every year, and many more live with the disability and reduced quality of life associated with glaucoma.

PACG is more common in East Asia than the rest of the world. Older age and female gender are demographic risk factors. Having a small eye and thus hypermetropia (far-sightedness) is also an important risk factor. Blindness is costly to health care, society and individuals.The effect of severe glaucoma on patients quality of life is profound (the utility associated with severe visual impairment is approximately half that of full health).The number of people diagnosed with PACG is predicted to increase substantially over the next few years as the result of an ageing population, increased optometric screening, and raised awareness of narrow angle pathologies among clinicians
Current treatments for PACG
The current standard care for PACG is a stepped approach of a combination of surgery (laser or incisional) and medical management. Initial surgery uses a laser to make a small hole in the iris (laser iridotomy [LI]) to open the drainage angle, and often eye drops are required as an adjunct to LI to further reduce the IOP. There are several types of drops used to lower IOP but prostaglandin and beta-blocker treatments are the most commonly used. If the drainage pathway is still closed after LI, alternative laser treatment whereby iris tissue is pulled away from the drainage angle, laser peripheral iridoplasty (LPI) is an option. If these first line treatments fail glaucoma filtration surgery (trabeculectomy) is then indicated. Trabeculectomy may fail to control the IOP, and in PACG complications are more likely (such as flat anterior chamber and malignant glaucoma) than for other types of glaucoma. These standard approaches to PACG management have been noted to have variable success.
HSRU Aberdeen