Evidence map›Paper›PMID 26526633›Full record

SynthesisOphthalmology2016

Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis.

Tianjing Li, Kristina Lindsley, Benjamin Rouse, Hwanhee Hong, Qiyuan Shi, David S Friedman, Richard Wormald, Kay Dickersin

Open access · greenAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Ophthalmology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 164 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
164citing papers in PubMed, 11 pooled it
14.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

164 citing papers in PubMed, 11 syntheses or guidelines pooled it, 305 citations in OpenAlex.

  1. Pooled it
  2. Laser trabeculoplasty for open-angle glaucoma and ocular hypertension.The Cochrane database of systematic reviews · 2022
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Medical management of pediatric glaucoma: lessons learned from randomized clinical trials.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2020
    Pooled it
  6. Pooled it
  7. Acupuncture for glaucoma.The Cochrane database of systematic reviews · 2020
    Pooled it
  8. Pooled it
  9. Ab interno trabecular bypass surgery with iStent for open-angle glaucoma.The Cochrane database of systematic reviews · 2019
    Pooled it
  10. Pooled it
  11. Pooled it
  12. Trial
  13. Trial
  14. Understanding Individual Intraocular Pressure Response to Treatment with Latanoprost and Timolol.Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics · 2025
    Trial
  15. Trial
  16. The Effects of Topical Timolol and Latanoprost on Calculated Ocular Perfusion Pressure in Nonglaucomatous Volunteers.Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics · 2021
    Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

104 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 2 countries.

Tianjing LiDepartment of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: tli19@jhu.edu.
Kristina LindsleyDepartment of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Benjamin RouseDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Hwanhee HongDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Qiyuan ShiDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
David S FriedmanThe Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
Richard WormaldCochrane Eyes and Vision Group, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Kay DickersinDepartment of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Johns Hopkins University · USLondon School of Hygiene & Tropical Medicine · GB

Funding

Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
Comparative Effectiveness Research & the Cochrane Eyes & Vision GroupU01EY020522 · NEI · JOHNS HOPKINS UNIVERSITY · PI DICKERSIN, KAY · 2010 to 2016
$9.2M
Comparative Effectiveness & Medical Interventions for Primary Open Angle GlaucomaRC1EY020140 · NEI · JOHNS HOPKINS UNIVERSITY · PI DICKERSIN, KAY · 2009 to 2010
$901k
NCATS NIH HHS UL1 TR001079NEI NIH HHS 1 RC1 EY020140NEI NIH HHS 1 U01 EY020522NEI NIH HHS RC1 EY020140NEI NIH HHS U01 EY020522
6 · The paper itself

Abstract

topicPrimary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first-line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments. CLINICAL RELEVANCE: Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). Although topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops.

methodsWe included randomized controlled trials (RCTs) that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE, and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses.

resultsWe included 114 RCTs with data from 20 275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in millimeters of mercury at 3 months ordered from the most to least effective drugs were as follows: bimatoprost 5.61 (4.94; 6.29), latanoprost 4.85 (4.24; 5.46), travoprost 4.83 (4.12; 5.54), levobunolol 4.51 (3.85; 5.24), tafluprost 4.37 (2.94; 5.83), timolol 3.70 (3.16; 4.24), brimonidine 3.59 (2.89; 4.29), carteolol 3.44 (2.42; 4.46), levobetaxolol 2.56 (1.52; 3.62), apraclonidine 2.52 (0.94; 4.11), dorzolamide 2.49 (1.85; 3.13), brinzolamide 2.42 (1.62; 3.23), betaxolol 2.24 (1.59; 2.88), and unoprostone 1.91 (1.15; 2.67).

conclusionsAll active first-line drugs are effective compared with placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost, should be considered in selecting a drug for a given patient.

Indexed as

Antihypertensive AgentsGlaucoma, Open-AngleHumansIntraocular PressureRandomized Controlled Trials as TopicTreatment OutcomeAntihypertensive Agents

Identifiers

PMID26526633
PMCPMC4695285
OpenAlexW2185914194

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.