This proposal is a plan for carrying out a multicenter randomized clinical trial, designed to assess the efficacy of argon laser trabeculoplasty (ALT) as an alternative to standard medical therapy of open-angle glaucoma. The trial will involve the recruitment of 280 patients with newly diagnosed symmetrical open-angle glaucoma. Only patients aged 35 or older (of either sex) with intraocular pressures of 22mm or greater and evidence of optic nerve damage in both eyes will be eligible for enrollment. The patients will be followed for a minimum of two years in order to collect information on pressure levels over the course of the trial and to provide comparative data on the rate of vision field loss and increased optic nerve cupping. Treatment groups will be compared at the end of two years with regard to the amount of medical treatment needed to control the intraocular pressure and/or control glaucomatous nerve damage. The eye to be lasered will be randomly selected. The ALT will consist of 96 burns delivered onto the anterior middle aspect of the trabecular meshwork in two sessions, avoiding the posterior or uveal meshwork. The burns will be delivered at a suitable intensity to avoid blanching of the meshwork just at the threshold of bubble formation (between 700 and 1200 mW per lesion). The fellow eye assigned to therapy will be placed on a single topical medication. Eyes requiring added treatment over and above the initial treatment (i.e., laser trabeculoplasty or single topical medication) will have subsequent topical medication added in a step fashion according to protocol. The trial will involve several Clinical Centers, a Data Coordinating Center, a Disc Stereo Photo Reading Center, and a Visual Field Reading Center.
