CLINICAL EFFECTIVENESS OF EARLY INTERVENTION STRATEGIES IN PREVENTING GLAUCOMA‑RELATED VISION LOSS

Abstract

Glaucoma is one of the common causes of irreversible blindness in the world, caused by this disorder in nearly 80 million people, with an estimate of 111.8 million people by 2040. Early intervention and diagnosis are essential in preventing optic nerve damage and loss of vision, but delays in diagnosis and poor adherence to treatment are major obstacles. This was a problem-based research study that systematically reviewed the clinical efficacy of early intervention measures to prevent vision loss associated with glaucoma. Systematic review based on PRISMA found 147 eligible studies with 2,384,617 eyes. Quantitative meta-analysis, exponential decay-based disease progression modeling, network meta-analysis as a comparison of therapeutics, and health economic analysis were done. Multimodal imaging using artificial intelligence was associated with the best diagnostic accuracy of 94.12 percent sensitivity, 95.78 percent specificity, and an area under the curve of 0.983, which is significantly better than conventional optical coherence tomography with an area under the curve of 0.942. Nonetheless, the performance of artificial intelligence declined by 0.041-0.083 when the controlled research settings were changed to real-world clinical scenarios. Pseudoexfoliation glaucoma phenotypes had the highest rate of progression and benefited most by the intervention at 58.34 percent early intervention, whereas the slow-progressing primary open-angle glaucoma benefited only 18.45 percent with intervention. The highest reduction of intraocular pressure was 12.34 millimeters of mercury with trabeculectomy surgery; however, the novel EP2 agonist had a better adverse event profile of 8.67 percent. Non-adherence to medication by patients enhanced the risk of failure in surgery by more than eight times, and the rate at which the patients lost their vision was 3.89 decibels per year as compared to the 0.67 decibels per year in patients who were highly adherent. Nerve growth factor and nicotinamide were the most promising neuroprotective factors that enhanced the survival of retinal ganglion cells by 31.23 and 28.34 percent, respectively. The economic analysis of health showed that artificial intelligence triage and early minimally invasive surgery to treat glaucoma are cost-effective even though the initial cost is high. Early treatment is an effective way to avoid the loss of vision in glaucoma, especially in the most aggressive phenotypes. Diagnostics based on artificial intelligence, phenotype-driven therapy, and adherence-enhancing strategies are essential to maximize the results. Future studies should aim at real-world validation of artificial intelligence and the development of neuroprotective agents and sustained drug delivery systems that can translate the current levels of diagnostic and therapeutic progress into the preservation of visual function over time.