Patients undergoing clear-lens extraction became emmetropic (final refraction 0♰8 ), whereas those assigned to laser iridotomy remained hyperopic (0♹2 ). This pragmatic trial is clinically relevant because it addresses a topic with widespread practical implications. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care, although the costs were assessed only for the subset of patients treated in the UK and, therefore, are not conclusive for other settings. The mean health status score (0♸7 ) on the European Quality of Life-5 Dimensions (EQ-5D) questionnaire, was 0♰52 higher (95% CI 0♰15 to 0♰88, p=0♰05) and mean intraocular pressure (16♶ mm Hg) 1♱8 mm Hg lower (95% CI −1♹9 to −0♳8, p=0♰04) after clear-lens extraction than after iridotomy. The results show a small but unquestionable advantage of primary clear-lens extraction over laser iridotomy for all measured outcomes. 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. 419 patients were randomised and followed up for 3 years, of whom 208 were assigned to clear-lens extraction and 211 to laser iridotomy. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. This is also the first prospective randomised therapeutic trial in ophthalmology in which one of the primary outcome measures is patient reported, through quality-of-life questionnaires. ![]() Report in The Lancet the results of an international prospective randomised study comparing laser iridotomy with clear-lens extraction as the initial treatment of primary angle closure and primary angle-closure glaucoma. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.
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