Evidence for the effectiveness of interventions to prevent the progression of optic nerve damage in open angle glaucoma has evolved over the last 25 years. We describe that evolution through the systematic reviews on various aspects of the topic and how those reviews have highlighted the need for new trials. Though we can be confident that lowering pressure does indeed reduce the risk of progression, we still lack good evidence on the comparative effectiveness of different treatments not so much on lowering pressure but on preventing progression of the disease. This is true for different medicines, types of laser and especially for different surgical interventions. As always there is a need for more research, but this needs to be focussed on key uncertainties using core outcome sets which avoid research waste. Ultimately, our guidelines can be based on sound and comprehensive evidence of effectiveness. 在过去的25年中, 已有证据表明针对开角型青光眼视神经损伤的干预以防止其进展是有效的。我们通过对本专题各方面的系统综述描述这一演变, 并且总结了这些研究所强调的开展新的临床试验的必要性。尽管降低眼压确实降低了疾病进展的风险, 但与降眼压治疗的研究相较, 目前仍然缺乏通过比较不同治疗方法来证实如何防止疾病进展方面的研究。这其中包括对不同种类药物, 不同种类激光, 特别是不同的外科手术干预的比较研究。与其它领域一致, 需要进行更多研究证据, 需使用核心研究结果聚焦于主要的不确定的因素的研究, 以避免研究浪费。最终我们的指南可作为健全和全面的有效性证据的基础。

中文翻译：

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开角型青光眼的系统评价和随机对照试验

Evidence for the effectiveness of interventions to prevent the progression of optic nerve damage in open angle glaucoma has evolved over the last 25 years. We describe that evolution through the systematic reviews on various aspects of the topic and how those reviews have highlighted the need for new trials. Though we can be confident that lowering pressure does indeed reduce the risk of progression, we still lack good evidence on the comparative effectiveness of different treatments not so much on lowering pressure but on preventing progression of the disease. This is true for different medicines, types of laser and especially for different surgical interventions. As always there is a need for more research, but this needs to be focussed on key uncertainties using core outcome sets which avoid research waste. Ultimately, our guidelines can be based on sound and comprehensive evidence of effectiveness. 在过去的25年中, 已有证据表明针对开角型青光眼视神经损伤的干预以防止其进展是有效的。我们通过对本专题各方面的系统综述描述这一演变, 并且总结了这些研究所强调的开展新的临床试验的必要性。尽管降低眼压确实降低了疾病进展的风险, 但与降眼压治疗的研究相较, 目前仍然缺乏通过比较不同治疗方法来证实如何防止疾病进展方面的研究。这其中包括对不同种类药物, 不同种类激光, 特别是不同的外科手术干预的比较研究。与其它领域一致, 需要进行更多研究证据, 需使用核心研究结果聚焦于主要的不确定的因素的研究, 以避免研究浪费。最终我们的指南可作为健全和全面的有效性证据的基础。