EAGLE:  Effectiveness, in Angle closure Glaucoma, of Lens Extraction

The active group had early lens extraction, i.e. cataract surgery. The control group had standard care where laser treatment was used to open drainage but did not improve sight. The outcomes were changes in quality of life; visual field; intra-ocular pressure; angle closure; need for additional medications; need for further surgery (trabeculectomy). The costs of the treatment and subsequent management for both interventions were estimated and incremental cost per QALY gained calculated, based on the responses to the EQ–5D.

Approximately 23 specialist centres in the UK, 7 centres in East Asia (from Singapore, Malaysia, Hong Kong and Taiwan), and 1 in Australia participated in this trial.

Outcome and Translation

This international, multicentre trial determined the best way of treating angle closure glaucoma, one of the main causes of blindness. The results of the study are being disseminated in a series of peer reviewed papers, keynote presentations and a lay summary.

HERU researchers involved in this research project: Graham Scotland, Mehdi Javanbakht (HERU)

External collaborators: A Azaura-Blanco, C Ramsay, J Norrie (HSRU, University of Aberdeen); T Aung (Singapore National Eye Centre); J Burr (University of St. Andrews); P Foster (UCL); D Friedman (The Johns Hopkins Hospital); J Lai (United Christian Hospital); Da-Wen Lu (Tri-Services General Hospital); C Lui (Taipei Veterans General Hospital); W Nolan (Sandwell and West Birmingham Hospital); J See (National University Hospital) and D Wong (University of Hong Kong)

EAGLE logoMore details are available on the EAGLE project website.

International Standard Randomised Controlled Trial Number Register (ISRCTN) 44464607.

The National Institute for Health Research (NIHR) have produced an NIHR Signal for this research project.


Azuara-Blanco, A., Burr, J.M., Cochran, C., Ramsay, C., Vale, L., Foster, P., Friedman, D., Quayyum, Z., Lai, J., Nolan, W., Aung, T., Chew, P., McPherson, G., McDonald, A., Norrie, J. and Effectiveness In Angle-closure Glaucoma of Lens Extraction (EAGLE) Study Group (2011) 'The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): study protocol for a randomized controlled trial' [protocol], Trials, 12, 133.

Azuara-Blanco, A., Burr, J., Ramsay, C., Cooper, D., Foster, P. J., Friedman, D. S., Scotland, G., Javanbakht, M., Cochrane, C. and Norrie, J. (2016) 'Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial', Lancet, 388(10052), 1389-1397.

Javanbakht, M., Azuara-Blanco, A., Burr, J. M., Ramsay, C., Cooper, D., Cochran, C., Norrie, J. and Scotland, G. (2017) 'Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial', BMJ Open, 7(1).


Scotland, G. (2017) 'Extrapolating cost-effectiveness beyond the time horizon of surgical trials: early lens extraction for angle closure glaucoma', Economic Evaluation Alongside Surgical Trials Meeting, MRC Hubs for Trials Methodology Research, University of Bristol, 21 November 2017.