Travoprost compared with other prostaglandin analogues or timolol in patients with open-angle glaucoma or ocular hypertension: meta-analysis of randomized controlled trials

BACKGROUND: It is still uncertain whether travoprost has comparable or better efficacy compared with other prostaglandin analogues or timolol in patients with open-angle glaucoma or ocular hypertension. The authors performed a meta-analysis of randomized controlled trials to evaluate the incidence of reported side-effects and intraocular pressure (IOP)-lowering effect of travoprost versus other prostaglandin analogues (latanaprost, bimatoprost, unoprostone) or timolol. METHODS: Systematic literature retrieval was conducted in Pubmed, EMBASE, Chinese Bio-medicine Database and Cochrane Controlled Trials Register to identify the potentially relevant randomized controlled trials. The statistical analysis was performed by RevMan 4.1 software that was provided by the Cochrane Collaboration. The outcome measures were the incidence of reported side-effects (hyperaemia, iris pigmentation, eyelash changes) and mean IOP pooled over treatment visits. RESULTS: In total, 12 articles involving 3048 patients with open-angle glaucoma or ocular hypertension were included in this meta-analysis. The combined results showed that travoprost 0.004% was more effective than timolol or travoprost 0.0015% in lowering IOP, but not more effective than bimatoprost or latanoprost. Travoprost 0.004% caused a higher percentage of hyperaemia than timolol, latanoprost, or travoprost 0.0015%. There was an increased incidence of pigmentation with travoprost than timolol. Travoprost 0.004% caused a higher percentage of eyelash changes than timolol, latanoprost, or travoprost 0.0015%. CONCLUSION: According to data available, travoprost is more effective than timolol in lowering IOP in patients with open-angle glaucoma or ocular hypertension. Compared with other prostaglandin analogues, travoprost appears to be equivalent to bimatoprost and latanoprost. Although a limited number of local side-effects were reported, no serious treatment-related side-effects were reported.     

Combined therapy of pilocarpine or latanoprost with timolol versus latanoprost monotherapy

Adjunctive intraocular pressure (IOP)-lowering therapy is widely used today, as one-third of all patients being treated for glaucoma need additional therapy to reach and maintain healthy IOPs. Timolol, latanoprost, and pilocarpine are three potent drugs that have been used in combination to reduce IOP. Timolol reduces the production rate of aqueous humor to achieve the IOP decrease. Latanoprost and pilocarpine both affect aqueous outflow, although by different mechanisms. The IOP efficacy of combined therapy with timolol and pilocarpine compared with timolol and latanoprost or with latanoprost alone has been investigated in three multicenter, randomized, clinical trials in Europe. This is a review of those published trials. In 2 of the 3 studies, the additional IOP lowering effect of latanoprost 0.005% administered once daily was compared with pilocarpine 2% administered 3 times daily in patients with primary open-angle glaucoma (POAG) or ocular hypertension currently on monotherapy with timolol 0.5% twice daily. These 6-month studies found that the timolol and latanoprost combination reduced IOP more and was better tolerated with fewer side-effects than the timolol and pilocarpine combination. At 6 months, there was no evidence of long-term drift in IOP with timolol and latanoprost. This combined therapy provides an effective and safe option for lowering IOP in glaucoma patients. These results suggest that the timolol/latanoprost combination is preferable to the timolol/pilocarpine combination not only with regard to side effects but also to the magnitude of IOP reduction. Two of the 3 studies compared latanoprost monotherapy with timolol and pilocarpine combined therapy in patients with POAG, various other glaucomas, or ocular hypertension. Treatment was for 6 weeks or 6 months. In both studies, latanoprost was more effective and better tolerated than the combination of timolol and pilocarpine. These results suggest that latanoprost alone should be tried before the addition of pilocarpine to timolol therapy is considered. The convenience of daily administration of a single drop of latanoprost versus multiple drops of timolol and pilocarpine should improve patient compliance.     

真空小梁成形术治疗开角型青光眼及高眼压症

目的 观察真空小梁成形术对原发性开角型青光眼和高眼压患者的降眼压效果和安全性.方法 前瞻性病例系列研究.开角型青光眼及高眼压患者100例（100眼）作为研究对象.所有研究对象都接受了全面的眼科检查,包括眼压、计算机视野检查,并进行UBM或前房角镜检查,排除前房角关闭者.进行真空小梁成形术治疗仪治疗.治疗后1d、1周、1月、3月复查.首次治疗后7d重复治疗1次.观察治疗前后眼压变化.结果 100例术前眼压为（24.50±4.14） mmHg（1 mmHg=0.133 kPa）,治疗后1d、1周、1月、3月各时间点眼压为（22.96±3.66） mmHg,（21.27±2.91） mm-Hg,（19.65±2.77） mmHg,（19.80±1.79） mmHg,3个月观察期末与治疗前眼压差异均有统计学意义（P＜0.05）.3个月观察期内,无视力下降者.结论 本文短期研究显示,真空小梁成形术可安全有效地降低开角型青光眼及高眼压患者的眼压.     

The effectiveness of latanoprost for the treatment of pediatric glaucoma.

PURPOSE: Latanoprost is a prostaglandin F2alpha analogue that substantially reduces intraocular pressure (IOP) in adults with open-angle glaucoma or ocular hypertension. The efficacy and safety of latanoprost in children is unknown. We wished to evaluate latanoprost therapy for children with glaucoma. METHODS: This was a prospective study of all patients who were given latanoprost at our institution between September 1996 and January 1998. The baseline IOP was compared with the postlatanoprost IOP for each patient, and side effects and any iris color change were noted at each follow-up examination. Responders were defined as those who had at least a 15% IOP reduction on latanoprost, whereas nonresponders showed less than a 15% IOP reduction on latanoprost. RESULTS: Fifty-seven eyes of 48 pediatric patients with a variety of glaucoma diagnoses and an average age of 7.1 years were included in the study. Of these, 31 eyes of 31 patients had interpretable IOP data; the mean IOP reduction for this group after the addition of latanoprostwas 0.9% (0.2 mm Hg). Six patients (6 eyes) were responders, with an average IOP reduction of 8.5 mm Hg (34%), whereas the majority of patients (25) were nonresponders. In the responders, there was a good correlation (r = 0.9) between baseline IOP and the magnitude of IOP reduction. Responders were significantly more likely to have juvenile open-angle glaucoma and to be older than nonresponders. Systemic and ocular side effects were infrequent and mild, and no patient had noticeable iris color changes. CONCLUSIONS: When used in a group of pediatric patients with a variety of glaucoma diagnoses and on various therapies, latanoprost is effective in only a minority of cases. In selected patients, however, latanoprost shows an impressive ocular hypotensive effect, comparable with that obtained when this drug is used in adults with open-angle glaucoma. This drug appears to be well tolerated in this short-term study of pediatric patients with glaucoma.     

Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study

OBJECTIVE: To assess the impact of vascular risk factors on the prevalence of primary open angle glaucoma. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Four thousand two hundred ninety-seven patients more than 40 years of age underwent a complete ocular examination in the context of the Egna-Neumarkt Glaucoma Study. INTERVENTION: Ocular examinations were performed by trained, quality-controlled ophthalmologists according to a predefined standardized protocol including medical interview, blood pressure reading, applanation tonometry, computerized perimetry, and optic nerve head examination. MAIN OUTCOME MEASURES: Prevalences of ocular hypertension, primary open-angle glaucoma, normal-tension glaucoma, and other types of glaucoma were determined. Correlation coefficients were calculated for the association between systemic blood pressure and age-adjusted intraocular pressure (IOP) and between age and both intraocular and systemic blood pressures. Odds ratios were computed to assess the risk of primary open-angle glaucoma and normal-tension glaucoma in relation to systemic hypertension or antihypertensive medication, blood pressure levels, diastolic perfusion pressure, and a number of other cardiovascular risk factors. RESULTS: A positive correlation was found between systemic blood pressure and IOP, and an association was found between diagnosis of primary open-angle glaucoma and systemic hypertension. Lower diastolic perfusion pressure is associated with a marked, progressive increase in the frequency of hypertensive glaucoma. No relationship was found between systemic diseases of vascular origin and glaucoma. CONCLUSIONS: Our data are in line with those reported in other recent epidemiologic studies and show that reduced diastolic perfusion pressure is an important risk factor for primary open-angle glaucoma.     

Latanoprost for the treatment of pediatric glaucoma

Latanoprost is a prostaglandin F(2alpha) analog that reduces intraocular pressure (IOP) by 20-40% in adults with open-angle glaucoma or ocular hypertension. The efficacy and safety of latanoprost in children has not been widely reported, but there are at least three peer-reviewed publications involving the use of this drug in the treatment of pediatric patients with glaucoma. Most of the patients in these studies showed disappointingly little IOP effect from this drug, but some children, particularly older children and those with juvenile-onset open-angle glaucoma, do have a significant ocular hypotensive effect with latanoprost. Systemic and ocular side effects in children on latanoprost are infrequent and mild.     

Efficacy and side effects of latanoprost monotherapy compared to adding dorzolamide to timolol in patients with glaucoma and ocular hypertension--a three-month randomised study. Spanish Latanoprost Study Group

PURPOSE: To compare the efficacy and safety of latanoprost monotherapy or dorzolamide and timolol in glaucoma patients inadequately controlled on adrenergic beta-receptor antagonist therapy. METHODS: A total of 164 patients with primary open-angle glaucoma, capsular glaucoma or ocular hypertension were included in a three-month, open-label, randomised multicentre study. Patients with open-angle glaucoma were required to have IOP at least 22 mmHg and patients with ocular hypertension were required to have IOP at least 27 mmHg, on treatment with one or two ocular hypotensive drugs of which at least one had to be a beta-blocker. All patients were treated with timolol, 5 mg/ml twice daily, for a 2-4 week run-in period. They were then randomised to latanoprost, 50 microg/ml once daily, or timolol 5 mg/ml plus dorzolamide, 20 mg/ml twice daily. The difference in mean diurnal IOP change from baseline to month 3 was compared in the two groups. RESULTS: When patients were switched to latanoprost, mean diurnal IOP was reduced by 5.2 mmHg (23%) compared to 4.0 mmHg (17%) in the group in which dorzolamide was added to timolol. The difference of 1.2 mmHg was statistically significant (p = 0.005). The majority of adverse events during both treatments were judged as mild. CONCLUSIONS: The results suggest that a switch to latanoprost monotherapy is an alternative to combined treatment with timolol and dorzolamide in patients inadequately controlled on a topical adrenergic beta-receptor antagonist alone.     

The safety and efficacy of travoprost 0.004%/timolol 0.5% fixed combination ophthalmic solution

PURPOSE: To compare the safety and intraocular pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% fixed combination ophthalmic solution (Trav/Tim) to its components travoprost 0.004% ophthalmic solution, TRAVATAN, (Trav) and timolol 0.5% ophthalmic solution (Tim) in patients with open-angle glaucoma or ocular hypertension. DESIGN: Randomized multicenter, double-masked, active-controlled, parallel group study. METHODS: Two hundred sixty-three patients with open-angle glaucoma or ocular hypertension were randomized to receive Trav/Tim once daily AM (and vehicle PM), Trav once daily PM (and vehicle AM), or Tim twice daily (AM and PM). Efficacy and safety were compared across treatment groups over 3 months. RESULTS: Trav/Tim produced a mean IOP decrease from baseline of 1.9 mm Hg to 3.3 mm Hg more than Tim, with a significant decrease in mean IOP at each of the nine study visits (P < or = .003). Trav/Tim decreased mean IOP by 0.9 mm Hg to 2.4 mm Hg more than Trav, with a significant decrease in mean IOP at seven of the nine study visits (P < or = .05). The adverse event profile for Trav/Tim was comparable to Trav or Tim alone. CONCLUSIONS: Over the 3 months of treatment, Trav/Tim produced clinically relevant IOP reductions in patients with open-angle glaucoma or ocular hypertension that were greater than those produced by either Trav or Tim alone. The clinical results that Trav/Tim was safe and well tolerated with an incidence of adverse events was comparable to the results of Trav or Tim alone. Trav/Tim provides both more effective IOP reduction than its components and the benefits of once-daily dosing.     

Efficacy and safety of latanoprost eye drops for glaucoma treatment: a 1-year study in Japan

PURPOSE: To evaluate the intraocular pressure (IOP)-lowering effect and safety of latanoprost, a prostaglandin analogue, in patients with primary open-angle glaucoma or ocular hypertension. METHOD: One hundred and twenty-four Japanese patients with primary open-angle glaucoma or ocular hypertension were enrolled in this open-labeled study and were treated with 0.005% latanoprost once daily for 1 year. RESULTS: At all follow-up visits there was a significant (P < .001) reduction in IOP compared with the baseline value. After 1 year, the IOP was reduced by 5.4 +/- 2.9 (mean +/- SD) mm Hg from a baseline value of 23.5 +/- 2.2 mm Hg. No evidence of an upward drift in the IOP was observed during the treatment period. The most frequently reported adverse ocular events were mild conjunctival hyperemia and iris pigmentation. Very few adverse systemic events were observed. CONCLUSIONS: Latanoprost eye drops showed a marked and stable IOP-lowering effect during the 1-year treatment period. Furthermore, latanoprost was well-tolerated and should be a valuable contribution to the management of glaucoma.     

The effect of latanoprost on intraocular pressure during 2 years of treatment

Our objective was to study the intraocular pressure (IOP) in open-angle glaucoma or ocular hypertensive patients during long-term treatment with latanoprost. A total of 532 patients treated with 0.005% latanoprost were enrolled, including 493 and 113 patients treated for 6 and 24 months, respectively. Mean IOP was analyzed with the analysis of variance technique. The risk of treatment failure was analyzed with survival analysis technique. After 2 weeks of latanoprost treatment, the mean IOP was reduced 8.2 (32%) and 8.9 (34%) mm Hg in the subgroups of patients treated for 6 and 24 months, respectively. The change in mean IOP during 2 years of latanoprost treatment was not statistically significant (p = 0.15). Patients with primary open-angle glaucoma or ocular hypertension showed an 86% and 97% chance of receiving a sufficient IOP reduction with latanoprost (p < 0.01), repectively. The initial mean IOP reduction was maintained throughout the 2 years of treatment.     

Comparative results of central corneal thickness measurements in primary open-angle glaucoma, pseudoexfoliation glaucoma, and ocular hypertension.

BACKGROUND AND OBJECTIVE: As clinical measurements of corneal thickness have become widely available, several studies found a positive correlation between central corneal thickness and applanation tonometry measurements. This study evaluated central corneal thickness in different types of glaucoma. PATIENTS AND METHODS: An observational cross-sectional study assessed central corneal thickness using a specular microscope in the following groups of patients: 60 eyes with primary open-angle glaucoma, 50 eyes with pseudoexfoliation glaucoma, 50 eyes with ocular hypertension, and 60 eyes without glaucoma or ocular hypertension (control group). RESULTS: Central corneal thickness was significantly thinner in cases with pseudoexfoliation glaucoma (P < .0001) and significantly thicker in cases with ocular hypertension (P< .0001). CONCLUSIONS: These results agree with the literature, strengthening the position that central corneal thickness varies in different types of glaucoma and, therefore, is a parameter that should be taken under consideration, especially when evaluating cases of pseudoexfoliative glaucoma and ocular hypertension.     

Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma

PURPOSE: To investigate the efficacy and safety of selective laser trabeculoplasty as an initial treatment for newly diagnosed open-angle glaucoma, and its role as adjunctive therapy. PATIENTS AND METHODS: A prospective multicenter nonrandomized clinical trial was performed. Patients with newly diagnosed open-angle glaucoma or ocular hypertension were assigned to the primary (selective laser trabeculoplasty) treatment group or the control (latanoprost) group according to patient choice. Both groups were followed up at 1, 3, 6, and 12 months. A secondary treatment group was also included to study the efficacy of selective laser trabeculoplasty for patients intolerant of medical therapy or in whom such therapy was unsuccessful, with or without a history of previous argon laser trabeculoplasty. RESULTS: One hundred eyes (61 patients) were enrolled, 74 in the primary treatment group and 26 in the control group. The average absolute and percent reductions in intraocular pressure for the primary treatment group were 8.3 mm Hg or 31.0%, compared with 7.7 mm Hg or 30.6% for the control group (P = 0.208 and P = 0.879). The responder rates (20% pressure reduction) were 83% and 84% for the primary and control groups, respectively. There were no differences in intraocular pressure lowering with selective laser trabeculoplasty on the basis of angle pigmentation. A modest contralateral effect was observed in the untreated fellow eyes of patients undergoing selective laser trabeculoplasty. CONCLUSIONS: Selective laser trabeculoplasty was found to be equally efficacious as latanoprost in reducing intraocular pressure in newly diagnosed open-angle glaucoma and ocular hypertension over 12 months, independent of angle pigmentation. Nonsteroidal antiinflammatory therapy had similar efficacy to steroids after laser therapy. These findings support the consideration of selective laser trabeculoplasty as a first-line treatment for newly diagnosed open-angle glaucoma or ocular hypertension.     

Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma

AIM: To compare the efficacy and tolerability of latanoprost versus brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. METHOD: Systematic review of randomised controlled trials comparing latanoprost and brimondine, identified by searches including Medline, Embase and Cochrane Controlled Trials Register. Two reviewers independently assessed trials for eligibility and quality and extracted data. Data were synthesised (random effects model) and expressed as the absolute mean intraocular pressure (IOP) reduction difference from baseline to end point for efficacy and relative risk for adverse events. Subgroup analysis and regression were used to explore heterogeneity according to patient characteristics, trial design and quality. RESULTS: 15 publications reporting on 14 trials (1784 participants) were included for meta-analysis. IOP reduction favoured latanoprost (weighted mean difference (WMD) = 1.10 mm Hg (95% confidence interval (CI) 0.57 to 1.63)). Significant heterogeneity was present (chi(2)(13) = 38.29, p = 0.001, I(2) = 66.0%). Subgroup analysis showed greater WMD for studies where data were analysed from end points >6 months duration, cross-over design, open-angle glaucoma or ocular hypertension and monotherapy. Multiple regression showed no significant association of WMD with trial duration (t(9) = 1.92, p = 0.09), trial design (t(9) = 1.79, p = 0.11), trial quality (t(9) = -0.46, p = 0.66), or monotherapy or adjunctive therapy (t(9) = -2.14, p = 0.06). Fatigue was less commonly associated with latanoprost (RR = 0.27, 95% CI 0.08 to 0.88). Publication bias was not evident on visual inspection of a funnel plot. CONCLUSION: Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is associated with a higher rate of fatigue.     

Diurnal intraocular pressure profiles and progression of chronic open-angle glaucoma

PURPOSE: To evaluate whether the amplitude of day-and-night intraocular pressure (IOP) profiles influences the rate of progression of chronic open-angle glaucoma. METHODS: The hospital-based clinical observational study included day-and-night profiles of IOP measurements performed on 458 patients (855 eyes) with chronic open-angle glaucoma or ocular hypertension. The 24-h pressure profiles obtained by Goldmann applanation tonometry contained measurements at 0700, noon, 1700, 2100, and midnight. RESULTS: In the whole study population, IOP amplitude was significantly (P<0.001) and positively associated with the mean (r=0.26), minimal (r=-0.23) and maximal (r=0.59) IOP values. Taking the whole study population, glaucoma progression was not associated with the IOP amplitude (P=0.09). After adjustment for age, neuroretinal rim area and the other IOP measurements, age (P<0.001) and neuroretinal rim area (P=0.05) remained as significant predictive factors in the selected Cox model. In the normal-pressure glaucoma group (n=174 eyes), progression was significantly positive associated with the minimal IOP value (P<0.001), the mean of the IOP values (P=0.024), and, less significantly (P=0.037) and negatively, with the pressure profile amplitudes. In the high-pressure glaucoma group (n=681 eyes), rate of glaucoma progression was not associated with the IOP amplitude (P=0.734) or the other IOP parameters. CONCLUSIONS: Taking into account the highly significant associations between the IOP amplitude and the mean, minimal and maximal IOP values suggests that it is the IOP itself, and less the pressure amplitude, which has the main influence on the rate of the glaucoma progression.     

The role of steroids in outflow resistance

Glucocorticoid (GC)-induced ocular hypertension and secondary iatrogenic open-angle glaucoma are serious side effects of GC therapy. Its clinical presentation is similar in many ways to primary open-angle glaucoma, including increased aqueous outflow resistance and morphological and biochemical changes to the trabecular meshwork (TM). Therefore, a large number of studies have examined the effects of GCs on TM cells and tissues. GCs have diverse effects on the TM, altering TM cell functions, gene expression, extracellular matrix metabolism, and cytoskeletal structure. Some or all of these effects may be responsible for the increased outflow resistance associated with GC therapy. In contrast to GCs, several different classes of steroids appear to lower IOP. Additional research will help better define the molecular mechanisms responsible for GC-induced ocular hypertension and steroid-induced IOP lowering activity.     

Efficacy and safety of once-daily levobunolol for glaucoma therapy

We studied the ocular hypotensive efficacy and safety of 0.5% levobunolol hydrochloride and 0.5% timolol maleate administered topically once daily for 3 months in 91 patients (46 in the levobunolol group and 45 in the timolol group) with primary or secondary open-angle glaucoma or ocular hypertension. In this randomized double-masked parallel clinical study, intraocular pressure (IOP) was successfully controlled in 78% of the patients who received levobunolol and 89% of those who received timolol. The overall mean decrease in IOP was 5.6 mm Hg (decrease of 23%) in the levobunolol group and 6.7 mm Hg (26%) in the timolol group, a nonsignificant difference. In both groups the overall mean IOP during treatment was significantly lower than the pretreatment value (p less than 0.001). For both treatment groups changes in heart rate and blood pressure were minimal. We conclude that both 0.5% levobunolol and 0.5% timolol administered once daily are effective and safe in lowering IOP in most patients with ocular hypertension or open-angle glaucoma.     

Weather influences on intraocular pressure in patients with chronic glaucoma or ocular hypertension

From January 1979 to August 1984 intraocular pressure (IOP) was measured on the first Friday of each month under comparable conditions (same instruments, nearly always the same examiner) in a total of 109 patients in whom a primary chronic open-angle glaucoma or ocular hypertension had been diagnosed: The IOP was correlated to the local weather parameters (atmospheric pressure, cloud cover, relative air humidity, mean, maximum and minimum temperature, precipitation, duration of sunshine, mean and maximum wind velocity). In the large number of measurements a significant correlation was found only between IOP and atmospheric pressure: IOP was lower when air pressure was high. There was only a suggestion of a significant correlation between IOP and relative air humidity. However, further statistical analysis revealed that in fact both atmospheric pressure and relative air humidity account for only a negligible part of the variation in IOP values. From a practical point of view, therefore, the IOP of patients with primary chronic open-angle glaucoma or ocular hypertension is not influenced by weather conditions.     

The relationship between intraocular pressure and glaucoma in a defined population. Data from the Egna-Neumarkt Glaucoma Study

PURPOSE: To provide data on the prevalence of ocular hypertension and glaucoma and on the diagnostic validity of tonometry. METHODS: In this cross-sectional, population-based study, 4,927 subjects over 40 years of age were examined. Each subject underwent a complete ocular examination as part of the Egna-Neumarkt Glaucoma Study. These examinations were carried out by trained, quality-controlled ophthalmologists, according to a predetermined standard protocol that included a medical interview, applanation tonometry, computerized perimetry, optic nerve head examination and other ocular measurements. The following data were recorded: mean IOP, prevalence of ocular hypertension, primary open-angle glaucoma and normal tension glaucoma. Sensitivity, specificity and the predictive value of the tonometric test, as well as the distribution of IOP in the different groups were also determined. RESULTS: The overall prevalence of ocular hypertension, hypertensive primary open-angle glaucoma and normal tension glaucoma corresponded to 2.1, 1.4 and 0.6%, respectively. Other types of glaucoma accounted for a further 0.9%. The sensitivity and specificity of the tonometric test in recognizing glaucoma (cut-off between 21 and 22 mm Hg) were, respectively, 80.1 and 97.8%. The predictive values of the positivity and negativity of the test were 52.1 and 99.4%, respectively. CONCLUSIONS: The prevalence of ocular hypertension and glaucoma was similar to that found in several recent epidemiological studies. Tonometry alone is obviously not sufficient to ascertain or to exclude the presence of glaucoma; its diagnostic validity however is high and should never be underestimated. An elevated IOP is the main risk factor for glaucoma, with the degree of risk increasing as the level of IOP increases.     

Intraocular pressure control and persistence on treatment in glaucoma and ocular hypertension

BACKGROUND: The purpose of this study was to characterize current patterns of treatment of glaucoma and ocular hypertension and to examine the effect of those patterns on intraocular pressure (IOP) control and persistence on therapy. METHODS: A retrospective chart review was conducted at 3 ophthalmology practices in Alberta. Data were collected for patients who had begun therapy for newly diagnosed primary open-angle glaucoma or ocular hypertension between May 1, 1998, and Sept. 30, 1999 (phase 1), and for patients who had begun second-line therapy after initial therapy with a beta-blocker had failed (phase 2). Data were collected for a minimum of 24 months for phase 1 and a minimum of 18 months for phase 2. RESULTS: We included 115 patient charts in phase 1 and 93 in phase 2. In each phase, the patients for whom latanoprost had been prescribed in unfixed combination with a beta-blocker had the greatest mean percentage reduction in IOP at month 24, and the patients for whom latanoprost had been prescribed alone or in combination with a beta-blocker were more likely to still be on initial therapy at month 24; the difference in persistence on therapy was statistically significant only in phase 1 (p = 0.001). The mean number of switches in therapy was smaller in phase 1 than in phase 2 in all therapy groups. INTERPRETATION: Compared with other first- and second-line forms of therapy, treatment with latanoprost, alone or in combination with a beta-blocker, was associated with greater reductions in IOP, better therapeutic persistence, fewer therapy switches and fewer ophthalmologist visits over a 2-year period.