Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study

OBJECTIVE: To estimate age- and gender-specific prevalences of ocular hypertension and open-angle glaucoma (OAG) in adult Latinos. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: The study cohort consisted of all self-identified Latinos of primarily Mexican ancestry 40 years and older residing in 6 census tracts in La Puente, California. All participants underwent a complete ophthalmologic examination, including measurement of intraocular pressure (IOP), visual field (VF) testing using an automated field analyzer, and simultaneous stereoscopic fundus photography of the optic disc. Ocular hypertension was defined as IOP of >21 mmHg and the absence of optic disc damage or abnormal VF test results. Open-angle glaucoma was defined as the presence of an open angle and various criteria that included a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. MAIN OUTCOME MEASURES: Prevalence of open-angle glaucoma and ocular hypertension. RESULTS: For the 6142 participants who underwent a complete ophthalmologic examination at the clinical center, the prevalence of OAG was 4.74% (95% confidence interval [CI], 4.22%-5.30%). The prevalence of ocular hypertension was 3.56% (95% CI, 3.12%-4.06%). The prevalences of OAG and ocular hypertension were higher in older Latinos than in younger Latinos (P<0.0001). No gender-related differences in prevalences of OAG and ocular hypertension were present. The mean IOP, mean deviation, and mean vertical cup-disc ratio in persons with OAG were 17 mmHg, -9.6 decibels, and 0.6, respectively. Seventy-five percent of Latinos with OAG and 75% of Latinos with ocular hypertension were previously undiagnosed. Further, 17% of Latinos with OAG and 23% of Latinos with ocular hypertension had received treatment for "glaucoma." CONCLUSION: Our data suggest that the prevalence of OAG is high among Latinos of Mexican ancestry. The higher prevalence of OAG in older Latinos emphasizes the public health importance of providing eye care services for the early diagnosis and management of this condition in Latinos.     

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.     

陕西农村50岁以上人群眼压不对称性与无确诊史青光眼相关研究

目的:通过对陕西省农村50岁以上人群眼压(IOP)不对称性的分布情况及其与无确诊史的调查,分析眼压不对称性与原发性青光眼之间的关系。方法:采用分层整群抽样法于2003-07/12在陕西省洋县、靖边县及富平县对50岁以上人口进行问卷调查,包括询问青光眼确诊史、家族史、发作史和手术史,并进行相关眼科检查,包括视力、眼压、外眼、眼前节、前房深度、眼底等,可疑青光眼者进行进一步检查,包括复查眼压、检查前房角、进行激发试验、检查视野等。双眼眼压之差≥3mmHg定义为眼压不对称性。服用抗青光眼药物者、有诊断史的青光眼患者、接受过白内障手术者及有不可信眼压的受检者不做为调查对象。结果:共调查50岁以上观察对象2125例,其中有1775例完成了青光眼的相关检查,受检率为83.53%。在排除了83例服用抗青光眼药物或有青光眼诊断史、或曾接受过白内障手术及眼压不可信的受检者后,共有1692例符合研究对象纳入标准。调查发现共有23例无青光眼确诊史的患者,患病率为1.36%(95%CI,0.88,2.07)。眼压不对称性共有124例,患病率为7.3%(95%CI,6.2,8.7)。通过Mantel-Haenszel分层分析,显示眼压不对称性的患病率随年龄的增长而显著增加(P=0.012)。双眼中最高眼压>21mmHg的受检者眼压不对称性的患病率(35.7%)明显高于最高眼压≤21mmHg的受检者(7.1%)。应用多因素非条件logistic回归分析显示眼压不对称性与无确诊史的原发性青光眼有显著性关联(OR为3.68;95%CI,1.37,9.86),此联系在双眼中的最高眼压≤21mmHg的受检者中依旧保持(OR为4.74;95%CI,1.16,19.35)。结论:对于那些没有出现高眼压并且还未诊断为青光眼的患者,眼压不对称性与原发性青光眼关联有统计学意义,提示临床上诊断原发性青光眼时,眼压不对称性可作为一个有价值的诊断参考指征。     

Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension.

BACKGROUND/AIMS: Recent studies have revealed patients with ocular hypertension to have thicker than normal central corneas and those with normal tension glaucoma to have thinner than normal ones, as determined by ultrasonic pachymetry. Since corneal thickness measurements and applanation tonometric estimates of intraocular pressure (IOP) correlate positively, monitoring of the former parameter have served as the basis for adjusting readings pertaining to the latter, with the consequence that many patients have had to be reclassified. With a view to validating these pachymetric studies, the central corneal thickness was determined in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension, as well as that of normal subjects, using optical low coherence reflectometry, which is a new and more precise method than ultrasonic pachymetry. METHODS: 34 patients with normal tension glaucoma, 20 with primary open angle glaucoma, 13 with pseudoexfoliation glaucoma, and 12 with ocular hypertension, together with 21 control subjects, were included in this observational, concurrent case-control study. One eye per individual was randomly selected for investigation. IOP was measured by Goldmann applanation tonometry and central corneal thickness by optical low coherence reflectometry. RESULTS: Central corneal thickness was significantly higher (p < or =0.001) in patients with ocular hypertension than in normal individuals or in subjects with either normal tension glaucoma, primary open angle glaucoma, or pseudoexfoliation glaucoma, there being no significant differences between the latter four groups. Patients with ocular hypertension were also significantly younger (p < or =0.003) than those within any of the three glaucomatous groups. CONCLUSION: This study confirms that a significant number of patients with ocular hypertension have normal IOPs after the appropriate adjustments have been made for deviations from normal in their central corneal thickness. The accurate measurement of this latter parameter is important not only for individual patient care, in permitting more precise estimations of IOP, but also for clinical studies, in assuring a more reliable classification of subjects.     

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.     

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.     

Effect of pilocarpine and cycloplegic substances on ophthalmic tone in healthy eyes and ones with glaucoma

The study was carried out on the eyes of patients (aged 20-75 eyes) without glaucoma and with primary open-angle glaucoma (POAG). A single instillation of 1 or 2% pilocarpin hydrochloride did not lead to a decrease of intraocular pressure (IOP) in the eyes without glaucoma. IOP fluctuations after pilocarpin instillations were accidental and as a rule were observed both in the treated and control eyes. Instillations of the same pilocarpin solutions significantly decreased IOP in the eyes with OAG in the majority of cases (in 76% in our study), which is apparently due to removal or decrease of the canalicular block. The results of relieving tonometric pilocarpin test should be taken account of in early diagnosis of glaucoma, but the diagnostic parameters of the test should be determined more precisely. After instillation of short-acting cycloplegic drugs (1% homatropin and 0.5% tropicamide) IOP did not change either in normal or POAG eyes. These drugs are recommended for dilatation of the pupil for ophthalmoscopy in patients with anterior chamber open angle 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.     

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.     

Evaluation of the high specificity Screening Program (C-20-1) of the Frequency Doubling Technology (FDT) perimeter in clinical practice

AIMS: To compare the efficacy of the high specificity Frequency Doubling Technology (FDT) Perimeter Screening Program (C-20-1) to standard threshold automated perimetry in the diagnosis of open-angle glaucoma. METHODS: A total of 100 consecutively presenting patients attending a glaucoma clinic who volunteered for the study (approximately 30% of whom were attending for an initial visit) were examined with the FDT C-20-1 Screening Program and with the Humphrey Field Analyzer (HFA) SITA Fast algorithm and Program 24-2. RESULTS: Of the patients, 17 were excluded due to unreliable visual field results or non-glaucomatous ocular abnormalities. In all, 10 patients were diagnosed as normal, 54 with open-angle glaucoma, eight with ocular hypertension, and 11 as glaucoma suspects. Of the 54 glaucomatous patients, 45 exhibited high-tension glaucoma and nine normal tension glaucoma. Perimetry with the HFA gave a sensitivity of 81.5% for the combined category of glaucoma and glaucoma suspect and a specificity of 83.3% for the combined category of normal and ocular hypertension. Perimetry with the FDT gave a sensitivity of 74.5% and a specificity of 85.2% compared to that of the HFA. CONCLUSION: In the detection of glaucoma, Program C-20-1 of the FDT perimeter exhibits high specificity. It exhibits low sensitivity for the detection of mild loss but high sensitivity for advanced field loss relative to Program 24-2 and the SITA Fast algorithm of the HFA.     

Intraocular pressure fluctuations in medical versus surgically treated glaucomatous patients.

The purpose of this study was to compare the IOP fluctuations in the daytime tension curves of glaucoma patients under ocular hypotensive therapy with those of patients previously submitted to trabeculectomy. We also evaluated the IOP peaks and fluctuations for the same patients in response to the water-drinking test (WDT). The study included 30 primary open-angle glaucoma (POAG) patients using ocular hypotensive medications and with no history of previous intraocular surgery (medical group), and 30 POAG patients previously submitted to one or more trabeculectomies though taking no medication at the time of the study (surgical group). All patients were submitted to a diurnal tension curve--DTC (8:30-17:00/3-hour intervals) followed by the WDT. The IOP peak and IOP fluctuation during the diurnal tension curve were significantly greater in the medical group than in the surgical group. The same was observed following the WDT. From an overall baseline IOP of 10.6 mmHg, the mean IOP change following the WDT was 13% in the surgical group and 40% in the medical group. Patients submitted to trabeculectomy have less TOP fluctuations during the diurnal tension curve and following a water-drinking provocative test. This effect could represent an additional benefit of surgery in controlling the intraocular pressure of glaucomatous patients.     

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.     

Open-angle glaucoma associated with Graves disease

PURPOSE: To estimate the prevalence of open-angle glaucoma, including normal-tension glaucoma, in association with Graves disease. METHODS: In a prospective study, a complete ophthalmic examination including applanation tonometry, exophthalmometry, automated static threshold perimetry, and computed tomography of the orbit was performed in 104 consecutive Japanese patients with Graves disease (age range, 11 to 86 years; mean, 42 years; 80 women, 24 men). Ocular hypertension was defined as an intraocular pressure greater than 21 mm Hg on at least two occasions during the period of follow-up. RESULTS: Of the 104 patients, 14 (13%) exhibited typical glaucomatous visual field defects in automatic static threshold perimetry in the absence of compressive optic neuropathy. The intraocular pressure in seven of the 14 patients was consistently less than 21 mm Hg during the follow-up period. Thus, these patients were diagnosed as having normal-tension glaucoma. Of the 104 patients, 23 (22%) were diagnosed as having ocular hypertension. CONCLUSIONS: The prevalence of normal-tension glaucoma as well as open-angle glaucoma and ocular hypertension was significantly higher among patients with Graves disease than in the general population.     

Crete, Greece glaucoma study

PURPOSE: To investigate the prevalence of primary open-angle glaucoma (POAG) in a randomized sample of the inhabitants of the island of Crete. PATIENTS AND METHODS: In 18 different villages in all four prefectures of the island of Crete, patients were randomly selected from 1993 through 1998, and an in situ study was accomplished. The sampling fraction (covered by the 1991 census) in each village was approximately 5%. Patients were considered to have POAG when the morphologic aspect of a glaucomatous optic disc was present, and/or a nerve fiber layer defect and a visual field defect was present. The presence of Pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (PEXG) was also investigated. RESULTS: The prevalence of glaucoma in Crete was 2.80%. Of those diagnosed with POAG, 9.67% had an intraocular pressure (IOP) under 21 mm Hg, and 25.80% had PEX. The prevalence of simple ocular hypertension without glaucoma was found in 6.58% of the patients. The ratio of subjects with hypertensive glaucoma to those with simple ocular hypertension was 1:2.6. CONCLUSION: The prevalence of POAG and exfoliation glaucoma appears to be quite high in Crete. Further research will be needed to set more accurate criteria for earlier diagnosis and to enable more efficient organization of the health care system.     

Frequency doubling technology and high-pass resolution perimetry in glaucoma and ocular hypertension

PURPOSE: To study the correlation between frequency doubling technology perimetry (FDT) and high-pass resolution perimetry (HRP) in eyes with primary open-angle glaucoma, suspect glaucoma, ocular hypertension, and in normal eyes. PATIENTS AND METHODS: Ninety-four patients (162 eyes) were studied. Visual fields were assessed by HRP, FDT screening C-20-5 and FDT threshold C-20 programs. In eyes with a discrepancy between the test results, a comprehensive clinical examination was performed, including optic disc photography and Heidelberg retinal tomography (HRT). RESULTS: There was a strong correlation between HRP global deviation and the FDT mean deviation (for FDT threshold C-20 test), and between HRP score and FDT score (for FDT screening C-20-5 ). The correlation coefficients were r = -0.83 and r = 0.77, respectively. In all, 75 eyes (46.3%) had normal HRP and FDT screening results, while 67 eyes (41.4%) showed abnormal results in both tests. In 12 eyes (7.4%) HRP was within normal limits while FDT screening was abnormal. Seven of these eyes were judged to have glaucoma; three of them had converted from ocular hypertension to glaucoma. In eight eyes (4.9%) HRP was abnormal while FDT screening was normal. Three of these were judged to have glaucoma. Thus, the sensitivity and specificity of the FDT screening test for the detection of glaucoma were 91.7% and 87.8%, respectively. CONCLUSION: There was a strong correlation between FDT threshold C-20, FDT screening C-20-5 and HRP test results. Frequency doubling technology perimetry C-20-5 represents a good screening test for the detection of optic nerve damage in open-angle glaucoma.     

Correlation between finger blood flow and changes in optic nerve head blood flow following therapeutic intraocular pressure reduction

PURPOSE: To correlate finger blood flow and changes in optic nerve head (ONH) blood flow following therapeutic intraocular pressure (IOP) reduction in open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS: Seventeen open-angle glaucoma patients and nineteen ocular hypertension patients underwent therapeutic IOP reduction followed by a minimum of 4 weeks of follow-up. Optic nerve head blood flow measurements were obtained by scanning laser Doppler flowmetry using full-field perfusion image analysis. Finger blood flow was measured using the Transonic laser Doppler Flowmeter. Finger blood flow was measured at baseline, after immersion in warm water (40 degrees C) for 2 minutes (Flow Max), and after immersion in cold water (4 degrees C) for 10 seconds (Flow Min). Patients were identified as vasospastic if their Flow Max/Flow Min >7. Statistical comparisons were performed using two-tailed distribution paired T-test and Pearson's correlation factor. RESULTS: For similar mean percentage intraocular pressure reduction, vasospastic patients had greater improvements in rim blood flow than did non-vasospastic patients [+35% versus +13%] (P = 0.01). While there was no difference in rim blood flow changes in the vasospastic versus the non-vasospastic OAG group, the vasospastic ocular hypertension group showed 18% increase in rim blood flow whereas the non-vasospastic ocular hypertension group showed an 8% decrease. A significant negative correlation was also found in the open-angle glaucoma group between rim blood flow change and Flow Max (-0.681, P = 0.003). In contrast, no such correlation was found in the ocular hypertension group (+0.144, P = 0.556). CONCLUSION: OAG patients had a significant negative correlation between changes in rim blood flow and maximum finger Doppler flow. Among ocular hypertension patients, increased rim blood flow was only found in the vasospastic group, though this increase was not statistically significant. These results suggest that open-angle glaucoma and ocular hypertension patients with the most severe vasospastic disease may show the greatest improvements in rim blood flow after sustained intraocular pressure reduction.     

Efficacy and safety of a fixed combination of travoprost 0.004%/timolol 0.5% ophthalmic solution once daily for open-angle glaucoma or ocular hypertension

PURPOSE: To compare the efficacy of a fixed combination of travoprost 0.004%/timolol 0.5% every day in the morning with a concomitant regimen of timolol 0.5% every day in the morning, plus travoprost 0.004% every day in the evening; and timolol 0.5% twice daily on the intraocular pressure (IOP) of subjects with open-angle glaucoma or ocular hypertension over 3 months. DESIGN: Prospective, randomized, double-masked, parallel-group, active-controlled, multicenter trial. METHODS: Patients comprised adult subjects (n = 403) of either gender with open-angle glaucoma or ocular hypertension in at least one eye. To qualify, the IOP had to be between 22 to 36 mm Hg in the same eye at two consecutive eligibility visits. The primary outcome variable was IOP measured with a Goldmann applanation tonometer. RESULTS: Mean IOP ranged from 16.2 to 17.4 mm Hg with the combination travoprost/timolol compared with 15.4 to 16.8 mm Hg in the concomitant travoprost + timolol group, from baselines of 23.1 to 25.6 mm Hg and 22.9 to 25.0 mm Hg, respectively. The fixed combination of travoprost/timolol significantly lowered IOP by 7 to 9 mm, similar to the IOP reductions observed with concomitant therapy. The most frequent ocular adverse event was hyperemia that occurred in 14.3% and 23.4% of subjects treated with travoprost/timolol combination and concomitant travoprost + timolol, respectively. CONCLUSIONS: Travoprost/timolol combination produces greater IOP reductions than the positive control, timolol 0.5%, and reductions that were similar to concomitant travoprost + timolol. This study demonstrates that the fixed combination of travoprost/timolol produces significant and clinically relevant reductions of IOP in a once-daily dosing regimen.     

A comparison of morning and evening instillation of a combination travoprost 0.004%/timolol 0.5% ophthalmic solution

PURPOSE: To compare the intraocular pressure lowering efficacy and side effect profile of travoprost 0.004%/timolol 0.5% ophthalmic solution dosed in the morning and evening. METHODS: This was a multicenter, prospective, randomized, double-masked, parallel group clinical study of 92 patients with open-angle glaucoma (with or without pseudoexfoliative or pigmentary glaucoma) or ocular hypertension. After a washout of existing glaucoma medications, patients were randomly assigned to receive one drop of travoprost 0.004%/timolol 0.5% in the morning or evening for 6 weeks. The main outcome measures were mean intraocular pressure (IOP) assessed at 9 am, 11 am, and 4 pm, and safety variables. RESULTS: Travoprost 0.004%/timolol 0.5% ophthalmic solution, dosed in the morning or evening, controlled IOP consistently throughout the day. Mean IOP ranged from 16.5 to 16.7 mmHg in the morning treatment group and from 16.1 to 17.2 mmHg in the evening treatment group. Travoprost 0.004%/timolol 0.5% ophthalmic solution produced statistically significant and clinically relevant reductions in IOP from baseline; mean reductions ranged from approximately 8 to 10 mmHg (32% to 38%). Travoprost 0.004%/timolol 0.5% ophthalmic solution was safe and well tolerated with the most frequently reported adverse event being ocular hyperemia, which occurred in 12.5% of patients in the morning treatment group and 13.6% of patients in the evening treatment group. CONCLUSIONS: Travoprost 0.004%/timolol 0.5% given once daily, either in the morning or evening, is a safe and effective treatment for open-angle glaucoma and ocular hypertension. It may be beneficial for patients judged to be inadequately controlled on a prostaglandin analogue or ophthalmic beta-blocker 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.     

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.