66 research outputs found
Selective Laser Trabeculoplasty and the Evolving Glaucoma Paradigm
No full textThe rapid and extensive expansion of therapeutic options for glaucoma management provides both the opportunity and the resources necessary to broadly reconsider our 150+ year topical medications-first approach. Although topical medications are safe and efficacious, their effectiveness is limited by less-than-ideal adherence. The reasons why patients do not take their medications as prescribed have been extensively studied and are both complex—having many facets—and complicated—having no simple solution. Novel therapies, including sustained-release medication platforms, selective laser trabeculoplasty (SLT), and minimally invasive glaucoma surgery, present opportunities to bypass topical medications and absolve patients of the responsibility for self-dosing of topical therapy. Because poor adherence increases the risk of glaucoma progression, moving away from topical therapy offers the potential for better long-term outcomes. In this article, we will review the strengths and limitations of topical medical therapy and propose that—based on new and emerging data—the paradigm shift to primary SLT is both entirely appropriate for the vast majority of patients and long overdue. We will also describe our conversations with patients about SLT, with the goal of facilitating readers’ integration of primary SLT into their clinical practices.
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Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article
Six-month results from a Phase III randomized trial of fixed-combination brinzolamide 1% + brimonidine 0.2% versus brinzolamide or brimonidine monotherapy in glaucoma or ocular hypertension
No full textJess T Whitson,1 Tony Realini,2 Quang H Nguyen,3 Matthew G McMenemy,4 Stephen M Goode5 1University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 2West Virginia University Eye Institute, Morgantown, WV, 3Scripps Clinic, La Jolla, CA, 4Lone Star Eye Care, Sugar Land, TX, 5Alcon Research Ltd, Fort Worth, TX, USA Background: The objective of this study was to examine the safety and intraocular pressure (IOP)-lowering efficacy of a fixed combination of brinzolamide 1% + brimonidine 0.2% (BBFC) after six months of treatment in patients with open-angle glaucoma or ocular hypertension. Methods: This was a randomized, multicenter, double-masked, three-month, three-arm contribution-of-elements study with a three-month safety extension. Patients were randomly assigned 1:1:1 to treatment with BBFC, brinzolamide 1%, or brimonidine 0.2% after a washout period. Patients dosed their study medications three times daily at 8 am, 3 pm, and 10 pm for six months. Patients returned for visits at two weeks, six weeks, three months, and six months. IOP measurements were used to assess efficacy. Safety assessments were adverse events, corrected distance visual acuity, slit-lamp biomicroscopy, pachymetry, perimetry, fundus parameters, and cardiac parameters. Results: A total of 690 patients were randomized. Six-month mean IOP values were similar to those at three months, when the mean IOP in patients treated with BBFC was significantly lower than that of either monotherapy group. A total of 175 patients experienced at least one treatment-related adverse event (BBFC, 33.0%; brinzolamide, 18.8%; brimonidine, 24.7%), eight of which were severe, and five resulted in discontinuation. Seventy-seven patients discontinued participation due to treatment-related adverse events (BBFC, 17.2%; brinzolamide, 2.1%; brimonidine, 14.5%). There were 21 serious adverse events (n = 7 in each group), none of which was related to treatment. Resting mean pulse and blood pressure with BBFC were similar to those with brimonidine, demonstrating modest, clinically insignificant decreases. No new or increased risks were identified with use of BBFC relative to either monotherapy. Conclusion: This study showed that, after six months of treatment, the safety profile of BBFC was similar to that of its individual components and its IOP-lowering activity was similar to its efficacy at three months, when it was superior to both brinzolamide 1% alone and brimonidine 0.2% alone. Keywords: brimonidine, brinzolamide, fixed combination, ocular hypertension, open-angle glaucom
Reproducibility of Central Corneal Thickness Measurements in Healthy and Glaucomatous Eyes
No full textPurposeThe purpose of this study is to characterize intraday and interday variation in central corneal thickness (CCT) in healthy and glaucomatous subjects.MethodsIn this prospective cohort study, 40 healthy subjects and 42 subjects with primary open-angle glaucoma underwent CCT measurements by ultrasonic pachymetry on 5 days over 1 year: first at baseline, then at 1 week and 1, 6, and 12 months after baseline. On 1visit, CCT was measured every 2 hours from 08:00 to 20:00. Intraday CCT variance was compared with interday CCT variance.ResultsMean CCT at all visits and time points ranged from 561 to 574 µm in healthy eyes and from 548 to 563 µm in glaucomatous eyes. The mean intraday CCT range (highest minus lowest readings) was 21±10 µm in healthy participants and 21±10 µm in glaucoma patients. The mean interday CCT range was 27±13 µm in healthy participants and 24±14 µm in glaucoma patients. Within-subject variance was significantly larger among the interday CCT measurements than the intraday CCT measurements in both healthy subjects and glaucoma patients (P<0.0001 for both) demonstrating that measurements taken on separate days are more different than measurements taken on the same day. Interday CCT differences of ≥30 µm were seen in 27.7% of normal subjects and 30% of glaucoma patients.ConclusionsCCT measurements exhibit intraday and interday variation, with the latter being significantly greater than the former. A single CCT assessment inadequately characterizes CCT and may impact risk assessment in patients with suspect and/or diagnosed glaucoma
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