Lowering IOP With Medical Therapy in Patients With Glaucoma

Palmberg P. Risk factors for glaucoma progression: where does intraocular pressure fit in. Arch Ophthalmol. 2001;119:897-898. Abstract
Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120:714-720. Abstract
Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120:701-713. Abstract
Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003;121:48-56. Abstract
Nouri-Mahdavi K, Hoffman D, Coleman AL, et al. Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology. 2004;111:1627-1635. Abstract
Asrani S, Zeimer R, Wilensky J, Gieser D, Vitale S, Lindenmuth K. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000;9:134-142. Abstract
Higginbotham EJ, Schuman JS, Goldberg I, et al. One-year, randomized study comparing bimatoprost and timolol in glaucoma and ocular hypertension. Arch Ophthalmol. 2002;120:1286-1293. Abstract
Camras CB. Comparison of latanoprost and timolol in patients with ocular hypertension and glaucoma: a six-month masked, multicenter trial in the United States. The United States Latanoprost Study Group. Ophthalmology. 1996;103:138-147. Abstract
Netland PA, Landry T, Sullivan EK, et al. Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol. 2001;132:472-484. Abstract
Lewis RA, Katz GJ, Weiss MJ, et al. Travoprost 0.004% with and without benzalkonium chloride: a comparison of safety and efficacy. J Glaucoma. 2007;16:98-103. Abstract
Toris CB, Alm A, Camras CB. Latanoprost and cholinergic agonists in combination. Surv Ophthalmol. 2002;47(suppl1):S141-S147.
Weinreb RN, Lindsey JD, Marchenko G, Marchenko N, Angert M, Strongin A. Prostaglandin FP agonists alter metalloproteinase gene expression in sclera. Invest Ophthalmol Vis Sci. 2004;45:4368-4377. Abstract
van der Valk R, Webers CA, Schouten JS, Zeegers MP, Hendrikse F, Prins MH. Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. Ophthalmology. 2005;112:1177-1185. Abstract
Fellman RL, Sullivan EK, Ratliff M, et al. Comparison of travoprost 0.0015% and 0.004% with timolol 0.5% in patients with elevated intraocular pressure: a 6-month, masked, multicenter trial. Ophthalmology. 2002;109:998-1008. Abstract
Parrish RK, Palmberg P, Sheu WP. A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study. Am J Ophthalmol. 2003;135:688-703. Abstract
Noecker RS, Dirks MS, Choplin NT, Bernstein P, Batoosingh AL, Whitcup SM. A six-month randomized clinical trial comparing the intraocular pressure-lowering efficacy of bimatoprost and latanoprost in patients with ocular hypertension or glaucoma. Am J Ophthalmol. 2003;135:55-63. Abstract
Fechtner RD, Khouri AS, Zimmerman TJ, et al. Anterior uveitis associated with latanoprost. Am J Ophthalmol. 1998;126:37-41. Abstract
Martin E, Martinez-de-la-Casa JM, Garcia-Feijoo J, Troyano J, Larrosa JM, Garcia-Sanchez J. A 6-month assessment of bimatoprost 0.03% vs timolol maleate 0.5%: hypotensive efficacy, macular thickness and flare in ocular-hypertensive and glaucoma patients. Eye. 2007;21:164-168. Abstract
Arcieri ES, Santana A, Rocha FN, Guapo GL, Costa VP. Blood-aqueous barrier changes after the use of prostaglandin analogues in patients with pseudophakia and aphakia: a 6-month randomized trial. Arch Ophthalmol. 2005;123:186-192. Abstract
Alm A, Widengard I, Kjellgren D, et al. Latanoprost administered once daily caused a maintained reduction of intraocular pressure in glaucoma patients treated concomitantly with timolol. Br J Ophthalmol. 1995;79:12-16. Abstract
Orengo-Nania S, Landry T, Von Tress M, Silver LH, Weiner A, Davis AA. Evaluation of travoprost as adjunctive therapy in patients with uncontrolled intraocular pressure while using timolol 0.5%. Am J Ophthalmol. 2001;132:860-868. Abstract
Toris CB, Gleason ML, Camras CB, Yablonski ME. Effects of brimonidine on aqueous humor dynamics in human eyes. Arch Ophthalmol. 1995;113:1514-1517. Abstract
Netland PA, Michael M, Rosner SA, Katzman B, Macy JI. Brimonidine Purite and bimatoprost compared with timolol and latanoprost in patients with glaucoma and ocular hypertension. Adv Ther. 2003;20:20-30. Abstract
Higginbotham EJ, Diestelhorst M, Pfeiffer N, Rouland JF, Alm A. The efficacy and safety of unfixed and fixed combinations of latanoprost and other antiglaucoma medications. Surv Ophthalmol. 2002;47(suppl1):S133-S140.
O'Connor DJ, Martone JF, Mead A. Additive intraocular pressure lowering effect of various medications with latanoprost. Am J Ophthalmol. 2002;133:836-837. Abstract
Bucci MG. Intraocular pressure-lowering effects of latanoprost monotherapy versus latanoprost or pilocarpine in combination with timolol: a randomized, observer-masked multicenter study in patients with open-angle glaucoma. Italian Latanoprost Study Group. J Glaucoma. 1999;8:24-30. Abstract
Zabriskie N, Netland PA. Comparison of brimonidine/latanoprost and timolol/dorzolamide: two randomized, double-masked, parallel clinical trials. Adv Ther. 2003;20:92-100. Abstract
Khouri A, Lama PJ, Fechtner, RD. Beta blockers. In: Netland PA, ed. Glaucoma Medical Therapy: Principles and Management. 2nd ed. New York: Oxford University Press; 2008:55-78.
Letchinger SL, Frohlichstein D, Glieser DK, et al. Can the concentration of timolol or the frequency of its administration be reduced? Ophthalmology. 1993;100:1259-1262. Abstract
Liu JH, Kripke DF, Weinreb RN. Comparison of the nocturnal effects of once-daily timolol and latanoprost on intraocular pressure. Am J Ophthalmol. 2004;138:389-395. Abstract
Mundorf T, Noecker RJ, Earl M. Ocular hypotensive efficacy of brimonidine 0.15% as adjunctive therapy with latanoprost 0.005% in patients with open-angle glaucoma or ocular hypertension. Adv Ther. 2007;24:302-309. Abstract
Feldman RM, Tanna AP, Gross RL, et al. Comparison of the ocular hypotensive efficacy of adjunctive brimonidine 0.15% or brinzolamide 1% in combination with travoprost 0.004%. Ophthalmology. 2007;114:1248-1254. Abstract
Yoles E, Wheeler LA, Schwartz M. Alpha2-adrenoreceptor agonists are neuroprotective in a rat model of optic nerve degeneration. Invest Ophthalmol Vis Sci. 1999;40:65-73. Abstract
Lama PJ. Systemic adverse effects of beta-adrenergic blockers: an evidence-based assessment. Am J Ophthalmol. 2002;134:749-760. Abstract
Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler LP. Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol. 1984;102:551-553. Abstract
Higginbotham EJ, Feldman R, Stiles M, Dubiner H. Latanoprost and timolol combination therapy vs monotherapy: one-year randomized trial. Arch Ophthalmol. 2002;120:915-922. Abstract
Katz LJ. Modern alchemy: fixed combinations of glaucoma drugs. Am J Ophthalmol. 2005;140:125-126. Abstract
Orzalesi N, Rossetti L, Bottoli A, Fumagalli E, Fogagnolo P. The effect of latanoprost, brimonidine, and a fixed combination of timolol and dorzolamide on circadian intraocular pressure in patients with glaucoma or ocular hypertension. Arch Ophthalmol. 2003;121:453-457. Abstract
Silver LH. Clinical efficacy and safety of brinzolamide (Azopt), a new topical carbonic anhydrase inhibitor for primary open-angle glaucoma and ocular hypertension. Brinzolamide Primary Therapy Study Group. Am J Ophthalmol. 1998;126:400-408. Abstract
Strahlman E, Tipping R, Vogel R. A double-masked, randomized 1-year study comparing dorzolamide (Trusopt), timolol, and betaxolol. International Dorzolamide Study Group. Arch Ophthalmol. 1995;113:1009-1016. Abstract
Khouri A, Realini T, Fechtner RD. Use of fixed-dose combination drugs for the treatment of glaucoma. Drugs Aging. 2007;24:1007-1016. Abstract
Strohmaier K, Snyder E, DuBiner H, Adamsons I. The efficacy and safety of the dorzolamide-timolol combination versus the concomitant administration of its components. Ophthalmology. 1999;106:1-9.
Choudhri S, Wand M, Shields MB. A comparison of dorzolamide-timolol combination versus the concomitant drugs. Am J Ophthalmol. 2000;130:832-823. Abstract
Sherwood MB, Craven ER, Chou C, et al. Twice-daily 0.2% brimonidine-0.5% timolol fixed-combination therapy vs monotherapy with timolol or brimonidine in patients with glaucoma or ocular hypertension: a 12-month randomized trial. Arch Ophthalmol. 2006;124:1230-1238. Abstract
Alvarado JA. Reduced ocular allergy with fixed-combination 0.2% brimonidine-0.5% timolol. Arch Ophthalmol. 2007;125:717; author reply 717-718.
Robin AL, Novack GD, Covert DW, Crockett RS, Marcic TS. Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol. 2007;144:533-540. Abstract

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Introduction

Glaucoma is a progressive optic neuropathy and a leading cause of visual impairment worldwide. Elevated intraocular pressure (IOP) is believed to be one of its strongest risk factors,^[1] and is associated with the development of glaucoma and glaucoma progression.^[2-4] Further, diurnal IOP range and the IOP range over multiple days have both been suggested as significant risk factors for glaucoma progression, even after adjusting for age, race, and visual field damage.^[5,6] The main focus of treatment for ocular hypertension and primary open-angle glaucoma, therefore, is to reduce IOP.

Several classes of medications have topical agents that have been approved for use in the reduction of IOP. With so many available agents, there is some question over not only the most optimal choice, but how many agents compare both within and across class and what to try in the case of treatment failure. The most robust available data come from the randomized, masked, prospective studies of medications as monotherapy that were used for regulatory approval. These studies give an indication of expected efficacy and adverse effects for individual agents. However, few direct comparison studies exist to offer definitive answers on agent difference. Moreover, studies about the adjunctive use of medications are even less available. In the past, we inferred how a medication would perform as a second-line agent on the basis of the results of monotherapy studies, but more recently, we have found that the observation by Kuldev Singh, MD, that the second best first-line agent may not be the best second-line agent, seems true. Indeed, it has become clear that although studies offer a guide to treatment, we the practitioners must ultimately assess the efficacy and tolerability of each agent in each individual patient.

Therefore, when considering the strengths and weaknesses of therapies, we must first acknowledge that all approved medications are going to be useful for certain clinical situations. With that in mind, the major factors to consider when choosing therapy include efficacy, convenience, safety, tolerability, and cost, and it is here that available studies can offer the most guidance. This article reviews the current options in IOP-lowering therapy, while reminding the reader that each patient may differ; therefore, treatment must be based on both the published studies and individual patient response.

Page 1 of 5

First-Line Agents -- Prostaglandin Analogs

Introduction
First-Line Agents -- Prostaglandin Analogs
Concomitant Treatment of Glaucoma
Fixed Combinations
Conclusion

References

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Faculty and Disclosures

Lowering IOP With Medical Therapy in Patients With Glaucoma

Introduction

Table of Contents