Intraocular Pressure Lowering Therapy Research Articles

Conversion to Glaucoma in Pediatric Glaucoma Suspects.

In this retrospective review of pediatric glaucoma suspects, 11.5% of eyes progressed to glaucoma over an average of 6.5 years; eyes with ocular hypertension had an 18-fold increased risk of progression compared with eyes with suspicious disc appearance. The purpose of this study was to describe the rate of progression to glaucoma of a large cohort of pediatric glaucoma suspects at a quaternary academic center. Retrospective case series. One thousand three hundred seventy-five eyes (824 individuals) followed as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016. Retrospective study of pediatric patients monitored as glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016. Progression to glaucoma, defined according to Childhood Glaucoma Research Network criteria or by surgical intervention; initiation of intraocular pressure-lowering therapy. One hundred fifty-eight (11.5%) eyes from 109 unique patients met the criteria for conversion to glaucoma during follow-up; rates of conversion ranged between 34.1% for eyes monitored for ocular hypertension, 16.2% for eyes with prior lensectomy, 12.1% for eyes monitored for other ocular risk factors, 2.4% for eyes with suspicious disc appearance, and 0.4% for eyes monitored for systemic risk factors. The first criterion met for conversion to glaucoma was ocular hypertension in 149 eyes (94.3%) and enlarged cup-to-disc ratio (CDR) in 9 eyes (5.7%); the most common second criterion met was the enlargement of CDR since initial presentation (45 eyes, 28.5%), surgical intervention (33 eyes, 20.9%), visual field changes (21 eyes, 13.3%), and asymmetric CDR change compared with fellow eye (20 eyes, 12.7%). The Kaplan-Meier survival curves across the different indications for being monitored as a glaucoma suspect significantly differed ( P <0.0001). Eyes being monitored for ocular hypertension had an 18-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance [hazard ratio (HR) 18.33, 95% CI, 10.05-33.41). Eyes monitored for prior lensectomy and for other ocular risk factors had a 6-fold and 5-fold increased risk of conversion to glaucoma than those followed for suspicious disc appearance, respectively (HR: 6.20, 95% CI, 3.66-10.51; HR: 5.43, 95% CI, 3.00-9.84). Eyes followed for ocular hypertension were nearly 4 times more likely to convert to glaucoma than those followed for prior lensectomy (HR: 3.72, 95% CI, 2.28-6.07). Eyes being followed as pediatric glaucoma suspects for ocular hypertension had higher rates of progression to glaucoma than eyes being monitored for prior lensectomy, other ocular risk factors, suspicious disc appearance, or systemic risk factors.

Viscotrabeculotomy versus trabeculectomy in the surgical treatment of open angle glaucoma: a single center, randomised controlled trial.

The aim of the study was to compare the effect of viscotrabeculotomy and the effect of trabeculectomy on the intraocular pressure (IOP) in cases of open angle glaucoma (OAG). Prospective comparative study. The study was conducted on 148 eyes of 148 patients (87 men) presenting with and operated upon for OAG at Mansoura Ophthalmic center of Mansoura University in Mansoura, Egypt from 2012 to 2016. Patients were randomized into viscotrabeculotomy and trabeculectomy groups. Postoperative follow up visits were scheduled at weeks 1 and 2 then months 1, 2, 3, 6, 9, 12, 15, 18, 21 and 24. Complications were noted and managed according to needs. The primary outcome measure was IOP. The study was conducted on 148 eyes (74 right) of 148 patients (87 men). The mean ± SD (range, median) age of the study patients was 50.1 ± 11.5 (20-67, 53) and 51.1 ± 10.0 (27-65, 54.5) years respectively. The mean ± SD (range, median) IOP of the study eyes on maximal tolerated IOP lowering therapy was 23.15 ± 2.31 (19-30, 23.0) and 23.64 ± 1.87 (20-28, 23.0) mmHg respectively and at the end of the 24months of follow up was 14.91 ± 2.4 (12-23, 14) and 16.64 ± 2.8 (14-25, 16) mmHg respectively (p = < 0.0005). Notable complications included a mild hyphema in the viscotrabeculotomy group and an IOP spike in the trabeculectomy group. Viscotrabeculotomy and trabeculectomy showed efficacy and safety in OAG patients. The former resulted in better IOP reduction.

Challenges in the complex management of post-keratoplasty glaucoma.

Glaucoma is a serious complication after corneal transplantation and itself a common cause for graft failure and leading cause of vision loss post-keratoplasty due to corneal endothelial decompensation. Endothelial keratoplasty procedures like Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) may be superior to penetrating keratoplasty (PK) regarding the incidence of elevated intraocular pressure (IOP) and development of glaucoma. There are indications that regardless of the method of keratoplasty, some corneal diseases like pseudophakic bullous keratopathy, corneal perforation, and graft rejection have a higher risk for developing post-keratoplasty glaucoma than keratoconus and corneal dystrophies and likewise respond less to IOP lowering therapy. In this review, the pathophysiology of post-keratoplasty glaucoma, the diagnostic tools with focus on different devices, and their limitations with regard to measuring IOP and the treatment modalities are presented.

Natural history of glaucomatous optic neuropathy in highly myopic Chinese: study protocol for a registry cohort study

IntroductionMyopic maculopathy and glaucoma belong to the most common causes of irreversible blindness worldwide and, having an ocular axial elongation as one of their main risk factors, can occur together....

Management of Primary Congenital Glaucoma

To study management of primary congenital glaucoma in a defined population of the Qalyubia governorate ,Egypt. Patients and methods The present study was a retrospective chart review of 28 children(48)eyes, who presented with PCG and were operated upon between January 2013 and December 2017 at the Ophthalmology Department of Benha University Hospital.The charts were reviewed for demographics as well as clinical data. Postoperative data were retrieved till the end of the follow-up period. Complications were noted, and success rates were studied. Results The mean age±SD (range) of the study population at presentation was 9.1±17.5 months, and of the follow-up period was 17.5±10.8 months.The most common primary glaucoma surgical procedure performed trabeculectomy with mitomycin C (36 procedures). The mean values (range) of preoperative intraocular pressure (on no intraocular pressure lowering therapy), corneal diameter and cup/disc ratio of the study eyes were 26.2 ±5.4 mmHg,13.6±0.8mm, 0.66± 0.1, respectively, and postoperatively at last follow-up were12.9±4.7mmHg, 12.9±0.9mm, 0.41±0.2. The most common complications were peaked pupil (10.5%), followed by cataract (8.4%) and tube endothelial touch (6.3%). Conclusion Most PCG patients present in the first 6 months of life, so that the most commonly performed procedure was trabeculectomy augmented with mitomycin-C. Meticulous, continuous and prolonged follow-up is mandatory for all operated cases to ensure long-term success.

Expression changes in microRNA in the retina of retinal degenerative diseases

Because visual information accounts for 80-90% of sensory information that we get from our circumstance, loss of vision seriously diminishes our quality of life. According to a recent epidemiological study, glaucoma is the first, and retinitis pigmentosa (RP) is the second leading causes of acquired blindness in Japan. Degeneration of the retinal ganglion cells (RGC) and photoreceptor cells causes glaucoma and RP, respectively. Intraocular pressure-lowering therapy is an only effective treatment for glaucoma, and the agents that protect RGC directly against glaucomatous injury have not been available yet. In addition, there is no effective treatment for RP at present. microRNAs are a class of small, endogenous, non-coding RNAs comprised of approximately 20 nucleotides. It has been clarified that microRNAs reduces the stability of the target mRNAs and/or repress the translation of the target genes. A single microRNA can affect the transcription of multiple mRNAs, and almost 30% of human genes are thought to be regulated by microRNAs. Therefore, it has been considered that the expression changes of microRNAs are possible to cause various diseases, such as cancer and neurodegenerative diseases. Recently, the expression changes in microRNAs have been reported in the retina of experimental model animals for glaucoma and RP. The expressional changes of microRNAs are suggested to be related with development and progression of glaucoma and RP. Here, we will discuss about the relationship between the expressional changes of microRNAs and neuronal cell death in glaucoma and RP.

Neuro-ophthalmic Disease in Pediatric Glaucoma Practice.

Pediatric glaucoma referral to neuro-ophthalmology has a high yield for diagnosing neurological disease and neuroimaging in this cohort often uncovers intracranial abnormalities. Multiple studies have examined the utility of neuro-ophthalmology referrals in an adult glaucoma patient population. No similar studies in the pediatric glaucoma population have been completed. An analysis of pediatric referral patterns and clinical characteristics can serve to guide future physician referrals and improve patient outcomes. A retrospective review of medical records was conducted to identify pediatric patients evaluated by both glaucoma and neuro-ophthalmology services at Bascom Palmer Eye Institute from January 2013 to August 2018. Records were reviewed for clinical examination findings, demographics, ophthalmic imaging, neuroimaging, and ultimate diagnosis. A total of 59 patients, average age 10 years old, were included for analysis. The majority of patients were referred from pediatric glaucoma to neuro-ophthalmology (n=52, 88.1%). The most common reasons for referral included suspected nonglaucomatous optic neuropathy (n=14), optic disc swelling (n=7), color vision deficiency (n=6), and nonglaucomatous visual field defect (n=4). Referral to neuro-ophthalmology resulted in neuro-imaging in 22 patients (22/52, 42.3%), with 7 patients (7/52, 13.7%) having pathology on the scan. Ultimately, 38 patients (73.1%) referred to neuro-ophthalmology had an ultimate diagnosis unrelated to glaucoma. Color vision abnormality, optic nerve pallor, and/or retinal nerve fiber layer <70 µm in at least 1 eye were associated with a diagnosis unrelated to glaucoma. Of the 7 patients referred from neuro-ophthalmology to pediatric glaucoma, none were diagnosed with glaucoma or started on intraocular pressure lowering therapy. Patients referred from pediatric glaucoma to neuro-ophthalmology often have nonglaucomatous disease requiring subspecialty evaluation and neuroimaging. Neuroimaging in this cohort is high yield for uncovering intracranial pathology.

The role of optical coherence tomography angiography in early detection of primary open-angle glaucoma

Introduction Glaucoma is a slowly progressive disease with characteristic optic nerve abnormalities caused by accelerated ganglion cell complex (GCC) loss and concomitant retinal nerve fiber layer (RNFL) thinning. Glaucoma suspects are the key group to identify and treat with intraocular pressure lowering therapy in an effort to prevent blindness. Aim Determination and correlation of the role of the whole image, peripapillary, and inside disk vascular density (%) (wiVD%, ppVD%, and idVD%) in the RNFL of optic nerve head by optical coherence tomography angiography (OCT-A) and their correlation to GCC and RNFL thickness by OCT in early detection of preperimetric primary open-angle glaucoma. Patients and methods This prospective, nonrandomized, noninvasive, and observational case–control study was performed at the Ophthalmology Department and clinics of Al-Zahraa University Hospital, Al-Azhar University. It included 46 eyes of 23 participants who were divided into two groups: group I (control) consisted of 20 eyes of 10 healthy eyes. Group II (glaucoma suspects) consisted of 26 eyes of 13 preperimetric glaucoma suspects of the same age group. The peripapillary and inside disk optic nerve head vessel density were measured. Clinical data, visual field (VF) parameters, and spectral-domain OCT evaluation (RNFL thickness, GCC thickness, and rim area) were recorded. Results Significant decreases were found in whole image, peripapillary, and inside disk vascular density (%) and RNFL thickness especially in the temporal side, GCC, VF mean deviation, and VF index in suspected eyes than the normal eyes indicating the presence of early vascular changes in glaucoma. Conclusion OCT-A is a novel, noninvasive imaging technology that detects vascular changes as early signs in glaucoma disease progression; reduced vessel density also was associated with thinning of RNFL, and decrease in GCC count in a majority of cases. So, the diagnostic ability of OCT-A is a promising tool for early diagnosis of glaucoma.

Optic Disc Drusen and Family History of Glaucoma-Results of a Patient-directed Survey.

Prospective evaluation of family history (FH) of glaucoma and FH of optic disc drusen (ODD) in patients with sonographically confirmed ODD. A total of 87 patients with ODD interviewed all their first-degree and second-degree relatives using a detailed questionnaire on whether an ophthalmologist had diagnosed or excluded glaucoma or ocular hypertension (OH). Using a second questionnaire, 62 of these patients also provided information about ODD in their FH. Control groups for FH of glaucoma consisted of 2170 patients with glaucoma or OH evaluated with the same methods and identical questions for FH of glaucoma in a previous study, and of 176 healthy individuals without glaucoma or ODD who were interviewed on family history of glaucoma. Glaucoma in FH was significantly more frequent in patients with ODD with an incidence of 20.7% compared with healthy controls with an incidence of 2.8%, and half as frequent as in glaucoma patients with an incidence of 40%. ODD in FH were found in 9.7% of patients with ODD. As there is a high frequency of family history of glaucoma in patients with ODD, evaluation of FH of ODD and FH of glaucoma is essential in patients with ODD. Glaucoma in FH of ODD patients requires intraocular pressure monitoring and whenever deemed beneficial timely initiation of intraocular pressure-lowering therapy.

Dislocation of a previously successful XEN glaucoma implant into the anterior chamber: a case report

BackgroundXEN glaucoma implant (XEN gel stent, Aquesys, Inc) is a new minimally invasive device approved for the treatment of glaucoma.Case presentationA 45 year old female was being followed and treated for primary open angle glaucoma in our tertiary referral center. Due to failure of medical treatment in controlling the glaucoma, surgery was offered to the patient. The XEN 45 μ-fistula implant was successfully placed in both eyes and adequate intraocular pressure control was achieved for 4 months. The left eye pressure then increased and the XEN implant was found in the anterior chamber. Topical intraocular pressure lowering therapy had to be re-initiated to achieve adequate pressure control.ConclusionWe describe a new potential complication of the XEN glaucoma implant.

Optic Disc Hemorrhages in Glaucoma

Optic disc hemorrhages are a significant clinical sign seen in patients with glaucoma and often herald glaucomatous progression. Longitudinal and population-based studies have shown that disc hemorrhages are most commonly seen in glaucoma, particularly normal tension glaucoma patients. The exact pathophysiology of an optic disc hemorrhage is not completely understood, but both mechanical rupture and vascular dysregulation theories have been proposed. Recent studies using spectral domain optic coherence tomography and visual field progression analysis have highlighted that structural and functional loss both precede and follow detection of an optic disc hemorrhage. The relationship between intraocular pressure and disc hemorrhages is not completely understood as some patients with disc hemorrhages may progress independent of intraocular pressure lowering therapy.

An observational study of bimatoprost 0.01% in patients on prior intraocular pressure-lowering therapy: the Canadian Lumigan(®) RC Early Analysis Review (CLEAR) trial.

PurposeTo evaluate the ocular hyperemia and intraocular pressure (IOP)-lowering efficacy of bimatoprost 0.01% in subjects with elevated IOP due to primary open-angle glaucoma (POAG) or ocular hypertension (OHT) in a real-world clinical setting.Subjects and methodsThis open-label, 12-week, observational study was conducted at 67 centers in Canada. Subjects with elevated IOP due to POAG or OHT instilled bimatoprost 0.01% as monotherapy once daily. Ocular hyperemia was graded by the investigator at baseline, week 6, and week 12 using a standardized photographic 5-point grading scale. Change in IOP from baseline was also evaluated at these time points. This analysis includes the subgroup of 268 subjects who had been previously treated with latanoprost 0.005%, bimatoprost 0.03%, travoprost 0.004%, and travoprost 0.004% with SofZia™ or nonselective beta-adrenergic receptor blockers prior to the study.ResultsAfter 12 weeks of treatment with 0.01% bimatoprost, ocular hyperemia was graded as none-to-mild hyperemia (grades 0, +0.5, or +1) for 94.1% of subjects and as moderate-to-severe hyperemia (grades +2 or +3) for 5.9%. No statistically significant shifts in ocular hyperemia ratings were observed at week 12 for any of the prior IOP-lowering therapies except bimatoprost 0.03%, in which 20.8% of subjects experienced an improvement. The mean percentage change from baseline IOP at week 12 following the switch to bimatoprost 0.01% monotherapy ranged from −2.3%±17.3% to −26.3%±12.4%. Furthermore, the decreased mean percentage change from baseline IOP was statistically significant across all prior IOP-lowering medications, except for bimatoprost 0.03% at the 6- and 12-week visits and travoprost 0.004% at the 6-week visit.ConclusionThis observational study demonstrates that bimatoprost 0.01% was well tolerated among POAG and OHT subjects who switched from prior IOP-lowering medication. Furthermore, a switch in ocular hypertensive treatment to bimatoprost 0.01% was associated with an additional 10%–15% reduction in IOP.

The Safety and Efficacy of Brinzolamide 1%/Timolol 0.5% Fixed Combination Versus Dorzolamide 2%/Timolol 0.5% in Patients with Open-Angle Glaucoma or Ocular Hypertension

The aim of this study was to compare the intraocular pressure (IOP) lowering efficacy and to determine patient preference based on ocular discomfort with fixed combination brinzolamide/timolol and fixed combination dorzolamide/timolol in patients with open-angle glaucoma or ocular hypertension who required a change in therapy due to elevated IOP while receiving IOP-lowering medication. This was a 3-month, randomized, double-blinded, active-controlled, parallel-group trial. Patients had open-angle glaucoma or ocular hypertension, which could not be controlled with monotherapy and were randomized to twice daily therapy with either brinzolamide 1%/timolol 0.5% or dorzolamide 2%/timolol 0.5%. IOP assessments were taken at 8 AM, 10 AM, and 4 PM at week 2 as well as at months 1, 2, and 3. Patients completed ocular discomfort assessments (based on stinging, burning, feeling of heat or warmth, or sharp pain) on their current IOP lowering therapy at baseline. Of the 114 patients enrolled, 57 received Brinz/Tim and 57 received Dorz/Tim twice daily. Both medications produced statistically relevant IOP reductions, which were similar in both groups at each visit. The IOP reductions with Brinz/Tim ranged from 6.42 to 9.74 mmHg (26.09%-37.46%), whereas Dorz/Tim produced mean IOP reductions ranging from 8.16 to 12.41 mmHg (31.19%-41.44%) (P>0.05). Brinz/Tim showed significantly less ocular irritation (0.5% vs. 15.7%, respectively; P=0.0004) than Dorz/Tim. Both Brinz/Tim and Dorz/Tim showed similar significant and clinically relevant IOP-lowering efficacy, whereas Brinz/Tim provided superior outcomes in terms of ocular comfort.

Sinais e sintomas de doença da superfície ocular em usuários de hipotensores oculares tópicos

To determine the prevalence of signs and symptoms of ocular surface disease (OSD) in patients using topical intraocular pressure-lowering therapy. In this cross-sectional study, 40 patients were consecutively recruited from the glaucoma clinic of a public hospital located in Rio de Janeiro, Brazil. Eligible patients were 18 years of age or older, with primary open-angle glaucoma or ocular hypertension and on the same topical ocular therapy for at least 6 months. The following data were considered: sex, age, medication history and number of years on topical intraocular pressure-lowering therapy. All patients underwent an evaluation of the ocular surface which included: an interview using the Ocular Surface Disease Index® (OSDI®) questionnaire, break-up time, biomicroscopy, fluorescein corneal staining and rose Bengal ocular surface staining. The mean OSDI® score was 24.6 ± 20.7. Most patients (67.5%) had an abnormal score on the OSDI® questionnaire. In 25% of patients, the score was consistent with mild symptoms, 12.5% with moderate symptoms and 30% with severe symptoms. Blepharitis and punctate keratitis were diagnosed in 42.5% and 20% of patients respectively. Tear film instability was observed in 75% of patients and ocular surface staining with rose Bengal in 35%. A positive statistically significant correlation (r=0.4; p=0.01) was found between OSDI® scores and the duration of topical intraocular pressure-lowering therapy. Patients with primary open-angle glaucoma or ocular hypertension on topical intraocular pressure-lowering therapy have high prevalence of OSD. Longer duration since diagnosis is significantly correlated with worsening of OSD symptoms.

Transscleral diode laser cyclophotocoagulation for refractory glaucoma secondary to juvenile idiopathic arthritis: a short term follow-up

To evaluate the success rates of transscleral diode cyclophotocoagulation (TD-CPC) for refractory secondary glaucoma in a paediatric patient with juvenile idiopathic arthritis. Report of a case of a 6-year-old boy suffering from severe uveitis, and secondary open angle glaucoma. The patient had undergone bilateral cataract surgery, two prior trabeculectomies in the left and one in the right eye. He was under systemic immunomodulation with methotrexate and cyclosporine. He presented with medically uncontrolled glaucoma, with an intraocular pressure (IOP) of 36 and 34mmHg in the right and left eye, respectively, under maximal medical antiglaucoma therapy. TD-CPC was performed under general anesthesia, including a total of 20 spots in the right and 34 in the left eye (2,000mW, 2s/spot) applied in one session. Visual acuity remained stable in the right eye and deteriorated in the left eye from 0.1 to no light perception. Postoperative hypotony was present 1month post op and IOP was 14mmHg in the left and 17mmHg in the right eye, respectively, in the 6-month follow-up with a topical beta-blocker. The anterior chamber was quiet in both eyes. TD-CPC was effective in the short term as IOP lowering therapy in a pediatric patient with refractory uveitic glaucoma.

The biology, pathology and therapeutic use of prostaglandins in the eye

Prostaglandins (PGs) are ubiquitous compounds found throughout the body, including the eye. They are involved in a variety of ocular functions, two of which are intraocular pressure (IOP) regulation and mediation of inflammation. Currently, PG analogs are the mainstay of topical IOP lowering therapy for glaucoma. The IOP effects of PGs are mediated by their actions on matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases, thereby facilitating the outflow of aqueous humor from the eye. Clinically used PGs are PGF2a analogs which bind to PGF receptors to influence matrix metalloproteinase transcription through c-Fos and c-Jun. Biological antagonists of endogenous PGs, including steroids and nonsteroidal anti-inflammatory drugs, are commonly used for control of ocular inflammation and management of cystoid macular edema. Recent work has demonstrated that endogenous PGs are implicated in the pathogenesis of diabetic retinopathy, macular degeneration and carcinogenesis.

Outcomes of Birdshot Chorioretinopathy Treated With an Intravitreal Sustained-Release Fluocinolone Acetonide–Containing Device

To evaluate outcomes in birdshot chorioretinopathy following intravitreal implantation of a fluocinolone acetonide-containing drug delivery device. Retrospective, multicenter, interventional case study. University- and community-based tertiary care. Twenty-two HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. Main outcome measures were Snellen acuity, intraocular inflammation, adjunctive therapy, cataract, ocular hypertension, or glaucoma. Paired Wilcoxon statistics were used to analyze visual acuities; paired McNemar statistics were used to analyze presence or absence of other outcomes. Nineteen of 22 patients (32 eyes) completed 12 months of follow-up with improvement in median visual acuity (P=.015). Prior to implantation, 18 of 22 patients (82%) received immunosuppressive therapy versus 1 of 19 (5%) by 12 months (P<.001). Eyes with zero vitreous haze increased from 7 of 27 scored eyes (26%) at baseline to 30 of 30 eyes (100%) by 12 months (P<.001). Cystoid macular edema decreased from 13 of 36 eyes (36%) at baseline to 2 of 32 eyes (6%) at 12 months (P=.006). Five of 24 phakic eyes at baseline exited the study before surgery; all other eyes received cataract surgery. One hundred percent of study eyes had ocular hypertension, required intraocular pressure-lowering therapy, or had glaucoma surgery by 12 months. Implantation of a fluocinolone acetonide-containing intraocular device in birdshot chorioretinopathy can improve vision, control inflammation, and eliminate systemic therapy. There is a high incidence of cataract progression and intraocular hypertension or glaucoma.

First-year treatment costs among new initiators of topical prostaglandin analog identified from November 2007 through April 2008

Objective:Ocular surface disease (OSD) is a common side effect of ophthalmic medications containing the preservative benzalkonium chloride (BAK). Little is known whether and how glaucoma treatment patterns and annual costs vary based on the presence of BAK. The objective of this analysis was to estimate first-year treatment costs among new initiators of topical prostaglandin analogs in a managed care population.Research design and methods:A model was developed to estimate first-year direct medical costs associated with glaucoma prescriptions and outpatient ophthalmic care. Patients were identified from a pharmacy claims database, covering more than 75 million individuals, if they initiated therapy with one of three prostaglandin analog products between November 1, 2007 and April 30, 2008. Patients needed to have at least 6 months of prior claims data in which there were no glaucoma therapy claims and at least 12 months of follow-up data available after the initial claim. Patients were excluded if they were not continuously eligible for pharmacy benefits throughout this 18-month period. Published studies were used to estimate outpatient visit-related health care resource use, and costs for prescription medications and health care resource use were derived from standard, published benchmarks.Results:The database analysis identified 9398 patients meeting study criteria, 45% (n = 4230) of whom remained on their initial prostaglandin therapy for 12 months after initiation. Adjunctive intraocular pressure lowering therapy was needed in 23.6%, 18.5%, and 13.3% of bimatoprost, latanoprost, and BAK-free travoprost patients, respectively. Median numbers of days to the first prescription filled for adjunctive therapy (if required) were 72.5, 74.0, and 125.0 for patients initiating on bimatoprost, latanoprost, and BAK-free travoprost. Total estimated first-year costs were $1973, $1807, and $1739 for patients initiating therapy with bimatoprost, latanoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis.Conclusions:A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year direct treatment costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit projecting findings to all glaucoma patients.

Congenital iris ectropion associated with juvenile glaucoma

Congenital iris ectropion is an uncommon malformation of the anterior segment of the eye. The authors describe a case of bilateral congenital iris ectropion associated with juvenile glaucoma in an otherwise healthy 9-year-old girl. Intra-ocular pressure (IOP) measured by Goldmann applanation tonometry was 40 mmHg in the right eye and 32 mmHg in the left eye. Despite maximum IOP lowering therapy, the desired IOP levels needed to prevent further progression of the glaucoma could not be achieved. Visual field testing and confocal scanning laser tomography showed glaucomatous neuropathy. Trabeculectomy with antimetabolites (mitomycin C 0.2 mg/ml) was performed in both eyes and IOP was normalized without IOP lowering medications during a follow-up of 4 years. The authors point out the importance of recognizing congenital iris ectropion early to prevent blindness in young patients and improve their prognosis.

First-year treatment costs among new initiators of topical prostaglandin analogs

To estimate first-year costs among new initiators of topical prostaglandin analogs in a managed care population. We developed a model to estimate first-year direct medical costs. We derived treatment patterns from a claims database analysis. Published studies were used to estimate visit-related resource use. Costs were obtained from standard sources. The database analysis identified 9,063 patients meeting study criteria, 41% (n = 3,672) of whom remained on their initial prostaglandin therapy for 12 months after initiation. Adjunctive intraocular pressure lowering therapy was needed in 20.7%, 16.5%, 13.9%, and 8.9% of bimatoprost, latanoprost, travoprost, and BAK-free travoprost patients, respectively. Median numbers of days to the first prescription filled for adjunctive therapy (if required) were 69.5, 67.0, 123.0, and 158.5 for patients initiating on bimatoprost, latanoprost, travoprost, and BAK-free travoprost. Total estimated first-year costs were $1,457, $1,360, $1,278, and $1,307 for patients initiating therapy with bimatoprost, latanoprost, travoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis. A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year direct medical costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit projecting findings to all glaucoma patients.