Management Of Primary Open-angle Glaucoma Research Articles

A comparative study of 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma or ocular hypertension

A comparative study of 0.4% ripasudil, 0.02% netarsudil, and 0.5% timolol in combination with 0.005% latanoprost in the medical management of primary open-angle glaucoma or ocular hypertension

Understanding the treatment paradigm and the sequencing of antiglaucoma fixed-dose combinations in a tertiary center in South India.

To analyze the medical management of primary open-angle glaucoma (POAG) and ocular hypertension (OHT) and the placement of fixed-drug combination drugs (FDC) in the treatment paradigm at a tertiary eye care center in South India. Retrospective study (January 2011-December 2015) of newly diagnosed POAG and OHT patients (≥18 years) with ≥5 years follow-up. Primary outcome included percentage use of different antiglaucoma drugs (at initiation) and FDCs at the first, second, and third progression (sequencing). Secondary outcomes: Percentage discontinuation for different FDCs, efficacy parameters (decrease in intraocular pressure (IOP)/visual field), adverse events, and the median number of antiglaucoma medications (AGMs) after 5 years. Three hundred and seventy eyes (198 patients) were analyzed; 84% of them had POAG. Prostaglandin analogs (PGAs) were the most common (66.2%). FDCs were started in 48 eyes (12.9%), with brimonidine + timolol combination being the most common. FDC usage at subsequent modifications was 10.1%, 24.04%, and 30.0%. Beta-blockers and PGAs were the most frequently prescribed AGMs in our practice pattern, with b-blockers being the most consistent one. This study is a fairly large study with a minimum of a 5-year follow-up of patients with POAG and OHT and gives insights into the treatment patterns, use of FDCs, and the need for multiple medications over time.

Surgery for Primary Open Angle Glaucoma (POAG) By Trabeculectomy: Indications and Results in 52 Cases

Introduction: POAG filtering surgery arouses a lot of interest regarding its indications and results in melanoderma subjects south of the Sahara. The aim of this work was to contribute to improving the management of this disease in our socio-economic environment. Material and Methods: Retrospective longitudinal study carried out on the medical records of 47 patients and 52 eyes operated on for primary open-angle glaucoma by trabeculectomy from August 1, 2018, to August 31, 2020 in a private health facility, with postoperative follow-up of at least 1 year, for each case. Results: The patients were aged 10 to 70 years (mean 62.5 +/- 13.81 years), with a male predominance (51.92%). Those who had health coverage were 44 (93.61%). Patients referred by other ophthalmologists for better care were 26 (55.31%). The mean preoperative IOP was 22.67 mm Hg. The surgical indication was the failure of medical treatment marked by visual field degradation associated with uncontrolled IOP in 34 eyes (65.38%) and the patient's desire for 5 eyes (9.61%). And of the 52 operated eyes, 8 (15.39%) were under monotherapy, 30 under dual therapy (57.69%) and 14 (26.92%) under triple therapy. All eyes had undergone trabeculectomy, associated with the use of mitomycin C for the 52 eyes (100%). The postoperative IOP at 1 year of follow-up was between 10- and 15-mm Hg in 98.08% of cases with an average pressure drop of 8.67 mm Hg (38.24%). Conclusion: A common practice of trabeculectomy with a view to refining the indications and mastering both the technique and the management of complications could make it a reliable alternative in the management of POAG in certain patients who are non-compliant or unable to cope the financial cost of medical treatment for life, in our conditions

Crocin supplementation in primary open angle glaucoma: A randomized, triple-blind, placebo-controlled clinical trial

PurposeGlaucoma is the leading cause of irreversible visual loss in the world. The present study was designed to evaluate the beneficial effects of crocin, as a supplement, in the management of primary open-angle glaucoma (POAG). MethodsIn total, 50 POAG patients within the age range of 30–71 years with intraocular pressure (IOP) between 12 and 21 mmHg were entered into the study, and ultimately, 40 patients (49 eyes) finished the clinical trial. The participants were randomly divided into crocin and placebo groups. Patients in the crocin group received a 15 mg crocin tablet per day for four months while others, in the placebo group, received a placebo tablet per day for four months besides the main medications during the study. After four months, all patients underwent a two-month washout period. The IOP level and optical coherence tomography of the retinal nerve fiber layer (RNFL), cup-to-disc ratio (CDR), and the best-corrected visual acuity (BCVA), as the secondary outcomes, were measured at baseline, as well as four and six months later. ResultsThe IOP value decreased significantly in the crocin group after four (P = 0.0001) and six months (P = 0.003). The difference in CDR changes after four and six months was significant between the two groups (P = 0.00009). The crocin and placebo groups did not have a statistically significant difference regarding the changes in BCVA values and RNFL thickness (P = 0.092); however, the optical coherence tomography results showed stable conditions in the retinal nerve fiber layer. ConclusionThis study indicated that administration of crocin, as a potent neuroprotective and antioxidant ingredient of saffron, could be useful as a supplement for the prevention of the POAG progression.

Direct healthcare cost and barriers to the medical management of primary open-angle glaucoma in healthcare facilities in Yaounde – Cameroon

Objectives: The objective of this study was to estimate the direct healthcare cost of glaucoma among patients attending two healthcare services in Yaounde, Cameroon. Materials and Methods: This investigation was a hospital-based, observational, and cross-sectional study of 122 glaucoma patients on follow-up from January to August 2021. The study was carried out using a pre-tested questionnaire and analyzed sociodemographic and clinical characteristics, monthly income, investigations performed, medications prescribed, and direct healthcare costs. Data were analyzed using the Statistical Package for the Social Sciences version 24. Results: A total of 122 glaucoma follow-up patients participated in the study of whom 73 (59.9%) were male (sex ratio M/F = 1.49). Seventy-one (58.19%) participants were above 60 years. The majority (67.4%) had a higher education level. Over 40% of participants reported a monthly income of <228 Euros. Only 38 (31.1%) had health insurance. During the study year, each patient underwent 2.25 ± 0.84 consultations, 2.76 ± 1.40 ocular pressure measurements, 0.73 ± 0.52 visual field examinations, and 0.32 ± 0.2 gonioscopy. Prostaglandin analogs were the most widely prescribed drugs (71%), followed by β-blockers (Carteolol and Timolol) and carbonic anhydrase inhibitors with frequencies of 62% and 15%, respectively. The direct medical cost of the study population was estimated at 468.47 ± 155.34 Euros. The greatest proportion of out-of-pocket expenses (61.13% of medical costs) concerned the purchase of drugs, with an average cost of 284.16 ± 115.25 Euros. Patients treated in the public sector spent an average of 425.78 ± 38.49 Euros, while those treated in the private sector spent 562.22 ± 139.18 Euros during the study year (P = 0.001). However, health coverage and type of glaucoma did not influence the direct cost of treatment. The main obstacles to glaucoma care were insufficient income followed by forgetfulness. Conclusion: The present study shows that almost all participants self-funded their glaucoma management. More than 60% of the direct healthcare cost was devoted to anti-glaucoma drugs and the main barrier to optimal glaucoma care was the lack of financial resources. All stakeholders need involvement, especially health policymakers, to prioritize glaucoma management to make it affordable for patients.

Phacoemulsification versus Phacoemulsification/Trabeculectomy for the Treatment of Primary Open-Angle Glaucoma Coexistent with Cataract: A Comparative Study.

Background: The purpose of this study was to evaluate the clinical outcomes in patients with primary open-angle glaucoma (POAG) and coexistent cataract treated with phacoemulsification cataract surgery, either alone or in combination with trabeculectomy. Methods: Participants in this retrospective study were 52 patients diagnosed with previously controlled POAG and coexistent cataract, who underwent either uneventful phacoemulsification cataract surgery (Group I, n = 27) or combined uneventful phacoemulsification cataract surgery and trabeculectomy (Group II, n = 25), with at least a 24-month postoperative follow-up. We recorded the changes in intraocular pressure (IOP) and in the need of anti-glaucoma medications before and after surgical procedures. Results: There was a statistically significant decrease in IOP at postoperative day 7 in both groups (p < 0.001), which remained until the end of the 24-month follow-up. At month 24, the two groups did not differ significantly in terms of IOP (14.3 ± 1.4 vs. 13.1 ± 1.2 for Group I and Group II, respectively; p = 0.447). In addition, there was a statistically significant decrease in the number of anti-glaucoma medications needed at postoperative day 7 in both groups (p < 0.001 for both groups compared to baseline). At month 24, patients in both groups needed about one additional anti-glaucoma medication to control their IOP. Of note, during the first month after surgery, 20% of patients in Group II needed 0.1 mL 5-FU injections to the bleb, although antimetabolites were not used in the primary surgery. Conclusions: Both surgical interventions, namely phacoemulsification cataract surgery alone and phacoemulsification/trabeculectomy, were found to be effective in the management of POAG with coexistent cataract, presenting a significant decrease in IOP and in the need of anti-glaucoma medications postoperatively at a long-term follow-up period of 24 months.

Comparison of Ab Externo 360-degree Suture Trabeculotomy and Deep Sclerectomy in Management of Primary Open-angle Glaucoma in Adults

Comparison of Ab Externo 360-degree Suture Trabeculotomy and Deep Sclerectomy in Management of Primary Open-angle Glaucoma in Adults

Clinical Practice Management of Primary Open-Angle Glaucoma in the United States: An Analysis of Real-World Evidence.

PurposeTo investigate clinical management of primary open-angle glaucoma (POAG) in the United States using real-world evidence and to examine healthcare resource utilization (HCRU), medication adherence/persistence, and procedure use.DesignA cross-sectional, retrospective analysis of Optum’s de-identified Market Clarity Dataset (July 1, 2013–December 31, 2019).Patients and MethodsPatients ≥18 years with POAG diagnosis and continuous enrollment for 1-year pre- and post-index were eligible and categorized into four mutually exclusive cohorts: CH1, treated with antiglaucoma medication(s) only; CH2, underwent glaucoma procedure(s) only; CH3, treated with antiglaucoma medication(s) and underwent procedure(s); and CH4, received no treatment for POAG. Adherence and persistence with antiglaucoma medications, and disease-specific HCRU were analyzed. Pairwise two-sample comparisons and multivariate regressions were conducted.ResultsExamined 232,572 eligible patients (CH1=60,895; CH2=4330; CH3=6027; CH4=161,320). Prostaglandin analogs were most prescribed antiglaucoma medications (CH1: 69.7%; CH3: 62.7%), of which latanoprost was most common (CH1: 51.3%; CH3: 46.1%). Disease-specific office visits occurred in 26.3%, 78.2%, 75.0%, 23.8%, and surgical services visits occurred in 3.8%, 36.3%, 42.5%, 3.3%, in CH1-CH4, respectively. Adherence was higher (medication possession ratio: 47.1% vs 39.4%; P<0.0001), and more patients remained persistent across 1-year post-index period in CH1 vs CH3 (25.4% vs 16.1%; P<0.0001). Positive predictors of medication persistence included being female, ≥55 years, and history of dyslipidemia or thyroid disease (all P≤0.0003).ConclusionOverall, 70% POAG patients might not have received antiglaucoma treatment. Since POAG is a slowly progressive blinding disease, the lack of antiglaucoma treatment and suboptimal adherence/persistence with medications are of major concerns. Targeted screening and educational approaches are needed to improve POAG management.

Direct Cost of Primary Open Angle Glaucoma Management

Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the management of POAG, to evaluate the annual economic weight of the management of POAG and to determine the factors associated with the annual economic weight of the management. Methods: We conducted a retrospective and descriptive study over a period of 12 months from January 1 to December 31, 2019 based on the records of patients followed for POAG in AFIA Eye Clinic in Lomé-Togo. The annual direct cost was defined by the sum of the costs of consultations, explorations and treatments. We defined the direct cost per patient and per year and related to the average annual income. It was said to be catastrophic at 20% or more of the estimated annual income. Chi 2 and Fisher tested the comparison of proportions. We conducted univariate and multivariate logistic regression to search correlations. Results: During the study period, 150 patient records were included. The average age was 47.24 ± 17.09 years and the sex ratio was 0.82. The cost of the diagnosis was 112.18 ± 22.26 €. The average cost of consultations was 19.46 ± 11.35 € and that of explorations was 92.71 ± 10.91 €. The annual cost of treatment per patient was 165.52 ± 110.16 €. The annual global direct cost of POAG management per patient was 277.69 ± 132.42 €. Compared to the annual income of 1166.29 €, the economic weight of the glaucoma management was 23.8%. This direct cost was catastrophic for 32.1% of patients in the study (44/150 of people with no care). Compared to the guaranteed inter-professional minimum wage (SMIG) of 640.30 €, the economic direct cost weight was 43.3%. Risk factors significantly associated with the direct cost were age over 40 (OR = 1.05 and p = 0.032), liberal profession (OR = 4.72 and p = 0.04), the absence of health insurance (OR = 6.68 and p = 0.017) and the use carbonic anhydrase inhibitors (OR = 7.4 and p = 0.012) and prostaglandin analogues (OR of 38.2 and p < 0.001). Conclusion: This first study on the direct cost of POAG management in Lomé showed that the economic burden glaucoma represents for the patient, his family and society. The data from this study will allow health decision-makers to adopt strategies to mitigate the effects of glaucoma on the economy.

Management of primary open-angle glaucoma through Ayurveda – An observation

Primary Open-Angle Glaucoma (POAG) is characterized by the normal appearance of the anterior-chamber angle and raised intraocular pressure (IOP) with no underlying disease or cause. Majority of cases are asymptomatic. Blurred vision and constricted visual fields appear in later stages of the condition. Due to the irreversible nature of visual loss, early detection and diagnosis are paramount. Ayurvedic management of a case of already-diagnosed POAG is presented in this report. A 55-year-old male presented with complaints of bilateral diminished distant vision associated with headache since January 2015. Examination of the anterior chamber in both eyes was normal, IOP was increased, visual fields were markedly constricted, and optic discs showed increased cup-to-disc ratio and bayonetting of blood vessels. The patient underwent two courses of inpatient management comprising Virechana (~therapeutic purgation), Marsha nasya (~high-dose medication through nasal route), Pratimarsha nasya (~low-dose medication through nasal route), and Shamana aushadhi (~palliative medicines including Vainateya ghrita, Dhanadarasnadi kwatha, Akshabijadi kwatha, and Bharngyadi kwatha). Sthanika chikitsa (~local treatments) including Netra kriyakalpa (~ocular therapeutic procedures) such as Seka (~ocular therapy by streaming), Aschyotana (~eye drops), Anjana (~collyrium), Netra tarpana (~therapeutic retention of medicated liquids over the eyes), and Bandhana karma (~bandaging) and therapies for the head such as Tala (~paste over the bregma), Talapoticchil (~paste on a plantain leaf over the head), and Shirodhara (~pouring medicated oil over the scalp) were also done. IOP was lowered and some expansion of the visual field was noted posttreatment. Ayurvedic management of POAG was observed to be useful in limiting the further progression of neuronal damage and maintaining the condition.

Primary open angle glaucoma management in a tertiary eye care center in Saudi Arabia: a best practice implementation pilot project.

Primary open angle glaucoma (POAG) is a leading cause of permanent visual loss affecting significant numbers in Saudi Arabia. There is no cure for glaucoma but there is mounting evidence to guide ophthalmologists in diagnosing and managing this disease. The aim of this pilot project was to assess the compliance with evidence-based criteria and to implement an adapted clinical practice guideline (CPG) for the management of patients with POAG at a tertiary eye care center in Riyadh, Saudi Arabia that will lead to improving quality, consistency and optimizing patients' care. The project consisted of three phases using audit and feedback strategy. It has utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. Eleven evidence-based audit criteria were developed. A baseline audit was then conducted. Barriers behind areas of noncompliance were identified and a number of strategies were implemented to overcome them. A follow-up postimplementation audit was then conducted. Twenty electronic medical files were randomly selected for baseline audit. The results of the audit have identified a number of possible areas to improve in the diagnosis and management of POAG in compliance with the adapted CPG with compliance rate as low as 20% (4/20) in some criteria. Multifaceted interventions were implemented targeting mainly attitude and lack of knowledge and time and resource barriers. Significant improvement occurred in most criteria audited postimplementation. The project demonstrates that audit and feedback is a feasible and effective tool to change glaucoma practice in a teaching hospital in Saudi Arabia. The success was due to multifaceted interventions including clear communication to promote awareness, an easily accessible CPG, and regular reminders to improve knowledge and change behavior. We propose our pilot implementation to be generalized to promote implementing evidence-based ophthalmology.

Elevated dimethylarginine, ATP, cytokines, metabolic remodeling involving tryptophan metabolism and potential microglial inflammation characterize primary open angle glaucoma

Glaucoma of which primary open angle glaucoma (POAG) constitutes 75%, is the second leading cause of blindness. Elevated intra ocular pressure and Nitric oxide synthase (NOS) dysfunction are hallmarks of POAG. We analyzed clinical data, cytokine profile, ATP level, metabolomics and GEO datasets to identify features unique to POAG. N9 microglial cells are used to gain mechanistic insights. Our POAG cohort showed elevated ATP in aqueous humor and cytokines in plasma. Metabolomic analysis showed changes in 21 metabolites including Dimethylarginine (DMAG) and activation of tryptophan metabolism in POAG. Analysis of GEO data sets and previously published proteomic data sets bins genes into signaling and metabolic pathways. Pathways from reanalyzed metabolomic data from literature significantly overlapped with those from our POAG data. DMAG modulated purinergic signaling, ATP secretion and cytokine expression were inhibited by N-Ethylmaleimide, NO donors, BAPTA and purinergic receptor inhibitors. ATP induced elevated intracellular calcium level and cytokines expression were inhibited by BAPTA. Metabolomics of cell culture supernatant from ATP treated sets showed metabolic deregulation and activation of tryptophan metabolism. DMAG and ATP induced IDO1/2 and TDO2 were inhibited by N-Ethylmaleimide, sodium nitroprusside and BAPTA. Our data obtained from clinical samples and cell culture studies reveal a strong association of elevated DMAG, ATP, cytokines and activation of tryptophan metabolism with POAG. DMAG mediated ATP signaling, inflammation and metabolic remodeling in microglia might have implications in management of POAG.

XEN Gel Stent in the management of primary open-angle glaucoma

PurposeTo assess the efficacy and safety of the XEN Gel Stent in patients with primary open-angle glaucoma.Materials and methodsTwenty eyes of 17 patients (6 males, 11 females) with primary open-angle glaucoma were implanted with XEN Gel Stent. The following data were ascertained in each participant at baseline and at 1, 3, 6, 9 and 12 months following implanting procedure: intraocular pressure, number of anti-glaucoma medications, retinal sensitivity (PS 24/2 w/w), pattern electroretinogram (ISCEV standard), as well as the number of complications.ResultsThe mean intraocular pressure reduction in a 1-year follow-up was 18% (21.56 vs. 17.69 mmHg, p < 0.001). The mean number of anti-glaucoma medications was reduced from 3.2 to 1.6 (p = 0.001). The PERG parameters at baseline and at 12 months postoperatively included a stable amplitude of P50 (2.55 µV vs. 2.65 µV, p = 0.024) and N95 (3.45 µV vs. 3.38 µV, p = ns) waves. The delta N95 and delta P50 amplitudes remained stable over the follow-up period (p = ns). The mean deviation (MD) of PS 24/2 was − 6.54 dB vs. − 8.43 dB, p = ns, whereas the pattern standard deviation (PSD) was 6.18 dB vs. 6.91 dB, p = ns. Transient hypotony within the first postoperative week occurred in 18 eyes (90%), whereas hyphema occurred in two eyes (10%). Needle revision of a filtration bleb was performed in five eyes (25%).ConclusionsThe XEN Gel Stent enables significant reduction in intraocular pressure with very low complication rates. It ensures a stabilization of the retinal function as established with the PERG.

A comparative study on the efficacy and cost-effectiveness of latanoprost and timolol in glaucoma

Background: Glaucoma is a chronic, progressive optic neuropathy which leads to optic nerve damage and loss of visual function. Elevated intraocular pressure (IOP) is the most important and only modifiable risk factor. Ocular hypotensive agents have the potential to lower the IOP and preserve vision. Aims and Objectives: The aims of the study were to compare topical latanoprost eye drop and topical timolol eye drop as appropriate and cost-effective management of primary open-angle glaucoma (POAG). Materials and Methods: A total of 70 newly diagnosed patients POAG who fulfilled the inclusion/exclusion criteria were enrolled and randomized into two groups. The first group L-Group was prescribed topical latanoprost 0.005% eye drop once daily, whereas the second group T-Group was prescribed topical timolol 0.5% eye drop twice a day. Final reduction in IOP was recorded after 3 months of treatment in both the groups. The cost-effectiveness was calculated as the cost of the drug per mmHg fall in IOP. Results: In our study, the IOP lowering efficacy of latanoprost was found to be superior to timolol. In the latanoprost group, the mean reduction in IOP from baseline to final visit was 10.13 mmHg, whereas only 5.84 mmHg in the timolol group. The average cost-effective ratio was found to be Rs. 32.4/ mmHg and Rs. 6.16/mmHg for latanoprost and timolol, respectively. Hence, timolol proved to be more cost effective as compare to latanoprost. Conclusion: Although latanoprost was found to be superior to timolol in reducing the IOP, yet because of its high cost the treatment should be started with timolol and latanoprost should only be used as an add-on therapy in cases not able to achieve target IOP by timolol monotherapy or in whom timolol is contraindicated.

Antiglaucoma medication utilization and therapeutic outcome among Nigerian older persons with primary open angle glaucoma

Background: Primary open angle glaucoma (POAG) is associated with older age. Antiglaucoma medications (AGM) are the cornerstones in the management of POAG. However, the relationship between AGM utilization, patients’ medication adherence (MA) and the therapeutic outcome remains largely unexplored among older persons.&#x0D; Objective: This study aimed to evaluate AGM utilization patterns, patients’ MA and intraocular pressure (IOP) reduction among older persons.&#x0D; Methods: This study was a 5-year retrospective review of medical records of consecutively selected older persons diagnosed of POAG at a University teaching hospital, in southwest Nigeria. Older persons were included if (1) aged 65 years and above, (2) had attended the outpatient ophthalmic clinics of the hospital between January 2010 and December 2015 (3) had at least 1-year clinic attendance during the period. The relationship between AGM utilization, patients’ self-reported MA and physicians’ comments on IOP was evaluated. A bivariate analysis was carried out to determine associations between variables and MA. Factors associated with IOP reduction were determined using a logistic regression. p&lt;0.05 was considered statistically significant.&#x0D; Results: The carbonic anhydrase inhibitors comprised (66/191; 34.6%) of the total 191 AGM prescriptions. Majority of the participants (36/60; 60.0%) had reduced IOP with AGM alone, of which (13/36;36.1%) were on triple AGM. The participants’ MA (p=0.01) and number of AGM (p=0.04) were significantly associated with IOP reduction among the participants in a logistic regression.&#x0D; Conclusion: The number of AGM prescribed and the patients’ medication adherence can influence IOP reduction among older persons with POAG.&#x0D; Bangladesh Journal of Medical Science Vol.19(1) 2020 p.141-147

Primary Open Angle Glaucoma: The Pathophysiolgy, Mechanisms, Future Diagnostic and Therapeutic Directions

Primary open angle glaucoma (POAG) is a multifactorial chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells (RGC), leading to structural damage to the optic nerve head (ONH), retinal nerve fiber layer (RNFL), with visual field defects. It is occasioned by major risk factors of high intraocular pressure (IOP) and age. The pathogenesis of POAG is the imbalance between the production and drainage of the aqueous humour (AH). The resultant fluid back-up increases the IOP with consequent optic nerve damage, causing POAG. Modern diagnosis, using scanning laser polarimetry (SLP), confocal scanning laser ophthalmoscopy (CSLO), optical coherence tomography (OCT) etc, plays a vital role in the assessment of the ONH, RNFL and the macular, in POAG. OCT operates on the principles of interferometery, utilizing light beams and their pattern of back-scattering, to build high resolution cross-sectional images of ocular tissues. It gives an objective evaluation of structural alterations in the ONH or macular area of the retina in vivo. POAG is managed medically using classes of drugs like α-adrenergic agonists, beta-adrenergic receptor antagonist, prostaglandin agonists, carbonic anhydrase inhibitors, ccholinergic agonists etc. Surgical intervention is indicated with laser or incisional surgeries, when medical option fails. Future pharmacotherapeutic directions in POAG management consider transgenic model, genetic model, neuroregeneration (stem cell technique), neurodegeneration (Seeing glaucoma as a neurologic disorder much like in Parkinson's and Alzheimer's diseases and the mechanisms that cause the degeneration of RGCs), autoimmune response and T-cell autoimmune response attack.

A COMPARATIVE STUDY OF TOPICAL BETAXALOL AND TIMOLOL FOR THEIR EFFICACY AND SIDE EFFECTS

Purpose: Primary open angle glaucoma (POAG) is one such field in Ophthalmology where ophthalmologists have failed to stop blindness due to it. All the available treatment modalities are directed towards the reduction of intraocular pressure (IOP) but without interfering the basic aetiopathogenesis. In this study we propose to study efficacy, potency and adverse effects of topical Timolol and Betaxalol in primary open angle glaucoma. Methodology: A comparative study of topical Betaxalol 0.5% and Timolol 0.5% in the management of POAG was conducted at Tertiary care hospital. Fifty patients of newly diagnosed POAG of different age, sex, religion from both urban and rural population attending eye OPD were included in this study. 25 patients were treated with topical Timolol maleate 0.5% ophthalmic solution BD and 25 patients were treated with topical 0.5% Betaxalol hydrochloride phthalmic solution BD. At 20 weeks follow up IOP levels n both the groups measured by applanation tonometer were compare to each other. Results: In this study a total of 50 patients with POAG were studied. 25 patients were treated with Timolol maleate 0.5% ophthalmic solution and 25 patients were treated with 0.5% Betaxalol hydrochloride ophthalmic solution. Out of 50 patients, 29 (58%) were male and 21(42%) were female patients. POAG was most common in the age group of 51-60 years with average age 51.50 (S.D. 9.8) years. Average age in males was 54.50 years, while in female it was 49.31 years. Conclusion: both Timolol and Betaxalol are effective in decreasing IOP in POAG patients. The magnitude of Timolol in decreasing IOP is more as compared to Betaxalol. The selective beta 1 adrenergic inhibition of Betaxalol provides an added benefit for those patients in whom beta 2 blockade could be harmful.

Prescribing pattern and adverse events of drugs used in patients with primary open-angle glaucoma (POAG) attending a tertiary care hospital: Retrospective study

Background: Primary open-angle glaucoma (POAG) is the most prevalent type of glaucoma leading to progressive loss of visual function in adults. Aims and Objectives: This study was conducted to determine the prescribing pattern and to assess the associated adverse reactions of drugs used in the treatment of POAG in a tertiary care teaching hospital. Materials and Methods: This was a retrospective, case-record-based study conducted on patients attending the department of ophthalmology for treatment of POAG at Srinivas Hospital, Mukka, from October 2014 to December 2015. The study was initiated after obtaining approval from the Institutional Ethics Committee. Data were analyzed using statistical package for social sciences version 17 and presented as percentages and frequency. Results: Out of 74 prescriptions analyzed, 48 (64.86%) patients were treated with monotherapy and 26 patients with combination therapy of drugs. The majority of patients were on timolol as monotherapy with prescription rate of 29.16% followed by bimatoprost 20.83%. Combination therapy was prescribed to 35.14% of the patients; the commonly used regimen was timolol + brimonidine (30.76% patients). 16 patients reported adverse effects such as blurred vision, ocular irritation, and foreign body sensation; however, the most of the patients tolerated the prescribed drugs well. Conclusion: The present study results help to know the different treatment strategies employed in the management of POAG, and reasons for the preference of prescribed drugs. Most of the patients tolerated the antiglaucoma medications well and had a few side effects which did not warrant discontinuation of treatment.

A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open angle glaucoma

Background: The purpose of this study was to compare and evaluate the clinical efficacy of topically applied travoprost 0.004% eye drops versus brimonidine/timolol fixed combination eye drops in the management of primary open-angle glaucoma. Methods: In this prospective, randomized study, 65 patients received either travoprost eye drops once daily in the morning (n=33) or brimonidine/timolol fixed combination eye drops twice daily (n=32). Intra ocular pressure (IOP) was assessed at 2, 4, 8, and 12 weeks. The primary outcome measure was mean reduction in IOP. Results: Thebaseline mean IOP values were similar between two groups. Mean reduction of IOP in the right eye for brimonidine/timolol fixed combination group was 9±2.9 mmHg, whereas in the left eye it was 10.9±2.8 mmHg. In the travoprost group, the reduction in IOP of the right eye was 7.8±2.9 mmHg (p=0.0002) and 7.5±3.4 mmHg (p=0.0001) in the left eye. The mean reduction of IOP for the brimonidine/timolol group was 9.95 mmHg and for the travoprost group it was 7.6 mmHg (p<0.0001) in both the eyes. Conclusions: The fixed combination brimonidine/timolol twice daily demonstrated superior mean IOP lowering efficacy compared to travoprost 0.004% in patients with open-angle glaucoma.

The impact of postgraduate training on UK optometrists' clinical decision-making in glaucoma.

To investigate the impact of a postgraduate training module on optometrists' clinical decision-making in relation to the diagnosis and management of primary open-angle glaucoma. A group of United Kingdom community optometrists (n=53) were assessed immediately before and again 3months after completing a 3-day didactic postgraduate university module on the diagnosis and management of glaucoma. A smaller control cohort (n=20), who did not receive the intervention, was recruited and completed the same assessments on two occasions, separated by approximately 3months. The assessments comprised: knowledge of five key features of the optic disc in glaucoma, performance on a computer program (Discus) that assessed the ability to differentiate normal from glaucomatous discs and a clinical decision-making exercise using case-based scenarios. The scores for the knowledge of important disc features for the intervention cohort significantly increased from a median of 2/5 to 5/5 post-intervention (p<0.001). For the control cohort, the difference in median scores between the two tests was not significant. Analysing the performance of the intervention cohort using the Discus program showed no significant improvement in ability to diagnose a glaucomatous disc following the intervention [mean area under the receiver operating characteristic curve pre-intervention=0.85 (95% CI: 0.76-0.91), post-intervention=0.84 (95% CI: 0.76-0.91)]. Similarly, there were no statistically significant differences in mean areas under the receiver operating characteristic curve between tests for the control cohort, although both cohorts compared favourably with a previously published Discus data set from a panel of experts in disc analysis (mean area=0.87). For the clinical decision-making exercise the median test score for the intervention cohort was unchanged pre- and post-intervention. The results of the present study suggest that a traditional didactic approach, in isolation, is unlikely to be suited to training optometrists to achieve or develop the clinical competencies required for glaucoma detection and management. Consideration should be given to the development of specialist postgraduate training that is more practice-based, provides opportunities for active learning and includes strategies for feedback and reinforcement.