Ophthalmologists In Germany Research Articles

Endogenous Candida endophthalmitis: diagnostics and treatment options based on case studies

Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as awhole organ but also the life of the patient due to its systemic cause. Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. 8patients with 14eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent apars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1patient received parabulbar administration of atriamcinolone depot in both eyes, 7patients received adexamethasone depot in 11eyes and all 8patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2logMar to 1.0logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2patients died from one of the underlying diseases after 3 and 25months, respectively. Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.

National survey of user-reported usability of electronic medical record software in ophthalmology in Germany.

A nationwide, comparative survey of the physician-reported usability of electronic medical record (EMR) software used by ophthalmologists in Germany using the System Usability Scale (SUS) as a standardized metric. A cross-sectional survey of members of the German Ophthalmological Society (DOG) and professional association of ophthalmologists (BVA) was conducted in May 2022. All 7788 physician members of both societies were invited to participate in an anonymous online-survey by individualized links. User-reported usability of the participants main software used for electronic medical recordkeeping was assessed using the SUS (range 0-100). A total of 881 participants with 51 different EMRs completed the entire questionnaire. Mean EMR-SUS score was 65.7 (SD ± 23.5). Significant differences in mean SUS of several EMR programs were observed with a range of 31.5 to 87.2 in programs with 10 or more responses. 31.8% of all main program SUS ratings were below 50 points. Female gender was associated with 4.02 higher SUS score (95% CI 0.46-7.59). Main program SUS was positively correlated with overall work-related satisfaction and work environment SUS but negatively correlated with the number of programs in the work environment. The SUS of the entire digital work environment including all programs used daily was closely correlated with the main EMR SUS, but not the number of programs used. Our survey revealed a fragmented pattern of EMR use by ophthalmologists in Germany with many competing software products and widely diverging mean System Usability Scale scores. A considerable share of ophthalmologists report EMR usability below what is commonly considered acceptable.

Glaucoma care in Germany-results of asurvey among German ophthalmologists-part2: treatment

The options for glaucoma treatment are quite diverse. The question therefore arises what is considered beneficial and feasible in daily practice. Our anonymized survey among members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists in Germany (BVA) intends to explore treatment patterns and strategies in routine glaucoma care in Germany. The current article reflects current opinions of German ophthalmologists regarding glaucoma care, therapeutic strategies, and the role of glaucoma surgery. The survey was conducted using an online questionnaire with 26 questions (107 items) regarding care practice for glaucoma diagnosis and treatment. Complete responses were available from 1361 participants. Atotal of 84.8% of responders define a target pressure regularly. Asystemic therapeutic approach is followed by 44.9%. Two thirds consider side effects of eye drops to impair quality of life. Most common are conjunctival hyperemia and burning. Non-adherence to treatment is estimated to occur in 32% of patients. Approximately 5-10% of glaucoma patients are treated surgically. Among interventional treatment options, 90% consider trabeculectomy beneficial, followed by minimally invasive glaucoma surgery (MIGS) and selective laser trabeculoplasty (SLT), which are, however, the most commonly performed procedures. The choice of treatment should intend along-lasting reduction of intraocular pressure and yet to be reasonable and manageable. There is ademand for more overview and structured care.

National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Infant", Society for Neonatology

National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Infant", Society for Neonatology

Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy : Status 18October 2021.

Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy : Status 18October 2021.

Statement of the legal commission of the Professional Association of Ophthalmologists in Germany (BVA) and the German Ophthalmological Society (DOG) on ophthalmological assessment in severe disability law and in cases of blindness : Status June 2021

Statement of the legal commission of the Professional Association of Ophthalmologists in Germany (BVA) and the German Ophthalmological Society (DOG) on ophthalmological assessment in severe disability law and in cases of blindness : Status June 2021

Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Dated October 2020.

Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Dated October 2020.

Assessment of subjective risk of infection and willingness to vaccinate against SARS-CoV-2 among German ophthalmologists : Results of a survey by DOG and BVA

Hintergrund und ZieleNach Zulassung erster COVID-19-Impfstoffe in Deutschland sind „Impfpriorisierung“ und „Impfbereitschaft“ zentrale Themen in der Diskussion über Strategien zur Beendigung der Pandemie. Wie Augenärztinnen und Augenärzte das Infektionsrisiko in Augenkliniken und -praxen subjektiv bewerten und wie groß die Impfbereitschaft in dieser Berufsgruppe ist, wurde bisher nicht untersucht. Ziel dieses Projekts war die Erfassung der subjektiven Bewertung des Infektionsrisikos und der Impfbereitschaft der Augenärzte in Deutschland.MethodenDie Daten wurden im Rahmen einer kurzen, anonymen Online-Umfrage des Berufsverbands der Augenärzte Deutschlands (BVA) und der Deutschen Ophthalmologischen Gesellschaft (DOG) unter Federführung der Universitätsaugenklinik Düsseldorf erhoben. Der Fragebogen war im Zeitraum vom 22.01. bis 12.02.2021 zur Teilnahme freigeschaltet. Die Umfrage richtete sich an alle augenärztlichen Kolleginnen und Kollegen.ErgebnisseInsgesamt wurden 1162 vollständige Antwortbögen ausgewertet. Das berufsbedingte Infektionsrisiko bewerten die Befragten durchschnittlich mit 7,5 ± 1,9 (Skala von 1 bis 10; 1 = sehr geringes Risiko, 10 = sehr hohes Risiko); 971 Umfrageteilnehmer (83,6 %) schätzen das Infektionsrisiko im Vergleich zu anderen ärztlichen Fachrichtungen als höher ein; 92,9 % (n = 1079) der Umfrageteilnehmer geben an, sich impfen lassen zu wollen.SchlussfolgerungDie befragten Augenärzte sehen ihre Berufsgruppe einem auch im Vergleich zu anderen Fachrichtungen überdurchschnittlich hohen SARS-CoV-2-Infektionsrisiko ausgesetzt. Dabei kritisieren sie häufig die Priorisierung des Bundesministeriums für Gesundheit (BMG), die von der Priorisierung der Ständigen Impfkommission (STIKO) abweicht. Die Impfbereitschaft ist unter den befragten deutschen Augenärzten sehr hoch.

Glaucoma care in Germany-Results of asurvey among German ophthalmologists-Part1: diagnostics

HintergrundDie Möglichkeiten in der Glaukomversorgung sind in den letzten Jahren immer vielfältiger geworden. Unter den Mitgliedern der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbands der Augenärzte Deutschlands (BVA) wurde eine anonymisierte Befragung durchgeführt, um zu erfassen, welche Behandlungswege in der Versorgung von Glaukompatienten gewählt werden, welche diagnostischen Parameter den Augenärztinnen und Augenärzten wichtig sind und welche Rolle Behandlungsleitlinien in der Alltagspraxis zukommt.Ziel der ArbeitMeinungsbild unter der deutschen Augenärzteschaft über die aktuelle Glaukomversorgung, zentrale diagnostische Parameter und ihre Anwendung in der Alltagspraxis.Material und MethodenDie Befragung wurde durch einen Online-Fragebogen mit insgesamt 26 Fragen (107 Items) zur Versorgungspraxis in der Glaukomdiagnostik und der Glaukomtherapie durchgeführt. Vollständig ausgefüllte Fragebögen lagen von 1361 Personen vor.ErgebnisseDie Papillenbeurteilung an der Spaltlampe hat für Augenärzte weiterhin den höchsten diagnostischen Stellenwert. Auch der Rolle der optischen Kohärenztomographie (OCT) kommt eine sehr hohe diagnostische Bewertung zu. Bei der Interpretation verschiedener diagnostischer Parameter ergibt sich eine höhere Sicherheit für papillennahe Parameter unter den Befragten. Eine leitliniengemäße Versorgung wird nach Selbstauskunft der Augenärzte weitgehend betrieben. Etwa zwei Drittel der Befragten führen im ersten Behandlungsjahr zwei oder mehr Gesichtsfelduntersuchungen durch und ebenso eine strukturelle Papillendarstellung einmal im Jahr. Die Rolle der Gonioskopie wird kontrovers gesehen und nicht einheitlich intensiv praktiziert.DiskussionDie Diagnosestellung beim Glaukom ist eine große klinische Herausforderung. Die verschiedenen diagnostischen Parameter haben einen unterschiedlich hohen Wert für Augenärzte. Morphometrische Verfahren haben eine sehr hohe Bedeutung gewonnen und ermöglichen eine assistierte, jedoch keine automatisierte Diagnostik. Mehr Behandlungsleitlinien und Standards bei der Glaukomversorgung werden gewünscht und sollten in Aus- und Weiterbildung und in den Behandlungsalltag implementiert sein.

Guidelines for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), Retinological Society (RG), Professional Association of Ophthalmologists in Germany e. V. (BVA), German Society of Paediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Child" , Society for

Guidelines for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020) : Joint recommendation of the German Ophthalmological Society (DOG), Retinological Society (RG), Professional Association of Ophthalmologists in Germany e. V. (BVA), German Society of Paediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association "The Premature Child" , Society for

Statement of the German Ophthalmological Society, the German Retina Society, and the Professional Association of Ophthalmologists in Germany on treatment of diabetic macular edema

Statement of the German Ophthalmological Society, the German Retina Society, and the Professional Association of Ophthalmologists in Germany on treatment of diabetic macular edema

Analysis of the importance of e-learning in ophthalmology and evaluation of an e-learning app

HintergrundZiel der Studie war die Analyse des Stellenwertes von „eLearning“ im Lern- und Fortbildungsverhalten von Augenärzten in Deutschland sowie die Bewertung der Akzeptanz einer neuen „eLearning“-Anwendersoftware (App).Material und MethodenOphthalmologische Weiterbildungsassistenten und Fachärzte wurden im Rahmen von Fortbildungsveranstaltungen mittels eines Fragebogens nach ihren Fortbildungsaktivitäten befragt. Des Weiteren erfolgte nach Vorstellung und Anwendung einer „eLearning-App“ eine strukturierte Bewertung.ErgebnisseEs nahmen 149 Augenärzte an der Befragung teil. Während der überwiegende Teil der Kollegen (74,3 %) analoge Fachzeitschriften wöchentlich oder monatlich zur Weiterbildung nutzt, verwenden 45,9 % der Augenärzte digitale Printmedien (Bücher, Zeitschriften, Artikel) sowie 46,5 % Fachbücher in gedruckter Form. Lediglich 35 % der Befragten bilden sich über Online-Fortbildungsplattformen, z. B. digitale Kurse (CME-Kurse) oder Portale zum Abrufen aufgezeichneter Vorträge, fort. Die Nutzung der angebotenen „eLearning-App“ ging insgesamt mit einer positiven Akzeptanz einher; 91,7 % der befragten Kollegen würden diese Form der interaktiven Lernvermittlung weiterempfehlen.DiskussionTrotz fortschreitender Digitalisierung in allen Lebensbereichen nimmt „eLearning“ als Lernmedium in der ophthalmologischen Fort- und Weiterbildung weiterhin einen geringen Stellenwert ein. Interessanterweise ergab die Bewertung der App-Nutzer eine hohe Benutzerakzeptanz, unabhängig von Alter oder Arbeitsbereich.

How to Implement Adherence-Promoting Programs in Clinical Practice? A Discrete Choice Experiment on Physicians' Preferences.

IntroductionThe aim of this study was to examine physicians’ preferences regarding adherence-promoting programs (APPs), and to investigate which APP characteristics influence the willingness of physicians to implement these in daily practice.Materials and MethodsA discrete choice experiment was conducted among general practitioners, cardiologists, neurologists and ophthalmologists in Germany. The design considered five attributes with two or three attribute levels each: validation status of the APP; possibility for physicians to receive a certificate; type of intervention; time commitment per patient and quarter of the year to carry out the APP; reimbursement for APP participation, per included patient and quarter of the year.A multinomial logit model was run to estimate physicians’ utility for each attribute and to evaluate the influence of different levels on the probability of choosing a specific APP. The relative importance of the attributes was compared between different pre-defined subgroups.ResultsIn total, 222 physicians were included in the analysis. The most important characteristics of APPs were time commitment to carry out the program (34.8% importance), reimbursement (33.3%), and validation status of the program (23.7%). The remaining attributes (type of intervention: 3.6%; possibility to receive a certificate: 4.7%) were proven to be less important for a physician’s decision to participate in an APP. Physicians on average preferred APP alternatives characterized by little time commitment (β=1.456, p<0.001), high reimbursement for work (β=1.392, p<0.001), “positive validation status” (β=0.990, p<0.001), the “possibility to get a certificate” (β=0.197, p<0.001), and the provision of “tools for both physicians and patients” (β=0.150, p<0.001).ConclusionFor the majority of the physicians participating in this survey, the willingness to implement an APP is determined by the associated time commitment and reimbursement. Considering physicians' preferences regarding different APP features in the promoting process of these programs may enhance physicians' participation and engagement.

Peri-/Postoperative antientzündliche Therapie im Rahmen von vitreoretinalen Eingriffen

The perioperative treatment of retinal surgery with anti-inflammatory drugs is an everyday procedure for ophthalmologists in Germany. Nevertheless, little data are available to investigate the efficacy of vitreoretinal surgery. Treatment is usually analogous to procedures on the anterior segment of the eye, for which much more robust data are available. In this article, the relevant clinical questions will be answered and, when possible, documented with study data.

Anti-VEGF therapy for neovascular age-related macular degeneration -therapeutic strategies: statement of the German Ophthalmological Society, the German Retina Society and the Professional Association of Ophthalmologists in Germany - November 2014

Anti-VEGF therapy for neovascular age-related macular degeneration -therapeutic strategies: statement of the German Ophthalmological Society, the German Retina Society and the Professional Association of Ophthalmologists in Germany - November 2014

The relevance of individual health services in German ophthalmology

Individual health services (ihs) have gained importance in the German health-care system. This article describes the economic impact and the daily practice of individual health services from the perspective of ophthalmologists. An online survey to examine the role of individual health services in ophthalmology was sent to the members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists in Germany (BVA). 1,361 ophthalmologists (one fifth of all ophthalmologists in Germany) responded to the poll. 87.5 % of the ophthalmologists agree that the quality of ophthalmic care could suffer if the necessary individual health services were not performed. 78.9 % consider individual health services to be financially feasible for the patient. 65.6 % responded to be hardly able to survive economically without individual health services. For approximately half of the ophthalmologists, individual health services represent more than 10 % of their overall income. 57.5 % wish to abolish individual health services and to extend the service catalogue of the statutory health insurances. In contrast to official reports about the benefit from individual health services, the ophthalmologists do see a medical need for individual health services. Obviously there is a discrepancy in the perspective between health insurers and ophthalmologists.

Aktuelle Inzidenz des Trockenen Auges in Deutschland

Dry eye is one of the most common eye surface disorders. Patients suffer in particular from annoying subjective symptoms that compromise quality of life. The aim of the study was to find out when patients consult ophthalmologists in Germany and what symptoms they present. 170 patients treated at ophthalmological practices in Bavaria, Saxony and Saxony-Anhalt with dry eye were surveyed regarding their symptoms. The majority of those questioned were 40 years of age or older (88 %) (average: 60), female (59 %) and described a variety of subjective symptoms (65 %). More than five different concurrent symptoms were named. There is a recognisable increase in cases - by more than 3.5 times - at the age of forty (in women) and fifty (in men). We hope to contribute with the data obtained to a more complete understanding of this highly complex pathological process. A further aim is to facilitate recognition of this mostly chronic condition in its early stages when the symptoms are still poorly defined. The data on the German population obtained here should become part of a comparative analysis within the international context. Despite considerable scientific effort, dry eye remains a difficult challenge for both patients and attending physicians.

Ergebnisse einer Expertenbefragung zum Einsatz der VEGF-Inhibitoren in der Augenheilkunde

VEGF inhibition is an important treatment option for patients with eye diseases like wet AMD or diabetic eye diseases. Concerning VEGF inhibition in Germany's ophthalmology there is lack of health-care data. A standardised telephone survey addressing treating ophthalmologists in Germany was used to acquire information in terms of VEGF inhibitors in ophthalmology. 44.9% considered ranibizumab (Lucentis®) and bevacizumab (Avastin®) as equal regarding efficacy and safety. Even so ranibizumab captured with 69.8% regarding patients under treatment the greatest market share. 26.1% estimated that less than 10% of patients with diabetic eye diseases are under treatment while 23.4% assumed that at present all treatable patients are under treatment. The integration of IVI into the EBM is recommended by only 9.4%. Using the content of one vial for the treatment of more than one patient is challenged by 66.4% of all participating ophthalmologists. 50.7% of these would accept the splitting procedure on condition that proof of drug quality in terms of efficacy and safety is given. The dominance of ranibizumab is based upon a forensic discussion about off-label use of drugs and liability of the treating physicians. In this connection it should not be forgotten that at the end of 2009 the approval of pegaptanib (Macugen®) and ranibizumab covers exclusively the indication "neovascular AMD". Since Novartis gained new indication for Lucentis in EU for vision loss due to diabetic macular edema (DME) it is to be expected that VEGF inhibition will become first line for patients with DME. The cost effectiveness of the anti-VEGF therapy in ophthalmology is based upon the treatment of several patients with one drug package. The integration of IVI into the EBM is not recommended by the majority of Germany's ophthalmologists because neither would the patients benefit nor would the health-care data transparency increase. To evaluate the ophthalmological anti-VEGF market in Germany and to identify and secure the treatment quality a recurring acquisition of health-care data with following management actions is needed.

Messtechnische Kontrollen für Impressionstonometer - eine Qualitätsgarantie in der Augenheilkunde

Impression tonometers are not only used for fast measurements of intraocular pressure on supine patients but also during surgery on the human eye. These mechanically very delicate devices have to be checked by metrological controls according to the German Medical Devices Act ("Medizinproduktegeset") and the German Ordinance on Operators of Medical Devices ("Medizinprodukte-Betreiberverordnung") every two years. These controls are carried out by independent testing agencies and are mandatory for all ophthalmologists in Germany using impression tonometers. For this purpose, special test devices have been developed by Physikalisch-Technische Bundesanstalt, Germany's national metrology institute. A large number of these test devices have been in use at private test agencies and verification offices since 1975. PROCEDURE AND METHOD: Eighteen test devices for impression tonometers from private test agencies, verification offices, or the Physikalisch-Technische Bundesanstalt were investigated. The instruments were checked for their measurement accuracy and their suitability to perform metrological controls. An impression tonometer of the Schiötz design served as reference instrument. The test devices were investigated with respect to parameters like tonometer mass, mass of the plunger-lever-pointer system, plunger displacement, or correlation of the curvature between foot plate and plunger. The findings were analysed by statistic methods. The main outcome of the present work is the conclusion that the investigated test devices are generally suitable to perform metrological controls on impression tonometers. For certain parameters some instruments reached the error tolerances, but the majority was inside permissible limits. For one parameter (effective mass of plunger-lever-pointer system for scale value 10) the reference tonometer itself was not within permissible tolerances. This was correctly determined by all test devices. Failures of test devices due to damage or maladjustment were not observed. Test devices for impression tonometers are mechanically delicate instruments. They have to be recalibrated at fixed intervals in order to remain suitable for metrological controls. If regularly maintained and recalibrated at least every three years, even devices with an age of 20 years or more are still absolutely fit for this purpose.

Long-term effect of latanoprost/timolol fixed combination in patients with glaucoma or ocular hypertension: A prospective, observational, noninterventional study

BackgroundProspective, observational studies that enroll large numbers of patients with few exclusion criteria may better reflect actual ongoing clinical experience than randomized clinical trials. Our purpose was to obtain efficacy and safety information from a cohort of subjects exposed to latanoprost/timolol fixed combination (FC) for ≥18 months using a prospective, observational design.MethodsIn all, 577 office-based ophthalmologists in Germany switched 2339 patients with glaucoma or ocular hypertension to latanoprost/timolol FC for medical reasons. Follow-up visits were scheduled for every 6 months over 24 months; physicians followed usual care routines. Intraocular pressure (IOP), visual field status, optic nerve head findings, and adverse events were recorded. Efficacy parameters were evaluated for the per protocol (PP) population; the safety population included subjects receiving ≥1 drop of FC. Physicians rated efficacy, tolerability, and subject compliance at month 24.ResultsOf the 2339 subjects switched to latanoprost/timolol FC (safety population), the primary reasons for switching were inadequate IOP reduction (78.2%) and desire to simplify treatment with once-daily dosing (29.4%; multiple reasons possible). In all, 1317 (56.3%) subjects completed the study, and 1028 (44.0%) were included in the PP population. Most discontinuations were due to loss to follow-up. Change in mean IOP from baseline to month 6 was -4.0 ± 4.31 mmHg, a reduction that was maintained throughout (P < 0.05 for change at all time points). By investigator assessments, optic disc parameters and visual field were stable over 24 months, and there was no relationship between IOP reduction over 24 months and development of a visual field defect. More than 90% of physicians rated latanoprost/timolol FC as "very good" or "good" for efficacy (PP population), tolerability, and compliance. The FC was safe and well tolerated. No change in iris color was reported by most subjects (83.1%) at month 24.ConclusionsOver 24 months, latanoprost/timolol FC effectively lowers IOP levels and is well tolerated in patients with glaucoma or ocular hypertension who change from their previous ocular hypotensive therapy for medical reasons. Investigator assessments found optic disc parameters and visual field to be stable throughout 24 months of follow-up.