Therapy For Open-angle Glaucoma Research Articles

Progressive Thickening of Retinal Nerve Fiber and Ganglion Cell Complex Layers Following SDM Laser Vision Protection Therapy in Open-Angle Glaucoma.

This work aims to determine the effect on nerve fiber layer (NFL) and ganglion cell complex (GCC) thickness trends in eyes with open-angle glaucoma (OAG) treated with Vision Protection Therapy™ (VPT). A retrospective analysis of spectral-domain optical coherence tomography (OCT) measured NFL and GCC thickness trends was performed, excluding eyes with poor-quality scans and principal diagnoses other than OAG. This study compares eyes with OAG managed conventionally with IOP control alone (controls) to eyes managed with the addition of VPT (VPT eyes). The direction (+ or -) and magnitude (microns/year) of the OCT trends were the study endpoints. Seventy-eight control eyes of 40 patients and 61 VPT-treated eyes of 39 patients were included in the study. Positive NFL trends were noted in 5% of control eyes vs. 71% of VPT eyes (p < 0.0001). Positive GCC trends were noted in 8% of control eyes vs. 43% of VPT eyes (p < 0.0001). Mean NFL trends (µm/year) were - 0.692 for controls vs. 0.347 for VPT (p < 0.0001). Mean GCC trends (µm/year) were - 0.554 for controls vs. - 0.148 for VPT (p = 0.0175). The addition of VPT to the conventional management of OAG resulted in highly significant improvements in NFL and GCC trends, indicating a reversal of key indicators of glaucoma severity and progression.

Frequency-doubled neodymium yttrium aluminum garnet (Nd:YAG) laser trabeculoplasty as adjuvant therapy for open-angle glaucomas

The thermal frequency-doubled Nd:YAG (neodymium: yttrium-aluminum-garnet) laser was used sparingly for trabeculoplasty. Our goal was to assess the efficacy and safety of frequency-doubled Nd:YAG laser trabeculoplasty as an adjunct therapy to anti-glaucoma medications in open-angle glaucoma. Laser trabeculoplasty was performed on 41 eyes of 22 adults with open-angle glaucomas using a thermal frequency-doubled Nd:YAG laser (Green laser photocoagulator GYC-500® 532 nm, Nidek, Japan). To assess the laser’s effectiveness, patients were monitored for intraocular pressure (IOP) reduction, control, and complications at 1 hour, 1 week, and then monthly for a year. Primary open-angle glaucoma was the most common diagnosis in 31 (75.6%) eyes. The pre-laser baseline IOP was 18.87±3.66 mmHg. The mean IOP was 14.9±2.54 mmHg at Week 1 (p = 0.000), 14.65±2.50 mmHg at Month 1, 14.53±2.60 mmHg at Month 3, 15.85±2.30 mmHg at Month 6, and 15.14±2.17 mmHg at Month 12 (p=0.000). A significant percentage reduction in IOP was achieved at 1, 3, 6, and 12 months: 21.78%, 22.48%, 16.73%, and 18.53%, respectively. Patients used an average of 2.73±1.00 topical drugs before laser treatment. There was a significant reduction in medicines after laser treatment on all occasions, at 1, 3, 6, and 12 months (p = 0.000). Complications included some degree of peripheral anterior synechiae (PAS) in 20 (51.3%) eyes; an IOP spike in one patient only, bilaterally (5.1%) at 1 hour after therapy; and mild anterior uveitis in four (9.75%) cases. To summarize, frequency-doubled Nd:YAG laser trabeculoplasty is a safe and effective adjuvant therapy for open-angle glaucoma that reduces intraocular pressure and medication use.

Modern trends in the treatment of glaucoma

In nearly all Russian regions, glaucoma ranks first among the causes of disability due to ophthalmic pathology, which is in line with global trends of glaucoma incidence growth and its leading position among the causes of irreversible blindness. Treatment of glaucoma is aimed at lowering intraocular pressure (IOP). This review presents the main current trends in the treatment of glaucoma: drug therapy, laser surgery, fistulizing, drainage and non-penetrating surgery, as well as the latest micro-invasive glaucoma surgery (MIGS).Currently, the pharmaceutical market offers many antihypertensive drops. Fixed-dose combinations of drugs have been proposed to increase treatment adherence, and effective drug delivery methods are being developed, which lower IOP with minimal side effects. Further development of laser surgery makes it both a method of choice for the initial treatment (selective laser trabeculoplasty) and expands its capabilities for various stages of glaucoma (micropulse cyclophotocoagulation). All this significantly reduces the frequency of classical macroinvasive antiglaucoma operations. The previously existing gap between conservative medical therapy and antiglaucoma surgery is filled by the newest MIHG procedures. In recent years, at all stages of primary open-angle glaucoma therapy, the emergence of new pharmaceuticals, methods and implants has been noted. These constitute the purpose of this publication.

A PHARMACIST INTERVENTION ON KNOWLEDGE AND ADHERENCE IN PATIENTS WITH OPEN-ANGLE GLAUCOMA

Objective: The objective of the study is to assess the pharmacist’s intervention on knowledge and adherence in patients with open-angle glaucoma therapy. Methods: The study was conducted at the glaucoma outpatient department of Shree Rana Ambika Shah Eye Hospital, Rupandehi, Nepal. Census sampling was performed among the glaucoma patients meeting the inclusion criteria from August 2018 to November 2018. Data were collected using a structured questionnaire that included questions about demography, knowledge of glaucoma, medication adherence, and factors associated with medication non-adherence to glaucoma therapy. Each patient was counseled by a pharmacist, and the relevant information was provided in the form of an information leaflet. Knowledge level and adherence level were re-assessed during the follow-up visit after 1 month. The Morisky–Green–Levine medication adherence scale was used to assess adherence. Results: A total of 103 patients were enrolled in the study, and the majority of the patients were of age ≥59 years. After intervention by the pharmacist, the knowledge level on glaucoma improved from poor to good. Before intervention, about 31% of patients were adherent to the medication therapy, but after intervention, about 73% of patients were adherence to the medication therapy. There was a significant difference in the mean of the knowledge level score and the mean of the medication adherence score before and after intervention. The common causes of non-adherence were reported to be forgetfulness, a stressful life, and difficulties with medication time. Conclusion: The study demonstrates that pharmacist intervention is effective in improving both knowledge and medication adherence to open-angle glaucoma therapy.

Effect of Topical Prostaglandin Analogue Therapy on Central Corneal Thickness: A Systematic Review.

To investigate whether prostaglandin analogue (PGA) eyedrops have a significant effect on central corneal thickness (CCT), we conducted a systematic search of literature published from 2000 to 2021. Among the studies conducted on topical PGA therapy in open-angle glaucoma or ocular hypertension patients over 18 years old, prospective studies with CCT change as an outcome were included. A single-arm meta-analysis was conducted to assess the overall effect on CCT, and subgroup analysis according to exposure time of PGA eyedrops was also performed. We counted the number of articles that reported on severe events (CCT reduction of 25 μm or more) and obtained their proportion. The methodological quality was assessed by the McHarm tool. Twenty-two reports of prospective studies were selected. The results of the single-arm meta-analysis showed very high heterogeneity. Still, in subgroup analysis, when PGA was used for more than 6 months, heterogeneity was low, and a significant decrease in CCT was observed. Severe events were reported in two reports and occurred in 3.8% to 14.8% of participants. PGA eyedrop use may cause a clinically significant CCT decrease, requiring CCT follow-up.

Intraocular Pressure Fluctuation in Primary Open-Angle Glaucoma with Canaloplasty and Microcatheter Assisted Trabeculotomy.

Background: Schlemm’s canal (SC) targeted procedures constitute a promising therapy for open angle glaucoma (POAG), safer and less invasive. However, little attention was paid to the intraocular pressure (IOP) variation in patients receiving these procedures, which is the risk factor for POAG progression. This study is to evaluate the IOP variation in eyes with POAG after modified canaloplasty (MC) and microcatheter assisted trabeculotomy (MAT). (2) Methods: POAG with good IOP in office hours after MC or MAT and age-matched normal subjects were recruited in this prospective coherent study. IOP in sitting and supine positions and 24-h IOP was measured. Aqueous vein and blood reflux into the SC were examined. (3) Results: Among 20 normal subjects, 25 eyes with MC eyes and 30 eyes with MAT were recruited in this study. Aqueous veins are frequently located in the inferior nasal quadrants in all groups. No pulsatile signs were observed in an aqueous vein in the MAT group but they were observed in 68% of the MC group. Blood reflux in the SC could be seen in all the operated eyes. The IOP in the sitting position was not significant different among groups (p = 0.419). Compared to normal, the IOP increased dramatically after lying down for 5 min in the MC and MAT groups (PMC vs. normal = 0.003, PMAT vs. normal = 0.004), which is similar for IOP change after lying down for 60 min (PMC vs. normal < 0.001, PMAT vs. normal < 0.001). In terms of diurnal IOP, subjects were stable in the MAT group (p < 0.01), variable in the normal group (p = 0.002), and most fluctuant in MC group (p < 0.001). (4) Conclusions: MC and MAT reduce the IOP but present aberrant short-term IOP regulation, which should be paid attention to in clinical settings.

Reviewing the evidence surrounding preservative-free tafluprost/timolol fixed-dose combination therapy in open-angle glaucoma and ocular hypertension management: a focus on efficacy, safety, and tolerability

ABSTRACT Introduction Elevated intraocular pressure (IOP) is the most important modifiable risk factor for irreversible sight loss in open-angle glaucoma (OAG). The topical fixed-dose combination (FC) of preservative-free (PF) tafluprost (0.0015%) and timolol (0.5%) (tafluprost/timolol) is among the second-line IOP-lowering options for OAG and ocular hypertension (OHT). Areas covered PubMed searches identified publications reporting key evidence from randomized controlled trials (RCTs) and real-world studies examining the safety, tolerability, and IOP-lowering efficacy of PF tafluprost/timolol FC therapy in OAG/OHT management. Expert opinion Glaucoma patients are more likely to have ocular surface disease, and treatment should be individualized so that target response may be achieved while considering tolerability and quality of life, according to European Glaucoma Society guidelines. PF FC therapies, such as PF tafluprost/timolol FC, avoid ocular surface exposure to toxic preservative agents and reduce the required number of treatment administrations. These properties may enhance treatment tolerability and adherence, resulting in improved IOP-lowering efficacy and disease control. Treatment outcomes from RCTs and real-world studies examining PF tafluprost/timolol FC therapy support this hypothesis, with significant IOP reductions and/or improvements in tolerability parameters demonstrated, regardless of the prior topical therapy used and even when switched directly to PF tafluprost/timolol FC treatment (without washout).

Applying the Health Belief Model to predict preference for surgical intervention versus medical therapy among patients with open-angle glaucoma

ObjectiveTo determine the factors influencing patient preference of surgical intervention versus medical therapy for open-angle glaucoma based on the Health Belief Model.Methods and analysisThe study is a cross-sectional study. The...

Treatment of open-angle glaucoma and ocular hypertension with preservative-free tafluprost/timolol fixed-dose combination therapy: 6 case reports and clinical outcomes

BackgroundTreatment of open angle glaucoma (OAG) and/or ocular hypertension (OHT) focuses on achievement of target intraocular pressure (IOP), with the objective of slowing disease progression. However, ocular surface health is an important consideration in the optimization of treatment. We report 6 patient cases in which enhanced IOP control was achieved following appropriate management of ocular surface inflammation and a therapeutic switch to the preservative-free (PF) tafluprost (0.0015%)/timolol (0.5%) fixed-dose combination (FC).Case presentationSix patient cases, aged 48–74 years, presented with OAG or OHT. Each patient had signs and symptoms of ocular surface disease (OSD). Cases 1–3 were each receiving maximal medical therapy for OAG; regimens comprising prostaglandin analogue (PGA), β-blocker, carbonic anhydrase inhibitor (CAI) and α-2 agonist agents (including treatments containing preservative agent). Cases 1 and 2 reported IOP values ≥23 mmHg in each eye, and wide IOP fluctuations were identified when reviewing patient data concerning case 3 (11–20 mmHg). Maximal therapy was ceased and PF tafluprost/timolol FC was initiated, after which the signs and symptoms of OSD were improved and IOP was reduced (≤18 mmHg for cases 1–3) and stabilized. Cases 4 and 5 were diagnosed with OAG and case 6 had OHT. Each had symptoms and signs of OSD and were treated with a preserved PGA monotherapy (latanoprost 0.005% or bimatoprost 0.03%). At presentation, IOP was 24 mmHg in both eyes (case 4), ≥18 mmHg (case 5) and ≥ 22 mmHg (case 6). Following a switch to the PF tafluprost/timolol FC, OSD symptoms were improved and IOP was 14 mmHg (both eyes; case 4), ≤14 mmHg (case 5) and 16 mmHg (both eyes; case 6).ConclusionsIn addition to IOP-lowering efficacy, approaches to the management of OAG and OHT should consider the impact of treatment tolerability and the susceptibility of these patients to OSD. The presence of ocular surface inflammation appears to be detrimental to adherence and therefore to the effectiveness of topical medications. Addressing OSD through the use of PF FC formations, such as the PF tafluprost/timolol FC, reduces exposure to potentially toxic agents and facilitates improvements in IOP control.

An observational study on the effectiveness & safety of anti-glaucoma medications in treatment naive patients of primary open angle glaucoma

Background: The paradox of open angle glaucoma therapy lies in the loss of reported efficacy of drugs when they are studied for real world effectiveness. Studies related to effectiveness and safety done in a longitudinal fashion in new cases of open angle glaucoma are scant. This study was undertaken to address the shortcomings in this regard. Materials and Methods: This was an open label, prospective, observational study. The patients were taken up for the study at their baseline visit and 3 subsequent follow up visits for next 6 months. The effectiveness was gauged on the basis of average IOP changes from baseline. Each patient was administered questionnaires for ocular surface disease and interviewed for possible adverse drug reactions at each follow up. Results: There were 68 participants who completed the study. All these patients reported at baseline and 3 subsequent follow ups. The mean baseline IOP was 27.20 (SD 6.29) mm of Hg and this reduced considerably to 16.97 mm of Hg (SD 3.18) which was a 37.61% reduction from the baseline (p

Beliefs and Attitudes of Ophthalmologists Regarding SLT as First Line Therapy for Glaucoma.

Targeted educational interventions for physicians may be useful in increasing adoption of selective laser trabeculoplasty (SLT) as first line therapy for the treatment of glaucoma. SLT is a safe and effective first line treatment for glaucoma, however, it is underutilized. To evaluate barriers for the widespread adoption of this procedure, we assessed the beliefs and attitudes of ophthalmologists. We developed an educational intervention directed to physicians to increase the consideration of SLT earlier in the glaucoma treatment paradigm. In this prospective study, an online survey and educational slide presentation was sent to a group of comprehensive ophthalmologists, ophthalmology residents, and glaucoma specialists. Subjects were asked to respond to questions regarding their beliefs and attitudes towards SLT before and after watching the educational slide presentation. A total of 53 subjects were enrolled. Before watching the slide presentation, 85% of subjects stated they offer SLT to newly diagnosed patients, although only 28% preferred it over medications. While 52% of physicians reported between 0% and 10% of their newly diagnosed patients receive laser therapy, 47% said they would use it as a first line therapy for all or most newly diagnosed glaucoma patients. Most subjects (94%) stated the educational slide presentation convinced them that SLT is appropriate as a first line therapy for treatment of open angle glaucoma. A better understanding of the barriers for utilizing SLT as a first line therapy provides valuable information to help increase the adoption of this safe and effective procedure. A targeted educational intervention may improve acceptance of SLT as first line therapy for open angle glaucoma.

Clinical outcomes of patterned laser trabeculoplasty as adjuvant therapy in open angle glaucoma and ocular hypertension.

To assess the efficacy and safety of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in open angle glaucoma (OAG) or ocular hypertension (OHT) patients who were under antiglaucoma medical treatment. This study was a retrospective review of primary or secondary OAG patients and OHT patients with medically uncontrolled (≥18 mm Hg) intraocular pressure (IOP) who underwent 360° PLT from June 2016 to August 2016. Follow-up visits at week 1, and 1, 3 and 6mo were performed. IOP, best corrected visual acuity (BCVA), complications and eye drop glaucoma medication were recorded at each follow-up visit. Success was defined as IOP reduction ≥20% from baseline. Forty-one eyes of 25 patients were included in this study. Pre-treatment mean IOP was 20.2±1.6 mm Hg. After PLT, IOP was 19.3±5.2, 16.1±2.7, 17.1±3.7 and 16.3±3.5 mm Hg, at 1wk, 1, 3 and 6mo, respectively. IOP reduction from baseline was statistically significant from the first month, remaining stable at 6mo (P<0.001). PLT success at 6mo of follow-up was 48.78%. The number of glaucoma medication per eye (P=0.10) and the mean BCVA both remained constant (P=0.37). Complications included transient IOP spikes in 4 eyes (9.8%) and peripheral anterior synechiae in 7 eyes (17.1%). PLT is an effective and safe method for the management of patients with OHT or OAG as an adjunctive therapy. Additional larger studies should be designed to verify the long-term stability of IOP reduction with this laser technology.

Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review

Medical & Surgical Ophthalmology Research Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review Gonen Baser1*, Eyyup Karahan2 1Özel Medifema Hospital, Turkey 2Van Education and Training Hospital, Department of Ophthalmology, Turkey *Corresponding author: Gonen Baser, Ozel Medifema Hospital, Eye Clinic, 1429 Sok. No: 1/3 Alsancak-Izmir/ Turkey, Tel: +90-532-2817848; Email: drgonenbaser@gmail.com Submission: January 05, 2018; Published: January 22, 2018 DOI: 10.31031/MSOR.2018.01.000508 ISSN: 2578-0360 Volume1 Issue2

Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review

Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review

Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review

Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review

The Quality Of Life of Patients as a Criterion of Efficacy of Primary Open Angle Glaucoma Therapy

The Quality Of Life of Patients as a Criterion of Efficacy of Primary Open Angle Glaucoma Therapy

EX-PRESS Glaucoma Filtration Device: efficacy, safety, and predictability.

Trabeculectomy has been the traditional primary surgical therapy for open-angle glaucoma. While trabeculectomy is effective in lowering intraocular pressure, complications associated with the procedure have motivated the development of alternative techniques and devices, including the EX-PRESS Glaucoma Filtration Device. This review describes the efficacy, safety, complication rates, and potential advantages and disadvantages of the EX-PRESS Glaucoma Filtration Device. EX-PRESS implantation is technically simpler compared with that of trabeculectomy, with fewer surgical steps. Vision recovery has been more rapid after EX-PRESS implantation compared with trabeculectomy. Intraocular pressure variation is lower during the early postoperative period, indicating a more predictable procedure. While efficacy of the EX-PRESS implant has been comparable to trabeculectomy, postoperative complications appear less common after EX-PRESS implantation compared with trabeculectomy. The EX-PRESS Glaucoma Filtration Device appears to be safe and effective in the surgical management of open-angle glaucoma.

Meta-analysis of randomized controlled trials comparing selective laser trabeculoplasty with prostaglandin analogue in the primary treatment of open-angle glaucoma or ocular hypertention

To compare the efficacy of selective laser trabeculoplasty (SLT) versus prostaglandinanalogue (PGA) in the treatment of open angle glaucoma (OAG) and ocular hypertension (OHT). Literature analysis.Systematic review of randomized controlled trials comparing SLT versus PGA, identified by searching literatures including Medline (January, 1966-December, 2012), EMBASE Reviews (January, 1974-December, 2012) OVID Evidence-Based Medicine Reviews (January, 1966-December, 2012), Chinese BioMedical Literature Database SinoMed (January, 1966-December, 2012), and CNKI (January, 1999-December, 2012). RevMan 5.0 was used to do meta-analysis. Three publications reporting 3 trials, 161 participants (231 eyes) with OHT or OAG were included for meta-analysis.IOP reduction favored PGA group, weighted mean difference (WMD) = -0.85[1 mmHg = 0.133 kPa; 95% confidence interval (CI) (-1.43 to -0.27), no significant heterogeneity present (P = 0.82, I² = 0%)].Success rates are equal in two groups [OR = 0.70, 95%CI = (0.49 to 1.19) , no significant heterogeneity present (P = 0.58, I² = 0%)]. Eyes underwent additional antiglaumatous interventions favored SLT group, OR = 1.11 [95%CI = (0.60 to 2.06), significant heterogeneity present, (P = 0.08, I² = 61%)]. As primary therapy of OAG or OHT, SLT is no more effective than PGA in success rate. IOP reduction affected by SLT is not effective than PGA. Compared with PGA, SLT can reduce the use of anti-glaucoma medications.

Financial return-on-investment of ophthalmic interventions

Although the patient value gain (improvement in quality-of-life and/or length-of-life) has been highlighted in Value-based Medicine cost-utility analyses, the financial value gain associated with healthcare interventions has received less emphasis. It is important for professional healthcare providers to realize their interventions often confer a large financial return-on-investment (ROI) to society. The societal costs associated with vitreoretinal and other ophthalmic interventions include: direct ophthalmic medical costs expended (hospital, physician, drug, diagnostic testing and so forth), direct medical costs saved (decreased costs for depression, injury, skilled nursing facility, nursing home and others), direct nonmedical costs saved (decreased costs for caregivers, transportation, residence costs, moving costs, and others), and indirect medical costs saved (improving employment incidence and wages). The financial ROI for direct ophthalmic medical costs expended for ranibizumab therapy for neovascular age-related macular degeneration is 450%, whereas that for cataract surgery is 4500% and for medical open-angle glaucoma therapy is 4000%. Many costs gained add to the Gross Domestic Product and increase the wealth of the nation. Many vitreoretinal and other ophthalmologic interventions confer considerable patient value, but also result in a large financial ROI to society. This financial ROI increases the wealth of the nation.

The hypotensive effect of selective laser trabeculoplasty depending on iridocorneal angle pigmentation in primary open angle glaucoma patients.

IntroductionSelective laser trabeculoplasty (SLT) is applied to reduce intraocular pressure in primary open angle glaucoma therapy. It selectively subjects trabecular pigmented cells to a pulsed, frequency-doubled Nd:YAG laser. The biostimulatory effect on trabecular macrophages was also postulated even in low-pigmented angles. The aim of the study was to assess the hypotensive effectiveness of SLT depending on the degree of iridocorneal angle pigmentation.Material and methodsSixty-three eyes of 53 patients with primary open angle glaucoma (POAG) were included in this study and than divided into three subgroups, dependind of iridocorneal angle pigmentation. All subjects underwent SLT on 270 degrees of the angle. Intraocular pressure (IOP) was assesed at baseline and 6 weeks after the laser procedure.ResultsSix weeks post-SLT mean IOP reduction was 2.63 mm Hg. The degree of IOP reduction showed a significant correlation with angle pigmentation. Intraocular pressure fell by 2.06 mm Hg, 2.46 mm Hg and 4.75 mm Hg in subgroups with low, marked and high pigmentation, respectively.ConclusionsThe SLT procedure most effectively reduces IOP only in the subgroup of POAG patients with marked angle pigmentation and it is equal to clinically succesfull hypontesive therapeutic effect, according to European Glaucoma Society guidelines. However, lower hypotensive effect in other study subjects may also be the valuable addition to pharmacological therapy of glaucoma.