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Glaucoma Incidence and Treatment (continued)

Latanoprost, Brimonidine, and Combination Timolol and Dorzolamide Affects Circadian Intraocular Pressure

N Orzalesi
Institute of Biomedical Science
Eye Clinic, S Paolo Hospital
Milan, Italy

Dr Orzalesi described a randomised cross-over trial to compare 24-hour intraocular pressure (IOP) reduction induced by latan-oprost, brimonidine, and a fixed combination of timolol and dorzolamide in patients with primary open angle glaucoma (POAG) and ocular hypertension. Ten patients with POAG and 10 with ocular hypertension were treated with latanoprost, brimonidine, or a fixed combination of timolol and dorzo-lamide for 1 month. All patients underwent 4 diurnal tonometric examinations twice at baseline and twice after 1 month of treatment. The IOP was measured 3 hourly with a handheld electronic tonometer, with the patient in the supine and sitting positions, and with a Goldmann applanation tonometer by 2 evaluators. A difference in mean IOP of 2.5 mm Hg was estimated to be clinically relevant. All the drugs significantly reduced IOP compared with baseline at all times except for brimonidine at midnight, 3, and 6 am. Latanoprost was more effective for lowering IOP compared with brimonidine at 3 am and 6 am and at 3 pm, while the combination of timolol with dorzolamide was more effective than brimonidine in lowering IOP at 3 am and 9 am (p < 0.04) and at 3 pm and 6 pm (p < 0.05).

In Conclusion

Latanoprost and the combination of timolol and dorzolamide provided uniform circadian IOP reduction, whereas brimonidine was less effective in lowering IOP, particularly during the night.

 

Compliance in the European Glaucoma Prevention Study
_________________________________________________

I Kersten
European Glaucoma Prevention Study Group
Department of Ophthalmology
University of Mainz Medical School
Mainz, Germany

The objective of this study was to evaluate the compliance of study patients within the ongoing European Glaucoma Prevention Study (EGPS) in order to identify factors interfering with patient compliance and to develop possible strategies to improve compliance. An anonymous compliance questionnaire based on a psychological model (the Health Action Process Approach) was completed by 145 patients. The questionnaire contained 64 questions with the following domains: demographic data (13 questions); medical history and interest in medical issues (11 questions); missing medications and side effects (9 questions); and compliance (31 questions).

In the factor analysis, 5 factors were determined to be essential regarding compliance: importance of prevention in the opinion of the patient; complexity of the treatment regimen; side-effects and consideration of benefits and disadvantages; social support; and feeling safe in the study.

The results showed that 78.3% of the patients admitted to missing an application of their medication less than once per week (with a dosage regimen of 3 times daily). The reasons for not taking medication were forgetting the appli-cation (31%), interfering with job (19%), and stress (6%). The lunchtime dose was the one that was most often missed.

In Conclusion

In this study, compliance was defined as not missing applications more than once per week (not more than 5% of all applications). This was fulfilled by 78.3% of the patients. Dr Kersten speculated that this rate of non-compliance was low compared with the estimation of non-compliance with antiglaucoma therapy in the literature, which is between 27% and 59%.

 

 

Safety and Efficacy of Latanoprost Versus Combination Dorzolamide And Timolol

D Spiegel
Department of Ophthalmology
University Eye Hospital Regensburg Regensburg, Germany

Dr Spiegel presented a study comparing the intraocular pressure (IOP) lowering effect of latanoprost monotherapy with the fixed combination of dorzolamide plus timolol in patients with IOP uncontrolled by timolol alone.

This prospective, multinational, open-label study included patients with unilateral or bilateral open angle glaucoma or pseudo-exfoliative glaucoma currently receiving mono or dual therapy with a ß-blocker.

226 patients with IOP 21 mm Hg after 3 to 6 weeks of run-in treatment with timolol twice daily were randomised to receive latanoprost once daily in the evening or dorzolamide and timolol twice daily. Diurnal IOP was measured at 10 am and 5 pm, at baseline and after 3 months of treatment.

205 patients (latanoprost, n = 103; dorzolamide and timolol, n = 102) were included in the per-protocol analysis. At baseline, the mean diurnal IOP was similar among patients given latanoprost and dorzolamide plus timolol. After 3 months, least square mean analysis showed both treatments resulted in a statistically significant reduction in diurnal IOP (p < 0.001; Table 2). The IOP lowering effects of the treatments were not statistically different based on the 95% confidence interval (-1.1, 0.4 mm Hg) for the difference in mean diurnal IOP reduction between the groups. However, the percentage of patients achieving diurnal IOP reduction 20% was higher in the latanoprost-treated group compared with the dorzolamide and timolol-treated group (Table 2).

Table 2. Mean reduction in diurnal intraocular pressure (IOP) following 3 months' treatment with latanoprost or dorzolamide plus timolol.

Baseline

Reduction in IOP

Percent of patients with diurnal IOP reduction 20%

mm Hg

Percent

Latanoprost

23.2

4.3

19 52

Dorzolamide plus timolol

23.1 4.0 17 43

Mean IOP reductions at 10 am and 5 pm were statistically significant in both groups (p < 0.001; Figure 1). At 10 am, the 2 treatments had a comparable IOP lowering effect, while at 5 pm, latanoprost showed a significantly higher IOP reducing effect (p = 0.0454). Both medications were well-tolerated.

Figure 1 . Mean intraocular pressure reductions following treatment with latanoprost or dorzolamide plus timolol. * p = 0.045.

Figure 1

In Conclusion

Monotherapy with latanoprost once daily is at least as effective as twice daily treatment with dorzolamide and timolol for patients with IOP uncontrolled by timolol alone.

 

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