DOCSLIB.ORG

Pilocarpine to Prevent Acute Pressure Increase Following Primary Laser Trabeculoplasty

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pilocarpine to Prevent Acute Pressure Increase Following Primary Laser Trabeculoplasty Eye (]991) 5, 390-394 Pilocarpine to Prevent Acute Pressure Increase Following Primary Laser Trabeculoplasty T. ELSAs , * H. JOHNSEN** AND 0. STANG" Trondhehn, Norway. Summary The effect of pilocarpine pretreatment on the transient pressure elevations immedi­ ately following primary laser trabeculoplasty was investigated in a prospective, ran­ domised study. Fifty eyes of 50 patients, 33 with exfoliative and 17 with simple glaucoma, were treated in 3600 of the trabecular meshwork. The mean maximum pressure increase was 2.4 (SO = 4.4)mm Hg with pilocarpine pretreatment and 12.8 (SD = 11.2)mm Hg without pretreatment (p<0.05). Except in two cases, all peak pressures appeared during the first two hours after treatment . The degree of cham­ ber angle pigmentation was predictive of the magnitude of the post laser hyperten­ sive pressure response in eyes without pretreatment (p<0.05). The most frequent and serious complication Material and methods after laser trabeculoplasty (LTP) is acute pres­ Fifty eyes of 50 patients were included, 33 sure elevation. I There are several reports of with exfoliative glaucoma and 17 with simple visual field loss following LTP probably glaucoma. The mean age of the patients was caused by pressure increase.2--1 Laser trabecu­ 69 (SO = 9.9) years in the pilocarpine pre­ loplasty was originally introduced as an alter­ treatment group and 71.9 (SO = 7.1) years in native to filtrationsurgery," and there are now the untreated group. several studies showing promising results with To be included in the study, the patients had LTP as the initial treatment for glaucomah-N to meet the following criteria: (a) Intraocular pressure �25mm Hg meas­ Pressure reducing agents such as pilocarpine ,'J iii ured by applanation tonometry at the acetazolamide, and apraclonidine" reduce initial evaluation by one of the authors the pressure increase of LTP in glaucoma (TE) and just before laser treatment. The patients on medication prior to treatment. mean of these two was taken as prelaser while anti-inflammatory drugs seem to have 1 4 lOP. no effect. 2 1 We are only aware of one study (b) Glaucomatous disc damage andlor visual on medical prophylaxis to prevent post­ field defects. operative pressure elevations in primary LTP. (c) No earlier glaucoma treatment. Odberg'5 recorded no cases of pressure The optic disc was evaluated by contact lens increase in an uncontrolled study of 27 eyes examination and nonstereo fundus photogra­ pretreated with timolol. phy by one of the authors (TE) according to Fifty eyes of 50 patients were investigated the recommendations of Schwartz. 10 Glauco­ in the present randomised study to determine matous disc damage was defined as vertical the influence of pilocarpine pretreatment on cup-disc ratio �().5 and at least one of the fol­ post laser pressure elevation in primary LTP. lowing criteria: From: Departments of Ophthalmology' and Clinical Chen11Stry·'··. UniverSity of Twndheim, Norway. Correspondence to: T. Fisas, Department of Ophthalmo]ogv. University of Trondheim, N-7()()(,. Norway. PRIMARY LASER TRAI3ECLJLOPLASTY 391 (a) cupping of the optic nerve head extending measurements one week and one, three, and to the margin of the disc. six months after laser surgery. Topical anti­ (b) a difference of vertical cup-disc ratio of glaucomatous medication was instituted if �0.2 between the two eyes. lOP was �40 mm Hg the day after treatment, (c) different degrees of disc pallor in the two �25 mm Hg after one week and >22 mm Hg eyes with no other explanation. after that. The visual field was examined with the We used the blue-green light of a Coherent Humphry visual field analyser using the argon laser photocoagulator. About a hun­ C-30-2 program before and one, three, and six dred burns were evenly spaced around 3600 of months after treatment. Glaucomatous visual the trabecular meshwork just in front of the field defects were defined as having at least scleral spur. We used the following settings: three contiguous spots with a depth of �5 dB n.l sec. power duration, 50 �L spot size and a within the 300 central field. Three patients mean power level of 1.0 (SD = 0.2) W. All who did not cooperate when tested by auto­ treatments were performed by one of the mated perimetry had their fields plotted with authors (TE) to maintain uniformity during the Goldmann perimeter. MO, the mean ele­ the study. vation or depression of the patient's overall The study took place from September 1989 field compared to the normal reference field to December 1990. Informed consent was in the STATPAC program of the Humphry obtained from all patients. visual field analyser, was used as an index of Multifactor analysis of variance (ANOVA) the degree of visual field damage. The visual with two-way interaction was used to evaluate fieldchanges following L TP will be the subject the effect of chamber angle pigmentation, of a separate study. glaucoma type, and prelaser pilocarpine The degree of chamber angle pigmenta­ treatment on pressure increase after treat­ tion in the 6 o'clock position was graded ment. For comparison of two mean values and according to Scheie on a scale from 0 to 4.17 of two frequencies, the t-test or binomial test Patients were randomly assigned to two was performed. A p-value less than 0.05 was drops of pilocarpine 2 '/"o pretreatment one considered significant. hour before LTP or to no pretreatment. In cases with bilateral disease one eye was ran­ Results domised to LTP. The study was not masked Various prelaser and laser treatment para­ because the pilocarpine induced miosis was meters are listed in Table I. There is no evi­ very obvious to the investigators. dence of dissimilarities between the two Intraocular pressure was measured one, groups. two, four, six, eight, and 24 hours after treat­ Data related to pressure increase are sum­ ment with the Goldmann applanation tonom­ marised in Table II and Figure 1. The mean eter. If the pressure was �50 mm Hg, the maximum pressure increase was 2.4 patient received glycerol, acetazolamide and (SO = 4.4) mm Hg in the pilocarpine group limolol. The patients returned for repeat and 12.8 (SO = 11.2) mm Hg in the group not Table I. Prelaser and LTP parameters. Pilocarpine No pilocarpine pretreatment pretreatment n =25 n =25 Mean prelascr [OP (mm Hg) 34.9 (SO=R.1) 33.3 (SO= 5.6) Mean age 69 (SO= 9.9) 71.9 (SO=7.1) Number of eyes with exfoliative glaucoma 16 17 Number of eyes with simple glaucoma 9 8 - Mean visual field defect (MO)(d8) -6.7 (SO= RA) 6 . 0 (SO= 9.7) Cup-disc ratio 0.7 (SO=O.I7) 0.7 (SO=O.I7) Pigmentation of chamber angle 2.2 (SO= 0.9) 2.3 (SO =O.R) Laser power (W) 0.94 (SO= 0.2) 1.03 (SO = 0.2) :-Jumber of laser burns 109 (SO= 15) 104 (SO= 17) 392 T ELSAs ET Al Table II. Pressure increase following primary LTP Pilocarpine No pilocarpine pretreatment pretreatment n =25 n =25 p-\'a/lle Mean maximum pressure increase (mm Hg) 2.4 (SD =4.4) 12.R (SD = 11.2) <(J.OS �P", lOmm Hg n=3 n= 13 <0.05 �P"'20mmHg n=O n = R <(J.05 Peak lOP ",SO mm Hg n = 1 n = 10 <0.05 on pilocarpine (P<0.05). Table II demon­ primary LTP. He found no cases of post­ strates that pressure increase ;310 mm Hg and operative pressure increase in an uncon­ ;320 mm Hg and pressure peaks ;350 mm Hg trolled study of 27 timolol pretreated eyes were more frequent without pilocarpine pre­ with LTP over 1800• The disadvantage of tim- treatment (P<0.05). There were no cases of 0101 is that it cannot be used in patients with permanently elevated pressure following obstructive lung disease, and should be used LTP. with caution in cardiac patients. IH Robinll ANaYA showed that pilocarpine pretreat­ reported that apraclonidine was superior to ment and chamber angle pigmentation were dipivefrin, timolol, acetazolamide and pil­ factors with significant effect on pressure ocarpine in preventing postlaser pressure ele­ increase after laser treatment (p<0.05). vations in patients on glaucoma medication. Specifically, pilocarpine generally reduced the We are aware of no such comparative studies pressure increase, and the reduction was on the efficacy of different drugs in primary higher the more pigmented the angle. This laser °trabeculoplasty. Ofner et al.9 reported observation is clearly shown in Figure 1. that pilocarpine reduced the acute pressure increase after laser trabeculoplasty in patients Discussion on medication. Leung and Gilliesl9 observed a Our study demonstrates that pilocarpine pre­ trend towards diminished pressure increase in treatment decreases the magnitude of the pilocarpine pretreated patients, but they did pressure rise after primary laser trabeculo­ not consider it significant. plasty. To our knowledge only Odbergl5 has In our study all except two patients experi­ studied the influence of medical pretreatment enced the pressure peaks during the first two on the immediate pressure response following hours after treatment. These two patients had 20 maximum pressures three and five hours after laser trabeculoplasty. Even if most pressure 18 ...... spikes occur during the first hours after laser tl) J: 16 surgery, delayed pressure peaks may occur as E 14 late as 24 hours after treatment. 13 There was E 12 no difference in the time course of the pres­ Q) U) sure increase between the pilocarpine and ." 10 Q) non pilocarpine group in our study. .... 0 8 c: There are several theories that attempt to 6 explain the hypertensive pressure response /l.
Load more

Recommended publications
  • Simbrinza BID Adjunctive to PGA Additive Effect of Twice Daily
    Alcon - Business Use Only Effective Date: 30-Mar-2017 Document: TDOC-0050474 Version: 3.0; Most-Recent; Effective; CURRENT Status: Effective Page 1 of 66 a Novartis company Short Title Simbrinza BID Adjunctive to PGA Long Title Additive Effect of Twice Daily Brinzolamide 1% /Brimonidine 0.2% Fixed Dose Combination as an Adjunctive Therapy to a Prostaglandin Analogue TDOC-0050474 Version 1.0 replaces TDOC-0018786 Version 1.0 (11-Mar-2015) Protocol Number: GLH694-P001 / NCT02419508 Study Phase: 4 Sponsor Name and Alcon Research, Ltd. Address: 6201 South Freeway Fort Worth, Texas 76134-2099 Investigational Product: SIMBRINZA™ Brinzolamide 1%/Brimonidine 0.2% tartrate ophthalmic suspension US IND# / EudraCT 2015-000736-15 Indication Studied: Ocular Hypertension Open Angle Glaucoma Printed By : Print Date: Alcon - Business Use Only Effective Date: 30-Mar-2017 Document: TDOC-0050474 Version: 3.0; Most-Recent; Effective; CURRENT Status: Effective Page 2 of 66 Investigator Agreement: I have read the clinical study described herein, recognize its confidentiality, and agree to conduct the described trial in compliance with Good Clinical Practices (GCP), the ethical principles contained within the Declaration of Helsinki, this protocol, and all applicable regulatory requirements. Additionally, I will comply with all procedures for data recording and reporting, will permit monitoring, auditing, and inspection of my research center, and will retain all records until notified by the Sponsor. Principal Investigator: Signature Date Name: Address: Printed By : Print Date: Alcon - Business Use Only Effective Date: 30-Mar-2017 Document: TDOC-0050474 Version: 3.0; Most-Recent; Effective; CURRENT Status: Effective Page 3 of 66 1 SYNOPSIS Sponsor: Alcon Research, Ltd.
    [Show full text]
  • Rhopressa™ Netarsudil Ophthalmic Solution 0.02%
    Rhopressa™ Netarsudil ophthalmic solution 0.02% CDER Dermatologic and Ophthalmic Drugs Advisory Committee October 13, 2017 Aerie Pharmaceuticals, Inc. 1 Introduction Marvin Garrett Vice President, Regulatory Affairs and Quality Assurance Aerie Pharmaceuticals, Inc. 2 Aerie Pharmaceuticals • 2005: Aerie founded as a spin-out from Duke University: – Dr. Eric Toone – Dr. Casey Kopczynski – Dr. David Epstein – Dr. Epstein’s goal from the beginning: Develop a therapy that targeted the diseased tissue in glaucoma, the trabecular outflow pathway • 2006: Aerie discovered its first Rho kinase inhibitor • 2009: Aerie invented netarsudil • 2012: Netarsudil 1st clinical study • 2017: NDA filed 3 Netarsudil: A New Drug Class for Lowering IOP We are requesting a recommendation for approval of netarsudil ophthalmic solution 0.02% for reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension given one drop QD 4 Agenda Unmet Medical Needs Richard A. Lewis, MD Chief Medical Officer Aerie Pharmaceuticals, Inc. Past President, American Glaucoma Society Program Design and Efficacy Casey Kopczynski, PhD Chief Scientific Officer Aerie Pharmaceuticals, Inc. Safety Theresa Heah, MD, MBA VP Clinical Research and Medical Affairs Aerie Pharmaceuticals, Inc. Benefits and Risks Janet Serle, MD Professor of Ophthalmology Glaucoma Fellowship Director Icahn School of Medicine at Mount Sinai 5 List of Expert Responders • Cynthia Mattox, MD – Associate Professor of Ophthalmology, Tufts University School of Medicine – Current President, American Glaucoma Society • Mark Reasor, PhD – Professor of Physiology & Pharmacology, Robert C. Byrd Health Sciences Center, West Virginia University • Bennie H. Jeng, MD – Professor and Chair, Department of Ophthalmology & Visual Sciences, University of Maryland School of Medicine • Dale Usner, PhD – Biostatistics Consultant to Aerie Pharmaceuticals, Inc.
    [Show full text]
  • Association Between Topical Beta-Blockers and Risks
    BMJ Open: first published as 10.1136/bmjopen-2019-034361 on 22 July 2020. Downloaded from PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. ARTICLE DETAILS TITLE (PROVISIONAL) Association between Topical Beta-Blockers and Risks of Cardiovascular and Respiratory Disease in Glaucoma Patients: a retrospective cohort study AUTHORS Chen, Hsin-Yi; Huang, Wei-Cheng; Lin, Cheng-Li; Kao, Chia-Hung VERSION 1 – REVIEW REVIEWER Marques-Neves, Carlos Ophthalmology University Clinic Faculdade de Medicina da Universidade de Lisboa REVIEW RETURNED 27-Oct-2019 GENERAL COMMENTS Some variables are difficult to control nevertheless, the point is achieved. REVIEWER Reza Razeghinejad Wills Eye Hospital, Philadelphia, PA REVIEW RETURNED 12-Nov-2019 http://bmjopen.bmj.com/ GENERAL COMMENTS A retrospective study on association between Topical Beta- Blockers and Risks of Cardiovascular, stroke, and Respiratory Diseases in Glaucoma Patients reporting higher rate of respiratory issues and stroke in those on beta-blockers. The reported correlations are valid under one condition, being on beta-blocker when the event (stroke, respiratory issues,…..) occurred. The major issue is not including the severity of the systemic diseases and also the severity of glaucoma. on September 25, 2021 by guest. Protected copyright. Although the frequency of DM, HTN, asthma,… were similar between both group, there is no data on the severity of these diseases, for example if the HbA1c of those taking beta blockers is higher it could be the cause of higher rate of stroke not the beta- blockers.
    [Show full text]
  • Glaucoma Medications
    9/5/2020 Glaucoma Pharmacology: Old, New and What to Do? Joseph Sowka, OD Greg Caldwell, OD Rho-Kinase White 1 2 GLAUCOMA EPIDEMIOLOGY AND AQUEOUS HUMOR DYNAMICS TREATMENT IOP – A Complex Homeostasis Current Medical Treatments for OAG Aqueous formation in ciliary body – passive diffusion, ultrafiltration and active secretion Cornea Aqueous Production Aqueous Outflow Conventional Outflow – Trabecular Meshwork → Schlemm’s Canal → Conventional Unconventional Episcleral Venous System Trabecular Meshwork Prostaglandin Non-Conventional Outflow – Schlemm’s -blocker Cholinergic agonist analog Uveoscleral Canal Episcleral CAI NO-donating PGA NO-donating Veins 2-agonist RhoKinase inhibitor PGA 2-agonist Uveoscleral Outflow Updated 1/7/18 Ciliary Processes 3 4 PROSTAGLANDINS: PROSTAGLANDINS OCULAR ADVERSE EFFECTS ▪ Prostaglandins are not indicated ideal in secondary inflammatory glaucoma or any ▪ Hyperemia clinical entity that has anterior segment ▪ Increased iris coloration inflammation as a component ▪ Periorbitopathy: skin darkening, Sulcus ▪ Prostaglandins are important in that they deepening flatten the diurnal IOP curve as well as giving - Hyperemia is reversible with medication cessation. Iris color lingering IOP reduction even as much as 60 changes appear to be irreversible. Periorbitopathy may be reversible if the medication is stopped soon enough, but may hours after dosing. Thus, they are more indeed be permanent. forgiving of patients that miss dosages. ▪ Hypertrichosis ▪ Punctate keratopathy, dry eye ▪ Uveitis, CME, and dendritic
    [Show full text]
  • Drug Class Review Ophthalmic Cholinergic Agonists
    Drug Class Review Ophthalmic Cholinergic Agonists 52:40.20 Miotics Acetylcholine (Miochol-E) Carbachol (Isopto Carbachol; Miostat) Pilocarpine (Isopto Carpine; Pilopine HS) Final Report November 2015 Review prepared by: Melissa Archer, PharmD, Clinical Pharmacist Carin Steinvoort, PharmD, Clinical Pharmacist Gary Oderda, PharmD, MPH, Professor University of Utah College of Pharmacy Copyright © 2015 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved. Table of Contents Executive Summary ......................................................................................................................... 3 Introduction .................................................................................................................................... 4 Table 1. Glaucoma Therapies ................................................................................................. 5 Table 2. Summary of Agents .................................................................................................. 6 Disease Overview ........................................................................................................................ 8 Table 3. Summary of Current Glaucoma Clinical Practice Guidelines ................................... 9 Pharmacology ............................................................................................................................... 10 Methods .......................................................................................................................................
    [Show full text]
  • The Eyes Have It! Update on Common Conditions Affecting the Eye
    Pharmacy Tech Topics™ VOLUME 22 NO. 2 | APRIL 2017 The Eyes Have It! Update on Common Conditions Affecting the Eye AUTHORS: Steven R. Abel, BS Pharm, PharmD, FASHP Kirk Evoy, PharmD, BCACP, BC-ADM, TTS PEER REVIEWERS: Sami Labib, RPh Rita Edwards, CPhT EDITOR: Patricia M. Wegner, BS Pharm, PharmD, FASHP DESIGN EDITOR: Leann Nelson Pharmacy Tech Topics™ (USPS No. 014-766) is published quarterly for $50 per year by the Illinois Council of Health-System Pharmacists, 4055 N. Perryville Road, Loves Park, IL 61111-8653. Phone 815-227-9292. Periodicals Postage Paid at Rockford, IL and additional mailing offices. POSTMASTER: Send address changes to: Pharmacy Tech Topics™, c/o ICHP, 4055 N. Perryville Road, Loves Park, IL 61111-8653 COPYRIGHT ©2017 by the Illinois Council of Health-System Pharmacists unless otherwise noted. All rights reserved. Pharmacy Tech Topics™ is a trademark of the Illinois Council of Health-System Pharmacists. This module is accredited for 2.5 contact hours of continuing pharmacy education and is recognized by the Pharmacy Technician Certification Board (PTCB). Cover image property of ©2017 Adobe Stock. LEARNING OBJECTIVES Upon completion of this module, the subscriber will be able to: 1. Identify the parts of the eye and the function of each part. 2. Summarize various eye disorders including ocular hypertension, glaucoma, infections, dry eyes, conjunctivitis, age-related macular degeneration, macular edema following retinal vein occlusion, and diabetic macular edema. 3. Discuss brand/generic substitutions, possible side effects, and proper administration of ophthalmic medications. 4. Describe the roles of various ophthalmic agents including those used to treat the following conditions: ocular hypertension, glaucoma, infections, dry eyes, conjunctivitis, age-related macular degeneration, macular edema following retinal vein occlusion, and diabetic macular edema.
    [Show full text]
  • Personalized Glaucoma Medication Compounding Reduces Intraocular Pressure and May Increase Adherence and Affordability
    Laroche D, et al., J Ophthalmic Clin Res 2021, 8: 085 DOI: 10.24966/OCR-8887/100085 HSOA Journal of Ophthalmology & Clinical Research Case Report leading cause of blindness worldwide [1]. The exact etiology of the Personalized Glaucoma degenerative damage to the optic nerve seen in glaucoma is multifac- torial, and risk factors include older age, increased cup-to-disc ratio Medication Compounding of the optic nerve, a thin central cornea, family history, and increased Intraocular Pressure (IOP) [2]. IOP is the only known modifiable risk Reduces Intraocular Pressure factor; the greater the IOP, the faster damage progresses. Glaucoma treatment is therefore focused on reducing IOP through surgery, laser, and May Increase Adherence and or pharmacological therapy, and medications are generally the first step. While the initial approach to adult glaucoma is often surgical Affordability and often involves early cataract extraction to lower IOP and accom- Daniel Laroche1,3*, Elise Mike2 and Chester Ng3 panying angle surgery to restore outflow via Schlemm’s canal, some 1New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, patients refuse or fail surgery and require multiple medications for New York, NY, USA disease management. Often, more than one medication is needed to 2Albert Einstein College of Medicine, Bronx, NY, USA meet and maintain the target IOP, and effectiveness of treatment is 3Advanced Eye care of New York, NY, USA limited by treatment adherence [3]. Medications also have the active ingredients and preservatives that can lead to ocular erythema and Abstract conjunctivitis, further reducing compliance [4]. Compounding mul- tiple topical agents into a single solution has several benefits when Glaucoma treatment relies on Intraocular Pressure (IOP) reduc- tion through surgical or pharmacological means.
    [Show full text]
  • Brimonidine/Timolol Versus Dorzolamide/Timolol and Various Two-Bottle Combinations Gail F
    perim Ex en l & ta a l ic O p in l h t C h Schwartz et al. f Journal of Clinical & Experimental a , J Clin Exp Ophthalmol 2012, 3:8 o l m l a o n l DOI: 10.4172/2155-9570.1000248 r o g u y o J Ophthalmology ISSN: 2155-9570 ResearchResearch Article Article OpenOpen Access Access Adherence and Persistence with Glaucoma Therapy: Brimonidine/Timolol versus Dorzolamide/Timolol and Various Two-Bottle Combinations Gail F. Schwartz1,2*, Caroline Burk3, Teresa Bennett4 and Vaishali D. Patel5 1Greater Baltimore Medical Center, Baltimore, MD, USA 2Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA 3Health Outcomes Consultant, Laguna Beach, CA, USA 4Source Healthcare Analytics, Phoenix, AZ, USA 5Allergan, Inc., Irvine, CA, USA Abstract Purpose: Patients with glaucoma often require multiple topical medications to reach target intraocular pressure. This database analysis examined persistence and adherence in patients’ prescribed fixed-combination brimonidine/ timolol, fixed-combination dorzolamide/timolol, or various commonly used two-bottle combinations. Participants: Glaucoma patients (ICD-9 code: 365.xx; n=7883) from the Source Healthcare Analytics Source® Lx database with an index prescription for fixed-combination brimonidine/timolol, fixed-combination dorzolamide/timolol, or various commonly used two-bottle combinations during the 6-month qualifying period (January 2008–June 2008), but not the 12 months before, were included. Methods: In this retrospective prescription database analysis, adherence and persistence for fixed- combination brimonidine/timolol were compared to fixed-combination dorzolamide/timolol and various commonly used two-bottle combinations. The two-bottle arms were: β-blocker+brimonidine; β-blocker+carbonic anhydrase inhibitor; β-blocker+prostaglandin analogue; carbonic anhydrase inhibitor+brimonidine; carbonic anhydrase inhibitor+prostaglandin analogue; and prostaglandin analogue+brimonidine.
    [Show full text]
  • Primary Open-Angle Glaucoma Preferred Practice Pattern®
    Primary Open-Angle Glaucoma Preferred Practice Pattern® P71 Secretary for Quality of Care Timothy W. Olsen, MD Academy Staff Ali Al-Rajhi, PhD, MPH Andre Ambrus, MLIS Meghan Daly Flora C. Lum, MD Medical Editor: Susan Garratt Approved by: Board of Trustees September 12, 2020 Copyright © 2020 American Academy of Ophthalmology® All rights reserved AMERICAN ACADEMY OF OPHTHALMOLOGY and PREFERRED PRACTICE PATTERN are registered trademarks of the American Academy of Ophthalmology. All other trademarks are the property of their respective owners. Preferred Practice Pattern® guidelines are developed by the Academy’s H. Dunbar Hoskins Jr., MD Center for Quality Eye Care without any external financial support. Authors and reviewers of the guidelines are volunteers and do not receive any financial compensation for their contributions to the documents. The guidelines are externally reviewed by experts and stakeholders before publication. P72 Primary Open-Angle Glaucoma PPP GLAUCOMA PREFERRED PRACTICE PATTERN® DEVELOPMENT PROCESS AND PARTICIPANTS The Glaucoma Preferred Practice Pattern® Panel members wrote the Primary Open-Angle Glaucoma Preferred Practice Pattern® guidelines (PPP). The PPP Panel members discussed and reviewed successive drafts of the document, meeting in person twice and conducting other review by e-mail discussion, to develop a consensus over the final version of the document. Glaucoma Preferred Practice Pattern Panel 2019-2020 Steven J. Gedde, MD, Chair Kateki Vinod, MD Martha M. Wright, MD, American Glaucoma Society Representative Kelly W. Muir, MD John T. Lind, MD Philip P. Chen, MD Tianjing Li, MD, MHS, PhD, Consultant, Cochrane Eyes and Vision Project Steven L. Mansberger, MD, MPH, Methodologist We thank our partners, the Cochrane Eyes and Vision US Satellite (CEV@US), for identifying reliable systematic reviews that we cite and discuss in support of the PPP recommendations.
    [Show full text]
  • Ophthalmic Drugs
    A Supplement to 22nd EDITION Randall Thomas, OD, MPH Patrick Vollmer, OD The Clinical Guide to Dr. Melton Ophthalmic[ [ Dr. Thomas Drugs Dispense as writ ten — no substit utions. Refills: unlimit ed. May 15, 2018 Dr. Vollmer Peer-to-peer advice to help boost your prescribing prowess. Supported by an unrestricted grant from Bausch + Lomb 001_dg0518_fc.indd 3 5/11/18 10:52 AM FROM THE AUTHORS DEAR OPTOMETRIC COLLEAGUES: Supported by an Welcome to the 2018 edition of our annual Clinical Guide to Ophthalmic unrestricted grant from Drugs. Herein, we provide updates on our collective clinical experiences and Bausch + Lomb heavily season them with pertinent excerpts from the literature. This guide is intended to bring solid, scientifically accurate and clinically relevant information to our optometric colleagues. If you want to understand CONTENTS how the three of us treat, and what factors led us to develop these methods, you’ll find it explained here. The methods and opinions represented are our own. We recognize that other doctors may use alternative approaches. That First-year Impressions ...........3 is true in all of health care. But this three-doctor writing team has logged over 75 combined years of clinical optometry, and we bring that ‘real-world’ spirit to the discussions that follow. Know that, above all, we are doctors who are genuinely concerned for our patients’ well-being and who endeavor to Glaucoma Care .......................... 6 provide them the best of care, and we write from that perspective. The two topics of greatest interest and need for most eye physicians right now are glaucoma and dry eye disease.
    [Show full text]
  • Understanding and Living with Glaucoma
    Understanding and Living with Glaucoma Betty hopes future generations won’t have to live with glaucoma. Dr. Goldberg’s breakthrough research could mean they won’t have to. Understanding and Living with Glaucoma C SUPPORTED BY AN EDUCATIONAL GRANT FROM AERIE PHARMACEUTICALS, INC. Glaucoma is an eye disease that gradually steals your vision. Usually, glaucoma has no symptoms in its early stages. But without proper treatment glaucoma can lead to blindness. The good news is that with regular eye exams, early detection, and treatment, you can preserve your sight. This guide will give you a complete introduction to the facts about glaucoma. D Glaucoma Research Foundation 2 INTRODUCTION 3 UNDERSTANDING GLAUCOMA 3 Understand the Eye to Understand Glaucoma 4 How Glaucoma Affects the Eye 6 Who Gets Glaucoma? 7 Are There Symptoms? 7 When Should You Get Your Eyes Checked for Glaucoma? 8 DIFFERENT TYPES OF GLAUCOMA 8 Primary Open-Angle or Open-Angle Glaucoma 9 Primary Angle-Closure or Angle-Closure Glaucoma or Narrow-Angle Glaucoma 10 Other Types of Glaucoma 10 • Normal-Tension Glaucoma 10 • Secondary Glaucoma 12 DETECTING GLAUCOMA 12 How Is Glaucoma Diagnosed? 12 What To Expect During Glaucoma Examinations 12 • Tonometry 12 • Ophthalmoscopy 15 • Perimetry 16 • Gonioscopy 16 • Pachymetry 17 TREATING GLAUCOMA 17 Treatment of Primary Open-Angle Glaucoma 17 • Selective Laser Trabeculoplasty 18 • Glaucoma Medications 21 • Incisional Surgeries 25 • Unapproved Treatments 25 Treatment of Primary Angle-Closure Glaucoma 26 Treatment of Other Types of Glaucoma 28 FREQUENTLY ASKED QUESTIONS 30 LIVING WITH GLAUCOMA 30 Working with Your Doctor 32 Responding to Vision Changes Due to Glaucoma 32 Questions For Your Doctor 34 Your Lifestyle Counts 35 Looking Ahead 36 APPENDIX 36 A Guide To Glaucoma Medications 38 Glossary Understanding and Living with Glaucoma 1 Introduction If you have been diagnosed with glaucoma, or are a glaucoma suspect, you probably have a lot of questions and some concerns.
    [Show full text]
  • Travatan, INN-Travoprost
    SCIENTIFIC DISCUSSION This module reflects the initial scientific discussion for the approval of Travatan. This scientific discussion has been updated until 1 November 2003. For information on changes after this date please refer to module 8B. 1. Introduction Travoprost is a prostaglandin analogue intended for use to reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. The product is presented in a concentration of 40 µg/ml of preserved eye drops (0.004%). The dose is one drop of Travoprost Eye Drops in the conjunctival sac of the affected eye(s) once daily. Travoprost Eye Drops contains travoprost (AL- 6221), a prostaglandin analogue, in a sterile ophthalmic solution formulation and it is a selective, full agonist for the FP prostanoid receptor. FP receptor agonists are reported to reduce IOP by increasing uveoscleral outflow. Rationale for the product Glaucoma is the leading cause of irreversible blindness in the world. It is a frequent disease and it has been estimated that 66.8 million have glaucoma, 6.7 million of whom are bilaterally blind. Open angle glaucoma is the most common type, mainly primary but also, in some cases, open angle glaucoma is secondary to the exfoliation syndrome or other primary ocular diseases. Glaucoma is an optic neuropathy that leads to loss of optic-nerve tissue with an excavation of the ophthalmoscopically visible optic nerve head and consequently, to a progressive loss of vision. The elevated IOP is the main risk factor for its development and reduction of IOP has been demonstrated to protect against further damage to the optic nerve, even in patients with IOP that is statistically "normal" (so called normal tension glaucoma).
    [Show full text]