Axonal loss was detected not only in MS eyes with a previous acute optic neuritis, but also in MS eyes with no known optic neuritis episode. Structural abnormalities correlate with functional assessments of the optic nerve.

Aim: To conduct a meta-analysis of randomised clinical trials (RCTs) in order to evaluate the development of conjunctival hyperaemia after the use of latanoprost versus travoprost and bimatoprost, in patients with ocular hypertension or glaucoma. Methods: In order to identify the potentially relevant RCTs, a systematic literature retrieval was conducted in Medline, Embase and Cochrane Controlled Trials Register (1995-April 2007) databases The outcome measure was the appearance of conjunctival hyperaemia during the study. Statistical analyses included the calculation of odds ratio (OR) and its respective confidence interval, along with intertrial statistical heterogeneity. Publication bias was evaluated through a funnel plot, and a sensitivity analysis was also performed. Results: In total, 13 RCTs involving 2222 patients with ocular hypertension or glaucoma were included, five comparing latanoprost versus travoprost, seven comparing latanoprost versus bimatoprost and one comparing latanoprost versus travoprost and bimatoprost. The combined results showed that latanoprost produced lower occurrence of conjunctival hyperaemia than both travoprost (OR = 0.51; 95% CI 0.39 to 0.67, p,0.0001) and bimatoprost (OR = 0.32; 95% CI 0.24 to 0.42, p,0.0001). No significant heterogeneity was found between the included RCTs. There was no evidence of publication bias. In the sensitivity analysis performed, none of the clinical trials included in this meta-analysis has an important impact in the global estimation of OR. Conclusions: According to available data, the use of latanoprost is associated with a lower incidence of conjunctival hyperaemia when compared with travoprost and bimatoprost in the treatment of patients with ocular hypertension or glaucoma.The estimated prevalence of glaucoma is 2% in the general population, 3% in people over 50, 5.7% in subjects 73 and 74 years old and 23.2% in those aged 75 years and older. This number is expected to increase in the future, given the progressive ageing of the population. 1-3For patients with ocular hypertension or openangle glaucoma, drug therapy focuses on reducing intraocular pressure (IOP) levels in order to delay or prevent the progression of ocular hypertension to glaucoma, and to slow disease progression in glaucoma patients. 4 5 In both cases, patients require lifelong treatment and follow-up care to preserve vision, so it is essential long-term patient compliance and medication persistency, because those who do not continue therapy risk developing elevated IOP levels and, over time, progressing to blindness. 6Compliance and persistency depends on many factors, including patient satisfaction with medication, medication costs, ease of medication administration and patient understanding of the importance of taking their medication over the long term, although one of the most important factors is local and systemic side effects. Currently, first-line treatment usually consists of monotherapy with a topical hypotensive drug. Although ophthalmologists traditionall...

Axonal loss in the optic nerve of patients with MS is greater than that expected in healthy subjects, regardless of the presence of a previous optic neuritis.

Acta Ophthalmol. 2010: 88: 748–752 Abstract. Purpose:  This study aimed to evaluate the presence of abnormalities in the retinal nerve fibre layer (RNFL) in multiple sclerosis (MS) patients with normal ophthalmic examination, and to compare the ability of optical coherence tomography (OCT) and scanning laser polarimetry (GDx) to detect axonal loss. Methods:  Patients with MS and disease‐free controls were invited to enrol in the study from 1 February 2007 to 30 June 2008. Ophthalmic examination, including evaluation of visual acuity (VA) and visual field (VF), showed normal results in all subjects. Retinal nerve fibre layer properties were measured by means of OCT and GDx. Visual evoked potentials (VEPs) were also recorded. Results:  Forty eyes of 40 MS patients and 20 eyes of age‐ and sex‐matched controls were included in the study. Despite normal VA and VF results, significant differences between the two groups were observed in VF mean deviation (MD), most of the RNFL measurements provided by OCT and GDx, and VEP P100 latency and amplitude. There was a significant correlation between OCT and GDx parameters, and between these parameters and VEP results. Nineteen MS eyes (35.7%) showed RNFL abnormalities detected either by OCT or GDx. Discussion:  Sub‐clinical ganglion cell loss can be detected in MS patients with normal visual function. Both OCT and GDx are useful complementary tools with which to identify this damage.

FDT and SWAP detect functional losses in cases of suspected glaucoma before glaucomatous losses detected by SAP.

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