Comparative Effectiveness of Treatments for Open-Angle Glaucoma: A Systematic Review for the U.S. Preventive Services Task Force

Boland, Michael V.; Ervin, Ann Margret; Friedman, David S.; Jampel, Henry D.; Hawkins, Barbara S.; Vollenweider, Daniela; Chelladurai, Yohalakshmi; Ward, Darcy; Suarez‐Cuervo, Catalina; Robinson, Karen A.

doi:10.7326/0003-4819-158-4-201302190-00008

Cited by 239 publications

(219 citation statements)

References 40 publications

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“…However, which treatments are the best to prevent visual disability and improve patient‐reported outcomes are not known (Boland et al. 2013). Some previous traditional meta‐analyses (Zhang et al.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Huang

Zhang

2017

Acta Ophthalmologica

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PurposeTo assess the efficacy and safety of different regimens, including monotherapy and double therapy, for primary open‐angle glaucoma (POAG) or ocular hypertension.MethodsWe searched PubMed, EMBASE and clinicaltrials.gov for studies that fit our inclusion criteria in this network meta‐analysis. Randomized controlled trials that report data on efficacy and safety of medications for POAG or ocular hypertension are included. Data on intra‐ocular pressure (IOP) lowering effect and incidence of adverse events including hyperaemia and ocular discomfort were extracted and used in mixed‐comparison analysis.ResultsThis study includes 72 randomized trials. Data were available on 12 medical treatments of POAG or ocular hypertension. Of 66 possible comparisons of outcome efficacy, 15 treatments were compared directly. Compared to prostaglandin analogues (PGA), beta‐blockers (BB) showed relatively weaker ability to lower IOP, followed by α2‐adrenergic agonists (AA) and carbonic anhydrase inhibitors (CAI). For dual therapy, regimens composed of a combination of PGA with another treatment demonstrated more powerful IOP lowering efficacy, while the combination of two non‐PGA drugs had lower efficacy in controlling IOP than PGA alone. There was no statistical significance in combinations that did not include PGA on efficacy of IOP control. In terms of tolerance, PGA alone leads to more severe hyperaemia than any other monotherapy regimen, while BBs have the lowest effect on the incidence of hyperaemia. Most dual therapy regimens containing PGA also lead to serious hyperaemia, with the exception of PGA + AA. Compared to regimens containing PGA, those with BB are less likely to cause hyperaemia.ConclusionOur network meta‐analysis showed that PGAs provide best IOP lowering effect among all the monotherapy regimen. Combination of PGA and other category of drugs leads to better IOP decrease. Combination of BB and another non‐PGA drug may have less ocular side‐effects than PGA alone.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Huang

Zhang

2017

Acta Ophthalmologica

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“…One important point is that glaucoma is a complex disease resulting from the confluence of various factors. [27][28][29][30][31][32]43,44 To fill the gap between glaucoma patients and animal disease models, 45 we are currently investigating GLAST gene abnormalities in glaucoma patients.…”

Section: -37mentioning

confidence: 99%

Dock3 attenuates neural cell death due to NMDA neurotoxicity and oxidative stress in a mouse model of normal tension glaucoma

et al. 2013

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Dedicator of cytokinesis 3 (Dock3), a new member of the guanine nucleotide exchange factors for the small GTPase Rac1, promotes axon regeneration following optic nerve injury. In the present study, we found that Dock3 directly binds to the intracellular C-terminus domain of NR2B, an N-methyl-D-aspartate (NMDA) receptor subunit. In transgenic mice overexpressing Dock3 (Dock3 Tg), NR2B expression in the retina was significantly decreased and NMDA-induced retinal degeneration was ameliorated. In addition, overexpression of Dock3 protected retinal ganglion cells (RGCs) from oxidative stress. We previously reported that glutamate/aspartate transporter (GLAST) is a major glutamate transporter in the retina, and RGC degeneration due to glutamate neurotoxicity and oxidative stress is observed in GLAST-deficient (KO) mice. In GLAST KO mice, the NR2B phosphorylation rate in the retina was significantly higher compared with Dock3 Tg:GLAST KO mice. Consistently, glaucomatous retinal degeneration was significantly improved in GLAST KO:Dock3 Tg mice compared with GLAST KO mice. These results suggest that Dock3 overexpression prevents glaucomatous retinal degeneration by suppressing both NR2B-mediated glutamate neurotoxicity and oxidative stress, and identifies Dock3 signaling as a potential therapeutic target for both neuroprotection and axonal regeneration.

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“…For this reason, improving awareness of glaucoma in the general population is important to early diagnosis to ensure that individuals at risk undergo appropriate eye examinations. Although screening the general population for glaucoma might reduce incidences of late presentation (Ramesh et al, 2010), at present there is no single effective screening test, largely due to the wide variation in normal (Boland et al, 2013;Burr et al, 2007). Nevertheless, while population screening is not cost effective, the targeted screening of high-risk groups may be cost effective (e.g., those with African ancestry or family history of glaucoma).…”

Section: Combining Information From Structural and Functional Testsmentioning

confidence: 99%

Strategies to improve early diagnosis in glaucoma

Tatham¹,

Medeiros²,

Zangwill³

et al. 2015

Progress in Brain Research

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Early diagnosis and treatment of glaucoma is important to reduce the risk of progressive and irreversible visual loss. The key to diagnosis is recognition of morphological changes to the optic nerve head and retinal nerve fiber layer, but in some patients, functional abnormalities are detected first. This review describes recent innovations with the potential to improve the early detection of glaucoma. Developments in imaging include novel optic nerve head metrics such as Bruch's membrane opening-minimum rim width, enhanced ability to quantify inner layers of the glaucomatous macula, and ability to image deep optic nerve head structures, including the lamina cribrosa. Developments in detection of early glaucomatous functional loss include novel perimetric tests using frequency-doubling technology and flicker-defined form stimuli. Methods to combine results of structural and functional assessments are also presented that may improve early detection of glaucoma. KeywordsGlaucoma, Optical coherence tomography, OCT, Perimetry, Spectral domain, Early diagnosis Glaucoma is a leading cause of blindness, affecting more than 70 million people worldwide, of whom approximately 10% are bilaterally blind (Quigley and Broman, 2006). Glaucomatous visual losses can be prevented with early diagnosis and treatment; however, affected individuals are typically asymptomatic until later stages of the disease and a large proportion of those affected remain undiagnosed. Population-level surveys suggest only 10-50% of people with glaucoma are aware that they have the condition and consequently there are a large number of people Progress in Brain Research, Volume 221, ISSN 0079-6123, http://dx

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Comparative Effectiveness of Treatments for Open-Angle Glaucoma: A Systematic Review for the U.S. Preventive Services Task Force

Abstract: Medical and surgical treatments for open-angle glaucoma lower intraocular pressure and reduce the risk for optic nerve damage over the short to medium term. Which treatments best prevent visual disability and improve patient-reported outcomes is unclear.

Cited by 239 publications

References 40 publications

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Dock3 attenuates neural cell death due to NMDA neurotoxicity and oxidative stress in a mouse model of normal tension glaucoma

Strategies to improve early diagnosis in glaucoma

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