Gold standard medical therapy for glaucoma: Defining the criteria identifying measures for an evidence-based analysis

Obstbaum, Stephen A.; Cioffi, George A.; Krieglstein, Guenther K.; Fennerty, M. Brian; Alm, Albert; Araie, Makoto; Carassa, Roberto; Greve, E. L.; Hitchings, Roger A.; Kaufman, Paul L.; Kitazawa, Yoshiaki; Pongpun, Prin Rojana; Susanna, Remo; Wax, Martin B.; Zimmerman, Thom J.

doi:10.1016/j.clintera.2004.12.007

Cited by 16 publications

(12 citation statements)

References 122 publications

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“…Timolol maleate (Timoptic) has been viewed as the gold standard therapy for glaucoma 7 and is used as the clinical benchmark in ocular hypotensive medication-registration trials. 8,9 DBA/2J mice develop a genetically determined form of pigmentary glaucoma that resembles iris stromal atrophy and iris pigment dispersion syndrome in humans.…”

Section: Resultsmentioning

confidence: 99%

A Neurobehavioral Analysis of the Prevention of Visual Impairment in the DBA/2J Mouse Model of Glaucoma

Wong¹,

Brown²

2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Timoptic-XE treatment was used to examine the relationship between age-related changes in intraocular pressure (IOP), retinal cell loss, visual ability, and neuronal labeling in the superior colliculus in the DBA/2J mouse model of pigmentary glaucoma.METHODS. Mice were administered Timoptic-XE (0.0%, 0.25%, or 0.50%) daily from 9 weeks to 12 months of age. Visual ability and IOP were evaluated at 3, 6, 9, and 12 months of age. Mice from each group were then given intraocular injections of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP), and estimates of the number of cells in the ganglion cell layer of the retina, WGA-HRP transneural labeling of cells, cell count, and cross-sectional area of Nissl-stained cells in the superior colliculus were obtained. RESULTS.Mice treated with 0.50% and 0.25% Timoptic-XE maintained a high level of performance in behavioral vision tasks, while 12-month-old untreated mice (0.0% Timoptic-XE) exhibited impaired visual performance. Timoptic-XE therapy reduced IOP and cell loss in the ganglion cell layer of the retina and prevented somal shrinkage and the decrease in WGA-HRP transneural labeling in the superior colliculus that occurred in untreated mice at 12 months of age.CONCLUSIONS. This study provides a comprehensive assessment of the efficacy of Timoptic-XE in DBA/2J mice by correlating age-related visual system changes in the retina and brain with changes in IOP and visual ability. These results showed that reducing IOP not only rescued retinal ganglion cell atrophy but also restored visual function and altered patterns of neurodegeneration that occur with blindness. (Invest Ophthalmol Vis Sci. 2012;53:5956-5966) DOI:10.1167/iovs.12-10020 G laucoma is the second leading cause of blindness after cataracts.1 Clinically, glaucoma is characterized by ''cupping'' of the optic nerve head and visual deterioration due to the progressive loss of retinal ganglion cells and axons. 2,3 Pigmentary glaucoma is caused by the liberation of melanin pigment through the mechanical disruption of the posterior iris by the lens zonules. When pigment accumulates within the anterior segment structures and the trabecular meshwork, it blocks aqueous outflow, resulting in an increase in intraocular pressure (IOP) and subsequent damage to the optic nerve and retinal ganglion cell death. 4,5 High IOP (>21 mm Hg) is the strongest and most consistent risk factor for glaucoma; and although not all patients exhibit ocular hypertension, the probability of retinal ganglion cell loss and optic nerve damage increases exponentially with higher IOP, thus all current glaucoma treatments involve the reduction of IOP.2,6 Timolol maleate, a nonselective b 1 and b 2 adrenergic receptor antagonist, applied topically to the eye, decreases IOP by reducing aqueous humor production by blocking of breceptors on the ciliary epithelium. Timolol maleate (Timoptic) has been viewed as the gold standard therapy for glaucoma 7 and is used as the clinical benchmark in ocular hypotensive medication-registr...

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Section: Resultsmentioning

confidence: 99%

A Neurobehavioral Analysis of the Prevention of Visual Impairment in the DBA/2J Mouse Model of Glaucoma

Wong¹,

Brown²

2012

Invest. Ophthalmol. Vis. Sci.

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“…OAG, of which NTG may be a subgroup, is part of a group of pathologic entities marked by optic neuropathy, which can ultimately lead to permanent vision loss. Although the exact mechanism involved in the pathophysiology of glaucoma is not fully understood, clinical literature reveals that progression of the disease is clearly slowed by reducing the IOP, even in patients with NTG [11,12]. Physiology of the ocular anatomy and fluid dynamics within the eye are key to understanding the fluctuations in intraocular pressure.…”

Section: Disease Progressionmentioning

confidence: 99%

Open-Angle Glaucoma: Burden of Illness, Current Therapies, and the Management of Nocturnal IOP Variation

et al. 2019

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Glaucoma is a chronic, debilitating disease and a leading cause of global blindness. Despite treatment efforts, 10% of patients demonstrate loss of vision. In the US, [ 80% of glaucoma cases are classified as open-angle glaucoma (OAG), with primary open-angle (POAG) being the most common. Although there has been tremendous innovation in the surgical treatment of glaucoma as of late, two clinical variants of OAG, normaltension glaucoma (NTG) and severe POAG, are especially challenging for providers because patients with access to care and excellent treatment options may progress despite achieving a ''target'' intraocular pressure value. Additionally, recent research has highlighted the importance of nocturnal IOP control in avoiding glaucomatous disease progression. There remains an unmet need for new treatment options that can effectively treat NTG and severe POAG patients, irrespective of baseline IOP, while overcoming adherence limitations of current pharmacotherapies, demonstrating a robust safety profile, and more effectively controlling nocturnal IOP.

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“…Minimal frequency of dosage in order to promote full patient compliance; and finally, 5. Applicability in diverse patient populations (Obstbaum et al 2004). To many caregivers, this would sound akin to a very demanding yet unrealistic list.…”

Section: Choice Of Medical Therapymentioning

confidence: 99%

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

Kulkarni¹,

Damji²,

Buys³

2008

PPA

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Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms “compliance, persistence and adherence” with reference to medication use is central not only for monitoring patients’ drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence.

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Gold standard medical therapy for glaucoma: Defining the criteria identifying measures for an evidence-based analysis

Cited by 16 publications

References 122 publications

A Neurobehavioral Analysis of the Prevention of Visual Impairment in the DBA/2J Mouse Model of Glaucoma

A Neurobehavioral Analysis of the Prevention of Visual Impairment in the DBA/2J Mouse Model of Glaucoma

Open-Angle Glaucoma: Burden of Illness, Current Therapies, and the Management of Nocturnal IOP Variation

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

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