Uniocular Drug Trial

Ophthalmology, 2004

To determine if the intraocular pressure (IOP) reduction observed in a uniocular trial correlates with the IOP reduction seen in the fellow eye when the same medication is then administered to the second eye of patients with glaucoma. Observational case series. Fifty-two patients with bilateral glaucoma. Glaucoma patients underwent uniocular trials of various glaucoma medications, then subsequently received the same drug in the fellow eye. The IOP reduction observed in the first eye was compared with that observed in the second eye to determine correlation. Intraocular pressure reduction in fellow-eye pairs. Intraocular pressure dropped a mean of 5.7+/-3.8 mmHg (mean +/- standard deviation) in the first eye after a uniocular trial, and 2.8+/-3.3 mmHg in the second eye after bilateral use. Regression analysis demonstrated a poor correlation between first-eye and second-eye response to the same medication (r(2) = 0.0174). To minimize possible contralateral IOP effects of first-eye therapy, a subset of 26 patients treated with latanoprost (which has little if any contralateral IOP effect, due to rapid systemic metabolism) was studied, with no improvement in correlation (r(2) = -0.0023). Uniocular trials of glaucoma medications do not adequately predict second-eye IOP responses to the same medications. If both eyes of a glaucoma patient require IOP reduction, one should not assume that magnitudes of response will be equal in both eyes. The effect of a given medicine must be assessed independently for each eye.

American Journal of Ophthalmology, 2008

PURPOSE: To evaluate whether inter-visit intraocular pressure (IOP) range, which reflects extreme and potentially damaging IOP fluctuations, provides additional information on IOP control compared to mean IOP.

American Journal of Ophthalmology, 2008

PURPOSE: To evaluate long-term intraocular pressure (IOP) fluctuation in patients with glaucoma or ocular hypertension treated with bimatoprost or latanoprost.

British Journal of Ophthalmology, 2005

Aim: To assess the intraocular pressure (IOP) variability in patients with primary open angle glaucoma (POAG) under clinical treatment who reached an established target pressure based on isolated office readings. Methods: Retrospective analysis of 65 eyes from 65 POAG patients under clinical therapy who submitted to modified diurnal tension curve (mDTC) (measurements at every 3 hours between 8 am and 5 pm) followed by a water drinking test (WDT). All subjects had established target IOP (15 mm Hg at 11 am or 2 pm. IOP variability during mDTC or WDT was evaluated. Results: mDTC revealed IOP measurements >17 mm Hg in 16 of 65 eyes (24.6%). Nine eyes (13.8%) presented values >18 mm Hg. The highest IOP detected by mDTC was 20 mm Hg in one patient (1.5%). WDT demonstrated IOP values >17 mm Hg in 32 of 65 eyes (49.2%). 22 eyes (33.8%) presented values >18 mm Hg after water ingestion. Moreover, IOP levels >20 mm Hg were observed in 14 eyes (21.5%). Conclusion: A great percentage of POAG patients undergoing clinical treatment and with IOP control based on single office measurement present significantly higher IOP measurements when performing mDTC and, especially, the WDT.

Ophthalmology, 2009

Purpose: To describe variability of intraocular pressure (IOP) measurements within the same eye and between right and left eyes over a 60-month period in participants in the Ocular Hypertension Treatment Study.

IP innovative publication pvt. ltd, 2019

Aim and Objectives: This article attempts to elucidate the role of round the clock IOP control and its relevance to current glaucoma practice. Materials and Methods: A prospective observational study was carried out on 50 patients of POAG or CACG on medical management whose intraocular pressures were found to be controlled by daytime office hours IOP estimation. The diurnal IOP readings obtained with Clarkes Hand held Perkins applanation tonometer and Reicherts Tonopen at 7am, 10am, 1pm, 4pm, 7pm, 10pm, 1am and 4am. Comparison of office hours IOP, extended office hours DVT and 24 hours IOP was done. Results: Fifty patients were enrolled (mean age: 53.88 ± 8.42 years) in the study. The mean office hours IOP for both eyes was significantly less (16.31±2.46) than extended office hours (17.18±2.50) and 24 hours DVT (17.49 ±2.45). There was significant difference in IOP fluctuation in office (3.72±2.14) versus extended office hours (9.26±3.11) and 24 hours DVT (10.28±2.76). The mean office hours peak IOP was significantly lower than that of extended office hours and 24 hours DVT. Conclusion: 24-hour IOP monitoring can reveal higher peaks and wider fluctuation of IOP than those found during typical office hours, it suggests a greater role for IOP-related risk for glaucoma progression. Thus may justify a more aggressive IOP-lowering treatment strategy.

Survey of Ophthalmology, 2009

Glaucoma is one of the leading causes of visual impairment and blindness. Lowering intraocular pressure (IOP) is the only proven means to slow or halt disease progression among those at higher risk of developing glaucoma and those with early to moderate or more advanced glaucoma. Recent publications have highlighted the potential for increased rates or likelihood of worsening glaucoma among those with larger IOP swings within defined time periods. The purpose of this systematic, comprehensive review and analysis of the literature was to assess the state of knowledge in the area of IOP changes over time and the potential impact of such changes on treatment. Current literature indicates that a random IOP measurement is a poor surrogate for IOP levels throughout the day and across visits. We address several key questions: 1) What is the best way to measure IOP? 2) Should multiple IOP measurements be performed in a day in the office (short-term IOP fluctuation)? 3) Is measurement at night required? 4) Should clinicians begin to assess long-term IOP fluctuation in patients under stable treatment (across days or visits)? and 5) Should therapy choices be influenced by properties of different treatment options relative to short- or long-term IOP fluctuation?

International Ophthalmology, 1989

The traditional opinion that increased intraocular pressure is the cause of glaucoma is controversial, probably mainly because of the fact that firm evidence for the value of pressure reduction is largely lacking. The present article reviews results from short term studies of visual fields before and after pressure reduction. It also reviews published and unpublished preliminary results from studies, addressing the problem of whether the long term visual field prognosis, in glaucoma and in ocular hypertension, is'affected by pressure lowering therapy. There is no convincing agreement among results from modem studies using computerized perimetry indicating that acute lowering of the ocular tension results in an improvement of the glaucomatous visual field. Long-term result are equally conflicting, and often negative. We have noted from a preliminary analysis of our own masked, prospective study of patients with 'high risk' ocular hypertension, that the same results may be interpreted in quite different ways. The results of available studies certainly indicate that pressure reduction does not automatically lead to clear and positive effects on the visual field. The studies have often been small, however, and have usually not had the power of detecting small effects of treatment. Also, pressure reduction has usually not been dramatic and many treated patients have maintained 'elevated' pressure levels. Patients with very high pressures have not been included, and the effect of pressure reduction in this situation has" therefore not been investigated at all. More controlled, prospective therapeutic studies are necessary and ethical. It seems particularly important to study the long-term effects of non-pharmacologi~lly induced pressure reduction in patients with manifest field loss. It is necessary to make every effort to avoid bias not only in the desig~ of such studies, but also in the interpretation of their results.

Ophthalmology, 2007

To study the concordance of diurnal intraocular pressure (IOP) between fellow eyes in primary open-angle glaucoma (POAG). Design: Retrospective chart review. Participants: Ninety-three POAG patients. Methods: Patients who met the definition of POAG and underwent diurnal curve measurement were included. Subjects were excluded if there was a history of surgery, trauma, ocular vascular disease, incomplete diurnal curve, or asymmetric ocular medication use. Patients on symmetric ocular medication were included and analyzed separately. Goldmann applanation tonometry was performed at 10 AM, 1 PM, 4 PM, 7 PM, 10 PM, and 7 AM (the next day). The following statistical analyses were performed: (1) average Pearson correlation coefficient (r) from individual correlations of right and left eye IOP over the 6 time points for each subject; (2) linear mixed model analysis for repeated measures, with eye (right and left) and time as the within-subject fixed effects, and (3) absolute difference in change in IOP between fellow eyes over each time interval and probability that the difference was within 2 or 3 mmHg. Main Outcome Measure: The concordance of the IOP between fellow eyes as measured by absolute difference in change in IOP between fellow eyes and probability of the difference being within 2 or 3 mmHg. Results: Thirty-seven patients were untreated and 56 were treated on symmetric IOP-lowering medications. The diurnal curves of fellow eyes exhibited parallel profiles according to the linear mixed model. The average difference in the change of IOP between fellow eyes over given time intervals ranged from 1.6 to 2.0 mmHg. The estimated probability that the absolute change in IOP between fellow eyes was within 2 mmHg was 68% to 90%, and within 3 mmHg was 78% to 95% for all time intervals. Conclusion: The diurnal variation of IOP in POAG is largely concordant between fellow eyes. For any given time interval, the fellow eye IOPs may fluctuate asymmetrically a minority of the time. Clinicians who utilize the uniocular trial should be aware of the limit of the IOP concordance. Ophthalmology 2007;

British Journal of Ophthalmology, 2007

Aim: To evaluate the diurnal intraocular pressure (IOP) control and safety of bimatoprost versus latanoprost in exfoliative glaucoma (XFG). Methods: One eye of 129 consecutive patients with XFG (mean (SD) age 66.5 (8.3) years) was included in this prospective, observer-masked, three-centre, crossover comparison. After a 4-6 week medicine-free period patients were randomised to bimatoprost or latanoprost monotherapy for 3 months. Patients were then switched to the opposite treatment for another 3 months. At the end of the washout and the treatment periods diurnal IOP was measured at 0800, 1300, and 1800. Results: At baseline the IOP (mean (SD)) was 28.0 (4.0), 26.9 (3.6), and 25.9 (3.6) mm Hg, at the three time points, respectively. Both treatments significantly reduced mean diurnal IOP at month 3. Mean diurnal IOP was 26.9 (3.5) mm Hg at baseline, 17.6 (3.3) mm Hg with bimatoprost, and 18.6 (3.6) mm Hg with latanoprost (p,0.0001). Furthermore, lower IOP values were obtained with bimatoprost at all time points (17.9 (3.4), 17.3 (3.3), and 17.6 (3.5) mm Hg, respectively) compared with latanoprost (18.7 (3.6), 18.5 (3.6), and 18.6 (4.1) mm Hg, respectively). The corresponding mean differences (0.8, 1.1, and 1.0 mm Hg, respectively) were all significant (p,0.001 for each comparison). Significantly more patients with XFG obtained a target diurnal IOP ,17 mm Hg with bimatoprost than with latanoprost, 55/123 (45%) v 34/123 (28%); (p = 0.001), and significantly fewer patients were non-responders with bimatoprost than with latanoprost (5 v 13, p = 0.021). More patients reported at least one adverse event with bimatoprost than with latanoprost (58 v 41 at 3 months; p = 0.0003). Conclusion: This crossover study suggests that better diurnal IOP control is obtained with bimatoprost than with latanoprost in patients with XFG.