Is glaucoma combination therapy a waste of time?

Is glaucoma combination therapy a waste of time?

It has been demonstrated that a single compound is as effective as fixed combination therapy in lowering intraocular pressure (IOP), according to a study presented at the recent ARVO (Association for Research in Vision and Ophthalmology) meeting.

It is common practice for glaucoma patients on a single agent to be prescribed a second, additive compound; however, patients could now benefit from switching to bimatoprost (Lumigan), according to a study presented by Luca Rossetti, MD.

An earlier study compared Lumigan monotherapy with dual Xalatan/timolol therapy in non-fixed combinations. The IOP lowering ability of Lumigan compared with Xalatan has been well-documented since the compound became available but it is only now that the important therapeutic implications of Lumigan in monotherapy replacement are becoming clear.

Laser treatment speeds onset of CNV

According to a study published in the February 2006 issue of the American Journal of Ophthalmology, prophylactic laser treatment actually accelerates choroidal neovascularization (CNV) in patients with unilateral age-related maculopathy (ARM).

A team of researchers, led by Sarah Owens, MD from the Moorfields Eye Hospital, London, UK, performed a prospective, interventional, randomized, controlled clinical trial in five centres in the UK, Germany and Australia. The patients in the unilateral group had neovascular ARM and drusen and were randomized to receive laser treatment or no treatment at all. For those in the bilateral drusen group, eyes were randomized to right eye, laser or no laser; and left eye, alternative. During the three-year follow-up period, best-corrected visual acuity measurements were taken and signs of CNV were sought.

At three years, 28.8% of laser subjects in the unilateral group had lost vision as opposed to just 19.7% of those receiving no treatment. The occurrence of CNV was recorded at 29.7% in laser patients and 17.7% in untreated patients with onset of the condition appearing, on average, six months earlier in the laser group.

In the bilateral drusen group, vision loss occurred in 8.3% of the laser-treated eyes as opposed to 13.9% of the fellow, untreated eyes. CNV was recorded in 11.6% and 6.8% of eyes, respectively and no difference in the onset was observed.

The researchers concluded that the use of prophylactic lasers in the fellow eye of patients with neovascular ARM cannot be justified as it appears to speed up the onset of CNV. However, it is, as yet, unclear what effect it may have on patients with bilateral drusen.

Optometrists: help or hindrance?

A study published in the British Journal of Ophthalmology, found that optometrists are able to make suitable, informed decisions and can work safely in a hospital setting.

The study revealed a 55% agreement between consultants and optometrists for evaluation of visual field status, 79% for medical management, 72–98% for other aspects of patient management and 78% for scheduling of next clinic appointment. Overall, the level of agreement between optometrist and consultant was comparable.

The authors concluded that, within an appropriate environment, optometrists can safely work as part of the hospital glaucoma team in outpatient clinics.