Influence of painless one-eye blindness on depression, anxiety and quality of life in glaucoma patients with a normal fellow eye.

BACKGROUND: For clinical practice it is important to evaluate and compare anxiety, depression and quality of life of glaucoma patients with painless one-eye blindness and a normal fellow eye to unaffected age-matched individuals from a similar environment. METHODS: Twenty-eight stable glaucoma patients (age, mean ± SD: 69.0 ± 13.3 years) with one normal and one painless blind eye, and 26 controls (age: 67.0 ± 14.0 years) completed the standard Hungarian adaptations of the Beck Depression Inventory, Beck Anxiety Inventory, Spielberger-Trait Anxiety Inventory, Hopelessness Scale, and Quality of Life Questionnaire SF-36 with the assistance of trained psychologist interviewers within 3 months after a detailed ophthalmological examination. RESULTS: The groups did not differ in age, gender distribution, number of children, grandchildren and people in their household (p ≥ 0.235). The best corrected visual acuity (BCVA) of the diseased eye was minimal (median: 0.00), while BCVA of their better eye (median: 1.0) did not differ from that of the control group (p ≥ 0.694). Compared to the control group, the patients' scores were significantly higher for depression (p ≤ 0.01), cognitive and psychophysiological symptoms of anxiety (p ≤ 0.05) and hopelessness (p ≤ 0.013), and lower (worse) for physical function, vitality, general health and bodily pain (p ≤ 0.045). No difference was found between the groups for mental health, physical role functioning, emotional role functioning and social role functioning (p ≥ 0.117). CONCLUSION: Our results show that patients with glaucoma-related one-eye blindness may require regular psychological support even when the visual performance of the fellow eye is fully maintained on the long run, and the patients' everyday functioning is normal.

Correction to: Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: The VISIONARY Study.

In the original article, the The VISIONARY Study Group Principal Investigator Jose Javier Garcia-Medina.

Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: The VISIONARY Study.

INTRODUCTION: A non-interventional, multicenter, European, prospective evaluation of the effectiveness, tolerability, and safety of a topical preservative-free tafluprost (0.0015%) and timolol (0.5%) fixed-dose combination (PF tafluprost/timolol FC) in adults with open-angle glaucoma (OAG) and ocular hypertension (OHT) demonstrating insufficient response to topical beta-receptor blockers or prostaglandin analogue (PGA) monotherapy. METHODS: Mean intraocular pressure (IOP) change from baseline was measured at study visits following a switch to PF tafluprost/timolol FC. Primary endpoint was absolute mean IOP change at month 6. Change from baseline concerning ocular signs and symptoms was also explored. RESULTS: Analyses included 577 patients (59.6% female). Mean age (SD) was 67.8 (11.67) years. Mean (SD) IOP reduction from baseline was significant at all study visits; 5.4 (3.76) mmHg (23.7%) at week 4, 5.9 (3.90) mmHg (25.6%) at week 12, and 5.7 (4.11) mmHg (24.9%) at month 6 (p < 0.0001 for all visits). At month 6, 69.2%, 53.6%, 40.0%, and 25.8% were responders based on ≥ 20%, ≥ 25%, ≥ 30%, and ≥ 35% cutoff values for mean IOP, respectively. Significant reductions were observed concerning corneal fluorescein staining (p < 0.0001), dry eye symptoms, irritation, itching, and foreign body sensation (p < 0.001 for each parameter). Conjunctival hyperemia was significantly reduced at all study visits (p < 0.0001 at each visit). Overall, 69 treatment-related adverse events (AEs) were reported, one of which was serious (status asthmaticus). Most AEs were mild to moderate in severity, and the majority had resolved or were resolving at the end of the study period. CONCLUSION: In clinical practice, PF tafluprost/timolol FC provided statistically and clinically significant IOP reductions in patients with OAG and OHT insufficiently controlled on or intolerant to PGA or beta-receptor blocker monotherapy. The full IOP reduction appeared at week 4 and was maintained over the 6-month study period. Key symptoms of ocular surface health improved. TRIAL REGISTRATION: European Union electronic Register of Post-Authorisation Studies (EU PAS) register number, EUPAS22204.

Real-life experience of using brinzolamide/brimonidine fixed drop combination in a tertiary glaucoma centre.

PURPOSE: To investigate the intraocular pressure (IOP)-lowering efficacy and tolerance of brinzolamide/brimonidine fixed combination (BBFC) under real-life conditions in a tertiary glaucoma centre. METHODS: Medical records of all ocular hypertensive and open-angle glaucoma patients (n = 52) treated with BBFC were retrospectively analysed. RESULTS: Thirty-nine patients had primary open-angle, 6 exfoliative, 2 pigment, 1 normal tension and 1 juvenile open-angle glaucoma and 3 ocular hypertension. The prior therapy was a prostaglandin analogue (PG) (n = 4), PG/timolol (n = 20), PG/timolol and topical carbonic anhydrase inhibitor (CAI; n = 19), timolol/CAI (n = 1), PG and CAI (n = 4), timolol/pilocarpine and PG (n = 1), timolol/brimonidine and PG (n = 1) and timolol/brimonidine, PG and CAI (n = 2). These were simplified to PG/timolol and BBFC (n = 41), PG and BBFC (n = 9), timolol and BBFC (n = 1) and timolol/pilocarpine, PG and BBFC (n = 1). The IOP on the study eyes was 21.2 ± 3.7 mmHg before and 16.9 ± 2.6, 16.0 ± 2.2, 17.6 ± 3.1 and 18.0 ± 3.1 mmHg after the introduction of BBFC at month 1, 3, 6 and 12, respectively (p < 0.0003 for all time points compared to baseline, p = 1.0 for all other comparisons). Thirty-one patients (59.6%) experienced no adverse event, 17 (32.7%) reported ocular and 6 (11.5%) systemic adverse events. BBFC therapy was terminated on 27 patients (51.9%): on 19 (36.5%) due to adverse events and on 8 (15.4%) due to insufficient IOP reduction. CONCLUSION: In real-life practice, the introduction of BBCF allows significant and clinically meaningful IOP reduction and therapy simplification in glaucoma patients requiring complex medication, but in more than one third of the patients it is not tolerated due to adverse events.

Prospective study of glaucoma referrals across Europe: are we using resources wisely?

BACKGROUND: To investigate the outcomes of glaucoma referrals across different European countries. METHODS: 250 patients newly referred to tertiary referral glaucoma specialist practices in the UK, Hungary, Slovenia, Italy and Greece were prospectively enrolled (50 consecutive patients per centre). Referral accuracy and predictive value of referral criteria for an intervention or further monitoring (positive predictive value) were analysed. RESULTS: Same-day discharges occurred in 43% (95% CI 39% to 75%) (12/28) of optometrist-initiated referrals (UK only), 37% (95% CI 30% to 45%) (59/158) of ophthalmologist-initiated referrals (all centres) and 54% (95% CI 40% to 68%) (26/48) of self-referrals (Hungary, Italy and Greece). The percentages from all referral sources were 46% (95% CI 32% to 60%) in the UK, 56% (95% CI 44% to 70%) in Hungary, 30% (95% CI 17% to 43%) in Slovenia, 22% (95% CI 11% to 34%) in Italy and 60% (95% CI 46% to 74%) in Greece (p<0.001). Overall, the referring criterion was confirmed in 54% (95% CI 45% to 63%) (64/119) for intraocular pressure (IOP) >21 mm Hg, 56% (95% CI 43% to 69%) (33/59) for a suspicious optic disc and 61% (95% CI 45% to 77%) (22/36) for a suspicious visual field, with large between-country differences (p<0.05 for all comparisons). Of all referrals, 32% (95% CI 26% to 37%) were initiated on the basis of IOP >21 mm Hg only. By combining the IOP criterion with any other referring criterion, the positive predictive value increased from 56% (95% CI 45% to 67%) to at least 89% (95% CI 68% to 100%). In the UK, a hypothetical IOP threshold of >26 mm Hg, as a requirement for IOP-only referrals, would reduce IOP-only referrals by 44%, while not missing any definite glaucoma cases. CONCLUSION: The accuracy of referrals was poor in the UK and the other countries. Requiring a combination of criteria and raising the IOP threshold for IOP-only referrals are needed to cut waste in clinical care.

Prostaglandin analogue-induced pigmentation of the skin of the nasal septum and nasal alae in a glaucoma patient.

PURPOSE: To present a case of topical prostaglandin analogue-induced skin pigmentation in a location previously never reported, with a differential diagnostic significance. CASE REPORT: An 83-year-old man successfully treated for primary open-angle glaucoma of both eyes with the bimatoprost/timolol fixed combination for 6 years reported increased pigmentation of the skin of the nasal septum and alae. According to his report, the darkened skin area was not present when he was a young or middle-aged man. The patient had noted periocular pigmentation and deepening of the upper lid sulcus on both sides, which developed during the years of his bimatoprost/timolol treatment. Dermatology consultation excluded any nevus, malignancy, or other pathology as a cause of the pigmentation. The otorhinolaryngology consultation failed to identify any pathologic condition in the nasal cavity, but described mild chronic senile rhinitis. CONCLUSIONS: The acquired pigmentation of the skin of the nasal septum and alae in our patient represents a new form of cutaneous pigmentation induced by topical prostaglandin analogue therapy, which may have differential diagnostic significance in clinical practice. We speculate that the senile rhinitis of the patient increased the exposure of the nasal skin to the prostaglandin analogue solution drained via the nasolacrimal duct, and could therefore play a role in the development of skin pigmentation in this location.

Evaluation of continuous 24-hour intraocular pressure monitoring for assessment of prostaglandin-induced pressure reduction in glaucoma.

PURPOSE: To evaluate 24-hour continuous intraocular pressure (IOP) monitoring with a telemetric contact lens sensor (CLS) to detect prostaglandin-induced IOP reduction. METHODS: In this prospective interventional study 9 ocular hypertensive and primary open-angle glaucoma patients were washed out from IOP-lowering medication for 6 weeks. One study eye per patient underwent 3 baseline 24-hour measurement curves 4 days apart: 2 curves with Sensimed Triggerfish CLS and 1 curve with Goldmann applanation tonometry (GAT). Then the patients received travoprost monotherapy for 3 months. The 24-hour CLS and GAT curves were repeated on the study eyes under treatment at the end of the third month. RESULTS: The 24-hour GAT IOP (mean±SD) decreased from 22.91±5.11 to 18.24±2.49 mm Hg (P<0.001). In contrast, the means of the 3 CLS curves showed no significant difference (152.94, 142.35, and 132.98 au, P=0.273). No difference was seen when the SD values of the 3 CLS curves were compared (133.51, 132.18, and 110.98 au, P=0.497). All CLS curves showed an increasing time trend (P≤0.001). Correlation of all 3 CLS curves of the individual eyes was high (r=0.726), but no correlation was seen between the corresponding CLS curve periods and GAT IOP values either at baseline (r=-0.223, P=0.546) or under treatment (r=0.320, P=0.402). No difference was seen between the erect/sitting (waking) and supine (sleeping) period CLS values (P>0.05). CONCLUSIONS: Our results suggest that the current CLS technique cannot be clinically used to monitor IOP decrease induced by topical medication in glaucoma, and has limited value in identification of transient IOP elevation periods.

Association of Cogan-Reese syndrome, exfoliation syndrome, and secondary open-angle glaucoma.

PURPOSE: To present a case with co-existence of Cogan-Reese syndrome and exfoliation syndrome. CASE REPORT: A 72-year-old Caucasian woman presented for consultation due to uncontrolled intraocular pressure (IOP) of the right eye. Clinical examination revealed the presence of Cogan-Reese syndrome and exfoliation syndrome OD. This eye exhibited elevated IOP, open anterior chamber angle, advanced glaucomatous optic nerve head damage, and severe glaucomatous visual field loss. The left eye was completely normal without IOP elevation or visual field damage. To our knowledge this is the first case report demonstrating the coexistence of the Cogan-Reese syndrome, exfoliation syndrome, and secondary open-angle glaucoma. Since both syndromes frequently lead to secondary open-angle glaucoma, it is not feasible to determine with certainty which condition was the cause of secondary open-angle glaucoma in our case. It is conceivable that both conditions contributed to glaucoma development. CONCLUSIONS: Cogan-Reese syndrome, exfoliation syndrome and secondary open-angle glaucoma may present on the same eye.

Risk factors associated with progression in exfoliative glaucoma patients.

PURPOSE: To evaluate exfoliative glaucoma (XFG) patients over 5 years, determining risk factors associated with progression or non-progression of glaucoma. METHODS: A retrospective, observational study. Patients were chosen from consecutive charts and data collected from each available visit included in the follow-up period. Data were abstracted for non-progressed XFG patients for 5 years and for progressed patients until glaucoma worsened. Progression was determined from patient records and by disc photographs. RESULTS: There were 71 (53%) progressed and 63 (47%) non-progressed XFG patients.Baseline parameters demonstrated worse visual field damage (p=0.014) and more prescribed medicines (p=0.03) in progressed patients. The mean intraocular pressure (IOP) for progressed patients was 18.7±4.3 and 17.3±3.4 mm Hg for non-progressed patients (p=0.047). The mean IOP that best separated the groups was 17 mm Hg with 60% staying non-progressed at or below this level and 30% above this level. At the last visit, progressed patients had more medicines prescribed (1.7) than non-progressed patients (1.3, p=0.005). A multivariate regression analysis showed higher mean, peak and variance of IOP, number of glaucoma medications at the final visit and presence of a disc hemorrhage (n=5) as independent risk factors for progression (p≤0.05). CONCLUSION: IOP reduction in XFG may be essential in reducing disease progression. The presence of disc hemorrhage in XFG may suggest an increased probability of progression despite treatment to within the normal IOP range.

Nonpopulation-based glaucoma screening exercise in an osteoporosis patient organization: can elderly persons with advanced health awareness identify their risk for glaucoma?

PURPOSE: To investigate whether osteoporosis patient organization members with advanced health awareness can identify their risk for glaucoma. METHODS: Members of an osteoporosis patient organization group were provided with structured written information on risk factors for glaucoma. Later, the participants completed questionnaires on their risk for glaucoma (average vs. increased), demographics, trait anxiety (Trait Anxiety Inventory), health anxiety (Shortened Health Anxiety Inventory), and underwent a detailed screening for glaucoma. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation. RESULTS: The average age of 114 self-recruited White attendees (107 female and 7 male) was 70.9 years (range, 41 to 88 y). The final prevalence of glaucoma was 7.9%. Forty-three participants indicated an increased risk for glaucoma and 71 participants did not estimate his/her risk to be increased. No relationship was found between the participants' response on the glaucoma risk assessment questionnaire and presence of glaucoma (Fisher exact test, P=0.725), presence of any risk factor of glaucoma (P>0.473 for all risk factors), various sociodemographic parameters (χ test, P>0.05 for all parameters), trait anxiety (Mann-Whitney test, P=0.178), or health anxiety (P=0.204). CONCLUSIONS: Our results suggest that even when general health information and awareness training sessions are regularly given to elderly members of a nonglaucoma patient organization, self-assessment of risk for glaucoma may remain poor among the members.

Long-term outcomes of prostaglandin analog versus timolol maleate in ocular hypertensive or primary open-angle glaucoma patients in Europe.

PURPOSE: To determine the direct costs of therapy over 5 years of a European monotherapy cohort begun on a prostaglandin (PTG) versus timolol in patients with primary open-angle glaucoma or ocular hypertension. METHODS: A retrospective, multicenter, active-controlled, observational study. Data were abstracted for European patients treated as initial monotherapy in 1996 or afterward, with 5 years of available records. RESULTS: This study included 271 patients (166 on a PTG and 105 on timolol at baseline). The average cost/month/patient over 5 years was $45.47±12.61 for PTG and $31.50±15.47 for timolol (P<0.001, based on German prices). After 5 years, although there was no difference in number of glaucoma medicines prescribed between groups (1.0 PTGs and 1.1 timolol, P=0.41), the timolol group demonstrated a higher intraocular pressure (17.7±2.9 vs. 16.5±3.0 mm Hg, P<0.001), more medication changes (P=0.01), greater incidence of glaucomatous progression (P=0.04), and less patients persistent on original monotherapy (P<0.001) than the PTG cohort. CONCLUSIONS: Patients originally on timolol monotherapy have a lower cost of care over 5 years than those started on a PTG. However, timolol patients during follow-up may demonstrate a higher intraocular pressure, more progression, more medication changes, and lower persistency of the original monotherapy.

Accuracy of the RTVue-100 Fourier-domain optical coherence tomograph in an optic neuropathy screening trial.

The aim of this study was to evaluate the usefulness of the RTVue-100 Fourier-domain optical coherence tomograph (RTVue-100 OCT) in screening for glaucoma and non-arteritic anterior ischemic optic neuropathy (NA-AION). In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma and NA-AION using the RTVue-100 OCT, and also by independent clinical examination. For the RTVue-100 OCT measurements, the optic nerve head (ONH) scan and the macular ganglion cell complex (GCC) scan were applied. Subjects with possible optic neuropathy (as indicated by any of the scans and/or by the clinical examination) underwent a detailed clinical investigation to verify or exclude the disease. Of the 146 attendees, 133 participants (256 eyes) successfully underwent the RTVue-100 OCT measurements. Of these, six eyes (2.3%) had glaucoma and three eyes (1.2%) had partial optic atrophy due to earlier NA-AION. The retinal nerve fibre layer (RNFL) parameters (provided by the instrument software) had 99.2-99.6% specificity, 96.5-96.9% accuracy, and positive likelihood ratio (PLR) of 27.3-54.7, but only 11.1-22.2% sensitivity. Accuracy and PLR for the ONH parameters were <95% and <8.3, respectively. The GCC scan of the macula provided up to 95.9% specificity, 94.0% accuracy, 10.7 PLR and 44.4% sensitivity. During the screening of this Caucasian population with 3.5% prevalence of optic neuropathy due to glaucoma and NA-AION, the RTVue-100 OCT was found to be useful for screening, with both RNFL and GCC parameters providing high accuracy and PLR values >10.

LOXL1 gene sequence variants and vascular disease in exfoliation syndrome and exfoliative glaucoma.

PURPOSE: To investigate whether the single nucleotide polymorphisms (SNPs) of the LOXL1 gene associated with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) are different in XFS/XFG patients with and without cardiovascular disease (CVD); and to compare the allele frequencies in XFS/XFG with those in ischemic cerebrovascular disease (stroke), in the Hungarian population. METHODS: G153D and R141L allele frequencies were determined for 56 XFS/XFG patients (10 patients with and 45 without CVD, 1 patient unclassified), and for 189 patients with stroke. RESULTS: For G153D the frequencies of guanine (G) and adenine (A) alleles were 71.4% and 28.6% in the ischemic stroke group, and 58.0% and 42.0% in XFS/XFG (χ test, P=0.008). The corresponding figures in XFS/XFG without CVD were 56.7% and 43.3%, and 60.0% and 40.0% in XFS/XFG with CVD (P=0.785). For R141L the frequencies of G and timidine (T) alleles were 68.2% and 31.7% in stroke patients, and 82.1% and 17.9% in XFS/XFG (P=0.004). No difference was seen for allele frequency distribution between XFS/XFG patients without and with CVD (84.4% and 15.6%; 80.0% and 20.0%, respectively, P=0.738). CONCLUSIONS: In Hungarians, the frequency of G (risk) allele of G153D SNP was low in XFS/XFG. The frequency of G allele in R141L and G153D SNPs of the LOXL1 gene did not differ between XFS/XFG patients with and without CVD, but its frequency was different in XFS/XFG and ischemic stroke. These results suggest that the G allele in these SNPs has no direct role in the development of vascular diseases associated with XFS/XFG.

Is there any difference in target intraocular pressure for exfoliative glaucoma patients with cardiovascular disease history?

PURPOSE: To investigate if patients with exfoliation glaucoma (XFG) with cardiovascular disease (CVD) require different target intraocular pressure (IOP) compared to patients with XFG with no CVD for long-term stability. METHODS: A retrospective, multicenter, observational cohort analysis included consecutive patients with XFG from 9 European academic centers, with a minimum of 5 years follow-up. RESULTS: In 201 patients, there was a statistical difference between progressed and non-progressed patients in mean (p=0.0049) and peak (p=0.015) IOP, variance of IOP (p=0.028), and number of medicine changes/year (p=0.0037). At a mean IOP ≥22 mmHg, patients progressed in 84% (32/38), between 14 and 21 mmHg in 54% (81/151), and at ≤13 mmHg in 33% (4/12). There was no difference in the rate of progression between groups based on CVD history (p=0.65). However, IOP that allowed ≤50% progression rate for patients with mild or no CVD was ≤20-21 mmHg and ≤18 mmHg for patients with severe disease. Further, at IOP ≥20 mmHg, 8% (1/12) of patients with severe CVD remained stable in contrast to 38% (16/42) of patients with mild and 21% (4/19) with no CVD history (p=0.0093). By multivariant regression analysis of the IOP and CVD measures, mean IOP was a risk factor for progression (p=0.0097). CONCLUSIONS: Although IOP is the main determinant of progression in XFG under treatment, history of severe CVD should be further investigated as potential risk factor for glaucomatous progression.

Influence of selective laser trabeculoplasty on 24-hour diurnal intraocular pressure fluctuation in primary open-angle glaucoma: a pilot study.

BACKGROUND AND OBJECTIVE: To investigate the influence of selective laser trabeculoplasty on mean diurnal intraocular pressure (IOP) and diurnal IOP fluctuation in primary open-angle glaucoma. PATIENTS AND METHODS: After washout from intraocular pressure-lowering drugs, a baseline diurnal IOP curve was obtained for 26 eyes of 13 patients before selective laser trabeculoplasty. The IOP curve was repeated at 3 and 6 months. RESULTS: In five eyes, office time (8:00 a.m. to 12:00 p.m.) IOP decreased by 20% or more. No similar decrease was seen in mean diurnal IOP in any case. IOP-lowering drugs were required for 11 eyes before the 3-month visit. Baseline diurnal IOP was higher for these eyes than for the others (P = .002). Compared with baseline values, a significant decrease was seen in mean IOP at the 6-month visit (P = .017) and in IOP fluctuation at both visits (P < .001 and P = .004, respectively) for the eyes without drug treatment. CONCLUSION: Although no eyes showed mean diurnal IOP reduction of 20% or more, selective laser trabeculoplasty resulted in a significant decrease in the amplitude of diurnal IOP fluctuation.

Personality traits, depression, and objectively measured adherence to once-daily prostaglandin analog medication in glaucoma.

PURPOSE: To investigate the influence of personality traits, depression, and training on objectively measured adherence to once-daily prostaglandin analog medication. METHODS: Adherence was measured with the Travalert Dosing Aid on 58 consecutive, regularly followed-up glaucoma patients already on self-administered travoprost. Before the 3-month data-collection period all patients received training on use of the device. Psychologic characteristics were measured using the State-Trait Anxiety Inventory, Eysenck Personality Questionnaire, and Beck Hopeless Scale and Depression Inventory. An adherent day was defined as travoprost instillation at 9 PM +/-2 hours. RESULTS: Adherence was 77% for the total period. Social desirability was higher than normal (U test, P<0.0001). Seven patients (12.1%) showed mild-to-moderate depression, which was not significantly associated with decreased adherence (Kruskal-Wallis test, P=0.071). Severity of glaucoma, number of ocular and systemic medications, satisfaction with the recording device, and socio-economic characteristics had no influence on adherence. CONCLUSIONS: Objectively measured adherence to once-daily prostaglandin analog medication was good, and not influenced by treatment characteristics or patient factors including mild-to-moderate depression. The elevated social desirability suggests that self-reported adherence is not a reliable measure of adherence in glaucoma.

Accuracy of scanning laser polarimetry, scanning laser tomography, and their combination in a glaucoma screening trial.

PURPOSE: To compare the usefulness in glaucoma screening of scanning laser polarimetry (GDx-VCC), scanning laser tomography [Heidelberg retina tomograph II (HRT II)], and their combined evaluation. METHODS: In a nonpopulation-based prepublicized trial, self-recruited white participants were screened for glaucoma with GDx-VCC, HRT II, and by independent clinical examination. Cases with possible glaucoma as found with any of the screening methods underwent a detailed clinical investigation to verify or exclude glaucoma. RESULTS: Of the 136 attendees 118 participants (218 eyes) successfully underwent the GDx-VCC and HRT II measurements. Twenty-three eyes (11%) of 13 participants had glaucoma. Seventeen of these glaucomatous eyes (74%) had early damage. Evaluated separately, the GDx-VCC screening test (borderline cases grouped with the normal cases) performed best with 96.8% specificity, 89.5% accuracy, 7.5 positive likelihood ratio (PLR), but with only 23.8% sensitivity. Accuracy and PLR for all HRT parameters were <86.4% and <3.7, respectively. Combining different threshold criteria, for GDx-VCC accuracy increased to 90.3% to 90.8% and PLR to 14.0 to 17.7; but for HRT no useful increase was seen (accuracy <86.4% and PLR<4.7 for all combinations). Combination of the best HRT and GDx-VCC criteria resulted in a PLR which was increased compared with the HRT combinations, but decreased compared with the GDx-VCC combinations (PLR<12.7 for all combinations). CONCLUSIONS: In this white screening population with relatively high risk for mild glaucomatous damage, a combination of different GDx-VCC criteria was useful for glaucoma screening; but combinations of HRT criteria or combinations of GDx-VCC criteria with HRT criteria were less good for this purpose.

Intraocular pressure reduction with travoprost/timolol fixed combination, with and without adjunctive brinzolamide, in glaucoma.

OBJECTIVE: To investigate if combined intraocular pressure (IOP)-lowering medication with travoprost/timolol fixed combination and a carbonic anhydrase inhibitor, brinzolamide, is superior to both travoprost monotherapy and travoprost/timolol fixed-combination therapy in primary open-angle glaucoma and ocular hypertension. METHODS: Following a 4-week wash-out period and using 4-week long treatment periods, 20 primary open-angle glaucoma or ocular hypertension patients were treated with evening travoprost 0.004%, then switched to evening travoprost 0.004%/timolol 0.5% fixed combination, and finally the treatment was combined with adjunctive twice-daily brinzolamide 1% ophthalmic suspension. Both eyes were treated, but only one eye per patient (the eye with the higher mean diurnal IOP at baseline), was evaluated. IOP was measured at 8 a.m., 12 noon and 4 p.m. at baseline and at the end of each treatment period. RESULTS: Mean diurnal IOP (mean (SD)) at baseline was 28.5 (7.3) mmHg which decreased to 22.3 (6.3) mmHg on travoprost, 19.2 (3.4) mmHg on travoprost/timolol fixed combination and 17.3 (3.4) mmHg when the brinzolamide was added to the travoprost/timolol combination (ANOVA, contrast test, p<0.003 for all comparisons). The individual time point IOP values showed similar and significant stepwise differences. CONCLUSION: Adjunctive brinzolamide medication provided further IOP decrease in patients receiving evening-dosed travoprost/timolol fixed combination. The travoprost/timolol fixed combination was significantly more effective in IOP reduction than travoprost monotherapy, which by itself induced a significant IOP decrease compared to the untreated baseline value. The results of this open label study suggest that combined therapy with travoprost/timolol fixed combination and brinzolamide is clinically useful for IOP-lowering in primary open-angle glaucoma and ocular hypertension.

Accuracy of combined GDx-VCC and matrix FDT in a glaucoma screening trial.

PURPOSE: To assess the advantage in glaucoma screening of the use of scanning laser polarimetry with customized cornea compensation (GDx-VCC) combined with Matrix Frequency Doubling Technology (M-FDT) testing. METHODS: In a nonpopulation-based prepublicized trial, self-recruited white participants were screened for glaucoma with GDx-VCC, with M-FDT, and by independent clinical examination. Cases with possible glaucoma as found with any of the screening methods underwent a detailed clinical investigation to verify or exclude glaucoma. Sensitivity, specificity, accuracy, likelihood ratios, and predictive values were calculated using different threshold criteria for GDx-VCC alone, M-FDT alone, and for various combinations. RESULTS: Of the 233 attendees, 181 participants (345 eyes) successfully underwent the GDx-VCC and M-FDT measurements. Thirty-nine eyes of 24 participants had glaucoma (11.3% prevalence among eyes tested successfully). All but 2 of the glaucomatous eyes had only early damage. Evaluated separately, the criterion GDx-VCC NFI (normal threshold < or =30) performed best, with 97.0% specificity, 88.8% accuracy, and 25.6% sensitivity; but with only 8.5 positive likelihood ratio (PLR). For paired criteria, the best combination of GDx-VCC-screening test with M-FDT-screening test provided 99.6% specificity, 91.3% accuracy, and 28.6 PLR. For NFI combined with GDx-VCC nerve fiber bundle defect criterion, specificity was 99.0%, accuracy 89.6%, and PLR 18.0. However, the sensitivities in the 2 cases fell to 12.0% and 18.0%. For a triple combination of M-FDT-screening test with the latter pair of criteria, sensitivity increased to 41.7% and PLR (13.6) still remained clinically useful. CONCLUSIONS: In a self-recruited white population with relatively high risk for mild glaucomatous damage, a combination of GDx-VCC together with M-FDT could usefully be employed for mass glaucoma screening.