Miotic effect of brimonidine tartrate 0.15% ophthalmic solution in normal eyes

Effects of brimonidine tartrate 0.2 and 0.15% ophthalmic solution on the static and dynamic pupil characteristics

Aims

To investigate the differences between 0.2 and 0.15% brimonidine tartrate eye drops for anti-mydriatic effects and the optical quality under different light conditions.

Methods

This prospective study involved 80 consecutive high myopia patients undergoing implantation of a V4c ICL. The patients were randomly instilled with brimonidine 0.2 and 0.15% 2 weeks postoperatively. Visual quality, pupil center, pupil size, and refraction under different light conditions were measured before and 0.5 h after brimonidine administration. A symptom questionnaire was also evaluated.

Results

There was no statistical difference in the static and dynamic pupil diameters and velocity after LS between the two groups (p > 0.05). The 0.2% group had significant changes in pupil center before and after treatment, while there was no obvious movement of the 0.15% group under all illumination condition (p > 0.05). The OSI after treatment of the 0.15% group was lower than that of 0.2% group (p = 0.012). The PVA9% and PVA100% of the 0.15% group was higher than that of 0.2% group in the dark (p = 0.009, p = 0.012). The HOA RMS of the 0.15% group was lower than that of 0.2% group (p = 0.016). The QIRC score in the 0.15% group was significantly higher than that in the 0.2% group (p = 0.043).

Conclusion

0.15 and 0.2% brimonidine tartrate eye drops had similar anti-mydriatic ability, while 0.15% group had better visual quality than 0.2% concentration, and hardly introduced pupil shift. 0.15% brimonidine tartrate eye drops may be more suitable for patients with nocturnal glare symptoms in the early postoperative period after ICL implantation.

Effect of over-the-counter brimonidine tartrate 0.025% ophthalmic solution on pupil size in healthy adults

Purpose

To evaluate the effect of brimonidine tartrate 0.025% ophthalmic solution on pupil size under scotopic conditions in healthy adults

Methods

Pupil size was measured in 56 eyes of 28 volunteer participants using a pupillometer under scotopic conditions. Age, gender, and iris color were recorded. Subjects using any ophthalmic medications other than artificial tears were excluded. The pupil size was subsequently measured again under scotopic conditions 60 min after instillation of brimonidine tartrate 0.025% ophthalmic solution.

Results

Statistically significant miosis was seen after instillation of brimonidine tartrate 0.025% (p = 0.04). Average pupil size prior to brimonidine 0.025% instillation was 7.28 ± 1.05 mm, and average pupil size after instillation of brimonidine 0.025% was 6.36 ± 1.68 mm, a reduction of − 23.7% in pupil area. Subjects with light irides demonstrated a greater miotic effect than subjects with dark irides (1.55 mm vs. 0.67 mm, p < 0.0001), with a pupil area reduction of − 37.6% and − 17.4%, respectively. The amount of miosis was independent of initial pupil size.

Conclusions

Brimonidine tartrate 0.025% causes significant miosis in scotopic settings, although the effect is not as great in darker colored eyes. Further studies are needed to determine the latency and duration of the effect and whether the amount of miosis is clinically significant.

Effects of a Single Dose of Topical Brimonidine 0.15% on Anterior Segment Morphology, Pupil Characteristics, and Choroidal Thickness in Healthy Subjects

PURPOSE

To investigate the effects of a single dose of brimonidine 0.15% on anterior segment morphology, pupil characteristics, and choroidal blood flow in treated and untreated eyes of healthy subjects and to compare the results obtained with those in another healthy volunteer group.

METHODS

Participants were classified as study and control groups. The eyes in the study group were randomized. Only one eye received one drop of brimonidine (treated eyes), and the contralateral eye received single dose of sodium hyaluronate (untreated eyes). In addition, only right eyes of control subjects, who had single dose of sodium hyaluronate to both eyes, were analyzed (control eyes). Anterior segment parameters including central corneal thickness (CCT), aqueous depth, anterior chamber volume, iridocorneal angle (ICA), horizontal anterior chamber diameter, and pupil measurements including scotopic, mesopic, photopic, and dynamic pupil diameters (PDs) were performed with Sirius Scheimpflug camera. Choroidal thickness (CT) measurements were taken with optical coherence tomography. These measurements were taken at baseline and repeated 1 hour after the dosing.

RESULTS

Only the treated eyes had significantly thicker CCT and wider ICA values after instillation of brimonidine. Static and dynamic PD values of treated eyes and even untreated eyes significantly decreased after brimonidine. However, brimonidine has no significant effect on CT measurements.

CONCLUSION

A single dose of brimonidine causes thickening in CCT and widening in ICA values in treated eyes. In addition, it has significant effect to decrease the scotopic, mesopic, photopic, and dynamic PD values in treated and even contralateral eyes while has no effect on choroidal blood flow.

Effect of brimonidine tartrate 0.15% on scotopic pupil size and upper eyelid position: controlled trial

BACKGROUND

To evaluate the effect of brimonidine tartrate 0.15% ophthalmic solution on pupil size under scotopic condition and upper eyelid position.

METHODS

This study comprised 72 eyes of 36 healthy subjects. A single drop of brimonidine tartrate 0.15% ophthalmic solution was instilled in the right eye and artificial tear was instilled in the left eye. Pupil size was measured using an infra-red pupillometer under scotopic condition before and at 30 min, 2, 4, 6, 8 and 10 h after instillation. Measurement of margin reflex distance 1 (MRD1) was performed using a millimetre ruler before and after at 10 min after instillation.

RESULTS

The mean age of the subjects was 32.19 ± 11.43 years (range 10-52 years), 17 were female and 19 were male. Before brimonidine instillation, the mean pupil size was 6.09 ± 1.03 mm in the brimonidine eyes and 6.06 ± 1.04 mm in the control eyes. There was a significant decrease in mean pupil size at 30 min (4.45 ± 1.04), 2 h (4.49 ± 1.06), 4 h (4.59 ± 1.06), 6 h (4.89 ± 1.06) and 8 h (5.38 ± 1.02) after instillation compared to before in brimonidine eyes (p < 0.001 for all). There was a significant miosis continued for at least 6 h (5.95 ± 1.03) in control eyes (p < 0.001). There was no significant change in MRD1, before and after instillation both in brimonidine and control eyes.

CONCLUSIONS

Brimonidine tartrate 0.15% had a significant miosis under scotopic condition for at least 8 h after instillation and had a significant miosis on the untreated eye for at least 6 h.

Melanopsin-mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma

PURPOSE

The intrinsically photosensitive retinal ganglion cells (ipRGCs) and sleep quality are impaired in patients with primary open-angle glaucoma (POAG). In this study, we investigated whether ipRGCs and sleep quality were also impaired in patients with normal tension glaucoma (NTG).

METHODS

We performed pupillometry and sleep quality assessment in 15 patients with NTG and 17 healthy age-matched controls. Pupillometry protocol consisted of monocular stimulation with high illuminance (100 lux) red (633 nm, 300 cd/m² or 15.23 log quanta/cm² /s) and blue light (463 nm, 332 cd/m² or 15.27 log quanta/cm² /s) and binocular pupil measurements. Prior to light stimulation, patients were dark-adapted for 5 min. The late postillumination pupillary response (PIPR_{L ate} ) to blue light was used as marker of ipRGC activity. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) questionnaire.

RESULTS

The PIPR_{L ate} to blue light was significantly reduced in patients with NTG compared to healthy subjects (p < 0.001), indicating impairment of the melanopsin-mediated pupillary pathway. There was no significant difference in the response elicited by red light (p = 0.6). Baseline pupil diameter and pupillary constriction amplitude to both red and blue light were reduced in patients with NTG (p < 0.05). The global score in PSQI was not significantly different between healthy controls and patients with NTG, indicating normal sleep quality (p = 0.6). Furthermore, we found no correlation between sleep parameters and pupillary light reflex parameters.

CONCLUSION

Patients with NTG exhibited reduced ipRGC activity compared to healthy subjects, while no differences were observed in sleep quality.

Low-dose brimonidine for relief of ocular redness: integrated analysis of four clinical trials

BACKGROUND

The aim of this study was to provide an integrated analysis of safety and efficacy data for brimonidine tartrate ophthalmic solution 0.025 per cent (low-dose; Bausch & Lomb Incorporated), a topical vasoconstrictor for relief of ocular redness.

METHODS

Integrated efficacy data from two randomised, double-masked, vehicle-controlled studies in subjects with ocular redness as well as safety data from the two efficacy studies, a vehicle-controlled safety study, and a pharmacokinetic study were analysed. Efficacy outcomes analysed included investigator-assessed ocular redness (scale, 0-4) before treatment instillation and at five to 240 minutes post-instillation on Day 1, at five minutes post-instillation on Days 15 and 29, and one week after treatment discontinuation (Day 36), and redness self-assessed by subjects recorded daily in diaries. Safety assessments included adverse events, ophthalmic examinations, and rebound redness upon treatment discontinuation. Drop comfort (scale, 0-10) was a tolerability measure.

RESULTS

The efficacy population included 117 subjects (brimonidine, n = 78; vehicle, n = 39). The safety population included 635 subjects (brimonidine, n = 426; vehicle, n = 209). Investigator-assessed ocular redness was significantly lower with brimonidine versus vehicle at all post-instillation time points on Day 1 (mean change from pre-instillation of -1.4 units for brimonidine and -0.2 units for vehicle; p < 0.0001). Subject-assessed ocular redness was also significantly lower with brimonidine versus vehicle (mean treatment difference in average daily ratings of -0.9; p < 0.0001). There was no evidence of tachyphylaxis through Day 29 and rebound redness was rare. Incidence of ocular adverse events was low, the most common being reduced visual acuity (brimonidine, 4.0 per cent; vehicle, 4.3 per cent) and conjunctival hyperaemia (2.6 and 2.9 per cent, respectively). Both brimonidine and vehicle were rated as very comfortable (mean post-instillation scores, 0.4-0.5).

CONCLUSION

In this integrated analysis, low-dose brimonidine significantly reduced ocular redness with no tachyphylaxis, and minimal rebound redness, and was generally safe and well tolerated.

Effects of brimonidine tartrate 0.1% ophthalmic solution on the pupil, refraction, and light reflex

This study aimed to assess changes in pupil size, uncorrected visual acuity, refraction, and the direct and consensual light reflexes after instillation of brimonidine 0.1% in healthy subjects. The investigation comprised 46 eyes of 23 healthy subjects with no eye diseases in whom brimonidine 0.1% was instilled in the right eye. Pupil size was measured quantitatively under photopic and scotopic conditions, uncorrected visual acuity, refraction, and direct and consensual light reflexes before and at 1, 6, and 24 h after instillation. We found No significant change was found in refraction or uncorrected visual acuity (P = 0.999 and P = 0.998, respectively). A significant reduction in pupil size was observed under scotopic conditions at 1 h and 6 h after instillation (P = 0.007 and P = 0.005, respectively). The rate of pupil contraction and constriction speed measured by light reflexes were significantly increased at 1 h and 6 h after instillation (P = 0.021 and P = 0.033, respectively). Brimonidine 0.1% induced a significant reduction in pupil size under scotopic conditions without a significant change in refraction or visual acuity due to suppression of the sympathetic nervous system.

Brimonidine Ophthalmic Solution 0.025% for Reduction of Ocular Redness: A Randomized Clinical Trial

SIGNIFICANCE

The α2-adrenergic receptor agonist brimonidine has been reported to induce conjunctival blanching in cataract, strabismus, laser refractive, and filtration procedures. Clinicians are often faced with red eyes with no apparent underlying pathology. Low-dose brimonidine reduced ocular redness in such subjects with efficacy maintained over 1 month and negligible rebound redness.

PURPOSE

The aim of this study was to evaluate the safety and efficacy of brimonidine tartrate ophthalmic solution 0.025% for the treatment of ocular redness.

METHODS

In this single-center, double-masked, phase 3 clinical trial, adult subjects with baseline redness of more than 1 unit in both eyes (0- to 4-unit scale) were randomized 2:1 to brimonidine 0.025% or vehicle. A single dose was administered in-office (day 1); thereafter subjects instilled treatment four times a day for 4 weeks, with clinic visits on days 15, 29, and 36 (7 days post-treatment). Efficacy end points included investigator-evaluated redness 5 to 240 minutes post-instillation on day 1 (primary); investigator-evaluated change from baseline 1, 360, and 480 minutes post-instillation on day 1, and 1 and 5 minutes post-instillation on days 15 and 29; total clearance of redness, and subject-assessed redness. Safety/tolerability measures included adverse events, rebound redness, and drop comfort.

RESULTS

Sixty subjects were randomized (n = 40 brimonidine, n = 20 vehicle). Investigator-assessed redness was lower with brimonidine versus vehicle over the 5- to 240-minute post-instillation period (mean [SE], 0.62 [0.076] vs. 1.49 [0.108]; P < .0001) and at each time point within that period (P < .0001). At 1, 360, and 480 minutes post-instillation, respectively, the mean differences (95% confidence interval) between treatments were -0.73 (-1.05 to -0.41), -0.57 (-0.84 to -0.29), and -0.39 (-0.67 to -0.10), respectively. No tachyphylaxis was evident with brimonidine on days 15 and 29, and minimal rebound redness was observed following discontinuation. Adverse events were infrequent, and brimonidine was rated as very comfortable.

CONCLUSIONS

Brimonidine 0.025% appeared safe and effective for reduction of ocular redness, with an 8-hour duration of action, no evidence of tachyphylaxis, and negligible rebound redness.

Evaluation of Efficacy and Safety of Brimonidine Tartrate Ophthalmic Solution, 0.025% for Treatment of Ocular Redness

Purpose/Aims: This study assessed the efficacy and safety of brimonidine tartrate ophthalmic solution, 0.025% for treating ocular redness in adult subjects.

MATERIALS AND METHODS

This was a single-center, double-masked, randomized, vehicle-controlled, parallel-group study in subjects ≥40 years, with ocular redness. Subjects were randomized 2:1 to brimonidine or vehicle, instilled QID for four weeks. Subjects completed four visits, the last occurring one week after treatment discontinuation. The investigator assessed ocular redness on a scale of 0-4 pre-instillation and 5-240 minutes post-instillation on Day 0, pre-instillation and 5 minutes post-instillation on Days 14 and 28, and on Day35; subjects assessed redness in diaries throughout the 28-day treatment period and following treatment discontinuation. Safety assessments included adverse events (AEs), rebound redness on treatment discontinuation, comprehensive ophthalmic exams, and vital signs. Drop comfort was assessed upon instillation, and 30 seconds and 1 minute post-instillation at Day 0.

RESULTS

Fifty-seven subjects (brimonidine, n = 38; vehicle, n = 19) were randomized. Investigator-assessed ocular redness was significantly reduced with brimonidine across the entire post-instillation time period (overall treatment difference: -1.37; P < 0.0001) and at all individual time points (P < 0.0001). Subject-assessed ocular redness was also significantly lower with brimonidine (P ≤ 0.0005). No tachyphylaxis was evident. There were few ocular AEs, all mild to moderate in severity, and no redness rebound was observed upon brimonidine discontinuation. There were no effects on any safety measures, and both brimonidine and its vehicle were reported to be very comfortable.

CONCLUSIONS

Brimonidine 0.025% appeared safe, well tolerated, and reduced ocular redness for at least 4 hours. No tachyphylaxis or rebound redness upon treatment discontinuation was observed.

Effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy for glaucoma

PURPOSE

To evaluate the effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy in the treatment of patients with glaucoma.

METHODS

To measure the main treatment effects of a fixed combination of brimonidine 0.2%-timolol 0.5%, we conducted three small studies: (1) a comparison of diurnal intraocular pressure (IOP) at baseline and at 6 months after brimonidine/timolol fixed-combination therapy (n = 81); (2) an assessment of the effects of one drop of the brimonidine/timolol fixed combination on diurnal IOP (n = 25); and (3) the effects of brimonidine/timolol fixed-combination therapy on the anterior ocular segment over time (n = 64).

RESULTS

(1) After 6 months of treatment with the brimonidine/timolol fixed combination, the mean diurnal IOP in primary open-angle glaucoma (POAG) decreased from 21.4 ± 2.0 to 14.5 ± 3.1 mmHg (32.2%, P < 0.001), and the mean diurnal IOP in normal-tension glaucoma (NTG) decreased from 13.5 ± 2.8 to 10.9 ± 2.0 mmHg (19.3%, P < 0.001). (2) After instillation with one drop of the brimonidine/timolol fixed combination, the IOP in the instilled eye was lowest at 9:00 p.m. and had decreased by 1.7 mmHg compared with the baseline IOP in the instilled eye. The difference in IOP between the instilled eye and untreated fellow eye was largest at 3:00 p.m., measuring 1.7 mmHg (P = 0.011). (3) Brimonidine/timolol fixed-combination therapy caused significant miosis over time (P = 0.003).

CONCLUSIONS

The results of this study suggest that brimonidine/timolol fixed-combination therapy has beneficial IOP-lowering effects and significant effects on pupil size.

Bimatoprost 0.03% versus brimonidine 0.2% in the prevention of intraocular pressure spike following neodymium:yttrium–aluminum–garnet laser posterior capsulotomy

PURPOSE

The aim of this study was to compare the efficacy of bimatoprost 0.03% with brimonidine 0.2% in preventing intraocular pressure (IOP) elevations after neodymium:yttrium–aluminum–garnet (Nd:YAG) laser posterior capsulotomy.

METHODS

In this prospective, randomized, double-masked study, 195 eyes of 195 consecutive patients who had YAG laser capsulotomy for posterior capsule opacification were recruited. Eyes received either 1 drop of bimatoprost 0.03% (98 patients) or brimonidine 0.2% (97 patients) at 1h before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1h, 3h, 24h, and 7 days. Inflammation was evaluated after surgery. Formation of cystoid macular edema was assessed by measuring the macular thickness before and after laser surgery.

RESULTS

The average peak of postoperative IOP elevation was 2.2±3.9mm Hg in the bimatoprost 0.03% and 3.6±3.1mm Hg in the brimonidine 0.2% group. The difference was statistically significant (P<0.001). Postoperative IOP elevations of 10mm Hg or more occurred in 1 eye (1.56%) in the bimatoprost 0.03% group and 5 eyes (7.35%) in the brimonidine 0.2%. This difference was statistically significant (P<0.001). Macular edema and anterior chamber reaction were not observed related to bimatoprost. No clinically significant side effects were noted in either group.

CONCLUSIONS

Our results indicate that prophylactic use of bimatoprost 0.03% is more effective than brimonidine 0.2% in preventing IOP elevation immediately after YAG laser capsulotomy. Bimatoprost 0.03% as a prostamide analog may provide new option for preventing IOP elevation after YAG laser capsulotomy.

Effects of some ophthalmic medications on pupil size: a literature review

Ophthalmological pharmacology is a rapidly expanding field aimed at achieving the safest and most effective treatment results. Physicians must be aware of the side-effect profiles, both beneficial and harmful, of medications currently used. This review highlights the available data on the effect of some ophthalmic medications on pupil size; it was limited to all reports or studies describing topical ophthalmic agents not originally designed or indicated to alter pupil diameter. This awareness will protect patients from unwanted drug-induced side effects and will improve clinical management and patient care.

Effect of Brimonidine Tartrate 0.15% on Scotopic Pupil: Controlled Trial

PURPOSE

The aim of this study was to evaluate the duration of the effect of one single dose of brimonidine tartrate 0.15% on pupil diameter, under scotopic conditions, when applied topically in 1 eye of normal subjects.

METHODS

The eyes of 19 normal volunteers were randomized so that 1 eye had 1 drop of brimonidine tartrate 0.15% and the other received no medication. Pupil diameter was measured using an infrared pupillometer. The first measure was obtained before the instillation of brimonidine. After that, four measures, with 2-h intervals, were performed.

RESULTS

From 19 participants, 14 were women and 5 were men, with a mean age of 25.05 years (standard deviation, +/- 6.98). Before brimonidine instillation, mean pupil diameter in the control eyes was 5.11 mm, and in the brimonidine eyes it was 5.15 mm. After 8 h, the mean pupil size was 4.01 mm in the treated eyes, and 4.56 mm in the untreated eyes. There was a tendency of miotic effect to be more important on the treated eye, as compared to the control eye in all intervals, but this did not reach statistical significance (P = 0.375). When comparing both eyes, independently of the periods, the treated eye had a smaller diameter than the untreated eye (P = 0.038). The miotic effect was observed for at least 8 h after instillation.

CONCLUSIONS

Miotic response of brimonidine tartrate 0.15% lasted for at least 8 h and has a significant effect on the nontreated eye.