1
|
Doliszny K, Quinn MP, El-Defrawy SR, Gill SS, Whitehead M, Johnson D, Campbell RJ. Evolution of first-line glaucoma therapy, 2007-2018: a population-based analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:89-95. [PMID: 36493801 DOI: 10.1016/j.jcjo.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the long-term evolution of first-line glaucoma therapy (FLGT) initiated by ophthalmologists and optometrists. DESIGN Retrospective population-based study using validated provincial health care databases. PARTICIPANTS 194,759 Ontario residents, 66 years of age or older, who received FLGT between 2007 and 2018. METHODS A total of 194,759 individuals from 12 annual cohorts were enrolled, and rates of first-line medical treatment (prostaglandin analogue [PGA], beta-blocker, alpha-2-agonist, and carbonic anhydrase inhibitor) and laser trabeculoplasty (LT) were calculated. Provider (ophthalmologist or optometrist) rates also were assessed. RESULTS Across the entire study period, of the 194,759 enrolled individuals who received FLGT, 60.2% initially received medical treatment and 39.8% underwent LT. Approximately 94.6% were treated by ophthalmologists. PGA therapy was the most common therapy prior to 2010, whereupon LT became the most common FLGT. By 2015, LT exceeded the total of all medications as FLGT. The annual rate of initial medication prescriptions by optometrists rose to 101.4 per 100,000 population between 2011 and 2018. In 2018, PGA and non-PGA prescription rates by ophthalmologists were 2.6 and 5.0 times higher, respectively, than prescription rates by optometrists. CONCLUSION LT therapy has become the most common FLGT for Ontario residents 66 years of age or older. PGAs remain the most frequently prescribed glaucoma medication. While ophthalmologists continue to provide the majority of FLGT, optometrists now provide a small but growing fraction of FLGT following the introduction of glaucoma medication prescribing privileges.
Collapse
Affiliation(s)
- Katharine Doliszny
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Matthew P Quinn
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Sherif R El-Defrawy
- Department of Ophthalmology, University of Toronto, Toronto, ON; Department of Ophthalmology, Kensington Eye Institute, Toronto, ON
| | - Sudeep S Gill
- ICES Queen's, Queen's University, Kingston, ON; Division of Geriatric Medicine, Queen's University, Kingston, ON; Division of Geriatric Medicine, Providence Care Hospital, Kingston, ON
| | - Marlo Whitehead
- ICES Queen's, Queen's University, Kingston, ON; Queen's University, Kingston, ON
| | - Davin Johnson
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON
| | - Robert J Campbell
- Department of Ophthalmology, Queen's University, Kingston, ON; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, ON.
| |
Collapse
|
2
|
Selective laser trabeculoplasty is safe and effective in patients previously treated with prostaglandin analogs: An evidence-based review. Int Ophthalmol 2023; 43:677-695. [PMID: 35962295 DOI: 10.1007/s10792-022-02460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Prostaglandin analogs (PGAs) are first-line treatments for ocular hypertension (OHT) and open-angle glaucoma (OAG). However, frequent side effects and high costs hinder patient's compliance resulting in disease progression. Evidence suggests selective laser trabeculoplasty (SLT) may be considered a first-line treatment for OHT and OAG due to its safety profile, minor side effects, and reduced costs. Considering that PGAs and SLT share action mechanisms, it is hypothesized that previous PGA therapy may affect subsequent SLT efficacy. Therefore, we analyzed if PGAs reduce SLT efficacy. METHODS An evidence-based review was performed to assess the safety and efficacy of SLT in patients previously treated with PGAs. For this purpose, we performed an extensive literature search using the National Library of Medicine's PubMed and Google Scholar database for all English language articles published until May 2021. RESULTS There is evidence of non-superiority of PGAs therapy versus SLT for OHT and OAG. A multicenter, randomized, observer-masked clinical trial (RCT) of untreated OHT and OAG patients concluded that SLT should be offered as the first-line treatment for these patients. This study was supported by a meta-analysis of RCTs, comparing SLT efficacy versus antiglaucoma drugs only, with the advantage of an SLT lower rate of adverse effects. CONCLUSIONS Cost-effectiveness, patient compliance, and antiglaucoma drugs' side effects, including higher surgical failure, favor consideration of SLT as first-line therapy for OAG and OHT. Furthermore, SLT efficacy does not seem to be affected by prior PGA administration; however, larger cohort, comparative, multicenter RCTs are necessary to answer this question.
Collapse
|
3
|
Espinoza G, Castellanos-Castellanos YA, Pedraza-Concha A, Rodríguez-Una I, Acuña MF, Parra JC. Mid-term results of patterned laser trabeculoplasty for uncontrolled ocular hypertension and primary open angle glaucoma. Int J Ophthalmol 2021; 14:1199-1204. [PMID: 34414084 DOI: 10.18240/ijo.2021.08.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the safety and efficacy of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in primary open angle glaucoma (POAG) and ocular hypertension (OHT) after 18-month follow-up in Hispanic population. METHODS A single-center, retrospective study was conducted. All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study. Investigated parameters were intraocular pressure (IOP), the number of IOP-lowering medications, best corrected visual acuity (BCVA), laser parameters and postoperative adverse events. Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction ≥20% at 18mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values. RESULTS From 40 PLT-treated eyes (mean baseline IOP 20.3±1.7 mm Hg), 24 patients were analyzed (age 63.4±7.3y). The mean IOP reductions from baseline across visits (months 1, 3, 6, 9, 12, and 18) ranged from 14.1% to 20.8%. Success rate after 18-month follow-up was 61.7% with a mean IOP of 16±3.2 mm Hg (P<0.001). The number of glaucoma IOP-lowering medications per eye (preoperative 2.1±1.1 and postoperative 2.3±1.1, P=0.86) and the mean BCVA (preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR, P=0.42) remained stable. Adverse events comprised transitory IOP spikes in 4 eyes (10%) and peripheral anterior synechiae in 7 eyes (17.5%). CONCLUSION Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.
Collapse
Affiliation(s)
- Gustavo Espinoza
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander 681004, Colombia.,Fundación Oftalmológica de Santander, Bucaramanga, Santander 681004, Colombia
| | | | - Angelica Pedraza-Concha
- Fundación Oftalmológica de Santander, Bucaramanga, Santander 681004, Colombia.,Universidad Industrial de Santander, Bucaramanga, Santander 680002, Colombia
| | | | - Maria Fernanda Acuña
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander 681004, Colombia.,Fundación Oftalmológica de Santander, Bucaramanga, Santander 681004, Colombia
| | - Juan Camilo Parra
- Fundación Oftalmológica de Santander, Bucaramanga, Santander 681004, Colombia
| |
Collapse
|
4
|
Sunaric Megevand G, Bron AM. Personalising surgical treatments for glaucoma patients. Prog Retin Eye Res 2020; 81:100879. [PMID: 32562883 DOI: 10.1016/j.preteyeres.2020.100879] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term "precision medicine" has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market. Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.
Collapse
Affiliation(s)
- Gordana Sunaric Megevand
- Clinical Eye Research Centre Memorial Adolphe de Rothschild, Geneva, Switzerland; Centre Ophtalmologique de Florissant, Geneva, Switzerland.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| |
Collapse
|
5
|
Balendra SI, Zollet P, Cisa Asinari Di Gresy E Casasca G, Cordeiro MF. Personalized approaches for the management of glaucoma. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2020.1756770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Shiama Indu Balendra
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Piero Zollet
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Department of Ophthalmology, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Cisa Asinari Di Gresy E Casasca
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Department of Ophthalmology, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| |
Collapse
|