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Glaucoma
Figure 1: Factors Affecting the Individual Risk of Figure 3: Difference in Mean Reductions from Baseline
Visual Disability Intraocular Pressure versus Latanoprost and Travoprost
IOP reduction Weighted mean, fixed model
High
End-point
Advanced Long Fast
0.67
(n=548) p=0.04
(8pm±2)
0.8
(n=275)
p=0.07
0.78
(n=893)
p=0.003
Risk Damage
Life Rate of
expectancy progression
(4pm±2)
0.52
(n=458) p=0.19
(n=893)
1.17
(12 noon±2)
p<0.001
0.86
Low Early Short Slow
(n=458) p=0.02
0.50
(n=893)
p=0.05
(8am±2)
1.02
(n=458)
p=0.09
The individual risk of developing symptomatic functional glaucoma damage depends on the
relationship between the stage of the damage, life expectancy and the progression rate of
the disease.
-1.9 Favours latanoprost 0.0 Favours LUMIGAN
®
1.9
or travoprost
Figure 2: Age/Function Diagram
versus latanoprost versus travoprost
13
0
Adapted from Aptel et al., 2008.
Figure 4: Mean Intraocular Pressure Reduction (%) from
-5
Baseline at Three Months
A
(Baseline IOP)
-10
22.7mmHG 22.1mmHG
B 0
-15
5
Mean deviation (dB)
10
1.7mmHG
-20 p<0.001
13.7%
greater reduction
Visual disability
15
in diurnal IOP
IOP reduction (%)
-25 20
21.4%
50 56 63 69 75 81 88 94 100
Latanoprost/timolol
Age (years) 25
GANFORT
®
fixed combination
(n=47) (n=35)
Patients with the same age and same initial stage of functional damage. Patient B has a higher
16
Adapted from Centofanti et al., 2009.
risk of reaching visual disability, as his disease is progressing more quickly than that of patient A.
individual risk profile. Thanks to the availability of new statistical most appropriate treatment, whether monotherapy, combination
software aids integrated into the most commonly available visual field therapy or parasurgical/surgical therapy. In the case of a patient with a
analysers, today it is possible in clinical practice to estimate the middle/low-risk profile, the choice is usually a monotherapy of proven
progression rate of functional measures (e.g. mean deviation or visual ocular hypotensive efficacy. Scientific literature on one side and clinical
field index) from series of visual fields taken over time,
10
allowing practice on the other have confirmed that among the drugs available
changes in the progression rate to be assessed at different stages of today, the prostaglandin analogues and the prostamides are probably
the disease or before and after therapeutic interventions, whether the classes with the highest ocular hypotensive efficacy.
11,12
medical, laser or surgical. Such software allows clinicians to assess
variation in glaucoma development rate following therapeutic A recent meta-analysis published in the
13
Journal of Glaucoma has
intervention, either medical, laser or surgical. For a patient with a shown that among the drug classes mentioned above, the prostamide
documented clinical and functional history it can be relatively easy to analogue bimatoprost has the highest ocular hypotensive efficacy
measure glaucoma progression rate before and after the therapeutic (see Figure 3).
14
The difference in ocular hypotensive efficacy between
intervention to assess its efficacy. A new patient without a history that bimatoprost and the other prostaglandin analogues could be considered
can characterise the pathology before the diagnosis is a separate small from a clinical point of view (about 1mmHg). However, it may have
matter. Without historical functional data, the estimation of an relevant consequences for the prognosis of long-term visual function of
individual’s risk should be based on the stage of damage at the point of the glaucoma patient under ocular hypotensive treatment.
diagnosis, the patient’s life expectancy and an assessment of the risk of
progression based on the presence of known factors. These factors The Early Manifest Glaucoma Trial (EMGT) clearly demonstrated that
include a higher IOP at diagnosis, presence of pseudoexfoliative every additional decrease of 1mmHg IOP compared with baseline
material or pigmentary dispersion in the anterior segment. obtained with therapy reduces the risk of disease progression by 13%.
5
In addition, the EMGT showed that IOP reduction obtained during the
Information referring to life expectancy, stage of damage and first three months of therapy is significantly linked to a reduction in risk
estimation of the probable progression rate is integrated in order to of disease progression (-11%). This underlines how early therapeutic
guide the grade of therapeutic intervention needed in the newly intervention, in addition to its efficacy, plays a fundamental role in the
diagnosed patient. This information aids the choice of the prognosis of long-term visual function.
38 EUROPEAN OPHTHALMIC REVIEW
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