April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Clinical Significance of a Third or Fourth Anti-Glaucoma Eye Drop
Author Affiliations & Notes
  • Pengcheng Li
    Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
  • Sung Chul Park
    Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
    Department of Ophthalmology, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
  • Gintien Huang
    Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
  • Jeffrey M Liebmann
    Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
    Department of Ophthalmology, New York University School of Medicine, New York, NY
  • Robert Ritch
    Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
    Department of Ophthalmology, New York Eye and Ear Infirmary of the Mount Sinai Health System, New York, NY
  • Footnotes
    Commercial Relationships Pengcheng Li, None; Sung Chul Park, None; Gintien Huang, None; Jeffrey Liebmann, Alcon, Inc. (C), Allergan, Inc (C), Allergan, Inc (F), Bausch & Lomb, Inc. (C), Bausch & Lomb, Inc. (F), Merz Phamaceuticals, Inc. (C), Quark Pharmaceuticals, Inc. (F), Valeant Pharmaceutiicals, Inc (C); Robert Ritch, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 543. doi:
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    • Get Citation

      Pengcheng Li, Sung Chul Park, Gintien Huang, Jeffrey M Liebmann, Robert Ritch; Clinical Significance of a Third or Fourth Anti-Glaucoma Eye Drop. Invest. Ophthalmol. Vis. Sci. 2014;55(13):543.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To evaluate the effectiveness of a third or fourth topical anti-glaucoma medication in lowering intraocular pressure (IOP) and the probability of eventual glaucoma filtering surgery thereafter.

 
Methods
 

Glaucoma patients who had a third (Group A) or a fourth (Group B) anti-glaucoma eye drop added to their regimen were consecutively enrolled by reviewing medical records. Patients were required to have a prostaglandin analogue drop but no oral carbonic anhydrase inhibitor in their preexisting regimen and no prior filtering surgery. Fixed-combination eye drops were considered 2 different classes. IOP response to the added eye drop (‘pre-addition IOP’ - ‘post-addition IOP’; average of 3 IOP readings, respectively) was analyzed and the cumulative probability of filtering surgery, irrespective of subsequent IOP-lowering therapy (medication and/or laser), was calculated. Factors associated with IOP response and filtering surgery were identified.

 
Results
 

We included 83 eyes of 83 patients in Group A and 49 eyes of 49 patients in Group B. The mean baseline age was 71±10 and 72±14 years, respectively. IOP decreased significantly after adding a third (18.8±4.9 to 16.5±4.6 mmHg) or a fourth (19.6±6.6 to 17.6±5.3 mmHg) drop (all p<0.001). IOP response varied considerably, with 24% having IOP reduction >20% and 22-25% having IOP increase in both groups (Table 1). In a multivariable analysis, greater percent IOP reduction was significantly correlated with baseline IOP (p=0.001, R=0.356, Group A; p=0.037, R=0.306, Group B) and VF MD (p=0.022, R=−0.255, Group A; p=0.028, R=−0.321, Group B). The cumulative probability of filtering surgery was 18% at 1 year and 28% at 2 years in Group A and 27% at 1 year and 38% at 2 years in Group B (Fig 1). The median time to filtering surgery was 70 months (95% CI: 34-106 months) in Group A and 63 months (95% CI: 28-98 months) in Group B (p=0.24). Baseline IOP was a risk factor for eventual filtering surgery in both Groups A and B, and better VF MD and higher percent IOP reduction were protective factors in Group B (Table 2).

 
Conclusions
 

A third or fourth anti-glaucoma eye drop lowered IOP >20% in approximately one-fourth of patients. Approximately 3 to 4 of 10 patients would have a filtering surgery within 2 years after adding a third or a fourth eye drop. Baseline IOP and VF MD may affect IOP response to the added eye drop.

     
Keywords: 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 568 intraocular pressure  
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