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D.B. Yan; A 12–week Comparison of Travoprost and Timolol in the Treatment of Newly Diagnosed, Normal Tension Glaucoma . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4461.
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Prostaglandin analogs have been shown to be superior to beta–blockers for lowering intraocular pressure (IOP) in the treatment of ocular hypertension or open angle glaucoma. The efficacy of prostaglandins and beta–blockers has not previously been compared in the treatment of normal tension glaucoma (NTG). The relative superiority of outflow–enhancing drugs such as progstaglandins over inflow–suppressing drugs such as beta blockers may be greater at normal IOP's than the elevated IOP's. From the Goldmann equation, if the desired IOP reduction is 20% and episcleral venous pressure is 10 mmHg, a 30% reduction in aqueous production is required if initial IOP is 30mmHg, but a 60% reduction in aqueous production is required if initial IOP is 15mmHg. Purpose: The IOP–lowering efficacy of travoprost is compared to timolol in the initial treatment of NTG. Methods: Patients with NTG (12 ≤ IOP ≤ 22mmHg) were randomized to receive initial treatment with travoprost qhs (n=24) or timolol bid (n=25) in a single–blinded, open–label study. Subjects were all newly diagnosed and naive to previous treatment to eliminate the effect of selection bias in the recruitment process. IOP’s at 11am ± 1 hr were measured at baseline, 4 and 12 weeks after the initiation of treatment. Results: Baseline IOP’s in the travoprost group (18.6±2.6mmHg) and the timolol group (18.2±2.5mmHg) were not significantly different (p=0.53, t–test). After 12 weeks of treatment, IOP’s were significantly lower (p<0.001, t–test) with travoprost (13.5±1.6mmHg) than with timolol (16.0±2.9mmHg). Target IOP–reduction of 25% or more was achieved in significantly more patients (p<0.001, chi–squared test) treated with travoprost (75%) than with timolol (16%). The difference in %IOP reduction between travoprost (27.9±2.4%) and timolol (12.5±2.2%) was shown by ANOVA to be greater in this study (p=0.011) than in a previous study comparing travoprost and timolol with elevated IOP's (Netland PA et al Am J Ophthalmol. 2001 Oct;132(4):472–84). Baseline IOP: travoprost=25.4mmHg, timolol=25.7mmHg. IOP reduction: travoprost=29.7±1.0%, timolol=24.5±1.1%, . Conclusions: Travoprost is superior to timolol in the initial treatment of NTG. The IOP–reducing superiority of travoprost over timolol is greater in NTG than ocular hypertension. Travoprost is a highly effective first–line agent in the treatment of NTG.
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