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D. Montgomery, M.A. Mychaskiw; Characterization of the Frequency and Reasons for Changes in Pharmacotherapy in the Treatment of Primary Open–Angle Glaucoma, Normal Tension Glaucoma, and Ocular Hypertension Using Retrospective Analysis of the Glasgow Royal Infirmary Glaucoma Database . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3645.
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Purpose:The objective of this study was to determine the frequency and describe the reasons for changes in pharmacotherapy in the treatment of primary open–angle glaucoma (POAG), normal tension glaucoma (NTG), and ocular hypertension (OH). Methods:: Retrospective analysis was conducted of the Glasgow Royal Infirmary Glaucoma Database. The database was comprised of computerized medical records of all POAG, NTG, and OH patients treated at the Glasgow Royal Infirmary from 1981 to present, representing 745 patients or >5,000 treatment years. Data elements recorded for each patient included demographics, diagnosis, and treatment history. Treatment history included initial and subsequent medication regimens. Changes in medication regimens were categorized by failure to reach or maintain target pressure, adverse effects, disc and visual field progression, compliance, surgery or surgical failure, and other reasons. Descriptive statistics were used to analyze patient demographics and distributions by study variables. Results: Among the 745 patients, there were 2,049 changes in treatment during the study period. Frequency of treatment changes were failure to reach target pressure (29%), failure to maintain target pressure (17%), adverse effects (20%), surgery (11%), failure of surgery (5%), disc progression (5%), visual field progression (5%), compliance (3%), and other reasons (6%). Discontinuations due to adverse events were: brimonidine (44.7%), dorzolamide/timolol fixed combination (25.9%), travoprost (14.7%), bimatoprost (13.9%), timolol (11.0%), latanoprost/timolol fixed combination (8.6%), and latanoprost (8.4%). Conclusions: Changes in treatment were most often associated with efficacy (failure to reach or maintain target pressure) and adverse effects. Discontinuations of therapy were greatest with brimonidine and lowest with latanoprost. Latanoprost and latanoprost/timolol fixed combination exhibited fewer discontinuations as a result of adverse effects in comparison to timolol or other prostaglandin monotherapies.
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