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Monica Ray, Nariman Nassiri, Chaesik Kim, Anju Goyal, Justin Tannir, Aman Shukairy, Mark S Juzych, Bret A Hughes; Prostaglandin Analog versus Brimonidine Mono-Therapy in Preserving Visual Function in Glaucomatous Eyes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4594.
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The neuro-protective properties of alpha 2 –adrenergic agonists have been demonstrated in experimental studies. In this retrospective longitudinal study, we aimed to investigate visual field progression in glaucomatous eyes on mono-therapy with prostaglandin analogs (PA) and brimonidine eyedrops.
Glaucomatous eyes with 4 or more reliable 24-2 SITA-fast HFA (Humphrey® Field Analyzer) were included from the Kresge Eye Institute database. Reliability was considered less than 33% fixation losses, and false positive and false negative errors. In each eye, a linear regression was performed on mean deviation over follow-up time to obtain the rate of change (dB/year).
A total of 99 eyes (65 patients) were included in the study while on brimonidine mono-therapy (36 eyes) and PA mono-therapy (63 eyes). The mean ± SD of follow-up time (yr) was 5.71 ± 4.59 and 5.07 ± 2.15 in the brimonidine and PA groups, respectively (p=0.15). The mean ± SD of number of visual field tests was 4.61 ± 1.05 and 5.02 ± 1.02 in the brimonidine and PA groups, respectively (p=0.06). The mean ± SD of MD (dB) was -4.60 ± 6.24 and -3.38 ± 3.86 in the brimonidine and PA groups, respectively (p=0.23). Between the two groups the only statistically significant patient demographic variables were race (67% and 84% African American in the brimonidine and PA groups respectively, p=0.05), and baseline visual acuity (.19 ± .20 and .12 ± .12 LogMar in the brimonidine and PA groups respectively, p=0.03). The mean ± SD of average IOP (mm Hg) at baseline was 16.94 ± 4.32 and 16.06 ± 4.45 in the brimonidine and PA groups, respectively (p=0.34). There was no statistically significant difference between the two groups in MD progression rate (-.27 ± .73 dB/yr for brimonidine and -.05 ± .53 dB/yr for PA, p=0.09).
We found no statistically significant difference between brimonidine and PA mono-therapy in visual field progression over an average follow up time of 5.36 ± 1.79 years in eyes with mild to moderate glaucoma. This needs to be further investigated in prospective studies with larger sample size and in eyes with more severe glaucoma.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Table 1. Comparison of different study outcomes in the study groups.
Table 2. Univariate regression analysis between progression rate (dB/year) and different study outcomes.
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