Abstract
Purpose
To describe changes in glaucoma treatment and achieved IOP (intraocular pressure) over the period 1995–2002, 4 years before and 4 years after new glaucoma drugs had become available (January 1999).
Methods
An observational study was conducted in primary open-angle glaucoma (suspect), and ocular hypertension patients (n=1561) who had started medical treatment in 1995 or thereafter. The processes of starting, changing and intensifying medical treatment in general, and in patients with contraindications to beta-blockers before and after January 1999 were described. The change in mean IOP and the percentage of patients achieving an intraocular pressure below 18 or 22 mmHg were calculated.
Results
After January 1999, a shift from starting on betaxolol to hypotensive lipids took place. This shift was more pronounced in patients with respiratory comorbidity. The percentage of patients starting on timolol did not differ between both periods. After January 1999, therapy was changed more often in the first two visits compared with the period before January 1999 (38% versus 27%,P<0.0001). In more recent years, a larger percentage of glaucoma patients were treated with two or more drugs (34% in 2002 versus 13% in 1995). Over the period 1995–2002, baseline IOP did not change (P=0.85); for mean IOP at visit 4, a trend to lower IOPs was observed (P<0.0001). More patients achieved an IOP level under 22 and 18 mmHg after January 1999 than before, 85% versus 77%, and 46% versus 33%, respectively (P<0.0001).
Conclusions
This study shows a change in process of glaucoma treatment and lower achieved IOP after new glaucoma drugs had become available.
Similar content being viewed by others
References
Bateman DN, Clark R, Azuara Blanco A, Bain M, Forrest J (2002) The effects of new topical treatments on management of glaucoma in Scotland: an examination of ophthalmological health care. Br J Ophthalmol 86:551–554
Black N (1996) Why we need observational studies to evaluate the effectiveness of health care. BMJ 312:1215–1218
Grimes DA, Schulz KF (2002) Bias and causal associations in observational research. Lancet 359:248–252
Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M (2002) Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol 120:1268–1279
Kass MA, Heuer DK, Higginbotham EJ et al (2002) The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120:701–713
Morgenstern H (1995) Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health 16:61–81
Paikal D, Yu F, Coleman AL (2002) Trends in glaucoma surgery incidence and reimbursement for physician services in the Medicare population from 1995 to 1998. Ophthalmology 109:1372–1376
Padkin A, Rowan K, Black N (2001) Using high quality clinical databases to complement the results of randomised controlled trials: the case of recombinant human activated protein C. BMJ 323:923–926
Rochon PA, Gurwitz JH, Sykora K, Mamdani M, Streiner DL, Garfinkel S, Normand SL, Anderson GM (2005) Reader’s guide to critical appraisal of cohort studies: 1. Role and design. BMJ 330:895–897
Stiller CA (1994) Centralised treatment, entry to trials and survival. Br J Cancer 70:352–362
Strutton DR, Walt JG (2004) Trends in glaucoma surgery before and after the introduction of new topical glaucoma pharmacotherapies. J Glaucoma 13:221–226
The AGIS Investigators (2000) The advanced glaucoma intervention study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 130:429–440
van der Valk R (2005) Glaucoma medication, evidence from clinical trials and effects in practice (Thesis). Universitaire Pers Maastricht, Maastricht, pp 74–80
van der Valk R, Schouten JSAG, Webers CAB, Beckers HJM, van Amelsvoort LGPM, Schouten HJA, Hendrikse F, Prins MH (2005) The impact of a nationwide introduction of new drugs and a treatment protocol for glaucoma on the number of glaucoma surgeries. J Glaucoma 14:239–242
van der Valk R, Webers CAB, Schouten JSAG, Zeegers MP, Hendrikse F, Prins MH (2005) Intraocular pressure-lowering effects of all commonly used glaucoma drugs, a meta-analysis of randomized clinical trials. Ophthalmology 112:1177–1185
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van der Valk, R., Schouten, J.S.A.G., Webers, C.A.B. et al. Changes in glaucoma treatment and achieved IOP after introduction of new glaucoma medication. Graefe's Arch Clin Exp Ophthalmo 244, 1267–1272 (2006). https://doi.org/10.1007/s00417-005-0241-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-005-0241-y