What is the diagnosis and treatment for Glaucoma (a group of eye conditions that damage the optic nerve)?

From the Guidelines

Glaucoma treatment should begin with prescription eye drops, such as prostaglandin analogs, to lower intraocular pressure and prevent optic nerve damage, as recommended by the most recent guidelines 1.

Key Considerations

• The primary goal of treatment is to reduce intraocular pressure (IOP) by 20-30% below baseline to slow disease progression 1.
• Prostaglandin analogs, such as latanoprost and travoprost, are the most frequently prescribed eye drops for lowering IOP due to their efficacy and tolerability 1.
• Regular eye exams, typically every 3-6 months, are essential to monitor pressure and disease progression 1.
• Patients should be educated on the importance of consistent pressure control, potential side effects, and the need for regular follow-up exams 1.

Treatment Options

• Medical therapy: prostaglandin analogs, beta-blockers (e.g., timolol), alpha-agonists (e.g., brimonidine), and carbonic anhydrase inhibitors (e.g., dorzolamide) 1.
• Laser procedures: selective laser trabeculoplasty may be considered if medical therapy is insufficient 1.
• Surgical interventions: trabeculectomy or other surgical procedures may be necessary in advanced cases or if other treatments fail 1.

Patient Education and Support

• Patients should be informed about the disease process, treatment options, and potential risks and benefits 1.
• Education on drop administration techniques and the importance of adherence to treatment plans is crucial 1.
• Patients with glaucoma may experience negative psychological effects, and ophthalmologists should provide support and encouragement 1.

From the FDA Drug Label

Patients with mean baseline intraocular pressure of 24 - 25 mmHg who were treated for 6 months in multi-center, randomized, controlled trials demonstrated 6-8 mmHg reductions in intraocular pressure. A 3-year open-label, prospective safety study with a 2-year extension phase was conducted to evaluate the progression of increased iris pigmentation with continuous use of Latanoprost Ophthalmic Solution, 0. 005% once-daily as adjunctive therapy In 519 patients with open-angle glaucoma.

Latanoprost is used to treat glaucoma by reducing intraocular pressure (IOP). The reduction in IOP is around 6-8 mmHg.

• The drug is effective in patients with open-angle glaucoma.
• IOP reduction is similar regardless of the development of increased iris pigmentation during the study 2.

Elevated intraocular pressure is a major risk factor in the pathogenesis of optic nerve damage and glaucomatous visual field loss. The higher the level of intraoular pressure, the greater the likelihood of glaucomatous field loss and optic nerve damage.

Dorzolamide also decreases elevated intraocular pressure, whether or not associated with glaucoma, by reducing aqueous humor secretion 3.

• Intraocular pressure reduction is the goal of treatment to prevent glaucomatous field loss and optic nerve damage.

From the Research

Definition and Prevalence of Glaucoma

• Glaucoma is a progressive optic neuropathy and the leading cause of irreversible vision loss 4
• Primary open-angle glaucoma (POAG) is the most common form of glaucoma in the United States, with a risk that increases with age, family history, and other factors 5

Diagnosis and Management of Glaucoma

• Diagnosis of POAG often requires monitoring over years to document changes, including a cup-to-disc ratio of 0.3 or greater, intraocular pressure greater than 21 mm Hg, nerve fiber layer defects, and reproducible visual field defects 5
• Topical intraocular pressure-lowering medications and selective laser trabeculoplasty are first-line treatments for POAG 5
• The goal of treatment for acute angle-closure glaucoma is to reduce intraocular pressure quickly with medications or surgery, then prevent the recurrence of the obstruction to aqueous flow by a definitive ophthalmologic procedure 5

Treatment Options for Glaucoma

• Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs for reducing intraocular pressure, although within-class differences may not be clinically meaningful 6
• Latanoprost has been shown to reduce intraocular pressure at least as well as timolol plus dorzolamide in patients with open-angle glaucoma 7
• The timolol/dorzolamide fixed combination and latanoprost are both efficacious in the treatment of newly diagnosed exfoliation glaucoma, with patient preference generally given to latanoprost due to its once daily dosing 8

Emerging Treatments for Glaucoma

• There are numerous drugs currently in development that have demonstrated significant and clinically relevant reduction of intraocular pressure, with differentiating factors including improved tolerability and novel mechanisms of action 4
• The availability of generic prostaglandin analogs may limit adoption of these novel compounds as first-line agents, except for certain subgroups of glaucoma patients 4