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      Open-Angle Glaucoma: Burden of Illness, Current Therapies, and the Management of Nocturnal IOP Variation

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          Abstract

          Glaucoma is a chronic, debilitating disease and a leading cause of global blindness. Despite treatment efforts, 10% of patients demonstrate loss of vision. In the US, > 80% of glaucoma cases are classified as open-angle glaucoma (OAG), with primary open-angle (POAG) being the most common. Although there has been tremendous innovation in the surgical treatment of glaucoma as of late, two clinical variants of OAG, normal-tension glaucoma (NTG) and severe POAG, are especially challenging for providers because patients with access to care and excellent treatment options may progress despite achieving a “target” intraocular pressure value. Additionally, recent research has highlighted the importance of nocturnal IOP control in avoiding glaucomatous disease progression. There remains an unmet need for new treatment options that can effectively treat NTG and severe POAG patients, irrespective of baseline IOP, while overcoming adherence limitations of current pharmacotherapies, demonstrating a robust safety profile, and more effectively controlling nocturnal IOP.

          Funding The Rapid Service Fees were funded by the corresponding author, Tanner J. Ferguson, MD.

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          The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators.

          (2000)
          To investigate the association between control of intraocular pressure after surgical intervention for glaucoma and visual field deterioration. In the Advanced Glaucoma Intervention Study, eyes were randomly assigned to one of two sequences of glaucoma surgery, one beginning with argon laser trabeculoplasty and the other trabeculectomy. In the present article we examine the relationship between intraocular pressure and progression of visual field damage over 6 or more years of follow-up. In the first analysis, designated Predictive Analysis, we categorize 738 eyes into three groups based on intraocular pressure determinations over the first three 6-month follow-up visits. In the second analysis, designated Associative Analysis, we categorize 586 eyes into four groups based on the percent of 6-month visits over the first 6 follow-up years in which eyes presented with intraocular pressure less than 18 mm Hg. The outcome measure in both analyses is change from baseline in follow-up visual field defect score (range, 0 to 20 units). In the Predictive Analysis, eyes with early average intraocular pressure greater than 17.5 mm Hg had an estimated worsening during subsequent follow-up that was 1 unit of visual field defect score greater than eyes with average intraocular pressure less than 14 mm Hg (P =.002). This amount of worsening was greater at 7 years (1.89 units; P <.001) than at 2 years (0.64 units; P =.071). In the Associative Analysis, eyes with 100% of visits with intraocular pressure less than 18 mm Hg over 6 years had mean changes from baseline in visual field defect score close to zero during follow-up, whereas eyes with less than 50% of visits with intraocular pressure less than 18 mm Hg had an estimated worsening over follow-up of 0.63 units of visual field defect score (P =.083). This amount of worsening was greater at 7 years (1.93 units; P <.001) than at 2 years (0.25 units; P =.572). In both analyses low intraocular pressure is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low intraocular pressure in visual field deterioration.
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            Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey.

            A Sommer, J Tielsch, J. Katz … (1991)
            A detailed ocular examination, including perimetry, was conducted on 5308 black and white subjects aged 40 years and older in a population-based prevalence survey in east Baltimore, Md. Repeated, detailed examinations were carried out on selected subjects. Roughly half of all subjects with optic nerve damage from primary open angle glaucoma, regardless of race, were unaware that they had the condition. The average intraocular pressure (IOP) among black patients with glaucoma who were receiving treatment was virtually identical to that in those black patients who were not receiving treatment (median IOP, 20 mm Hg); treated eyes of white patients had a lower IOP than those eyes of white patients who were not receiving treatment (mean [+/- SD] IOP, 18.69 +/- 3.23 mm Hg vs 24.15 +/- 5.23 mm Hg; P less than .001). The risk of glaucomatous optic nerve damage increased with the height of the screening IOP, particularly at levels of 22 to 29 and 30 mm Hg and above (relative rate compared with IOP of 15 mm Hg or lower, 12.8 and 40.1 mm Hg, respectively). More than half of all glaucomatous eyes had a screening IOP below 21 mm Hg, whether these eyes were receiving treatment or not. The IOP in glaucomatous eyes tended to rise on follow-up, in contrast with nonglaucomatous eyes in which the IOP was as likely to rise as to fall. Results confirmed that IOP is an important factor in glaucoma, but did not support the traditional distinction between "normal" and "elevated" pressure, nor its corollaries, "low-tension" glaucoma and "high-tension" glaucoma.
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              Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study.

              L Bonomi (2000)
              To assess the impact of vascular risk factors on the prevalence of primary open angle glaucoma. Population-based cross-sectional study. Four thousand two hundred ninety-seven patients more than 40 years of age underwent a complete ocular examination in the context of the Egna-Neumarkt Glaucoma Study. Ocular examinations were performed by trained, quality-controlled ophthalmologists according to a predefined standardized protocol including medical interview, blood pressure reading, applanation tonometry, computerized perimetry, and optic nerve head examination. Prevalences of ocular hypertension, primary open-angle glaucoma, normal-tension glaucoma, and other types of glaucoma were determined. Correlation coefficients were calculated for the association between systemic blood pressure and age-adjusted intraocular pressure (IOP) and between age and both intraocular and systemic blood pressures. Odds ratios were computed to assess the risk of primary open-angle glaucoma and normal-tension glaucoma in relation to systemic hypertension or antihypertensive medication, blood pressure levels, diastolic perfusion pressure, and a number of other cardiovascular risk factors. A positive correlation was found between systemic blood pressure and IOP, and an association was found between diagnosis of primary open-angle glaucoma and systemic hypertension. Lower diastolic perfusion pressure is associated with a marked, progressive increase in the frequency of hypertensive glaucoma. No relationship was found between systemic diseases of vascular origin and glaucoma. Our data are in line with those reported in other recent epidemiologic studies and show that reduced diastolic perfusion pressure is an important risk factor for primary open-angle glaucoma.
              Article 0 comments Cited 151 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tanner J. Ferguson:
                ORCID: http://orcid.org/0000-0002-7754-0465
                tannerferg@gmail.com
                Journal
                Journal ID (nlm-ta): Ophthalmol Ther
                Journal ID (iso-abbrev): Ophthalmol Ther
                Title: Ophthalmology and Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 2193-8245
                ISSN (Electronic): 2193-6528
                Publication date (Electronic): 15 November 2019
                Publication date PMC-release: 15 November 2019
                Publication date (Print): March 2020
                Volume: 9
                Issue: 1
                Pages: 1-14
                Affiliations
                [1 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Washington University School of Medicine, ; St. Louis, MO USA
                [2 ]GRID grid.39382.33, ISNI 0000 0001 2160 926X, Baylor College of Medicine, ; Houston, TX USA
                [3 ]GRID grid.477546.3, Minnesota Eye Consultants, ; Minneapolis, MN USA
                [4 ]GRID grid.429325.b, ISNI 0000 0004 5373 135X, Department of Ophthalmology, , University of Colorado Health Eye Center, ; Aurora, CO USA
                [5 ]GRID grid.214572.7, ISNI 0000 0004 1936 8294, Department of Ophthalmology, , Carver College of Medicine, ; Iowa City, IA USA
                [6 ]GRID grid.477184.9, Prism Eye Institute, ; Mississauga, Ontario Canada
                [7 ]GRID grid.478136.f, Vance Thompson Vision, ; Sioux Falls, SD USA
                [8 ]GRID grid.239578.2, ISNI 0000 0001 0675 4725, Cole Eye Institute, Cleveland Clinic, ; Cleveland, OH USA
                [9 ]GRID grid.26009.3d, ISNI 0000 0004 1936 7961, Duke University School of Medicine, , Duke Eye Center, ; Durham, NC USA
                Author information
                http://orcid.org/0000-0002-7754-0465
                Article
                Publisher ID: 222
                DOI: 10.1007/s40123-019-00222-z
                PMC ID: 7054505
                PubMed ID: 31732872
                SO-VID: ad916934-aad4-4339-a9f4-519eb3268227
                Copyright © © The Author(s) 2019
                History
                Date received : 4 September 2019
                Categories
                Subject: Commentary
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: glaucoma treatment,normal-tension glaucoma,oag,open-angle glaucoma,pharmacotherapy,surgical treatment of glaucoma
                Data availability:
                Keywords: glaucoma treatment, normal-tension glaucoma, oag, open-angle glaucoma, pharmacotherapy, surgical treatment of glaucoma

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