Background: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. Methods: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. Results: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated J86 for each incremental step ranging from J455 per person year for stage 0 to J969 per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease.Conclusions: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.

The aim of this study was to examine the relationship between visual field (VF) loss, vision-related quality of life (QoL) and glaucoma-related symptoms in a large cohort of primary open angle glaucoma (POAG) patients. POAG patients with or without VF defects or “glaucoma suspect” patients were considered eligible. QoL was assessed using the validated versions of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and glaucoma-related symptoms were assessed using the Glaucoma Symptom Scale (GSS). Patients were classified as having VF damage in one eye (VFD-1), both eyes (VFD-2), or neither eye (VFD-0). 3227 patients were enrolled and 2940 were eligible for the analysis. 13.4% of patients were classified in the VFD-0, 23.7% in the VFD-1, and 62.9% in the VFD-2 group. GSS visual symptoms domain (Func-4) and GSS non-visual symptoms domain (Symp-6) scores were similar for the VFD-0 and VFD-1 groups (p = 0.133 and p = 0.834 for Func-4 and Symp-6, respectively). VFD-0 group had higher scores than VFD-2 both in Func-4 (p < 0.001) and Symp-6 domains (p = 0.035). Regarding the NEI-VFQ-25, our data demonstrated that bilateral VF defects are associated with vision-related QoL deterioration, irrespective of visual acuity.

Purpose: To compare the intraocular pressure (IOP) reducing effect and safety of fixed combination (FC) latanoprost/ timolol with unfixed combination (UFC) brimonidine/timolol in patients with increased IOP. Methods: In this 6 month, randomised, evaluator masked, parallel group European study, patients with glaucoma or ocular hypertension and IOP >21 mm Hg on monotherapy or .16 mm Hg on dual therapy received either FC latanoprost/timolol at 8:00AM or UFC brimonidine/timolol at 8:00AM and 8:00PM. The primary outcome was the difference from baseline to month 6 in mean diurnal IOP reduction. Results: 325 of 334 randomised patients were included in intent to treat analyses (FC latanoprost/timolol, 163; UFC brimonidine/timolol, 162). Baseline diurnal IOP levels were similar: FC latanoprost/timolol, 26.4 (SD 2.7) mm Hg; UFC brimonidine/timolol, 26.5 (SD 2.8) mm Hg (p = 0.851). At month 6, levels were 16.9 (SD 2.8) mm Hg in FC latanoprost/timolol patients and 18.2 (SD 3.1) mm Hg in UFC brimonidine/timolol patients (p,0.001). No adverse events were reported by 76.4% and 75.5% of patients receiving FC latanoprost/timolol versus UFC brimonidine/ timolol, respectively. Larger proportions of brimonidine/ timolol treated patients reported study medication related adverse events (18.6% v 7.3%) and discontinued study participation because of this (10.8% v 1.8%). Conclusion: Fixed combination latanoprost/timolol administered once daily is both more effective and better tolerated than twice daily dosing with UFC brimonidine/timolol. T opical hypotensive medication is considered the treatment of choice in the initial management of increased intraocular pressure (IOP) in patients with glaucoma. Target IOP levels are not always achieved with the use of one agent, however, and many patients require combination therapy. Several new and effective IOP lowering drugs have additive effects when used in combination with the b adrenergic receptor antagonist timolol. [3][4][5][6] Latanoprost, the only prostaglandin analogue indicated for first line use as an ocular hypotensive in Europe and the United States, lowers IOP levels by increasing uveoscleral outflow with little or no effect on aqueous humour production, 7 8 while b blockers are believed to reduce aqueous humour formation. 9The concomitant administration of latanoprost and timolol produces an additive IOP reducing effect.10 11 Because complex, multidrug regimens can reduce patient compliance, 12 13 a fixed formulation of latanoprost 0.005% and timolol 0.5% has been made available. Once daily administration of this combination is well tolerated and reduces IOP more effectively than either individual component alone in patients with open angle glaucoma and ocular hypertension. 14 15Brimonidine, a selective a 2 agonist ocular hypotensive agent, acts by reducing aqueous humour production and increasing uveoscleral outflow.16 17 Compared with timolol in patients with open angle glaucoma or ocular hypertension, brimonidine dosed twice daily produces similar 18 19 or significantly low...

In order to reduce corneal complications in 27 glaucomatous eyes that underwent trabeculectomy and postoperative subconjunctival injection of 5-fluorouracil we tried 1) a low-dose administration of 5-fluorouracil and 2) a modified subconjunctival injection technique. The mean total 5-fluorouracil dose was 18.0 +/- 6 mg. A life-table analysis showed a success rate, at 15 months, of 78% (+/- 7 S.E.). Four of the 27 eyes (13%) had corneal complications, limited to punctate keratopathy, with no corneal epithelial defects and/or abrasions. Our study shows that corneal complications decreased when the contact between 5-fluorouracil and the ocular surface was reduced.

In the entire group, cup shape measure showed to be the most significant factor correlating functional and morphologic changes. The presence of significant correlations between some HRT parameters and visual field indices in the ocular hypertensive and glaucoma subgroup suggested that HRT parameters and FDT indices could detect glaucoma damage differently.