Factors associated with long-term progression or stability in primary open-angle glaucoma

Stewart, William C.; Kolker, Allan E.; Sharpe, Elizabeth D.; Day, Douglas G.; Holmes, Keri T; Leech, Jessica N.; Johnson, Mark H.; Cantrell, Jennifer B

doi:10.1016/s0002-9394(00)00487-6

Cited by 148 publications

(104 citation statements)

References 20 publications

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“…[12][13][14] Accordingly, based on the literature, within the first year of therapy a majority of patients started on timolol were switched to latanoprost. [1][2][3]7 Consequently, these patients were able to gain the efficacy and advantage of prostaglandin therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The potential of developing progressive glaucomatous long-term visual field loss over 5 years, based on previous studies evaluating progression at different mean intraocular pressure levels in primary open-angle and exfoliation glaucoma, is demonstrated in the model (see Supplementary Information). [12][13][14][15] Figure 1 demonstrates the model steps. Glaucomatous progression was assumed to be slow and staged over time.…”

Section: Markov Model: Medical Aspectsmentioning

confidence: 99%

“…[12][13][14][15] We presupposed that those who were stable (no additional glaucomatous optic disc or visual field progression) maintained therapy, and remained stable, for the remaining life of the model. Those who were unstable, ie, suffered progression, received a second medication.…”

Section: Markov Model: Medical Aspectsmentioning

confidence: 99%

“…This adjunctive therapy cohort progressed or remained stable according to rates published previously for 15 mmHg. [12][13][14][15] Stable patients again were assumed to maintain their therapy, and to remain stable, for the remaining life of the model. Unstable patients, at such a low pressure, were progressed to trabeculectomy at rates determined from previously published success/failure rates.…”

Section: Markov Model: Medical Aspectsmentioning

confidence: 99%

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Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model

Stewart

Mychaskiw

2007

Eye

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Purpose To assess the cost-effectiveness of latanoprost or timolol in glaucoma treatment in Norway, Sweden, Denmark (Scandinavia) and the United Kingdom (UK). Methods A Markov model was constructed to perform a cost-effectiveness analysis. Health states were 'stable' and 'progressed' glaucoma, and transition probabilities for both primary open-angle and exfoliation glaucoma were derived from the medical literature. Practice patterns were obtained from surveys completed by 54 ophthalmologists geographically dispersed throughout each country. Country specific unit costs were used for medications, patient visits, diagnostics, and therapeutic procedures. Results Over the life of the model latanoprost was less expensive than timolol by 5.3-7.6% (Scandinavia) and 2.1% (UK). Following adjustments, therapy in the original timolol-treated cohort was slightly more effective in each country with a difference in 0.003-0.015 years to progression of glaucoma existing between latanoprost. This may have resulted from the model design, which reflected that physicians ultimately control most patients' glaucoma over 5 years by adding or changing therapy. The associated incremental cost-effectiveness ratios for latanoprost vs timolol generated by the Scandinavian and the UK models, respectively, were: Norway 351 396 NOK; Sweden 988 985 SEK; Denmark 351 641; and the UK 4751 GBP. Conclusions Over 5 years, in the UK timolol is the cost-effective option, whereas in Scandinavia latanoprost may be the costeffective alternative to timolol.

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Section: Discussionmentioning

confidence: 99%

Section: Markov Model: Medical Aspectsmentioning

confidence: 99%

Section: Markov Model: Medical Aspectsmentioning

confidence: 99%

Section: Markov Model: Medical Aspectsmentioning

confidence: 99%

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Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model

Stewart

Mychaskiw

2007

Eye

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“…The smaller fluctuation of treated IOP may confer a long-term benefit in the management of XFG since it has been shown in POAG that the less the fluctuation, the better the prognosis in the management of glaucoma. [39][40][41] With regard to specific time points, latanoprost treatment reduced the IOP significantly more than timolol and provided a lower absolute IOP at 0800 hours (12 h following dosing). However, only a trend of a lower IOP existed (after the Bonferroni Correction) with latanoprost for the other time points and the diurnal curve following 3 months of chronic dosing.…”

Section: Discussionmentioning

confidence: 99%

Diurnal intraocular pressure reduction with latanoprost 0.005% compared to timolol maleate 0.5% as monotherapy in subjects with exfoliation glaucoma

Konstas

Mylopoulos

Karabatsas

et al. 2004

Eye

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Aims To compare the diurnal intraocular pressure (IOP) efficacy and safety of timolol vs latanoprost in subjects with exfoliation glaucoma (XFG). Methods A 3-month prospective, singlemasked, active-controlled, parallel comparison performed in six centres in Greece that randomized subjects in a 1 : 1 ratio to either latanoprost in the evening (2000 hours) and placebo in the morning (0800 hours), or timolol twice daily (0800 and 2000 hours).Results In all, 103 subjects completed the study. After 3 months of chronic dosing, the latanoprost group exhibited a trend to a greater diurnal IOP reduction from an untreated baseline (24.973.2-17.472.9) compared with timolol (24.772.8-18.371.9 mmHg) (P ¼ 0.07). Latanoprost showed a significantly greater IOP reduction at 0800 hours (À8.5 vs À6.0 mm Hg for timolol, Po0.0001) whereas no difference was observed between the two medications at 1000, 1400, and 2000 hours after a Bonferroni Correction. In addition, latanoprost demonstrated a narrower range of diurnal IOP (2.4) than timolol (3.2 mmHg)(P ¼ 0.0017). Safety was similar between groups, except there was more conjunctival hyperaemia with latanoprost (n ¼ 8) than timolol (n ¼ 1)(P ¼ 0.01). Conclusions This study suggests that latanoprost provides a statistically lower 08:00-hour IOP and better range of IOP than timolol in the treatment of XFG glaucoma.

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Factors for Glaucoma Progression and the Effect of Treatment

Leske

Heijl

Hussein³

et al. 2003

Arch Ophthalmol

1,797

513

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Setting/Participants: Two hundred fifty-five openangle glaucoma patients randomized to argon laser trabeculoplasty plus topical betaxolol or no immediate treatment (129 treated; 126 controls) and followed up every 3 months. Methods: Progression was determined by perimetric and photographic optic disc criteria. Patient-based risk of progression was evaluated using Cox proportional hazard regression models and was expressed as hazard ratios (HR) with 95% confidence intervals (95% CI). Results: After 6 years, 53% of patients progressed. In multivariate analyses, progression risk was halved by treatment (HR = 0.50; 95% CI, 0.35-0.71). Predictive baseline factors were higher intraocular pressure (IOP) (ie, the higher the baseline IOP, the higher the risk), exfoliation, and having both eyes eligible (each of the latter 2 factors doubled the risk), as well as worse mean deviation and older age. Progression risk decreased by about 10% with each millimeter of mercury of IOP reduction from baseline to the first follow-up visit (HR=0.90 per millimeter of mercury decrease; 95% CI, 0.86-0.94). The first IOP at that visit (3 months' follow-up) was also related to progression (HR = 1.11 per millimeter of mercury higher; 95% CI, 1.06-1.17), as was the mean IOP at follow-up (HR=1.13 per millimeter of mercury higher; 95% CI, 1.07-1.19). The percent of patient follow-up visits with disc hemorrhages was also related to progression (HR=1.02 per percent higher; 95% CI, 1.01-1.03). No other factors were identified. Conclusions: Patients treated in the EMGT had half of the progression risk of control patients. The magnitude of initial IOP reduction was a major factor influencing outcome. Progression was also increased with higher baseline IOP, exfoliation, bilateral disease, worse mean deviation, and older age, as well as frequent disc hemorrhages during follow-up. Each higher (or lower) millimeter of mercury of IOP on follow-up was associated with an approximate 10% increased (or decreased) risk of progression.

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Factors associated with long-term progression or stability in primary open-angle glaucoma

Cited by 148 publications

References 20 publications

Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model

Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model

Diurnal intraocular pressure reduction with latanoprost 0.005% compared to timolol maleate 0.5% as monotherapy in subjects with exfoliation glaucoma

Factors for Glaucoma Progression and the Effect of Treatment

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