<p>Canaloplasty in the Treatment of Primary Open-Angle Glaucoma: Patient Selection and Perspectives</p>

Glaucoma is the leading cause of irreversible blindness worldwide, with elevated intraocular pressure (IOP) as the only known modifiable risk factor. Trabecular meshwork (TM)-inducible myocilin (the MYOC gene) was the first to be identified and linked to juvenile and primary open-angle glaucoma. It has been suggested that mutations in the MYOC gene and the aggregation of mutant myocilin in the endoplasmic reticulum (ER) of TM may cause ER stress, resulting in a reduced outflow of aqueous humor and an increase in IOP. We selected 20 MYOC mutations with experimentally determined melting temperatures of mutated myocilin proteins. We included 40 published studies with at least one glaucoma patient with one of these 20 MYOC mutations and information on age at glaucoma diagnosis. Based on data from 458 patients, we found that a statistically significant but weak correlation was present between age and melting temperature based on various assumptions for age. We therefore conclude that genetic analysis of MYOC mutations alone cannot be used to accurately predict age at glaucoma diagnosis. However, it might be an important prognostic factor combined with other clinical factors for critical and early detection of glaucoma.

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Evaluation of Topical Monotherapy for Early Primary Open Angle Glaucoma Patient

The Egyptian Journal of Hospital Medicine ◽

10.12816/0043477 ◽

2018 ◽

Vol 70 (3) ◽

pp. 403-408 ◽

Cited By ~ 1

Author(s):

Saber Hamed El-Saied ◽

Adel Galal Zaky ◽

Ahmed El-Refaie Ali Abou El-Agha

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Glaucoma Patient ◽

Open Angle ◽

Early Primary

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Tailoring Pharmacological Therapy for the Progressing Primary Open-angle Glaucoma Patient – What Is the Best Approach?

European Ophthalmic Review ◽

10.17925/eor.2010.04.01.33 ◽

2010 ◽

Vol 04 (01) ◽

pp. 33

Author(s):

Norbert Pfeiffer ◽

Keyword(s):

Quality Of Life ◽

Disease Progression ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Glaucoma Patient ◽

Pharmacological Therapy ◽

Open Angle ◽

Tailored Approach ◽

Compliance To Treatment

Glaucoma progression can lead to a significant economic burden and reduction in quality of life. Primary open-angle glaucoma (POAG) is the most common form of this condition, and intraocular pressure (IOP) reduction in POAG patients can either delay or stop disease progression. POAG treatment aims to preserve visual function and quality of life (QoL) by lowering the IOP to the target level needed to limit progression. Importantly, the decision to treat and treatment choice should be based on a patient-tailored approach to optimise treatment outcomes. Commonly used IOP-lowering medications include the first-line prostaglandin analogues/prostamides and β-blockers. POAG patients are initially treated with monotherapy; however, they often experience disease progression due to inadequate IOP reduction. In such cases, combination therapy may be considered to achieve better IOP lowering. Fixed combinations of IOP-lowering medication are highly preferred over unfixed preparations as the former are associated with better patient compliance to treatment. Among the fixed combinations, long-term data for the latanoprost/timolol fixed combination (LTFC, once daily [QD]) is now available, showing LTFC to be effective, well-tolerated and safe over a three-year period in glaucoma patients who did not achieve the target IOP with monotherapy. In addition, LTFC may allow effective treatment tailoring as it has IOP-lowering effects whether dosed in the morning or the evening.

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Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1241-4489 ◽

2020 ◽

Author(s):

Christian Helbig ◽

Anja Wollny ◽

Attila Altiner ◽

Annette Diener ◽

Juliane Kohlen ◽

...

Keyword(s):

Patient Selection ◽

Private Practice ◽

Rural Areas ◽

Primary Open Angle Glaucoma ◽

Qualitative Content Analysis ◽

Open Angle Glaucoma ◽

Glaucoma Surgery ◽

Work Organisation ◽

Open Angle ◽

Common Causes

Abstract Background Primary open-angle glaucoma (POAG) is still one of the most common causes of impaired vision worldwide, despite the further development of therapy options, and can lead to blindness. Micro-invasive glaucoma surgery (MIGS) using stents aims at reducing intraocular pressure (IOP), as it is the main risk factor. With regard to adherence and adverse drug reactions it also aims at reducing the drug burden on patients. The study investigates under everyday conditions the criteria according to which ophthalmologists in Germany select patients for MIGS using stents. In addition, it will be investigated which patients (could) benefit most from the therapy. Material and Methods In this qualitative study, 11 narrative interviews were conducted between May 2017 and July 2018 with ophthalmologists working in the hospital or in a private practice. They were interviewed on their experiences in the treatment of POAG with microstents. The interviews were analysed by an interdisciplinary team using the qualitative content analysis. Results The stages of therapy escalation form the frame of reference for patient selection in MIGS using stents. Only if the IOP cannot be sufficiently reduced by drop therapy or when this causes drug-related side effects that are intolerable for the patients, stents are apparently used as the next higher escalation stage. The intensive post-operative medication and the frequent check-up appointments are perceived as barriers by the interviewees, especially for people with or without disabilities, who are dependent on external help and/or those living in rural areas. The active cooperation of the patients in the demanding aftercare seems to be indispensable for the ophthalmologists. In addition, necessary revisions are sometimes stressful for patients (physical/psychological) and doctors (work organisation/therapy). Against the background of the organisational and economic challenges in the outpatient spectrum of tasks, especially physicians in private practice seem to weigh up carefully for which patients microstent therapy would be reasonable. Conclusion In view of the therapeutic requirements, the current microstent therapy seems to be used in a selected, adherent patient group. Further qualitative and quantitative studies (in other health care regions and structures) are necessary to verify and extend the available results.

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Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

Russian Osteopathic Journal ◽

10.32885/2220-0975-2019-3-4-97-105 ◽

2020 ◽

pp. 97-105

Author(s):

E. N. Simakova ◽

O. V. Stenkova

Keyword(s):

Intraocular Pressure ◽

Drug Therapy ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Randomized Study ◽

Main Group ◽

Control Group ◽

Open Angle ◽

Complex Treatment ◽

Hypotensive Drug

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

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