Eyeworld

EW GLAUCOMA 56 April 2015 by Vanessa Caceres EyeWorld Contributing Writer effective glaucoma treatment efficacy with the lowering of IOP, said Fiaz Zaman, MD, Houston Eye Associates, Houston. Dr. Zaman assisted with the survey. The results also point to a physi- cian's natural inclination to focus on efficacy, safety, and tolerability of a medication. "You can have an effica- cious medication but if it stings the eye or has a long list of side effects, the patient is probably not going to use it," he said. "This survey demonstrates that eye doctors understand the single most important component of glaucoma therapy is efficacious pressure lowering," said Nathan Radcliffe, MD, assistant professor of ophthalmology, Weill Cornell Med- ical College, New York-Presbyterian Hospital, New York. "When it comes to adjunctive therapy, pressure low- ering may be more difficult because the primary agent was likely a pow- erful, well-chosen medication that fell short of the patient's needs," Dr. Radcliffe added. He said the desire for an adjunctive therapy that lowers IOP by 3–5 mm Hg implicitly shows that fixed combination ther- apy may be needed to achieve that level of efficacy. Reay Brown, MD, Atlanta, EyeWorld glaucoma editor, was not surprised by the study results, noting that efficacy and reduction of IOP are paramount when selecting glaucoma therapies. He thinks that compliance is another factor that glaucoma specialists should monitor more carefully. "I think the responses reflect what we are judged by rather than what is truly most important," he said. "The compliance issue is huge but we are generally not aware, and most of us, including me, don't really factor it in. But all studies of compliance show that it is terrible, so the IOP we measure is just a point in time rather than an accurate re- flection of what the pressure is most of the time." Although measuring the im- portance of patient compliance was beyond the scope of the survey, Dr. Zaman agreed that it plays a major role in the effectiveness of glaucoma treatment. "Glaucoma often pro- gresses because people aren't compli- ant with their medication," he said. "The key is compliance. It's human nature. I always tell patients to be vigilant with their medications. As physicians, we must continue to educate patients to keep them on track." In the near future, extended-re- lease drug delivery systems could help provide an easier path to com- pliance, leading to more effective treatment, Dr. Zaman said. EW Editors' note: The physicians inter- viewed have no financial interests related to their comments. Contact information Brown: reaymary@comcast.net Radcliffe: drradcliffe@gmail.com Zaman: fiazzaman@gmail.com Efficacy crucial for glaucoma adjunctive therapy Survey: Physicians rank efficacy, tolerability, and safety as most important W hat's the number one factor you consid- er when choosing adjunctive therapy for glaucoma patients? If you answered efficacy, then you are in line with your peers, based on the results of a recent survey from M3 Research in partner- ship with Allergan (Irvine, Calif.). M3 Research surveyed 126 glaucoma specialists to find out what attributes they value the most in a glaucoma adjunctive therapy. Here is what was ranked as most important: 1. Efficacy (75%) 2. Safety (6%) 3. Covered by managed care (6%) 4. Dosing (4%) 5. Tolerability (4%) 6. Duration (4%) 7. Beta-blocker free (1%) More than 75% of those re- sponding said that they include a reduction in IOP as a defining factor for efficacy. Additionally, 75% said that they look for a 3–5 mm Hg IOP reduction when they add an adjunc- tive therapy. The survey showed that medical therapy with a sole prostaglandin analogue (PGA) is the most com- mon treatment choice for patients; the physicians surveyed said they treat 52% of their patients with one PGA. An average of 25% of patients receive both a PGA and 1 adjunc- tive therapy. Medications currently available on the market include Xalatan (latanoprost, Pfizer, New York), Lumigan (bimatoprost, Allergan), Travatan (travoprost, Alcon, Fort Worth, Texas), Alphagan (brimonidine tartrate, Allergan), and Cosopt (dorzolamide hydrochloride, timolol maleate, Merck, Kenilworth, N.J.). Weighing in The survey results match the findings of clinical trials from the past decade or so that correlate

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