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An analysis of first line treatment in open-angle glaucoma in Trinidad and Tobago

Poster Details

First Author: S.Lalchan TRINIDAD AND TOBAGO

Co Author(s):    J. Cook              

Abstract Details



Purpose:

Glaucoma is the leading cause of irreversible blindness in patients of African descent. It occurs at an earlier age, lower intraocular pressure with rapid progression to advanced glaucoma in high risk groups such as those in the Caribbean. The aims of the study were to qualify the epidemiology of patients diagnosed with glaucoma and to introduce educational pathways to increase awareness and compliance. Also, to determine, within the practical clinical setting, the IOP response to various first line treatment.

Setting:

Trinidad and Tobago

Methods:

A retrospective, consecutive series from August 2011 to present was analysed. All patients were examined by a Consultant Ophthalmologist as follows: history, slit lamp examination, Goldmann tonometry, indentation gonioscopy, pachymetry, dilated fundoscopy, stereo discs photography and Humphreys 24-2 SITA perimetry. The patient pathway incorporated multiple educational components ie educational videos, booklets, perimetry questionnaire, drop instillation techniques, compliance tips, prognosis and risks to family members. Treatment included prostaglandin analogues and/or fixed combinations. Patients were reviewed within 3mths. STATA was used for statistical analysis. Inclusion criteria: age >35yrs, open angle glaucoma, new diagnosis and treatment initiation (glaucomatous optic neuropathy and/or visual field defect consistent with retinal nerve fibre layer damage), refractive error +3.0 to -5.0DS. Exclusion criteria: primary angle closure glaucoma, secondary glaucoma, previous complex anterior segment/vitreoretinal procedures.

Results:

Demographics: 68 patients (n 131 eyes) were diagnosed with open angle glaucoma. The mean age was 60yrs (range 36-80yrs, SD 8.92); 47% male; 28% had family history of glaucoma. The pre-treatment IOP mean 24.5mmHg (95% CI 23- 25.9; S.D. 8.59; range 12-62mmHg); mean CCT 537um (95% CI 532.8-542.3; S.D. 26.4; range 483-619um); 78.5% of eyes had a CCT <555um. Eleven eyes n11 (8.4%) had a mean deviation of <-12 db. 36% of eyes (n48) had normal tension glaucoma. There was a female preponderance 74% (n 20 pts); mean IOP 17.4mmHg (95% CI 16.9-18.0, SD 1.98;12-20mmHg) and mean CCT 529um (95% CI 523.1-535.3,SD 20.64; range 487-580 ┬Ám). IOP response: n 30 eyes was excluded from analysis. Travoprost (Alcon) n 33eyes, mean IOP reduction 37.9% (95% CI CI 34.5-41.4; Range 13.3-52.4%). Latanoprost (Pfizer) n 19 eyes, mean IOP reduction 37.6% (95% CI 32.4-42.8; Range 25-61.5%). Travoprost/timolol (Alcon) n 28 eyes, mean IOP reduction 44.2% (95% CI 39.9-48.5; Range 25-71.4%). Latanoprost/timolol (Pfizer) n 22eyes, mean IOP reduction 39.9% (95% CI 36.9-42.8; Range 24-52.8%). There was no statistically significant difference in the IOP reduction among the four ocular hypotensives (one way ANOVA: F= 2.59, p=0.06).

Conclusions:

Patient education and compliance are critical to achieving successful IOP reduction to reduce the risk of progression of glaucoma. Education needs to be emphasized within the patient pathway in developing countries and high risk patients. The epidemiological profile showed 78.5%% patients had a CCT < 555um and 28% had a family history of glaucoma. First line therapy demonstrates good efficacy in a practical clinical scenario in a high risk population. The authors declare no financial interests. FINANCIAL INTEREST: NONE

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