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Is the medication used to achieve the target intraocular pressure in glaucoma therapy of relevance? : an exemplary analysis on the basis of two beta-blockers

Grieshaber, Matthias C. and Flammer, Josef. (2010) Is the medication used to achieve the target intraocular pressure in glaucoma therapy of relevance? : an exemplary analysis on the basis of two beta-blockers. Progress in retinal and eye research, Vol. 29, no. 1. pp. 79-93.

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Official URL: http://edoc.unibas.ch/dok/A6007322

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Abstract

Glaucoma, the most common optic neuropathy (GON) is characterised by the loss of retinal ganglion cells and their axons, as well as tissue remodelling of both the retina and the optic nerve head with corresponding visual field defects. Elevated intraocular pressure (IOP) is generally regarded as the major risk factor for glaucoma and its reduction is the most common target for therapy of GON. There are indications that the greater the IOP reduction, the better is the visual field prognosis. This article investigates, on the basis of two beta-blockers, betaxolol and timolol, whether the amount of IOP reduction is truly a good surrogate for successful glaucoma therapy with respect to visual field outcome. Contrary to what is generally expected, our analysis of the literature exemplifies that despite a smaller IOP reduction, patients treated with betaxolol had a smaller rate of visual field deterioration than patients treated with timolol. Based on the dissociation of IOP reduction and visual field prognosis, we postulate that for successful treatment in glaucoma not only the amount of IOP reduction is relevant but also the drug by which the reduction is achieved. This seeming paradox phenomenon highlights that ocular hypotensive drugs have relevant effects on GON other than IOP-related. Some of these effects on retinal ganglion cells (neuroprotection) or on ocular blood flow are mediated by calcium- and sodium channels. Future studies on glaucoma treatment should focus on their effect on visual field function, and not just on IOP. This should particularly be considered when comparing drugs from different classes.
Faculties and Departments:03 Faculty of Medicine > Bereich Spezialfächer (Klinik) > Ehemalige Einheiten Spezialfächer (Klinik) > Ophthalmologie (Flammer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Spezialfächer (Klinik) > Ehemalige Einheiten Spezialfächer (Klinik) > Ophthalmologie (Flammer)
UniBasel Contributors:Flammer, Josef
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Bibsysno:Link to catalogue
Publisher:Pergamon Press
ISSN:1350-9462
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:13 Sep 2013 07:59
Deposited On:13 Sep 2013 07:48

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