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European Journal of Pharmacology Sep 2023Glaucoma is a chronic and progressive neurodegenerative disease characterized by the loss of retinal ganglion cells and visual field defects, and currently affects... (Review)
Review
Glaucoma is a chronic and progressive neurodegenerative disease characterized by the loss of retinal ganglion cells and visual field defects, and currently affects around 1% of the world's population. Elevated intraocular pressure (IOP) is the best-known modifiable risk factor and a key therapeutic target in hypertensive glaucoma. The trabecular meshwork (TM) is the main site of aqueous humor outflow resistance and therefore a critical regulator of IOP. Fibrosis, a reparative process characterized by the excessive deposition of extracellular matrix components and contractile myofibroblasts, can impair TM function and contribute to the pathogenesis of primary open-angle glaucoma (POAG) as well as the failure of minimally invasive glaucoma surgery (MIGS) devices. This paper provides a detailed overview of the current anti-fibrotic therapeutics targeting the TM in glaucoma, along with their anti-fibrotic mechanisms, efficacy as well as the current research progress from pre-clinical to clinical studies.
Topics: Humans; Trabecular Meshwork; Glaucoma, Open-Angle; Neurodegenerative Diseases; Intraocular Pressure; Glaucoma; Aqueous Humor
PubMed: 37391006
DOI: 10.1016/j.ejphar.2023.175882 -
Asia-Pacific Journal of Ophthalmology... 2016Selective laser trabeculoplasty (SLT) is an effective treatment option for the reduction of intraocular pressure (IOP) in patients with ocular hypertension or open-angle... (Review)
Review
Selective laser trabeculoplasty (SLT) is an effective treatment option for the reduction of intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma. The mechanism by which SLT lowers IOP is not completely understood and is likely multifactorial. Published studies indicate that SLT is at least as effective as argon laser trabeculoplasty or medications at lowering IOP in many forms of glaucoma. In addition to IOP reduction, SLT may decrease IOP fluctuation and can be successfully used as primary or adjunctive therapy for the management of both early and advanced glaucoma. However, SLT may not be effective in certain forms of glaucoma, and the IOP-lowering effect seems to wane with time. High pretreatment IOP is the strongest predictor of treatment success, even in patients with normal-tension glaucoma. Repeatability of SLT has been controversial, but recent evidence suggests that it can be successfully repeated to achieve additional or recurrent IOP reduction, even in eyes that only had a modest response to initial treatment. Adverse events are uncommon after SLT, and the most common complications such as discomfort and inflammation are typically mild and transient. Further investigation is required to determine the optimal treatment parameters for SLT treatment. Limited evidence suggests that SLT is cost-effective as primary therapy for patients with glaucoma.
Topics: Glaucoma, Open-Angle; Humans; Intraocular Pressure; Laser Therapy; Ocular Hypertension; Trabeculectomy
PubMed: 26886122
DOI: 10.1097/APO.0000000000000175 -
FP Essentials Aug 2022Primary open-angle glaucoma (POAG) is a progressive, chronic, irreversible ocular disease that leads to loss of visual field. In the United States, its prevalence is...
Primary open-angle glaucoma (POAG) is a progressive, chronic, irreversible ocular disease that leads to loss of visual field. In the United States, its prevalence is expected to more than double from 2011 to 2050. POAG is three times more common among Black people than White people. More than half of patients with POAG are asymptomatic. Management focuses on decreasing intraocular pressure. Prostaglandin analogue eye drops can preserve visual field and are the first-line therapy. There currently is no evidence to support universal screening for POAG in adults. Physicians should recognize patients at high risk and provide early referral to an ophthalmologist. They also should encourage patients with POAG to adhere to treatment and follow up with their ophthalmologist. Cataract is a progressive condition caused by opacification of the lens of the eye. It affects 24.4 million Americans and is expected to affect 50 million Americans by 2050. Patients with cataracts present with visual impairment, glare, decreased color and contrast sensitivity, and poor adaptation to darkness. Management consists of surgical removal of the lens via small-incision phacoemulsification with placement of a foldable intraocular lens. After surgery, patients may develop posterior capsular opacification, which can be managed with laser capsulotomy.
Topics: Adult; Cataract; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Phacoemulsification
PubMed: 35947132
DOI: No ID Found -
Acta Cardiologica Feb 2020Glaucoma is commonly defined as high intra ocular pressure (≥21 mmHg) with optic neuropathy characterised by progressive loss of retinal ganglion cells which is...
Glaucoma is commonly defined as high intra ocular pressure (≥21 mmHg) with optic neuropathy characterised by progressive loss of retinal ganglion cells which is associated with characteristic structural damage to the optic nerve and visual field loss. There are several studies investigating relation between primary open angle glaucoma (POAG) and both systemic hypertension and especially night hypotension. Our aim was to compare 24-h ambulatory blood pressure variability of patients with glaucoma followed-up in the eye outpatient clinic with that of patients free of glaucoma. A total of 75 patients were included in the study, 35 in the patient group and 40 in the control group. Both groups were compared for daytime, night-time, and whole day mean systolic and diastolic blood pressure (BP) readings in the ambulatory blood pressure testing. Mean daytime systolic BP of the glaucoma patients was 119.5 ± 11.6 mmHg, and 128.3 ± 15.5 mmHg for control group ( = 0.008). The night-time systolic blood pressure, whole day systolic BP, and mean diastolic BP were significantly lower in patients with glaucoma ( = 0.001, = 0.001, = 0.028, respectively). In multiple regression analysis, we identified daytime systolic BP, night-time systolic BP, and whole day systolic BP were independent risk factors for developing glaucoma. If the progression of the disease is noticeable in patients with glaucoma at follow-up, night-time hypotension should be ruled out with ambulatory blood pressure and if this is observed medical treatments used by the patients should be reviewed and necessary measures should be taken.
Topics: Aged; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Case-Control Studies; Circadian Rhythm; Disease Progression; Female; Glaucoma, Open-Angle; Humans; Hypotension; Intraocular Pressure; Male; Middle Aged; Risk Factors; Time Factors
PubMed: 30650042
DOI: 10.1080/00015385.2018.1549004 -
Graefe's Archive For Clinical and... Aug 2018
Topics: Filtering Surgery; Glaucoma, Open-Angle; Humans; Intraocular Pressure
PubMed: 29911272
DOI: 10.1007/s00417-018-4026-5 -
Journal of Glaucoma Aug 2023Cost-effectiveness analyses (CEAs) quantify and compare both costs and measures of efficacy for different interventions. As the costs of glaucoma management to patients,...
PURPOSE
Cost-effectiveness analyses (CEAs) quantify and compare both costs and measures of efficacy for different interventions. As the costs of glaucoma management to patients, payers, and physicians are increasing, we seek to investigate the role of CEAs in the field of glaucoma and how such studies impact clinical management.
METHODS
We adhered to the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines for our systematic review structure. Eligible studies included any full-text articles that investigated cost-effectiveness or cost-utility as it relates to the field of open angle glaucoma management in the United States. Risk of bias assessment was conducted using the validated Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations.
RESULTS
Eighteen studies were included in the review. Dates of publication ranged from 1983 to 2021. Most of the studies were published in the 2000s and performed CEAs in the domains of treatment/therapy, screening, and adherence for patients with primary angle open glaucoma. Of the 18 articles included, 14 focused on treatment, 2 on screening, and 2 on adherence. Most of these studies focused on the cost-effectiveness of different topical medical therapies, whereas only a few studies explored laser procedures, surgical interventions, or minimally invasive procedures. Economic models using decision analysis incorporating state-transition Markov cycles or Montecarlo simulations were widely used, however, the methodology among studies was variable, with a wide spectrum of inputs, measures of outcomes, and time horizons used.
CONCLUSION
Overall, we found that cost-effectiveness research in glaucoma in the United States remains relatively unstructured, resulting in unclear and conflicting implications for clinical management.
Topics: Humans; Glaucoma, Open-Angle; Cost-Benefit Analysis; Intraocular Pressure; Glaucoma; Cost-Effectiveness Analysis
PubMed: 37311022
DOI: 10.1097/IJG.0000000000002249 -
American Journal of Ophthalmology Sep 2014To conduct a systematic review and meta-analysis of the association between blood pressure levels and hypertension with primary open-angle glaucoma and intraocular... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To conduct a systematic review and meta-analysis of the association between blood pressure levels and hypertension with primary open-angle glaucoma and intraocular pressure endpoints.
DESIGN
Systematic review with quantitative meta-analysis.
METHODS
Studies were identified by searching the PubMed and EMBASE databases. Inverse-variance weighted random-effects models were used to summarize relative risks. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity across studies.
RESULTS
Sixty observational studies were included. The pooled relative risk for primary open-angle glaucoma comparing patients with hypertension to those without hypertension was 1.16 (95% CI = 1.05-1.28), with modest heterogeneity across studies (I(2) 34.5%). Virtually all studies reported a positive association between blood pressure and intraocular pressure (IOP). The pooled average increase in IOP associated with a 10 mm Hg increase in systolic blood pressure was 0.26 mm Hg (95% CI 0.23-0.28, I(2) 30.7%), and the average increase associated with a 5 mm Hg increase in diastolic blood pressure was 0.17 mm Hg (95% CI 0.11-0.23, I(2) 90.5%).
CONCLUSIONS
In this meta-analysis, hypertension was associated with increased intraocular pressure. The association between hypertension and primary open-angle glaucoma was stronger in cross-sectional compared with case-control and longitudinal studies. Our findings support a role of increased blood pressure in elevated intraocular pressure and possibly in the development of glaucoma.
Topics: Blood Pressure; Glaucoma, Open-Angle; Global Health; Humans; Hypertension; Incidence; Intraocular Pressure; Risk Factors
PubMed: 24879946
DOI: 10.1016/j.ajo.2014.05.029 -
Der Ophthalmologe : Zeitschrift Der... Apr 2022Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular... (Review)
Review
Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure. This article is the first part of a review of the more common forms of secondary open-angle glaucomas. The pathogenesis, characteristic clinical findings and treatment of pseudoexfoliative glaucoma, pigmentary glaucoma and neovascular glaucoma are discussed. An emphasis is placed on the differences in treatment compared to primary open-angle glaucoma and prophylactic treatment approaches are explained where possible.
Topics: Glaucoma; Glaucoma, Neovascular; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Tonometry, Ocular
PubMed: 35362756
DOI: 10.1007/s00347-022-01609-3 -
Handbook of Experimental Pharmacology 2023The trabecular meshwork (TM) of the eye serves as an essential tissue in controlling aqueous humor (AH) outflow and intraocular pressure (IOP) homeostasis. However,...
The trabecular meshwork (TM) of the eye serves as an essential tissue in controlling aqueous humor (AH) outflow and intraocular pressure (IOP) homeostasis. However, dysfunctional TM cells and/or decreased TM cellularity is become a critical pathogenic cause for primary open-angle glaucoma (POAG). Consequently, it is particularly valuable to investigate TM characteristics, which, in turn, facilitates the development of new treatments for POAG. Since 2006, the advancement in induced pluripotent stem cells (iPSCs) provides a new tool to (1) model the TM in vitro and (2) regenerate degenerative TM in POAG. In this context, we first summarize the current approaches to induce the differentiation of TM-like cells from iPSCs and compare iPSC-derived TM models to the conventional in vitro TM models. The efficacy of iPSC-derived TM cells for TM regeneration in POAG models is also discussed. Through these approaches, iPSCs are becoming essential tools in glaucoma modeling and for developing personalized treatments for TM regeneration.
Topics: Humans; Trabecular Meshwork; Glaucoma, Open-Angle; Induced Pluripotent Stem Cells; Glaucoma; Aqueous Humor
PubMed: 37495850
DOI: 10.1007/164_2023_671 -
Graefe's Archive For Clinical and... Apr 2019Primary open-angle glaucoma is currently characterized by a pattern of progressive retinal ganglion cell loss that stems from a complex underlying pathophysiology that... (Review)
Review
Primary open-angle glaucoma is currently characterized by a pattern of progressive retinal ganglion cell loss that stems from a complex underlying pathophysiology that remains poorly elucidated. The roles of blood flow and intraocular pressure (IOP) in glaucoma pathogenesis have been extensively studied. Further, it has been established that lowering IOP can slow the progression of glaucoma. In addition, a number of influential factors have emerged and gained momentum over the years. Increasing evidence implicates the contributions of low cerebrospinal fluid pressure, autoimmunity, neurodegeneration, and impaired autoregulation towards glaucoma pathophysiology. We aggregate and explore these different camps of thought that have garnered attention over the last few decades, and, in doing so, aim to challenge the long-standing view of glaucoma as a primary disease of the eye. A shift in our perspective towards understanding glaucoma as an ocular manifestation of systemic dysregulation may lead ultimately to better clinical management of the disease.
Topics: Autoimmune Diseases; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Nerve Fibers; Neurodegenerative Diseases; Retinal Ganglion Cells; Vascular Diseases
PubMed: 30643967
DOI: 10.1007/s00417-019-04239-9