Adjunctive therapy 'alive and well,' but an individual's regimen should be tested

LAS VEGAS — The obvious truths of adjunctive therapy — that patients are less compliant and there are more side effects with more medications — should encourage ophthalmologists to rethink fundamental approaches to it, said a glaucoma specialist. He offered strategies to improve therapeutic outcomes.

Steven T. Simmons, MD, discussed considerations in using adjunctive glaucoma therapy.

"Adjunctive therapy is alive and well," said Steven T. Simmons, MD, at a CME symposium held during the OSN Las Vegas meeting. The symposium was supported by an unrestricted grant from Allergan. "We can do better with what happens to a lot of our patients with this disease."

The primary goal when adding a second or third medication is to achieve a 15% IOP reduction, Dr. Simmons said. If that does not occur, he said to try another combination.

In choosing appropriate adjunctive therapy, one major problem is that there are few studies that have been conducted that give insight into what are the best combination therapies.

Another problem that might jeopardize the effectiveness of combination therapy is that a therapeutic regimen might initially work but might not continue to work.

"When was the last time you did a reverse one-eye trial to test whether that patient's pressures were drifting because of the loss of efficacy or just worsening of the disease before you added a third medication or laser trabeculoplasty?" Dr. Simmons asked the audience.

He said a physician should not assume that a medical therapy foundation built for a patient does not fluctuate. One-eye trials should also be conducted on adjunctive therapy to test the effectiveness of an individual's current treatment regimen.