Recent studies update views on glaucoma treatment in Europe

PARIS – Recent clinical trials have “deeply modified” some older views on the treatment of glaucoma, said Norbert Pfeiffer, MD, speaking here at the French Society of Ophthalmology meeting.

“Probably the most important discovery is that in advanced glaucoma or in progressing glaucoma IOP needs to be far lower than previously assumed, namely around 12 mm Hg, to keep a stable eye,” he said.

Physicians will often prescribe more than one medication to achieve such low IOP levels, leading to potential patient compliance problems, Dr. Pfeiffer said.

“We should be aware that at least 50% of our patients have a poor compliance with the treatment when they have to use more than one medication several times a day,” Dr. Pfeiffer said.

Prescribing fixed combination drugs would probably improve patient compliance, as well as treatment efficacy, for most of these patients, he said.

Norbert Pfeiffer, MD, said European treatment regimens for glaucoma are changing because of recent clinical trial results.

Recent studies have also demonstrated that prostaglandins have several mechanisms of action, he said. Prostaglandins not only decrease IOP by increasing uveoscleral flow, but also seem to factor in the increased levels of endothelin in patients with glaucoma.

“Endothelin, which constricts the trabecular meshwork and decreases the outflow, is antagonized by at least some of the prostaglandins,” Dr. Pfeiffer said.

The European Glaucoma Society (EGS) has summarized key findings and treatment guidelines. The group translated the guidelines into several languages for distribution to more than 70,000 ophthalmologists throughout Europe and beyond, Dr. Pfeiffer said.

“The executive committee of the EGS hopes that this will uniform and strengthen glaucoma treatment in Europe,” Dr. Pfeiffer. “According to recent statistics, 74% of European ophthalmologists are aware of the EGS guidelines and 61% follow them in their daily practice.”