Study suggests neuroprotective action for brimonidine

FLORENCE, Italy — Brimonidine preserved visual fields better than argon laser trabeculoplasty in a prospective clinical study in glaucoma patients, despite lower IOPs achieved in the eyes undergoing ALT. This finding suggests that the drug has neuroprotective properties beyond IOP-lowering, according to a speaker here at the European Glaucoma Society meeting.

Stefano Gandolfi, MD, and colleagues at London’s Moorfields Eye Hospital compared the results of treatment with brimonidine and treatment with ALT in a masked, prospective, randomized study .

Patients were eligible for participation if they had a glaucomatous visual field defect; visual acuity better than 0.2 LogMAR; a refraction of between –5 D and +2 D; no presence of age-related macular degeneration, diabetic neuropathy or other neurological disease; and IOP of 20 mm Hg or greater, Dr. Gandolfi said.

Prior to randomization, patients underwent an 18-month observation period, during which they were observed for changes in VA and progression of visual field defects. Once progression of damage was confirmed, patients were then randomized to receive treatment with ALT or brimonidine to lower and control IOP levels. A total of 41 eyes completed follow-up, 22 that had been treated with brimonidine and 19 with ALT.

Patients treated with ALT had lower IOPs than those treated with brimonidine. ALT-treated patients also had better-controlled IOPs, Dr. Gandolfi said.

However, Dr. Gandolfi noted, significantly fewer patients treated with brimonidine experienced progression of visual field deterioration than those treated with ALT. Among the brimonidine-treated patients, 17 had stable visual fields and two had progression of damage. Eleven ALT patients continued to show progressive visual field loss, despite the group in general having better IOP control than the brimonidine-treated patients.