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Corneal thickness monitoring recommended in patients on specific glaucoma therapies
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Patients treated with prostaglandin monotherapy or a combined therapy of prostaglandins, carbonic anhydrase inhibitors and β-blockers should have regular central corneal thickness measurements taken, according to a study recently published in the Journal of Glaucoma.
Schrems and colleagues conducted a controlled, longitudinal, retrospective single-center study to evaluate rates of central corneal thickness change after various antiglaucomatous drug therapies.
"The measurement of central corneal thickness (CCT) is part of the comprehensive ocular examination," the researchers wrote. "It allows the correct estimation of IOP readings as obtained by Goldmann applanation tonometry and also represents an independent risk factor for development and progression of primary open-angle glaucoma."
They also noted that other studies have shown a possible association between topical antiglaucomatous drugs and corneal changes.
Researchers assessed changes in 130 healthy control eyes, 121 ocular hypertensive eyes, 105 glaucoma suspect eyes and 49 perimetric glaucoma eyes. Patients underwent standard automated perimetry as well as optic disc photography, 24-hour intraocular pressure profile and optical coherence pachymetry (Heidelberg Engineering). Participants were assigned to eight different groups depending on topical antiglaucomatous medication.
Researchers reported that the mean follow-up period of participants in the study was 4.2 years.
Results showed a statistically significant decrease in central corneal thickness in two groups: eyes treated with prostaglandin monotherapy and a combined therapy of prostaglandins, carbonic anhydrase inhibitors (CAIs) and β-blockers.
"We suggest that regular CCT measurements should be performed in every patient before and during therapy with prostaglandins and β-blockers + prostaglandins + CAIs," the authors concluded. "Follow-up IOP measurements may be underestimated for eyes treated with prostaglandins and β-blockers + prostaglandins + CAIs if CCT is not measured on a regular basis. Regular CCT measurements seem to be of great importance in those treatment groups to achieve proper targeting of IOP."
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
The clinical utility of using central corneal thickness in glaucoma management is not straightforward.
In general, a thinner cornea may be associated with a more progressive course of open-angle glaucoma. However, the degree to which this occurs is unclear. Similarly, the influence of central corneal thickness upon Goldmann applanation tonometry accuracy is recognized, but a universal corrective calculation has not been established to date.
This study brings to our attention the biophysical changes within the cornea that accompany chronic topical glaucoma therapy and the need to account for this dynamic. Here, we see that it may be worthwhile to track central corneal thickness changes over time to factor in the corresponding effect upon intraocular pressure measurements. This is a departure from prior thinking that central corneal thickness measurement was essentially a “one-and-done” glaucoma test.
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