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Latanoprostene bunod reduced IOP more than timolol at night
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Latanoprostene bunod yielded a greater IOP reduction and a larger increase in ocular perfusion pressure than timolol 0.5% during the nocturnal period in patients with ocular hypertension or early primary open-angle glaucoma, according to researchers in the American Journal of Ophthalmology.
Researchers enrolled 25 patients with ocular hypertension or early primary open-angle glaucoma (POAG). Subjects were randomly assigned to bilateral treatments of latanoprostene bunod 0.024% at 8 p.m. or timolol 0.5% at 8 a.m. and 8 p.m. The treatments were switched 4 weeks before the third laboratory reading.
Baseline IOP and blood pressure were measured in the sitting and supine positions during the 16-hour diurnal/wake period and in the supine position during the 8-hour nocturnal period, according to the study.
The mean IOP reading prior to the first laboratory reading was 23.2 mm Hg for all enrolled subjects under no glaucoma medication, and mean central cornea thickness was 556.3 µm.
With latanoprostene bunod, mean IOP was found to be the lowest among the three experimental conditions during the 16-hour diurnal period, according to researchers.
During the nocturnal period, mean baseline IOP and mean IOP under the timolol treatment were similar. Mean IOP with latanoprostene bunod was lower than the baseline IOP in addition to the IOP with timolol.
At most time points, ocular perfusion pressures after latanoprostene bunod were the highest, according to the study.
During the nocturnal period, the supine IOP under latanoprostene bunod treatment was significantly lower than the baseline by 2.5 mm Hg and the timolol treatment by 2.3 mm Hg, according to researchers.
Mean blood pressure showed no significant change with either treatment for the diurnal sitting, diurnal supine and nocturnal supine readings. – by Abigail Sutton
Disclosure: Liu has received support for research from Aerie, Alcon, Allergan, Bausch + Lomb and Sensimed.
Perspective
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Derek MacDonald, OD, FAAO
We have all had patients with progressive glaucoma despite what appear to be consistently low IOPs. Why?
Well, tonometry is typically performed during office hours while the patient is sitting. However, the peak IOP often occurs in the early morning while the patient is supine. Further, nocturnal IOP spikes may coincide with systemic blood pressure troughs, dropping ocular perfusion pressure (OPP) below 55 mm Hg, the level that appears to be critical for retinal ganglion cell survival. In short, glaucoma is a 24-hour disease that we monitor over the wrong 8 hours.
While pharmacologic nocturnal blood pressure dips may be minimized through morning dosing of systemic medication, clinicians treating glaucoma would be wise to prescribe agents that effectively decrease IOP and increase OPP around the clock. Currently available prostaglandin analogs (PGAs) and carbonic anhydrase inhibitors (CAIs) reduce both diurnal and nocturnal IOP, whereas beta-blockers and alpha agonists have little effect on nocturnal IOP and may lower blood pressure, further compromising OPP.
Liu and colleagues have demonstrated that the latanoprostene bunod safely and effectively lowers IOP by enhancing both uveoscleral and trabecular outflow and increases OPP both diurnally and nocturnally. With rho-kinase inhibitors and adenosine mimetics also showing promise, we may soon see the first additions to our treatment arsenal since PGAs arrived on the scene some 25 years ago – additions that are long awaited and very welcome.
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