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Editors Selection IGR 14-2

IOP-Related: Treatment effect on diurnal IOP

Comment by Kuldev Singh on:

22679 Comparing diurnal and nocturnal effects of brinzolamide and timolol on intraocular pressure in patients receiving latanoprost monotherapy, Liu JH; Medeiros FA; Slight JR et al., Ophthalmology, 2009; 116: 449-454

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Liu et al. (337), in the most recent in a series of elegant studies from their sleep laboratory, have confirmed that timolol lowers IOP significantly during the diurnal but not the nocturnal period. In this study, the comparator was brinzolamide, a topical carbonic anhydrase inhibitor with both agents being added, in random order with washout in between, to subjects already receiving Latanoprost monotherapy. This adjunctive study confirmed the earlier findings from the same clinical laboratory that IOP, when measured in habitual body positions, is highest in the nocturnal period during which brinzolamide has an IOP lowering effect comparable to the diurnal effect, and timolol does not lower IOP significantly from baseline. While the impact of nocturnal IOP levels on the natural history of glaucoma has yet to be

Glaucoma is a twenty-four-hour disease and agents which only lower IOP for part of this period are less than optimal glaucoma therapeutic options

elucidated, it is generally agreed that glaucoma is a twenty-four hour disease and that agents which only lower IOP for part of this period are less than optimal glaucoma therapeutic options. This study shows that differences between beta blockers and carbonic anhydrase inhibitors as adjunctive IOP lowering agents in patients already receiving a prostaglandin analog are, not surprisingly, similar to the circumstance when the same classes of agents are used alone. Also notable is the finding that the two agents are approximately equally effective adjuncts to prostaglandin analogs in the diurnal period.

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