Evidence-based approach to eye care analyzed

The greatest preoperative risk factor for CME is diabetes—the risk of developing post-cataract extraction CME has been reported to be as high as 60% in diabetics.

The program, held during the annual meeting of the American Academy of Ophthalmology, was jointly sponsored by the New York Eye and Ear Infirmary and Ophthalmology Times and supported by an unrestricted educational grant from Allergan.

Dr. Simmons summarized the findings from a number of trials. Two clinical trials comparing latanoprost (Xalatan, Pfizer) and travoprost (Travatan, Alcon) found that the two drugs are relatively equal in effectiveness except that travoprost achieves maximum efficacy somewhat more quickly. Both also show a slight dip in afternoon pressure control, he said.

Four clinical trials have compared latanoprost and bimatoprost (Lumigan, Allergan), with similar results. They found that the drugs are equivalent in IOP-lowering at 8 a.m. but that bimatoprost is more effective in the afternoon and evening.

Three comparisons of bimatoprost and travoprost have shown that bimatoprost is more effective in lowering IOP.

In summarizing the findings of both these drug studies and large trials studying various aspects of progression and treatment, Dr. Simmons outlined several strategies for physicians.

"To be successful at treating glaucoma today, we need to lower IOP consistently and aggressively. The hypotensive lipids are clearly the most effective class of medication to achieve that goal. And when one looks at the weight of evidence in numerous trials, bimatoprost appears to be the most effective in lowering IOP and has the fewest nonresponders, the best diurnal pressure control, and equal or better compliance and adherence," Dr. Simmons said.

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