R.E. P. Frenkel

Evaluation of circadian control of intraocular pressure after a single drop of bimatoprost 0.03% or travoprost 0.004%

ABSTRACT Purpose: To compare circadian control of intraocular pressure (IOP) after a single drop of bimatoprost 0.03% or travoprost 0.004% in patients with glaucoma or ocular hypertension. Methods: Randomized, investigator-masked, paired-eye, 36-hour clinical comparison. After completing a washout, patients (N = 19) were randomized to a single drop of bimatoprost in one eye and travoprost in the other eye at 8 PM. At night, IOP was measured with patients lying in bed and sitting. IOP was measured every 4 h for 36 h in total. Results: Mean IOP at 8 PM (prior to drop instillation) was 20.6 mmHg (18.5–24.0 mmHg) with the bimatoprost eye group and 21.1 mmHg (18.5–26.5 mmHg) with the travoprost eye group ( p = 0.369). At every measurement, both bimatoprost and travoprost significantly reduced IOP from baseline. During the first 24 h, mean IOP (while sitting) after instillation of a single drop of study medication ranged from 17.8 to 19.7 mmHg with bimatoprost and from 17.2 to 20.0 mmHg with travoprost ( p ≥ 0.075). While in the supine position, IOP ranged from 21.6 to 24.9 mmHg with bimatoprost and from 21.1 to 25.2 mmHg with travoprost ( p ≥ 0.351). Both medications continued to control IOP for the remaining 12 h, with IOP approaching baseline after 36 h (mean IOP of 20.5 mmHg with bimatoprost and 21.5 mmHg with travoprost, p = 0.381). Study limitations included single-drop instillation and a short follow-up time. Conclusions: This marks the first time a single drop has been used for this type of evaluation. These findings suggest that both bimatoprost and travoprost provide comparable and lasting control of circadian IOP in patients with glaucoma or ocular hypertension.

Predicting vision gains with anti-VEGF therapy in neovascular age-related macular degeneration patients by using low-luminance vision

Background/aims To evaluate baseline low-luminance visual acuity (LLVA) as a predictor of visual acuity improvement in patients with neovascular (wet) age-related macular degeneration (wAMD) receiving antivascular endothelial growth factor A (anti-VEGF) therapy. Methods In the HARBOR trial, 1084 treatment-naïve patients ≥50 years of age with subfoveal wAMD received intravitreal ranibizumab 0.5 or 2.0 mg monthly or as needed. To measure LLVA, patients read a normally illuminated ETDRS (Early Treatment Diabetic Retinopathy Study) chart with a neutral density filter placed in front of the study eye. Patients were assigned into quartiles based on the magnitude of the difference between best-corrected visual acuity under optimal luminance (BCVA) and LLVA (BCVA–LLVA gap). The association between mean change in BCVA from baseline and BCVA–LLVA gap at baseline was analysed using a general linear model. Results A smaller baseline BCVA–LLVA gap predicted significantly higher BCVA gains over 24 months (p<0.0001 at each month; Pearson correlation), even after controlling for baseline BCVA or stratifying by treatment arm. Patients in the smallest baseline BCVA–LLVA gap quartile gained an average of +13.4 letters compared with +2.4 letters for patients in the widest baseline BCVA–LLVA gap quartile. At months 12 and 24, the smallest baseline BCVA–LLVA gap quartile had the highest proportion of ≥15−≥30-letter gain, and the widest baseline BCVA–LLVA gap quartile had the highest proportion of ≥15-/≥30-letter loss (p<0.0001; Fishers exact test). Conclusions The baseline BCVA–LLVA gap is a significant predictor of visual acuity response to anti-VEGF treatment in patients with wAMD. Trial registration number NCT00891735; Post-results.