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Ocular hypertension (OHT) is a condition with raised intraocular pressure (IOP) without visual field changes or discernible pathology of the optic nerve head. Ocular hypertension with IOP above 21 mmHg untreated is a major risk factor for development of primary open angle glaucoma, which is progressive nerve fibre loss and damage to the optic disc so that the visual field develops characteristic defects. Topical medications are given to reduce the IOP as a way of preventing the onset or progression of damage and associated visual field loss. These medications may have local and systemic side effects that may be severe enough for the treatment to be stopped and include local irritation, drowsiness, shortage of breath and cardiovascular side effects, particularly in the elderly. The results of this review support the current practice of topical medication to lower IOP and clearly demonstrate a visual field protective effect. The review authors identified a total of 26 controlled trials that randomised 4979 people with OHT or open angle glaucoma to receive topical medication or a placebo, another topical medication or no treatment for at least a year. Meta‐analysis of 10 trials testing different topical medications against placebo or untreated controls showed reduced incidence of glaucomatous visual field defects with treatment for people with OHT. The odds ratio (OR) was 0.62 (range 0.5 to 0.8). The class of beta‐blockers (including timolol) had positive but weak evidence for a beneficial effect in protecting against visual field defects (OR 0.7, range 0.5 to 1.0). No single drug showed significant visual field protection in OHT with the evidence available. Medications included beta‐blockers, dorzolamide, brimonidine, pilocarpine and epinephrine. From the reports, the majority of trials were of low methodological quality. Local and systemic side effects leading to treatment being stopped were often poorly reported and did not appear to differ between treatment groups. Drop‐outs due to side effects occurred with similar frequency in people treated with beta‐blocker or placebo and appeared to be less with timolol compared to brimonidine, in three trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2007

Bibliographic details: Ge Y, Wang L, Cheng J, Huang Z.  A meta-analysis of therapy comparison between bimatoprost and timolol in ocular hypertension eye. Chinese Ophthalmic Research 2009; 27(12): 1120-1125

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related disability. This review examines the effectiveness of screening and treatment of asymptomatic individuals with early POAG.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: March 2005

To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

Health Technology Assessment - NIHR Journals Library.

Version: June 2012

This guideline covers adults (18 and older) with a diagnosis of chronic open angle glaucoma or ocular hypertension and those with chronic open angle glaucoma or ocular hypertension associated with pseudoexfoliation or pigment dispersion. In addition, the guideline will cover populations who have a higher prevalence of glaucoma and may have worse clinical outcomes including people with a family history of glaucoma, younger people (<50 years) and people who are of black African or black Caribbean descent. Options for pharmacological, surgical, laser and complimentary or alternative treatments are considered in terms of clinical effectiveness and cost effectiveness.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: April 2009

Bibliographic details: Wu YY, Song SF, Li H, Lu S.  Efficacy and safety of latanoprost versus timolol for primary open angle glaucoma and ocular hypertension: a meta-analysis. International Eye Science 2014; 14(3): 430-434

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Glaucoma is a chronic progressive optic neuropathy leading to impaired vision and blindness if inadequately treated. Open-angle glaucoma is the most common form. A raised intraocular pressure (IOP) is the only modifiable risk factor. Ocular hypertension (OHT) is defined as IOP > 21 mmHg and the absence of clinical signs of glaucoma.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2012

Bibliographic details: Qian ZG, Ke M, Huang G, Zou J.  Efficacy and safety of latanoprost versus travoprost for primary open-angle glaucoma and ocular hypertension: a meta-analysis. Chinese Journal of Evidence-Based Medicine 2011; 11(8): 965-970 Available from: http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=201108018

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Glaucoma is a chronic progressive disease of the optic nerve which, if not treated, leads to visual field decay and blindness at end stages. Intraocular pressure (IOP) decreasing is shown to diminish the progression of the disease, and could be achieved by the chronic use of hypotensive eyedrops, incisional surgery or laser trabeculoplasty. There is still great controversy about where in the treatment scale laser trabeculoplasty is positioned, although this technique has already been described three decades ago. This treatment consists of application of laser spots in the trabecular meshwork, the structure responsible for the aqueous humor drainage, leading to an increase in the outflow facility through it and in consequence, decreasing IOP. It is an interesting form of treatment since it does not depend on chronic instillation of eyedrops, as does medical treatment, and also does not have too many complications, as does incisional surgery. This review included 19 trials (2137 participants). One trial compared laser trabeculoplasty associated with a hypotensive eyedrop with no intervention, and at six years of follow up the risk of visual field decay was greater in non treated participants. Three trials compared hypotensive eyedrops with trabeculoplasty, and the risk of uncontrolled IOP was greater at two years in the laser group. It is necessary to mention that the eyedrops used in these trials differ significantly from the ones used currently, since these trials were developed a decade ago. Three other trials compared trabeculoplasty with trabeculectomy and the risk of uncontrolled IOP was higher in the laser group at six months of follow up. There is some evidence showing that diode laser and selective trabeculoplasty have similar effect in controlling IOP when compared to argon laser trabeculoplasty. Comparisons of different lasers and different techniques of application were done in the remaining trials, but there is still not enough evidence to determine which is the best treatment protocol. Further research is necessary to compare trabeculoplasty with new hypotensive eyedrops and also the results of laser therapy in people of different ethnicities, since some studies suggest that they have a different response to this kind of laser therapy. More research is required to analyse cost‐effectiveness of these interventions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2007

A large number of people do not use eye drops as prescribed. Glaucoma is a slowly progressive eye disease, which can result in severe vision loss. Drops prescribed for raised eye pressure or glaucoma are aimed at lowering the pressure to assist in reducing the rate of progression, or preventing the conversion of raised eye pressure to glaucoma. It is important that these eye drops are used continually, usually for life. Approximately one‐third of people who are prescribed eye drops for the first time fail to continue collecting prescriptions within the first year and even when patients collect prescriptions they do not always use the drops as frequently as they should. A number of reasons are thought to be the cause, for example, forgetfulness, being prescribed a large number of medications, difficulties instilling drops, lack of knowledge about glaucoma, a busy lifestyle and seeing no benefit.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 30, 2013

The aim of this Cochrane Review was to find out what the benefits and harms of laser‐assisted cataract surgery are compared with standard ultrasound phacoemulsification cataract surgery. Cochrane researchers collected and analysed all relevant studies to answer this question and found 16 studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 8, 2016

OBJECTIVE: To systematically review the efficacy and tolerability of 4 prostaglandin analogues (PGAs) as first-line monotherapies for intraocular pressure (IOP) lowering in adult patients with primary open-angle glaucoma or ocular hypertension.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

AIM: To assess the effects of the fixed combination of 0.005% latanoprost and 0.5% timolol (FCLT) vs their individual components for primary open angle glaucoma (POAG) and ocular hypertension (OHT).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

3. how successful and safe aqueous shunts are when the procedure is modified.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 28, 2017

This review concluded that small but significant improvements in patient compliance are associated with interventions to reduce noncompliance with ocular hypotensive treatment, in patients with glaucoma or ocular hypertension. However, the poor quality and small size of the included studies suggest that these findings may not be reliable, therefore the reviewers’ conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

This review compared travoprost versus other prostaglandin analogues or timolol as treatments for open-angle glaucoma (OAG) or ocular hypertension (OH). Overall, travoprost 0.004% was more effective than timolol 0.5% for reducing intraocular pressure in patients with OAG or OH, and appears to be equivalent to other prostaglandin analogues. This was a well-conducted review and the authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

The authors concluded that latanoprost was associated with a lower incidence of conjunctival hyperaemia than travoprost and bimatoprost in patients with ocular hypertension or glaucoma. The review was generally well conducted and the authors’ conclusions appear appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This review concluded that the lowering of intraocular pressure in patients with ocular hypertension or open angle glaucoma is beneficial in reducing the risk of visual field loss in the long term. The authors' conclusion is likely to be reliable, although they did not evaluate the effectiveness of different treatments used to lower intraocular pressure.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

The review concluded that the non-contact tonometer and the handheld applanation tonometer seem to achieve a measurement close to the Goldmann applanation tonometer for measuring ocular hypertension but there was substantial variability in measurements both within and between studies. These conclusions reflect the evidence presented and appear likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The authors concluded that preservative-free latanoprost (T2345) was better tolerated and no less effective than all other prostaglandin analogues assessed. All comparisons except one were indirect so there was insufficient data from direct comparisons to assess the validity of the indirect comparisons and the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

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