Christina Lindén

: Purpose:  To report the results from a nationwide survey on glaucoma management in Sweden, performed as a part of an Open Angle Glaucoma project conducted by the Swedish Council on Health Technology Assessment 2004–2008.Methods:  In 2005, a survey was distributed to all providers of glaucoma care in Sweden: public eye departments, public outpatient departments and private practices. The questionnaire included questions on number of examined patients, types of examinations during one defined week, internal organization and access to diagnostic equipment. The questionnaire was endorsed by the Swedish Ophthalmological Society. Reminders were sent out to nonresponders.Results:  Response rate was high; 97% (33/34) of eye departments, 85% (39/46) of outpatient departments and 55% (69/125) of private practices. Out of 29 282 visits in ophthalmic care during the study week, 7737 (26%) were related to glaucoma. Diagnostic equipment was generally available; all public eye facilities and 92% of private practices had at least one computerized perimeter, while equipment for fundus photography/imaging was available at 100% of eye departments, 82% of outpatient departments and 62% of private practices. The number of visual field tests and fundus images was rather low. Survey results indicate that patients on the average underwent bilateral field testing every 2nd year and fundus imaging every 8th year.Conclusion:  Glaucoma care generated about a quarter of all patient visits in Swedish ophthalmic care. Access to diagnostic facilities was good. To meet modern standards of glaucoma care, glaucoma damage must be measured and followed more closely than at the time of the survey.

: Purpose: To explore the possibility of estimating the prevalence of open‐angle glaucoma (OAG) on the west coast of Iceland using a clinical retrospective material, and to compare that estimate with the results from a recent prospective Icelandic study.Methods: The compulsory ophthalmological examination for the prescription of eye glasses in combination with information obtained from Statistics Iceland were used to establish the prevalence of glaucoma in Akranes and to estimate the minimum prevalence for the greater west coast area. A recent prospective study from Iceland was used as reference.Results: In all, 79% of 1443 Akranes inhabitants aged 50 years or more had visited the eye clinic at least once between 1996 and 2001. The prevalence of OAG was 4.8% (95% CI 3.6–6.1). The minimum prevalence for the west coast was 3.8% (95% CI 3.2–4.4). The prevalence increased with age (p < 0.001). The overall prevalence was similar to that of recently published prospective data but the prevalence of normal tension glaucoma (NTG) was lower.Conclusion: The results from the two studies are similar in many respects, which indicates that retrospective data may supply meaningful information on glaucoma prevalence. Important sources of error are the selection and attendance of patients, screening methods and diagnostic criteria. If routine examination does not include fundus photography and/or perimetry, the prevalence of NTG will be underestimated.

To compare the effect on intraocular pressure (IOP) of latanoprost applied once daily with four times daily and to study if the difference persisted when treatment changed to once daily. IOP was followed in 28 healthy volunteers in a double masked randomised 52 day study. Latanoprost 50 microg/ml was administered once daily in one eye and four times daily in the other during 2 weeks. Subsequently both eyes received one daily drop for 2 weeks. After another 3 weeks without treatment, a single drop was instilled in each eye. The IOP reduction on days 2 and 3 was greater in the eyes treated with four daily doses (p<0.01). During the following period there were no statistically significant differences between the eyes. After 3 weeks without treatment the IOP was lower than pretreatment (p<0.001). A single dose of latanoprost on day 50 resulted in a similar decrease in IOP in both eyes. Transient photophobia, mild flare, and/or a few cells occurred in 15 subjects. Two subjects were withdrawn because of photophobia and/or signs of anterior uveitis. Latanoprost four times daily caused an IOP reducing effect which was similar to once daily dosing, except for the first 2 days of treatment when it was more effective. Transient photophobia, cells, and flare were common during the four dose regimen, but resolved spontaneously without cessation of treatment.

One of the most recent contributions to the therapeutic arsenal available for the treatment of glaucoma is the prostaglandin (PG) analogues. They represent a new class of ocular hypotensive drugs, targeting the uveoscleral outflow of ocular aqueous humour. Two drugs, latanoprost and unoprostone, are presently commercially available. In terms of intraocular pressure (IOP) reduction, latanoprost is the most powerful drug in clinical use today. The once daily dosing promotes compliance. Additional effect is achieved in combination with other hypotensive drugs, including those that increase trabecular outflow facility. The most frequent side effect is increased iris pigmentation that seems to be irreversible. A low frequency of cystoid macular oedema has been reported, predominantly in patients whose blood-retinal barrier (BRB) is compromised. Systemic side effects are rare. The experience with unoprostone is still much less than that with latanoprost. The ocular hypotensive mechanism of action of unoprostone...

Purpose. It is known that twice daily dosing of Iatanoprost is less effective in reducing intraocular pressure (IOP) than once daily applications. The aim of the present study was to investigate this phenomenon further in order to see if the results could be compatible with a subsensitivity of the FP-receptor. Methods. Latanoprost, 50 μg/ml, was instilled once daily (8 PM) in one eye of 40 healthy volunteers and twice daily (8 AM and 8 PM) in the fellow eye in a randomized, masked fashion for 2 weeks, with the last drop on the evening of Day 15. IOP was determined at 8 AM, noon and 4 PM on Days 0, 2, 15 and 16. Also, the effect of a single dose of latanoprost was measured 6–11 months after cessation of treatment. Results. There was a significant reduction of mean diurnal IOP from Day 2 (p < 0.001), with both dose regimens. Once-daily dosing resulted in a significantly lower IOP compared with twice-daily dosing on Day 15 (p < 0.001) but not on Day 2. The difference remained (p < 0.001) on Day 16 when no morning dose had been given, but was not present after a single application 6–11 months later. Conclusions. The results of the present study are compatible with development of subsensitivity, at the level of the FP-receptor or its associated intracellular signaling pathways, with twice- but not with once-daily dosing of latanoprost. This effect is reversible. Curr. Eye Res. 17: 567–572, 1998.

Objective: To investigate if a pronounced ciliary muscle contraction, induced by physostigmine salicylate, can abolish the ocular hypotensive effect of latanoprost, a prostaglandin analogue, via inhibition of the uveoscleral outflow. Design: A randomized, crossover study that was double-masked for latanoprost. Physostigmine was the second factor in a 2²factorial experiment. Participants: A total of 20 male and female healthy volunteers (median age, 25 years; age range, 17-30 years). Interventions: Between 7amand 7pm, 1 drop of physostigmine salicylate (8 mg/mL) was instilled in 1 eye every other hour. At 8am, 1 drop of either latanoprost (50 mg/L or placebo was instilled in both eyes. This protocol was repeated a second time with latanoprost administered to previously placebo-treated eyes and vice versa. Main Outcome Measures: Intraocular pressure differences were measured with Goldmann applanation tonometry hourly for 13 hours. Results: Latanoprost reduced the intraocular pressure significantly at 3 to 12 hours after application with a maximal effect at 8 hours after the administration of the dose. The reduction that was obtained with physostigmine administered every other hour was more pronounced, was observed at 1 hour after the administration of the first dose, and increased throughout the day. A significant interaction was seen between 3 and 6PM(ie, at 7-10 hours after application of latanoprost). Conclusions: Latanoprost and physostigmine have a mainly additive ocular hypotensive effect. Thus, high doses of physostigmine did not abolish the eye pressure-lowering effect of latanoprost, but some interaction was seen at low intraocular pressures. It was concluded that any mechanical effect on the uveoscleral flow achieved with physostigmine is short-lasting compared with the effect obtained with latanoprost, and that latanoprost and miotics can be combined.

To investigate if part of the progressive reduction of intraocular pressure (IOP), seen when physostigmine is applied on alternate hours, is due to a reduced aqueous flow.