SURGE: Sound Understanding of Real Glaucoma Efficacy

Chicago-Panelists at a CME symposium on Saturday evening provided an in-depth review of current information on the results of early detection and treatment with lipid therapy. Prostaglandin and prostamide drugs are widely used to lower IOP, and speakers discussed clinical data on these drugs as well as the differences between the three once-daily lipids available today.

As part of their discussion of lipids, speakers also explored topics such as systemic optic nerve evaluation, guidelines for glaucoma management, and challenges in clinical practice, such as patient compliance, adherence, and communication.

Presenters included Louis B. Cantor, MD, Indiana University School of Medicine; Ronald L. Gross, MD, Cullen Eye Institute, Baylor College of Medicine, Houston; Leon W. Herndon, MD, Duke University Eye Center, Durham, NC; Robert J. Noecker, MD, MBA, University of Pittsburgh; and Steven T. Simmons, MD, Albany Medical College, Albany, NY.

Dr. Cantor discussed methods of evaluating endpoints and treatment goals and noted that clinical trials sponsored by the National Eye Institute have answered key questions about the benefits of lowering IOP in different patients. Conclusions that can be drawn include:

• Early treatment reduces and delays glaucoma progression.
• Regardless of stage, lowest IOP is the critical factor in preventing disease progression.
• Every mm Hg counts.
• It is vital to maintain a steady level of IOP over time.

“If you want to place your patients in the best possible condition, lower is better,” Dr. Cantor emphasized.

If medical therapy is analogous to building a house and primary therapy is the foundation, physicians need to be aware that many patients experience moderate-to-large diurnal fluctuations in their IOP while on primary therapy, typically a prostaglandin.

“Your foundation is on sand if your foundation is fluctuating,” suggested Dr. Simmons, explaining that it is difficult to tell if therapy is working if IOP varies up to 8 to 10 mm Hg from measurement to measurement.

He advised physicians try to determine which medication causes the least fluctuation in individual patients. He also recommended that they consider switching medication before adding a second, since compliance drops as more medications are added. Also, evidence suggests that the often-used combination of a prostaglandin and a beta-blocker is ineffective in many patients.

The program was jointly sponsored by Ophthalmology Times and the New York Eye and Ear Infirmary and supported by an unrestricted educational grant from Allergan. The event was held at the Cadillac Club at Soldier Field.