Specialist Insights in Glaucoma Treatment
A SILENT THIEF OF SIGHT
Glaucoma is a progressive disease that causes gradual and irreversible loss of vision 1,2
There is a need for patients to be initiated on an efficacious PGA treatment early and escalated appropriately from monotherapy to combination therapies to delay disease progression 3-10
OUR PURPOSE IN GLAUCOMA IS TO CREATE A FUTURE WHERE PEOPLE’S VISION LASTS A LIFETIME
Effective IOP reduction in the first 3 months post diagnosis may reduce the risk of progression by approximately 10% over six years with early effective treatment enabling patients to retain vision11,12-14
Bimatoprost is the most effective prostaglandin within the PGA class, that offers a differentiating dual mechanism of action 15,16
Let’s hear them from
Dr. Fang Seng Kheong
Presently Senior Consultant Ophthalmologist and Glaucoma specialist at the International Specialist Eye Centre, Kuala Lumpur, Malaysia.
Graduated with MBBS from University Malaya, Kuala Lumpur 1986. Obtained Masters of Surgery in Ophthalmology, UKM in 1994, Clinical fellow in glaucoma at Department of Ophthalmology, Prince of Wales Hospital, Sydney under Dr Ivan Goldberg in 1995. Conferred Fellow of the Academy of Medicine Malaysia October 2017
Consultant Ophthalmologist in Hospital Kuala Lumpur and head the Glaucoma service between 1995 to 1999. Then Senior Consultant Ophthalmologist and Glaucoma Specialist at the Tun Hussein Onn National Eye Hospital from 1999 to May 2007.
Presently President Elect of Asia Pacific Glaucoma Society since 2020, previously Honorary Secretary since 2012. Committee member and founding member of the Malaysian Society of Ophthalmology (MSO) since 2008 and being its Past President from 2013 to 2017. Committee member of the College of Ophthalmologist, Academy of Medicine Malaysia since 2015. Received distinguished service award from Asia Pacific Academy of Ophthalmology (APAO) in 2007, the Asian Angle Closure Glaucoma Club in 2012, MSO in 2017, ASEAN Economic Community Ophthalmology Meeting in 2017 and Outstanding Service award from the APAO in 2016. Conferred Fellow of the Academy of Medicine Malaysia in October 2017. Also member of the IMAGE Asia Pacific Glaucoma Advisory Board since its inception. Elected Council member of the APAO since 2010 being regional secretary representing Malaysia. Chairman of the Young Ophthalmologist Standing Committee of the APAO since 2013. Board member of ASEAN Ophthalmology Society from 2013 to 2017. Editorial board of the International Glaucoma Review of the World Glaucoma Association, Asian Joumal of Ophthalmology, Asia Pacific Journal of Ophthalmology. Ophthalmic Surgery News APAO Edition and EyeWorld Asia Pacific. Also Chairman of the Medical Board of ISEC Healthcare Ltd, since 2014
Dr. Fang Seng Kheong
MBBS (Malaya), MS Ophthalmology (UKM),
AM (Mal) Consultant Ophthalmologist & Eye Surgeon,
Glaucoma Specialist
Product Focus l Ganfort
Channel l Clinic and Specialist, private hospital
PGA Advocates
Role of PGA in Glaucoma Management
References (from standard medical literature):
1.Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
2.Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
3.European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Efficacy of PGA vs non-PGA
References:
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
How does bimatoprost compare vs the other PGAs
References:
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Is the bimatoprost / timolol combination a suitable choice for IOP control?
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
Guideline and patient profiles suitable for bimatoprost
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas,’ 8th Ed., Elsevier, 2021.
How to integrate bimatoprost into your practice
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas,’ 8th Ed., Elsevier, 2021..
Please explain the class effect of PGA
References:
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
How do you manage PGA associated PAP / Hyperemia in your practice
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas,’ 8th Edition. Elsevier, 2021.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Balancing safety and efficacy when making treatment choices
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020
Monotherapy VS FDC – when to start ?
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020
Does the concentration of glaucoma drops impact the safety/efficacy ?
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20
Practical Advice to Patients with glaucoma : Effective use of PGA
Non - PGA Advocates
Product Focus l Alphagan
Channel l Private hospital
Role of Alpha Agonist in Glaucoma Management ?
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
Efficacy of AA vs other classes
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
Is brimonidine a suitable choice for IOP control in patients with glaucoma?
References:
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Guideline and patient profiles suitable for brimonidine
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
How to integrate brimonidine into your practice
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas,’ 8th Ed., Elsevier, 2021.
Please explain the class effect of Alpha agonists
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
How do you manage AA associated AEs in your practice
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021
Balancing safety and efficacy when making treatment choices
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20.
Does the concentration of glaucoma drops impact the safety/efficacy ?
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020.
Stamper RL, Lieberman MF, Drake MV. ‘Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas.’ 8th Edition. Elsevier, 2021.
Weinreb RN, Khaw PT. ‘Primary open-angle glaucoma.’ Lancet. 2004 May 22;363(9422):1711-20
Practical Advice to Patients with glaucoma : Effective use of AA
References:
European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition, 2020
Footnote:
1. Leske MC, et al. Ophthalmology. 2007 Nov;114(11):1965-72.
2. Kwon, et al 2001. Am J Ophthalmol. 2001 Jul;132(1):47-56.
3. Leske M et al. Ophthalmology 2007; 114(11): 1965–1972
4. Enoch J et al. JAMA Ophthalmol 2019: DOI:10.1001/jamaophthalmol.2019.353
5. Baig S et al. JAMA Ophthalmol 2016; 134(8): 880–886
6. Takahashi A et al. BMC Ophthalmol 2018; 18(1): 1222. https://DOI.org/10.1186/s12886-018-0788-0
7. Zhang X et al. Am J Ophthalmol 2017; 183: 37–41;
8. Abbvie. Unpublished Data. [DOF2 – INT-NON-2051227]. 2020
9. Abbvie. Unpublished Data. [DOF3 – INT-NON-2051227]. 2020
10. Abbvie. Unpublished Data. [DOF4 – INT-NON-2051227]. 2020.
11. Leske M et al. Ophthalmology 2007; 114(11): 1965–1972 – IOP reduction results in reduced progression
12. Zhang X et al. Am J Ophthalmol 2017; 183: 37–41;
13. Noecker et al, 2004, Therapy, 1(1), 31–41
14. Lou H et al. Curr Med Res Opin 2015; 31(6): 1139–1147.
15. Brubaker R. Survey of Ophthalmology 2001; 45(4): S347-S351.
16. Cantor et al., Br J Opthalmol 2006; 90(11):1370-1373
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