Clinical Ophthalmology (Aug 2020)
Improved Efficacy of Topical Latanoprost 0.005% Demonstrated by Corneal Biomechanical Correcting Modified Goldmann Prism
Abstract
Nathan Radcliffe,1 John Berdahl,2 Mitchel Ibach,2 Justin Schweitzer,2 Jason Levine,3 Sean McCafferty3 1New York Eye Surgery Center, New York, NY, USA; 2Vance Thompson Vision, Sioux Falls, SD, USA; 3Arizona Eye Consultants, Tucson, AZ, USACorrespondence: Sean McCaffertyArizona Eye Consultants, 6422 E. Speedway Blvd, Tucson, AZ 85710, USATel +1 (520) 327-3487Email [email protected]: To evaluate intraocular pressure (IOP) reduction measured by a Goldmann applanation tonometer (GAT) prism and a modified surface Goldmann (CATS) prism with the institution of a topical prostaglandin analog (PGA) or alternatively a topical beta blocker.Design: Prospective, open-label, randomized, controlled, and reference device comparison.Methods: Thirty-six (36) treatment naïve glaucoma patients (72 eyes) were randomized equally to treatment with latanoprost 0.005% or timolol maleate 0.5%. Each patient underwent IOP measurement with standard GAT and CATS prisms before and at 1, 3, and 6 months of treatment. Central corneal thickness (CCT) and corneal hysteresis (CH) were also measured. Medication response was defined as a 20% reduction in IOP from baseline.Results: The CATS prism demonstrated the IOP reduction with topical latanoprost at a mean of 1.9 mmHg lower than the IOP measured with GAT (p=0.01). The CATS and GAT prisms detected no difference in IOP reduction with timolol (p=0.23). The number of latanoprost treatment non-responders was reduced from 36.1% measured with GAT to 13.8% when measured with the CATS prism (p=0.005). Timolol indicated no difference in the treatment non-response rate at 22.2% (p=0.999). CH increased significantly with latanoprost treatment by an average of 0.55 mmHg (p=0.014) and remained unchanged with timolol at − 0.014 mmHg (p=0.68).Discussion: IOP reduction and responder rates were increased when measured with a CATS prism in patients using latanoprost and not with timolol use. Latanoprost-induced alterations in corneal biomechanics may dampen the actual IOP reduction measured with a standard GAT prism.Clinical Trial Registration: ClinicalTrials.gov NCT04178863.Keywords: glaucoma, prostaglandins, IOP, tonometer, corneal biomechanics, timolol, latanoprost
