Improved Efficacy of Topical Latanoprost 0.005% Demonstrated by Corneal Biomechanical Correcting Modified Goldmann Prism

Nathan Radcliffe, John Berdahl, Mitchel Ibach, Justin Schweitzer, Jason Levine, Sean McCafferty, Nathan Radcliffe, John Berdahl, Mitchel Ibach, Justin Schweitzer, Jason Levine, Sean McCafferty

Abstract

Purpose: 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: IOP; corneal biomechanics; glaucoma; latanoprost; prostaglandins; timolol; tonometer.

Conflict of interest statement

Sean McCafferty has an interest in Intuor Technologies (Tucson, AZ) which owns the technology being examined in this clinical trial. Additional grant support unrelated to this study has been provided by Abbott Medical Optics (Santa Ana, CA), and Alcon, Inc. (Ft. Worth, TX). He also reports grants from NIH/NEI, during the conduct of the study; non-financial support from Reichert, outside the submitted work. Sean McCafferty has a patent on prism owned by CATS Tonometer issued. Jason Levine has unrelated study grant support from Innfocus, Inc. John Berdahl is a consultant to and reports personal fees from Intuor. Justin Schweitzer reports personal fees from Reichert, during the conduct of the study. Mitchel Ibach reports personal fees from Aerie pharmaceuticals, outside the submitted work. Nathan Radcliffe reports personal fees from Reichert, CATS, LLC, Allergan, Alcon, Novartis, Glaukos, Ivantis, New World Medical, Bausch & Lomb, Omeros, Lumenis, and Ellex, outside the submitted work. The authors report no other conflicts of interest in this work.

© 2020 Radcliffe et al.

Figures

Figure 1
Figure 1
Applanating surface of the centrally concave and circumferentially convex (CATS) prism.
Figure 2
Figure 2
Timolol and latanoprost cohort IOP measurements at treatment times.
Figure 3
Figure 3
Non-response rates less than 20% reduction from baseline IOP in CATS and GAT measured IOP reduction using topical latanoprost 0.005% or alternatively timolol 0.5%.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7434574/bin/OPTH-14-2245-g0001.jpg

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