title: The clinical impact of 2 different strategies for initiating therapy in patients with ocular hypertension.
abstract: OBJECTIVE
  To assess the impact of 2 strategies for initiating therapy in ocular hypertension (OH) on drug use, intraocular pressure (IOP), and blindness caused by glaucoma.
  
  
  METHODS
  Using a simulation model, initiating therapy with timolol (strategy 1) and with latanoprost (strategy 2) was simulated for a hypothetic cohort of ocular hypertension patients with an initial IOP distribution (data of 1000 patients). Adjustment of therapy within 15 months and a subsequent lifelong follow-up, with an IOP dependent conversion to glaucoma, were modeled. The IOP lowering effect of medication (based on a meta-analysis) was applied by Monte Carlo simulation. Therapy could be maintained or changed, depending on the achieved IOP and side effects. Four drugs (latanoprost, timolol, brimonidine, dorzolamide) were used as monotherapy or in combination. Glaucoma conversion rate was based on literature.
  
  
  RESULTS
  Treatment goal was achieved in both strategies in 90% by monotherapy. This was 60% for patients with initial IOP's of 30 mm Hg. The originally prescribed medication was maintained in 66% (1) and in 77% (2). IOP decreased with approximately 34%, from 25.4 mm Hg (mean) to 16.7 mm Hg (1) and to 16.5 mm Hg (2) Blindness per person within 18.7 years of life expectancy was 0.0923 years (1) and 0.0870 years (2), which corresponds to approximately 1 month. The difference between strategies was 2 days spent in blindness per patient.
  
  
  CONCLUSIONS
  The difference in clinical effects of the strategies is small. This is largely owing to the key concept of a target pressure, which underlies both strategies.
authors.affiliation: Department of Ophthalmology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Andrea
authors.initials: A
authors.lastname: Peeters
authors.forename: Carroll A B
authors.initials: CA
authors.lastname: Webers
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
authors.forename: Fred
authors.initials: F
authors.lastname: Hendrikse
authors.forename: Jan S A G
authors.initials: JS
authors.lastname: Schouten
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001766:Blindness / Q000503:physiopathology*; D000068438:Brimonidine Tartrate; D003663:Decision Trees; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D009010:Monte Carlo Method; D009798:Ocular Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage* / Q000009:adverse effects; D011810:Quinoxalines / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D013999:Timolol / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; D000068438:Brimonidine Tartrate; D000077338:Latanoprost; D013999:Timolol; C062765:dorzolamide