Meta-Analysis of Articles Evaluating Routine Intraocular Pressure Control in Monotherapy in the United States and Germany

Abstract

Purpose

To evaluate routine intraocular pressure (IOP) control in monotherapy patients in the United States and Germany.

Methods

Meta-analysis of published articles. We included articles that were prospective studies of ocular hypotensive therapies that measured an unaltered (visit 1) IOP on monotherapy before enrolling into a clinical trial.

Results

This meta-analysis included 5 studies with 7913 patients, of whom 3245 were from the United States (n=1) and 4668 were from Germany (n=4). In the United States, 2939 patients (91%), and in Germany, 4059 patients (87%), had glaucoma (p<0.0001). Of these, all the US patients (100%) and 2694 (58%) of those from Germany were treated with monotherapy. The mean IOP with individual monotherapies in the United States was 19.6±2.2 and in Germany 20.8±0.8 mmHg (p=0.015). Among individual classes of medicine, patients treated with a prostaglandin demonstrated equal pressures (18.8 mmHg, p=0.60) in both countries, whereas the United States showed a lower pressure (20.2 mmHg) than Germany (21.2 mmHg, p=0.0019) with beta blockers. US physicians less often indicated that IOP was adequately controlled (n=1035, 32%) than in Germany (n=2030 of all patients, 44%, p<0.0001).

Conclusions

This study suggests that patients treated by individual monotherapies in the United States demonstrate a lower pressure, but generally are more often considered uncontrolled, than those in Germany. This finding, if true, indicates a possible variance in treatment goals, or access to treatment, between the United States and Germany in treating patients with elevated pressure. (Eur J Ophthalmol 2009; 19: 769–75)