STATEMENT OF NEED

The goal of this continuing medical education (CME) supplement is to provide current, evidence-based information to help guide glaucoma specialists and general eye care professionals in deciding on appropriate therapy for their patients with glaucoma. Factors that may influence this decision include disease type and stage, risk factors, patients' adherence to therapy, and evidence of efficacy, safety, tolerability, and convenience of the various treatments, such as topical agents, individually or in combination, and surgical interventions.

A recent analysis of studies relevant to emerging glaucoma treatments identified 42 citations focusing on

  • monotherapy
  • prostaglandin analogues
  • combination therapy
  • combination versus monotherapy and fixedcombination therapy
  • side effects, safety and stability, and efficacy
  • long-term effects of treatment
  • cost-effectiveness and implications to the health care system.1

Focusing on these issues, clinicians can use today's therapies to benefit every type of patient, including older and younger patients, those with high- and normaltension glaucoma, and those with low and greater visual field loss.2

Challenges remain, however. Lack of compliance with medications and effective use of therapy are central issues, often because of the complexity of regimens, adverse effects, the cost of medications, and patients who are forgetful or lack understanding of the disease.3,4 Another major challenge is an increasing volume of new treatments, used in varying combinations. The result has been the development of complicated guidelines and algorithms needed to make sound clinical decisions.3,4

  1. Glaucoma Annual Evidence Update: 24-30 November 2008: Medical Management, National Library for Health: http://www.moorfields.nhs.uk/Eyehealth/Commoneyeconditions/Glaucoma/GlaucomaAnnualE videnceUpdate. Accessed June 8, 2011.
  2. Heijl A, Leske MC, Bengtsson B, et al.; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120:1268-1279.
  3. Kowal M, Choragiewicz T, Mietlicka K, et al. Obstacles to medication compliance for patients with glaucoma. Klin Oczna. 2008;110:347-351.
  4. Tsai JC, McClure CA, Ramos SE, et al. Compliance barriers in glaucoma: a systematic classification. J Glaucoma. 2003;12:393-398.

TARGET AUDIENCE

This certified CME activity is designed for glaucoma specialists and general eye care professionals.

LEARNING OBJECTIVES

Upon completion of this activity, participants should be able to

  • evaluate and treat the various types and stages of glaucoma
  • recognize and address disease progression
  • evaluate topical therapies, including agents to be used as monotherapy or in combination, as well as fixedcombination agents

METHOD OF INSTRUCTION

Participants should read the CME activity in its entirety. After reviewing the material, please complete the selfassessment test, which consists of a series of multiplechoice questions. To answer these questions online and receive real-time results, please visit http://www.dulaneyfoundation. org and click “Online Courses.”

Upon completing the activity and achieving a passing score of over 70% on the self-assessment test, you may print out a CME credit letter awarding 1 AMA PRA Category 1 Credit.™ The estimated time to complete this activity is 1 hour.

ACCREDITATION AND DESIGNATION

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Dulaney Foundation and Glaucoma Today. The Dulaney Foundation is accredited by the ACCME to provide continuing education for physicians. The Dulaney Foundation designates this print activity for a maximum of 1 AMA PRA Category 1 Credit.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DISCLOSURE

In accordance with the disclosure policies of the Dulaney Foundation and to conform with ACCME and US Food and Drug Administration guidelines, anyone in a position to affect the content of a CME activity is required to disclose to the activity participants (1) the existence of any financial interest or other relationships with the manufacturers of any commercial products/devices or providers of commercial services and (2) identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.

FACULTY CREDENTIALS

Ronald L. Gross, MD, is a professor of ophthalmology at Baylor College of Medicine in Houston. Dr. Gross may be reached at (713) 798-6100; rgross@bcm.edu.

L. Jay Katz, MD, is the director of the Glaucoma Service at Wills Eye Institute and a professor of ophthalmology at Thomas Jefferson University in Philadelphia. Dr. Katz may be reached at (215) 928-3197; ljaykatz@gmail.com.

Jonathan S. Myers, MD, is associate attending surgeon on the Glaucoma Service at Wills Eye Institute and an assistant professor of ophthalmology at Thomas Jefferson University in Philadelphia. Dr. Myers may be reached at jmyers@willseye.org

FACULTY/STAFF DISCLOSURE DECLARATIONS

Dr. Gross has received grant/research support from Alcon Laboratories, Inc., and Allergan, Inc.; he is a consultant to Alcon Laboratories, Inc., Allergan, Inc., Merck & Co., Inc., and Ono Pharmaceutical Co., Ltd.; and he is on the speakers' bureaus of Alcon Laboratories, Inc., Allergan, Inc., and Ono Pharmaceutical Co., Ltd.

Dr. Katz has received grant/research support from Airie Pharmaceuticals, Inc., Allergan, Inc., Lumenis, Ltd., Pfizer, Inc., and Glaukos Corporation; he is a consultant to Alcon Laboratories, Inc., Allergan, Inc., and Glaukos Corporation; and he is on the speakers' bureaus of Alcon Laboratories, Inc., Allergan, Inc., and Merck & Co., Inc. He is a stock/shareholder of Glaukos Corporation.

Dr. Myers has received grant/research support from Alcon Laboratories, Inc., Allergan, Inc., Inotek Pharmaceuticals, Pfizer, Inc., and Merck & Co., Inc.; he is a consultant to Alcon Laboratories, Inc., Allergan, Inc., Inotek Pharmaceuticals, and Sucampo Pharmaceuticals, Inc.; and he is on the speakers' bureaus for Alcon Laboratories, Inc., Allergan, Inc., and Merck & Co., Inc.

All others involved in the planning, editing, and peer review of this educational activity have indicated they have no financial relationships to disclose