Eye Disease Clinical Trial
— DIOXXACTOfficial title:
Change in Optic Nerve Head Blood Flow,Optic Nerve Topography and Diurnal Fluctuation of Intraocular Pressure and Pulsatile Ocular Blood Flow in Glaucoma:Cosopt and Xalatan vs Xalatan Alone
Verified date | March 2017 |
Source | Maisonneuve-Rosemont Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Diurnal and intervisit fluctuations in IOP are strongly associated with progression of open
angle glaucoma and therefore need to be minimized. Control of diurnal fluctuations of IOP
with different ocular hypotensive medications has been studied in some detail. But how do
IOP changes contribute to progressive glaucomatous optic nerve damage? It is reasonable to
assume that there are two principal effects of IOP changes. First, IOP fluctuations result
in changes in the stresses and strains on the ONH which in turn result in morphological
changes to the ONH. These morphological changes could in turn result in stretching and
damage to axons of the ONH. Secondly, IOP fluctuations results in changes to the forces
acting on the ONH vasculature, leading to changes in ONH vascular perfusion. These changes
to perfusion could in turn result in relative ischemia of the ONH and consequent ONH damage.
The investigators propose to monitor diurnal fluctuations in IOP and choroidal blood flow
(Pulsatile Ocular Blood Flow,POBF), and intervisit ONH topographical and blood flow
changes—ie to monitor the direct ONH consequences of IOP . Open angle glaucoma patients are
commonly prescribed topical latanoprost as first line therapy. The EXACCT study, for which I
was the principal investigator and which is now submitted for publication, demonstrated that
COSOPT was an efficacious choice as second line therapy for patients not controlled on
latanoprost monotherapy. The investigators will therefore recruit 20 OAG patients on
latanoprost monotherapy, perform diurnal curves of IOP, as well as a.m. ONH morphology and
ONH blood flow. Cosopt will then be added and at the next visit the same measurements will
be repeated.
The investigators expect that when Cosopt is added the investigators will demonstrate
improved IOP, morphology and blood flow compared to the latanoprost baseline. Furthermore
the investigators expect the the diurnal fluctuation of IOP and choroidal blood flow will be
stabilized on Cosopt therapy. The implications are that adding Cosopt to latanoprost can
stabilize not only the IOP but also the damaging consequences of IOP to the optic nerve
head.
Status | Completed |
Enrollment | 25 |
Est. completion date | February 2012 |
Est. primary completion date | September 14, 2011 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 30 Years to 80 Years |
Eligibility |
Inclusion Criteria: - Subjets with open angle glaucoma or ocular hypertension currently on latanoprost immunotherapy. - Subjets must have clear media, corrected visual acuity of 6/12 or better,and be able to sit for imaging. Exclusion Criteria: - Subjets with contraindications or known allergies to any of the components of Cosopt. - Subjets who had undergoing laser or any ocular surgery. |
Country | Name | City | State |
---|---|---|---|
Canada | Maisonneuve-Rosemont Hospital | Montreal | Quebec |
Lead Sponsor | Collaborator |
---|---|
Maisonneuve-Rosemont Hospital | Merck Sharp & Dohme Corp. |
Canada,
Hafez AS, Bizzarro RL, Rivard M, Trabut I, Lovasik JV, Kergoat H, Lesk MR. Reproducibility of retinal and optic nerve head perfusion measurements using scanning laser Doppler flowmetry. Ophthalmic Surg Lasers Imaging. 2003 Sep-Oct;34(5):422-32. — View Citation
Lesk MR, Hafez AS, Descovich D. Relationship between central corneal thickness and changes of optic nerve head topography and blood flow after intraocular pressure reduction in open-angle glaucoma and ocular hypertension. Arch Ophthalmol. 2006 Nov;124(11) — View Citation
Michelson G, Schmauss B. Two dimensional mapping of the perfusion of the retina and optic nerve head. Br J Ophthalmol. 1995 Dec;79(12):1126-32. — View Citation
Sehi M, Flanagan JG, Zeng L, Cook RJ, Trope GE. Anterior optic nerve capillary blood flow response to diurnal variation of mean ocular perfusion pressure in early untreated primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2005 Dec;46(12):4581-7. — View Citation
Yoshida A, Feke GT, Mori F, Nagaoka T, Fujio N, Ogasawara H, Konno S, Mcmeel JW. Reproducibility and clinical application of a newly developed stabilized retinal laser Doppler instrument. Am J Ophthalmol. 2003 Mar;135(3):356-61. Erratum in: Am J Ophthalmo — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Clinical evidence for lower diurnal variational Intraocular Pressure | Six weeks | ||
Secondary | The Intraocular Pressure, Retinal and choroidal blood flow will be stabilized on Cosopt therapy | Six weeks |
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