Mapping the Future of Glaucoma, edited by Robert N. Weinreb
IGR 10-2 September, 2008
Strengthening the Link Between IOP Efficacy and Progression
Keypoints
|
- There is growing interest in identifying useful biomarkers of disease progression to aid
clinical trial development of new treatments for Alzheimer’s disease, and to help reliably
and meaningfully monitor treatment effects.
- Using biomarkers helps reduce or eliminate test-retest and day-to-day variability, and
biomarkers represent important tools as markers of progression, for disease staging,
and for predicting progression.
- The degree of correlation or validation between a structural endpoint and visual field
changes will vary, but the correlation between IOP and visual functioning is at times
weak too.
- There are doubts whether it is possible to generate evidence that structural change
correlates robustly with functional change in glaucoma – the magnitude and degree of
correlated change will vary over time in what is a highly variable disease.
- Structural markers of progressive glaucomatous optic neuropathy provide confirmatory or
supportive evidence of glaucomatous change; incorporating such endpoints into clinical
trial design will help reduce sample size and shorten study duration.
- Moreover, structural changes may be more apparent at certain stages of disease,
providing a compelling rationale for combining these data with others to effect a composite
indication of true progression.
- One possible research approach is to evaluate the association between structural
markers of disease progression and quality of life measurements/activities of daily living
instruments in glaucoma patients.
- Change is the hallmark of glaucomatous optic neuropathy; both structural and functional
progression should be independently evaluated as respective indicators of disease
severity or progression.
- Although the clinical predictive value of longitudinal progression detected by imaging
instruments has yet to be established, there is some current evidence that abnormal
results obtained on these tests are associated with worse future outcomes in glaucoma
patients.
- While newer imaging technologies and selective visual function tests are promising in
providing better ways of monitoring glaucoma, well-designed studies demonstrating the
clinical relevance of progression detected by these technologies are still lacking for
most instruments.
- The relationship between IOP and the outcome is imperfect.
|
 |  |
