The Diurnal and Nocturnal Effect of Pilocarpine on Intraocular Pressure and Ocular Perfusion Pressure

Not Applicable

Completed

Brief Summary: The aim of this study will be to determine the effects of pilocarpine as an adjunct medication to latanoprost monotherapy at multiple intervals throughout a 24-hour period and compare these effects to latanoprost alone.

Detailed Description: This study plans to learn more about the effect of pilocarpine on intraocular pressure and ocular perfusion pressure for a full twenty-four hour period.

In this study, the investigators seek to better characterize the knowledge base of the intraocular pressure (IOP) lowering effects of pilocarpine in patients with open angle glaucoma or ocular hypertension who are currently taking latanoprost. The goal is to define the potential additive effect of pilocarpine throughout a 24-hour period, not only for IOP, but for ocular perfusion pressure (defined as 2/3\[diastolicBP + 1/3(systolicBP - diastolicBP)\] - IOP). These data will allow to expand current knowledge of the effects of pilocarpine and help determine if this medication has a useful role as an adjunctive treatment in glaucoma.

Recruitment & Eligibility

Inclusion Criteria

Current confirmed diagnosis of:
- open angle glaucoma, or
- ocular hypertension including pigment dispersion glaucoma, and
- pseudoexfoliation glaucoma.
Current use of topical latanoprost once a day in both eyes for at least 6 weeks
any race/ethnicity

Exclusion Criteria

Females who are currently pregnant or planning to become pregnant during the study period
Diagnosis of any other form of glaucoma other than open-angle
Intraocular pressure readings of <14mmHg in either eye when measured during routine office visit in the past 12 months.
Schaffer angle grade < 2 in either eye by gonioscopy
Intraocular surgery within 6 months or laser within 3 months
History of retinal tear or detachment in either eye
Active iritis in either eye as determined by most recent eye examination
Patients who smoke or have irregular daily sleep patterns
Patients who have started or changed glucocorticoids therapy in the last 3 months
Patients who are currently using medical or recreational marijuana
Any use of a non-FDA approved medication for glaucoma in the last 3 months

Arm && Interventions

Group	Intervention	Description
Pilocarpine group	Pilocarpine	Subjects with open-angle glaucoma and ocular hypertension that are currently taking latanoprost

Primary Outcome Measures

Name	Time	Method
Change in Intraocular Pressure From Baseline at Visit 3	Two 24-hour visits: Baseline/Visit 2; Up to week 4/Visit 3	Subjects will be enrolled at the first visit. Patients already on latanoprost may proceed immediately with the second visit. Patients on a different prostaglandin analog medication will be switched to latanoprost for at least 6 weeks. At second visit, intraocular pressure and blood pressure will be measured every 2 hours for a 24-hour period. At any point over the next 4 weeks, another 24-hour visit will be performed. This time, a dose of pilocarpine 2% will be administered at 4 different times in addition to the latanoprost . As before, intraocular pressure and blood pressure will be measured every 2 hours. After visit 3, subjects will return to their prior treatment regimen. Change in the intraocular pressure from the second and the third visit will be determined. 8 diurnal readings and 4 nocturnal readings were averaged separately during both Visit 2 for the PGA Monotherapy and Visit 3 for Pilocarpine+PGA

Secondary Outcome Measures

Name	Time	Method
Change in Ocular Perfusion Pressure	Two 24-hour visits: Baseline/Visit 2; Up to week 4/Visit 3	Ocular perfusion pressure will calculated from the intraocular pressure and blood pressure measurements. At Baseline/Visit 2, intraocular pressure and blood pressure will be measured every 2 hours for a 24-hour period. At any point over the next 4 weeks, another 24-hour visit (Visit 3) will be performed. This time, a dose of pilocarpine 2% will be administered at 4 different times in addition to the latanoprost (PGA monotherapy). As before, intraocular pressure and blood pressure will be measured every 2 hours. 8 diurnal readings and 4 nocturnal readings were averaged separately during both Visit 2 for the PGA Monotherapy and Visit 3 for Pilocarpine+PGA

Locations (1): University of Colorado Denver Eye Hospital
🇺🇸
Denver, Colorado, United States