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    New world order of glaucoma presenting strong challenges

    Changes in both technology and the healthcare policy are presenting new challenges for glaucoma specialists. As the demand for eye care surges, ophthalmologists are struggling to keep up–despite the availability of better tools for diagnosis and treatment.

    “There is a real crisis ahead of us,” said Andrew Iwach, MD, who outlined the situation in his presentation, “Glaucoma: Managing the Odds,” during the Glaucoma Symposium at the 2017 Glaucoma 360 meeting.

    Trends in diagnosis and treatment

    Medicare data shows that clinicians are billing almost as often for optical coherence tomography as for visual field tests in glaucoma. “This is the pattern,” Dr. Iwach said. “We’re still doing photography a little bit and pachymetry.”

    Citing data from Novartis Alcon, Dr. Iwach noted a dip in prostaglandin analogs (PGAs) and an uptick in beta blockers to control intraocular pressure. “Is cost a factor?” he asked. “I don’t know the reason.”

    On the other hand, a survey by Market Scope found that about 65% of prescribers were using PGAs and only 11% beta blockers as first-line medication treatments for glaucoma. “As to what agents are being added second, the fixed combinations come in quite high,” Dr. Iwach pointed out.

    Allergies to the medication preservative benzalkonium chloride (BAK) remain a concern. Alternatives include stabilized oxychloro complex (Purite) found in Alphagan-P (Allergan) and ionic-buffered preservatives (sofZia) found in Travatan Z (Alcon Laboratories), according to the Glaucoma Research Foundation. Timolol, a dorzolamide/timolol fixed combination, and tafluprost, a PGA, can be obtained in preservative-free forms, the foundation said.

    It is worth noting that the volume of medication in a preservative-free bottle maybe different from the standard formula, Dr. Iwach said.

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