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Effects of Brimonidine and Timolol on the Progression of Visual Field Defects in Open-angle Glaucoma

A Single-center Randomized Trial

Yokoyama, Yu MD, PhD*; Kawasaki, Ryo MD, PhD†,‡; Takahashi, Hidetoshi MD, PhD*,§; Maekawa, Shigeto MD; Tsuda, Satoru MD, PhD*; Omodaka, Kazuko MD, PhD*; Nakazawa, Toru MD, PhD∥,¶

doi: 10.1097/IJG.0000000000001285
Original Studies

Précis: Instillation of brimonidine or timolol slowed visual field deterioration in patients with open-angle glaucoma; both brimonidine and timolol might improve the mean deviation (MD) slopes.

Purpose: The purpose of this study was to investigate and compare the effects of 0.1% brimonidine and 0.5% timolol on the progressing visual field defects in open-angle glaucoma.

Patients and Methods: We evaluated 1 eye each of 68 glaucoma patients who were treated with at least 1 prostaglandin analog. Their baseline MD slopes were < −0.5 dB/y based on at least 5 Humphrey field analyzer measurements within 3 years. Eligible eyes were randomly assigned to brimonidine or timolol treatment groups and treatments were administered without the wash-out period. Clinical examinations were performed every 4 months for 2 years. We designated the MD slope as the primary endpoint.

Results: Ultimately, 56 eyes (brimonidine:timolol=26:30) were included in the present study (mean age=65.2 y). Dropout rates of brimonidine and timolol treatment groups were 27.8% and 6.3%, respectively. There were no significant differences in baseline intraocular pressure or MD slopes between brimonidine and timolol groups (12.7 and 12.9 mm Hg, P=0.77, and −1.22 and −1.08 dB/y, P=0.43, respectively). Intraocular pressure decreased significantly in the brimonidine group at 4, 8, 12, and 16 months, and in the timolol group at 4 months, without significant differences between the drugs (P=0.20). MD slopes significantly improved in both groups (brimonidine: −0.38 dB/y, P<0.001; timolol: −0.52 dB/y, P=0.04). Furthermore, there was no significant difference between groups in the primary endpoint (P=0.59).

Conclusion: Brimonidine and timolol treatments improved MD slopes in open-angle glaucoma.

*Department of Ophthalmology, Tohoku University Hospital

§Department of Medicine, Division of Ophthalmology, Tohoku Medical and Pharmaceutical University

Departments of Ophthalmology

Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai

Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata

Department of Vision Informatics (Topcon), Osaka University Graduate School of Medicine, Suita, Japan

Supported by Senju Pharmaceutical Co. Ltd which was involved in the research planning through provision of drug information.

Y.Y., R.K., H.T., S.M., S.T., K.O., and T.N. has received lecture fees from Senju Pharmaceutical Co. Ltd.

Reprints: Toru Nakazawa, MD, PhD, Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Miyagi Prefecture, Japan (e-mail:

Received December 1, 2018

Accepted May 5, 2019

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