M-03: To Evaluate Efficacy of Aerobic Exercise as an Addition to the Existing Treatment in Primary Open Angle Glaucoma Patients
Akhil Bharat Agarwal
Sinhagad Institute India
To evaluate efficacy and ocular tolerability of anti-glaucoma drugs & to study effect of aerobic exercise on intra-ocular pressure in glaucoma patients
The study included 300 cases of glaucoma patients, divided into 3 groups: 1-Timolol, 2- Brimolol and 3- Timolol with exercise. Each patient was administered with topical drugs and followed up every 15th day for 2 months. In group 3, patients were advised to do 30 min exercise daily for 2 months.
Total 300 patients were enrolled in this study, 276 (92.2%) completed study; 15 (5%) patients discontinued owing to ADRs while 13(4.3%) patients discontinued owing to the cost of treatment both of which were from Timolol + Brimonidine (Brimolol) group.
The efficacy of the drug was tested based on IOP measurement by non-contact tonometer, slit lamp examination and fundoscopy at interval of 15 days. The mean fall in IOP from baseline was found significant (p<0.05) at each 15 th day follow up visit in all three groups. One way Anova was used to compare the decrease in IOT values between the three groups followed by post-hoc tukey hsd test. However this fall in IOP was found to be maximum in Brimolol group with p<0.05 followed by Timolol with exercise group.
The safety of the anti-glaucoma drugs and drug combination was tested on the basis of adverse drug reaction (ADR) check list, fundoscopy and slit lamp examination. ADRs in Brimolol group (42.5%) was comparable to the incidence in the Timolol group (40 %) and higher than Timolol + Exercise group (27.6%) with the most frequent ADR in group 1&2 as burning of eyes (53%) & in group 3 as dryness (28%). Based on data, the frequency of ADR was more common in elderly age group (60% vs. 40%) and was more associated with lower socio-economic status (65% vs. 35 %).The Naranjo's probability scale was used for causality assessment of adverse events. Based on causality assessment, majority of the ADR were in the probable category (62%) followed by definite category (22%).
Compliance and quality of life
The frequency of patients missing ophthalmic doses was ADR in timolol (48%) and timolol with exercise group (33%) while in brimolol group; it was monetary reason (40%). The GQR-15 (quality of life) score was 36, 30 & 31.5 in Group 1, 2& 3 respectively. Quality of life score was higher in younger age group (<45 years) and was more associated in patients with upper socio-economic status.
It can be concluded that; twice daily fixed Brimolol provides superior IOP lowering compared to Timolol monotherapy however it is quite expensive with less tolerability. Exercise along with Timolol provides superior IOP lowering effect in comparison with monotherapy of Timolol with better tolerability along with reduced frequency of missed ophthalmic doses and good quality of life. On the basis of these results, combination of Timolol and exercise is recommended for cheap and safe treatment of glaucoma with good quality of life and improved patient compliance, however with sub-maximal efficacy as compared to Brimolol.