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Eyelid Closure in Glaucoma Therapy

Primary Purpose

Glaucoma

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Eyelid closure
No intervention will be assigned
Sponsored by
Johns Hopkins University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glaucoma focused on measuring Glaucoma, Eye drop, Intraocular pressure, Eyelid closure

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Age over 18 years, use of one of the three topical prostaglandins (latanoprost, travaprost, or bimatoprost), and no other IOP-lowering eye drops for at least one month.

Exclusion Criteria:

  • Previous laser or incisional surgery for glaucoma, use of punctual plugs, an abnormal slit lamp exam (except for cataract or intraocular lens implant) and incisional eye surgery within the last 6 months.

Sites / Locations

  • Johns Hopkins - The Wilmer Eye Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Eyelid closure

No eyelid closure

Arm Description

Eyelids will be closed after administration of eye drop

Eyelids will not be closed after eye drop instillation

Outcomes

Primary Outcome Measures

Amount of intraocular pressure lowering

Secondary Outcome Measures

Amount of intraocular pressure lowering

Full Information

First Posted
January 29, 2009
Last Updated
September 19, 2012
Sponsor
Johns Hopkins University
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1. Study Identification

Unique Protocol Identification Number
NCT00832832
Brief Title
Eyelid Closure in Glaucoma Therapy
Official Title
Eyelid Closure in Topical Glaucoma Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
September 2012
Overall Recruitment Status
Completed
Study Start Date
January 2009 (undefined)
Primary Completion Date
January 2011 (Actual)
Study Completion Date
January 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Johns Hopkins University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This research is being done to determine if closing your eyelids after you take your glaucoma drops makes them more effective in lowering your eye pressure, and to determine if closing your eyelids for 5 minutes is better than closing them for one minute
Detailed Description
Abstract Eye drops to lower intraocular pressure (IOP) remain the principal therapy for glaucoma. The path from the writing of a prescription of IOP-lowering drops to optimal lowering of IOP and preventing the development or worsening of glaucoma has many steps. One critical step is to maximize the amount of drug in the eye drop that reaches the target tissue in the eye once the eye drop is on the ocular surface. The literature supports the conclusion that eyelid closure (EC) and/or nasolacrimal occlusion (NLO) can increase the effect on IOP, decrease the frequency of dosing, and decrease blood levels. They do so by increasing the contact time of the applied drug with the ocular surface, and by decreasing the amount of drug that passes through the nasolacrimal duct and into the nasopharynx. Fifteen years ago landmark studies were performed with pilocarpine and timolol. In retrospect, the principal limitations of these studies were that they empirically studied only one duration (5 minutes) of EC or NLO, and did not include (because they hadn't yet been invented) what are now the most commonly used eye drops to lower IOP, the prostaglandins. The limitation of the 5 minute duration is that it may be impractical for many patients and decrease adherence due to its inconvenience. My research hypothesis is that EC used in conjunction with prostaglandin eye drop administration will result in greater IOP lowering and that 1 minute of EC may be as effective as 5 minutes. The research is potentially of great clinical importance. Pharmaceutical companies invest heavily in developing and marketing eye drops that may be 1 mm Hg more effective than their competitors. If similar or greater improvements can be made with a simple patient action, patient care will be improved Objectives (include all primary and secondary objectives) To determine if EC increases the IOP lowering effect of prostaglandin eye drops. To determine the relative effectiveness of EC of 1 and 5 minute duration. Study Procedures Controlled clinical trial, using one eye of each subject as the experimental eye (EC plus drug) and the other as a control (drug alone). Half of the patients will perform EC for 1 minute; the other half for 5 minutes. Subjects will be recruited from the glaucoma practices at Johns Hopkins Hospital and Wilmer at Greenspring Station. Eligibility (see 5 below) will be assessed during their regularly scheduled visit. Participants will sign consent forms and will be scheduled for 3 study visits, none of which will be part of routine clinical care. The subject will be instructed NOT to use his/her prostaglandin eye drop on the day preceding study visit 1. Study visit 1-day 1 The subject will be instructed by the study coordinator in eyelid closure. The IOP will be measured 3 times in one 5 minute period between 7:30 and 10 am using Goldmann applanation tonometry and the median IOP will be recorded (baseline IOP). The subject will be randomized to performing eyelid closure in the right or left eye for either 1 or 5 minutes. Based on the randomization, the study coordinator will instill one drop of the prostaglandin eye drop (latanoprost, travoprost, or bimatoprost) that the patient normally uses into the appropriate eye, and observe the subject perform eyelid closure in the chosen eye for either 1 or 5 minutes. One hour later, the IOP will be measured 3 times by an individual masked to which eye had EC and the median IOP will be recorded (1 hour IOP). The patient will be instructed NOT to use his/her prostaglandin eye drop that night and an appointment for the following morning will be scheduled. Study visit 2-day 2 The IOP will be measured 3 times in one 5 minute period between 7:30 and 10 am using Goldmann applanation tonometry by an individual masked to which eye had EC, and the median IOP will be recorded (24 hour IOP). The subject will be instructed to resume his/her prostaglandin that evening and will be instructed to continue EC at home in the selected eye for the designated amount of time (1 or 5 minutes) until the third study visit. Study visit 3-between day 8 and 15 The IOP will be measured 3 times between 7:30 and 10 am using Goldmann applanation tonometry, by an individual masked to which eye had EC, and the median IOP will be recorded (1 week IOP). Study duration and number of study visits required of research participants. The total duration of the study is 1-2 weeks Blinding, including justification for blinding or not blinding the trial, if applicable. Subjects will not be masked. Masking of the IOP measurer is essential for avoiding bias Justification of why participants will not receive routine care or will have current therapy stopped. Subjects will be continuing their routine care throughout the study. Justification for inclusion of a placebo or non-treatment group. There is no placebo group. Definition of treatment failure or participant removal criteria. Participants will be removed if they are unable to perform EC or if they desire to leave the study Description of what happens to participants receiving therapy when study ends or if a participant's participation in the study ends prematurely. All subjects will be continuing the therapy that they were already taking before entering the study Inclusion/Exclusion Criteria Inclusion - Patient must be using one of the three topical prostaglandins (latanop rost, travaprost, or bimatoprost), and no other IOP lowering eye drops for at least one month. Exclusion -Previous laser or incisional surgery for glaucoma. Use of punctual plugs Abnormal slit lamp exam (except for cataract or intraocular lens implant). No incisional eye surgery for at least 6 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glaucoma
Keywords
Glaucoma, Eye drop, Intraocular pressure, Eyelid closure

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Eyelid closure
Arm Type
Experimental
Arm Description
Eyelids will be closed after administration of eye drop
Arm Title
No eyelid closure
Arm Type
Active Comparator
Arm Description
Eyelids will not be closed after eye drop instillation
Intervention Type
Other
Intervention Name(s)
Eyelid closure
Intervention Description
Eyelid will be closed after eye drop instillation
Intervention Type
Other
Intervention Name(s)
No intervention will be assigned
Other Intervention Name(s)
No intervention needed in Arm 2
Intervention Description
No intervention will be assigned to this arm
Primary Outcome Measure Information:
Title
Amount of intraocular pressure lowering
Time Frame
24 hours
Secondary Outcome Measure Information:
Title
Amount of intraocular pressure lowering
Time Frame
1 hour and one week

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age over 18 years, use of one of the three topical prostaglandins (latanoprost, travaprost, or bimatoprost), and no other IOP-lowering eye drops for at least one month. Exclusion Criteria: Previous laser or incisional surgery for glaucoma, use of punctual plugs, an abnormal slit lamp exam (except for cataract or intraocular lens implant) and incisional eye surgery within the last 6 months.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Henry D Jampel, MD
Organizational Affiliation
Johns Hopkins University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Johns Hopkins - The Wilmer Eye Institute
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21009
Country
United States

12. IPD Sharing Statement

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Eyelid Closure in Glaucoma Therapy

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