Efficacy and tolerability of dorzolamide and timolol products in the management of glaucoma

Abstract

Overview: Glaucoma subsumes a group of ocular diseases characterised by visual field defects. Glaucoma cannot be cured however it can be treated. The most commonly prescribed medications are Dorzolamide and Timolol eye drops which are available as individual products or as fixed combination in a single applicator. The purpose of this study is to determine whether the current health care system is offering the best evidence based product for patients requiring Dorzolamide and Timolol products. Research question: In patients with glaucoma does a fixed combination of Dorzolamide 2% and Timolol 0.5% compared to their concomitant administration improve treatment efficacy and tolerability? Research question was formulated within PICO framework: (P) population of patients with glaucoma, (I) intervention with fixed combination Dorzolamide/Timolol, (C) comparison with concomitant Dorzolamide and Timolol, (O) outcome related to treatment efficacy and tolerability. Method: A literature search was conducted through electronic resources HyDi, PubMed, Google and Google Scholar. Exclusion/inclusion criteria established the selection of studies in: English language, conducted on humans, exclusively focusing on fixed combination versus concomitant administration of Dorzolamide and Timolol products and treatment efficacy and tolerability. Five studies were selected to answer the research question: one Systematic Review, three Randomised Controlled Trials, one prospective clinical study. CASP tools were used to appraise the quality of these studies. Findings: Fixed combination and concomitant Dorzolamide and Timolol products are equivalent in treatment efficacy and tolerability. Conclusion: Both fixed combination and concomitant Dorzolamide and Timolol products should be available so as to customise treatment regimens according to individual patient needs. Recommendations and implications for practice: National audit to address glaucoma therapy in Malta, participation in ongoing research updates, sharing of knowledge within the interdisciplinary team and various stakeholders, effective communication with patients, glaucoma treatment protocol and cost-benefit analysis for Dorzolamide and Timolol products.