The Effect of Topical Antiglaucoma Drugs on the Results of High-Pass Resolution Perimetry
Lene Μ . Martin-Boglind, R.N., Adrienne Graves, Ph.D., and Peter Wanger, M . D .
We c o n d u c t e d a r a n d o m l y a s s i g n e d , d o u b l e m a s k e d , c r o s s o v e r s t u d y of t h e effects of b e t a xolol, epinephrine, pilocarpine, and timolol on t h e h i g h - p a s s r e s o l u t i o n p e r i m e t r y r e s u l t s in n o r m a l subjects. T h e influence of topical a d m i n i s t r a t i o n of t h e s e i n t r a o c u l a r p r e s s u r e reducing drugs was negligible, which con firmed t h e r e l i a b i l i t y o f h i g h - p a s s r e s o l u t i o n perimetry results. The method seems appro p r i a t e for t h e d i a g n o s i s o f g l a u c o m a a n d t h e f o l l o w - u p of p a t i e n t s w i t h g l a u c o m a .
S E R I A L V I S U A L FIELD e x a m i n a t i o n s a r e e s s e n t i a l for t h e d i a g n o s i s a n d m a n a g e m e n t o f g l a u c o m a . T h e m o n i t o r i n g o f a n t i g l a u c o m a t h e r a p y is dependent upon the correct analysis of c h a n g e s in t h e v i s u a l fields. H i g h - p a s s r e s o l u t i o n p e r i m e t r y h a s b e e n r e p o r t e d to b e a s e n s i t i v e test for o p t i c n e r v e d a m a g e in g l a u c o m a w i t h l o w v a r i ability.''^ T h e m e t h o d h a s a l s o g i v e n h i g h l y r e p r o d u c i b l e r e s u l t s in n o r m a l s u b j e c t s . ^ H i g h p a s s r e s o l u t i o n t h r e s h o l d h a s b e e n s h o w n to correlate directly with retinal ganglion cell sep aration.^ T h i s p r o p o s a l h a s b e e n v a l i d a t e d b y comparison with other sophisticated tech n i q u e s for d e m o n s t r a t i n g o p t i c n e r v e d a m a g e . W a n g e r a n d Persson^ r e p o r t e d a g o o d c o n c o r dance between high-pass resolution perimetry findings and pattern-reversal electroretino grams. Airaksinen and associates^ found a good correlation between semiquantitative evalua t i o n o f r e t i n a l n e r v e fiber l a y e r p h o t o g r a p h s and high-pass resolution perimetry results. Lindblom*^ r e p o r t e d s i m i l a r o b s e r v a t i o n s . A l i n -
ear relationship has b e e n observed w h e n com paring reduction of the functional retinal area from l a s e r p h o t o c o a g u l a t i o n a n d i n c r e a s e o f t h e m e a n r e s o l u t i o n t h r e s h o l d in p a t i e n t s w i t h d i a betes (B. Lindblom, unpublished data). Miosis induced by pilocarpine has been s h o w n to i n f l u e n c e t h e v i s u a l field w i t h differ e n t i a l l i g h t - s e n s e p e r i m e t r y . ' ' * T h e d e c r e a s e in s e n s i t i v i t y r e m a i n e d w h e n c o m p e n s a t i n g for t h e d r u g - i n d u c e d m y o p i a . ' W e a t t e m p t e d to e s t a b l i s h if a n d t o w h a t e x t e n t t o p i c a l a d m i n i s tration of intraocular pressure-reducing drugs would influence the results of high-pass resolu t i o n p e r i m e t r y in n o r m a l s u b j e c t s .
Subjects and Methods The high-pass resolution perimetric system w e u s e d h a s b e e n d e s c r i b e d previously.'-^ B r i e f ly, it c o n s i s t e d o f a p e r s o n a l c o m p u t e r w i t h a second graphics card, w h i c h controlled the s t i m u l u s d i s p l a y m o n i t o r . T h e s u b j e c t s in t h e study, eight men and seven women, were healthy volunteers, a g e - m a t c h e d to typical pa tients with glaucoma (mean age, 6 6 . 7 ± 3 years; r a n g e , 6 1 to 7 2 y e a r s ) , w i t h n o h i s t o r y o f o c u l a r disease, no opacities of the optic media, normal intraocular pressure and fundus appearance, a n d b e s t - c o r r e c t e d v i s u a l a c u i t y o f at l e a s t 2 0 / 20. They had had no previous experience with h i g h - p a s s r e s o l u t i o n p e r i m e t r y . All s u b j e c t s gave i n f o r m e d c o n s e n t to p a r t i c i p a t e in t h e study when the procedure and aims had b e e n e x p l a i n e d to t h e m . T h e s t u d y w a s a p p r o v e d b y the local ethical c o m m i t t e e .
Accepted for publication March 13, 1991. From the Department of Ophthalmology, Sabbatsberg Hospital, Stockholm, Sweden (L. M. Martin-Boglind and Dr. Wanger); and Alcon Laboratories, Fort Worth, Texas (Dr. Graves). This study was supported by grants from the Stockholm County Council and Alcon Laboratories, Fort Worth, Texas. Reprint requests to Lene Martin-Boglind, R.N., De partment of Ophthalmology, Sabbatsberg Hospital, P.O. Box 6401, S-113 82 Stockholm, Sweden.
©AMERICAN JOURNAL OF OPHTHALMOLOGY 111:711-714, JUNE,
We i n s t i l l e d a s i n g l e d o s e o f b e t a x o l o l ( 0 . 5 % ) , e p i n e p h r i n e ( 1 % ) , p i l o c a r p i n e ( 2 % ) , or t i m o l o l ( 0 . 5 % ) in o n e e y e a n d p l a c e b o in t h e o t h e r e y e of all 15 s t u d i e d s u b j e c t s in a r a n d o n i i z e d , d o u b l e - m a s k e d , crossover m a n n e r . Before the s t u d y a n d 9 0 m i n u t e s after t h e i n s t i l l a t i o n , e a c h subject was e x a m i n e d with subjective refrac tion, high-pass resolution perimetry, Goldmann tonometry, and pupil size m e a s u r e m e n t
1991
711
712
June, 1991
AMERICAN JOURNAL OF OPHTHALMOLOGY
w i t h a m i l l i m e t e r r u l e r . For e a c h s u b j e c t in t h e study this procedure was repeated on four occa s i o n s at a p p r o x i m a t e l y t h e s a m e t i m e o f t h e day, w i t h an i n t e r v a l of at l e a s t 4 8 h o u r s . T h e e y e s w e r e t e s t e d in a r a n d o m f a s h i o n . S t u d e n t ' s i-test a n d c o r r e l a t i o n t e s t s w e r e u s e d for s t a t i s t i c a l a n a l y s i s . A Ρ v a l u e o f l e s s than .05 was considered statistically significant.
Results T h e p r e s t u d y v a l u e s for t h e 15 s u b j e c t s ( 3 0 eyes) were the following: m e a n resolution threshold, 4.6 ± 0.6 dB; intraocular pressure, 15 ± 2 . 7 m m Hg; r e f r a c t i o n , -1-1 ± 2.1 d i o p t e r s ; and pupil diameter, 3.2 ± 0.5 m m . T h e m e a n r e s o l u t i o n t h r e s h o l d from the first-examined eyes o f e a c h s u b j e c t w a s 4 . 8 ± 0 . 5 dB a n d from the s e c o n d - e x a m i n e d e y e s 4 . 3 ± 0 . 7 d B (Ρ = . 0 3 1 ) . The prestudy tests showed no statistical ly significant d i f f e r e n c e in m e a n r e s o l u t i o n t h r e s h o l d b e t w e e n t h e r i g h t a n d left e y e s (P = . 2 7 ) , w h e n e x a m i n e d in r a n d o m o r d e r . N o s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e in m e a n resolution threshold was found b e t w e e n the u n t r e a t e d a n d t h e t r e a t e d e y e s in any g r o u p (Table, Figs. 1 and 2 ) . Betaxolol and timolol i n d u c e d a s i g n i f i c a n t r e d u c t i o n in i n t r a o c u l a r p r e s s u r e c o m p a r e d to p r e s t u d y v a l u e s (P = . 0 0 7 and Ρ = . 0 0 0 1 6 , respectively). No patient had an a s t i g m a t i c r e f r a c t i v e e r r o r o f m o r e t h a n 1 d i o p t e r b e f o r e or after drug i n s t i l l a t i o n ; t h u s , only spherical refraction was taken into ac c o u n t . N o s i g n i f i c a n t c h a n g e in s p h e r i c a l r e fraction w a s o b s e r v e d . P i l o c a r p i n e i n d u c e d a significant r e d u c t i o n in p u p i l d i a m e t e r , from 3 . 2 to 1.6 m m ( P < . 0 0 0 0 1 ) , yet t h e r e w a s n o significant c h a n g e in m e a n r e s o l u t i o n t h r e s h o l d s (P = . 5 4 ) .
Discussion V i s u a l field e x a m i n a t i o n s are i m p o r t a n t in the diagnosis and m a n a g e m e n t of glaucoma, a n d all f a c t o r s that m a y i n f l u e n c e t h e p e r i m e t r i c r e s u l t s h a v e to b e e v a l u a t e d . We a t t e m p t e d to d e m o n s t r a t e the p o t e n t i a l effects o f t o p i c a l a n t i g l a u c o m a d r u g s o n r e s u l t s from h i g h - p a s s resolution perimetry. In d i f f e r e n t i a l l i g h t - s e n s e p e r i m e t r y the t h r e s h o l d l e v e l in o n e s i n g l e v i s u a l field l o c a tion may show a variability of 10 d B . " The high-pass resolution perimetric technique has s h o w n l o w v a r i a b i l i t y b o t h in n o r m a l s u b j e c t s a n d p a t i e n t s w i t h g l a u c o m a . ' " " T h e r e is a s m a l l l e a r n i n g effect, h o w e v e r , b e t w e e n t h e first a n d s e c o n d e x a m i n a t i o n in n o r m a l s u b j e c t s , s u b jects suspected of having glaucoma, and pa t i e n t s w i t h g l a u c o m a , ' ^ a n d a still s m a l l e r effect, although not statistically significant, over a l o n g e r period.'' W e o b s e r v e d a s t a t i s t i c a l l y sig nificant d e c r e a s e in m e a n r e s o l u t i o n t h r e s h o l d v a l u e s o f 0 . 5 d B b e t w e e n t h e first- a n d s e c o n d e x a m i n e d e y e s (P = . 0 3 1 ) , w h i c h i n d i c a t e d a l e a r n i n g effect. In t h i s s i n g l e - d o s e s t u d y , w e o b s e r v e d n o s t a t i s t i c a l l y s i g n i f i c a n t effects o f t h e t e s t e d a n t i g l a u c o m a d r u g s on t h e m e a n r e s o l u t i o n t h r e s h old. The timolol-treated eyes performed slight ly w o r s e c o m p a r e d to t h e c o n t r o l e y e s ( m e a n resolution threshold, 4.5 ± 0.6 dB c o m p a r e d with 4.2 ± 0.6 dB), but this difference was not s t a t i s t i c a l l y s i g n i f i c a n t (P = . 1 8 ) . In p a t i e n t s with glaucoma a statistically significant reduc t i o n in d i f f e r e n t i a l l i g h t s e n s i t i v i t y h a s b e e n r e p o r t e d after t r e a t m e n t w i t h t i m o l o l . " We o b s e r v e d a s i g n i f i c a n t i n t r a o c u l a r p r e s sure decrease with betaxolol and timolol when c o m p a r e d to t h e p r e s t u d y v a l u e s . T h e r e w a s n o correlation b e t w e e n intraocular pressure level
TABLE EFFECTS OF TESTED DRUGS ON STUDY FACTORS* BETAXOLOL PRESTUDY
Mean resolution 4.6 ± threshold (dB) Intraocular 15 ± pressure (mmHg) Refraction (diopters) +1.0 ± Pupil diameter (mm) 3.2 ±
PLACEBO
TREATED
PLACEBO
EPINEPHRINE
PILOCARPINE
TREATED PLACEBO TREATED
PLACEBO
TIMOLOL TREATED
PLACEBO
0.6 4.3 ± 0.6 4.2 ± 0.7 4.1 ± 0.6 4.4 ± 0.7 4.4 ± 0.7 4.5 ± 0.4 4.4 ± 0.5 4.4 ± 0.6 4.2 ± 0.6 2.7
14 ± 2.8
12 ± 3
14 ± 2.9 15 ± 2.8 14 ± 2.6 13 ± 3.2
14 ± 3.2 11 ± 2.3
13 ± 2.7
2.1 +1.0 ± 2.2 +1.1 ± 2 +1.1 ± 2.3 +1 ± 2 +1 ± 2.2 +1 ± 2.2 +1.1 ± 2 +1 ± 2.2 +1.1 ± 2.1 0.5 3.1 ± 0.4 3.2 ± 0.4 3.2 ± 0.4 3.7 ± 1.0 3.3 ± 0.5 1.6 ± 0.7 3.2 + 0.4 3 ± 0.4 3 ± 0.3
•Values given are mean ± standard deviation.
Vol. I l l , No. 6
Betaxolol Epinephrine Pilocarpine
713
Antiglaucoma Drugs and Resolution Perimetry
Timolol
Epinephrine
Betaxolol
o o "¡"o o °
1
o o I o o Θ-o
O o
Placebo
o 1 O
Lene Μ . Martin-Boglind, R.N., Adrienne Graves, Ph.D., and Peter Wanger, M . D .
We c o n d u c t e d a r a n d o m l y a s s i g n e d , d o u b l e m a s k e d , c r o s s o v e r s t u d y of t h e effects of b e t a xolol, epinephrine, pilocarpine, and timolol on t h e h i g h - p a s s r e s o l u t i o n p e r i m e t r y r e s u l t s in n o r m a l subjects. T h e influence of topical a d m i n i s t r a t i o n of t h e s e i n t r a o c u l a r p r e s s u r e reducing drugs was negligible, which con firmed t h e r e l i a b i l i t y o f h i g h - p a s s r e s o l u t i o n perimetry results. The method seems appro p r i a t e for t h e d i a g n o s i s o f g l a u c o m a a n d t h e f o l l o w - u p of p a t i e n t s w i t h g l a u c o m a .
S E R I A L V I S U A L FIELD e x a m i n a t i o n s a r e e s s e n t i a l for t h e d i a g n o s i s a n d m a n a g e m e n t o f g l a u c o m a . T h e m o n i t o r i n g o f a n t i g l a u c o m a t h e r a p y is dependent upon the correct analysis of c h a n g e s in t h e v i s u a l fields. H i g h - p a s s r e s o l u t i o n p e r i m e t r y h a s b e e n r e p o r t e d to b e a s e n s i t i v e test for o p t i c n e r v e d a m a g e in g l a u c o m a w i t h l o w v a r i ability.''^ T h e m e t h o d h a s a l s o g i v e n h i g h l y r e p r o d u c i b l e r e s u l t s in n o r m a l s u b j e c t s . ^ H i g h p a s s r e s o l u t i o n t h r e s h o l d h a s b e e n s h o w n to correlate directly with retinal ganglion cell sep aration.^ T h i s p r o p o s a l h a s b e e n v a l i d a t e d b y comparison with other sophisticated tech n i q u e s for d e m o n s t r a t i n g o p t i c n e r v e d a m a g e . W a n g e r a n d Persson^ r e p o r t e d a g o o d c o n c o r dance between high-pass resolution perimetry findings and pattern-reversal electroretino grams. Airaksinen and associates^ found a good correlation between semiquantitative evalua t i o n o f r e t i n a l n e r v e fiber l a y e r p h o t o g r a p h s and high-pass resolution perimetry results. Lindblom*^ r e p o r t e d s i m i l a r o b s e r v a t i o n s . A l i n -
ear relationship has b e e n observed w h e n com paring reduction of the functional retinal area from l a s e r p h o t o c o a g u l a t i o n a n d i n c r e a s e o f t h e m e a n r e s o l u t i o n t h r e s h o l d in p a t i e n t s w i t h d i a betes (B. Lindblom, unpublished data). Miosis induced by pilocarpine has been s h o w n to i n f l u e n c e t h e v i s u a l field w i t h differ e n t i a l l i g h t - s e n s e p e r i m e t r y . ' ' * T h e d e c r e a s e in s e n s i t i v i t y r e m a i n e d w h e n c o m p e n s a t i n g for t h e d r u g - i n d u c e d m y o p i a . ' W e a t t e m p t e d to e s t a b l i s h if a n d t o w h a t e x t e n t t o p i c a l a d m i n i s tration of intraocular pressure-reducing drugs would influence the results of high-pass resolu t i o n p e r i m e t r y in n o r m a l s u b j e c t s .
Subjects and Methods The high-pass resolution perimetric system w e u s e d h a s b e e n d e s c r i b e d previously.'-^ B r i e f ly, it c o n s i s t e d o f a p e r s o n a l c o m p u t e r w i t h a second graphics card, w h i c h controlled the s t i m u l u s d i s p l a y m o n i t o r . T h e s u b j e c t s in t h e study, eight men and seven women, were healthy volunteers, a g e - m a t c h e d to typical pa tients with glaucoma (mean age, 6 6 . 7 ± 3 years; r a n g e , 6 1 to 7 2 y e a r s ) , w i t h n o h i s t o r y o f o c u l a r disease, no opacities of the optic media, normal intraocular pressure and fundus appearance, a n d b e s t - c o r r e c t e d v i s u a l a c u i t y o f at l e a s t 2 0 / 20. They had had no previous experience with h i g h - p a s s r e s o l u t i o n p e r i m e t r y . All s u b j e c t s gave i n f o r m e d c o n s e n t to p a r t i c i p a t e in t h e study when the procedure and aims had b e e n e x p l a i n e d to t h e m . T h e s t u d y w a s a p p r o v e d b y the local ethical c o m m i t t e e .
Accepted for publication March 13, 1991. From the Department of Ophthalmology, Sabbatsberg Hospital, Stockholm, Sweden (L. M. Martin-Boglind and Dr. Wanger); and Alcon Laboratories, Fort Worth, Texas (Dr. Graves). This study was supported by grants from the Stockholm County Council and Alcon Laboratories, Fort Worth, Texas. Reprint requests to Lene Martin-Boglind, R.N., De partment of Ophthalmology, Sabbatsberg Hospital, P.O. Box 6401, S-113 82 Stockholm, Sweden.
©AMERICAN JOURNAL OF OPHTHALMOLOGY 111:711-714, JUNE,
We i n s t i l l e d a s i n g l e d o s e o f b e t a x o l o l ( 0 . 5 % ) , e p i n e p h r i n e ( 1 % ) , p i l o c a r p i n e ( 2 % ) , or t i m o l o l ( 0 . 5 % ) in o n e e y e a n d p l a c e b o in t h e o t h e r e y e of all 15 s t u d i e d s u b j e c t s in a r a n d o n i i z e d , d o u b l e - m a s k e d , crossover m a n n e r . Before the s t u d y a n d 9 0 m i n u t e s after t h e i n s t i l l a t i o n , e a c h subject was e x a m i n e d with subjective refrac tion, high-pass resolution perimetry, Goldmann tonometry, and pupil size m e a s u r e m e n t
1991
711
712
June, 1991
AMERICAN JOURNAL OF OPHTHALMOLOGY
w i t h a m i l l i m e t e r r u l e r . For e a c h s u b j e c t in t h e study this procedure was repeated on four occa s i o n s at a p p r o x i m a t e l y t h e s a m e t i m e o f t h e day, w i t h an i n t e r v a l of at l e a s t 4 8 h o u r s . T h e e y e s w e r e t e s t e d in a r a n d o m f a s h i o n . S t u d e n t ' s i-test a n d c o r r e l a t i o n t e s t s w e r e u s e d for s t a t i s t i c a l a n a l y s i s . A Ρ v a l u e o f l e s s than .05 was considered statistically significant.
Results T h e p r e s t u d y v a l u e s for t h e 15 s u b j e c t s ( 3 0 eyes) were the following: m e a n resolution threshold, 4.6 ± 0.6 dB; intraocular pressure, 15 ± 2 . 7 m m Hg; r e f r a c t i o n , -1-1 ± 2.1 d i o p t e r s ; and pupil diameter, 3.2 ± 0.5 m m . T h e m e a n r e s o l u t i o n t h r e s h o l d from the first-examined eyes o f e a c h s u b j e c t w a s 4 . 8 ± 0 . 5 dB a n d from the s e c o n d - e x a m i n e d e y e s 4 . 3 ± 0 . 7 d B (Ρ = . 0 3 1 ) . The prestudy tests showed no statistical ly significant d i f f e r e n c e in m e a n r e s o l u t i o n t h r e s h o l d b e t w e e n t h e r i g h t a n d left e y e s (P = . 2 7 ) , w h e n e x a m i n e d in r a n d o m o r d e r . N o s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e in m e a n resolution threshold was found b e t w e e n the u n t r e a t e d a n d t h e t r e a t e d e y e s in any g r o u p (Table, Figs. 1 and 2 ) . Betaxolol and timolol i n d u c e d a s i g n i f i c a n t r e d u c t i o n in i n t r a o c u l a r p r e s s u r e c o m p a r e d to p r e s t u d y v a l u e s (P = . 0 0 7 and Ρ = . 0 0 0 1 6 , respectively). No patient had an a s t i g m a t i c r e f r a c t i v e e r r o r o f m o r e t h a n 1 d i o p t e r b e f o r e or after drug i n s t i l l a t i o n ; t h u s , only spherical refraction was taken into ac c o u n t . N o s i g n i f i c a n t c h a n g e in s p h e r i c a l r e fraction w a s o b s e r v e d . P i l o c a r p i n e i n d u c e d a significant r e d u c t i o n in p u p i l d i a m e t e r , from 3 . 2 to 1.6 m m ( P < . 0 0 0 0 1 ) , yet t h e r e w a s n o significant c h a n g e in m e a n r e s o l u t i o n t h r e s h o l d s (P = . 5 4 ) .
Discussion V i s u a l field e x a m i n a t i o n s are i m p o r t a n t in the diagnosis and m a n a g e m e n t of glaucoma, a n d all f a c t o r s that m a y i n f l u e n c e t h e p e r i m e t r i c r e s u l t s h a v e to b e e v a l u a t e d . We a t t e m p t e d to d e m o n s t r a t e the p o t e n t i a l effects o f t o p i c a l a n t i g l a u c o m a d r u g s o n r e s u l t s from h i g h - p a s s resolution perimetry. In d i f f e r e n t i a l l i g h t - s e n s e p e r i m e t r y the t h r e s h o l d l e v e l in o n e s i n g l e v i s u a l field l o c a tion may show a variability of 10 d B . " The high-pass resolution perimetric technique has s h o w n l o w v a r i a b i l i t y b o t h in n o r m a l s u b j e c t s a n d p a t i e n t s w i t h g l a u c o m a . ' " " T h e r e is a s m a l l l e a r n i n g effect, h o w e v e r , b e t w e e n t h e first a n d s e c o n d e x a m i n a t i o n in n o r m a l s u b j e c t s , s u b jects suspected of having glaucoma, and pa t i e n t s w i t h g l a u c o m a , ' ^ a n d a still s m a l l e r effect, although not statistically significant, over a l o n g e r period.'' W e o b s e r v e d a s t a t i s t i c a l l y sig nificant d e c r e a s e in m e a n r e s o l u t i o n t h r e s h o l d v a l u e s o f 0 . 5 d B b e t w e e n t h e first- a n d s e c o n d e x a m i n e d e y e s (P = . 0 3 1 ) , w h i c h i n d i c a t e d a l e a r n i n g effect. In t h i s s i n g l e - d o s e s t u d y , w e o b s e r v e d n o s t a t i s t i c a l l y s i g n i f i c a n t effects o f t h e t e s t e d a n t i g l a u c o m a d r u g s on t h e m e a n r e s o l u t i o n t h r e s h old. The timolol-treated eyes performed slight ly w o r s e c o m p a r e d to t h e c o n t r o l e y e s ( m e a n resolution threshold, 4.5 ± 0.6 dB c o m p a r e d with 4.2 ± 0.6 dB), but this difference was not s t a t i s t i c a l l y s i g n i f i c a n t (P = . 1 8 ) . In p a t i e n t s with glaucoma a statistically significant reduc t i o n in d i f f e r e n t i a l l i g h t s e n s i t i v i t y h a s b e e n r e p o r t e d after t r e a t m e n t w i t h t i m o l o l . " We o b s e r v e d a s i g n i f i c a n t i n t r a o c u l a r p r e s sure decrease with betaxolol and timolol when c o m p a r e d to t h e p r e s t u d y v a l u e s . T h e r e w a s n o correlation b e t w e e n intraocular pressure level
TABLE EFFECTS OF TESTED DRUGS ON STUDY FACTORS* BETAXOLOL PRESTUDY
Mean resolution 4.6 ± threshold (dB) Intraocular 15 ± pressure (mmHg) Refraction (diopters) +1.0 ± Pupil diameter (mm) 3.2 ±
PLACEBO
TREATED
PLACEBO
EPINEPHRINE
PILOCARPINE
TREATED PLACEBO TREATED
PLACEBO
TIMOLOL TREATED
PLACEBO
0.6 4.3 ± 0.6 4.2 ± 0.7 4.1 ± 0.6 4.4 ± 0.7 4.4 ± 0.7 4.5 ± 0.4 4.4 ± 0.5 4.4 ± 0.6 4.2 ± 0.6 2.7
14 ± 2.8
12 ± 3
14 ± 2.9 15 ± 2.8 14 ± 2.6 13 ± 3.2
14 ± 3.2 11 ± 2.3
13 ± 2.7
2.1 +1.0 ± 2.2 +1.1 ± 2 +1.1 ± 2.3 +1 ± 2 +1 ± 2.2 +1 ± 2.2 +1.1 ± 2 +1 ± 2.2 +1.1 ± 2.1 0.5 3.1 ± 0.4 3.2 ± 0.4 3.2 ± 0.4 3.7 ± 1.0 3.3 ± 0.5 1.6 ± 0.7 3.2 + 0.4 3 ± 0.4 3 ± 0.3
•Values given are mean ± standard deviation.
Vol. I l l , No. 6
Betaxolol Epinephrine Pilocarpine
713
Antiglaucoma Drugs and Resolution Perimetry
Timolol
Epinephrine
Betaxolol
o o "¡"o o °
1
o o I o o Θ-o
O o
Placebo
o 1 O
