A Systematic Review: Efficacy of Different Intraocular Pressure-Lowering Agents in Black Individuals

TL;DR

This study reviews how well different eye pressure-lowering drugs work in Black patients with glaucoma, finding that prostaglandin analogues are most effective.

Contribution

The study systematically evaluates the efficacy of IOP-lowering agents specifically in the Black population, a group underrepresented in prior glaucoma research.

Findings

Prostaglandin analogues are highly effective in lowering intraocular pressure in Black patients.

Non-selective beta-adrenergic antagonists show lower efficacy in this population.

Prostamides are slightly less effective than prostaglandin analogues in Black individuals.

Abstract

Glaucoma is one of the leading causes of blindness worldwide, with the Black population experiencing an earlier onset and severe form of the disease compared to the White population. Despite the increased prevalence in the Black community, most research pertaining to glaucoma is focused on White patients. The current management guidelines recommend prostaglandin analogues and non-selective beta-adrenergic antagonists as the mainstay treatment, however their comparative efficacy in the Black community has not been thoroughly investigated.

This systematic review aims to investigate the efficacy of the various intraocular pressure (IOP) lowering agents used to treat primary open angle glaucoma (POAG) and ocular hypertension (OHT) in Black patients.

A systematic review of three randomised controlled trials was conducted to assess the efficacy of IOP-lowering agents specifically in the Black population. The protocol was set prior to the literature search and registered in PROSPERO (CRD420025652374). Databases searched included PubMed, Cochrane Library, Europe PMC and Semantic Scholar. Two independent researchers reviewed the articles and data was extracted from the three eligible articles. Risk of bias was assessed using the Risk of Bias (RoB) 2 tool.

Our study found prostaglandin analogues to be highly efficient in the Black community and non-selective beta-adrenergic antagonists to have a lower efficacy in this population. The results align with the current National Institute for Health and Care Excellence (NICE) guidelines recommending prostaglandin analogue as the first-line treatment for POAG and OHT. However, the NICE guidelines recommend non-selective beta-adrenergic antagonists as the second-line treatment, which has a lower efficacy in Black patients. In addition, our study found prostamides to be only slightly less efficient compared to prostaglandin analogues in the Black population.

In conclusion, prostaglandin analogues are a suitable first-line IOP-lowering agent in Black patients. Further research is required to investigate a suitable second-line treatment option in this community if patients have any adverse effects or do not tolerate the first-line option or need additional reduction in IOP.

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