Clinical success and quality of life with brimonidine 0.2% or timolol 0.5%used twice daily in glaucoma or ocular hypertension: A randomized clinicaltrial

Purpose: To compare the clinical success rates and duality of life impact o f brimonidine 0.2% with timolol 0.5% in newly diagnosed patients naive to g laucoma therapy. Methods: A prospective, multicenter, randomized, double-masked, clinical ef fectiveness trial in which the clinical outcomes of twice daily brimonidine tartrate 0.2% were compared with those of timolol maleate 0.5% in patients with glaucoma and ocular hypertension was conducted. Two hundred nineteen patients were enrolled-111 in the brimonidine group and 108 in the timolol group. Patients instilled their study medications twice daily for 4 months. Factors for determining clinical success were reduction of intraocular pre ssure (IOP), safety, and adverse events. Quality of life effects were asses sed with the SF-36 Health Survey and Glaucoma Disability Index questionnair es. Results: Clinical success was 71% (75/106) with brimonidine and 70% (73/105 ) with timolol as initial treatment, The overall mean decrease in IOP was 6 .5 mm Hg with brimonidine and 6.2 mm Hg with timolol. Few patients reported a specific adverse event and, with the exception of a slightly higher rate of ocular burning and stinging in the brimonidine group, there were no sig nificant between-group differences. No significant chronotropic effects on the heart were seen with brimonidine, while small but significant mean decr eases in heart rate were seen at months I and 4 with timolol. Mean systolic and diastolic blood pressure remained relatively stable in both groups. Qu ality of life remained stable, with no significant between-group difference s. Conclusions: As a first-line agent for the treatment of glaucoma and ocular hypertension? brimonidine has clinical effectiveness equivalent to timolol , but with less chronotropic effect on the heart. Brimonidine is a viable a lternative to timolol for first-line therapy in glaucoma and ocular hyperte nsion.