Comparison of aqueous and gellan ophthalmic timolol with placebo on the 24-hour heart rate response in patients on treatment for glaucoma.

PURPOSE: Topical beta-blocker treatment is routine therapy in the management of patients with glaucoma. Therapy results in systemic absorption, however, the degree of reduction of resting and peak heart rate has not been quantified. DESIGN: This trial evaluated the effect of placebo, 0.5% aqueous timolol (timolol solution) and a 0.5% timolol suspension that forms a gel on application to the conjunctiva (timolol gellan) on the 24-hour heart rate in patients currently being treated for glaucoma to quantify the reduction in mean heart rate. METHODS: Forty-three Caucasian patients with primary open-angle glaucoma or ocular hypertension with a mean (+/-SD) age of 63 (+/-8) years were randomized and crossed over in a double-masked manner to 14 days of treatment with placebo (morning and evening in both eyes), timolol solution (morning and evening in both eyes), or timolol gellan (morning in both eyes with placebo in the evening). On the 13th day of each period, heart rate was recorded continuously during a typical, ambulant 24-hour period. RESULTS: Both timolol solution and timolol gellan reduced the mean 24-hour heart rate compared with placebo (P < or = .001), and this reduction was most pronounced during the daytime (-7.5% change in mean heart rate, -5.7 beats/min). Timolol gellan showed a numerically but not significantly smaller reduction in 24-hour heart rate, compared with timolol solution. During the night, the mean 12-hour heart rate on placebo and timolol gellan were both significantly less than on timolol solution; the difference between solution and gellan treatments was statistically significant (P = .01). CONCLUSIONS: Both timolol solution and timolol gellan decrease the mean 24-hour heart rate compared with placebo. This response was most pronounced during the active daytime period. These data quantify the modest bradycardia associated with ophthalmic beta-blocker therapy in a typical patient population on therapy for glaucoma. Although exercise performance was not assessed in this trial, reductions of this magnitude should not have substantial clinical consequences.

Diabetic eye complications in a medium sized municipality in southwest Norway.

To find the prevalence of diabetes and diabetic eye complications, all inhabitants of the municipality of Eigersund were contacted. Those with known diabetes were encouraged to participate in our study. Among 12,447 people we found 223 diabetics (1.8%). Two hundred and ten of them (94.2%) participated in the study. Ophthalmological history was taken and careful ophthalmological examination carried out by one ophthalmologist. Twenty-nine patients (13.8%) had diabetic retinopathy -24 (11.4%) nonproliferative and 5 (2.4%) proliferative retinopathy. Retinopathy was found in 11 (34.4%) of 32 type I diabetics and in 18 (10.1%) of 178 type II diabetics. Forty-three patients (20.5%) had significant cataract, and 15 patients (7.3%) had one or both eyes operated for cataract. Forty-two patients (20.0%) had their therapy adjusted as a result of our investigation. The prevalence of retinopathy was lower than expected, especially among the type II diabetics. The ophthalmological care of diabetics can, however, still be much improved.

Comparison of topical timolol vs betaxolol on cardiopulmonary exercise performance in healthy volunteers.

The effects of topical timolol vs betaxolol on cardiopulmonary exercise performance were studied in a randomised double-masked fashion in 12 healthy male volunteers. Cardiopulmonary parameters were evaluated at the anaerobic threshold and at peak exercise. Intraocular pressure was determined before and after treatment by applanation tonometry. No differences were found in aerobic or peak exercise capacity. Maximal heart rate was slightly lower (P less than 0.05) following treatment with timolol compared with betaxolol. However, a correspondingly higher oxygen pulse (oxygen uptake/heart rate) compensated for this reduction and resulted in no difference in peak performance. At physiological work levels, it was not possible to demonstrate any influence of topical, selective or non-selective, beta-adrenergic blockade on cardiopulmonary exercise performance in these healthy volunteers.

A subhyaloid haemorrhage as the presenting symptom of bilateral optic neuropathy.

A 28 year-old man with a spontaneous vitreous haemorrhage as the first sign of Leber's optic atrophy is presented. The blood collected in a central retrohyaloid area covering the left macula. The exact starting point of the haemorrhage was never positively identified, but it seemed to originate from an area of microangiopathy adjacent to the optic disc. For 8-10 months the vision of the left eye gradually decreased to counting fingers. A year later the visual acuity dropped to the same level on the right eye. The picture was compatible with Leber's optic atrophy. Other disorders causing bilateral optic neuropathy were excluded. A careful family history revealed several cases of visual problems for several generations. Vitreous haemorrhage as the first sign of Leber's optic atrophy has not previously been reported. Peripapillar microangiopathy, however, has been described in the asymptomatic stage of the disease.

Soft contact lenses worn at a simulated altitude of 18 000 feet.

Five subjects wearing soft contact lenses were placed in a low pressure chamber where the atmospheric pressure was reduced to 50%. Subjective and objective criteria were used to determine corneal distress. After four hours at 1/2 atmosphere all 10 eyes showed objective changes and four out of five subjects claimed subjective changes indicating corneal distress. None of the subjects showed subjective or objective signs of similar changes, when the study was repeated at normal atmospheric pressure.