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October 1993

Patient Selection in the Timpilo Study-Reply

Author Affiliations

Kuopio, Finland

Arch Ophthalmol. 1993;111(10):1313. doi:10.1001/archopht.1993.01090100019004

In reply  Drs Loewenstein and Lazar are concerned that patients were not properly selected for our study. They believe that patients who do not respond to monotherapy should not be defined as requiring two medications until the first one is withdrawn and a replacement is tried. In clinical practice, it is very rare to encounter a patient who does not respond to timolol or to pilocarpine eye drops. If such a patient was to be treated rationally, then the ineffective first drug would be withdrawn and a second drug tried.We have not seen any published argument that shows that 2% or 4% pilocarpine three or four times daily would be more effective than 0.25% or 0.5% timolol twice daily. Although some long-term timolol users demonstrate a slow upward "drift" of the intraocular pressure after several months of the start of the therapy1 and higher pilocarpine concentrations—seldom used in

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