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Data Collection Form
(To be filled only by physician)


A retrospective, cross-sectional, observational survey study to understand the role of FDC of 1.0% Brinzolamide/0.5% Timolol eye drops in primary open angle glaucoma or ocular hypertension
  1. As per your clinical practice, what is the approximate number of patients diagnosed with primary open angle glaucoma every month? *

  2. As per your clinical practice, what is the approximate number of patients diagnosed with ocular hypertension every month? *

  3. As per your clinical practice, which is the most common age group in patients diagnosed with primary open angle glaucoma? *

  4. As per your clinical practice, kindly provide the approximate break-up of patients with primary open angle glaucoma on the basis of duration of diagnosis? *
    5. Name

    %

    %

    %

    %

    100%

  5. As per your clinical practice, kindly provide the approximate break-up of patients with glaucoma on the basis of glaucoma type? *
    6. Name

    %

    %

    %

    %

    100%

  6. What is the approximate percentage of glaucoma patients with co-morbidities, as per observations in your practice? (Please tick the applicable option) *

  7. Kindly rank the most common co-morbidities observed in glaucoma patients as per your practice? (Please rank from rank 1 to rank 6 as from most common to least common comorbidity) *
    8. Name Rank
    1 2 3 4 5 6
    Dry eye diseases
    Post-operative
    Cataract
    COPD
    Asthma
    CVD

  8. As per your clinical practice, which is the most common presenting symptom in patients diagnosed with glaucoma, as observed in your practice? (Please tick the applicable option) *

  9. How frequently are the patients with glaucoma required to follow-up ? (Please tick the applicable options) *

  10. What is the approximate percentage of patients with glaucoma requiring anti-glaucoma medications, as per your practice? *

  11. As per your clinical practice, kindly rank your preferred anti-glaucoma medications in patients diagnosed with glaucoma? (Kindly specify the rankings in front of each agent as per your preference) *
    12. Name Rank
    1 2 3 4 5
    Blind spots
    Difficult vision
    Side vision
    Blurry or hazy vision
    Colored halos around light
  12. What is the approximate percentage of patients diagnosed with glaucoma requiring single agent eye drops as per your practice? *

  13. What is the approximate percentage of patients diagnosed with glaucoma requiring combination eye drops as per your practice? *

  14. Do you encounter any specific challenges when prescribing combination anti-glaucoma medications? (Select all that apply) *

  15. What are the factors that influence your decision to use fixed dose combination medications? *

  16. In your experience, do combination anti-glaucoma medications provide better outcomes compared to monotherapy? (Select all that apply) *
  17. How often do you monitor patients on combination anti-glaucoma medications? (Select all that apply) *
  18. As per your clinical practice, does your treatment option varies according to the below mentioned factors in glaucoma patients ? (Please specify yes or No) *
    19. Name YES or NO

    Age

    Presence or absence of co-morbidities

    Presence of refractive error

    Presence of ocular surface disease
  19. In your experience, which combination anti-glaucoma medications have demonstrated the best efficacy in reducing intraocular pressure? *

  20. Are there any specific patient populations or clinical scenarios where you find combination anti-glaucoma medications to be particularly beneficial? (Select all that apply) *
  21. Are you familiar with the comb ination anti-glaucoma medication FDC Brinzolamide and timolol eye drops? *

  22. How do you recommend Brinzolamide and Timolol FDC eye drops to your glaucoma patients? *

  23. What are the primary reasons for prescribing Brinzolamide and Timolol eye drops? (Select all that apply)? *
  24. How would you rate the efficacy of Brinzolamide and Timolol FDC eye drops in reducing IOP? (Please tick the applicable option) *

  25. How would you rate the efficacy of Brinzolamide and Timolol FDC eye drops in providing relief in terms of symptom control? (Please tick the applicable option) *

  26. Do you recommend Brinzolamide and Timolol eye drops in Ocular hypertensive patients? *

  27. How would you rate Brinzolamide and Timolol FDC eye drops in terms of compliance in patients with Glaucoma? (Please tick the applicable option) *

  28. Is there anything else you would like to share about your experience with Brinzolamide and Timolol FDC eye drops or any suggestions for their optimal use? *