Biological characterization of a clinical and an environmental isolate of Acanthamoeba polyphaga: analysis of relevant parameters to decode pathogenicity. - da Rocha-Azevedo, Bruno; Costa e Silva-Filho, Fernando (Archives of microbiology, 2007)
Acanthamoeba spp. consists of free-living amoebae, widespread in nature, which occasionally can cause human infections including granulomatous amoebic encephalitis and amoebic keratitis. Acanthamoeba pathogenesis is not entirely known and correlations between pathogenic potential and taxonomy are complex issues. In order to decipher the definition of a pathogenic amoeba, the objective of this work was to decipher the definition of pathogenic amoeba by characterizing two isolates of Acanthamoeba polyphaga obtained from different origins (a keratitis patient and freshwater), looking for differences among them. The clinical isolate grew faster in Peptone-yeast extract-glucose (PYG) medium, transformed more rapidly from a trophozoite to cyst and exhibited increased cytopathic effect on cultured cells. Morphological differences were also noted, since freshwater amoebae presented more acanthopodia than the clinical isolate. Moreover, actin labeling demonstrated that microfilament organization varies between isolates, with the presence of locomotory structures as lobopodia and lamellipodia in the keratitis isolate, which were less adherent on plastic. Zymography demonstrated that the keratitis isolates presented higher proteolytic activity and also were more able to invade collagen matrices. Altogether, we conclude that a group of stable physiological characteristics exist in Acanthamoeba that can be related to pathogenicity.
Keywords: Acanthamoeba/cl [Classification]; Acanthamoeba/ip [Isolation & Purification]; Acanthamoeba/py [Pathogenicity]; Acanthamoeba/ph [Physiology]; *Acanthamoeba; *Acanthamoeba Keratitis/ps [Parasitology]; Animals; Cell Adhesion; Cell Line; Epithelial Cells/ps [Parasitology]; *Fresh Water/ps [Parasitology]; Humans; Microscopy, Confocal; Microscopy, Electron, Scanning; Phenotype

Tolerability, quality of life, and persistency of use in patients with glaucoma who are switched to the fixed combination of latanoprost and timolol. - Dunker, Stephan; Schmucker, Achmed; Maier, Hubert; Latanoprost/Timolol Fixed Combination Study Group (Advances in therapy, 2007)
This study was undertaken to assess tolerability, quality of life, and persistency of use and to monitor changes in intraocular pressure (IOP) during the first 6 mo after a switch to fixed combination latanoprost/timolol. In Germany, 271 general ophthalmology practices enrolled patients who were switched from previous ocular hypotensive therapies to latanoprost/timolol for medical reasons. Usual care routines were followed, and IOP was measured at baseline and approximately 6 mo later. Adverse events were recorded throughout. Immediately before switching and at follow-up, patients completed a 29-item quality-of-life questionnaire. Of 1052 patients who met analysis criteria, 748 (71%) switched from combination therapy and 304 (29%) from monotherapy. An insufficient IOP reduction with the previous therapy was a reason for switching in 71% of patients; the desire to simplify to once-daily administration was cited in 66%. Ocular adverse events were reported in 19 patients after the switch, and 97% remained on therapy throughout the follow%up period. After switching, patients were less likely to forget to instill their eyedrops or to feel that their drops had adverse effects; they found it easier to include eyedrop administration in their routine; they were more satisfied with the frequency of instillation; and they were more likely to want to continue with the drops. Across all previous therapies, mean IOP decreased from 20.6+/-3.7 mm Hg to 17.2+/-2.8 mm Hg after the switch (P<.001)-a 14.8% difference. Fixed combination latanoprost/timolol is well tolerated and effective in patients who are switched from other monotherapies or combination therapies for medical reasons. Such a switch may be associated with improved quality of life.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Double-Blind Method; Drug Combinations; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Patient Compliance; Patient Satisfaction; Prospective Studies; Prostaglandins F, Synthetic/ae [Adverse Effects]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; *Quality of Life; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. - Mendis, Shanti; Fukino, Keiko; Cameron, Alexandra; Laing, Richard; Filipe, Anthonio Jr; Khatib, Oussama; Leowski, Jerzy; Ewen, Margaret (Bulletin of the World Health Organization, 2007)
OBJECTIVE: To assess the availability and affordability of medicines used to treat cardiovascular disease, diabetes, chronic respiratory disease and glaucoma and to provide palliative cancer care in six low- and middle-income countries., METHODS: A survey of the availability and price of 32 medicines was conducted in a representative sample of public and private medicine outlets in four geographically defined areas in Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. We analysed the percentage of these medicines available, the median price versus the international reference price (expressed as the median price ratio) and affordability in terms of the number of days wages it would cost the lowest-paid government worker to purchase one month of treatment., FINDINGS: In all countries<or=7.5% of these 32 medicines were available in the public sector, except in Brazil, where 30% were available, and Sri Lanka, where 28% were available. Median price ratios varied substantially, from 0.09 for losartan in Sri Lanka to 30.44 for aspirin in Brazil. In the private sector in Malawi and Sri Lanka, the cost of innovator products (the pharmaceutical product first given marketing authorization) was three times more than generic medicines. One month of combination treatment for coronary heart disease cost 18.4 days wages in Malawi, 6.1 days wages in Nepal, 5.4 in Pakistan and 5.1 in Brazil; in Bangladesh the cost was 1.6 days wages and in Sri Lanka it was 1.5. The cost of one month of combination treatment for asthma ranged from 1.3 days wages in Bangladesh to 9.2 days wages in Malawi. The cost of a one-month course of intermediate-acting insulin ranged from 2.8 days wages in Brazil to 19.6 in Malawi., CONCLUSION: Context-specific policies are required to improve access to essential medicines. Generic products should be promoted by educating professionals and consumers, by implementing appropriate policies and incentives, and by introducing market competition and/or price regulation. Improving governance and management efficiency, and assessing local supply options, may improve availability. Prices could be reduced by improving purchasing efficiency, eliminating taxes and regulating mark-ups.
Comment in (CIN), Comment in (CIN)
Keywords: *Chronic Disease/dt [Drug Therapy]; Commerce/og [Organization & Administration]; *Developing Countries; *Drugs, Essential/ec [Economics]; *Drugs, Essential/sd [Supply & Distribution]; Global Health; *Health Services Accessibility/ec [Economics]; Health Services Accessibility/og [Organization & Administration]; Humans; Palliative Care/og [Organization & Administration]; Private Sector/og [Organization & Administration]; Public Sector/og [Organization & Administration]

Magnitude and causes of unilateral absolute blindness in a region of Oman: a hospital-based study. - Bansal, R K; Khandekar, R; Nagendra, P; Kurup, P (European journal of ophthalmology, 2007)
PURPOSE: To report the magnitude and causes of unilateral absolute blindness (no light perception) and barriers faced by persons with unilateral blindness in the South Batinah region of Oman., METHODS: Between January and June 2002, 12,000 patients were evaluated for visual acuity, ocular pressure, anterior ocular biomicroscopic examination, and posterior segment indirect ophthalmoscopy examination by ophthalmologists at Al Rustaq hospital in Oman. Patients having no perception of light in at least one eye were included in the cohort. A closed-ended questionnaire was used to collect data on the personal profile, history of blindness, barriers perceived as the cause of blindness, and participants' attitude towards eye care and quality of life following visual disability., RESULTS: In the 12,000 patients studied, absolute unilateral blindness (no perception of light) was present in 122 persons, a rate of 1.0% in our series. The onset of blindness was gradual in 78 (63.9%) persons and 64 (54.9%) persons had unilateral blindness for more than 10 years. The main causes of blindness e phthisis/absent/disorganized blind eye, which was present in 64 (52.5%) persons; glaucoma, seen in 49 (40.2%) participants; and corneal opacity, seen in 8 (6.5%) persons. Eighty 4.8%) persons had <3/60 vision in the fellow eye. Thirty (24.6%) persons had cataract and 19 (15.6%) persons glaucoma in the fellow eye. Forty-eight (39.3%) persons had undergone cataract surgeries while 2 (1.6%) persons were operated for glaucoma in the fellow eye. Lack of access to ophthalmic services and use of traditional medicines during the onset of blindness were reported by nearly half of the cohort. The attitude towards blindness was negative in two thirds of subjects., CONCLUSIONS: Cataract and glaucoma were important determinants of visual impairment in the fellow eyes of this cohort. These patients are at higher risk of developing bilateral impairment and need special care to prevent/treat visual disabilities in the fellow eyes. Using appropriate services, one can attempt attitudinal changes, rehabilitate them, and create a positive attitude towards life.
Keywords: Adolescent; Adult; Attitude to Health; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Eye Diseases/co [Complications]; Female; Hospitals, Special; Humans; Intraocular Pressure; Male; Middle Aged; Oman/ep [Epidemiology]; Ophthalmology; Ophthalmoscopy; Prevalence; Visual Acuity; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Knowledge, attitudes, and beliefs about dilated eye examinations among African-Americans. - Ellish, Nancy J; Royak-Schaler, Renee; Passmore, Susan R; Higginbotham, Eve J (Investigative ophthalmology & visual science, 2007)
PURPOSE: To understand factors that influence African-Americans' attitude toward eye examinations., METHODS: Ten focus groups were conducted with 86 African-Americans. Four focus groups were conducted with people 65 years of age and older who had not received a dilated fundus examination (DFE) in the past 2 years, two groups were held with people 65 years of age and older who had had a recent DFE, and two groups each were held with people 40 to 64 years of age, with and without recent DFEs. Focus group interviews were conducted by using a moderator guide to address perceived benefits of and barriers to getting an eye examination; motivators for getting DFEs; and knowledge of eye examinations, glaucoma, and diabetic retinopathy. Participants also completed a questionnaire that provided demographic information. Quantitative and qualitative analyses were conducted., RESULTS: Cost or lack of sufficient insurance was identified as the most important barrier to getting a DFE. Also frequently mentioned was not having any symptoms and being too busy. The most frequently cited benefit of getting a DFE was to help prevent eye disease, whereas the most frequently reported motivating factor was experiencing a vision problem. Regarding knowledge, many people did not know the risk factors for glaucoma, but seemed to have a better understanding of how to reduce the effects of diabetes on their eyes., CONCLUSIONS: Study findings identified important links between financial resources and experiencing a vision problem and the adoption of preventive eye care in an urban African-American population.
Keywords: Adult; *African Americans/px [Psychology]; Aged; Baltimore; *Eye Diseases/di [Diagnosis]; Female; Focus Groups; Health Care Costs; *Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Insurance, Health; Male; Middle Aged; Motivation; *Mydriatics/ad [Administration & Dosage]; *Physical Examination; *Pupil/de [Drug Effects]; Surveys and Questionnaires

Diagnostic markers in the structures of human biological liquids. - Shabalin, V N; Shatokhina, S N (Singapore medical journal, 2007)
INTRODUCTION: To date, morphology research in laboratory diagnostics has referred only to cell tissues and excluded biological fluids. Our new technology is based on the study of structures of biological fluids formed during transition from liquid to solid state by dehydration under special conditions. These structures are formed due to the special "mosaic" configuration of molecules and microaggregates of the substance (protein and others) dissolved in the studied fluids. It should be considered as well that the specific structure of protein molecules is a fundamental basis of anatomical and physiological peculiarities of an organism. All pathological processes are initiated by the changes in the spatial configuration of protein molecules., METHODS: We have developed a special method named "cuneiform dehydration of biological liquids" to obtain thin films which possess specific structures. During the transition of a biological liquid into a solid, organic molecules build specific macrostructures in conformity with their configuration., RESULTS: Studies of the solid phase structures of different biological liquids allow us to find specific markers of various pathological processes in the human organism. In blood serum, we discovered markers of inflammation, sclerosis, chronic intoxication; in tear--markers of different stages of glaucoma; and in synovial fluid--markers of different stages of osteoarthrosis. In our investigation of 143 healthy people and 1,419 patients, a high rate of compliance of the discovered markers with the results of routine clinical and laboratory methods were observed. As the suggested technology has a higher sensitivity, the results obtained by this technology and routine methods do not always coincide., CONCLUSION: The developed technology gives new information about the state of the human organism and may be used in practice for diagnostics of various pathological processes and at pre-clinical studies of their development, as well as for the evaluation of the efficacy of medical treatment.
Keywords: *Biomarkers/an [Analysis]; *Body Fluids/ch [Chemistry]; Chemical Phenomena; Chemistry, Physical; Desiccation; Humans; Phase Transition

Lifetime visual disability in open-angle glaucoma and ocular hypertension. - Forsman, Eva; Kivela, Tero; Vesti, Eija (Journal of glaucoma, 2007)
PURPOSE: To study how many of the patients with treated glaucoma or ocular hypertension go blind during their lifetime and which factors are associated with blindness., PATIENTS: The data on 106 consecutive patients who had died between 1991 and 2002 was retrospectively evaluated. At diagnosis 39 patients had primary open-angle glaucoma, 27 had exfoliation glaucoma, and 40 had ocular hypertension., METHODS: Clinical records and causes of death were reviewed. Visual disability at the last visit before death was evaluated. Outcome measures were visual handicap and blindness based on visual acuity and/or visual fields., RESULTS: At the last visit, 17 patients [16%, 95% confidence interval (CI) 9-23] were visually handicapped. Thirteen patients (14%) were bilaterally blind. Glaucoma was the cause of blindness in one or both eyes in 16 patients (15%, 95% CI 8-22) and in both eyes in 6 patients (6%, 95% CI 1-10). In the analysis of only 1 eye of each patient, the cumulative incidence of glaucoma-caused blindness was 6% (95% CI 2-11) at 5 years, 9% (95% CI 4-15) at 10 years, and 15% (95% CI 9-23) at 15 years. An advanced stage of glaucoma at diagnosis, fluctuation in intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance increased the occurrence of blindness. Positive family history of glaucoma and vascular causes of death had no effect on visual outcome., CONCLUSIONS: Glaucoma-caused blindness was associated with an advanced stage of glaucoma at diagnosis, fluctuation of intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance. The risk of going blind from glaucoma in both eyes was 6%.
Keywords: Aged; Aged, 80 and over; Blindness/ep [Epidemiology]; *Blindness/et [Etiology]; Cause of Death; *Disability Evaluation; Follow-Up Studies; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Incidence; Intraocular Pressure; Middle Aged; Ocular Hypertension/co [Complications]; Ocular Hypertension/ep [Epidemiology]; Retrospective Studies; Vision, Low/ep [Epidemiology]; *Vision, Low/et [Etiology]; Visual Acuity

Microbial keratitis in orthokeratology: the Australian experience. - Watt, Kathleen G; Boneham, Gavin C; Swarbrick, Helen A (Clinical & experimental optometry, 2007)
BACKGROUND: This study was conducted to investigate the demographics of orthokeratology (OK) practice in Australia, to uncover any previously undocumented cases of serious adverse responses in OK, including microbial keratitis (MK), and to review the demographics of MK in OK in Australia., METHODS: A questionnaire was sent to the 62 members of the Orthokeratology Society of Australia (OSA). Questions related to aspects of their OK practice, demographics of their OK patient base and any adverse responses to OK lens wear that they had encountered., RESULTS: Thirty-three questionnaires (53 per cent) were returned. OSA members have been fitting OK lenses for a median of 7.5 years. OK patients were predominantly female, Caucasian, aged between 15 and 39 years and wearing lenses in an overnight modality. In addition to two cases reported previously, the survey uncovered seven further cases of MK in OK patients over an eight-year period. The infecting organism was Pseudomonas aeruginosa in four cases, Acanthamoeba spp. in two cases and unknown in three cases. There was no loss of visual acuity in seven cases. One case resulted in vision of counting fingers at one metre and another case resolved with 6/12 visual acuity. Non-compliance with instructions on lens care and after-care was reported in seven of nine cases of MK., CONCLUSION: Overall, OSA members who responded to the survey have many years of experience in OK. The typical Australian OK patient is in young adulthood, female and Caucasian. A total of nine cases of presumed MK associated with OK have been reported in Australia over an eight-year period and seven of these were new cases uncovered by this survey. Our analysis suggests that the demographics of MK cases in OK reflect the demographics of the OK lens-wearing population.
Keywords: Acanthamoeba Keratitis/ep [Epidemiology]; *Acanthamoeba Keratitis/et [Etiology]; Adolescent; Adult; Aged; Australia; Bacterial Infections/ep [Epidemiology]; *Bacterial Infections/et [Etiology]; Contact Lens Solutions; *Contact Lenses/ae [Adverse Effects]; Demography; Female; Humans; Incidence; *Keratitis/mi [Microbiology]; Male; Middle Aged; *Myopia/th [Therapy]; *Optometry/mt [Methods]; Patient Compliance; Pseudomonas Infections; Pseudomonas aeruginosa

[Improved visualization of fundus with green-light ophthalmoscopy]. - Vignal, R; Gastaud, P; Izambart, C; Daubas, P; Freton, A (Journal francais d'ophtalmologie, 2007)
Monochromatic light accentuates details of different retinal layers because of its variable absorption and reflectance by structures both within and above these layers. Red-free light is little used, although it is an elementary method. Green-light ophthalmoscopy, with its short wavelength, enhances some fundus and vitreous structures and may make the examination of pathologic conditions (premacular pathology, vascular abnormalities, etc.) easier. Furthermore, it is often more comfortable for the patient.
Keywords: Adolescent; Adult; Child; Color; Diabetic Retinopathy/di [Diagnosis]; Equipment Design; *Fundus Oculi; Glaucoma/di [Diagnosis]; Humans; *Light; Macular Degeneration/di [Diagnosis]; Myopia/di [Diagnosis]; *Ophthalmoscopes; *Ophthalmoscopy/mt [Methods]; Patient Acceptance of Health Care; Retina/pa [Pathology]; Retinal Degeneration/di [Diagnosis]; Retinal Degeneration/ge [Genetics]; *Retinal Diseases/di [Diagnosis]; Vitreous Body/pa [Pathology]

The economic implications of glaucoma: a literature review. - Schmier, Jordana K; Halpern, Michael T; Jones, Mechelle L (PharmacoEconomics, 2007)
Glaucoma is a common ophthalmic condition, often associated with elevated intraocular pressure (IOP). It affects >2 million people in the US, and the incidence is expected to exceed 3 million by 2020. However, relatively little is known about the cost of glaucoma compared with costs for other eye conditions. This comprehensive report reviews published literature on costs and cost effectiveness of treatments for glaucoma. Cost-of-illness studies in glaucoma focus on direct medical costs and generally exclude indirect costs. In general, increased costs are associated with increased severity or lack of control over IOP and the distribution of costs (e.g. medication vs procedures) varies with severity. A large number of studies have evaluated the cost of glaucoma medications, assessing the number of drops per bottle and associated cost per drop or per treatment dose. These studies have limited usefulness as they generally evaluate unit medication costs without including differential effectiveness or adverse effects associated with various therapies, and thus provide only one component of real-world costs for glaucoma. Broader comparative cost studies, mainly adopting a cost-minimisation approach, have evaluated the impact of differing treatments and management strategies on all types of medical care resource utilisation and associated costs, but a variety of metrics for success makes interpretation challenging. Studies have generally found beta2-adrenoceptor antagonists to be associated with greater healthcare costs than newer therapies. Among newer treatments such as prostaglandin analogues, no specific treatment has demonstrated a clear cost advantage over other treatments. A number of studies have modelled hypothetical cohorts of glaucoma patients through courses of therapy, projecting costs, outcomes and cost effectiveness. A majority of these cost-effectiveness models compare one of the newer prostaglandin analogues with older medications or with one another. Existing studies suggest that bimatoprost may be more cost effective than other agents. However, the effectiveness outcomes used in these studies vary, including achieving IOP thresholds, IOP-controlled days, percent reduction in IOP and QALYs. Methods used to determine costs also vary substantially between studies. Future evaluations of the burden of glaucoma need to consider the issues of comparability between, and generalisability of, study results. Differences in methods have created barriers to understanding the cost of glaucoma and comparing costs or cost effectiveness between studies. Furthermore, future studies should also consider direct costs of glaucoma generally not covered by health insurance as well as indirect costs of glaucoma. As new screening technologies for early detection of individuals at elevated risk of glaucoma are now in use, more complete estimates of the cost of glaucoma are critical for issues of resource allocation and health policy.
Keywords: Drug Therapy/ec [Economics]; General Surgery/ec [Economics]; *Glaucoma/ec [Economics]; *Glaucoma/th [Therapy]; Humans; Meta-Analysis as Topic

Developments in dosing aids and adherence devices for glaucoma therapy: current and future perspectives. - Kahook, Malik Y (Expert review of medical devices, 2007)
Glaucoma is a leading cause of blindness worldwide. Currently, topical drops are the mainstay of treatment for patients who suffer from this chronic disease. Adherence to topical therapy is known to be affected by forgetfulness, frequent dosing requirements and physical limitations. Dosing and adherence aids are designed to help patients adhere to their prescribed therapeutic regimens. This review discusses commonly used dosing and adherence aids, and offers opinions on how future devices may improve on currently available technology.
Keywords: Administration, Topical; *Drug Delivery Systems/is [Instrumentation]; *Drug Delivery Systems/mt [Methods]; Drug Delivery Systems/td [Trends]; Equipment Design/td [Trends]; Forecasting; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; *Self Administration/is [Instrumentation]; *Self Administration/mt [Methods]

Travoprost 0.004%/timolol 0.5% fixed combination. - Noecker, Robert J; Awadallah, Nida S; Kahook, Malik Y (Drugs of today (Barcelona, Spain : 1998), 2007)
Fixed-combination travoprost/timolol solution consists of travoprost 0.004% and timolol 0.5%. Several studies have demonstrated the efficacy and safety of this medication used once daily for the treatment of open-angle glaucoma and ocular hypertension. This fixed combination has been compared to travoprost and timolol used concomitantly, latanoprost and timolol used concomitantly, latanoprost/timolol fixed combination and travoprost and timolol monotherapy. Fixed-combination medicines such as travoprost/timolol offer the potential of maximizing patient adherence by decreasing the burden of using multiple topical agents that lower intraocular pressure, and by potentially decreasing the overall cost to both the patient and the health-care system. We discuss the benefits of fixed-dose medications, report on previous clinical trials and summarize the existing data on the performance of travoprost/timolol. Copyright (c) 2007 Prous Science. All rights reserved.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Clinical Trials as Topic; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Drug Combinations; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ocular Hypertension/dt [Drug Therapy]; *Timolol/ad [Administration & Dosage]; Travoprost

[Retinal vein occlusions in patients treated with anticoagulant and/or platelet aggregation inhibitors. Five case studies]. - Ducos de Lahitte, G; Quintyn, J C; Leparmentier, A; Mathis, A (Journal francais d'ophtalmologie, 2007)
INTRODUCTION: Retinal vein occlusions (RVOs) are a common cause of severe or total loss of vision. Although the disease entity has long been known, its management is still controversial. We report five patients (six eyes) who experienced RVO even though they were taking anticoagulants or antiplatelet agents., CASE REPORTS: Two patients developed a central retinal vein occlusion (two eyes), two patients a branch retinal vein occlusion (two eyes), and one patient a bilateral central retinal vein occlusion (two eyes). Three patients were treated with anticoagulants, two for hemostatic pathologies and one for cardiopathy; two patients were treated with antiplatelet agents, one for auricular fibrillation and one for a cardiac graft. Retinal photocoagulation was performed in all cases to treat retinal ischemia. Neovascular glaucoma occurred in a single eye., DISCUSSION: Treatments for thromboembolic disorders are more and more commonly used for various indications. Nevertheless, many patients develop RVO while taking such treatments, even though the International Normalized Ratio (INR) shows good patient compliance. Many case reports and small case series illustrate the occurrence of RVO with such treatments. These examples seem to illustrate the lack of efficacy of anticoagulants and platelet aggregation inhibitors in preventing vascular complications in the retinal venous circulation., CONCLUSION: Anticoagulants and platelet aggregation inhibitors must only be used to treat systemic factors or thromboembolic disorders associated with RVO. These five case reports illustrate that anticoagulants and platelet aggregation inhibitors cannot guarantee that a severe RVO will not occur. A prospective study would be useful to analyze their advantages in RVO management.
Keywords: Adult; Aged; Aged, 80 and over; *Anticoagulants/tu [Therapeutic Use]; Humans; International Normalized Ratio; Male; Middle Aged; Patient Compliance; *Platelet Aggregation Inhibitors/tu [Therapeutic Use]; *Retinal Vein Occlusion/dt [Drug Therapy]; Treatment Outcome

Endoscopic laser cyclophotocoagulation in pediatric glaucoma with corneal opacities. - Al-Haddad, Christiane E; Freedman, Sharon F (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2007)
INTRODUCTION: Endoscopic diode cycloablation (ECP) has shown modest efficacy for the management of pediatric glaucomas. Eyes with pediatric glaucoma and corneal opacities pose obstacles to intraocular surgery. We examined the role of ECP in lowering intraocular pressure (IOP) as well as that of endoscopy in facilitating tube shunt placement in these eyes., METHODS: Retrospective chart review of 12 eyes (11 patients) with glaucoma and corneal opacities from 12/99 to 9/05. ECP was performed for IOP control with success defined as postoperative IOP < or =21 mm Hg, with or without medications and without procedure-related complications. Success of ECP, repeat ECP, and endoscopically guided tube shunt placement was studied., RESULTS: Diagnoses included the following: Peters/anterior segment dysgenesis in nine eyes and corneal scar/failed corneal graft in three. Patients included eight females and three males with median age 3 years (0.5 to 10.3) at treatment. Median number of prior surgeries was three; median time to failure was 7.8 months (0.3 to 38). Ten eyes had prior external cycloablation(s). Success of first ECP (mean 6.1 clock hours) was 2/12 (17%), with Kaplan-Meier median survival 12 months. Two treatment failures had repeat ECP, and both failed. Four treatment failures had subsequent tube shunt surgery (three with endoscopic assistance), and all were successful at median follow-up of 33 months (11 to 63). Baseline IOP was 36.8 +/- 11 mm Hg before ECP versus 28.2 +/- 16 mm Hg after first treatment (p = 0.07). Procedure-related complications included chorioretinal detachment in one eye., CONCLUSIONS: ECP had limited success in children with refractory glaucoma. However, with anatomic limitations, endoscopy itself was valuable in facilitating subsequent successful tube shunt surgery.
Erratum in (EIN), Comment in (CIN)
Keywords: Adolescent; Child; Child, Preschool; *Ciliary Body/su [Surgery]; *Corneal Opacity/co [Complications]; *Endoscopy; Female; Follow-Up Studies; Glaucoma/co [Complications]; *Glaucoma/su [Surgery]; Humans; Infant; Intraocular Pressure; *Laser Coagulation/mt [Methods]; Male; Retrospective Studies; Treatment Outcome

Heavier molecular weight ocular viscoelastic devices and timing of post-operative review following cataract surgery. - Thirumalai, Balaji; Blamires, Trudi L; Brooker, Lucenne; Deeks, Jon (BMC ophthalmology, 2007)
BACKGROUND: To assess the safety of abandoning the next day post-operative review in preference for assessment only 2 hours post-surgery for both phacoemulsification and extracapsular surgery with heavier molecular weight ocular viscoelastic devices (OVD)., METHODS: 475 patients who underwent uncomplicated cataract surgery using heavier molecular weight ocular viscoelastic device (Healon GV) were studied. Of these 415 were phacoemulsification and 60 extracapsular and none received Intraocular pressure (IOP) lowering prophylaxis at the end of surgery. All were examined at 2 hours post-surgery and on the following day. Results were tabulated and analysed assessing wound stability, corneal clarity, anterior chamber reaction and IOP., RESULTS: In the time between the two assessments 44 (10.6%) patients developed a total of 53 new problems, with a majority being increases in IOP. Based on the lower threshold of IOP of 30 mmHg, the incidence of new problems at the next-day assessment was 9.8% (95% CI: 7.0 to 13.6) in the phacoemulsification group and 16.3% (7.3 to 29.7)in the extracapsular surgery group. At the higher threshold of IOP of 35 mmHg the corresponding figures were 6.6% and 16.3%., CONCLUSION: There is a higher incidence of new problems at the next-day assessment than previous studies with conventional OVD. Therefore results from previous studies using standard OVDs cannot be simply extrapolated to heavier molecular weight OVDs. When these agents are used, routine use of an ocular hypotensive agent may be necessary to increase the safety of abandoning the review on the first post-operative day for phacoemulsification patients. This is to be studied.
Keywords: *Ambulatory Surgical Procedures; *Appointments and Schedules; Cataract Extraction/ae [Adverse Effects]; Cataract Extraction/mt [Methods]; *Cataract Extraction; Elasticity; Humans; *Hyaluronic Acid/ad [Administration & Dosage]; *Hyaluronic Acid/ch [Chemistry]; Incidence; Intraocular Pressure; Molecular Weight; Ocular Hypertension/ep [Epidemiology]; Ocular Hypertension/et [Etiology]; Phacoemulsification/ae [Adverse Effects]; *Postoperative Care; Postoperative Complications/ep [Epidemiology]; Postoperative Period; *Prostheses and Implants; Time Factors; Viscosity

[Glaucoma with aniridia and isolated congenital glaucoma in siblings: contribution and limits of genetics]. - Lise-Schneider, B; Calvas, P; Roche, O; Lambert, J C; Dufier, J L; Costet-Fighiera, C (Journal francais d'ophtalmologie, 2007)
INTRODUCTION: Congenital glaucoma associated with aniridia and primary congenital glaucoma are regarded as different entities. Indeed, the abnormalities of the angle's structures as well as the genes involved are different. We report the observation of two sisters presenting these two types of glaucoma with particular attention paid to the importance and the difficulty of genetic counseling., OBSERVATIONS: Child L, with no particular family history, had presented bilateral aniridia complicated by bilateral glaucoma since birth. In addition to medical and surgical treatment, general and genetic investigations were undertaken that revealed no abnormalities. No microdeletion of the gene PAX6 responsible for the aniridia was found. Consequently, the genetic advice was in favor of a second pregnancy for this couple. At birth, L's sister also presented bilateral congenital glaucoma, which was isolated, without aniridia. New genetic investigations were carried out but no abnormalities in PAX6, nor in FOXC1 or PITX2 involved in the development of the anterior chamber, were found. Moreover, the haplotypes for aniridia locus AN2 inherited by the two sisters were different, proof that this gene could not be responsible for the glaucoma., DISCUSSION: At L's birth, the hypothesis retained was that she was a sporadic case whose gene mutation could not be identified (which happens in 50% of sporadic cases). The risk for the second pregnancy was negligible, although not null. The primary congenital glaucoma presented by L's sister remains unexplained in the context of aniridia and the role of the PAX6 gene was eliminated. The study of PITX2 and FOXC1 genes involved in anterior segment dysgenesis proved that they were also not involved. Thus, this observation evokes the responsibility of a gene other than PAX6 in aniridia, which could also have a role in isolated congenital glaucoma., CONCLUSION: Analysis of congenital pathologies from a more genetic than clinical point of view seems to progressively break down the barriers established between the various phenotypes of hereditary congenital anomalies. Even if the association of aniridia and primary congenital glaucoma in siblings is reported here for the first time, it does not appear so extraordinary if one considers the complexity of the anterior chamber's development, which involves many genes, most of them still unidentified to date.
Keywords: Adult; *Aniridia/co [Complications]; Anterior Chamber/em [Embryology]; Antigens/ge [Genetics]; Corneal Edema/cn [Congenital]; Eye Proteins/ge [Genetics]; Female; Forkhead Transcription Factors/ge [Genetics]; Genetic Counseling; *Glaucoma/cn [Congenital]; Glaucoma/em [Embryology]; Glaucoma/ge [Genetics]; Haplotypes/ge [Genetics]; Homeodomain Proteins/ge [Genetics]; Humans; *Hydrophthalmos/et [Etiology]; Hydrophthalmos/ge [Genetics]; Infant, Newborn; Karyotyping; PAX6 Transcription Factor; Paired Box Transcription Factors/ge [Genetics]; Pregnancy; Proteoglycans/ge [Genetics]; Repressor Proteins/ge [Genetics]; Risk; Siblings; Transcription Factors/ge [Genetics]

Use of eyedrops in glaucoma: how can we help to reduce non-compliance?. - Chawla, Anand; McGalliard, Jim N; Batterbury, Mark (Acta ophthalmologica Scandinavica, 2007)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure; *Ophthalmic Solutions/ad [Administration & Dosage]; Surveys and Questionnaires; *Treatment Refusal/sn [Statistics & Numerical Data]

Experience with the polymer-coated hydroxyapatite implant after enucleation in 126 patients. - Shields, Carol L; Uysal, Yusuf; Marr, Brian P; Lally, Sara E; Rodriques, Eduardo; Kharod, Bhairavi; Shields, Jerry A (Ophthalmology, 2007)
OBJECTIVE: To evaluate the new polymer-coated hydroxyapatite implant., DESIGN: Retrospective nonrandomized single-center case series., PARTICIPANTS: One hundred twenty-six patients managed with enucleation and placement of the polymer-coated hydroxyapatite implant at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University., METHODS: A retrospective analysis was performed on 126 patients managed with enucleation and placement of the polymer-coated hydroxyapatite implant., MAIN OUTCOME MEASURES: Ease of placement, functional ocular motility, tissue complications, and patient satisfaction., RESULTS: The preenucleation diagnoses included uveal melanoma (n = 76; 61%), retinoblastoma (n = 34; 27%), blind painful eye (n = 8; 6%), neovascular glaucoma from intraocular tumors or retinal detachment (n = 5; 4%), and others (n = 3; 2%). Previous ocular therapies for posterior segment conditions such as plaque radiotherapy, retinal detachment repair, and chemoreduction, thermotherapy, and cryotherapy had been performed in 22% of patients (n = 27). The implant size was 20 mm (n = 103; 82%), 18 mm (n = 22; 17%), and 16 mm (n = 1; 1%). Implant preparation and placement was uncomplicated in all patients, without adhesion to surrounding tissue. Four rectus muscles were attached to the implant in all patients. Socket motility was judged to be good (n = 118; 94%), fair (n = 6; 5%), and poor (n = 2; 2%). Complications included conjunctival thinning (n = 1; <1%), pyogenic granuloma (n = 1; <1%), conjunctival cyst (n = 3; 2%), implant infection (n = 1; <1%), and implant exposure (n = 3; 2%). There were no cases of implant extrusion or allergic reaction to the polymer. Patient satisfaction was reported as good (n = 123; 98%), fair (n = 2; 2%), and poor (n = 1; <1%)., CONCLUSIONS: The polymer-coated hydroxyapatite implant is smoothly placed into the orbit after enucleation without the need for additional tissue wrap. With proper placement, this implant provides satisfactory functional motility and shows favorable tissue tolerance with no clinical evidence of allergic reaction or extrusion.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; *Coated Materials, Biocompatible; *Durapatite; *Eye Enucleation; Eye Movements; Eye, Artificial; Female; Humans; Infant; Male; Middle Aged; *Orbital Implants; Patient Satisfaction; *Polymers; Retrospective Studies

Phenotypic and plasmid pattern analysis of Staphylococcus epidermidis in bacterial keratitis. - Nayak, Niranjan; Satpathy, Gita; Vajpayee, Rasik B; Mrudula, Srikantam (Indian journal of ophthalmology, 2007)
BACKGROUND: Staphylococcus epidermidis, a commensal of the conjunctival sac has been incriminated as the commonest etiological agent of bacterial keratitis. However, the pathogenic potential of this commensal organism is not clearly known., AIM: To determine any phenotypic, molecular markers of S. epidermidis pathogenicity in bacterial keratitis., MATERIALS AND METHODS: A total of 382 corneal ulcer isolates of S. epidermidis and 87 S. epidermidis isolates from healthy eyes (controls) were studied. Speciation, biotyping and antibiotic sensitivity testing were performed by conventional methods. Tube slime and adherence tests were carried out by recommended techniques. Plasmid analysis was conducted by a standard protocol., STATISTICAL ANALYSIS: Chi-square test was employed for calculations., RESULTS: Out of 382 corneal ulcer isolates (Pathogens) 284 (74.3%) belonged to biotypes I and II. Slime was detected in 164 (42.9%) of 382 pathogens vs. 21 (24.1%) of 87 controls (P<0.001). Sixty-five (39.6%) of 164 slime positive isolates were multidrug-resistant as compared to only 49 (22.4%) of 218 slime negative isolates (P<0.001). A significantly higher number i.e, 73.1% (120/164) of slime-producers possessed a 21 Kb plasmid in contrast to only 53.2% (116/218) of nonslime-producers (P<0.001). Presence of this plasmid had a statistical correlation of low significance with multidrug resistance (P=0.04). One hundred and seventy-two (45.0%) of 382 pathogens and 24 (27.6%) of the 87 controls were adherent to artificial surfaces (P=0.003) and the majority of the adherent organisms (99/172, 57.6%) were slime producers (P<0.001)., CONCLUSIONS: Slime was associated with multidrug resistance in corneal ulcer isolates of S. epidermidis. The 21 Kb plasmid could determine virulence as it was responsible for slime production and adherence.
Keywords: Corneal Ulcer/mi [Microbiology]; Drug Resistance, Multiple, Bacterial; Humans; *Keratitis/mi [Microbiology]; *Phenotype; *Plasmids; *Staphylococcal Infections/mi [Microbiology]; *Staphylococcus epidermidis/ge [Genetics]; *Staphylococcus epidermidis/py [Pathogenicity]; Staphylococcus epidermidis/ph [Physiology]

Drugs for some common eye disorders. - Anonymous (Treatment guidelines from the Medical Letter, 2007)
Keywords: Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Angiogenesis Inhibitors/tu [Therapeutic Use]; Anti-Bacterial Agents/tu [Therapeutic Use]; Antioxidants/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cholinergic Agonists/tu [Therapeutic Use]; *Conjunctivitis, Allergic/dt [Drug Therapy]; *Conjunctivitis, Bacterial/dt [Drug Therapy]; Cyclosporine/tu [Therapeutic Use]; Diuretics, Osmotic/tu [Therapeutic Use]; *Dry Eye Syndromes/dt [Drug Therapy]; Eye Diseases/dt [Drug Therapy]; *Glaucoma/dt [Drug Therapy]; Glucocorticoids/tu [Therapeutic Use]; Humans; Immunosuppressive Agents/tu [Therapeutic Use]; *Macular Degeneration/dt [Drug Therapy]; Macular Degeneration/th [Therapy]; Ophthalmic Solutions/ae [Adverse Effects]; *Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; Patient Selection; Photochemotherapy; Prostaglandins/tu [Therapeutic Use]; Treatment Outcome; Triamcinolone Acetonide/tu [Therapeutic Use]; Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]; Zinc/tu [Therapeutic Use]

Statins and the risk of lung, breast, and colorectal cancer in the elderly. - Setoguchi, Soko; Glynn, Robert J; Avorn, Jerry; Mogun, Helen; Schneeweiss, Sebastian (Circulation, 2007)
BACKGROUND: Although most randomized trials and meta-analyses suggest a slight or no increase in the risk of cancer in statin users, results from observational studies have been conflicting, and some have even suggested a large protective effect of statins on certain cancers. Long-term statin users tend to be healthier, less frail, and more adherent to therapy than nonusers, however. This could explain such apparent "protective" effects., METHODS AND RESULTS: We conducted the present cohort study by linking data from a large state drug benefit program with cancer registry data and Medicare healthcare utilization data. We identified all initiators of statins; initiators of glaucoma medications, another preventive drug, served as a comparison group. Outcomes included all registry-identified cases of colorectal, lung, and breast cancer. Multivariable Cox proportional models were used to adjust for confounding. Patient characteristics were similar in both groups, but statin initiators (n=24,439) were slightly younger and used some services more frequently than glaucoma drug initiators (n=7284). The mean follow-up was 2.9 years, with the longest follow-up being 8.4 years. Incidence rates of colorectal, lung, and breast cancers in both groups were very similar to rates in the general population. Adjusted hazard ratios were 0.96 (95% CI, 0.70 to 1.31) for colorectal cancer, 1.11 (95% CI, 0.77 to 1.60) for lung cancer, and 0.99 (95% CI, 0.74 to 1.33) for breast cancer., CONCLUSIONS: These data from a large population of typical older patients who began using statins indicate that it is unlikely that statins confer a clinically important decrease or increase in the risk of colorectal, lung, or breast cancer over the durations studied.
Keywords: Aged; Aged, 80 and over; Breast Neoplasms/ci [Chemically Induced]; *Breast Neoplasms/ep [Epidemiology]; Cohort Studies; Colorectal Neoplasms/ci [Chemically Induced]; *Colorectal Neoplasms/ep [Epidemiology]; Female; Humans; *Hydroxymethylglutaryl-CoA Reductase Inhibitors/ae [Adverse Effects]; Lung Neoplasms/ci [Chemically Induced]; *Lung Neoplasms/ep [Epidemiology]; Male; Registries; Risk Factors

Patients prefer once-daily glaucoma drops. - Buller, Alex J; Morgan, Laurence H; Hercules, Brian L (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2007)
BACKGROUND: The relationship between complexity of eye drop regime and compliance is not straightforward, i.e. fewer drops may not mean better compliance. We investigated the level of inconvenience different eye drop regimes incurred in comparison with a once-daily (OD) regime for patients experienced with using topical anti-glaucoma medication., METHODS: Patients indicated the level of inconvenience from drop regimes of 1, 2, 3 or 4 times daily on 10-cm visual analogue scales. The score for the OD regime was then compared with the scores for the other regimes using paired t-tests with Bonferroni correction., RESULTS: At a significance limit of p = 0.05, five of six subgroups indicated once-a-day drops were significantly more convenient than other regimes. Patients who had used the OD regime considered this difference greater than those who had not., CONCLUSIONS: This study's results offer some pragmatic guidance on choice of therapy and on counselling patients about compliance. We would suggest starting patients on OD drops in preference to alternatives to promote compliance.
Comment in (CIN)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Drug Administration Schedule; Drug Delivery Systems; *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; *Patient Satisfaction; Surveys and Questionnaires

Safety of inhaled corticosteroids: room for improvement. - Rossi, Giovanni A; Cerasoli, Franklin; Cazzola, Mario (Pulmonary pharmacology & therapeutics, 2007)
Inhaled corticosteroids (ICS) are the standard of care in asthma and are widely used in the treatment of patients with chronic obstructive pulmonary disease. High-dose regimens and long-term use of ICS in predisposed individuals may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. Side effects associated with long-term ICS use include reduction in growth velocity, cataracts, glaucoma, osteoporosis, and fractures. Fear of unwanted complications may be of concern in all patients using ICS, particularly in age- and gender-specific populations that are more prone to develop side effects or to reduce treatment adherence because of physical, behavioral, or psychological problems. In addition to concerns about ICS safety, dosing regimens that are difficult to follow may further reduce a patient's ability to comply with treatment. Ciclesonide, a new-generation ICS with unique pharmacokinetic properties, was developed to provide effective anti-inflammatory control for asthma with once-daily administration to improve patient adherence and a high safety profile to reduce the occurrence of local and systemic side effects.
Keywords: Administration, Inhalation; Adrenal Cortex Hormones/ad [Administration & Dosage]; Adrenal Cortex Hormones/ae [Adverse Effects]; *Adrenal Cortex Hormones/tu [Therapeutic Use]; Anti-Allergic Agents/ad [Administration & Dosage]; Anti-Allergic Agents/ae [Adverse Effects]; Anti-Allergic Agents/tu [Therapeutic Use]; *Asthma/dt [Drug Therapy]; Humans; Models, Biological; Pregnenediones/ad [Administration & Dosage]; Pregnenediones/ae [Adverse Effects]; Pregnenediones/tu [Therapeutic Use]; Pulmonary Disease, Chronic Obstructive/dt [Drug Therapy]; Risk Assessment/mt [Methods]

South-East Scotland trabeculectomy survey. - Cackett, P; Vallance, J; Cobb, C; Devlin, H; Simpson, A; Sanders, R (Eye (London, England), 2007)
AIM: Assessment of trabeculectomy in South-East Scotland (SESTS) with comparison to National Survey of Trabeculectomy (NST) and outcomes of consultant and trainee surgery., METHOD: A retrospective study of 304 consecutive, primary trabeculectomies, in two Scottish centres (Edinburgh and Dunfermline) with two glaucoma specialists and higher surgical trainees, was performed. The study group had primary open angle glaucoma (65.5%), pseudoexfoliation (6.9%), normal tension glaucoma (7.6%), pigment dispersion syndrome (1.6%), and other complicated glaucoma (18.4%). All patients underwent trabeculectomy by the glaucoma specialist (57.6%) and higher surgical trainee (42.4%) with close scrubbed supervision., RESULTS: Compared to the NST, the waiting time for surgery (<3 months) was significantly less in the SESTS (P<0.001). There was also significantly more use of intraoperative antimetabolites (P<0.01), bleb intervention (P<0.001), and a higher rate of early complications (P<0.025). There was no significant difference in outcome at intraocular pressure (IOP)<2/3 listing IOP (qualified and unqualified) between the SESTS and the NST. Significantly, more patients achieved an unqualified success of IOP<21 mmHg (P<0.01) and an unqualified success of IOP<16 mmHg in the SESTS than the NST (P<0.05). At 1 year post surgery, visual loss of greater than one Snellen line was more common in the NST (P<0.01) as was the use of anti-glaucoma medication (P<0.001). Trainee cases returned to theatre more frequently (P<0.025) and merited more bleb intervention (P<0.01) than consultant cases, but the long-term outcome was similar., CONCLUSION: Our study highlights significant changes in the practice and outcome of trabeculectomy compared to the national survey conducted a decade ago.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; Clinical Competence; Consultants; Drug Administration Schedule; Female; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Health Care Surveys; Humans; Intraocular Pressure; Male; Middle Aged; Retrospective Studies; Scotland; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy/mt [Methods]; Trabeculectomy/st [Standards]; Treatment Outcome; Waiting Lists

Role of early trabeculectomy in primary open-angle glaucoma in the developing world. - Anand, A; Negi, S; Khokhar, S; Kumar, H; Gupta, S K; Murthy, G V S; Sharma, T K (Eye (London, England), 2007)
BACKGROUND: The lack of prospective data comparing early surgery and medical management in primary open-angle glaucoma (POAG) in the developing world led us to conduct a small randomised controlled clinical trial to evaluate acceptance and effectiveness of early trabeculectomy in these patients., METHODS: A total of 60 patients with moderately advanced POAG were randomised into three groups (Group I-Conventional medical management, Group II-Option for early trabeculectomy, Group III-Received an educational package about their disease before an option for early trabeculectomy). The patients were followed up for a period of 6 months for visual acuity, intraocular pressures (IOP), and subjective satisfaction., RESULTS: The three study groups were statistically similar with respect to mean IOP, demographic, and socio-economic profile. 35% of the patients accepted early surgery when offered a choice between early surgery and medical management in one of the groups. 65% of patients in another group expressed willingness for an early surgery after receiving health education on glaucoma. The mean IOP in the operated eyes was lower than the medically treated eyes at 2 weeks (16.6 vs 23.0 mmHg), 6 months (18.5 vs 22.8 mmHg), and 1-year review (17.9 vs 22.3 mmHg) (P<0.001). No significant difference was seen among the groups with regard to visual acuity and subjective satisfaction., CONCLUSION: There is a reasonable acceptance of early surgery in POAG patients in the developing world and increases on educating patients about their disease. Early surgery offers better IOP control with no long-term subjective adverse effects.
Keywords: Adult; Aged; Antihypertensive Agents/tu [Therapeutic Use]; *Developing Countries; Female; Follow-Up Studies; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; India; Intraocular Pressure; Male; Middle Aged; Patient Education as Topic/mt [Methods]; Patient Satisfaction; Prospective Studies; *Trabeculectomy; Treatment Outcome; Treatment Refusal; Visual Acuity

Corneal epithelial stem cells in health and disease. - Daniels, Julie T; Harris, Anna R; Mason, Chris (Stem cell reviews, 2006)
The cornea on the front surface of the eye provides our window to the world. Maintenance of corneal transparency is dependent on the integrity and functionality of the outermost corneal epithelium which itself is maintained throughout life by a population of limbal epithelial stem cells (LESC). If this adult stem cell population is depleted by injury or disease, the transparency of the cornea and therefore vision is threatened. LESC deficiency results in corneal opacification, inflammation, vascularization, and severe discomfort. Cultured LESC therapy is one of only several examples of the successful use of an adult stem cell therapy in patients. Hence, the ready accessibility of a transparent stem cell niche and the clinical precedence for use of stem cell therapy make the cornea a unique and excellent model for the study of adult stem cells in health and disease. This review will discuss our current understanding of LESC biology, pathology, and therapeutic application.
Keywords: Animals; *Disease; *Epithelium, Corneal/cy [Cytology]; *Health; Humans; Limbus Corneae/cy [Cytology]; *Stem Cells/cy [Cytology]

Patients' and physicians' perceptions of the travoprost dosing aid: an open-label, multicenter study of adherence with prostaglandin analogue therapy for open-angle glaucoma or ocular hypertension. - Flowers, Brian; Wand, Martin; Piltz-Seymour, Jody; Berke, Stanley J; Day, Douglas; Teague, James; Smoot, Tonya M; Landry, Theresa A; Bergamini, Michael V W; Mallick, Sushanta; Travatan Dosing Aid Study Group (Clinical therapeutics, 2006)
OBJECTIVE: This study describes patients' and physicians' perceptions of issues related to dosing adherence with topical therapies for lowering intraocular pressure before and after use of the travoprost dosing aid (Travatan Dosing Aid, Alcon Research Ltd., Fort Worth, Texas)., METHODS: The study had an open-label, multicenter, single-treatment-arm design that included sequential patients with open-angle glaucoma (with or without pigment dispersion or pseudoexfoliation component) or ocular hypertension who were taking any prostaglandin analogue monotherapy. Ten participating physicians were chosen on the basis of factors such as their experience, qualifications, and previous clinical study participation. The study consisted of 2 visits: screening and week 4. Patients were asked to complete a survey about their medication adherence before study entry at the screening visit and at study exit during the week-4 visit. In addition, each physician was asked to complete an entry and exit survey on each patient as well as a survey to provide feedback on the travoprost dosing aid., RESULTS: Of the 87 enrolled patients, 6 did not complete the exit survey; therefore, 81 patients were included in the intent-to-treat analysis. Mean (SD) age at enrollment was 65.4 (11.6) years; 61.7% (50/81) of the patients were women and 60.5% (49/81) were white. Most patients (96.3% [78/81]) had open-angle glaucoma. Participating physicians perceived that problems involving dosing and adherence were reduced after patients used the dosing aid. Physicians indicated that they would recommend continued use of the travoprost dosing aid for 91.3% (73/80) of patients. All 10 participating physicians said that they would recommend the dosing aid to patients in the future. Of the 81 patients, the majority (68.8% [55/80]) indicated that they would like to continue using the travoprost dosing aid. For 67.5% (54/80) of patients, dosing adherence as recorded by the travoprost dosing aid was >70%. The dosing lever (39.7% [31/78]) and the visual alarm (29.5% [23/78]) were the 2 most favored features of the dosing aid reported by all evaluable patients. The majority of patients (58.8% [47/80]) indicated that they were "relieved" or "very relieved" that the doctor was able to monitor when they dosed their medication; few (7.5% [6/80]) were "concerned" or "very concerned" that the doctor was able to monitor their dosing., CONCLUSIONS: The travoprost dosing aid was perceived to be effective in reminding this group of patients to take their medication as prescribed. In this study, the device was well accepted by both patients and physicians.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Attitude to Health; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; *Physicians; Prostaglandins, Synthetic/ad [Administration & Dosage]; Travoprost

[Prevalence and description of treatment with intraocular pressure-lowering topical medications in continental France]. - Delcourt, C; Bron, A; Baudouin, C; Denis, P; Nordmann, J-P; Renard, J-P; Rouland, J-F; Sellem, E; Stephan, M; Levrat, F; Solesse, A (Journal francais d'ophtalmologie, 2006)
PURPOSE: The first objective of the present study was to estimate the prevalence of patients treated for glaucoma or ocular hypertension (OHT) with an IOP (intraocular pressure) -lowering topical medication. Subjects were 40 years old and living in continental France. The second objective was to describe the type of therapy, compliance, and the quality of life of the subjects treated., METHODS: This study was a telephone survey conducted in a general population on a representative sample of 5726 subjects in 2004. Subjects treated for glaucoma or OHT were defined as those declaring use of eye drops for more than 1 month and mentioning one of the 52 registered IOP-lowering topical medications and/or stating that they were taking eye drops for glaucoma or OHT. Quality of life was measured using the GlauQOL-17 questionnaire., RESULTS: 237 subjects (4.1%) corresponded to this definition. The prevalence increased with age, from 0.7% in subjects aged 40-44 years to 10.6% in those aged 80 years or more. The age-standardized prevalence was higher in the Paris area (5.3%), the Mediterranean (4.5%), and the Southwest (4.7%), and lower in rural areas (3.2%), and in subjects with less than high school education (2.9%). Beta-blockers (49.5%) and prostaglandins (37.4%) were the most frequent treatments, followed by carbonic anhydrase inhibitors (15.3%), sympathomimetics (5.7%), and myotics (1.3%). Compliance was not total in 39% of the patients (22% of those treated with once-a-day dosage)., DISCUSSION: The results of the present study are in line with French health authority data and with the results of the French "Glaucoma and intraocular high pressure, one day" study results. Moreover, the lower prevalence in regions with low medical density, low socioeconomic level, and rural areas, suggest that glaucoma or OHT might be underdiagnosed., CONCLUSION: On the basis of this first nationwide study, it can be estimated that the prevalence of subjects treated with IOP-lowering topical medications is about 1.2 million in France. The number of daily doses appears to influence compliance.
Keywords: Adult; Aged; Aged, 80 and over; Data Collection; France/ep [Epidemiology]; Humans; Intraocular Pressure; Middle Aged; *Ocular Hypertension/cl [Classification]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ep [Epidemiology]; Prevalence; Telephone

Assessment of retinal nerve fiber layer using optical coherence tomography and scanning laser polarimetry in progressive glaucomatous optic neuropathy. - Sehi, Mitra; Greenfield, David S (American journal of ophthalmology, 2006)
PURPOSE: To describe a case of progressive glaucomatous optic neuropathy using scanning laser polarimetry with fixed (SLP-FCC) and variable corneal compensation (SLP-VCC) and optical coherence tomography (OCT)., DESIGN: Observational case report., METHODS: A 21-year-old male with juvenile primary open-angle glaucoma developed progression because of noncompliance with therapy. The patient underwent dilated stereoscopic examination and photography of the optic disk, standard automated perimetry (SAP), OCT, and SLP imaging with FCC and VCC at the baseline examination and after four years of follow-up., RESULTS: Optic disk, retinal nerve fiber layer (RNFL) atrophy, and SAP progression was observed. Reduction in mean RNFL thickness (average, superior, inferior) was 18, 18, and 27 microns (OCT); 22, 40, and 17 microns (SLP-FCC); and 6, 12, and 12 microns (SLP-VCC), respectively., CONCLUSIONS: This case demonstrates that digital imaging of the peripapillary RNFL is capable of documentation and measurement of progressive glaucomatous RNFL atrophy.
Keywords: Adult; *Diagnostic Techniques, Ophthalmological; Disease Progression; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Intraocular Pressure; Lasers; Male; *Nerve Fibers/pa [Pathology]; Optic Disk/pa [Pathology]; *Optic Nerve Diseases/di [Diagnosis]; *Retinal Ganglion Cells/pa [Pathology]; *Tomography, Optical Coherence; Vision Disorders/di [Diagnosis]; Visual Field Tests; Visual Fields

[FDT versus automated standard perimetry in healthy subjects]. - Chiselita, D; Ioana, Marcu Crenguta; Danielescu, C; Mihaela, Nitu Miruna (Oftalmologia (Bucharest, Romania : 1990), 2006)
PURPOSE: To assess the frequency of visual field defects in frequency doubling technology (FDT) perimetry performed in healthy volunteers and the correlations between FDT and standard automated perimetry (SAP)., METHOD: A transversal study that included 57 healthy volunteers who were subject to visual field testing in both FDT and SAP (randomly effectuated in the same day). The studied parameters were: the frequency of visual field defects in the two techniques, the correlation of the quantitative parameters (MD, PSD) with the C/D ratio and also between techniques, the test reliability and the test duration. The subjects have been questioned about their preference for one test or another., RESULTS: The frequency of visual field defects was 47.35% in FDT and 22.8% in SAP. The MD values were significantly higher in FDT (MD FDT= -1.45+/-1.91, MD SITA= -0.77+/-1.58, p< 0.0001). Also the PSD values were higher in FDT (PSD FDT= 3.76+/-0.96, PSD SITA= 1.94+/-1.05). The correlation of quantitative parameters between the two techniques was low (r = 0.369 for MD and 0.206 for PSD). The correlation between the PSD value and the C/D ratio was extremely weak in both methods (because the subjects were healthy). The mean duration of a FDT test (4 '29") was significantly lower than that of a SITA test (5'18") - p < 0.00001. The reliability indices (fixation losses, false negative and false positive errors) were significantly better in FDT, and 3/4 of subjects declared that they preferred the FDT test., CONCLUSIONS: In normal subjects the frequency of visual field defects was greater in FDT than in SAP. There was a low correlation of quantitative parameters (MD, PSD) between SAP and FDT, and also with the C/D ratio. Better reliability indices, shorter test duration and better patient compliance are arguments for using FDT as a screening test for glaucoma.
Keywords: Adult; Algorithms; Cross-Sectional Studies; Humans; Middle Aged; Predictive Value of Tests; Romania; Sensitivity and Specificity; Vision Disorders/di [Diagnosis]; *Visual Field Tests/mt [Methods]; *Visual Fields

[Regression of lid-parallel conjunctival folds (LIPCOF) on topical treatment with Liposic Eye Gel--a pilot study]. - Hoh, H; Schwanengel, M (Klinische Monatsblatter fur Augenheilkunde, 2006)
INTRODUCTION: The aim of this observation study was to determine whether regression of lid-parallel conjunctival folds (LIPCOF) can be induced by repeated and intensive treatment with a gel-forming tear substitute., METHODS: In cooperation with the referring ophthalmologists, patients suffering from advanced dry eye condition were recruited. LIPCOF grades from 1 to 3 were included. Tear film break-up time (BUT) had to be less than 10 sec and the Schirmer-I test less than 10 mm. All patients recruited had been using watery tear substitutes. Examinations including visual acuity, slit lamp, fluorescein test, Schirmer-I test, BUT, LIPCOF were performed at baseline and after 2 weeks and 2 months. All examinations were done by the same physician at the Dietrich-Bonhoeffer Eye Hospital of Neubrandenburg. Exclusion criteria were severe eye diseases such as glaucoma, cataract, retinal detachment, history of intraocular or conjunctival surgery and disorders of the eye lids. Pretreatment with gels was not allowed. In the study, patients were treated with Liposic Eye Gel at least three times a day for a period of two months., RESULTS: LIPCOFs regressed in 10 eyes of 5 patients (1 x male, 4 x female) from a mean grade of 2.58 at baseline to 2.29 after 2 months under Liposic treatment. This improvement is statistically significant (n = 10, p = 0.04). Schirmer-I test results had improved in the same time period from a mean of 6.4 mm at baseline to a mean of 8.1 mm after 2 months (n. s., n = 10, p = 0.73). BUT improved from a mean of 12.5 sec at baseline to a mean of 17.5 sec at the 2-month follow-up (n. s., n = 10, p = 0,085). In one patient the cornea was fluorescein-positive at baseline and stayed so throughout the follow-up. Liposic Gel was used by the patients between 3 to 8 times per day. Tolerance was excellent., DISCUSSION: The study results show that the morphological signs of the dry-eye condition like LIPCOFs can be reversed by intensive treatment with Liposic Gel. The improvements in BUT and Schirmer-I test results confirm the adherence of the patients to the treatment schedule., CONCLUSION: This pilot study provides the statistical data necessary for designing a major treatment study to prove not only the reversibility of LIPCOF, but also the dependence of the possible improvement on the grade of LIPCOF stage on the age of the patient and on other criteria.
Keywords: Administration, Topical; *Conjunctiva/de [Drug Effects]; *Conjunctiva/pa [Pathology]; *Dry Eye Syndromes/di [Diagnosis]; *Dry Eye Syndromes/dt [Drug Therapy]; *Eyelids/de [Drug Effects]; *Eyelids/pa [Pathology]; Female; Gels/ad [Administration & Dosage]; Humans; Male; *Ophthalmic Solutions/ad [Administration & Dosage]; Pilot Projects; Polymers/ad [Administration & Dosage]; Treatment Outcome

[Prevalence of glaucomas in a Black Cameroonian population]. - Ellong, Augustin; Mvogo, Come Ebana; Bella-Hiag, Assumpta Lucienne; Mouney, Emilienne Nyouma; Ngosso, Angele; Litumbe, Calex Njoh (Sante (Montrouge, France), 2006)
OBJECTIVES: To determine the prevalence and the various types of glaucoma in a Black urban Cameroonian population., MATERIAL AND METHOD: A retrospective analysis of 1,343 glaucomatous patients' files (757 men and 586 women) from a total of 24,462 Cameroonian patients of all ages was carried out from January 1991 to December 2001 in the Douala General Hospital in Cameroon in Central Africa., RESULTS: The prevalence of glaucoma of all types is 5.5%. It increases with age. Of subjects with glaucoma, 79.6% had not been previously diagnosed. The mean patient's age is 53.3 (+/-17.1) years. The mean intraocular pressure is 29.6 (+/-12.6) mmHg. The mean vertical cup-disc ratio is 0.7 (+/-0.2). The prevalence of primary glaucoma of any type is 4.5%. The overall prevalence of primary open-angle glaucoma, primary angle-closure glaucoma and congenital glaucoma was 4.3%, 0.03% and 0.07%, respectively. The normal-tension glaucoma is rare in this study (6.3% of primary open-angle glaucoma). The most common form of primary angle closure glaucoma is chronic angle closure glaucoma (61,1%) and is usually undiagnosed due to a lack of gonioscopic evaluation. The prevalence of secondary glaucoma of any type is 1%. The most common forms of secondary angle closure glaucoma were neovascular glaucoma (47.4% of cases with the prevalence of 0.5%) and post-traumatic glaucoma (23.1% of cases with the prevalence of 0.2%). Prevalence of bilateral and monocular blindness due to glaucoma is 8% (108/1,343) and 32.9% (441/1,343) respectively of glaucoma patients., CONCLUSION: This study confirms the high prevalence of glaucoma in a black African population. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in our region. The very high rate of blindness among the glaucoma patients in Cameroon is due to a lack of care. The patients are young, the disease is advanced, and compliance and follow-up are poor. Glaucoma surgery therefore offers a favourable option from an economical standpoint. Glaucoma is a devastating disease and constitutes a significant public health problem.
Keywords: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Blindness/ep [Epidemiology]; Cameroon/ep [Epidemiology]; Child; Child, Preschool; Female; Glaucoma/cl [Classification]; Glaucoma/cn [Congenital]; *Glaucoma/ep [Epidemiology]; Glaucoma, Angle-Closure/ep [Epidemiology]; Glaucoma, Neovascular/ep [Epidemiology]; Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Infant; Intraocular Pressure; Male; Middle Aged; Prevalence; Retrospective Studies; Urban Health/sn [Statistics & Numerical Data]

Migration of glaucoma drainage device extender into anterior chamber after trauma. - Sheets, Clinton W; Ramjattan, Trudy K; Smith, Mary F; Doyle, James W (Journal of glaucoma, 2006)
PURPOSE: Glaucoma drainage devices, on rare occasions, need repositioned and the intraocular portion of the implant tube is found to be "too short" to do so. Previously, a technique was described for "extending" the tube with angiocatheter material (rather than replacing the entire apparatus), and had been performed successfully without complication for 7 years. This case describes the first known complication: trauma causing anterior chamber migration of the tube extension requiring retrieval and reconstruction of the tube extension apparatus., PATIENT AND METHODS: One eye of 1 patient (age 8) with a prior glaucoma drainage device and tube extension with angiocatheter material with elevated intraocular pressure after direct trauma to the eye from a pencil. Office examination revealed inferior corneal edema and no tube segment visible in the anterior chamber on limited examination due to age-related compliance. Gonioscopy under anesthesia revealed the tube extender in the inferior anterior chamber. The tube extender was retrieved from the anterior chamber. The glaucoma drainage device was surgically exposed and the tube extension was reconstructed, including securing the tube extension with a suture placed through the lumens of both the angiocatheter extender and the tube extension., RESULTS: The reconstructed tube extension maintained good draining function with the secured extension and no further migration of the tube extension into the anterior chamber was seen., CONCLUSIONS: Tube extension using angiocatheter material continues to be a viable, cost-effective option in difficult cases. Placing a securing suture in patients prone to eye trauma can be considered.
Keywords: *Anterior Chamber/pa [Pathology]; Child; *Eye Injuries/co [Complications]; *Foreign-Body Migration/et [Etiology]; Foreign-Body Migration/su [Surgery]; Glaucoma/su [Surgery]; *Glaucoma Drainage Implants; Humans; Intraocular Pressure; Male; Reoperation; Suture Techniques; *Wounds, Nonpenetrating/co [Complications]

Considerations in developing model-based economic evaluations of glaucoma treatment. - Althin, Rikard; Grima, Daniel T; Dhawan, Ravinder; Bernard, Lisa M (Journal of glaucoma, 2006)
PURPOSE: To facilitate future glaucoma model development and to provide guidance for decision-makers evaluating them, we provide an overview of an innovative glaucoma model and highlight important modeling considerations., CONSIDERATIONS: The considerations that were addressed include: disease outcome that is both relevant and meaningful to current clinical practice; diversity in treatment options and practices; incorporation of therapy discontinuation; and consideration of the variability in patient response to treatment., MODEL SCOPE: A state-transition, Monte Carlo simulation model was developed to simulate the management and treatment of patients with glaucoma and/or ocular hypertension. The model examines strategies involving sequential use of up to 6 pharmacologic interventions. Transitions are based on the monthly probability that a patient is no longer "successfully maintained" on therapy, which can be a consequence of lack of intraocular pressure control, adverse events, lack of compliance, or lack of persistence. Outputs of the model include months on each treatment, frequency of therapy switches, days of intraocular pressure control, frequency of ophthalmologist visits, frequency of surgery, and glaucoma-related costs. The model allows the user to specify country-specific treatment strategies, survival on therapy, surgical rates, practice patterns, and costs., CONCEPT APPLICATION: The model presented offers insights into accommodating patient and clinician variability through the use of persistence distributions. It will facilitate future glaucoma model development and provide insight for decision-makers who must evaluate model-based analyses of the economic value of glaucoma interventions.
Keywords: Antihypertensive Agents/ec [Economics]; Antihypertensive Agents/tu [Therapeutic Use]; Cost-Benefit Analysis; Delivery of Health Care/ec [Economics]; Drug Costs; Filtering Surgery/ec [Economics]; *Glaucoma/ec [Economics]; *Glaucoma/th [Therapy]; Health Care Costs; Health Services Research/ec [Economics]; Humans; Intraocular Pressure; *Models, Economic; Monte Carlo Method; Ocular Hypertension/ec [Economics]; Ocular Hypertension/th [Therapy]; Treatment Outcome

Relationship between central corneal thickness and changes of optic nerve head topography and blood flow after intraocular pressure reduction in open-angle glaucoma and ocular hypertension. - Lesk, Mark R; Hafez, Ali S; Descovich, Denise (Archives of ophthalmology (Chicago, Ill. : 1960), 2006)
OBJECTIVES: To investigate changes in optic nerve head topography and blood flow after therapeutic intraocular pressure reduction and to correlate them with central corneal thickness., METHODS: Sixteen patients with open-angle glaucoma and 16 patients with ocular hypertension underwent Heidelberg retina tomography and scanning laser Doppler flowmetry in 1 eye before and at least 2 months after a mean 35% sustained therapeutic reduction in intraocular pressure. Patients were assigned to a thin or thick group based on their median central corneal thickness., RESULTS: Compared with 16 patients with thick corneas (mean +/- SD central corneal thickness, 587 +/- 31 microm), the 16 patients with thin corneas (518 +/- 32 microm) had greater reductions in mean (36 +/- 32 vs 4 +/- 36 microm, P = .003) and in maximum cup depth (73 +/- 107 vs 4 +/- 89 microm, P = .02). These changes were not statistically significantly different between the patients with open-angle glaucoma and those with ocular hypertension. Smaller mean +/- SD improvements in neuroretinal rim blood flow were seen in patients with thinner corneas compared with those with thicker corneas (35 +/- 80 vs 110 +/- 111 arbitrary units, P = .04)., CONCLUSION: Patients with open-angle glaucoma and ocular hypertension with thinner corneas show significantly greater shallowing of the cup, a surrogate marker for lamina cribrosa displacement (compliance), and smaller improvements of neuroretinal rim blood flow after intraocular pressure reduction.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Blood Flow Velocity/ph [Physiology]; Body Weights and Measures; Cornea/dg [Diagnostic Imaging]; *Cornea/pa [Pathology]; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/th [Therapy]; Gonioscopy; Humans; *Intraocular Pressure/ph [Physiology]; Laser-Doppler Flowmetry; Middle Aged; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/th [Therapy]; *Optic Disk/bs [Blood Supply]; *Optic Disk/pa [Pathology]; Regional Blood Flow/ph [Physiology]; Tomography; Tonometry, Ocular; Trabeculectomy; Ultrasonography

Biocide uptake in contact lenses and loss of fungicidal activity during storage of contact lenses. - Rosenthal, Ruth A; Dassanayake, Nissanke L; Schlitzer, Ronald L; Schlech, Barry A; Meadows, David L; Stone, Ralph P (Eye & contact lens, 2006)
PURPOSE: With recent outbreaks of Fusarium keratitis related to contact lens wear, studies were conducted to determine the biocide uptake during lens storage, and the resulting effect on antifungal activity of related products., METHODS: ACUVUE 2 (etafilcon A) soft, hydrophilic contact lenses (group IV) were soaked from 1 hour to 7 days in OPTI-FREE Express and OPTI-FREE RepleniSH multipurpose disinfecting solutions with POLYQUAD (polyquaternium-1) and ALDOX (myristamidopropyl dimethylamine) biocides and multipurpose solutions, Bausch & Lomb ReNu with MoistureLoc (Alexidine), ReNu MultiPlus (polyhexamethylene biguanide [PHMB]), and AMO Complete MoisturePLUS (PHMB). Storage solutions were tested to evaluate the effect of preservative uptake on the residual biocide activity against Fusarium solani., RESULTS: Approximately 30% to 60% of the PHMB and Alexidine were depleted by 6 hours, with comparable loss of antimicrobial activity. Decreasing activity was noted with corresponding decreases in active concentration throughout the course of the evaluation. The POLYQUAD systems retained nearly 100% of the biocide and fungicidal activity and maintained their concentration in the solution., CONCLUSIONS: OPTI-FREE Express and OPTI-FREE RepleniSH multipurpose disinfecting solutions maintained fungicidal efficacy after storage of lenses. The Alexidine- and PHMB-based multipurpose solutions tested showed significant uptake of preservative into group IV lenses, resulting in a decrease in the residual activity of the storage solution. The POLYQUAD systems showed a low uptake of biocide and maintained fungicidal efficacy against F. solani.
Keywords: *Antifungal Agents/me [Metabolism]; Antifungal Agents/pd [Pharmacology]; *Biguanides/me [Metabolism]; Biguanides/pd [Pharmacology]; *Contact Lens Solutions/me [Metabolism]; Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses, Hydrophilic; *Disinfectants/me [Metabolism]; Disinfectants/pd [Pharmacology]; Equipment Reuse; Fusarium/de [Drug Effects]; *Fusarium/gd [Growth & Development]; Patient Compliance

Report on testing from an investigation of fusarium keratitis in contact lens wearers. - Levy, Brian; Heiler, David; Norton, Sue (Eye & contact lens, 2006)
PURPOSE: Recent reports of disproportionate outbreaks of microbial keratitis caused by Fusarium solani have led to the removal of the Bausch & Lomb multipurpose lens care solution ReNu With MoistureLoc ("MoistureLoc") from the global market. Previous studies have shown an increased risk of contact lens-related corneal infection in connection with overnight wear, noncompliant lens wearing and lens care behaviors, specific treatment regimens, and other patient-related and non-patient-related factors. The purpose of the laboratory evaluations reported in this article were to observe the effects of levels of simulated lens care noncompliance on the antimicrobial efficacy of multipurpose solutions following recent reports of F. solani keratitis., METHODS: Two multipurpose contact lens care solutions, MoistureLoc and ReNu MultiPlus multipurpose solution ("ReNu MultiPlus"), were tested under conditions that attempted to simulate the possible effect of the noncompliant behaviors reported to Bausch & Lomb as part of the investigation into cases of Fusarium keratitis. Testing conditions included simulated multiple reuse of solutions and evaporation of solutions., RESULTS: The biocidal efficacy of MoistureLoc and other tested solutions was reduced under conditions that simulated the possible impact of solution reuse. Further investigation of MoistureLoc and ReNu MultiPlus suggests that although efficacy with ReNu MultiPlus was maintained across a variety of noncompliant conditions, the MoistureLoc formula could be rendered less effective under certain conditions., CONCLUSIONS: Under conditions simulating the possible impact of noncompliance, the MoistureLoc solution showed reduced biocidal efficacy. In contrast, ReNu MultiPlus retained a higher level of biocidal activity under the same conditions.
Erratum in (EIN), Comment in (CIN), Comment in (CIN)
Keywords: *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses/mi [Microbiology]; Disinfection/mt [Methods]; *Fusarium/de [Drug Effects]; Fusarium/gd [Growth & Development]; Humans; Keratitis/ep [Epidemiology]; *Keratitis/mi [Microbiology]; Mycoses/ep [Epidemiology]; *Mycoses/mi [Microbiology]; *Treatment Refusal

Psychiatric manifestations and personality traits associated with compliance with glaucoma treatment. - Pappa, Chrisavgi; Hyphantis, Thomas; Pappa, Sofia; Aspiotis, Miltiadis; Stefaniotou, Maria; Kitsos, Georgios; Psilas, Konstantinos; Mavreas, Venetsanos (Journal of psychosomatic research, 2006)
OBJECTIVE: The aim of this study was to assess the impact of psychological distress and personality traits on self-rated compliance with glaucoma treatment., METHODS: One hundred patients with primary open-angle glaucoma participated in the study. General Health Questionnaire, Symptom Distress Checklist, Center for Epidemiological Studies Depression Scale, Defense Style Questionnaire, and Hostility and Direction of Hostility Questionnaire were used., RESULTS: Forty-two percent of patients with glaucoma classified as "noncompliers," those who omitted more than two doses per week. Noncompliers presented more severe symptoms of glaucoma. Depression was found to be associated with poor compliance, whereas adoption of immature defensive style further increased the risk for noncompliance with glaucoma treatment., CONCLUSIONS: Depression is associated with self-reported noncompliance with glaucoma treatment, whereas certain personality traits are involved in the increased risk for noncompliance. Further assessment of the depressive feelings by an ophthalmologist and treatment of depression as well as proper psychotherapeutic approaches for maladaptive personality features could be an essential strategy to diminish compliance problems.
Keywords: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Character; Cross-Sectional Studies; Defense Mechanisms; Depression/di [Diagnosis]; Depression/px [Psychology]; Exfoliation Syndrome/di [Diagnosis]; *Exfoliation Syndrome/dt [Drug Therapy]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/px [Psychology]; Health Knowledge, Attitudes, Practice; Hostility; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Personality Inventory; Sick Role; *Treatment Refusal/px [Psychology]

[Practical measures. Contact lenses after glaucoma surgery]. - Malet, F (Journal francais d'ophtalmologie, 2006)
New soft therapeutic contact lenses after glaucoma surgery provide good results, both in terms of tolerance and efficacy (60% pressure increase in a personal series of ten patients with the Trabeculens contact lens). Indicated for moderate immediate postoperative leakage, their use remains transitory and they should be removed as soon as intraocular pressure is (rapidly) corrected. After glaucoma surgery, wearing contact lenses can be discussed if there are no contraindications and 6-12 months after the intervention in a compliant patient. Evaluation of the risk-benefit ratio is important. Gas-permeable, small-diatmeter hard contact lenses, bi- or trifocal spherical or posterior toric - the most stable - should be favored. Soft contact lenses can also be used, but because of their presence on the conjunctiva, notably in the filtration zone, they are less frequently recommended. Contact lens wear should in all cases be strictly limited to the daytime.
Keywords: *Contact Lenses, Hydrophilic; Glaucoma/su [Surgery]; *Glaucoma/th [Therapy]; Humans

[Practical measures. Advantages of fixed combination treatments]. - Denis, P (Journal francais d'ophtalmologie, 2006)
Even if glaucoma treatment often begins with monotherapy, combined treatments are in fact frequent. However, they are associated with poorer compliance, which may lead to lower efficacy, notably if the delay between two eyedrops is too short. The main advantages of fixed combinations are better therapeutic compliance and a lesser effect of dilution of the first eyedrops by the second. Nevertheless, it is impossible to change the dosing interval of one or the other of the components and adverse side effects cannot be controlled. The fixed combinations available today or in the near future are based for the most part on the combination of timolol and a prostaglandin. Their efficacy is comparable to the efficacy of each of the components or of nonfixed combinations, but it is not strictly equivalent. This difference (on the order of 1 mmHg) could be explained by unsuitable frequency or poor timing of the instillation.
Keywords: Drug Therapy, Combination; *Glaucoma/dt [Drug Therapy]; Humans

Relative risk of progressive glaucomatous visual field loss in patients enrolled and not enrolled in a prospective longitudinal study. - Henson, David B; Shambhu, Siddesh (Archives of ophthalmology (Chicago, Ill. : 1960), 2006)
OBJECTIVE: To establish the relative risk of progressive visual field loss in a sample of glaucomatous eyes enrolled in a prospective longitudinal study vs a matched sample of eyes not enrolled in a study., METHODS: The first visual field records of 66 glaucomatous eyes enrolled in a prospective longitudinal study (mean follow-up time, 3.4 years; mean number of visual field tests, 8.3) were matched to 66 eyes from patients not enrolled in a study (mean follow-up time, 3 years; mean number of visual field tests, 3.7). Eyes were matched on the basis of (1) time of enrollment, (2) length of follow-up, and (3) the extent and spatial pattern of visual field loss. Linear regression of global visual field indexes was used to measure change and the relative risk of progression was calculated for a series of progression criteria sample., RESULTS: The relative risk of progressive visual field loss was on average 368% (range, 209%-673%) higher in the eyes not enrolled in a prospective longitudinal study., CONCLUSION: Selection bias may reduce the risk of progressive visual field loss in patients enrolled in longitudinal studies.
Keywords: Disease Progression; *Glaucoma/pp [Physiopathology]; Humans; Longitudinal Studies; Patient Participation; Retrospective Studies; Risk; *Vision Disorders/pp [Physiopathology]; *Visual Fields

Effect of Proview self-tonometry on pharmaceutical compliance. - Lievens, Christopher W; Gunvant, Pinakin; Newman, James; Gerstner, Michael; Simpson, Chad (Clinical & experimental optometry, 2006)
AIM: To evaluate changes in patient compliance with medical treatment while using the Proview Eye Pressure Monitor., METHODS: A crossover study design was used to compare the compliance of patients with established use of topical medication to lower intraocular pressure in the treatment of primary open-angle glaucoma. Thirty-two patients currently managed with latanoprost 0.005%, brimonidine 0.15%, travoprost 0.004% or bimatoprost 0.03% as monotherapy or in combination were randomly assigned to two study groups. Group 1 was instructed in the use of Proview Eye Pressure Monitor three times daily for 30 days as an adjunct to the glaucoma regimen. Group 2 was observed with no change in the patients' treatment regimen during this phase of study. A crossover occurred at 30 days. Compliance was monitored by assigning new bottles of topical medication during each phase of study. Bottles were weighed with a Mettler balance (Mettler Toledo Co.) at the initiation and completion of each phase. The changes in bottle-weight determined the amount of medication consumed by each patient for each phase of the study. The weights were analysed to estimate changes in compliance., RESULTS: A paired samples Student t-test compared the consumed bottle weights with and without Proview Eye Pressure Monitor usage. No statistical significance or trend was identifiable (p = 0.98). Use of the Proview Eye Pressure Monitor did not significantly change compliance with adjunct eye drop medication., CONCLUSION: The use of the Proview Eye Pressure Monitor use did not improve but appeared to hinder compliance with glaucoma treatment in this study.
Keywords: Adult; Aged; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Over Studies; Follow-Up Studies; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Middle Aged; Ophthalmic Solutions; *Patient Compliance; Prognosis; Prospective Studies; *Tonometry, Ocular/mt [Methods]

Supraorbital nerve block in trabeculectomy surgery: an observational case series. - Tay, Eugene; Gupta, Mohit; Franks, Wendy (Clinical & experimental ophthalmology, 2006)
Thirteen patients completed a visual analogue pain scale after trabeculectomy with topical anaesthesia and a supraorbital nerve block with 2 mL of lignocaine 2%. Ease of surgery was graded on a scale of 0-5. Inadvertent eye movements and episodes of orbicularis spasm were recorded. Statistical analysis was performed using STATA software. Median pain score (range) during delivery of anaesthesia was 2 (1-5), during surgery was 0 (0-4) and postoperatively was 0 (0-3). Pain scores after surgery were significantly lower than during delivery of anaesthesia (Wilcoxon signed rank test, P = 0.0289). Three subjects had inadvertent eye movements with ease of surgery recorded as 1 of 5 in 12 cases and 2 of 5 in one case. The novel application of this anaesthetic technique offers adequate analgesia in trabeculectomy surgery. However, a larger scale comparative trial is needed to further evaluate the value of this technique.
Keywords: Aged; Aged, 80 and over; Anesthesia, Local/mt [Methods]; *Anesthetics, Local/ad [Administration & Dosage]; Eye Movements; Female; Glaucoma/su [Surgery]; Humans; *Lidocaine/ad [Administration & Dosage]; Male; Middle Aged; *Nerve Block; *Orbit/ir [Innervation]; Pain Measurement; Patient Satisfaction; *Trabeculectomy/mt [Methods]

Standardized exchange of clinical documents--towards a shared care paradigm in glaucoma treatment. - Gerdsen, F; Muller, S; Jablonski, S; Prokosch, H-U (Methods of information in medicine, 2006)
OBJECTIVES: The exchange of medical data from research and clinical routine across institutional borders is essential to establish an integrated healthcare platform. In this project we want to realize the standardized exchange of medical data between different healthcare institutions to implement an integrated and interoperable information system supporting clinical treatment and research of glaucoma., METHODS: The central point of our concept is a standardized communication model based on the Clinical Document Architecture (CDA). Further, a communication concept between different health care institutions applying the developed document model has been defined., RESULTS: With our project we have been able to prove that standardized communication between an Electronic Medical Record (EMR), an Electronic Health Record (EHR) and the Erlanger Glaucoma Register (EGR) based on the established conceptual models, which rely on CDA rel.1 level 1 and SCIPHOX, could be implemented. The HL7-tool-based deduction of a suitable CDA rel.2 compliant schema showed significant differences when compared with the manually created schema. Finally fundamental requirements, which have to be implemented for an integrated health care platform, have been identified., CONCLUSIONS: An interoperable information system can enhance both clinical treatment and research projects. By automatically transferring screening findings from a glaucoma research project to the electronic medical record of our ophthalmology clinic, clinicians could benefit from the availability of a longitudinal patient record. The CDA as a standard for exchanging clinical documents has demonstrated its potential to enhance interoperability within a future shared care paradigm.
Keywords: *Computer Communication Networks/st [Standards]; Database Management Systems; *Delivery of Health Care, Integrated/og [Organization & Administration]; Germany; *Glaucoma/th [Therapy]; Humans; *Medical Record Linkage; *Medical Records Systems, Computerized/st [Standards]; *Ophthalmology/og [Organization & Administration]; Programming Languages; Research; *Semantics; *Systems Integration

Age-related changes in the thickness of the human lamina cribrosa. - Kotecha, A; Izadi, S; Jeffery, G (The British journal of ophthalmology, 2006)
OBJECTIVE: To measure the human lamina cribrosa thickness (LCT) in vitro in fully hydrated specimens and to determine whether there is any association between thickness and age or sex., METHODS: 45 fixed human optic nerves, age range 9-90 years, were dissected from the globe and frozen sectioned. The study was divided into two parts: the first investigated the overall change in LCT and cribrosal beam thickness (CBT) with age, and the second divided eyes into two specific age groups (38-49 and 78-87 years) and assessed differences with respect to age and sex., RESULTS: LCT ranged from 345.4 to 555.9 microm between the samples. A positive relationship was found between LCT and age (LCT = 2.41xage+365.5, 95% confidence interval (CI) for slope 1.31 to 3.52; r(2) = 0.30, p<0.001). A regional difference in CBT was observed, with beams being thickest at the posterior cribrosa (mean 14.8 (standard deviation (SD) 2.2) microm) and thinnest at the anterior cribrosa (9.8 (SD 2.4) microm). CBT increased with increasing age. Differences related to sex were also found, with females having relatively thinner LCT than males, irrespective of age, but this was not statistically significant., CONCLUSIONS: This study shows an increase in human LCT with increasing age. This changing structural property of the lamina cribrosa may have implications for its functioning with respect to compliance and reversibility, and has particular relevance to glaucoma, where increasing age has been identified as a strong risk factor for the development of the disease.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Aging/pa [Pathology]; Child; Cross-Sectional Studies; Humans; Middle Aged; *Optic Disk/ah [Anatomy & Histology]; Sex Characteristics

Prostanoids in the therapy of glaucoma. - Ishida, Naruhiro; Odani-Kawabata, Noriko; Shimazaki, Atsushi; Hara, Hideaki (Cardiovascular drug reviews, 2006)
Elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma, which is a progressive optic neuropathy. Lowering IOP is currently the only therapeutic approach to the therapy of glaucoma. Since the use of pilocarpine eye drops for glaucoma treatment was reported in the late 1870s, academic researchers and pharmaceutical companies attempted to discover new drugs with more potent, prolonged, and safer IOP-reducing effects. These persistent efforts finally paid off, and prostanoids with FP-receptor agonist activity were found to be very potent IOP-lowering agents. To date, three prostanoids (latanoprost, travoprost and bimatoprost) have been launched in many countries, and now a new FP-receptor agonist, tafluprost, is entering clinical development. All of these prostanoids are superior to the beta-adrenoceptor antagonists in their IOP-lowering efficacy, and no severe side effects have been reported in their long-term clinical use. In addition, tafluprost may be expected to improve ocular blood flow. Hence, prostanoids currently occupy center stage among glaucoma medications. It cannot be denied that in terms of efficacy, safety, patient compliance, and medical economy prostanoids are currently the first-line medicines among ocular antihypertensive drugs.
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Prostaglandins/pd [Pharmacology]; Prostaglandins/tu [Therapeutic Use]; *Prostaglandins; Randomized Controlled Trials as Topic; Receptors, Prostaglandin/ag [Agonists]

Travoprost/timolol. - Hoy, Sheridan M; Keam, Susan J; Keating, Gillian M (Drugs & aging, 2006)
Travoprost 0.004%/timolol 0.5% fixed combination (travoprost/timolol) is a once-daily eyedrops solution comprising the prostaglandin F(2alpha) analogue travoprost and the beta-adrenoceptor antagonist timolol. It is indicated for the treatment of patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to topical beta-adrenoceptor antagonists or prostaglandin analogues. Once-daily travoprost/timolol had generally similar efficacy to travoprost plus timolol and was more effective than travoprost or timolol monotherapy in reducing intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension in randomised, well designed studies. Both travoprost/timolol and latanoprost plus timolol maintained IOP control, and travoprost/timolol was shown to be noninferior to latanoprost/timolol in randomised, well designed studies. Travoprost/timolol was generally well tolerated, with a tolerability profile similar to those of travoprost plus timolol, travoprost or timolol monotherapy and latanoprost plus timolol. The majority of adverse events, such as ocular hyperaemia, were mild and resolved with or without treatment.
Keywords: Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/pk [Pharmacokinetics]; Cloprostenol/pd [Pharmacology]; Cloprostenol/tu [Therapeutic Use]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Humans; Patient Compliance; Timolol/ae [Adverse Effects]; Timolol/pk [Pharmacokinetics]; Timolol/pd [Pharmacology]; *Timolol/tu [Therapeutic Use]; Travoprost

[Glaucoma in the aged--barriers to understanding and compliance]. - Dietlein, T S (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2006)
Glaucoma is a relatively common ocular disease among adults aged >65 years. However, knowledge about glaucoma, the physical capacity to perform self-application of antiglaucomatous drops, and general compliance may be massively restricted in the older population owing to significantly increasing comorbidity and other factors (e.g. their social and financial situation). Additional efforts by ophthalmologists, the pharmaceutical industry and health politics are required to improve knowledge and compliance among elderly glaucoma patients.
Keywords: Aged; Aged, 80 and over; Germany; *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance; *Quality of Life; *Self Medication/mt [Methods]

The course of glaucoma during pregnancy: a retrospective case series. - Brauner, Stacey C; Chen, Teresa C; Hutchinson, B Thomas; Chang, Michael A; Pasquale, Louis R; Grosskreutz, Cynthia L (Archives of ophthalmology (Chicago, Ill. : 1960), 2006)
OBJECTIVE: To better understand the course of glaucoma during pregnancy in women with preexisting disease., METHODS: Retrospective case series of 28 eyes of 15 women with glaucoma followed up during pregnancy. Data were analyzed for age, race/ethnicity, medications, glaucoma type, intraocular pressure (IOP), and visual fields before, during, and after pregnancy., RESULTS: In 16 (57.1%) of 28 eyes, IOP was stable during pregnancy, with no progression of visual field loss. In 5 eyes (17.9%), visual field loss progressed during pregnancy, while IOP remained stable or increased. In 5 eyes (17.9%), IOP increased during pregnancy, but there was no progression of visual field loss. In 2 eyes (7.1%), data were inconclusive because of medication noncompliance and preexisting severe visual field loss. Glaucoma medications were used by 13 of 15 patients to control glaucoma during pregnancy. The classes of medications used most frequently were beta-blockers, alpha2-adrenergic agents, cholinergic agents, and topical carbonic anhydrase inhibitors., CONCLUSIONS: The course of glaucoma during pregnancy is variable, and women must be monitored closely during pregnancy. Medications may be necessary to control IOP and to prevent vision loss during pregnancy.
Keywords: Adult; Disease Progression; Female; *Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/ph [Physiology]; Pregnancy; *Pregnancy Complications/pp [Physiopathology]; Retrospective Studies; Visual Fields/ph [Physiology]

Prostaglandin analogues for the treatment of glaucoma and ocular hypertension: a systematic review of economic evidence. - Orme, Michelle; Boler, Annabel (PharmacoEconomics, 2006)
We conducted a systematic review of economic studies of prostaglandin analogues for the treatment of glaucoma to assess the scope of current cost-effectiveness evidence and its relevance to decision-makers. The literature search retrieved 102 studies published before July 2005; after additional hand searching of conference proceedings, 13 full-text articles and 13 abstracts met the inclusion criteria. The reviewers extracted the key characteristics of each of the economic evaluations, and all studies received a grade in five categories to summarise the quality of the study: methodology, transparency, sensitivity, relevance and overall score. The current economic literature is predominantly focused on identifying the short-term direct cost of glaucoma treatment, particularly the precise quantification of glaucoma drug costs. Using the European and US treatment guidelines as a benchmark, it is evident that the current body of literature does not satisfy the needs of decision-makers, although certain studies provide some valuable information, which is a step towards reaching this goal. The main methodological issue in the economic models is an absence of a clinically relevant long-term effectiveness measure, or where this measure is produced, there is a lack of transparency and validation of the methods used. More attention needs to be given to modelling the consequences of treatment, and those consequences should include patient compliance, control of intraocular pressure and progression of visual field deficit, since these drive both the costs and the overall outcomes. We recognise that constructing the 'ideal' clinical outcome measure represents a major challenge to researchers. As such, we have outlined a modelling framework that could be used to produce the required level of economic evidence, and ongoing clinical research (such as the Early Manifest Glaucoma Trial) could provide the validated link between intraocular pressure and disease progression, which forms an essential part of such models.
Keywords: Cost-Benefit Analysis; *Glaucoma/dt [Drug Therapy]; Health Care Costs; Humans; Intraocular Pressure/de [Drug Effects]; *Ocular Hypertension/dt [Drug Therapy]; Prostaglandins, Synthetic/ec [Economics]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Quality of Life

[Antiglaucoma drugs--content of preservatives and the patient's compliance]. - Vyborny, P; Sejckova, L (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2006)
The presence of preservatives in eye drops, may have, depending on the concentration, cytotoxic influence on the corneal and conjunctival cells, and may cause the patients' subjective inconveniences. The authors compare the benzalconium chloride (BAC) concentrations in individual drug used for glaucoma treating. The daily dose of BAC was calculated according to the drop's size and BAC concentration. The daily dose of BAC differs depending on the selected therapy markedly--doses in the range from 0 to 10 micrograms were found. The BAC concentration is one of important factors affecting the patient's compliance in the treatment of the primary open angle glaucoma.
Keywords: *Benzalkonium Compounds/ae [Adverse Effects]; Benzalkonium Compounds/an [Analysis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ch [Chemistry]; *Patient Compliance; *Preservatives, Pharmaceutical/ae [Adverse Effects]; Preservatives, Pharmaceutical/an [Analysis]

[Efficacy of first- or second-line latanoprost on intraocular pressure and ocular symptoms in patients with open-angle glaucoma or ocular hypertension]. - Baudouin, C; Rouland, J-F; Nordmann, J-P; Bron, A; Pelen, F (Journal francais d'ophtalmologie, 2006)
OBJECTIVES: The aim of this study was to assess the changes in intraocular pressure (IOP) and ophthalmic symptoms with the Glaucoma Symptom Scale in patients suffering from open-angle glaucoma (OAG) or ocular hypertension (OHT) after 3 months of treatment with latanoprost., MATERIALS AND METHODS: This multicentric open study was carried out in adult patients suffering from OAG or simple OHT (naive or previously treated with monotherapy) and needing a change or initiation of anti-glaucomatous treatment. One drop of latanoprost 0.005% was instilled every evening for 12 weeks in each affected eye. Efficacy was assessed by the variation in IOP and ophthalmic symptomatology at the end of treatment. Prognosis factors associated with a relative IOP reduction of at least 30% were sought (using a logistic regression model)., RESULTS: A total of 920 patients suffering from OAG (54%) or OHT (44%), either previously treated (69%) or naive (31%), were included. The male:female ratio was 0.78 and the mean age was 63+/-13 years. At inclusion, the mean IOP was 22.1+/-3.8 mmHg. After treatment, IOP was significantly decreased by 5.1+/-4 mmHg, corresponding to a 22% reduction. IOP reduction was 7.1+/-4 mmHg, corresponding to 29% in naive patients and 4.2+/-4 mmHg, corresponding to 19% in previously treated patients. A relative IOP reduction of at least 30% was reached by 47% of naive patients and 21% of previously treated patients. In previously treated patients, a relative IOP reduction of at least 30% had a greater chance of being reached in men with previous ophthalmic history and high IOP at inclusion (above 21 mmHg). IOP reduction was similar in patients with OAG and OHT. A significant improvement in ophthalmic symptoms was observed after treatment in previously treated patients. A total of 7% of the patients presented an adverse event affecting the visual system: eye irritation (2%), eye pain (2%), or eye hyperemia (1%). Compliance was good for 94% of the patients., CONCLUSION: Latanoprost given as first or second-line treatment at the recommended dose effectively decreases IOP in patients with OAG or OHT. This treatment also improves visual and nonvisual symptoms in previously treated patients and presents a good safety profile.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Time Factors

[Relationship between compliance and background factors of glaucoma patients]. - Ikushima, Toru; Mori, Kazuhiko; Ishibashi, Takeshi; Ikeda, Yoko; Naruse, Shigeta; Hozono, Yukako; Kinoshita, Shigeru (Nippon Ganka Gakkai zasshi, 2006)
PURPOSE: To obtain useful information for the improvement of patient compliance in the medical treatment of glaucoma., SUBJECTS AND METHODS: An unsigned attitude survey on glaucoma and eye drops was conducted with 431 glaucoma patients. Correlation between compliance and individual(objective and subjective) factors was investigated. Objective factors were age, sex, number of eye drop products, duration of disease, and degree of visual field defects. Subjective factors were "stinging sensation with application of eye drops" and "worry about blindness"., RESULTS: Thirty-eight percent of the glaucoma patients were compliant, instilling eye drops at the right time and with good technique. For the factor "duration of disease", patients who had glaucoma for 6-10 years had the best compliance. Compliance became poorer with an increasing number of eye drop products. In the subjective factors, less pain and worry led patients to better compliance., CONCLUSION: To improve compliance with medical treatment, we should categorize patients based on objective factors, eliminating their pain and worry, and instructing them not only in the frequency of instillation but also in the technique of administration.
Keywords: Attitude; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance; Patients/px [Psychology]

Health literacy and adherence to glaucoma therapy. - Muir, Kelly W; Santiago-Turla, Cecile; Stinnett, Sandra S; Herndon, Leon W; Allingham, R Rand; Challa, Pratap; Lee, Paul P (American journal of ophthalmology, 2006)
PURPOSE: To describe the health literacy of subjects with open angle glaucoma and to investigate the hypothesis that low health literacy is associated with poor glaucoma medication adherence., DESIGN: Cross-sectional patient survey and concomitant chart review., METHODS: One hundred and ninety-seven subjects with open angle glaucoma participated in a survey which included basic demographic information such as age, gender, ethnicity, and level of education completed, and a test of heath literacy, the Rapid Assessment of Adult Literacy in Medicine. Information was collected regarding visual field tests and prescribed medication. The subjects' pharmacies were contacted to ascertain the number of refills requested over the previous six months., RESULTS: Although 146 subjects (74%) reported completing high school, only 94 subjects (48.0%) read at or above a ninth grade level; 23 (11.7%) read at a level of third grade or below. The mean number of refills requested by a subject in the preceding six months was not predicted by race (P = .27,) gender (P = .31), age (P = .92), mean deviation of the visual field (P = .36), or level of education (P = .58). There was a positive relationship between health literacy and the number of refills obtained (P = .003)., CONCLUSIONS: Many patients with open angle glaucoma may have poor health literacy. The subjects in our study with low literacy were less adherent with their glaucoma medications than those with a higher level of literacy. Interventions specifically targeting patients with low literacy may improve medication adherence.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; *Drug Prescriptions/sn [Statistics & Numerical Data]; *Educational Status; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Male; North Carolina; *Patient Compliance/sn [Statistics & Numerical Data]; Patient Education as Topic

Utilization of eye care services in Victoria. - Muller, Andreas; Vu, Hien T; Ferraro, John G; Keeffe, Jill E; Taylor, Hugh R (Clinical & experimental ophthalmology, 2006)
PURPOSE: To determine baseline eye care utilization by older Victorians in order to assess change in 2 years after an eye health promotion campaign., METHODS: A letter of invitation to participate was sent to all people aged 70-79 years in randomly selected Melbourne postcode areas. A questionnaire was designed to allow gathering of eye health-related information. Eye exams included autorefraction, frequency doubling technology and non-mydriatic fundus photography. Results were compared with the Melbourne Vision Impairment Project ., RESULTS: A total of 1695 people with a mean age of 74 years were recruited. The overall proportion with visual impairment was 8% (134/1695), of which 27% (36/134) was due to non-refractive causes. Only 31% (11/36) of visually impaired people knew about low-vision services, of whom 20% (7/36) had used them. Of all people with diabetes, only 52% (96/184) had a dilated eye exam within the recommended 2 years (Melbourne Vision Impairment Project 44%)., CONCLUSIONS: Compliance rates with recommendations for 2-yearly eye exams for people with diabetes have not improved since the last major eye health study in Victoria 10 years ago. The same is true for the rate of undiagnosed glaucoma, suggesting that messages about eye examinations need to be promoted for older people at high risk of vision loss, for example, those with diabetes and at risk of vision loss from glaucoma.
Keywords: Aged; Aging/ph [Physiology]; *Delivery of Health Care/sn [Statistics & Numerical Data]; Female; Health Promotion; Health Services Accessibility/sn [Statistics & Numerical Data]; *Health Services for the Aged/sn [Statistics & Numerical Data]; Humans; Male; *Ophthalmology/sn [Statistics & Numerical Data]; Quality of Life; Surveys and Questionnaires; Victoria/ep [Epidemiology]; Vision Disorders/di [Diagnosis]; Vision Disorders/th [Therapy]; Visually Impaired Persons/sn [Statistics & Numerical Data]

Practical considerations for the treatment of elderly patients with migraine. - Sarchielli, Paola; Mancini, Maria Luisa; Calabresi, Paolo (Drugs & aging, 2006)
Treatment of migraine presents special problems in the elderly. Co-morbid diseases may prohibit the use of some medications. Moreover, even when these contraindications do not exist, older patients are more likely than younger ones to develop adverse events. Managing older migraine patients, therefore, necessitates particular caution, including taking into account possible pharmacological interactions associated with the greater use of drugs for concomitant diseases in the elderly. Paracetamol (acetaminophen) is the safest drug for symptomatic treatment of migraine in the elderly. Use of selective serotonin 5-HT(1B/1D) receptor agonists ('triptans') is not recommended, even in the absence of cardiovascular or cerebrovascular risk, and NSAID use should be limited because of potential gastrointestinal adverse effects. Prophylactic treatments include antidepressants, beta-adrenoceptor antagonists, calcium channel antagonists and antiepileptics. Selection of a drug from one of these classes should be dictated by the patient's co-morbidities. Beta-adrenoceptor antagonists are appropriate in patients with hypertension but are contraindicated in those with chronic obstructive pulmonary disease, diabetes mellitus, heart failure and peripheral vascular disease. Use of antidepressants in low doses is, in general, well tolerated by elderly people and as effective, overall, as in young adults. This approach is preferred in patients with concomitant mood disorders. However, prostatism, glaucoma and heart disease make the use of tricyclic antidepressants more difficult. Fewer efficacy data in the elderly are available for selective serotonin reuptake inhibitors, which can be tried in particular cases because of their good tolerability profile. Calcium channel antagonists are contraindicated in patients with hypotension, heart failure, atrioventricular block, Parkinson's disease or depression (flunarizine), and in those taking beta-adrenoceptor antagonists and monoamine oxidase inhibitors (verapamil). Antiepileptic drug use should be limited to migraine with high frequency of attacks and refractoriness to other treatments. Promising additional strategies include ACE inhibitors and angiotensin II type 1 receptor antagonists because of their effectiveness and good tolerability in patients with migraine, particularly in those with hypertension. Because of its favourable compliance and safety profile, botulinum toxin type A can be considered an alternative treatment in elderly migraine patients who have not responded to other currently available migraine prophylactic agents. Pharmacological treatment of migraine poses special problems in regard to both symptomatic and prophylactic treatment. Contraindications to triptan use, adverse effects of NSAIDs, and unwanted reactions to some antiemetics reduce the list of drugs available for the treatment of migraine attacks in elderly patients. The choice of prophylactic treatment (beta-adrenoceptor antagonists, calcium channel antagonists, antiepileptics, and more recently, some antihypertensive drugs) is influenced by co-morbidities and should be directed at those drugs that are believed to have fewer adverse effects and a better safety profile. Unfortunately, for most of these drugs, efficacy studies are lacking in the elderly.
Keywords: Aged; Analgesics/tu [Therapeutic Use]; Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use]; Antiemetics/tu [Therapeutic Use]; Drug-Related Side Effects and Adverse Reactions; Hormone Replacement Therapy/ae [Adverse Effects]; Humans; Menopause; *Migraine Disorders/dt [Drug Therapy]; Migraine Disorders/pc [Prevention & Control]; Serotonin Receptor Agonists/tu [Therapeutic Use]; Tryptamines/tu [Therapeutic Use]

Glaucoma screening during regular optician visits: can the population at risk of developing glaucoma be reached?. - Stoutenbeek, R; Jansonius, N M (The British journal of ophthalmology, 2006)
AIM: To determine the percentage of the population at risk of developing glaucoma, which can potentially be reached by conducting glaucoma screening during regular optician visits., METHODS: 1,200 inhabitants aged >40 years were randomly selected from Dutch community population databases. A questionnaire was mailed to these inhabitants with questions on their latest optician visit and risk factors for glaucoma. A second questionnaire was sent to their opticians, who were asked about their willingness to conduct an additional glaucoma screening programme in the future., RESULTS: The questionnaire was returned by 959 of 1,200 inhabitants and 37 of 50 opticians. The percentage of inhabitants who visited an optician during a 5-year period was 83% (95% confidence interval (CI) 80% to 85%). This percentage was adjusted for the presence of risk factors for glaucoma to obtain the percentage of the population at risk of developing glaucoma. The percentage of opticians willing to cooperate in a glaucoma screening programme extended beyond a non-contact tonometry measurement alone was 91% (95% CI 77% to 98%)., CONCLUSION: By conducting glaucoma screening during regular optician visits, a large section of the population at risk of developing glaucoma can be reached.
Keywords: Aged; Attitude of Health Personnel; Community Health Services/og [Organization & Administration]; Female; *Glaucoma/di [Diagnosis]; Glaucoma/et [Etiology]; Humans; Male; Middle Aged; Netherlands; *Optometry/og [Organization & Administration]; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Vision Screening/og [Organization & Administration]; Visual Fields

Effect of hospitalization on intraocular pressure in patients with high tension and normal tension glaucoma. - Haufschild, Timo; Orgul, Selim; Flammer, Josef (American journal of ophthalmology, 2006)
PURPOSE: To determine the effect of hospitalization on intraocular pressure (IOP) in glaucoma patients., DESIGN: Prospective case series., METHODS: IOP was measured on three consecutive days in 26 high-tension (HTG) and 13 normal-tension (NTGwm) glaucoma patients under IOP-lowering treatment, and in 28 normal-tension glaucoma patients without IOP-lowering treatment (NTGnm), and change was compared by analysis of variance., RESULTS: IOP decreased significantly, but comparably, in the three groups and between right and left eyes, although, the relative change to IOP on day 1 was significantly less pronounced in the group without treatment on day 2 and 3 compared with the treated groups., CONCLUSIONS: Glaucoma patients showed a significant decrease in IOP during hospitalization. Although this decrease was more pronounced among the treated patients, it was also present in nontreated patients. Consequently, other factors than improved compliance during hospitalization must play a role in this phenomenon.
Keywords: Aged; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; *Hospitalization; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Prospective Studies; Tonometry, Ocular

Views of glaucoma patients on aspects of their treatment: an assessment of patient preference by conjoint analysis. - Bhargava, Jonathan S; Patel, Bakula; Foss, Alexander J E; Avery, Anthony J; King, Anthony J (Investigative ophthalmology & visual science, 2006)
PURPOSE: To determine by conjoint analysis which factors in the management and treatment of glaucoma were of most importance to patients and to relate these factors to the patient's clinical glaucoma condition., METHODS: An interview-based study was performed. Demographic and visual function data are recorded. Participants completed the Visual Function Questionnaire-25 and ranked 10 hypothetical patient scenarios that contained different risks of moderate visual loss, postoperative complications, long-term blindness, use of topical medication, and glaucoma surgery. Conjoint analysis was performed to determine the relative importance of these factors for individuals and the group as a whole., RESULTS: Eighty-two patients were interviewed from two consultants' outpatient clinics. Forty-five were male and 37 female. Seventy-nine were white. The most important factors to patients with glaucoma were the risk of moderate visual impairment and the risk of blindness, with an importance of 38% and 27%, respectively. The use of topical medication had an importance of 11%. Proceeding to surgical intervention (trabeculectomy) had an importance of 15%, and the small risk of visual deterioration after surgery (trabeculectomy) had an importance of 9%., CONCLUSIONS: To patients, the most important factors regarding glaucoma and its treatment are the risks of moderate visual loss (the ability to continue to drive) and long-term blindness. The treatment methods used are of much less importance.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Blindness/et [Etiology]; Female; *Glaucoma, Open-Angle/th [Therapy]; Health Care Surveys; Humans; Intraocular Pressure; Male; Middle Aged; *Patient Satisfaction/sn [Statistics & Numerical Data]; *Patients/px [Psychology]; Risk Assessment; Surveys and Questionnaires; Trabeculectomy/mt [Methods]; Vision, Low/et [Etiology]

The epidemiology of medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994 to 2003. - Owen, C G; Carey, I M; De Wilde, S; Whincup, P H; Wormald, R; Cook, D G (The British journal of ophthalmology, 2006)
AIMS: To study trends in the prevalence of being treated for glaucoma and ocular hypertension from 1994 to 2003, and to examine factors determining treatment in 2002., METHODS: Computerised data (the DIN-LINK database) from 131 general practices across the United Kingdom, in which half a million patients aged 40 years or more were registered annually, were used. On average 10 000 patients were treated for glaucoma and ocular hypertension annually., RESULTS: Prevalence of being treated for glaucoma and ocular hypertension increased from 1.7% in 1994 to 2.3% in 2003. Those aged 85 years or more were 13 times (95% CI 12.2 to 13.8) more likely to be treated than those aged 40-64 years. Men were more likely to be treated than women (OR 1.24, 95% CI 1.19 to 1.28). Subjects "hard pressed" were less likely to be treated than "wealthy achievers" (OR 0.92, 95% CI 0.86 to 0.99). While use of topical beta blocker only medications has declined since 1995, use of topical prostaglandins and combination therapies has increased. In 2003, use of prostaglandins overtook beta blocker only medications., CONCLUSION: Prevalence of being treated for glaucoma has increased over time, and rises with age. Differences in treatment by sex and social status could be explained by use of or access to health care or by underlying prevalence of disease. Trends in treated glaucoma emphasise the shift from use of topical beta blockers to newer therapies.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Age Distribution; Aged; Aged, 80 and over; Family Practice; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Humans; Information Storage and Retrieval; Male; Medical Records Systems, Computerized; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ep [Epidemiology]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Prevalence; Prostaglandin Antagonists/tu [Therapeutic Use]; Sex Distribution; Social Class; United Kingdom/ep [Epidemiology]

Effect of written instructions on accuracy of self-reporting medication regimen in glaucoma patients. - Kharod, Bhairavi V; Johnson, Paul B; Nesti, Heather A; Rhee, Douglas J (Journal of glaucoma, 2006)
PURPOSE: Our purpose was to evaluate the accuracy of self-reporting of the prescribed medication regimen in a glaucoma population, identify contributing factors, and assess the effect of written instructions., METHODS AND MATERIALS: All patients at an urban resident glaucoma clinic were offered participation in this prospective, case-controlled study. Two trained interviewers administered a confidential questionnaire consisting of six questions regarding the name and dosage of ophthalmic medications, education level, ability to read, and age. A verbatim response for each question was recorded on the questionnaire. At the end of the visit, patients were given a written chart describing their ophthalmic medications, frequency, and dosage. At their next scheduled visit, the same questionnaire was repeated. The patients' responses from both visits were compared with the regimen they were prescribed and with each other. This information was used to determine the accuracy of reporting medications., RESULTS: A total of 193 patients were enrolled in the study over a 10-month period; 164 patients completed both phases (85% completion rate). The study population consisted of 85 women and 79 men with a mean age of 68.40+/-11.6 years. Eighty-four patients had attained less than 12th grade education and 80 had completed high school. At the first visit, 66 patients (40%) showed less than 100% accuracy. Forty-nine of 84 (58%) patients who had not completed high school education showed less than 100% accuracy with a mean score of 65% (P=0.001), whereas 17 of 80 (21%) of patients who had completed high school showed less than 100% accuracy with a mean score of 87% (P=0.001). After written instruction, the accuracy of reporting improved by 23.36+/-30.8 percentile points in patients without completion of high school education and improved by 8.46+/-21.7 percentile points in patients who had completed high school (P<0.001). The mean number of ophthalmic medications prescribed was 2.10+/-0.93 (range 1 to 4). Patients on one medication had 100% accuracy in reporting 82% of the time, whereas those with four medications had 100% accuracy 21% of the time. Gender, age, and race of the patient were not correlated with the accuracy of self-reporting (P>0.05)., CONCLUSION: The education level of the patient and the number of medications showed direct correlation with patients' ability to report medications accurately. Patients showed improvement in accuracy of reporting medications when given written instructions about their regimen, regardless of their level of education or number of medications.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Drug Prescriptions; Educational Status; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; *Patient Education as Topic; Reading; Reproducibility of Results; Self Disclosure; Surveys and Questionnaires

Factors associated with failure to follow up after glaucoma screening: a study in an African American population. - Gwira, Jane A; Vistamehr, Setareh; Shelsta, Heather; Bashford, Kent; Forster, Susan; Palmisano, Phillip; Shafranov, George; Shields, M Bruce (Ophthalmology, 2006)
PURPOSE: To evaluate variables associated with failure to access free eye care after participating in glaucoma screening., DESIGN: Review of responses to a survey completed by participants during glaucoma screening., PARTICIPANTS: Two hundred seventy-three surveys completed by participants of African descent during screening., METHODS: African Americans 40 years or older participated in community glaucoma screening clinics, which included a survey with demographic and social variables. Each participant was given a preliminary diagnosis and encouraged to attend a free eye clinic for a complete examination. Survey results were correlated with attendance at the follow-up examination, using Student's t test, chi-square test, and logistic regression analysis., MAIN OUTCOME MEASURE: Noncompliance with follow-up after glaucoma screening., RESULTS: When adjusting for risk factors in logistic regression analysis, noncompliance was associated with living alone (P = 0.008), smoking (P = 0.0005), and lacking a car (P<0.01). Odds of noncompliance for participants living alone were 2.2 times higher than those for participants not living alone. Odds of noncompliance for participants who smoked were 3.0 times greater than those for participants who did not smoke. Odds of noncompliance for participants who did not have access to a car for their last eye examination were 2.1 times greater than those for participants who did., CONCLUSION: Socioeconomic factors such as smoking, lack of access to a car for eye examinations, and living alone are associated with noncompliance to follow-up after glaucoma screening clinics. Identifying persons with these variables may facilitate improved compliance.
Keywords: Adult; African Americans/sn [Statistics & Numerical Data]; *African Americans; Aged; Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; *Diagnostic Techniques, Ophthalmological; Follow-Up Studies; *Glaucoma/di [Diagnosis]; *Glaucoma/eh [Ethnology]; Humans; *Mass Screening; Middle Aged; *Patient Compliance; Residence Characteristics; Retrospective Studies; Smoking; Transportation

Surgical removal of intraocular antibiotic ointment after routine cataract phacoemulsification. - Wong, James G; Bank, Allan (Journal of cataract and refractive surgery, 2006)
We report surgical removal of a droplet of intraocular chloramphenicol ointment in a 70-year-old man who had routine small-incision phacoemulsification. A spherical droplet of ointment adherent to the intraocular lens was noted 2 months postoperatively. The source was considered to be the immediate postoperative conjunctival fornix chloramphenicol ointment. Gonioscopy revealed tiny droplets adherent to the peripheral iris and angle. The droplet was surgically explanted using a minimally traumatic technique with a lens glide and ophthalmic viscosurgical device through an enlarged clear corneal incision and sent intact for laboratory biochemical analysis. The patient maintained good vision without evidence of uveitis or secondary glaucoma at 1 year of follow-up. This uncommon case also raises issues about the need for immediate postoperative antibiotic ointment for endophthalmitis prophylaxis and phacoemulsification thermal wound effects on the integrity of self-sealing clear corneal incisions.
Keywords: Aged; *Anterior Chamber/me [Metabolism]; *Anterior Chamber/su [Surgery]; *Anti-Bacterial Agents/me [Metabolism]; Antibiotic Prophylaxis; *Chloramphenicol/me [Metabolism]; Endophthalmitis/pc [Prevention & Control]; Gonioscopy; Humans; Lens Implantation, Intraocular; *Lenses, Intraocular; Male; *Ointments/me [Metabolism]; *Phacoemulsification; Tissue Adhesions

Adjunctive glaucoma therapy use associated with travoprost, bimatoprost, and latanoprost. - Covert, David; Robin, Alan L (Current medical research and opinion, 2006)
PURPOSE: This study contrasts the utilization of adjunctive medication associated with travoprost, bimatoprost, or latanoprost, as primary glaucoma therapies., METHODS: Patients in the Medco Health database who initiated prostaglandin analog therapy on travoprost, bimatoprost or latanoprost between January 1, 2002 and July 31, 2002 were selected if they had no prostaglandin analog use in the prior 6 months. Patients were also required to have 12 months of prostaglandin therapy subsequent to the initial prescription. Data were available through July 31, 2003. The t-test and chi-square were used where appropriate to calculate p-values and assess significant differences., RESULTS: A total of 13 171 benefit-eligible subjects were identified of which 8381 (64%), 2637 (20%), and 2153 (16%) patients were treated with latanoprost, bimatoprost, and travoprost, respectively. There were no significant differences in mean age or gender between the three study groups with the exception that latanoprost patients were statistically older than travoprost patients (69.0 vs. 68.0). This was not considered a clinically meaningful difference. Overall, patients using travoprost or bimatoprost had a significantly lower rate of adjunctive medication use compared to patients starting on latanoprost monotherapy (22.5%, 23.2%, and 30.2 %, respectively). Therefore, for every 14 patients treated with latanoprost instead of travoprost or bimatoprost, one additional patient would be expected to need adjunctive therapy with another agent. The difference between travoprost and bimatoprost patients was not significant., CONCLUSIONS: The use of adjunctive medications to control intraocular pressure was significantly higher for latanoprost patients compared to travoprost and bimatoprost patients. This finding should be interpreted in the context that this study was based only on prescription claims data. It is important to simplify ophthalmic medical regimen as it is more cost effective, better for the patient, and minimizes the washout effect from administering two eye medications within 5 min. Decreasing the complexity of the patients' drug regimen may lead to increased adherence to prescribed therapy and a decreased risk of the incidence of blindness.
Keywords: Aged; *Amides/tu [Therapeutic Use]; Bimatoprost; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Drug Therapy, Combination; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; *Lipids/tu [Therapeutic Use]; Male; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Travoprost

Side effects of glaucoma medications. - Detry-Morel, M (Bulletin de la Societe belge d'ophtalmologie, 2006)
The safety profile of the different glaucoma medications is an important issue when initiating therapy in glaucomatous patients. The decision on which medication to prescribe depends not only on the type of glaucoma, but also on the patient's medical history and needs a detailed knowledge of the potential side-effects of each medication. Medications side effects may be an important cause of non adherence for the individual patient The properties of the drugs, the composition of the glaucoma eyedrops and the dynamics of ocular drug absorption must be considered. The ocular surface changes induced by long-term antiglaucomatous treatment especially by their preservatives are a major cause of intolerance or poor tolerance to glaucoma eyedrops. Moreover topically applied ophthalmic medications can attain sufficient serum levels through absorption into conjunctival and nasal mucosas to have systemic effects and to potentially interact with other drugs. Then this presentation will deal with the ocular and systemic side-effects which can be encountered with the different classes of the currently available glaucoma topical medications. Recommendations than can be applied to reduce both frequency and severity of side-effects of glaucoma medications will be stressed on. Concurrently patients should be fully informed not only about their disease but also the medications they used and what side-effects they have to expect.
Keywords: Administration, Topical; Adrenergic alpha-Agonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Aged; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Dry Eye Syndromes/ci [Chemically Induced]; Eye Diseases/ci [Chemically Induced]; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; Prostaglandins F, Synthetic/ae [Adverse Effects]; Prostaglandins, Synthetic/ae [Adverse Effects]

Sutureless amniotic membrane fixation using fibrin glue for ocular surface reconstruction in a rabbit model. - Szurman, Peter; Warga, Max; Grisanti, Salvatore; Roters, Sigrid; Rohrbach, Jens M; Aisenbrey, Sabine; Kaczmarek, Radoslaw T; Bartz-Schmidt, Karl U (Cornea, 2006)
PURPOSE: Amniotic membrane transplantation has become an important treatment option for corneal surface reconstruction. However, suture fixation of the transplant has various disadvantages like corneal irritation, scarring, graft loss due to membrane shrinkage, and the need for subsequent suture removal. Replacement of sutures by bioadhesives might be an advantageous alternative. This controlled study was designed to evaluate a new sutureless technique for amniotic membrane fixation onto the corneal surface by using fibrin glue., METHODS: Standardized disks of cryopreserved amniotic membranes were transplanted onto the deepithelialized cornea of 12 rabbits using either conventional suture fixation or a new fibrin glue technique. The rabbits were followed-up with slit-lamp examination and fluorescein staining until epithelialization was completed. Consecutively, the rabbits were killed and the eyes processed for histology and immunohistochemistry for cytokeratin-3., RESULTS: All membranes of both groups stayed in place throughout the follow-up time and showed a progressive graft epithelialization that was completed after 12 days. Whereas suture-fixated membranes showed progressive tissue shrinkage, fibrin-glued sheets remained unaltered. In the bioadhesive group, histology revealed a smooth fibrin layer in the graft-host interface and a continuous, stratified layer of cytokeratin-3 expressing corneal epithelial cells on the membrane surface. In contrast, suture-fixated membranes showed contracted and prominent membrane edges with epithelial ingrowth into the submembrane interface., CONCLUSION: Our results demonstrate the general feasibility of reproducible and reliable sutureless amniotic membrane fixation onto the corneal surface in rabbits. Stable adherence is maintained until epithelialization is completed. The sutureless technique gives sufficient manipulation time for the sheet before the final cross-linking process is completed. Furthermore, several advantageous characteristics could be demonstrated as increased biocompatibility, better epithelialization pattern and the lack of membrane shrinkage.
Keywords: *Amnion/tr [Transplantation]; Animals; *Corneal Diseases/dt [Drug Therapy]; *Corneal Diseases/su [Surgery]; Cryopreservation; Disease Models, Animal; Epithelium, Corneal/ph [Physiology]; *Fibrin Tissue Adhesive/tu [Therapeutic Use]; Humans; Immunoenzyme Techniques; Keratin-3; Keratins/me [Metabolism]; Rabbits; *Suture Techniques; *Tissue Adhesives/tu [Therapeutic Use]

Descemet's stripping with endothelial keratoplasty in 200 eyes: Early challenges and techniques to enhance donor adherence. - Price, Francis W Jr; Price, Marianne O (Journal of cataract and refractive surgery, 2006)
PURPOSE: To describe early challenges and techniques to promote donor tissue adherence in Descemet's stripping with endothelial keratoplasty (DSEK)., SETTING: Price Vision Group, Indianapolis, Indiana, USA., METHODS: The first 200 consecutive cases of DSEK performed by a single surgeon were analyzed retrospectively. Follow-up was 7 to 20 months for 124 eyes and 2 to 6 months for 76 eyes. The surgical technique consisted of stripping Descemet's membrane and endothelium from the recipient's central cornea and transplanting an 8.0 to 9.0 mm disc of donor endothelium and posterior stroma through a 5.0 mm incision, with sutures used only to close the incision., RESULTS: The most frequent challenge was inadequate donor attachment. Using techniques to remove fluid from the donor-recipient graft interface, the donor detachment rate in the last 64 cases was 6%, with half attributable to patient eye rubbing. Detached grafts were reattached by injecting an air bubble to press the donor against the recipient cornea. There were 7 primary graft failures, with only 1 occurring in the second 100 cases, which primarily used microkeratome-dissected donor tissue. Other complications were infrequent and included pupillary block glaucoma (1), aqueous misdirection syndrome (1), and cataract development in 2 of 27 phakic eyes. The DSEK procedure was performed safely before and after laser in situ keratomileusis (1 each)., CONCLUSIONS: Early outcomes in the initial 200 consecutive DSEK procedures suggest the technique provides significant advantages over penetrating keratoplasty, including more rapid healing, more predictable refractive outcomes, and better retention of corneal strength and integrity. Although donor adherence was more challenging, DSEK was technically easier and should be less traumatic to anterior chamber structures than earlier posterior grafting techniques.
Keywords: Aged; Cell Adhesion; Corneal Diseases/pp [Physiopathology]; *Corneal Diseases/su [Surgery]; *Corneal Transplantation/mt [Methods]; Descemet Membrane/pp [Physiopathology]; *Descemet Membrane/su [Surgery]; Endothelium, Corneal/pp [Physiopathology]; *Endothelium, Corneal/su [Surgery]; Female; Follow-Up Studies; *Graft Survival/ph [Physiology]; Humans; Male; Postoperative Complications; Refraction, Ocular/ph [Physiology]; Retrospective Studies; Suture Techniques; Tissue Donors; Wound Healing/ph [Physiology]

Causes of blindness among hospital outpatients in Ecuador. - Cass, Helene; Landers, John; Benitez, Paul (Clinical & experimental ophthalmology, 2006)
BACKGROUND: There is a lack of published information on the causes of blindness in Ecuador and the Latin American region in general. This study is designed to enumerate the proportions of ocular conditions contributing to blindness in an outpatient population of an ophthalmology hospital in the coastal region of Ecuador., METHODS: All cases presenting to an ophthalmology outpatient clinic over a 3-week period during September 2004 were reviewed (n = 802). Visual acuity was measured using a Snellen acuity chart and those who met the criteria for blindness were included in the study (n = 118). Blindness was defined under the World Health Organization protocol as visual acuity of <3/60. Both unilateral and bilateral blindness were included in the study. The diagnosis of ocular pathology contributing to blindness was recorded., RESULTS: Among those considered to have unilateral blindness (n = 88), cataract was the most common cause (43%). This was followed by corneal pathologies (17%) and glaucoma (15%). Among those considered to have bilateral blindness (n = 30), refraction was the most common cause (37%), followed by cataract (23%) and glaucoma (17%)., CONCLUSION: The major causes of blindness found in this study reflected those in estimated data for the region. More studies are needed to improve the quality and quantity of epidemiological data on blindness in Ecuador and Latin America. Many obstacles to successful implementation of prevention of blindness programmes in South America still need to be overcome.
Keywords: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Cataract/co [Complications]; Cataract/ep [Epidemiology]; Child; Ecuador/ep [Epidemiology]; Female; Glaucoma/co [Complications]; Glaucoma/ep [Epidemiology]; Humans; Male; Middle Aged; Ophthalmology/sn [Statistics & Numerical Data]; *Outpatient Clinics, Hospital/sn [Statistics & Numerical Data]; Refractive Errors/co [Complications]; Refractive Errors/ep [Epidemiology]; Sex Distribution; Visual Acuity

Agreement between optometrists and ophthalmologists on clinical management decisions for patients with glaucoma. - Banes, M J; Culham, L E; Bunce, C; Xing, W; Viswanathan, A; Garway-Heath, D (The British journal of ophthalmology, 2006)
BACKGROUND/AIMS: Although optometrists have become an accepted part of the team in many hospital glaucoma clinics, their decision making ability has not been assessed formally. This study aims to document the accuracy and safety of clinical work undertaken by optometrists in the hospital setting by investigating their management decisions on follow up of patients with glaucoma., METHODS: Four optometrists and three medical clinicians examined 50 patients each. Clinical findings were recorded as usual in the hospital records but management decisions were documented separately on a specially designed data collection form. Subsequently, the patient records and clinical findings were reviewed retrospectively and independently by two consultant ophthalmologists, who were masked to the management decisions of the optometrists and medical clinicians. The consultants' management decisions were then compared with those made by the optometrists and medical clinicians. Percentage agreements were computed together with kappa (kappa), or weighted kappa, statistics where appropriate., RESULTS: Agreement between consultants and optometrists was 55% (kappa = 0.33) for evaluation of visual field status, 79% (kappa = 0.67) for medical management, 72-98% for other aspects of patient management, and 78% (weighted kappa = 0.35) for scheduling of next clinic appointment. Very similar levels of agreement were found between consultants and medical clinicians., CONCLUSION: Agreement between optometrists and consultants, in glaucoma clinical decision making, was at least as good as that between medical clinicians and consultants. Within an appropriate environment, optometrists can safely work as part of the hospital glaucoma team in outpatient clinics.
Keywords: Appointments and Schedules; Clinical Competence; Glaucoma/di [Diagnosis]; Glaucoma/pa [Pathology]; *Glaucoma/th [Therapy]; Humans; Interprofessional Relations; *Ophthalmology; Optic Disk/pa [Pathology]; *Optometry; Outpatient Clinics, Hospital; Physical Examination/mt [Methods]; *Physician's Role; Sensitivity and Specificity; Visual Fields

[Case of recurrent fungal endophthalmitis with suspected Munchausen syndrome]. - Minemura, Kenji; Nagahara, Miyuki; Kaburaki, Toshikatsu; Sakurai, Masahiko; Araie, Makoto; Tanaka, Sakae; Doi, Takako; Okugawa, Shu; Tsukada, Kunihisa (Nippon Ganka Gakkai zasshi, 2006)
PURPOSE: To report recurrent fungal endophthalmitis which developed after endogenous fungal endophthalmitis. The patient was suspected to be suffering from Munchausen syndrome., CASE: A 44-year-old woman contracted endogenous fungal endophthalmitis in her right eye in October 2000. After the endophthalmitis was healed by vitrectomy, corneal ulcer and endophthalmitis repeatedly occurred in the eye from an unknown cause. The patient finally lost the sight of her right eye. The corneal ulcer and endophthalmitis resulted from self-injury for which we found material evidence in the course of the treatment. Munchausen's syndrome was suspected but the patient persistently refused to see a psychiatrist., CONCLUSION: We must be prepared to provide mental and psychiatric care in addition to ophthalmological treatment for such a case.
Keywords: Adult; Blindness/et [Etiology]; Corneal Ulcer/et [Etiology]; *Endophthalmitis/et [Etiology]; *Eye Infections, Fungal/et [Etiology]; Female; Humans; *Munchausen Syndrome/co [Complications]; Munchausen Syndrome/px [Psychology]; Recurrence; Self-Injurious Behavior/co [Complications]; Treatment Refusal

Medication adherence in glaucoma: approaches for optimizing patient compliance. - Tsai, James C (Current opinion in ophthalmology, 2006)
PURPOSE OF REVIEW: To summarize recent literature regarding medication adherence with a focus on the complexities inherent in glaucoma management., RECENT FINDINGS: Adherence to medications can be enhanced by undertaking the following strategies: enhanced patient education; improved dosing schedules; increased accessibility to healthcare (including longer hours, evening hours, and shorter wait times), and improved provider-patient relationships (e.g. increased trust). Patients may be less likely to forgo medication use due to cost pressures if the physician trust level is high. Recent studies suggest a role for baseline screening for adherence predictors and focused interventions in addressing modifiable risk factors for poor adherence (such as depression, stress, and lower education)., SUMMARY: Many factors are associated with the lack of medication adherence in patients. The solution is likely to be multi-dimensional and employ combination strategy (must be individualized for the patient). Educational interventions involving patients, family members, or both can be effective in improving adherence.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Attitude to Health; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; Patient Education as Topic

Glaucoma screening: current trends, economic issues, technology, and challenges. - Nduaguba, Constance; Lee, Richard K (Current opinion in ophthalmology, 2006)
PURPOSE OF REVIEW: Glaucoma is one of the leading causes of irreversible blindness worldwide. Early glaucoma detection and treatment are currently the only known methods for preventing blindness and low vision resulting from this frequently asymptomatic disease., RECENT FINDINGS: New technologies for detecting early glaucomatous damage are important in diagnosing optic nerve disease, not only in community screening settings but also in clinics. Imaging of the optic nerve head and macula and retinal nerve fiber layer analysis can provide quick, automated, and quantitative measurements in agreement with clinical estimates of optic disc structure and visual function. In the area of perimetry, frequency-doubling technology is a promising and feasible mass-screening method with reasonable sensitivity for detecting visual field loss. Central corneal thickness has emerged as a new risk factor for the development and progression of glaucoma, thereby complicating the role of tonometry and measurement of intraocular pressure as screening parameters for glaucoma. Along with technological advances, strides are also being made with public policy and legislative efforts to bring glaucoma onto the national and global health care agenda. These initiatives incorporate vision-screening goals into national disease prevention programs emphasizing the need for early glaucoma detection and treatment., SUMMARY: Glaucoma awareness needs to be increased through better education, and compliance with follow-up care needs to be improved to decrease the economic and social costs from glaucoma. In addition, screening models need to be developed that will be effective in developing countries where the risk of blindness from glaucoma is highest.
Keywords: Biomedical Technology; Diagnostic Imaging/mt [Methods]; *Diagnostic Techniques, Ophthalmological/ec [Economics]; *Diagnostic Techniques, Ophthalmological/td [Trends]; *Glaucoma/di [Diagnosis]; *Glaucoma/ec [Economics]; Humans; Intraocular Pressure; Risk Factors

Keeping an eye on glaucoma treatment. - Anonymous (The Johns Hopkins medical letter health after 50, 2006)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance/sn [Statistics & Numerical Data]; *Patient Compliance; Polypharmacy

A case of a pseudomonas corneal ulcer in an occasional use daily disposable contact lens wearer. - Munneke, Robert; Lash, Stephen C; Prendiville, Catherine (Eye & contact lens, 2006)
PURPOSE: To report a case that suggests that factors associated with daily disposable contact lenses contribute to the risk of developing infectious keratitis., METHODS: A case of a culture-positive Pseudomonas corneal ulcer in a compliant daily disposable contact lens wearer is presented., RESULTS: The case involves a 35-year-old woman with a culture-positive Pseudomonas corneal ulcer that was treated successfully with topical antibiotics. The patient wore daily disposable contact lenses on a part-time basis and was fully compliant with the instructions for use., CONCLUSIONS: Compliance and wearing time were not causal in this episode of infectious keratitis, but factors related to the lens might have been.
Keywords: Administration, Topical; Adult; Anti-Bacterial Agents/ad [Administration & Dosage]; Anti-Bacterial Agents/tu [Therapeutic Use]; *Contact Lenses, Hydrophilic/mi [Microbiology]; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; *Corneal Ulcer/mi [Microbiology]; Disposable Equipment; Eye Infections, Bacterial/di [Diagnosis]; Eye Infections, Bacterial/dt [Drug Therapy]; *Eye Infections, Bacterial/mi [Microbiology]; Female; Humans; Patient Compliance; Pseudomonas Infections/di [Diagnosis]; Pseudomonas Infections/dt [Drug Therapy]; *Pseudomonas Infections/mi [Microbiology]; *Pseudomonas aeruginosa/ip [Isolation & Purification]

Opaque contact lens treatment for older children with amblyopia. - Anderson, Justin E; Brown, Sandra M; Mathews, Taryn A; Mathews, Steven M (Eye & contact lens, 2006)
PURPOSE: To investigate the usefulness of daily-wear opaque contact lens treatment for older children with amblyopia., METHODS: A retrospective chart review of all children undergoing opaque contact lens therapy for amblyopia between 2000 and 2003 was performed. All patients were included except for those younger than 5 years of age, those undergoing maintenance treatment only, those lost to follow-up, or those unable to cooperate with Snellen visual acuity testing., RESULTS: Thirteen children were identified, and seven met the inclusion criteria. The seven patients had a mean age of 7.5 years (range, 5.7-8.7 years). The causes of amblyopia were anisometropia (five patients), cataract (one patient), and strabismus (one patient). For all seven patients, the mean logMAR improvement in visual acuity was 0.52 (range, 0.26-1.22). The average duration of opaque contact lens use was 9.3 months (range, 2-21 months). Compliance problems were encountered in three patients. No major complications occurred, but one patient had an episode of mild superficial punctate keratitis., CONCLUSIONS: Daily-wear opaque contact lens treatment is a useful occlusion method for amblyopia treatment in older children with various practical and social impediments to skin patching. Meaningful improvement in visual acuity can be obtained, even in children older than 8 years of age.
Keywords: *Amblyopia/th [Therapy]; Child; *Contact Lenses, Hydrophilic; Humans; Patient Compliance; Prosthesis Design; Retrospective Studies; *Sensory Deprivation; Visual Acuity

Automated combined kinetic and static perimetry: an alternative to standard perimetry in patients with neuro-ophthalmic disease and glaucoma. - Pineles, Stacy L; Volpe, Nicholas J; Miller-Ellis, Eydie; Galetta, Steven L; Sankar, Prithvi S; Shindler, Kenneth S; Maguire, Maureen G (Archives of ophthalmology (Chicago, Ill. : 1960), 2006)
OBJECTIVES: To create a fully automated, combined perimetry program consisting of a static examination and a kinetic examination, and to compare the results of this test with standard static and kinetic visual fields (VFs)., METHODS: Fifty-six patients (74 eyes) undergoing neuro-ophthalmic or glaucoma evaluation who had standard static or kinetic perimetry examinations underwent the combined perimetry test. This automated, combined test, performed on the Octopus 101 perimeter, consisted of a static tendency-oriented perimetry examination and a preprogrammed kinetic examination. Three masked physician reviewers independently classified all of the VFs. The VF pairs were considered a match if the consensus descriptions of the standard and combined VFs matched., RESULTS: Thirty-seven eyes underwent evaluation for neuro-ophthalmic disease (comparison standard test, 20 static and 17 kinetic) and 37 for glaucoma (comparison standard test, 17 static and 20 kinetic). The VP pairs matched in 32 eyes (86%) in the neuro-ophthalmic group and 28 (76%) in the glaucoma group. On inspection by a fourth reviewer, many of the nonmatching VF pairs were those for which a consensus was not reached, but still conveyed similar information. Two glaucomatous eyes demonstrated central scotomata not delineated by the combined examination findings. Two subtle nasal steps were detected solely by the combined examination. The combined test ranged in time from 6 to 12 minutes per eye., CONCLUSIONS: The Octopus 101 perimeter can be used to create an automated test that combines the advantages of static and kinetic perimetry and produces equivalent results while not requiring examiner expertise.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; *Optic Nerve Diseases/di [Diagnosis]; Patient Satisfaction; Reproducibility of Results; Sensitivity and Specificity; *Vision Disorders/di [Diagnosis]; Visual Acuity; *Visual Field Tests/mt [Methods]; *Visual Fields

[Compliance and persistence]. - Detry-Morel, M (Journal francais d'ophtalmologie, 2006)
PURPOSE: 1) To summarize the literature on compliance (the extent to which the patient's behaviors correspond with the provider's recommendations) and persistence (total time on therapy) in patients with open-angle glaucoma or ocular hypertension. 2) To suggest guidelines to improve these two parameters, which are both essential and integral elements of optimizing patient care., METHODS: Compliance-related research published between 1980 and March 2005., RESULTS: Medication compliance has mostly been investigated and measured using patient self-reports, electronic monitoring, and medication possession ratio. Noncompliance-related problems are underestimated, complex, unpredictable and frequent. Noncompliance rates of at least 25% have been reported. The main obstacles to medication compliance are situational/environmental or related to the side effects or complexity of the medication regimen. Persistence with glaucoma medications has also been proven to be poor. Based on retrospective studies using survival analyses, fewer than 25% of patients may be persistent over 12 months. Persistence rates differ from one treatment to another and may fluctuate with time in the same patient., CONCLUSIONS: Improving the quality of information, the patient-physician relationship, and educating patients are all crucial. Simplification of the treatment regimen and selection of medications with the fewest systemic and ocular side effects must be a priority. Accurately assessing patient compliance and persistence are indispensable to reducing mistakes from either medication noncompliance or lack of persistence with poor efficacy and to avoid unnecessary changes in a patient's therapeutic regimen or surgery.
Keywords: *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Ocular Hypertension/dt [Drug Therapy]; *Patient Compliance/sn [Statistics & Numerical Data]; Patient Education as Topic; Physician-Patient Relations; Time Factors

[Observational survey on the use of dual therapy in ocular hypertension or glaucoma treatment]. - Bron, A; Nordmann, J-P; Rouland, J-F; Baudouin, C; Sartral, M (Journal francais d'ophtalmologie, 2006)
AIM: To ascertain why ophthalmologists shift therapy to a fixed-combination or non-fixed-combination drug therapy., PATIENTS AND METHODS: A prospective multicenter observational study was conducted among French ophthalmologists working in private or mixed practice. The study included adult patients with open-angle glaucoma or ocular hypertension, treated with monotherapy or dual therapy and needing to modify their initial treatment. The patients had to fill out a self-questionnaire 15 days after the change in therapy, evaluating the compliance and assessment of the new treatment., RESULTS: The analysis was made on 775 questionnaires filled out by ophthalmologists between March 1st and July 31st 2003 on 5734 patients. The mean age was 66.4+/-12.4 years and women represented 53.6% of the patients. The diagnosis had been made, on average, 7.5+/-7.3 years before. The mean initial intraocular pressure under treatment was 19.8+/-4.1 mmHg in both eyes. Initially, 58.2% of the patients had monotherapy, 40.4% dual therapy and 1.4% triple therapy. The main reasons for shifting therapy were "high intraocular pressure under treatment" for 63.5% of the patients and "simplification of the treatment" for 39.1% of the patients (several reasons per patient were accepted). Most of the patients were satisfied with their new therapy (71%), which in most cases was a fixed-combination therapy (95.2%)., DISCUSSION: This study has shown that the use of at least two active principles is a common practice in the treatment of glaucoma and ocular hypertension. An additive therapy is given in order to better control the intraocular pressure, mainly with a fixed combination.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Practice Patterns, Physicians'; Prospective Studies; Surveys and Questionnaires

Refractive laser surgery in children with coexisting medical and ocular pathology. - Astle, William F; Papp, Andrea; Huang, Peter T; Ingram, April (Journal of cataract and refractive surgery, 2006)
PURPOSE: To report the visual, refractive, and functional outcomes of photorefractive keratectomy (PRK) and of laser-assisted subepithelial keratectomy in a group of children with significant refractive error and underlying medical conditions or ocular pathology who were noncompliant with traditional management., SETTING: Nonhospital surgical facility and a hospital clinic., METHODS: This case series comprised 5 individual cases of anisometropic amblyopia and/or high myopia. Underlying medical and ocular conditions were as follows: upper eyelid hemangioma with oblique myopic astigmatism, Pelizaeus-Merzbacher leukodystrophy with nystagmus, Klippel-Trenaunay-Weber syndrome with glaucoma, incontinentia pigmenti with unilateral optic nerve atrophy, and Goldenhar syndrome with unilateral optic nerve hypoplasia. Photorefractive keratectomy or LASEK was performed in 6 eyes of 5 patients. Age range at the time of surgery was 1.0 to 7.0 years. All procedures were performed under general anesthesia., RESULTS: Best corrected visual acuity improved by 2 lines in 2 patients and 1 line in 2 patients by 6 months after surgery. Stereopsis and/or fusional status improved in 3 patients. Amblyopia treatment compliance improved in 1 patient. Alignment improved without strabismus surgery in 2 cases. A functional vision survey demonstrated a positive effect on the ability of all 5 children to function in their environment., CONCLUSION: During the period of visual cortical plasticity, refractive surgery, by eliminating the refractive component of amblyopia and by promoting fusional ability, provides considerable improvement in children, even those with underlying medical conditions associated with ocular pathology.
Keywords: Abnormalities, Multiple; Amblyopia/co [Complications]; *Amblyopia/th [Therapy]; Anisometropia/co [Complications]; *Anisometropia/su [Surgery]; Child; Child, Preschool; Comorbidity; Eye Diseases/co [Complications]; Female; Humans; Infant; *Keratectomy, Subepithelial, Laser-Assisted; Lasers, Excimer; Male; Myopia/co [Complications]; *Myopia/su [Surgery]; Patient Compliance; *Photorefractive Keratectomy; Visual Acuity/ph [Physiology]

Increase of carotid artery stiffness and decrease of baroreflex sensitivity in exfoliation syndrome and glaucoma. - Visontai, Z; Merisch, B; Kollai, M; Hollo, G (The British journal of ophthalmology, 2006)
AIM: To investigate the distensibility of the common carotid artery (CCA), baroreflex sensitivity (BRS) and its relation to plasma homocysteine concentration in exfoliation syndrome or exfoliation glaucoma (XFS/XFG)., METHODS: Homocysteine concentrations were measured in 30 XFS/XFG patients and 18 age matched controls. In 21 patients and 17 controls the end diastolic diameter of the CCA and pulsatile distension were measured and BRS was calculated., RESULTS: There was no significant difference between the groups in sex distribution, age, heart rate, blood pressure, systemic diseases, or medication. In XFS/XFG patients homocysteine concentration was significantly elevated (unpaired t test, p = 0.023), and CCA stiffness was higher (p<0.05), while strain, cross sectional compliance coefficient, distensibility, and BRS were significantly reduced compared to the controls (Mann-Whitney U test, p< or =0.013 for each parameter). In XFS/XFG patients a positive correlation was found between age and plasma homocysteine level (Pearson's correlation, r = 0.490, p = 0.007), and a negative correlation between age and BRS (Kendall's correlation r = -0.374, p = 0.021), as well as between homocysteine concentration and BRS (Kendall's correlation r = -0.377, p = 0.024). No correlation was seen between these variables in the control group., CONCLUSIONS: These results suggest a pathological large artery function as well as altered parasympathetic vascular control in XFS/XFG which increases with age and with higher homocysteine concentration.
Comment in (CIN)
Keywords: Aged; Aged, 80 and over; *Baroreflex; Blood Pressure; *Carotid Artery, Common/dg [Diagnostic Imaging]; Carotid Artery, Common/pp [Physiopathology]; Case-Control Studies; Chi-Square Distribution; Elasticity; Electrocardiography; Exfoliation Syndrome/co [Complications]; *Exfoliation Syndrome/dg [Diagnostic Imaging]; Exfoliation Syndrome/pp [Physiopathology]; Female; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/dg [Diagnostic Imaging]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Hyperhomocysteinemia/co [Complications]; Hyperhomocysteinemia/dg [Diagnostic Imaging]; Hyperhomocysteinemia/pp [Physiopathology]; Male; Middle Aged; Pulse; Tunica Intima/dg [Diagnostic Imaging]; Ultrasonography

Patient-reported behavior and problems in using glaucoma medications. - Sleath, Betsy; Robin, Alan L; Covert, David; Byrd, John E; Tudor, Gail; Svarstad, Bonnie (Ophthalmology, 2006)
OBJECTIVE: The objectives of the current study were to describe the different types of problems patients receiving adjunctive therapy reported having when taking their glaucoma medications and to examine the relationship between patient-reported problems in taking their glaucoma medications and patient adherence., DESIGN: Cross-sectional survey., PARTICIPANTS: A survey was distributed to glaucoma patients in 4 geographically distinct ophthalmology practices. We excluded patients using only 1 glaucoma medication. The survey was completed by 324 patients., METHODS: For each patient, average percent adherence to his or her glaucoma medication regimen was calculated. Logistic regression was used to examine how patient characteristics and problems in using glaucoma medications were related to reported adherence., MAIN OUTCOME MEASURE: Whether patients were less than 100% adherent in the previous week., RESULTS: We found that 60% of patients reported 1 or more problems with taking their glaucoma medications. Fourteen percent of patients reported being less than 100% adherent to their glaucoma regimen medications during the previous week. Patients who had difficulty remembering to take their glaucoma medications and those who reported that they had other problems or concerns with their glaucoma medications were significantly less likely to be 100% adherent., CONCLUSIONS: Patient adherence to a glaucoma medication regimen could be improved among patients receiving adjunctive therapy. Ophthalmologists and their clinical colleagues should make sure to discuss the problems and concerns that patients may have in taking their glaucoma medications in an effort to improve adherence.
Keywords: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Humans; Logistic Models; Male; *Medication Errors; *Memory; Middle Aged; *Patient Compliance; Surveys and Questionnaires

Prolonging contact lens wear and making contact lens wear safer. - Foulks, Gary N (American journal of ophthalmology, 2006)
PURPOSE: To summarize the present status of safety and efficacy of contact lens wear., DESIGN: Literature review., METHODS: Ovid Medline searches were performed on records from 1966 through 2005 using keywords: keratitis, contact lens complications, extended-wear contact lenses, and silicone-hydrogel contact lenses., RESULTS: Patients desire comfort, clarity of vision, and prolonged contact lens wear when contact lenses are used to correct refractive error. Practitioners desire patient satisfaction but also require maintenance of the integrity of the eye and no complications that jeopardize vision or health of the eye. Improvements in the oxygen permeability of the contact lens materials, design of the contact lens and its surface, and solutions for the maintenance of the lens have reduced but not eliminated the risks of infection, inflammation, and conjunctival papillary reaction associated with contact lens wear. The lessons of past and recent history suggest that patient education and practitioner participation in the management of contact lens wear continue to be critical factors for patient satisfaction and safety in the extended wear of contact lenses., CONCLUSIONS: The availability of highly oxygen permeable contact lenses has increased the tolerance and safety of extended contact lens wear, but patient instruction and education in proper use and care of lenses is required and caution is advised.
Keywords: Contact Lenses/ae [Adverse Effects]; *Contact Lenses/sn [Statistics & Numerical Data]; Contact Lenses, Extended-Wear/ae [Adverse Effects]; Contact Lenses, Extended-Wear/sn [Statistics & Numerical Data]; Equipment Safety; Humans; Oxygen/me [Metabolism]; Patient Satisfaction; Permeability; *Refractive Errors/th [Therapy]

Switching from dorzolamide to brinzolamide: effect on intraocular pressure and patient comfort. - Inoue, Kenji; Wada, Shige-aki; Wakakura, Masato; Inoue, Jiro; Tomita, Goji (Japanese journal of ophthalmology, 2006)
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Patient Satisfaction; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiazines/ae [Adverse Effects]; *Thiazines/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Tonometry, Ocular

Should patients choose their own eyedrops?. - Buller, Alex; Hercules, Brian L (Acta ophthalmologica Scandinavica, 2006)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Drug Administration Schedule; Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Satisfaction; Surveys and Questionnaires; Time Factors

Socioeconomic differences in glaucoma patients' knowledge, need for information and expectations of treatments. - Hoevenaars, Juliette G M M; Schouten, Jan S A G; van den Borne, Bart; Beckers, Henny J M; Webers, Carroll A B (Acta ophthalmologica Scandinavica, 2006)
PURPOSE: To study the specific items for which socioeconomic differences in glaucoma patients' knowledge, need for information and expectations of treatments exist, with the aim of developing a patient education programme., METHODS: A total of 44 randomly selected ophthalmologists assigned 166 consecutive outpatient glaucoma patients to complete a questionnaire that had been systematically developed based on focus group interviews, suggestions from several experts and a pilot test. Topics included knowledge about glaucoma and its treatment, need for information and expectations of treatment. Educational level was used as a measure for socioeconomic status. Logistic regression analysis was conducted to adjust for age, sex and duration of glaucoma., RESULTS: After adjusting for age, sex and duration of glaucoma, knowledge of glaucoma and its treatment was found to be positively correlated with socioeconomic status. Items on knowledge with socioeconomic differences concerned risk factors, pathophysiology and consequences of glaucoma, as well as effects and adverse effects of treatments. The lowest socioeconomic group demonstrated more need for information on public assistance and practical aspects of glaucoma and more often expected that glaucoma damage could be repaired., CONCLUSION: Important socioeconomic differences in knowledge, need for information and expectations of treatment exist in glaucoma patients. Patient education should focus on every glaucoma patient, but better information for the lower socioeconomic groups about specific items mentioned in this study might reduce the negative effects of low socioeconomic status on visual impairment.
Comment in (CIN)
Keywords: Adult; Aged; Attitude to Health; Cross-Sectional Studies; Educational Status; Female; Focus Groups; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Health Behavior; *Health Knowledge, Attitudes, Practice; Humans; Information Services; Male; Middle Aged; Ophthalmology/ed [Education]; *Patient Education as Topic; *Patient Satisfaction; *Socioeconomic Factors; Surveys and Questionnaires

ReGAE 1: using the Shah-Cross model as an orientating framework in African-Caribbean glaucoma research. - Shah, P; Cross, V (Eye (London, England), 2006)
The inter-relationship between health-care research, policy and service development is convoluted and difficult to articulate. This paper describes a framework for planning research into a range of ophthalmic conditions differentially associated with specific ethnic groups. It discusses the utility of the 'Shah-Cross Model' in mapping development of a glaucoma research project, and communicating its implications for local eye-care policy and ophthalmic services directed towards detection and management of primary open-angle glaucoma in the African-Caribbean population in the UK.
Keywords: *African Continental Ancestry Group/px [Psychology]; *Delivery of Health Care/og [Organization & Administration]; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/eh [Ethnology]; Glaucoma, Open-Angle/et [Etiology]; Health Behavior; Health Knowledge, Attitudes, Practice; Health Services Research/mt [Methods]; Humans; *Models, Organizational; Patient Acceptance of Health Care; United Kingdom

Systemic side effects of inhaled corticosteroids in patients with asthma. - Dahl, Ronald (Respiratory medicine, 2006)
Asthma is a complex disease of the respiratory tract associated with chronic inflammation in which an intricate network of cells and cellular factors plays a major role. Asthma is one of the most common chronic diseases, with an estimated 300 million cases worldwide, imposing a considerable burden on society in morbidity, quality of life, and healthcare costs. Inhaled corticosteroids (ICSs) form the gold standard, first-line therapy in the effective management of persistent asthma and reduce morbidity and mortality from asthma. However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitary-adrenal-axis suppression, measured by serum or urine cortisol decrease, correlates with the occurrence of systemic side effects of high-dose ICSs. Therefore, cortisol may be a relevant surrogate marker to identify the potential for adverse effects from ICS therapy. Ciclesonide is a new generation ICS with demonstrable safety and efficacy in the treatment of asthma. The unique pharmacologic characteristics of ciclesonide, such as reduced local adverse effects, lack of cortisol suppression, and the option for once-daily dosing, may improve compliance with therapy and allow long-term use of ICSs without fear of systemic adverse effects.
Keywords: Administration, Inhalation; *Adrenal Cortex Hormones/ae [Adverse Effects]; Adrenal Insufficiency/ci [Chemically Induced]; Adult; Anti-Allergic Agents/ae [Adverse Effects]; *Asthma/dt [Drug Therapy]; Bone Density/de [Drug Effects]; Cataract/ci [Chemically Induced]; Child; Child Development/de [Drug Effects]; Contusions/ci [Chemically Induced]; Glaucoma/ci [Chemically Induced]; Humans; Hydrocortisone/bl [Blood]; Hydrocortisone/ur [Urine]; Hypothalamo-Hypophyseal System/de [Drug Effects]; Osteoporosis/ci [Chemically Induced]; Pituitary-Adrenal System/de [Drug Effects]; Pregnenediones/ae [Adverse Effects]; Skin Diseases/ci [Chemically Induced]

Measurement of persistence and adherence to regimens of IOP-lowering glaucoma medications using pharmacy claims data. - Wilensky, Jacob; Fiscella, Richard G; Carlson, Angeline M; Morris, Lisa S; Walt, John (American journal of ophthalmology, 2006)
PURPOSE: Determine persistence and adherence of glaucoma patients to therapeutic regimens of prostaglandin/prostamide-class IOP-lowering medications., DESIGN: Retrospective, population-based study., METHODS: Glaucoma patients in the IMS Health LifeLink database with a pharmacy claim for latanoprost (n = 1567), travoprost (n = 381), or bimatoprost (n = 476) between September, 2001 and March, 2002 who had no claims for IOP-lowering medication in the previous 180 days, and who were persistent during the first 90 days of therapy. Values reported in the quantity dispensed and days supply fields of the database were used in an algorithm that corrected anomalous data and adjusted days supply to calculate the main outcome measures, persistence, and adherence to therapy., RESULTS: The percentage of patients persistent for the 12-month observation period was 69.4% (1087/1567) for those prescribed latanoprost, 70.6% (269/381) for those prescribed travoprost, and 68.1% (324/467) for those prescribed bimatoprost. Mean adherence for patients prescribed latanoprost was 75.4% of the year, for those prescribed travoprost, 77.1% of the year, and for those prescribed bimatoprost, 78.2% of the year. The mean number of days adherent for bimatoprost-treated patients (291.2 days) was significantly greater than for latanoprost-treated patients (281.0 days), and not remarkably different from travoprost-treated patients (287.0 days)., CONCLUSIONS: Overall, patients in this study who were taking IOP-lowering prostaglandin/prostamide medications had a mean adherence rate of 76% on average, suggesting that opportunities remain for improvement of adherence to therapeutic regimens for glaucoma treatment with prostamides and prostaglandins.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Drug Prescriptions/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Patient Compliance/sn [Statistics & Numerical Data]; *Pharmacies/sn [Statistics & Numerical Data]; Preferred Provider Organizations/sn [Statistics & Numerical Data]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Retrospective Studies

Evaluation of quality of life for patients with glaucoma. - Spaeth, George; Walt, John; Keener, John (American journal of ophthalmology, 2006)
PURPOSE: To understand the impact of glaucoma on ability to function and on quality of life to guide therapeutic choices and strategies for improved adherence to therapeutic regimens and to suggest alterations to environments to help the patient to cope better with the effects of the disease., DESIGN: Review of the published literature on quality-of-life assessments of patients with glaucoma., METHODS: The published literature on quality-of-life impacts of glaucoma was reviewed with a focus on the design and evolution of quality-of-life instruments, correlations of responses with objective measures of disease progression, and insights that were gained from the analyses of results., RESULTS: Information about the impact of glaucoma has been derived from responses to general health-related questionnaires, vision-specific questionnaires, and questionnaires that were designed to be glaucoma specific. Responses to glaucoma-specific instruments tend to correlate best with visual field measurements and other objective measures of disease progression, which suggests that such responses reflect the effects of glaucoma rather than the effects of other health-related issues in this patient population. Recent advances in the design of glaucoma-specific instruments and in analysis of the responses to them have provided some interesting insights. For example, patients who have experienced significant (peripheral) visual field loss attach greater importance to their central vision than do patients with less-advanced disease, but these patients seem to have accepted or adapted to their difficulties with outdoor mobility., CONCLUSION: Continued improvements in the collection and analysis of quality-of-life data should assist health care providers with the effective delivery of therapies to patients with glaucoma.
Keywords: Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; Humans; *Quality of Life/px [Psychology]; Sickness Impact Profile; Surveys and Questionnaires; Vision Disorders/pp [Physiopathology]; Visual Fields

Patient perspectives in glaucoma care: introduction to the American Journal of Ophthalmology Supplement. - Lee, Paul P (American journal of ophthalmology, 2006)
Keywords: *Glaucoma/th [Therapy]; Humans; Patient Satisfaction; Quality of Life

Accuracy of an electronic monitoring and reminder device for use with travoprost eye drops. - Boden, Catherine; Sit, Arthur; Weinreb, Robert N (Journal of glaucoma, 2006)
PURPOSE: To evaluate the accuracy of a prototype electronic device for recording eye drop usage., PARTICIPANTS AND METHODS: Ten volunteers were randomly assigned to one of five usage patterns designed to mimic common patterns of use in glaucoma patients from 100% compliant to 50% compliant. All participants agreed to adhere to a pre-determined "dosing" schedule for 15 days using the monitoring/reminder device to instill artificial tears. Participants also recorded drop usage in a diary. The main outcome measures were device accuracy and reproducibility. Device accuracy was defined as the magnitude of the difference between the diary and device output for three variables: date, number of drops, and instillation time., RESULTS: Date stamping by the device was 100% accurate. The mean +/- SD time difference between the device and the diary was -2.0 +/- 19.7 minutes when data from all participants was pooled. In seven of the ten participants, the device did not record at least one drop. The mean +/- SD difference in the number of drops recorded by the device minus the diary was 0.16 +/- 0.97 when data from all participants was pooled., CONCLUSIONS: The prototype compliance reminder/monitoring device may underestimate compliance in some patients. The date and time stamping mechanisms were generally accurate and reproducible.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Drug Utilization; *Glaucoma/dt [Drug Therapy]; Humans; *Monitoring, Ambulatory/is [Instrumentation]; Monitoring, Ambulatory/mt [Methods]; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Reproducibility of Results; Travoprost

Penetrating keratoplasty for perforated corneal ulcers: preservation of iris by corneal debulking. - Vajpayee, Rasik B; Singhvi, Arun; Sharma, Namrata; Sinha, Rajesh (Cornea, 2006)
PURPOSE: This study was designed to study an alternative technique of lamellar separation of corneal layers for therapeutic keratoplasty in place of an en bloc removal of host corneal button in eyes with perforated corneal ulcers with pseudocornea., METHODS: Twelve eyes with perforated corneal ulcers with pseudocornea in which therapeutic keratoplasty was planned were included in the study. A new technique was used in which the host corneal tissue was removed in layers by lamellar dissection started peripherally and proceeding centripetally with care taken to prevent perforation at the site of iris incarceration. After injection of viscoelastic into the anterior chamber with a 26-gauge needle entered tangentially, the deeper layer of the cornea was then gently dissected and peeled away from the iris tissue, with care not to avulse the fragile iris and the overlying fibrotic membrane. Adjunctive procedures were performed, and the donor tissue was secured over the host bed., RESULTS: A complete separation of the iris tissue from corneal button and the fibrous membrane was achieved in 9 eyes. In 3 eyes, iris was partly trimmed along with the fibrous membrane, because the membrane was totally adherent to the iris tissue. Eight patients required pupilloplasty. Apart from minimal bleeding, no other complication was encountered. At the end of 3 months, 9 of 12 grafts remained clear., CONCLUSIONS: Debulking and layer-by-layer removal of host corneal tissue is effective in preservation of iris while performing therapeutic keratoplasty in eyes with perforated corneal ulcers with pseudocornea.
Keywords: Adult; Aged; *Cornea/su [Surgery]; Corneal Ulcer/mi [Microbiology]; *Corneal Ulcer/su [Surgery]; Corneal Ulcer/vi [Virology]; Eye Infections, Bacterial/mi [Microbiology]; *Eye Infections, Bacterial/su [Surgery]; *Eye Infections, Viral/su [Surgery]; Eye Infections, Viral/vi [Virology]; Female; Humans; *Keratoplasty, Penetrating/mt [Methods]; Male; Middle Aged; Rupture, Spontaneous; Visual Acuity

What do glaucoma specialists know about their patients?. - Dietlein, Thomas S; Jordan, Jens; Dinslage, Sven; Krieglstein, Gunter K (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2006)
BACKGROUND: Although interaction between doctor and patient is undoubtedly influenced by their mutual expectations, little information is available about the knowledge and expectations of glaucoma doctors concerning their patients' attitudes and treatment patterns. The aim of our prospective study was to compare the actual responses of glaucoma patients concerning various issues related to their disease and the responses the glaucoma doctors expected their patients to give., METHODS: Glaucoma patients consecutively sent to our glaucoma centre were asked to complete a standardised questionnaire about their glaucoma history, treatment routines and opinions on issues related to glaucoma. Ophthalmologists at the glaucoma centre were asked to predict patients' answers., RESULTS: One hundred and twenty-eight consecutive glaucoma patients completed the patients' questionnaire and 12 glaucoma specialists completed the corresponding questionnaire for doctors. Frequency of intraocular pressure (IOP) measurements and visual field testing, as well as the number of topical medications, were relatively accurately predicted by the glaucoma doctors. Differences between the doctors' predictions and patients' responses were found concerning discomfort after surgery and the influence of stress or environmental factors on IOP. The largest range of doctors' predictions (0-100%) was observed concerning the portion of patients claiming a 100% adherence to glaucoma medication., CONCLUSION: Glaucoma specialists are familiar with the treatment patterns of their patients. The knowledge of glaucoma specialists of their patients' subjective attitudes to glaucoma-related issues deserves further investigation, as discrepancies between doctors' and patients' responses were observed in this area.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Filtering Surgery; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Medicine; Middle Aged; Ophthalmology; Patient Compliance; Physician's Role; *Physician-Patient Relations; Pilot Projects; Prospective Studies; Specialization; Surveys and Questionnaires

The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients. - Day, D G; Sharpe, E D; Atkinson, M J; Stewart, J A; Stewart, W C (Eye (London, England), 2006)
PURPOSE: To provide initial validation of the Treatment Satisfaction Survey-Intraocular Pressure (TSS-IOP) quality-of-life survey that analyses specific issues related to side effects, patient satisfaction, and compliance., METHODS: A prospective, observational cohort of 250 consecutive patients with primary open-angle glaucoma or ocular hypertension was administered the TSS-IOP survey., RESULTS: Factors that correlated with patient satisfaction included perceived effectiveness of the medicine (F=7.47, P<0.001), ocular irritation (F=6.06, P<0.001), conjunctival hyperaemia (F=4.40, P<0.001), ease of use (F=8.52, P<0.001), and convenience of use (F=6.90, P<0.001). Patient compliance, acceptance of their illness, and knowledge of glaucoma were also related to perceived effectiveness of the medicine (P<0.001), ease of use (P<0.05) and convenience (P<0.001). Physician ratings of patient pressure control, side effects, and instillation problems also were significantly correlated to patient satisfaction (R=0.13-0.26, P=0.05-0.001). The physician ratings of patient compliance, however, were not significantly related to any dimension of patient satisfaction (P>0.05). Among monotherapy prostaglandin treatments, latanoprost demonstrated statistically greater satisfaction than bimatoprost or travoprost regarding conjunctival hyperaemia (P<0.05) and eye irritation (P<0.01)., CONCLUSIONS: This study provides initial evidence that patient satisfaction may be related to compliance, perceived effectiveness of treatment, adverse side effects, ease and convenience of use, acceptance of illness, and knowledge of glaucoma.
Keywords: Aged; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Administration Schedule; Female; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; Health Knowledge, Attitudes, Practice; Health Status Indicators; Humans; Intraocular Pressure; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/px [Psychology]; Ophthalmic Solutions; Patient Compliance; *Patient Satisfaction; Psychometrics; Surveys and Questionnaires; Treatment Outcome

Efficacy and safety of bimatoprost for the treatment of open-angle glaucoma and ocular hypertension: a three-month, open-label study in community-based practices in Thailand. - Wanichwecha-Rungruang, Boonsong; Iemsomboon, Wallop (Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005)
The authors evaluated the effectiveness and safety of bimatoprost using an open-label, non-comparative, three-month, community-based surveillance study. Patients (n = 458) with open-angle glaucoma or ocular hypertension received bimatoprost 0.03% ophthalmic solution as monotherapy, replacement therapy or adjunctive therapy. Bimatoprost produced a rapid, significant (p < 0.0001) reduction in intraocular pressure: monotherapy (34.6% reduction), replacement therapy (16.4% reduction); adjunctive therapy (24.1% reduction). Bimatoprost enabled more patients to achieve their pre-defined target intraocular pressure (p < 0.0001), compared to previous treatments, and significantly lowered intraocular pressure, regardless of the patients' baseline pressure level or history of pressure control. Bimatoprost was well-tolerated; the most commonly reported adverse event was conjunctival hyperaemia (19.9%). Most patients and ophthalmologists rated bimatoprost highly, compared to previously used treatments. The authors concluded that bimatoprost is an effective, well-tolerated treatment for lowering intraocular pressure in Thai patients with open-angle glaucoma or ocular hypertension.
Keywords: Amides; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/aa [Analogs & Derivatives]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Lipids/ad [Administration & Dosage]; Lipids/ae [Adverse Effects]; *Lipids/tu [Therapeutic Use]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ae [Adverse Effects]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Satisfaction; Population Surveillance; Safety; Thailand; Treatment Outcome

[Post-traumatic glaucoma with irido-corneal angle injuries in Cameroon]. - Ellong, A; Ebana Mvogo, C; Nyouma Moune, E; Bella-Hiag, A; Ngosso, A; Njoh Litumbe, C (Bulletin de la Societe belge d'ophtalmologie, 2005)
AIM: To study the particularities of late post-traumatic glaucoma with irido-corneal angle injuries in black Cameroonians., MATERIAL AND METHODS: Retrospective analysis of 1343 files of glaucomatous patients was carried out from January 1991 to December 2001 at the Douala General Hospital in Cameroon in Central Africa. Fifty seven of them had post-traumatic glaucoma. Of these 28 were secondary to irido-corneal angle injuries., RESULTS: The prevalence of post-traumatic glaucoma related to irido-corneal angle injuries in our population was 2.1%. The mean patients age was 45.9 +/- 18.3 years (range, 17 to 67 years). The time from injury to diagnosis ranged from 1 year 4 months to 7 years (median: 3.7 years). The follow-up period ranged from 3 months to 5 years 6 months, with a mean of 1.7 +/- 1.9 years. The prevalence of monocular blindness was 61.9% and 81% at the first and last examination respectively. The mean intraocular pressure was 36.9 +/- 13.8 mmHg (range: 22 and 66 mmHg) at the first examination and 24.3 +/- 13 mmHg (range: 12 and 29 mmHg) at the last examination. The mean recorded cup/disc ratio was 0.8 +/- 0.2. It was equal to 1.0 in 61.9% of cases. Irido-corneal angle recession was the most common lesion (61.9%) followed by iridodialysis (38.1%) and cyclodialysis (14.3%). Normalization of the intraocular pressure was achieved with medical treatment in 23.8% and with trabelectomy in 12.3% of the cases. Neovascular glaucoma was found in 4.8% of the cases., CONCLUSION: The treatment of secondary post-traumatic open angle glaucoma is disappointing. The patients are young, the disease is advanced, and the compliance and follow-up are poor. The prevention of post-traumatic glaucoma is based on the control of ocular trauma and the periodic follow-up of patients with and history of non perforating injury of the eye.
Keywords: Adolescent; Adult; Aged; Blindness/ep [Epidemiology]; Cameroon/ep [Epidemiology]; Comorbidity; Corneal Injuries; *Eye Injuries/ep [Epidemiology]; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Iris/in [Injuries]; Male; Middle Aged; Prevalence; Retrospective Studies; Treatment Outcome

A review of the choice of therapy in primary open angle glaucoma. - Omoti, A E (Nigerian journal of clinical practice, 2005)
We are in the midst of a therapeutic revolution and the choice of therapy in the management of glaucoma can no longer be based on long-held beliefs. The choice between medical, surgical and argon laser trabeculoplasty as primary therapy for glaucoma has been a matter of debate and research for many years. Arguments are based mainly on 3 factors: efficacy, safety and cost. In Africa, other factors that must be considered include acceptability of surgery, compliance with medical therapy, scarcity and expense of modern drugs, absence of laser facilities among others. It is generally accepted that trabeculectomy surgery is the most acceptable form of therapy in Africans mainly because of its efficacy, late presentation and problems encountered during medical therapy. However many African patients are reluctant to have surgery for glaucoma mainly because of fear and the fact that there will be no visual improvement after the surgery. There are now several potent modern drugs, which though expensive have acceptable safety profile, and fewer problems with compliance. The decision on the choice of therapy should be individualized and not be based on long-held beliefs.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Decision Making; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure/ph [Physiology]; *Trabeculectomy; Treatment Outcome

Comparison of latanoprost monotherapy and combined therapy of 0.5% timolol and 1% dorzolamide in chronic primary angle-closure glaucoma (CACG) in Japanese patients. - Sakai, Hiroshi; Shinjyo, Sayo; Nakamura, Yoshimi; Nakamura, Yuko; Ishikawa, Shusaku; Sawaguchi, Shoichi (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2005)
To compare the efficacy, adverse effects, and patient compliance of latanoprost monotherapy with unfixed combination therapy with 0.5% timolol maleate and 1% dorzolamide in the treatment of chronic primary angle-closure glaucoma (CACG), 36 Japanese patients with CACG following laser iridotomy (LPI) were treated for 12 weeks with instillation of latanoprost alone or with unfixed combination therapy of 0.5% timolol maleate and 1% dorzolamide hydrochloride. After 12 weeks of treatment, latanoprost reduced intraocular pressure (IOP) from 22.2 +/- 2.0 mmHg to 14.8 +/- 1.9 mmHg (33% reduction); timolol maleate and dorzolamide hydrochloride also reduced IOP from 22.5 +/- 2.2 mmHg to 17.1 +/- 2.7 mmHg (24% reduction). Latanoprost monotherapy significantly lowered IOP compared with unfixed combination therapy of 0.5% timolol maleate and 1% dorzolamide hydrochloride. Furthermore, a systemic adverse effect of bradycardia was not observed in the latanoprost monotherapy group. Concerning compliance, no significant difference was observed between the two groups. Thus, latanoprost monotherapy is more effective than unfixed combination therapy with 0.5% timolol maleate and 1% dorzolamide in the treatment of CACG following relief of pupillary block in Japanese patients.
Keywords: Aged; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Chronic Disease; Drug Combinations; Female; *Glaucoma, Angle-Closure/dt [Drug Therapy]; Humans; Instillation, Drug; *Intraocular Pressure/de [Drug Effects]; Japan; Latanoprost; Male; Ophthalmic Solutions; Patient Compliance; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Influence of switching to travoprost on intraocular pressure of uncontrolled chronic open-angle glaucoma patients compliant to previously-used topical medication. - Hollo, Gabor; Vargha, Peter; Kothy, Peter (Current medical research and opinion, 2005)
OBJECTIVE: To investigate the influence of switching to travoprost on intraocular pressure (IOP) of chronic open-angle glaucoma (COAG) patients., RESEARCH DESIGN AND METHODS: Multicentre, open-label, non-comparative, 12-week, phase IV study conducted at 10 academic and hospital centres in Hungary. Patients' compliance to use of the pre-study medication was confirmed at a visit 10 days before the baseline measurements, and compliance was monitored throughout the study period., RESULTS: Of the 203 COAG patients three (1.48%) ceased travoprost medication due to ocular hyperaemia, and one subject was lost from follow-up. Self-reported compliance was optimal except for two patients. For the per-protocol analysis 197 patients were evaluable. IOP of the 37 per-protocol patients receiving additional travoprost medication decreased from 23.1 +/- 3.2 mmHg (mean +/- SD) to 17.3 +/- 2.6 mmHg at week 12 (p < 0.001). Switching the 121 per-protocol patients from latanoprost to travoprost IOP decrease from 20.8 +/- 3.5 mmHg to 17.7 +/- 2.4 mmHg (p < 0.001). IOP of the 11 patients switched from topical nonselective beta-blockers to travoprost decreased from 20.1 +/- 2.1 mmHg to 15.7 +/- 1.5 mmHg (p < 0.001). For the whole per-protocol population (n = 197) IOP decreased from 21.0 +/- 3.4 mmHg to 17.4 +/- 2.4 mmHg (p < 0.001). Defining responders as having an IOP decrease > 2.0 mmHg or >or= 5 mmHg at week 12, the responder rate was respectively 62.9% or 31% for the total study population; 86.5% or 54.1% when travoprost was added to the established therapy; 54.5% or 24.0% if latanoprost was switched to travoprost; and 90.9% or 36.4% for those who switched from beta-blockers., CONCLUSION: Travoprost provided a clinically and statistically significant IOP decrease in uncontrolled COAG patients whose self-reported compliance to their previous topical medication was optimal. Our results suggest that the IOP reduction found after switching to travoprost is not explainable by improved compliance due to the clinical study situation.
Keywords: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Patient Compliance; Travoprost

Telemedicine for eye care. - Tang, Rosa Ana; Morales, Marlene; Ricur, Giselle; Schiffman, Jade S (Journal of telemedicine and telecare, 2005)
Tele-ophthalmology has been employed mainly for patients in under-served rural areas in need of specialty care, but other applications such as telementoring have also been used. In certain populations, cost containment is a significant issue and telemedicine is a solution. Tele-ophthalmology can be performed in realtime, by store-and-forward mode, or by hybrid techniques. After appropriate modification, a range of peripherals may be used for tele-ophthalmology, including the direct ophthalmoscope, indirect ophthalmoscope, slit lamp or retinal camera. Tele-ophthalmology applications include: detecting, screening and diagnosing diabetic retinopathy; anterior segment imaging; glaucoma screening; low vision consultation; telementoring. Tele-ophthalmology shows great promise for improving patient care and increasing access to specialty care not available in under-served areas. In developing countries tele-ophthalmology may be a cost-effective method by which richer countries can assist them.
Keywords: *Diabetic Retinopathy/di [Diagnosis]; Female; *Glaucoma/di [Diagnosis]; Health Services Accessibility; Humans; Male; Ophthalmoscopy; Telemedicine/is [Instrumentation]; *Telemedicine/mt [Methods]; Vision Screening/is [Instrumentation]; *Vision Screening/mt [Methods]

Increasing compliance with glaucoma therapy: "so, convince me I have something wrong with my eyes". - Shaw, Mary E (Insight (American Society of Ophthalmic Registered Nurses), 2005)
Successful management of primary open-angle glaucoma (POAG) depends heavily on patient compliance with the treatment plan. Studies have clearly shown that early treatment will slow the progress of the POAG. Despite this fact, and even when treatment plans are negotiated with the patient, patient behavior may not be conducive to conserving vision in later life. Poor compliance results from a variety of causes, including lack of understanding of the diagnosis and the progress of POAG. As POAG is a "silent" condition, unless they are aware of visual loss at the point of presentation, POAG patients need to be convinced that there is actually something wrong with them. This paper explores how health care professionals can better understand their patients' response to a diagnosis of POAG.
Keywords: Female; *Glaucoma, Open-Angle/nu [Nursing]; Glaucoma, Open-Angle/th [Therapy]; Humans; Male; *Patient Care Planning; *Patient Compliance

Continuous light increment perimetry compared to full threshold strategy in glaucoma. - Wabbels, B K; Diehm, S; Kolling, G (European journal of ophthalmology, 2005)
PURPOSE: Continuous light increment perimetry (CLIP) is an improved testing strategy for automated static perimetry designed to save test time and enhance patient compliance. CLIP uses a modified ramp stimulus where stimulus intensity is continuously increased according to patient reaction time, starting from a subthreshold intensity until recognition. The test is constantly modified according to patient performance. As CLIP showed good results in normal subjects in previous studies, the authors now compared CLIP to the standard 4/2-full threshold (4/2) strategy in glaucoma patients., METHODS: Fifty-two patients with glaucomatous visual field defects (mean sensitivities 2.9 to 18.4 dB), all with perimetric experience, were tested with CLIP (three times) and 4/2 in a randomized fashion. Tests were performed at 55 test locations within the central 30 degree visual field (24-2 area) using the Twinfield perimeter., RESULTS: Average mean sensitivity was significantly higher for CLIP than for 4/2 (t test, p<0.0001). Absolute scotomas and extension of scotomas were comparable for both strategies, whereas CLIP found less deep relative scotomas in some cases. Mean test time was significantly shorter for CLIP (5.6 min) compared to 4/2 (8.9 min) (Wilcoxon signed rank test, p<0.0001). Patient acceptance was better for CLIP than for 4/2., CONCLUSIONS: CLIP showed comparable results to 4/2 with excellent patient acceptance. Mean sensitivities are 1.8 dB higher than for 4/2; similar results were found previously in normal subjects. CLIP was able to save a mean 38% of test time compared to full threshold strategy with good reproducibility.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; Patient Compliance; Photic Stimulation; Reproducibility of Results; *Scotoma/di [Diagnosis]; Sensory Thresholds; Time Factors; *Visual Field Tests/mt [Methods]; *Visual Fields

Compliance with medicine. - Shaya, Fadia T (Ophthalmology clinics of North America, 2005)
Compliance with medication regimens is critical in assessing the effectiveness of treatments. As new drugs are approved for marketing and prescribed to diverse patient populations, the FDA now recommends further observational studies to continuously monitor unforeseen side effects or efficacy. More research is needed to develop valid and reliable tools to assess adherence of patients to treatment recommendations and adherence of patients to treatment guidelines, when applicable. Information on adherence is a relevant to physicians and their patients as it is to insurers and payers, who need to implement cost-effective disease management programs. This review also has highlighted examples in the adherence literature specific to glaucoma medications and based on longitudinal survival analyses of claims data. Such results may be best complemented by primary, survey-based data collected from patients in observational studies.
Keywords: *Clinical Trials as Topic/mt [Methods]; Clinical Trials as Topic/px [Psychology]; Eye Diseases/dt [Drug Therapy]; Guideline Adherence; Humans; *Ophthalmology; *Patient Compliance

What is practical in glaucoma management?. - Rotchford, A (Eye (London, England), 2005)
This article addresses some important issues in the detection and management of glaucoma using examples from the developing world, particularly drawing on experiences and research in sub-Saharan Africa.
Keywords: Africa South of the Sahara; *Developing Countries; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; *Glaucoma/th [Therapy]; Humans; Manometry; Mass Screening/mt [Methods]; Patient Compliance; Trabeculectomy

The value of corneal transplantation in reducing blindness. - Garg, P; Krishna, P V; Stratis, A K; Gopinathan, U (Eye (London, England), 2005)
PURPOSE: To analyse the role of keratoplasty in reducing world blindness due to corneal diseases., METHODS: Review of published literature. We collected and analysed articles published in the English language literature related to the prevalence and causes of blindness in different parts of the world, causes of corneal blindness, and outcome of corneal transplantation for various corneal diseases., RESULTS: A total of 80% of the world's blind live in developing countries. Retinal diseases are the most important causes of blindness (40-54%) in established economy nations while cataract (44-60%) and corneal diseases (8-25%) are the most common causes of blindness in countries with less developed economies. Keratitis during childhood, trauma, and keratitis during adulthood resulting in a vascularized corneal scar and adherent leucoma are the most frequent causes of corneal blindness in developing countries. Corneal diseases are responsible for 20% of childhood blindness. Nearly 80% of all corneal blindness is avoidable. The outcome of keratoplasty for vascularized corneal scar and adherent leucoma is unsatisfactory, necessitating repeat surgery in a high proportion of these cases. Other barriers for keratoplasty in these nations are suboptimal eye banking, lack of trained human resources, and infrastructure., CONCLUSIONS: Since the developing world carries most of the load of corneal blindness and the major causes of corneal blindness are corneal scar and active keratitis, development of corneal transplantation services need a comprehensive approach encompassing medical standards in eye banking, training of cornea specialists and eye banking personnel and exposure of ophthalmologists to care of corneal transplants for better follow-up care. However, concerted efforts should be made to develop and implement prevention strategies since most corneal blindness is preventable.
Keywords: Blindness/ep [Epidemiology]; Blindness/et [Etiology]; *Blindness/su [Surgery]; Corneal Diseases/co [Complications]; Corneal Diseases/su [Surgery]; *Corneal Transplantation; Developing Countries; Graft Survival; Humans

The implications of the upregulation of ICAM-1/VCAM-1 expression of corneal fibroblasts on the pathogenesis of allergic keratopathy. - Okada, Naoko; Fukagawa, Kazumi; Takano, Yoji; Dogru, Murat; Tsubota, Kazuo; Fujishima, Hiroshi; Matsumoto, Kenji; Nakajima, Toshiharu; Saito, Hirohisa (Investigative ophthalmology & visual science, 2005)
OBJECTIVE: The present study investigated the expression of ICAM-1 and VCAM-1 on fibroblasts with interleukin (IL)-4 and/or tumor necrosis factor (TNF)-alpha stimulation and assessed the effect of eosinophil adhesion on fibroblast viability., METHODS: Primary cultured human corneal fibroblasts were incubated with IL-4, TNF-alpha, or their combination for 24 hours. Expression of ICAM-1 and VCAM-1 was examined by real-time quantitative PCR and flow cytometric analysis. Purified eosinophils were cocultured with activated fibroblasts, and the number of eosinophils adhered to fibroblasts and the number of damaged fibroblasts were counted using microscopy. In a separate trial, conjunctival and corneal impression cytology was performed on patients with atopic keratoconjunctivitis and corneal ulcers (eight eyes) to assess the status of the ocular surface epithelium and the presence of inflammatory cell infiltrates., RESULTS: Real-time quantitative PCR and flow cytometric analysis revealed that both mRNA and protein of VCAM-1 and ICAM-1 were upregulated by IL-4 and TNF-alpha. IL-5-primed eosinophils adhered to the corneal fibroblasts treated with IL-4 and TNF-alpha, and the fibroblasts were damaged by eosinophil adherence. Anti-ICAM-1 antibody and anti-VCAM-1 antibody inhibited the eosinophil adherence to fibroblasts and the fibroblast damage. Impression cytology revealed extensive infiltration of neutrophil and eosinophils among isolated ocular surface epithelial cells with advanced squamous metaplasia., CONCLUSIONS: Corneal fibroblasts expressed ICAM-1 and VCAM-1 when activated with IL-4 and TNF-alpha. Eosinophils can adhere to the activated fibroblasts and can induce subsequent fibroblast damage through these adhesion molecules. Eosinophil adhesion to fibroblasts may possibly contribute to the pathogenesis of severe persistent allergic corneal ulcers.
Keywords: Cell Adhesion; Cells, Cultured; Coculture Techniques; Conjunctivitis, Allergic/et [Etiology]; *Conjunctivitis, Allergic/me [Metabolism]; Conjunctivitis, Allergic/pa [Pathology]; Cornea/cy [Cytology]; *Cornea/de [Drug Effects]; Cornea/me [Metabolism]; Corneal Ulcer/et [Etiology]; *Corneal Ulcer/me [Metabolism]; Corneal Ulcer/pa [Pathology]; Drug Combinations; Eosinophils/me [Metabolism]; *Fibroblasts/de [Drug Effects]; Fibroblasts/me [Metabolism]; Fibroblasts/pa [Pathology]; Flow Cytometry; Gene Expression; Humans; In Situ Nick-End Labeling; Intercellular Adhesion Molecule-1/ge [Genetics]; *Intercellular Adhesion Molecule-1/me [Metabolism]; Interleukin-4/pd [Pharmacology]; RNA, Messenger/me [Metabolism]; Reverse Transcriptase Polymerase Chain Reaction; Tumor Necrosis Factor-alpha/pd [Pharmacology]; Up-Regulation; Vascular Cell Adhesion Molecule-1/ge [Genetics]; *Vascular Cell Adhesion Molecule-1/me [Metabolism]

Ophthalmic drug delivery considerations at the cellular level: drug-metabolising enzymes and transporters. - Attar, Mayssa; Shen, Jie; Ling, Kah-Hiing John; Tang-Liu, Diane (Expert opinion on drug delivery, 2005)
Ophthalmic drugs typically achieve < 10% ocular bioavailability. A drug applied to the surface of the eye may cross ocular-blood barriers where it may encounter metabolising enzymes and cellular transporters before it distributes to the site of action. Characterisation of ocular enzyme systems and cellular transporters and their respective substrate selectivity have provided new insight into the roles these proteins may play in ocular drug delivery and distribution. Altered metabolism and transport have been proposed to contribute to a number of ocular disease processes including inflammation, glaucoma, cataract, dry eye and neurodegeneration. As ocular enzyme and transport systems are better characterised, their properties become an integral consideration in drug design and development.
Keywords: Animals; Carrier Proteins/ge [Genetics]; Carrier Proteins/me [Metabolism]; *Drug Delivery Systems; *Eye/cy [Cytology]; Eye/en [Enzymology]; *Eye/me [Metabolism]; Eye Diseases/dt [Drug Therapy]; Humans; *Ophthalmic Solutions; Structure-Activity Relationship

Noncompliance with medical treatment among glaucoma patients in Oman--a cross-sectional descriptive study. - Khandekar, Rajiv; Shama, Mona El-Sayed; Mohammed, Ali Jaffer (Ophthalmic epidemiology, 2005)
PURPOSE: Glaucoma is a priority eye disease in Oman. In order to revise the existing policies for eye care, a study was conducted to review the noncompliance rates among glaucoma patients., METHODS: Using the random method, we selected 105 glaucoma patients from among those visiting glaucoma clinics during 2003. They were interviewed by trained health professionals. A closed-ended questionnaire with 42 questions was used to note their responses. The questions dealt with their personal characteristics along with the patients' glaucoma treatment and their knowledge of and attitudes towards different components of noncompliance with medical treatment. The field staffs also observed the 'practice' of instilling placebo eyedrops. The responses were analyzed to grade the compliance, knowledge, attitude and practice of each patient., RESULTS: Excellent compliance was found in 26 patients. Discontinuation of medication in the past was reported by 87 patients. Missing instillation of eyedrops and irregular visits to the ophthalmologist were noted in 10 and 14 patients, respectively. Adequate knowledge about glaucoma and its complications was negatively associated with noncompliance [RR 2.05 (95% CI 1.07-3.93)]., CONCLUSIONS: The high rates of noncompliance among glaucoma patients in Oman demand a systematic programmed approach. Longitudinal studies are needed to confirm the causal association between noncompliance and Knowledge, Attitude and Practice. Health education, communication while dispensing medication, reducing the frequency of medication and using devices for the easy administration of eyedrops could further improve compliance.
Keywords: Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Oman/ep [Epidemiology]; Surveys and Questionnaires; *Treatment Refusal/sn [Statistics & Numerical Data]

Primary open-angle glaucoma presentation at a tertiary unit in Africa: intraocular pressure levels and visual status. - Mafwiri, M; Bowman, R J C; Wood, M; Kabiru, J (Ophthalmic epidemiology, 2005)
AIM: To investigate the presentation of POAG at a tertiary referral hospital in East Africa, including intraocular pressures, visual status and management decisions., METHODS: Retrospective review of first-time presenters with POAG over a 6-month period., RESULTS: Of the 298 patients identified, mean age 57 years (n = 296, range = 14-88, SD = 14), 213 (72%) male, 122 (41%) had normal vision (using WHO better eye acuity criteria: visual impairment < 6/18, blind < 3/60) at presentation, 87 (30%) had visual impairment and 86 (29%) were blind. The mean presenting IOP was 32 mmHg (SD = 11) and 70% of the patients had a cup:disc ratio of 0.8 or worse in the better eye. Longer disease duration (OR = 1.20, 95% CI 1.04-1.39) and higher mean IOP (OR = 1.06, 95% CI 1.02-1.10) were associated with visual impairment or blindness. Intraocular pressure showed a negative linear correlation with presenting logMAR acuity (R(2) = 0.115, SE = 1.30, p < 0.0005). The mean IOP in eyes that had undergone trabeculectomy (19 mmHg, SD = 8, n = 17) was significantly (p < 0.0005) lower than that in eyes that had not (34 mmHg, SD = 12, n = 274). The referral rate for trabeculectomy was 158/275 (57%). Male sex (OR = 2.17, 95% CI 1.0-4.72), higher mean IOP (OR = 1.09, 95% CI 1.05-1.14) and not being blind (OR = 26.47, 95% CI 9.90-70.78) were associated with surgical referral. Of the 158 patients, 76 (48%) accepted surgery., CONCLUSIONS: A high proportion of patients presenting to our unit with POAG are visually impaired or blind and the higher their presenting IOP the poorer their visual acuity. Previous trabeculectomy was associated with lower IOPs and protection from visual impairment and blindness. Further training of clinic staff towards early surgical referral and investigation of gender barriers is required.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Blindness/di [Diagnosis]; Blindness/ep [Epidemiology]; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Retrospective Studies; Tanzania/ep [Epidemiology]; *Visual Acuity/ph [Physiology]; Visually Impaired Persons/sn [Statistics & Numerical Data]

[Pituitary-adrenal axis system condition in patients with open angle glaucoma]. - Dzhodzhua, T; Sumbadze, Ts (Georgian medical news, 2005)
Our study included 71 patients (38 males and 33 females) with diagnosed open angle glaucoma and healthy 71 persons for control group. Their age ranged from 45 to 70. The patients and healthy persons were divided into three groups: I group--45-55 years old persons, II group--55-65 years old persons, III group--65-75 years old persons. Examination included ophthalmologic and hormonal research. To assess the function of pituitary-adrenal axis, we measured the concentrations of cortisol, aldosterone and adrenocorticotropic hormone (ACTH) in the plasma of patients and control groups by radioimmunoassay method. The level of ACTH was decreased in I and II groups of females and in III group of males. The level of cortisol was increased in all--I, II and III groups of males. Aldosterone was decreased in III group of males and in I and III groups of females. According to our studies there were some changes in secretion of these hormones as well as in their regulation. The findings confirmed the role pituitary-adrenal axis of in the regulation of IOP. In compliance to our data, the investigation of the hormonal status of patients with glaucoma is recommended for complete understanding of glaucoma etiology and pathogenesis.
Keywords: Adrenocorticotropic Hormone/bl [Blood]; Adult; Aged; Aldosterone/bl [Blood]; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Hydrocortisone/bl [Blood]; Male; Middle Aged; *Pituitary-Adrenal System/pp [Physiopathology]

The probability of blindness in patients treated for glaucoma. - Chang, Li-Chun; Teng, Mei-Ching; Chang, Hsueh-Wen; Lai, Ing-Chou; Lin, Pei-Wen; Tsai, Jen-Chia (Chang Gung medical journal, 2005)
BACKGROUND: To investigate the risk factors and probability of blindness in patients treated for glaucoma., METHODS: The study design was a retrospective, hospital-based, clinical chart, review study. Medical records were reviewed from patients seen between January 2003 and December 2003 at the Kaohsiung Chang Gung Memorial Hospital eye clinic, who had been diagnosed with glaucoma in 1986 or later and who had been treated for at least 2 years for glaucoma., RESULTS: A total of 186 charts were reviewed, which included 66 patients who were blind in at least one eye from glaucoma on presentation. A total of 172 patients and 290 eyes were followed-up for a mean duration of 10.6 +/- 4.67 years. Twenty seven patients and 31 eyes developed blindness from glaucoma during follow-up. The Kaplan-Meier survival estimate at 16 years was 28.6% for glaucoma-related blindness in at least one eye. A worse visual field on presentation, older age, and poor compliance during therapy were significantly associated with the development of blindness. Glaucoma type, a gender difference, systemic disease, greater intraocular pressure fluctuation in the last year of therapy and blindness in one eye on presentation did not show a significant relationship with the rate of development of blindness., CONCLUSION: Blindness from treated glaucoma is considerable. Our results gave a 28.6% probability of blindness at 16 years in at least one eye. An older age, poor compliance and a worse visual field on presentation were significant risk factors.
Keywords: Adult; Age Factors; Aged; *Blindness/et [Etiology]; Female; *Glaucoma/co [Complications]; Humans; Intraocular Pressure; Male; Middle Aged; Probability; Retrospective Studies; Risk Factors

Current concepts and challenges in ocular surface reconstruction using cultivated mucosal epithelial transplantation. - Inatomi, Tsutomu; Nakamura, Takahiro; Koizumi, Noriko; Sotozono, Chie; Kinoshita, Shigeru (Cornea, 2005)
Ocular surface disorders wherein corneal stem cells are deficient result in total conjunctivalization leading to severe visual dysfunction and blindness. Treatment of these diseases requires reconstruction of the ocular surface using epithelial transplantation to provide a smooth refractive corneal surface and biologic and physical barriers against a variety of destructive factors. Recently, regenerative medicine focusing on tissue-engineered techniques has been developed and established as a new clinical field. In particular, cultivated mucosal epithelial transplantation using well-differentiated, stratified epithelial sheets on amniotic membrane allows a rapid re-epithelial cover over the entire corneal surface, resulting in early reduction of inflammation and cicatrization. This surgical approach dramatically improves the prognosis of severe ocular surface diseases, especially severely inflamed corneal stem cell deficiency. This new approach not only provides early epithelialization but also allows reconstruction of the corneal surface using autologous cultivated epithelium including the cornea and oral mucosa from a small number of cell sources after amplification. Tissue-engineered strategies using autologous corneal or oral mucosal epithelial sheet transplantation avoid the risk of rejection and complications associated with immunosuppressive treatments. In addition to new cellular transplantation, combined automated lamellar therapeutic keratoplasty provides better refractive stromal interference and contributes to performance and safety of cataract surgery in severe corneal opacity cases. Although long-term prognosis and cell biologic behavior of tissue-engineered epithelium after transplantation should be carefully monitored, these recent surgical treatments have opened a new field for ocular surface reconstruction.
Keywords: Corneal Transplantation; *Epithelium, Corneal/tr [Transplantation]; Humans; *Mouth Mucosa/tr [Transplantation]; *Ophthalmologic Surgical Procedures/td [Trends]; *Reconstructive Surgical Procedures/td [Trends]; Tissue Engineering; Transplantation, Autologous

Persistence and adherence with topical glaucoma therapy. - Nordstrom, Beth L; Friedman, David S; Mozaffari, Essy; Quigley, Harry A; Walker, Alexander M (American journal of ophthalmology, 2005)
PURPOSE: The present study describes the patterns and predictors of treatment persistence and adherence among patients who are diagnosed with glaucoma or as glaucoma suspects (based on claims codes)., DESIGN: A retrospective cohort study using health insurance claims data., METHODS: Newly treated individuals with diagnosed glaucoma (n = 3623) and suspect glaucoma (n = 1677) were obtained from healthcare claims data in the Ingenix Research Database. For each of these two diagnostic groups, we calculated the duration of continuous treatment with the initially prescribed medication (persistence) and the prevalence of use of the initial medication at various time points (adherence). Four drug classes were included: beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs., RESULTS: Nearly one half of the individuals who had filled a glaucoma prescription discontinued all topical ocular hypotensive therapy within six months, and just 37% of these individuals recently had refilled their initial medication at three years after the first dispensing. Prostaglandins were associated with better persistence than any other drug class, which was indicated by hazard ratios for discontinuation of prostaglandins compared with beta-blockers of 0.40 (95% confidence interval, 0.35-0.44) for diagnosed patients and 0.44 (95% confidence interval, 0.37-0.52) for patients with suspect glaucoma. Prostaglandins showed a similar advantage in adherence. Furthermore, patients with diagnosed glaucoma were more likely to adhere to therapy than patients with suspect glaucoma (relative risk = 1.11; 95% confidence interval, 1.05-1.18)., CONCLUSION: Persistence and adherence were substantially better with prostaglandins than with other drug classes, and patients with diagnosed open-angle glaucoma were more likely to adhere to treatment than suspected glaucoma.
Keywords: Administration, Topical; Adrenergic alpha-Agonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Cohort Studies; Databases, Factual; *Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Insurance, Health/sn [Statistics & Numerical Data]; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Patient Compliance/sn [Statistics & Numerical Data]; Prostaglandins/ad [Administration & Dosage]; Retrospective Studies; Self Administration; Time Factors

Benefits and side effects of bandage soft contact lens application after LASIK: a prospective randomized study. - Sekundo, Walter; Dick, H Burkhard; Meyer, Carsten H (Ophthalmology, 2005)
PURPOSE: To evaluate benefits and side effects of bandage soft contact lens (BSCL) insertion after LASIK in relation to patients' characteristics., DESIGN: Prospective, randomized, bicenter comparative investigational trial., PARTICIPANTS: One hundred patients (200 eyes) with myopia and/or myopic astigmatism., METHODS: Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours., MAIN OUTCOME MEASURES: Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients' subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal-Wallis 1-way analysis of variance on ranks test., RESULTS: Fifty-four percent of patients felt discomfort in the eye that had the BSCL (contra-BSCL subgroup), whereas 27% enjoyed having a BSCL (pro-BSCL subgroup). The remaining 19% felt no difference. The average Schirmer II value was 16.6 mm (+/-7.7) in the pro-BSCL subgroup, 14.9 mm (+/-6.4) in the no difference subgroup, and 12.3 mm (+/-7.7) in the contra-BSCL subgroup. There was a female preponderance in the contra-BSCL (39:15) and no difference (15:6) subgroups. A preoperative history of poor contact lens tolerance was recorded in 50% of the contra-BSCL subgroup patients; 41%, no difference; and 33%, pro-BSCL. Postoperative parameters such as first-day UCVA, number of eyes with microstriae, folds requiring stretching, or cases of diffuse lamellar keratitis did not differ significantly. Eyes with flap microstriae had a significantly deeper mean ablation (114.5 microm [range, 52-146 microm]) than eyes without any flap abnormalities (75.4 microm [39-120 microm]). No significant differences were found between the consecutive and simultaneous groups., CONCLUSION: The majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.
Keywords: Adult; *Astigmatism/su [Surgery]; Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Contact Lenses, Hydrophilic; Cornea/su [Surgery]; Female; Humans; *Keratomileusis, Laser In Situ; Male; *Myopia/su [Surgery]; Occlusive Dressings/ae [Adverse Effects]; *Occlusive Dressings; Pain, Postoperative; Patient Satisfaction; Postoperative Care/mt [Methods]; Postoperative Complications; Prospective Studies; Visual Acuity; *Wound Healing/ph [Physiology]

[Surgical controversy. Combined surgery in one procedure]. - Hamard, P (Journal francais d'ophtalmologie, 2005)
Combined surgery (phacoemulsification and penetrating or nonpenetrating filtering surgery) has the advantage of treating two distinct disorders in a single operation, with the objective of improving visual acuity and controlling ocular hypertension. In addition, it improves patient comfort and compliance to treatment. It lowers intraocular pressure more than simple lens surgery and the same as surgery carried out in two steps, notably with nonpenetrating filtering surgery, whereas the incidence of complications is lower. Our personal experience with 35 patients, operated on for phacoemulsification and deep sclerectomy with external trabeculectomy in the same operation confirms that this combined surgery in a single operation is effective in controlling ocular pressure in glaucoma subjects (mean reduction in tension, 23%), with few complications.
Keywords: Glaucoma/co [Complications]; *Glaucoma/su [Surgery]; Humans; Ophthalmologic Surgical Procedures/mt [Methods]; Retrospective Studies

[Medical treatments and practices. Ascertaining maximal drug treatment]. - Cochereau, I (Journal francais d'ophtalmologie, 2005)
Maximal drug treatment can be absolute, using all the combinations possible if no surgery can reasonably be undertaken, or relative, with surgery as the next step. The drug treatment is chosen in collaboration with the patient, who should always receive attentive explanations, detailing the prescription and adapting it to each situation so as to achieve maximum compliance.
Keywords: *Glaucoma/dt [Drug Therapy]; Humans

[Glaucoma in the young patient. Therapeutic problems]. - Denis, P (Journal francais d'ophtalmologie, 2005)
Achieving an adequate intraocular pressure (IOP) is critical to the successful management of children affected with juvenile glaucoma, in whom medical therapy is often insufficient to control IOP. Anti-glaucoma eyedrops are usually not approved for use in children but, however, are frequently used in pediatrics. Although ocular hypotensive eyedrops may be well tolerated in young patients, their chronic use is often problematic because of systemic side effects or noncompliance. Glaucoma filtering surgery with adjunctive antifibrosis therapy (particularly with mitomycin C), aqueous shunt surgery and cyclodestructive procedures are currently undertaken in patients with juvenile glaucoma. Filtration surgery is usually less successful in patients with juvenile glaucoma: the higher failure rate stems from the excessive wound healing response in younger patients, resulting in subconjunctival fibrosis.
Keywords: Adolescent; Age Factors; Child; Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; *Glaucoma/th [Therapy]; Humans

Systemic medications and glaucoma patients. - Covert, David; Robin, Alan L; Novack, Gary D (Ophthalmology, 2005)
Keywords: Adult; Aged; Aged, 80 and over; Arthritis/dt [Drug Therapy]; Arthritis/ec [Economics]; Cardiovascular Diseases/dt [Drug Therapy]; Cardiovascular Diseases/ec [Economics]; Comorbidity; Depressive Disorder/dt [Drug Therapy]; Depressive Disorder/ec [Economics]; Drug Costs; Drug Prescriptions; *Drug Therapy; Estrogen Replacement Therapy; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Humans; Hyperlipidemias/dt [Drug Therapy]; Hyperlipidemias/ec [Economics]; Male; Middle Aged; *Patient Compliance; Randomized Controlled Trials as Topic

Compliance: clear communication's critical. - Buller, A J; Connell, B; Spencer, A F (The British journal of ophthalmology, 2005)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Communication; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; Physician-Patient Relations

Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe. - Traverso, C E; Walt, J G; Kelly, S P; Hommer, A H; Bron, A M; Denis, P; Nordmann, J-P; Renard, J-P; Bayer, A; Grehn, F; Pfeiffer, N; Cedrone, C; et al. (The British journal of ophthalmology, 2005)
BACKGROUND: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase., METHODS: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated., RESULTS: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated 86 for each incremental step ranging from 455 euro per person year for stage 0 to 969 euro per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease., CONCLUSIONS: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Drug Costs/sn [Statistics & Numerical Data]; Europe; Female; Follow-Up Studies; *Glaucoma/ec [Economics]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; *Health Care Costs/sn [Statistics & Numerical Data]; *Health Resources/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; Office Visits/ec [Economics]; Severity of Illness Index; Sex Distribution; Visual Fields

Utility values among glaucoma patients: an impact on the quality of life. - Gupta, V; Srinivasan, G; Mei, S S; Gazzard, G; Sihota, R; Kapoor, K S (The British journal of ophthalmology, 2005)
AIM: To ascertain utility values and associated quality of life with different severity and duration of glaucoma among Indian patients., METHODS: Utility values of 105 consecutive patients with primary glaucoma of at least 12 months' duration were evaluated in a cross sectional study. Utility values were ascertained in five groups using both the time-trade off and standard gamble methods: group 1 (best corrected visual acuity in the better eye of 6/9 or better), group 2 (best corrected visual acuity in the better eye of 6/18 to 6/12), group 3 (best corrected visual acuity in the better eye of 6/36 to6/24), group 4 (best corrected visual acuity in the better eye of 3/60 to 6/60), and group 5 (best corrected visual acuity in the better eye of 3/60 or worse)., RESULTS: The mean utility value for the glaucoma group as a whole was 0.64 (SD 0.69; 95% confidence interval (CI), 0.58 to 0.70) with the time-trade off method and 0.86 (SD 1.00; 95% CI, 0.81 to 0.90) with the standard gamble method for a gamble of death and 0.97 (SD 1.00; 95% CI, 0.94 to 0.99) for a gamble of blindness. The mean utility results by the time-trade off method were as follows: group 1 = 0.66, group 2 = 0.66, group 3 = 0.62, group 4 = 0.55, and group 5 = 0.61. The utility value was much lower (0.46) in those with no formal education or only primary education compared to those with postgraduate education (0.75) (p = 0.038). Those patients with glaucoma of less than 5 years' duration had a utility score of 0.62 while those with glaucoma for more than 10 years had a score of 0.74 (p = 0.40)., CONCLUSIONS: Visual acuity loss occurring secondary to glaucoma is associated with a substantial decrease in patient utility value (and quality of life) in a developing country like India. The utility value is directly dependent on the degree of visual acuity loss associated with the disease and educational status and not on the duration of disease, the number of medications, or the visual field indices.
Comment in (CIN)
Keywords: Adult; Aged; Cross-Sectional Studies; Developing Countries; Female; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; Glaucoma/rh [Rehabilitation]; *Health Status Indicators; Humans; India; Linear Models; Male; Middle Aged; Patient Participation/mt [Methods]; *Quality of Life; Quality-Adjusted Life Years; Visual Acuity

12-week study comparing the fixed combination of brimonidine and timolol with concomitant use of the individual components in patients with glaucoma and ocular hypertension. - Goni, F J; Brimonidine/Timolol Fixed Combination Study Group (European journal of ophthalmology, 2005)
PURPOSE: To evaluate the efficacy and safety of fixed-combination brimonidine tartrate 0.2%/timolol 0.5% ophthalmic solution dosed BID and demonstrate non-inferiority to concomitant use of brimonidine tartrate 0.2% BID and timolol 0.5% BID in glaucoma and ocular hypertension patients with intraocular pressure (IOP) uncontrolled on monotherapy., METHODS: Randomized, multicenter, double-masked, parallel-group study involving 371 patients with inadequate IOP control (IOP from 22 to 34 mmHg) after > or =3 weeks of run-in on any monotherapy. Patients were treated with fixed-combination brimonidine/timolol BID (fixed-combination group, n = 188) or concomitant brimonidine BID and timolol BID (concomitant group, n = 183). IOP was assessed pre-dose and 2 hours after morning dosing at weeks 2, 6, and 12., RESULTS: A total of 355 patients (96%) completed the study. Patient demographics, run-in monotherapy, and baseline mean IOP on monotherapy were comparable between treatment groups. During follow-up, the mean reduction from baseline IOP was significant (p < 0.001) at all time points and ranged from 4.4 to 5.3 mmHg in each group. Brimonidine/timolol fixed combination was as effective as concomitant therapy with respect to mean IOP and mean change from baseline IOP at all time points and visits. Between-group differences were < or =0.35 mmHg for mean IOP and < or 0.30 mmHg for mean change from baseline IOP; none were significant. No unexpected side effects were associated with the fixed combination. Both treatments were well tolerated with no difference in adverse events between groups., CONCLUSIONS: Brimonidine/timolol fixed-combination therapy is as safe and effective as concomitant treatment with the individual components. Its simplified dosing regimen has the potential to improve compliance.
Keywords: Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ae [Adverse Effects]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; Quinoxalines/ae [Adverse Effects]; *Quinoxalines/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

Naturalistic, prospective study of glaucoma and ocular hypertension treatment in France: Strategies, clinical outcomes, and costs at 2 years. - Rouland, J-F; Le Pen, C; Benhaddi, H; Piriou, E; Lilliu, H; Kenigsberg, P-A; Glaucoma Study Group (European journal of ophthalmology, 2005)
PURPOSE: To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) in France., METHODS: Second-line patients were recruited from September 14, 1998, to December 20, 2000, in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure (IOP) levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management. This article reports results of the final analysis of 2-year follow-up data for patients with at least two contacts with a study ophthalmologist., RESULTS: Data were analyzed for 346 patients and 672 treated eyes. Monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 2.8+/-0.2 years after diagnosis, primarily due to insufficient IOP control (60.3%) and adverse drug reactions (18.3%). Relative risk (RR) (95% CI) for adverse drug reactions (ADR) under monotherapy was 1.00 (1.00-1.00) under beta blockers (n = 116) versus 0.40 (0.16-0.64) under latanoprost (n = 21), 2.30 under carbonic anhydrase inhibitors (n = 29), and 2.90 under adrenergics (n = 38); RR for ADR under combination therapy was 1.00 (1.00-1.00) for unfixed combinations without latanoprost (n = 66) versus 0.11 (0.00-0.22) for unfixed combinations of latanoprost + timolol (n = 3). Cardiac or pulmonary problems have been reported in 26.9% of patients. Persistency on initial therapy was 62.5% (95% CI 53.0-72.0) for latanoprost monotherapy versus 41.1% (34.8-47.4) for beta-blocker monotherapy and 43.6% (26.6-60.6) for the latanoprost + timolol combination versus 29.8% (15.2-44.4) for combination therapies that did not include latanoprost. Average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy: latanoprost + timolol did not cost more than therapeutic combinations without latanoprost., CONCLUSIONS: Insufficient IOP control and adverse drug reactions are the two main reasons for changing first-line treatment in patients with POAG or OH. After 2 years, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior safety and persistency to treatment at an acceptable cost.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/ec [Economics]; Delivery of Health Care/ec [Economics]; *Drug Costs; Drug Therapy, Combination; Female; Follow-Up Studies; France; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; Health Care Costs; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ec [Economics]; Patient Compliance; Prospective Studies; Treatment Outcome

Microbial keratitis in overnight orthokeratology: review of the first 50 cases. - Watt, Kathleen; Swarbrick, Helen A (Eye & contact lens, 2005)
PURPOSE: Despite growing evidence for clinical efficacy of orthokeratology (OK) for the temporary reduction of myopic refractive error, there has been an increasing number of reports of microbial keratitis (MK) in association with overnight wear of OK lenses. This article analyzes the first 50 cases of MK reported in overnight OK, in order to define the spectrum of the disease and to identify possible risk factors., METHODS: All reported cases of presumed MK in overnight OK from 2001 onwards were included in the analysis. Demographic data of patients affected and lenses worn, and details of the disease process and possible risk factors were extracted from these reports., RESULTS: Most cases of MK in OK were reported from East Asia (80%) and most affected patients were Asian (88%). The peak age range was from 9 to 15 years (61%). Although Pseudomonas aeruginosa was the predominant organism implicated in this series of cases (52%), an alarmingly high frequency of Acanthamoeba infection (30%) was found. Inappropriate lens care procedures, patient noncompliance with practitioner instructions, and persisting in lens wear despite discomfort emerged as potential risk factors., CONCLUSIONS: The high frequency of MK in overnight OK in young Asian patients is likely to reflect the demographics of the OK lens-wearing population. The high frequency of Acanthamoeba infection strongly suggests that tap water rinsing should be eliminated from the lens care regimen for overnight OK. This study does not reveal the absolute incidence or relative risk of MK in overnight OK, and it is therefore premature to ascribe increased risk to this lens-wearing modality compared with other contact lens modalities.
Keywords: Acanthamoeba Keratitis/eh [Ethnology]; *Acanthamoeba Keratitis/et [Etiology]; Adolescent; Adult; Age Distribution; Child; *Contact Lenses/sn [Statistics & Numerical Data]; Corneal Ulcer/eh [Ethnology]; *Corneal Ulcer/mi [Microbiology]; Eye Infections, Bacterial/eh [Ethnology]; *Eye Infections, Bacterial/et [Etiology]; Eye Infections, Fungal/eh [Ethnology]; *Eye Infections, Fungal/et [Etiology]; Female; Geography; Global Health; Humans; Male; Middle Aged; Myopia/th [Therapy]; Risk Factors

A three-month, multicenter, double-masked study of the safety and efficacy of travoprost 0.004%/timolol 0.5% ophthalmic solution compared to travoprost 0.004% ophthalmic solution and timolol 0.5% dosed concomitantly in subjects with open angle glaucoma or ocular hypertension. - Hughes, Bret A; Bacharach, Jason; Craven, E Randy; Kaback, Martin B; Mallick, Sushanta; Landry, Theresa A; Bergamini, Michael V W (Journal of glaucoma, 2005)
PURPOSE: The primary objective of this study was to compare the intraocular pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% fixed combination to the concomitant administration of travoprost 0.004% (TRAVATAN) and timolol 0.5% in subjects with open angle glaucoma or ocular hypertension., METHODS: This was a randomized, multicenter, double-masked, active-controlled, parallel group study. Three hundred sixteen patients with open angle glaucoma or ocular hypertension were randomly assigned to travoprost 0.004%/timolol 0.5% ophthalmic solution fixed combination once daily in the morning or concomitant administration of timolol 0.5% once daily in the morning and travoprost 0.004% ophthalmic solution once daily in the evening. The efficacy and safety of the fixed combination were compared with concomitant therapy over three months. The primary efficacy outcome measure was mean intraocular pressure., RESULTS: Both travoprost 0.004%/timolol 0.5% fixed combination and the concomitant administration of travoprost 0.004% and timolol 0.5% produced statistically significant reductions from baseline in IOP, with mean IOP ranging from 15.2 to 16.5 mm Hg in the patients using travoprost 0.004%/timolol 0.5% fixed combination compared with 14.7 to 16.1 mm Hg in the concomitant group. The upper 95.1% confidence limit for the differences in mean IOP (fixed combination minus concomitant) was < or =1.5 mm Hg at 7 of 9 visits, including all three 8 AM time points, 24-hours post-dose. Mean IOP reductions from baseline ranged from 7.4 to 9.4 mm Hg in the fixed combination group compared with 8.4 to 9.4 mm Hg with concomitant therapy. Safety analysis demonstrated equivalent safety between the two treatment groups., CONCLUSIONS: A fixed combination of travoprost 0.004% and timolol 0.5% produced clinically relevant IOP reductions in patients with open angle glaucoma or ocular hypertension that were comparable to concomitant therapy with its components. Safety and tolerability of the fixed combination were also equivalent to concomitant therapy. Travoprost 0.004%/timolol 0.5% fixed combination offers IOP reduction equivalent to concomitant therapy, with potential benefits that include convenience (fewer bottles and drops per day), improved compliance, cost savings (based on fewer co-payments), and elimination of potential washout effects.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Travoprost; Treatment Outcome

Letter to the editor: patient persistency with glaucoma therapy. - Fiscella, Richard; Stewart, William C (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2005)
Comment on (CON)
Keywords: Analysis of Variance; *Antihypertensive Agents/ad [Administration & Dosage]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Patient Compliance/sn [Statistics & Numerical Data]; *Patient Compliance; Treatment Outcome

Effectiveness of latanoprost (Xalatan) monotherapy in newly discovered and previously medicamentously treated primary open angle glaucoma patients. - Pavan, Josip; Stambuk, Nikola; Curkovic, Tihomir; Konjevoda, Pasko; Pavan-Jukic, Doroteja; Gotovac, Marta; Karaman, Ksenija (Collegium antropologicum, 2005)
We evaluated the effectiveness of latanoprost (Xalatan) monotherapy in primary open angle glaucoma (POAG). Latanoprost is a prostaglandin analogue, the pure 15(R) epimer of 13,14-dihydro-17-phenyl-18,19,20-trinor-PGF2alpha-isopropyl ester. As a prodrug it is being activated by enzymatic hydrolysis in the cornea after which it becomes active acid of latanoprost. Latanoprost is lowering the intraocular pressure (IOP) by increasing the uveoscleral outflow. In this study, latanoprost was used once daily as monotherapy what offers much better compliance for the patients than other combinations of drugs, preserving good IOP control. Based on the significant reduction of the IOP, measured on the day 60 of the trial (mean change in IOP was -5.1 mmHg, with 95% confidence interval in range from -5.6 to -4.5), it is concluded that use of latanoprost is advisable when calculating better IOP control, few side-effects and reductions in costs of potential surgical procedures.
Keywords: Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Neuroprotective Agents; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Treatment Outcome

Ocular findings seen among the staff of an institution in Lagos, Nigeria. - Ashaye, A O; Asuzu, M C (West African journal of medicine, 2005)
BACKGROUND: The degree to which ocular morbidity affects workers productivity in the developing countries has not been studied adequately. A federal government research institute based in Lagos introduced an annual health screen for all its workers, which included eye tests. This provided an opportunity to study the pattern of ocular conditions among workers who were 30 years and above, and to determine the effect of eye diseases on the workers productivity., STUDY DESIGN: Detailed eye examination including refraction, was done on every respondent at the institution's clinic by an ophthalmologist. A questionnaire on ocular health status and occupational history was administered independently by an ophthalmic nurse. Sickness absenteeism, use of the clinic were obtained from clinic records, and the results were analysed., RESULTS: The common ocular conditions were uncorrected or poorly corrected refractive error, uncorrected or poorly corrected presbyopia and allergic. conjunctivitis. Glaucoma, maculopathy and optic atrophy were causes of severe visual impairment or blindness in 1.9 % of the subjects. Absenteeism and clinic use were more common in subjects with ocular morbidity than those with non-ocular morbidity. Subjects with ocular morbidity had more illnesses, absenteeism and used the clinic more., CONCLUSION: Ocular problems which reduce worker's productivity are prevalent among the staff of the institution studied. They are mostly unrecognised.
Keywords: *Absenteeism; Academies and Institutes; Adult; Aged; Developing Countries; *Efficiency; Eye Diseases/cl [Classification]; Eye Diseases/di [Diagnosis]; *Eye Diseases/ep [Epidemiology]; Female; Humans; Male; Mass Screening; Middle Aged; Nigeria/ep [Epidemiology]; Occupational Diseases/di [Diagnosis]; *Occupational Diseases/ep [Epidemiology]; Surveys and Questionnaires; Urban Health; Workplace

A more proactive approach is needed in glaucoma care. - Friedman, David S; Cramer, Joyce; Quigley, Harry (Archives of ophthalmology (Chicago, Ill. : 1960), 2005)
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Behavior Therapy; *Delivery of Health Care; Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Patient Compliance; Patient Education as Topic; Physician-Patient Relations

Evaluation of an eye drop guide to aid self-administration by patients experienced with topical use of glaucoma medication. - Salyani, Asif; Birt, Catherine (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2005)
BACKGROUND: Methods to improve patient compliance with prescribed topical use of glaucoma medication are sorely needed. A guide for the topical administration of ocular medication was suggested as such a tool. We investigated whether eye drop self-administration would be improved with use of the guide., METHODS: An eye drop guide, a funnel-shaped device designed to fit within the contour of the orbital margins, was offered to 114 patients for use at home with their glaucoma medication. A questionnaire asking about the ease of eye drop self-administration was administered before and after 1 week's use of the device., RESULTS: Of the 111 patients who accepted the guide, 93 returned a usable completed questionnaire. Seventy-four percent said that they found it easier to administer their eye drops without the guide and preferred to do so (chi2 = 21.77, p < 0.01). Patients using more doses per day found it more difficult to administer their drops using the guide (r = -0.233, p < 0.05), and those who had been using drops longer preferred not to continue using the guide (r = -0.222, p < 0.05). Patients who found the written instructions clearer found it easier to administer their drops using the guide (r = 0.329, p < 0.05)., INTERPRETATION: Although intended to ease the administration of eye drops, the guide proved to be counterproductive. Further work is necessary to investigate other methods of improving patient compliance with prescribed topical use of ocular medications.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Drug Delivery Systems/is [Instrumentation]; *Drug Packaging; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Self Administration/is [Instrumentation]; Surveys and Questionnaires

Intraocular pressure control and persistence on treatment in glaucoma and ocular hypertension. - Tingey, David; Bernard, Lisa M; Grima, Daniel T; Miller, Betsy; Lam, Annette (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2005)
BACKGROUND: The purpose of this study was to characterize current patterns of treatment of glaucoma and ocular hypertension and to examine the effect of those patterns on intraocular pressure (IOP) control and persistence on therapy., METHODS: A retrospective chart review was conducted at 3 ophthalmology practices in Alberta. Data were collected for patients who had begun therapy for newly diagnosed primary open-angle glaucoma or ocular hypertension between May 1, 1998, and Sept. 30, 1999 (phase 1), and for patients who had begun second-line therapy after initial therapy with a beta-blocker had failed (phase 2). Data were collected for a minimum of 24 months for phase 1 and a minimum of 18 months for phase 2., RESULTS: We included 115 patient charts in phase 1 and 93 in phase 2. In each phase, the patients for whom latanoprost had been prescribed in unfixed combination with a beta-blocker had the greatest mean percentage reduction in IOP at month 24, and the patients for whom latanoprost had been prescribed alone or in combination with a beta-blocker were more likely to still be on initial therapy at month 24; the difference in persistence on therapy was statistically significant only in phase 1 (p = 0.001). The mean number of switches in therapy was smaller in phase 1 than in phase 2 in all therapy groups., INTERPRETATION: Compared with other first- and second-line forms of therapy, treatment with latanoprost, alone or in combination with a beta-blocker, was associated with greater reductions in IOP, better therapeutic persistence, fewer therapy switches and fewer ophthalmologist visits over a 2-year period.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; Practice Patterns, Physicians'; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Retrospective Studies

A comparison of participants and non-participants in the Chennai Glaucoma Study-rural population. - Paul, Pradeep P; George, Ronnie J; Arvind, Hemamalina; Raj, Madan; Augustian; Ramesh, S Ve; Sriram, Prema; Kumaramanickavel, Govindasamy; McCarthy, Catherine; Vijaya, Lingam (Ophthalmic epidemiology, 2005)
PURPOSE: To study whether the difference in the demographic characteristics of participants and non participants could result in biased prevalence estimates and associations., AIM: To compare the non-participant and participant characteristics, and to ascertain if non-response bias is present in the rural population of the Chennai Glaucoma Study (CGS)., METHODS: Rural participants and non-participants were compared with regard to socio-demographic variables (age, gender, religion, mother tongue, literacy and employment)., RESULTS: 4800 subjects aged 40 years or over were enumerated, 82% (3934: 45% male and 55% female) responded. Gender did not influence participation (adjusted OR-1.11, CI: .91-1.36). Subjects in the 70-79 year age group were more likely to respond (OR-1.76; CI-1.31-2.38). Hindus had a higher participation rate than Christians or Muslims (adjusted OR-2.63, CI: 1.80-3.84). The other predictors of participation were illiteracy (adjusted OR-1.44, CI: 1.22-1.70), unemployment (OR-1.28, CI: 1.04-1.58), place of residence (main villages) (OR-6.66, 95% CI: 4.6-9.64)., CONCLUSION: Based on our study findings, it does not seem likely that participation bias will affect the study results.
Keywords: Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Bias; Female; *Glaucoma/ep [Epidemiology]; Humans; India/ep [Epidemiology]; Male; Middle Aged; *Patient Participation/sn [Statistics & Numerical Data]; Prevalence; *Refusal to Participate/sn [Statistics & Numerical Data]; Religion; *Rural Population/sn [Statistics & Numerical Data]; Sex Distribution

The importance of models in glaucoma research. - Weinreb, Robert N; Lindsey, James D (Journal of glaucoma, 2005)
Experimental models have enhanced our understanding of the biology of glaucoma. Moreover, they have enabled the testing of potential therapies prior to the initiation of human trials. Each have advantages and limitations. In vitro cell and organ culture offer direct cellular accessibility and microenvironmental control, as well as efficient comparison between many experimental conditions or potential therapeutic compounds. However, they generally have less relevance to clinical glaucoma than in vivo models. Rat models allow moderate sized investigations of intact biological systems that have greater relevance to glaucoma than in vitro experiments, but less than primate experiments. Mouse models are similar to rat models but have the advantage of investigating mutant and transgenic strains mimicking specific aspects of glaucoma that are not available in other model systems. Primate models of glaucoma generally are the most relevant to human glaucoma but must be limited in scope because of availability and the high cost of experimentation.
Keywords: Animals; Biomedical Research; Cell Culture Techniques; Disease Models, Animal; *Glaucoma; Humans; *Models, Biological; Organ Culture Techniques; Tissue Donors

[Efficacy of Carbopol 974P (Siccafluid) in the treatment of severe to moderate keratoconjunctivitis sicca in patients with primary Sjogren's syndrome not responding to standard treatment with artificial tears]. - Ostuni, P; Battista, M E C; Furlan, A (Reumatismo, 2005)
OBJECTIVE: To determine efficacy and safety of Carbopol 974P in the treatment of severe to moderate keratoconjunctivitis sicca (KCS) in patients with primary Sjogren's syndrome (SS) not responding to standard treatment with artificial tears., METHODS: 60 patients (57 F, 3 M, mean age 52.5+/-12.0, mean disease duration 12.2+/-7.1 yrs) affected with primary SS diagnosed according to the European Community Study Group criteria were studied. Foregoing medications for SS and artificial tears for KCS have not been changed within 3 and 2 months respectively prior to the study onset. In all cases Carbopol 974P was added because symptoms of KCS were not adequately controlled with traditional lubricants. Schirmer I test, B.U.T. (break up time), rose Bengal-stain, clinical ophthalmological examination (i.e. fluorescein staining, keratis, corneal infiltrates and ulcers) and a questionnaire for dry eye symptoms (range 0-30) were performed at entry (T0) and after 2 (T1) and 12 (T2) weeks. Assessment of global efficacy was obtained by VAS 0-100 at T2 either by patients and by the ophthalmologist., RESULTS: Lachrymal tests significantly improved after 2 and, even more, after 12 weeks. Clinical ophthalmologic picture also ameliorated: a remarkable reduction of fluorescein positive lesions was demonstrated from 71.6% of the cases at T0 to 38.3% at T2. Total score of symptoms (T0: 16.1+/-7.3) dropped to 11.9+/-6.6 (T1) (p=0.000) and then to 6.7+/-5.3 (T2) (p=0.000). Global efficacy expressed by patients and physician was 74.8+/-15.9 and 76.6+/-13.0, respectively. No adverse events (blurred vision, allergy) were reported throughout the study., CONCLUSIONS: Our study seems to demonstrate that addition of Carbopol 974P to the traditional therapeutic armamentarium for moderate to severe KCS is useful and well accepted in patients with primary SS in which management of ocular symptoms is unsatisfactory.
Keywords: Acrylates/ad [Administration & Dosage]; *Acrylates/tu [Therapeutic Use]; Adult; Aged; Drug Resistance; Female; Gels; Humans; Keratoconjunctivitis Sicca/di [Diagnosis]; *Keratoconjunctivitis Sicca/dt [Drug Therapy]; Keratoconjunctivitis Sicca/et [Etiology]; Keratoconjunctivitis Sicca/pp [Physiopathology]; Lubricants/ad [Administration & Dosage]; *Lubricants/tu [Therapeutic Use]; Male; Middle Aged; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Acceptance of Health Care; *Sjogren's Syndrome/co [Complications]; Staining and Labeling; Surveys and Questionnaires; Tears/me [Metabolism]

Gene therapy in the cornea. - Mohan, Rajiv R; Sharma, Ajay; Netto, Marcelo V; Sinha, Sunilima; Wilson, Steven E (Progress in retinal and eye research, 2005)
Technological advances in the field of gene therapy has prompted more than three hundred phase I and phase II gene-based clinical trials for the treatment of cancer, AIDS, macular degeneration, cardiovascular, and other monogenic diseases. Besides treating diseases, gene transfer technology has been utilized for the development of preventive and therapeutic vaccines for malaria, tuberculosis, hepatitis A, B and C viruses, AIDS, and influenza. The potential therapeutic applications of gene transfer technology are enormous. The cornea is an excellent candidate for gene therapy because of its accessibility and immune-privileged nature. In the last two decades, various viral vectors, such as adeno, adeno-associated, retro, lenti, and herpes simplex, as well as non-viral methods, were examined for introducing DNA into corneal cells in vitro, in vivo and ex vivo. Most of these studies used fluorescent or non-fluorescent marker genes to track the level and duration of transgene expression in corneal cells. However, limited studies were directed to evaluate prospects of gene-based interventions for corneal diseases or disorders such as allograft rejection, laser-induced post-operative haze, herpes simplex keratitis, and wound healing in animal models. We will review the successes and obstacles impeding gene therapy approaches used for delivering genes into the cornea.
Keywords: Animals; Cornea/ph [Physiology]; *Corneal Diseases/th [Therapy]; Corneal Dystrophies, Hereditary/th [Therapy]; Corneal Opacity/th [Therapy]; Corneal Transplantation; Genetic Therapy/mt [Methods]; *Genetic Therapy; Genetic Vectors; Graft Survival; Humans; Wound Healing

I just want the protocol, doctor!. - McColl, E (Quality & safety in health care, 2005)
Comment on (CON)
Keywords: Clinical Protocols; *Clinical Trials as Topic; Female; Glaucoma, Open-Angle/th [Therapy]; Humans; Optometry; *Patient Participation; *Practice Guidelines as Topic; Pre-Eclampsia/th [Therapy]; Pregnancy

Ophthalmologic disorders in minority populations. - Wilson, M Roy; Eezzuduemhoi, Deborah R (The Medical clinics of North America, 2005)
Race- and ethnicity-related differences in prevalence of a number ofophthalmologic disorders have been documented. More importantly, blackand Hispanic Americans share a disproportionate share of morbidity, asmeasured by visual impairment and blindness, when compared with whiteAmericans. The reasons for this health disparity are complex andmultifactorial. If the unequal, individual, and societal burden of avoidable vision lossamong black and Hispanic Americans is to be decreased, it is essential tounderstand the apparent barriers to accessing timely and appropriateophthalmologic monitoring and care for these minority populations. Forthose who do gain access to ophthalmologic care, it is important tounderstand better the determinants leading to different treatment of blackand Hispanic Americans compared with white Americans. Opportunities for decreasing vision-related morbidity caused by cataract,diabetic retinopathy, and glaucoma for these minority groups clearly exist. Strategies for each of these ophthalmologic disorders may differ. Cataract isa reversible cause of visual impairment and removal of cataract improvesquality of life. Cataract surgery should be offered to all who can potentiallybenefit from this treatment. Earlier diagnosis, before the disease hasprogressed to loss of vision, should be a goal in both glaucoma and diabeticretinopathy. Strategies for screening high-risk groups may be particularlyrelevant in this regard. Additionally, with diabetic retinopathy, improvedmanagement of contributing risk factors, such as blood glucose control andblood pressure control, is important. Asian Americans are increasingly becoming a sizable minority group inthe United States. It is projected that by 2070, the Asian population willreach 11% of the total population of the United States. Virtually all of thepopulation-based data relating to ophthalmologic disorders in Asians havebeen performed in Asia. The reported relative proportion of PACG versusPOAG, however, among some Asian populations and of normal-tensionglaucoma versus high-tension glaucoma among the Japanese seems to applyto the United States Asian population. This assertion is based onwidespread clinical impression and analysis of Medicare claims data [56]. Understanding the differences is important for optimal treatment of theseminority populations as the proportion of Asians in the United Statescontinues to grow. The common denominator in all of these diseases is the role of thephysician and patient. Educational programs aimed at the physician tofacilitate cultural competence and at the patient to increase level of knowledgeabout their disease are appropriate and enthusiastically endorsed.
Keywords: *Eye Diseases/ep [Epidemiology]; Humans; *Minority Groups/sn [Statistics & Numerical Data]; United States/ep [Epidemiology]; *Vision Disorders/ep [Epidemiology]

Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension an evidence-based review. - Olthoff, Christine M G; Schouten, Jan S A G; van de Borne, Bart W; Webers, Carroll A B (Ophthalmology, 2005)
OBJECTIVE: To summarize the available scientific evidence to support clinical decisions on how to deal with noncompliance in glaucoma patients., CLINICAL RELEVANCE: Insufficient reduction of intraocular pressure and progression of visual field (VF) loss in glaucoma patients due to noncompliance with topical treatment may result in unnecessary therapy, with additional risks and costs., METHODS/LITERATURE REVIEWED: We conducted a literature search in the databases MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane and reference lists. Thirty-four articles describing 29 original quantitative studies, in English, German, French, or Dutch, were included. Studies on noncompliance in drug trials were excluded. Two investigators independently selected the articles and abstracted their content, before negotiating their inclusion or exclusion., RESULTS: The proportions of patients who deviate from their prescribed medication regimen ranged from 5% to 80%. The impact of noncompliance on clinical outcome has not yet been established. There are no determinants sensitive and specific enough to identify potential noncompliers accurately. Patient knowledge and dose frequency can be used as starting points to improve compliance. A combination of patient education and prevention of forgetting doses seems to be successful in enhancing patient compliance., CONCLUSION: Noncompliance with hypotensive treatment is common among glaucoma patients. However, there is no strong evidence supporting a relation between noncompliance and progression of VF loss. Only a few guidelines for clinicians can be derived from the currently available literature. Future research should be guided by clinically relevant questions.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Delivery of Health Care; Disease Progression; *Drug Utilization/sn [Statistics & Numerical Data]; Evidence-Based Medicine; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Patient Compliance; Prevalence; *Treatment Refusal/sn [Statistics & Numerical Data]; Vision Disorders/dt [Drug Therapy]; Vision Disorders/pp [Physiopathology]; Visual Fields/de [Drug Effects]

Ocular complications of hypovitaminosis a after bariatric surgery. - Lee, W Barry; Hamilton, Stephen M; Harris, Jason P; Schwab, Ivan R (Ophthalmology, 2005)
PURPOSE: To report the ocular complications of xerophthalmia, nyctalopia, and visual deterioration to legal blindness as a result of inadequate vitamin A supplementation after malabsorptive bariatric surgery., DESIGN: Observational case report and literature review., PARTICIPANT: A 39-year-old woman with xerophthalmia and nyctalopia occurring 3 years after gastric bypass surgery., RESULTS: We report a patient with a rare finding of xerophthalmia and visual deterioration after gastric bypass surgery as a result of vitamin A deficiency. The patient was referred for decreased vision associated with chronic dry eyes, bilateral diffuse punctate keratitis, and corneal scarring of unknown cause after several ophthalmologic examinations. The medical history, ophthalmic findings, and clinical course are discussed., CONCLUSIONS: Gastric bypass procedures can cause vitamin A deficiency leading to serious ocular complications, including xerophthalmia, nyctalopia, and ultimate blindness. The increasing incidence of obesity and gastric bypass procedures warrants patient and physician education regarding strict adherence to vitamin supplementation. Education is imperative to avoid detrimental ophthalmic complications resulting from hypovitaminosis A and to prevent a potential epidemic of iatrogenic xerophthalmia and blindness.
Keywords: Adult; *Bariatrics; Blindness/et [Etiology]; Female; *Gastric Bypass/ae [Adverse Effects]; Humans; Malabsorption Syndromes/et [Etiology]; *Night Blindness/et [Etiology]; Visual Acuity; *Vitamin A Deficiency/et [Etiology]; *Xerophthalmia/et [Etiology]

Does adjunctive glaucoma therapy affect adherence to the initial primary therapy?. - Robin, Alan L; Covert, David (Ophthalmology, 2005)
OBJECTIVE: To examine the effect of adding complexity to a glaucoma medical treatment regimen--specifically, what would occur to the refill rate (and, by inference, to adherence) when a second medication was added to a currently used once-daily drug., DESIGN: Open-label retrospective review of patient records., PARTICIPANTS: Patients of a large national health care provider who had received a prescription for latanoprost between July 1, 2001 and June 30, 2002. There were 1784 patients who had a second medication added and 3146 patients who remained on monotherapy., METHODS: For each patient, the mean number of days between refills was calculated for both the period before and that subsequent to the addition of the second medication, and an interperiod difference in refill interval between the 2 periods was calculated. Probability comparisons were performed using paired t tests (continuous) and Wilcoxon signed rank tests (categorical)., RESULTS: The mean age of the population using second-line therapy was 68.3+/-14.5 years (range, 4-97), and 56% were female. In this population of 1784 patients who used 2 different ocular-hypotensive medications, mean refill intervals for latanoprost were 40.6+/-21.8 days before the addition of a second drug and 47.4+/-24.4 days after the addition of a second drug, with a mean increase of 6.7+/-25.6 days. For 22.9% (409/1784) of patients, the interval was increased by >2 weeks (P<0.0001). The mean refill interval was longer than that for the 3146 patients who continued on latanoprost monotherapy, which was 41+/-24 days., CONCLUSIONS: This statistically and clinically significant increase in refill intervals may affect intraocular pressure control. We suggest that, when adding a second drug, physicians need to consider the possible impact on the patient's adherence to the first drug.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Child; Child, Preschool; *Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Therapy, Combination; *Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; Male; Managed Care Programs/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Retrospective Studies

Resident glaucoma surgical training in United States residency programs. - Golden, Richard P; Krishna, Rohit; DeBry, Peter W (Journal of glaucoma, 2005)
PURPOSE: To determine current trends in resident glaucoma surgical training throughout the United States., METHODS: A comprehensive survey was sent to the residency director of all 121 ACGME-accredited ophthalmology training programs in the United States., RESULTS: The mean and median number of glaucoma procedures a resident will complete by the end of their training is 8.6 and 8 respectively for trabeculectomy, 5.3 and 4 for combined trabeculectomy/phacoemulsification, and 3.6 and 2 for tube-shunts. One percent of residents will gain experience as primary surgeon on trabeculectomies during their first year, 32% during their second year, and 67% during their third year. Seventy-five percent of residents are taught more than one trabeculectomy technique by more than one staff surgeon. Eighty-four percent of residents are taught glaucoma surgery almost exclusively by fellowship-trained glaucoma surgeons. Eighty-two percent of residents use antimetabolites (mitomycin C or 5-FU) as an adjunct to trabeculectomy most or all of the time. More than 96% of resident tube-shunt procedures use Ahmed, Baerveldt, or Molteno devices. Eighty percent of residents do not perform any pediatric glaucoma surgeries. Sixty-two percent of residents rotate out of their main facility to perform glaucoma surgery., CONCLUSIONS: Residents are being exposed to glaucoma surgery early in their residency training. Most are performing a variety of different procedures and techniques, and are taught by fellowship-trained surgeons. Residents gain very little exposure to pediatric glaucoma surgery. All programs reported compliance with minimum RRC requirements for glaucoma filtering surgery.
Keywords: *Clinical Competence/sn [Statistics & Numerical Data]; Cross-Sectional Studies; *Filtering Surgery/ed [Education]; Filtering Surgery/sn [Statistics & Numerical Data]; *Glaucoma/su [Surgery]; Glaucoma Drainage Implants; Humans; *Internship and Residency/td [Trends]; Ophthalmology/sn [Statistics & Numerical Data]; *Ophthalmology/td [Trends]; United States

The development of the Indian vision function questionnaire: field testing and psychometric evaluation. - Gupta, S K; Viswanath, K; Thulasiraj, R D; Murthy, G V S; Lamping, D L; Smith, S C; Donoghue, M; Fletcher, A E (The British journal of ophthalmology, 2005)
OBJECTIVE: To develop and evaluate the acceptability, reliability, validity, and responsiveness of the Indian vision function questionnaire (IND-VFQ)., METHODS: Problem statements from previous qualitative studies were reduced to a 45 item interviewer administered questionnaire representing three a priori domains (general functioning, psychosocial impact, and visual symptoms) which was evaluated in patients with cataract (n = 420), glaucoma (n = 120), diabetic retinopathy, or age related macular degeneration (n = 120) and normal controls (n = 120). Standard methods were used for item reduction and to evaluate psychometric properties., RESULTS: Psychometric item reduction produced a 33 item questionnaire. Psychometric evaluation showed that two of the three scales (psychosocial impact and visual symptoms) had good acceptability, and that all three scales showed high internal consistency (alpha >0.80; item-total correlations 0.54-0.86) and test-retest reliability (>0.89). All three scales showed moderate evidence of convergent and discriminant validity. Responsiveness, assessed in cataract patients (n = 120) before and after surgery, was good for all three scales (effect sizes >1)., CONCLUSIONS: The IND-VFQ33 is a psychometrically sound measure of vision function addressing a gap in patient defined measures of vision function developed in populations living in low income countries.
Keywords: Activities of Daily Living; Aged; Cataract/co [Complications]; *Developing Countries; Female; Glaucoma/co [Complications]; Humans; India; Male; Middle Aged; Patient Satisfaction; Psychometrics; *Quality of Life; Reproducibility of Results; Retinal Diseases/co [Complications]; *Surveys and Questionnaires; Vision Disorders/et [Etiology]; Vision Disorders/px [Psychology]; *Vision Disorders/rh [Rehabilitation]

A cluster of cases of Mycobacterium chelonei keratitis following penetrating keratoplasty. - Srinivasan, M; Prajna, Lalitha; Prajna, N Venkatesh (Indian journal of ophthalmology, 2005)
Cluster infection with Mycobacterium chelonei following penetrating keratoplasty is described. All the donor eyes were harvested from the same collection centre. This underscores the importance of adherence to sterile protocols.
Keywords: Adult; Aged; Aged, 80 and over; Cluster Analysis; Female; Humans; *Keratitis/mi [Microbiology]; Keratitis/pa [Pathology]; *Keratoplasty, Penetrating/ae [Adverse Effects]; Middle Aged; *Mycobacterium Infections, Nontuberculous; *Mycobacterium chelonae

The biomechanics of keratoconus and rigid contact lenses. - McMonnies, Charles W (Eye & contact lens, 2005)
PURPOSE: To examine aspects of the genesis and progression of keratoconus through an analysis of the biomechanical forces associated with this condition, including those generated by rigid contact lenses., METHODS: The biomechanics of applanation tonometry and rigid contact lenses serve as a basis for examining contact lens adherence and the potential for contact lens induced mid peripheral corneal applanation and apical molding with apical clearance fittings., DISCUSSION: Some physiologic and pathologic mechanisms for increases in intraocular pressure are reviewed. The possibility is raised that hard squeeze blinks, for example, could significantly increase the distending forces that bear on the corneal apex in keratoconus and that some apical clearance contact lens fittings could increase the risk of progressive ectasia. Support for these hypotheses is found among healthy eyes and eyes with keratoconus that show increased curvature when apical clearance fittings are worn., CONCLUSIONS: The known risk of scarring responses to excessively flat fitting rigid contact lenses must be balanced against the possible risk of molding and ectasia advancement responses to tight definite apical clearance lenses. Fittings within the range of minimal apical clearance and minimal apical contact (divided support) may be the most appropriate. The appearance and performance of these fittings may be difficult to distinguish clinically. Because some patients may develop pathologic levels of intraocular pressure with vigorous eye rubbing, strong squeeze blinks, inverted body positions, and strenuous muscular effort, patients with, or at risk for, keratoconus, glaucoma, or progressive myopia should be advised of the possible adverse significance of these activities.
Keywords: *Biomechanical Phenomena; Blinking; *Contact Lenses; *Cornea/pp [Physiopathology]; Eyelids/ph [Physiology]; Humans; Intraocular Pressure; *Keratoconus/pp [Physiopathology]

Compliance and persistency in glaucoma follow-up treatment. - Schwartz, Gail F (Current opinion in ophthalmology, 2005)
PURPOSE OF REVIEW: To summarize research published between 1980 and October 2004 regarding compliance (the extent to which patients' behaviors correspond with providers' recommendations) and persistency (total time on therapy) in patients diagnosed with open-angle glaucoma or ocular hypertension; to suggest approaches ophthalmologists might consider to improve compliance and persistency; and to identify areas warranting future research., RECENT FINDINGS: Medication compliance, the focus of most compliance-related research, has been measured using a variety of methods including patient self-reports, the medication possession ratio, and electronic monitoring. Noncompliance rates of at least 25% commonly have been reported. The primary obstacles to medication compliance appear to be situational/environmental (e.g., being away from home or a change in routine) or related to the medication regimen (e.g., side effects or complexity). Persistency with ocular hypotensive therapies has been found to be poor. Retrospective cohort studies using survival analyses have reported that fewer than 25% of patients are persistent over 12 months., SUMMARY: Accurately assessing patient compliance and persistency is important to optimizing patient care. Physicians may mistake either medication noncompliance or lack of persistency with poor efficacy. Such errors would likely increase health care costs if they result in unnecessary changes to a patient's therapeutic regimen or in surgery.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Delivery of Health Care/mt [Methods]; Delivery of Health Care/st [Standards]; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Patient Compliance/sn [Statistics & Numerical Data]; *Patient Compliance; Patient Dropouts/sn [Statistics & Numerical Data]; *Patient Dropouts; Physician-Patient Relations; Retrospective Studies; Treatment Outcome

Preferences for eye drop characteristics among glaucoma specialists: a willingness-to-pay analysis. - Jampel, Henry D; Parekh, Parag; Johnson, Elizabeth; Robin, Alan L; Miller, Rhonda B (Journal of glaucoma, 2005)
PURPOSE: To determine the importance that US glaucoma specialists place on attributes of eye drops for lowering intraocular pressure., MATERIALS AND METHODS: We performed a cross-sectional survey by conducting a telephone interview with 113 members of the American Glaucoma Society. We administered a willingness-to-pay (WTP) instrument asking glaucoma specialists how much they would pay to obtain particular characteristics in an eye drop. Demographic data were correlated with the WTP responses. We compared the glaucoma specialists' responses to those previously obtained from patients. The main outcome measure was willingness-to-pay more (in US dollars)., RESULTS: Almost all respondents were willing to pay extra to reduce the frequency of administration of eye drops from 3 times a day to once a day, and to avoid blurred vision, drowsiness, or inhibition of sexual performance. Only 54 (48%) were willing to pay more to avoid iris darkening. The mean amount that respondents were willing to pay (relative to US 50 dollars) differed significantly across eye drop characteristics (P < 0.001). The mean amount that the respondents were willing to pay was highest for avoidance of inhibition of sexual performance (US 105 dollars), blurred vision (US 92 dollars), and drowsiness (US 92 dollars). When compared with glaucoma and glaucoma suspect patients, more ophthalmologists were likely to pay extra for desirable eye drop attributes. However, the magnitude of the extra amount was similar between ophthalmologists and patients., CONCLUSIONS: Glaucoma specialists place differing value on various eye drop characteristics. Although the proportion of glaucoma specialists willing to pay more is generally greater than the proportion of patients, the preferences of glaucoma specialists and patients are alike.
Keywords: Adult; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ec [Economics]; Cost-Benefit Analysis; Cross-Sectional Studies; *Drug Therapy/ec [Economics]; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medicine; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/ec [Economics]; *Ophthalmology/ec [Economics]; Ophthalmology/sn [Statistics & Numerical Data]; Patient Satisfaction; *Practice Patterns, Physicians'; Specialization

Management of glaucoma: focus on pharmacological therapy. - Marquis, Robert E; Whitson, Jess T (Drugs & aging, 2005)
Glaucoma represents a major cause of vision loss throughout the world. Primary open-angle glaucoma, the most common form of glaucoma, is a chronic, progressive disease often, though not always, accompanied by elevated intraocular pressure (IOP). In this disorder, retinal ganglion cell loss and excavation of the optic nerve head produce characteristic peripheral visual field deficits. Patients with normal-tension glaucoma present with typical visual field and optic nerve head changes, without a documented history of elevated IOP. A variety of secondary causes, such as pigment dispersion syndrome and ocular trauma, can result in glaucoma as well. Treatment of all forms of glaucoma consists of reducing IOP. With proper treatment, progression of this disease can often be delayed or prevented. Treatment options for glaucoma include medications, laser therapy and incisional surgery. Laser techniques for the reduction of IOP include argon laser trabeculoplasty and selective laser trabeculoplasty. Both techniques work by increasing outflow of aqueous humour through the trabecular meshwork. Surgical options for glaucoma treatment include trabeculectomy, glaucoma drainage tube implantation and ciliary body cyclodestruction. While each of these types of procedures is effective at lowering IOP, therapy usually begins with medications. Medications lower IOP either by reducing the production or by increasing the rate of outflow of aqueous humour within the eye. Currently, there are five major classes of drugs used for the treatment of glaucoma: (i) cholinergics (acetylcholine receptor agonists); (ii) adrenoceptor agonists; (iii) carbonic anhydrase inhibitors (CAIs); (iv) beta-adrenoceptor antagonists; and (v) prostaglandin analogues (PGAs). Treatment typically begins with the selection of an agent for IOP reduction. Although beta-adrenoceptor antagonists are still commonly used by many clinicians, the PGAs are playing an increasingly important role in the first-line therapy of glaucoma. Adjunctive agents, such as alpha-adrenoceptor agonists and CAIs are often effective at providing additional reduction in IOP for patients not controlled on monotherapy. As with any chronic disease, effective treatment depends on minimising the adverse effects of therapy and maximising patient compliance. The introduction of a variety of well tolerated and potent medications over the past few years now allows the clinician to choose a treatment regimen on an individual patient basis and thereby treat this disorder more effectively.
Keywords: Adrenergic Agonists/ad [Administration & Dosage]; Adrenergic Agonists/ae [Adverse Effects]; Adrenergic Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aqueous Humor/ph [Physiology]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cholinergic Agonists/ad [Administration & Dosage]; Cholinergic Agonists/ae [Adverse Effects]; Cholinergic Agonists/tu [Therapeutic Use]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Prostaglandins/ad [Administration & Dosage]; Prostaglandins/ae [Adverse Effects]; Prostaglandins/tu [Therapeutic Use]

Evisceration via superior temporal sclerotomy. - Ozgur, Ozlen Rodop; Akcay, Levent; Dogan, Omer Kamil (American journal of ophthalmology, 2005)
PURPOSE: To describe evisceration via superior temporal equatorial sclerotomy with preservation of the cornea as an alternative technique., DESIGN: Retrospective case series., METHODS: Records of 31 consecutive patients who underwent evisceration via superior temporal equatorial sclerotomy between November 1996 and November 2002 were reviewed. Patient age ranged from 1 to 79 years (mean, 27.93 years). Posterior sclerotomies were performed in 14 eyes (45%). The surgical indications, prior ocular surgeries, complications, cornea alterations, cornea sensitivities, size and material of the implants, and the motility of the globes with and without prosthesis were evaluated., RESULTS: Average follow-up was 31.68 months (range, 5-77 months). No intraoperative complications occurred. One patient had late-term pain due to partial implant extrusion from the melted cornea. All corneas remained clear until the 1st month after surgery. After the 2nd month some corneas became semiopaque (61%) and totally opaque (16%). Seven corneas remained clear (23%). Cornea vascularization started in the second week postsurgery in all patients. It was limited peripherally in six patients and moved forward to the central part in 25 patients. No patient had corneal sensation. In one case, keratitis occurred at month 13 postsurgery; in another, conjunctival dehiscence in the superior temporal region was noted, 26 months after surgery, due to esotropia resulting from pressure exerted on the region by the prosthesis. Globe motility was satisfactory in all patients., CONCLUSIONS: Implant motility is satisfactory and the implant exposure rate is low with this technique.
Keywords: Adolescent; Adult; Aged; Child; Child, Preschool; Eye Diseases/su [Surgery]; *Eye Evisceration/mt [Methods]; Eye Movements; *Eye, Artificial; Female; Follow-Up Studies; Humans; Infant; Intraoperative Complications; Male; Middle Aged; *Orbital Implants; Patient Satisfaction; Postoperative Complications; Retrospective Studies; *Sclerostomy/mt [Methods]

[Patient characteristics in a tertiary glaucoma center. Circumstances of treatment and attitudes of patients]. - Dietlein, T S; Jordan, J; Dinslage, S; Jacobi, P C; Krieglstein, G K (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2005)
BACKGROUND: In order to look for conceptual improvements in the practical management of patients sent to our glaucoma department, we analyzed the structures, behaviour, and knowledge about the disease in this patient group., METHODS: Glaucoma patients who were sent for the first time to our department were included prospectively. Before being examined 129 patients were asked to answer a questionnaire concerning their individual characteristics, their behaviour, and patterns of treatment., RESULTS: Of the patients 74% had open-angle glaucoma (including normal tension, exfoliative, and pigment glaucoma), 22% had secondary glaucoma (including neovascular, congenital, and chronic closed-angle glaucoma), and 4% had suspected glaucoma. Written documentation of previously performed intraocular pressure measurements was not available for 84% of the patients. Younger patients had significantly more knowledge about glaucoma and used more possibilities to get information about the disease than elder patients., CONCLUSION: Education about glaucoma disease should be optimized especially for elder glaucoma patients. Documentation of intraocular pressure measurements is insufficient in our patient group.
Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Female; Glaucoma/cn [Congenital]; Glaucoma/dt [Drug Therapy]; *Glaucoma/th [Therapy]; Glaucoma, Angle-Closure/th [Therapy]; Glaucoma, Neovascular/th [Therapy]; Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Patient Compliance; *Patient Education as Topic; Prospective Studies; Surveys and Questionnaires

Conjunctival necrosis and bleb leakage secondary to an adherent conjunctival foreign body. - Puri, P; Saxena, R; Nelson, M E (Eye (London, England), 2005)
Keywords: Aged; *Conjunctiva/pa [Pathology]; Conjunctiva/su [Surgery]; *Eye Foreign Bodies/pa [Pathology]; Eye Foreign Bodies/su [Surgery]; *Glaucoma/co [Complications]; Glaucoma/su [Surgery]; *Granuloma, Foreign-Body/pa [Pathology]; Granuloma, Foreign-Body/su [Surgery]; Humans; Male; Necrosis; *Postoperative Complications/pa [Pathology]; Postoperative Complications/su [Surgery]; Seeds; *Trabeculectomy

Visual impairment in elderly patients with hip fracture: causes and associations. - Cox, A; Blaikie, A; MacEwen, C J; Jones, D; Thompson, K; Holding, D; Sharma, T; Miller, S; Dobson, S; Sanders, R (Eye (London, England), 2005)
AIMS: To evaluate the current visual status and ophthalmic history of a sample of elderly patients with fractured neck of femur and to study the relationship between visual status and demographic factors., METHODS: A four-centre study of all patients admitted to hospital with fractured neck of femur. The setting was two district (Ayr, Dunfermline) and two teaching (Glasgow, Dundee) hospitals in Scotland. The study examined 537 patients aged 65 years and over admitted with acute fractured neck of femur to hospital., RESULTS: Bilateral visual impairment (binocular visual acuity worse than 6/12) was found in 239 of 518 patients (46%). Of this group, the principal causes for visual deficit were untreated cataract (49%), macular degeneration (21%), uncorrected refractive error (17%), and glaucoma (3%). The visually impaired group were more likely to have symptomatic visual complaints (58 vs 26%), however, were less likely to be under optometric care (71 vs 85%). A higher proportion of the group with visual impairment lived in areas of social deprivation (40 vs 26%)., CONCLUSIONS: Patients with fractured neck of femur represent a frail elderly group that have poorer vision than that documented in any other elderly population. The visual defect was potentially remediable in the majority of cases but this group of individuals are not generally in touch with the ophthalmic services. Social deprivation appears to be associated with this groups' inability to access ophthalmic care.
Keywords: Aged; Aged, 80 and over; Causality; Chi-Square Distribution; Cross-Sectional Studies; Female; *Femoral Neck Fractures/co [Complications]; Femoral Neck Fractures/pp [Physiopathology]; *Frail Elderly; Health Services Accessibility; Humans; Male; Psychosocial Deprivation; Scotland; *Vision Disorders/et [Etiology]

Outcome of penetrating keratoplasty in patients with bilateral corneal blindness. - Sinha, R; Vanathi, M; Sharma, N; Titiyal, J S; Vajpayee, R B; Tandon, R (Eye (London, England), 2005)
PURPOSE: To evaluate the outcome of penetrating keratoplasty in patients with bilateral corneal blindness., METHODS: Bilaterally blind patients who had undergone optical penetrating keratoplasty (PK) were evaluated on optical and refractive parameters and presence of complications if any. The results at 3 months, 6 months, and 1 year were compared with age-matched and indication-matched unilaterally blind controls., RESULTS: The most common indication for surgery in both the groups was the presence of a corneoiridic scar. Best corrected visual acuity of > or =6/18 was seen in five (16.66%) patients in the study group and in 11 (36.66%) patients in the control group (P = 0.14). In all, 15 (50%) grafts in the study group and six (20%) in the control group failed (P = 0.03). The most common cause of failure was graft infection (40%) in the study group and post-PK glaucoma (20%) in the control group. The percentage of graft rejection as a cause of graft failure was the same in both the groups. A composite socioeconomic status scale based on family literacy and income suggested that 70% of the cases in the study group and 30% in the control group belonged to the low socioeconomic group (P = 0.004)., CONCLUSION: The outcome of optical penetrating keratoplasty in patients with bilaterally blinding corneal disease is poorer than those who are unilaterally blind. Low socioeconomic status may be a contributing factor for the poor outcome.
Keywords: Adult; Aged; Blindness/et [Etiology]; Blindness/pa [Pathology]; *Blindness/su [Surgery]; Corneal Diseases/co [Complications]; Corneal Diseases/pa [Pathology]; *Corneal Diseases/su [Surgery]; Developing Countries; Graft Rejection; Humans; India; *Keratoplasty, Penetrating; Middle Aged; Patient Satisfaction; Retrospective Studies; Socioeconomic Factors; Surgical Wound Infection/et [Etiology]; Treatment Outcome; Visual Acuity

Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population. - Bhatt, R; Whittaker, K W; Appaswamy, S; Desai, A; Fitt, A; Sandramouli, S (Eye (London, England), 2005)
AIM: To identify the relative incidence and profile of adverse drug reaction (ADR) to various topical ocular hypotensives in a hospital setting., METHODS: All the patients presenting in outpatients clinic and accident and emergency with an ADR to topical hypotensive agent from August 2000 to January 2001 were included in the study. Details regarding the type date of commencing the treatment, the date of developing ADR, time to resolution of the ADR were noted., RESULTS: Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP > 21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR., CONCLUSION: Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.
Keywords: Adrenergic alpha-Agonists/ae [Adverse Effects]; Aged; Aged, 80 and over; *Antihypertensive Agents/ae [Adverse Effects]; Brimonidine Tartrate; Female; Filtering Surgery; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/su [Surgery]; Humans; Intraocular Pressure; Male; Middle Aged; Ophthalmic Solutions/ae [Adverse Effects]; Outpatient Clinics, Hospital; Patient Acceptance of Health Care; Prospective Studies; Quinoxalines/ae [Adverse Effects]; Time Factors

[Evaluation of portable TGDc-01 tonometers and comparison with the Goldmann applanation tonometer]. - Rombold, F; Thiel, M J; Neubauer, A S; Hirneiss, C; Kampik, A (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2005)
PURPOSE: The aim of this study was to evaluate patients' acceptance and intraocular pressure (IOP) readings of a new digital mobile tonometer (TGDc-01) and compare it to Goldmann applanation tonometry., METHOD: Measurements repeated five times with the TGDc-01 and three times with Goldmann tonometry were performed in 100 eyes of 100 patients by two independent investigators. Patients' acceptance of both techniques was evaluated by a visual analogue scale (VAS)., RESULTS: The mean IOP with the TGDc-01 yielded 15.4 mmHg for investigator 1 and 12.7 mmHg for investigator 2 (range: 4-43 mmHg). Results of the measurements with Goldmann tonometry showed 17.6 mmHg for investigator 1 and 17.3 mmHg for investigator 2 (9-42 mmHg). The IOP difference of the two tonometry methods was highly significant (p<0.001). The intraobserver variability was 29% for investigator 1 and 8% for investigator 2. Mean IOP values of the two investigators taken with the TGDc-01 differed significantly (p<0.01) from each other by a mean of 2.6 mmHg., CONCLUSIONS: The new mobile tonometer TGDc-01 is better accepted by patients but IOP values are significantly lower compared to Goldmann tonometry and variability is high. Regarding glaucoma diagnostics it seems to be less suitable than Goldmann tonometry.
Keywords: Adult; Aged; Aged, 80 and over; *Equipment Failure Analysis; Female; Glaucoma/co [Complications]; *Glaucoma/di [Diagnosis]; Humans; *Intraocular Pressure; Male; Middle Aged; Miniaturization; *Patient Acceptance of Health Care; Reproducibility of Results; Sensitivity and Specificity; *Tonometry, Ocular/is [Instrumentation]; Tonometry, Ocular/mt [Methods]; *Vision Disorders/di [Diagnosis]; Vision Disorders/et [Etiology]

When do you perform an examination under anesthesia?. - Simpson, Jennifer; Ellenhorn, Naomi (Journal of pediatric ophthalmology and strabismus, 2004)
Keywords: *Anesthesia, General/mt [Methods]; Arthritis, Juvenile/co [Complications]; Child, Preschool; Female; *Glaucoma/di [Diagnosis]; Glaucoma/et [Etiology]; Glucocorticoids/tu [Therapeutic Use]; Humans; Intraocular Pressure/de [Drug Effects]; Patient Compliance; Physical Examination/mt [Methods]; *Uveitis/di [Diagnosis]; Uveitis/et [Etiology]; *Vision Tests/mt [Methods]

Gold standard medical therapy for glaucoma: defining the criteria identifying measures for an evidence-based analysis. - Obstbaum, Stephen A; Cioffi, George A; Krieglstein, Guenther K; Fennerty, M Brian; Alm, Albert; Araie, Makoto; Carassa, Roberto G; Greve, Erik L; Hitchings, Roger A; Kaufman, Paul L; Kitazawa, Yoshiaki; Pongpun, Prin Rojana; et al. (Clinical therapeutics, 2004)
BACKGROUND: Over the past decade, several new medical therapies have become available for the treatment of primary open-angle glaucoma (POAG). A systematic evidence-based approach for identifying an optimal therapeutic agent is lacking., OBJECTIVES: The aims of this review were to critically evaluate published treatment recommendations for POAG and, based on a systematic review of the literature, to develop criteria that would define a "gold standard" medical therapy that reflects new treatment advances and established therapeutic goals., METHODS: A MEDLINE search spanning the years 1966 to 2002 and using the search terms gold standard, drug of choice, agent of choice, benchmark, ophthalmology, eye, and glaucoma was conducted and the results reviewed by a panel of 15 experts in the field of glaucoma. Published treatment recommendations for POAG were discussed. Criteria, anchored to medical evidence, for distinguishing a standard of medical therapy for POAG were defined., RESULTS: The terms connoting a gold standard therapy were found in only 258 of approximately 368,000 ophthalmology-related citations and 53 of almost 23,000 glaucoma citations, validating the need to define therapeutic standards. The lack of recommendations for the use of new classes of ocular hypotensive agents was acknowledged. Criteria identified to evaluate intraocular pressure (IOP)-lowering agents as gold standards included the following: efficacy in reducing IOP consistently over a 24-hour period to a level that will preserve the visual field and protect the optic nerve without inducing tachyphylaxis and tolerance, paucity of local and systemic adverse effects, promotion of patient compliance, and applicability in diverse patient populations., CONCLUSIONS: These criteria should be employed as measures for evidence-based analyses to evaluate available and future IOP-lowering medical therapies for POAG. The conceptual framework presented may be applicable to other therapeutic areas.
Keywords: *Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Benchmarking/mt [Methods]; Chronic Disease; *Evidence-Based Medicine; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ophthalmology/st [Standards]; Patient Compliance; Quality of Life

Evaluation of a mobile diabetes care telemedicine clinic serving Aboriginal communities in Northern British Columbia, Canada. - Jin, Andrew J; Martin, David; Maberley, David; Dawson, Keith G; Seccombe, David W; Beattie, Joyce (International journal of circumpolar health, 2004)
INTRODUCTION: In British Columbia, Aboriginal diabetes prevalence, hospitalization and mortality rates are all more than twice as high as in the rest of the population. We describe and evaluate a program to improve access to diabetes care for Aboriginal people in northern communities., STUDY DESIGN: Cost-effectiveness evaluation., METHODS: A diabetes nurse educator and an ophthalmic technician travel to Aboriginal reserves, offering people with diabetes services recommended in current clinical practice guidelines: retinopathy screening by digital retinal fundus photography, glaucoma screening by tonometry, point-of-care urine and blood testing to detect microalbuminuria and dyslipidemia and to measure glycated hemoglobin, foot examinations and foot care advice, blood pressure and height and weight measurement and diabetes care advice. Via electronic communication, an ophthalmologist and an endocrinologist in Vancouver review the findings and supervise the mobile clinic staff., RESULTS: During the first year, 25 clinics were held at 22 sites, examining 339 clients with diabetes. Exit surveys showed high levels of client satisfaction. Mean cost per client (Cdn dollars 1,231) was less than for the alternative, transporting clients to care in the nearest cities (Cdn dollars 1,437)., CONCLUSIONS: The mobile clinic is cost-effective and improves access to the recommended standard of diabetes care.
Keywords: Adult; Aged; British Columbia; Diabetes Mellitus/eh [Ethnology]; *Diabetes Mellitus/th [Therapy]; Female; Health Services Accessibility; Humans; Male; Middle Aged; *Mobile Health Units; *Population Groups/sn [Statistics & Numerical Data]; Practice Guidelines as Topic; *Telemedicine

Patient and ophthalmologist attitudes concerning compliance and dosing in glaucoma treatment. - Stewart, William C; Konstas, Anastasios G P; Pfeiffer, Norbert (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2004)
AIM: The aim of this study was to identify research avenues that might improve patient compliance with glaucoma therapy., METHODS: 500 patients and physicians were interviewed by telephone in 5 European countries, and the results were compiled and evaluated by 2 independent physicians., RESULTS: Most physicians believed that pressure reduction is useful (UK (96%), France (94%), Spain (80%), Italy (72%), and Germany (70%), p < 0.0001). The majority of physicians believed that noncompliance exists in 0%-25% of patients, whereas 34% of patients admitted to noncompliance. Physicians believed patients would prefer once-daily dosing (92%) and that it would help compliance, whereas 60% of patients preferred once-daily dosing, and 20% of patients believed it would help compliance. Physicians (94%) believed that noncompliance could lead to visual loss and, while this information concerned most physicians, this was less likely in Germany (52%) (p < 0.0001). Most patients received information concerning dosing of their medicines (79%), and, accordingly, waited an average of 10 minutes between doses; but only half of the patients had been told to wait at least 5 minutes between instilling preparations. Approximately 2 of 3 patients knew that missing medicines could cause visual loss., CONCLUSIONS: Once-daily dosing to increase patient satisfaction and/or dosing convenience and providing patient education are potential clinical techniques that could be further evaluated as a means to increase compliance.
Keywords: *Attitude to Health; Data Collection/mt [Methods]; Data Collection/sn [Statistics & Numerical Data]; Europe; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/ch [Chemistry]; Ophthalmic Solutions/cl [Classification]; Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance/px [Psychology]; Patient Compliance/sn [Statistics & Numerical Data]; Patient Education as Topic/mt [Methods]; *Physician-Patient Relations; Time Factors

A persistency and economic analysis of latanoprost, bimatoprost, or beta-blockers in patients with open-angle glaucoma or ocular hypertension. - Day, Douglas G; Schacknow, Paul N; Sharpe, Elizabeth D; Ellyn, John C; Kulze, John C 3rd; Threlkeld, Anisa B; Jones, Evan D; Brown, Reay H; Jenkins, Jessica N; Stewart, William C (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2004)
PURPOSE: The aim of this study was to evaluate differences in the persistency and treatment costs for latanoprost, bimatoprost, or beta-blockers in open-angle glaucoma or ocular hypertensive patients., METHODS: This study was a retrospective, multicenter, parallel, active-controlled comparison of patients who were prescribed with ocular hypotensive monotherapy between September 1996 and August 2002., RESULTS: 1,182 patients were included. The Kaplan Meier life table analysis showed that latanoprost was continued longest among the groups for the first year of therapy (p=0.02). A significant difference existed between groups in the final intraocular pressure for latanoprost (17.3+/-3.9, N=357), for bimatoprost (18.0+/-3.6, N=146), and for the beta-blockers (17.9+/-3.7, N=335) (p=<0.0001). The average number of visits was statistically higher for beta-blockers (3.3), compared to latanoprost (2.9) and bimatoprost (3.1) (p=0.01). Further, the mean number of medicine changes was greater for bimatoprost (0.45) and beta-blockers (0.47) than for latanoprost (0.27) (p=0.0008). The cost of visits and medications was lowest for beta-blockers ($119.3+/-$78.9) and highest for bimatoprost ($163.8+/-$51.2) (p<0.0001)., CONCLUSIONS: Patients were more persistent with latanoprost and demonstrated lower intraocular pressure, fewer visits, and fewer medicine changes when compared to bimatoprost or beta-blocker therapy. In contrast, the beta-blocker group provided lower overall cost.
Comment in (CIN)
Keywords: *Adrenergic beta-Antagonists/ec [Economics]; Aged; Amides; *Antihypertensive Agents/ec [Economics]; Bimatoprost; Cloprostenol/aa [Analogs & Derivatives]; Drug Costs; Economics, Pharmaceutical; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; Health Care Costs; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; *Lipids/ec [Economics]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ec [Economics]; Office Visits; *Patient Compliance; *Prostaglandins F, Synthetic/ec [Economics]; Retrospective Studies; Safety

Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses. - Dagres, Evgenios; Khan, Mushtaq A; Kyle, Graham M; Clark, David (Journal of cataract and refractive surgery, 2004)
PURPOSE: To evaluate the perioperative complications of intraocular lens (IOL) exchange in 25 eyes of 22 patients with opacified Aqua-Sense IOLs (Ophthalmic Innovations International)., SETTING: Department of Ophthalmology, University Hospital Aintree, Liverpool, United Kingdom., METHODS: The study comprised 22 patients (25 eyes) who had previous phacoemulsification and implantation of Aqua-Sense single-piece hydrophilic acrylic IOLs in the capsular bag and developed severe late opacification of the IOL. All patients reported glare and deterioration in vision. The IOLs were explanted and replaced with new lenses. The perioperative complications were evaluated. The best corrected visual acuity (BCVA) before and after surgery was compared., RESULTS: In 24 eyes, the opacification was complete, involving the optic, haptics, and substance of the IOLs. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 13 eyes (52%). Complications occurred in the remaining 12 eyes (48%). Ten eyes (40%) developed zonular dehiscence, 4 (16%) of which were managed with anterior chamber IOL implantation. One eye (4%) developed posterior capsule rupture and 1 eye (4%), posterior capsule rupture and zonular dehiscence. The cornea decompensated in 2 eyes (8%). One eye (4%) developed Pseudomonas keratitis. The mean BCVA (decimal scale) before and after IOL exchange was 0.57 +/- 0.24 and 0.60 +/- 0.28, respectively. There was no significant difference in visual acuity between before and after IOL exchange (P=.782, paired t test)., CONCLUSIONS: Explantation of Aqua-Sense IOLs was challenging because of the tight adherence of the optic and haptics to the capsule. Long-term follow-up of patients with Aqua-Sense IOLs should be maintained.
Keywords: Aged; Device Removal; Female; Humans; *Intraoperative Complications; *Lens Implantation, Intraocular; *Lenses, Intraocular; Male; Phacoemulsification; *Prosthesis Failure; Reoperation; Visual Acuity

Switching from latanoprost to fixed-combination latanoprost-timolol: a 21-day, randomized, double-masked, active-control study in patients with glaucoma and ocular hypertension. - Olander, Kenneth; Zimmerman, Thom J; Downes, Nina; Schoenfelder, John; Xalacom/Latanoprost Study Group (Clinical therapeutics, 2004)
BACKGROUND: Approximately 40% of patients with glaucoma are concomitantly prescribed >or=2 different intraocular pressure (IOP)-lowering medications. An effective and well-tolerated fixed combination of agents requiring once-daily instillation may improve patient compliance., OBJECTIVE: The purpose of this study was to compare the efficacy and safety profile of the fixed combination latanoprost 0.005% + timolol maleate 0.5% QD with those of latanoprost 0.005% monotherapy QD in patients whose elevated IOP (>or=21 mm Hg) was inadequately controlled by latanoprost., METHODS: This 21-day, randomized, double-masked, active-control study was conducted at 49 study sites in Argentina, Brazil, Colombia, Mexico, Peru, the United States, and Venezuela. Adults with glaucoma or ocular hypertension who had failed to reach an IOP of <21 mm Hg while receiving latanoprost for at least 28 days were enrolled. After an additional 28 days of latanoprost run-in, patients were randomly assigned to continue latanoprost monotherapy or to switch to the fixed combination for 21 days. The intent-to-treat (ITT) population included all patients who received at least 1 dose of double-masked study medication; the per-protocol (PP) analysis included patients who completed the study without a major protocol violation and who had IOP measurements both at baseline and at day 21. The primary end point was the proportion of patients whose IOP was decreased >or=2 mm Hg from the baseline level on day 21. Proportions of patients demonstrating IOP decreases >or=3, >or=4, or >or=5 mm Hg from the baseline level and of patients reaching an 10P <or=18 mm Hg were evaluated. Adverse events (AEs) were also assessed., RESULTS: A total of 350 patients were enrolled. In all, 348 patients were included in the ITT and tolerability analyses (fixed combination, n = 175; latanoprost, n = 173; mean [SD] age, 64.4 [13.2] and 63.2 [14.0] years, respectively; 103 women in each group). Baseline demographic and clinical characteristics were similar between groups. A higher percentage of patients receiving the fixed combination had IOP decreases of 2 mm Hg on day 21 relative to baseline compared with latanoprost-treated patients (79.4% vs 51.4%, respectively; P < 0.001). PP analyses found that more patients in the fixed-combination group had IOP decreases >or=3, >or=4, or >or=5 mm Hg (for each target level, P < 0.001 vs latanoprost group) or final IOP 18 mm Hg (fixed -combination, 35.1%; latanoprost, 17.8%; P < 0.001). Both treatments were well tolerated. Similar proportions of patients in the fixed-combination and latanoprost groups reported at least 1 treatment-emergent AE (10.9% and 12.1%, respectively)., CONCLUSION: In this selected population of patients with an inadequate initial IOP response to latanoprost, switching to fixed-combination latanoprosttimolol resulted in a greater decrease in IOP and similar tolerability compared with continuing latanoprost therapy.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Treatment Outcome

Utilization of eye care services by Victorians likely to benefit from eye care. - Bylsma, Guy W; Le, Anhchuong; Mukesh, Bickol N; Taylor, Hugh R; McCarty, Catherine A (Clinical & experimental ophthalmology, 2004)
AIM: To assess the utilization of eye care services by Australians most likely to benefit from eye assessment., METHODS: The Melbourne Visual Impairment Project was a population-based study that collected demographic, health and vision-related information including use of eye care services. A standardized detailed ophthalmic examination was performed. Utilization of eye care services by those who might most benefit from eye care was assessed and compared to the general population. These participants include those with undiagnosed glaucoma, unoperated visually significant cataract, undercorrected refractive error, diabetes mellitus, age-related macular degeneration and visual acuity < 6/12. Sociodemographic characteristics were assessed for their influence on eye care utilization among these participants., RESULTS: A total of 4744 urban and rural residents participated (86% of those eligible) and 4612 (83% of total eligible) of these had a complete data set for the use of eye care services and were included. There were 933 participants (20.2%) who did not report eye assessment in the previous 5 years, and 891 participants (19.3%) had one or more aforementioned conditions potentially benefiting from eye care. Of these, between 34.4% and 59.4% reported no examination in the previous year and between 9% and 25% reported no examination within the previous 5 years. These participants were more likely to seek eye care within the short term (1 year) if they had a family history of eye disease, otherwise a noticed change in vision was the main influence in the longer term (2-5 years). Male participants, younger participants and those whose main spoken language was not English were less likely to seek eye care in the longer term., CONCLUSIONS: In Victoria 19% of those >40 years of age have potentially unmanaged eye disease including glaucoma, unoperated visually significant cataract, undercorrected refractive error, age-related macular degeneration, diabetes mellitus or visual acuity < 6/12. A substantial proportion of these report no eye assessment in the previous 1, 2 or 5 years or ever before. Younger age, male sex and main language other than English make assessment less likely. Many may have these conditions despite having had a recent eye assessment.
Keywords: Adult; Aged; Aged, 80 and over; *Delivery of Health Care/sn [Statistics & Numerical Data]; *Eye Diseases/ep [Epidemiology]; *Eye Diseases/th [Therapy]; Female; *Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility; Humans; Male; Middle Aged; *Ophthalmology/sn [Statistics & Numerical Data]; *Optometry/sn [Statistics & Numerical Data]; Prevalence; Rural Population; Urban Population; Victoria/ep [Epidemiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

[Comparison of once-daily nonpreserved timolol and timolol maleate gel-forming solution associated with latanoprost]. - Bron, A; Velasque, L; Rebica, H; Pouliquen, P; Elena, P-P; Rouland, J-F (Journal francais d'ophtalmologie, 2004)
AIM: To compare the efficacy and safety of a single daily instillation of nonpreserved timolol to a timolol maleate gel-forming solution in patients with chronic glaucoma or ocular hypertension already treated with latanoprost., PATIENTS AND METHODS: A randomized, prospective, multicenter, open, parallel-group clinical trial was undertaken with 73 patients with chronic glaucoma treated with latanoprost and a timolol maleate gel-forming solution. In 36 patients, the previous regimen was substituted by nonpreserved timolol given instead of timolol maleate gel for 3 months. The changes in intraocular pressure (IOP) were recorded as well as local and systemic tolerance and patient compliance., RESULTS: At 3 months, both regimens were found equivalent in maintaining IOP control between D0 and D84. The difference with baseline was -0.08 +/- 2.22 mmHg and -0.38 +/- 2.41 mmHg in the nonpreserved timolol group and in the timolol maleate gel-forming solution group, respectively (CI 95% [-0.79; 1.38]). After 84 days of treatment, blurred vision (5.9%) and eyelid deposits (5.9%) were reduced in the preservative-free timolol group compared to the other group (respectively, 33.3% and 24.2%). These differences were statistically significant for both signs (blurred vision: p < 0.0001 and for eyelid deposits: p = 0.03)., CONCLUSION: This short-term study has demonstrated the equivalence of nonpreserved timolol to timolol maleate gel-forming solution in terms of IOP control. Moreover, the local tolerance of nonpreserved timolol was better.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Delayed-Action Preparations; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; Male; Middle Aged; Prospective Studies; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Time Factors; *Timolol/ad [Administration & Dosage]

Surgical results of persistent fetal vasculature. - Cheng, Li-Sheng; Kuo, Hsi-Kung; Lin, Sue-Ann; Kuo, Ming-Lun (Chang Gung medical journal, 2004)
BACKGROUND: To evaluate the surgical results of patients with persistent fetal vasculature (PFV), also known as persistent hyperplastic primary vitreous (PHPV)., METHODS: From 1991 to 2001, a retrospective, noncomparative study of 7 eyes of 7 patients diagnosed with PFV was conducted. In each case, type of anterior and/or posterior PHPV findings, preoperative testing, surgical procedures, and visual outcomes were obtained from the records. Follow-up ranged from 12 to 43 months, with a mean of 15 months., RESULTS: Of the 7 eyes, one (14%) had strictly anterior PFV, 1 (14%) had strictly posterior PFV, and 5 (71%) had components of both anterior and posterior disease. Initial lens aspiration only was performed in 3 (43%) eyes. Initial vitrectomy only was performed in 1 eye (14%). Initial lensectomy and vitrectomy was performed in 3 (42.8%) eyes. The reoperation rate was 43% for membrane reproliferation, glaucoma, vitreous hemorrhage, and retinal detachment. Final best-corrected visual acuity ranged from light perception only to 20/70 on the Snellen chart., CONCLUSIONS: Functional vision is possible in selected patients. However, poor final visual outcome despite adequate anatomic success were noted in this study. The poor outcomes might have been due to patients delaying vitrectomy until retinal detachment developed or that the patients had poor compliance with postoperative ocular rehabilitation.
Keywords: Child; Child, Preschool; *Eye Abnormalities/su [Surgery]; Female; Humans; Hyperplasia; Infant; Lens, Crystalline/su [Surgery]; Male; Postoperative Complications/et [Etiology]; Retrospective Studies; Visual Acuity; Vitrectomy; *Vitreous Body/ab [Abnormalities]

Optic nerve and neuroprotection strategies. - Osborne, N N; Chidlow, G; Layton, C J; Wood, J P M; Casson, R J; Melena, J (Eye (London, England), 2004)
BACKGROUND: Experimental studies have yielded a wealth of information related to the mechanism of ganglion cell death following injury either to the myelinated ganglion cell axon or to the ganglion cell body. However, no suitable animal models exist where injury can be directed to the optic nerve head region, particularly the unmyelinated ganglion cell axons. The process of relating the data from the various animal models to many different types of optic neuropathies in man must, therefore, be cautious., RESULTS: Extensive studies on the isolated optic nerve have yielded valuable information on the way white matter is affected by ischaemia and how certain types of compounds can attenuate the process. Moreover, there are now persuasive data on how ganglion cell survival is affected when the ocular blood flow is reduced in various animal models. As a consequence, the molecular mechanisms involved in ganglion cell death are fairly well understood and various pharmacological agents have been shown to blunt the process when delivered before or shortly after the insult., CONCLUSIONS: A battery of agents now exist that can blunt animal ganglion cell death irrespective of whether the insult was to the ganglion cell body or the myelinated axon. Whether this information can be applied for use in patients remains a matter of debate, and major obstacles need to be overcome before the laboratory studies may be applied clinically. These include the delivery of the pharmacological agents to the site of ganglion cell injury and side effects to the patients. Moreover, it is necessary to establish whether effective neuroprotection is only possible when the drug is administered at a defined time after injury to the ganglion cells. This information is essential in order to pursue the idea that a neuroprotective strategy can be applied to a disease like glaucoma, where ganglion cell death appears to occur at different times during the lifetime of the patient.
Keywords: Animals; Apoptosis/de [Drug Effects]; Apoptosis/ph [Physiology]; Axons/ph [Physiology]; Disease Models, Animal; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Neuroprotective Agents/tu [Therapeutic Use]; Optic Disk/de [Drug Effects]; Optic Disk/pp [Physiopathology]; *Optic Nerve/de [Drug Effects]; Optic Nerve/pp [Physiopathology]; *Optic Nerve Diseases/dt [Drug Therapy]; Optic Nerve Diseases/pp [Physiopathology]; Optic Nerve Injuries/dt [Drug Therapy]; Optic Nerve Injuries/pp [Physiopathology]; Optic Neuropathy, Ischemic/dt [Drug Therapy]; Optic Neuropathy, Ischemic/pp [Physiopathology]; Rats; *Retinal Ganglion Cells/de [Drug Effects]; Retinal Ganglion Cells/ph [Physiology]

Adverse corneal events associated with corneal reshaping: a case series. - Lang, Jacob; Rah, Marjorie J (Eye & contact lens, 2004)
PURPOSE: This case series presents the first documented cases of infectious ulcers associated with overnight orthokeratology in North America and other less serious complications associated with overnight corneal reshaping., CASE REPORTS: Five cases of adverse corneal events associated with corneal refractive therapy are described: two cases of microbial keratitis, one case of infiltrates, one case of toxic keratitis, and one corneal abrasion., CONCLUSIONS: Corneal compromise and poor compliance can cause adverse events with corneal reshaping. The need for ongoing patient education is important not only for pediatric contact lens patients, but also for adults.
Keywords: Adult; Anti-Bacterial Agents/tu [Therapeutic Use]; Child; *Contact Lenses/ae [Adverse Effects]; Corneal Ulcer/dt [Drug Therapy]; *Corneal Ulcer/et [Etiology]; Corneal Ulcer/mi [Microbiology]; Eye Infections, Bacterial/dt [Drug Therapy]; *Eye Infections, Bacterial/et [Etiology]; Eye Infections, Bacterial/mi [Microbiology]; Female; *Foreign-Body Reaction/et [Etiology]; Humans; Male; *Myopia/th [Therapy]; Ofloxacin/tu [Therapeutic Use]; Serratia Infections/dt [Drug Therapy]; *Serratia Infections/et [Etiology]; Serratia Infections/mi [Microbiology]; Serratia marcescens/ip [Isolation & Purification]

[Telematic-assisted self-tonometry (TAS)]. - Lammer, R; Groh, M E M; Michelson, G (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2004)
BACKGROUND: Close supervision of intraocular pressure (IOP) means monitoring an important risk factor for glaucoma., METHOD: After instruction in its use, patients measure their own IOP several times a day with the Drager self-tonometer. The measurements are subsequently transmitted to a server via the telephone keypad and recorded separately for each patient. The software enables statistical evaluation of the pressure levels collected., RESULTS: Up to now 30 of 35 patients transmit measurements or had done so for at least 6 months. Registration of measurement levels covering months and years provides the opportunity for optimizing treatment and hence can be considered a start toward quality assurance in the treatment of glaucoma patients., CONCLUSION: TAS is a cost-efficient method for obtaining long-term profiles of eye pressure. Thus, the possibility exists for early therapeutic intervention in patients at risk. The compliance gained by the close relationship between the physician and the patient represents a positive prognostic factor.
Comment in (CIN)
Keywords: Equipment Design; Equipment Failure Analysis; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; Quality Assurance, Health Care/mt [Methods]; Reproducibility of Results; *Risk Assessment/mt [Methods]; *Self Care/is [Instrumentation]; Self Care/mt [Methods]; Sensitivity and Specificity; Severity of Illness Index; *Telemedicine/is [Instrumentation]; Telemedicine/mt [Methods]; *Tonometry, Ocular/is [Instrumentation]; Tonometry, Ocular/mt [Methods]

Risk factors for corneal regraft in patients on the French waiting list. - Tuppin, Philippe; Poinard, Chantal; Loty, Bernard; Delbosc, Bernard (Cornea, 2004)
PURPOSE: To determine the frequency of corneal regraft (CR) and to identify risk factors associated with CR for all primary diagnoses, secondary endothelial failure (SEF), and keratoconus., METHODS: This survey included 8904 eyes registered on the French national waiting list that underwent keratoplasty between 2000 and 2002., RESULTS: The frequency of CR was 14.0% for all diagnoses, 16.9% among SEF patients, and 8.3% among keratoconus patients. For all diagnoses, the following factors were found to be independently associated with a significantly increased risk of CR (P < 0.05): primary diagnosis (stromal dystrophy, herpes simplex keratitis, SEF, trauma, and keratoconus with Fuchs dystrophy as reference), vascularization in more than 2 quadrants, planned recipient diameter over 8.5 mm, immunologic disorders, previous lens surgery (aphakic, pseudophakic anterior or posterior chamber intraocular lens), previous surgery for glaucoma or trauma, being grafted in 2001 or in 2002. For SEF patients, the risk factors were younger age, vascularization in more than 2 quadrants, planned recipient diameter over 8.5 mm, immunologic disorders, previous surgery for glaucoma or trauma, associated cataract or dry eye, and graft year. For keratoconus patients, the risk factors for CR were older age, vascularization in more than 2 quadrants, immunologic disorders, and previous lens surgery., CONCLUSION: The frequency of CR increased in France over the 2000-2002 time period. Patients presenting the above risk factors should be followed up closely to limit the loss of the first graft.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Corneal Diseases/pp [Physiopathology]; Corneal Diseases/su [Surgery]; Corneal Transplantation/sn [Statistics & Numerical Data]; *Corneal Transplantation; Endothelium, Corneal/pp [Physiopathology]; Female; France; Humans; Infant; Infant, Newborn; Keratoconus/su [Surgery]; Male; Middle Aged; Reoperation/sn [Statistics & Numerical Data]; Risk Factors; *Waiting Lists

Ocular hypotensive efficacy of travoprost in patients unsuccessfully treated with latanoprost. - Kaback, Martin; Geanon, John; Katz, Gregory; Ripkin, Douglas; Przydryga, Johan; START Study Group (Current medical research and opinion, 2004)
OBJECTIVE: To evaluate the efficacy of travoprost 0.004% monotherapy in patients unsuccessfully treated with latanoprost monotherapy., RESEARCH DESIGN AND METHODS: Open-label, noncomparative study conducted at US academic and private practice clinics in adult patients with ocular hypertension or primary open-angle glaucoma who required a change in therapy (due to either inadequate efficacy or safety issues) as judged by the investigator. Intraocular pressure (IOP) was measured at entry and 30 days later., MAIN OUTCOME MEASURES: Mean change in intraocular pressure (mm Hg)., RESULTS: Reported here are 488 per-protocol patients from 330 centers who were using latanoprost monotherapy prior to study entry, and who received travoprost monotherapy during the study. Patients had a mean age of 69 years, were approximately two-thirds Caucasian, 60% female, predominantly brown or blue eyes, and 91% were diagnosed as having primary open-angle glaucoma. The mean days in treatment were 31.9 +/- 6.4. Mean IOP at study entry was 21.2 mm Hg. Following travoprost monotherapy, this was reduced by a mean of 3.2 mm Hg to 18 mm Hg (p < 0.0001, paired t-test). There were 21 adverse events reported in the intent-to-treat (ITT) population for an incidence of 3.5%. There were some limitations to the current study including: no washout period, no control therapy, single IOP determinations at the beginning and the end of the study; patient compliance with the initial therapy was not measured, and the study was not masked. This study reflects a real-life situation of what a clinician can expect when he changes a patient from latanoprost monotherapy to travoprost monotherapy., CONCLUSION: This study showed that travoprost provided a statistically and clinically significant reduction (p < 0.0001) in IOP of 3.2 mm Hg for patients who had not been successfully treated with latanoprost monotherapy. The results of this trial demonstrate the potential benefit of using travoprost as a replacement therapy in order to ensure adequate IOP control.
Keywords: Aged; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; *Cloprostenol/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Travoprost

Utilisation of eye care services in rural south India: the Aravind Comprehensive Eye Survey. - Nirmalan, P K; Katz, J; Robin, A L; Krishnadas, R; Ramakrishnan, R; Thulasiraj, R D; Tielsch, J (The British journal of ophthalmology, 2004)
AIM: To determine utilisation of eye care services in a rural population of southern India aged 40 years or older., METHODS: 5150 subjects aged 40 years and older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers before ocular examinations., RESULTS: 3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827 (35.5%) people gave a history of previous eye examinations, primarily from a general hospital (n = 1073, 58.7%). Increasing age and education were associated with increased utilisation of eye care services. Among the 3323 people who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of individuals with vision impairment, cataracts, refractive errors, and glaucoma had previously utilised services., CONCLUSIONS: A large proportion of people in a rural population of southern India who require eye care are currently not utilising existing eye care services. Improved strategies to improve uptake of services is required to reduce the huge burden of vision impairment in India.
Keywords: Adult; Age Distribution; Age Factors; Aged; Cross-Sectional Studies; Educational Status; *Eye Diseases/di [Diagnosis]; Eye Diseases/ep [Epidemiology]; Female; Humans; India/ep [Epidemiology]; Male; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Rural Health/sn [Statistics & Numerical Data]; Vision Disorders/di [Diagnosis]; Vision Disorders/ep [Epidemiology]

Monitoring visual status: why patients do or do not comply with practice guidelines. - Sloan, Frank A; Brown, Derek S; Carlisle, Emily Streyer; Picone, Gabriel A; Lee, Paul P (Health services research, 2004)
OBJECTIVE: To determine factors affecting compliance with guidelines for annual eye examinations for persons diagnosed with diabetes mellitus (DM) or age-related macular degeneration (ARMD)., DATA SOURCES/STUDY SETTING: Nationally representative, longitudinal sample of individuals 65+ drawn from the National Long-Term Care Survey (NLTCS) with linked Medicare claims records from 1991 to 1999., STUDY DESIGN: Medicare beneficiaries were followed from 1991 to 1999, unless mortality intervened. All claims data were analyzed for presence of ICD-9 codes indicating diagnosis of DM or ARMD and the performance of eye exams. The dependent variable was a binary indicator for whether a person had an eye exam or not during a 15-month period. Independent variables for demographics, living conditions, supplemental insurance, income, and other factors affecting the marginal cost and benefit of an eye exam were assessed to determine reasons for noncompliance., DATA COLLECTION/EXTRACTION METHODS: Panel data were created from claims files, 1991-1999, merged with data from the NLTCS., PRINCIPAL FINDINGS: The probability of having an exam reflected perceived benefits, which vary by patient characteristics (e.g., education, no dementia), and factors associated with the ease of visit. African Americans were much less likely to be examined than were whites., CONCLUSIONS: Having an exam reflects multiple factors. However, much of the variation in the probability of an exam remained unexplained as were reasons for the racial differences in use.
Keywords: Aged; Comorbidity; *Diabetes Mellitus/ep [Epidemiology]; Diabetic Retinopathy/ep [Epidemiology]; *Diabetic Retinopathy/pc [Prevention & Control]; Eye Diseases/ep [Epidemiology]; *Eye Diseases/pc [Prevention & Control]; Female; Glaucoma/ep [Epidemiology]; Glaucoma/pc [Prevention & Control]; Humans; Logistic Models; Longitudinal Studies; Macular Degeneration/ep [Epidemiology]; *Macular Degeneration/pc [Prevention & Control]; Male; Medicare/sn [Statistics & Numerical Data]; *Patient Compliance; Practice Guidelines as Topic; Socioeconomic Factors; United States/ep [Epidemiology]; *Vision Tests/sn [Statistics & Numerical Data]

Pressure phosphene self-tonometry: a comparison with goldmann tonometry in glaucoma patients. - Lam, Dennis S C; Leung, Dexter Y L; Chiu, Thomas Y H; Fan, Dorothy S P; Cheung, Eva Y Y; Wong, Tien-Yin; Lai, Jimmy S M; Tham, Clement C Y (Investigative ophthalmology & visual science, 2004)
PURPOSE: To evaluate whether the pressure phosphene tonometer (PPT) is suitable for self-tonometry in patients with glaucoma or ocular hypertension., METHODS: This was a prospective comparative study of 102 eyes of 102 patients with chronic glaucoma or ocular hypertension. Intraocular pressure (IOP) measurements by the Goldmann tonometer (GT) were compared with self-measured readings with the PPT. Patients evaluated the ease of home use of the PPT. The last 15 patients were asked to stop their glaucoma medications, and the ability of the PPT to detect an elevated IOP during self-tonometry was studied., RESULTS: The mean +/- SD difference between PPT and GT readings was -0.24 +/- 1.57 mm Hg. Comparing the PPT with the GT, 86% of the readings were within +/- 2.0 mm Hg, and 91% were within +/- 3.0 mm Hg. Spearman's correlation coefficient was 0.91. A Bland-Altman plot showed that the 95% limits of agreement between the two methods lay between 2.90 and -3.38 mm Hg. Within-subject coefficients of variation for the GT and the PPT were 4.4% and 7.3%, respectively. In detecting an elevated IOP of more than 21 mm Hg, the sensitivity and the specificity of the PPT were 92.3% and 98.6% respectively. The mean satisfaction score for home use of the PPT was 87.4 +/- 16.3 (maximum 100)., CONCLUSIONS: With proper training and technique, self-tonometry with the PPT appears to be accurate up to at least 25 mm Hg and is reproducible. The PPT was sensitive and specific in detecting an elevated IOP of more than 21 mm Hg. As patients were expected to seek ophthalmic care before the self-measured IOP reaches 25 mm Hg, the PPT may have a value for self-monitoring. Patients rated the PPT as satisfactory for home use. Because the PPT is portable and relatively inexpensive and requires no topical anesthesia or direct contact with the eyeball, it may have potential as an instrument for home self-tonometry. Copyright Association for Research in Vision and Ophthalmology
Keywords: Adult; Aged; Chronic Disease; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure; Middle Aged; *Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/pp [Physiopathology]; Patient Satisfaction; *Phosphenes; Prospective Studies; Reproducibility of Results; *Self Care; Sensitivity and Specificity; *Tonometry, Ocular/mt [Methods]

Long-term, targeted genetic modification of the aqueous humor outflow tract coupled with noninvasive imaging of gene expression in vivo. - Loewen, Nils; Fautsch, Michael P; Teo, Wu-Lin; Bahler, Cindy K; Johnson, Douglas H; Poeschla, Eric M (Investigative ophthalmology & visual science, 2004)
PURPOSE: To address a problem impeding research into glaucoma-associated genetic mutations and glaucoma gene therapy and achieve permanent, targeted transgene expression in the trabecular meshwork (TM). Lentiviral vectors are known to transduce human donor eye TM ex vivo, but efficacy in vivo has not been shown. More generally in the field of gene therapy, the authors hypothesized that distinctive properties of the intraocular aqueous circulation could facilitate solving problems of accessibility, targeting, and scale that have hindered realization of gene therapy in other settings., METHODS: A domestic cat model was developed in which long-term in vivo studies were performed. After dose-response studies in primary human TM cells, 19 cats received anterior chamber (AC) injections of stepped doses (10(6)-10(8) transduction units) of lentiviral vectors encoding different marker transgenes (beta-galactosidase, Aequorea victoria green fluorescent protein [GFP], or Renilla reniformis GFP). Animals were monitored serially for transgene expression and IOP., RESULTS: High-grade, stable transgene expression in the TM was achieved and monitored noninvasively over time in living animals. Extensive expression resulted after a single transcorneal injection, persisted for at least 10 months (time of death in the present studies), and was targeted to the TM. The initial IOP did not differ significantly from the IOP at the end of the study (P = 0.4). Aequorea GFP was superior to Renilla GFP. Vectors were effective enough to cause GFP-specific overexpression cytotoxicity at the highest dose, which was solved by dose reduction., CONCLUSIONS: High-grade transgene expression in this large-animal model persisted stably for at least 10 months after a single transcorneal lentiviral vector injection, was highly targeted, and could be monitored serially and noninvasively in living animals. These studies provide a basis for developing realistic disease models and administering glaucoma gene therapy. Copyright Association for Research in Vision and Ophthalmology
Keywords: Animals; Animals, Genetically Modified; *Aqueous Humor/ph [Physiology]; Cats; Cells, Cultured; *Gene Expression; *Gene Targeting; Genetic Vectors; Green Fluorescent Proteins; Humans; Indicators and Reagents/me [Metabolism]; Intraocular Pressure; Lentivirus/ge [Genetics]; Luminescent Proteins/ge [Genetics]; Luminescent Proteins/me [Metabolism]; Time Factors; Trabecular Meshwork/cy [Cytology]; Trabecular Meshwork/ph [Physiology]; Transduction, Genetic; Transgenes; beta-Galactosidase/ge [Genetics]

The efficacy and safety of once-daily versus once-weekly latanoprost treatment for increased intraocular pressure. - Kurtz, Shimon; Shemesh, Gabi (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2004)
We evaluated the efficacy and safety of latanoprost eye drops once-weekly, compared to once-daily for improving patient compliance. Twenty (20) patients (11 women and 9 men), 12 with ocular hypertension and 8 with early glaucoma, were studied after washout of the antiglaucoma treatment. One (1) group was treated with latanoprost once-daily (control). The other group was treated once-weekly (study group). Intraocular pressure (IOP) was measured at baseline and on the 2nd, 4th, 6th, and 9th day after the last drop in the study group, and for 3 months on the same schedule thereafter. The mean baseline IOP was 24.3 +/- 3.9 mmHg in the study group (range, 18-29) and 24.4 +/- 4.4 mmHg in the control group (range, 17-32). The average IOP at all time points of post-treatment was 17.7 +/- 1.5 mmHg (range, 14-23) and 16.9 +/- 2.30 mmHg (range, 13-21), respectively. Latanoprost significantly lowered IOP in both groups (study group, p = 0.005; controls, p = 0.0019). The difference between post-treatment IOP was insignificant in both groups at each time point. The study group had fewer minor side effects than the control group (1/10 versus 6/10, respectively). Latanoprost treatment once-weekly was as effective, and bore fewer minor side effects, as once-daily treatment after 3 months of follow-up.
Keywords: Adult; Aged; Analysis of Variance; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Latanoprost; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; *Prostaglandins F, Synthetic/ae [Adverse Effects]; Pruritus/ci [Chemically Induced]; Statistics, Nonparametric

[Initial medical treatment: beta-blockers or prostaglandins? The beta-blocker is the Swiss Army knife of the glaucoma physician]. - Rouland, J-F (Journal francais d'ophtalmologie, 2004)
With the emergence of prostaglandin analogs, beta-blockers have been challenged as the initial treatment for glaucoma. It should be remembered that their clinical efficacy in reducing intraocular pressure is well established, systemic passage is much lower with delayed-action forms and gel forms, compliance is excellent and all of these therapeutic advantages are provided with a particularly low cost.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/ec [Economics]; Adrenergic beta-Antagonists/pd [Pharmacology]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Clinical Trials as Topic; Delayed-Action Preparations; Gels; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Patient Compliance

Prospective study comparing lidocaine 2% jelly versus sub-Tenon's anaesthesia for trabeculectomy surgery. - Carrillo, M M; Buys, Y M; Faingold, D; Trope, G E (The British journal of ophthalmology, 2004)
AIMS: To compare the analgesic properties of lidocaine 2% jelly versus sub-Tenon's anaesthesia with lidocaine 2% without adrenaline (epinephrine) for trabeculectomy surgery., METHODS: A prospective randomised clinical trial. 59 consecutive patients scheduled for trabeculectomy at the Toronto Western Hospital were randomly assigned to topical unpreserved lidocaine 2% jelly or sub-Tenon's anaesthesia with 2% lidocaine. Both groups received a standardised sedative consisting of midazolam, fentanyl. and/or propofol. The visual analogue scale was utilised to measure intraoperative pain. Patient comfort, physician assessment of intraoperative patient compliance, volume of local anaesthetic used, need for supplemental anaesthesia, and any complications were recorded. The two groups were compared using the Student's t test., RESULTS: The sub-Tenon's anaesthesia group and the lidocaine 2% jelly group did not vary significantly in subjective pain score (18.3 (SD 16.2) v 19.8 (12.4) respectively, p = 0.739) and surgeons' satisfaction scale (3.6 (0.7) and 3.8 (0.6) respectively, p = 0.328). Four patients required additional anaesthesia, all of them in the sub-Tenon's group., CONCLUSION: Topical lidocaine 2% jelly is as effective as sub-Tenon's anaesthesia for pain control in patients undergoing trabeculectomy. Lidocaine 2% jelly is similar to sub-Tenon's anaesthesia in patient comfort and surgeon satisfaction.
Keywords: Aged; *Anesthesia, Local/mt [Methods]; *Anesthetics, Local; Female; *Glaucoma/su [Surgery]; Humans; Hypnotics and Sedatives/ad [Administration & Dosage]; *Lidocaine; Male; Middle Aged; Pain/pc [Prevention & Control]; Prospective Studies; *Trabeculectomy/mt [Methods]

Racial variations in causes of vision loss in nursing homes: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) Study. - Friedman, David S; West, Sheila K; Munoz, Beatriz; Park, William; Deremeik, James; Massof, Robert; Frick, Kevin; Broman, Aimee; McGill, Wendy; Gilbert, Donna; German, Pearl (Archives of ophthalmology (Chicago, Ill. : 1960), 2004)
OBJECTIVE: To determine the prevalence and causes of low vision in a large sample of nursing home residents., METHODS: Twenty-eight nursing homes on the Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration/rehabilitation on nursing home residents. Visual acuity was measured using both recognition charts and preferential looking techniques. An ophthalmologist examined all residents with visual acuity worse than 20/40 in the better-seeing eye and determined the primary cause for decreased vision. Results are reported for the better-seeing eye., RESULTS: Of 2544 eligible residents, 1591 (63%) participated, but 286 residents were unable to respond to visual acuity testing. Of the remaining 1307 residents, 496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeing eye. Causes were ascribed for 412 subjects. Rates of low vision were similar between African American subjects and white subjects (39% and 38%, respectively; age-adjusted P =.18). Cataract was the leading cause of low vision, responsible for 37% of low vision among white subjects and 54% of low vision among African American subjects. Macular degeneration was responsible for 29% of low vision among white subjects but only 7% among African American subjects. Glaucoma caused low vision in 4% of white subjects and 10% of African American subjects. Refractive error was not a frequent cause of low vision in nursing home residents., CONCLUSIONS: Low vision is highly prevalent among nursing home residents, with 37% having visual acuity worse than 20/40 in the better-seeing eye. Differences in causes of low vision between African American subjects and white subjects were noted, with African American subjects more likely to have vision loss on the basis of cataract, a readily treated condition. Appropriate interventions for nursing home residents, who face significant obstacles in accessing eye care services, have the potential to improve the quality of life of this at-risk older population.
Keywords: *African Continental Ancestry Group/sn [Statistics & Numerical Data]; Aged; Aged, 80 and over; *Blindness/eh [Ethnology]; Blindness/et [Etiology]; Blindness/rh [Rehabilitation]; Causality; Delaware/ep [Epidemiology]; *European Continental Ancestry Group/sn [Statistics & Numerical Data]; Eye Diseases/co [Complications]; Female; *Homes for the Aged/sn [Statistics & Numerical Data]; Humans; Male; Maryland/ep [Epidemiology]; *Nursing Homes/sn [Statistics & Numerical Data]; Prevalence; *Vision, Low/eh [Ethnology]; Vision, Low/et [Etiology]; Vision, Low/rh [Rehabilitation]; Visual Acuity

Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services. - Sinclair, A; Hinds, A; Sanders, R (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2004)
The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty-five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one-third of patients had a hearing impairment. One-third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.
Keywords: Aged; *Blindness/et [Etiology]; Blindness/pc [Prevention & Control]; Blindness/rh [Rehabilitation]; Dementia/co [Complications]; *Glaucoma/co [Complications]; Glaucoma/th [Therapy]; Health Services Needs and Demand; Hearing Disorders/co [Complications]; Humans; Nurses; *Ophthalmology/og [Organization & Administration]; *Optometry/og [Organization & Administration]; Patient Compliance; Scotland; Social Support

Ocular surface treatment before laser in situ keratomileusis in patients with severe dry eye. - Toda, Ikuko; Asano-Kato, Naoko; Hori-Komai, Yoshiko; Tsubota, Kazuo (Journal of refractive surgery (Thorofare, N.J. : 1995), 2004)
PURPOSE: To evaluate the efficacy and safety of laser in situ keratomileusis (LASIK) in patients with severe dry eye associated with Sjogren's syndrome., METHODS: Three patients (six eyes) with Sjogren's syndrome who underwent bilateral LASIK were retrospectively evaluated for visual outcome, intraoperative and postoperative complications, dry eye status (subjective symptoms and objective findings, Schirmer test, vital staining of the ocular surface), and outcome satisfaction by subjective questionnaire. All patients had negative reflex tearing and were treated with topical autologous serum and/or punctal occlusion prior to LASIK to improve the ocular surface. This treatment was continued postoperatively., RESULTS: Mean attempted correction of six eyes was -8.46 +/- 1.55 D (range -7.00 to -10.63 D). One year after LASIK, mean uncorrected visual acuity was 1.07 (range 0.7 to 1.5), mean best spectacle-corrected visual acuity was 1.29 (range 1.2 to 1.5), and mean refraction was -0.19 +/- 0.51 D (range -1.00 to +0.50 D). Tear production, rose bengal and fluorescein staining, and dry eye symptoms were not exacerbated after LASIK. No complications, such as intraoperative epithelial defect, diffuse lamellar keratitis, epithelial ingrowth, or recurrent erosion occurred. All three patients were satisfied with the outcome of their surgery., CONCLUSION: LASIK can be safely and effectively managed in patients with severe dry eye with reduced reflex tearing by preoperative and postoperative treatments consisting of a combination of artificial tears, topical autologous serum, and punctal occlusion. Careful assessment of preoperative and postoperative ocular surface status is mandatory in such patients.
Keywords: Cornea/pa [Pathology]; *Cornea/su [Surgery]; Dry Eye Syndromes/co [Complications]; *Dry Eye Syndromes/su [Surgery]; Female; Humans; Keratomileusis, Laser In Situ; Middle Aged; Myopia/co [Complications]; *Myopia/su [Surgery]; Patient Satisfaction; *Perioperative Care/mt [Methods]; Postoperative Complications; Retrospective Studies; Safety; Treatment Outcome; Visual Acuity

Molecular cloning and characterization of a cDNA encoding a laminin-binding protein (AhLBP) from Acanthamoeba healyi. - Hong, Yeon-Chul; Lee, Won-Myung; Kong, Hyun-Hee; Jeong, Hae-Jin; Chung, Dong-Il (Experimental parasitology, 2004)
Adherence of Acanthamoeba to host tissue is believed to be crucial in the establishment of amoebic keratitis or GAE. We have isolated a cDNA from a GAE-causing gymnoamoeba, Acanthamoeba healyi, encoding a protein that binds laminin by screening with a peptide G-specific DNA probe. The cDNA clone (AhLBP) was identified on the basis of sequence homology to the nonintegrin mammalian metastasis-associated 67-kDa laminin receptor (67-LR). The predicted amino acid sequence is 256 residues long with a calculated molecular mass of 28.2kDa and a theoretical pI of 5.48. Southern and Northern blot analyses suggested the gene as a single copy in A. healyi genome and expressed as a single transcript of approximately 1.0kb. Virulent strains of Acanthamoeba revealed higher level of the AhLBP mRNA expression than soil isolates. Specific binding of the purified recombinant protein to laminin was confirmed by sandwich Western blot. The polypeptide encoded by AhLBP shared substantial identity with the acidic class ribosomal proteins involved in protein synthesis. Therefore, the AhLBP may be multifunctional in A. healyi, acting as a laminin-binding molecule but also playing a role in cell division and growth. AhLBP-EGFP fusion protein expressed in A. healyi was localized mainly at the cell membrane and nucleus and at cytoplasm with lesser degree. N-terminal 64 amino acids were important for the localization at the cell membrane. This is the first description of a cDNA encoding a laminin-binding protein from protozoan parasites.
Keywords: Acanthamoeba/cl [Classification]; *Acanthamoeba/ge [Genetics]; Acanthamoeba/me [Metabolism]; Amebiasis/et [Etiology]; Amino Acid Sequence; Animals; Base Sequence; Blotting, Northern; Blotting, Southern; Blotting, Western; Cell Adhesion/ph [Physiology]; Cloning, Molecular; *DNA, Complementary/ch [Chemistry]; DNA, Complementary/ge [Genetics]; Gene Expression Regulation; Humans; Molecular Sequence Data; Molecular Weight; Phylogeny; Protein Precursors/ch [Chemistry]; *Protein Precursors/ge [Genetics]; Protein Precursors/me [Metabolism]; Protozoan Proteins/ch [Chemistry]; *Protozoan Proteins/ge [Genetics]; Protozoan Proteins/me [Metabolism]; RNA, Messenger/bi [Biosynthesis]; Receptors, Laminin/ch [Chemistry]; *Receptors, Laminin/ge [Genetics]; Receptors, Laminin/me [Metabolism]; Reverse Transcriptase Polymerase Chain Reaction; Sequence Alignment

Glaucoma case finding: a cluster-randomised intervention trial. - Theodossiades, J; Murdoch, I; Cousens, S (Eye (London, England), 2004)
PURPOSE: To assess the effect of an intervention comprising training in optic disc assessment, explicit referral criteria and ophthalmologist feedback on referred patients, on the number of optometrist referrals for suspected glaucoma seen at a referral site and the positive predictive value of those referrals., METHODS: Optometric practices routinely referring to the Ealing Hospital Eye Clinic were randomly divided into two groups taking into consideration those practices, which shared an optometrist (a cluster) and the number of optometrist days worked per week. One group of practices acted as controls, while the other practices were invited to receive the intervention. Data on 397 new patients referred and presenting to Ealing Hospital with suspected glaucoma were collected over a 20-month period. The data on patients who had failed to attend their appointment were collected over 7 months of this period. The number of referrals seen, the positive predictive value of those referrals, and the attendance rate were calculated. Optometrist's opinions of the intervention were assessed qualitatively. Data relating to optometrist compliance with the intervention were also collected., RESULTS: The number of glaucoma referrals presenting to Ealing Hospital from the intervention practices was almost double that from the control practices (210 vs 119). When cluster randomisation, the number of optometrist days per cluster and the number of assessed referrals in the preintervention period are taken into consideration, it is estimated that the intervention is associated with a 52% increase in the number of referrals reaching Ealing Hospital. However, the design effect resulting from the cluster randomisation was unexpectedly high (of the order of 13-14)and so the confidence intervals around the estimate of 52% are very wide (95% c.i. 35% decrease to 253% increase, P = 0.34). There was no evidence of an association between optometrist compliance with the intervention and the number of referrals seen at Ealing Hospital. The positive predictive value (PPV)of referrals was similar for the intervention(0.49 (95% c.i. 0.42, 0.55)) and control groups(0.46 (95% c.i. 0.33, 0.60)). Optometrist opinions of the intervention were largely favourable. All expressed a willingness to participate in future programmes., CONCLUSION: A large difference in the number of referrals between the practice groups was observed. Since the PPV of referral was unchanged, the potential impact of the intervention in terms of numbers of new cases of glaucoma detected in the community is substantial. However, because of its large design effect, this trial does not provide conclusive evidence of an impact of the intervention on referral numbers. A considerably larger trial will be required to produce conclusive evidence of an effect.
Keywords: Attitude of Health Personnel; Cluster Analysis; Education, Medical, Continuing; Feedback; *Glaucoma/di [Diagnosis]; Humans; Interprofessional Relations; London; Optic Disk/pa [Pathology]; *Optometry/ed [Education]; Practice Guidelines as Topic; Predictive Value of Tests; *Referral and Consultation

Comparison of latanoprost and dorzolamide in the treatment of patients with open angle glaucoma. - Niazi, Muhammad Khizar; Raja, Naseer (Journal of Ayub Medical College, Abbottabad : JAMC, 2004)
BACKGROUND: This study was conducted to compare the effects on intraocular pressure and side effects of monotherapy with either latanoprost or dorzolamide in patients with open angle glaucoma, pseudoexfoliation glaucoma or ocular hypertension., METHODS: Sixty patients with open angle glaucoma or ocular hypertension were recruited to a 3-month study. Previous glaucoma medications were washed out and the patients were randomised to receive either latanoprost 0.005% once daily or dorzolamide 2% three times daily. The follow-up visits were conducted at two weeks, one months and three months of study and intraocular pressures and slit lamp examinations were carried out to look for response of therapy and detect complications., RESULTS: After 3 months, latanoprost reduced mean baseline intraocular pressure from 27.2 +/- 3.0 mm Hg by 8.5 +/- 3.3 mm Hg. The corresponding figures for dorzolamide were 27.2 +/- 3.4 and 5.6 +/- 2.6 mm Hg. The difference of 2.9 mm Hg (95% CI: 2.3-3.6) was highly significant (p < 0.001). Both drugs were well tolerated systemically and locally., CONCLUSION: Latanoprost was superior to dorzolamide in reducing the intraocular pressure, judged from the effect on mean intraocular pressure. The once daily dose in the evening ensures better compliance and the problem of hyperpigmentation of the iris were not encountered.
Keywords: Adult; Aged; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Prostaglandins F, Synthetic/pd [Pharmacology]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Sulfonamides/pd [Pharmacology]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/pd [Pharmacology]; *Thiophenes/tu [Therapeutic Use]

Sterility of glaucoma medications among chronic users in the community. - Porges, Yair; Rothkoff, Levi; Glick, Joseph; Cohen, Shimon (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2004)
PURPOSE: To evaluate the sterility of topical glaucoma medications among chronic glaucoma medication users in the community., SETTING: Glaucoma service, Sanz Medical Center, Laniado Hospital, Netanya. Research mode: Cross-sectional laboratory and clinical study., PATIENTS AND METHODS: Chronic glaucoma patients were asked to submit their topical glaucoma preparations to the microbiology laboratory at Laniado hospital. Samples taken from the interior of the bottle and the tip were cultured using MacConkey agar, blood agar, and chocolate agar plates., RESULTS: Sixty-two bottles of topical glaucoma medications used by 27 patients were tested. Bacterial growth was detected in eight (12.9%) preparations, three of which revealed Pseudomonas aeruginosa, three Staphylococcus epidermidis, one Streptococcus viridans, and one Klebsiella. During the study, acute conjunctivitis was found in one patient, possibly due to the use of infected drops. In another case, two identical medications, which had been used simultaneously for more than 6 weeks by the same patient, were found to be infected., CONCLUSIONS: Glaucoma topical preparations are generally found safe in terms of sterility, though bacterial growth may be found in a small percentage. In most cases, the cause of the loss of sterility could not be determined. However, in two preparations, contamination was related to the noncompliance of the patient who continued using the same preparation longer than instructed. It is imperative to increase the awareness of glaucoma patients to the fact that improper use can lead to eye-drop contamination.
Keywords: Aged; *Antihypertensive Agents/st [Standards]; Cross-Sectional Studies; *Drug Contamination; Female; *Glaucoma/dt [Drug Therapy]; Humans; Klebsiella/ip [Isolation & Purification]; Male; Pseudomonas aeruginosa/ip [Isolation & Purification]; Staphylococcus/ip [Isolation & Purification]

An evaluation of the fixed-combination of latanoprost and timolol for use in open-angle glaucoma and ocular hypertension. - Feldman, Robert M (Expert opinion on pharmacotherapy, 2004)
Glaucoma is one of the leading causes of irreversible blindness worldwide. Although there is no cure for this chronic disease, medical treatment is aimed at reducing levels of intraocular pressure (IOP) using ocular hypotensive agents. Very often, patients require more than one IOP-reducing drug, resulting in complex medication regimens that may be difficult to maintain and that can lead to non-compliance. A fixed-combination (FC) ophthalmic solution consisting of the prostaglandin, latanoprost (0.005%), and the beta-blocker, timolol (0.5%), is now available. The primary mechanism of action of latanoprost is to increase uveoscleral outflow whereas timolol lowers IOP levels by decreasing the formation of aqueous humor in the ciliary epithelium. Due to the unique mechanism of action of latanoprost, once-daily dosing of one drop of FC latanoprost/timolol results in additional IOP reduction compared with either drug administered separately. FC latanoprost/timolol is well-tolerated and has a safety profile similar to that of its individual components. This combination drug provides a safe, effective and convenient alternative for the treatment of patients with elevated IOP levels uncontrolled with monotherapy.
Keywords: Antihypertensive Agents/pk [Pharmacokinetics]; Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Combinations; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Prostaglandins F, Synthetic/pk [Pharmacokinetics]; Prostaglandins F, Synthetic/pd [Pharmacology]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Randomized Controlled Trials as Topic; Timolol/pk [Pharmacokinetics]; Timolol/pd [Pharmacology]; *Timolol/tu [Therapeutic Use]

Dorzolamide/Timolol fixed combination versus concomitant administration of brimonidine and timolol in patients with elevated intraocular pressure: a 3-month comparison of efficacy, tolerability, and patient-reported measures. - Solish, Alfred M; DeLucca, Paul T; Cassel, Deborah A; Kolodny, Andrea H; Hustad, Carolyn M; Skobieranda, Franck (Journal of glaucoma, 2004)
BACKGROUND: To compare the intraocular pressure (IOP) lowering effect, tolerability, and patient-reported measures of the dorzolamide/timolol fixed combination and the concomitant administration of brimonidine and timolol after 3 months., METHODS: Four hundred ninety-two patients with ocular hypertension, primary open-angle glaucoma, exfoliative glaucoma, or pigmentary glaucoma participated in this randomized, observer-masked, multicenter study. Following 3 weeks of timolol monotherapy, patients with a peak IOP of > or = 2 mm Hg were randomized to receive either fixed combination dorzolamide/timolol twice daily or concomitant brimonidine plus timolol twice daily for 3 months. The IOP-lowering effects at peak and trough, tolerability, and patient-reported convenience and satisfaction were measured at months 1 and 3., RESULTS: At month 3 peak, the dorzolamide/timolol group had an adjusted mean (SE) change from baseline IOP of -4.30 (0.24) mm Hg versus -5.27 (0.23) mm Hg in the brimonidine-plus-timolol group, with a treatment difference of 0.97 mm Hg (95% CI: 0.40, 1.53). At the month 3 trough timepoint and both month 1 timepoints, the 95% CIs of the treatment differences were within the prespecified comparability boundary of +/- 1.5 mm Hg. The incidence of drug-related adverse experiences was similar between treatment groups. Patient-reported assessments of convenience and satisfaction showed no statistically significant differences between treatment groups., CONCLUSIONS: The IOP-lowering effect of the dorzolamide/timolol fixed combination and concomitant brimonidine plus timolol were comparable at 3 of the 4 timepoints measured. Patient-reported measures and the incidence of adverse experiences in both treatment groups were similar.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Double-Blind Method; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Patient Satisfaction; Prospective Studies; Quinoxalines/ae [Adverse Effects]; *Quinoxalines/tu [Therapeutic Use]; Safety; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

A questionnaire survey of patient acceptability of optic disc imaging by HRT II and GDx. - Tay, E; Andreou, P; Xing, W; Bunce, C; Aung, T; Franks, W A (The British journal of ophthalmology, 2004)
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Diagnostic Techniques, Ophthalmological/px [Psychology]; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; *Patient Acceptance of Health Care; Surveys and Questionnaires

[Results of pars plana lensectomy for childhood cataract]. - Gessner, B; Wiese, S; Lagreze, W A (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2004)
BACKGROUND: Pars plana lensectomy with subsequent fitting of contact lenses is the standard procedure for cataracts occurring within the first 2 years of life. We wanted to assess the outcome and complication rate of this procedure., METHODS: Pars plana lensectomy was performed on 29 eyes of 15 children with bilateral as well as 12 eyes with unilateral cataracts. All children were reexamined at an age of at least 3 years., RESULTS: In bilateral cases the mean age at the time of surgery was 4.0 months and mean resulting visual acuity 0.32. After exclusion of three eyes with complications or bad postoperative compliance, we found a statistically significant correlation between age at surgery and visual acuity (r(2)=0.432, p<0.05). Some form of binocular vision was achieved by 40% of the children; 17% developed ocular hypertension and 7% a secondary cataract. In the unilateral cases the mean age at surgery was 3.9 months and the mean resulting visual acuity 0.14. There was no significant correlation between age and visual acuity; 17% gained binocular function and 5% had ocular hypertension., CONCLUSION: Visual function after lensectomy is better in eyes with bilateral cataracts compared to unilateral cataracts. Early surgery as well as adequate orthoptic therapy and compliance with wearing the contact lens are necessary for good outcome.
Keywords: *Cataract/cn [Congenital]; Child; Child, Preschool; Contact Lenses; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; *Lens Capsule, Crystalline/su [Surgery]; Male; Patient Compliance; *Postoperative Complications/et [Etiology]; Reading; Refraction, Ocular/ph [Physiology]; Treatment Outcome; Vision, Binocular/ph [Physiology]; Visual Acuity/ph [Physiology]; *Vitrectomy

Latanoprost therapy in patients with glaucoma and ocular hypertension inadequately controlled with carteolol. - Yasar, Tekin; Ozdemir, Murat; Andi, Inayet; Ozdemir, Gokhan; Simsek, Saban (Japanese journal of ophthalmology, 2004)
Keywords: Adult; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; *Carteolol/tu [Therapeutic Use]; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Dropout rates for intent-to-treat and per protocol analyses. - Stewart, William C; Jackson, Angi L; Jenkins, Jessica N (American journal of ophthalmology, 2004)
PURPOSE: To describe dropout rates for the intent-to-treat and per protocol analyses from prospective clinical trials., METHODS: Review of prospective multi-center parallel studies of 100 patients or more from 1996 onwards., RESULTS: We identified 33 articles (70 treatment arms) that fit the criteria for this study. No statistical differences in dropout rates were observed among drug classes for either the intent-to-treat (P =.075) or per protocol analyses (P =.40). A difference was observed in the percent dropout rate for the intent-to-treat analyses decreasing with the length of the study (P <.0001). This finding was not observed by the number of study visits (P =.44). However, a statistically greater percent dropout rate was observed for the per protocol analyses increasing with the length of the study (P =.034) and number of study visits (P =.01). No statistical differences were observed or with increasing sample size of the study for either the intent-to-treat or per protocol analyses (P >.05)., CONCLUSIONS: Known discontinuation rates for per protocol and intent-to-treat analyses may help in planning sample sizes for future clinical trials.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Clinical Protocols; *Clinical Trials as Topic/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Models, Statistical; Ocular Hypertension/dt [Drug Therapy]; *Patient Dropouts/sn [Statistics & Numerical Data]; Prospective Studies; Research Design; Sampling Studies

Preventing and managing visual disability in primary care: clinical applications. - Goldzweig, Caroline L; Rowe, Susannah; Wenger, Neil S; MacLean, Catherine H; Shekelle, Paul G (JAMA, 2004)
Clinicians in primary care settings are well positioned to participate in the prevention and management of visual disability. They can have a significant impact on their patients' visual health by screening for vision problems, aggressively controlling known risk factors for visual loss, ensuring adherence to ophthalmologic treatment and continuity of eye care, and by timely referral of specific patient populations to qualified eye care professionals (eg, ophthalmologists and optometrists). Using their knowledge about common ophthalmic medications, clinicians can detect adverse effects of these agents, including exacerbations of heart or lung disease. They can ensure that appropriate patients are screened for common serious eye diseases, such as glaucoma, and that patients with disabilities related to vision problems are assessed for treatable conditions, such as cataracts or refractive error. Finally, clinicians can direct patients with low vision from any cause to resources designed to help enhance patient function and emotional support.
Keywords: Aged; Diabetes Mellitus/pc [Prevention & Control]; *Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; *Family Practice/st [Standards]; Female; Glaucoma/pc [Prevention & Control]; Humans; Hypertension/pc [Prevention & Control]; Macular Degeneration/pc [Prevention & Control]; Male; Middle Aged; Smoking; *Vision Screening/st [Standards]; Visual Acuity

Risk and risk factors for blindness from glaucoma. - Chen, Philip P (Current opinion in ophthalmology, 2004)
PURPOSE OF REVIEW: Estimates of blindness from glaucoma and risk factors for blindness remain of interest for all ophthalmologists., RECENT FINDINGS: Long-term retrospective studies of patients with open-angle glaucoma in developed countries have noted that progression to bilateral blindness among treated patients is relatively uncommon. Risk factors for development of blindness include advanced visual field loss at presentation and noncompliance with the treatment regimen. Age is a risk factor in some studies. Many of those with blindness are blind at presentation. Untreated rates of blindness are higher. Population-based studies of glaucoma in developing countries have highlighted the obstacles to prevention of blindness in such settings, with astonishingly high rates of blindness noted., SUMMARY: The risk of blindness from glaucoma is very high among patients in developing countries, the vast majority of whom do not know they are afflicted. When considering all glaucoma worldwide, the greatest risk factor for blindness is almost certainly being an average citizen of a developing country. Among those with open-angle glaucoma in developed countries, more advanced visual field loss at presentation and noncompliance are risk factors for development of blindness, as well as advanced age. Effective public education about glaucoma and targeted screening of those most likely to have glaucoma are necessary if the number of blind from glaucoma is to be reduced worldwide. Better treatment options for those in developing countries must also be developed.
Keywords: *Blindness/ep [Epidemiology]; *Blindness/et [Etiology]; *Glaucoma/co [Complications]; Glaucoma/ep [Epidemiology]; Humans; Risk Assessment; Risk Factors

[Preserving vision in the elderly: a survey to start a quality development program in general practice]. - Peltenburg, M; Kiener, M; Iseli, H P; Trub, P; Christen, P; Hurni, R; Aebi, B; Steurer, J; Gloor, B (Praxis, 2004)
The study examined the rate of patients, who do not follow recommendations for routine screening, do not visit physicians for eye-symptoms and when suffering from diabetes or glaucoma do not adhere to follow-up. To what extent can primary care physicians impact on these deficits of ophthalmologic care? 4918 consecutive, > or = 40 old patients of 107 primary care physicians of 9 networks participated. Of these patients 15% had never, 43% not within the last 3 years, consulted an ophthalmologist. 16% were diabetics, 7% had glaucoma and 46% had observed subjective eye symptoms. A quarter of these patients turn to their primary care physician, when having eye problems. Primary care physicians do not frequently suggest routine ophthalmologic controls nor do they use diagnostic tools like the Amsler-grid or the Swinging-Flash-Light Test.
Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Color Perception Tests; Diabetes Complications; *Diagnostic Techniques, Ophthalmological; *Eye Diseases/di [Diagnosis]; Eye Diseases/pc [Prevention & Control]; Eyeglasses; Family Practice; Female; Follow-Up Studies; Glaucoma/co [Complications]; Humans; Male; Middle Aged; Office Visits; Ophthalmology; Ophthalmoscopy; *Patient Compliance; Physician-Patient Relations; Primary Health Care; Referral and Consultation; Surveys and Questionnaires; Time Factors; Vision Disorders/di [Diagnosis]; *Vision Disorders/pc [Prevention & Control]; Vision Tests

Black eye drop bottle tips improve compliance. - Stack, Rebecca R; McKellar, Malcolm J (Clinical & experimental ophthalmology, 2004)
AIM: To determine if dark coloured tips on eye drop bottles facilitate ocular therapy., METHODS: Eye drop bottles were modified by placing sterile black tape around the bottle tip. Patients on regular timolol therapy were asked to use bottles with the modified tip for one month. They then completed a questionnaire comparing the black tips with the standard tips on the bottle they normally use., RESULTS: Eighty-eight per cent of patients found the black tipped bottles easier to use than bottles with the standard tip. Sixty-eight per cent of patients had fewer occasions on which they needed to instil a second drop and 30% of patients touched their eyelid less when using the modified bottle tips., CONCLUSION: Black coloured bottle tips aid ocular therapy. They are easier to use, result in less contact with the eye on instillation and patients note a reduction in need for a second or additional drop. This is likely to improve compliance and reduce contamination. A change in manufacturing practise should be encouraged.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Color; *Drug Packaging; Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions; *Patient Compliance; Surveys and Questionnaires; *Timolol/ad [Administration & Dosage]

Three-dimensional computer-automated threshold Amsler grid test. - Fink, Wolfgang; Sadun, Alfredo A (Journal of biomedical optics, 2004)
We describe a novel method for testing a visual field that employs a computer monitor with displays of varying contrast that permits unprecedented resolution and characterization of the structure of scotomas in three dimensions. Patients are placed in front of a touch-sensitive computer screen at a fixed distance. With one eye covered, they focus on a central fixation marker and trace with their finger the areas on an Amsler grid that are missing from their field of vision. Increasing degrees of contrast of the Amsler grid are simulated by repeating the test at different gray-scale levels. The results are recorded and then displayed as topographical contour rings by the computer test program. The results can also be rendered as an immediate 3-D depiction of the central hill-of-vision. Several clinical pilot studies have been conducted at the Doheny Eye Institute and more than 200 patients have been examined with this system so far. Conditions such as optic neuritis, anterior ischemic optic neuropathy (AION), age-related macular degeneration (AMD), glaucoma, and ocular hypertension have been successfully assessed by this test. Each condition provides unique patterns that are most evident in 3-D. The 3-D computer-automated threshold Amsler grid test is an innovative and noninvasive visual field test. It provides several advantages over state-of-the-art standard automated perimetry, including: (1) additional information through 3-D depiction of scotomas, such as location, extent, slope, depth, and shape; (2) high angular resolution (1 deg compared with typically 6 deg); (3) a simple test setup (merely a touch-sensitive computer monitor and the test software); (4) excellent patient compliance (spending 4 to 5 min per eye). In light of its promising initial tests, the 3-D visual field test appears to have the potential for the early detection and monitoring of various diseases over time. Copyright (c) 2004 Society of Photo-Optical Instrumentation Engineers.
Keywords: Diagnosis, Computer-Assisted/is [Instrumentation]; *Diagnosis, Computer-Assisted/mt [Methods]; Equipment Design; Equipment Failure Analysis; *Glaucoma/di [Diagnosis]; Humans; *Macular Degeneration/di [Diagnosis]; Optic Neuritis/di [Diagnosis]; Optic Neuropathy, Ischemic/di [Diagnosis]; Reproducibility of Results; *Scotoma/di [Diagnosis]; Sensitivity and Specificity; Sensory Thresholds; Vision Tests/is [Instrumentation]; Vision Tests/mt [Methods]; *Vision, Binocular; *Visual Acuity; Visual Field Tests/is [Instrumentation]; *Visual Field Tests/mt [Methods]; *Visual Fields

Bartonella henselae infection associated with neuroretinitis, central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss. - Gray, Andrea V; Michels, Kevin S; Lauer, Andreas Katsuya; Samples, John R (American journal of ophthalmology, 2004)
PURPOSE: To report a case of Bartonella henselae infection., DESIGN: Observational case report., METHODS: Review of the clinical, laboratory, photographic, and angiographic records of a patient with cat scratch disease associated with central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss., RESULTS: A 21-year-old man had no light perception in the left eye secondary to concurrent central retinal artery and vein occlusion believed to have resulted from infection with Bartonella henselae. Forty days later, he developed neovascular glaucoma in the left eye., CONCLUSION: Ocular complications associated with Bartonella henselae infection may include central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss.
Keywords: Adult; Anti-Bacterial Agents; Antihypertensive Agents/tu [Therapeutic Use]; Bartonella henselae/im [Immunology]; *Bartonella henselae/ip [Isolation & Purification]; Cat-Scratch Disease/dt [Drug Therapy]; *Cat-Scratch Disease/mi [Microbiology]; Drug Therapy, Combination/tu [Therapeutic Use]; Eye Infections, Bacterial/dt [Drug Therapy]; *Eye Infections, Bacterial/mi [Microbiology]; Fluorescein Angiography; Glaucoma, Neovascular/dt [Drug Therapy]; *Glaucoma, Neovascular/mi [Microbiology]; Humans; Male; Retinal Artery Occlusion/dt [Drug Therapy]; Retinal Artery Occlusion/mi [Microbiology]; Retinal Diseases/dt [Drug Therapy]; *Retinal Diseases/mi [Microbiology]; Retinal Vein Occlusion/dt [Drug Therapy]; Retinal Vein Occlusion/mi [Microbiology]; Retinitis/dt [Drug Therapy]; Retinitis/mi [Microbiology]; Treatment Refusal; Vision Disorders/dt [Drug Therapy]; *Vision Disorders/mi [Microbiology]; Visual Acuity

Contact lens-related corneal ulcers in compliant patients. - Najjar, Dany M; Aktan, S Gulderen; Rapuano, Christopher J; Laibson, Peter R; Cohen, Elisabeth J (American journal of ophthalmology, 2004)
PURPOSE: To report a case series of contact lens-related corneal ulcers in compliant patients with no apparent predisposing factors., DESIGN: Retrospective case series., METHODS: Charts of 70 patients with contact lens-related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study., RESULTS: Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses., CONCLUSION: Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses.
Keywords: Adolescent; Adult; Aged; Contact Lens Solutions; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Corneal Ulcer/et [Etiology]; Eye Infections, Bacterial/et [Etiology]; Female; Humans; Male; Middle Aged; Patient Compliance; Retrospective Studies; Risk Factors

Observed time between prescription refills for newer ocular hypotensive agents: the effect of bottle size. - Platt, Robert; Reardon, Gregory; Mozaffari, Essy (American journal of ophthalmology, 2004)
PURPOSE: To describe prescription refill patterns of ocular hypotensive therapies and to measure differences among refill rates across bottle sizes., DESIGN: Retrospective, population-based, cohort study., METHODS: This study included patients dispensed bimatoprost, brimonidine, dorzolamide/timolol, latanoprost, timolol gel (XE) 0.5%, or travoprost between January 1, 1996, and March 30, 2002. The initial fill date was identified for the cohort-defining ocular hypotensive, and the number of days between each subsequent refill was calculated. The analysis was repeated in patients with at least four refills to evaluate potential bias. Descriptive and survival analyses evaluated differences in refill rates across bottle sizes., RESULTS: In the 27,387 patients contributing up to four evaluable refill sequences, the amount of drug contained in bottles did not predict the number of days between fills. Patients dispensed larger bottles typically refilled sooner than drop-count studies would predict; results for patients with at least four refills (n = 12,976) confirmed these findings. Survival analysis demonstrated that the bottle size trend held across classes of therapy. Compared with 5.0-ml bottles, patients dispensed 10.0-ml and 15.0-ml bottles returned for refills at approximately 1.5 times the expected rate. When average wholesale prices were applied to refill intervals for selected agents, a 45% excess cost per month was found for the larger bottle sizes (10.0 ml vs 5.0 ml or 5.0 ml vs 2.5 ml)., CONCLUSIONS: Expected refill patterns predicted by bottle size and mean number of drops do not reflect observed refill patterns. Patients dispensed larger bottle sizes return for refills much sooner than expected, regardless of the class of therapy.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; Cohort Studies; Databases, Factual; *Drug Packaging; Drug Prescriptions/ec [Economics]; *Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Utilization/ec [Economics]; *Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Managed Care Programs/sn [Statistics & Numerical Data]; Ophthalmic Solutions; Patient Compliance; Retrospective Studies

Persistency with latanoprost or timolol in primary open-angle glaucoma suspects. - Schwartz, Gail F; Reardon, Gregory; Mozaffari, Essy (American journal of ophthalmology, 2004)
PURPOSE: To evaluate persistency of pharmacotherapy in primary open-angle glaucoma suspects (glaucoma suspects) treated with latanoprost and timolol., DESIGN: Retrospective, cohort study using the Protocare Sciences managed care database; approximately 3 million members in commercial health maintenance organizations and preferred provider organizations and in Medicare risk plans., METHODS: Patients 20 years of age or older beginning therapy between January 1, 1997, and June 30, 2002, with latanoprost or timolol monotherapy were included. Patients must have been continuously enrolled and not undergone glaucoma surgery in the year preceding the index prescription fill and had glaucoma suspect diagnoses before and after the index date. Prescription refill records for all ocular hypotensives were extracted through June 30, 2002. The two outcome measures were (1) discontinuation of index drug, and (2) either discontinuation or change in index drug. Changing therapy was defined as switching to or adding another ocular hypotensive. Rates of discontinuation and discontinuation/change were compared using Cox regression models., RESULTS: In all, 1,474 patients met the inclusion criteria. Latanoprost was prescribed for 583 patients (40%) and timolol for 891 (60%). Compared with latanoprost, those treated with timolol were 39% more likely to discontinue and 27% more likely to discontinue/change therapy (P <.001 for both comparisons). At 12 months, 39% of patients receiving latanoprost and 25% of those treated with timolol had not discontinued therapy; no discontinuation or change in therapy was seen in 30% and 18%, respectively., CONCLUSIONS: Latanoprost-treated glaucoma suspects demonstrated significantly greater persistency than did patients treated with timolol. The reasons for this difference and its impact on intraocular pressure control and disease progression require further research.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Managed Care Programs/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Patient Compliance; Prostaglandins F, Synthetic/ad [Administration & Dosage]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]

Patient persistency with topical ocular hypotensive therapy in a managed care population. - Reardon, Gregory; Schwartz, Gail F; Mozaffari, Essy (American journal of ophthalmology, 2004)
PURPOSE: To evaluate persistency with topical ocular hypotensive therapies in patients new to pharmacological management of elevated intraocular pressure (IOP)., DESIGN: Retrospective, cohort study; Protocare Sciences managed care database; approximately 3 million members in commercial health maintenance organizations and preferred provider organizations and in Medicare risk plans., METHODS: Patients were at least 20 years of age initiating therapy between July 1, 1996, and June 30, 2002, with betaxolol, bimatoprost, brimonidine, dorzolamide, latanoprost, timolol, or travoprost as monotherapy. Patients must have been continuously enrolled and not have received glaucoma surgery in the 180 days before the index prescription fill. Prescription refill records for all ocular hypotensive drugs were extracted through June 30, 2002. Outcome measures were (1) discontinuation of index drug, and (2) either discontinuation or change in index drug. Changing therapy was defined as switching to or adding another ocular hypotensive. Rates of discontinuation and discontinuation/change were compared using Cox regression models., RESULTS: In all, 28,741 patients met the inclusion criteria. Compared with latanoprost, those treated with other drugs were from 37% (timolol) to 72% (bimatoprost) more likely to discontinue and from 20% (timolol) to 58% (dorzolamide) more likely to discontinue/change therapy (P <.001 for all comparisons). At 12 months, 33% of patients treated with latanoprost and 19% of those receiving other ocular hypotensives had not discontinued therapy; 23% and 13%, respectively, had not discontinued or changed therapy. Compared with latanoprost, significantly higher percentages of patients treated with each alternate agent had only one fill of their index drugs (P <.001)., CONCLUSIONS: Although persistency rates were low across agents, latanoprost-treated patients demonstrated significantly greater persistency than did those treated with other topical ocular hypotensive therapies.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Databases, Factual; Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Managed Care Programs/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Patient Compliance; Retrospective Studies

Persistency and tolerability of ocular hypotensive agents: population-based evidence in the management of glaucoma. - Schwartz, Gail F (American journal of ophthalmology, 2004)
Comment in (CIN)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; Patient Compliance; Safety