Criteria for choosing clinically effective glaucoma treatment: A discussion panel consensus. - Thygesen, John; Burk, Reinhard; Carassa, Roberto; Crichton, Andrew; Goni, Francisco Javier; Menage, Mitch; Miglior, Stefano; Montgomery, Donald; Nordmann, John-Philippe; Roberts, Tim; Singh, Kuldev (Current therapeutic research, clinical and experimental, 2007)
UNLABELLED: Abstract., BACKGROUND: In the clinical management of patients at risk for or diagnosed with primary open-angle glaucoma (POAG), the aim of medical treatment is to reduce intraocular pressure (IOP) and then maintain it over time at a level that preserves both the structure and function of the optic nerve., OBJECTIVE: The objective of this report was to establish a consensus on the criteria that should be used to determine the characteristics of IOP-lowering medication., METHODS: Discussion was held among a panel of 12 physicians considered to be experts in glaucoma to develop a consensus on the criteria used by them to determine the characteristics of the IOP-lowering medication chosen for initial monotherapy and adjunctive treatment of ocular hypertension (OHT) or POAG. Consensus development combined available evidence and the impressions of these physicians regarding the clinical effectiveness of IOP-lowering medication for OHT and POAG. Once the panel identified the criteria, the order of priority and the relative importance of these criteria were then established in the setting of 3 risk categories (low, medium, and high) for a patient to experience significant visual disability from glaucoma over their expected life span., RESULTS: The panel identified 5 criteria to determine the characteristics of IOP-lowering medication for OHT and POAG: IOP-lowering effect, systemic adverse events (AEs), ocular tolerability, compliance/administration, and cost of treatment. IOP-lowering effect was consistently ranked as the highest priority and cost as the lowest. The priority of compliance/administration did not vary by clinical situation. Systemic AEs and ocular tolerability were ranked as higher priorities in initial monotherapy than in adjunctive treatment and ranked lower as the risk for visual disability increased. The priority given to the criteria used to determine clinical effectiveness varied both with the risk for functional vision loss from glaucoma and whether initial monotherapy or adjunctive treatment was being considered., CONCLUSION: Glaucoma treatment should be assessed with regard to the need not only to lower IOP but also to minimize systemic and ocular AEs, promote patient compliance, and minimize cost. The order of priority and relative importance given to these treatment criteria will vary as part of individualizing patient care.

Comparison of intraocular pressure fluctuations measured by goldmann applanation tonometer and pulsatile ocular blood flow analyser. - Januleviciene, Ingrida; Kuzmiene, Loreta; Sliesoraityte, Ieva (International journal of biomedical science : IJBS, 2006)
BACKGROUND: Intraocular pressure (IOP) is the major known risk factor in glaucoma and the primer mover of the functional damage in glaucomatous patients but it is not a unique determinant of glaucomatous damage. Clinical assessment of glaucoma patients may not be a true reflection of overall IOP control. Evaluation of the effect of glaucoma medication is restricted by measurement of IOP as a dynamic physiological parameter., PURPOSE: To compare IOP fluctuations over time using Goldmann applanation tonometry (IOPGAT) and pulsatile ocular blood flow analyzer (IOP-POBFA) under the Dorzolamide/timolol or latanoprost treatment regimes., DESIGN: Prospective 1 year follow-up study., PARTICIPANTS: 30 randomly chosen controlled open angle glaucoma patients (60 eyes): 16 patients (32 eyes) receiving Dorzolamide/timolol fixed combination (D/T) and 14 (28 eyes) latanoprost 0.005% treatment., MAIN OUTCOME MEASURES: Changes in IOP and perfusion pressure dynamics., RESULTS: THERE WAS NO STATISTICALLY SIGNIFICANT DIFFERENCE IN BASELINE IOP PARAMETERS BETWEEN STUDY GROUPS: 15.69 +/- 2.02 mmHg with D/T and 16.71 +/- 2.84 mmHg with latanoprost (p=0.314). Both treatment regimes were tolerated and patients were adherent to treatment. Determined a strong positive correlation between IOP-GAT and IOP-POBFA; verified over time period under particular treatment regime. After 1 year follow-up D/T and latanoprost results referred to statistically significant tachyphylaxis effect, i.e. IOP-GAT increased in 2.31mmHg with D/T (p=0.007) and 2.72 mmHg (p=0.004) with latanoprost and IOP-POBFA increased in 1.74 mmHg (p=0.026) and 3.13 mmHg (p=0.007) respectively. Multiple regression analysis revealed no important blood flow factors as predictors in the increase of IOP., CONCLUSIONS: Strong positive correlation was revealed between IOP-POBFA and IOP-GAT over a time period. Observed tachyphylaxis effects after 1 year under both treatment regimes should be assessed with respect to patient compliance and persistence to treatment.

Prevalence and causes of blindness and visual impairment in sokoto state, Nigeria: baseline data for vision 2020: the right to sight eye care programme. - Muhammad, Nasiru; Mansur, Rabiu M; Dantani, Adamu M; Elhassan, Elizabeth; Isiyaku, Sunday (Middle East African journal of ophthalmology, 2011)
PURPOSE: To estimate the prevalence of low vision and blindness, identify the causes, and suggest policies for an effective eye care program based on 2005 data from Sokoto State, Nigeria., MATERIALS AND METHODS: A stratified two-stage cluster sampling method was used to quantify the prevalence of blindness and the causes from 4 health zones in Sokoto State. Subjects were evaluated using a magnifying loupe, direct ophthalmoscope and torchlight. Data were collected based on the World Health Organization prevention of blindness coding for an eye examination. Prevalences with 95% confidence intervals (CI) were calculated and surgical coverage for causes of blindness was also analyzed., RESULTS: The response rate was 91%. The prevalence of bilateral blindness was 1.9% (95% CI: 1.5-2.3%) ranging from 1.6% to 2.0% across the four health zones. The prevalence was 2.1% (95% CI: 1.6-2.6%) in males and 1.6% (95% CI: 1.1-2.1%) in females. The leading cause of bilateral blindness was cataract (51.6%), followed by uncorrected aphakia (20.9%) and glaucoma (11%). The prevalence of bilateral operable cataract was 1.9% (95% CI: 1.5-2.3%). The cataract surgical coverage (individuals with visual acuity <6/60) for the study was lower than the couching coverage (4.4% vs. 14.9%, respectively). Surgical coverage for trichiasis was 4.4%. The major barrier to cataract and glaucoma management was cost., CONCLUSIONS: The prevalence of blindness in Sokoto State is high yet the main causes are largely avoidable. Barriers can be reduced by appropriate health education regarding the eye care program and the provision of integrated, sustainable, affordable and equitable services.

Overcoming gender inequity in prevention of blindness and visual impairment in Africa. - Mganga, Herrieth; Lewallen, Susan; Courtright, Paul (Middle East African journal of ophthalmology, 2011)
BACKGROUND: Globally, and in Africa, after adjusting for age, women are about 1.4 times more likely to be blind than men. While women generally live longer than men, the lack of accessibility to and use of services is likely the most important reason for excess blindness in women in Africa., AIM: We sought to review the literature on vision loss in Africa and summarize the findings related to gender equity., MATERIALS AND METHODS: Information from across sub-Saharan Africa was collected on the evidence of gender inequity and reasons for this inequity. Finally, the results were used to generate suggestions on how gender equity could be improved., RESULTS: In all published surveys (except one), cataract surgical coverage among women was lower than cataract surgical coverage among men. Although data available are limited, similar findings appeared in the use of services for other disease conditions, notably, childhood cataract and glaucoma. Evidence suggests that a variety of approaches are needed to improve the use of eye care services. Three main strategies are needed to address gender inequity in vision loss in Africa. First, it is important to address transport needs. Second, counseling of patients and family members is required. Finally, programs need to put in place pricing systems that make the services affordable the population., CONCLUSIONS: VISION 2020 can be achieved in Africa, but investment is needed in a variety of strategies that will ensure that eye care services are affordable, accessible, and acceptable to women and girls.

Stem cell therapy for glaucoma: possibilities and practicalities. - Johnson, Thomas V; Bull, Natalie D; Martin, Keith R (Expert review of ophthalmology, 2011)
Glaucoma is a progressive, neurodegenerative, optic neuropathy in which currently available therapies cannot always prevent, and do not reverse, vision loss. Stem cell transplantation may provide a promising new avenue for treating many presently incurable degenerative conditions, including glaucoma. This article will explore the various ways in which transplantation of stem or progenitor cells may be applied for the treatment of glaucoma. We will critically discuss the translational prospects of two cell transplantation-based treatment modalities: neuroprotection and retinal ganglion cell replacement. In addition, we will identify specific questions that need to be addressed and obstacles to overcome on the path to clinical translation, and offer insight into potential strategies for approaching this goal.

Identification of noncompliant glaucoma patients using Bayesian networks and the Eye-Drop Satisfaction Questionnaire. - Nordmann, Jean-Philippe; Baudouin, Christian; Renard, Jean-Paul; Denis, Philippe; Regnault, Antoine; Berdeaux, Gilles (Clinical ophthalmology (Auckland, N.Z.), 2010)
OBJECTIVE: To identify poorly compliant glaucoma patients, using the Eye-Drop Satisfaction Questionnaire (EDSQ)., METHODS: This was an observational cross-sectional study with compliance data collected by an electronic monitoring device. Patients with primary open-angle glaucoma or ocular hypertension completed the EDSQ, a six-dimension self-reported questionnaire addressing "treatment concern", "disease concern", "patient-clinician relationship", "positive beliefs", "treatment convenience", and "self-declared compliance". A Bayesian network (BN) was applied to explore compliance associations with EDSQ., RESULTS: Among 169 patients who completed the EDSQ, 113 had valid Travalert R data, of whom 25 (22.1%) demonstrated low compliance. All six EDSQ dimensions were associated directly, or indirectly, with compliance. Two profiles exhibited low compliance, ie, patients aged younger than 77.5 years with a poor patient-physician relationship and self-declared poor compliance and patients aged older than 77.5 years with a poor patient-physician relationship and self-declared good compliance. The third profile showed high compliance, ie, patients aged younger than 77.5 years with a good patient-physician relationship and self-declared good compliance., CONCLUSION: Our results confirm a central role for the patient-physician relationship in the compliance process. Age, self-declared compliance, and patient satisfaction with the patient-physician relationship are all dimensions worth exploring before glaucoma medication is switched or proceeding to laser treatment or surgery.

Carbopol/chitosan based pH triggered in situ gelling system for ocular delivery of timolol maleate. - Gupta, Swati; Vyas, Suresh P (Scientia pharmaceutica, 2010)
The poor bioavailability and therapeutic response exhibited by conventional ophthalmic preparations due to rapid precorneal elimination, dilution and nasolacrimal drainage of the drug may be vanquished by the use of in situ gelling systems that are instilled as drops in to the eye and undergo a sol-gel transition in the cul-de-sac. Timolol eye drops may cause systemic side effects in glaucoma patients due to absorption of the drug into systemic circulation. In situ gelling system of this drug can provide localized effect with reduced contraindications, improved patient compliance and better therapeutic index. The present work describes the formulation and evaluation of an ophthalmic delivery system of an antiglaucoma drug, timolol maleate (TM) based on the concept of pH-triggered in situ gelation. Polyacrylic acid (carbopol) was used as the gelling agent in combination with chitosan (amine polysaccharide), which was acted as a viscosity-enhancing agent. Formulations were evaluated for pH, viscosity, gelling capacity and drug content. The 0.4% w/v carbopol/0.5% w/v chitosan based in situ gelling system was in liquid state at room temperature and at the pH formulated (pH 6.0) and underwent rapid transition into the viscous gel phase at the pH of the tear fluid (lacrimal fluid) (pH 7.4). The in vitro drug release and in vivo effects of the developed in situ gelling system were compared with that of GlucomolA (a 0.25% TM ophthalmic solution), 0.4% w/v carbopol solution as well as liposomal formulation. The results clearly demonstrated that developed carbopol-chitosan based formulation was therapeutically efficacious and showed a fickian (diffusion controlled) type of release behaviour over 24 h periods. The developed system is thus a viable alternative to conventional eye drops and can also prevent the rapid drainage as in case of liposomes.

Safety, tolerability, and efficacy of fixed combination therapy with dorzolamide hydrochloride 2% and timolol maleate 0.5% in glaucoma and ocular hypertension. - Bell, Nicholas P; Ramos, Jose L; Feldman, Robert M (Clinical ophthalmology (Auckland, N.Z.), 2010)
Glaucoma is a collection of diseases characterized by multifactorial progressive changes leading to visual field loss and optic neuropathy most frequently due to elevated intraocular pressure (IOP). The goal of treatment is the lowering of the IOP to prevent additional optic nerve damage. Treatment usually begins with topical pharmacological agents as monotherapy, progresses to combination therapy with agents from up to 4 different classes of IOP-lowering medications, and then proceeds to laser or incisional surgical modalities for refractory cases. The fixed combination therapy with the carbonic anhydrase inhibitor dorzolamide hydrochloride 2% and the beta blocker timolol maleate 0.5% is now available in a generic formulation for the treatment of patients who have not responded sufficiently to monotherapy with beta adrenergic blockers. In pre- and postmarketing clinical studies, the fixed combination dorzolamide-timolol has been shown to be safe and efficacious, and well tolerated by patients. The fixed combination dorzolamide-timolol is convenient for patients, reduces their dosing regimen with the goal of increasing their compliance, reduces the effects of "washout" when instilling multiple drops, and reduces the preservative burden by reducing the number of drops administered per day.

Efficacy and safety of travoprost alone or in combination with other agents for glaucoma and ocular hypertension: patient considerations. - Suzuki, Emilio Rintaro Jr; Suzuki, Cibele Lima Belico (Clinical ophthalmology (Auckland, N.Z.), 2010)
Travoprost is a prostaglandin analog used in the management of glaucoma and ocular hypertension for reducing intraocular pressure (IOP). The IOP-lowering efficacy of travoprost has been shown to be similar to that of other prostaglandins, including latanoprost and bimatoprost. When compared with fixed combinations of timolol and either latanoprost or dorzolamide, travoprost alone can reduce mean IOP in a similar or superior manner. Concomitant therapy of travoprost and timolol can reach even greater IOP reductions than fixed combinations at some time points, but with no difference in the early morning, when IOP is usually higher. In addition, the long duration of action of travoprost can also provide better control of IOP fluctuation, probably due to its stronger prostaglandin F receptor mechanism. The side effects of travoprost do not represent a risk to the vision or health of the patient. The proven efficacy and safety combined with convenient once-daily dosing for travoprost increases patient compliance with treatment for glaucoma.
Erratum in (EIN)

Fixed combination of bimatoprost and timolol in patients with primary open-angle glaucoma or ocular hypertension with inadequate IOP adjustment. - Brief, Gerrett; Lammich, Tobias; Nagel, Edgar; Pfennigsdorf, Stefan; Spraul, Christoph W; Ho, Selwyn (Clinical ophthalmology (Auckland, N.Z.), 2010)
OBJECTIVE: To assess the efficacy and tolerability of a fixed combination of bimatoprost and timolol (BTFC) in a large patient sample in a clinical setting., METHODS: In this multicenter, observational, noncontrolled, open-label study, patients (n = 1862) with primary open-angle glaucoma or ocular hypertension were treated with BTFC. Assessments were made at baseline, six weeks, and three months., RESULTS: Prior to starting BTFC, 92.3% of patients were taking other ocular hypotensive medications. In the overall group at three months, mean intraocular pressure was reduced from baseline (21.7 +/- 4.5 mmHg and 21.8 +/- 4.9 mmHg for the right and left eye, respectively) to 16.1 +/- 3.0 mmHg for each eye (P < 0.0001). The majority of patients (92%) reported no adverse events. The most commonly reported adverse events (in >1% of patients) were eye irritation, and ocular and conjunctival hyperemia. Adherence to treatment was generally better than (35.4%) or the same as (57.5%) with prior therapy. BTFC tolerability was rated as excellent or good by 92.3% of physicians and 85.8% of patients., CONCLUSIONS: In a large group of patients with primary open-angle glaucoma or ocular hypertension, treatment with BTFC was associated with consistent reductions in IOP, improved adherence to treatment, and good tolerability.
Erratum in (EIN)

Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence. - Cook, Paul F; Bremer, Robert W; Ayala, A J; Kahook, Malik Y (Clinical ophthalmology (Auckland, N.Z.), 2010)
INTRODUCTION: Adherence to glaucoma treatment is poor, potentially reducing therapeutic effects. A glaucoma educator was trained to use motivational interviewing (MI), a patient-centered counseling style, to improve adherence. This study was designed to evaluate whether MI was feasible in a busy ophthalmology practice., METHODS: Feasibility was assessed using five criteria from the National Institutes of Health Behavior Change consortium: fidelity of intervention components to MI theory; success of the training process; delivery of MI-consistent interventions by the glaucoma educator; patient receipt of the intervention based on enrollment, attrition, and satisfaction; and patient enactment of changes in motivation and adherence over the course of the intervention., RESULTS: A treatment manual was designed by a multidisciplinary team with expertise in health psychology, public health, and ophthalmology. The glaucoma educator received 6 hours of training including role-play exercises, self-study, and individual supervision. His MI-related knowledge and skills increased following training, and he delivered exclusively MI-consistent interventions in 66% of patient encounters. 86% (12/14) of eligible patients agreed to be randomized into glaucoma educator support or a control condition. All 8 patients assigned to the glaucoma educator completed at least 2 of 6 planned contacts, and 50% (4/8) completed all 6 contacts. Patients assigned to the glaucoma educator improved over time in both motivation and adherence., CONCLUSION: The introduction of a glaucoma educator was feasible in a busy ophthalmology practice. Patients improved their adherence while participating in the glaucoma educator program, although this study was not designed to show a causal effect. The use of a glaucoma educator to improve glaucoma patients' medication adherence may be feasible at other ophthalmology clinics, and can be implemented with a standardized training approach. Pilot data show the intervention can be implemented with fidelity, is acceptable to patients and providers, and has the potential to improve adherence.

A management dilemma: infectious keratitis associated with soft contact lens use and dubious treatment compliance. - Tsaousis, Konstantinos T; Sakkias, Georgios; Kozeis, Nikolaos; Tahiaos, Periklis (Case reports in medicine, 2010)
Purpose . To present a case of infectious keratitis caused by the microorganism Serratia marcescens in a contact lens user and further to confer on the most advantageous management of comparable situations. Case. After altering the routine that she used for contact lens disinfection, a 24-year-old patient presented with pain and conjunctival redness in both eyes. Slit-lamp examination revealed two infiltrates in the inferior part of the cornea in the right eye and five smaller infiltrates in the superior half of the left cornea. Appropriate treatment, after hospitalization, improved the symptoms while culture of the contact lens material revealed Serratia marcescens as the responsible infectious factor. Conclusion . Enhancing the availability of information with respect to contact lens users and customized analysis regarding treatment for a particular complication could be beneficial in order to reduce the frequency of admission to the eye clinic due to infectious keratitis. In addition, rapid laboratory testing of the infected materials should be a priority for selection of the optimal treatment regimen.

Efficacy and patient tolerability of travoprost BAK-free solution in patients with open-angle glaucoma and ocular hypertension. - Mirza, Sophia K; Johnson, Sandra M (Clinical ophthalmology (Auckland, N.Z.), 2010)
The medical treatment of glaucoma has evolved significantly over the past several decades. The main driving forces behind this evolution are the safety profiles and efficacy of these medications. Prostaglandin (PG) analogues are shown to be superior to older drugs in both efficacy and tolerability. Though there are much fewer side effects that manifest after using PG analogues, the adherence and compliance to medication regimens are surprisingly lower than expected. A commonly sited reason is the ocular irritation and inflammation with these medications. Much of this inflammation can be attributed to the preservative, benzalkonium chloride (BAK). The chronic clinical and subclinical inflammation becomes increasingly detrimental when filtration surgery fails from bleb fibrosis secondary to this hypercellularity. A BAK-free formulation of a PG analogues recently became available. BAK-free travoprost is reviewed here. It has demonstrated equal efficacy and less ocular surface toxicity than its preserved counterparts. It is expected to serve as an instrumental resource in managing ocular hypertension and glaucoma in patients who demonstrate significant sensitivity to BAK. More randomized, controlled, double-blind studies are encouraged to evaluate its improved safety and tolerability.

Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension. - Lee, Anne J; McCluskey, Peter (Clinical ophthalmology (Auckland, N.Z.), 2010)
Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents available for the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004% are prodrugs and analogs of prostaglandin F2alpha. Bimatoprost 0.03% is regarded as a prostamide, and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP by enhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation and remodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-lowering superiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine 0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOP-lowering compared with latanoprost, with weighted mean difference in IOP reduction documented in one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOP further when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprost formulated with timolol 0.5% and administered once daily are superior to monotherapy of its constituent parts. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. The adverse effects of PGA, and also those found more frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocular pigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administration and near absence of systemic side effects enhances tolerance and compliance. PGAs are often prescribed as first-line treatment for ocular hypertension and open-angle glaucoma.

Measurement of treatment compliance using a medical device for glaucoma patients associated with intraocular pressure control: a survey. - Nordmann, Jean-Philippe; Baudouin, Christophe; Renard, Jean-Paul; Denis, Philippe; Lafuma, Antoine; Laurendeau, Caroline; Jeanbat, Viviane; Berdeaux, Gilles (Clinical ophthalmology (Auckland, N.Z.), 2010)
OBJECTIVE: To identify and characterize treatment compliance profiles of glaucoma patients and evaluate the association with intraocular pressure (IOP)., METHODS: A computerized device (Travalert((R))) that recorded daily instillation times and eye-drop counts was given for 3 months. Patients were declared compliant when at least 2 drops were instilled per day. Compliance rates were calculated for weekdays and weekends, separately, over 8 consecutive weeks. A principal components analysis (PCA) was followed by an ascendant hierarchical classification (AHC) to identify compliance groups., RESULTS: 140 patients were recruited (mean age 65.5 years; 51.8% female) of whom 83.6% had primary open-angle glaucoma with mean IOP 23.9 mmHg before Travalert((R)) use. 60.7% were treated with DuoTrav((R)) (travoprost timolol fixed combination) and 39.3% with travoprost. The PCA identified two axes (compliance and treatment weeks). The AHC identified 3 compliance groups: 'high' (56.6%, approx. 80% compliance), 'medium' (21.2%, approx. 50% compliance), and 'low' (22.1%, approx. 20% compliance). Demographics and glaucoma parameters did not predict low compliance. Final mean IOP was 16.1 mmHg, but higher in the low compliance group (17.7 mmHg, P = 0.02)., CONCLUSIONS: Compliance measurement by a medical device showed compliance rates <80% by 50% (approx.) of patients, significantly impacting IOP control. No demographic or glaucoma variable was associated with low compliance.

Considerations in glaucoma therapy: fixed combinations versus their component medications. - Higginbotham, Eve J (Clinical ophthalmology (Auckland, N.Z.), 2010)
Fixed combinations of medications that lower intraocular pressure (IOP) are increasingly used in the treatment of glaucoma and ocular hypertension and offer several potential advantages over combined use of the separate component medications including enhanced convenience, improved adherence, reduced exposure to preservatives, and possible cost savings. This review aims to examine the current role of IOP-lowering fixed combinations in disease management. The results of studies that compared the efficacy and safety of IOP-lowering fixed combinations with their component medications are summarized, including those fixed combinations that consist of a prostaglandin analog and timolol. The fixed combinations currently available for use in the United States are fixed-combination dorzolamide/timolol (FCDT) and fixed-combination brimonidine/timolol (FCBT). Both of these fixed combinations reduce IOP more effectively than their component medications used separately as monotherapy. FCBT therapy also demonstrates a more favorable safety profile and reduced ocular allergy compared to monotherapy with brimonidine, a component medication. Few studies have directly compared the efficacy and safety of FCDT and FCBT, but available evidence suggests that FCBT is at least as effective as FCDT in lowering IOP and is more comfortable and better tolerated. Additional studies are needed to further evaluate the comparative efficacy and tolerability of FCDT and FCBT in the management of glaucoma and ocular hypertension.

Glaucoma patients' trust in the physician. - Muir, Kelly W; Santiago-Turla, Cecilia; Stinnett, Sandra S; Herndon, Leon W; Allingham, R Rand; Challa, Pratap; Lee, Paul P (Journal of ophthalmology, 2009)
Objectives . To describe glaucoma patients' trust in the physician and to test the hypothesis that increased interpersonal trust is associated with increased medication adherence. Methods. One hundred ninety-five subjects with open-angle glaucoma seen by multiple glaucoma subspecialists participated in a cross-sectional patient survey and concomitant chart review which included a test of health literacy and the Trust in Physician Scale (TPS), a scale from 1-100, with 100 indicating greatest trust. Charts were reviewed for visual acuity and visual field results. Subjects' pharmacies were contacted to ascertain medication refill rates over the preceding six months. Results . TPS scores ranged from 57.5 to 100, 78.7 +/- 8.4 (mean +/- SD,) median 75.0. When age, race, gender, baseline visual acuity and visual field status, education level, and literacy status were considered, only race was associated with TPS. Caucasians expressed slightly higher levels of trust (n = 108; TPS 80.1 +/- 8.2) than non-Caucasians, (n = 87 (82 Africans Americans); TPS 77.1 +/- 8.4; P = .012). TPS score was not associated with refill rates (P = .190). Conclusions . Trust in physician is generally high in this group of glaucoma patients but varies slightly by race. Trust in physician was not associated with glaucoma medication adherence in this tertiary care population.

Subconjunctival Air Leakage After Descemet's Stripping Automated Endothelial Keratoplasty(DSAEK) in a Post-Trabeculectomy Eye. - Ide, Takeshi; Yoo, Sonia H; Leng, Theodore; O'Brien, Terrence P (The open ophthalmology journal, 2009)
PURPOSE: To report a case of subconjunctival air leakage from the anterior chamber (AC) into a trabeculectomy bleb after Descemet's stripping automated endothelial keratoplasty (DSAEK)., METHODS: An 89 year-old woman with a previous history of primary open angle glaucoma in her left eye and previous trabeculectomy with mitomycin C had DSAEK on the patient's left eye in order to treat her endothelial disease. During the DSAEK procedure, air was injected into the AC to aid in graft adherence., RESULTS: The day after the surgery, subconjunctival air leakage from the AC into a trabeculectomy bleb was observed., CONCLUSIONS: Although our patient did not have any complications from this leak, there exists the potential for hypotony, bleb-related infections, and dislocations of the DSAEK graft. Given the potential consequences, these patients should be monitored closely.

Dark secrets behind the shimmer of contact lens: the Indian scenario. - Tuli, Lekha; Bhatt, Gopal Krishna; Singh, Deepak Kumar; Mohapatra, Tribhuban Mohan (BMC research notes, 2009)
BACKGROUND: We studied the bacteriological profile of soft contact lens and its accessories among the asymptomatic subjects and monitored the compliance level with the lens use and its cleaning protocol., FINDINGS: A total of 115 (104 daily wear and 11 extended wear) subjects using contact lens were studied. Data regarding the duration of use and frequency and method of cleaning were recorded. Contact lens, lens cases, preserving solutions and tips of solution bottles were the samples collected. The isolates were identified on the basis of their phenotypic characters. Samples from 24 subjects (21 daily wear and 3 extended wear) were found contaminated. Of the 24 contaminated cases, 23 showed medium adherence to the cleaning protocol. Contamination rate was higher among the 56 daily wear lens users who used same lens for 2 years and more, than the 48 users who used their lenses for less than 2 years. Lens case contamination was found in all the 24 cases. The bacteria isolated were Citrobacter freundii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus epidermidis and Streptococcus pneumoniae. In extended wear lens users, there was no change in microbial flora on repeating the cultures on day 7 and 14., CONCLUSION: Non-compliance with contact lens use may lead to invitation of microbial flora. The accumulation of these bacteria may act as a precursor to biofilm formation, thus colonizing the lens accessories as well. The bacteria isolated in this study were similar to the ones causing microbial keratitis thus, predisposing the otherwise asymptomatic subjects to permanent visual damage.

Recent advances in pharmacotherapy of glaucoma. - Gupta, S K; Niranjan D, Galpalli; Agrawal, S S; Srivastava, Sushma; Saxena, Rohit (Indian journal of pharmacology, 2008)
Glaucoma is a slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to irreversible blindness if left undiagnosed and untreated. Although increased intraocular pressure is a major risk factor of glaucoma, other factors include increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species. Glaucoma is the second leading cause of blindness globally, accounting for 12.3% of the total blindness. Glaucoma has been broadly classified as primary or secondary open-angle or angle-closure glaucoma. The primary goal in management of glaucoma is to prevent the risk factor, especially elevated intraocular pressure (IOP), using medications, laser therapy or conventional surgery. The first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective blocker or a prostaglandin analog. Second-line drugs of choice include alpha-agonists and topical carbonic anhydrase inhibitors. Cholinergic agonists are considered third-line treatment options. When a single therapy is not sufficient to lower the IOP, a combination therapy is indicated. To enhance the patient compliance, drug delivery systems like electronic devices, ocular inserts, tansdermal and mechanical drug delivery systems have been developed. Use of viscoelastic agents in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) enhance patience compliance and ocular drug delivery in patients in long-term glaucoma therapy. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are recommended. Several nutrients and botanicals hold promise for the treatment of glaucoma, but most studies are preliminary, and larger, controlled studies are required. Future directions for the development of a novel therapy glaucoma may target glutamate inhibition, NMDA receptor blockade, exogenously applied neurotrophins, open channel blockers, antioxidants, protease inhibitors and gene therapy.

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency. - Kulkarni, Sadhana V; Damji, Karim F; Buys, Yvonne M (Patient preference and adherence, 2008)
Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms "compliance, persistence and adherence" with reference to medication use is central not only for monitoring patients' drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence.

A patient preference comparison of Azarga (brinzolamide/timolol fixed combination) vs Cosopt (dorzolamide/timolol fixed combination) in patients with open-angle glaucoma or ocular hypertension. - Mundorf, Thomas K; Rauchman, Steven H; Williams, Robert D; Notivol, Ricardo; Brinzolamide/Timolol Preference Study Group (Clinical ophthalmology (Auckland, N.Z.), 2008)
PURPOSE: To determine patient preference of and ocular discomfort with fixed combination brinzolamide/timolol compared with fixed combination dorzolamide/timolol., METHODS: In a prospective, double-masked, randomized, active-controlled, crossover, multicenter study, patients received 1 drop of brinzolamide/timolol and dorzolamide/timolol in both eyes on consecutive days in random order. Ocular discomfort was rated 1 minute after instillation of each medication, and preference was noted on Day 2. Adverse events, if any, were solicited at each visit., RESULTS: 127 subjects with ocular hypertension or open-angle glaucoma were included in the intent-to-treat analysis. Of the 106 subjects who expressed a drug preference, 79.2% preferred brinzolamide/timolol (p < 0.0001). Ocular discomfort scores were significantly higher with dorzolamide/timolol than brinzolamide/timolol (2.9 vs 1.4, respectively; p < 0.0001). Significantly more patients reported ocular pain and discomfort after dorzolamide/timolol instillation and transient blurred vision after brinzolamide/timolol instillation., CONCLUSIONS: Patients with ocular hypertension or open-angle glaucoma preferred the brinzolamide/timolol fixed combination over the dorzolamide/timolol fixed combination. This is likely due to the greater ocular discomfort associated with dorzolamide/timolol. The differences in preference, discomfort, and adverse events are likely attributable to formulation differences given the similarities of the active ingredients. Stronger patient preference for brinzolamide/timolol may lead to better therapeutic compliance.

Rational use of the fixed combination of dorzolamide - timolol in the management of raised intraocular pressure and glaucoma. - Yeh, Jason; Kravitz, Daniel; Francis, Brian (Clinical ophthalmology (Auckland, N.Z.), 2008)
Glaucoma is a multifactorial optic neuropathy in which the main therapeutic target is lowering of intraocular pressure (IOP) in order to retard the progression of existing structural and functional damage. The three mainstays of treatment are pharmacologic, laser, and surgical. The primary standard therapy in patients with open-angle glaucoma or ocular hypertension is topical medication. When monotherapy does not adequately lower the intraocular pressure, one or more agents are added or substituted. Combination pharmacotherapy such as Cosopt((R)) is available to improve efficacy and simplify medication regimen. A fixed combination of two ocular hypotensive drugs (the carbonic anhydrase inhibitor dorzolamide and the beta-adrenoceptor antagonist timolol), Cosopt((R)) is indicated for the treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension insufficiently responsive to topical beta-adrenoceptor antagonist monotherapy. Compared with concomitant therapy with the individual components, the primary advantage of fixed combination dorzolamide - timolol is convenience, which may also improve compliance. Clinical trials have demonstrated that the fixed combination dorzolamide - timolol is safe, effective and generally well tolerated in lowering IOP in patients with open angle glaucoma or ocular hypertension, including individuals uncontrolled on beta-adrenoceptor antagonist or other monotherapy.

Effect of audible and visual reminders on adherence in glaucoma patients using a commercially available dosing aid. - Ho, Lawrence Y; Camejo, Larissa; Kahook, Malik Y; Noecker, Robert (Clinical ophthalmology (Auckland, N.Z.), 2008)
We studied the effects of audible and visual alarms on adherence with a recommended dosing regimen in the management of glaucoma. Forty-two patients were begun on therapy with the Travatan((R)) Dosing Aid (TDA) and randomly divided into two observation groups - one with visual and audible alarm functions turned on and the other with alarms off. Dosing information was analyzed for mean rates of adherence, missed days, and dosing at the wrong time. Twenty patients were randomized to the TDA alarm on group and 22 to the alarm off group. The rates of adherence were 87.9% and 79.7% (p = 0.02), rates of missed dosing were 7.6% and 14.4% (p = 0.03), and rates of dosing at the incorrect times were 7.1% and 9.8% (p = 0.19), respectively for alarm on versus alarm off groups. In the alarm on group, the adherence rate was significantly higher and proportion of missed dosing was significantly lower. It is still yet to be determined whether there is a relationship between adherence and progression of glaucoma.

Risk factors for progression to blindness in high tension primary open angle glaucoma: Comparison of blind and nonblind subjects. - Kooner, Karanjit S; AlBdoor, Mohannad; Cho, Byung J; Adams-Huet, Beverley (Clinical ophthalmology (Auckland, N.Z.), 2008)
AIMS: To determine which risk factors for blindness were most critical in patients diagnosed with high tension primary open angle glaucoma (POAG) in a large ethnically diverse population managed with a uniform treatment strategy., METHODS: A longitudinal observational study was designed to follow 487 patients (974 eyes) with POAG for an average of 5.5 +/- 3.6 years. Detailed ocular and systemic information was collected on each patient and updated every six months. For this study, blindness was defined as visual acuity of 20/200 or worse and/or visual field less than 20 degrees in either eye. Known risk factors were compared between patients with blindness in at least one eye versus nonblind patients., RESULTS: The patients with blindness had on average: higher intraocular pressure (IOP, mmHg): (24.2 +/- 11.2 vs. 22.1 +/- 7.7, p = 0.03), wide variation of IOP in the follow-up period (5.9 vs. 4.1 mmHg, p = 0.031), late detection (p = 0.006), poor control of IOP (p < 0.0001), and noncompliance (p < 0.0003). Other known risk factors such as race, age, myopia, family history of glaucoma, history of ocular trauma, hypertension, diabetes, vascular disease, smoking, alcohol abuse, dysthyoidism, and steroid use were not significant., CONCLUSIONS: The most critical factors associated with the development of blindness among out patients were: elevated initial IOP, wide variations and poor control of IOP, late detection of glaucoma, and noncompliance with therapy.

Managing refractory glaucoma with a fixed combination of bimatoprost (0.03%) and timolol (0.5%). - Gheith, Moataz E; Mayer, Jason R; Siam, Ghada A; Monteiro de Barros, Daniela S; Thomas, Tricia L; Katz, L Jay (Clinical ophthalmology (Auckland, N.Z.), 2008)
Glaucoma is a chronic progressive optic neuropathy characterized by progressive loss of retinal ganglion cells, which manifests clinically with loss of optic disc neuroretinal rim tissue, defects in the retinal nerve fiber layer, and deficits on functional visual field testing. The goal of glaucoma treatment is to reduce the intraocular pressure to a level that prevents or minimizes the progressive loss of vision. The current standard of management for the newly diagnosed primary open angle glaucoma (PAOG) patient is to start topical medication. Available topical medications include: beta-adrenergic antagonists, alpha-adrenergic agonists, carbonic anhydraze inhibitors, prostaglandin analogues and miotics. In some patients, IOP is not adequately controlled by monotherapy. In those refractory patients, where more efficacy is required, shifting to another medication or adding a second medication is indicated. The complimentary action between two drugs serves as the basis for combination medications. One avenue of delivering a second medication is through a fixed combination medication that has the advantage of providing two medicines within one drop. Bimatoprost/timolol represents a new fixed combination which is clinically and statistically more effective than either of its active constituents for patients with refractory glaucoma. As regard the safety of the combination, there were no signs or symptoms of intolerance and the incidence of conjunctival hyperemia was clinically and statistically significantly less than each of the two components separately. Bimatoprost/timolol fixed combination offers cost and time savings, which may enhance compliance; also reducing the amount of preservative applied to the eye, will improve tolerability and may also favorably improve eventual surgical outcomes in patients who might require filtering procedures.

The Clinical and Cellular Basis of Contact Lens-related Corneal Infections: A Review. - Robertson, Danielle M; Cavanagh, H Dwight (Clinical ophthalmology (Auckland, N.Z.), 2008)
Microbial keratitis (MK) is the most visually devastating complication associated with contact lens wear. Pseudomonas aeruginosa (PA) is highly invasive in the corneal epithelium and is responsible for more than half of the reported cases of contact lens-related MK. To protect against Pseudomonas-mediated MK, the corneal epithelium has evolved overlapping defense mechanisms that function to protect the ocular surface from microbial invasion. Research has shown that contact lens wear disrupts these protective mechanisms through breakdown of normal homeostatic surface renewal as well as damaging the corneal surface, exposing underlying cell membrane receptors that bind and internalize PA through the formation of lipid rafts. Human clinical trials have shown that initial adherence of PA with resulting increased risk for microbial infection is mediated in part by contact lens oxygen transmissibility. Recently, chemical preserved multipurpose solutions (MPS) have been implicated in increasing PA adherence to corneal epithelial cells, in addition to inducing significant levels of toxic staining when used in conjunction with specific silicone hydrogel lenses. This review summarizes what is currently known about the relationship between contact lenses, the corneal epithelium, MPS, and infection.

Evaluation of adherence to morning versus evening glaucoma medication dosing regimens. - Kahook, Malik Y; Noecker, Robert J (Clinical ophthalmology (Auckland, N.Z.), 2007)
PURPOSE: Compare patient adherence to glaucoma therapy with morning versus evening dosing schedules., METHODS: Retrospective chart review of 41 consecutive patients who had used the Travatan Dosing Aid (Alcon, Fort Worth, TX). Patients had been nonrandomly assigned morning or evening dosing at initiation of usage. Dosing aid data was recorded and analyzed using paired student t-tests where appropriate. Adherence was defined as the dose being administered within 3 hours of the prescribed dosing time., RESULTS: Records of 18 patients in the morning group and 23 in the evening group were reviewed. Average time of use was 51.06 +/- 4.94 days for the morning group and 50.65 +/- 5.38 days for the evening group (p = 0.80). Patients taking the morning dose were less likely to miss an entire day of dosing (days missed in morning group = 3.33 +/- 1.33; evening group = 5.87 +/- 1.52, p < 0.001). The overall adherence rate was not statistically different between groups (morning group = 82.72 +/- 7.32%; evening group = 78.96 +/- 6.12%, p = 0.08) although the morning group tended to be more adherent to therapy. Patients in the morning group were also more likely to take their drops later rather than miss the entire day's dose., CONCLUSIONS: The rate of adherence for both the morning and evening dosing groups was better than previously reported. Dosing drops in the morning, rather than in the evening, may lead to fewer entirely missed days of glaucoma eye drop therapy.

Effects of topical antiglaucoma medications on the ocular surface. - Asbell, Penny A; Potapova, Natalia (The ocular surface, 2005)
The side effects of topical antiglaucoma medications and their preservatives range from ocular discomfort to sight-threatening alterations of the ocular surface. Conjunctival hyperemia, decreased tear production and function, and superficial punctate keratitis are among the most common signs seen on routine clinical examination. Squamous cell metaplasia and changes in cell morphology have been demonstrated by impression cytology studies and evaluation of biopsy specimens, and inflammatory effects are documented by the presence of inflammatory markers. The adverse effects of topical antiglaucoma eyedrops interfere with the treatment of glaucoma on two levels: first, the discomfort produced by the eye drops discourages patient compliance; and, second, long-term treatment with eyedrops is associated with a higher failure of filtration surgery. The detailed mechanism of inflammatory response and/or direct toxicity of eye drops has yet to be determined, but it may vary with the different classes of eye drops, different preservatives, and durations of treatments. Upcoming multicenter trials for new antiglaucoma eye drops should specifically evaluate ocular surface effects.

Risk factors for contact lens associated microbial keratitis. - Weissman, Barry A; Mondino, Bartly J (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2002)
Although the risk of developing contact lens associated microbial keratitis is small, the potential consequences of this condition, such as vision loss, are serious. This paper presents an analysis of the risk factors that have been identified for contact lens induced microbial keratitis, which include extended wear, hypoxia, non-compliance, blepharitis, diabetes mellitus, epithelial trauma, steroid use, therapeutic lens use, tobacco use, and possibly travel to warm climates. By remaining mindful of these risk factors, practitioners can take action and offer advice to patients so as to optimize the safety of contact lens wear.

Diagnosis and management of open angle glaucoma: suggested guidelines for optometrists. - Cockburn, David M (Clinical & experimental optometry, 2000)
OBJECTIVE : The aims of this review are to define open angle glaucoma, to outline its prevalence and its financial and personal costs, to discuss the difficulties encountered in establishing the diagnosis and monitoring treatment, and to suggest initial clinical guidelines for the comanagement of glaucoma between ophthalmologists and optometrists. METHODS: The literature was selectively reviewed to permit deductions that can be directed toward an effective comanagement strategy for patients with open angle glaucoma. CONCLUSIONS : Comanagement of patients having open angle glaucoma is a viable option, provided the opportunity for improved monitoring and better compliance is available. The basis for successful management rests with the ability to detect change in the optic disc and surrounding retina, visual fields and intraocular pressure. All these signs are continuous variables for which there are no known limits of normality. The division of responsibilities of management will be established initially by legislation and in the future modified according to experience and the emergence of new therapies.

Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis. - Brooks, D.E.; Andrew, S.E.; Denis, H.; Strubbe, D.T.; Biros, D.J.; Cutler, T.J.; Samuelson, D.A.; Gelatt, K.N. (Veterinary ophthalmology, 2000)
Purpose To describe the clinical appearance of corneal epithelial cell microerosions associated with keratomycosis in the horse. METHODS: Retrospective clinical study. RESULTS: Multifocal, punctate, superficial corneal opacities with positive rose bengal retention were noted in six horses with presumed 'viral keratitis'. Faint fluorescein staining was also present in three cases. Equine herpesvirus tissue culture inoculation was negative for a cytopathic effect in three cases. Aspergillus (n = 3), Curvularia (n = 1), and an unidentified fungus (n = 1) were cultured in five horses, and hyphae found on corneal cytology from the sixth. Mixed bacterial infections were present in three eyes. The eyes of two horses with Aspergillus progressed to deep melting corneal ulcers that required surgical therapy. The microerosions remained superficial, but persistent in the other four eyes. Natamycin was utilized topically in all six horses. Transmission electron microscopy from case 6 revealed mucin layer disruption, an intact corneal epithelial cell layer, and fungal attachment to degenerating epithelial cells. The visual outcome was positive in all six horses, although healing was prolonged (48.5 +/- 14.5 days on average in the horses with no surgery; 62 days on average in the two horses that required surgery). CONCLUSIONS : Complete removal or full-thickness penetration of the corneal epithelial cell barrier may not be necessary to allow fungal adherence and initiation of keratomycosis in the horse. Prior to colonization and invasion of the horse cornea, fungi may induce changes in the mucin layer of the tear film that result in or are associated with rose bengal positive microerosions of the superficial corneal epithelium. Horses with painful eyes, and eyes with superficial, multifocal corneal opacities should have their corneas stained with both fluorescein and rose bengal as fungal microerosions may stain weakly, or not at all, with fluorescein, and may thus be mistaken for presumed 'viral keratitis' of the horse.

The peculiar challenges of blindness prevention in Nigeria: a review article. - Babalola, O E (African journal of medicine and medical sciences, 2011)
AIM: To describe the challenges peculiar to Nigeria in the implementation of vision 2020: the right to sight and to proffer solutions as to the way forward, METHOD: A review of the recently completed national blindness survey, current literature, and the advocacy experience of the Ophthalmological Society of Nigeria., FINDINGS: The prevalence of blindness in Nigeria is 0.78%. Over 43% of these are blind from cataracts and a further 9% from uncorrected aphakia or complications of couching. 50% of all cataract interventions are carried out by itinerant couchers. Other major causes of blindness are glaucoma (16%) corneal opacities (12%), trachoma (4%), optic atrophy (3%) onchocerciasis (1%) and macular disease (1%). 70% of these are either preventable or reversible. Nigeria has a relatively favourable ophthalmologist/population ratio of about 2.8 per million, but has a low Cataract surgical rate of 300 per million per year. The reasons for this include a lack of ownership of blindness prevention programs, a lack of political will and parlous state of funding for vision 2020. There is an abdication of responsibility for both training and services on the part of government to the International NonGovernmental organisations. Teaching hospitals no longer generate enough patient surgical load to support training. We estimate it would cost N8.5 billion ($56.8 million) to sustain the WHO recommended Cataract Surgical Rate of 3000 per million per year in Nigeria., CONCLUSIONS: Nigeria is not headed in the direction of meeting Vision 2020 targets. Advocacy involving funding through the MDGs, needs to be intensified.
Keywords: Blindness/ep [Epidemiology]; *Blindness/et [Etiology]; *Blindness/pc [Prevention & Control]; Cataract/di [Diagnosis]; Cataract/ep [Epidemiology]; Cataract Extraction/sn [Statistics & Numerical Data]; Consumer Advocacy; Financing, Government; Health Services Accessibility; Health Surveys; Health Workforce/sn [Statistics & Numerical Data]; Humans; Nigeria/ep [Epidemiology]; Ophthalmology; Physicians; Prevalence; Societies, Medical; Vision, Low/ep [Epidemiology]; *Vision, Low/et [Etiology]; *Vision, Low/pc [Prevention & Control]

Glaucoma medication compliance issues in a Jamaican hospital eye clinic. - Mowatt, L; Nelson-Imoru, J; Gordon-Strachan, G (The West Indian medical journal, 2011)
OBJECTIVE: To investigate the level of compliance with glaucoma medications in a clinic setting and the factors associated with failed compliance., METHOD: This was a prospective study done at the Glaucoma Clinic, University Hospital of the West Indies, between April and June 2005. Consecutive patients in the clinic were administered a questionnaire by the doctor Statistical analysis was done using cross-tabulations, Chi-square (Chi2) tests and odds ratio using SPSS version 11.0., RESULTS: One hundred glaucoma patients were recruited: 63% were female; 57% of the total group was in the 61-80-year age group. Forty-seven per cent had been attending the glaucoma clinic for over 10 years. Eighty-five per cent knew their diagnosis, although only 22% understood their diagnosis. Patients who did not have a full understanding of glaucoma were more likely to be non-compliant (odds ratio 0.771 (95% CI 0.298, 1.995, p = 0.591)). Females were more likely to be compliant than males (odds ratio was 1.64 (95% CI 0.72, 3.75, p = 0.24)). Patients who were clinic attendees for less than five years duration were less compliant than those attending the glaucoma clinic for 6-10 years. The reasons for reduced compliance were financial in 44%, forgetfulness in 20% and eye-drops being unimportant in 12% of cases. The educational level of patients was not related to compliance., CONCLUSION: The level of full compliance was 50% and partial compliance 43%. There was a 7% level of non-compliance. Higher levels of compliance were seen in females, patients who understood their diagnosis and those who had no co-morbid disease.
Keywords: Aged; Aged, 80 and over; Chi-Square Distribution; Comorbidity; Educational Status; Female; *Glaucoma/dt [Drug Therapy]; Humans; Jamaica; Male; *Medication Adherence; Middle Aged; Prospective Studies; Risk Factors; Surveys and Questionnaires

[The latest developments in glaucoma therapy using fixed combination products]. - Calugaru, M; Calugaru, D (Oftalmologia (Bucharest, Romania : 1990), 2011)
Modern fixed-combination products simplify medication dose regimen without sacrificing their effectiveness.Potential benefits of the therapy with fixed-combination products are enhanced tolerability increased convenience,better compliance,cost and time economy and removal of the wash out effect. Regarding intraocular pressure lowering effect, fixed-combination agents are superior to monotherapy with the two medication components, with the exception of Duotrav that is not superior to travoprost action.Fixed-combination products are noninferior to concomitant administration of the two components of medication (nonfixed-combination agents) relative to their ocular hypotensive efficacy with the exception of Ganfort that is however inferior to concurrent administration of both the bimatoprost and timolol.
Keywords: Amides/tu [Therapeutic Use]; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Brimonidine Tartrate, Timolol Maleate Drug Combination; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Drug Combinations; Drug Therapy, Combination; Glaucoma/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Ophthalmic Solutions/ad [Administration & Dosage]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Quinoxalines/tu [Therapeutic Use]; Sulfonamides/tu [Therapeutic Use]; Thiazines/tu [Therapeutic Use]; Thiophenes/tu [Therapeutic Use]; Timolol/tu [Therapeutic Use]; Travoprost; Treatment Outcome

[Availability of patients living in rural areas, to have surgical method of treatment of cataract and glaucoma]. - Cheremukhina, O M (Likars'ka sprava, 2011)
Using modern surgical treatment on patients that live in rural areas, with cataract and glaucoma is not sufficient. There is insufficient expertise of ophthalmologists, low level of human, logistical and financial resource support for eye hospitals, low level of motivation and socio-psychological problems among patients, creating a favorable situation in Ukraine for further growth of low vision and blindness in rural areas. Institutional solutions of existing problems are proposed.
Keywords: Blindness/ep [Epidemiology]; Blindness/pa [Pathology]; *Blindness/pc [Prevention & Control]; Blindness/su [Surgery]; Cataract/ep [Epidemiology]; Cataract/pa [Pathology]; *Cataract/pc [Prevention & Control]; *Cataract Extraction/sn [Statistics & Numerical Data]; Cataract Extraction/td [Trends]; Female; Glaucoma/ep [Epidemiology]; Glaucoma/pa [Pathology]; *Glaucoma/pc [Prevention & Control]; Glaucoma/su [Surgery]; Health Services Accessibility/ec [Economics]; *Health Services Accessibility/og [Organization & Administration]; Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; *Lens, Crystalline/pa [Pathology]; Lens, Crystalline/su [Surgery]; Male; Rural Health/ec [Economics]; Rural Health/st [Standards]; *Rural Health/sn [Statistics & Numerical Data]; Ukraine/ep [Epidemiology]; Vision, Low

Ab externo trabeculectomy performed under topical anesthesia supplemented by conscious sedation. - Cortes-Gastelum, Marco Antonio; Paczka-Zapata, Jose Antonio; Mendoza-Barbosa, Jossue Fernando (Cirugia y cirujanos, 2011)
BACKGROUND: Ab externo trabeculectomy (AET) is the most common surgical procedure to treat glaucoma; topical anesthesia supplemented by conscious sedation is one of the diverse anesthetic methods to perform such type of surgery. The efficacy and safety of using topical anesthesia supplemented with conscious sedation for performing trabeculectomy were assessed in this prospective study., METHODS: Twenty-six eyes of 26 consecutive patients underwent trabeculectomy under the effect of topical anesthesia and sedation. All cases were prospectively assessed during five different intra-operative times in which the degree of pain was measured using a visual analog scale (VAS)., RESULTS: One patient was excluded from the study due to excessive somnolence. Performing the iridectomy caused less tolerance (p = 0.03) but with acceptable scores according to the VAS (score 2 = minimal and tolerable pain; p = 0.02), followed by conjunctival closure (nonsignificant p values). The entire procedure did not cause either moderate to extreme pain (scores 4 and 5 of the scale, respectively) in any of the patients. Levels of pain, blood pressure, heart rate, and oxygen saturation were compared among the different intra-operative times. No statistically significant (p >0.05) differences were demonstrated. Eighty percent (n = 4) of the patients with green or blue iris had symptoms during the surgery, but this was of borderline statistical significance (p = 0.053). No ocular or systemic side effects appeared related to the reported anesthesia regime., CONCLUSIONS: Topical anesthesia associated with conscious sedation seems to be efficacious and safe and can be recommended for performing trabeculectomy.
Keywords: Adjuvants, Anesthesia/ad [Administration & Dosage]; Administration, Topical; Aged; *Anesthesia, Local/mt [Methods]; *Anesthetics, Local/ad [Administration & Dosage]; *Conscious Sedation; Epinephrine/ad [Administration & Dosage]; Eye Color; Female; Hemodynamics; Humans; *Lidocaine/ad [Administration & Dosage]; Male; Middle Aged; Oxygen/bl [Blood]; Pain Measurement; Pain, Postoperative/ep [Epidemiology]; Pain, Postoperative/pc [Prevention & Control]; Patient Acceptance of Health Care; Prospective Studies; *Tetracaine/ad [Administration & Dosage]; *Trabeculectomy/mt [Methods]

Profile of vernal keratoconjunctivitis in Nepal: a hospital based study. - Kansakar, I (Nepal Medical College journal : NMCJ, 2011)
Vernal keratoconjunctivitis (VKC) or Spring Catarrh is recurrent, chronic, allergic conjunctivitis occurring in prepubertal age-group during spring and summer season. Though this is a self-limiting disorder, it often leads to visual impairment due to secondary corneal complications if not treated during active stage of the illness. Apart from this, the illness is known to affect the productivity and quality of life in school going children due to absenteeism and limitations to outdoor activities. Knowing the clinical profile of disease would provide the evidence for developing, treatment protocol in coming years. Therefore a hospital based study was designed to see the profile of VKC. Total of 220 patients were enrolled in this study. Male to female ratio with VKC was found to be 4:1. Clinical presentation showed seasonal variation; 78.2% during the spring and summer season. Bilateral involvement was seen in 100% cases, out of which 44.5% were limbal type. The best spectacle corrected visual status of better than 6/9 was in 96.4%, while 2.3% had vision less than 6/12. In 9.5% corneal involvement was seen as superficial keratopathy, while others, such as Shield ulcer, pannus, corneal scar, and keratoconus consisted of 8.3%. The disease is predominantly seen in male child with seasonal variation. Visual impairment is mainly due to involvement of cornea.
Keywords: Adolescent; Adult; Child; Child, Preschool; *Conjunctivitis, Allergic/ep [Epidemiology]; Cross-Sectional Studies; Female; Humans; Male; Nepal/ep [Epidemiology]; Retinoscopy; Seasons; Young Adult

Compliance with eye care in glaucoma patients with comorbid depression. - Weiss, Guy A; Goldich, Yakov; Bartov, Elisha; Burgansky-Eliash, Zvia (The Israel Medical Association journal : IMAJ, 2011)
BACKGROUND: Comorbid depression may play an important role in non-compliance with medical treatment among patients with chronic illnesses. Glaucoma is a potentially blinding chronic disease requiring life-long commitment to medical therapy. Failure to adhere to anti-glaucoma treatment may lead to disease progression and visual loss., OBJECTIVES: To assess the prevalence of depressive symptoms in glaucoma patients and the association between these symptoms and non-compliance with anti-glaucoma therapy., METHODS: In this cross-sectional observational study, compliance with pharmacotherapy was assessed with the Morisky Medication Adherence questionnaire (eight items). Screening for depression was performed by means of the CES-D (Center for Epidemiologic Studies Depression scale). The association between depression and compliance rates was analyzed., RESULTS: The study group comprised 76 glaucoma patients; 19.7% of the subjects were classified as non-compliant (Morisky cutoff 10) and 21.1% suffered from depression (CES-D cutoff > or = 16). We found a similar level of non-compliance when comparing depressed with non-depressed glaucoma patients. However, a correlation was observed between the level of depression and the level of non-compliance (P = 0.04)., CONCLUSIONS: Our study revealed a similar rate of depression in glaucoma patients and the general israeli population. The presence of depression was not associated with the presence of non-compliance, yet the level of depression was associated with the level of non-compliance.
Keywords: Adult; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Chronic Disease; Comorbidity; Cross-Sectional Studies; Depression/ep [Epidemiology]; Depression/pp [Physiopathology]; *Depression; Disease Progression; Female; Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Glaucoma/px [Psychology]; *Glaucoma; Humans; Instillation, Drug; Intraocular Pressure/de [Drug Effects]; Israel/ep [Epidemiology]; Long-Term Care; Male; Middle Aged; Patient Compliance/px [Psychology]; Patient Compliance/sn [Statistics & Numerical Data]; *Patient Compliance; Prevalence; Surveys and Questionnaires; Vision Tests

[Causes of patients' non-adherence with glaucoma medication dosing: systemic classification based on dosing schedule]. - Kobayashi, Hiroshi (Nippon Ganka Gakkai zasshi, 2011)
PURPOSE: To study the causes of patients' nonadherence with the instruction of glaucoma medication dosing and to analyze them based on the dosing schedules by means of systemic classification., METHODS: Four hundred twenty eight patients who had been prescribed glaucoma medication for at least six months were studied. Adherence was ascertained by means of a predetermined questionnaire. Nonadherent patients were interviewed with stratified questionnaires to elicit the causes for the non-adherence, which were analyzed with cluster analysis., RESULTS: The total number of non-adherents (more than 3 doses missed per month) was 114 (26.6%). The non-adherence rate in the morning was 18.2% (51/280) and in the evening 24.7% (75/304); there was no significant difference. Structured interviews for the 114 non-adherents elicited 194 unique situational problems (1.7 +/- 0.6/individual), which were grouped into four major categories: 25 medication regimen factors (12.9%), 119 patients' related factors (61.3%), 6 provider-related factors (3.1%) and 44 environmental factors (22.7%). Patients' related factors showed the higher incidence compared with other factors in both dosing time (p<0.01): Sleeping and taking a bath caused 39 patients (20.1%) to miss medication in patients with eye-drops' application in the evening., CONCLUSIONS: Each dosing time may have its own situational problems, which may be likely to be multidimensional and must considered with each individual patient.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Cluster Analysis; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Humans; Male; Middle Aged; Ophthalmic Solutions; *Patient Compliance/px [Psychology]; *Patient Compliance/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Time Factors; Young Adult

[Adherence]. - Kiuchi, Yoshiaki (Nippon Ganka Gakkai zasshi, 2011)
Keywords: Communication; Drug Administration Schedule; Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; *Patient Compliance/px [Psychology]; Patient Education as Topic; Physician-Patient Relations

Comparison of fixed combinations of dorzolamide/timolol and brimonidine/timolol in patients with primary open-angle glaucoma. - Gulkilik, Gokhan; Oba, Ersin; Odabasi, Mahmut (International ophthalmology, 2011)
To compare the short-term effectiveness and ocular side-effects of fixed combinations of dorzolamide/timolol (DTFC) and brimonidine/timolol (BTFC) in patients with primary open-angle glaucoma (POAG). Forty-two eyes of 42 patients newly diagnosed with primary open-angle glaucoma were assessed prospectively. One of the two eyes was chosen randomly and treated with DTFC (2 x 1) for 4 weeks. The treatment was then stopped to allow a 4-week wash-out period. Following the wash-out period, the same eye was treated with BTFC (2 x 1) for 4 weeks. Intraocular pressure (IOP) values were measured before and after each treatment at 0800, 1,200 and 1,600 h. Tear function test results and ocular side-effects were also recorded. The mean baseline IOP values for DTFC and BTFC were 24.1 +/- 1.8 and 24.6 +/- 2.4 mmHg, respectively. The mean IOP values after 4 weeks of treatment with DTFC or BTFC were 17.1 +/- 2.9 and 16.9 +/- 2.5 mmHg, respectively. Both medications reduced IOP values significantly (P = 0.0000). The effectiveness of both medications was similar (P = 0.7363). Both combinations significantly reduced the amount of tear secretion and tear break-up time (P = 0.0000). Eye burning was more common with DTFC than with BTFC (P = 0.0182). Other adverse effects were observed at similar rates for both combinations. This study demonstrated that the IOP-reducing effects of DTFC and BTFC in patients with POAG are similar. The side-effect profile of BTFC is similar to that of DTFC. Lower occurrence of a burning sensation may improve patient compliance in the BTFC group.
Keywords: Aged; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Patient Compliance; Prospective Studies; *Sulfonamides/ad [Administration & Dosage]; *Sulfonamides/ae [Adverse Effects]; *Thiophenes/ad [Administration & Dosage]; *Thiophenes/ae [Adverse Effects]; *Timolol/ad [Administration & Dosage]; *Timolol/ae [Adverse Effects]; Treatment Outcome

Substratum compliance regulates human trabecular meshwork cell behaviors and response to latrunculin B. - Wood, Joshua A; McKee, Clayton T; Thomasy, Sara M; Fischer, Marion E; Shah, Nihar M; Murphy, Christopher J; Russell, Paul (Investigative ophthalmology & visual science, 2011)
PURPOSE: To determine the impact of substratum compliance and latrunculin-B (Lat-B), both alone and together, on fundamental human trabecular meshwork (HTM) cell behavior. Lat-B is a reversible actin cytoskeleton disruptor that decreases resistance to aqueous humor outflow and decreases intraocular pressure., METHODS: HTM cells were cultured on polyacrylamide hydrogels possessing values for compliance that mimic those reported for normal and glaucomatous HTM, or tissue culture plastic (TCP). Cells were treated with 0.2 muM or 2.0 muM Lat-B in dimethyl sulfoxide (DMSO) or DMSO alone. The impact of substratum compliance and/or Lat-B treatment on cell attachment, proliferation, surface area, aspect ratio, and migration were investigated., RESULTS: HTM cells had profoundly decreased attachment and proliferation rates when cultured on hydrogels possessing compliance values that mimic those found for healthy HTM. The effect of Lat-B treatment on HTM cell surface area was less for cells cultured on more compliant hydrogels compared with TCP. HTM cell migration was increased on stiffer hydrogels that mimic the compliance of glaucomatous HTM and on TCP in comparison with more compliant hydrogels. Lat-B treatment decreased cellular migration on all surfaces for at least 7 hours after treatment., CONCLUSIONS: Substratum compliance profoundly influenced HTM cell behaviors and modulated the response of HTM cells to Lat-B. The inclusion of substratum compliance that reflects healthy or glaucomatous HTM results in cell behaviors and responses to therapeutic agents in vitro that may more accurately reflect in vivo conditions.
Keywords: Acrylic Resins; *Bridged Bicyclo Compounds, Heterocyclic/pd [Pharmacology]; Cell Adhesion/de [Drug Effects]; Cell Movement/de [Drug Effects]; Cell Proliferation/de [Drug Effects]; Cells, Cultured; Cytoskeleton/de [Drug Effects]; Extracellular Matrix Proteins; Glaucoma; Humans; Hydrogels; Marine Toxins/pd [Pharmacology]; Microscopy, Atomic Force; *Thiazolidines/pd [Pharmacology]; *Trabecular Meshwork/de [Drug Effects]; *Trabecular Meshwork/pa [Pathology]

Ocular hypotensive effects and safety over 3 months of switching from an unfixed combination to latanoprost 0.005%/timolol maleate 0.5% fixed combination. - Inoue, Kenji; Okayama, Ryoko; Higa, Risako; Sawada, Hideko; Wakakura, Masato; Tomita, Goji (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2011)
PURPOSE: Latanoprost 0.005%/timolol maleate 0.5% combination eye drops are now available in Japan. The aim of the present study was to investigate the prospective intraocular pressure (IOP) reduction effects and adherence with the combination eye drops in Japanese patients., METHODS: The subjects were 162 patients (162 eyes) with glaucoma or ocular hypertension concomitantly using latanoprost 0.005% and timolol maleate 0.5% eye drops. Concomitant use of the 2 eye drops was stopped, and patients were switched to the latanoprost 0.005%/timolol maleate 0.5% combination eye drops without any washout period. IOP was measured before the switch, and at 1 and 3 months after the switch, and then compared. A questionnaire survey on adherence was also conducted 1 month after the switch., RESULTS: IOP was the same before and after the switch: 15.2+/-3.3 mmHg before the switch, 14.9+/-3.0 mmHg 1 month after the switch, and 15.1+/-3.2 mmHg 3 months after the switch. According to the questionnaire survey, the frequency of forgetting to administer eye drops decreased with the switch, but 45.1% of the patients experienced irritation. About 82.1% replied that they preferred the latanoprost 0.005%/timolol maleate 0.5% combination eye drops. By the third month after the switch, 13 patients (8.0%) had discontinued the eye drops due to side effects or insufficient IOP reduction., CONCLUSION: The switch from the concomitant use of latanoprost 0.005% and timolol maleate 0.5% eye drops to latanoprost 0.005%/timolol maleate 0.5% combination eye drops improved adherence and helped maintain IOP.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/tu [Therapeutic Use]; Drug Combinations; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Medication Adherence; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ophthalmic Solutions; Prospective Studies; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Surveys and Questionnaires; *Timolol/ad [Administration & Dosage]; Timolol/tu [Therapeutic Use]; Tonometry, Ocular; Treatment Outcome

Compliance and knowledge about glaucoma in patients at tertiary glaucoma units. - Mansouri, Kaweh; Iliev, Milko E; Rohrer, Kaspar; Shaarawy, Tarek (International ophthalmology, 2011)
To document the rate of self-reported compliance and glaucoma-related knowledge in Swiss patients and to identify risk factors for their poor compliance. This was an observational study, including a total of 200 consecutive patients already under glaucoma medication in two Swiss tertiary glaucoma clinics (Geneva and Bern). Personal characteristics, presence of systemic disease, compliance with glaucoma medication, attitude to the ophthalmologist, and glaucoma-related attitudes were ascertained by means of a predetermined questionnaire with 40 questions. Patients were subsequently assessed for the ability to correctly instil placebo eye drops. Non-compliance with glaucoma medication was defined as omitting more than two doses a week as reported by the patient. Logistic regression was used to evaluate how patient characteristics and knowledge about the disease were related to compliance. Overall, 81% (n = 162) of patients reported to be compliant. Forgetfulness was the most frequently cited reason for non-compliance with dosing regimen (63%). Although 90.5% (n = 181) of patients believed glaucoma medication to be efficient, only 28% (n = 56) could correctly define glaucoma. Factors positively associated with compliance were 'knowledge of glaucoma' [adjusted odds ratio (OR) 4.77 (95% CI 1.36-16.70)] and 'getting help for administration of drops' [OR 2.95 (1.25-6.94)]. These findings indicate that despite the comparatively high compliance rate among glaucoma patients, knowledge of glaucoma remains poor in long-term glaucoma sufferers. Improving knowledge about the disease is important since it is positively associated with compliance in our study.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; Aged; Ambulatory Care Facilities; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Cohort Studies; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Prostaglandins, Synthetic/ad [Administration & Dosage]; Risk Factors; Surveys and Questionnaires; Switzerland

Tafluprost for glaucoma. - Papadia, Marina; Bagnis, Alessandro; Scotto, Riccardo; Traverso, Carlo E (Expert opinion on pharmacotherapy, 2011)
INTRODUCTION: Lowering intraocular pressure (IOP) is, at present, the only therapeutic approach to the treatment of glaucoma. Good compliance is essential in every chronic therapy; therefore, the development of IOP-lowering eye drops that are well tolerated and have an easy administration schedule is essential for the treatment of glaucoma. Prostaglandins are a first-choice drug class for the treatment of glaucoma., AREAS COVERED: This review provides a background on tafluprost, a newly synthesized prostaglandin analogue, and summarizes the existing data on its efficacy and safety, including comparative data with the other prostaglandin derivatives now available on the market. A review of the literature was performed., EXPERT OPINION: Current research focuses not only on the efficacy of the drugs but also on their tolerability. The importance of obtaining good compliance by the patient is increasingly relevant; therefore, new formulations are studied to provide fewer side effects and an easier schedule. Tafluprost is a new prostaglandin analogue that has been marketed in some European countries and in Japan for more than 2 years and was recently (July 2009) approved in 21 countries. Besides a well-demonstrated IOP-lowering effect, tafluprost is the first topical prostaglandin available as a preservative-free formulation.
Keywords: Administration, Ophthalmic; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/su [Surgery]; Humans; Hypersensitivity/et [Etiology]; Intraocular Pressure; Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F/ae [Adverse Effects]; *Prostaglandins F/tu [Therapeutic Use]

Early outcomes of primary pediatric keratoplasty in patients with acquired, atraumatic corneal pathology. - Ganekal, Sunil; Gangangouda, Chandrashekar; Dorairaj, Syril; Jhanji, Vishal (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2011)
PURPOSE: To evaluate the early outcomes of pediatric corneal transplantation in patients with acquired, nontraumatic corneal pathology., METHODS: In this retrospective series, the records of children 15 years of age or younger who underwent optical penetrating keratoplasty for acquired nontraumatic corneal pathologies between December 2008 and June 2010 were reviewed. Demographic features, etiology of opacification, visual acuity, and other clinical findings were recorded., RESULTS: Nineteen eyes of 19 children (10 females) were included. Mean age at time of surgery was 9.1 +/- 3.01 years (range, 5-15 years). Adherent leukoma secondary to healed infectious keratitis (n = 12, 63%) and keratoconus (n = 7, 37%) were the leading indications for surgery. The mean follow-up period was 10.2 +/- 3.3 months (range, 6-18 months). Postoperatively, clear grafts were seen in 15 cases (79%). Graft failure was noted in 4 eyes secondary to allograft rejection (n = 1), graft infection (n = 1), primary graft failure (n = 1), and uncontrolled glaucoma (n = 1). The most common cause of moderate or poor visual outcome was amblyopia (80%). Overall, 13 patients (68%) had postoperative visual acuity better than the preoperative vision., CONCLUSIONS: Penetrating keratoplasty can yield good anatomic results in children with acquired, nontraumatic causes of corneal scarring, but amblyopia limits the visual outcomes. Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
Keywords: Adolescent; Amblyopia/di [Diagnosis]; Child; Child, Preschool; *Corneal Diseases/su [Surgery]; *Corneal Transplantation; Female; Follow-Up Studies; Glaucoma/di [Diagnosis]; Humans; *Keratitis/su [Surgery]; Male; Postoperative Complications/di [Diagnosis]; Retrospective Studies; Treatment Outcome; Visual Acuity

[Survey of medical treatment in primary open-angle glaucoma]. - Tchabi, S; Abouki, C; Sounouvou, I; Yehouessi, L; Doutetien, C; Bassabi, S K (Journal francais d'ophtalmologie, 2011)
PURPOSE: To survey patient understanding of primary open-angle glaucoma (POAG) and difficulties associated with medical treatment of POAG patients, to determine patient compliance rates with medical therapy, to study factors influencing compliance rates, and to formulate suggestions to improve patient compliance., PATIENTS AND METHODS: Our descriptive prospective study was carried out at the ophthalmology clinic of the Hubert K. Maga national university medical center and in the "La Lumiere" ophthalmology clinic in Cotonou, from January 5 through April 25, 2009. The study included all glaucoma patients under medical treatment for at least 1 year with no surgical POAG intervention, seen in consultation during the study period, i.e. 120 patients. The following parameters were studied: whether the patient took or forgot to take his or her medication within the week preceding the survey, the patient's statement of whether or not voluntary interruption of antiglaucoma treatment occurred for more than 1 day, and the regularity of follow-up appointments with the doctor over the preceding 2 years., RESULTS: The median age of the patients was 56.5 +/- 11.9years. A percentage of 90.8 of patients understood the chronic nature of POAG. A percentage of 91.7 knew that, in the absence of treatment, POAG can result in irreversible blindness. A percentage of 90 knew that medical treatment is intended to be lifelong. A percentage of 84.2 knew that the dosing schedule must be adhered to. The rate of total compliance was 53.3%. Only regularity of follow-up visits and adherence to dosing schedules were found as significant factors (P<0.05)., CONCLUSION: Compliance is a dynamic variable which ophthalmologists need to evaluate throughout the follow-up of POAG patients, in order to reduce the prevalence of glaucoma blindness in Benin. Copyright A© 2011 Elsevier Masson SAS. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Benin/ep [Epidemiology]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ep [Epidemiology]; Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Male; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Socioeconomic Factors; Withholding Treatment/sn [Statistics & Numerical Data]

[The influence of the Travalert( R) dosing aid on medical treatment compliance and the quality of life of glaucoma patients]. - Sanchez-Pulgarin, M; Martinez-de-la-Casa, J M; Escalada, A; Saenz-Frances, F; Garcia-Feijoo, J; Garcia Sanchez, J (Archivos de la Sociedad Espanola de Oftalmologia, 2011)
PURPOSE: To study compliance in the medical treatment of glaucoma, its possible association with other factors, and quality of life of patients with glaucoma., MATERIAL AND METHODS: Longitudinal prospective study of 60 patients with ocular hypertension or glaucoma who were treated with travoprost, or with a fixed combination of travoprost/timolol nightly. All subjects were given a Travalert( R) dosing aid and were reviewed after one and four months. Strict and relative compliance data were collected on each visit. The relationship between compliance and other variables was studied using univariate analysis. To analyse quality of life, patients were given self-assessment STAI anxiety questionnaires after the first and last visits., RESULTS: Relative compliance for the four months was significantly greater than the strict compliance (P=.001). In the group of least compliance the number of patients on treatment with combination therapy was significantly higher than those on monotherapy. In the lost cases, the number of men was significantly higher than women. No association was found in the other variables. The anxiety was similar to that in the normal population., CONCLUSIONS: Compliance is very important in the treatment of glaucoma, and our study provides objective data through the use of Travalert dosing aid with relative compliances of 70%. Patients with combined therapies have lower compliance than those on monotherapy. Copyright © 2010 Sociedad Espanola de Oftalmologia. Published by Elsevier Espana. All rights reserved.
Keywords: Administration, Ophthalmic; Aged; Anxiety/et [Etiology]; Anxiety/px [Psychology]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Drug Administration Schedule; Drug Combinations; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Instillation, Drug; Male; *Medication Adherence; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/px [Psychology]; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Quality of Life; *Reminder Systems/is [Instrumentation]; Surveys and Questionnaires; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]; Travoprost

Balancing efficacy and tolerability of prostaglandin analogues and prostaglandin-timolol fixed combinations in primary open-angle glaucoma. - Aptel, F; Denis, P (Current medical research and opinion, 2011)
BACKGROUND: Lowering intraocular pressure (IOP) is currently the only therapeutic approach that preserves visual function in primary open-angle glaucoma. In making treatment decisions for first- and second-line therapy, the clinician needs to provide an appropriate balance of efficacy and tolerability. Prostaglandin analogues (PGAs) are frequently used as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Similarly, PGA-based fixed combinations are frequently used in patients who progress or fail to achieve the target IOP., SCOPE: We have reviewed the literature on the management of primary open-angle glaucoma with PGAs, both as monotherapies and in fixed combinations., FINDINGS: In the clinical trial and meta-analysis data identified, bimatoprost 0.03% seems to be associated with a greater overall ability to lower IOP compared with latanoprost, travoprost or tafluprost, at the cost of a slightly higher incidence of conjunctival hyperaemia. Studies indicate that patients' adherence to treatment is generally better with PGAs than with many other monotherapies. In patients requiring more than one IOP-lowering agent, fixed combination treatments may provide improved adherence and tolerability benefits compared with concomitant use of individual treatments. Bimatoprost/timolol fixed combination appears to be slightly more efficacious than latanoprost/timolol or travoprost/timolol, and tolerability differences between the fixed combinations appear to be slight, probably because the addition of timolol to the PGA component lessens the associated hyperaemia. Surveys on EU physician attitudes appear largely in line with these clinical data., CONCLUSION: An appropriate balance between efficacy and tolerability ensures optimum IOP lowering and reduces the risk of non-adherence. PGAs largely fulfil this need as monotherapies and as components of combinations.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/ec [Economics]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Conjunctival Diseases/ci [Chemically Induced]; Conjunctival Diseases/ec [Economics]; Conjunctival Diseases/pp [Physiopathology]; Drug Therapy, Combination/mt [Methods]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Hyperemia/ci [Chemically Induced]; Hyperemia/ec [Economics]; Hyperemia/pp [Physiopathology]; Patient Compliance; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; Timolol/ec [Economics]; *Timolol/tu [Therapeutic Use]

[Principles of treatment of early stage glaucoma: surgery vs. therapy (review of literature)]. - Kuroedov, A V; Brezhnev, A Iu; Aleksandrov, A S; Ogorodnikova, V Iu (Voenno-meditsinskii zhurnal, 2011)
Swift development of ophthalmopharmacology in last years has led to loss of starting positions surgery in glaucoma treatment, especially in early stage. Medical therapy is considered safer and not less effective in spite of problems of compliance, intolerance to hypotensive drugs in some patients with ocular surface diseases and less significant reduction of baseline intraocular pressure. There are many glaucoma guidelines refer to this data which led to significant decrease of proportions of surgery. Whether such an approach is applicable in all cases?
Keywords: *Glaucoma/th [Therapy]; Humans; Practice Guidelines as Topic

An international analysis of contact lens compliance. - Morgan, Philip B; Efron, Nathan; Toshida, Hiroshi; Nichols, Jason J (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2011)
PURPOSE: To evaluate compliance to contact lens use in 14 countries, and to identify wearer attributes which indicate lower compliance levels., METHODS: A web-based survey was undertaken by 4021 contact lens wearers, revealing information about demographics, and lens and solution information including daily handling details, case care and aftercare frequency. Particular attention was paid to eight modifiable compliance-related behaviours which are associated with an increased risk of microbial keratitis., RESULTS: Full compliance was very rare for most lens users, although better (15% of wearers) for daily disposable lenses. Reduced compliance was demonstrated in South Korea, and for young male full-time contact lens users, especially those who have not consulted their eyecare practitioner for some time. The behaviours associated with the lowest levels of compliance were rubbing and rinsing, handwashing, correct lens replacement and case cleaning., CONCLUSIONS: Given other recent literature, which suggests improved contact lens compliance with regular self-review exercises, we encourage clinical colleagues to particularly examine case cleaning, handwashing and rubbing and rinsing at aftercare examinations, especially in young male wearers. Copyright © 2011 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Keywords: Adult; *Attitude to Health; Contact Lens Solutions/st [Standards]; *Contact Lenses/st [Standards]; Female; Follow-Up Studies; Humans; Male; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; *Patient Education as Topic/st [Standards]; Retrospective Studies; *Surveys and Questionnaires; Young Adult

The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity. - Sleath, Betsy; Blalock, Susan; Covert, David; Stone, Jennifer L; Skinner, Asheley Cockrell; Muir, Kelly; Robin, Alan L (Ophthalmology, 2011)
OBJECTIVE: The purpose of the study was to examine (1) how patient adherence and eye drop technique were associated with visual field defect severity and (2) how general glaucoma adherence self-efficacy and eye drop technique self-efficacy were related to visual field defect severity., DESIGN: Cross-sectional study conducted at a single private practice site., PARTICIPANTS: Patients using eye drops for their glaucoma., METHODS: Subject adherence to glaucoma medications through Medication Events Monitoring System (MEMS) devices were measured, and eye drop instillation technique was assessed by video recording. General glaucoma medication adherence self-efficacy was measured using a 10-item scale, and eye drop technique self-efficacy was measured using a 6-item scale. Multivariate logistic regression was used to analyze the data., MAIN OUTCOME MEASURES: Visual field defect severity., RESULTS: Patients who were less than 80% adherent according to the MEMS devices were significantly more likely to have worse defect severity. Patients with lower scores on the general glaucoma medication adherence self-efficacy scale also were significantly more likely to have worse defect severity. Eye drop technique and eye drop technique self-efficacy were not related significantly to visual field defect severity., CONCLUSIONS: Eye care providers need to assess patient adherence and to work with those patients with poor adherence to find ways to improve their ability and self-efficacy in using their glaucoma medications., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Ophthalmic; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; Humans; Male; *Medication Adherence; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Self Administration; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome; Video Recording; *Vision Disorders/pp [Physiopathology]; Visual Acuity/ph [Physiology]; Visual Field Tests; *Visual Fields/ph [Physiology]

Intraocular pressure: modulation as treatment for glaucoma. - Caprioli, Joseph; Varma, Rohit (American journal of ophthalmology, 2011)
PURPOSE: To review the role of intervisit intraocular pressure (IOP) fluctuation as an independent risk factor for glaucoma., DESIGN: Perspective after literature review., METHODS: Analysis of pertinent publications in the peer-reviewed literature., RESULTS: Disparate findings regarding the role of intervisit IOP variation have been published. IOP variation was a significant risk factor in the Advanced Glaucoma Intervention Study (AGIS), the Collaborative Initial Glaucoma Treatment Study, and other smaller studies. These studies have in common low IOPs (often after surgery) and moderately advanced disease. In the AGIS, when patients were stratified by mean IOP, only those patients with low IOPs showed the detrimental effects of IOP variation. IOP variation was not a significant risk factor in the Early Manifest Glaucoma Treatment Trial, and in 2 separate studies of ocular hypertensives. These studies have in common generally higher IOPs and an earlier stage of glaucoma (or no glaucoma at all). We believe these results are complementary rather than contradictory: existing data suggest that the effects of IOP variation depend on the characteristics of the patient, the baseline IOP, their stage of damage, the type of glaucoma, and other as-yet unknown factors., CONCLUSIONS: Practitioners should consider whether patients who are progressing at low mean IOP may benefit from having IOP variation reduced. Single elevated measures of IOP may not be an anomaly or may not be related to compliance, but may identify patients who are at high risk for progressive glaucomatous damage, and thus should be monitored more carefully and potentially treated more aggressively. Copyright © 2011 Elsevier Inc. All rights reserved.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; *Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Risk Factors; Tonometry, Ocular; Vision Disorders/pp [Physiopathology]; Visual Acuity/ph [Physiology]

Pseudomonas aeruginosa growth in Refresh Plus R. - Pinna, Antonio; Usai, Donatella; Zanetti, Stefania (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2011)
PURPOSE: To assess Pseudomonas aeruginosa growth in Refresh Plus( R), a unit-dose preservative-free ophthalmic solution indicated for the treatment of dry eye and after laser-assisted in situ keratomileusis (LASIK) surgery, which contains carboxymethylcellulose 0.5% as its active ingredient., METHODS: Multiple test tubes of Refresh Plus were inoculated with 3 clinical ocular isolates of P. aeruginosa to achieve a target concentration of ~100 colony-forming units (CFU)/mL. The tubes were incubated at 25degreeC and samples were aseptically removed at 6, 12, and 24 h. The samples were cultured to enumerate the population at each time point., RESULTS: After 6 h incubation, the number of CFU/mL was 3,200 for isolate 1, 2,000 for isolate 2, and 6,480 CFU/mL for isolate 3. For all 3 organisms tested, the number of CFU/mL after 12 and 24 h incubation was >10(6) CFU/mL., CONCLUSIONS: Under the conditions of this experiment, Refresh Plus appears to support P. aeruginosa growth, suggesting that if the solution in a unit-dose vial of Refresh Plus were contaminated with P. aeruginosa during use, the organism would survive and replicate in the solution over time. Noncompliance with the manufacturer's recommendations (i.e., reuse of an open vial) may result in contamination of the solution with P. aeruginosa, which may cause severe keratitis.
Keywords: Carboxymethylcellulose Sodium/ad [Administration & Dosage]; Carboxymethylcellulose Sodium/ch [Chemistry]; *Carboxymethylcellulose Sodium/st [Standards]; Carboxymethylcellulose Sodium/tu [Therapeutic Use]; Drug Contamination; Drug Delivery Systems; Dry Eye Syndromes/dt [Drug Therapy]; Dry Eye Syndromes/et [Etiology]; Humans; Keratitis/mi [Microbiology]; Keratomileusis, Laser In Situ/ae [Adverse Effects]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ch [Chemistry]; *Ophthalmic Solutions/st [Standards]; Ophthalmic Solutions/tu [Therapeutic Use]; Preservatives, Pharmaceutical; *Pseudomonas aeruginosa/gd [Growth & Development]

A video study of drop instillation in both glaucoma and retina patients with visual impairment. - Hennessy, Amy L; Katz, Joanne; Covert, David; Kelly, Colleen A; Suan, Eric P; Speicher, Matthew A; Sund, Newman J; Robin, Alan L (American journal of ophthalmology, 2011)
PURPOSE: To compare self-administration of drops in both visually impaired glaucoma subjects and retina subjects., DESIGN: Prospective, observational study., METHODS:, SETTING: Distinct glaucoma and retina practices., STUDY POPULATION: Subjects with glaucoma or retinal diseases with visual acuity of 20/60 or worse in 1 eye, significant field loss, or both., OBSERVATION PROCEDURES: Subjects were video recorded self-instilling a drop onto the worse eye., MAIN OUTCOME MEASURE: Proper instillation of eye drop onto ocular surface., RESULTS: We included 409 subjects (205 glaucoma, 204 retina). Differences between the groups included the following: glaucoma subjects included fewer females (P = .05), included fewer white persons (P < .005), had worse visual acuity (P < .005), had less self-reported arthritis (P < .05), were younger (P < .005), and had more previous exposure to drop use (P < .005). Glaucoma subjects had more bilateral impairment (60% vs 42%; P < .0005). Retina subjects instilled more drops (1.7 vs 1.4; P = .02) and more frequently touched the bottle to the eye (47% vs 33%; P = .003). Of subjects claiming not to miss the eye, nearly one third from each group (P = .32) actually missed. Approximately one third of each group could not get a drop onto the eye (30% retina vs 29% glaucoma; P = .91). Among subjects placing 1 drop onto the eye without touching the adnexae, there was a trend for glaucoma patients to perform better, although both groups did poorly (success, 39% glaucoma vs 31% retina; P = .09)., CONCLUSIONS: Among visually impaired subjects, regardless of cause, drop administration was a problem. Both groups wasted drops, contaminated bottles, and had inaccurate perception of their abilities. This has implications for future therapeutic delivery systems. Copyright © 2011 Elsevier Inc. All rights reserved.
Keywords: Administration, Topical; Aged; Anti-Bacterial Agents/ad [Administration & Dosage]; Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Glucocorticoids/ad [Administration & Dosage]; Humans; Male; Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; *Retinal Diseases/dt [Drug Therapy]; Self Administration; Surveys and Questionnaires; *Task Performance and Analysis; *Video Recording; Vision Disorders/et [Etiology]; Visual Acuity/ph [Physiology]; *Visually Impaired Persons

The cost of vision loss in Canada. 2. Results. - Cruess, Alan F; Gordon, Keith D; Bellan, Lorne; Mitchell, Scott; Pezzullo, M Lynne (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2011)
OBJECTIVE: This study was conducted to provide the financial underpinnings necessary for effective planning for the provision of eye health services in Canada. Canada is facing an aging demographic and all the major eye diseases are diseases associated with aging. It is essential that we have information based on the best available data to support national and provincial vision health plans., DESIGN: The design associated with the prevalence-based approach used in this study was outlined previously in detail in The Cost of Vision Loss in Canada: Methodology., METHODS: The methods associated with the prevalence-based approach used in this study were previously outlined in detail in The Cost of Vision Loss in Canada: Methodology., RESULTS: The financial cost of VL in Canada in 2007 was estimated to be $15.8 billion per annum: $8.6 billion (54.6%) represents direct health system expenditure; $4.4 billion (28.0%) was productivity lost due to lower employment, higher absenteeism, and premature death of Canadians with VL; $1.8 billion (11.1%) was the dead weight losses (DWL) from transfers including welfare payments and taxation forgone; $0.7 billion (4.4%) was the value of the care for people with VL; $305 million (1.9%) was other indirect costs such as aids and home modifications and the bring forward of funeral costs. Additionally, the value of the lost well-being (disability and premature death) was estimated at a further $11.7 billion. In per capita terms, this amounts to a financial cost of $19370 per person with VL per annum. Including the value of lost well-being, the cost is $33704 per person per annum., CONCLUSIONS: There is a growing awareness in Canada and around the world of the impact of VL on health costs and on the economy in general. This awareness is supported by the growing number of independent studies on the cost of vision loss both nationally and globally. Because most of these studies are limited by the minimal amount of available data, the overall cost of vision loss is likely underestimated. Nevertheless, this study reports the cost of vision loss in Canada as being greater than previously reported, making the problem even more urgent to address. A comprehensive national vision health plan, that is a coordinated federal, provincial and territorial initiative dealing with all aspects of vision loss prevention, sight restoration, and vision rehabilitation is called for. Copyright © 2011 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: *Blindness/ec [Economics]; Blindness/ep [Epidemiology]; Canada/ep [Epidemiology]; Cataract/ep [Epidemiology]; Cost of Illness; Delivery of Health Care; Diabetic Retinopathy/ep [Epidemiology]; Glaucoma/ep [Epidemiology]; *Health Care Costs; *Health Expenditures/sn [Statistics & Numerical Data]; Health Resources/sn [Statistics & Numerical Data]; Health Services Research; Humans; Macular Degeneration/ep [Epidemiology]; Prevalence; Quality-Adjusted Life Years; Refractive Errors/ep [Epidemiology]; *Vision, Low/ec [Economics]; Vision, Low/ep [Epidemiology]

Impact of lens case hygiene guidelines on contact lens case contamination. - Wu, Yvonne T; Teng, Yuu Juan; Nicholas, Mary; Harmis, Najat; Zhu, Hua; Willcox, Mark D P; Stapleton, Fiona (Optometry and vision science : official publication of the American Academy of Optometry, 2011)
PURPOSE: Lens case contamination is a risk factor for microbial keratitis. The effectiveness of manufacturers' lens case cleaning guidelines in limiting microbial contamination has not been evaluated in vivo. This study compared the effectiveness of manufacturers' guidelines and an alternative cleaning regimen., METHODS: A randomized cross-over clinical trial with two phases (n = 40) was performed. Participants used the lens types of their choice in conjunction with the provided multipurpose solution (containing polyhexamethylene biguanide) for daily wear. In the manufacturers' guideline phase, cases were rinsed with multipurpose solution and air dried. In the alternative regimen phase, cases were rubbed, rinsed with solution, tissue wiped, and air-dried face down. The duration of each phase was 1 month. Lens cases were collected at the end of each phase for microbiological investigation. The levels of microbial contamination were compared, and compliance to both regimens was assessed., RESULTS: The case contamination rate was 82% (32/39) in the manufacturers' guideline group, compared with 72% (28/39) in the alternative regimen group. There were significantly fewer (p = 0.004) colony forming units (CFU) of bacteria from cases used by following the alternative regimen (CFU range of 0 to 10, and median of 12 CFU per well) compared with that of the manufacturer's guidelines (CFU range of 0 to 10, and median of 28 CFU per well). The compliance level between both guidelines was not significantly different (p > 0.05)., CONCLUSIONS: The alternative guidelines are more effective in eliminating microbial contamination from lens cases than that of the current manufacturer's guideline. Simply incorporating rubbing and tissue-wiping steps in daily case hygiene reduces viable organism contamination.
Keywords: Adolescent; Adult; *Contact Lens Solutions/st [Standards]; *Contact Lenses; Cross-Over Studies; *Equipment Contamination/pc [Prevention & Control]; Female; Follow-Up Studies; Humans; *Hygiene/st [Standards]; Male; New South Wales; Pilot Projects; *Practice Guidelines as Topic; Time Factors; Young Adult

Persistence with prostaglandin agonist use with and without adjunctive therapy for glaucoma patients: a Canadian population-based analysis. - Iskedjian, Michael; Covert, David W; Walker, John H (The patient, 2011)
BACKGROUND: Glaucoma is one of the leading causes of blindness and visual disability. Few studies have examined persistence and adherence with topical medications in glaucoma patients., OBJECTIVE: The objective of this study was to compare patient persistence with prostaglandin agonist (PA) monotherapy versus with concomitant adjunctive therapy (AT) in Canada., METHODS: Data were obtained from the Quebec prescription claims database. Persistence rates were determined for previously treated naive glaucoma patients at 1 year after their index date for use of any of the three available PAs (bimatoprost, latanoprost, and travoprost). Patients who had at least 334 days on their index PA were defined as being persistent during the analysis timeframe. Patient baseline demographics and persistence rates were reported. A logistic regression was used for comparing the PA and PA + AT groups, which incorporated baseline cofounders, such as age and sex, in the analyses., RESULTS: From an initial cohort of 28 534 patients, 14 893 were identified as naive to glaucoma therapy and had a PA as their index therapy. Of these, 11 197 (75.2%) continued to receive monotherapy and 3696 (24.8%) had an AT added to the PA; 59.0% were females, and the average age was 70.5 +/- 11.3 years. Overall, at the end of the first year of therapy, 57.4% of patients were persistent on their index PA; however, a statistically significant difference was observed between the two subgroups, with 54.6% for those receiving PA monotherapy and 65.8% for those receiving PA + AT (p < 0.01) persistent with therapy. On average, 10.5 prescriptions per year were dispensed to persistent patients., CONCLUSIONS: In this Canadian population, persistence rates fall to approximately 60% at the end of the first year of therapy, with patients taking AT being more persistent. Similar persistence analyses are warranted on other populations, and would yield helpful data for conducting economic evaluations of non-persistence.
Keywords: Aged; Aged, 80 and over; Amides/tu [Therapeutic Use]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Canada; Chemotherapy, Adjuvant/sn [Statistics & Numerical Data]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Databases, Factual; Female; *Glaucoma/dt [Drug Therapy]; Humans; Insurance; Latanoprost; Logistic Models; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Prostaglandin Antagonists/tu [Therapeutic Use]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Quebec; Travoprost

[Non-Descemet stripping endothelial keratoplasty for treating iridocorneal endothelial syndrome in phakic eyes]. - Wu, Hu-Ping; Dong, Nuo; Xie, Su-Zhen; Li, Cheng; Li, Xue-Zhi; Liu, Zhao-Sheng ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2011)
OBJECTIVE: To investigate the feasibility and clinical effects of non-Descemet stripping endothelial keratoplasty (nDSEK) on treating iridocorneal endothelial (ICE) syndrome in phakic eyes., METHODS: Retrospective noncomparative interventional case series. 7 patients (7 eyes) with ICE syndrome at the Affiliated Xiamen Eye Center of Xiamen University from January 2008 to December 2009 underwent non-Descemet stripping endothelial keratoplasty. All patients were followed up for 3 - 12 months, pre- and postoperative best corrected visual acuity (BCVA) were compared, the adherence of the donor disc to the recipient endothelium and postoperative donor disc dislocation were monitored during the follow-up period. Graft clearance and endothelial cell density (ECD) were observed, too., RESULTS: After nDSEK, no primary graft failures dislocation and decentered graft occurred during the follow-up period. Study group intraoperative complications included 3 case with elevated intraocular pressure 2 day postoperatively. Subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases by in vivo laser confocal microscopy. Anterior segment optical coherence tomography and ultrasound biomicroscopy showed the adherence of the donor disc to the recipient endothelium and peripheral anterior synechiae were separated. All corneas remained clear during the follow-up. 6 patients had improved BCVA while 1 patient had the same BCVA. The reason for poor VA was optic atrophy due to glaucoma. Postoperative mean EDC was (2176.6 +/- 267.6) cells/mm(2)., CONCLUSIONS: nDSEK for iridocorneal endothelial (ICE) syndrome is feasible, technically easy, safe and effective. It can be one of the surgical treatment option for bullous keratopathy.
Keywords: Adult; Aged; Case-Control Studies; *Cornea; Corneal Transplantation; Descemet Membrane; *Descemet Stripping Endothelial Keratoplasty/mt [Methods]; Endothelium, Corneal/tr [Transplantation]; Female; Humans; *Iridocorneal Endothelial Syndrome/su [Surgery]; Male; Middle Aged; Retrospective Studies; Tissue Donors

[Benzalkonium chloride daily dose--an important criterion in glaucoma treatment]. - Vyborny, P; Sicakova, S (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2011)
Preservatives in eye drops, especially benzalkonium chloride (BAC), may act as cytotoxic; furthermore, it may cause the instability of the tear film, conjunctivitis, subconjunctival fibrosis, epithelium apoptosis and worsening the prognosis of possible surgical treatment. The patient's subjective symptoms may decrease his compliance. For better orientation in this issue, the authors calculated the daily BAC doses in eye drops used in the glaucoma treatment. Significant differences are caused by different size of the drop in specific medicament, different BAC concentrations in the volume unit of the package, and frequency of application. The daily BAC doses are in micrograms as follows: Beta-blockers: Timo-COMOD 0.0, Arutimol 2.6, Vistagan 2.8, Timolol POS 3.0, Arteoptic 3.7, Carteol 4.0, Betoptic S 4.8, Timoptol MSD 6.3, Betoptic 10.0. Alpha-mimetics: Alphagan and Luxfen 3.5, Aruclonine 7.1. Prostaglandin derivates, prostamides and docosanoides: Taflotan 0.0, Lumigan 1.4, Unilat 3.0, Travatan 3.9, Rescula 5.8, Xalatan 6.0, Latanoprost-ratiopharm, Xaloptic, Latanoprost Actavis, Latanoprost Arrow, Solusan, Glaucotens 6.0. Carbonic anhydrase inhibitors: Azopt 4.8, Trusopt 5.4. Fixed combinations: Ganfort 1.4, Combigan 3.2, Duotrav 4.3, Cosopt 5.6, Xalacom 6.0.
Keywords: *Benzalkonium Compounds/ad [Administration & Dosage]; Benzalkonium Compounds/an [Analysis]; *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/ch [Chemistry]; *Preservatives, Pharmaceutical/ad [Administration & Dosage]; Preservatives, Pharmaceutical/an [Analysis]

Racial and ethnic disparities in adherence to glaucoma follow-up visits in a county hospital population. - Murakami, Yohko; Lee, Bradford W; Duncan, Martin; Kao, Andrew; Huang, Jehn-Yu; Singh, Kuldev; Lin, Shan C (Archives of ophthalmology (Chicago, Ill. : 1960), 2011)
OBJECTIVES: To identify predictors of inconsistent attendance at glaucoma follow-up visits in a county hospital population., METHODS: Prospective recruitment from August 1, 2008, through January 31, 2009, of 152 individuals with glaucoma, with 1-to-1 matching of patients (those with inconsistent follow-up) and controls (those with consistent follow-up). Data were collected via oral questionnaire. Survey results were correlated with attendance at follow-up examinations, using the t test, chi(2) test, and multivariate stepwise logistic regression analysis to calculate the odds ratios (ORs) and 95% confidence intervals., RESULTS: After adjusting for covariates in the logistic regression analysis, factors independently associated with inconsistent follow-up included black race (adjusted OR, 7.16; 95% confidence interval, 1.64-31.24), Latino ethnicity (adjusted OR, 4.77; 1.12-20.29), unfamiliarity with necessary treatment duration (adjusted OR, 3.54; 1.26-9.94), lack of knowledge of the permanency of glaucoma-induced vision loss (adjusted OR, 3.09; 1.18-8.04), and perception that it is not important to attend all follow-up visits (adjusted OR, 3.54; 1.26-9.94)., CONCLUSIONS: Demographic factors, including race and ethnicity, may directly or indirectly affect adherence to recommended glaucoma follow-up visits. Lack of information regarding irreversible vision loss from glaucoma, need for lifelong treatment, and lack of visual symptoms may be significant barriers to follow-up in this population. Targeted glaucoma education by physicians may improve follow-up, thereby decreasing the morbidity associated with glaucomatous disease.
Keywords: Adult; Aged; Aged, 80 and over; Case-Control Studies; *Continental Population Groups/sn [Statistics & Numerical Data]; Continuity of Patient Care; *Ethnic Groups/sn [Statistics & Numerical Data]; Female; *Glaucoma/eh [Ethnology]; *Healthcare Disparities/eh [Ethnology]; Healthcare Disparities/sn [Statistics & Numerical Data]; *Hospitals, County/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; *Office Visits/sn [Statistics & Numerical Data]; *Patient Compliance/sn [Statistics & Numerical Data]; Prospective Studies; San Francisco

[Diabetic neovascularisation and secondary glaucoma]. - Hollo, Gabor (Orvosi hetilap, 2011)
Neovascular glaucoma develops from intraocular neovascularisation in diabetes mellitus. Neovascularisation is a consequence of hypoxia-induced production of vascular endothelial growth factor-A. Neovascular glaucoma is one of the most serious, sight-threatening late complications of diabetes. Several intraocular pressure lowering drugs, surgical and adjunctive laser treatments have been used to treat this disease, but the efficacy of the interventions is limited. The role of vascular endothelial growth factor-A blocking therapy in the treatment of neovascular glaucoma remains to be determined. Development of neovascularisation, however, can be prevented with adequate long-term glycemic and lipid control, effective treatment of arterial hypertension and optimal timing of adequate panretinal photocoagulation, in the majority of the cases. Unfortunately, in clinical practice diabetic neovascular glaucoma is more frequently experienced in Hungary than would be expected based on the variety of available therapeutic possibilities. In order to increase the success of prevention both cooperation of general practitioners, diabetologists, dietitians and ophthalmologists, and compliance of diabetic patients need to be improved.
Keywords: Animals; *Diabetic Retinopathy/co [Complications]; Diabetic Retinopathy/dt [Drug Therapy]; Diabetic Retinopathy/su [Surgery]; *Glaucoma, Neovascular/et [Etiology]; Glaucoma, Neovascular/pp [Physiopathology]; Glaucoma, Neovascular/pc [Prevention & Control]; *Glaucoma, Neovascular/th [Therapy]; Humans; Neovascularization, Pathologic/co [Complications]; Neovascularization, Pathologic/et [Etiology]

Eye care utilization in Canada: disparity in the publicly funded health care system. - Jin, Ya-Ping; Trope, Graham E (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2011)
OBJECTIVES: To examine patterns in, determinants of, and barriers to eye care utilization in Canada., DESIGN: Cross-sectional survey., PARTICIPANTS: All 132,221 respondents to the Canadian Community Health Survey 2005., METHODS: Eye care utilization was self-reported and was defined as having seen or talked on the telephone with an eye care provider (ophthalmologist or optometrist) in a 12-month period. Associations of interest were assessed by prevalence ratios (PR)., RESULTS: Forty percent (11 million) of Canadians aged 12 years or older reported utilization of eye care providers. The lowest utilization rates occurred in people aged 30-39 years and the highest in those aged 70 years and older. Utilization was not related to levels of education or household income in people with self-reported glaucoma, cataracts, or diabetes. Among Canadians without these conditions, significantly less utilization occurred in men, in those with less than a postsecondary education, and in those with annual household incomes under $30,000. Canadians residing in Newfoundland and Labrador utilized eye care providers significantly less than those residing in other provinces (adjusted PR 0.80, 95% CI 0.74-0.86). Fourteen percent of glaucoma patients, 37% of diabetic patients, and 41% of people aged 65 years or older did not access eye care providers over a 12-month period., CONCLUSIONS: Marked disparities occur in eye care utilization among Canadians without known eye diseases. A substantial proportion of people at a high risk of vision loss do not access eye care providers. Attributable factors are likely incomplete government coverage, asymptomatic ocular diseases, and lack of perceived benefits of eye care services.
Comment in (CIN)
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Canada; Child; Cross-Sectional Studies; Female; *Financing, Government; *Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility; Health Services Needs and Demand; Health Surveys; *Healthcare Disparities/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; *National Health Programs/sn [Statistics & Numerical Data]; *Ophthalmology/sn [Statistics & Numerical Data]; *Optometry/sn [Statistics & Numerical Data]; Young Adult

From dorzolamide 2%/timolol 0.5% to brinzolamide 1%/timolol 0.5% fixed combination: a 6-month, multicenter, open-label tolerability switch study. - Rossi, Gemma Caterina Maria; Pasinetti, Gian Maria; Sandolo, Francesco; Bordin, Marco; Bianchi, Paolo Emilio (Expert opinion on pharmacotherapy, 2011)
PURPOSE: To assess ocular surface status and tolerability after switching glaucoma patients from dorzolamide/timolol to brinzolamide/timolol fixed combination (FC)., METHODS: Six-month, multicenter, open-label, prospective study that switched 72 patients from dorzolamide/timolol to brinzolamide/timolol FC. Intraocular pressure (IOP), tear film break-up-time (TF-BUT), fluorescein staining and Glaucoma Symptom Scale (GSS) questionnaire were recorded at baseline and after 6 months., RESULTS: Median interquartile range (IQR) IOP was 16 (IQR 15 - 18) mmHg at baseline and 16 (15 - 17) mmHg and 6 months. TF-BUT significantly improved (p < 0.0001); the regression analysis found a negative association between TF-BUT changes and age at baseline and at month 6 (r = -0.32; p = 0.0082 and r = -0.31; p = 0.0085). Patients with no corneal fluorescein staining statistically increased after substitution (p = 0.04). Quality of life - as examined by the GSS symptoms (SYMP) score - statistically improved (p < 0.0001), revealing an association between GSS SYMP score and age [coefficient -0.67, 95% confidence interval (CI) -1.13 to -0.21, p = 0.0005), superficial keratitis (coefficient -8.26, 95% CI -15.73 to -0.80, p = 0.031) and TF-BUT (coefficient 4.94, 95% CI 1.71 to 8.17, p = 0.003)., CONCLUSION: Brinzolamide/timolol FC is associated with reduced topical discomfort and improved signs of ocular surface disease. The good tolerability and comfort of this FC might contribute to good patient adherence.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Diagnostic Techniques, Ophthalmological; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Quality of Life; *Sulfonamides/ad [Administration & Dosage]; Surveys and Questionnaires; *Thiazines/ad [Administration & Dosage]; *Thiophenes/ad [Administration & Dosage]; *Timolol/ad [Administration & Dosage]

Concise review: toward stem cell-based therapies for retinal neurodegenerative diseases. - Bull, Natalie D; Martin, Keith R (Stem cells (Dayton, Ohio), 2011)
Loss of sight due to irreversible retinal neurodegeneration imposes a significant disease burden on both patients and society. Glaucoma and age-related macular degeneration are the commonest neurodegenerative blinding diseases in the developed world, and both are becoming increasingly prevalent as populations age. Our heavy reliance on our sense of sight means that visual loss often severely restricts day-to-day life, making it difficult to function without additional support. Visual impairment also limits employment possibilities, adding to the economic burden. Current therapies for many degenerative retinopathies are limited in their efficacy, often treating the effects of disease rather than the underlying causes. Consequently, the development of novel adjunctive neuroprotective and neuroregenerative treatments are important goals. Evidence from animal models suggests that stem cells could be useful as part of novel new treatment strategies for eye disease. The accessibility of the eye and extensive repertoire of available surgical techniques may facilitate the translation of stem cell-based therapies, for example, via transplantation, to the retina more rapidly than to other parts of the central nervous system. This concise review will examine how cell therapies are being applied experimentally for neuroregenerative and neuroprotective treatment of currently incurable degenerative retinal diseases. Furthermore, recent progress toward clinical translation of such therapies will be highlighted. Copyright © 2011 AlphaMed Press.
Keywords: Animals; Humans; Neural Stem Cells/tr [Transplantation]; *Neurodegenerative Diseases/th [Therapy]; *Retinal Diseases/th [Therapy]; *Stem Cell Transplantation

[Improve adherence in glaucoma patients: a doctor's duty]. - Nordmann, J-P; Akesbi, J (Journal francais d'ophtalmologie, 2011)
Adherence to treatment through observance and persistence is mandatory to treat any glaucoma patient. Identifying the factors related to nonadherence is therefore crucial. Factors responsible for poor adherence could be related to the patients (doubt, forgetfulness, denial), environmental factors (cost, competing activities, travel, etc.), the treatment regimen (refill, side effects, complexity), and finally the relation with the physician. Physicians should presume that patients have low adherence to their treatment and give clear and precise information about the expected benefits of the treatment, the disease, and its risks of progression. Combined fixed treatments and preservative-free topical treatments should improve adherence and quality of life by simplifying instillation and tolerance of eye drops. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Keywords: Attitude to Health; Cost of Illness; Disease Progression; Glaucoma/ec [Economics]; *Glaucoma/th [Therapy]; Humans; Life Style; Medication Adherence; Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance; Patient Education as Topic; *Physician-Patient Relations; Quality of Life; Risk Assessment

Laser trabeculoplasty in the treatment of open-angle glaucoma. - Francis, Brian A; Winarko, Jonathan (International ophthalmology clinics, 2011)
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Circadian Rhythm; Glaucoma/cl [Classification]; Glaucoma/su [Surgery]; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; Laser Therapy/ae [Adverse Effects]; *Laser Therapy/mt [Methods]; *Laser Therapy/td [Trends]; Models, Biological; Patient Compliance; Postoperative Care; Retreatment; Risk Assessment; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy/mt [Methods]; *Trabeculectomy/td [Trends]; Treatment Outcome

[Characteristics of corneal endothelium during allograft rejection after corneal transplantation]. - Song, Jing; Huang, Yi-fei ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2011)
Allograft corneal transplantation is currently the most effective and optimum method to treat corneal disease, however it is the immune rejection that the main reason for graft edema caused by vascularization and inflammation of the cornea and surgical failure after transplantation. Corneal endothelial cells occupy a crucial position as immune privilege and the primary barriers for maintaining normal physiological function of eye. In this paper, the various stages (recognition, response and reaction of immune system) of corneal endothelial changes in the morphological and biological characteristics had been presented after allograft corneal transplantation.
Keywords: *Corneal Transplantation; *Endothelium, Corneal; *Graft Rejection; Humans; Transplantation, Homologous

Association between intraocular pressure and adherence: is there one?. - Cate, H; Broadway, D C (Eye (London, England), 2011)
Comment on (CON)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]

Frequency of fundus pathology related to patients' dissatisfaction after phacoemulsification cataract surgery. - Chatziralli, I P; Kanonidou, E; Papazisis, L (Bulletin de la Societe belge d'ophtalmologie, 2011)
PURPOSE: The benefit of cataract surgery in the general population concerning visual acuity and subjective visual function has been well established. However, a small proportion of patients are dissatisfied after cataract surgery. Our study aims to evaluate patients' dissatisfaction after phacoemulsification cataract surgery related to low visual function and to analyze the factors associated with this outcome., METHODS: 397 patients, who underwent uneventful phacoemulsification cataract surgery, participated in the study. All the participants completed a self-administered questionnaire which evaluated their visual function pre- and post-operatively. Best Corrected Visual Acuity (BCVA) was measured before and after cataract surgery and patients' contentment if they were satisfied or not with the result of the surgery was also recorded., RESULTS: Macular disease, diabetic retinopathy and glaucoma were the main factors limiting the final visual result after phacoemulsification cataract surgery., CONCLUSIONS: It is very important for the patients to be preoperatively fully aware of the presentation of the aforementioned fundus pathology and to be warned about the predicted visual outcome after cataract surgery.
Keywords: Aged; Aged, 80 and over; Cataract/ep [Epidemiology]; Comorbidity; Diabetic Retinopathy/ep [Epidemiology]; Female; Glaucoma/ep [Epidemiology]; Humans; Macular Degeneration/ep [Epidemiology]; Male; *Patient Satisfaction/sn [Statistics & Numerical Data]; Phacoemulsification/ae [Adverse Effects]; *Phacoemulsification/sn [Statistics & Numerical Data]; Population Surveillance; Surveys and Questionnaires; Treatment Outcome; Truth Disclosure; Visual Acuity

Medical treatment of glaucoma: present and future. - Fogagnolo, Paolo; Rossetti, Luca (Expert opinion on investigational drugs, 2011)
INTRODUCTION: In the last decades, the therapy of glaucoma has largely shifted from surgery to medical treatment thanks to the introduction of strongly effective formulations, that is, prostaglandin analogs and fixed combinations. This clinical scenario may dramatically change in the future thanks to the progresses in biochemistry, genetics and drug delivery technology., AREAS COVERED: This review covers the strategies currently used to achieve effective medical reduction of intraocular pressure in clinical practice; treatments that are currently been experimented in humans and that may be clinically available in the next few years; treatments at preclinical stages; and future goals of glaucoma treatment (gene therapy, ocular implants and neuroprotection)., EXPERT OPINION: Apart from an adequate reduction of intraocular pressure, effective glaucoma treatments should guarantee other characteristics: good tolerability, low problems of adherence and, possibly, multiple ways of action. From this viewpoint, a crucial clinical role may be played by drugs remodeling the trabecular meshwork (i.e., ROCK inhibitors, metalloproteinases). Other strategies such as the use of ocular implants for drug delivery, neuroprotection or gene therapy could renew glaucoma management in the future, but need long-term rigorous verification of safety and efficacy.
Keywords: Animals; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/me [Metabolism]; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Neuroprotective Agents/ad [Administration & Dosage]; Neuroprotective Agents/me [Metabolism]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/me [Metabolism]; Predictive Value of Tests; Prostaglandins/ad [Administration & Dosage]; Prostaglandins/me [Metabolism]; Treatment Outcome

[Managing treatment side effects: the respective roles of the active ingredient and the preservative]. - Aptel, F; Denis, P; Baudouin, C (Journal francais d'ophtalmologie, 2011)
The side effects of glaucoma hypotensive treatments usually remain moderate and limited to local side effects - conjunctival hyperemia, itching, discomfort after instillation - but are very often a leading source of poor compliance to treatment and thereby may decrease its efficacy. Moreover, these symptoms usually reflect progressive and irreversible major ocular surface changes. These ocular surface changes induced by glaucoma eyedrops may include subconjunctival fibrosis, increasing the risk of failure of a further glaucoma surgery. All the components of the hypotensive eye drops, including the active ingredient, the preservatives, and the excipients, may be involved in the occurrence of these side effects. It is therefore important to identify the agents involved and the mechanisms of these side effects, in order to choose a treatment minimizing their risk and the discomfort felt by patients, and therefore increasing the likelihood of good compliance. When available, preservative-free solutions should be considered. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Keywords: Benzalkonium Compounds/ae [Adverse Effects]; Conjunctival Diseases/ci [Chemically Induced]; Dry Eye Syndromes/ci [Chemically Induced]; Excipients/ae [Adverse Effects]; Fibrosis; *Glaucoma/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; Medication Adherence; *Ophthalmic Solutions/ae [Adverse Effects]; *Preservatives, Pharmaceutical/ae [Adverse Effects]; Prostaglandins/ae [Adverse Effects]; Pruritus/ci [Chemically Induced]

Novel drug delivery systems for glaucoma. - Lavik, E; Kuehn, M H; Kwon, Y H (Eye (London, England), 2011)
Reduction of intraocular pressure (IOP) by pharmaceutical or surgical means has long been the standard treatment for glaucoma. A number of excellent drugs are available that are effective in reducing IOP. These drugs are typically applied as eye drops. However, patient adherence can be poor, thus reducing the clinical efficacy of the drugs. Several novel delivery systems designed to address the issue of adherence and to ensure consistent reduction of IOP are currently under development. These delivery systems include contact lenses-releasing glaucoma medications, injectables such as biodegradable micro- and nanoparticles, and surgically implanted systems. These new technologies are aimed at increasing clinical efficacy by offering multiple delivery options and are capable of managing IOP for several months. There is also a desire to have complementary neuroprotective approaches for those who continue to show progression, despite IOP reduction. Many potential neuroprotective agents are not suitable for traditional oral or drop formulations. Their potential is dependent on developing suitable delivery systems that can provide the drugs in a sustained, local manner to the retina and optic nerve. Drug delivery systems have the potential to improve patient adherence, reduce side effects, increase efficacy, and ultimately, preserve sight for glaucoma patients. In this review, we discuss benefits and limitations of the current systems of delivery and application, as well as those on the horizon.
Keywords: *Drug Delivery Systems/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Medication Adherence; Neuroprotective Agents/ad [Administration & Dosage]; *Ophthalmic Solutions/ad [Administration & Dosage]

Glaucoma. - Quigley, Harry A (Lancet (London, England), 2011)
Most medical practitioners have regular contact with adults who have one of the two forms of glaucoma: open-angle glaucoma or angle-closure glaucoma. Data from population-based surveys indicate that one in 40 adults older than 40 years has glaucoma with loss of visual function, which equates to 60 million people worldwide being affected and 8.4 million being bilaterally blind. Even in developed countries, half of glaucoma cases are undiagnosed. Glaucoma is mostly asymptomatic until late in the disease when visual problems arise. Vision loss from glaucoma cannot be recovered, and improved case-detection methods for glaucoma are needed. Glaucoma is commonly treated with daily eye-drop drugs, but adherence to treatment is often unsatisfactory. As a usually asymptomatic and chronic disease, glaucoma has similar treatment challenges to chronic systemic diseases. Similarities to the pathogenesis of common CNS diseases mean that common neuroprotective strategies might exist. Successful gene therapy, which has been used for other eye diseases might be possible for the treatment of glaucoma in the future. Copyright © 2011 Elsevier Ltd. All rights reserved.
Keywords: Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Glaucoma/th [Therapy]; *Glaucoma; Humans; Intraocular Pressure; Risk Factors

Glaucoma public service announcements: factors associated with follow-up of participants with risk factors for glaucoma. - Hoffelt, Zakary; Fallon, Shawn; Wong, Brad A; Lucas, Betty; Coleman, Anne L; Mills, Richard P; Wilson, Richard; Mansberger, Steven L (Ophthalmology, 2011)
PURPOSE: To determine the prevalence of follow-up and factors associated with completing an eye examination after a glaucoma public service announcement., DESIGN: Cross-sectional observational study., PARTICIPANTS: Individuals who participated in the Glaucoma EyeCare Program by calling a toll-free telephone number and receiving referral by meeting inclusion criteria., METHODS: The Glaucoma EyeCare Program uses public service announcements to encourage those at increased risk for glaucoma to obtain an eye examination. The program requires interested persons to dial a toll-free telephone number to collect demographic, medical, and socioeconomic information, and refers those at higher risk of glaucoma to an ophthalmologist for a free eye examination. The ophthalmologist completes an outcome form, which indicates whether the participant obtained an eye examination and the results of this eye examination. We determined the factors associated with obtaining an eye examination., MAIN OUTCOME MEASURES: Sociodemographic characteristics associated with obtaining an eye examination after referral through the Glaucoma EyeCare Program., RESULTS: Ophthalmologists returned outcome forms for 1514 of 6343 participants (24%). Of those with outcome forms, 671 (44.3%) had an eye examination, 756 (49.9%) did not make an appointment, and 87 (5.7%) made an appointment but did not complete the examination. A multivariate logistic regression model showed younger age, female gender, lack of health insurance, medical history of diabetes, and shorter distance to be associated with obtaining an eye examination., CONCLUSIONS: Public service announcements encourage participants to have an eye examination. Multiple factors alter the success of obtaining an eye examination. Future studies are needed regarding the best method of decreasing the risk of undiagnosed glaucoma. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Age Factors; Aged; Cross-Sectional Studies; Diabetes Mellitus; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; *Glaucoma/et [Etiology]; *Health Education/mt [Methods]; Health Services Accessibility; Hotlines; Humans; Internet; Logistic Models; Male; Medical Records; Medically Uninsured; Middle Aged; *Persuasive Communication; *Public Health Practice; Referral and Consultation; Risk Factors; Sex Factors; Visual Field Tests/sn [Statistics & Numerical Data]; *Visual Field Tests

Effects of common topical antiglaucoma medications on the ocular surface, eyelids and periorbital tissue. - Servat, J Javier; Bernardino, C Robert (Drugs & aging, 2011)
Glaucoma affects millions of people around the world. With the baby boom generation aging, the number of people affected by primary open-angle glaucoma in the US is expected to reach 3.3 million by 2020, and about half may not know they have the disease. The treatment of most forms of glaucoma includes the use of topical agents that enhance aqueous humour outflow, reduce aqueous production, or both. Topical intraocular pressure-lowering drugs must penetrate across the tissues of the eye to reach their therapeutic targets. Often, these tissues show the first signs and symptoms of drug toxicity and adverse effects. These include eyelid dermatitis, malpositions, lacrimal system scarring, ocular discomfort upon instillation, tear film instability, conjunctival inflammation, subconjunctival fibrosis, conjunctival epithelium changes, and corneal surface and endothelial impairment. For these reasons, ophthalmologists should evaluate the risks and benefits of ophthalmic medications before initiating therapy, identify the minimum dosages necessary to achieve a therapeutic benefit, and monitor patients for local and systemic adverse effects. Adverse events may be reduced by changing to a different class of topical medication, using corticosteroids, lubricating the eyes frequently, and reducing exposure to preservatives. This in turn can lead to higher levels of adherence to antiglaucoma therapy, improved outcomes and a reduction in the costs associated with long-term glaucoma complications. This article reviews the ocular adverse effects associated with the various classes of topical antiglaucoma drugs, with a particular focus on the ocular surface, eyelids and periorbital tissue.
Keywords: Administration, Topical; Adrenergic alpha-Agonists/pd [Pharmacology]; Adrenergic beta-Agonists/pd [Pharmacology]; Carbonic Anhydrase Inhibitors/pd [Pharmacology]; Cholinergic Agents/pd [Pharmacology]; Conjunctiva/de [Drug Effects]; Cornea/de [Drug Effects]; *Eye/de [Drug Effects]; Eye Diseases/ci [Chemically Induced]; Eye Diseases/pa [Pathology]; *Eyelids/de [Drug Effects]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Patient Compliance; Prostaglandins/pd [Pharmacology]; Treatment Outcome

[Progress of anti-glaucoma fixed combination formulation]. - Yang, Yang-Fan; Yu, Min-Bin ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2011)
Glaucoma is a common cause of visual impairment and irreversible blindness. Medication is important in the management of glaucoma, especially in primary open-angle glaucoma. Combination drug therapy is needed because single drug therapy can not always control the intraocular pressure effectively to a safe level in glaucoma patients with higher baseline intraocular pressure. Traditional unfixed combination therapy of glaucoma may disturb daily life because the frequency of admitting eye-drops is increased, it is less persistence or compliance, and results in the increase of local concentration of preservatives in the eye. The new fixed combination formulations for glaucoma have been developed to be safer, more effect and more compliable. This article reviews the comparative studies of therapeutic effects of anti-glaucoma fixed combination formulation and summarizes features of each formulation, and then prospects the new developing tendency of anti-glaucoma medication.
Keywords: Drug Combinations; *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/tu [Therapeutic Use]

[Challenge and treatment strategy for ocular surface damage in patients with long term use of antiglaucoma drugs]. - He, Xiang-Ge ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2011)
Long term use of topical anti-glaucoma drugs has been shown to induce chronic conjunctivitis, superficial punctate keratitis (SPK) and dry eye symptom. Under these conditions, a loss of goblet cells in conjunctiva, epithelial squamous metaplasia and apoptosis were morphologically revealed. Benzalkonium Chloride (BKC), a most frequently used preservative in eye drops, has been found to be an important factor causing ocular surface damage. Furthermore, a big challenge for ophthalmologists is that toxic damage of medication to ocular surface tissues is mild, poor specificity, and delayed manifestation in patients, especially when coexisting with other ocular surface diseases. Impairment of ocular surface tissues greatly impacts the life quality of patients and subsequently influences compliance with glaucoma therapy. This paper emphasizes to take measures to prevent ocular surface tissue damage resulted from chronic use of topical anti-glaucoma drugs and further discusses the treatment strategy. Effective and long-lasting action drugs should always be selected for glaucomatous patients in order to decrease the frequency of topical instillation or at a more expensive medication, a fixed combination formula can be considered for glaucoma therapy. An early surgery or laser treatment is also proposed for the patients who require an IOP reduction with an existing ocular surface impairment. Future investigation and development of new medications with long-term efficacy and appropriate BKC are suggested and preservative-free or drugs with new preservative materials recommended.
Keywords: *Benzalkonium Compounds/ae [Adverse Effects]; Benzalkonium Compounds/tu [Therapeutic Use]; *Conjunctivitis/ci [Chemically Induced]; Dry Eye Syndromes/ci [Chemically Induced]; *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ae [Adverse Effects]

Patient-reported outcomes (PRO's) in glaucoma: a systematic review. - Vandenbroeck, S; De Geest, S; Zeyen, T; Stalmans, I; Dobbels, F (Eye (London, England), 2011)
The aim of this review was to summarize literature in view of patient-reported outcome (PRO) instruments for glaucoma and provide guidance on how outcomes are best assessed based on evidence about their content and validity. A systematic literature review was performed on papers describing the developmental process and/or psychometric properties of glaucoma or vision-specific PRO-instruments. Each of them was assessed on their adherence to a framework of quality criteria. Fifty-three articles were identified addressing 27 PRO-instruments. In all, 18 PRO's were developed for glaucoma and 9 for diverse ophthalmologic conditions. Seven instruments addressed functional status, 11 instruments quality of life and 9 instruments disease and treatment-related factors. Most of the instruments demonstrated only partially adherence to predefined quality standards. The tools for assessing functional status were of poor quality, while the Glaucoma Quality of Life Questionnaire and the Vision Quality of Life Index were well-developed QoL measures, yet only validated using classical techniques. The Rasch-scaled QoL-tools, IVI and VCM1 need to improve their item-content for glaucoma patients. The questionnaires to measure adherence should improve their validity and the Treatment Satisfaction Survey for Intra Ocular Pressure pops out as the highest quality tool for measuring topical treatment side effects. This review revealed that most PRO-instruments demonstrated poor developmental quality, more specifically a lack of conceptual framework and item generation strategies not involving the patients' perspective. Psychometric characteristics were mostly tested using classical validation techniques.
Keywords: Activities of Daily Living; *Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Medication Adherence; Patient Satisfaction; Psychometrics; Quality of Life; Reproducibility of Results; *Surveys and Questionnaires

[Specific problems linked to glaucoma in elderly patients]. - Parc, Christine (Soins. Gerontologie, 2011)
Chronic glaucoma is one of the main causes of blindness in France. The incidence of the disease increases with age and forms an ever greater public health problem as the population ages. It is therefore important to be aware of the disabilities related to glaucoma in order to optimise the treatment of elderly patients suffering from the disease.
Keywords: Age Distribution; Aged; Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Chronic Disease; Disease Progression; France/ep [Epidemiology]; Geriatric Nursing/mt [Methods]; Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; *Glaucoma/th [Therapy]; Humans; Incidence; Mass Screening; Medication Adherence; Visually Impaired Persons/rh [Rehabilitation]

Antimicrobial efficacy of multi-purpose contact lens disinfectant solutions following evaporation. - Kilvington, Simon; Powell, Charles H; Lam, Anthony; Lonnen, James (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2011)
PURPOSE: Non-compliance is a significant factor in contact lens related microbial keratitis and includes solution reuse and failure to recap the lens storage case resulting in evaporation effects. To address this, impact of partial evaporation on the antimicrobial efficacy of multipurpose contact lens care solutions was investigated., METHODS: Solutions were evaporated under a stream of air to 2x and 4x concentration and challenged with Fusarium solani (ATCC 36031), Candida albicans (ATCC 10231) and Acanthamoeba castellanii (ATCC 50370). The level of organism kill at 6h was compared to the non-evaporated product., RESULTS: ReNu with MoistureLoc( R) (RML) lost 90-100% of biocidal activity against C. albicans on evaporation, 75-99% for F. solani and 29-33% with A. castellanii at 2x or 4x concentration, respectively. OPTI-FREE( R) RepleniSH( R) lost 72-90% efficacy against C. albicans and F. solani, and 61% at 2x and 10% at 4x concentration with A. castellanii. ReNu( R) MultiPlus, AQuify( R) Multi-Purpose and Biotrue TM showed only loss in efficacy with C. albicans at 4x concentration giving 79%, 34.5% and 48% reduction, respectively. No loss in biocidal activity on evaporation was obtained with Complete( R) Revitalens for all organisms., CONCLUSION: Partial evaporation can affect biocidal efficacy of multi-purpose solutions and may have been a significant factor in an outbreak of Fusarium keratitis cases associated with RML. Evaporation results in increased binding of cationic disinfectants to counter-ions in the formulation, reducing ability to attach and rupture anionic microbial cell walls. Interaction may also occur between the biocidal ingredient and other components, such as surfactants, resulting in sequestration of activity through micelle formation. Copyright © 2011 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Keywords: *Anti-Bacterial Agents/ch [Chemistry]; *Anti-Bacterial Agents/pd [Pharmacology]; *Bacterial Physiological Phenomena/de [Drug Effects]; Cell Survival/de [Drug Effects]; *Contact Lens Solutions/ch [Chemistry]; *Contact Lens Solutions/pd [Pharmacology]; *Desiccation

Signs and symptoms of ocular surface status in glaucoma patients switched from timolol 0.5% to brinzolamide 1%/timolol 0.5% fixed combination: a 6-month efficacy and tolerability, multicenter, open-label prospective study. - Rossi, Gemma Caterina Maria; Tinelli, Carmine; Pasinetti, Gian Maria; Fusetti, Marina; Pallavicini, Claudio; Stringa, Massimo; Vacchi, Sauro; Stringa, Francesco; Bianchi, Paolo Emilio (Expert opinion on pharmacotherapy, 2011)
PURPOSE: To examine the impact of switching glaucoma patients from timolol 0.5% to brinzolamide 1%/timolol 0.5% fixed combination (Brinz/Tim FC) on quality of life and on ocular surface status; to assess efficacy after the switch., METHODS: 6-month, multicenter, open-label, prospective, switch study in 119 early to moderate glaucoma patients. Intraocular pressure (IOP), tear film break-up time (TF-BUT), fluorescein staining and Glaucoma Symptom Scale (GSS) questionnaire were recorded at baseline and after 6 months., RESULTS: Median (interquartile range) IOP significantly decreased from 20 to 16 mmHg, independent of sex and age. Most patients (95.8%) reached an IOP < 18 mmHg. TF-BUT improved, with a negative weak correlation to age at baseline and at 6 months. The percentage of patients with no fluorescein staining improved. The quality of life recorded by GSS also improved, being related both to age and corneal staining., CONCLUSION: Brinz/Tim FC is effective and well tolerated. In this study, patients switched to Brinz/Tim FC obtained further reduction in IOP with no effects on ocular surface status and improved quality of life perception: a better quality of life could determine a better adherence to prescribed therapy.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; *Epithelium, Corneal/pa [Pathology]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Prospective Studies; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiazines/ad [Administration & Dosage]; Thiazines/ae [Adverse Effects]; *Thiazines/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Emerging drugs for ocular hypertension. - Lee, Anne J; Goldberg, Ivan (Expert opinion on emerging drugs, 2011)
INTRODUCTION: Glaucoma is a prevalent ocular disease with characteristic optic disc and visual field changes. Globally, it is the second most common cause of visual disability, and the most common cause of irreversible and preventable blindness. Ocular hypertension (OH) occurs where intraocular pressure elevation occurs in the absence of glaucomatous disc and visual field changes. OH is a strong risk factor for glaucoma. Ocular hypotensive medications are the mainstay of glaucoma and OH treatment, and their use modifies the course of the disease by preventing onset and progression of damage., AREAS COVERED: Prostaglandin analogs, beta-blockers, alpha-agonists, carbonic anhydrase inhibitors and parasympathomimetics are available in our glaucoma armamentarium and are reviewed. Novel agents have evolved as our understanding of the complex mechanisms involved in aqueous humor production and obstacles to aqueous outflow increases. Potential future candidates appear to act on enhancing trabecular meshwork outflow: the Rho-kinase inhibitors, ion-channel modulators and chelating agents. Further work is needed on other promising agents: serotonergics, melatonins, cannabinoids, adenosine agonists, components of the actomyosin system, nucleotide analogs and gene silencing. Methods to improve side effect profiles or efficacy of currently available therapies are also being developed. As glaucoma treatment adherence is poor, novel drug delivery methods might address this challenge., EXPERT OPINION: Although there are good intraocular pressure-lowering medications available, novel mechanisms and drug delivery modes may provide more effective glaucoma control in future.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Clinical Trials as Topic; Drug Combinations; *Drug Discovery/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Glaucoma/en [Enzymology]; Glaucoma/me [Metabolism]; Humans; *Intraocular Pressure/de [Drug Effects]; Treatment Outcome

Role of fixed combinations in the management of open-angle glaucoma. - Hommer, Anton (Expert review of pharmacoeconomics & outcomes research, 2011)
The first-line option for lowering intraocular pressure (IOP) is a single hypotensive agent, but patients frequently require additional IOP-lowering agents to reach their target pressures. Disadvantages of this multi-therapy approach include washout effect, inconvenience and poor adherence. Fixed combinations (FCs) combine two or more hypotensive agents in a single bottle, providing a convenient once-daily therapy, which tends to improve adherence. FCs generally offer equivalent efficacy to concomitant use of the individual components, with equivalent or superior tolerability. Studies also show that FCs can be more cost effective than nonfixed combinations. In terms of optimizing IOP control, minimizing visual field deterioration, preventing visual disability and minimizing associated healthcare costs, FCs are an important component of glaucoma management.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/ec [Economics]; Cost-Benefit Analysis; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Health Care Costs; Humans; *Intraocular Pressure/de [Drug Effects]; Medication Adherence

Silicone punctal plugs as an adjunctive therapy for open-angle glaucoma and ocular hypertension. - Opitz, Dominick L; Tung, Sherman; Jang, Unsun Sarah; Park, Jenny J (Clinical & experimental optometry, 2011)
BACKGROUND: Primary open-angle glaucoma is a progressive optic neuropathy that can cause an irreversible loss of vision. A reduction in intraocular pressure (IOP) is beneficial in slowing or halting its progression. Once-per-day monotherapy glaucoma medications, such as prostaglandin analogues, are effective in lowering IOP while maintaining patients' adherence. Achieving the desired target IOP often requires multiple medications. The present study evaluates punctal occlusion of both the inferior and superior puncta as an adjunctive therapy to travoprost ophthalmic solution 0.004% for patients with primary open-angle glaucoma or ocular hypertension in order to reduce IOP., METHODS: Thirteen patients who were using travoprost 0.004% ophthalmic solution for the treatment of open-angle glaucoma or ocular hypertension received silicone punctal plugs in the superior and inferior puncta of one eye. After one month, the IOP was remeasured. The percentage change of the IOP from the baseline was analysed by using a paired sample t-test., RESULTS: The mean baseline IOP was 19.82 +/- 1.19 mmHg in the test eyes and 18.32 +/- 1.11 mmHg in the control eyes. The mean IOP at the one-month visit was 18.23 +/- 1.17 mmHg in the test eyes and 18.45 +/- 1.04 mmHg in the control eyes. The test eyes demonstrated a decrease in IOP of 1.59 (+/- 0.95) mmHg from the baseline, or a 6.82 per cent decrease in the IOP from the baseline. The control eyes had an increase in IOP of 0.14 +/- 0.77 mmHg from the baseline, or a 1.91 per cent increase in the IOP. The relative difference in the IOP between the test eyes and the control eyes at the one-month visit was 1.73 mmHg, or 8.74 per cent., CONCLUSION: Based on the results of this study, punctal occlusion offers a statistically and clinically significant decrease in IOP when it is used as an adjunctive therapy to travoprost 0.004% for patients who are suffering from open-angle glaucoma or ocular hypertension. Copyright © 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.
Keywords: Adult; Antihypertensive Agents/tu [Therapeutic Use]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Combined Modality Therapy/mt [Methods]; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Ocular Hypertension/dt [Drug Therapy]; *Ocular Hypertension/su [Surgery]; *Prostheses and Implants; Prosthesis Implantation; *Silicones/tu [Therapeutic Use]; Travoprost

Glaucoma medication adherence: room for improvement in both performance and measurement. - Muir, Kelly W; Lee, Paul P (Archives of ophthalmology (Chicago, Ill. : 1960), 2011)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]

[Therapeutic compliance in primary open angle glaucoma]. - Taktak, Jalel; Ajmi Nabli, Thouraya; Ben Othmen, Hafedh; Mtiraoui, Ali; Ben Hadj Hamida, Fafani (La Tunisie medicale, 2011)
BACKGROUND: Compliance with medical treatment is a public health problem. It denotes the patient's perception of the disease and the treatment prescribed by doctors. It concerns one out of two patients. It may happen to any patient at one or another. It is secondary for reasons that are numerous and modifiable in time. It results from problems related to the patient as much as to the doctor. It represents an obstacle to paying for chronic diseases such as chronic open-angle glaucoma, hence the importance given to it in the recent years., AIM: To evaluate the compliance of adult patients suffering from early open-angle glaucoma and to determine the influential factors., METHODS: We conducted a survey at the ophthalmology department of Ibn El Jazzar Hospital among 132 adults being treated for early open-angle glaucoma. The evaluation was done on the basis of patient's medical files and a questionnaire from January 2007 to June of the same year. It ranges between good, average or bad depending on the frequency of the patient's visits to doctors, regularity of treatment and compliance with the doctor's prescription., RESULTS: 40.15% of the patients have positively complied with the prescriptions. This improvement has mainly been due to the following factors: The patient's good knowledge of the disease and its treatment; use of antiseptic eye lotion with the utmost effectiveness for the least instillation and side effects; patient's mastery of drop usage; doctor's intensive care required for some particular cases., CONCLUSION: Our results need to be confirmed by other studies. It's very important to consider all the determining factors in order to improve patient's compliance.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Middle Aged

Comparison of the in vitro tolerance and in vivo efficacy of traditional timolol maleate eye drops versus new formulations with bioadhesive polymers. - Andres-Guerrero, Vanessa; Vicario-de-la-Torre, Marta; Molina-Martinez, Irene T; Benitez-del-Castillo, Jose Manuel; Garcia-Feijoo, Julian; Herrero-Vanrell, Rocio (Investigative ophthalmology & visual science, 2011)
PURPOSE: To assess the in vitro tolerance and in vivo efficacy of new unpreserved formulations of timolol maleate (TM) in aqueous solutions of bioadhesive polymers used for dry eye treatment and to compare them with three traditional TM formulations: unpreserved Timabak (Thea, Madrid, Spain), benzalkonium chloride (BAK)-preserved Timoftol (Frosst Laboratories, Madrid, Spain), and BAK-preserved Timolol Sandoz (Frosst Laboratories)., METHODS: New formulations were composed of TM (0.5%) and carboxymethyl cellulose (0.5%), hyaluronic acid (0.2%), or hydroxypropylmethyl cellulose (0.3% or 0.5%). In vitro tolerance was determined in human corneal-limbal epithelial cells and normal human conjunctival cells. The ocular hypotensive effect was evaluated measuring IOP in rabbit eyes for 8 hours., RESULTS: In all cases, cell survival after exposure to the formulations was greater in the new unpreserved TM formulations than in the traditional TM solutions (BAK-preserved and unpreserved). In addition, the new formulations were demonstrated to maintain the hypotensive effect of TM in different magnitudes. The maximum hypotensive effect was reached by TM 0.5% in carboxymethyl cellulose 0.5% (32.37%)., CONCLUSIONS: The results demonstrated that new unpreserved formulations of TM with bioadhesive polymers decreased IOP in rabbits and reached values closer to those reached by traditional solutions. Furthermore, new formulations presented a significantly higher in vitro tolerance than the same compound in traditional formulations. Although unpreserved formulations are usually more expensive, preservative-free antiglaucoma eye drops should improve compliance and adherence in the medical treatment of glaucoma. Bioadhesive polymers could be part of antiglaucoma formulations to reduce ocular toxicity, improve drug efficacy, and protect the ocular surface in long-term therapies.
Keywords: Animals; Carboxymethylcellulose Sodium/pd [Pharmacology]; Cell Survival; Cells, Cultured; Chemistry, Pharmaceutical; *Conjunctiva/de [Drug Effects]; Conjunctiva/pa [Pathology]; *Epithelium, Corneal/de [Drug Effects]; Epithelium, Corneal/pa [Pathology]; Humans; Hyaluronic Acid/pd [Pharmacology]; Hydrogen-Ion Concentration; Hypromellose Derivatives; *Intraocular Pressure/de [Drug Effects]; Male; Methylcellulose/aa [Analogs & Derivatives]; Methylcellulose/pd [Pharmacology]; Ophthalmic Solutions/ch [Chemistry]; *Ophthalmic Solutions/pd [Pharmacology]; Osmolar Concentration; Pharmaceutical Preparations; Preservatives, Pharmaceutical/pd [Pharmacology]; Rabbits; Rheology; Timolol/ch [Chemistry]; *Timolol/pd [Pharmacology]; Tonometry, Ocular

[Handiness and acceptability of the new Abak bottle in chronically treated patients. A cross-sectional, retrospective and multicentre study]. - Gabisson, P; Briat, B; Le Foll, J; Conan, S; Bale-Le Bescond, F; Talmud, M; Chibret, H (Annales pharmaceutiques francaises, 2011)
BACKGROUND: Difficulty of use of eyedrops is a factor associated with poor patient compliance that reduces treatment efficacy. The aim of this study was to evaluate the handiness and global acceptability of the new Abak timolol bottle (multidose preservative-free eyedrops) in comparison with that of other administration systems (classical multidose eyedrops or single-doses) in patients treated for glaucoma or ocular hypertension., METHODS: Cross-sectional, retrospective and multicentre study involving 41 ophthalmologists in France. Selected patients were those who had been treated with the new Abak bottle since at least two months, as a replacement for other beta-blocker eyedrops. Handiness and acceptability of the new Abak bottle in comparison with other delivery systems were evaluated using a questionnaire filled by the investigator., RESULTS: Almost all the patients were unanimous regarding the handiness of the new Abak bottle: easy to open for 96.5% of them, easy to handle for 96.0%, and easy to get drops for 91.1%. For all these criteria and in a general manner, patients preferred the new Abak bottle in comparison with the previous eyedrop container. These results were confirmed in the oldest patients., CONCLUSION: The new Abak bottle had a greater acceptability compared to preserved multidose eyedrops or to single-doses. Its handiness and the absence of preservative which may improve local tolerance are in favor of a greater compliance in chronically treated patients. Copyright © 2010 Elsevier Masson SAS. All rights reserved.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; *Drug Packaging; Female; France; Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ch [Chemistry]; Patient Acceptance of Health Care; Patient Compliance; Retrospective Studies; Young Adult

Rapid, cell-based toxicity screen of potentially therapeutic post-transcriptional gene silencing agents. - Kolniak, Tiffany A; Sullivan, Jack M (Experimental eye research, 2011)
Post-transcriptional gene silencing (PTGS) agents such as antisense, ribozymes and RNA interference (RNAi) have great potential as therapeutics for a variety of eye diseases including retinal and macular degenerations, glaucoma, corneal degenerations, inflammatory and viral conditions. Despite their great potential and over thirty years of academic and corporate research only a single PTGS agent is currently approved for human therapy for a single disease. Substantial challenges exist to achieving both efficacious and safe PTGS agents. Efficacy, as measured in specific target mRNA and protein knockdown, depends upon a number of complex factors including the identification of rare regions of target mRNA accessibility, cellular co-localization of the PTGS agent in sufficient concentration with the target mRNA, and stability of the PTGS agent in the target cells in which it is delivered or expressed. Safety is commonly measured by lack of cytotoxicity or other deleterious cellular responses in cells in which the PTGS agent is delivered or expressed. To relieve major bottlenecks in RNA drug discovery novel, efficient, inexpensive, and rapid tools are needed to facilitate lead identification of the most efficacious PTGS agent, rational optimization of efficacy of the lead agent, and lead agent safety determinations. We have developed a technological platform using cell culture expression systems that permits lead identification and efficacy optimization of PTGS agents against arbitrary disease target mRNAs under relatively high throughput conditions. Here, we extend the technology platform to include PTGS safety determinations in cultured human cells that are expected to represent the common cellular housekeeping microenvironment. We developed a high throughput screening (HTS) cytotoxicity assay in 96-well plate format based around the SYTOX Green dye which is excluded from healthy viable cells and becomes substantially fluorescent only after entering cells and binding to nuclear DNA. In this format we can test a number of PTGS agents for cellular toxicity relative to control elements. We also developed an HTS 96-well plate assay that allows us to assess the impact of any given PTGS agent on stimulating a variety of common cellular stress signaling pathways (e.g. CRE, SRE, AP-1, NFkappaB, Myc, and NFAT) that could indicate possible deleterious effects of PTGS agents either dependent or independent of base pairing complementarity with target mRNAs. To this end we exploited the secreted alkaline phosphatase (SEAP) Pathway Profiling System where the expression of the secreted reporter protein is coupled to transcriptional activation of a variety of promoter elements involved in common cell signaling pathways. We found that a variety of lead hammerhead ribozyme (hhRz) and short hairpin (shRNA) expression constructs did not exert cytotoxicity in human cells when driven by highly active RNA Pol-III promoters. We also found that most of the cell signaling pathways tested (CRE, SRE, Myc, and NFAT) did not significantly couple through upregulation to expression of the set of PTGS agents tested. AP-1 and NFkappaB upregulation both appear to couple to the expression of some PTGS agents which likely reflect the known properties of these pathways to be stimulated by abundant small structured RNAs. Copyright Published by Elsevier Ltd.
Keywords: Genetic Vectors; HEK293 Cells/de [Drug Effects]; *High-Throughput Screening Assays; Humans; Plasmids; RNA/ge [Genetics]; *RNA Interference/ph [Physiology]; RNA, Catalytic/ge [Genetics]; RNA, Messenger/ge [Genetics]; RNA, Small Interfering/ge [Genetics]; Scavenger Receptors, Class A/ge [Genetics]; Silencer Elements, Transcriptional/ph [Physiology]; Transcriptional Activation; Transfection

Ophthalmic complications following treatment of paranasal sinus rhabdomyosarcoma in comparison to orbital disease. - Gandhi, Parag D; Fleming, James C; Haik, Barrett G; Wilson, Matthew W (Ophthalmic plastic and reconstructive surgery, 2011)
PURPOSE: To identify the type and frequency of ocular and orbital complications observed following treatment for primary rhabdomyosarcoma of the paranasal sinuses or the orbit., METHODS: An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective chart review was conducted to identify all patients treated at one institution from 1966 to 2005 with biopsy-proven primary paranasal sinus or orbital rhabdomyosarcoma. Pretreatment, treatment, and follow-up data were collected., RESULTS: Forty-four patients (25 male) of a median age of 7.8 years (range 1.0-18.0 years) with primary paranasal sinus (17) or orbital (27) rhabdomyosarcoma were treated and followed for a median period of 5.3 years (range 0.6-32.0 years). The three most frequently observed ophthalmic complications were persistent eyelid erythema or cellulitis (12), epithelial keratitis (7), and conjunctival injection (6) in the paranasal sinus and epithelial keratitis (18), conjunctival injection (11), and cataract (10) in the orbit. Overall survival after treatment trended higher for the orbital rhabdomyosarcoma group (23 of 27) than the paranasal sinus group (9 of 17)., CONCLUSIONS: The most frequently observed treatment-induced ophthalmic complications in the paranasal sinus group were manageable with minimal patient morbidity, as in the patients with orbital disease. Vision-threatening complications were infrequently encountered. Despite maximal therapy, the mortality rate was higher in the paranasal sinus rhabdomyosarcoma group than in the orbital rhabdomyosarcoma group.
Keywords: Adolescent; *Antineoplastic Combined Chemotherapy Protocols/ae [Adverse Effects]; Child; Child, Preschool; Combined Modality Therapy; Cyclophosphamide/ae [Adverse Effects]; Dactinomycin/ae [Adverse Effects]; *Eye Diseases/ci [Chemically Induced]; Female; Humans; Infant; Male; Orbital Neoplasms/dt [Drug Therapy]; Orbital Neoplasms/mo [Mortality]; Orbital Neoplasms/rt [Radiotherapy]; *Orbital Neoplasms/th [Therapy]; Paranasal Sinus Neoplasms/dt [Drug Therapy]; Paranasal Sinus Neoplasms/mo [Mortality]; Paranasal Sinus Neoplasms/rt [Radiotherapy]; *Paranasal Sinus Neoplasms/th [Therapy]; *Radiation Injuries/et [Etiology]; *Radiotherapy/ae [Adverse Effects]; Retrospective Studies; Rhabdomyosarcoma/dt [Drug Therapy]; Rhabdomyosarcoma/mo [Mortality]; Rhabdomyosarcoma/rt [Radiotherapy]; *Rhabdomyosarcoma/th [Therapy]; Survival Rate; Vincristine/ae [Adverse Effects]

Persistence of patients receiving topical glaucoma monotherapy in an Asian population. - Quek, Desmond T L; Ong, Geok-Teng; Perera, Shamira A; Lamoureux, Ecosse L; Aung, Tin (Archives of ophthalmology (Chicago, Ill. : 1960), 2011)
OBJECTIVE: To determine the persistence rates of patients who started taking topical intraocular pressure (IOP)-lowering monotherapy in a Singapore eye hospital., METHODS: This was a retrospective review of patients who started taking a single IOP-lowering medication between October 1, 2005, and September 30, 2006. Pharmacy dispensing records were traced for 3 years from the date of first prescription. A patient was defined as persistent if he or she was prescribed the same medication before or within 90 days after the previous prescription had lapsed during this period. Persistence was assessed after 1 and 3 years., RESULTS: A total of 2781 patients started taking topical IOP-lowering monotherapy during the 1-year study period. The mean (SD) age was 61.1 (15.7) years; 50.2% were male, and most were Chinese (81.1%) or Singaporean residents (85.4%). After 1 year, only 22.5% of patients (626 of 2781) persistently received the same therapy, which decreased to 11.5% (320 of 2781) after 3 years. Prostaglandin analogues had better persistence rates at 1 year compared with timolol maleate (29.6% vs 23.7%; P = .004) and all other medications combined (29.6% vs 20.6%; P < .001). Those who were not persistent at year 1 were younger (P < .001) and more likely to not be Singaporean (P = .008), not receiving government subsidies (P < .001), and receiving unilateral therapy (P < .001)., CONCLUSIONS: In this hospital-based study, the persistence rate of patients who started taking topical IOP-lowering monotherapy was low after 1 (22.5%) and 3 years (11.5%). These rates are lower than in previous studies in Western countries and may have implications for glaucoma care in Singapore and other parts of Asia.
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; Asian Continental Ancestry Group/eh [Ethnology]; Databases, Factual; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Pharmacy Service, Hospital/sn [Statistics & Numerical Data]; Retrospective Studies; Singapore/ep [Epidemiology]

The effect of biophysical attributes of the ocular trabecular meshwork associated with glaucoma on the cell response to therapeutic agents. - McKee, Clayton T; Wood, Joshua A; Shah, Nihar M; Fischer, Marion E; Reilly, Christopher M; Murphy, Christopher J; Russell, Paul (Biomaterials, 2011)
Glaucoma is a devastating neurodegenerative disease, which can lead to vision loss and is associated with irreversible damage to retinal ganglion cells. Although the mechanism of disease onset remains unknown, we have recently demonstrated that the stiffness of the ocular trabecular meshwork (HTM) increases dramatically in human donor eyes with a history of glaucoma. Here we report that polyacrylamide hydrogels, which mimic the compliant conditions of normal and glaucomatous HTM, profoundly modulate cytoskeletal dynamics and the elastic modulus of the overlying HTM cells. Substratum compliance also modulates HTM cell response to Latrunculin-B, a cytoskeletal disrupting agent currently in human clinical trials for the treatment of glaucoma. Additionally, we observed a compliance-dependent rebound effect of Latrunculin-B with an unexpected increase in HTM cell elastic modulus being observed upon withdrawal of the drug. The results predict that cytoskeletal disrupting drugs may be more potent in advanced stages of glaucoma. Copyright A© 2010 Elsevier Ltd. All rights reserved.
Keywords: Biomechanical Phenomena/de [Drug Effects]; Biophysical Phenomena/de [Drug Effects]; *Biophysical Phenomena; Bridged Bicyclo Compounds, Heterocyclic/pd [Pharmacology]; *Bridged Bicyclo Compounds, Heterocyclic/tu [Therapeutic Use]; Cell Adhesion/de [Drug Effects]; Cell Shape/de [Drug Effects]; Cell Survival/de [Drug Effects]; Elastic Modulus/de [Drug Effects]; *Glaucoma/dt [Drug Therapy]; *Glaucoma/pa [Pathology]; Humans; Microscopy, Atomic Force; Microscopy, Fluorescence; Thiazolidines/pd [Pharmacology]; *Thiazolidines/tu [Therapeutic Use]; Trabecular Meshwork/de [Drug Effects]; *Trabecular Meshwork/pa [Pathology]

Compliance and adherence in glaucoma management. - Robin, Alan; Grover, Davinder S (Indian journal of ophthalmology, 2011)
Glaucoma is a preventable cause of blindness if timely effective and successful treatment is provided. Patient adherence to the medication is a constant challenge that is now recognized as an essential component to treatment. Several studies have demonstrated that patients are more likely to be adherent to their medication if they understand the disease and the rationale for treatment and if their treatment regimen is simplified. Additionally, using eye drops has its own set of challenges that must be recognized and addressed at the clinical level. Although numerous socioeconomic factors are associated with poor adherence, these factors must be addressed at the societal level. Maximizing patient adherence to medication has the potential to reduce the number of surgical interventions required to treat glaucoma, prevent unnecessary vision loss, and save the overall healthcare system money in the long run.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Blindness/pc [Prevention & Control]; *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions; *Patient Compliance; Socioeconomic Factors

Medical management of glaucoma: principles and practice. - Singh, Kuldev; Shrivastava, Anurag (Indian journal of ophthalmology, 2011)
Glaucoma care is more an art than science. The introduction of several new classes of glaucoma medications and the completion of many large randomized clinical trials have not changed this fact. While we now have better choices when initiating glaucoma therapy relative to our predecessors, the principles of glaucoma therapy have not changed much during this period. Debates continue regarding the utility of concepts such as "the monocular therapeutic trial," "target intraocular pressure (IOP)," and "maximal medical therapy." Our tools for detecting and following glaucomatous disease have improved but are not precise enough for us to prospectively predict which patients will do better or worse than others. Much attention has been given to disease stage, rate of progression, and compliance with medications but regular patient follow-up, an area that has received little attention, may be among the most important predictors of patient outcomes.
Keywords: Adrenergic alpha-Antagonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Disease Progression; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Goals; Humans; Intraocular Pressure/de [Drug Effects]; Parasympathomimetics/tu [Therapeutic Use]; Prostaglandins/ae [Adverse Effects]; Prostaglandins/tu [Therapeutic Use]

Surgical management of glaucoma: evolving paradigms. - Sharaawy, Tarek; Bhartiya, Shibal (Indian journal of ophthalmology, 2011)
Surgical intervention is mandatory in the case of documentation of the progression of glaucomatous optic neuropathy despite the administration of maximal tolerated medical therapy, and in cases where compliance is poor. Minimal complications, good long-term intraocular pressure (IOP) control, and precisely titrated target IOPs resulting in avoidance of visual impairment are the primary goals of surgical intervention. This article is an attempt to provide a broad overview of the therapeutic options available to the glaucoma surgeon. The available surgical modalities have undergone modifications and refinements over time, with a view to improve patient outcomes and visual recovery, yet are fraught with intra- and postoperative complications. The risk and benefits of each of the available surgical options must be critically evaluated and customized to fit the needs of the particular patient. There is insufficient evidence at present to establish the superiority of any of these surgeries over the other.
Keywords: Glaucoma/cn [Congenital]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Ophthalmologic Surgical Procedures/td [Trends]; *Ophthalmologic Surgical Procedures; Postoperative Period; Trabeculectomy

Surgical management of glaucoma: an Indian perspective. - Ramakrishnan, R; Khurana, Mona (Indian journal of ophthalmology, 2011)
Glaucoma is a serious sight-threatening disorder aptly named the Silent thief of sight. India, being the second most populous country in the world, has about 20% of the world glaucoma population. The complex geographical and socioeconomic architecture and the economic extremes have a profound effect on its health system. The present times are abundant with fresh developments in the field of glaucoma. Though newer modalities are present in India, they are not ample and are unequally distributed. Adherence and persistence with medical therapy is an issue owing to a multitude of factors. In such a setting, most of the ophthalmologists find themselves performing glaucoma surgeries quite often. In the present era, there are a number of new surgeries to choose from, especially procedures which are nonpenetrating and blebless. Faced with a spectrum of surgeries from shunts to canal surgeries and trabecular bypass devices, the surgeon is often in a dilemma. Still, trabeculectomy remains the gold standard with an increasing trend toward glaucoma drainage devices. The new procedures and devices are worth exploring but await long-term results, good training of surgeons and cost effectiveness.
Keywords: *Glaucoma/su [Surgery]; Glaucoma Drainage Implants; Humans; India; Ophthalmologic Surgical Procedures/td [Trends]; *Ophthalmologic Surgical Procedures; Trabeculectomy

A potential new therapeutic system for glaucoma: solid lipid nanoparticles containing methazolamide. - Li, Rui; Jiang, Sunmin; Liu, Dongfei; Bi, Xinyun; Wang, Fengzhen; Zhang, Qing; Xu, Qunwei (Journal of microencapsulation, 2011)
Methazolamide (MTA) is an antiglaucoma drug; however, there are many side effects of its systemic administration with insufficient ocular therapeutic concentrations. The aim of this study was to formulate MTA-loaded solid lipid nanoparticles (SLNs) and evaluate the potential of SLNs as a new therapeutic system for glaucoma. SLNs were prepared by a modified emulsion-solvent evaporation method and their physicochemical characteristics were evaluated. The pharmacodynamics was investigated by determining the percentage decrease in intraocular pressure. The ocular irritation was studied by Draize test. Despite a burst release of SLNs, the pharmacodynamic experiment indicated that MTA-SLNs had higher therapeutic efficacy, later occurrence of maximum action, and more prolonged effect than drug solution and commercial product. Formulation of MTA-SLNs would be a potential delivery carrier for ocular delivery, with the advantages of a more intensive treatment for glaucoma, lower in doses and better patient compliance compared to the conventional eye drops.
Keywords: Animals; Carbonic Anhydrase Inhibitors/ch [Chemistry]; Carbonic Anhydrase Inhibitors/pk [Pharmacokinetics]; Carbonic Anhydrase Inhibitors/pd [Pharmacology]; *Carbonic Anhydrase Inhibitors; *Drug Delivery Systems; Female; *Glaucoma/dt [Drug Therapy]; Humans; Lipids/ch [Chemistry]; Lipids/pk [Pharmacokinetics]; Lipids/pd [Pharmacology]; *Lipids; Male; Methazolamide/ch [Chemistry]; Methazolamide/pk [Pharmacokinetics]; Methazolamide/pd [Pharmacology]; *Methazolamide; *Nanoparticles/ch [Chemistry]; Rabbits

Do adherence rates and glaucomatous visual field progression correlate?. - Rossi, Gemma C M; Pasinetti, Gian Maria; Scudeller, Luigia; Radaelli, Rosella; Bianchi, Paolo Emilio (European journal of ophthalmology, 2011)
PURPOSE: To assess the relation between visual field progression and adherence rate in patients with glaucoma using Travatan Dosing Aid R (TDA)., METHODS: In this 36-month retrospective study, 35 patients with primary open-angle glaucoma on travoprost or travoprost/timolol fixed combination monotherapy were submitted to ophthalmic examination and to visual field (VF) test from 2007 to 2009. Adherence was recorded with TDA. The association between VF progression (from 2007 to the end of the follow-up period) and a number of predictors (adherence rates at 12 months) was tested by means of chi-square test (or Fisher exact test) or Mann-Whitney test as appropriate., RESULTS: The mean (+/-SD) adherence rates were 71.9%+/-27.8% after 1 month of follow-up and 76.8%+/-20.9% at 12 months. A total of 25 (71.4%) patients with stable VF had a median adherence rate (IQR) of 85% (75%-97%); patients who worsened (n=10; 28.6%) recorded a median (IQR) adherence of 21% (9%-45%) (p<0.001). No association was found between VF progression and any of the other variables (age, sex, schooling, visual acuity, intraocular pressure (IOP) at baseline and over time, other ocular diseases, time since diagnosis and actual therapy, number of concomitant systemic therapies). Patients who were at least 90% adherent did not progress, while 43.5% of the patients with lower adherence worsened (p=0.01)., CONCLUSIONS: Our data suggest that adherence rate may play a role in glaucomatous damage and/or progression; the target IOP therefore should be adjusted by adherence rates. Monitoring tools, educational programs, use of videos, a better doctor-patient relationship, or other means to improve adherence are desirable and necessary to preserve visual function.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Disease Progression; Drug Combinations; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; *Medication Adherence; Middle Aged; Retrospective Studies; Timolol/tu [Therapeutic Use]; Travoprost; *Vision Disorders/pp [Physiopathology]; Visual Acuity/ph [Physiology]; *Visual Fields/ph [Physiology]

Treatment of severe fungal keratitis with subconjunctival amphotericin B. - Carrasco, Maria Alejandra; Genesoni, Graciela (Cornea, 2011)
PURPOSE: To report the beneficial properties of subconjunctival amphotericin B as an adjunctive therapy in patients with severe fungal keratitis., METHODS: Case reports and review of medical literature. Four patients with advanced fungal keratitis were treated with repeated injections of subconjunctival amphotericin B in addition to topical and systemic antifungal treatment., RESULTS: Two to 8 injections were given to each patient. All patients showed rapid clinical improvement after the injections. No serious adverse effects were observed. However, all patients experienced pain during the injections., CONCLUSIONS: Subconjunctival injections of amphotericin B are useful as an adjunctive treatment of advanced fungal keratitis. This treatment assures compliance and may be an alternative to avoid a surgical intervention in an acute stage of advanced fungal keratitis. More cases are needed to validate our findings.
Keywords: Acremonium/ip [Isolation & Purification]; Adult; Aged, 80 and over; *Amphotericin B/tu [Therapeutic Use]; *Antifungal Agents/tu [Therapeutic Use]; Candida/ip [Isolation & Purification]; Conjunctiva/de [Drug Effects]; Corneal Ulcer/di [Diagnosis]; *Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; Eye Infections, Fungal/di [Diagnosis]; *Eye Infections, Fungal/dt [Drug Therapy]; Eye Infections, Fungal/mi [Microbiology]; Female; Fusarium/ip [Isolation & Purification]; Humans; Injections, Intraocular; Male; Mycoses/di [Diagnosis]; *Mycoses/dt [Drug Therapy]; Mycoses/mi [Microbiology]

Adherence with brimonidine in patients with glaucoma aware and not aware of electronic monitoring. - Hermann, Manuel Marcel; Papaconstantinou, Dimitris; Muether, Philipp Sebastian; Georgopoulos, Gerasimos; Diestelhorst, Michael (Acta ophthalmologica, 2011)
PURPOSE: To assess the impact of open versus masked adherence monitoring on adherence with topical brimonidine using two different dosing schedules., METHODS: Thirty-seven patients with glaucoma or ocular hypertension were enrolled in a prospective, observational cohort study. Patients were randomly assigned to open or masked adherence monitoring and to brimonidine twice daily (BID) or three times daily (TID). Patients received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks with weekly intraocular pressure measurements. Adherence calculations comprised dosing intervals, adherence rate and time covered. Subgroup analysis with anova included the factors masking, regimen, diagnosis and age., RESULTS: Among 36 individually analysed patients, 12 (33%) had adherence rates above 75%, therein two (5%)>90%. The mean adherence rate in 19 patients aware of adherence measurements was 70 +/- 17% for brimonidine BID and 65 +/- 14% for TID, not significantly different to the rates of 17 patients not informed about adherence measurements (77 +/- 6% BID, 62 +/- 9% TID, p = 0.24). On average, patients with brimonidine TID achieved significantly lower adherence rates (64 +/- 12%) than patients on BID (73 +/- 13%, p = 0.02). Still, patients on TID applied brimonidine more often (TID 1.9 +/- 0.3, BID 1.5 +/- 0.1 mean applications per day). The median coverage was 70% and showed no statistically significant difference between patients on BID and TID (p = 0.36)., CONCLUSION: The study findings suggest that adherence measurements are not significantly altered by open adherence monitoring, which may simplify future adherence studies. Adherence with brimonidine eye drops was insufficient for most patients. These results demonstrate the necessity to develop new strategies to improve compliance in glaucoma therapy. Copyright © 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.
Keywords: Administration, Topical; Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Brimonidine Tartrate; *Drug Monitoring/is [Instrumentation]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Prospective Studies; *Quinoxalines/ad [Administration & Dosage]; Visual Acuity/ph [Physiology]

Adherence of Finnish people with glaucoma to treatment plans and connected factors. - Lunnela, Jaana; Kaariainen, Maria; Kyngas, Helvi (International journal of circumpolar health, 2011)
OBJECTIVES: The aim of the study was to describe the adherence of Finnish people with glaucoma to prescribed treatment plans, the factors connected to adherence and to produce knowledge for developing effective interventions to improve adherence to treatment plans., STUDY DESIGN: This was a cross-sectional study., METHODS: The data (n = 249) were collected at one point in time from Finnish adults diagnosed with glaucoma with a questionnaire covering adherence to treatment. These patients used glaucoma medication and had follow-up appointments with ophthalmologists., RESULTS: Sixty-seven percent (n = 166) of the patients with glaucoma were very adherent to the prescribed treatment plan in terms of self-care, treatment and follow-up visits. Almost all were very adherent to medical care (97%, n = 242). More than half of those who had received information from physicians and nurses were very adherent to treatment (66%, n = 163). Two factors, support from physicians and nurses (p < 0.001) and being informed of the consequences of treatments (p=0.003), had a statistically significant connection to treatment adherence., CONCLUSIONS: This study indicates that people with glaucoma in Finland adhere well to care and exceptionally well to medical care. Support and patient education from health care personnel is crucial to maintain patient adherence to treatment. These results indicate that nurses play a very important role in patient education and support. In practice, it is crucial to maintain this level of patient engagement by developing more tailored and time-saving education and support methods. The results of this study could be helpful for developing new patient education and support approaches for people with glaucoma.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Drug Utilization; Female; Finland; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Office Visits; *Patient Compliance; Patient Education as Topic; Self Care; Surveys and Questionnaires; Young Adult

Evaluation of compliance with the EGS guidelines in Spain, using Achievable Benchmarks of Care (ABC R) methodology: the IMCA Study. - Castejon-Cervero, Miguel A; Jimenez-Parras, Rafael; Fernandez-Arias, Isabel; Teus-Guezala, Miguel A; IMCA Study Group (European journal of ophthalmology, 2011)
PURPOSE: To evaluate compliance with diagnostic and therapeutic recommendations of the European Glaucoma Society (EGS) for the management of glaucoma in Spain, as determined using the Achievable Benchmarks of Care approach., METHODS: A panel of 3 experts extracted quality and process-of-care indicators from the EGS guidelines. Investigators from all over the country, representative of Spanish ophthalmologists, were invited to participate in the study, completing a questionnaire on quality indicators (pertaining to the center) and process-of-care indicators (pertaining to all patients) for the first, diagnostic visit (retrospective) and the study visit., RESULTS: A total of 495 Spanish ophthalmologists included 5,060 patients with glaucoma or intraocular hypertension. The treatment was initiated with monotherapy in 88.5% of the patients. Overall, the percentage compliance with diagnostic examinations was 84.6% for intraocular pressure measurement, 96.3% for optic nerve head evaluation, 76.6% for visual field evaluation, 29.5% for central corneal thickness evaluation, and 49.3% at the study visit. The benchmark performance was close to 100% for most examinations. Only 32.8% of the centres had a written protocol for the management of the patients with glaucoma, and in these centers the recommendations of the EGS were followed in a higher proportion (p<0.0001) than in the rest., CONCLUSIONS: The use of local protocols for the management of glaucoma seems to enhance compliance. Benchmark performance was close to 100% in most indicators, suggesting that EGS recommendations are attainable in Spain. The overall performance suggests that certain diagnostic procedures are, in practice, not as widely used as recommended.
Keywords: Aged; *Benchmarking/mt [Methods]; Cross-Sectional Studies; European Union; Female; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/th [Therapy]; *Glaucoma, Open-Angle; *Guideline Adherence; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/th [Therapy]; *Practice Guidelines as Topic; *Quality Indicators, Health Care; Societies, Medical; Spain; Surveys and Questionnaires; Tonometry, Ocular

Adherence to topical glaucoma medication during hospitalization. - Yousuf, Salman J; Jones, Leslie S (Journal of glaucoma, 2011)
PURPOSE: To describe the patterns and predictors of adherence to topical glaucoma medication during hospitalization for medical disease., DESIGN: Retrospective, nonrandomized, and comparative case-series., METHODS: Medical records of all the patients hospitalized with a secondary diagnosis of glaucoma between January 2006 and March 2009 were reviewed. Baseline characteristics of all patients were recorded including sex, ethnicity, age, primary medical diagnosis, and the length of stay. The outpatient topical glaucoma medications known on admission and prescribed at the time of admission were recorded, and the numbers of outpatient and inpatient systemic medications were tracked. Adherence was defined as receiving more than 75% of the expected doses. The patient discharge instructions were also reviewed., RESULTS: Of the 184 patients included, 98 (53%) were female, 102 (55%) were African-American, and the mean age was 78.3 (+/-11.7) years old. The most common reason for hospitalization was cardiovascular disease and the median length of stay was 9.5 days. Adherence was achieved in 51.6% of patients. Knowing (P<0.01) and prescribing (P<0.01) the complete outpatient regimen upon admission was associated with adherence. Neither class of topical glaucoma medication nor the number of medications was associated with adherence. Doses were most commonly omitted owing to the failure to prescribe (72.3%). Discharge instructions correctly listed the outpatient regimen 54.3% of the time., CONCLUSION: Adherence to the topical glaucoma medications was suboptimal during hospitalization; this is likely related to the poor reporting of outpatient regimen upon admission. The effect of hospitalization may be a factor to consider in future studies of adherence and when evaluating glaucoma patients after hospitalization.
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; *Hospitalization/sn [Statistics & Numerical Data]; Humans; Length of Stay; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Retrospective Studies

Prevalence and correlates of self-reported nonadherence with eye drop treatment: the Belgian Compliance Study in Ophthalmology (BCSO). - Vandenbroeck, Sofie; De Geest, Sabina; Dobbels, Fabienne; Fieuws, Steffen; Stalmans, Ingeborg; Zeyen, Thierry (Journal of glaucoma, 2011)
PURPOSE: This study aimed to investigate (1) the prevalence of nonadherence with eye drop treatment; (2) selected correlates of nonadherence at the patient and health-care organization level; and (3) the diagnostic value of the ophthalmologists' ratings, using patients' self-reports as standard., METHODS: This cross-sectional multicenter survey used questionnaires for ophthalmologists and their patients to assess self-reported nonadherence and its correlates. One item, using a 4-point scale [never (ie, adherent) to daily], asked the patients whether they had forgotten to administer eye drops during the past 2 weeks. Ophthalmologists rated their patients as adherent or nonadherent. Nonadherence was also determined by combined methods, whereby either could indicate nonadherence. Given the nested structure of the data, multilevel modeling was used to investigate self-reported nonadherence-correlates. Diagnostic values of ophthalmologists' report were calculated., RESULTS: Of 663 patients (48% female, 44% >69 years), nonadherence was indicated in 39.2% (n=260) through self-reporting, 2.1% (n=14) through ophthalmologists' ratings, and 40% (n=266) through combined measures. The multivariable, multilevel model showed following significant nonadherence-correlates: Male sex (P=0.01), younger age (P=0.027), and higher-dose frequency (P=0.001). No significant correlation with treating ophthalmologist (P=0.21) could be seen. Yet, the patients visiting their ophthalmologists at least every 3 months were less nonadherent than patients with fewer consultations (P=0.01). The ophthalmologists' report showed a sensitivity and specificity of 3% and 98.5%, respectively., CONCLUSIONS: The prevalence of self-reported nonadherence was congruent with literature. The patients visiting their ophthalmologists at least every 3 months have a lower risk of nonadherence. Ophthalmologist report is an insensitive method for detecting nonadherence.
Keywords: Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Belgium/ep [Epidemiology]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Health Surveys; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmology/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patient Compliance/sn [Statistics & Numerical Data]; Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prevalence; Self Disclosure; Sensitivity and Specificity; Surveys and Questionnaires

Descemet stripping endothelial keratoplasty after Ophtec 311 iris reconstruction lens implantation. - Aldave, Anthony J; Baghdasaryan, Elmira; Miller, Kevin M (Cornea, 2011)
PURPOSE: To describe the variations in intraoperative technique, postoperative complications, and visual outcomes associated with Descemet stripping endothelial keratoplasty (DSEK) after Ophtec iris reconstruction lens implantation., DESIGN: Retrospective, interventional, consecutive case series., PARTICIPANTS: Patients who underwent DSEK after Ophtec 311 iris reconstruction lens implantation at the Jules Stein Eye Institute, University of California, Los Angeles., METHODS: Medical records were reviewed for demographic information, ophthalmic history, DSEK surgical technique, and postoperative clinical course., MAIN OUTCOME MEASURES: Intraoperative and postoperative complications and visual outcomes., RESULTS: Four patients were identified (1 man and 3 women, age: 43-78). Three of the eyes had undergone prior penetrating keratoplasty (PKP), and each of the eyes had a history of glaucoma, with previous glaucoma surgery having been performed in 2 of the eyes. No intraoperative complications were encountered during the procedures, although an unplanned anterior vitrectomy was required in a previously vitrectomized eye. In each case, a complete air fill of the globe was obtained to ensure adherence of the donor button, and in 3 of the 4 cases, the donor button was sutured to the recipient cornea to prevent potential posterior dislocation. None of the cases developed donor button dislocation or primary graft failure. Corrected distance visual acuities improved to 20/40-20/160, corresponding to a mean improvement of 0.25 (range, 0.12-0.40), limited by irregular corneal astigmatism and advanced glaucomatous optic neuropathy. During a mean follow-up period of 15.6 months (range, 4.9-24.8 months), graft rejection developed in 2 of the 3 eyes with a history of endothelial rejection after PKP (0.42 episode per eye-year). Both of these eyes developed secondary graft failure, which also developed 14 months after DSEK in the other eye with a history of PKP failure before DSEK., CONCLUSIONS: DSEK can be successfully performed in eyes with partial or complete aniridia, such as those after Ophtec iris reconstruction lens implantation. Modifications to the standard DSEK technique increase the probability of successful donor adherence and decrease the risk of posterior dislocation of the donor corneal button. However, endothelial rejection may occur at an increased frequency, resulting in secondary graft failure.
Keywords: Adult; Aged; Corneal Edema/su [Surgery]; *Descemet Stripping Endothelial Keratoplasty; Female; Graft Rejection/su [Surgery]; Humans; Intraoperative Complications; *Iris Diseases/rh [Rehabilitation]; *Lens Implantation, Intraocular; Male; Middle Aged; Postoperative Care; Postoperative Complications; Prosthesis Design; Retrospective Studies; Sclerostomy; Surgical Flaps; Visual Acuity/ph [Physiology]

Clinician-patient communication in a glaucoma clinic in India. - Mocherla, Shobha; Raman, Usha; Holden, Brien (Qualitative health research, 2011)
We compiled data from nonparticipant observations of clinician-patient communication in clinical interactions in a tertiary care eye hospital in India. Applying elements of the French philosopher Michel Foucault's concept of power and knowledge, we deconstructed the structuring and moderating influences on the expert/nonexpert dyad. We found that clinicians enforce their "disciplining power" through varying degrees of communicativeness to bring about compliance in the patient. Clinicians appear to classify the patient as "participant" or "deviant" based on the patient's "internalization" of instructions, and then communicate in predictable ways with the patient. Patients can also wield power, communicating it by understanding and following or not understanding and not clarifying/verifying instructions in the clinic, and thereafter failing to comply with the clinician's advice. We suggest that clinicians need to hone their communication skills both to optimally utilize interactions in the clinic and to encourage patient compliance, thereby making possible better treatment outcomes.
Keywords: Adult; *Ambulatory Care Facilities; Chronic Disease; *Communication; Female; *Glaucoma; Humans; India; Interview, Psychological; Male; Patient Education as Topic; *Physician-Patient Relations; Power, Psychological; Qualitative Research; Vision, Ocular; Young Adult

Diabetic retinopathy management by Australian optometrists. - Ting, Daniel S W; Ng, Jonathon Q; Morlet, Nigel; Yuen, Joshua; Clark, Antony; Taylor, Hugh R; Keeffe, Jill; Preen, David B (Clinical & experimental ophthalmology, 2011)
BACKGROUND: To survey the current diabetic retinopathy screening and management practices of Australian optometrists following the release of the 1997 National Health Medical Research Council Diabetic Retinopathy Management Guidelines., DESIGN: Cross-sectional national survey, primary care setting., PARTICIPANTS: 1000 Australian optometrists across different states., METHODS: A self-administered questionnaire was sent to 1000 optometrists across all states during 2007/2008., MAIN OUTCOME MEASURES: Use of retinal camera, screening practices/attitudes and behaviour in diabetic retinopathy management., RESULTS: 568 optometrists (57%) responded to the survey. Patients' unpreparedness to drive post dilation (51%) and the fear of angle closure glaucoma (13%) were the two main barriers to optometrists not performing dilated ophthalmoscopy. Those who had strong desire to screen for diabetic retinopathy were more likely to use a retinal camera (p<0.005). Use of a retinal camera was significantly associated with an increased confidence in detecting clinical signs of diabetic retinopathy including macular oedema (P<0.001). Optometrists who read the guidelines at least once were 2.5-times (P<0.001) more likely to have confidence in detecting macular oedema than those who had never read the guidelines. Although they may be confident in diagnosis, and may use retinal cameras for screening, nearly 60% of optometrists would not refer patients with macular oedema to an ophthalmologist., CONCLUSIONS: Despite their self-reported desire for involvement in diabetic retinopathy, the management of macular oedema by Australian optometrists needs improvement. The use of retinal cameras and promotion of the 2008 NHMRC guidelines should be encouraged to improve overall optometric diabetic retinopathy management, particularly with macular oedema. Copyright © 2010 The Authors. Clinical and Experimental Ophthalmology © 2010 Royal Australian and New Zealand College of Ophthalmologists.
Comment in (CIN), Comment in (CIN)
Keywords: Australia; Cross-Sectional Studies; *Delivery of Health Care/st [Standards]; Delivery of Health Care/sn [Statistics & Numerical Data]; *Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/th [Therapy]; Diagnostic Techniques, Ophthalmological; Guideline Adherence; Health Care Surveys; Health Services Research; Humans; National Health Programs; *Optometry/st [Standards]; Optometry/sn [Statistics & Numerical Data]; Practice Guidelines as Topic; *Practice Patterns, Physicians'/st [Standards]; Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Surveys and Questionnaires

Effects of osmoprotection on symptoms, ocular surface damage, and tear film modifications caused by glaucoma therapy. - Monaco, Gaspare; Cacioppo, Viviana; Consonni, Dario; Troiano, Pasquale (European journal of ophthalmology, 2011)
PURPOSE: To determine the effects of 2 artificial tear formulas on the ocular surface in patients with glaucoma using topical preserved beta-blockers (BB) or prostaglandins (PG)., METHODS: This was a prospective, comparative, randomized, double-blind study with a crossover design. Twenty patients with dry eye were divided into 2 groups based on glaucoma treatment: BB (10 subjects) or PG (10 subjects). Each group was administered a 4-week course of unpreserved isotonic (300 mOsm/L) solution containing 0.2% sodium hyaluronate (SH) or a preserved isotonic (295-305 mOsm/L) solution containing 0.5% carboxymethylcellulose and 0.9% glycerin as compatible solute (CMCs) administered QID. After a 2-week washout period, the course of treatment was reversed. The primary efficacy criteria consisted of assessing symptoms according to the Ocular Surface Disease Index© (OSDI); the secondary efficacy criteria consisted of evaluating tear film confocal microscopy, central corneal thickness (CCT), and lissamine corneal and conjunctival staining (Oxford Grading System Score [OGSS])., RESULTS: Within each group, only CMCs induced a significant improvement in OSDI and OGSS compared to baseline values: OSDI -20.5, p<0.0001; OGSS -0.9, p<0.0001. Tear film confocal microscopy improved after treatment, especially in case of patients who were administered CMCs. No difference in CCT was noticed for any subject., CONCLUSIONS: This study demonstrates for the first time that the use of concomitant CMCs in the management of glaucoma undergoing treatment with BB or PG may assist in tear film production and could lead to better compliance with intraocular pressure-lowering medication and ultimately better prognosis.
Keywords: *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carboxymethylcellulose Sodium/ad [Administration & Dosage]; *Cornea/de [Drug Effects]; Cornea/pa [Pathology]; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Dry Eye Syndromes/co [Complications]; Dry Eye Syndromes/dt [Drug Therapy]; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glycerol/ad [Administration & Dosage]; Humans; Hyaluronic Acid/ad [Administration & Dosage]; Intraocular Pressure/de [Drug Effects]; Isotonic Solutions/ad [Administration & Dosage]; Microscopy, Confocal; *Ophthalmic Solutions/ad [Administration & Dosage]; Osmolar Concentration; Preservatives, Pharmaceutical/ad [Administration & Dosage]; Prospective Studies; *Prostaglandins, Synthetic/tu [Therapeutic Use]; *Tears/ch [Chemistry]

Measurement of adherence to brimonidine therapy for glaucoma using electronic monitoring. - Hermann, Manuel Marcel; Bron, Alain Marie; Creuzot-Garcher, Catherine P; Diestelhorst, Michael (Journal of glaucoma, 2011)
PURPOSE: To assess the patient adherence and behavior with brimonidine twice daily (bid) or 3 times daily (tid) in patients used to topical glaucoma medication., PATIENTS AND METHODS: Seventy-five patients with glaucoma or ocular hypertension were enrolled in a prospective, observational cohort study. Consenting patients were randomly assigned to brimonidine bid or tid and received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks. Patients were not explicitly informed on the compliance monitoring., RESULTS: The study was completed by 67 patients (89%). In 65 patients (97%), at least 1 dosing interval exceeded 24 hours. The mean adherence rates were better in the brimonidine bid group (72 +/- 19% vs. 62 +/- 16%, P=0.04), although dosing frequency was higher in the tid group (1.9 +/- 0.5 vs. 1.4 +/- 0.4 per day; P<0.001). On average medication coverage was 70% for the bid group and 67% for the tid group; 19 patients (28%) had a coverage rate above 75%, 42 patients (63%) 50% to 75%, and 6 (9%) below 50%. Patients with normal-tension glaucoma had lower coverage rates than patients with primary open-angle glaucoma and ocular hypertension (P<0.05). Data also showed that on average 20% of the glaucoma medication was wasted owing to inefficient drug delivery by using more than 1 drop per dosing., CONCLUSIONS: Individual adherence with brimonidine was highly variable and pharmacologically insufficient for more than two-third of the patients. Special attention should be paid to compliance of patients with normal-tension glaucoma. Our findings underline the need to improve individual adherence and drug delivery in topical glaucoma therapy.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Brimonidine Tartrate; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Behavior; Humans; Intraocular Pressure/de [Drug Effects]; *Low Tension Glaucoma/dt [Drug Therapy]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; *Quinoxalines/ad [Administration & Dosage]; Tonometry, Ocular

A population-based study of care-seeking behavior in rural Tanzanians with glaucoma blindness. - Lewallen, Susan; Hassan, Hassan G; Al Attas, Ahmed H; Courtright, Paul (Journal of glaucoma, 2011)
PURPOSE: To describe the care-seeking behavior of a representative sample of rural Africans blind from glaucoma., PATIENTS AND METHODS: Patients blind from posterior segment diseases (including diseases affecting the retina or optic nerve) were identified though a population-based survey in Kilimanjaro Region, Tanzania in 2007. A year later they were traced to their homes to detail the diagnoses with more thorough examination. In-depth interviews were conducted to determine healthcare sought and received and symptoms which prompted this. Data were analyzed by framework analysis., RESULTS: Of 30 patients previously identified, 20 were found and interviewed, 4 had died, 2 had moved, 2 lived too far to trace, and 2 could not be located. The average age was 77 years. Few patients could give a clear temporal history of how their vision failed or a sequential description of visits made to healthcare facilities over the years. However, every patient had sought eye care and most made numerous visits. Understanding of the disease and treatment was uniformly limited. Most received topical medicines and the histories of nonglaucoma and glaucoma blind were similar except that 5 glaucoma patients had received surgery. Patients described obstacles to care including poverty and other lack of support., CONCLUSIONS: These findings contrast to previous which showed that most rural Africans blind from glaucoma have not sought or received treatment. It is likely that this is partly the result of widely accessible services offered in Kilimanjaro Region. However, the challenges in treating this chronic disease are highlighted.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/th [Therapy]; Female; *Glaucoma/ep [Epidemiology]; Glaucoma/th [Therapy]; Health Care Surveys; Humans; Male; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Primary Health Care/sn [Statistics & Numerical Data]; *Rural Population/sn [Statistics & Numerical Data]; Tanzania/ep [Epidemiology]

Association of strength of religious adherence with attitudes regarding glaucoma or ocular hypertension. - Stewart, William C; Sharpe, Elizabeth D; Kristoffersen, Caroline J; Nelson, Lindsay A; Stewart, Jeanette A (Ophthalmic research, 2011)
BACKGROUND: To evaluate the impact of religious adherence on a patient's outlook on disease in a glaucoma population., METHODS: A prospective survey analysis of patients with open-angle glaucoma or ocular hypertension evaluating self-reported global religious adherence, adherence to specific basic activities and knowledge of faith ('maturity') and 'comfort' (ability to cope, attitude toward glaucoma, motivation to take medication and God's concern). This specific analysis was limited to self-professed Christians., RESULTS: 248 patients were included and religious adherence was correlated to religious activity and knowledge (p < 0.0001). Patients who scored as adherent on at least 1 of 4 maturity questions had greater benefit than less adherent patients from each of the 5 comfort questions (p < 0.0001). We found an increased statistical separation on each of the 5 comfort questions between religiously adherent and less adherent individuals for patients who scored as adherent on any 2 (n = 40), 3 (n = 50) or all 4 (n = 57) of the maturity questions (p < 0.001)., CONCLUSIONS: This study suggests, at least for the Christian faith, that religious patients are subjectively more prone to cope with treatment and that religiosity increases the self-confidence, and possibly the quality of life, of patients with glaucoma or ocular hypertension. Whether this necessarily translates into better glaucoma practices remains to be demonstrated by further studies. Copyright © 2010 S. Karger AG, Basel.
Keywords: Aged; *Christianity/px [Psychology]; Female; *Glaucoma, Open-Angle/px [Psychology]; *Health Knowledge, Attitudes, Practice; Humans; Male; Ocular Hypertension/px [Psychology]; Prospective Studies; *Quality of Life/px [Psychology]; *Religion and Medicine; *Spiritualism/px [Psychology]; Surveys and Questionnaires

Assessment of interrelationship between poverty and blindness in Maiduguri, Nigeria. - Ribadu, D Y; Mahmoud, A O (The Nigerian postgraduate medical journal, 2010)
AIMS AND OBJECTIVE: To assess the possible role of poverty as a cause and a consequence of blindness among blind individuals in Maiduguri, Nigeria., PATIENTS AND METHODS: Eighty-five consenting blind individuals living within 4 wards of Maiduguri had ocular examination to determine the cause of their blindness with a view to determining the avoidable nature (preventable and/or curable, were adequate resources available) of their blindness. A semi-structured questionnaire which captured their demographic data, antecedents of blindness and interventions (medical and rehabilitative) sought, access to welfare support services was also administered. Socio-economic status of the respondents was explored through information sought on educational attainment, employment status, means of livelihood, possession of personal assets, and estimates of monthly income., RESULTS: Blindness from the main causes were avoidable as they were either curable (cataract 41, 48%) or preventable (xerophthalmia 20, 23.5%; glaucoma 12, 14.1%; and trachoma 5, 5.1%). Only 8.2% of the subjects were employed, majority (75.3%) roamed the streets begging; and 69% lived on less than a dollar a day. Over three-quarters had no access to any form of welfare support. Majority (70.6%) did not have any personal asset. More than two-thirds had no formal education and over three-quarters had no access to health services. CONCLUSIONS & RECOMMENDATION: The avoidable nature of blindness in 78 (90%) of the subjects implicates poverty as a causative factor. In turn, the subjects' subsequent existence in poverty and destitution appear directly related to their blindness. We recommend an effective and comprehensive eye care service, and an intensification of poverty-alleviation measures.
Keywords: Adult; Aged; *Blindness/ec [Economics]; Blindness/ep [Epidemiology]; *Blindness/et [Etiology]; Blindness/pc [Prevention & Control]; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Income; Male; Middle Aged; Nigeria/ep [Epidemiology]; *Poverty/sn [Statistics & Numerical Data]; Prevalence; Social Class; Young Adult

A case of essential iris atrophy in a male patient. - Bandyopadhyay, Sabyasachi; Biswas, Gautam; Biswas, Jaya; Das, Debabrata (Journal of the Indian Medical Association, 2010)
Essential iris atrophy is a rare disease of abnormal proliferative corneal endothelium which usually presents with iris atrophy, corectopia, pseudopolycoria, corneal oedema and glaucoma. The disease occurs typically in one eye of a young to middle aged woman. The unusual feature in this case was that, the patient was a 36-year-old male presenting with iris atrophy, corneal oedema and uniocular glaucoma.
Keywords: Acetazolamide/tu [Therapeutic Use]; Adult; Brimonidine Tartrate; Humans; *Iridocorneal Endothelial Syndrome/dt [Drug Therapy]; Iridocorneal Endothelial Syndrome/pa [Pathology]; *Iridocorneal Endothelial Syndrome/pp [Physiopathology]; Male; Quinoxalines/tu [Therapeutic Use]; Timolol/tu [Therapeutic Use]; Treatment Refusal; Visual Acuity

[The six keys of the monitoring of the glaucoma patient]. - Detry-Morel, M (Bulletin de la Societe belge d'ophtalmologie, 2010)
Treatment of glaucoma aims at preserving the visual function and the Quality of Life (QoL) of the patients. To slow down the progression of the disease, the IOP should be decreased to a level where the risk of further deterioration is reduced to a minimum. Rates of progression vary between patients. Detection of glaucoma progression should be based on the assessment of structure and function. When making a treatment plan, one should take into consideration the rate of progression and the impact of visual field deterioration on the QoL. Therefore, a careful and reliable baseline examination is crucial. Furthermore, yearly documentation of the optic disc and frequent examinations of the visual field, especially during the first two years of follow-up, are mandatory to evaluate how aggressive the treatment should be. Slowing down progression of the disease is closely related to a good communication with the patient, the quality of the information provided, and the tolerance of the medications, all keys to a good adherence. Other risk factors than IOP should be looked for and treated if possible, especially when worsening of glaucoma damage is observed despite apparently good IOP control and compliance. Modern monitoring of the glaucoma patient can be summarized in six keys. Current limitations of this approach will be briefly discussed.
Keywords: Disease Progression; Follow-Up Studies; *Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure; Patient Compliance; Patient Education as Topic; Physician-Patient Relations; Quality of Life; Risk Factors; Trabeculectomy; Visual Field Tests

[Litigation in ophthalmology: analysis of possible triggers]. - Santos, Wellington; Solari, Helena Parente; Ventura, Marcelo Palis (Arquivos brasileiros de oftalmologia, 2010)
PURPOSE: To analyze the possible predisposing factors of lawsuits involving ophthalmologists., METHODS: Retrospective study of 70 lawsuits involving the practice of Ophthalmology. The patient's gender, age, medical and ophthalmic history were reviewed. The eye disorder that generated the prosecution, the pre-existing ophthalmic diagnosis, the preoperative exams and the operating room data were also analyzed. The informed consent form, the outcome of the litigation and the value of compensation were recorded., RESULTS: Blindness was reported in 45 (64.3%) of the 70 lawsuits and was the principal eye disorder related to litigation. The pre-existing eye diseases associated with legal claims were: cataracts in 46 (65.7%) lawsuits, refractive errors in 12 (17.1%), ocular trauma in 8 (11.4%), glaucoma in 3 (4.3%) and retinal detachment in 1 (1.4%) lawsuit. The major surgical complications that possibly motivated the patient to sue the ophthalmologist were retinal detachment in 37 (52.8%) lawsuits, poor visual acuity after cataract surgery in 12 (17.1%), corneal disorders following refractive surgery in 8 (11.4%), endophthalmitis in 4 (5.7%), discomfort with refractive prescriptions in 4 (5.7%) and ocular atrophy in 4 (5.7%) lawsuits. Ophthalmic surgery was involved in 94.3% of the 70 prosecutions analyzed. Two or less visits to the ophthalmologist preceding the surgical or refractive event leading to legal dispute were recorded in 67.1% of the lawsuits. A pre-surgical Informed consent form was not used in 63% of the 66 surgical procedures leading to litigation. 62.9% of the lawsuits were unfavorable to the Ophthalmologist and the amount of compensation was less than R$ 50,000 in 72.7% of these legal claims., CONCLUSIONS: Blindness, surgery, retinal detachment, few pre-operative ophthalmic visits and the lack of informed consent forms were possible risk factors associated with lawsuits in the field of Ophthalmology.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Brazil; Child; Child, Preschool; Female; Humans; Infant; Male; *Malpractice/lj [Legislation & Jurisprudence]; Malpractice/sn [Statistics & Numerical Data]; Medical Errors/lj [Legislation & Jurisprudence]; Middle Aged; *Ophthalmologic Surgical Procedures/lj [Legislation & Jurisprudence]; *Ophthalmology/lj [Legislation & Jurisprudence]; Patient Satisfaction; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome; Visual Acuity/ph [Physiology]

Barriers perceived by UK-based community optometrists to the detection of primary open angle glaucoma. - Myint, Joy; Edgar, David F; Kotecha, Aachal; Murdoch, Ian E; Lawrenson, John G (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2010)
PURPOSE: This paper aims to identify the barriers to case-finding for primary open angle glaucoma (POAG) as perceived by community optometrists in the United Kingdom (UK)., METHODS: An anonymous, online survey to investigate the current mode of optometric practice for the detection of POAG was developed. The survey included a free-text question relating to barriers to case-finding for the disease. Optometrists on the Association of Optometrists (AOP) electronic database were invited to participate. The survey was open for 16 weeks between April and July 2008., RESULTS: A total of 1680 responses was received to the survey, of which 1293 (77%) answered the free-text question relating to perceived barriers. Eighty-eight per cent of these reported one or more barriers to the detection of glaucoma in the community, most commonly: time constraints limiting the options for repeat testing and lack of financial remuneration to perform the additional tests required. Barriers were less frequently reported in Scotland, with 23.4% of optometrists reporting no barriers compared to only 12% in England, 6% in Northern Ireland and 4% in Wales., CONCLUSION: In general, UK optometrists believed that their ability to detect POAG in the community is hampered by time and financial constraints. However, barriers were significantly fewer in Scotland, where optometrists have different contractual terms of service with the NHS than their counterparts in the rest of the UK. Copyright © 2010 The Authors. Ophthalmic and Physiological Optics © 2010 The College of Optometrists.
Keywords: *Attitude of Health Personnel; *Community Health Services/og [Organization & Administration]; Delivery of Health Care/og [Organization & Administration]; Diagnostic Techniques, Ophthalmological/is [Instrumentation]; *Glaucoma, Open-Angle/di [Diagnosis]; Health Care Surveys; Humans; Optometry/ec [Economics]; *Optometry/st [Standards]; Professional Practice/sn [Statistics & Numerical Data]; Time Factors; United Kingdom

[The secret of red eyes]. - Zemba, M; Enache, Veronica; Manole, Camelia; Cucu, B; Furedi, G; Halmaci, Viorica (Oftalmologia (Bucharest, Romania : 1990), 2010)
"Red eye" is a sign and the same time a symptom frequently met in the ophthalmological practice. The "red eye" is not always the clinical manifestation of a common conjunctivitis. We will present a case report of a patient who accused conjunctival hyperemia, lacrimation, foreign--body sensation; she was also describing recurrent conjunctivitis for the past year. After an detailed ophthalmologic examination and interdisciplinary consultations. She was diagnosed with Basedow Disease and paraselar meningioma with invasion in the pterigoid fossa. The authors are suggesting that there is an indirect left carotid - cavernous fistula.
Keywords: *Carotid-Cavernous Sinus Fistula/di [Diagnosis]; Carotid-Cavernous Sinus Fistula/et [Etiology]; Carotid-Cavernous Sinus Fistula/th [Therapy]; *Conjunctival Diseases/di [Diagnosis]; Conjunctival Diseases/et [Etiology]; Conjunctival Diseases/th [Therapy]; Diagnosis, Differential; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/et [Etiology]; Glaucoma, Open-Angle/th [Therapy]; Graves Disease/co [Complications]; Humans; *Meningeal Neoplasms/di [Diagnosis]; Meningeal Neoplasms/th [Therapy]; *Meningioma/di [Diagnosis]; Meningioma/th [Therapy]; Middle Aged; *Sella Turcica/pa [Pathology]; Treatment Refusal

Observational study of patients switched to the fixed travoprost 0.004%/timolol 0.5% combination in Croatia. - Mandic, Z; Novak-Laus, K; Bojic, L; Popovic-Suic, S; Maricic-Dosen, V; Pelcic, G; Dobutovic, D; Biuk, D; Kovacic, Z; Pavan, J (Methods and findings in experimental and clinical pharmacology, 2010)
The purpose of this study was to assess both the benefits of a 3-month travoprost 0.004%/timolol 0.5%fixed combination (trav/tim) regimen in comparison with previous medications for the control of intraocular pressure (IOP) and the tolerability of these drug regimens in glaucoma patients. An observational, non-interventional, open-label study of 406 eyes with primary open angle glaucoma and ocular hypertension was thus undertaken. One drop of trav/tim fixed combination was administered in the evening for 3 months. Patients were divided into five groups according to previous drug regimens: timolol 0.5% monotherapy; betaxolol 0.5% monotherapy; latanoprost 0.005% monotherapy; travoprost 0.004% monotherapy; and dorzolamide 2%/timolol 0.5% fixed combination. Upon medication substitution, the trav/tim fixed combination provided better IOP control and tolerability in all five patient groups. At the 3-month follow up, the mean IOP changes from previous therapy were as follows: 5.2 +/- 2.7 mmHg (20.8% change) in timolol 0.5% group; 5.7 +/- 2.2 mmHg (22.5% change) in betaxolol 0.5% group; 3.8 +/- 2.6 mmHg (24.5% change) in latanoprost 0.005% group; 4.4 +/- 2.8 mmHg (20% change) in travoprost 0.004% group; and 3.4 +/- 4.1 mmHg (14.5% change) in dorzolamide 2%/timolol 0.5% fixed combination group. The difference between baseline and trav/tim combination patient satisfaction at the 3-month follow-up was significant. Thus, the trav/tim fixed combination provided better IOP control and tolerability than previous mono- or polytherapies. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Croatia; Drug Therapy, Combination; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Patient Satisfaction; Prospective Studies; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Travoprost; Treatment Outcome

[Ocular intolerance to antiglaucoma medications is underestimated]. - Bresson-Dumont, H (Bulletin de la Societe belge d'ophtalmologie, 2010)
Since about 20 years, the large panel of the antiglaucoma eyedrops has drastically changed the management of glaucoma. Indications for filtering surgery had decreased in frequency. A great number of patients are controlled only by medications. However ocular intolerance and side effects have been reported until in 50% of the cases with 10% of severe manifestations of intolerance. Ocular side effects to topical medications may very often alter compliance. Ocular intolerance had been shown to be secondary to immunological mechanisms and direct or indirect toxicity. The immunological or allergic mechanisms are induced by a type I or IV hypersensibility and only represent 3% to 10% of all the side effects induced by topical medications. Toxic effect can be a direct through different mechanisms: pure toxic effect, acid pH, osmolarity of the solution, photosensibilisation. This will induce inflammatory reaction that will produce fibrosis in the long term. This toxic effect can be worsened by eye dryness or rosacea. Toxicity can also be indirect through an alteration of the conjunctival microbial flora and/or the lacrymal secretion. Concomitant obstruction of the lacrymal ducts may also contribute to this effect. These mechanisms could have been elucidated thank to histological studies from conjunctival mark, and more recently with confocal HRT, which gives an analysis of the ocular surface in vivo. Appropriate and early detection of intolerance to antiglaucoma medications is mandatory to adjust management strategies accordingly. These are based on the suppression or the reduction of conservative agents whenever possible, the use of fixed combinations, the reduction of the number of the instillations and the associated treatment of the ocular surface.
Keywords: Administration, Topical; *Antihypertensive Agents/ae [Adverse Effects]; Conjunctivitis/ci [Chemically Induced]; *Drug Hypersensitivity/et [Etiology]; Fibrosis/ci [Chemically Induced]; *Glaucoma/dt [Drug Therapy]; Humans; Inflammation/ci [Chemically Induced]; *Ophthalmic Solutions/ae [Adverse Effects]

Glaucoma among patients enrolled in a national vision care plan. - Soroka, Mort; Krumholz, David M; Wende, Joseph (Optometry (St. Louis, Mo.), 2010)
BACKGROUND: Glaucoma is one of the leading causes of impaired vision and blindness in the United States. An understanding of the disease process and its risk factors by patients is essential if its consequences are to be mitigated. Among the known risk factors, family history is one that can help promote awareness for early recognition and treatment among potential patients. This study reports on the responses to a questionnaire by glaucoma patients on their use of vision care, their understanding of their disease, and whether they shared their medical history with other family members., METHODS: A survey was mailed to members of a national vision care benefits plan who received an eye examination with a diagnosis of glaucoma. Patients were identified by diagnosis through the managed care organization's management information system. A survey instrument was designed to determine family history, use of vision care, medications used, and basic knowledge of glaucoma., RESULTS: One hundred forty-eight surveys were returned; two thirds were from glaucoma patients and one third from glaucoma suspects. The frequency of eye examinations and the reason for their most recent examination differed between the 2 groups. Most glaucoma patients informed relatives of their condition. As expected, glaucoma patients were better educated than the glaucoma suspect group; however, knowledge of the disease process and its consequences was lacking even among those who were taking glaucoma medication., CONCLUSIONS: Some glaucoma patients appear to be unaware as to how glaucoma affects their vision. Understanding one's disease can enhance patient compliance and ensure that the patient returns for continued treatment and management. Patients with poor health literacy (especially with a disease with an asymptomatic beginning stage) are at a higher risk for noncompliance. Copyright © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; Family Health; Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; *Glaucoma/pc [Prevention & Control]; *Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Risk Factors; United States/ep [Epidemiology]

Cost-effectiveness of monitoring glaucoma patients in shared care: an economic evaluation alongside a randomized controlled trial. - Holtzer-Goor, Kim M; van Sprundel, Esther; Lemij, Hans G; Plochg, Thomas; Klazinga, Niek S; Koopmanschap, Marc A (BMC health services research, 2010)
BACKGROUND: Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU) rather than by glaucoma specialists, the specialists' workload and waiting lists might be reduced. We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH) in a 30-month randomized clinical trial. Because quality of care turned out to be similar, we focus here on the costs., METHODS: Stable glaucoma patients were randomized between the GFU and the glaucoma specialist group. Costs per patient year were calculated from four perspectives: those of patients, the Rotterdam Eye Hospital (REH), Dutch healthcare system, and society. The outcome measures were: compliance to the protocol; patient satisfaction; stability according to the practitioner; mean difference in IOP; results of the examinations; and number of treatment changes., RESULTS: Baseline characteristics (such as age, intraocular pressure and target pressure) were comparable between the GFU group (n = 410) and the glaucoma specialist group (n = 405). Despite a higher number of visits per year, mean hospital costs per patient year were lower in the GFU group (139 vs. 161). Patients' time and travel costs were similar. Healthcare costs were significantly lower for the GFU group (230 vs. 251), as were societal costs (310 vs. 339) (p < 0.01). Bootstrap-, sensitivity- and scenario-analyses showed that the costs were robust when varying hospital policy and the duration of visits and tests., CONCLUSION: We conclude that this GFU is cost-effective and deserves to be considered for implementation in other hospitals.
Keywords: Aged; Appointments and Schedules; Cost of Illness; Cost-Benefit Analysis; Female; Follow-Up Studies; Glaucoma/ec [Economics]; *Glaucoma/th [Therapy]; Health Care Costs; *Hospitals, Special/ec [Economics]; Humans; Intraocular Pressure; Male; Middle Aged; Netherlands; *Ophthalmology/ec [Economics]; *Optometry/ec [Economics]; Patient Satisfaction; *Quality of Health Care/st [Standards]; Referral and Consultation/ec [Economics]; Travel; Workforce; Workload

Glaucoma expert patient programme and ocular hypotensive treatment. - Amro, Raed; Cox, Carol L; Waddington, Kathryn; Siriwardena, Dilani (British journal of nursing (Mark Allen Publishing), 2010)
Expert patient programmes (EPPs) are becoming an increasingly important aspect of chronic disease management, resulting in improved health outcomes for patients. Patients with chronic open angle glaucoma (COAG) require lifelong therapy. However, to date, no EPPs have been designed specifically for patients with chronic eye conditions like COAG. This article describes the development and implementation of the Glaucoma Expert Patient Programme (GEPP), a glaucoma-specific educational self-management programme which aims to improve glaucoma patients' knowledge, self-management skills, expectations and adherence to treatment. A review of theoretical frameworks and models which underpin the design, use and conduct of EPPs was undertaken, and the GEPP was designed based on the model by Kate Lorig (2003). The result is an educational programme which offers COAG patients a different perspective on their condition and supports them with knowledge, skills and strategies to better manage their condition on a daily basis.
Keywords: Chronic Disease; Disease Management; *Glaucoma, Open-Angle/pc [Prevention & Control]; Glaucoma, Open-Angle/px [Psychology]; Health Behavior; Humans; Models, Educational; Models, Organizational; Motivation; Patient Compliance; *Patient Education as Topic/og [Organization & Administration]; Patient Participation; Peer Group; Program Development; Self Care/mt [Methods]; Self Care/px [Psychology]; *Self-Help Groups/og [Organization & Administration]

[Clinical investigation of medication adherence of glaucoma patients]. - Wu, Hong-yan; Yin, Jin-fu ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2010)
OBJECTIVE: To investigate the medication adherence and modulation factors of medication adherence in long-term treated glaucoma patients., METHODS: It was a cross-sectional study. One hundred glaucoma patients who have been followed-up for more than 6 month in the Second Hospital affiliated to Medical College of Zhejiang University were investigated with questionnaires and interview. The data was analyzed by binary logistic regression and chi(2) test., RESULTS: In the 100 glaucoma patients being investigated, the medication compliance of patients is 61(61.0%), the medication non-compliance of patients is 39 (39.0%). Age, gender, habitat, glaucoma types, surgical history, ingesting patient before writing out a prescription and informing them the methods for application of eyedrops were not significantly co-related with medication adherence (chi(2) = 0.718, 0.537, 0.338, 3.797, 0.338, 0.297, 0.157; P > 0.05). Intraocular pressure before treatment, types of eyedrops, instillation of eye-drops to the eyelids, request for help during application of eyedrops, rechecking regularly and confidence in glaucoma treatment were found significantly related to medication adherence (P = 0.013, 0.005, 0.005, 0.012, 0.011, 0.004). However, drug side effect, forgetting application of eyedrops and inconvenience to see a doctor was considered the most important factors by patients in the interview., CONCLUSIONS: Glaucoma physicians should discuss with patients about the methods for the application of glaucoma medication. This can improve the medication adherence of glaucoma patients and promote the therapeutic effect.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Humans; Male; *Medication Adherence; Middle Aged; *Patient Compliance; Surveys and Questionnaires; Young Adult

Improving care of chronic open angle glaucoma. - Watkinson, Sue (Nursing older people, 2010)
This article focuses on the nursing care and management of older people with chronic open angle glaucoma (COAG). It provides an overview of the condition, its pathogenesis, clinical features, aetiology, diagnosis and approaches to care and treatment. Patient education and promotion of adherence to medical therapy are paramount in establishing the confidence and independence required for the long-term self-management of COAG because the majority of older people with this condition are based in the community.
Keywords: Chronic Disease; Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/nu [Nursing]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Monitoring, Physiologic; Patient Education as Topic; Risk Factors; United Kingdom/ep [Epidemiology]

Oestrus ovis ophthalmomyiasis with keratitis. - Sreejith, R S; Reddy, A K; Ganeshpuri, S S; Garg, P (Indian journal of medical microbiology, 2010)
A 35-year-old male patient presented with complaints of redness, swelling around the eyelids, watering, and irritation in the right eye. At presentation his best-corrected visual acuity was 20/20 partial in the right eye. The tarsal conjunctiva of the upper eyelid showed injection with pseudomembrane. Underneath the pseudomembrane we noticed four motile larvae. The cornea showed an irregular cobweb-like mucous plaque adherent to the epithelium, with a clear stroma. The pseudomembrane was easily peeled-off under topical anaesthesia. The organisms were removed and identified as Oestrus ovis. Three days later the patient was comfortable and his visual acuity was 20/20 in the right eye.
Keywords: Adult; Animals; *Conjunctivitis/ps [Parasitology]; Conjunctivitis/pa [Pathology]; Diptera/gd [Growth & Development]; *Diptera; *Eye Infections, Parasitic/ps [Parasitology]; Eye Infections, Parasitic/pa [Pathology]; Humans; *Keratitis/ps [Parasitology]; Keratitis/pa [Pathology]; Larva; Male; *Myiasis/ps [Parasitology]; Myiasis/pa [Pathology]

Patient compliance during contact lens wear: perceptions, awareness, and behavior. - Bui, Thai H; Cavanagh, H Dwight; Robertson, Danielle M (Eye & contact lens, 2010)
OBJECTIVES: Patient noncompliance with recommended hygienic practices in contact lens wear is often considered a significant risk factor for microbial keratitis and adverse contact lens-related events. Despite advancements in lens materials and care solutions, noncompliant behavior continues to hinder efforts to maximize contact lens safety. The objective of this pilot study was to assess the relationship between perceived and actual compliance with awareness of risk and behavior., METHODS: One hundred sixty-two established contact lens wearers were sequentially evaluated after their routine contact lens examination at the Optometry Clinic at the University of Texas Southwestern Medical Center at Dallas, TX. Each patient was questioned by a single trained interviewer regarding his or her lens care practices and knowledge of risk factors associated with lens wear., RESULTS: Eighty-six percent of patients believed they were compliant with lens wear and care practices; 14% identified themselves as noncompliant. Using a scoring model, 32% demonstrated good compliance, 44% exhibited average compliance, and 24% were noncompliant; age was a significant factor (P = 0.020). Only 34% of patients who perceived themselves as compliant exhibited a good level of compliance (P<0.001). Eighty percent of patients reported an awareness of risk factors, but awareness did not influence negative behavior. Replacing the lens case was the only behavior associated with a positive history for having experienced a prior contact lens-related complication (P = 0.002)., CONCLUSIONS: Perceived compliance is not an indicator for appropriate patient behavior. A large proportion of patients remain noncompliant despite awareness of risk. Education alone is not a sufficient strategy to improve behavior; newer approaches aimed at improving compliance with lens care practices are urgently needed.
Keywords: Adolescent; Adult; Aged; Contact Lens Solutions; Contact Lenses/ae [Adverse Effects]; *Contact Lenses; Female; *Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Male; Middle Aged; *Patient Compliance; Risk Factors; Self-Assessment; Young Adult

Nanotechnology in ophthalmology. - Zarbin, Marco A; Montemagno, Carlo; Leary, James F; Ritch, Robert (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2010)
Nanotechnology involves the creation and use of materials and devices at the size scale of intracellular structures and molecules, and involves systems and constructs in the order of <100 nm. The aim of nanomedicine is the comprehensive monitoring, control, construction, repair, defence, and improvement of human biological systems at the molecular level, using engineered nanodevices and nanostructures that operate massively in parallel at the single-cell level, ultimately to achieve medical benefit. In this review we consider general principles of nanotechnology as applied to nanomedicine (e.g., biomimicry and pseudointelligence). Some applications of nanotechnology to ophthalmology are described (including treatment of oxidative stress; measurement of intraocular pressure; theragnostics; use of nanoparticles to treat choroidal new vessels, prevent scarring after glaucoma surgery, and treat retinal degenerative disease with gene therapy; prosthetics; and regenerative nanomedicine). Nanotechnology will revolutionize our approach to current therapeutic challenges (e.g., drug delivery, postoperative scarring) and will enable us to address currently unsolvable problems (e.g., sight-restoring therapy for patients with retinal degenerative disease). Obstacles to the incorporation of nanotechnology remain, such as safe manufacturing techniques and unintended biological consequences of nanomaterial use. These obstacles are not insurmountable, and revolutionary treatments for ophthalmic diseases are expected to result from this burgeoning field.
Keywords: Humans; Nanomedicine; Nanostructures; *Nanotechnology; *Ophthalmology; Regenerative Medicine

Brinzolamide 1%/timolol 0.5%: safety and efficacy of a new fixed-combination IOP-lowering product for glaucoma. - Januleviciene, Ingrida (Current medical research and opinion, 2010)
OBJECTIVE: To provide a commentary on recent studies with the new IOP-lowering fixed-combination product brinzolamide 1%/timolol 0.5%., METHODS: Medline was searched for brinzolamide/timolol fixed-combination clinical literature (up to May 18, 2010) and the current comprehensive brinzolamide/timolol literature was reviewed., RESULTS: Compared with another carbonic anhydrase inhibitor-containing product, dorzolamide 2%/timolol 0.5%, brinzolamide/timolol has similar IOP-lowering efficacy. Brinzolamide/timolol also produces superior comfort ratings as assessed by patients who have tried both drugs - this may be explained by the more physiologic pH of brinzolamide/timolol. A recent study reported that brinzolamide/timolol was preferred over dorzolamide/timolol at a ratio of nearly 4:1 among those expressing a preference., CONCLUSION: These results demonstrate that brinzolamide/timolol is equally effective and more comfortable than dorzolamide/timolol, a fact that may positively impact patient adherence, leading to an increased likelihood of reaching target IOP goals.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/pd [Pharmacology]; *Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/pd [Pharmacology]; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; *Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; Sulfonamides/pd [Pharmacology]; *Thiazines/ad [Administration & Dosage]; Thiazines/ae [Adverse Effects]; Thiazines/pd [Pharmacology]; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Timolol/pd [Pharmacology]; Treatment Outcome

Prevalence and causes of blindness, low vision and status of cataract in 50 years and older citizen of Qatar-a community based survey. - Al Gamra, Hamad; Al Mansouri, Fatima; Khandekar, Rajiv; Elshafei, Maha; Al Qahtani, Omar; Singh, Rajvir; Hashim, Shakeel P; Mujahed, Amjad; Makled, Alaa; Pai, Anant (Ophthalmic epidemiology, 2010)
BACKGROUND: Rapid Assessment for the Avoidable Blindness (RAAB) was conducted in Qatar during 2009. We present the prevalence and determinants of visual disabilities and status of cataract among citizens aged 50 years and older., METHODS: Residents of randomly selected houses and clusters participated in the survey. Opticians noted the presenting and the best corrected vision of participants from 49 clusters. Ophthalmologists examined participants with additional instruments like bio-microscope, digital camera, auto-perimeter and auto-refractor in a mobile van. World Health Organization recommended principal cause of blindness (Visual acuity [VA] < 3/60 in better eye), Severe visual impairment (SVI) (<6/60), low vision (VA < 6/18) and unilateral blindness (VA < 3/60) were designated. Persons with VA < 6/18 and cataract were interviewed to calculate coverage and barriers for cataract surgeries. Age sex adjusted prevalence of visual disabilities and their 95% Confidence Intervals (CI) were estimated., RESULTS: We examined 2,433 (97.3%) participants. The age sex adjusted prevalence of bilateral blindness was 1.28% [95% CI 1.22-1.35], SVI (1.67%), low vision (3.66%) and unilateral blindness (3.61%) in 50 years and older population. Female and older age groups were significant risk factors of visual disabilities. Cataract and glaucoma were the main causes of visual disabilities. The coverage of cataract services was 68.2%. Believing that cataract as an aging process (25) and adequate vision in the fellow eye (15) were the reasons for delay in surgery., CONCLUSIONS: To reduce avoidable blindness, un-operated cataract should be addressed. Primary and secondary eye care systems should be strengthened to improve the care of blinding eye diseases in Qatar.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; *Cataract/ep [Epidemiology]; Disability Evaluation; Female; Health Surveys; Humans; Male; Middle Aged; Prevalence; Qatar/ep [Epidemiology]; Risk Factors; *Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]; Visual Acuity/ph [Physiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Efficacy of hydroxypropyl cellulose ophthalmic inserts (LACRISERT) in subsets of patients with dry eye syndrome: findings from a patient registry. - Luchs, Jodi I; Nelinson, Donald S; Macy, Jonathan I; LAC-07-01 Study Group (Cornea, 2010)
PURPOSE: To determine acceptability and efficacy of hydroxypropyl cellulose ophthalmic inserts in patients with dry eye syndrome (DES) and additional comorbidities., DESIGN: A multicenter, 2-visit, open-label, 4-week registry study., PARTICIPANTS: Five hundred twenty patients were recruited to the intent-to-treat group. Four hundred eighteen patients completed the study including 86 contact lens wearers, 79 with cataract diagnosis, 52 with prior cataract surgery, 22 with prior laser-assisted in situ keratomileusis, and 15 with glaucoma., METHODS: Patient questionnaires were completed at baseline and after 4 weeks of treatment to assess mean change in severity of DES symptoms, ocular surface disease index (OSDI) scores, frequency of occurrence of DES symptoms, occurrence of difficulty when performing activities of daily living (ADLs), and frequency of discomfort in various environmental conditions. Mean change was measured from visit 1 to visit 2., MAIN OUTCOME MEASURES: Symptoms, OSDI scores, and measure of degree of difficulty when performing ADLs., RESULTS: Four hundred eighteen patients completed the study. Compared with baseline, this population of patients demonstrated statistically significant improvements in mean OSDI scores (P = 0.0215) and symptoms of discomfort, burning, dryness, grittiness, stinging, and light sensitivity (P < 0.05). Mean improvement in OSDI scores of patients in the 5 identified subsets of patients with comorbid conditions were significant for patients using contact lenses (P < 0.025), who had undergone prior cataract surgery (P < 0.04), and with prior laser-assisted in situ keratomileusis surgery (P < 0.05). Patients diagnosed with cataracts or glaucoma did not show significant changes in any measures in this study. Patients with DES and comorbid conditions experienced relief of symptoms and benefit to ADLs and quality of life similar to patients without comorbid conditions., CONCLUSIONS: In subsets of patients with moderate to severe DES and comorbid conditions, hydroxypropyl cellulose ophthalmic inserts improve the symptoms of DES, ability to perform ADLs, and quality of life. The reported benefits may be additive to those seen with patients' existing therapies.
Keywords: *Activities of Daily Living; Cataract/co [Complications]; Cellulose/ad [Administration & Dosage]; *Cellulose/aa [Analogs & Derivatives]; Contact Lenses/sn [Statistics & Numerical Data]; Drug Implants; *Dry Eye Syndromes/dt [Drug Therapy]; Dry Eye Syndromes/pp [Physiopathology]; Female; Glaucoma/co [Complications]; Humans; Keratomileusis, Laser In Situ; Male; Middle Aged; Patient Compliance; *Quality of Life; Registries; Surveys and Questionnaires; Tears/ph [Physiology]; Treatment Outcome

[Preservatives in eye drops: toward awareness of their toxicity]. - Vaede, D; Baudouin, C; Warnet, J-M; Brignole-Baudouin, F (Journal francais d'ophtalmologie, 2010)
Preservatives are present in numerous multidose eyedrops and provide the sterility of the solution against bacteria and fungi. However, numerous studies have shown their toxicity for the ocular surface, particularly in long-term treatments. The most widely used preservative in eyedrops is benzalkonium chloride. This quaternary ammonium acts as a detergent, antiseptic, disinfectant, fungicide, bactericide, and spermicide. Its use on the ocular surface therefore has significant consequences. Indeed, the preservatives are pro-apoptotic, pro-inflammatory and they cause the dissolution of the lachrymal film. The prolonged administration of one or several eye drops containing preservatives induces changes in the superficial structures (conjunctiva, cornea) as well as in deeper structures (trabecula, lens). The least severe symptoms are irritation and discomfort, including sensation of a foreign body, itching, or burning sensations. However, more severe side effects have been described, such as chronic inflammation of variable intensity or the progressive development of fibrosis with higher risk of failure after glaucoma filtering surgery. Ideally, preservative-free eyedrops should be recommended, or at least a reduction of the number of instilled preserved eyedrops should be considered. All these strategies could increase patient comfort, quality of life, and compliance, with better outcome at the time of filtering surgery. Copyright © 2010 Elsevier Masson SAS. All rights reserved.
Keywords: Animals; Eye Diseases/ci [Chemically Induced]; Humans; *Ophthalmic Solutions; *Preservatives, Pharmaceutical/to [Toxicity]

Preliminary survey of educational support for patients prescribed ocular hypotensive therapy. - Gray, T A; Fenerty, C; Harper, R; Lee, A; Spencer, A F; Campbell, M; Henson, D B; Waterman, H (Eye (London, England), 2010)
PURPOSE: to establish the impact of educational support on patients' knowledge of glaucoma and adherence, in preparation for an intervention study., METHODS: structured observation encapsulated the educational support provided during clinical consultations and patient interviews captured the depth of glaucoma knowledge, problems associated with glaucoma therapy, and adherence issues., RESULTS: one hundred and thirty-eight patients completed the study. Education was didactic in nature, limited for many patients and inconsistent across clinics. Patients showed generally poor knowledge of glaucoma with a median score of 6 (range 0-16). A significant association was found between educational support and knowledge for newly prescribed patients (Kendall's tau=0.30, P=0.003), but no association was found for follow-up patients (Kendall's tau=0.11, P=0.174). Only five (6%) patients admitted to a doctor that they did not adhere to their drop regimen, yet 75 (94%) reported at interview that they missed drops., CONCLUSIONS: although important, knowledge alone may not sufficiently improve adherence: a patient-centred approach based on ongoing support according to need may provide a more effective solution for this patient group.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Humans; Male; *Medication Adherence; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ocular Hypertension; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Education as Topic/st [Standards]

Applications of nanoparticles in ophthalmology. - Diebold, Yolanda; Calonge, Margarita (Progress in retinal and eye research, 2010)
Nanocarriers, such as nanoparticles, have the capacity to deliver ocular drugs to specific target sites and hold promise to revolutionize the therapy of many eye diseases. Results to date strongly suggest that ocular medicine will benefit enormously from the use of this nanometric scale technology. One of the most important handicaps of the eye as a target organ for drugs is the presence of several barriers that impede direct and systemic drug access to the specific site of action. Superficial barriers include the ocular surface epithelium and the tear film, and internal barriers include the blood-aqueous and blood-retina barriers. Topical application is the preferred route for most drugs, even when the target tissues are at the back part of the eye where intraocular injections are currently the most common route of administration. Direct administration using any of these two routes faces many problems related to drug bioavailability, including side effects and repeated uncomfortable treatments to achieve therapeutic drug levels. In this regard, the advantages of using nanoparticles include improved topical passage of large, poorly water-soluble molecules such as glucocorticoid drugs or cyclosporine for immune-related, vision-threatening diseases. Other large and unstable molecules, such as nucleic acids, delivered using nanoparticles offer promising results for gene transfer therapy in severe retinal diseases. Also, nanoparticle-mediated drug delivery increases the contact time of the administered drug with its target tissue, such as in the case of brimonidine, one of the standard treatments for glaucoma, or corticosteroids used to treat autoimmune uveitis, a severe intraocular inflammatory process. In addition, nanocarriers permit the non-steroidal anti-inflammatory drug indomethacin to reach inner eye structures using the transmucosal route. Finally, nanoparticles allow the possibility of targeted delivery to reach specific types of cancer, such as melanoma, leaving normal cells untouched. This review summarizes experimental results from our group and others since the beginnings of nanocarrier technology to deliver drugs to different locations in the eye. Also, it explores the future possibilities of nanoparticles not only as drug delivery systems but also as aides for diagnostic purposes. Copyright © 2010 Elsevier Ltd. All rights reserved.
Keywords: Animals; Drug Delivery Systems/mt [Methods]; Humans; Nanoparticles/sn [Statistics & Numerical Data]; *Nanoparticles/tu [Therapeutic Use]; *Ophthalmology; *Retinal Diseases/th [Therapy]

Long-term effect of latanoprost/timolol fixed combination in patients with glaucoma or ocular hypertension: a prospective, observational, noninterventional study. - Schwenn, Oliver; Heckmann, Barbara; Guzy, Claudia; Miller, Paul J (BMC ophthalmology, 2010)
BACKGROUND: Prospective, observational studies that enroll large numbers of patients with few exclusion criteria may better reflect actual ongoing clinical experience than randomized clinical trials. Our purpose was to obtain efficacy and safety information from a cohort of subjects exposed to latanoprost/timolol fixed combination (FC) for >=18 months using a prospective, observational design., METHODS: In all, 577 office-based ophthalmologists in Germany switched 2339 patients with glaucoma or ocular hypertension to latanoprost/timolol FC for medical reasons. Follow-up visits were scheduled for every 6 months over 24 months; physicians followed usual care routines. Intraocular pressure (IOP), visual field status, optic nerve head findings, and adverse events were recorded. Efficacy parameters were evaluated for the per protocol (PP) population; the safety population included subjects receiving >=1 drop of FC. Physicians rated efficacy, tolerability, and subject compliance at month 24., RESULTS: Of the 2339 subjects switched to latanoprost/timolol FC (safety population), the primary reasons for switching were inadequate IOP reduction (78.2%) and desire to simplify treatment with once-daily dosing (29.4%; multiple reasons possible). In all, 1317 (56.3%) subjects completed the study, and 1028 (44.0%) were included in the PP population. Most discontinuations were due to loss to follow-up. Change in mean IOP from baseline to month 6 was -4.0 +/- 4.31 mmHg, a reduction that was maintained throughout (P < 0.05 for change at all time points). By investigator assessments, optic disc parameters and visual field were stable over 24 months, and there was no relationship between IOP reduction over 24 months and development of a visual field defect. More than 90% of physicians rated latanoprost/timolol FC as "very good" or "good" for efficacy (PP population), tolerability, and compliance. The FC was safe and well tolerated. No change in iris color was reported by most subjects (83.1%) at month 24., CONCLUSIONS: Over 24 months, latanoprost/timolol FC effectively lowers IOP levels and is well tolerated in patients with glaucoma or ocular hypertension who change from their previous ocular hypotensive therapy for medical reasons. Investigator assessments found optic disc parameters and visual field to be stable throughout 24 months of follow-up.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Child; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Prospective Studies; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Time Factors; *Timolol/ad [Administration & Dosage]; Treatment Outcome; Visual Fields/de [Drug Effects]; Young Adult

A Canadian population-based study of vision problems: assessing the significance of socioeconomic status. - Perruccio, Anthony V; Badley, Elizabeth M; Trope, Graham E (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2010)
OBJECTIVE: To examine the relationship between age, gender, socioeconomic status, and 3 chronic conditions (glaucoma, cataracts, and diabetes) and corrected and uncorrected vision problems, and to document the prevalence of visual problems in Canada across the adult age range., DESIGN: Cross-sectional, representative, population-based study., PARTICIPANTS: Health survey respondents (n = 113 212, aged <=20 years)., METHODS: Data are from a 2000-2001 Canadian health survey. Self-reported data included sociodemographic/economic characteristics, vision problems, eye care professional consultations, and medical conditions. Prevalence estimates were calculated; multinomial logistic regression examined the relationship between indicated variables and vision problems, generally and by type., RESULTS: Fifty-seven percent of adults reported some form of vision problem, the majority corrected by lenses. Blindness was reported by 0.09% of adults. Increasing age, being female, and having a low income and lower educational attainment were significantly associated with reported vision problems. However, age and gender were not significant determinants of the type of vision problem. Cataracts, diabetes, and glaucoma in particular, were significantly associated with reported vision problems., CONCLUSIONS: Socioeconomic characteristics may underscore the socioeconomic burden of visual impairments in the population and highlight obstacles to eye service utilization among subgroups. This information is essential to establishing the need for treatment and management services, developing targeted screening programmes, and identifying priority areas of research.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Canada/ep [Epidemiology]; Cross-Sectional Studies; *Educational Status; Female; Health Surveys; Humans; *Income/sn [Statistics & Numerical Data]; Male; Middle Aged; Prevalence; Sex Distribution; Social Class; *Vision Disorders/ep [Epidemiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]; Young Adult

Use of glaucoma medications: state of the science and directions for observational research. - Lu, Vicky H; Goldberg, Ivan; Lu, Christine Y (American journal of ophthalmology, 2010)
PURPOSE: To summarize observational studies that focus on the use of glaucoma medications and to identify gaps in knowledge to guide future investigation., DESIGN: Literature study., METHODS: We searched the electronic databases MEDLINE, EMBASE, and PubMed for English language articles published through December 2009 using the search terms physician's practice patterns, drug prescriptions, pharmaceutical services, medication adherence, ophthalmology, glaucoma, and ophthalmic solutions. We categorized studies by areas of focus and extracted and summarized key features: study population, data sources, and main findings., RESULTS: We identified 2224 articles by the search. Fifty-five described glaucoma medication use using large databases. Predominant areas of focus were: trends in prescription choices (n = 13); adherence, persistence, or both (n = 31); rational use of medications (n = 9); and policy-related issues (n = 2). Over the last decade, use of beta-blockers and miotics has decreased substantially, whereas new agents, particularly prostaglandin analogs, have become more popular. Nonadherence was an issue in more than 25% of patients. A significant proportion of patients with comorbidities, contraindications, or both had received topical beta-blockers., CONCLUSIONS: To date, most studies have focused on adherence to glaucoma medications and changes in treatment choices. Major gaps in knowledge include prescribing patterns by prescriber specialty (ophthalmologists, primary care physicians, and optometrists), medication-related problems, and subsequent adverse health outcomes. Well-designed longitudinal observational studies addressing these gaps are warranted to improve patient safety. Copyright © 2010 Elsevier Inc. All rights reserved.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Databases, Factual; *Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Utilization; *Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence/sn [Statistics & Numerical Data]; *Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmology/sn [Statistics & Numerical Data]; Pharmaceutical Services/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]

Screening and managing eye disease in 2010: an Asian perspective. - Congdon, Nathan G; He, Mingguang (American journal of ophthalmology, 2010)
Keywords: Asia/ep [Epidemiology]; Cataract/di [Diagnosis]; Cataract/ep [Epidemiology]; Cataract/pc [Prevention & Control]; Delivery of Health Care; Developing Countries; Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/ep [Epidemiology]; Diabetic Retinopathy/pc [Prevention & Control]; Eye Diseases/di [Diagnosis]; Eye Diseases/ep [Epidemiology]; Eye Diseases/pc [Prevention & Control]; *Eye Diseases; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Glaucoma/pc [Prevention & Control]; Health Care Rationing; Humans; Refractive Errors/di [Diagnosis]; Refractive Errors/ep [Epidemiology]; Refractive Errors/pc [Prevention & Control]; Resource Allocation

Programs to optimize adherence in glaucoma. - Kowing, Dianne; Messer, Dawn; Slagle, Scott; Wasik, Alyon; V-POAG Study Group (Optometry (St. Louis, Mo.), 2010)
PURPOSE: This study was designed to raise awareness of the materials, devices, and Internet resources available to improve adherence to use of medications for the treatment of glaucoma and to review new devices under development., METHODS: A review of current indexed literature and Internet resources was conducted., RESULTS: A variety of educational brochures, pamphlets, and fact sheets promoting adherence to ocular hypotensive medications are available through multiple organizations and are easily accessed and ordered on the Internet. Video and Web-based patient educational tools have been designed to support patient adherence to glaucoma management plans and promote open dialogue between patients and providers. Reminder and recall systems that integrate with office software can be sent to cell phones as well as e-mails and personal digital assistant (PDAs), alerting patients to upcoming appointments and reminding them to instill their drops. Bottle devices with dosing support (timers with audible and visual signals and dispensing aids) and electronic monitoring have been shown to promote adherence. New products currently under development to improve the delivery of medications include nanoparticles, punctal plugs, and contact lenses that release glaucoma medications., CONCLUSIONS: Many educational materials, services, Internet resources, and devices are available to optometrists to encourage patient adherence to glaucoma treatment and management. Copyright Published by Elsevier Inc.
Keywords: Drug Delivery Systems; Equipment Design; *Glaucoma/dt [Drug Therapy]; Humans; Internet; Ophthalmic Solutions/ad [Administration & Dosage]; Optometry/is [Instrumentation]; Optometry/mt [Methods]; *Patient Compliance; Patient Education as Topic/mt [Methods]; Reminder Systems; Videotape Recording

Feasibility of lipid nanoparticles for ocular delivery of anti-inflammatory drugs. - Souto, Eliana B; Doktorovova, Slavomira; Gonzalez-Mira, Elisabet; Egea, Maria Antonia; Garcia, Maria Luisa (Current eye research, 2010)
Due to the multiple barriers imposed by the eye against the penetration of drugs, the ocular delivery and targeting are considered difficult to achieve. A major challenge in ocular drug therapy is to improve the poor bioavailability of topically applied ophthalmic drugs by overcoming the severe constraints imposed by the eye on drug absorption. One of the promising strategies nowadays is the use of colloidal carrier systems characterized by a submicron-meter size. Solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC) represent promising alternatives to conventional and very popular ocular carrier systems, such as the nanoemulsions, liposomes, and polymeric nanoparticles. Nevertheless, taking into account the characteristics of the eye, morphometrical properties of the colloidal systems (e.g., average particle size and polydispersion) may represent a limiting factor for topical application without induced corneal irritation, being responsible for the selected system. This review article focuses on the application of lipid nanoparticles (SLN, NLC) as carriers for both non-steroidal and steroidal anti-inflammatory drugs for the treatment of ocular inflammatory disorders. Major benefits, as well as shortcomings, of ocular inflammation conditions are described, in particular upon management of inflammation induced by ocular surgery (e.g., cataracts, refractive surgery). Particular emphasis is given to the clinical choices currently available, while examining the most recent drugs that have been approved.
Keywords: Animals; *Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage]; Biological Availability; *Drug Carriers; Eye/de [Drug Effects]; *Eye Diseases/dt [Drug Therapy]; Feasibility Studies; Humans; *Lipids; *Nanoparticles

Differentially altered Ca2+ regulation and Ca2+ permeability in Cx26 hemichannels formed by the A40V and G45E mutations that cause keratitis ichthyosis deafness syndrome. - Sanchez, Helmuth A; Mese, Gulistan; Srinivas, Miduturu; White, Thomas W; Verselis, Vytas K (The Journal of general physiology, 2010)
Mutations in GJB2, which encodes Cx26, are one of the most common causes of inherited deafness in humans. More than 100 mutations have been identified scattered throughout the Cx26 protein, most of which cause nonsyndromic sensorineural deafness. In a subset of mutations, deafness is accompanied by hyperkeratotic skin disorders, which are typically severe and sometimes fatal. Many of these syndromic deafness mutations localize to the amino-terminal and first extracellular loop (E1) domains. Here, we examined two such mutations, A40V and G45E, which are positioned near the TM1/E1 boundary and are associated with keratitis ichthyosis deafness (KID) syndrome. Both of these mutants have been reported to form hemichannels that open aberrantly, leading to "leaky" cell membranes. Here, we quantified the Ca(2+) sensitivities and examined the biophysical properties of these mutants at macroscopic and single-channel levels. We find that A40V hemichannels show significantly impaired regulation by extracellular Ca(2+), increasing the likelihood of aberrant hemichannel opening as previously suggested. However, G45E hemichannels show only modest impairment in regulation by Ca(2+) and instead exhibit a substantial increase in permeability to Ca(2+). Using cysteine substitution and examination of accessibility to thiol-modifying reagents, we demonstrate that G45, but not A40, is a pore-lining residue. Both mutants function as cell-cell channels. The data suggest that G45E and A40V are hemichannel gain-of-function mutants that produce similar phenotypes, but by different underlying mechanisms. A40V produces leaky hemichannels, whereas G45E provides a route for excessive entry of Ca(2+). These aberrant properties, alone or in combination, can severely compromise cell integrity and lead to increased cell death.
Keywords: Amino Acid Substitution/ph [Physiology]; Animals; Barium/pd [Pharmacology]; *Calcium/me [Metabolism]; Calcium/pd [Pharmacology]; Cell Line, Tumor; Chelating Agents/pd [Pharmacology]; Chloride Channels/de [Drug Effects]; Chloride Channels/ph [Physiology]; Connexin 26; Connexins/de [Drug Effects]; *Connexins/ph [Physiology]; Cysteine/ge [Genetics]; *Deafness/ge [Genetics]; Electrophysiological Phenomena/de [Drug Effects]; Electrophysiological Phenomena/ph [Physiology]; Ethylenediamines/pd [Pharmacology]; Gap Junctions/ph [Physiology]; Humans; Ion Channel Gating/de [Drug Effects]; *Ion Channel Gating/ph [Physiology]; *Keratitis/ge [Genetics]; Membrane Potentials/ph [Physiology]; Mesylates/pd [Pharmacology]; Mice; *Mutation, Missense/ph [Physiology]; Oocytes; Permeability; RNA, Messenger/ge [Genetics]; Streptomyces/ge [Genetics]; Sulfhydryl Reagents/pd [Pharmacology]; Syndrome; Transfection; Xenopus laevis

Videotaped evaluation of eyedrop instillation in glaucoma patients with visual impairment or moderate to severe visual field loss. - Hennessy, Amy L; Katz, Joanne; Covert, David; Protzko, Colleen; Robin, Alan L (Ophthalmology, 2010)
PURPOSE: Objective ly evaluate the ability of visually disabled glaucoma patients to successfully administer a single drop onto their eye., DESIGN: Prospective, observational study., PARTICIPANTS: Experienced glaucoma patients with Early Treatment of Diabetic Retinopathy Study visual acuity (VA) of <= 6/18 (<= 20/60) >= 1 eye, or moderate or severe visual field damage in >= 1 eye., METHODS: Subjects were "low vision" (20/60 <= VA <20/200) or "blind" (light perception <VA <= 20/200). They completed a survey about eyedrop use, and were video-recorded instilling 1 drop into their worst-seeing eye in their usual fashion, using a 5-ml bottle., MAIN OUTCOME MEASURES: Successful instillation of a single drop., RESULTS: Of 204 glaucoma subjects (55% female; 74% Caucasian; 89% primary open-angle glaucoma; mean age, 68.8 +/- 13.1 years), 192/204 (94%) used drops >6 months. Subjects used a mean of 1.9 +/- 1.1 bottles of intraocular pressure-lowering medications to treat their glaucoma. Seventy-six percent (155/204) of subjects had severe visual field damage, with a mean deviation of -14.5 +/- 8.0. Twenty-six percent (54/204) had acuity of <= 20/200 in >= 1 eye, and subjects had a mean logarithm of minimal angle of resolution acuity of 0.8 +/- 0.9. Seventy-one percent of subjects were able to get a drop onto the eye; only 39% instilled 1 drop onto the eye without touching the ocular surface, instilling a mean 1.4 +/- 1.0 drops, using 1.2 +/- 0.6 attempts. Of the 142 subjects who denied touching the bottle to the ocular surface, 24% did touch the bottle to the eye. Multiple factors were tested for ability to predict successful application of an eyedrop; however, only age (< 70 vs >= 70 years) was found to be a significant predictor for less successful instillation., CONCLUSIONS: In this video analysis of visually impaired glaucoma patients, we evaluated the difficulty this population has instilling eyedrops, most important, the use of multiple drops per instillation, potential contamination of a chronically used bottle, and poor patient understanding of the situation. Ability to self-administer eyedrops and cost considerations of wasted drops must be thought out before institution of glaucoma therapy. Efforts to determine better methods of eyedrop administration need to be undertaken. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Prospective Studies; *Videotape Recording; *Vision, Low/co [Complications]; Visual Acuity; *Visual Fields; *Visually Impaired Persons

Delayed adjustable sutures: a multicentred clinical review. - Robbins, S L; Granet, D B; Burns, C; Freeman, R S; Eustis, H S; Yafai, S; Cruz, F; Danylyshyn-Adams, K; Langham, K (The British journal of ophthalmology, 2010)
PURPOSE: To characterise the results of the largest patient series to date undergoing closed conjunctival delayed adjustable suture techniques., METHODS: A multicentre retrospective review of 440 operations (patients aged 10-91 years) by five surgeons at four centres were evaluated for surgical outcomes associated with the delayed adjustable suture technique., RESULTS: 26% (116 of 440) of all patients required postoperative manipulation, with individual surgeon rates ranging from 13% to 56%. The majority of these patients did not complain of diplopia in target gaze and/or had satisfactory cosmetic improvement as evaluated at the 1-3 months follow-up visit (84%). Transient complications included dellen, poor conjunctival appearance, filamentary keratitis, infection, granuloma, exposed suture and corneal abrasion. Serious complications were rare., CONCLUSIONS: This large multicentred series characterises the closed conjunctival delayed adjustable suture technique for the correction of strabismus. It may present some significant advantages to more traditional adjustable suture techniques.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Conjunctiva/su [Surgery]; Female; Humans; Male; Middle Aged; Patient Satisfaction; *Postoperative Complications/et [Etiology]; Retrospective Studies; *Strabismus/su [Surgery]; *Suture Techniques; *Sutures; Time Factors; Young Adult

A review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertension. - Hommer, A (Drugs of today (Barcelona, Spain : 1998), 2010)
Glaucoma affects an increasing number of people worldwide and is the second leading cause of blindness. The aim of antiglaucoma therapy is to maintain a patient's visual function and quality of life. Prostaglandin analogues are first-line topical antiglaucoma therapy. They are effective at lowering intraocular pressure (IOP) and are generally well tolerated, with fewer systemic adverse events compared with the other classes. However, the use of prostaglandin analogues can be associated with ocular adverse effects, such as stinging/burning sensation, dry eyes, iris and periocular hyperpigmentation, and eye lash growth, which can affect patient compliance. Preservatives used in antiglaucoma preparations can have dose-dependent toxic effects, which contribute to adverse effects. The development of preservative-free preparations may reduce such adverse effects and therefore improve patient compliance. Tafluprost is a prostaglandin analogue in a preservative-free formulation that was recently approved for the reduction of elevated IOP in open-angle glaucoma and ocular hypertension. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.
Erratum in (EIN)
Keywords: Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Glaucoma/co [Complications]; Glaucoma/ep [Epidemiology]; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Hypersensitivity/et [Etiology]; Latanoprost; *Ocular Hypertension/dt [Drug Therapy]; Preservatives, Pharmaceutical/ae [Adverse Effects]; *Preservatives, Pharmaceutical/pd [Pharmacology]; Preservatives, Pharmaceutical/tu [Therapeutic Use]; Prostaglandins F/tu [Therapeutic Use]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Prostaglandins, Synthetic/ae [Adverse Effects]; Prostaglandins, Synthetic/tu [Therapeutic Use]

IOP-lowering efficacy and tolerability of preservative-free tafluprost 0.0015% among patients with ocular hypertension or glaucoma. - Hommer, Anton; Mohammed Ramez, Osman; Burchert, Maria; Kimmich, Friedemann (Current medical research and opinion, 2010)
OBJECTIVE: Tafluprost, the first preservative-free prostaglandin analogue for topical ophthalmic use to lower IOP, was introduced in Germany in 2008. After the approval for ophthalmic use, an open-label, multicentre, observational study was conducted between October 2008 and April 2009. Major objectives of this study were to evaluate the real world efficacy, local tolerability and safety of this first in class preservative-free prostaglandin preparation in patients with ocular hypertension and glaucoma., METHODS: A total of 544 patients were treated with the preservative-free formulation of tafluprost 0.0015%. The majority of these patients had poor IOP control and/or poor local tolerance of their medication prior change of medication. The decision to change the previous therapy or to initiate treatment was made solely by the participating ophthalmologists. IOP readings were recorded at baseline before changing medication or initiating treatment in newly diagnosed patients, 4-6 weeks and 12 weeks after change of medication or initiation of treatment with preservative-free tafluprost. In addition, patient demographics, subjective symptoms (i.e. burning, foreign body sensation, itching and stinging) and objective clinical signs such as conjunctival hyperaemia were collected. Subjective symptoms were evaluated using a 4 point scale ranging from 'no symptoms', 'mild symptoms', 'moderate symptoms' to 'severe symptoms'. As a clinical sign severity of conjunctival hyperaemia was evaluated. All adverse events were collected., RESULTS: Three hundred and sixty patients were switched from monotherapy, 45 patients were naive to treatment. A total of 139 patients were treated with fixed or non-fixed combinations prior to changing medication. In these patients preservative-free tafluprost was used either as a substitution for the fixed or non-fixed combination, as an add-on to the existing combination therapy or as one agent in a newly initiated treatment regimen. Preservative-free tafluprost provided an IOP decrease in most pre-treatment subgroups, with an overall reduction of IOP in all patients (N = 544) from 19.4 +/- 5.0 mmHg at baseline to 15.7 +/- 4.1 mmHg after 4 to 6 weeks and to 15.3 +/- 3.5 mmHg after 12 weeks. Both values were significantly lower than treated baseline IOP (p < 0.001). An IOP of <or=18 mmHg was achieved in 79.5% of eyes treated with the preservative-free formulation of tafluprost 12 weeks after changing medication. Both subjective symptoms and objective clinical signs improved after changing medication. Only a few adverse events occurred during the follow-up period., CONCLUSIONS: Although this study was limited by its observational design, the results demonstrate that preservative-free tafluprost is an effective, well tolerated, and safe medication in a patient population with poor IOP control and/or tolerability issues with their medication prior used.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Female; *Glaucoma/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]; Patient Dropouts; Preservatives, Pharmaceutical; *Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F/ae [Adverse Effects]; Treatment Outcome; Young Adult

[Factors related to glaucoma treatment compliance: patients' opinions from a University Hospital]. - Silva, Lucas Ravagnani; de Paula, Jayter Silva; Rocha, Eduardo Melani; Rodrigues, Maria de Lourdes Veronese (Arquivos brasileiros de oftalmologia, 2010)
PURPOSE: Considering that noncompliance to glaucoma treatment is one of the risk factors associated with disease s progression, the purpose of the present study was to evaluate: 1) knowledge and feelings about the disease; 2) self-reported noncompliance to treatment and related factors; and 3) influence of disease in lifestyle., METHODS: Interviews, with application of a semi-structured questionnaire, of 50 patients with primary open-angle glaucoma. The analysis was performed using Lefevre's technique (Collective Subject Speech--CSS, qualitative/quantitative research)., RESULTS: Thirty-eight percent of patients did not consider themselves well informed about glaucoma. The percentage of patients that reported noncompliance was 20%. The main causes of noncompliance are: side effects of antiglaucomatous drugs (24%); lack of information about the disease (22%); difficulty in understanding information and communication problems with the physician (14%); difficulties in administering the eye drops (14%); poverty, with impossibility to pay for the eye drops (10%); patients attitudes and beliefs (10%). Eighteen percent of the participants informed that the disease affected their life quality., CONCLUSION: In the studied population, most of the problems related to noncompliance to glaucoma treatment pointed out different factors that may decrease with education about POAG, interventions on attitudes and behavior, improvement of doctor-patient relationship and anti-glaucoma drugs supply.
Keywords: Aged; Aged, 80 and over; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/px [Psychology]; *Health Knowledge, Attitudes, Practice; Hospitals, University; Humans; Male; Middle Aged; Patient Compliance/px [Psychology]; *Patient Compliance/sn [Statistics & Numerical Data]; *Physician-Patient Relations; Quality of Life; Surveys and Questionnaires

Switching from a preserved to a preservative-free prostaglandin preparation in topical glaucoma medication. - Uusitalo, Hannu; Chen, Enping; Pfeiffer, Norbert; Brignole-Baudouin, Francoise; Kaarniranta, Kai; Leino, Markku; Puska, Paivi; Palmgren, Elina; Hamacher, Thomas; Hofmann, Gunter; Petzold, Gernot; Richter, Ulrich; et al. (Acta ophthalmologica, 2010)
PURPOSE: The purpose of this study was to investigate the tolerability and intraocular pressure (IOP) reducing effect of the first preservative-free prostaglandin tafluprost (Taflotan) in patients exhibiting ocular surface side-effects during latanoprost (Xalatan) treatment., METHODS: A total of 158 patients were enrolled in this open-label multicentre study. Eligible patients had to have at least two ocular symptoms, or one sign and one symptom, during treatment with latanoprost. At baseline, the patients were directly switched from latanoprost to preservative-free tafluprost for 12 weeks. The patients were queried for ocular symptoms, and ocular signs were assessed by using tear break-up time, Schirmer's test, fluorescein staining and evaluation of conjunctival hyperaemia and blepharitis. In addition, HLA-DR and MUC5AC in conjunctival impression cytology specimens were analyzed, and a drop discomfort/quality of life (QoL) questionnaire was employed. IOP was measured at all visits., RESULTS: Preservative-free tafluprost maintained IOP at the same level after 12- weeks treatment (16.4 +/- 2.7 mmHg) as latanoprost at baseline (16.8 +/- 2.5 mmHg). During treatment with preservative-free tafluprost, the number of patients having irritation/burning/stinging (56.3%), itching (46.8%), foreign body sensation (49.4%), tearing (55.1%) and dry eye sensation (64.6%) decreased to 28.4%, 26.5%, 27.1%, 27.1% and 39.4% correspondingly. The number of the patients with abnormal fluorescein staining of cornea (81.6%) and conjunctiva (84.2%), blepharitis (60.1%), conjunctival hyperaemia (84.2%) and abnormal Schirmer's test (71.5%) was also reduced significantly to 40.6%, 43.2%, 40.6%, 60.0% and 59.4% correspondingly. The tear break-up time improved significantly from 4.5 +/- 2.5 seconds to 7.8 +/- 4.9 seconds. A reduction in the number of patients with abnormal conjunctival cells based on HLA-DR and MUC5AC was also detected., CONCLUSIONS: Preservative-free tafluprost maintained IOP at the same level as latanoprost, but was better tolerated in patients having signs or symptoms while on preserved latanoprost. Preservative-free tafluprost treatment resulted in improved QoL, increased patient satisfaction and drop comfort.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Benzalkonium Compounds/ad [Administration & Dosage]; Benzalkonium Compounds/ae [Adverse Effects]; Blepharitis/ci [Chemically Induced]; Blepharitis/me [Metabolism]; Blepharitis/pc [Prevention & Control]; Conjunctival Diseases/ci [Chemically Induced]; Conjunctival Diseases/me [Metabolism]; Conjunctival Diseases/pc [Prevention & Control]; *Exfoliation Syndrome/dt [Drug Therapy]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Gonioscopy; HLA-DR Antigens/me [Metabolism]; Humans; Hyperemia/ci [Chemically Induced]; Hyperemia/me [Metabolism]; Hyperemia/pc [Prevention & Control]; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Mucin 5AC/me [Metabolism]; Ocular Hypertension/dt [Drug Therapy]; Ophthalmoscopy; Patient Satisfaction; *Preservatives, Pharmaceutical/ad [Administration & Dosage]; Preservatives, Pharmaceutical/ae [Adverse Effects]; *Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ae [Adverse Effects]; Quality of Life; Surveys and Questionnaires; Tonometry, Ocular

Penetrating keratoplasty in active Acanthamoeba keratitis. - Nguyen, Truc H; Weisenthal, Robert W; Florakis, George J; Reidy, James J; Gaster, Ronald N; Tom, Danita (Cornea, 2010)
PURPOSE: To report the results of penetrating keratoplasty (PK) in active Acanthamoeba keratitis (AK)., METHODS: Nine patients with deep stromal infiltrates because of AK were treated with intensive antiamoebic medical therapy followed by PK during the acute infectious phase because of poor clinical response or poor compliance. Antiamoebic therapy was tapered after PK., RESULTS: Visual acuity ranged from 20/15 to 20/50 after an average of 17 months after PK with no signs of recurrences. Patients had rapid resolution of symptoms., CONCLUSION: PK is a viable option for active AK not responding to maximum medical treatment.
Keywords: Acanthamoeba Keratitis/di [Diagnosis]; Acanthamoeba Keratitis/dt [Drug Therapy]; *Acanthamoeba Keratitis/su [Surgery]; Adolescent; Adult; Antiprotozoal Agents/tu [Therapeutic Use]; *Corneal Stroma/ps [Parasitology]; Drug Therapy, Combination; Female; Humans; *Keratoplasty, Penetrating; Male; Middle Aged; Visual Acuity/ph [Physiology]; Young Adult

[Compliance, concordance, adherence]. - Urquhart, John; Demonceau, Jenny; Vrijens, Bernard (Therapeutische Umschau. Revue therapeutique, 2010)
Ambulatory pharmacotherapy is marked by many deviations, mostly downward, in drug dosing from prescribed instructions. Soundly compiled dosing histories date from 1977, based on electronic time-stamping of medication 'events': package entry times, done first with eyedrop dispensers for glaucoma drugs. Electronically monitored packages for oral dosage forms date from 1988. Since then, expanding data have brought many surprises, as evidence has replaced eminence in clinical views regarding discrepancies between prescription and reality. Key features of electronic monitoring are: automaticity of time-stamping, inviolable data, and high rates of data-sampling (60/hr vs 2 - 12/yr with older methods), revealing time-of-day, day-of-week, and white coat effects that facilitate medication management, opening new ways to improve care.
Keywords: *Ambulatory Care/sn [Statistics & Numerical Data]; *Directly Observed Therapy/sn [Statistics & Numerical Data]; Europe/ep [Epidemiology]; Humans; Internationality; *Medication Adherence/sn [Statistics & Numerical Data]; *Outcome Assessment, Health Care/sn [Statistics & Numerical Data]; Risk Assessment/mt [Methods]; United Kingdom

Combined anterior and posterior segment injuries in children: a review. - Meier, Petra (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2010)
BACKGROUND: Combined anterior and posterior segment injuries in children require special attention to the unique characteristics of children's eyes, including a pronounced tendency to scar formation and proliferation, adherence of the posterior vitreous, as well as the danger of amblyopia., METHODS: This article reviews the current body of literature documenting the main aspects of surgical management, complications, and prognosis of combined anterior and posterior segment injuries in children., RESULTS: For optimal treatment success, special strategies are necessary with regard to: 1) comprehensive secondary operation for internal reconstruction, 2) encircling buckle surgery, 3) management of the lens, 4) use of a temporary keratoprosthesis, 5) endophthalmitis, and 6) late complications, e.g., secondary glaucoma, secondary strabismus, leukoma cornea, and phthisis bulbi. Further crucial prognostic factors were analyzed., CONCLUSION: Combined anterior and posterior segment injuries in children require optimal surgical treatment management that varies from adult treatment with regard to several essential aspects. Care should be provided by pediatric ophthalmology specialists with orthoptic follow-up as necessary, over many years.
Keywords: Adolescent; *Anterior Eye Segment/in [Injuries]; Child; Child, Preschool; *Choroid/in [Injuries]; *Eye Injuries, Penetrating/et [Etiology]; Eye Injuries, Penetrating/su [Surgery]; Female; Humans; Infant; Male; Ophthalmologic Surgical Procedures; Prognosis; *Retina/in [Injuries]; *Sclera/in [Injuries]

A glaucoma equity profile: correlating disease distribution with service provision and uptake in a population in Northern England, UK. - Day, F; Buchan, J C; Cassells-Brown, A; Fear, J; Dixon, R; Wood, F (Eye (London, England), 2010)
AIMS: Glaucoma is a significant health problem, with associated inequalities. Equity profiles are an established public health tool to examine the scale of health inequalities and to imbed action into the commissioning cycle. This is the first equity profile conducted in the United Kingdom for an ophthalmic condition. This methodology also provides a model for use in other localities and for other eye conditions., METHODS: Existing services were mapped and need identified. A wide variety of data sources were analysed. Mapping was undertaken using Mapinfo Professional Geographical Information Systems software. Statistical analysis was conducted using Microsoft Excel 2003., RESULTS: No single data source provided a fully informed perspective. A clear mismatch between areas of deprivation and location of optometry was observed. Secondary analysis of electronic patient records revealed a significant association between 'late presentation' and older age (mean age of late presenters=76.4 years, 95% CI=75.1-77.6 compared with earlier presenters, 72.4 years, 95% CI=71.7-73.1). Late presentation was also associated with living in an area of high deprivation (chi(2)=7.1, df, P<0.05). Ethnicity data was poorly recorded. Qualitative data provided invaluable insights., CONCLUSIONS: Increasing access to services involves collaboration with optometrists, ophthalmologists, public health, and commissioners. It is no longer acceptable to rely on private high street optometry to provide primary eye care services in areas of high need. Outreach services must be developed and evaluated in areas of relative deprivation if world class eye services are to be achieved.
Keywords: Age Factors; Aged; Aged, 80 and over; England/ep [Epidemiology]; Female; Glaucoma/ep [Epidemiology]; Glaucoma/eh [Ethnology]; *Glaucoma; *Health Services Accessibility/og [Organization & Administration]; Health Services Accessibility/st [Standards]; *Health Services Needs and Demand; Humans; Male; Middle Aged; *Ophthalmology/og [Organization & Administration]; Public Health; Socioeconomic Factors; State Medicine/og [Organization & Administration]

Causes of intrastromal corneal ring segment explantation: clinicopathologic correlation analysis. - Ferrer, Consuelo; Alio, Jorge L; Montanes, Antonio Uceda; Perez-Santonja, Jose J; del Rio, Miguel A Diaz; de Toledo, Juan Alvarez; Teus, Miguel A; Javaloy, Jaime (Journal of cataract and refractive surgery, 2010)
PURPOSE: To determine the main causes of intrastromal corneal ring segment (ICRS) explantation and the relationship with the microscopic findings on the ICRS surface., SETTING: Vissum Corporation-Instituto Oftalmologico de Alicante, Alicante, Spain., METHODS: This study evaluated ICRS that were explanted in centers in Spain from 2000 to 2008. Clinical data (reasons for explantation, date of implantation/explantation, tunnel creation technique, ICRS type) and scanning electron microscopy findings on the ICRS surface (adherent tissue-like material, cell deposits, protein) were documented., RESULTS: Intrastromal corneal ring segments were explanted from 58 eyes (47 patients). The main cause was extrusion (48.2% of explanted segments), followed by refractive failure (ie, poor refractive outcome) (37.9%), keratitis (6.8%; 3.7% culture positive), and corneal melting and perforation (6.8%). Scanning electron microscopy showed cells and cell debris on the ICRS explanted by extrusion, a clean surface on the ICRS explanted for refractive failure, and bacteria (cocci) in the case of proven infectious keratitis., CONCLUSIONS: The main cause of explantation was extrusion of the ICRS followed by refractive failure. There was a clear correlation between the cause of explantation and the microscopic findings on the ICRS. Extrusion was accompanied by inflammatory cells and cell debris on the ICRS surface. No inflammatory reaction was observed on the ICRS explanted for refractive failure. Copyright (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Comment in (CIN)
Keywords: Adolescent; Adult; *Corneal Diseases/su [Surgery]; *Corneal Stroma/su [Surgery]; *Device Removal; Female; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Polymethyl Methacrylate; Prostheses and Implants/mi [Microbiology]; *Prostheses and Implants/ul [Ultrastructure]; *Prosthesis Failure; *Prosthesis Implantation; Young Adult

Eye-care utilization among women aged > or =40 years with eye diseases--19 states, 2006-2008. - Centers for Disease Control and Prevention (CDC) (MMWR. Morbidity and mortality weekly report, 2010)
Diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (ARMD) are major causes of vision loss and blindness. Women have been found to have a higher prevalence of vision loss than men. Early detection and timely treatment by eye-care providers are necessary to delay disease progression and prevent vision loss. To assess the use of professional eye care among women aged > or = 40 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 19 U.S. states for the period 2006-2008. This report summarizes the results of that analysis, which indicated that 21% of women with self-reported DR, 12% of women with self-reported glaucoma, and 8% of women with self-reported ARMD did not visit an eye-care provider in the recommended follow-up period. Women who did not have insurance coverage for eye care or who did not receive routine medical check-ups were more likely to report not having the recommended follow-up eye care. The two most commonly cited reasons for not having an eye-care visit were cost or not having insurance (range across diseases: 40%-46%) and having no reason to go for follow-up (range: 20%-29%). Compliance with obtaining eye examinations at recommended intervals among women aged > or = 40 years with eye diseases might be enhanced by improving access to health care and implementing and expanding existing educational programs to raise awareness regarding the importance of routine follow-up eye examinations.
Keywords: Adult; Aged; Behavioral Risk Factor Surveillance System; *Diabetic Retinopathy/di [Diagnosis]; Female; *Glaucoma/di [Diagnosis]; *Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility; Humans; Insurance Coverage; *Macular Degeneration/di [Diagnosis]; Medically Uninsured; Middle Aged; Patient Compliance; United States; *Vision Screening/sn [Statistics & Numerical Data]

The challenges of monitoring glaucoma progression. - Termote, K; Zeyen, T (Bulletin de la Societe belge d'ophtalmologie, 2010)
Diagnosing glaucoma progression is complex: it requires the precise assessment of functional loss and structural change compared with baseline measurements. Establishing reliable baseline data is essential in this process. Determining a functional baseline requires repeated visual field testing, while documentation of the optic disc appearance is needed for the acquisition of a structural baseline. The latter can be achieved using both clinical and imaging methods, which are complementary. Although imaging-based modalities to assess absolute and rate of progression are likely to prove more important in the future, more guidance is currently required for their use in clinical practice. Because the rate of progression provides important information about the risk of vision loss, guidelines recommend determining the rate of progression for each individual patient when planning management. Adherence issues must be addressed before changing the treatment strategy, since poor compliance can play a considerable role in many patients' disease progression. In conclusion, we must strive to improve the management of glaucoma to limit the impact disease progression has on the patient's quality of life.
Keywords: Disease Progression; *Glaucoma/di [Diagnosis]; Humans; Photography/mt [Methods]; Visual Field Tests; Visual Fields

Self-reported vision and health of indigenous Australians. - Goujon, Nicolas; Brown, Cherylee M; Xie, Jing; Arnold, Anna-Lena; Dunn, Ross A; Keeffe, Jill E; Taylor, Hugh R (Clinical & experimental ophthalmology, 2010)
PURPOSE: To describe the self-reported vision, history of eye disease and general health of indigenous Australian participants in the National Indigenous Eye Health Survey., METHODS: Using a multistage cluster sampling methodology, 30 geographic areas, stratified by remoteness, were selected to provide a representative population of indigenous Australians aged 5-15 years and 40 years and over. Before an eye examination, participants completed a questionnaire about their eye health and eye care facilities consulted, satisfaction with their vision and general health., RESULTS: A total of 1694 indigenous children (49.2% female, mean age 9.5 +/- 2.9 years) and 1189 adults (61.0% female, mean age 53.1 +/- 9.7 years) participated. Three-quarters of adults (259/342) and 88.4% of children (129/146) wore the right distance glasses. Adults from remote areas were less likely to have refractive error (P = 0.002) as well as males versus females (P = 0.02). Similar results were found for children. Adults wearing appropriate distance glasses were as satisfied with their vision as people with normal vision who did not need glasses (P = 0.6). Both groups were more satisfied with their distance vision than people with poor presenting vision (P = 0.007). Self-report of cataract, diabetic retinopathy, glaucoma and age-related macular degeneration did not match with clinical findings (P < 0.001). Over 37% of adults (417/1187) and 1.3% of children (22/1691) reported having diabetes., CONCLUSION: The National Indigenous Eye Health Survey provided information to guide future planning of eye health prevention strategies for indigenous Australians. Findings indicate the importance of correcting refractive error to improve quality of life. Prevention messages should be renewed in appropriate sociocultural formats. Copyright © 2010 The Authors. Clinical and Experimental Ophthalmology © 2010 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Australia/ep [Epidemiology]; Child; Child, Preschool; *Eye Diseases/eh [Ethnology]; Eyeglasses/sn [Statistics & Numerical Data]; Female; *Health Status; *Health Surveys; Humans; Male; Middle Aged; *Oceanic Ancestry Group/sn [Statistics & Numerical Data]; Patient Satisfaction; Self Report; Surveys and Questionnaires; *Vision, Ocular/ph [Physiology]; Young Adult

Development of a specific questionnaire measuring patient satisfaction with glaucoma treatment: Glausat. - Ruiz, Miguel A; Pardo, Antonio; Martinez de la Casa, Jose M; Polo, Vicente; Esquiro, Jordi; Soto, Javier (Ophthalmic epidemiology, 2010)
OBJECTIVE: Patient satisfaction with glaucoma therapy is one of the aspects that affects adequate adherence to treatment; therefore, it would be interesting to measure the satisfaction properly. We present the development process and psychometric properties of a new instrument for measuring patient satisfaction with glaucoma treatment., MATERIAL AND METHODS: After collection and discussion of contents, a 38-item questionnaire was proposed and arranged into seven theoretical domains. The questionnaire was applied to a sample of 194 patients and its length was reduced using an exploratory factor analysis. Psychometric properties were assessed under classic theory., RESULTS: The final questionnaire is formed by 22 items grouped into seven dimensions: expectations and beliefs about treatment, ease of use, efficacy, undesired effects, impact on health-related quality of life, medical care, and general satisfaction with treatment. Some dimensions correlated slightly. The reliability of the dimensions ranged from 0.77 to 0.93. Confirmatory factor analysis revealed an additional support of the proposed structure (chi(2) (188) = 217, P = 0.073). Glausat scores were proven to correlate with patients' self rating on medication tolerability, and with clinicians' assessment of tolerability, effectiveness and compliance., CONCLUSIONS: The Glausat questionnaire has proven to be reliable and structurally valid. This instrument may be used to assess patients' satisfaction with glaucoma treatment.
Keywords: Adult; Aged; Aged, 80 and over; Chronic Disease; *Glaucoma/th [Therapy]; Health Status; Humans; Middle Aged; *Patient Satisfaction/sn [Statistics & Numerical Data]; Psychometrics; Quality of Life; Reproducibility of Results; *Surveys and Questionnaires

Treatment adherence in ophthalmology and astrophysics. - Novack, Gary D (The ocular surface, 2010)
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; *Astronomical Phenomena; Drug Labeling; Drug Monitoring/mt [Methods]; Drug Packaging; *Eye Diseases/dt [Drug Therapy]; Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence; *Ophthalmology

Pathogenesis of acanthamoeba keratitis. - Panjwani, Noorjahan (The ocular surface, 2010)
Acanthamoeba keratitis (AK) is a serious infection of the cornea. At present, diagnosis of the disease is not straightforward and treatment is very demanding. While contact lens wear is the leading risk factor for A K, Acanthamoeba parasites are increasingly recognized as an important cause of keratitis in non-contact lens wearers. The first critical step in the pathogenesis of infection is the adhesion of the microbe to the surface of the host tissues. Acanthamoebae express a major virulence protein, the mannose-binding protein (MBP), which mediates the adhesion of amoebae to the surface of the cornea. The MBP is a transmembrane protein with characteristics of a typical cell surface receptor. Subsequent to the MBP-mediated adhesion to host cells, the amoebae produce a contact-dependent metalloproteinase and several contact-independent serine proteinases. These proteinases work in concert to produce a potent cytopathic effect (CPE ) involving killing of the host cells, degradation of epithelial basement membrane and underlying stromal matrix, and penetration into the deeper layers of the cornea. In the hamster animal model, oral immunization with the recombinant MBP protects against AK, and this protection is associated with an increased level of anti-MBP IgA in tears of protected animals. Normal human tear fluid contains IgA antibodies against Acanthamoeba MBP that is likely to provide protection by inhibiting the adhesion of parasites to host cells. Indeed, in in vitro CPE assays, even a low concentration of tears (10 microL of undiluted tears per milliliter of media) almost completely inhibits Acanthamoeba-induced CPE . In addition to adherence-inhibiting, IgA-mediated protection, human tears also contain IgA-independent factors that provide protection against Acanthamoeba-induced CPE by inhibiting the activity of cytotoxic proteinases. Characterization of the CPE-inhibitory factors of human tears should lead to a better understanding of the mechanism by which the tissues of the host resist the infection and also help decode circumstances that predispose to Acanthamoeba infections.
Keywords: *Acanthamoeba/ph [Physiology]; *Acanthamoeba Keratitis/et [Etiology]; Animals; Cell Adhesion/ph [Physiology]; *Cornea/ps [Parasitology]; Humans; *Mannose-Binding Lectin/ph [Physiology]; *Protozoan Proteins/ph [Physiology]

Molecularly imprinted therapeutic contact lenses. - White, Charles J; Byrne, Mark E (Expert opinion on drug delivery, 2010)
IMPORTANCE OF THE FIELD: There exists a considerable unmet need for more efficacious delivery of ocular therapeutics. Contact lenses have been developed with high loading and controllable sustained release to overcome limited patient compliance and significant ocular transport limitations. This can best be achieved by extending and controlling the residence time of drugs on the eye surface and thereby limiting drug loss by lacrimation, drainage and non-productive absorption., AREAS COVERED IN THE REVIEW: Within hydrogels, molecular imprinting can be used to create memory for template molecules embedded within a flexible macromolecular network. Control in therapeutic loading and delay of release have been demonstrated with careful attention to the functional monomer/template ratio, the diversity of functional monomers, and the polymer backbone and network structure. Experimental work has also confirmed that macromolecular memory and not structural differences or phenomena are responsible for delayed drug release kinetics compared with non-imprinted systems. A therapeutically relevant amount of drug can be loaded for release to occur over multiple days, which allows the technique to be applied to daily-wear and extended-wear contact lenses., WHAT THE READER WILL GAIN: The focus of this article is to review the emerging field of molecularly imprinted contact lenses and highlight significant accomplishments, trends, as well as future strategies and directions., TAKE HOME MESSAGE: In the past 8 years, molecular imprinting has been used to produce therapeutic contact lenses with enhanced loading and delayed release. Progress in the field has mostly included low-molecular-weight therapeutics such as anti-glaucoma, antihistamine, antibiotic and anti-inflammatory therapeutics used to treat anterior eye disorders. Recently, high molecular weight comfort molecules have also been successfully demonstrated. Current methods can produce lenses of suitable thickness, water content, and mechanical and optical properties compared with commercial lenses on the market today.
Keywords: *Contact Lenses; *Drug Administration Routes; Hydrogels

Severe pseudomonal keratitis in an infrequent daily disposable contact lens wearer. - Batta, Priti; Goldstein, Michael H (Eye & contact lens, 2010)
PURPOSE: To report an unusual case of contact lens-associated pseudomonal keratitis in a compliant daily disposable contact lens wearer., METHODS: A case report is presented of a compliant daily disposable contact lens wearer who developed culture-positive pseudomonal keratitis., RESULTS: A 38-year-old woman who reported compliant and infrequent use of daily disposable contact lenses presented with rapid-onset, severe keratitis consistent with pseudomonal infection. Corneal cultures were positive for Pseudomonas aeruginosa. She had no identifiable risk factors, although notably had a remote history of contact lens-associated keratitis in the fellow eye., CONCLUSIONS: Although extremely rare, pseudomonal keratitis should still be considered in the differential diagnosis of severe keratitis in daily disposable contact lens wearers. Given the history of a previous contact lens-related bacterial keratitis in this compliant patient, it is possible that host susceptibility factors played a role in the case of pseudomonal keratitis described here.
Keywords: Adult; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Diagnosis, Differential; Disposable Equipment; Female; Humans; *Keratitis/mi [Microbiology]; Keratitis/pa [Pathology]; Medical Records; Pseudomonas Infections/di [Diagnosis]; *Pseudomonas Infections/et [Etiology]; *Pseudomonas aeruginosa; Severity of Illness Index

Electronic compliance monitoring of topical treatment after ophthalmic surgery. - Hermann, Manuel Marcel; Ustundag, Can; Diestelhorst, Michael (International ophthalmology, 2010)
The success of many medical treatments is built on compliance. Electronic monitoring is the most accurate tool to quantify compliance by measuring adherence. In order to assess the efficiency of a recently introduced miniature monitoring device for eye drop application, we evaluated adherence in ophthalmic patients undergoing post-operative short-term topical treatment. This pilot study enrolled 30 outpatients (mean age 61.8 +/- 18.5 years) after cataract (n = 24) and glaucoma filtration surgery (n = 6) applying fixed-combination eye drops containing prednisolone and gentamicin five times daily for 2 weeks. Patients received eye drops in conventional bottles each equipped with a miniature monitoring device recording events of application. Two patients failed to bring back the monitoring device; therefore data collected from only 28 patients could be examined. Data showed highly variable results with a mean dose compliance of 50.2%. Dose compliance was below 25% in approximately one out of five patients. Four cataract patients, but no glaucoma patient, discontinued therapy prematurely. The observed mean dosage interval was calculated for each patient and ranged 4.6-19.7 h. Thirty percent of analysed dosage intervals exceeded 12.0 h. Different patterns of compliance behaviour-like early non-persistence, drug holiday and low treatment frequency could be identified and illustrated using electronic data. Age or gender did not significantly influence compliance rates. Our pilot study demonstrates successful electronic compliance monitoring using a technology capable of continuous data recording over weeks of treatment. The low compliance rate for a relevant part of the patients demonstrates the necessity to study and improve compliance in ophthalmology. In future, new application methods and electronic application devices may improve treatment response in eye care.
Keywords: Aged; Aged, 80 and over; Cataract Extraction; Cold Temperature; Drug Administration Schedule; *Drug Monitoring/is [Instrumentation]; Drug Storage; *Electronics; Equipment Design; Female; Filtering Surgery; Glaucoma/su [Surgery]; Humans; Male; Medical Records; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmologic Surgical Procedures; *Patient Compliance/sn [Statistics & Numerical Data]; Pilot Projects; *Postoperative Care

[Acceptance of own disease by patients with diagnosed glaucoma]. - Karna-Matyjaszek, Urszula; Sierzantowicz, Regina; Mariak, Zofia (Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2010)
UNLABELLED: The notion of glaucoma comprises a number of diseases which are all characterized by optic nerve damage. It was estimated that nearly 70 million people all over the world suffer from glaucoma and 10% of them have lost their sight because of glaucomatous optic nerve atrophy. The aim of this paper is to determine the acceptance level of the condition by patients with primary glaucoma as well as to study the relations between the acceptance level and the parameters influencing it directly or indirectly., MATERIAL AND METHODS: The study included 50 patients (40 women and 10 men) aged between 20 and 90 with recognized primary open-angle glaucoma. A questionnaire and a standardized Acceptance of Illness Scale (AIS) were used to evaluate the study material. The observed differences and relation levels were subjected to statistical analysis with the use of the Student's t test as well as the chi2 test, and the statistical significance level was established at p < 0.05., RESULTS: Within the studied group, people between the ages of 61 and 70 (38%), with secondary education (48%), were the most numerous. The most frequent therapeutic method was local treatment (application of eye drops). Prescribed medication was taken on a regular basis by 86% of patients, lack of regularity was declared by 14% of them. The 26% of patients realize their duties less accurately than before and 12% of them declared the need of frequent breaks in their work. The analysis showed a statistically significant relation (p = 0.0005) between the acceptance level of the condition and refraining from various forms of activity. The low acceptance of patients' illness determined the increase of they resignation from all forms of physical activity., CONCLUSIONS: The consecutive degrees of disease acceptance (low, medium, high) are comprised in glaucoma patients in the same proportion, i.e. each degree comprises around 30% of patients the most serious problems accepting the illness. This means that the tolerance of the disease is observed in 1/3 of patients with glaucoma. The most serious problems in disease acceptance were determined in elderly people and those with elementary or vocational education.
Keywords: *Activities of Daily Living/px [Psychology]; Adult; Aged; Aged, 80 and over; Female; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/px [Psychology]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Patient Acceptance of Health Care/px [Psychology]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Poland; Population Surveillance; Surveys and Questionnaires; Young Adult

Twelve-month, randomized, controlled trial of bimatoprost 0.01%, 0.0125%, and 0.03% in patients with glaucoma or ocular hypertension. - Katz, L Jay; Cohen, John S; Batoosingh, Amy L; Felix, Carlos; Shu, Vincent; Schiffman, Rhett M (American journal of ophthalmology, 2010)
PURPOSE: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of ophthalmic formulations of bimatoprost 0.01% and 0.0125% compared with bimatoprost 0.03%., DESIGN: Prospective, randomized, double-masked, multicenter clinical trial., METHODS: Patients with glaucoma or ocular hypertension were randomized to receive once-daily bimatoprost 0.01% (n = 186), bimatoprost 0.0125% (n = 188), or bimatoprost 0.03% (n = 187) for 12 months. The primary efficacy measure was IOP. Safety measures included adverse events and an objective assessment of conjunctival hyperemia., RESULTS: Baseline mean IOPs were similar among treatment groups. Differences in mean IOP between the bimatoprost 0.01% or 0.0125% groups and the bimatoprost 0.03% group were less than 0.9 mm Hg throughout follow-up. Bimatoprost 0.01%, but not bimatoprost 0.0125%, was equivalent in efficacy to bimatoprost 0.03% based on predetermined criteria (limits of the 95% confidence interval of the between-group difference in mean IOP within +/- 1.5 mm Hg at all time points and within +/- 1 mm Hg at most time points). The overall incidence of treatment-related adverse events was reduced significantly in the bimatoprost 0.01% and bimatoprost 0.0125% groups compared with the bimatoprost 0.03% group (P < or = .034). The percentage of patients with a moderate to severe increase from the baseline macroscopic hyperemia score was: bimatoprost 0.01%, 3.2%; bimatoprost 0.0125%, 9.0%; bimatoprost 0.03%, 9.1% (P = .019 for bimatoprost 0.01% vs 0.03%)., CONCLUSIONS: Bimatoprost 0.01% was equivalent to bimatoprost 0.03% in lowering IOP throughout 12 months of treatment and demonstrated improved tolerability, including less frequent and severe conjunctival hyperemia. Bimatoprost 0.01% demonstrated a better benefit-to-risk ratio than bimatoprost 0.0125%. Copyright 2010 Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Amides/ad [Administration & Dosage]; Amides/ae [Adverse Effects]; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Double-Blind Method; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Patient Satisfaction; Prospective Studies; Surveys and Questionnaires; Tonometry, Ocular; Young Adult

Patterns and rate of adherence to glaucoma therapy using an electronic dosing aid. - Ajit, R R; Fenerty, C H; Henson, D B (Eye (London, England), 2010)
AIMS AND PURPOSE: To identify patterns and rates of adherence with travoprost eye drops using the Travatan dosing aid (TDA) and to present a method for graphically presenting adherence data., METHODS: A prospective observational cohort study of patients on travoprost (prostaglandin) monotherapy. Patients were dispensed a TDA and followed up after approximately 3 months of usage. Data were downloaded from the TDA into a computer for analysis. Analysis used inter-dose intervals (the time between each dosing) to look at adherence between days 4 and 75., RESULTS: In all, 100 patients were invited to participate, 53 agreed and complete TDA data sets were obtained from 37. In total 23 of the complete data sets showed good adherence (dosing within +/-4 h of the agreed dosing time on >80% of occasions), 3 patients discontinued usage before 75 days, 4 showed frequent drug holidays (no dosing for > or =8 days) and 7 frequently missed doses with adherence rates of <60%. Of the 16 patients for whom no TDA data was obtained, 5 were lost to follow-up, 4 had faulty/damaged TDAs, 3 changed medication, 3 preferred not to use the TDA, and 1 was hospitalized., CONCLUSIONS: There were four easily defined patterns of adherence; (1) good adherence; (2) discontinued usage; (3) frequent drug holidays; and (4) frequent missed doses with low adherence rates. A new method for graphically presenting adherence data helps clinicians identify the pattern of usage and is a valuable aid to the overall management of patients on travoprost therapy.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cohort Studies; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Travoprost

Fixed combinations of dorzolamide-timolol and brimonidine-timolol in the management of glaucoma. - Razeghinejad, M Reza; Sawchyn, Andrea K; Katz, L Jay (Expert opinion on pharmacotherapy, 2010)
IMPORTANCE OF THE FIELD: The emergence of fixed-combination drugs for the treatment of glaucoma has, to some extent, changed the medical management of glaucoma. The potential benefits of these drugs include a reduction in the total number of drops and preservatives instilled per day and improved patient comfort factors, which may contribute to better compliance. Combination medications may also improve therapeutic efficacy and play an important role in controlling medication cost. However, the fixed dosing may be a disadvantage in some cases., AREA COVERED IN THIS REVIEW: This review describes the composition, pharmacokinetics, mode of action, efficacy, side effects, and safety profile of fixed-combination dorzolamide-timolol and fixed-combination brimonidine-timolol., WHAT THE READER WILL GAIN: Understanding of the pros, cons, and safety profile of two FDA approved fixed-combination antiglaucoma medication., TAKE HOME MESSAGE: Fixed-combination medications may be a reasonable adjunct to prostaglandins if a large drop in the intraocular pressure (IOP) is desired and adding only one medication is unlikely to reach the target IOP range. Both mentioned drugs are effective in reducing the IOP and further clinical studies will help identify differences in efficacy between the two. The clinician must make an individualized assessment of the medication's risk-benefit profile for each patient.
Keywords: Adrenergic alpha-Agonists/ad [Administration & Dosage]; Adrenergic alpha-Agonists/ae [Adverse Effects]; Adrenergic alpha-Agonists/pk [Pharmacokinetics]; *Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/pk [Pharmacokinetics]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Brimonidine Tartrate; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/pk [Pharmacokinetics]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Patient Selection; Quinoxalines/ad [Administration & Dosage]; Quinoxalines/ae [Adverse Effects]; Quinoxalines/pk [Pharmacokinetics]; *Quinoxalines/tu [Therapeutic Use]; Risk Assessment; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; Sulfonamides/pk [Pharmacokinetics]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; Thiophenes/pk [Pharmacokinetics]; *Thiophenes/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Timolol/pk [Pharmacokinetics]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

[Adherence to glaucoma therapy]. - Renard, J P; Giraud, J M; Fenolland, J R; May, F (Journal francais d'ophtalmologie, 2010)
Adherence to glaucoma therapy is a major factor of therapeutic efficacy. It reflects the patient's perception of the glaucoma disease and its treatment. Evaluation of adherence, often underestimated, is simple with a four-step strategy underscoring the importance of informing and educating the patient. The quality of the physician-patient relationship is essential for a good adapted assessment with every patient and at all stages of the disease so as to enhance adherence to glaucoma treatment and help patients. Copyright 2010 Elsevier Masson SAS. All rights reserved.
Keywords: Attitude to Health; *Glaucoma/dt [Drug Therapy]; Glaucoma/pc [Prevention & Control]; Humans; Medication Adherence; Motivation; Motor Skills; *Patient Compliance; Patient Education as Topic; Physician-Patient Relations; Social Environment; Treatment Outcome

Understanding why patients with cataract refuse free surgery: the influence of rumours in Kenya. - Briesen, Sebastian; Geneau, Robert; Roberts, Helen; Opiyo, Jael; Courtright, Paul (Tropical medicine & international health : TM & IH, 2010)
OBJECTIVES: To understand the reasons that hinder people from uptake of sponsored cataract surgery., METHODS: A mixed methods (qualitative and quantitative) approach was used. During routine screening activities at Kwale District, Kenya, local residents with visually impairing cataract were clinically assessed and offered free surgery. Interviews were conducted using a semi-structured guide that covered different aspects related to acceptance of cataract surgery including knowledge of others who underwent surgery and their outcome. Analysis focused on differences between people accepting and people refusing surgery and the reasons for non-acceptance of surgery., RESULTS: Ninety interviews were conducted, 48 with people accepting and 42 with people refusing free surgery. Those who accepted surgery generally reported good outcome in others, while people who refused surgery often reported to know someone who worsened or even become blind after surgery. Many of these 'failed cases' were prominent figures in the local community, and most of them had already died. Glaucoma was the single most common underlying medical condition. On being re-interviewed, several people admitted that they had actually never met someone who had unsuccessful surgery but only heard rumours., CONCLUSION: In Africa, a rumour of blinding eye surgery is not uncommonly being used by patients to justify their refusal to have cataract surgery. Underlying reasons appear to be related to shame, fear of surgery or missing social support. Improved awareness of the general population regarding eye conditions and their management, involvement of the family and local community in decision making, good surgical outcomes and appropriate counselling are possible methods to enhance acceptance.
Keywords: Adult; Aged; *Anecdotes as Topic; Cataract/ec [Economics]; *Cataract/px [Psychology]; Cataract Extraction/ec [Economics]; *Cataract Extraction/px [Psychology]; Communication; Decision Making; Female; Glaucoma/ec [Economics]; Glaucoma/th [Therapy]; Health Knowledge, Attitudes, Practice; Health Services Accessibility/ec [Economics]; Humans; Kenya; Male; Middle Aged; Qualitative Research; Quality of Life; *Treatment Refusal/px [Psychology]; Treatment Refusal/sn [Statistics & Numerical Data]; Visual Acuity

Risk factors for subject withdrawals in clinical trials evaluating glaucoma medications. - Stewart, William C; Demos, Christina M; Turner, Meredith K; Stewart, Jeanette A (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2010)
BACKGROUND: To evaluate risk factors for subject withdrawals from multicenter clinical trials evaluating glaucoma medications., METHODS: An analysis of prospective, randomized, multicenter, parallel, active-controlled clinical trials with 70 subjects/treatment arm published from 1996-2008., RESULTS: We analyzed 36 glaucoma studies including 17,511 subjects at 1,294 clinical sites. There were 2,060 (12%) subject withdrawals with 669 (32%) for administrative errors, 945 (46%) for adverse events (AEs), 197 (10%) for inadequate intraocular pressure (IOP) control and 249 (12%) for unknown reasons. By multilinear regression analysis, no positive risk factors for early subject withdrawals were observed following a Bonferroni correction (p > or = 0.01). A positive correlation was observed for medication errors and protocol violations to withdrawals due to ocular AEs and total administrative errors (p < 0.0001). Protocol violations alone were correlated to subject withdrawals for any AE (total/month) and systemic AEs (p < 0.0001). Females and Caucasians were correlated to medication errors (p < 0 .0001). Among medical therapies, alpha-agonists, beta-blockers, the carbonic anhydrase inhibitor/beta-blocker fixed combination and prostaglandins were correlated with systemic AEs (p < or = 0.005) while the alpha-agonists were correlated with withdrawals for poor IOP control (p = 0.00056)., CONCLUSIONS: Subject withdrawals from clinical trials for total administrative errors or AEs potentially might be reduced by choosing sites with lower historical rates of protocol violations or medication dispensing errors. Drug class choice also may influence subject withdrawals for AEs and poor IOP control.
Keywords: *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Controlled Clinical Trials as Topic/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; *Glaucoma/ep [Epidemiology]; Humans; Multicenter Studies as Topic/sn [Statistics & Numerical Data]; Patient Dropouts/sn [Statistics & Numerical Data]; Risk Factors

The views of compliant glaucoma patients on counselling and social support. - Lunnela, Jaana; Kaariainen, Maria; Kyngas, Helvi (Scandinavian journal of caring sciences, 2010)
The purpose of this study was to describe the views of compliant glaucoma patients with good compliance on patient education and social support they received during their illness. The aim was to gain knowledge for developing patient compliance by means of promoting education and support methods. Twelve glaucoma patients with good compliance were interviewed, and the transcripts based on those interviews were analysed using content analysis. In the data, the participants described education and social support they had received from healthcare personnel, relatives and partly from their peers. Patient education emerged as the content, timing and methods of education. Social support emerged as emotional, informational and instrumental support, lack of support as well as patients' activity. Consequently, patients need education and support from healthcare personnel as well as from their relatives to cope with glaucoma. The need for education and support is individual but the most important time for education and support is at the initial stages of the illness. The need for education and support is also evident when the patient's treatment is changed or an operative procedure is performed. To conclude, the individual, patient-centred and properly timed education and support is a huge challenge for healthcare personnel because of the decrease in individual time for each patient. Therefore, new and timesaving methods of education and support should be developed. Copyright © 2010 The Authors. Journal compilation © 2010 Nordic College of Caring Science.
Keywords: Adaptation, Psychological; *Counseling; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; *Patient Compliance; Patient Education as Topic; *Social Support

Effect of patient-centered communication training on discussion and detection of nonadherence in glaucoma. - Hahn, Steven R; Friedman, David S; Quigley, Harry A; Kotak, Sameer; Kim, Elizabeth; Onofrey, Meaghan; Eagan, Corey; Mardekian, Jack (Ophthalmology, 2010)
PURPOSE: To assess communication about adherence and to determine the impact of communication skills training on physicians' approach to nonadherence., DESIGN: Sociolinguistic analysis of videotaped community ophthalmologists' encounters with patients with glaucoma before and after training. Patients in both phases and physicians in phase I knew communication was being studied but not what the focus of the study was. In phase II, physicians knew the targeted communication behaviors., PARTICIPANTS: Twenty-three ophthalmologists and 100 regularly scheduled patients with glaucoma (50 per phase)., METHODS: An educational program with videotaped vignettes of simulated patient encounters using audience response and role play to teach patient-centered communication skills, including a 4-step adherence assessment and the use of open-ended questions in ask-tell-ask sequences., MAIN OUTCOME MEASURES: Physician eliciting an acknowledgment of nonadherence during a clinical encounter compared with acknowledgment of nonadherence during a postvisit research interview (primary outcome), and performance of targeted communication and substantive discussion of adherence., RESULTS: After intervention, physicians increased the proportion of open-ended questions (15% vs 6%; P = 0.001) and specifically about medication taking (82% compared with 18% of encounters; P<0.001). Compared with the absence of ask-tell-ask communication, 32% of phase II encounters included a complete ask-tell-ask sequence, 78% included an ask-tell sequence, and 32% a tell-ask sequence (P<0.001). Three of 4 steps for assessment of adherence were more common in phase II, and substantial discussions of adherence occurred in 86% versus 30% of encounters (P<0.001). In phase II, physicians elicited acknowledgment of nonadherence in 78% (7/9) of those who acknowledged nonadherence in the postvisit interview compared with 25% in phase I (3/12; P = 0.03)., CONCLUSIONS: This study demonstrates that experienced community physicians significantly improved their communication strategies and ability to detect and address nonadherence after a 3-hour educational program., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; Communication; *Education, Medical, Continuing; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ophthalmology/ed [Education]; *Patient Compliance/px [Psychology]; Patient Education as Topic; *Patient-Centered Care/mt [Methods]; *Physician-Patient Relations

Persistence on prostaglandin ocular hypotensive therapy: an assessment using medication possession and days covered on therapy. - Reardon, Gregory; Schwartz, Gail F; Kotak, Sameer (BMC ophthalmology, 2010)
BACKGROUND: Prior research has demonstrated that medication persistence (continued acquisition of therapy over time) is far from optimal among patients with glaucoma. The purpose of the present study was to evaluate persistence with prostaglandin analogs among glaucoma patients in the first therapy year using a modification of a previously published technique., METHODS: This retrospective analysis of medical and pharmacy claims database included treatment-naive patients dispensed bimatoprost, latanoprost, or travoprost between 1/1/04-12/31/04. "Index agent" was defined as the first agent filled; "index date" was defined as the fill date. Follow-up continued for 358 days. Persistence measures for first therapy year were: (1) whether last fill had sufficient days supply to achieve medication possession at year's end, and (2) number of days for which the index agent was available (days covered). Associations between index agent and medication possession (logistic regression) and days covered (linear regression) were evaluated. Models were adjusted for gender, age, and previous ocular hypertension diagnosis., RESULTS: 7873 patients met inclusion criteria (bimatoprost, n = 1464; latanoprost, n = 4994; travoprost, n = 1415). Medication possession was 28% and days covered was 131 when using the unadjusted (pharmacy-reported) days supply estimates and rose to 47-48% and days covered to 228-236 days when days supply was imputed. Compared to latanoprost, odds of achieving medication possession at first year's end were 26-34% lower for bimatoprost and 34-36% lower for travoprost (p <or= 0.001 for all comparisons). Days covered in the first year were 21-29 days lower for bimatoprost and 33-42 days lower for travoprost (p <or= 0.001 for all comparisons). Failure to refill the index agent within the initial 90 days was a strong predictor of poor persistence., CONCLUSIONS: Persistence with ocular prostaglandin therapy remains a problem. Latanoprost users had greater odds of achieving medication possession and had more days covered during the first therapy year.
Keywords: Adult; Aged; Amides/ad [Administration & Dosage]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; Databases, Factual; Drug Administration Schedule; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; Linear Models; Male; *Medication Adherence; Middle Aged; Prostaglandins F, Synthetic/ad [Administration & Dosage]; *Prostaglandins, Synthetic/ad [Administration & Dosage]; Retrospective Studies; Travoprost

Drug attitude and adherence to anti-glaucoma medication. - Hong, Samin; Kang, Sung Yong; Yoon, Jong Uk; Kang, Uicheon; Seong, Gong Je; Kim, Chan Yun (Yonsei medical journal, 2010)
PURPOSE: The purpose of this study is to assess patient attitudes towards anti-glaucoma medication and their association with adherence, visual quality of life, and personality traits., MATERIALS AND METHODS: One hundred and forty-seven glaucoma patients were enrolled this study. The participants were divided into 'pharmacophobic' and 'pharmacophilic' groups according to their scores on the Modified Glaucoma Drug Attitude Inventory (MG-DAI). To establish a correlation with patient drug attitude, each group had their subjective drug adherence, visual quality of life, and personality traits examined. For personality traits, the Myers-Briggs Type Indicator (MBTI) was used to sub-classify each group., RESULTS: Among the patients analyzed, 91 (72.80%) patients showed a 'pharmacophobic' attitude and 34 (27.20%) patients showed a 'pharmacophilic' attitude. The pharmacophobic group tended to have worse adherence than the pharmacophilic group. Personality dichotomies from the MBTI also showed different patterns for each group., CONCLUSION: In glaucoma patients, pharmacological adherence was influenced by their attitude towards drugs; an association might exist between drug attitude and underlying personality traits.
Keywords: Adult; Aged; Attitude; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance/px [Psychology]; Personality Inventory; Surveys and Questionnaires

Continued visual field progression in eyes with prior visual field progression in patients with open-angle glaucoma. - Chen, Philip P; Cady, Robert Samuel; Mudumbai, Raghu C; Ngan, Rose (Journal of glaucoma, 2010)
PURPOSE: To evaluate continued visual field (VF) progression in eyes with prior VF progression from open-angle glaucoma, using event-based criteria., METHODS: Retrospective observational case series of 70 eyes (70 patients) with open-angle glaucoma, treated for at least 2 years, that had earlier shown 1 step of VF progression. Further VF progression required a worsening of 3 adjacent points at the same location on 2 consecutive VF tests. Potential risk factors for continued progression were evaluated., RESULTS: The mean follow-up was 127+/-43 months. Thirty-seven eyes (55%) continued to progress. At 5, 10, and 15 years after the initial VF, the Kaplan-Meier estimate of the risk of developing 2 steps of progression was 18%, 53%, and 71%. A shorter time to the first step of progression was significantly associated with further progression (P<0.001), as was slope of the VF mean deviation (P<0.001) and pattern standard deviation (P=0.041). Eyes with further progression had higher mean IOP after the first step of progression (P=0.026). Among 37 eyes with 2 steps of progression, the estimate of the risk of progressing further was 32% at 10 years after the initial VF., CONCLUSION: Eyes with a relatively shorter time to initial VF progression from open-angle glaucoma are likely to continue to progress over long-term follow-up. More aggressive treatment in such eyes might reduce the likelihood of further VF progression.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; Disease Progression; Female; Follow-Up Studies; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Patient Compliance; Retrospective Studies; Risk Factors; Time Factors; *Vision Disorders/pp [Physiopathology]; Visual Field Tests; *Visual Fields/ph [Physiology]

Microbial contamination of contact lenses, lens care solutions, and their accessories: a literature review. - Szczotka-Flynn, Loretta B; Pearlman, Eric; Ghannoum, Mahmoud (Eye & contact lens, 2010)
PURPOSE: A contact lens (CL) can act as a vector for microorganisms to adhere to and transfer to the ocular surface. Commensal microorganisms that uneventfully cohabitate on lid margins and conjunctivae and potential pathogens that are found transiently on the ocular surface can inoculate CLs in vivo. In the presence of reduced tissue resistance, these resident microorganisms or transient pathogens can invade and colonize the cornea or conjunctiva to produce inflammation or infection., METHODS: The literature was reviewed and used to summarize the findings over the last 30 years on the identification, enumeration, and classification of microorganisms adherent to CLs and their accessories during the course of normal wear and to hypothesize the role that these microorganisms play in CL infection and inflammation., RESULTS: Lens handling greatly increases the incidence of lens contamination, and the ocular surface has a tremendous ability to destroy organisms. However, even when removed aseptically from the eye, more than half of lenses are found to harbor microorganisms, almost exclusively bacteria. Coagulase-negative Staphylococci are most commonly cultured from worn lenses; however, approximately 10% of lenses harbor Gram-negative and highly pathogenic species, even in asymptomatic subjects. In storage cases, the incidence of positive microbial bioburden is also typically greater than 50%. All types of care solutions can become contaminated, including up to 30% of preserved products., CONCLUSIONS: The process of CL-related microbial keratitis and inflammation is thought to be preceded by the presence or transfer or both of microorganisms from the lens to the ocular surface. Thus, this detailed understanding of lens-related bioburden is important in the understanding of factors associated with infectious and inflammatory complications. Promising mechanisms to prevent bacterial colonization on lenses and lens cases are forthcoming, which may decrease the incidence of microbially driven CL complications.
Keywords: Bacteria/ip [Isolation & Purification]; Biofilms; *Contact Lens Solutions; *Contact Lenses/mi [Microbiology]; *Drug Contamination; Equipment Contamination/pc [Prevention & Control]; *Equipment Contamination; Eye/mi [Microbiology]; Gram-Negative Bacteria/ip [Isolation & Purification]; Humans; Keratitis/et [Etiology]; Keratitis/mi [Microbiology]; Orthokeratologic Procedures/ae [Adverse Effects]; Staphylococcus/ip [Isolation & Purification]

Post-traumatic fungal keratitis caused by Carpoligna sp. - Chew, Hall F; Jungkind, Donald L; Mah, Dean Y; Raber, Irving M; Toll, Adam D; Tokarczyk, Mindy J; Cohen, Elisabeth J (Cornea, 2010)
PURPOSE: To report the first case of fungal keratitis caused by presumed Carpoligna species., METHODS: A 37-year-old gardener sustained a full-thickness, stellate corneal laceration while cutting wood outdoors with a circular saw. Two months after surgical repair, he developed a severe infectious keratitis with descemetocoele at the apex of the original stellate laceration., RESULTS: Culture results confirmed fungal elements without evidence of bacteria. Oral and topical voriconazole were initiated. Due to compliance and cost issues, voriconazole was replaced with natamycin 5% prior to discharge from hospital. The patient improved and healed without perforation. The patient was left with a central stromal scar. DNA extraction from the fungal colony allowed PCR amplification of the 28s ribosomal RNA region of the fungus that led to the diagnosis of Carpoligna pleurothecii. Corticosteroids were never used during the patient's treatment., CONCLUSION: This is the first reported case of infectious keratitis caused by presumed Carpoligna species. The treatment for Carpoligna pleurothecii keratitis includes voriconazole, natamycin, and possibly amphotericin B.
Keywords: Adult; Amphotericin B/tu [Therapeutic Use]; Antifungal Agents/tu [Therapeutic Use]; Base Sequence; *Corneal Injuries; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; *Corneal Ulcer/mi [Microbiology]; DNA, Fungal/ge [Genetics]; Eye Infections, Fungal/di [Diagnosis]; Eye Infections, Fungal/dt [Drug Therapy]; *Eye Infections, Fungal/mi [Microbiology]; Eye Injuries/di [Diagnosis]; Eye Injuries/dt [Drug Therapy]; *Eye Injuries/mi [Microbiology]; Humans; Lacerations/di [Diagnosis]; Lacerations/dt [Drug Therapy]; *Lacerations/mi [Microbiology]; Male; Mitosporic Fungi/ge [Genetics]; *Mitosporic Fungi/ip [Isolation & Purification]; Molecular Sequence Data; Natamycin/tu [Therapeutic Use]; Polymerase Chain Reaction; Pyrimidines/tu [Therapeutic Use]; RNA, Fungal/ge [Genetics]; RNA, Ribosomal, 28S/ge [Genetics]; Triazoles/tu [Therapeutic Use]; Voriconazole

Interaction of endocannabinoid receptors with biological membranes. - Dainese, E; Oddi, S; Maccarrone, M (Current medicinal chemistry, 2010)
Cellular signaling is regulated by several biochemical reactions, whose dynamics depends on changes in the fluxes of specific ligands through the containment barriers that are the biological membranes. The regulation of this complex dynamic equilibrium is mainly due to the activity of border proteins, that must be able to interact simultaneously with the lipid bilayer and the extracellular milieu. Endocannabinoid receptors, that include type-1 and type-2 cannabinoid receptors, the transient vanilloid potential receptors and the peroxisome proliferator-activated receptors, represent one of the most intriguing examples of "border" proteins. They have also been identified as important drug discovery targets with potential therapeutic applications, from antiemesis, appetite enhancement, analgesia, glaucoma treatment, and immune suppression. However, as yet the molecular details of endocannabinoid receptor regulation remain elusive. In this review we summarize the most relevant aspects of the structural/functional characterization of these receptors, with a focus on the active role played by biological membranes (in particular lipid rafts) in the modulation of their accessibility and mode of ligand binding. Based on available evidence, we propose that endocannabinoid receptors can be regulated by the rate of interlayer exchange and lateral diffusion of endocannabinoid/cholesterol complexes within lipid bilayers, thus suggesting innovative approaches for the therapeutic exploitation of the membrane component of endocannabinoid signaling.
Keywords: Cannabinoid Receptor Modulators/ch [Chemistry]; Cannabinoid Receptor Modulators/pd [Pharmacology]; Cholesterol/me [Metabolism]; Endocannabinoids; *Lipid Bilayers/me [Metabolism]; Peroxisome Proliferator-Activated Receptors/me [Metabolism]; *Receptors, Cannabinoid/me [Metabolism]; Signal Transduction; TRPV Cation Channels/me [Metabolism]

Physicians' treatment decisions, patient persistence, and interruptions in the continuous use of prostaglandin therapy in glaucoma. - Hahn, Steven R; Kotak, Sameer; Tan, Jason; Kim, Elizabeth (Current medical research and opinion, 2010)
BACKGROUND: Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians' decisions and patient persistence, and differences between medications may impact persistence., OBJECTIVE: To examine differences in physician's decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians' charted therapeutic decisions., METHODS: A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as 'persistent', 'switched', 'restarted', or 'discontinued' with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription., RESULTS: Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56%) stopped and then restarted, 16% switched, and 19% discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11%) compared to bimatoprost (9%) or travoprost (5%; p < 0.0001 overall comparison). Overall, 68% of patients on latanoprost persisted or restarted after a gap compared to 61% for bimatoprost and 58% for travoprost (p < 0.0001). Patient charts demonstrated a parallel pattern in physicians' decisions to continue latanoprost (56%), bimatoprost (45%), and travoprost (40%). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population., CONCLUSIONS: Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians' decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records.
Keywords: Adult; Amides/ae [Adverse Effects]; *Amides/tu [Therapeutic Use]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; *Continuity of Patient Care; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; *Medication Adherence; *Practice Patterns, Physicians'; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Travoprost; United States

Monitoring adherence rates in glaucoma patients using the Travatan Dosing Aid. A 6-month study comparing patients on travoprost 0.004% and patients on travoprost 0.004%/timolol 0.5% fixed combination. - Rossi, Gemma Caterina Maria; Pasinetti, Gian Maria; Scudeller, Luigia; Tinelli, Carmine; Milano, Giovanni; Bianchi, Paolo Emilio (Expert opinion on pharmacotherapy, 2010)
OBJECTIVE: To assess adherence in glaucoma patients using the Travatan Dosing Aid (TDA); to record differences in adherence by age, sex, therapy, systemic therapies, years from diagnosis, type of therapy and intraocular pressure (IOP)., RESEARCH DESIGN AND METHODS: Sixth-month cohort study; fifty-six Caucasian, primary open-angle glaucoma patients on travoprost (T) or travoprost/timolol fixed combination (TTFC) monotherapy were submitted to four visits: at baseline and months 1, 3 and 6 (M1, M3, M6). Adherence was recorded with TDA and classified as 'high' if greater than 90%. Self-reported and physician-presumed adherence data were collected. Kruskall-Wallis and Fisher's exact tests were applied., RESULTS: Thirty-two patients (54.2%) were treated with T. Age, sex, level of schooling, presence of systemic comorbidities, duration of current therapy and IOP were similar between T and TTFC. Seventeen subjects (30.3%) recorded high adherence at every visit, 13 (23.2%) at two visits, 26 (46.4%) otherwise. Adherence was maintained over time with a slight decrease from month 1 to month 6 without statistical differences within and between groups. Adherence was statistically influenced by age (p = 0.007) and duration of therapy (p = 0.004)., CONCLUSION: The typical nonadherent patient is elderly. TDA records indicate that only a minority of patients are really adherent: predictive models to screen for poor adherence are needed.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Drug Combinations; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pa [Pathology]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; Prospective Studies; *Timolol/tu [Therapeutic Use]; Travoprost; Treatment Outcome

Factors associated with site requirement for glaucoma clinical trials. - Stewart, William C; Demos, Christina M; Turner, Meredith; Stewart, Jeanette A (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2010)
Keywords: Antihypertensive Agents/ec [Economics]; Biomedical Research; Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; Humans; *Multicenter Studies as Topic/ec [Economics]; *Patient Participation; Prospective Studies; *Randomized Controlled Trials as Topic/ec [Economics]

Intentional and unintentional nonadherence to ocular hypotensive treatment in patients with glaucoma. - Rees, Gwyneth; Leong, Omega; Crowston, Jonathan G; Lamoureux, Ecosse L (Ophthalmology, 2010)
OBJECTIVE: To determine the rate of intentional and unintentional nonadherence in glaucoma patients and to identify associations between adherence behavior and patients' beliefs., DESIGN: Cross-sectional study., PARTICIPANTS: One hundred thirty-one glaucoma patients using topical eye drops for at least 6 months., METHODS: Interviewer-administered surveys., MAIN OUTCOME MEASURES: Self-reported adherence and beliefs about glaucoma and its treatment were assessed using the Reported Adherence to Medication scale, the Brief Illness Perception Questionnaire, and the Beliefs about Medicines-Specific Questionnaire., RESULTS: Overall, 59 (45%) participants reported some degree of nonadherence, among whom 39 (66.1%) reported unintentional nonadherence (e.g., forgetting), 10 (16.9%) reported intentional nonadherence (deliberate nonadherence), and 10 (16.9%) reported both forms of nonadherence. Compared with adherers, nonadherers were significantly younger, were less likely to have other nonocular health conditions or to use medicines other than their eye drops, and reported lower belief in the necessity of eye drops for glaucoma (P<0.05). Degree of unintentional nonadherence was associated with lower belief in necessity of eye drops, whereas degree of intentional nonadherence was associated with concerns about eye drops., CONCLUSIONS: Strategies aimed at improving adherence in glaucoma patients need to address both intentional and unintentional dimensions. Interventions focused on eliciting and addressing patients' beliefs and concerns about their eye drops require evaluation. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; *Health Knowledge, Attitudes, Practice; Health Surveys; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/px [Psychology]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Acceptance of Health Care/px [Psychology]; *Patient Compliance/px [Psychology]; Surveys and Questionnaires; Young Adult

Glaucoma clinical trials. - Stewart, William C; Stewart, Jeanette A; Robin, Alan L; Hennessy, Amy; Sharpe, Elizabeth D (Ophthalmology, 2010)
Keywords: Aged; *Altruism; *Attitude to Health; *Clinical Trials as Topic/px [Psychology]; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Motivation; Patient Acceptance of Health Care; *Patient Participation/px [Psychology]; Prospective Studies; Surveys and Questionnaires

Scoring and psychometric properties of the Eye-Drop Satisfaction Questionnaire (EDSQ), an instrument to assess satisfaction and compliance with glaucoma treatment. - Regnault, Antoine; Viala-Danten, Muriel; Gilet, Helene; Berdeaux, Gilles (BMC ophthalmology, 2010)
BACKGROUND: The objective of this study was to ascertain the scoring and assess the psychometric properties of the Eye-Drop Satisfaction Questionnaire (EDSQ), a 43-item Patient-Reported Outcome instrument developed to assess patients' satisfaction and compliance with glaucoma treatment., METHODS: The EDSQ was administered during an observational, retrospective study to 184 French patients treated for glaucoma. The hypothesized structure, including six dimensions (patient-clinician relationship; patient experience; patient-treatment interaction; apprehension; patient knowledge; travel), was tested by assessing the internal consistency reliability (Cronbach's alpha) and construct-related validity (item convergent and discriminant validity). As unsatisfactory results were demonstrated, another structure was defined using a principal component analysis (PCA) combined with content of items. Psychometric properties of this new structure were assessed. Scores were compared between low, moderate and high compliance profile groups defined using data collected with the Travalert electronic device., RESULTS: Analyses were performed with the 169 patients who completed at least half of the EDSQ items. The hypothesized structure showed a Cronbach's alpha lower than 0.70 for four dimensions out of six and an overall poor construct-related validity (range of item-scale correlations: 0.00-0.68). The new structure obtained with the PCA included six dimensions: concern about treatment (five items); concern about disease (two items); satisfaction with patient-clinician relationship (five items); positive beliefs (three items); treatment convenience (three items); and self-declared compliance (three items). A score ranging from 0 to 100 was calculated for each dimension, with higher scores indicating more of the attribute referred to in the dimension. Internal consistency reliability was good (Cronbach's alpha greater than 0.70 for five dimensions). The structure offered good construct-related validity (range of item-scale correlations: 0.36-0.82). Ceiling effects of 21% and 49%, were observed for the satisfaction with patient-clinician relationship and self-declared compliance scores. Patients in low compliance profile group reported the lowest score for the satisfaction with patient-clinician relationship, positive beliefs, treatment convenience and self-declared compliance dimensions, and the highest score for the concern about treatment dimension., CONCLUSIONS: The scoring of the EDSQ was developed and the questionnaire proved to have satisfactory psychometric properties. EDSQ scores showed a promising relationship to compliance profiles. The EDSQ could be used in future studies.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Drug Delivery Systems/is [Instrumentation]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Physician-Patient Relations; Principal Component Analysis; *Psychometrics/mt [Methods]; Reproducibility of Results; Retrospective Studies; *Surveys and Questionnaires; Young Adult

Are you compliant with addressing glaucoma adherence?. - Mansberger, Steven L (American journal of ophthalmology, 2010)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; Cost of Illness; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; *Medication Adherence/px [Psychology]; *Patient Compliance; Patients/px [Psychology]

An exploratory study of factors influencing glaucoma treatment adherence. - Stryker, Jo Ellen; Beck, Allen Dale; Primo, Susan A; Echt, Katharina V; Bundy, Lucja; Pretorius, Grace Cho; Glanz, Karen (Journal of glaucoma, 2010)
PURPOSE: To understand the factors that influence glaucoma treatment adherence with medication taking, prescription refills, and appointment keeping to develop an intervention for a specific population., PATIENTS AND METHODS: In-depth interviews were conducted with 80 individuals diagnosed with open-angle glaucoma, glaucoma suspect, or ocular hypertension. Additional eligibility requirements were that all participants were: between the ages of 18 to 80; white or African American; spoke and understood English; and were taking daily doses of topical glaucoma treatments for at least the past year. Cross-tabulations and chi2 tests were conducted to compare adherent and nonadherent individuals, classified as such based on self-report and medical chart/pharmacy data., RESULTS: Compared with adherent participants, nonadherent participants were less likely to: believe their eye doctors spent sufficient time with them; ask their eye doctor if they had any questions; know of benefits to taking their glaucoma medication regularly; and have someone help them take their glaucoma medications or drive them to eye appointments. Conversely, compared with adherent individuals, nonadherent participants were more likely to have difficulty remembering to take their medications and to believe their glaucoma would affect their eye sight in the future., CONCLUSIONS: Nonadherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care. Interventions are needed to address these modifiable factors related to glaucoma treatment adherence.
Keywords: Adolescent; Adult; African Americans; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Attitude to Health; Communication; European Continental Ancestry Group; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/px [Psychology]; Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Male; *Medication Adherence/px [Psychology]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/px [Psychology]; Physician-Patient Relations; Risk Factors

Effects of scleral stiffness properties on optic nerve head biomechanics. - Eilaghi, Armin; Flanagan, John G; Simmons, Craig A; Ethier, C Ross (Annals of biomedical engineering, 2010)
The biomechanical environment within the optic nerve head, important in glaucoma, depends strongly on scleral biomechanical properties. Here we use a range of measured nonlinear scleral stress-strain relationships in a finite element (FE) model of the eye to compute the biomechanical environment in the optic nerve head at three levels of intraocular pressure (IOP). Three stress-strain relationships consistent with the 5th, 50th and 95th percentiles of measured human scleral stiffness were selected from a pool of 30 scleral samples taken from 10 eyes and implemented in a generic FE model of the eye using a hyperelastic five-parameter Mooney-Rivlin material model. Computed strains within optic nerve head tissues depended strongly on scleral properties, with most of this difference occurring between the compliant and median scenarios. Also, the magnitudes of strains were found to be substantial even at normal IOP (up to 5.25% in the lamina cribrosa at 15 mmHg), being larger than previously reported values even at normal levels of IOP. We conclude that scleras that are "weak", but still within the physiologic range, will result in appreciably increased optic nerve head strains and could represent a risk factor for glaucomatous optic neuropathy. Estimations of the deformation at the optic nerve head region, particularly at elevated IOP, should take into account the nonlinear nature of scleral stiffness.
Keywords: Compressive Strength/ph [Physiology]; Computer Simulation; Elastic Modulus/ph [Physiology]; Humans; *Models, Biological; *Optic Nerve/ph [Physiology]; *Sclera/ph [Physiology]

[Patient-reported and patient-weighted outcomes in ophthalmology]. - Scheibler, F; Finger, R P; Grosselfinger, R; Dintsios, C-M (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2010)
Considering patients' values and preferences in comparative effectiveness research (CER) is one of the main challenges in ophthalmology (value-based medicine). This article defines core terms in CER. The concept of patient-relevant (or patient-important) outcomes is distinguished from patient-reported outcomes (PRO) by means of examples in the field of ophthalmology. In order to be able to give a consistant recommendation if an intervention leads to conflicting results for different outcomes (trade-off), a ranking of outcomes will be necessary. Examples of studies in glaucoma patients are provided that demonstrate the possibilities of ranking of outcomes based on patient preferences.
Keywords: Comparative Effectiveness Research; Cost-Benefit Analysis/ec [Economics]; Evidence-Based Medicine/ec [Economics]; Germany; Glaucoma/ec [Economics]; Glaucoma/th [Therapy]; Humans; *National Health Programs/ec [Economics]; *Ophthalmology/ec [Economics]; *Patient Satisfaction/ec [Economics]; Quality of Life; *Relative Value Scales

Long-term visual outcome after extraction of unilateral congenital cataracts. - Allen, R J; Speedwell, L; Russell-Eggitt, I (Eye (London, England), 2010)
BACKGROUND: Congenital cataract significantly impairs visual development. Although treatable, a good visual outcome is difficult to achieve, requiring prompt lensectomy and prolonged visual rehabilitation., PURPOSE: The aim of this study was to investigate whether useable visual acuity (VA) is a realistic goal in these patients., METHODS: A retrospective case review from a tertiary referral centre was performed. This study included children with unilateral congenital cataract who underwent cataract surgery with posterior capsulectomy and anterior vitrectomy., RESULTS: A total of 62 patients were identified. Of them, 32% of aphakic eyes had a final VA of 0.6 LogMAR or better (average 0.34+/-0.17). The average age at the time of surgery was 5.0+/-4.1 weeks. The remaining 68% had vision that was less than 0.6, with 27% having vision of <1.00. The group with vision less than 0.6 (68%) had an average age of 9.7+/-6.5 weeks at the time of surgery. One case (1.6%) achieved a VA of 0.0 and also had demonstrable stereoacuity (110 arc s). Manifest strabismus was present in 85% of cases. Glaucoma developed in 19% of patients and 31% discontinued the occlusion regime before the age of 4 years. In most of these cases, occlusion was ceased by the age of 2 years when testing revealed dense amblyopia in the aphakic eye even if good compliance had previously been achieved. In many cases, this coincided with the child becoming noncompliant with occlusion., CONCLUSIONS: More than two-thirds of children in our cohort did not develop acuity better than 0.6 LogMAR in their aphakic eye.
Keywords: Anterior Chamber/su [Surgery]; *Cataract/cn [Congenital]; Cataract/pp [Physiopathology]; *Cataract Extraction; Child; Child, Preschool; Cohort Studies; Female; Humans; Lens Capsule, Crystalline/su [Surgery]; Male; Refraction, Ocular; Retrospective Studies; *Visual Acuity; Vitrectomy

Resource use and costs of branch and central retinal vein occlusion in the elderly. - Fekrat, Sharon; Shea, Alisa M; Hammill, Bradley G; Nguyen, Hiep; Kowalski, Jonathan W; Schulman, Kevin A; Curtis, Lesley H (Current medical research and opinion, 2010)
OBJECTIVE: To examine the incidence, prevalence, resource use, and costs associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in elderly patients., RESEARCH DESIGN AND METHODS: In a retrospective cohort study of a nationally representative sample of Medicare beneficiaries from 2001 through 2006, the authors identified patients with BRVO (n = 10,682) and CRVO (n = 6236) and controls with hypertension (n = 49,524) and glaucoma (n = 49,569) but no retinal vein occlusion. Incident cases were those with no claims listing a diagnosis for the same type of retinal vein occlusion in the previous 12 months. Prevalence was defined as the number of beneficiaries with a diagnosis of BRVO or CRVO. The authors summed Medicare reimbursements for all claims and used generalized linear models to estimate the effects of BRVO and CRVO on 1-year and 3-year costs compared with hypertension and glaucoma control groups. The authors also examined trends in the use of diagnostic and treatment modalities., MAIN OUTCOME MEASURES: Resource use (fluorescein angiography, optical coherence tomography, intravitreal injection, laser photocoagulation, and vitrectomy) and direct medical costs (total Medicare reimbursement amounts as recorded on each inpatient, outpatient, home health, skilled nursing, hospice, durable medical equipment, and professional service claim) at 1 year and 3 years., RESULTS: After adjustment for baseline characteristics, BRVO was associated with 16% higher 1-year costs and 12% higher 3-year costs compared with hypertension and 18% higher 1-year costs and 13% higher 3-year costs compared with glaucoma. CRVO was associated with 22% higher 1-year costs and 15% higher 3-year costs compared with hypertension and 24% higher 1-year costs and 16% higher 3-year costs compared with glaucoma. Use of fluorescein angiography and optical coherence tomography increased during the study. Use of intravitreal injections increased from less than 1% of patients overall to greater than 13% for BRVO and 16% for CRVO. The incidence of BRVO declined slightly during the study period, whereas the incidence of CRVO remained relatively flat. Prevalence increased in both groups., LIMITATIONS: The results may not be generalizable to younger patients or managed-care beneficiaries. The study included only direct costs to Medicare, not nonmedical expenditures or outpatient prescription medications. Diagnosis and procedure codes may not have been complete. The study could not account for clinical variables, such as the amount of vision loss. It was not feasible to adjust for whether one or both eyes were affected or treated., CONCLUSIONS: Although not common in the Medicare population, BRVO and CRVO are important independent predictors of total medical costs. Diagnostic and treatment modalities have changed over time.
Keywords: Aged; Aged, 80 and over; *Cost of Illness; Female; Fluorescein Angiography; *Health Care Rationing; Humans; Laser Coagulation; Male; Retinal Vein Occlusion/ec [Economics]; Retinal Vein Occlusion/pp [Physiopathology]; *Retinal Vein Occlusion/th [Therapy]; Tomography, Optical Coherence

Corneal thinning associated with recurrent microbial keratitis resulting from 7-day extended wear of low Dk hydrogel contact lenses: a case report. - Cardona, Genis; Saona-Santos, Carlos Luis (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2010)
CASE DESCRIPTION: Corneal thinning and an increased risk of corneal perforation, resulting from recurrent episodes of microbial keratitis, required a 38-year-old Caucasian female to undergo bilateral corneal grafting. Although strongly advised otherwise, the patient had been a long time user of low oxygen permeability hydrogel contact lenses in a flexible wear regime, with frequent overnight use., DISCUSSION: Microbial keratitis is a potentially severe contact lens related complication which, if not properly treated, may lead to permanent visual loss. The introduction of silicone-hydrogel materials and daily replacement modalities has not resulted in a significant decrease in the incidence of microbial keratitis, thus suggesting that the condition is mainly dependent on patient hygiene and wearing habits. Non-compliance, which is endemic in contact lens wear, may be combated by increasing patient awareness of the potential risk factors of contact lens misuse. This is accomplished through constant, rigorous information provided by contact lens practitioners.
Keywords: *Blindness/di [Diagnosis]; *Blindness/et [Etiology]; Blindness/su [Surgery]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Eye Infections, Bacterial/di [Diagnosis]; *Eye Infections, Bacterial/et [Etiology]; Eye Infections, Bacterial/su [Surgery]; Female; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; *Keratitis/di [Diagnosis]; *Keratitis/et [Etiology]; Keratitis/su [Surgery]; Middle Aged; Recurrence

Long-term benefit of reduced intraocular pressure in primary open-angle glaucoma patients in Ethiopia. - Alemu, Abiye M; Kristoffersen, Caroline J; Kristoffersen, Michael S; Stewart, Jeanette A; Stewart, William C (European journal of ophthalmology, 2010)
PURPOSE: To determine the incidence of progression of primary open-angle glaucoma at individual levels of mean intraocular pressure (IOP) in patients in Ethiopia., METHODS: A retrospective, multicenter, cohort analysis of patient records with at least 5 years of potential follow-up were evaluated for risk factors associated with progressive optic disc and visual field loss., RESULTS: There were 300 patients with the potential of 5 years of follow-up. In total, 166 patients progressed before 5 years and 134 remained stable for the full 5-year follow-up period. Of the total sample, 84% of patients with IOPs or =25 mmHg (n=0/79) remained stable over at least 5 years. The mean IOP was 17.4+/-2.1 in the stable group and 25.0+/-5.9 mmHg in the progressed group (p<0.0001). The highest average peak IOP was 24.5+/-4.5 in the stable group and 29.0+/-6.1 mmHg in the progressed group (p<0.0001). A multivariant regression analysis to determine risk factors for progression was positive for mean IOP (p=0.0097)., CONCLUSIONS: This study suggests that IOP reduction in a developing country, despite potential limitations in diagnostic techniques, follow-up, and compliance, can be effective in reducing the risk of glaucomatous progression over long-term follow-up.
Keywords: Aged; Antihypertensive Agents/tu [Therapeutic Use]; Disease Progression; Ethiopia/ep [Epidemiology]; Female; Follow-Up Studies; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/th [Therapy]; Gonioscopy; Humans; Incidence; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Prognosis; Retinoscopy; Retrospective Studies; Risk Factors; Time Factors; Trabeculectomy/mt [Methods]

In sickness and in health: Corneal epithelial stem cell biology, pathology and therapy. - Notara, M; Alatza, A; Gilfillan, J; Harris, A R; Levis, H J; Schrader, S; Vernon, A; Daniels, J T (Experimental eye research, 2010)
Our window to the world is provided by the cornea on the front surface of the eye. The integrity and functionality of the outermost corneal epithelium is essential for vision. A population of limbal epithelial stem cells (LESCs) are responsible for maintaining the epithelium throughout life by providing a constant supply of daughter cells that replenish those constantly lost from the ocular surface during normal wear and tear and following injury. LESC deficiency leads to corneal opacification, inflammation, vascularization and discomfort (Daniels et al., 2001, 2007). Cultured LESC delivery is one of several examples of successful adult stem cell therapy in patients. The clinical precedence for use of stem cell therapy and the accessibility of the transparent stem cell niche make the cornea a unique model for the study of adult stem cells in physiological conditions as well as in disease. Copyright 2009 Elsevier Ltd. All rights reserved.
Comment in (CIN)
Keywords: Biomarkers/me [Metabolism]; Cell Biology; Cell Culture Techniques; *Corneal Diseases/pa [Pathology]; *Corneal Diseases/su [Surgery]; *Epithelium, Corneal/cy [Cytology]; Epithelium, Corneal/me [Metabolism]; Humans; *Limbus Corneae/cy [Cytology]; *Stem Cell Transplantation; *Stem Cells/cy [Cytology]; Stem Cells/me [Metabolism]; Tissue Scaffolds

A prospective audit on the validity of written informed consent prior to glaucoma surgery: an Asian perspective. - Kang, Kui Dong; Abdul Majid, Aman Shah B; Kwag, Jee Hyun; Kim, Yeon Deok; Yim, Hye Bin (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2010)
PURPOSE: To assess the validity of written informed consent taken from patients prior to undergoing glaucoma surgery by testing their ability to understand the information offered to them during the consent-taking process., METHODS: Seventy-three patients were asked to complete a standardised confidential questionnaire after giving a written informed consent. Surgeons who were taking the consent were also requested to submit their self-evaluation form. Patients' understanding of the information they were given was evaluated using a standardised point scoring system., RESULTS: Fifty patients (68.5%) agreed that they were given enough time to make an informed decision, while 67 doctors (91.8%) claimed that they had allocated enough time to explain the procedures. Fifty-two patients (71.2%) reported that they were given adequate information on the details or diagnosis of their problems, 65 patients (89.0%) on the details of the procedure and 69 patients (94.5%) on the risks and complications. Thirty-four patients (46.6%) were not sure, or refused information on the risks and complications of the procedure. Only half of the patients (57.5%) had overall moderate understanding of their surgical problem, and only 13 patients (17.8%) were able to demonstrate a good overall understanding of their surgical problem., CONCLUSIONS: Although most patients acknowledged that they received sufficient information to give consent, few could objectively recall the information given to them. This study thus raises some doubts on the validity and quality of written informed consent, and highlights the importance of giving clear information to patients undergoing glaucoma surgery.
Keywords: Adult; Aged; Cataract Extraction; Female; Glaucoma/ep [Epidemiology]; *Glaucoma/su [Surgery]; Glaucoma Drainage Implants; *Health Knowledge, Attitudes, Practice; Humans; *Informed Consent; Korea/ep [Epidemiology]; Male; Medical Audit; *Mental Recall; Middle Aged; Patient Education as Topic; Patient Participation; Prospective Studies; Surveys and Questionnaires; Trabeculectomy; Young Adult

Development of an instrument to measure glaucoma medication self-efficacy and outcome expectations. - Sleath, B; Blalock, S J; Robin, A; Hartnett, M E; Covert, D; DeVellis, B; Giangiacomo, A (Eye (London, England), 2010)
PURPOSE: The purpose of this study was to develop and evaluate the psychometric properties of (a) a glaucoma medication self-efficacy scale and (b) a glaucoma outcome expectations scale., PATIENTS AND METHODS: Two instruments were developed: a glaucoma medication self-efficacy scale and a glaucoma outcome expectations scale. Packets containing (a) the instruments and patient demographic questions and (b) a letter explaining the study were distributed to 225 glaucoma patients from three ophthalmology practices between August and December 2007. The instrument was completed by 191 patients for a response rate of 85%. Principal components factor analysis with a varimax rotation and Cronbach's alpha reliability were used to analyse the data. To assess discriminant validity, we administered the scales and two self-reported measures of adherence in a separate sample of 43 glaucoma patients who were currently using at least one glaucoma medication., RESULTS: Our results yielded a 21-item self-efficacy in overcoming barriers that might interfere with the use of glaucoma medications scale, a 14-item self-efficacy in carrying out specific tasks required to use eye drops correctly scale, and a four-item glaucoma outcome expectations scale. Results of the Cronbach's alpha reliability indicated that the scales are internally consistent. The self-efficacy scales were both significantly associated with two patient self-reported measures of glaucoma medication adherence, which show discriminant validity., CONCLUSIONS: Eye care providers and researchers can use these scales to identify patients with low self-efficacy in using their glaucoma medications and patients who do not believe that following their eye care providers' advice can help their vision.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/px [Psychology]; Middle Aged; *Ophthalmic Solutions/tu [Therapeutic Use]; Psychometrics; Reproducibility of Results; *Self Efficacy; *Self Medication/px [Psychology]; *Surveys and Questionnaires/st [Standards]; Treatment Outcome; Young Adult

Correlation of visual function with health-related quality of life in glaucoma patients. - Lin, Jen-Chieh; Yang, Ming-Chin (Journal of evaluation in clinical practice, 2010)
OBJECTIVES: The purpose of this study was to assess visual impairment and quality of life (QOL), the relationship between visual function and health-related and vision-related QOL, and to identify factors significantly impacting QOL for glaucoma patients., METHODS: One-on-one interviews of 280 glaucoma patients at a regional hospital in Taiwan from 1 April 2005 to 30 September 2005. Data collected included demographics, clinical examinations and treatment status. QOL data collected utilized the Chinese (Taiwanese) version of the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) and the National Eye Institute Visual Function-25 (NEIVFQ-25)., RESULTS: The majority of study participants had open-angle glaucoma (54.3%) and were classified as moderate stage (33.6%). The higher the health-related QOL scores for both questionnaires, the fewer difficulties experienced by the patients. Moderate correlation was found between the SF-36 and NEIVFQ-25 subscales and visual function. Significant predicting factors for the SF-36 were gender, age, employment status, presence of systemic disease, better-eye visual acuity and better-eye mean defect. For the NEIVFQ-25, these were general vision, near and distance activities, colour vision and peripheral vision scores., CONCLUSIONS: A combination of demographic data, clinical examination and QOL questionnaires may help clinicians better ascertain the impact of disease severity on glaucoma patients' QOL. This information may help in patient education, treatment compliance and selection of treatment options.
Keywords: Adult; Aged; Female; *Glaucoma; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; *Quality of Life; Taiwan; *Visual Acuity

Health anxiety in a non-population-based, pre-publicised glaucoma screening exercise. - Hollo, G; Kothy, P; Geczy, A; Vargha, P (Eye (London, England), 2010)
OBJECTIVE: To investigate whether anxiety plays a role in self-recruitment for non-population-based glaucoma screening., METHODS: In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma, and also completed the Trait Anxiety Inventory and Shortened Health Anxiety Inventory questionnaires. In pre-publicity for the trial, information on risk factors for glaucoma was given. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation., RESULTS: Of the 120 total participants (72 females, 48 males), 12 were considered glaucoma suspects at the screening, although only three (2.5%) were ultimately diagnosed with glaucoma. Health anxiety showed significant correlation with trait anxiety (r=0.525, P<0.001). Trait anxiety was similar for both the genders; this score was significantly below the normal Hungarian population value in women (P<0.001) and at the normal population level in men (P=0.560). In contrast, health anxiety was significantly higher than for both the 'normal' and 'anxious' reference groups (P<0.001), although smaller than that for hypochondriacs (P<0.001). Participants with pre-existing ocular symptoms, and those who attended because of fear of blindness, had significantly higher trait- and health-anxiety scores (P<0.05 for all comparisons)., CONCLUSION: In this screening trial, the health anxiety of the self-recruited participants was significantly above normal, whereas the prevalence of glaucoma was within the usual range for a Caucasian population. This suggests that providing pre-publicity information on risk factors for glaucoma does not necessarily increase the prevalence of glaucoma among self-recruited participants in non-population-based screening, as some individuals may participate on account of elevated health anxiety, rather than because of higher potential risk for glaucoma.
Keywords: Aged; Analysis of Variance; *Anxiety/px [Psychology]; European Continental Ancestry Group; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/px [Psychology]; Health Behavior; Humans; Hungary; Male; Middle Aged; *Patient Acceptance of Health Care/px [Psychology]; Risk Factors

Young's modulus of elasticity of Schlemm's canal endothelial cells. - Zeng, Dehong; Juzkiw, Taras; Read, A Thomas; Chan, Darren W-H; Glucksberg, Matthew R; Ethier, C Ross; Johnson, Mark (Biomechanics and modeling in mechanobiology, 2010)
Schlemm's canal (SC) endothelial cells are likely important in the physiology and pathophysiology of the aqueous drainage system of the eye, particularly in glaucoma. The mechanical stiffness of these cells determines, in part, the extent to which they can support a pressure gradient and thus can be used to place limits on the flow resistance that this layer can generate in the eye. However, little is known about the biomechanical properties of SC endothelial cells. Our goal in this study was to estimate the effective Young's modulus of elasticity of normal SC cells. To do so, we combined magnetic pulling cytometry of isolated cultured human SC cells with finite element modeling of the mechanical response of the cell to traction forces applied by adherent beads. Preliminary work showed that the immersion angles of beads attached to the SC cells had a major influence on bead response; therefore, we also measured bead immersion angle by confocal microscopy, using an empirical technique to correct for axial distortion of the confocal images. Our results showed that the upper bound for the effective Young's modulus of elasticity of the cultured SC cells examined in this study, in central, non-nuclear regions, ranged between 1,007 and 3,053 Pa, which is similar to, although somewhat larger than values that have been measured for other endothelial cell types. We compared these values to estimates of the modulus of primate SC cells in vivo, based on images of these cells under pressure loading, and found good agreement at low intraocular pressure (8-15 mm Hg). However, increasing intraocular pressure (22-30 mm Hg) appeared to cause a significant increase in the modulus of these cells. These moduli can be used to estimate the extent to which SC cells deform in response to the pressure drop across the inner wall endothelium and thereby estimate the extent to which they can generate outflow resistance.
Keywords: Animals; *Aqueous Humor/cy [Cytology]; Computer Simulation; *Elastic Modulus/ph [Physiology]; Endothelial Cells/cy [Cytology]; *Endothelial Cells/ph [Physiology]; Endothelial Cells/ul [Ultrastructure]; Finite Element Analysis; Humans; Magnetics; Microscopy, Phase-Contrast; Microspheres; Primates

Fusarium keratitis and endophthalmitis associated with lens contact wear. - Proenca-Pina, Julia; Ssi Yan Kai, Isabelle; Bourcier, Tristan; Fabre, Monique; Offret, Herve; Labetoulle, Marc (International ophthalmology, 2010)
INTRODUCTION: Fusarium keratitis is a severe corneal infection that is usually seen in tropical and subtropical countries after a corneal trauma. In 2005-2006, an epidemic of Fusarium keratitis, occurring predominantly among contact lens wearers, was observed in several countries., CASE REPORT: We describe the clinical course of a Fusarium keratitis which failed to respond to systemic and local voriconazole treatment, and experienced a progression to a severe keratitis with endophthalmitis, requiring early therapeutic keratoplasty ("a chaud"). After 8 months of follow up, the vision recovered to 20/50., DISCUSSION: After the 2005-2006 worldwide epidemics, case-control studies pointed out that a new lens care solution, ReNu with MoistureLoc (Bausch & Lomb), was likely responsible of numerous cases. Complementary studies underlined that this infection mostly concerned non-compliant patients, i.e., those reusing the solution several times, since this results in a decrease of the antifungal activity due to the uptake of the biguanides into the lens., CONCLUSION: Fusarium endophtalmitis can result in a devastating disease with a poor visual outcome. An initial antifungal dual therapy may control the infection. In case of failure, an early keratoplasty may be mandatory. For contact lens wearers, education on sanitary good practice is necessary to avoid new epidemics in the future.
Keywords: Adult; Antifungal Agents/ad [Administration & Dosage]; Contact Lens Solutions/ae [Adverse Effects]; *Contact Lenses; Cornea/mi [Microbiology]; Cornea/pa [Pathology]; Cornea/su [Surgery]; Corneal Transplantation; Disease Progression; Drug Resistance, Fungal; *Endophthalmitis/et [Etiology]; Endophthalmitis/pa [Pathology]; Endophthalmitis/th [Therapy]; *Fusarium/ip [Isolation & Purification]; Humans; Keratitis/co [Complications]; *Keratitis/mi [Microbiology]; Keratitis/pa [Pathology]; Keratitis/th [Therapy]; Male; Patient Compliance; Pyrimidines/ad [Administration & Dosage]; Time Factors; Triazoles/ad [Administration & Dosage]; Visual Acuity; Voriconazole

Morphological features of Acanthamoeba causing keratitis contaminated from contact lens cases. - Lek-Uthai, Usa; Passara, Rangsima; Roongruangchai, Kosol (Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009)
OBJECTIVE: To study the morphological characteristics of genus Acanthamoeba which is an opportunistic organism associated with wearing contact lenses that the biofilm phenomenon in contact lens cases contained Acanthamoeba causing keratitis by conventional culture technique., MATERIAL AND METHOD: A total of 150 contact lens cases were biofilm scraped in March till September 2007, at an institution in Nakhornpathom Province, Thailand. The 'gold standard' culture technique was used for the excystation growth development observation. Cysts of Acanthamoeba spp. contained 50 microlitres of Escherichia coli and contact lens solution were incubated and observed for the presence of cysts and/or trophozoites for 12 days. An infected slide was stained with giemsa solution and other non-stained and non-fixed slides were carried out for morphological characteristics study by different microscopes., RESULTS: The prevalence of Acanthamoeba spp. in scraping of contact lens cases was 6.7% (10/150). These Acanthamoeba isolates at temperature around 37 degrees C were consisted of all three groups, which in summary; the average diameter of cysts in Astronyxids (group I) was relatively large. They were > or = 18 micrometers, while those of Polyphagids (group II) and Culbertsonids (group III) were < or = 18 micron. The typical morphology of Acanthamoeba trophozoites moving freely in water were recognized by the presence of lobopodium and acanthopodia within 12 observed days. The average size of Acanthamoeba trophozoites was in the range of 12-45 micron. Three different images of cyst were feature studied., CONCLUSION: Three Acanthamoeba groups by biofilm scraping from contact lens cases should be differentiated. Morphological characteristics cysts and trophozoites should be confirmed. In addition, to improve contact lens wearer education, compliance with contact lens cases, hygiene recommendations and regular disposal of contact lens cases might help to solve contact lens cases.
Keywords: Acanthamoeba/cl [Classification]; *Acanthamoeba/ip [Isolation & Purification]; Acanthamoeba/ph [Physiology]; *Acanthamoeba/ul [Ultrastructure]; Acanthamoeba Keratitis/ep [Epidemiology]; *Acanthamoeba Keratitis/ps [Parasitology]; Acanthamoeba Keratitis/pc [Prevention & Control]; Amebiasis/ep [Epidemiology]; Biofilms/gd [Growth & Development]; *Contact Lens Solutions; *Contact Lenses/ps [Parasitology]; Humans; Microscopy, Atomic Force; Pilot Projects; Prevalence; Pseudopodia; Thailand/ep [Epidemiology]; Trophozoites

[An epidemiological study of visual disability and visual rehabilitation in Beijing]. - Zou, Yan-hong; Ding, Ji-yuan; Peng, Hong; Shi, Ji-liang; Qu, Cheng-yi; Liu, Xi-pu (Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi, 2009)
OBJECTIVE: To investigate the status of visual disability and the demands for visual rehabilitation services in Beijing., METHODS: Five hundred and fifty-five persons with visual disability in Beijing from the Second National Survey on Disability of China were involved in this study. Their visual disability and demands for rehabilitation were evaluated., RESULTS: About three fourth of the visual disabled persons were over 60 years of age. Cataract, retinal and choroidal diseases, and glaucoma were the three leading causes of the visual impairment. Medical service was the number one (82.0%) demand for the persons with visual disability, although 89.4% of them had previously received some kinds of medial services. People who had received visual aid devices or rehabilitation training were 26.7% and 5.8%, respectively, while more people showed their demand for these service (36.6% and 11.9%, respectively). The demand for visual rehabilitation varied in different groups of age and severity of disability., CONCLUSION: Accessibility of high quality medical services for preventable blindness diseases should be further promoted. Public health education on visual rehabilitation is also needed.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; China/ep [Epidemiology]; *Disabled Persons/rh [Rehabilitation]; Female; *Health Services Needs and Demand; Humans; Infant; Infant, Newborn; Male; Middle Aged; Vision, Low/ep [Epidemiology]; *Vision, Low/rh [Rehabilitation]; Young Adult