Comparison of resident and glaucoma faculty practice patterns in the care of open-angle glaucoma. - Zebardast, Nazlee; Solus, Jason F; Quigley, Harry A; Srikumaran, Divya; Ramulu, Pradeep Y (BMC ophthalmology, 2015)
BACKGROUND: Previous studies suggest there are large variations in adherence of ophthalmologists with the American Academy of Ophthalmology's Preferred Practice Patterns (PPPs). The purpose of this study was to compare rates of compliance with glaucoma care guidelines between resident and glaucoma faculty physicians at a single institution., METHODS: Charts of resident continuity clinic or glaucoma faculty patients with primary open angle glaucoma (POAG), ocular hypertension (OHTN), or suspicion of glaucoma were reviewed during the 2005-6 academic year. Performance within care measures specified by the 2005 PPP guidelines was compared between resident and faculty physicians using univariate and multivariable logistic regression models., RESULTS: 112 resident and 100 faculty charts were reviewed. The mean compliance rate for all 7 care measures for resident physicians was significantly lower than that of faculty physicians (78% vs. 96%, p < 0.001). As compared to glaucoma faculty, resident physicians were less likely to have documented 6 of the 7 individual care measures (p <= 0.001 for all); the exception was optic nerve (ON) description. In multivariable analyses, resident patients were more likely to have at least one undocumented care measure than faculty patients (OR = 10.1, 95% CI = 5.1 to 20.0, p < 0.001). Among resident patients, undocumented care measures were more common among patients with poorer visual acuity (VA) in the better eye., CONCLUSIONS: Though unmeasured differences in clinic structure and patient characteristics may have partially contributed to poorer resident performance, residents were more likely than faculty to omit PPP care measures and significantly underperformed faculty in global assessment of glaucoma care. Resident education should focus on integration of PPPs into residency training and monitoring of resident compliance with evidence-based guidelines.
Keywords: Academies and Institutes/st [Standards]; Aged; *Faculty, Medical/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; Gonioscopy; *Guideline Adherence; Humans; *Internship and Residency/sn [Statistics & Numerical Data]; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmology/st [Standards]; *Practice Guidelines as Topic/st [Standards]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Tonometry, Ocular

Glaucoma patient expression of medication problems and nonadherence. - Slota, Catherine; Sayner, Robyn; Vitko, Michelle; Carpenter, Delesha M; Blalock, Susan J; Robin, Alan L; Muir, Kelly W; Hartnett, Mary Elizabeth; Sleath, Betsy (Optometry and vision science : official publication of the American Academy of Optometry, 2015)
PURPOSE: The purpose of this study was to examine if patient demographic factors influenced self-reporting of medication side effects, difficulty with drop instillation, and nonadherence to glaucoma therapy., METHODS: English-speaking adult glaucoma patients (n = 279) from six ophthalmology clinics were enrolled. Patients' medical visits were videotaped and patients were interviewed immediately afterward by research assistants. The videotapes were transcribed verbatim and coded to identify patients who expressed problems with medication side effects, eye drop administration, and nonadherence during the glaucoma office visits. Generalized estimating equations were performed to identify whether patient characteristics were associated with expression of problems with glaucoma medication and medication nonadherence during the office visit., RESULTS: Patients with lower health literacy were significantly less likely to express problems with side effects (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.25 to 0.88) and eye drop administration (OR, 0.26; 95% CI, 0.11 to 0.63) during the visit. Patients who reported eye drop administration and side effect problems during the interview were significantly more likely to express these problems to their ophthalmologist (OR, 3.13; 95% CI, 1.82 to 5.37 and OR, 1.86; 95% CI, 1.12 to 3.08, respectively). Patients who expressed a problem with eye drop administration and with side effects were significantly more likely to express medication nonadherence to their ophthalmologist (OR, 2.89; 95% CI, 1.44 to 5.80 and OR, 2.03; 95% CI, 1.16 to 3.54, respectively). Patients who reported greater than 80% medication adherence during the interview were significantly less likely to express nonadherence to their ophthalmologist (OR, 0.22; 95% CI, 0.12 to 0.40)., CONCLUSIONS: Eye care providers should be aware that glaucoma patients with lower health literacy are less likely to express problems with side effects and eye drop administration. Providers should work with patients to assess medication-related problems to mitigate potential barriers to medication adherence because patients who expressed medication problems were also more likely to express nonadherence.
Keywords: Adult; African Americans; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ae [Adverse Effects]; European Continental Ancestry Group; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; *Health Literacy/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; *Patients/px [Psychology]; Surveys and Questionnaires; Young Adult

Medical interventions for fungal keratitis. - FlorCruz, Nilo Vincent; Evans, Jennifer R (The Cochrane database of systematic reviews, 2015)
BACKGROUND: Fungal keratitis is a fungal infection of the cornea. It is common in lower income countries, particularly in agricultural areas but relatively uncommon in higher income countries. Although there are medications available, their effectiveness is unclear., OBJECTIVES: To assess the effects of different antifungal drugs in the management of fungal keratitis., SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to March 2015), EMBASE (January 1980 to March 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to March 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 16 March 2015., SELECTION CRITERIA: We included randomised controlled trials of medical therapy for fungal keratitis., DATA COLLECTION AND ANALYSIS: Two review authors selected studies for inclusion in the review, assessed trials for risk of bias and extracted data. The primary outcome was clinical cure at two to three months. Secondary outcomes included best-corrected visual acuity, time to clinical cure, compliance with treatment, adverse outcomes and quality of life., MAIN RESULTS: We included 12 trials in this review; 10 trials were conducted in India, one in Bangladesh and one in Egypt. Seven of these trials were at high risk of bias in one or more domains, two of these studies were at low risk of bias in all domains. Participants were randomised to the following comparisons: topical 5% natamycin compared to topical 1% voriconazole; topical 5% natamycin compared to topical 2% econazole; topical 5% natamycin compared to topical chlorhexidine gluconate (0.05%, 0.1% and 0.2%); topical 1% voriconazole compared to intrastromal voriconazole 50 g/0.1 mL (both treatments combined with topical 5% natamycin); topical 1% voriconazole combined with oral voriconazole compared to both oral voriconazole and oral itraconazole (both combined with topical 5% natamycin); topical 1% itraconazole compared to topical 1% itraconazole combined with oral itraconazole; topical amphotericin B compared to topical amphotericin B combined with subconjunctival injection of fluconazole; intracameral injection of amphotericin B with conventional treatment compared to conventional treatment alone (severe fungal ulcers); topical 0.5% and 1% silver sulphadiazine compared to topical 1% miconazole. Overall the results were inconclusive because for most comparisons only one small trial was available. The exception was the comparison of topical natamycin and topical voriconazole for which three trials were available. In one of these trials clinical cure (healed ulcer) was reported in all 15 people allocated to natamycin and in 14/15 people allocated to voriconazole (risk ratio (RR) 1.07; 95% confidence interval (CI) 0.89 to 1.28, low quality evidence). In one trial people randomised to natamycin were more likely to have a microbiological cure at six days (RR 1.64; 95% CI 1.38 to 1.94, 299 participants). On average, people randomised to natamycin had better spectacle-corrected visual acuity at two to three months compared to people randomised to voriconazole but the estimate was uncertain and the 95% confidence intervals included 0 (no difference) (mean difference -0.12 logMAR, 95% CI -0.31 to 0.06, 434 participants; 3 studies, low quality evidence) and a decreased risk of corneal perforation or therapeutic penetrating keratoplasty, or both (RR 0.61; 95% CI 0.40 to 0.94, 434 participants, high quality evidence). There was inconclusive evidence on time to clinical cure. Compliance with treatment and quality of life were not reported. One trial comparing natamycin and voriconazole found the effect of treatment greater in Fusarium species, but this subgroup analysis was not prespecified by this review., AUTHORS' CONCLUSIONS: The trials included in this review were of variable quality and were generally underpowered. There is evidence that natamycin is more effective than voriconazole in the treatment of fungal ulcers. Future research should evaluate treatment effects according to fungus species.
Update of (UOF)
Keywords: *Antifungal Agents/tu [Therapeutic Use]; *Eye Infections, Fungal/dt [Drug Therapy]; Humans; *Keratitis/dt [Drug Therapy]; Keratitis/mi [Microbiology]; Natamycin/tu [Therapeutic Use]; Randomized Controlled Trials as Topic; Voriconazole/tu [Therapeutic Use]

Combined endonasal and sublabial endoscopic transmaxillary approach to the pterygopalatine fossa and orbital apex. - Alimohamadi, Maysam; Hajiabadi, Mohamadreza; Gerganov, Venelin; Fahlbusch, Rudolf; Samii, Madjid (Acta neurochirurgica, 2015)
BACKGROUND: The pterygopalatine fossa (PPF) and inferomedial orbital apex are difficult regions for open neurosurgical access. The traditional extensive anterior approach (transfacial or transmandibular) and lateral/posterolateral (transcranial) approach were used to access the PPF. The combined endonasal and sublabial transmaxillary approach is a less invasive access route for these lesions. In this study, we present the technical and clinical details of our experience with the combined endoscopic endonasal and transmaxillary approach., METHODS: A retrospective analysis of our patients operated on using a combined endoscopic endonasal and transmaxillary approach was done. The preoperative, intraoperative and postoperative images and all the clinical data were evaluated. The accessibility to the area and extent of surgical resection were reviewed. The surgery-related complications and postoperative morbidities were analyzed. The main items of interest were the exposure of the target area and possibility for safe removal., RESULTS: Five patients with pathologies located in the area of the PPF and orbital apex were operated on using the combined endoscopic sublabial and endonasal transmaxillary approach. The technique provided sufficient exposure of the area and allowed for safe removal of the preoperatively determined target in all of the patients. One patient developed dry eye and a neurotrophic corneal ulcer, and another patient developed temporary postoperative facial numbness. In the follow-up, only one patient with skull base chordoma had an asymptomatic tumor regrowth. The other patients had no recurrence or regrowth., CONCLUSIONS: The combined endoscopic sublabial and endonasal transmaxillary approach is a safe and effective method for resection of lesions in the PPF and inferomedial orbital apex.
Erratum in (EIN)
Keywords: Adolescent; Adult; Chordoma/su [Surgery]; *Endoscopy/mt [Methods]; Female; Humans; Intraoperative Neurophysiological Monitoring; Male; Middle Aged; *Mouth Floor/su [Surgery]; *Nasal Cavity/su [Surgery]; Neuronavigation; *Neurosurgical Procedures/mt [Methods]; *Orbit/su [Surgery]; *Pterygopalatine Fossa/su [Surgery]; Retrospective Studies; Skull Base Neoplasms/su [Surgery]; Treatment Outcome

Psychometric properties of the Glaucoma Treatment Compliance Assessment Tool in a multicenter trial. - Barker, Gordon T; Cook, Paul F; Schmiege, Sarah J; Kahook, Malik Y; Kammer, Jeffrey A; Mansberger, Steven L (American journal of ophthalmology, 2015)
PURPOSE: To assess the psychometric properties of a new version of the Glaucoma Treatment Compliance Assessment Tool, a survey evaluating health behavior and glaucoma adherence using constructs from the Health Belief Model., DESIGN: Psychometric analysis., METHODS: We administered the 47-statement Glaucoma Treatment Compliance Assessment Tool to 201 participants who were using a single bottle of an ocular hypotensive agent, and objectively measured adherence with medication event monitoring system devices over 60 days. Adherence was the percentage of days with correctly timed bottle openings. We used principal components analysis to determine construct validity, Cronbach's alpha for internal consistency reliability, frequency analysis for floor and ceiling effects, and Spearman rho for test-retest reliability. We determined predictive validity using univariate and multiple regression., RESULTS: The mean (+/-SD, range) adherence percentage was 79.9% (+/-18.5%, 20.3%-100.0%). Principal component analysis loaded 24 questions into 6 components that were consistent with the Health Belief Model. All 6 components had Cronbach's alpha reliability between 0.601 and 0.797. No statements had floor or ceiling effects, and all statements had acceptable test-retest reliability. Multiple regression analysis showed 4 Health Belief Model statements, white race, older age, and married marital status to be associated with higher adherence (adjusted R(2) = 0.27, P < .001)., CONCLUSIONS: The newest version of the Glaucoma Treatment Compliance Assessment Tool showed acceptable psychometric properties. With further refinement, clinicians and researchers could use it to examine factors related to adherence and measure improvement in adherence with a change in health behavior attitudes. Copyright © 2015 Elsevier Inc. All rights reserved.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Attitude to Health; False Positive Reactions; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/px [Psychology]; *Health Behavior; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Models, Psychological; Models, Statistical; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/px [Psychology]; Ophthalmic Solutions; Patient Acceptance of Health Care; Predictive Value of Tests; *Psychometrics; Reproducibility of Results; *Surveys and Questionnaires

Usability of prostaglandin monotherapy eye droppers. - Drew, Tom; Wolffsohn, James S (The British journal of ophthalmology, 2015)
AIM: To determine the force needed to extract a drop from a range of current prostaglandin monotherapy eye droppers and how this related to the comfortable and maximum pressure subjects could exert., METHODS: The comfortable and maximum pressure subjects could apply to an eye dropper constructed around a set of cantilevered pressure sensors and mounted above their eye was assessed in 102 subjects (mean 51.2+/-18.7 years), repeated three times. A load cell amplifier, mounted on a stepper motor controlled linear slide, was constructed and calibrated to test the force required to extract the first three drops from 13 multidose or unidose latanoprost medication eye droppers., RESULTS: The pressure that could be exerted on a dropper comfortably (25.9+/-17.7 Newtons, range 1.2-87.4) could be exceeded with effort (to 64.8+/-27.1 Newtons, range 19.9-157.8; F=19.045, p<0.001), and did not differ between repeats (F=0.609, p=0.545). Comfortable and maximum pressures exerted were correlated (r=0.618, p<0.001), neither were influenced strongly by age (r=0.138, p=0.168; r=-0.118, p=0237, respectively), but were lower in women than in men (F=12.757, p=0.001). The force required to expel a drop differed between dropper designs (F=22.528, p<0.001), ranging from 6.4 Newtons to 23.4 Newtons. The force needed to exert successive drops increased (F=36.373, p<0.001) and storing droppers in the fridge further increased the force required (F=7.987, p=0.009)., CONCLUSIONS: Prostaglandin monotherapy droppers for glaucoma treatment vary in their resistance to extract a drop and with some a drop could not be comfortably achieved by half the population, which may affect compliance and efficacy. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Keywords: Adult; Aged; Aged, 80 and over; Analysis of Variance; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Instillation, Drug; Latanoprost; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Pressure; *Prostaglandins/ad [Administration & Dosage]; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Young Adult

The equity profile of an enhanced optometry scheme. - Ratnarajan, Gokulan; Coombes, E; Jones, A; Parker, M; Bourne, R (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2015)
Erratum in (EIN)
Keywords: *Delivery of Health Care/og [Organization & Administration]; *Glaucoma/di [Diagnosis]; *Health Services Accessibility/og [Organization & Administration]; Health Services Accessibility/st [Standards]; *Health Services Needs and Demand; Healthcare Disparities; Humans; *Optometry/og [Organization & Administration]; State Medicine/og [Organization & Administration]; United Kingdom

Impact of supply problems of preservative-free glaucoma medications on patients and hospital staff. - Shah, Shima; Theodossiades, Julia; Chapman, Kristin; Murdoch, Ian (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2015)
PURPOSE: Glaucoma is a chronic ocular disease, which is usually managed with long-term daily medical therapy, in the form of eye drops. Patients who are intolerant to preservatives in topical medicines require preservative-free versions. From early 2011 patients attending Moorfields Eye Hospital, London, UK, started to report recurring problems with the supply of the following preservative-free glaucoma medications: Timolol 0.25% (Timoptol 0.25%, MSD UK); Dorzolamide (Trusopt, MSD UK); Dorzolamide and Timolol 0.5% (Cosopt, MSD UK). This study investigates the impact of the supply problems of these medications at Moorfields Eye Hospital from a patient, administrative and clinical perspective., METHODS: Information was sought by interviewing both patients and hospital staff, and by a retrospective case note review between April 2010 and May 2013., RESULTS: Many hospital roles, both administrative and clinical, were involved in attempting to resolve the impact of the supply problems. All staff reported a considerable increase in their workload. At the peak of the problem, the glaucoma secretaries received about 150 enquiries per week. A review of 83 sets of patient notes, retrieved from a random sample of 125 patients, showed that 22% encountered a supply problem. Of these, more than one-third attended Moorfields Eye Hospital Accident & Emergency (A&E) for repeat supplies and 89% eventually had their medication changed. In telephone interviews with 39 of a random sample of 50 patients (a subset of the 83 notes retrieved), 59% of the interviewees reported a supply problem. Of these, one-third attended Moorfields Eye Hospital A&E for repeat supplies and half eventually required an alternative medication. Some patients reported going to considerable lengths to obtain ongoing supplies in the community., CONCLUSIONS: This study shows that medication supply problems can have a major impact on patients and hospital services. Supply problems occur across many fields of medicine and with increasing frequency. The findings of this study highlight the importance of early communication of impending shortages between manufacturers and the Department of Health, as recommended in the best practice guidelines. In order to minimise the impact of medicine shortages on patients, clinicians and administrative staff, hospitals need immediate notification of potential supply problems and clear updates on supply resolution. In addition, hospitals should consider nominating an individual as a contact point for patient enquiries regarding medicine supply problems. Copyright © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.
Keywords: Adult; Aged; *Antihypertensive Agents/sd [Supply & Distribution]; *Attitude of Health Personnel; Drug Substitution; Female; *Glaucoma/dt [Drug Therapy]; Humans; Middle Aged; Patient Satisfaction; Retrospective Studies; Stress, Psychological/et [Etiology]; Surveys and Questionnaires; Workload

Implantation of refractive multifocal intraocular lens with a surface-embedded near section for cataract eyes complicated with a coexisting ocular pathology. - Ouchi, M; Kinoshita, S (Eye (London, England), 2015)
PURPOSE: To evaluate the postoperative outcomes of cataract eyes complicated with coexisting ocular pathologies that underwent implantation of a refractive multifocal intraocular lens (MIOL) with a surface-embedded near section., METHODS: LENTIS MPlus (Oculentis GmbH) refractive MIOLs were implanted in 15 eyes with ocular pathologies other than cataract (ie, six high-myopia eyes with an axial length longer than 28 mm, two fundus albipunctatus eyes, two branch retinal-vein occlusion eyes, four glaucoma eyes (one with high myopia), and two keratoconus eyes). Uncorrected or corrected distance and near visual acuity (VA) (UDVA, UNVA, CDVA, and CNVA), contrast sensitivity, and defocus curve were measured at 1 day and 6 months postoperatively, and each patient completed a 6-month postoperative questionnaire regarding vision quality and eyeglass use., RESULTS: Thirteen eyes (87%) registered 0 or better in CDVA and 12 eyes (73%) registered better than 0 in CNVA. Contrast sensitivity in the eyes of all patients was comparable to that of normal healthy subjects. No patient required eyeglasses for distance vision, but three patients (20%) required them for near vision. No patient reported poor or very poor vision quality., CONCLUSION: With careful case selection, sectorial refractive MIOL implantation is effective for treating cataract eyes complicated with ocular pathologies.
Keywords: Adult; Aged; Cataract/co [Complications]; *Eye Diseases/co [Complications]; Female; Humans; *Lens Implantation, Intraocular/mt [Methods]; *Lenses, Intraocular; Male; Middle Aged; Patient Satisfaction; *Phacoemulsification/mt [Methods]; Prospective Studies; Prosthesis Design; Refraction, Ocular/ph [Physiology]; Surveys and Questionnaires; Visual Acuity/ph [Physiology]; Young Adult

Comparison of 3 different anesthetic approaches for intravitreal injections: a prospective randomized trial. - Andrade, Gabriel Costa de; Carvalho, Andre Correa Maia de (Arquivos brasileiros de oftalmologia, 2015)
PURPOSE: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel., METHODS: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients' eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection., RESULTS: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma., CONCLUSION: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections.
Keywords: Adult; Aged; Aged, 80 and over; *Anesthesia, Local/mt [Methods]; *Anesthetics, Local/ad [Administration & Dosage]; Eye Movements; Female; Humans; Intravitreal Injections/ae [Adverse Effects]; *Intravitreal Injections/mt [Methods]; Keratitis/ci [Chemically Induced]; *Lidocaine/ad [Administration & Dosage]; Macular Degeneration/dt [Drug Therapy]; Macular Edema/dt [Drug Therapy]; Male; Middle Aged; Pain Measurement; Patient Satisfaction; *Propoxycaine/ad [Administration & Dosage]; Prospective Studies

Socioeconomics of long-term glaucoma therapy in India. - Nayak, Bhagabat; Gupta, Shikha; Kumar, Guresh; Dada, Tanuj; Gupta, Viney; Sihota, Ramanjit (Indian journal of ophthalmology, 2015)
PURPOSE: To determine the socioeconomic impact of long-term glaucoma therapy., MATERIALS AND METHODS: One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side-effects was administered., RESULTS: The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/- (range: Rs. 500/- to Rs. 50,000/-) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti-glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6-96 h/month). About 2.7% experienced systemic side-effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment., CONCLUSIONS: Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Glaucoma/ep [Epidemiology]; *Health Expenditures/td [Trends]; Humans; Incidence; *Income/sn [Statistics & Numerical Data]; India/ep [Epidemiology]; Middle Aged; *Patient Compliance; *Poverty; Prognosis; Socioeconomic Factors; Surveys and Questionnaires; Time Factors; *Visual Acuity/ph [Physiology]; Young Adult

Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. - Siegel, Michael J; Boling, Whitney S; Faridi, Omar S; Gupta, Chirag K; Kim, Chaesik; Boling, Richard C; Citron, Matthew E; Siegel, Marc J; Siegel, Les I (Clinical & experimental ophthalmology, 2015)
BACKGROUND: To evaluate the long-term effects of combined endoscopic cyclophotocoagulation and phacoemulsification (phaco) versus phacoemulsification alone on intraocular pressure control and medication reliance in the treatment of mild to moderate glaucoma., DESIGN: Retrospective chart review in private practice setting by glaucoma fellowship trained surgeons., PARTICIPANTS: A total of 261 eyes in the combined phaco-endoscopic cyclophotocoagulation group with 52 eyes in the phaco-alone group., METHODS: Comparison of phaco-endoscopic cyclophotocoagulation with phaco alone over 36 months., MAIN OUTCOME MEASURES: Full and qualified success cumulative survival, intraocular pressure and medication reliance 6-36 months compared with baseline. Full success was defined as minimum 20% intraocular pressure reduction with a decrease of at least one ocular hypertensive medication. Qualified success was defined as intraocular pressure no higher than baseline with a decrease of at least one ocular hypertensive medication., RESULTS: At 36 months, mean intraocular pressure in the combined phaco-endoscopic cyclophotocoagulation group was 14.6 mmHg, whereas the phaco-alone group was 15.5 mmHg (P = 0.34). Mean medication reliance in the combined phaco-endoscopic cyclophotocoagulation group was 0.2 medications, whereas the phaco-alone group was 1.2 (P < 0.001). Full success in the phaco-endoscopic cyclophotocoagulation group was 61.4%; the phaco-alone group was 23.3% (P < 0.001). Qualified success survival was 72.6% in the phaco-endoscopic cyclophotocoagulation group and 23.3% in the phaco-alone group (P < 0.001)., CONCLUSIONS: Combined phaco-endoscopic cyclophotocoagulation effectively lowers or maintains intraocular pressure and results in ocular hypertensive medication reduction up to 36 months when compared with phaco alone. Therefore, phaco-endoscopic cyclophotocoagulation may help to increase medication compliance and reduce glaucoma progression in mild to moderate glaucoma. Copyright © 2015 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; *Ciliary Body/su [Surgery]; Endoscopy; Female; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; *Laser Coagulation/mt [Methods]; *Lasers, Semiconductor/tu [Therapeutic Use]; Lens Implantation, Intraocular; Male; *Phacoemulsification/mt [Methods]; Retrospective Studies; Tonometry, Ocular; Visual Acuity/ph [Physiology]

Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists. - Zangerl, Barbara; Hayen, Andrew; Mitchell, Paul; Jamous, Khalid F; Stapleton, Fiona; Kalloniatis, Michael (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2015)
PURPOSE: Previous studies confirmed that optometrists have access to and confidence in applying clinical tests recommended for glaucoma assessment. Less is known about factors best predicting compliance with national clinical guidelines and thus by inference, the provision of suitable care by primary care ophthalmic practitioners. We utilised the unique two-tiered profession (therapeutic and non-therapeutic scope of practice) in Australia and New Zealand to assess the prospective adherence to glaucoma guidelines dependent on the clinician's background., METHODS: Australian and New Zealand optometrists were surveyed on ophthalmic techniques for glaucoma assessment, criteria for the evaluation of the optic nerve head, glaucoma risk categories and review times while also recording background, training, and experience. Parameters identifying progression/conversion and patients' risk levels were analysed comparatively to ophthalmologists' opinions. Linear regression analysis identified variables significantly improving the likelihood of concordance with guidelines., RESULTS: Reported application of techniques complied well with glaucoma guidelines although gonioscopy and pachymetry, pupil dilation for optic nerve head examination, and acquisition of permanent records were less frequently employed. The main predictors for entry-level diagnostic standards were therapeutic endorsement together with the associated knowledge of relevant guidance and procedural confidence. Other findings suggested a potential underestimation in the value of optic disc size and intraocular pressure for the prediction of glaucoma risk, while optometrists more frequently relied on the outcomes of non-standardised automated perimetry and auxiliary imaging., CONCLUSIONS: Optometrists in Australia and New Zealand may not always exercise optimal clinical acumen regarding techniques/criteria for glaucoma diagnosis. Therapeutic endorsement was gradually adopted in different jurisdictions in various forms since 1999 and is mandatory for registration since late 2014. The result of the two-tiered optometric cohorts suggest that inclusion of therapeutic training as part of the core training is likely a key factor to enhanced compliance with glaucoma guidelines. Improved adherence to the current clinical standards should positively impact on the facilitation of appropriate glaucoma diagnosis and management. Obligatory knowledge and possibly accreditation of available guidelines might ensure a uniform standard in glaucoma testing protocols in concordance with compulsory entry-level skills. Copyright © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.
Keywords: Adult; Australia; *Clinical Competence/st [Standards]; Diagnostic Techniques, Ophthalmological; Female; *Glaucoma/di [Diagnosis]; *Guideline Adherence/st [Standards]; Health Care Surveys; Humans; Intraocular Pressure; Male; Middle Aged; New Zealand; *Optometry/mt [Methods]; Practice Guidelines as Topic; *Practice Patterns, Physicians'/st [Standards]; Prospective Studies; Regression Analysis; Risk Assessment/mt [Methods]; Risk Assessment/st [Standards]; Tonometry, Ocular; Visual Field Tests

Impact of the introduction of generic latanoprost on glaucoma medication adherence. - Stein, Joshua D; Shekhawat, Nakul; Talwar, Nidhi; Balkrishnan, Rajesh (Ophthalmology, 2015)
PURPOSE: To assess possible changes in medication adherence to prostaglandin analog (PGA) regimens among patients with open-angle glaucoma (OAG) after the initial introduction of generic PGAs., DESIGN: Longitudinal cohort analysis., PARTICIPANTS: Patients older than 40 years with OAG continuously enrolled in a nationwide managed-care network during 2009-2012 who used PGAs., METHODS: Mean adherence rates were calculated for topical PGA use during the 18 months before the introduction of generic latanoprost (September 2009-February 2011) and the 18 months after generic latanoprost became available (July 2011-December 2012). The rates were compared between persons who continued to use brand-name PGAs once generic latanoprost became available and others who switched to generic latanoprost. Multivariable logistic regression identified variables associated with an improvement or worsening of adherence of >=25%., MAIN OUTCOME MEASURES: Mean adherence rates and odds of 25% or more improved or worsened adherence (with 95% confidence intervals [CIs])., RESULTS: A total of 8427 patients met the study eligibility criteria. Compared with persons switching to generic latanoprost, patients who continued taking brand name PGAs were 28% less likely to have improved adherence (odds ratio [OR], 0.72; 95% CI, 0.55-0.94) and 39% more likely to have reduced adherence (OR, 1.39; 1.04-1.86) of >=25%. Improved adherence after the generic drug's introduction was also associated with higher monthly medication copay in the pregeneric period (P = 0.02), lower copay after introduction of the generic drug (P < 0.0001), and black race (OR, 1.25; 95% CI, 1.04-1.50). Six-hundred twelve patients (7.3%) discontinued all antiglaucoma interventions when generic latanoprost became available., CONCLUSIONS: Given that cost can significantly deter adherence, switching patients to generic medications may help improve patients' drug-regimen adherence. A considerable number of patients discontinued glaucoma drug use altogether when generic latanoprost became available. Ophthalmologists should work with insurers and pharmacists to prevent such discontinuation of use as generic forms of other PGA agents become available. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Drug Costs; Drugs, Generic/ec [Economics]; *Drugs, Generic/tu [Therapeutic Use]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Managed Care Programs; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Odds Ratio; Ophthalmic Solutions; Prostaglandins F, Synthetic/ec [Economics]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Incremental Healthcare Service Utilization for Open-angle Glaucoma: A Population-Based Study. - Chung, Shiu-Dong; Ho, Jau-Der; Lin, Herng-Ching; Kao, Li-Ting; Tsai, Ming-Chieh (Journal of glaucoma, 2015)
PURPOSE: To investigate differences in the utilization of healthcare services between subjects with open-angle glaucoma (OAG) and comparison subjects without OAG using Taiwan's National Health Insurance population-based database., PATIENTS AND METHODS: The study comprised 2204 subjects with OAG and 2204 sex-matched and age-matched subjects without OAG. We individually followed each subject for a 1-year period to evaluate their healthcare resource utilization. Outcome variables of the healthcare resource utilization were as follows: numbers of outpatient visits and inpatient days and the mean costs of outpatient and inpatient treatment. In addition, we divided healthcare resource utilization into ophthalmologic and nonophthalmologic services., RESULTS: As for the utilization of ophthalmologic services, OAG subjects had significantly more outpatient visits (7.4 vs. 1.3, P<0.001) and significantly higher outpatient costs (US$272 vs. US$39, P<0.001) than comparison subjects. For nonophthalmologic services, OAG subjects also had significantly more outpatient visits (29.4 vs. 21.8, P<0.001) and significantly higher outpatient costs (US$1263 vs. US$847, P<0.001) than comparison subjects. Furthermore, OAG subjects incurred significantly higher inpatient costs compared with comparison subjects (US$434 vs. US$234, P<0.001). For all healthcare services, OAG subjects had significantly more outpatient visits (36.8 vs. 23.1, P<0.001) and significantly higher outpatient (US$1535 vs. US$887, P<0.001) and total (US$2245 vs. US$1122, P<0.001) costs than comparison subjects. In other words, the total cost was about 2-fold greater for OAG subjects than comparison subjects., CONCLUSIONS: We concluded that subjects with OAG had significantly higher utilization of all healthcare services than comparison subjects.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Databases, Factual; Female; *Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/th [Therapy]; *Health Care Costs/sn [Statistics & Numerical Data]; *Health Services/ec [Economics]; *Health Services/sn [Statistics & Numerical Data]; Health Services Research; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; National Health Programs/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Taiwan/ep [Epidemiology]; Young Adult

Safety and tolerability of the tafluprost/timolol fixed combination for the treatment of glaucoma. - Hollo, Gabor; Katsanos, Andreas (Expert opinion on drug safety, 2015)
INTRODUCTION: The preservative-free (PF) fixed combination (FC) of tafluprost 0.0015%/timolol 0.5% is the newest member of the prostaglandin analogue/timolol FC class., AREAS COVERED: In this review, we summarize data on safety and tolerability of this FC., EXPERT OPINION: The intraocular pressure-lowering effect of the tafluprost/timolol FC is approximately 30 - 35%, which is similar to that of the other members of the class. However, in contrast to most similar eye drops the tafluprost/timolol FC is manufactured in a PF, unit-dose pipette formulation. The PF nature eliminates preservative-related ocular surface changes, and improves tolerability. In clinical studies, the tafluprost/timolol FC was well tolerated. The side effects represented the typical side effects of the topical prostaglandin analogue class. The most common side effect, conjunctival hyperemia was mild, and occurred in only 6.4 - 8% of patients during 6 months of treatment. The figures for ocular irritation were also low (7.0 - 12.7%). The other side effects occurred only in very few patients. The frequency and severity of conjunctival hyperemia was lower than those published for most prostaglandin/timolol FCs. Thus, the main clinical advantage of this PF FC is improved tolerability, which may support treatment adherence of glaucoma patients.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Conjunctival Diseases/ci [Chemically Induced]; Conjunctival Diseases/ep [Epidemiology]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; Hyperemia/ep [Epidemiology]; Intraocular Pressure/de [Drug Effects]; Medication Adherence; Prostaglandins F/ad [Administration & Dosage]; *Prostaglandins F/ae [Adverse Effects]; Prostaglandins F/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; *Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Adherence to topical glaucoma medications in Ethiopian patients. - Tamrat, Lemlem; Gessesse, Girum W; Gelaw, Yeshigeta (Middle East African journal of ophthalmology, 2015)
PURPOSE: Successful outcomes of medical treatment for glaucoma require proper and daily use of medication to prevent disease progression. The aim of this study was to determine the adherence to anti-glaucoma medications and factors associated with non-adherence among patients with ocular hypertension (OHT) or glaucoma at Jimma University Specialized Hospital, Ethiopia., MATERIALS AND METHODS: A hospital based cross sectional study was conducted on 200 consecutive patients from July to November 2010 at Jimma University Hospital in Southwest Ethiopia. Patients with OHT or glaucoma who were taking topical anti-glaucoma medications for more than six months were included. The study subjects were interviewed and their medical records were reviewed. Non-adherence to glaucoma therapy (NAGT) was defined as self-reported on missed medications or missed appointments, or a physician noting poor adherence. A P < 0.05 was statistically significant., RESULT: Overall, 135 (67.5%) patients were non adherent to glaucoma therapy. Non adherence was associated with older age (P = 0.04), advanced stage of glaucoma (P = 0.01), longer frequency of follow up (P = 0.00) and financial problem (P = 0.000). Sex (P = 0.53), level of education (P = 0.09), and marital status (P = 0.77) were not statistically significantly associated with non-adherence to anti-glaucoma drug treatment., CONCLUSION: A relatively high proportion of patients were not adhering to the medications regimen for glaucoma. Older age, advanced glaucoma, lengthier frequency of follow-up and financial hardship were associated with non-adherence. Eye care providers should be aware of the problem of non-adherence to topical medications.
Keywords: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Ethiopia/ep [Epidemiology]; Female; Glaucoma/cl [Classification]; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Prospective Studies; Rural Population/sn [Statistics & Numerical Data]; Tertiary Care Centers/sn [Statistics & Numerical Data]; Urban Population/sn [Statistics & Numerical Data]

Level of knowledge about glaucoma in Vienna. - Fabjani, Sonja; Richter-Muksch, Sibylla; Cakmak, Nesrin; Markstaller, Monika; Weingessel, Birgit; Vecsei-Marlovits, Veronika Pia (Wiener klinische Wochenschrift, 2015)
BACKGROUND: Glaucoma is a chronic and serious disease calling for consistent lifelong therapy. The patient's compliance requires that he/she be well informed about the disease. The purpose of the present study was to determine the level of knowledge about glaucoma, and compare young patients with older ones as well as glaucoma patients with nonglaucoma ones., METHODS: A total of 1110 questionnaires were distributed to patients and their relatives at the outpatient eye clinic of Hietzing Hospital (Vienna), of which 1041 were returned. The questionnaire comprised 18 questions. Patients were divided into two groups: group 1 consisted of those aged 18-60 years, while group 2 consisted of those older than 61 years., RESULTS: In total, 941 questionnaires were evaluated; 72.8% of the respondents were older than 60 years, and one-half of the respondents had glaucoma (51%). The majority of patients had "moderate knowledge" of the disease (41.87%), followed by "poor knowledge" (32.52%). Glaucoma patients had considerably better knowledge of the disease (p < 0.01) than did nonglaucoma patients. Younger patients were significantly better informed than older ones (p < 0.01). Nonglaucoma patients with a positive diagnosis of glaucoma among their circle of friends or family were significantly better informed (p < 0.01) than those without such persons in their circle of friends., CONCLUSION: Persons with glaucoma are much better informed about the disease than nonglaucoma patients, but the general level of knowledge is very low. Notably, younger patients were better informed than older ones. The present study, comprising a large number of patients, revealed poor knowledge of glaucoma among patients with the disease and especially among nonglaucoma patients in Vienna.
Keywords: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Austria/ep [Epidemiology]; *Family; Female; *Glaucoma/ep [Epidemiology]; *Health Knowledge, Attitudes, Practice; *Health Literacy/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; *Patient Education as Topic/sn [Statistics & Numerical Data]; Sex Distribution; Surveys and Questionnaires; Young Adult

Pharmacotherapy of glaucoma. - Schmidl, Doreen; Schmetterer, Leopold; Garhofer, Gerhard; Popa-Cherecheanu, Alina (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2015)
Glaucoma is a group of diseases involving the optic nerve and associated structures, which is characterized by progressive visual field loss and typical changes of the optic nerve head (ONH). The only known treatment of the disease is reduction of intraocular pressure (IOP), which has been shown to reduce glaucoma progression in a variety of large-scale clinical trials. Nowadays, a relatively wide array of topical antiglaucoma drugs is available, including prostaglandin analogues, carbonic anhydrase inhibitors, beta-receptor antagonists, adrenergic agonists, and parasympathomimetics. In clinical routine, this allows for individualized treatment taking risk factors, efficacy, and safety into account. A major challenge is related to adherence to therapy. Sustained release devices may help minimize this problem but are not yet available for clinical routine use. Another hope arises from non-IOP-related treatment concepts. In recent years, much knowledge has been gained regarding the molecular mechanisms that underlie the disease process in glaucoma. This also strengthens the hope that glaucoma therapy beyond IOP lowering will become available. Implementing this concept with clinical trials remains, however, a challenge.
Keywords: Animals; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]

A Survey on the Preference of Sustained Glaucoma Drug Delivery Systems by Singaporean Chinese Patients: A Comparison Between Subconjunctival, Intracameral, and Punctal Plug Routes. - Chan, Hiok Hong; Wong, Tina T; Lamoureux, Ecosse; Perera, Shamira (Journal of glaucoma, 2015)
PURPOSE: To investigate the acceptance and preferences rates of 3 sustained drug delivery systems in glaucoma patients., MATERIALS AND METHODS: A cross-sectional study involving 250 Chinese patients recruited from outpatient glaucoma clinics in Singapore using an interviewer-administered survey. Beliefs toward medicines, eye drops, illness perception, medication adherence, and health literacy were assessed using validated questionnaires. After receiving standard information on the 3 sustained drug delivery systems, that is, subconjunctival, intracameral, and punctal routes; each route's acceptance and attitudes were determined., RESULTS: The subconjunctival (acceptance: 61.6%, n=154), intracameral (acceptance: 57.2%, n=143), and punctal (acceptance: 63.2%, n=158) routes were willing to be accepted by the majority of the interviewed patients. Among those, 78.6%, 79.1%, and 78.5% were willing to pay an equal or higher cost compared with their current eye drops for the subconjunctival, intracameral, and punctal plug routes, respectively. Independent factors associated with the acceptance for subconjunctival, intracameral, and punctal plug routes included: male sex (P=0.007, 0.014, 0.046, respectively), patients not on health care subsidies (P=0.022, 0.002, 0.016, respectively), and bilateral glaucoma disease (P=0.003, 0.013, 0.004, respectively). A total of 120 (48.0%) patients ranked punctal plug placement as the preferred route for sustained drug delivery followed by subconjunctival (n=76, 30.4%) and intracameral (n=54, 21.6%) routes., CONCLUSIONS: Sustained drug delivery for the medical treatment of glaucoma is an acceptable alternative to daily eye drop administration by most Singaporean Chinese individuals in this study. Male patients, nonsubsidized patients, and those with bilateral glaucoma were independently associated with preference of these 3 alternative routes of administration to traditional glaucoma drops.
Keywords: Adult; Aged; *Anterior Chamber/de [Drug Effects]; *Antihypertensive Agents/ad [Administration & Dosage]; Asian Continental Ancestry Group; Attitude to Health; *Conjunctiva/de [Drug Effects]; Cross-Sectional Studies; Delayed-Action Preparations; *Drug Delivery Systems; Female; *Glaucoma/dt [Drug Therapy]; Health Surveys; Humans; Intraocular Pressure/de [Drug Effects]; *Lacrimal Apparatus/de [Drug Effects]; Male; Medication Adherence; Middle Aged; Ophthalmic Solutions; Patient Acceptance of Health Care; *Patient Preference/sn [Statistics & Numerical Data]; Singapore; Surveys and Questionnaires

Ophthalmologist-patient communication, self-efficacy, and glaucoma medication adherence. - Sleath, Betsy; Blalock, Susan J; Carpenter, Delesha M; Sayner, Robyn; Muir, Kelly W; Slota, Catherine; Lawrence, Scott D; Giangiacomo, Annette L; Hartnett, Mary Elizabeth; Tudor, Gail; Goldsmith, Jason A; Robin, Alan L (Ophthalmology, 2015)
OBJECTIVE: To examine the associations of provider-patient communication, glaucoma medication adherence self-efficacy, and outcome expectations with glaucoma medication adherence., DESIGN: Prospective, observational cohort study., PARTICIPANTS: Two hundred seventy-nine patients with glaucoma who were newly prescribed or taking glaucoma medications were recruited at 6 ophthalmology clinics., METHODS: Patients' visits were video recorded and communication variables were coded using a detailed coding tool developed by the authors. Adherence was measured using Medication Event Monitoring Systems for 60 days after their visits., MAIN OUTCOME MEASURES: The following adherence variables were measured for the 60-day period after their visits: whether the patient took 80% or more of the prescribed doses, percentage of the correct number of prescribed doses taken each day, and percentage of the prescribed doses taken on time., RESULTS: Higher glaucoma medication adherence self-efficacy was associated positively with better adherence with all 3 measures. Black race was associated negatively with percentage of the correct number of doses taken each day (beta = -0.16; P < 0.05) and whether the patient took 80% or more of the prescribed doses (odds ratio, 0.37; 95% confidence interval, 0.16-0.86). Physician education about how to administer drops was associated positively with percentage of the correct number of doses taken each day (beta = 0.18; P < 0.01) and percentage of the prescribed doses taken on time (beta = 0.15; P < 0.05)., CONCLUSIONS: These findings indicate that provider education about how to administer glaucoma drops and patient glaucoma medication adherence self-efficacy are associated positively with adherence. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Drug Monitoring; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; *Health Communication; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; *Ophthalmology; *Patient Education as Topic; *Physician-Patient Relations; Prospective Studies; *Self Efficacy; Surveys and Questionnaires; Young Adult

[Original preparations versus generics--latanoprost: how similar is different?]. - Leitritz, M A; Lipp, H-P; Voykov, B; Ziemssen, F (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2015)
BACKGROUND: To test the interchangeability of the commercially available (in Germany) latanoprost drugs and their generics respectively, the concentration of the active substance was tested. Guidelines of the European Medicines Agency postulate a sufficient bioequivalence, if the range of the agent is within 80-125% of the original drug., METHODS: All compounds of latanoprost were procured registered. The concentration of latanoprost and benzalkoniumchloride was measured by high-performance liquid chromatography (HPLC) in a validated reference labroratory for 23 generics. In addition, the mean volume of drops and the pH of the formulation were measured. The packaging label and the readability of the enclosed information leaflet were checked., RESULTS: All products contained less than 50 mug/ml latanoprost. The deviating reduction of the active substance (mean: - 7.39%, +/- 2.8%) was accompanied by fluctions of the eyedrops' mass (mean: 0.03 g, +/- 0.002 g). The concentration of benzalkonium chloride was mostly increased (median: 5.45%, min: - 2.5%, max: 11.5%). The pH of the original drug and the generics (median 6.78, min: 6.62, max: 6.81) was similar to the original drug, but was significantly different from an unpreserved formulation (pH 7.18). Due to type size, the packaging leaflet was illegible for humans with impaired vision., CONCLUSIONS: Before prescribing generics in ophthalmology, different factors have to be considered, which might influence the amount of IOP lowering in effect. In the absence of healthcare research it is still unclear, how different bottle forms of eyedrops--such as appearance (e.g. Cyrillic characters) or pressure point (administration)--reduce the adherence of glaucoma patients.
Keywords: Antihypertensive Agents/an [Analysis]; Antihypertensive Agents/ch [Chemistry]; *Drug Evaluation, Preclinical; *Drug Labeling/cl [Classification]; *Drugs, Generic/an [Analysis]; *Drugs, Generic/ch [Chemistry]; Germany; Latanoprost; *Prostaglandins F, Synthetic/an [Analysis]; *Prostaglandins F, Synthetic/ch [Chemistry]; Therapeutic Equivalency

Comparison of surface roughness and bacterial adhesion between cosmetic contact lenses and conventional contact lenses. - Ji, Yong Woo; Cho, Young Joo; Lee, Chul Hee; Hong, Soon Ho; Chung, Dong Yong; Kim, Eung Kweon; Lee, Hyung Keun (Eye & contact lens, 2015)
OBJECTIVE: To compare physical characteristics of cosmetic contact lenses (Cos-CLs) and conventional contact lenses (Con-CLs) that might affect susceptibility to bacterial adhesion on the contact lens (CL) surface., METHODS: Surface characteristics of Cos-CLs and Con-CLs made from the same material by the same manufacturer were measured by atomic force microscopy (AFM) and scanning electron microscopy. To determine the extent and rate of bacterial adhesion, Cos-CL and Con-CL were immersed in serum-free Roswell Park Memorial Institute media containing Staphylococcus aureus or Pseudomonas aeruginosa. Additionally, the rate of removal of adherent bacteria was evaluated using hand rubbing or immersion in multipurpose disinfecting solutions (MPDS)., RESULTS: The mean surface roughness (root mean square and peak-to-valley value) measured by AFM was significantly higher for Cos-CL than for Con-CL. At each time point, significantly more S. aureus and P. aeruginosa adhered to Cos-CL than to Con-CL, which correlated with the surface roughness of CL. In Cos-CL, bacteria were mainly found on the tinted surface rather than on the noncolored or convex areas. Pseudomonas aeruginosa attached earlier than S. aureus to all types of CL. However, P. aeruginosa was more easily removed from the surface of CL than S. aureus by hand rubbing or MPDS soaking., CONCLUSIONS: Increased surface roughness is an important physical factor for bacterial adhesion in Cos-CL, which may explain why rates of bacterial keratitis rates are higher in Cos-CL users in CL physical characteristics.
Keywords: Bacterial Adhesion/de [Drug Effects]; Bacterial Adhesion/ph [Physiology]; *Bacterial Adhesion; Beauty Culture; Biofilms/de [Drug Effects]; Biofilms/gd [Growth & Development]; Colony Count, Microbial; *Contact Lenses, Hydrophilic/mi [Microbiology]; Disinfectants/pd [Pharmacology]; Humans; Microscopy, Atomic Force; Microscopy, Electron, Scanning; Ophthalmic Solutions/pd [Pharmacology]; Pseudomonas aeruginosa/ph [Physiology]; Staphylococcus aureus/ph [Physiology]; *Surface Properties

Improving patient access to prevent sight loss: ophthalmic electronic referrals and communication (Scotland). - Khan, A A; Mustafa, M Z; Sanders, R (Public health, 2015)
INTRODUCTION: With the number of people with sight loss predicted to double to four million people in the UK by the year 2050, preventable visual loss is a significant public health issue. Sight loss is associated with an increased risk of falls, accidents and depression and evidence suggests that 50% of sight loss can be avoided. Timely diagnosis is central to the prevention of sight loss. Access to care can be a limiting factor in preventable cases. By improving referrals and access to hospital eye services it is possible to treat and minimise the number of patients with preventable sight loss and the impact this has on wider society., CLINICAL PILOT STUDY: In 2005, NHS Fife took part in a flagship pilot funded by the Scottish government e-health department to evaluate the feasibility, safety, clinical effectiveness, and cost of electronic referral with images of patients directly from community optometrists to Hospital Eye Service (HES). The pilot study showed that electronic referral was feasible, fast, safe, and obviated the need for outpatient appointments in 128 (37%) patients with a high patient satisfaction., CENTRALISED OPHTHALMIC ELECTRONIC REFERRAL UNIT: The results of the pilot study were presented and in May 2007, the electronic referral system was rolled out regionally in southeast Scotland. Referrals were accepted at a single site with vetting by a trained team and appointments were allocated within 48 hours. Following the implementation of electronic referral, waiting times were reduced from a median of 14 to 4 weeks. Significantly fewer new patients were seen (7462 vs 8714 [p < 0.001]). There were also fewer casualties (1984 vs 2671 [p < 0.001]) and 'did not arrive' (DNA) new patients (503 vs 635 [p < 0.001])., EYE CARE INTEGRATION PROJECT (SCOTLAND): In 2010 the Scottish Government Health Department committed 6.6 million to community and hospital ophthalmic services forming the Eyecare Integration Project in 2011. The main aim of this project was to create electronic communication between community optometry practices and hospital eye departments. Five electronic forms were specifically designed for cataract, glaucoma, macula, paediatric and general ophthalmic disease. A Virtual Private Network was created which enabled optometrists to connect to the Scottish clinical information gateway system and send referrals to hospital and receive referral status feedback. Numerous hurdles have been encountered and overcome in order to deliver this project., DISCUSSION: An efficient unique system has been described within the NHS whereby the provision of eye care has been modernised by creating a user-friendly electronic interface between the community and HES. This system ensures patients are vetted into the correct specialist clinic and thus will be less likely to go blind from treatable conditions. Urgent conditions will continue to be prioritised and savings made with efficiencies gained can be re-invested towards better overall patient care. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Keywords: *Blindness/pc [Prevention & Control]; Communication; *Community Health Centers/og [Organization & Administration]; *Electronic Health Records/og [Organization & Administration]; Feasibility Studies; *Health Services Accessibility/og [Organization & Administration]; *Hospital Departments/og [Organization & Administration]; Humans; Interinstitutional Relations; *Ophthalmology/og [Organization & Administration]; Patient Satisfaction/sn [Statistics & Numerical Data]; Pilot Projects; *Referral and Consultation/og [Organization & Administration]; Scotland; State Medicine

Fungal isolation from disinfectant solutions of contact lens storage cases among asymptomatic users. - Mela, Ephigenia K; Anastassiou, Evangelos D; Gartaganis, Sotirios P; Christofidou, Myrto (Eye & contact lens, 2015)
OBJECTIVES: To investigate the incidence of fungal contamination of store disinfectant solutions contained in contact lens storage cases belonging to asymptomatic contact lens users., METHODS: Asymptomatic contact lens users were asked to bring their storage cases, lenses included, without having opened the lid of the cup after placing lenses inside. The following information was recorded: age, sex, type of refractive error, contact lens material, schedule of wear, and brand of disinfectant solution. Included subjects had to comply with lens handling, cleaning, and replacement instructions given by the manufacturer or their attending optometrist. One sample per cup of contact lens case was collected using a sterile syringe. Samples were cultured on proper media for 96 hr at 35degreeC. Fungi were identified to species level by standard methodology., RESULTS: A total of 216 samples were collected from 117 contact lens storage cases. All participants were using monthly disposable hydrogel lenses on a daily wear basis. Seven fungal species were isolated from 15 specimens (6.9%) collected from 12 storage cases (10.2%). These included one Fusarium solani, four Aspergillus niger, two Aspergillus fumigatus, five Candida parapsilosis, one Candida tropicalis, one Rhodotorula rubra, and one F. solani in combination with Candida guilliermondii. Disinfectant solutions containing hydrogen peroxide were found to be less effective than various alternative solutions in eliminating fungal species., CONCLUSIONS: The results of this study show that even when contact lens users report compliance for handling, cleaning, and replacement according to the manufacturer's instructions, the potential risk of contact lens-related fungal keratitis still remains.
Keywords: Adult; *Contact Lenses, Hydrophilic; Disinfectants/pd [Pharmacology]; Disinfection/mt [Methods]; *Drug Contamination/sn [Statistics & Numerical Data]; *Equipment Contamination/sn [Statistics & Numerical Data]; Eye Infections, Fungal; Female; Fungi/de [Drug Effects]; *Fungi/ip [Isolation & Purification]; Humans; Hydrogen Peroxide/pd [Pharmacology]; Male; Middle Aged; Young Adult

Robust multi-scale superpixel classification for optic cup localization. - Tan, Ngan-Meng; Xu, Yanwu; Goh, Wooi Boon; Liu, Jiang (Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society, 2015)
This paper presents an optimal model integration framework to robustly localize the optic cup in fundus images for glaucoma detection. This work is based on the existing superpixel classification approach and makes two major contributions. First, it addresses the issues of classification performance variations due to repeated random selection of training samples, and offers a better localization solution. Second, multiple superpixel resolutions are integrated and unified for better cup boundary adherence. Compared to the state-of-the-art intra-image learning approach, we demonstrate improvements in optic cup localization accuracy with full cup-to-disc ratio range, while incurring only minor increase in computing cost. Copyright © 2014 Elsevier Ltd. All rights reserved.
Keywords: *Algorithms; *Glaucoma/pa [Pathology]; Humans; Image Enhancement/mt [Methods]; *Image Interpretation, Computer-Assisted/mt [Methods]; *Optic Disk/pa [Pathology]; *Pattern Recognition, Automated/mt [Methods]; Reproducibility of Results; *Retinoscopy/mt [Methods]; Sensitivity and Specificity

Addressing inequalities in eye health with subsidies and increased fees for General Ophthalmic Services in socio-economically deprived communities: a sensitivity analysis. - Shickle, Darren; Todkill, Daniel; Chisholm, Catharine; Rughani, Sonal; Griffin, Marcus; Cassels-Brown, Andy; May, Helen; Slade, Sarah V; Davey, Christopher J (Public health, 2015)
OBJECTIVES: Poor knowledge of eye health, concerns about the cost of spectacles, mistrust of optometrists and limited geographical access in socio-economically deprived areas are barriers to accessing regular eye examinations and result in low uptake and subsequent late presentation to ophthalmology clinics. Personal Medical Services (PMS) were introduced in the late 1990 s to provide locally negotiated solutions to problems associated with inequalities in access to primary care. An equivalent approach to delivery of optometric services could address inequalities in the uptake of eye examinations., STUDY DESIGN: One-way and multiway sensitivity analyses., METHODS: Variations in assumptions were included in the models for equipment and accommodation costs, uptake and length of appointments. The sensitivity analyses thresholds were cost-per-person tested below the GOS1 fee paid by the NHS and achieving break-even between income and expenditure, assuming no cross-subsidy from profits from sales of optical appliances., RESULTS: Cost per test ranged from 24.01 to 64.80 and subsidy required varied from 14,490 to 108,046. Unused capacity utilised for local enhanced service schemes such as glaucoma referral refinement reduced the subsidy needed., CONCLUSIONS: In order to support the financial viability of primary eye care in socio-economically deprived communities, income is required from additional subsidies or from sources other than eye examinations, such as ophthalmic or other optometric community services. This would require a significant shift of activity from secondary to primary care locations. The subsidy required could also be justified by the utility gain from earlier detection of preventable sight loss. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Keywords: Aged; Female; *Financing, Government; Health Expenditures/sn [Statistics & Numerical Data]; *Health Services Accessibility/ec [Economics]; *Health Status Disparities; Humans; Income/sn [Statistics & Numerical Data]; Male; Middle Aged; *Ophthalmology/ec [Economics]; *Poverty Areas; Primary Health Care/ec [Economics]; Socioeconomic Factors; State Medicine

The Peterborough scheme for community specialist optometrists in glaucoma: results of 4 years of a two-tiered community-based assessment and follow-up service. - Roberts, Harry W; Rughani, Keshma; Syam, Padmanhaba; Dhingra, Sumit; Ramirez-Florez, Susanna (Current eye research, 2015)
AIMS: To report on results of an innovative glaucoma shared-care scheme based in Peterborough, UK., METHODS: A retrospective review of all new appointments with 11 community-based specialist optometrists in glaucoma (SOG) was conducted. There are two tiers of SOG, whereby tier 2 SOGs have increased levels of autonomy. All optometrist assessments were reviewed by a consultant ophthalmologist, and levels of agreement were calculated for assessment of optic nerve head appearance, Humphrey visual field test interpretation, diagnosis and outcome., RESULTS: 1639 new patients were assessed by SOGs over a 4-year period. The median waiting time for patients from referral to SOG assessment was 0 days (IQR 0-56), and from SOG assessment to consultant review in a virtual clinic was 12 days (IQR 8-18days). After first appointment, over 60% of patients were classified as low-risk and remained within the SOG scheme. Rates of frank disagreement between SOG and consultant regarding diagnosis and proposed outcome were 5.6 and 10.4%, respectively, for tier 2 SOGs and 15.3 and 28.6%, respectively, for tier 1 SOGs., CONCLUSIONS: The SOG scheme demonstrates acceptable levels of accuracy between SOG and glaucoma consultant. This scheme allows many stable low-risk patients to remain out of hospital eye department outpatient clinics.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Anterior Chamber/pa [Pathology]; Community Health Services/og [Organization & Administration]; *Community Health Services/st [Standards]; Corneal Pachymetry; Decision Making; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Gonioscopy; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; *Ophthalmology; *Optometry; Patient Care Team/og [Organization & Administration]; *Patient Care Team/st [Standards]; Referral and Consultation; Retrospective Studies; *Specialization; Tonometry, Ocular; United Kingdom; Visual Field Tests; Visual Fields/ph [Physiology]; Waiting Lists

Potential Limitations of E-mail and Text Messaging in Improving Adherence in Glaucoma and Ocular Hypertension. - Saeedi, Osamah J; Luzuriaga, Christine; Ellish, Nancy; Robin, Alan (Journal of glaucoma, 2015)
PURPOSE: To determine how receptive patients are to the use of e-mail and text message reminders for appointments and medications., METHODS: We conducted a consecutive cross-sectional survey of eligible patients with glaucoma or ocular hypertension at a private glaucoma subspecialty practice with 3 locations from February 2011 to January 2012. Main outcome measures were answers to survey questions regarding how receptive patients are to e-mail and text messaging reminders for appointments and medications., RESULTS: Of 989 patients, 404 (40.8%) patients reported that e-mail reminders would help remember appointments and 185 (18.7%) reported that they would help for medications. Among those with access to text messaging, 280 (68.9%) reported text messaging would help them remember appointments and 193 (47.5%) reported it would help with medications. Patients who reported e-mail would help them remember medications were more likely to live in an urban location [P=0.05, odds ratio (OR)=1.84], check the internet at least daily (P<=0.001, OR=1.04), check e-mail when not at home or the office (P=0.02, OR=1.62), and know how to open attachments (P=0.03, OR=1.87). Patients who reported that text messaging would help them remember their medications were more likely to be 40 or less (P<=0.001, OR=8.54) and African American (P<0.001, OR=2.59)., CONCLUSIONS: E-mail and text messaging reminders currently may have a limited utility in improving adherence in the general glaucoma population but may be useful in younger patients with glaucoma.
Keywords: Adolescent; Adult; African Americans; Aged; Aged, 80 and over; *Appointments and Schedules; Cell Phone; Cross-Sectional Studies; *Electronic Mail; Female; *Glaucoma/th [Therapy]; Health Care Surveys; Humans; Intraocular Pressure; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/th [Therapy]; *Reminder Systems; *Text Messaging

Predictors of adherence to glaucoma treatment in a multisite study. - Cook, Paul F; Schmiege, Sarah J; Mansberger, Steven L; Kammer, Jeffrey; Fitzgerald, Timothy; Kahook, Malik Y (Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2015)
BACKGROUND: Poor adherence hinders glaucoma treatment. Studies have identified demographic and clinical predictors of adherence but fewer psychological variables., PURPOSE: We examined predictors from four health behavior theories and past research., METHODS: In the baseline phase of a three-site adherence study, before any intervention, 201 participants used electronic Medication Event Monitoring System (MEMS) bottles to monitor eyedrop use for 2 months, and completed questionnaires including self-reported adherence., RESULTS: MEMS showed 79% adherence and self-report 94% (0.5-1.5 missed weekly doses), but they correlated only r(s) = 0.31. Self-efficacy, motivation, dose frequency, and nonminority race/ethnicity predicted 35% of variance in MEMS. Cues to action, self-efficacy, and intention predicted 20% of variance in self-reported adherence., CONCLUSIONS: Self-efficacy, motivation, intention, cues to action, dose frequency, and race/ethnicity each independently predicted adherence. Predictors from all theories were supported in bivariate analyses, but additional study is needed. Researchers and clinicians should consider psychological predictors of adherence. (ClinicalTrials.gov ID# NCT01409421.).
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/dt [Drug Therapy]; *Health Behavior; *Health Knowledge, Attitudes, Practice; Humans; Male; *Medication Adherence; Middle Aged; Motivation; Self Efficacy; Self Report; Young Adult

Contact topical anesthesia for strabismus surgery in adult patients. - Valles-Torres, J; Garcia-Martin, E; Pena-Calvo, P; Sanjuan-Villarreal, A; Gil-Arribas, L M; Fernandez-Tirado, F J (Revista espanola de anestesiologia y reanimacion, 2015)
OBJECTIVE: To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients., MATERIAL AND METHODS: A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed., RESULTS: The operation was performed successfully in all patients. Average pain intensity was 1.40 +/- 1.73 during anesthesia implementation, 4.20 +/- 2.57 during the surgical procedure, 2.50 +/- 2.54 30 min after surgery, and 3.55 +/- 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 +/- 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters., CONCLUSIONS: Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment. Copyright © 2014 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Publicado por Elsevier Espana, S.L.U. All rights reserved.
Keywords: Administration, Ophthalmic; Adult; Aged; Aged, 80 and over; *Anesthesia, Local/mt [Methods]; *Anesthetics, Local/ad [Administration & Dosage]; Bupivacaine/ad [Administration & Dosage]; Conscious Sedation; Corneal Ulcer/co [Complications]; Female; Humans; Hypnotics and Sedatives/tu [Therapeutic Use]; Lidocaine/ad [Administration & Dosage]; Male; Middle Aged; Pain Measurement; Pain, Postoperative/et [Etiology]; Pain, Postoperative/pc [Prevention & Control]; Patient Satisfaction; Piperidines/tu [Therapeutic Use]; Postoperative Nausea and Vomiting/ep [Epidemiology]; Postoperative Nausea and Vomiting/et [Etiology]; Prospective Studies; Reflex, Oculocardiac; Remifentanil; Strabismus/co [Complications]; *Strabismus/su [Surgery]; Treatment Outcome; Young Adult

Reminder systems, not education, improve glaucoma adherence: a comment on Cook et al. - Quigley, Harry A (Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2015)
Comment on (CON)
Keywords: Female; *Glaucoma/dt [Drug Therapy]; *Health Behavior; *Health Knowledge, Attitudes, Practice; Humans; Male; *Medication Adherence

Repeat Descemet membrane endothelial keratoplasty after complicated primary Descemet membrane endothelial keratoplasty. - Baydoun, Lamis; van Dijk, Korine; Dapena, Isabel; Musa, Fayyaz U; Liarakos, Vasilis S; Ham, Lisanne; Melles, Gerrit R J (Ophthalmology, 2015)
PURPOSE: To describe the clinical outcome and complications of repeat Descemet membrane endothelial keratoplasty (re-DMEK)., DESIGN: Retrospective case series study at a tertiary referral center., PARTICIPANTS: From a series of 550 consecutive DMEK surgeries with >= 6 months follow-up, 17 eyes underwent re-DMEK for graft detachment after initial DMEK (n = 14) and/or endothelial graft failure (n = 3). The outcomes were compared with an age-matched control group of uncomplicated primary DMEK surgeries., METHODS: The re-DMEK eyes were evaluated for best-corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications., MAIN OUTCOME MEASURES: Feasibility and clinical outcome of re-DMEK., RESULTS: In all eyes, re-DMEK was uneventful. At 12 months, 12 of 14 eyes (86%) achieved a BCVA of >= 20/40 (>= 0.5); 8 of 14 eyes (57%) achieved >= 20/25 (>= 0.8), 3 of 14 eyes (21%) achieved >= 20/20 (>= 1.0), and 1 eye (7%) achieved 20/17 (1.2); 5 eyes were fitted with a contact lens. Average donor ECD decreased from 2580 +/- 173 cells/mm(2) before to 1390 +/- 466 cells/mm(2) at 6 months after surgery, and pachymetry from 703 +/- 126 mum to 515 +/- 39 mum, respectively. No difference in densitometry could be detected between re-DMEK and control eyes (P = 0.99). Complications after re-DMEK included primary graft failure (n = 1), secondary graft failure (n = 2), graft detachment requiring rebubbling (n = 1), secondary glaucoma (n = 2), cataract (n = 1), and corneal ulcer (n = 1). One eye received tertiary DMEK., CONCLUSIONS: In the management of persistent graft detachment and graft failure after primary DMEK, re-DMEK proved a feasible procedure. Acceptable BCVA may be achieved, albeit lower than after DMEK in virgin eyes, and some cases may benefit from contact lens fitting. Complications after re-DMEK may be better anticipated than after primary DMEK because graft detachment and graft failure tended to recur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Cell Count; *Corneal Diseases/su [Surgery]; Corneal Pachymetry; *Descemet Stripping Endothelial Keratoplasty/ae [Adverse Effects]; *Descemet Stripping Endothelial Keratoplasty/mt [Methods]; Endothelium, Corneal/pa [Pathology]; Feasibility Studies; Female; Graft Rejection/et [Etiology]; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Reoperation; Retrospective Studies; Tissue Donors; Visual Acuity/ph [Physiology]

Impact on intraocular pressure after 20-mg decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy. - Barteselli, Giulio; Amini, Payam; Ezon, Isaac C; Nezgoda, Joseph T; Cheng, Lingyun; Freeman, William R (Retina (Philadelphia, Pa.), 2015)
PURPOSE: To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy., METHODS: Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed., RESULTS: In cases of consistent compliance with IOP-lowering drugs (79.2%), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8%), IOP increased by 7 mmHg at 1 month (P < 0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46% greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45% greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome., CONCLUSION: Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/pc [Prevention & Control]; *Glucocorticoids/ad [Administration & Dosage]; Humans; *Intraocular Pressure/de [Drug Effects]; Intravitreal Injections; *Macular Edema/dt [Drug Therapy]; Male; Middle Aged; Retrospective Studies; Tonometry, Ocular; *Triamcinolone Acetonide/ad [Administration & Dosage]; Triamcinolone Acetonide/ch [Chemistry]

Patient question-asking about glaucoma and glaucoma medications during videotaped medical visits. - Sleath, Betsy; Sayner, Robyn; Blalock, Susan J; Carpenter, Delesha M; Muir, Kelly W; Hartnett, Mary E; Tudor, Gail; Lawrence, Scott; Giangiacomo, Annette L; Robin, Alan L (Health communication, 2015)
We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.
Keywords: Adult; Aged; Aged, 80 and over; *Communication; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; Office Visits; *Patients/px [Psychology]; Patients/sn [Statistics & Numerical Data]; *Physician-Patient Relations; Physicians/sn [Statistics & Numerical Data]; Videotape Recording; Young Adult

The relationship between sociodemographic factors and persistence with topical glaucoma medications. - Leung, Victoria C; Jin, Ya-Ping; Hatch, Wendy; Mammo, Zaid; Trope, Graham E; Buys, Yvonne M; Macrae, William G (Journal of glaucoma, 2015)
PURPOSE: To investigate the relationship between sociodemographic factors and nonpersistence with topical glaucoma medication., DESIGN: This was a retrospective, observational cohort study., PATIENTS AND METHODS: We invited glaucoma patients on medical therapy from a general ophthalmology practice to complete a standardized questionnaire between November 2011 and April 2012. Nonpersistence was defined as having >= 1 gaps (>= 14 d without medication) in therapy over the last year. Patients' pharmacy records, dating back 1 year from study enrollment, were used to determine the total number of gaps and the cumulative number of days off therapy in the last year. Prevalence ratios (PR) and 95% confidence intervals (CI) were used to assess the relationship between sociodemographic factors and nonpersistence. The relationships between sociodemographic factors and the median number of gaps, as well as the median number of days off, were also assessed., RESULTS: Sixty-one patients were included for analysis. The mean age was 72 years; 61% were male patients and 71% were on one medication for glaucoma. Fifty-four percent of patients (n=33) were nonpersistent with glaucoma medications over the 1 year study period. Median numbers of gaps and days off therapy were 1 and 11, respectively. Patients reporting below average income were twice as likely to be nonpersistent (prevalence ratio, 2.02; 95% confidence interval, 1.37-2.96; P<0.01). Below average income also trended toward a greater median number of days off therapy (P=0.07)., CONCLUSIONS: Below average socioeconomic status may negatively impact persistence with topical glaucoma medications, potentially threatening long-term visual outcomes.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Risk Factors; *Social Class; Surveys and Questionnaires; Visual Fields

[Bilateral vascularized disciform corneal scar of herpetic origin in a child]. - Fiorentzis, M; Szentmary, N; Seitz, B (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2015)
BACKGROUND: Bilateral keratitis is rare and can have various causes. For a good outcome after treatment, the correct diagnosis is decisive., CASE REPORT: A 15-year-old boy presented to our clinic with recurrent keratoconjunctivitis and progressive loss of vision in both eyes since 6 years. The best corrected visual acuity was 0.1 in the right eye and 1/12 in the left eye. Slit-lamp examination verified keratitis disciformis with strongly vascularized corneal stromal scars without conjunctival follicles on both sides. Based on the clinical diagnosis, antiviral treatment was initiated. Best corrected visual acuity 8 weeks later increased to 0.4 in the right eye and 0.8 in the left eye and the corneal edema decreased in both eyes. Due to noncompliance the patient returned with a perforated corneal ulcer of the left eye, where an a chaud penetrating keratoplasty had to be performed., RESULTS: Herpes simplex virus is one of the most common causes of keratitis and has different manifestations. In the treatment of keratitis disciformis the use of topical steroids is mandatory as there is an active immunological process. The use of systemic and local antiviral treatment is necessary at the same time in order to avoid reactivation of viral replication. Bilateral keratitis is relatively frequent in children., CONCLUSION: Herpetic keratitis is now well treatable if the various manifestations of the disease are recognized early and an appropriate therapy is adjusted accordingly.
Keywords: Adolescent; *Corneal Injuries/di [Diagnosis]; Corneal Injuries/th [Therapy]; Diagnosis, Differential; Humans; *Keratitis, Herpetic/di [Diagnosis]; Keratitis, Herpetic/th [Therapy]; Male; *Neovascularization, Pathologic/di [Diagnosis]; Neovascularization, Pathologic/th [Therapy]; Treatment Outcome

Providing prescheduled appointments as a strategy for improving follow-up compliance after community-based glaucoma screening: results from an urban underserved population. - van Zyl, Tave; Su, Zhuo; Zhou, Elaine; Wong, Ryan K; Mohsenin, Amir; Rogers, Spencer; Tsai, James C; Forster, Susan H (Journal of community health, 2015)
To determine if receiving a prescheduled appointment is associated with an increased likelihood of complying with follow-up eye care among individuals identified as at risk for glaucoma during community-based glaucoma screening in an urban underserved population. This study sampled 362 individuals aged >=30 years without known glaucoma from low-income, predominantly black/Hispanic neighborhoods in New Haven, Connecticut presenting to one of twelve community-based glaucoma screening events from May 2010 to October 2012. A quasi-experimental design systematically assigned 63 individuals identified as at risk for glaucoma into either intervention or control group with a 1:2 ratio. Individuals in the control group (n = 41) received counseling on glaucoma and a recommendation for obtaining a follow-up appointment at the eye department of a local community health center, which offers affordable health services with income-adjusted fee discounts to uninsured, low-income patients. Those in the intervention group (n = 22) received the same counseling and a prescheduled appointment at the community health center. The overall rate of follow-up compliance within 3 months of screening was 30 % (41 % in the intervention group; 24 % in the control group). Multivariate logistic regression analysis adjusting for sex, age, ethnicity, health insurance status, car access, living situation, and smoking status found that follow-up compliance was significantly associated with intervention (adjusted odds ratio 4.8; 95 % confidence interval 1.1-20.9). Providing prescheduled appointments can improve follow-up compliance after community-based glaucoma screening. This finding may be potentially applicable to community-based health screening for other preventable diseases.
Keywords: Adult; African Americans; *Appointments and Schedules; *Community Health Centers/og [Organization & Administration]; Connecticut/ep [Epidemiology]; Counseling; Female; *Glaucoma/di [Diagnosis]; Glaucoma/eh [Ethnology]; Health Services Accessibility/og [Organization & Administration]; Hispanic Americans; Humans; Male; Middle Aged; *Patient Compliance/eh [Ethnology]; Risk Factors; *Vision Screening; Vulnerable Populations

Four Measures of Intraocular Pressure Fluctuation: Which Correlates Most Optimally With Actual Office-hour Readings?. - Huang, Rui; Ge, Jian; Chen, Geng; Gao, Xinbo; Laties, Alan M; Zhang, Xiulan (Journal of glaucoma, 2015)
PURPOSE: To compare the power of the 4 intraocular pressure (IOP) measures, that is, peak, mean, range, and SD, over a 24-hour period in predicting IOP variations in order to determine which measure of IOP fluctuation correlates best with actual office-hour readings in glaucoma patients and healthy subjects., METHODS: For this prospective study, 25 subjects with untreated primary open-angle glaucoma and 33 healthy individuals were hospitalized for 24 hours. Measurements of the subjects' IOP for both eyes were recorded with a Goldmann applanation tonometer every 3 hours in the sitting position during the daytime (9 AM to 9 PM) and with a TonoPen in both the sitting and supine positions for 24 hours. Only 1 eye was selected randomly per subject for the final analysis. The strength of association between the estimated values and the actual 24-hour IOP data in habitual body positions was analyzed using the coefficient of determination (R). The differences were calculated. The percentage of subjects with estimated IOP values falling within the cutoff values from the 24-hour data were assessed., RESULTS: The peak IOP was captured outside office hours in 57% of the young subjects, 75% in the elderly control group, and 52% of the glaucoma patients. The estimation of the strength of association for the mean IOP and peak IOP showed strong to moderate correlations (R range from 0.29 to 0.95) compared with the estimation of range and SD of IOP fluctuation, which demonstrated weak to moderate relationships (R range from 0.001 to 0.69). The percentage of significant cases mostly corresponded with the correlation., CONCLUSIONS: With the combination of sitting and supine position readings during office hours, the study provides promising results in estimating the mean and peak IOP in glaucoma patients and healthy subjects; however, it showed little advantage in range and SD of IOP fluctuation.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Circadian Rhythm/ph [Physiology]; Female; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/pp [Physiopathology]; Gonioscopy; Healthy Volunteers; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Office Visits; *Posture/ph [Physiology]; Prospective Studies; *Tonometry, Ocular/is [Instrumentation]; Young Adult

The relationship between quality of life and adherence to medication in glaucoma patients in Singapore. - Loon, Seng Chee; Jin, Jing; Jin Goh, Miao (Journal of glaucoma, 2015)
PURPOSE: (i) To evaluate the medication adherence rate of glaucoma patients in Singapore. (ii) To evaluate patients' quality of life status. (iii) To explore the factors related to patients' nonadherence to medication., PATIENTS AND METHODS: A cross-sectional, prospective study, using interviewer-administered survey questionnaires. A total of 314 patients were interviewed altogether, of which 175 (55.7%) were male and 139 (44.3%) were female. (i) Patients' medication adherence was assessed using the Reported Adherence to Medication scale. (ii) Patients' beliefs about glaucoma and treatment were evaluated using the Brief Illness Perception Questionnaire and the Beliefs about Medicine-Specific Questionnaire. (iii) Patients' quality of life was evaluated using Glaucoma Symptom Scale and The Glaucoma Quality of Life-15 questionnaire., RESULTS: Sixty-two (19.7%) patients reported themselves to be adherent to their medication. Male patients (P=0.044) and smokers (P=0.002) were more likely to be nonadherent to their medication regimen. Nonadherent patients were more likely to have (i) more concerns about their glaucoma medications (P=0.000); (ii) less belief in the effects of their medications (P=0.026); (iii) a lower quality of life (higher score of GQOL-15, P=0.014); (iv) less symptoms from their glaucoma (lower score of Glaucoma Symptom Scale, P=0.026); and (v) more effect on their lives from glaucoma (P=0.01)., CONCLUSIONS: The full-adherence rate is low among glaucoma patients. Having less belief in the need for and more concerns about their medication are the 2 factors associated with nonadherence. In the future, effective strategies should be explored to improve patients' beliefs. Nonadherence has an association with decreased quality of life. Strategies to improve adherence will need to deal with these areas.
Keywords: Adult; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Chronic Disease; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; Humans; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/px [Psychology]; Middle Aged; Prospective Studies; *Quality of Life/px [Psychology]; Singapore; Surveys and Questionnaires

A study of the association between patterns of eye drop prescription and medication usage in glaucoma subjects. - Kawai-Tsuboi, Naoko; Kawai, Motofumi; Minami, Yoshiro; Yoshida, Akitoshi (Journal of glaucoma, 2015)
PURPOSE: To investigate the association between patterns of eye drop prescription and medication usage in patients with glaucoma., PATIENTS AND METHODS: Sixty-seven Japanese patients with glaucoma who were prescribed topical antiglaucoma medications including a prostaglandin analogue bilaterally for >6 months at Nayoro City General Hospital, Nayoro, Japan, were included in the study. A self-administered, 5-item patient questionnaire was administered to determine how patients routinely use medications, including the method of eye drop administration, number of eye drops per instillation, accuracy of eye drop placement, weekly frequency of eye drop application, and their awareness of local side effects. The number of prostaglandin analogue bottles prescribed monthly was compared in each factor., RESULTS: The mean patient age was 74.4+/-10.0 years (range, 52 to 95 y; 39 women, 28 men). The mean duration of glaucoma treatment was 4.2+/-3.2 years (range, 0.7 to 10.6 y). Patients who placed the eye drops outside the eye were prescribed significantly more bottles monthly (P=0.008). The other factors had no significant effect on the number of bottles prescribed monthly., CONCLUSIONS: Patients with glaucoma who used eye drops incorrectly were routinely prescribed additional bottles of eye drops. Ophthalmologists should determine whether patients who request an unusual number of eye drops are using the eye drops correctly.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; *Drug Prescriptions/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Japan; Latanoprost; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Surveys and Questionnaires; Travoprost

A qualitative investigation into patients' views on visual field testing for glaucoma monitoring. - Glen, Fiona C; Baker, Helen; Crabb, David P (BMJ open, 2014)
OBJECTIVES: To investigate the views and experiences of patients regarding their glaucoma follow-up, particularly towards the type and frequency of visual field (VF) testing., DESIGN: A qualitative investigation using focus groups. The group discussion used broad open questions around the topics in a prompt guide relating to experiences of glaucoma follow-up, and in particular, VF monitoring. All the groups were taped, transcribed and coded using manual and computer-aided methods., SETTING: Three National Health Service (NHS) hospitals in England; two focus groups took place at each hospital., PARTICIPANTS: 28 patients (mean (SD) age: 74 (9) years; 54% women) diagnosed with glaucoma for at least 2 years. Each focus group consisted of 3-6 patients., PRIMARY AND SECONDARY OUTCOMES: (1) Attitudes and experiences of patients with glaucoma regarding VF testing. (2) Patients' opinions about successful follow-up in glaucoma., RESULTS: These patients did not enjoy the VF test but they recognised the importance of regular monitoring for preserving their vision. These patients would agree to more frequent VF testing on their clinician's recommendation. A number of themes recurred throughout the focus groups representing perceived barriers to follow-up care. The testing environment, waiting times, efficiency of appointment booking and travel to the clinic were all perceived to influence the general clinical experience and the quality of assessment data. Patients were also concerned about aspects of patient-doctor communication, and often received little to no feedback about their results., CONCLUSIONS: Patients trust the clinician to make the best decisions for their glaucoma follow-up. However, patients highlighted a number of issues that could compromise the effectiveness of VF testing. Addressing patient-perceived barriers could be an important step for devising optimal strategies for follow-up care.
Keywords: Aged; *Attitude to Health; Evaluation Studies as Topic; Female; Focus Groups; *Glaucoma/di [Diagnosis]; *Glaucoma/px [Psychology]; Humans; Male; Patient Participation; Surveys and Questionnaires; *Visual Field Tests/px [Psychology]

Outcomes of Individualized Formative Assessments in a Pharmacy Skills Laboratory. - Gums, Tyler Harris; Kleppinger, Erika L; Urick, Benjamin Y (American journal of pharmaceutical education, 2014)
OBJECTIVE: To determine the effectiveness of an individualized teaching method in a pharmacy skills laboratory., DESIGN: All third-year students enrolled in an Accreditation Council for Pharmacy Education (ACPE) accredited doctor of pharmacy program (n=150) received an individual formative assessment from clinical pharmacists on communication skills and clinical competency after the students counseled standardized mock glaucoma patients during a laboratory focused on alternative dosing formulations. Objective structured clinical examination (OSCE) scores for this station from the 2012 and 2013 classes were compared before and after the intervention., ASSESSMENT: Ophthalmic OSCE station scores were higher after the individual formative feedback intervention. Students in 2013 had a mean score of 83.2 +/- 8.3% compared to a mean of 74.3 +/- 12.9% in 2012 for this OSCE station. The percentage of students receiving an "A" on the OSCE station increased from 8.1% to 31.3% after the intervention., CONCLUSION: Individualized formative teaching methods benefited students in both their communication skills and clinical assessment. Future research should focus on wider implementation and overcoming obstacles, such as increased facilitator needs.
Keywords: Chemistry, Pharmaceutical/ed [Education]; Clinical Competence; Curriculum; Drug Dosage Calculations; *Education, Pharmacy/mt [Methods]; Educational Measurement; Educational Status; *Formative Feedback; Glaucoma/dt [Drug Therapy]; Humans; *Laboratories; Professional-Patient Relations; Program Evaluation; *Students, Pharmacy/px [Psychology]; *Teaching/mt [Methods]

[Survey on avoidable blindness and visual impairment in Panama]. - Lopez, Maritza; Brea, Ileana; Yee, Rita; Yi, Rodolfo; Carles, Victor; Broce, Alberto; Limburg, Hans; Silva, Juan Carlos (Revista panamericana de salud publica = Pan American journal of public health, 2014)
OBJECTIVE: Determine prevalence of blindness and visual impairment in adults aged >= 50 years in Panama, identify their main causes, and characterize eye health services., METHODS: Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged >= 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment., RESULTS: A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refractive errors were the main cause of moderate visual impairment (60.7%). Surgical cataract coverage in individuals was 76.3%. Of all eyes operated for cataract, 58.0% achieved visual acuity <= 20/60 with available correction., CONCLUSIONS: Prevalence of blindness in Panama is in line with average prevalence found in other countries of the Region. This problem can be reduced, since 76.2% of cases of blindness and 85.0% of cases of severe visual impairment result from avoidable causes.
Keywords: Aged; Aged, 80 and over; Blindness/et [Etiology]; *Blindness/pc [Prevention & Control]; Cataract/co [Complications]; Cataract/ep [Epidemiology]; Cataract Extraction/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Diabetic Retinopathy/co [Complications]; Diabetic Retinopathy/ep [Epidemiology]; Female; Glaucoma/co [Complications]; Glaucoma/ep [Epidemiology]; Humans; Macular Degeneration/co [Complications]; Macular Degeneration/ep [Epidemiology]; Male; Middle Aged; Panama/ep [Epidemiology]; Prevalence; Refractive Errors/co [Complications]; Refractive Errors/ep [Epidemiology]; Sampling Studies; Treatment Outcome; Vision Disorders/co [Complications]; *Vision Disorders/ep [Epidemiology]

[Treatment of glaucoma]. - Dufrane, R; Ehongo, A (Revue medicale de Bruxelles, 2014)
Glaucoma is a group of chronic and evolutive optic neuropathies. It is caracterised by a progressive loss of optic nerve cells with specific modifications of the optic nerve head and of the visual field. A high intraocular pressure is one of the main risk factors. Thereby, the aim of glaucoma treatment is to reduce the intraocular pressure by medical, physical and/or surgical means. Eyedrops are used as initial treatment. As the most effective drops, prostaglandin analogs are the first-line therapy and have only few systemic side effects. Beta-blockers, local carbonic anhydrase inhibitors and alpha-agonists are the other most employed glaucoma drugs. Pilocarpine, acetazolamide and hyperosmotic agents are used in specific cases. Fixed combinations improve the compliance and the quality of life of patients who need several eyedrops. Preservative-free drops reduce ocular toxicity and improve the compliance of the patients. Trabeculoplasty or trabeculectomy are usefull in case of non response on ocular drops, or if the target pressure is not reached, or when dealing with toxicity or compliance matters. Nevertheless, the first procedure has a time-limited efficiency and the second-one exposes the patient to common surgery-related complications. Therefore, despite good results, they are rarely proposed as first-line therapy.
Keywords: Adrenergic alpha-2 Receptor Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Glaucoma/th [Therapy]; Humans; Laser Therapy; Muscarinic Agonists/tu [Therapeutic Use]; Neuroprotective Agents/tu [Therapeutic Use]; Trabeculectomy

[Progression of drug delivery system for glaucoma]. - Xu, Yan; Lyu, Liu ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2014)
Reduction of intraocular pressure (IOP) by drugs is a major treatment for glaucoma. Clinically, diverse antiglaucoma drugs take effect to decrease the IOP through different mechanisms.However, due to limitations of traditional form of eye drops, the bioavailability of the drug and the patient compliance is lowered, the clinical efficacy is not good and also some toxic and side-effects come out.Otherwise, traditional medication is not suitable for neuroprotective drugs to work on both retina and optic nerve. Drug delivery system has the potential to improve the bioavailability of the drug, prolong the time of drug action, decrease the dosage and frequency of drugs, reduce the side-effects, and improve the patient compliance and efficacy.It is one of the most important studies in glaucoma medication development because it is valuable for patients' neuroprotection.Nowadays, several novel delivery systems have been designed. This review will focus on the progressions of some of the sustained-release antiglaucoma eye drops, polymeric gels, colloidal systems, membrane-controlled drug delivery system, ocular implants, and transscleral drug delivery systems.
Keywords: Biological Availability; Delayed-Action Preparations/ad [Administration & Dosage]; Delayed-Action Preparations/pk [Pharmacokinetics]; *Drug Delivery Systems; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Neuroprotective Agents/ad [Administration & Dosage]; Neuroprotective Agents/pk [Pharmacokinetics]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/pk [Pharmacokinetics]; Optic Nerve

[National survey of blindness and avoidable visual impairment in Honduras]. - Alvarado, Doris; Rivera, Belinda; Lagos, Luis; Ochoa, Mayra; Starkman, Ivette; Castillo, Mariela; Flores, Eduardo; Lansingh, Van C; Limburg, Hans; Silva, Juan Carlos (Revista panamericana de salud publica = Pan American journal of public health, 2014)
OBJECTIVES: To determine the prevalence of blindness and visual impairment in Honduras, its causes and the response by the health services to growing demand., METHODS: A cross-sectional population study was conducted between June and December 2013 using the standard methodology of the Rapid Assessment of Avoidable Blindness. A random sample survey was done in 63 clusters of 50 individuals aged >= 50, representative of the country as a whole. Visual acuity (VA) was assessed using a Snellen eye chart, and the condition of the lens and posterior pole was examined by direct ophthalmoscopy. Cataract surgical coverage was calculated and an assessment made of its quality, the causes of VA < 20/60 and the barriers to accessing surgical treatment., RESULTS: A total of 2 999 people were examined (95.2% of the forecast total). Blindness prevalence was 1.9% (confidence interval of 95%: 1.4-2.4%) and 82.2% of these cases were avoidable. The main causes of blindness were unoperated cataracts (59.2%) and glaucoma (21.1%). Uncorrected refraction error was the main cause of severe (19.7%) and moderate (58.6%) visual impairment. Cataract surgical coverage was 75.2%. 62.5% of the eyes operated for cataracts achieved a VA > 20/60 with available correction. The main barriers against cataract surgery were cost (27.7%) and the lack of availability or difficulty of geographical access to the treatment (24.6%)., CONCLUSIONS: The prevalence of blindness and visual impairment in Honduras is similar to that of other Latin American countries. 67% of cases of blindness could be resolved by improving the response capacity of the ophthalmological services, especially of cataract surgery, improving optician services and incorporating eye care in primary health care.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Blindness/pc [Prevention & Control]; Cataract/co [Complications]; Cataract/ep [Epidemiology]; Cataract Extraction; Cross-Sectional Studies; Female; Glaucoma/co [Complications]; Glaucoma/ep [Epidemiology]; Health Services Needs and Demand; Health Surveys; Honduras/ep [Epidemiology]; Humans; Male; Middle Aged; Prevalence; Sampling Studies; Vision Disorders/ep [Epidemiology]; Vision Disorders/th [Therapy]

[National survey on the prevalence and causes of blindness in Peru]. - Campos, Betty; Cerrate, Amelia; Montjoy, Enrique; Dulanto Gomero, Victor; Gonzales, Cesar; Tecse, Aldo; Pariamachi, Andres; Lansingh, Van C; Dulanto Reinoso, Victor; Minaya Barba, Jean; Silva, Juan Carlos; Limburg, Hans (Revista panamericana de salud publica = Pan American journal of public health, 2014)
OBJECTIVE: To estimate the prevalence of blindness and visual impairment among adults in Peru and to determine their causes, to evaluate the coverage and quality of the cataract surgical services and to investigate the barriers that inhibit access to these services., METHODS: A cross-sectional population study with two-stage random cluster sampling of individuals of >= 50 years old, representative of the entire country, using the standard methodology of the Rapid Assessment of Avoidable Blindness. Visual acuity was assessed and the condition of the lens and posterior pole examined by direct ophthalmoscopy. Cataract surgical coverage was calculated. Its quality, as well as the causes of visual acuity < 20/60 and the barriers to accessing surgical treatment were assessed., RESULTS: A total of 4 849 people were examined. Blindness prevalence was 2.0% (confidence interval of 95%: 1.5-2.5%). The main causes of blindness were cataract (58.0%), glaucoma (13.7%) and age-related macular degeneration (11.5%). Uncorrected refraction errors were the principal cause of moderate visual impairment (67.2%). Cataract surgical coverage was 66.9%. 60.5% of the eyes operated for cataracts achieved a visual acuity >= 20/60 with available correction. The main barriers to cataract surgery were the high cost (25.9%) and people being unaware that treatment was possible (23.8%)., CONCLUSIONS: The prevalence of blindness and visual impairment in Peru is similar to that of other Latin American countries. Given the low cataract surgical coverage and the aging of the population, access to the services could be improved by increasing the population education on eye health and the response capacity of the ophthalmological and cataract surgical services, and by reducing the costs of the latter.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Cataract/co [Complications]; Cataract/ep [Epidemiology]; Cataract Extraction; Cross-Sectional Studies; Female; Glaucoma/co [Complications]; Glaucoma/ep [Epidemiology]; Health Services Needs and Demand; Health Surveys; Humans; Macular Degeneration/co [Complications]; Macular Degeneration/ep [Epidemiology]; Male; Middle Aged; Peru/ep [Epidemiology]; Prevalence; Sampling Studies

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey. - Gallarreta, Marcelo; Furtado, Joao M; Lansingh, Van C; Silva, Juan Carlos; Limburg, Hans (Revista panamericana de salud publica = Pan American journal of public health, 2014)
OBJECTIVE: To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay., METHODS: All individuals aged >= 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction., RESULTS: Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see >= 20/60 and 15.3% could not see 20/200 post-surgery., CONCLUSIONS: Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people >= 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.
Keywords: Aged; Aged, 80 and over; Aphakia/ep [Epidemiology]; Blindness/di [Diagnosis]; Blindness/ep [Epidemiology]; Blindness/pc [Prevention & Control]; Cataract/ep [Epidemiology]; Cataract Extraction/px [Psychology]; Cataract Extraction/sn [Statistics & Numerical Data]; Diagnostic Techniques, Ophthalmological; Fear; Female; Health Services Accessibility; Health Services Needs and Demand; Health Surveys/mt [Methods]; Humans; Lens Implantation, Intraocular/sn [Statistics & Numerical Data]; Male; Middle Aged; Motivation; Prevalence; Pseudophakia/ep [Epidemiology]; Uruguay/ep [Epidemiology]; Vision Disorders/di [Diagnosis]; *Vision Disorders/ep [Epidemiology]; Vision Disorders/pc [Prevention & Control]

The first rapid assessment of avoidable blindness (RAAB) in Thailand. - Isipradit, Saichin; Sirimaharaj, Maytinee; Charukamnoetkanok, Puwat; Thonginnetra, Oraorn; Wongsawad, Warapat; Sathornsumetee, Busaba; Somboonthanakij, Sudawadee; Soomsawasdi, Piriya; Jitawatanarat, Umapond; Taweebanjongsin, Wongsiri; Arayangkoon, Eakkachai; Arame, Punyawee; et al. (PloS one, 2014)
BACKGROUND: The majority of vision loss is preventable or treatable. Population surveys are crucial for planning, implementation, and monitoring policies and interventions to eliminate avoidable blindness and visual impairments. This is the first rapid assessment of avoidable blindness (RAAB) study in Thailand., METHODS: A cross-sectional study of a population in Thailand age 50 years old or over aimed to assess the prevalence and causes of blindness and visual impairments. Using the Thailand National Census 2010 as the sampling frame, a stratified four-stage cluster sampling based on a probability proportional to size was conducted in 176 enumeration areas from 11 provinces. Participants received comprehensive eye examination by ophthalmologists., RESULTS: The age and sex adjusted prevalence of blindness (presenting visual acuity (VA) <20/400), severe visual impairment (VA <20/200 but >=20/400), and moderate visual impairment (VA <20/70 but >=20/200) were 0.6% (95% CI: 0.5-0.8), 1.3% (95% CI: 1.0-1.6), 12.6% (95% CI: 10.8-14.5). There was no significant difference among the four regions of Thailand. Cataract was the main cause of vision loss accounted for 69.7% of blindness. Cataract surgical coverage in persons was 95.1% for cut off VA of 20/400. Refractive errors, diabetic retinopathy, glaucoma, and corneal opacities were responsible for 6.0%, 5.1%, 4.0%, and 2.0% of blindness respectively., CONCLUSION: Thailand is on track to achieve the goal of VISION 2020. However, there is still much room for improvement. Policy refinements and innovative interventions are recommended to alleviate blindness and visual impairments especially regarding the backlog of blinding cataract, management of non-communicative, chronic, age-related eye diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy, prevention of childhood blindness, and establishment of a robust eye health information system.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/pc [Prevention & Control]; Cross-Sectional Studies; Female; Health Services Accessibility/sn [Statistics & Numerical Data]; Health Surveys; Humans; Male; Middle Aged; Thailand/ep [Epidemiology]

The impact of lack of government-insured routine eye examinations on the incidence of self-reported glaucoma, cataracts, and vision loss. - Chan, Christina H; Trope, Graham E; Badley, Elizabeth M; Buys, Yvonne M; Jin, Ya-Ping (Investigative ophthalmology & visual science, 2014)
PURPOSE: We determined the impact of lack of government insured routine eye examinations on the incidence of self-reported glaucoma, cataracts and vision loss., METHODS: We analyzed data from the Canadian longitudinal National Population Health Survey (1994-2011). White respondents aged 65+ in 1994/1995 were included (n = 2618). Three cohorts were established at baseline: those free of glaucoma, cataracts, and vision loss (i.e., unable to see close or distance when wearing glasses or contact lenses). Incident cases were identified through self-reporting of these conditions during the follow-up period., RESULTS: The incidence (per 1000 person-years) of glaucoma was lower in uninsured provinces (8.1; 95% confidence interval [CI], 5.5-10.7) than in insured provinces (12.8; 95% CI, 10.5-15.1). The incidence of cataracts was also lower in the uninsured (67.2; 95% CI, 55.7-78.6) versus insured provinces (75.7; 95% CI, 69.2-82.2). The incidence of vision loss was higher in the uninsured (26.6; 95% CI, 20.2-33.0) versus insured provinces (22.5; 95% CI, 20.0-25.5). Adjusting for confounders, seniors in insured provinces had a 59% increased risk of glaucoma (incidence rate ratio [IRR], 1.59; 95% CI, 1.07-2.37), a 13% greater risk of cataracts (IRR, 1.13; 95% CI, 0.93-1.37), and a 12% reduced risk of vision loss (IRR, 0.88; 95% CI, 0.67-1.16)., CONCLUSIONS: Lack of government-funded routine eye examinations is associated with a reduced incidence of self-reported glaucoma and cataracts, likely due to reduced detection. Lack of insurance also is associated with a higher incidence of self-reported vision loss, likely due to poorer access to eye care and late treatment. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Canada/ep [Epidemiology]; *Cataract/ep [Epidemiology]; Cross-Sectional Studies; Educational Status; Female; *Glaucoma/ep [Epidemiology]; Government Programs; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Surveys; Healthcare Disparities/sn [Statistics & Numerical Data]; Humans; Incidence; *Insurance Coverage/sn [Statistics & Numerical Data]; Longitudinal Studies; Male; *National Health Programs; Regression Analysis; Social Class; *Vision Screening

Selective laser trabeculoplasty as a first-line therapy: a review. - Waisbourd, Michael; Katz, L Jay (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2014)
Poor adherence with glaucoma medications has been well documented. There remains a significant unmet need for a relatively safe intraocular pressure (IOP)-lowering procedure that minimizes or eliminates patient participation, and thus reduce the incidence of treatment failures attributable to nonadherence. Selective laser trabeculoplasty (SLT) offers several advantages: It effectively reduces IOP in most patients with open-angle glaucoma, it is cost-effective compared with eye drops, it can be repeated if needed, and it eliminates the issue of adherence to medications when used as an initial treatment. This article reviews the evidence supporting the use of SLT as a first-line therapy in glaucoma. Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; *Laser Therapy/mt [Methods]; *Trabecular Meshwork/su [Surgery]; *Trabeculectomy/mt [Methods]

Clinicians' perspectives on the use of drug-eluting contact lenses for the treatment of glaucoma. - Taniguchi, Elise V; Kalout, Patricia; Pasquale, Louis R; Kohane, Daniel S; Ciolino, Joseph B (Therapeutic delivery, 2014)
Glaucoma is the leading cause of irreversible blindness worldwide. The perspective of clinicians who treat the disease is important and may ultimately dictate the adoption of new treatment modalities, such as drug-eluting contact lenses. Recent advances have enabled contact lenses to serve as a sustained-release drug-delivery platform capable of treating glaucoma. This review covers the medical treatment of glaucoma, suboptimal adherence rates to treatment, and factors that may influence the clinical applicability of drug-eluting contact lenses. Ophthalmologists who treat glaucoma were surveyed to determine their perspective on treatment adherence, bandage contact lens use and the use of a drug-eluting contact lens to treat glaucoma. Given the challenge of treating glaucoma and the clinical need for improved drug delivery, drug-eluting contact lenses appear to be a promising treatment option.
Keywords: Administration, Ophthalmic; *Attitude of Health Personnel; Chemistry, Pharmaceutical; *Contact Lenses; Delayed-Action Preparations; *Drug Carriers; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Health Knowledge, Attitudes, Practice; Humans; *Intraocular Pressure/de [Drug Effects]; Medication Adherence; *Pharmaceutical Preparations/ad [Administration & Dosage]; Technology, Pharmaceutical/mt [Methods]

Age- and race-related differences in human scleral material properties. - Grytz, Rafael; Fazio, Massimo A; Libertiaux, Vincent; Bruno, Luigi; Gardiner, Stuart; Girkin, Christopher A; Downs, J Crawford (Investigative ophthalmology & visual science, 2014)
PURPOSE: We tested the hypothesis that there are age- and race-related differences in posterior scleral material properties, using eyes from human donors of European (20-90 years old, n = 40 eyes) and African (23-74 years old, n = 22 eyes) descent., METHODS: Inflation tests on posterior scleral shells were performed while full-field, three-dimensional displacements were recorded using laser speckle interferometry. Scleral material properties were fit to each eye using a microstructure-based constitutive formulation that incorporates the collagen fibril crimp and the local anisotropic collagen architecture. The effects of age and race were estimated using Generalized Estimating Equations, while accounting for intradonor correlations., RESULTS: The shear modulus significantly increased (P = 0.038) and collagen fibril crimp angle significantly decreased with age (P = 0.002). Donors of African descent exhibited a significantly higher shear modulus (P = 0.019) and showed evidence of a smaller collagen fibril crimp angle (P = 0.057) compared to donors of European descent. The in-plane strains in the peripapillary sclera were significantly lower with age (P < 0.015) and African ancestry (P < 0.015)., CONCLUSIONS: The age- and race-related differences in scleral material properties result in a loss of scleral compliance due to a higher shear stiffness and a lower level of stretch at which the collagen fibrils uncrimp. The loss of compliance should lead to larger high frequency IOP fluctuations and changes in the optic nerve head (ONH) biomechanical response in the elderly and in persons of African ancestry, and may contribute to the higher susceptibility to glaucoma in these at-risk populations. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.
Keywords: Adult; *African Continental Ancestry Group; Aged; *Aging/ph [Physiology]; Biomechanical Phenomena; Collagen/an [Analysis]; *Elasticity/ph [Physiology]; *European Continental Ancestry Group; Female; Humans; Interferometry/mt [Methods]; Male; Middle Aged; Posterior Eye Segment/ph [Physiology]; *Sclera/ph [Physiology]; Young Adult

Understanding and living with glaucoma and non-communicable diseases like hypertension and diabetes in the Jhaukhel-Duwakot Health Demographic Surveillance Site: a qualitative study from Nepal. - Shakya-Vaidya, Suraj; Povlsen, Lene; Shrestha, Binjwala; Grjibovski, Andrej M; Krettek, Alexandra (Global health action, 2014)
BACKGROUND: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glaucoma., OBJECTIVES: Anticipating a knowledge gap regarding these diseases, this study aimed to explore the knowledge of POAG, hypertension, and diabetes in the community and barriers to health care., DESIGN: We conducted this qualitative study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), a peri-urban community near Kathmandu, a capital city of Nepal. To study how disease influences knowledge, we conducted focus group discussions separately for men and women with and without pre-existing POAG, hypertension, and diabetes. Data were analyzed using the framework analysis approach., RESULTS: Although people suffering from POAG, hypertension, and/or diabetes exhibited adequate knowledge of hypertension and diabetes, they lacked in-depth knowledge of POAG. People believed mostly in internal health locus of control. Perception of disease consequences and impact of disease on daily life was influenced by pre-existing POAG, hypertension, and/or diabetes but only in men. Gender disparity was observed regarding health literacy, health perception, and health barriers, which put women in a more difficult situation to tackle their health. We also revealed a gap between knowledge, attitude, and practice of health among women and healthy men., CONCLUSION: Although people in JD-HDSS exhibited adequate knowledge regarding hypertension and diabetes, they lacked in-depth knowledge about POAG. This study demonstrated gender difference in health literacy and access to health care, making women more vulnerable towards disease. We also demonstrated a gap between knowledge, attitude, and practice of health. However, tailored health literacy programs may bring changes in the health status in the community.
Keywords: Adult; *Diabetes Mellitus/ep [Epidemiology]; Female; Focus Groups; *Glaucoma, Open-Angle/ep [Epidemiology]; *Health Knowledge, Attitudes, Practice; Humans; *Hypertension/ep [Epidemiology]; Male; Middle Aged; Nepal/ep [Epidemiology]; Population Surveillance; Qualitative Research; *Quality of Life

Surgical management of severe complications arising from uveitis in juvenile idiopathic arthritis. - Langner-Wegscheider, Beate J; de Smet, Marc D (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2014)
PURPOSE: Evaluate outcomes from severe ocular complications of juvenile idiopathic arthritis following surgery., METHODS: Eleven eyes of 7 patients underwent complete vitrectomy and peeling of the inner limiting membrane. Inclusion criteria were: anteroposterior segment involvement, hypotony, inflammation control of less than 3 months, compliance issues, rapidly progressive disease. Phacoemulsification was allowed if the patient was >6 years old and inflammation free >3 months. The alternative was a complete lensectomy., RESULTS: Visual acuity improved from a logMAR of 1.48 to 0.37 (p < 0.0001), and 0.20 at 6 and 12 months (p < 0.0001). No flare-up was observed within the first 6 months. Five eyes developed inflammation between 7 and 19 months. Glaucoma developed in 5 eyes at a median of 16 months. No patient developed cystoid macular edema., CONCLUSION: Extensive pars plana vitrectomy and cataract extraction can lead to significant improvement in visual acuity. Patients continue to require long-term immunosuppression and adequate follow-up. Copyright 2014 S. Karger AG, Basel
Keywords: Adolescent; *Arthritis, Juvenile/co [Complications]; Cataract/et [Etiology]; Child; Child, Preschool; Chronic Disease; Epiretinal Membrane/su [Surgery]; Female; Humans; *Lens Implantation, Intraocular; Male; Ocular Hypotension/et [Etiology]; Ocular Hypotension/su [Surgery]; *Phacoemulsification; *Uveitis/et [Etiology]; Visual Acuity/ph [Physiology]; *Vitrectomy

Noninvasive ocular drug delivery: potential transcorneal and other alternative delivery routes for therapeutic molecules in glaucoma. - Foldvari, Marianna (Journal of glaucoma, 2014)
Drug delivery to the eye is made difficult by multiple barriers (such as the tear film, cornea, and vitreous) between the surface of the eye and the treatment site. These barriers are difficult to surmount for the purposes of drug delivery without causing toxicity. Using nanotechnology tools to control, manipulate, and study delivery systems, new approaches to delivering drugs, genes, and antigens that are effective and safe can be developed. Topical administration to the ocular surface would be the safest method for delivery, as it is noninvasive and painless compared with other delivery methods. However, there is only limited success using topical delivery methods, especially for gene therapy. Current thinking on treatments of the future enabled by nanodelivery systems and the identification of target specificity parameters that require deeper understanding to develop successful topical delivery systems for glaucoma is highlighted.
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; *Cornea/de [Drug Effects]; *Drug Delivery Systems; Exfoliation Syndrome/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions; *Pharmaceutical Preparations/ad [Administration & Dosage]

Potential drug delivery approaches for XFS-associated and XFS-associated glaucoma. - Kulkarni, Shreya S; Kompella, Uday B (Journal of glaucoma, 2014)
Key tissue targets in treating exfoliation syndrome (XFS) and the associated glaucoma include lens, iris, and ciliary body, which produce the exfoliative material, and the trabecular meshwork, which may be impaired by the exfoliative material. In addition to antiglaucoma drug therapy, strategies for treating the disease include approaches for preventing formation of exfoliative material as well as those aimed at digesting exfoliative material. A variety of drug molecules including small molecules, protein drugs, and nucleic acids are potential candidates for treating XFS. Potential drug classes include antioxidants, lysyl oxidase-like 1 enhancers, antifibrotics, anti-inflammatory agents, proteases, and chaperones. However, the delivery of these agents to the target tissues in the anterior segment is hindered by protective static and dynamic barriers of the eye. Thus, unique drug delivery approaches are needed for each drug type (small molecules, proteins, and nucleic acids). In addition, there is a need for sustaining drug therapy for treating XFS, which can potentially be addressed by using nanoparticles, microparticles, implants, and contact lens delivery systems. This article provides an overview of drug delivery challenges and opportunities in treating XFS with the focus being on nanomedicines.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Antioxidants/ad [Administration & Dosage]; *Drug Delivery Systems; *Exfoliation Syndrome/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Molecular Chaperones/ad [Administration & Dosage]

Brinzolamide plus brimonidine for the treatment of glaucoma: an update. - Chew, Sky K; Skalicky, Simon E; Goldberg, Ivan (Expert opinion on pharmacotherapy, 2014)
INTRODUCTION: Glaucoma is a common sight-threatening condition that is primarily treated by lowering intraocular pressure (IOP). Today the mainstay of treatment is topical ocular hypotensive medications; many patients require more than one agent to achieve target IOP. For such patients, fixed combination formulations have several advantages including simplicity of treatment regimen, adherence to the treatment regimen, efficacy, improved ocular surface comfort and reduced cost. All currently available fixed combinations contain a beta-blocker, which is contraindicated in some patients. Hence there is a clinical need for fixed-combination preparations without a beta-blocker. This paper reviews the current literature on a new fixed-combination drug containing brinzolamide 1% and brimonidine 0.2% (BBFC)., AREAS COVERED: A PubMed, Embase and ClinicalTrials.gov registry search was performed to identify all relevant studies. Four published clinical papers pertaining to three randomized controlled trials were identified for review. All studies demonstrated a significant reduction (p < 0.01) in mean IOP in patients administered with BBFC compared with its individual components, brinzolamide 1% or brimonidine 0.2%. Adverse effects from BBFC were no different from each of the individual components, the most common being blurred vision, eye irritation and dysgeusia (abnormal taste sensation). Although BBFC use was associated with more adverse effects compared with the individual components used as monotherapy (p < 0.001), the cumulative adverse effect profile from BBFC did not appear greater than one would expect from the simultaneous use of the two components., EXPERT OPINION: BBFC is a potential alternative to other fixed-combination medications and is especially useful when topical beta-blockers are contraindicated. Longer-term experience will determine if additional adverse effects occur or if efficacy is maintained over longer periods.
Keywords: *Adrenergic alpha-2 Receptor Agonists/tu [Therapeutic Use]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Clinical Trials as Topic; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; *Quinoxalines/tu [Therapeutic Use]; *Sulfonamides/tu [Therapeutic Use]; *Thiazines/tu [Therapeutic Use]

Ophthalmic digital image transfer: benefits to triage, patient care and resource. - Goudie, Colin; Lunt, David; Reid, Suzanna; Sanders, Roshini (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2014)
PURPOSE: Hospital capacity in the UK is currently significantly challenged due to new treatments, targets and resource limitations. There have been significant improvements in training, equipment and shared care services in community primary care optometry services. Despite this the challenges to ophthalmic service delivery are considerable. One area of potential benefit is the effect on outcome when a clinical image is attached to a referral. We aimed to quantify the effect of attaching digital images to ophthalmic referrals., METHODS: Retrospective analysis of 358 consecutive optometry referrals to the Hospital Eye Service in Dunfermline, Scotland using electronic referral with digital images. All images were screened by consultant ophthalmologists., RESULTS: The patients were aged between 9 and 100 years (mean age 63.6 years). Sixty four (18%) referrals were deemed urgent (requiring appointment within 24-60 h), with the majority, 28 (8%) being wet macular degeneration. One hundred and seventy (48%) were deemed routine (appointment within 2-6 weeks), with categories including macular disease, glaucoma, cataract, optic disc and retinal abnormalities. Twenty seven (8%) patients were already attending the hospital eye service, or had been referred previously for the same condition. Categories were mainly glaucoma, diabetic retinopathy and cataract. Ninety-five (25%) were 'e-diagnosed' based on image and referral information (i.e. with no secondary eye care appointment). Diagnosis included glaucoma suspect (22, 6%), macular pathology (12, 3%), abnormal looking discs (9, 2.5%) and cataract (9, 2.5%). The overall 'did not attend' rate for those patients seen in the hospital eye service (254) was <1% (two patients)., CONCLUSIONS: The attachment of digital images improved the quality of referral triaging from optometry to secondary eye care in the hospital eye service. It allowed detection of sight threatening disease early and more appropriate allocation of patients to specific specialist clinics at first visit. They allowed safe and speedy 'e-diagnosis' of a subgroup, saving hospital capacity and minimising patient inconvenience. Indirectly the service also reduced the 'did not attend' rate. With recent improvements in camera and internet technology digital images will have an ever increasing role in secondary eye care as it continues to adapt to meet modern demands. Copyright © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Diagnostic Techniques, Ophthalmological/st [Standards]; *Eye Diseases/di [Diagnosis]; Female; Humans; Image Processing, Computer-Assisted/mt [Methods]; Male; Middle Aged; *Optometry/st [Standards]; *Patient Care/st [Standards]; Patient Satisfaction; *Photography; Referral and Consultation/sn [Statistics & Numerical Data]; Retrospective Studies; Scotland; *Triage/st [Standards]; Young Adult

Persistence of topical glaucoma medication: a nationwide population-based cohort study in Taiwan. - Hwang, De-Kuang; Liu, Catherine Jui-Ling; Pu, Cheng-Yun; Chou, Yiing-Jenq; Chou, Pesus (JAMA ophthalmology, 2014)
IMPORTANCE: Medication persistence is an important factor for treatment effect in patients with glaucoma. Evaluating risk factors for refill discontinuation might be helpful for improving persistence and preventing blindness in patients with glaucoma., OBJECTIVES: To estimate the persistence rate with topical glaucoma medication 2 years after diagnosis and evaluate risk factors for nonpersistence among patients in Taiwan with open-angle glaucoma and ocular hypertension., DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based study using claims data from the National Health Insurance Research Database. One million patients were randomly selected from the registered beneficiaries of the National Health Insurance Research Database in 2000. All patients with newly diagnosed open-angle glaucoma and ocular hypertension were included and followed up until December 31, 2008. Patients were included in the analysis only if they had follow-up data for more than 2 years after diagnosis., MAIN OUTCOMES AND MEASURES: Nonpersistence was defined as the patient not refilling any topical glaucoma medication for more than 90 days. Patient characteristics, prescription-related clinical factors, and physician and hospital characteristics were identified and considered in the analysis. The rate of persistence was estimated and risk factors for nonpersistence were investigated using Cox proportional regression models., RESULTS: A total of 3134 patients were identified and observed in the study. After a 2-year follow-up, 759 patients (24.2%) persisted with their glaucoma medications. Multivariate analysis showed that patients' living or working areas (P < .001), number of glaucoma medications (P < .001), prescription of pilocarpine hydrochloride (adjusted ratio of persistence = 0.72; 95% CI, 0.59-0.88) or prostaglandin analogs (adjusted ratio of persistence = 2.04; 95% CI, 1.82-2.33), the year in which glaucoma diagnosis was made (adjusted ratios of persistence for patients whose condition was diagnosed after 2004 = 1.18; 95% CI, 1.09-1.27), sex of the main physicians (adjusted ratios of persistence for male ophthalmologists = 0.82; 95% CI, 0.74-0.90), treatment in hospitals (P < .001), and continuity of care index (P < .001) were associated with patients' persistence with glaucoma medications., CONCLUSIONS AND RELEVANCE: The rate of persistence for glaucoma medications is low in Taiwan, although health care costs, including the cost of medication, are mostly covered by the nationwide health insurance system. This study suggests that factors other than cost, such as physician-patient relationship and patient education, may play an important role in the persistence of topical glaucoma medication.
Keywords: Administration, Topical; Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cohort Studies; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; National Health Programs/sn [Statistics & Numerical Data]; Ophthalmic Solutions; Retrospective Studies; Rural Population/sn [Statistics & Numerical Data]; Taiwan/ep [Epidemiology]; Urban Population/sn [Statistics & Numerical Data]; Young Adult

Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. - Sloan, Frank A; Yashkin, Arseniy P; Chen, Yiqun (Ophthalmology, 2014)
OBJECTIVE: To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM)., DESIGN: Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS)., PARTICIPANTS: The sample consisted of 2151 Medicare beneficiaries who responded to the HRS., METHODS: Medicare beneficiaries with >= 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination., MAIN OUTCOME MEASURES: The primary outcome measure was the number of 15-month periods with an eye examination., RESULTS: One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations., CONCLUSIONS: Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Activities of Daily Living; Aged; Attitude to Health; Chronic Disease; *Diabetes Mellitus; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/pc [Prevention & Control]; Female; Glaucoma/di [Diagnosis]; *Glaucoma/pc [Prevention & Control]; Health Behavior; Health Care Surveys; *Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Macular Degeneration/di [Diagnosis]; *Macular Degeneration/pc [Prevention & Control]; Male; Medicare/sn [Statistics & Numerical Data]; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Retrospective Studies; Sex Factors; United States

Efficacy and safety of tafluprost 0.0015% and timolol maleate 0.5% fixed combination in patients with ocular hypertension or open-angle glaucoma. - Lorenz, Katrin; Pfeiffer, Norbert (Expert opinion on pharmacotherapy, 2014)
INTRODUCTION: Lowering intraocular pressure (IOP) is at present the only therapeutic approach to the treatment of glaucoma proven to be successful. The choice of therapy must take into account efficacy, tolerability, safety, quality of life, adherence and cost. Monotherapy fails to achieve a satisfactory IOP reduction in 40 - 75% of glaucoma patients after > 2 years of therapy. So far, three prostaglandin/timolol maleate 0.5% fixed combinations (FCs) are available., AREAS COVERED: This review provides a background on the tafluprost-timolol FC (TTFC, Santen Oy) and its individual compounds. It summarizes the data on efficacy and safety, including comparative data with prostaglandin/timolol FCs already available., EXPERT OPINION: Tafluprost is a preservative-free prostaglandin analog with a similar IOP efficacy when compared with other prostaglandin analogs. However, its improved adverse effect profile seems to be beneficial in patients sensitive to preservatives. The preservative-free TTFC has no market authorization yet. Only one Phase III trial was published so far, but results are promising in terms of efficacy, tolerability and safety. It is likely that the TTFC will play a role in the treatment of open-angle glaucoma and ocular hypertension.
Erratum in (EIN)
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Combinations; Drug Evaluation; Drug-Related Side Effects and Adverse Reactions; Glaucoma/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ocular Hypertension/dt [Drug Therapy]; Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F/ae [Adverse Effects]; *Prostaglandins F/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Efficacy and tolerability of fixed-combination brinzolamide/timolol in Latin American patients with open-angle glaucoma or ocular hypertension previously on brimonidine/timolol fixed combination. - Alezzandrini, Arturo; Hubatsch, Douglas; Alfaro, Rene (Advances in therapy, 2014)
INTRODUCTION: Fixed-combination glaucoma medications are commonly used to achieve target intraocular pressure (IOP) reduction in patients uncontrolled with monotherapy; however, ocular discomfort associated with eye drops can decrease adherence. This study assessed the efficacy and tolerability of twice-daily fixed-combination brinzolamide 1%/timolol 0.5% (BRINZ/TIM-FC) in Latin American patients transitioned from fixed-combination brimonidine 0.2%/timolol 0.5% (BRIM/TIM-FC) because of insufficient IOP control or treatment intolerance., METHODS: This 8-week, open-label, prospective study was conducted at six sites in Argentina, Chile, and Mexico. Enrolled patients were aged >=18 years with open-angle glaucoma (including primary, exfoliative, or pigment-dispersion glaucoma) or ocular hypertension with IOP of 19-35 mmHg in >=1 eye at baseline (on BRIM/TIM-FC). Patients self-administered BRINZ/TIM-FC to both eyes at 8 a.m. and 8 p.m. daily for 8 weeks. The primary and secondary efficacy endpoints were mean IOP change from baseline at week 8 and percentage of patients achieving target IOP (<=18 mmHg) at week 8, respectively. Exploratory endpoints included patient and investigator preference for treatment at week 8. Adverse events (AEs) were assessed as the safety endpoint., RESULTS: Fifty patients (mean +/- SD age, 66.7 +/- 11.5 years) received BRINZ/TIM-FC, and 49 were included in the intent-to-treat population. Mean +/- SD IOP was significantly reduced from baseline after 8 weeks of treatment with BRINZ/TIM-FC (-3.6 +/- 3.0 mmHg; P < 0.0001, Wilcoxon signed-rank test; 17.1% reduction). Overall, 55.3% of patients achieved IOP <=18 mmHg at week 8. Significantly more patients (89.4%) and investigators (95.7%) preferred BRINZ/TIM-FC to BRIM/TIM-FC (both P < 0.0001, exact binomial test). Of the 13 AEs observed, 8 were related to BRINZ/TIM-FC; the most common treatment-related AEs were eye irritation (n = 4) and abnormal sensation in the eye (n = 2)., CONCLUSION: BRINZ/TIM-FC provides an effective and well-tolerated treatment option for patients transitioned from BRIM/TIM-FC.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate/ad [Administration & Dosage]; Brimonidine Tartrate/ae [Adverse Effects]; *Brimonidine Tartrate/tu [Therapeutic Use]; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure; Latin America; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Prospective Studies; Research Design; 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]; United States

Resource utilization and use of life-extending therapies and corticosteroids in prostate cancer patients with corticosteroid-sensitive comorbidities. - Bui, Cat N; Wang, Li; Baser, Onur (Current medical research and opinion, 2014)
OBJECTIVES: Corticosteroids (CSs) are used concomitantly with life-extending therapies (LETs) in patients with castration-resistant prostate cancer (CRPC). This study examined time to LETs, LETs and concomitant CS adherence, and monthly all-cause healthcare utilization and costs in patients with CPRC with and without CS-sensitive comorbidities in the Veterans Health Administration population., METHODS: Patients had CRPC if records showed prostate cancer diagnosis, medical/surgical castration and >=2 prostate-specific antigen increases through 1 June 2007-31 May 2012. CS-sensitive comorbidities were assessed 6 months prior to the index date. Adherence, defined as medication possession ratio (MPR) >=0.8, among patients initiating LETs (cabazitaxel, docetaxel, or abiraterone acetate) before 30 November 2011, resource utilization and costs among patients with concomitant CS were assessed. Statistical analysis included descriptive, Cox proportional hazards, and logistic regression models., RESULTS: Common CS-sensitive conditions among 12,128 patients with CRPC included hypertension (75.74%) and hyperlipidemia (54.69%). Those with glaucoma (hazard ratio [HR] = 0.67), ischemic heart disease (HR = 0.78), and peripheral vascular disease (PVD) (HR = 0.78) were less likely to be prescribed LETs (all p < 0.01). Duration of LET was shorter among patients with CS-sensitive comorbidities (125.02 vs 133.08 days; p = 0.04) in the 6 month follow-up period. Among LET-treated patients with and without CS-sensitive comorbidities, less than half had MPR >= 0.8 (LET: 48.72% vs 54.05%; concomitant CS: 42.19% vs 40.54%, respectively). Cerebrovascular disease (odds ratio = 0.107; 95% confidence interval = 0.012 to 0.966) and PVD (odds ratio = 0.523; 95% confidence interval = 0.276 to 0.991) were associated with reduced CS adherence. Among patients with concomitant CS, those with CS-sensitive comorbidities had more inpatient stays than those without (20.45% vs 12.88%; p = 0.033), incurring higher monthly inpatient costs ($1157 vs $342; p < 0.0001) and total costs ($5725 vs $4772; p = 0.036)., CONCLUSION: CS-sensitive conditions influence initiation and duration of LETs, concomitant CS adherence, inpatient stays, and total costs. Future efforts should focus on specific strategies for treating prostate cancer patients with CS-sensitive comorbidities to ensure that they have appropriate access to LETs and to reduce costs and inpatient stays. Study limitations include the use of retrospective claims data and the relatively restricted subpopulation of older North American males.
Keywords: Adult; Aged; Contraindications; *Glucocorticoids/tu [Therapeutic Use]; *Health Care Costs; *Health Services/sn [Statistics & Numerical Data]; Humans; Logistic Models; Male; Medication Adherence; Middle Aged; *Prostatic Neoplasms/co [Complications]; *Prostatic Neoplasms/dt [Drug Therapy]; Prostatic Neoplasms/pa [Pathology]; Retrospective Studies; United States

[Alterations of intraocular pressure in comparison of self- and external-administered topical antiglaucomatosa during diurnal intraocular pressure measurements]. - Bohm, M R R; Lill, T M; Eter, N; Prokosch-Willing, V (Klinische Monatsblatter fur Augenheilkunde, 2014)
BACKGROUND: The correct self-administration of topical antiglaucomatous eye drops is important for the success of glaucoma treatment. Individual impairment, like increased age, decreased visual acuity, impaired visual-field perception or the frequency of drug appliance may influence a correct application technique and the patients compliance and therewith intraocular pressure (IOP). The aim of this study was to explore alterations of IOP due to self versus external administration (by trained medical personnel) of topical antiglaucomatous eye drops due to impairing factors., MATERIAL AND METHODS: A prospective analysis was undertaken of 123 patients with primary chronic open-angle glaucoma receiving a diurnal intraocular pressure (DIP) measurement over 72 hours at our department. During the first 24 hours, the application of topical eye drops was self-administered by patients (SA), while the application of eye drops within the following 48 hours was performed by trained medical personnel (EA). Alterations of mean intraocular pressure (MIP) and diurnal fluctuations (DF) between EA and SA were analysed with regard to initial IOP, restrictions of visual field perception, visual acuity, age, general health status and frequency of daily eye drop administration., RESULTS: Overall comparable MIP in SA and EA was seen. 19.2-43.9 % of the patients with an initial IOP >= 11 mmHg showed beneficial effects of EA with lowering of IOP under 15.5 mmHg. 27.6 % of the patients showed lowering of DF < 5 mmHg due to EA. EA influenced DF beneficially in cases of poor visual acuity (<= 0.1, - 0.8 mmHg) and frequent drop administration (- 0.75 mmHg)., CONCLUSIONS: Subpopulations of investigated patients showed lowering of MIP due to EA, although EA showed no MIP lowering effects in comparison with SA in general. Glaucoma-impaired patients show decreased DF by EA. Particularly beneficial influences to DF by EA were observed due to impaired visual acuity and frequent drop administration. We recommend a 72-hour DIP to evaluate individual parameters influencing the success of topical glaucomatous treatment. The benefit of EA in patients with certain impairments should be the subject of further investigations. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Administration, Ophthalmic; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Circadian Rhythm/de [Drug Effects]; *Clinical Competence; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Self Administration; Young Adult

Does government assistance improve utilization of eye care services by low-income individuals?. - Hong, Chris J; Trope, Graham E; Buys, Yvonne M; Robinson, Barbara E; Jin, Ya-Ping (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2014)
OBJECTIVE: To examine whether government-funded, low-income vision care programs improve use of eye care services by low-income individuals in Canada., DESIGN: Cross-sectional survey., PARTICIPANTS: 27,375 white respondents to the Canadian Community Health Survey (CCHS) Healthy Aging 2008/2009., METHODS: Government-funded, low-income vision care programs were reviewed. The amount of assistance provided was compared with professional fee schedules for general/routine eye examinations and market prices for eyeglasses. The utilization of eye care providers was derived from the CCHS., RESULTS: To receive low-income vision care assistance, individuals must be in receipt of social assistance. Criteria for receiving social assistance are stringent. The Canadian Financial Capability Survey revealed that 7.9% of Canadians aged 45 to 64 years and 5.5% aged >=65 years received social assistance in 2009. The CCHS found in 2008/2009 that 12.5% of citizens aged 45 to 64 years and 13.2% of those aged >=65 years had difficulty paying for basic expenses such as food. In 5 provinces, low-income vision care assistance fully covers a general/routine eye examination. In the remainder, the assistance provided is insufficient for a general/routine eye examination. The assistance for eyeglasses is inadequate in 5 provinces, requiring out-of-pocket copayments. Among middle-aged whites who self-reported not having glaucoma, cataracts, diabetes, or vision problems not corrected by lenses, utilization of eye care providers was 28.1% among those with financial difficulty versus 41.9% among those without (p < 0.05), giving a prevalence ratio 0.68 (95% CI 0.57-0.80) adjusted for age, sex and education., CONCLUSIONS: Despite government assistance, low-income individuals use vision care services less often than wealthy individuals. Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Canada; Cross-Sectional Studies; Female; Government Programs; Health Care Surveys; *Health Services/sn [Statistics & Numerical Data]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Services Research; Humans; Male; *Medical Assistance/sn [Statistics & Numerical Data]; Middle Aged; National Health Programs; *Ophthalmology/sn [Statistics & Numerical Data]; *Optometry/sn [Statistics & Numerical Data]; *Poverty/sn [Statistics & Numerical Data]; Young Adult

Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines. - Jamous, Khalid F; Kalloniatis, Michael; Hayen, Andrew; Mitchell, Paul; Stapleton, Fiona J; Zangerl, Barbara (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2014)
PURPOSE: Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma were released by the Australian National Health and Medical Research Council in 2010. Comparable guidance has been made available by respective bodies in the USA and UK at a similar time. Key to successful translation of guidelines into clinical practice includes clinicians having the necessary skills to perform required tests. Optometrists in Australia and New Zealand were invited to participate in an online survey exploring these aspects. The results provide insights for improving glaucoma diagnosis and management by optometric primary eye care practitioners., METHODS: An online questionnaire was developed to investigate glaucoma assessment of optometrists as a function of demographic details, educational background and experience. Key points to ascertain compliance with current guidelines were the availability of equipment, procedural confidence in techniques, and preferences in visual field tests. Chi square statistics was employed to support similarity to national averages and highlight differences between the two countries. Multivariate linear regression analysis identified variables significantly associated with individual tests being available to optometrists and their confidence in applying them., RESULTS: Thirteen per cent of all Australian and 36% of the New Zealand optometrists responded to the survey in 2013, which reflected the demographics/geography of the practising populations. Techniques considered essential or preferred for glaucoma assessment were widely available in both countries with the exception of gonioscopy and pachymetry. After correcting for availability, regression models highlighted therapeutic endorsement and knowledge of glaucoma guidelines as the main variables to maintain high diagnostic confidence. Correlations to number of years in optometric practice mirrored a changed emphasis in teaching and technology over the past 10-15 years., CONCLUSIONS: Australian and New Zealand optometrists were well equipped to perform glaucoma assessments with the possible exception of gonioscopy. Advanced imaging modalities were not yet fully integrated into optometric practice, although optical coherence tomography has shown use by 23-32% of optometrists. A marked increase in use, availability and procedural confidence of gonioscopy and other techniques with therapeutically endorsed optometrists demonstrates the advantage and importance of additional training. Copyright © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.
Keywords: Australia; Clinical Competence; Educational Status; Female; *Glaucoma/di [Diagnosis]; *Guideline Adherence/st [Standards]; Humans; Male; New Zealand; Optometry/is [Instrumentation]; *Optometry/mt [Methods]; Practice Guidelines as Topic; *Practice Patterns, Physicians'/st [Standards]; Regression Analysis; Surveys and Questionnaires; Tomography, Optical Coherence; Visual Field Tests/mt [Methods]

Clinico-biochemical correlation of the effect of subconjunctival bevacizumab for corneal neovascularization. - Agarwal, Shweta; Angayarkanni, Narayanasamy; Iyer, Geetha; Srinivasan, Bhaskar; Natarajan, Radhika; Charola, Sanket; Arumugam, Sumathi; Padmanabhan, Prema (Cornea, 2014)
PURPOSE: The aim of this study was to evaluate the effect of clinical and biochemical effects of subconjunctival bevacizumab injection in eyes with corneal neovascularization (CNV) due to varied etiologies., METHODS: This prospective interventional case series included 12 eyes of 12 patients with CNV after failed therapeutic penetrating keratoplasty (4 eyes), viral keratitis (4 eyes), adherent leucoma (2 eyes), and pseudophakic bullous keratopathy (2 eyes). Each eye received 3 doses of 1.25 mg (0.05 mL) of bevacizumab at 1-month intervals. Morphological changes in neovascularization were evaluated at each visit by slit-lamp examination and corneal digital photography. Corneal buttons of 4 eyes that underwent optical penetrating keratoplasty after bevacizumab injections were analyzed for vascular endothelial growth factor (VEGF) expression and were compared with untreated vascularized and normal cadaveric donor corneas., RESULTS: Of the 12 patients, 10 were males and 2 were females. Four eyes received injections in the early phase of vascularization (<12 weeks of onset) of which 3 showed regression of vessels. Eight eyes received bevacizumab in the mature phase (>12 weeks) of which 5 showed regression. The follow-up ranged from 1 to 16 months. Five eyes underwent optical penetrating keratoplasty after receiving the last dose of bevacizumab and maintained graft clarity with no episodes of rejection over a mean follow-up of 9.8 months. Four of these 5 corneal buttons analyzed for VEGF expression revealed clinically significant lower levels of expression as compared with the vascular untreated corneas. No local or systemic adverse effects were noted in any patient., CONCLUSIONS: Subconjunctival bevacizumab helps to regress CNV due to a decrease in corneal VEGF levels and might prove beneficial for use in clinical conditions leading to CNV.
Keywords: Adolescent; Adult; Aged; *Angiogenesis Inhibitors/tu [Therapeutic Use]; *Antibodies, Monoclonal, Humanized/tu [Therapeutic Use]; Bevacizumab; Conjunctiva/de [Drug Effects]; *Corneal Neovascularization/dt [Drug Therapy]; Corneal Neovascularization/pa [Pathology]; Corneal Neovascularization/su [Surgery]; Female; Follow-Up Studies; Humans; Injections, Intraocular; Keratoplasty, Penetrating; Male; Middle Aged; Prospective Studies; RNA, Messenger/ge [Genetics]; Real-Time Polymerase Chain Reaction; Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]; Vascular Endothelial Growth Factor A/ge [Genetics]; Young Adult

Ab interno approach to Schlemm canal: ab interno trabecular ablative procedures. - Bailey, Andrew K; Vold, Steven D; Sarkisian, Steven R Jr (Journal of cataract and refractive surgery, 2014)
UNLABELLED: The high risk of complications and long period of recovery associated with glaucoma filtration procedures have been significant deterrents to surgery for both clinicians and patients. With the advent of microinvasive glaucoma procedures and the persistence of glaucoma medical compliance issues, clinicians have demonstrated a renewed interest in earlier glaucoma surgical intervention. This article reviews the indications, technique, and surgical results for trabecular ablation to lower intraocular pressure., FINANCIAL DISCLOSURE: Dr. Vold has received research support and is on the speakers bureau for Neomedix Corp. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Keywords: Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; Limbus Corneae/su [Surgery]; *Trabecular Meshwork/su [Surgery]; *Trabeculectomy/mt [Methods]

[Transient increase of intraocular pressure with primary open angle glaucoma patients associated with warm and cold seasons after long waiting time in an ophthalmology clinic]. - Nishino, Kazuaki; Yoshida, Fujiko; Nitta, Akari; Saito, Mieko; Saito, Kazuuchi (Nippon Ganka Gakkai zasshi, 2014)
PURPOSE: To retrospectively evaluate the influence of long waiting time on intraocular pressure (IOP) with primary open angle glaucoma (POAG) patients in the waiting room of an ophthalmology clinic., PATIENTS AND METHOD: We reviewed 74 consecutive patients with POAG who visited at Kaimeido Ophthalmic and Dental Clinic within the past 8 years without change of glaucoma medications, 34 men and 40 woman, average age +/- standard deviation) 67.9 +/- 13.4 years. Right eye data of all patients were enrolled and IOP was split into 4 groups, short waiting time (< 30 min ; SH30) and long waiting time (> or = 60 min; LH60) in the hot (> or = 15 degrees C) season. Short waiting time (SC30) and long waiting time (LC60) in the cold (< or = 5 degrees C) season; according to the average outdoor air temperature in Sapporo Japan. All groups were compared each other (paired t test)., RESULTS: There was a significant difference between SH30 (14.6 2.4 mmHg) and LH60 (14.9 +/- 2.4 mmHg; p = 0.038), between SC30 (14.6 +/- 2.4 mmHg) and LC60 (15.5 +/- 2.6 mmHg; p = 3.45 x 10(-7)) and between LH60 and LC60 (p = 0.00079). On the other hand, there was no significant difference between SH30 and SC30 (p = 0.89)., CONCLUSION: This retrospective study suggests that patients with POAG show a transient IOP elevation after longer waiting time, especially during the cold season.
Keywords: Aged; Ambulatory Care Facilities; *Appointments and Schedules; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Seasons

Novel telemedicine device for diagnosis of corneal abrasions and ulcers in resource-poor settings. - Maamari, Robi N; Ausayakhun, Somsanguan; Margolis, Todd P; Fletcher, Daniel A; Keenan, Jeremy D (JAMA ophthalmology, 2014)
Keywords: *Cell Phone/is [Instrumentation]; *Corneal Ulcer/di [Diagnosis]; Developing Countries; *Epithelium, Corneal/pa [Pathology]; Fluorophotometry; Health Resources; *Health Services Accessibility; Humans; *Photography/is [Instrumentation]; Sensitivity and Specificity; *Telemedicine/is [Instrumentation]; Telemedicine/mt [Methods]; Thailand

Fixed-combination intraocular pressure-lowering therapy for glaucoma and ocular hypertension: advantages in clinical practice. - Hollo, Gabor; Topouzis, Fotis; Fechtner, Robert D (Expert opinion on pharmacotherapy, 2014)
INTRODUCTION: Several large, randomized, prospective clinical trials have demonstrated that medical therapy to reduce intraocular pressure (IOP) delays the onset and decreases progression of glaucoma. Many patients with glaucoma require more than one ocular hypotensive medication to achieve and maintain their target IOP; however, use of multiple topical glaucoma preparations is associated with factors that may decrease treatment efficacy and increase adverse effects., AREAS COVERED: This article reviews the use of fixed-combination therapies in glaucoma management, the relationship between IOP management and disease progression and challenges associated with glaucoma therapy when multiple instillations are required. Specific topics discussed include IOP-lowering efficacy, adherence and persistence, preservative exposure and washout-related risk of diminished IOP reduction. Potential benefits of fixed combinations versus multiple non-fixed medications are reviewed based on a detailed literature search., EXPERT OPINION: Compared with non-fixed combinations, fixed-combination glaucoma therapies provide various demonstrated benefits (similar IOP-lowering efficacy with reduced exposure to preservatives and risk of preservative-related ocular surface disease symptoms, elimination of washout associated with insufficient time separation of instillations and reduced number of total instillations). Further, due to simplification of the instillation regimen, fixed combinations may improve treatment adherence and persistence, thereby improving stability of IOP control over time.
Keywords: Administration, Topical; Animals; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma/pa [Pathology]; Humans; *Intraocular Pressure/de [Drug Effects]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pa [Pathology]; Preservatives, Pharmaceutical/ad [Administration & Dosage]; Preservatives, Pharmaceutical/ae [Adverse Effects]; Preservatives, Pharmaceutical/tu [Therapeutic Use]; Treatment Outcome

Ocular comorbidity and self-assessed visual function after cataract surgery. - Grimfors, Magnus; Mollazadegan, Kaziwe; Lundstrom, Mats; Kugelberg, Maria (Journal of cataract and refractive surgery, 2014)
PURPOSE: To study the association between ocular comorbidities and the change in patient-perceived visual function, postoperative patient-perceived visual function, and visual satisfaction after cataract surgery., SETTING: Forty-one Swedish cataract surgical units., DESIGN: Clinic-based cross-sectional study., METHODS: Patients who had cataract surgery from 2008 to 2011 completed the Catquest-9SF questionnaire preoperatively and 3 months postoperatively. Questionnaire data were converted into interval data using Rasch analysis. Multiple regression and logistic regression models were used to examine possible predictors associated with self-assessed visual function after cataract surgery., RESULTS: The total questionnaire was completed by 10,364 patients. Patients without diabetic retinopathy, corneal guttata, glaucoma, macular degeneration, any other comorbidity, or the presence of more than 1 ocular comorbidity had greater improvement in self-assessed visual function than their counterparts. Patients with other factors such as young age, female sex, short preoperative surgical waiting time, and low preoperative and high postoperative corrected distance visual acuities (CDVAs) also had significantly greater improvement in self-assessed visual function than their counterparts. Young patients and those with no specific ocular comorbidities, a short surgical waiting time, and low preoperative and high postoperative CDVAs had significantly higher self-assessed postoperative visual function than their counterparts. Patients without the mentioned ocular comorbidities and a high postoperative CDVA had a higher odds ratio of general satisfaction rather than dissatisfaction than their counterparts., CONCLUSIONS: Multiple ocular comorbidities, age, preoperative waiting time, and preoperative and postoperative CDVAs affected patients' improvement and self-assessed visual function after cataract surgery., FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Keywords: Age Factors; Aged; *Cataract Extraction; Comorbidity; Cross-Sectional Studies; *Eye Diseases/pp [Physiopathology]; Female; Humans; Lens Implantation, Intraocular; Male; *Patient Satisfaction; Prospective Studies; *Pseudophakia/pp [Physiopathology]; *Quality of Life; Self-Assessment; Sickness Impact Profile; Surveys and Questionnaires; *Visual Acuity/ph [Physiology]; Waiting Lists

The effect of health education video on ocular massage after trabeculectomy. - Hua, Liu; Yingjuan, Lv; Jingshu, Zhao; Wei, Cao (Computers, informatics, nursing : CIN, 2014)
The aim of this study was to investigate the effect of different ocular massage health education methods on ocular massage in glaucoma patients after trabeculectomy. Eighty-six patients with glaucoma after trabeculectomy (86 eyes) were randomly divided into two health education groups. One group was a watch video group (43 patients, 43 eyes), while the other was an orally taught health education group (43 patients, 43 eyes). Patients were followed up for 1 week, 1 month, and 3, 6, and 12 months after discharge. Records of the patient responses after health education, compliance of patients with follow-up, and intraocular pressure were determined. Measurements included intraocular pressure and differences between the watch video and orally taught health education groups. The differences between the watch video group and orally taught health education group were not statistically significant at 1 week and 1 month, while the differences were statistically significant at 3, 6, and 12 months. The results indicated that health education videos can enable glaucoma patients to have a better mastery of ocular massage after trabeculectomy. According to the needs of patients, health education video use produced good results and should be promoted.
Keywords: Aged; Female; Follow-Up Studies; Glaucoma/su [Surgery]; *Health Education/mt [Methods]; Humans; Intraocular Pressure; Male; *Massage/mt [Methods]; Middle Aged; Trabeculectomy; Videotape Recording

Prevalence of self-reported early glaucoma eye drop bottle exhaustion and associated risk factors: a patient survey. - Moore, Daniel B; Walton, Charlene; Moeller, Kristy L; Slabaugh, Mark A; Mudumbai, Raghu C; Chen, Philip P (BMC ophthalmology, 2014)
BACKGROUND: One barrier to patient adherence with chronic topical glaucoma treatment is an inadequate amount of medication available between prescription refills. We examined the self-reported prevalence of early exhaustion of glaucoma eye drops prior to a scheduled refill, and associated risk factors., METHODS: This cross-sectional survey was performed at a University-based clinical practice. Glaucoma patients at the University of Washington who were experienced with eye drop application and were on a steady regimen of self-administered glaucoma drops in both eyes took a survey at the time of clinic examination. The main outcome measure was self-reported early eye drop bottle exhaustion., RESULTS: 236 patients were eligible and chose to participate. In general, patients included were relatively healthy (mean 2.3 comorbid medical conditions). Sixty patients (25.4%) reported any problem with early exhaustion of eye drop bottles, and this was associated with visual acuity <= 20/70 in the better eye (P = .049). Twelve patients (5.1%) reported that they "often" (5-7 times per year), "usually" (8-11 times per year) or "always" ran out of eye drops prior to a scheduled refill. Patients affected by this higher level (>= 5 times yearly) of eye drop bottle exhaustion were more likely to have poor visual acuity in their worse eye <= 20/70 (P = .015) and had significantly lower worse-eye logMAR (P = .043)., CONCLUSIONS: Self-reported early glaucoma bottle exhaustion regularly affected 5% of patients in our population and 25% reported early exhaustion at least once; the main risk factor was poor vision in at least one eye. These results may not be generalizable to a broad patient population, or to those inexperienced with eye drop self-administration. However, this pilot study compels further evaluation and consideration of early eye drop bottle exhaustion in glaucoma patients.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Female; Follow-Up Studies; Glaucoma/dt [Drug Therapy]; *Glaucoma/ep [Epidemiology]; Humans; Male; Medication Adherence; Ophthalmic Solutions; Pilot Projects; Prevalence; Retrospective Studies; Risk Factors; Self Administration; *Self Report; Surveys and Questionnaires; Time Factors; Visual Acuity; Washington/ep [Epidemiology]

Factors associated with adherence to glaucoma pharmacotherapy in the primary care setting. - Cohen Castel, Orit; Keinan-Boker, Lital; Geyer, Orna; Milman, Uzi; Karkabi, Khaled (Family practice, 2014)
BACKGROUND: Primary open-angle glaucoma is a leading cause of irreversible blindness., OBJECTIVES: To identify factors associated with adherence to glaucoma pharmacotherapy in the primary care setting, focusing on physicians' role., METHODS: Patients were recruited from primary care clinics and telephone-interviewed using a structured questionnaire that addressed patient-, medication-, environment- and physicians-related factors. Patients' data on pharmacy claims were retrieved to calculate the medication possession ratio for measuring adherence., RESULTS: Seven hundred thirty-eight glaucoma patients were interviewed. The multivariate analysis identified eight variables that were associated independently with adherence. Barriers to adherence were found to be low income, believing that 'It makes no difference to my vision whether I take the drops or not' and relying on someone else for drop instillation (exp(B) = 1.91, P = 0.002; exp(B) = 2.61, P < 0.0001; exp(B) = 2.17, P = 0.001, respectively). Older age, having a glaucoma patient among close acquaintances, taking a higher number of drops per day, taking a prostaglandin drug and reporting that the ophthalmologist had discussed the importance of taking eye drops as prescribed, were found to promote adherence (exp(B) = 0.96, P < 0.0001; exp(B) = 0.54, P = 0.014; exp(B) = 0.81, P = 0.001; exp(B) = 0.37, P < 0.0001; exp(B) = 0.60, P = 0.034, respectively). No association was found between the patient's relationship with the family physician and adherence to glaucoma treatment., CONCLUSION: Adherence to glaucoma pharmacotherapy is associated with patient-related, medication-related, physician-related and environmental factors. Ophthalmologists have a significant role in promoting adherence. However, the potential role of family physicians is unfulfilled and unrecognized. Copyright © The Author 2014. Published by Oxford University Press.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Humans; Israel; Male; *Medication Adherence; Ophthalmology; *Physician's Role; Physicians, Family; *Primary Health Care; Surveys and Questionnaires

Sustained delivery of latanoprost by thermosensitive chitosan-gelatin-based hydrogel for controlling ocular hypertension. - Cheng, Yung-Hsin; Hung, Kuo-Hsuan; Tsai, Tung-Hu; Lee, Chia-Jung; Ku, Ruy-Yu; Chiu, Allen Wen-Hsiang; Chiou, Shih-Hwa; Liu, Catherine Jui-Ling (Acta biomaterialia, 2014)
Glaucoma is an irreversible ocular disease that may lead to progressive visual field loss and eventually to blindness with inadequately controlled intraocular pressure (IOP). Latanoprost is one of the most potent ocular hypotensive compounds, the current first-line therapy in glaucoma. However, the daily instillation required for efficacy and undesirable side-effects are major causes of treatment adherence failure and persistence in glaucoma therapy. In the present study, we developed an injectable thermosensitive chitosan/gelatin/glycerol phosphate (C/G/GP) hydrogel as a sustained-release system of latanoprost for glaucoma treatment. The latanoprost-loaded C/G/GP hydrogel can gel within 1min at 37degreeC. The results show a sustained release of latanoprost from C/G/GP hydrogel in vitro and in vivo. The latanoprost-loaded C/G/GP hydrogel showed a good in vitro and in vivo biocompatibility. A rabbit model of glaucoma was established by intravitreal injection of triamcinolone acetonide. After a single subconjunctival injection of latanoprost-loaded C/G/GP hydrogel, IOP was significantly decreased within 8days and then remained at a normal level. The results of the study suggest that latanoprost-loaded C/G/GP hydrogel may have a potential application in glaucoma therapy. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
Keywords: Animals; Anti-Inflammatory Agents/ch [Chemistry]; Anti-Inflammatory Agents/pd [Pharmacology]; Antihypertensive Agents/ch [Chemistry]; Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents; Chitosan/ch [Chemistry]; Chitosan/pd [Pharmacology]; *Chitosan; Delayed-Action Preparations/ch [Chemistry]; Delayed-Action Preparations/pk [Pharmacokinetics]; Drug Evaluation, Preclinical; Gelatin/ch [Chemistry]; Gelatin/pd [Pharmacology]; *Gelatin; Humans; Hydrogels/ch [Chemistry]; Hydrogels/pd [Pharmacology]; *Hydrogels; Latanoprost; Male; *Ocular Hypertension/dt [Drug Therapy]; Prostaglandins F, Synthetic/ch [Chemistry]; *Prostaglandins F, Synthetic/pd [Pharmacology]; Rabbits; Triamcinolone Acetonide/ch [Chemistry]; Triamcinolone Acetonide/pd [Pharmacology]

Effects of polyquaternium- and benzalkonium-chloride-preserved travoprost on ocular surfaces: an impression cytology study. - Sezgin Akcay, Betul Ilkay; Guney, Esra; Bozkurt, Tahir Kansu; Topal, Cumhur Selcuk; Akkan, Julide Canan Umurhan; Unlu, Cihan (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2014)
PURPOSE: To compare the toxicity effect of polyquaternium (PQ) and benzalkonium chloride (BAK) preservation of travoprost on the ocular surface., METHODS: This prospective study included 44 eyes of 44 patients with newly diagnosed glaucoma. Twenty-two patients used PQ-preserved travoprost (PQ group) and 22 patients used BAK-preserved travoprost (BAK group). To investigate the effect on the ocular surface, conjunctival impression cytology (IC) was performed at baseline and the 1- and 6-month follow-up visits. Additionally, the ocular surface disease index (OSDI) questionnaire, Schirmer I test, and tear break-up time (TBUT) measurement were administered at baseline, and at 1-, 3-, and 6-month follow-up visits., RESULTS: While both groups showed statistically significant IC grade increases at 1 and 6 months when compared with baseline measurements, IC grades were significantly higher for patients using PQ-preserved travoprost compared with patients using BAK-preserved travoprost. The Schirmer I test and TBUT scores were not statistically significant between group 1 and BAK group at baseline and at 1-, 3-, and 6-month visits (P>0.05). OSDI scores did not statistically differ at baseline and the 1-month measurements between the 2 groups (P>0.05), but the 3- and 6-month OSDI scores were significantly higher for BAK group (P=0.001). Differences in OSDI and Schirmer I test scores were statistically significant at 1, 3, and 6 months in both groups as compared with baseline values (P<0.05). Statistically significant differences in the TBUT scores were seen for both groups at 3 and 6 months, while BAK group, but not PQ group, had insignificant score differences at 1 month as compared with baseline values of PQ group (P=0.083)., CONCLUSION: PQ-preserved travoprost was found to be safer and better-tolerated than BAK-preserved travoprost. PQ-preserved travoprost provided better ocular surface comfort, and therefore a better patient experience, which would likely result in higher treatment compliance.
Keywords: *Benzalkonium Compounds/ae [Adverse Effects]; Benzalkonium Compounds/ch [Chemistry]; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/ch [Chemistry]; Cloprostenol/tu [Therapeutic Use]; *Cornea/de [Drug Effects]; Cornea/pa [Pathology]; Cytological Techniques; Female; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Polymers/ae [Adverse Effects]; Polymers/ch [Chemistry]; *Preservatives, Pharmaceutical/ae [Adverse Effects]; Preservatives, Pharmaceutical/ch [Chemistry]; Prospective Studies; Surface Properties; Travoprost

Controlled ocular drug delivery with nanomicelles. - Vaishya, Ravi D; Khurana, Varun; Patel, Sulabh; Mitra, Ashim K (Wiley interdisciplinary reviews. Nanomedicine and nanobiotechnology, 2014)
Many vision threatening ocular diseases such as age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, and proliferative vitreoretinopathy may result in blindness. Ocular drug delivery specifically to the intraocular tissues remains a challenging task due to the presence of various physiological barriers. Nonetheless, recent advancements in the field of nanomicelle-based novel drug delivery system could fulfil these unmet needs. Nanomicelles consists of amphiphilic molecules that self-assemble in aqueous media to form organized supramolecular structures. Micelles can be prepared in various sizes (10-1000 nm) and shapes depending on the molecular weights of the core and corona forming blocks. Nanomicelles have been an attractive carrier for their potential to solubilize hydrophobic molecules in aqueous solution. In addition, small size in nanometer range and highly modifiable surface properties have been reported to be advantageous in ocular drug delivery. In this review, various factors influencing rationale design of nanomicelles formulation and disposition are discussed along with case studies. Despite the progress in the field, influence of various properties of nanomicelles such as size, shape, surface charge, rigidity of structure on ocular disposition need to be studied in further details to develop an efficient nanocarrier system. Copyright © 2014 Wiley Periodicals, Inc.
Keywords: Animals; *Drug Carriers; Humans; Hydrophobic and Hydrophilic Interactions; *Micelles; *Nanostructures; *Ophthalmic Solutions; Rabbits

Symptom based diagnosis of infant under one year in outpatient clinic. - Han, Sangyoun; Kim, Ungsoo Samuel (Korean journal of ophthalmology : KJO, 2014)
PURPOSE: We investigated chief complaints and ocular disorders in infants under one year of age and analyzed the association between complaints and disorders., METHODS: The medical records of 815 infants were reviewed. Chief complaints were grouped into the following 11 categories: eyelid drooping, epiphora (tearing), ocular discharge, lid swelling, eyelashes touching the eyeball, abnormalities of the anterior segment, abnormal eyeball movement (e.g., squint or nystagmus), red eye, trauma, poor eye contact, and miscellaneous. We performed ophthalmologic examinations at the doctors' discretion and analyzed the relationship between chief complaint and final diagnosis., RESULTS: Mean age of visiting the outpatient clinic was 6.09 +/- 3.07 months. The most common complaint was ocular discharge, followed by abnormal eyeball movement, epiphora, and eye redness. Among infants with ocular discharge, most were attributed to congenital nasolacrimal duct obstruction (155 infants) and conjunctivitis (75 infants). A total of 160 guardians complained of abnormal eyeball movement and 86 of 160 infants (51.9%) suffered from pseudoesotropia. Additionally, exodeviation and esodeviation was found in 17.9% and 16.4% of infants, respectively. Eight guardian complained of poor eye contact in their infants and these infants were diagnosed with retinal disorders (3), congenital optic nerve disorders (2), cataract (1), glaucoma (1), and high hyperopia (1)., CONCLUSIONS: The most common ocular symptoms in infants under one year of age included ocular discharge, epiphora, and eye redness. However, infants with poor eye contact or suspected abnormal eye movement should undergo a full ophthalmologic examination.
Keywords: *Ambulatory Care Facilities; *Eye Diseases/di [Diagnosis]; Female; Follow-Up Studies; Humans; Infant; Male; *Patient Compliance; Retrospective Studies

Is glaucoma comprehension associated with psychological disturbance and vision-related quality of life for patients with glaucoma? A cross-sectional study. - Kong, Xiang Mei; Zhu, Wen Qing; Hong, Jia Xu; Sun, Xing Huai (BMJ open, 2014)
OBJECTIVE: To investigate whether understanding of glaucoma is associated with psychological disturbance and vision-related quality of life (QoL) in patients with glaucoma., DESIGN: A prospective, hospital-based, cross-sectional study., SETTING: Shanghai, China., PARTICIPANTS: Five hundred patients with glaucoma were included in the study. Participants were asked to complete the glaucoma comprehension questionnaire, the Hospital Anxiety and Depression Scale (HADS) questionnaire, and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25)., OUTCOME MEASURES: Sociodemographic data and clinical data were collected. Multivariate adjusted linear regression analyses were performed to examine factors related to psychological disorder and QoL. The relationship between understanding of glaucoma and psychological status or QoL was analysed., RESULTS: The mean age of patients was 56.5+/-17.2 years, and the mean duration of glaucoma was 4.6+/-6.3 years. About half (54.2%) of the patients had primary open angle glaucoma, 37.2% had primary angle closure glaucoma, and 8.6% had secondary glaucoma. The total score and the subscores of knowledge of glaucoma, compliance and habits were all negatively correlated with the HADS-Depression and HADS scores. For NEI VFQ-25, the total comprehension score was positively related to general vision, near activity, distance activity, social function, colour vision and the composite score. Habits had a significant influence on both HADS-Depression and the composite score of NEI VFQ-25., CONCLUSIONS: The level of understanding about glaucoma is an independent factor negatively associated with psychological disturbance and positively associated with QoL in patients with glaucoma. However, it is a subjective factor which can be regulated, so imparting knowledge about glaucoma and establishing appropriate habits might help patients alleviate psychological disturbance and enhance their QoL. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Keywords: Adolescent; Adult; *Comprehension; Cross-Sectional Studies; Female; *Glaucoma/co [Complications]; *Glaucoma/px [Psychology]; Humans; Male; Middle Aged; Prospective Studies; *Quality of Life; *Stress, Psychological/et [Etiology]; Surveys and Questionnaires; Young Adult

Glaucoma prescribing trends in England 2000 to 2012. - Connor, A J; Fraser, S G (Eye (London, England), 2014)
PURPOSE: In 2009, the National Institute for Clinical Excellence (NICE) published guidance on the treatment of ocular hypertension and glaucoma. The aim of the present study was to describe the impact this guidance had on glaucoma prescribing and to describe recent prescribing trends in England., METHOD: Prescribing cost analysis data held by NHS Business Authority for the years 2000-2012 was analysed., RESULTS: The number of prescriptions dispensed increased by 67% from 4.76 million in 2000 to 7.96 million in 2012. Over the same time period, drug costs increased by 88% from 55.2 million to 103.7 million. Prescriptions for prostaglandin analogues increased fourfold, while there was a threefold decrease in the use of beta-blockers. The most commonly prescribed glaucoma medication was latanoprost. The introduction of generic latanoprost in 2012 more than halved the cost associated with this medication. NICE guidance appeared to have had no effect on the total number of prescriptions or the classes of medications prescribed., CONCLUSION: The introduction of the NICE guidelines did not change glaucoma prescribing practice, although it is not clear whether this represents non-adherence to the guidelines or whether the guidelines embodied pre-existing practice.
Comment in (CIN)
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; Drug Costs; Drug Prescriptions/ec [Economics]; *Drug Prescriptions/sn [Statistics & Numerical Data]; England; *Glaucoma/dt [Drug Therapy]; Guideline Adherence; Humans; *Intraocular Pressure/de [Drug Effects]; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Practice Guidelines as Topic; *Practice Patterns, Physicians'/td [Trends]

Automated telecommunication-based reminders and adherence with once-daily glaucoma medication dosing: the automated dosing reminder study. - Boland, Michael V; Chang, Dolly S; Frazier, Travis; Plyler, Ryan; Jefferys, Joan L; Friedman, David S (JAMA ophthalmology, 2014)
IMPORTANCE: Topical glaucoma medications lower intraocular pressure and alter the course of the disease. Because adherence with glaucoma medications is a known problem, interventions are needed to help those patients who do not take their medications as prescribed., OBJECTIVE: To assess the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications., DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study of medication adherence, followed by a randomized intervention for those found to be nonadherent, of individuals recruited from a university-based glaucoma subspecialty clinic. A total of 491 participants were enrolled in the initial assessment of adherence. Of those, 70 were nonadherent with their medications after 3 months of electronic monitoring and randomized to intervention and control groups., INTERVENTIONS: A personal health record was used to store the list of patient medications and reminder preferences. On the basis of those data, participants randomized to the intervention received daily messages, either text or voice, reminding them to take their medication. Participants randomized to the control group received usual care., MAIN OUTCOMES AND MEASURES: Difference in adherence before and after initiation of the intervention., RESULTS: Using an intent-to-treat analysis, we found that the median adherence rate in the 38 participants randomized to the intervention increased from 53% to 64% (P < .05). There was no statistical change in 32 participants in the control group. To assess the real efficacy of the intervention, the same comparison was performed for the participants who successfully completed the study after randomization. Analyzed this way, the adherence rate in the 20 participants in the intervention group increased from 54% to 73% (P < .05), whereas there was again no statistical change in the 19 participants in the control group. Eighty-four percent of the participants who received reminders agreed they were helpful and would continue using them outside the study., CONCLUSIONS AND RELEVANCE: Automated telecommunication-based reminders linked to data in a personal health record improved adherence with once-daily glaucoma medications. This is an effective method to improve adherence that could realistically be implemented in ophthalmology practices with a minimum amount of effort on the part of the practice or the patient.
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cohort Studies; *Drug Monitoring; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medical Record Linkage; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Prospective Studies; *Reminder Systems/is [Instrumentation]; *Telecommunications/is [Instrumentation]

Electronic monitoring to assess adherence with once-daily glaucoma medications and risk factors for nonadherence: the automated dosing reminder study. - Boland, Michael V; Chang, Dolly S; Frazier, Travis; Plyler, Ryan; Friedman, David S (JAMA ophthalmology, 2014)
IMPORTANCE: Adherence with topical glaucoma medications is low in some patients. To identify these patients, we need more information on risk factors for nonadherence., OBJECTIVE: To assess adherence with once-daily glaucoma medication., DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study involving patients who were recruited from a university-based glaucoma clinic and treated with once-daily prostaglandin eyedrops. Baseline characteristics were recorded, and each patient was provided a medication bottle to hold his or her eyedrop bottle throughout the study. An electronic cap recorded each time the larger bottle holding the eyedrops was opened. Participants were administered standardized tests of depression and mental status and answered questions about their health and their attitudes toward medication adherence. They used the electronic monitors for 3 months, during which their adherence with medications was assessed., MAIN OUTCOMES AND MEASURES: Adherence with daily glaucoma medication and factors associated with poor adherence., RESULTS: Of the 491 participants enrolled, 407 (82.9%) successfully completed the 3-month adherence assessment. Of this group, 337 (82.8%) took their medication correctly on at least 75% of days and were deemed adherent. Compared with this adherent group, the 70 participants (17.2%) who were nonadherent were slightly younger, were more likely to be of African descent, took medications for a shorter time, had a lower level of educational attainment, and had worse scores on mental status and depression scales (P < .05 for all). Nonadherent participants were less likely to be able to name their glaucoma medications, reported a lower estimate of adherence, and were more likely to admit some missed doses over the past 2 weeks or in general (P < .05 for all). Those who were nonadherent were also less likely to agree that remembering their eyedrops is easy, more likely to strongly agree with the statement that eyedrops can cause problems, and less likely to agree that they followed physicians' orders., CONCLUSIONS AND RELEVANCE: Electronic monitoring of patient adherence documented that a sizable number of patients with glaucoma do not take their medications as prescribed. Factors were identified that may prove useful in targeting those nonadherent patients for interventions.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Drug Monitoring/is [Instrumentation]; *Drug Monitoring/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Ophthalmic Solutions; Prospective Studies; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; *Reminder Systems/is [Instrumentation]; Risk Factors; Surveys and Questionnaires

The pathophysiology and treatment of glaucoma: a review. - Weinreb, Robert N; Aung, Tin; Medeiros, Felipe A (JAMA, 2014)
IMPORTANCE: Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition., OBJECTIVE: To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma., EVIDENCE REVIEW: A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians., FINDINGS: The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression., CONCLUSIONS AND RELEVANCE: Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
Keywords: Glaucoma, Angle-Closure/co [Complications]; Glaucoma, Angle-Closure/di [Diagnosis]; Glaucoma, Angle-Closure/pa [Pathology]; Glaucoma, Angle-Closure/th [Therapy]; *Glaucoma, Angle-Closure; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pa [Pathology]; Glaucoma, Open-Angle/th [Therapy]; *Glaucoma, Open-Angle; Humans; Primary Health Care

[Giant papillary conjunctivitis]. - Bischoff, G (Klinische Monatsblatter fur Augenheilkunde, 2014)
Giant papillary conjunctivitis is an inflammation of the conjunctiva, which is associated with immunological-allergic disorders, but is difficult to integrate as a defined type of illness. The deposits of contact lenses are responsible in predisposed wearers. They induce a special immune answer to their biochemical ingredients. In addition, roughness of the superficial corneal layers and the conjunctiva, even without any contact lenses after filtrating glaucoma surgery, leads to mechanically induced papillary formations. In former days these symptoms of building giant papillae were seen mostly in wearers of soft hydrogel contact lenses. Nowadays manufacturers have developed contact lens systems with a variety of material components, with an increase of protein and lipid deposits. In combination with the observed non-compliance of wearers regarding lens exchange and contact lens hygiene, GPC is an issue which should be taken into consideration again. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Conjunctivitis, Allergic/di [Diagnosis]; *Conjunctivitis, Allergic/et [Etiology]; *Conjunctivitis, Allergic/pc [Prevention & Control]; *Contact Lenses/ae [Adverse Effects]; Eyelid Diseases/di [Diagnosis]; *Eyelid Diseases/et [Etiology]; *Eyelid Diseases/pc [Prevention & Control]; Humans; *Immunosuppressive Agents/tu [Therapeutic Use]; *Ophthalmic Solutions/ad [Administration & Dosage]

A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities. - Blumberg, Dana M; Vaswani, Reena; Nong, Eva; Al-Aswad, Lama; Cioffi, George A (Investigative ophthalmology & visual science, 2014)
PURPOSE: To assess the impact on visual function of community glaucoma screening in an African American population using spectral-domain optical coherence tomography (SD-OCT)., METHODS: Using a Monte Carlo microsimulation model with a 10-year time horizon, we analyzed the efficacy of SD-OCT screening on visual field outcomes in a population of African Americans who are not otherwise seeking office-based care. Outcomes included classification of visual field severity, quality-adjusted life years, and direct health care costs., RESULTS: Assuming a 60% follow-up rate, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%, and decreased the prevalence of severe visual field loss in patients with glaucoma from 29.1% to 23.9%. Conversely, screening increased the prevalence of mild visual field loss in patients with glaucoma from 9.2% to 18.7%. From initial screening through confirmatory eye examination, the screening program ("screen only") cost $98 per screened individual, and $2561 per new diagnosis of glaucoma. When considering the costs of initial screening though the resultant treatment, the screening program ("screen and treat") had an average annual cost of $79 and $2138, respectively, over a 10-year time period. The cost of one quality-adjusted life year (QALY) gained by screening, including management and treatment, in comparison with opportunistic case finding, ranged from $46,416 to $67,813., CONCLUSIONS: Our findings suggest that community SD-OCT screening in an African American population will minimize glaucoma-related visual morbidity. Ideally, strategies to maximize treatment efficacy through improved medication adherence and improved compliance with follow-up should be identified and implemented before instituting a screening program. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.
Keywords: *African Americans; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Glaucoma/eh [Ethnology]; Humans; Male; *Mass Screening/mt [Methods]; Middle Aged; Monte Carlo Method; Prevalence; Quality-Adjusted Life Years; *Scotoma/di [Diagnosis]; Scotoma/eh [Ethnology]; Scotoma/et [Etiology]; Time Factors; *Tomography, Optical Coherence/mt [Methods]; United States/ep [Epidemiology]; *Visual Fields

Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial. - Abdull, Mohammed M; Gilbert, Clare; McCambridge, Jim; Evans, Jennifer (Trials, 2014)
BACKGROUND: Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa., METHODS: This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being "standard care") compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale., DISCUSSION: Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa., TRIAL REGISTRATION: ISRCTN79330571 (Controlled-Trials.com).
Keywords: Clinical Protocols; Glaucoma/di [Diagnosis]; Glaucoma/px [Psychology]; *Glaucoma/su [Surgery]; Health Knowledge, Attitudes, Practice; Humans; *Motivational Interviewing; Nigeria; *Ophthalmologic Surgical Procedures; *Patient Acceptance of Health Care/px [Psychology]; Patient Education as Topic; *Research Design; Time Factors; Treatment Outcome

[Objective evaluation of applying eye drops by elderly patients]. - Colome-Campos, J; Martinez-Salcedo, I; Martorell-Hallado, M C; Romero-Aroca, P (Archivos de la Sociedad Espanola de Oftalmologia, 2014)
OBJECTIVE: To objectively evaluate the ability and skills of patients older than 65 years to successfully administer a topical ocular eye drop., METHODS: A prospective study was conducted on a group of 25 patients with a diagnosis of dry eye or glaucoma, undergoing daily treatment with eye drops for at least one year. The procedure was recorded with a video camera at the time of the application., RESULTS: Of the total, 64% were diagnosed with glaucoma and 36% with dry eye. Almost half (44%) needed a single attempt to apply the drop, and 56% required 2 attempts. In terms of the number of eye drops applied, 52% managed with a single drop, 16% 2 drops, a 12% 3 drops, and 20% 4 or more eye drops. Areas where the eye drop was deposited in the first attempt was, 32% into the conjunctival sac, 32% on the outer corner of the eye, 8% in the inner angle, 8% in the nose, 12% on the cheek, 8% in other areas., CONCLUSIONS: Self-administration of eye drops by the elderly is a complex activity that can have an effect on the expected results. Copyright © 2013 Sociedad Espanola de Oftalmologia. Published by Elsevier Espana. All rights reserved.
Keywords: Aged; Female; Humans; Male; *Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; *Psychomotor Performance

A survey of Alabama eye care providers in 2010-2011. - Maclennan, Paul A; McGwin, Gerald Jr; Searcey, Karen; Owsley, Cynthia (BMC ophthalmology, 2014)
BACKGROUND: State level information regarding eye care resources can provide policy makers with valuable information about availability of eye care services. The current study surveyed ophthalmologists, optometrists and vision rehabilitation providers practicing in Alabama., METHODS: Three mutually exclusive provider groups were identified, i.e., all ophthalmologists, optometrists, and vision rehabilitation providers working in Alabama in 2010. Eligible providers were contacted in 2010 and 2011 and information was requested regarding provider demographics and training, practice type and service characteristics, and patient characteristics. Descriptive statistics (e.g., means, proportions) were used to characterize provider groups by their demographic and training characteristics, practice characteristics, services provided and patients or clients served. In addition, county level figures demonstrate the numbers and per capita ophthalmologists and optometrists., RESULTS: Ophthalmologists were located in 24 of Alabama's 67 counties, optometrists in 56, and 10 counties had neither an ophthalmologist nor an optometrist. Overall, 1,033 vision care professionals were identified as eligible to participate in the survey: 217 ophthalmologists, 638 optometrists, and 178 visual rehabilitation providers. Of those, 111 (51.2%) ophthalmologists, 246 (38.6%) optometrists, and 81 (45.5%) rehabilitation providers participated. Most participating ophthalmologists, optometrists, and vision rehabilitation providers identified themselves as non-Hispanic White. Ophthalmologists and optometrists estimated that 27% and 22%, respectively, of their patients had diabetes but that the proportion that adhered to eye care guidelines was 61% among ophthalmology patients and 53% among optometry patients., CONCLUSIONS: A large number of Alabama communities are isolated from eye care services. Increased future demand for eye care is anticipated nationally given the aging of the population and decreasing numbers of providers; however, Alabama also has a high and growing prevalence of diabetes which will result in greater numbers at risk for diabetic retinopathy, glaucoma, and cataracts.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Alabama/ep [Epidemiology]; Child; Child, Preschool; Diabetic Retinopathy/ep [Epidemiology]; Diabetic Retinopathy/rh [Rehabilitation]; Education, Medical, Continuing/sn [Statistics & Numerical Data]; Female; Health Services Accessibility/og [Organization & Administration]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Services Needs and Demand/sn [Statistics & Numerical Data]; Health Services Research; Humans; Male; Middle Aged; Ophthalmology/ed [Education]; Ophthalmology/og [Organization & Administration]; *Ophthalmology; Optometry/ed [Education]; Optometry/og [Organization & Administration]; *Optometry; Workforce; Young Adult

Provider use of collaborative goal setting with glaucoma patients. - Sleath, Betsy; Slota, Catherine; Blalock, Susan J; Sayner, Robyn; Carpenter, Delesha M; Muir, Kelly W; Hartnett, Mary Elizabeth; Robin, Alan L (Optometry and vision science : official publication of the American Academy of Optometry, 2014)
PURPOSE: The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications., METHODS: English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment., RESULTS: Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson chi2 = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson chi2 = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non-African American patients (Pearson chi2 = 5.62, p = 0.02)., CONCLUSIONS: Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.
Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Ethnic Groups; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Health Personnel/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/px [Psychology]; *Ophthalmology/sn [Statistics & Numerical Data]; *Patient Care Planning/sn [Statistics & Numerical Data]; Patient Participation; *Patients/px [Psychology]; Sex Factors; Surveys and Questionnaires; Video Recording

Using filtered forecasting techniques to determine personalized monitoring schedules for patients with open-angle glaucoma. - Schell, Greggory J; Lavieri, Mariel S; Helm, Jonathan E; Liu, Xiang; Musch, David C; Van Oyen, Mark P; Stein, Joshua D (Ophthalmology, 2014)
PURPOSE: To determine whether dynamic and personalized schedules of visual field (VF) testing and intraocular pressure (IOP) measurements result in an improvement in disease progression detection compared with fixed interval schedules for performing these tests when evaluating patients with open-angle glaucoma (OAG)., DESIGN: Secondary analyses using longitudinal data from 2 randomized controlled trials., PARTICIPANTS: A total of 571 participants from the Advanced Glaucoma Intervention Study (AGIS) and the Collaborative Initial Glaucoma Treatment Study (CIGTS)., METHODS: Perimetric and tonometric data were obtained for AGIS and CIGTS trial participants and used to parameterize and validate a Kalman filter model. The Kalman filter updates knowledge about each participant's disease dynamics as additional VF tests and IOP measurements are obtained. After incorporating the most recent VF and IOP measurements, the model forecasts each participant's disease dynamics into the future and characterizes the forecasting error. To determine personalized schedules for future VF tests and IOP measurements, we developed an algorithm by combining the Kalman filter for state estimation with the predictive power of logistic regression to identify OAG progression. The algorithm was compared with 1-, 1.5-, and 2-year fixed interval schedules of obtaining VF and IOP measurements., MAIN OUTCOME MEASURES: Length of diagnostic delay in detecting OAG progression, efficiency of detecting progression, and number of VF and IOP measurements needed to assess for progression., RESULTS: Participants were followed in the AGIS and CIGTS trials for a mean (standard deviation) of 6.5 (2.8) years. Our forecasting model achieved a 29% increased efficiency in identifying OAG progression (P<0.0001) and detected OAG progression 57% sooner (reduced diagnostic delay) (P = 0.02) than following a fixed yearly monitoring schedule, without increasing the number of VF tests and IOP measurements required. The model performed well for patients with mild and advanced disease. The model performed significantly more testing of patients who exhibited OAG progression than nonprogressing patients (1.3 vs. 1.0 tests per year; P<0.0001)., CONCLUSIONS: Use of dynamic and personalized testing schedules can enhance the efficiency of OAG progression detection and reduce diagnostic delay compared with yearly fixed monitoring intervals. If further validation studies confirm these findings, such algorithms may be able to greatly enhance OAG management. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Algorithms; Appointments and Schedules; Disease Progression; Female; Follow-Up Studies; Forecasting; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Models, Statistical; Precision Medicine; Sensitivity and Specificity; Tonometry, Ocular; *Vision Disorders/di [Diagnosis]; Visual Field Tests; *Visual Fields/ph [Physiology]

Silicone hydrogel contact lenses surface promote Acanthamoeba castellanii trophozoites adherence: qualitative and quantitative analysis. - Omana-Molina, Maritza A; Gonzalez-Robles, Arturo; Salazar-Villatoro, Lizbeth; Bernal-Escobar, Alexander; Duran-Diaz, Angel; Mendez-Cruz, Adolfo Rene; Martinez-Palomo, Adolfo (Eye & contact lens, 2014)
PURPOSE: To describe the adhesion properties of Acanthamoeba castellanii trophozoites to silicone hydrogel contact lenses of first generation (lotrafilcon A), second generation (galyfilcon A), and third generation (comfilcon A) and correlate the results with their specific surface characteristics, time of interaction, and suspension media., METHODS: Qualitative and quantitative assessments of the adhesion of 200 trophozoites of A. castellanii on contact lenses in culture medium (Bacto Casitone) and isotonic saline (IS) at different time points (15 minutes and 6 hours) were determined., RESULTS: By scanning electron microscopy, A. castellanii trophozoites were observed firmly adhered to the surface of hydrogel lenses after 15 minutes of interaction. The surface of lotrafilcon A lenses on which amoebae adhere better (16.4+/-10.2 amoebae/lens section) is rough and folded, which increases the contact surface with trophozoites, allowing acanthopodia to attach firmly. Contrarily, galyfilcon A lenses have a smoother surface, and lower numbers of amoebae were observed adhered to these lenses (4.7+/-2.9 amoebae/lens section). Even fewer amoebae adhered to the smoother surface of the comfilcon A lens (2.2+/-1.7 amoebae/lens section). Trophozoites showed similar behavior in both Bacto Casitone medium and IS., CONCLUSION: A rough surface may contribute to better adhesion of amoebae to silicone hydrogel lenses. Although a reduced numbers of trophozoites adhered to smooth lenses, trophozoites are a risk factor for amoebic keratitis. Isotonic saline facilitated trophozoite survival, suggesting that homemade saline solutions may contribute to the persistence of trophozoites, especially when there is no proper hygiene regimen used with the contact lens cases.
Keywords: *Acanthamoeba castellanii/ip [Isolation & Purification]; *Contact Lenses, Hydrophilic/mi [Microbiology]; *Hydrogels; Microscopy, Electron, Scanning; *Silicone Elastomers; Surface Properties; Time Factors; Trophozoites

Improving adherence to glaucoma medication: a randomised controlled trial of a patient-centred intervention (The Norwich Adherence Glaucoma Study). - Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Fordham, Richard; Holland, Richard; Broadway, David C (BMC ophthalmology, 2014)
BACKGROUND: Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy., METHODS: A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached. Participants were randomised into two groups and adherence was measured over 8 months, using an electronic monitoring device (Travalert R dosing aid, TDA). The control group received standard clinical care, and the intervention group received a novel glaucoma education and motivational support package using behaviour change counselling. Cost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence., RESULTS: Two hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in mean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8% (CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage intraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the intervention group (p = 0.45). Participants in the intervention group were more satisfied with information about glaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51 (CI, 7.72, 9.30). The mean intervention cost per patient was GB10.35 (<US$16) and not cost-effective., CONCLUSIONS: Adherence with travoprost was high and not further increased by the intervention. Nevertheless, the study demonstrated that provision of information, tailored to the individual, was inexpensive and able to achieve high patient satisfaction with respect to information about glaucoma medication. Measurement of adherence remains problematic since awareness of study participation may cause a change in participant behaviour., TRIAL REGISTRATION: Current Controlled Trials, ISRCTN89683704.
Keywords: Aged; Aged, 80 and over; Analysis of Variance; *Antihypertensive Agents/tu [Therapeutic Use]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Counseling/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Health Care Costs; Humans; Intraocular Pressure; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Education as Topic/ec [Economics]; Patient Education as Topic/mt [Methods]; Patient Education as Topic/st [Standards]; *Patient Education as Topic; Patient Satisfaction; *Patient-Centered Care/mt [Methods]; Travoprost

Primary selective laser trabeculoplasty: a cautionary tale. - Kaushik, Shweta; Ferrier, Ross; Clement, Colin (Clinical & experimental ophthalmology, 2014)
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Follow-Up Studies; Glaucoma/dt [Drug Therapy]; *Glaucoma/su [Surgery]; Humans; *Intraocular Pressure; *Laser Therapy; Male; Middle Aged; *Patient Compliance; *Trabeculectomy/ae [Adverse Effects]; *Vision Disorders/et [Etiology]

Prevalence, causes of blindness, visual impairment and cataract surgical services in Sindhudurg district on the western coastal strip of India. - Patil, Shailbala; Gogate, Parikshit; Vora, Siddharth; Ainapure, Sachin; Hingane, Ramkrishna N; Kulkarni, Anil N; Shammanna, B R (Indian journal of ophthalmology, 2014)
BACKGROUND: Konkan coast of India is geographically distinct and its pattern of blindness has never been mapped., AIM: To study the prevalence and causes of blindness and cataract surgical services in Sindhudurg district of West Coast., SUBJECTS: Individual aged > 50 years., MATERIALS AND METHODS: Rapid assessment of avoidable blindness used to map blindness pattern in the district., STATISTICAL ANALYSIS: SPSS version 19., RESULTS: Amongst those examined 1415 (51.7%) had visual acuity (VA) >20/60, 924 (33.8%, confidence interval (C.I) 30.5%-36.8%) had VA 20/200-<20/60(visual impairment), 266 (9.7%, C.I. 6.1%-13.3%) had VA < 20/200-20/400 (severe visual impairment) and 132 (4.8%, C. I. 1.1%-8.5%) had VA < 20/400 (blindness by WHO standards). There was no significant gender difference in prevalence of blindness, but blindness and visual impairment was more in older and rural residing individuals. Amongst those with presenting vision < 20/200 in better eye, 309 (82.4%) had cataract, 36 (9.7%) had corneal scars, 13 (3.5%) had diabetic retinopathy and 3 (0.8%) had glaucoma. Cataract surgical coverage for the district was only 30.5%; 32% for males and 28.4% for females. Unable to afford, lack of knowledge and lack of access to services were the commonest barriers responsible for cataract patients not seeking care. Amongst those who had undergone cataract surgery, only 50% had visual acuity >= 20/60.46.9% of the population had spectacles for near, but only 53.3% of the population had presenting near vision < N10., CONCLUSION: Cataract, refractive errors and diabetes were significant causes of visual impairment and blindness.
Keywords: Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; *Cataract/ep [Epidemiology]; Cataract/et [Etiology]; *Cataract Extraction; Cross-Sectional Studies; Female; Humans; India/ep [Epidemiology]; Male; Middle Aged; Prevalence; Risk Factors; *Rural Population; *Urban Population; *Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]; *Visual Acuity

Improved access and cycle time with an "in-house" patient-centered teleglaucoma program versus traditional in-person assessment. - Arora, Sourabh; Rudnisky, Chris J; Damji, Karim F (Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2014)
BACKGROUND: To compare access time and cycle time between an "in-house" teleglaucoma program and in-person glaucoma consultation., PATIENTS AND METHODS: This was a prospective comparative study of 71 patients seen through the teleglaucoma program (eligible patients were glaucoma suspects or early-stage open-angle glaucoma) and 63 patients seen via a traditional in-person exam with a physician present. Access time was calculated as the time from the patient being referred to the date of a booked visit for either a teleglaucoma or in-person exam. Cycle time was defined as the time from registration until departure during the visit to the hospital; it was calculated for the subset of patients from each study group who completed activity logs on the day of their visit., RESULTS: The mean access time was significantly shorter for patients seen through teleglaucoma compared with in-person exam: 45+/-22 days (range, 13-121 days) (n=68) versus 88+/-47 days (range, 27-214 days) (n=63), respectively (p<0.0001). The cycle time was also reduced for patients seen through teleglaucoma, compared with in-person assessment: 78+/-20 min (range, 40-130 min) (n=39) versus 115+/-44 min (range, 51-216 min) (n=39), respectively (p<0.001). The mean percentage time spent in the waiting room was also significantly reduced for patients seen through teleglaucoma versus in-person assessments: 19+/-13% versus 41+/-24% (n=39), respectively (p<0.01)., CONCLUSIONS: Teleglaucoma improves access to care and is a more efficient way of managing glaucoma suspects and patients with early-stage glaucoma compared with in-person assessment.
Keywords: Adult; Aged; Aged, 80 and over; Alberta; *Appointments and Schedules; Cohort Studies; Female; *Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; Health Services Accessibility/og [Organization & Administration]; Humans; Inpatients/sn [Statistics & Numerical Data]; Male; Middle Aged; Ophthalmology/mt [Methods]; *Patient-Centered Care/og [Organization & Administration]; *Physical Examination/mt [Methods]; Program Evaluation; Prospective Studies; Quality Improvement; *Referral and Consultation/og [Organization & Administration]; Statistics, Nonparametric; *Telemedicine/og [Organization & Administration]; Time Factors

Changes in the morphological and functional patterns of the ocular surface in patients treated with prostaglandin analogues after the use of TSP 0.5% R preservative-free eyedrops: a prospective, multicenter study. - Iester, Michele; Oddone, Francesco; Fogagnolo, Paolo; Frezzotti, Paolo; Figus, Michele; Confocal Microscopy Study Group (Ophthalmic research, 2014)
AIM: To investigate and compare the effects of topical benzalkonium chloride-preserved prostaglandins (PGAs) on the ocular surface in patients with primary open-angle glaucoma before and after 3 months of treatment with additional 0.5% preservative-free tamarind seed polysaccharide single-dose eyedrops (TSP R, Oftagen, Pisa, Italy)., METHODS: This was a prospective, longitudinal, multicenter study. From 5 different Italian glaucoma centers, 10 glaucomatous patients were recruited in each center. All the patients were treated with a PGA with preservative for at least 1 year. Preservative-free artificial tears 3 times per day were prescribed. The participants were subjected to clinical and instrumental evaluation at baseline, after 1 month and after 3 months of treatment. All patients were examined with a digital corneal confocal laser scanning microscope (HRT II Rostock Cornea Module)., RESULTS: After 3 months of TSP 0.5% treatment, an improvement of some ocular signs and symptoms was found. The percentage of conjunctival hyperemia decreased from 67 to 13%. Schirmer's test and breakup time significantly changed from the baseline after 3 months. Confocal microscopy showed a significant increase in conjunctival goblet cells., CONCLUSION: Artificial substitutes, in particular TSP 0.5%, might protect the ocular surface hence giving higher compliance, adherence and quality of life to the patients. Copyright © 2014 S. Karger AG, Basel.
Keywords: Adult; Aged; Aged, 80 and over; Conjunctiva/bs [Blood Supply]; Conjunctiva/de [Drug Effects]; Cornea/de [Drug Effects]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/me [Metabolism]; Glaucoma, Open-Angle/pa [Pathology]; Humans; Hyperemia/pa [Pathology]; Italy; Male; Middle Aged; *Ophthalmic Solutions/tu [Therapeutic Use]; *Phytotherapy/mt [Methods]; *Plant Preparations/tu [Therapeutic Use]; Prospective Studies; *Prostaglandins/tu [Therapeutic Use]; *Tamarindus; Tears/me [Metabolism]

A novel tele-eye protocol for ocular disease detection and access to eye care services. - Maa, April Y; Evans, Centrael; DeLaune, William R; Patel, Purnima S; Lynch, Mary G (Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2014)
BACKGROUND: Telemedicine can improve access to care, especially for rural patients, and ophthalmology is a field that lends itself readily to telemedicine because interpretation of photographs is a routine part of diagnosing eye disease and patient care. We developed a novel tele-eye protocol based on diabetic teleretinal screening. We performed a feasibility study to see if our tele-eye program was comparable to the gold standard face-to-face eye exam., MATERIALS AND METHODS: Fifty-two subjects underwent the tele-eye protocol and then received a face-to-face exam. A masked reader reviewed the tele-eye data remotely and developed an impression and plan for the patient. The provider assessments from the face-to-face exams and the tele-eye exams were compared. Sensitivity, specificity, and percentage agreement were calculated for the tele-eye protocol, focusing on the most common age-related eye diseases: cataract, macular degeneration, and glaucoma. The difference between the autorefraction and manifest eyeglass prescription was calculated., RESULTS: The pilot study showed excellent percentage agreement between the screening protocol and the face-to-face exam. The percentage agreement for cataract was 100%, that for macular degeneration was 96%, and that for glaucoma suspect was 87%. The difference between the autorefraction's eyeglass prescription and the final manifest refraction was within American National Standards Institute for lens manufacturing guidelines., CONCLUSIONS: The initial data suggest that the tele-eye program is feasible to execute and appears fairly accurate when compared with the gold standard face-to-face eye exam. However, the study is significantly limited by the small sample size. This pilot provides justification of a much larger study of a similar design.
Keywords: *Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; Feasibility Studies; Female; *Health Services Accessibility; Humans; Male; Pilot Projects; Sensitivity and Specificity; *Telemedicine/mt [Methods]; Vision Screening/mt [Methods]

Patient acceptance to smartphone technology to monitor and improve glaucoma health-care outcomes. - Lee, R M H; Oleszczuk, J D; Hyer, J N; Gazzard, G (Eye (London, England), 2014)
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Attitude to Computers; *Cell Phone; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Medication Adherence; Middle Aged; *Patient Acceptance of Health Care; Prospective Studies

Glaucoma medication adherence in veterans and influence of coexisting chronic disease. - Asefzadeh, Baharak; Rett, Douglas; Pogoda, Terri K; Selvin, Gerald; Cavallerano, Anthony (Journal of glaucoma, 2014)
BACKGROUND: The aim of this study was to characterize veterans' adherence to glaucoma medications and follow-up eye care, and to examine the influence of coexisting chronic conditions such as posttraumatic stress disorder (PTSD)/anxiety., PATIENTS AND METHODS: A retrospective review of computerized medical records was performed for 161 veterans taking topical glaucoma medications. Medication possession ratio (MPR) was calculated using pharmacy data. Mean follow-up ratio (FUR) was calculated using the number of days between visits., RESULTS: Among the health conditions examined, the most prevalent was hearing loss (0.34), followed by arthritis (0.29), PTSD, or other anxiety disorder (0.27), and dementia or other memory disorder (0.09). The average rates of MPR and FUR were 0.69+/-0.20 and 0.84+/-0.19, respectively.Group comparisons found that patients with hearing loss had higher MPR compared with patients without hearing loss, and patients who were white had higher FUR than African American patients. When demographic and health characteristics were examined simultaneously in multiple linear regressions, hearing loss emerged as a significant predictor of MPR, and being older was significantly related to FUR. Younger age was also associated with MPR and being white (vs. African American) or having a PTSD/other anxiety disorder was related to FUR, although these findings did not reach statistical significance., CONCLUSIONS: FUR was better than MPR in a veteran population being treated for glaucoma.Hearing loss was significantly related to higher MPR, whereas being older was significantly associated with higher FUR. These characteristics should be taken into consideration in future programs to improve adherence to glaucoma care.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; Ambulatory Care/sn [Statistics & Numerical Data]; *Antihypertensive Agents/tu [Therapeutic Use]; Anxiety Disorders/co [Complications]; Arthritis/co [Complications]; *Chronic Disease; Dementia/co [Complications]; Drug Prescriptions/sn [Statistics & Numerical Data]; *Exfoliation Syndrome/dt [Drug Therapy]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Hearing Loss/co [Complications]; Humans; *Low Tension Glaucoma/dt [Drug Therapy]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Stress Disorders, Post-Traumatic/co [Complications]; United States; Veterans; *Veterans Health/sn [Statistics & Numerical Data]

In situ gelling dorzolamide loaded chitosan nanoparticles for the treatment of glaucoma. - Katiyar, Shefali; Pandit, Jayamanti; Mondal, Rabi S; Mishra, Anil K; Chuttani, Krishna; Aqil, Mohd; Ali, Asgar; Sultana, Yasmin (Carbohydrate polymers, 2014)
The most important risk associated with glaucoma is the onset and progression of intraocular pressure. The objective of this study was to formulate in situ gel of chitosan nanoparticles to enhance the bioavailability and efficacy of dorzolamide in the glaucoma treatment. Optimized nanoparticles were spherical in shape (particle size: 164 nm) with a loading efficiency of 98.1%. The ex vivo release of the optimized in situ gel nanoparticle formulation showed a sustained drug release as compared to marketed formulation. The gamma scintigraphic study of prepared in situ nanoparticle gel showed good corneal retention compared to marketed formulation. HET-CAM assay of the prepared formulation scored 0.33 in 5 min which indicates the non-irritant property of the formulation. Thus in situ gel of dorzolamide hydrochloride loaded nanoparticles offers a more intensive treatment of glaucoma and a better patient compliance as it requires fewer applications per day compared to conventional eye drops. Copyright © 2013 Elsevier Ltd. All rights reserved.
Keywords: Animals; Calorimetry, Differential Scanning; Carbonic Anhydrase Inhibitors/ch [Chemistry]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Chitosan/ch [Chemistry]; *Glaucoma/dt [Drug Therapy]; Goats; Humans; In Vitro Techniques; Nanoparticles/ch [Chemistry]; *Nanoparticles/tu [Therapeutic Use]; Radionuclide Imaging; Sulfonamides/ch [Chemistry]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ch [Chemistry]; *Thiophenes/tu [Therapeutic Use]; X-Ray Diffraction

Comparison of peroperative subconjunctival injection of methylprednisolone and standard postoperative steroid drops after uneventful cataract surgery. - Merkoudis, Nikolaos; Wikberg Matsson, Anna; Granstam, Elisabet (Acta ophthalmologica, 2014)
PURPOSE: To compare the safety and efficacy of a single subconjunctival injection of methylprednisolone and a standard postoperative steroid regimen in terms of intraocular inflammation and intraocular pressure (IOP) after uncomplicated phacoemulsification surgery., METHODS: Two groups of 25 patients each were included in this prospective randomized controlled trial. Patients in the injection group were given a subconjunctival injection of 20 mg methylprednisolone and the topical group received the conventional postoperative care with steroid eye drops (dexamethasone 1 mg/ml). The patients were examined 1 week and 1 month after surgery. Slit-lamp evaluation of anterior chamber inflammation and IOP were performed. Changes in IOP of >=2.4 mmHg were considered clinically relevant., RESULTS: In the injection group, mean IOP decreased from 15.4 +/- 2.2 mmHg (baseline) to 14.1 +/- 3.2 mmHg at 1 week (p = 0.03). The topical group had a stable IOP at 1 week (16.3 +/- 2.6 mmHg) compared to baseline (16.1 +/- 2.7 mmHg; p = 0.74). At 1 month, mean IOP was 14.3 +/- 2.6 mmHg (p = 0.03) in the injection group and 15.6 +/- 2.3 mmHg (p = 0.2) in the topical group. The intragroup changes were neither statistically significant nor clinically relevant at any postoperative visit. Both groups had the highest values of intraocular inflammation at the 1-week postoperative visit, followed by a decline to barely traceable levels at 1 month. The difference was not clinically relevant at any postoperative visit., CONCLUSIONS: The subconjunctival injection of methylprednisolone appears to be as safe and effective as the conventional treatment, and it might therefore be considered for treatment of individuals with compliance issues. Copyright © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Conjunctiva/de [Drug Effects]; *Dexamethasone/ad [Administration & Dosage]; Dexamethasone/ae [Adverse Effects]; Double-Blind Method; Female; *Glucocorticoids/ad [Administration & Dosage]; Glucocorticoids/ae [Adverse Effects]; Humans; Injections, Intraocular; Intraocular Pressure/de [Drug Effects]; Lens Implantation, Intraocular; Male; *Methylprednisolone/ad [Administration & Dosage]; Methylprednisolone/ae [Adverse Effects]; Middle Aged; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/pc [Prevention & Control]; Ophthalmic Solutions; *Phacoemulsification; Preoperative Care; Prospective Studies; Uveitis, Anterior/pp [Physiopathology]; Uveitis, Anterior/pc [Prevention & Control]

Biochemical and cellular mechanisms regulating Acanthamoeba castellanii adherence to host cells. - Soto-Arredondo, K J; Flores-Villavicencio, L L; Serrano-Luna, J J; Shibayama, M; Sabanero-Lopez, M (Parasitology, 2014)
Free-living amoebae belonging to the genus Acanthamoeba are the causative agents of infections such as amoebic keratitis (AK), granulomatous amoebic encephalitis (GAE) and cutaneous lesions. The mechanisms involved in the establishment of infection are unknown. However, it is accepted that the initial phase of pathogenesis involves adherence to the host tissue. In this work, we analysed surface molecules with an affinity for epithelial and neuronal cells from the trophozoites of Acanthamoeba castellanii. We also investigated the cellular mechanisms that govern the process of trophozoite adhesion to the host cells. We first used confocal and epifluorescence microscopy to examine the distribution of the A. castellanii actin cytoskeleton during interaction with the host cells. The use of drugs, as cytochalasin B (CB) and latrunculin B (LB), revealed the participation of cytoskeletal filaments in the adhesion process. In addition, to identify the proteins and glycoproteins on the surface of A. castellanii, the trophozoites were labelled with biotin and biotinylated lectins. The results revealed bands of surface proteins, some of which were glycoproteins with mannose and N-acetylglucosamine residues. Interaction assays of biotinylated amoebae proteins with epithelial and neuronal cells showed that some surface proteins had affinity for both cell types. The results of this study provide insight into the biochemical and cellular mechanisms of the Acanthamoeba infection process.
Keywords: Acanthamoeba castellanii/de [Drug Effects]; Acanthamoeba castellanii/py [Pathogenicity]; *Acanthamoeba castellanii/ph [Physiology]; Acetylglucosamine/me [Metabolism]; Actin Cytoskeleton/me [Metabolism]; *Amebiasis/ps [Parasitology]; Bridged Bicyclo Compounds, Heterocyclic/pd [Pharmacology]; Cell Adhesion; Cell Line; Cell Surface Extensions/me [Metabolism]; Cytochalasin B/pd [Pharmacology]; *Cytoskeleton/me [Metabolism]; Epithelial Cells/ps [Parasitology]; Glycoproteins/me [Metabolism]; *Host-Parasite Interactions; Humans; Lectins/me [Metabolism]; Mannose/me [Metabolism]; Models, Biological; Protozoan Proteins/me [Metabolism]; Thiazolidines/pd [Pharmacology]; Trophozoites

Sustained drug delivery in glaucoma. - Knight, O'Rese J; Lawrence, Scott D (Current opinion in ophthalmology, 2014)
PURPOSE OF REVIEW: This article reviews recently published studies and important clinical trials of novel drug delivery systems for glaucoma and evaluates the potential of these systems to provide sustained therapeutic benefits., RECENT FINDINGS: The efficacy of topical medications to lower intraocular pressure (IOP) is limited by poor patient adherence, low bioavailability of drug and the potential for local and systemic side effects. Recent studies highlight the potential for sustained drug delivery through innovative delivery platforms. Nanoparticle-based formulations, drug-eluting contact lenses, punctum inserts and bioadhesive matrices placed in the conjunctival sac can enhance drug delivery by increasing precorneal residence time, enhancing corneal permeation and lowering the systemic absorption of drug. Periocular injections and surgically implanted drug reservoirs could offer even greater duration of drug delivery, particularly when the drug is packaged within stable vehicles., SUMMARY: Novel platforms for providing sustained drug delivery in glaucoma continue to evolve. The ability to incorporate effective commercially available drugs into more stable compounds is an important element. Although more research is needed to establish their clinical efficacy, novel delivery systems will allow for more targeted medical therapy and for the opportunity to further explore neuroprotective and gene-based therapies.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Biological Availability; *Delayed-Action Preparations/ad [Administration & Dosage]; *Drug Delivery Systems; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]

Impact of patient access to Internet health records on glaucoma medication: randomized controlled trial. - Kashiwagi, Kenji; Tsukahara, Shigeo (Journal of medical Internet research, 2014)
BACKGROUND: Glaucoma is one of the leading causes of blindness. Reduction of intraocular pressure is the only proven way to prevent progression of glaucomatous optic neuropathy. The majority of glaucoma patients need to use antiglaucoma ophthalmic solutions over the course of their life. Thus, good adherence and persistency of glaucoma treatment are important factors for better glaucoma care., OBJECTIVE: The purpose of this study was to investigate the impact of an Internet-based glaucoma care support system on glaucoma medication use., METHODS: Patients were randomly divided into two groups. The non-Internet access (NIA) group consisted of patients who had access to the Internet-based glaucoma care support system during the 4-year period only when they were examined by ophthalmologists. The Internet access (IA) group consisted of patients who had the same Internet-based glaucoma care support system access as the NIA group for the first 2 years following enrollment but who were also given free access to the glaucoma care support system for the remaining 2 years. Changes in glaucoma medication use were investigated., RESULTS: In total, 81 patients in the IA group and 90 patients in the NIA group satisfied the study protocol. The number of antiglaucoma ophthalmic solutions used during the study period significantly increased in the NIA group (P<.03) but not in the IA group. The percentages of patients with unchanged, increased, and decreased antiglaucoma ophthalmic solution use during the study period were 61.1% (55/90), 17.8% (16/90), and 3.3% (3/90), respectively, in the NIA group, and 56.8% (46/81), 8.6% (7/81), and 13.6% (11/81), respectively, in the IA group (P<.001). Internet access significantly shifted from an increasing intraocular pressure trend to a decreasing trend in the IA group (P=.002) among the patients who did not have any medication changes., CONCLUSIONS: Allowing patients to browse their medical data may reduce the use and improve the effectiveness of glaucoma medication., TRIAL REGISTRATION: UMIN-CTR Clinical Trial Number: UMIN000006982; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000008238&language=E (Archived by WebCite at http://www.webcitation.org/6MRPQeEAv).
Keywords: *Access to Information; *Glaucoma/dt [Drug Therapy]; Humans; *Internet; Ophthalmic Solutions; Prospective Studies; Single-Blind Method

Persistence with topical glaucoma therapy among newly diagnosed Japanese patients. - Kashiwagi, Kenji; Furuya, Toshie (Japanese journal of ophthalmology, 2014)
PURPOSE: To investigate persistence with glaucoma medication use and factors associated with it among newly diagnosed Japanese patients., PATIENTS AND METHODS: The subjects of this study were Japanese patients entered in the Japan Health Insurance Society database who were newly diagnosed as having glaucoma and who had been prescribed antiglaucoma medication. Newly diagnosed was defined as having no history of glaucoma diagnosis, antiglaucoma medication use, or glaucoma surgery, including laser treatment, during at least 6 months prior to enrollment. Discontinuation of glaucoma medication was defined as no record of an antiglaucoma medication prescription or monthly claims for medical expenses for 6 months or longer. Patients who met the following criteria were eliminated from the analysis: those who changed insurance systems, those without records in the Japan Health Insurance Society database, or those whose glaucoma diagnosis was retracted., RESULTS: A total of 2799 patients (age 47.3 +/- 13.9 years) were defined as patients with newly diagnosed glaucoma. They comprised 1494 male (46.9 +/- 13.6 years) and 1305 female (47.8 +/- 14.1 years) patients. Soon after starting to take the antiglaucoma medication, many patients discontinued it. The persistence rates at 3 months, 6 months, 12 months, and 3 years after the initiation of medication were 73.2, 68.1, 60.9, and 52.5 %, respectively. Younger age, the number of medications, and the hospital size were significantly associated with the patients' persistence with medication use., CONCLUSIONS: One-quarter of the newly diagnosed glaucoma patients discontinued glaucoma medication within the first 3 months of being prescribed it, and some factors were significantly associated with persistence with medication use.
Keywords: Administration, Topical; Adrenergic beta-Antagonists/ad [Administration & Dosage]; *Antihypertensive Agents/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Databases, Factual; *Drug Prescriptions/sn [Statistics & Numerical Data]; *Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Insurance, Health/sn [Statistics & Numerical Data]; Male; Middle Aged; Ophthalmic Solutions; *Patient Compliance/sn [Statistics & Numerical Data]; Prostaglandins, Synthetic/ad [Administration & Dosage]

Comparison of cataract surgery techniques: safety, efficacy, and cost-effectiveness. - Jaggernath, Jyoti; Gogate, Parikshit; Moodley, Vadi; Naidoo, Kovin S (European journal of ophthalmology, 2014)
PURPOSE: To compare the safety, efficacy, and cost-effectiveness of manual sutureless small-incision cataract surgery (SICS) and phacoemulsification (Phaco) as treatment options for cataract surgery with focus on intumescent, mature, and hypermature lenses (white cataracts)., METHODS: A systematic search of research articles was conducted to develop an internal database for the investigators' appraisal. Literature searches were conducted by using key words and MeSH terms including cataracts, phacoemulsification, small-incision cataract incision, visual acuity, costs, training, time, and barriers to cataract surgery. The final synthesis included 42 manuscripts., RESULTS: All studies show that both Phaco and SICS are safe and effective techniques to rehabilitate cataract patients, but Phaco is costlier, with its preoperative and postoperative medicines, anesthetic agents, viscoelastic materials, disposables, instrumentation, and intraocular lens (IOLs), and had a steeper learning curve. Small-incision cataract surgery, in comparison, has been shown to be faster and more cost-effective. It is useful in intumescent white, black, brown, and lens-induced glaucoma cataracts and could incorporate recent trends like topical and sub-Tenon anesthesia and temporal incisions. Both give equal best-corrected visual acuity but unaided vision has been shown to be slightly better in Phaco due to lesser astigmatism., CONCLUSIONS: The literature points to SICS being more useful for intumescent and hard cataracts and is the preferred technique for less-resourced settings. Small-incision cataract surgery is comparable to Phaco in almost all aspects except postoperative astigmatism.
Keywords: Cataract Extraction/ae [Adverse Effects]; *Cataract Extraction/ec [Economics]; *Cataract Extraction/mt [Methods]; Cost-Benefit Analysis; Health Care Costs; Humans; Lens Implantation, Intraocular/mt [Methods]; Middle Aged; Phacoemulsification/ae [Adverse Effects]; Phacoemulsification/ec [Economics]; Phacoemulsification/mt [Methods]; Refraction, Ocular/ph [Physiology]; Treatment Outcome; Visual Acuity/ph [Physiology]

Intraocular pressure regulation: findings of pulse-dependent trabecular meshwork motion lead to unifying concepts of intraocular pressure homeostasis. - Johnstone, Murray A (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2014)
Intraocular pressure (IOP) is the only treatable risk factor in glaucoma, one of the world's leading causes of blindness. Mechanisms that maintain IOP within a normal range have been poorly understood in contrast to intrinsic mechanisms that regulate systemic blood pressure. Vessel walls experience continuous pulse-induced cyclic pressure and flow. Pressure-dependent wall stress and flow-dependent shear stress provide sensory signals that initiate mechanotransduction responses. The responses optimize vessel wall elasticity, compliance and lumen size, providing a feedback loop to maintain intrinsic pressure homeostasis. Aqueous humor is part of a vascular circulatory loop, being secreted into the anterior chamber of the eye from the vasculature, then returning to the vasculature by passing through the trabecular meshwork (TM), a uniquely modified vessel wall interposed between the anterior chamber and a vascular sinus called Schlemm's canal (SC). Since pressure in circulatory loops elsewhere is modulated by cyclic stresses, one might predict similar pressure modulation in the aqueous outflow system. Recent laboratory evidence in fact demonstrates that cyclic IOP changes alter aqueous outflow while increasing cellularity and contractility of TM cells. Cyclic changes also lead to alterations in gene expression, changes in cytoskeletal networks and modulation of signal transduction. A new technology, phase-based optical coherence tomography, demonstrates in vivo pulse-dependent TM motion like that elsewhere in the vasculature. Recognition of pulse-dependent TM motion provides a linkage to well-characterized mechanisms that provide pressure homeostasis in the systemic vasculature. The linkage may permit unifying concepts of pressure control and provide new insights into IOP homeostatic mechanisms.
Keywords: Anterior Chamber/ph [Physiology]; Aqueous Humor/ph [Physiology]; *Glaucoma/pa [Pathology]; Homeostasis; Humans; *Intraocular Pressure/ph [Physiology]; Mechanotransduction, Cellular; Risk Factors; Tomography, Optical Coherence/mt [Methods]; *Trabecular Meshwork/pa [Pathology]; Trabecular Meshwork/ph [Physiology]

[Increase in examinations for cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration : Comparative cross-sectional study between 2010 and 1997 in ophthalmological practices]. - Bertram, B; Gante, C; Hilgers, R-D (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2014)
BACKGROUND: The importance of the four most commonly occurring vision-threatening diseases, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy and cataract in ophthalmological practices has changed due to demographic developments, medical progress and transference of inpatient treatment to the outpatient area of private practice., METHODS: In the fourth quarter year of 2010 a survey of 15,125 patients (approximately 10%) from 96 private ophthalmology practices (mean 149 patients per ophthalmologist, range 45-376) was carried out. The results for the four most commonly occurring vision-threatening diseases were compared with the result from a previous survey carried out for the fourth quarter year of 1997., RESULTS: Compared to 1997 there was an increase in the age-adjusted proportion of examinations in 2010 for cataracts by 29 %, for glaucoma by 21 %, for diabetic retinopathy by 39 % and for vitreoretinal diseases by 19 %. The number of AMD examinations in the age group over 70 years old showed a particularly high increase., CONCLUSIONS: The number of patients examined for the four most commonly occurring vision-threatening diseases increased from 1997 to 2010 not only in absolute numbers but also in relation to age. In the future financial and personnel resources must be made available for the early and guidelines-conform detection, diagnostics and therapy by ophthalmologists.
Keywords: Adult; Aged; Aged, 80 and over; *Cataract/di [Diagnosis]; Cataract/ep [Epidemiology]; Comorbidity; Cross-Sectional Studies; *Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/ep [Epidemiology]; *Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; Diagnostic Techniques, Ophthalmological/td [Trends]; Female; Germany/ep [Epidemiology]; *Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Health Care Surveys; Humans; *Macular Degeneration/di [Diagnosis]; Macular Degeneration/ep [Epidemiology]; Male; Middle Aged; Office Visits/sn [Statistics & Numerical Data]; Office Visits/td [Trends]; *Ophthalmology/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prevalence; Utilization Review

[Glaucoma treatment compliance]. - Santos-Bueso, E; Saenz-Frances, F; Garcia-Saenz, S; Mendez-Hernandez, C D; Fernandez-Vidal, A M; Morales-Fernandez, L; Martin-Valdizan, C; Martinez-de-la-Casa, J M; Garcia-Feijoo, J; Garcia-Sanchez, J (Archivos de la Sociedad Espanola de Oftalmologia, 2014)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence

Clinic-based glaucoma care in the era of surgical subspecialization. - Campbell, Robert J; Bell, Chaim M; Gill, Sudeep S; Whitehead, Marlo; Campbell, Erica de L P; Xu, Kunyong; El-Defrawy, Sherif R (American journal of ophthalmology, 2014)
PURPOSE: To evaluate the impact of surgeon practice profile on clinic-based glaucoma care., DESIGN: Population-based study of glaucoma care patterns in Ontario, Canada from 2000-2010., METHODS: Using comprehensive physician services data from the Ontario Health Insurance Plan database, ophthalmologists were divided into 5 surgical practice subgroups. The role of each subgroup in the provision of glaucoma care was evaluated. Consultations and office visits were used to assess nonsurgical care, while laser trabeculoplasty procedures were used to assess clinic-based procedural care., RESULTS: Between 2000 and 2010, the population rate of glaucoma consultations and follow-up visits provided by ophthalmologists who do not perform incisional glaucoma surgery increased at average annual rates of 1.6% (P < .0002) and 3.3% (P < .0001), respectively. In contrast, no significant growth in the rate of glaucoma consultations or follow-up visits provided by glaucoma surgeons was observed (0.8%/year [P = .2] for consultations; 0.2%/year [P = .6] for follow-up visits). Between 2000 and 2010, the rate of laser trabeculoplasty procedures provided by ophthalmologists who do not perform incisional glaucoma surgery increased 19.3% annually (P < .0001), while growth among glaucoma surgeons was more modest (annual growth of 9.2% [P = .0002])., CONCLUSIONS: While subspecialization is a growing reality in most areas of medicine, we found that the provision of clinic-based glaucoma care remains dependent on ophthalmologists who do not perform incisional glaucoma surgery. With increasing focus on integrated care, these findings will have important implications for residency education programs and their accrediting bodies and will inform decisions of health care policymakers, hospitals, and academic departments. Copyright © 2014 Elsevier Inc. All rights reserved.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; *Delivery of Health Care/sn [Statistics & Numerical Data]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure; Laser Therapy/sn [Statistics & Numerical Data]; Office Visits; Ontario; *Ophthalmology/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Referral and Consultation; Retrospective Studies; Specialties, Surgical; *Trabeculectomy/sn [Statistics & Numerical Data]

Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. - Sebag, Jerry; Yee, Kenneth M P; Wa, Christianne A; Huang, Laura C; Sadun, Alfredo A (Retina (Philadelphia, Pa.), 2014)
PURPOSE: Floaters impact vision but the mechanism is unknown. We hypothesize that floaters reduce contrast sensitivity function, which can be normalized by vitrectomy, and that minimally invasive vitrectomy will have lower incidences of retinal tears (reported at 30%) and cataracts (50-76%)., METHODS: Seventy-six eyes (34 phakic) with floaters were evaluated in 2 separate studies. Floater etiologies were primarily posterior vitreous detachment in 61 of 76 eyes (80%) and myopic vitreopathy in 24 of 76 eyes (32%). Minimally invasive 25G vitrectomy was performed without posterior vitreous detachment induction, leaving anterior vitreous, and using nonhollow probes for cannula extraction. Efficacy was studied prospectively (up to 9 months) in 16 floater cases with Freiburg Acuity Contrast Testing (Weber index [%W] reproducibility = 92.1%) and the National Eye Institute Visual Function Questionnaire. Safety was separately evaluated in 60 other cases followed up on an average of 17.5 months (range, 3-51 months)., RESULTS: Floater eyes had 67% contrast sensitivity function attenuation (4.0 +/- 2.3 %W; control subjects = 2.4 +/- 0.9 %W, P < 0.013). After vitrectomy, contrast sensitivity function normalized in each case at 1 week (2.0 +/- 1.4 %W, P < 0.01) and remained normal at 1 month (2.0 +/- 1.0 %W, P < 0.003) and 3 months to 9 months (2.2 +/- 1.5 %W, P < 0.018). Visual Function Questionnaire was 28.3% lower in floater patients (73.2 +/- 15.6, N = 16) than in age-matched control subjects (93.9 +/- 8.0, N = 12, P < 0.001), and postoperatively improved by 29.2% (P < 0.001). In the safety study of 60 floater cases treated with vitrectomy, none developed retinal breaks, infection, or glaucoma after a mean follow-up of 17.5 months. Only 8 of 34 cases (23.5%) required cataract surgery (none younger than 53 years) at an average of 15 months postvitrectomy., CONCLUSION: Floaters lower contrast sensitivity function, which normalizes after vitrectomy. Visual Function Questionnaire quantified improvement in satisfaction. Not inducing posterior vitreous detachment reduced retinal tear incidence from 30% to 0% (P < 0.007). Postvitrectomy cataract incidence was reduced from 50% to 23.5% (P < 0.02). This approach thus seems effective and safe in alleviating the visual dysfunction induced by floaters.
Comment in (CIN), Comment in (CIN), Comment in (CIN)
Keywords: Aged; Contrast Sensitivity/ph [Physiology]; Eye Diseases/pp [Physiopathology]; *Eye Diseases/su [Surgery]; Female; Humans; Male; Middle Aged; Myopia/co [Complications]; Patient Satisfaction; Prospective Studies; Retrospective Studies; Suture Techniques; Visual Acuity/ph [Physiology]; Vitrectomy/ae [Adverse Effects]; *Vitrectomy/mt [Methods]; Vitreous Detachment/co [Complications]

Re: Adherence to NICE guidelines for new glaucoma referrals. - Sullivan, L; Burton, D; Bong, C; Galloway, P (Eye (London, England), 2014)
Comment on (CON)
Keywords: *Glaucoma/di [Diagnosis]; *Guideline Adherence/st [Standards]; Humans; *Practice Guidelines as Topic

Guidelines for the collaborative care of glaucoma patients and suspects by ophthalmologists and optometrists in Australia. - White, Andrew; Goldberg, Ivan; Australian and New Zealand Glaucoma Interest Group and the Royal Australian and New Zealand College of Ophthalmologists (Clinical & experimental ophthalmology, 2014)
Keywords: Australia; *Delivery of Health Care/og [Organization & Administration]; Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Interprofessional Relations; Intraocular Pressure; Ocular Hypertension/di [Diagnosis]; *Ocular Hypertension/th [Therapy]; *Ophthalmology/mt [Methods]; *Optometry/mt [Methods]; *Patient Care Team/og [Organization & Administration]; Patient Satisfaction

In vitro characterization of a controlled-release ocular insert for delivery of brimonidine tartrate. - Mealy, J E; Fedorchak, M V; Little, S R (Acta biomaterialia, 2014)
Glaucoma is the second leading cause of blindness in the US. Brimonidine tartrate (BT) is a modern anti-glaucoma agent that is currently administered as frequently as a thrice-daily topical eye drop medication. Accordingly, compliance with BT regimens is low, limiting overall effectiveness. One attempt that has previously proved effective in addressing non-adherence is the formation of ocular inserts, such as the Ocusert( R), whose diffusion-based control released an older drug (pilocarpine) for a week-long period. Modern controlled drug-release technology provides an avenue for extending the release of practically any drug (including new drugs such as BT) for as long as 1 month from a singular insert. Currently, no controlled-release formulations for BT exist. This work outlines the development and characterization of a BT-releasing ocular insert designed from poly(lactic co-glycolic) acid/polyethylene glycol (PEG). It was found that a formulation containing 15% PEG can be created that produces a linear BT-release profile corresponding to BT eye drop delivery estimates. Additionally, these inserts were shown, through the use of atomic force microscopy and scanning electron microscopy, to have smooth surfaces and physical properties suitable for ophthalmic use. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
Keywords: Animals; Brimonidine Tartrate; Cell Death/de [Drug Effects]; Delayed-Action Preparations; *Drug Delivery Systems; Epithelial Cells/cy [Cytology]; Epithelial Cells/de [Drug Effects]; *Eye/de [Drug Effects]; Humans; Lactic Acid/ch [Chemistry]; Polyethylene Glycols/ch [Chemistry]; Polyglycolic Acid/ch [Chemistry]; Polylactic Acid-Polyglycolic Acid Copolymer; *Quinoxalines/ad [Administration & Dosage]; *Quinoxalines/pd [Pharmacology]

In vivo confocal microscopy of conjunctiva in preservative-free timolol 0.1% gel formulation therapy for glaucoma. - Frezzotti, Paolo; Fogagnolo, Paolo; Haka, Gentiana; Motolese, Ilaria; Iester, Michele; Bagaglia, Simone A; Mittica, Pietro; Menicacci, Cristina; Rossetti, Luca; Motolese, Eduardo (Acta ophthalmologica, 2014)
PURPOSE: To evaluate the effects at 1 year of preservative-free timolol gel and preserved timolol eye drops on conjunctiva and tear parameters., METHODS: Forty patients with primary open-angle glaucoma or ocular hypertension were randomized to the two treatment groups and compared with 20 healthy age-matched controls. Clinical tests (IOP, Schirmer I test, and lacrimal film break-up time BUT) and in vivo conjunctival confocal microscopy (IVCM) were performed in all patients at baseline and after 12 months. IVCM (HRT II Rostock Cornea Module; Heidelberg Engineering GmbH, Heidelberg, Germany) was performed after topical anaesthesia in the four cardinal locations and at the corresponding limbus to analyse conjunctiva cells. The main IVCM outcomes were goblet cell density and epithelial regularity., RESULTS: IVCM and clinical parameters were similar in the three groups at baseline. After 12 months, intra-epithelial goblet cell density was significantly lower in the preserved (48.25 +/- 7.70) than in the preservative-free beta-blocker group (86.83 +/- 22.17, p < 0.001) and controls (88.9 +/- 18.33, p < 0.001). The epithelial layer was significantly more regular in the preserved beta-blocker medication group than in the preservative-free beta-blocker group (p < 0.001) and the control group (p < 0.001). A significant reduction in both Schirmer I and BUT was found in the group of preserved timolol (respectively, 11.3 +/- 2.97 and 8.12 +/- 0.99) compared with preservative-free timolol (16.8 +/- 1.83 and 11.27 +/- 1.27, p < 0.001) and controls (17.8 +/- 1.87 and 12.10 +/- 1.28, p < 0.001)., CONCLUSIONS: Based on our IVCM data, preservative-free beta-blocker gel induces less changes at ocular surface than preserved beta-blockers, a fact that should be considered to obtain less adverse effects and maximal adherence to treatment in a chronic condition such as glaucoma. Copyright © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: *Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Benzalkonium Compounds/tu [Therapeutic Use]; Cell Count; *Conjunctiva/de [Drug Effects]; Conjunctiva/pa [Pathology]; Female; Gels; *Glaucoma, Open-Angle/dt [Drug Therapy]; Goblet Cells/pa [Pathology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Microscopy, Confocal; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Pharmaceutical Preparations; *Preservatives, Pharmaceutical/tu [Therapeutic Use]; Tears/me [Metabolism]; *Timolol/tu [Therapeutic Use]; Tonometry, Ocular

A prospective observational study of techniques to remove corneal foreign body in the emergency department. - Quirke, Michael; Mullarkey, Caitriona; Askoorum, Shakti; Coffey, Norma; Binchy, James (Emergency medicine journal : EMJ, 2014)
INTRODUCTION: Patients with corneal foreign bodies (CFBs) often present to the emergency department (ED). However, removal techniques vary among emergency physicians (EPs). A prospective, single-blinded, observational study was performed to compare slit-lamp-aided (SLA) versus non-slit-lamp-aided (NSLA) CFB removal by EPs., METHODS: Five EPs enrolled consecutive patients with a CFB over 3 months. One blinded EP reviewed patients after 3 days. The study end points were: change in visual acuity; visual analogue pain scale (VAS) score at 12 and 24 h; satisfaction rating; symptoms at follow-up; and rate of complications., RESULTS: 54 patients were enrolled: 28 had SLA removal and 26 NSLA removal; 52 were male; 22 had undergone previous CFB removal; six were wearing eye protection at the time of injury. Forty-three patients were reviewed: 26 by attendance and 18 by telephone. There was no difference in any end points at review. However, patients in the SLA group had median VAS scores that were 1.5 cm lower after 24 h than patients in the NSLA group (p=0.43, 95% CI -2.0 to 1.0). One patient in the SLA group developed keratitis., CONCLUSIONS: We show that patient satisfaction ratings, complications and visual acuity were similar for the two methods. There was a trend for increased pain in the NSLA group at 12 and 24 h. Slit-lamp biomicroscopy and the use of magnification to remove CFBs remains the gold standard of care, and more intensive training should be given to EPs at the departmental level, particularly in EDs that receive patients with eye injuries. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Comment in (CIN), Comment in (CIN)
Keywords: Adult; *Corneal Injuries/su [Surgery]; *Emergency Service, Hospital; *Eye Foreign Bodies/su [Surgery]; *Eye Injuries, Penetrating/su [Surgery]; Female; Humans; Male; *Ophthalmologic Surgical Procedures/mt [Methods]; Patient Satisfaction; Prospective Studies; Single-Blind Method; Visual Acuity; Visual Analog Scale; Young Adult

Canadian ophthalmologists' opinions concerning complementary and alternative medicine (CAM) use in glaucoma. - Bower, Tenley N; Muhsen, Sana; Overbury, Olga; Birt, Catherine; Kasner, Oscar (Journal of glaucoma, 2014)
PURPOSE: Our goal is to investigate the opinion and practice pattern of Canadian ophthalmologists regarding the use of and recommendations for complementary and alternative medicine (CAM) for their glaucoma patients., METHODS: Institutional review board approval for this prospective, cross-sectional survey was obtained from the Research Ethics Board of Sunnybrook Health Sciences Centre. The survey was sent to all ophthalmologists in Canada electronically through the e-mail lists of 4 ophthalmology associations., RESULTS: A total of 241 ophthalmologists representing all provinces in Canada responded to the questionnaire. Twenty-two percent felt that CAM does have a role in glaucoma therapy with specialists being more likely to believe there is a role (P<0.05). Of the total respondents, 26% ask their patients if they use CAM with those in practice for <20 years more likely to encourage use (P<0.05). Of the respondents, 9% recommend CAM and if an ophthalmologist was in practice for <20 years he/she was significantly more likely to recommend CAM (P<0.01). Respondents (62%) in general do not discourage CAM with younger ophthalmologists (younger than 50 y, P<0.02) and ophthalmologists in practice for <20 years (P<0.05) being less likely to discourage CAM use. Respondents (41%) believe that CAM rarely ever affects compliance with ophthalmologists from an urban practice (P<0.01) and academic practice (P<0.05) more likely to deny effect on compliance. Respondents believe that CAM sometimes (46%) results in patient morbidity with ophthalmologists being in practice for <20 years believing that morbidity is less likely (P<0.05)., CONCLUSION: A substantial minority of respondents believe that CAM has a role in glaucoma therapy, recommend its use, and ask their patients if they use CAM. Younger doctors are more likely to encourage alternatives; those in practice for <20 years are more likely to ask about alternative medicine use, recommend its use, and believe that morbidity usually does not result from the use of alternative treatments.
Keywords: Aged; *Attitude of Health Personnel; Canada; Complementary Therapies/mt [Methods]; *Complementary Therapies/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Female; *Glaucoma/th [Therapy]; Health Surveys; Humans; Male; *Ophthalmology; Patient Compliance; *Practice Patterns, Physicians'; Prospective Studies; Surveys and Questionnaires; Workforce

Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses. - Zimmerman, Aaron B; Marks, Amanda (Eye & contact lens, 2014)
PURPOSE: To report a case of neurotrophic keratitis in which scleral contact lenses improved vision from 20/100 to 20/20, however, due to poor lens care, an incident of microbial keratitis developed., METHODS: A 64-year-old man with an ocular history of neurotrophic keratitis secondary to herpes simplex in each eye was successfully fit with scleral lenses. He subsequently developed microbial keratitis due to a number of risk factors., RESULTS: The lesion was culture negative, yet was very responsive to treatment with moxifloxacin. The lesion fully healed, and the patient did not suffer additional vision loss., CONCLUSIONS: This case demonstrates the ability of scleral lenses to correct visual impairments secondary to poor epithelial integrity and illustrates the importance of the practitioner providing detailed lens care instruction.
Keywords: *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Contact Lenses, Extended-Wear/mi [Microbiology]; *Equipment Contamination; *Eye Infections, Bacterial/et [Etiology]; Humans; Hygiene; *Keratitis/et [Etiology]; Male; Middle Aged; Patient Compliance; *Sclera

Beliefs and adherence to glaucoma treatment: a comparison of patients from diverse cultures. - Rees, Gwyneth; Chong, Xue-Ling; Cheung, Carol Y; Aung, Tin; Friedman, David S; Crowston, Jonathan G; Lamoureux, Ecosse L (Journal of glaucoma, 2014)
PURPOSE: To determine adherence rates and beliefs about glaucoma and its treatment in white Americans, African Americans, white Australians, and Singaporeans of Chinese descent., PATIENTS AND METHODS: Cross-sectional study of 475 glaucoma patients using topical eye drops for at least 6 months. The sample consisted of white Americans (n=133), African Americans (n=58), white Australians (n=107), and Singaporeans of Chinese descent (n=117). 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: Accounting for sociodemographic differences, significant differences in self-reported adherence rates were identified (P<0.001). White Americans and Australians reported significantly higher adherence (65.4%, 67.7% reported complete adherence) than African Americans or Singaporeans (56.9%, 47.5%, respectively; P<0.05). Beliefs about glaucoma treatment were predictive of adherence only in the Australian and white American samples (P<0.05)., CONCLUSIONS: In western cultures, attempts to improve adherence may benefit from greater examination of individual's concerns about, and perceived need, for glaucoma treatment. Further studies are needed to identify the critical predictors of adherence in nonwestern cultures and to validate measures in these populations.
Keywords: African Americans/eh [Ethnology]; Aged; Antihypertensive Agents/tu [Therapeutic Use]; Asian Continental Ancestry Group/eh [Ethnology]; *Cross-Cultural Comparison; Cross-Sectional Studies; Educational Status; European Continental Ancestry Group/eh [Ethnology]; Female; *Glaucoma/dt [Drug Therapy]; *Glaucoma/eh [Ethnology]; *Health Knowledge, Attitudes, Practice; Humans; Male; *Medication Adherence/px [Psychology]; Surveys and Questionnaires

Theoretical and empirical dimensions of the Aberdeen Glaucoma Questionnaire: a cross sectional survey and principal component analysis. - Prior, Maria; Ramsay, Craig R; Burr, Jennifer M; Campbell, Susan E; Jenkinson, David J; Asoaka, Ryo; Francis, Jillian J (BMC ophthalmology, 2013)
BACKGROUND: To develop patient-reported outcome instruments, statistical techniques (e.g., principal components analysis; PCA) are used to examine correlations among items and identify interrelated item subsets (empirical factors). However, interpretation and labelling of empirical factors is a subjective process, lacking precision or conceptual basis. We report a novel and reproducible method for mapping between theoretical and empirical factor structures. We illustrate the method using the pilot Aberdeen Glaucoma Questionnaire (AGQ), a new measure of glaucoma-related disability developed using the International Classification of Functioning and Disability (ICF) as a theoretical framework and tested in a sample representing the spectrum of glaucoma severity., METHODS: We used the ICF to code AGQ item content before mailing the AGQ to a UK sample (N = 1349) selected to represent people with a risk factor for glaucoma and people with glaucoma across a range of severity. Reflecting uncertainty in the theoretical framework (items with multiple ICF codes), an exploratory PCA was conducted. The theoretical structure informed our interpretation of the empirical structure and guided the selection of theoretically-derived factor labels. We also explored the discrimination of the AGQ across glaucoma severity groups., RESULTS: 656 (49%) completed questionnaires were returned. The data yielded a 7-factor solution with a simple structure (using cut-off point of a loading of 0.5) that together accounted for 63% of variance in the scores. The mapping process resulted in allocation of the following theoretically-derived factor labels: 1) Seeing Functions: Participation; 2) Moving Around & Communication; 3) Emotional Functions; 4) Walking Around Obstacles; 5) Light; 6) Seeing Functions: Domestic & Social Life; 7) Mobility. Using the seven factor scores as independent variables in a discriminant function analysis, the AGQ scores resulted in correct glaucoma severity grading of 32.5% of participants (p < 0.001)., CONCLUSIONS: This paper addresses a methodological gap in the application of classical test theory (CTT) techniques, such as PCA, in instrument development. Labels for empirically-derived factors are often selected intuitively whereas they can inform existing bodies of knowledge if selected on the basis of theoretical construct labels, which are more explicitly defined and which relate to each other in ways that are evidence based.
Keywords: Aged; Cross-Sectional Studies; *Disability Evaluation; Empirical Research; Female; *Glaucoma/di [Diagnosis]; Health Status; Humans; Male; Middle Aged; Pilot Projects; Principal Component Analysis; Reproducibility of Results; Self Report/st [Standards]; *Self Report; Severity of Illness Index; *Surveys and Questionnaires

Why do people present late with advanced glaucoma? A qualitative interview study. - Prior, Maria; Francis, Jill J; Azuara-Blanco, Augusto; Anand, Nitin; Burr, Jennifer M; Glaucoma screening Platform Study group (The British journal of ophthalmology, 2013)
OBJECTIVE: To explore the presentation behaviours and pathways to detection of adults who first presented to UK hospital eye services with severe glaucoma., DESIGN: Semistructured interviews, based on models of diagnostic delay, to obtain a descriptive self-reported account of when and how participants' glaucoma was detected., RESULTS: 11 patients participated (five in Aberdeen, six in Huddersfield). Four participants reported that the optometry appointment at which their glaucoma was detected was their first ever eye test or their first for over 10 years. Seven participants reported attending regular routine optometrist appointments. Their self-reported experiences and pathways to detection describe a variety of missed detection opportunities and delayed referral and treatment., CONCLUSIONS: The qualitative data suggest that late detection of glaucoma can result from delays at the patient level but, although based on a small sample, delays also occurred at the healthcare provider (system) level both in terms of accuracy of case detection and effective referral. We suggest that current attempts to address the significant burden of over-referral of glaucoma suspects to hospital eye services (a large proportion of which are false positives) must also focus on the issue of false negatives and on reducing missed detection and service delays.
Keywords: Adult; Aged; *Delayed Diagnosis/px [Psychology]; Disease Progression; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/px [Psychology]; Humans; Interviews as Topic; Male; Middle Aged; *Patient Acceptance of Health Care/px [Psychology]; Qualitative Research; Risk Reduction Behavior; *Severity of Illness Index; United Kingdom

Substratum stiffness and latrunculin B modulate the gene expression of the mechanotransducers YAP and TAZ in human trabecular meshwork cells. - Thomasy, Sara M; Morgan, Joshua T; Wood, Joshua A; Murphy, Christopher J; Russell, Paul (Experimental eye research, 2013)
The compliance of the human trabecular meshwork (HTM) has been shown to dramatically stiffen in glaucomatous patients. The purpose of this study was to determine the impact of substratum stiffness and latrunculin-B (Lat-B) on the expression and activity of the mechanotransducers, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding domain (TAZ), in primary HTM cells as the cells start to recover from Lat-B treatment. Primary human trabecular meshwork (HTM) cells were cultured on hydrogels possessing stiffness values mimicking those found in normal (5 kPa) and glaucomatous meshworks (75 kPa), or tissue culture polystyrene (TCP; >1 GPa). Cells were treated with 2.0 muM Lat-B in DMSO or DMSO alone. RT-PCR was used to determine the impact of substratum stiffness and/or Lat-B treatment on the expression of YAP, TAZ, 14-3-3sigma, plasminogen activator inhibitor-1 (PAI-1), and connective tissue growth factor (CTGF). Immunoblotting was used to determine the expression of YAP and TAZ as well as the phosphorylation status of YAP. Immunofluorescence was used to determine YAP protein localization. YAP and TAZ mRNA expression were upregulated on the 75 kPa hydrogels in comparison to the 5 kPa hydrogels and TCP. Treatment with Lat-B resulted in a rapid and dramatic downregulation of YAP and TAZ on the 75 kPa hydrogels. On hydrogels, Lat-B treatment increased the phosphorylation of YAP at S127, while decreasing it on TCP. Similarly, Lat-B treatment resulted in markedly decreased nuclear localization of YAP on the hydrogels but elevated nuclear localization on TCP. Lat-B treatment of HTM cells on the 75 kPa hydrogels also increased 14-3-3sigma mRNA, a protein important in YAP/TAZ degradation. In addition, Lat-B treatment decreased CTGF and PAI-1 mRNA on the 75 kPa hydrogels. In conclusion, substratum stiffness alters YAP/TAZ expression and YAP localization in primary HTM cells which then may modulate the expression of extracellular matrix proteins important in glaucoma. During the recovery period after Lat-B treatment, gene expression changes are more dramatic on substrates with stiffness similar to glaucomatous meshwork. Use of these hydrogels may more accurately reflect the alterations occurring in HTM cells in glaucoma after treatment with this drug. Copyright © 2013 Elsevier Ltd. All rights reserved.
Keywords: 14-3-3 Proteins/ge [Genetics]; 14-3-3 Proteins/me [Metabolism]; *Adaptor Proteins, Signal Transducing/ge [Genetics]; Adaptor Proteins, Signal Transducing/me [Metabolism]; Biomarkers, Tumor/ge [Genetics]; Biomarkers, Tumor/me [Metabolism]; *Bridged Bicyclo Compounds, Heterocyclic/pd [Pharmacology]; Cells, Cultured; Connective Tissue Growth Factor/ge [Genetics]; Connective Tissue Growth Factor/me [Metabolism]; Down-Regulation; Exonucleases/ge [Genetics]; Exonucleases/me [Metabolism]; Exoribonucleases; *Extracellular Matrix/de [Drug Effects]; Extracellular Matrix/pa [Pathology]; Fluorescent Antibody Technique, Indirect; *Gene Expression Regulation/ph [Physiology]; Glaucoma/me [Metabolism]; *Glaucoma/pa [Pathology]; Humans; Immunoblotting; *Intracellular Signaling Peptides and Proteins/ge [Genetics]; Intracellular Signaling Peptides and Proteins/me [Metabolism]; *Phosphoproteins/ge [Genetics]; Phosphoproteins/me [Metabolism]; Phosphorylation; Plasminogen Activator Inhibitor 1/ge [Genetics]; Plasminogen Activator Inhibitor 1/me [Metabolism]; RNA, Messenger/me [Metabolism]; Reverse Transcriptase Polymerase Chain Reaction; *Thiazolidines/pd [Pharmacology]; *Trabecular Meshwork/de [Drug Effects]; Trabecular Meshwork/me [Metabolism]; Trabecular Meshwork/pa [Pathology]; Trans-Activators; Transcription Factors; Uvea/me [Metabolism]

[Study on causes of ophthalmologists' inertia in glaucoma treatment]. - Onishchenko, A L; Kolbasko, A V; Isakov, I N; Shirina, M A (Vestnik oftalmologii, 2013)
The problem of inertia in ophthalmological practice, which implies the absence of any adjustment of the given treatment, even if an adjustment is objectively necessary or clinically indicated, was studied. According to the authors, the problem is most pressing when multifactorial diseases, including primary glaucoma, are concerned. An anonymous survey of 147 ophthalmologists from different West Siberian regions (Altai Krai, Kemerovo region, and Republic of Khakassia) was conducted. The set of causes for ophthalmologists' inertia was identified. The leading cause appeared to be psychological reluctance to achieve target intraocular pressure and overestimation of therapeutic success. Other causes, although less significant, include lack of professional awareness and economic barriers to decision making.
Keywords: Adult; Aged; *Attitude of Health Personnel; *Decision Making; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Physicians/px [Psychology]; Siberia; *Stress, Psychological; Surveys and Questionnaires; Young Adult

[Compliance of treatment in glaucoma patients]. - Banc, Ana; Stan, Cristina (Oftalmologia (Bucharest, Romania : 1990), 2013)
PURPOSE: To evaluate the treatment compliance level of glaucoma patients and the correlation between the compliance level and a series of patient's demographic characteristics., METHODS: We conducted an observational study in which we studied 100 glaucoma patients who answered the questions we included into a questionnaire. We defined and calculated a broad compliance score and a narrow score, and we investigated the connection between the first score and age, gender, demographic location (urban versus rural), education level, current occupation and duration of disease respectively., RESULTS: The mean of the broad compliance score was 9.64 +/- 1.72, which represents 80% of the maximum value of the score, and the mean of the narrow compliance score was 4.73 +/- 1.12, (78% of the maximum value). The correlation coefficient between score and age was z = -0.09 (p value = 0.19), the Z value for the evaluation of the connection between score and gender was -1.16 (p value = 0.24), and for the connection between compliance score and demographic location Z value = -2.42 (p value = 0.01). Chi-square value for the evaluation of the relation between the score and education level was 14.66 (p value = 0.001), and for the current occupation Chi-square value = 3.47 (p value = 0.06). The correlation coefficient between score and disease duration was tau = 0.09 (p value = 0.23)., DISCUSSIONS: According to the answers the patients gave, we identified the parameters that require more attention in the ophthalmologist - glaucoma patient communication: genetic transmission of glaucoma, treatment's side effects, number of visits to the ophthalmologist, awareness of the life-long gradului period of treatment., CONCLUSIONS: In this study, the compliance level of glaucoma patients is relatively high and we observe a correlation between the compliance level and demographic location, and between the compliance level and patient's education level respectively.,
Keywords: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Educational Status; Female; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Male; *Medication Adherence; Middle Aged; Risk Factors; Surveys and Questionnaires

[Clinical efficacy of travoprost-timolol fixed combination on ocular hypotensive agents and ocular surface agents in Japanese glaucoma patients]. - Kanamoto, Takashi; Kiuchi, Yoshiaki; Ichioka, Ikuko; Onishi, Toru; Osada, Kenji; Kimura, Wataru; Suchiro, Tatsunori; Nagaya, Manabu; Hirota, Atsushi; Mukai, Satoshi; Miyoshi, Teruyuki; Yoshi, Hironori (Nippon Ganka Gakkai zasshi, 2013)
PURPOSE: To investigate the clinical effects of travoprost-timolol fixed combination on ocular hypotensive agents, ocular surface agents and adherence in Japanese glaucoma patients., METHODS: 28 Japanese glaucoma patients, who had used topical prostaglandin F2alpha analogue (28 eyes; PG group), were assigned to treatment with travoprost-timolol fixed combination. Reduction of intraocular pressure (IOP), grades of conjuctival follicle, conjuctival injection and keratoepitheliopathy, as well as interviews for topical administration, were evaluated. 38 patients, who switched from the topical prostaglandin F2alpha analogue and a beta-blocker to travoprost-timolol fixed combination (38eyes: PG+BB group) were also evaluated in the same manner., RESULTS: While IOP was significantly reduced in the PG group, IOP was not changed in the PG+BB group. Both groups showed no significant changes in scores for conjuctival follicle, keratoepitheliopathy, or interview., CONCLUSION: These results suggest that travoprost-timolol fixed combination reduces IOP and produces low toxicity on the ocular surface.
Keywords: *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/pd [Pharmacology]; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/pd [Pharmacology]; Asian Continental Ancestry Group; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/pd [Pharmacology]; Cornea/de [Drug Effects]; Dinoprost/ad [Administration & Dosage]; Dinoprost/aa [Analogs & Derivatives]; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/px [Psychology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ophthalmic Solutions; *Patient Satisfaction; Surveys and Questionnaires; *Timolol/ad [Administration & Dosage]; Timolol/pd [Pharmacology]; Travoprost; Treatment Outcome

Ahmed valve, suture-less implantation: A new approach to an easier technique. - Garcia-Delpech, Salvador; Sanz-Marco, Empar; Martinez-Castillo, Sebastian; Lopez-Prats, Maria Jesus; Udaondo, Patricia; Salom, David; Diaz-Llopis, Manuel (Journal of glaucoma, 2013)
PURPOSE: Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma., PATIENTS AND METHODS: Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) >= 21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-up (mean follow-up, 13.23 mo, 6 to 28 mo)., RESULTS: IOP control, defined as IOP <= 21 mm Hg with or without antiglaucoma eye drops, was achieved in 82.2% of patients, and 58.8% were able to eliminate antiglaucoma eye drops. Mean surgical time was 9.76 +/- 2.60 and 6 +/- 0.81 minutes in patients with previous vitrectomy (4 cases). Postoperative complications included transiently increased IOP, transient hyphema, early postoperative hypotony (4 cases), and tube block by the vitreous (2 cases): 1 resolved by Nd:YAG and the other by second vitrectomy. No cases of tube or plate extrusion, plate migration, choroidal or retinal detachment, or vitreous hemorrhage were observed., CONCLUSIONS: These results are promising and demonstrate a safe and effective alternative to the traditional scleral suture. Our data suggest that Ahmed valve implantation through pars plana with cyanoacrylate is a safe and effective method for refractory glaucoma. Further studies are needed to confirm our observation.
Keywords: Adult; Aged; Aged, 80 and over; Anterior Chamber/su [Surgery]; Cyanoacrylates; Female; *Glaucoma/su [Surgery]; *Glaucoma Drainage Implants; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Pilot Projects; Postoperative Complications; Prospective Studies; *Prosthesis Implantation/mt [Methods]; *Suture Techniques; Time Factors; Tonometry, Ocular; Treatment Outcome

Demographics and behaviour of patients with contact lens-related infectious keratitis in singapore. - Lam, Janice S H; Tan, Grace; Tan, Donald T H; Mehta, Jodhbir S (Annals of the Academy of Medicine, Singapore, 2013)
INTRODUCTION: This study aims to identify the demographics and hygiene behaviours associated with contact lens (CL)-related microbial keratitis in Singapore., MATERIALS AND METHODS: The hygiene and social behaviours of lens wearers presenting with infectious keratitis in Singapore were examined using an externally validated questionnaire. Fifty-eight consecutive lens wearers who presented with infectious keratitis at Singapore National Eye Centre were surveyed using a self-administered questionnaire. Patients' demographics, CL-related behaviour, attitude to aftercare visits and microbial study results were collected and analysed., RESULTS: More than half (55%) of the patients surveyed were female, and the average age of the participants was 25.7 +/- 6.4 years. Ninety-six percent of participants used soft CL, with the majority wearing monthly disposable lenses (74.1%). Myopia was the commonest reason for use of CL. CL overwear (81%), sleeping (50.9%) and swimming (33%) with their CL were the major non-compliant behaviours discovered. When encountered with eye discomfort as a result of lens-related infective keratitis, 83% of patients sought the advice of general medical practitioners prior to presentation at the hospital. Many (59%) patients have encountered media coverage but only 24% had any behavioural change as a result. Many patients relied on the recommendations of eyecare practitioners when purchasing disinfecting solutions (26%) and other hygiene practices. Pseudomonas Aeruginosa was the most common organism grown in 22.4% of patients while 47% of patients were culture-negative., CONCLUSION: Inadequate lens cleaning, poor aftercare, sleeping and swimming with CL were the major non-compliant behaviours among participants, and these are significant factors when assessing risks in acquiring CL-related infectious keratitis. General eyecare practitioners are the first-line of contact in patients presenting with keratitis symptoms and play an important role in emphasising the need for regular aftercare and good hygiene practices to CL wearers.
Keywords: *Contact Lenses, Hydrophilic; Demography; Humans; Hygiene; *Keratitis; Singapore

[Fungal keratitis caused by Scedosporium apiospermum: first report from Turkey]. - Kalkan Akcay, Emine; Acikgoz, Ziya Cibali; Can, Mehmet Erol; Celikbilek, Nevreste; Dereli Can, Gamze; Cagil, Nurullah (Mikrobiyoloji bulteni, 2013)
Fungal keratitis, an eye infection with poor prognosis, is difficult to treat and can lead to loss of vision. Among filamentous fungi Scedosporium spp. rarely lead to fungal keratitis. Here we present a case of keratitis caused by Scedosporium apiospermum. A 61-year-old female patient was admitted to our hospital with the complaints of right eye pain and decreased vision after a foreign body trauma to the right eye. The patient was diagnosed as keratitis by biomicroscopic examination. Conjunctival swabs collected from both eyes were inoculated onto sheep blood agar, chocolate agar, eosin methylene blue agar and Sabouraud dextrose agar. Corneal scrapings from the right eye were inoculated onto the same solid media by "C-streak" method, and in brain-heart-infusion broth by immersion. While gram-stained smears of conjunctival swabs showed no significant finding, smears of corneal scrapings revealed abundant neutrophils and profuse septate hyphae. Fungal keratitis was diagnosed and topical enhanced amphotericin B (0.5 mg/ml) therapy was initiated with netilmicin sulfate and oxytetracycline HCl plus polymyxin B sulfate. At the 10th day of therapy a mold growth was detected in corneal scraping cultures and was identified microscopically as S.apiospermum. Based on the relevant literature, therapy was changed to enhanced topical voriconazole (2 mg/ml) applied hourly, plus systemic voriconazole administration. At the third day of treatment, reduction of epithelial defect and decline in the focus of keratitis were observed. In the following days, however, a progression occurred in the focus of keratitis and 5% natamycin ophthalmic suspension was added to the therapy. Since the patient did not respond to any of the medical treatments, therapeutic penetrating keratoplasty was planned; yet, the patient refused the operation and was discharged with her own request. As far as the local literature was concerned, this is the first report of keratitis caused by S.apiospermum in Turkey. Though a very rare causative agent of keratitis, S.apiospermum is generally resistant to antifungal therapy and often require surgical treatment. Especially in patients with predisposing factors, this organism should be kept in mind as a potential causative agent and relevant microbiological examinations should be performed.
Comment in (CIN)
Keywords: Antifungal Agents/ad [Administration & Dosage]; *Antifungal Agents/tu [Therapeutic Use]; Conjunctiva/mi [Microbiology]; Cornea/mi [Microbiology]; Disease Progression; Drug Resistance, Fungal; Drug Therapy, Combination; Eye Foreign Bodies/co [Complications]; Eye Infections, Fungal/dt [Drug Therapy]; *Eye Infections, Fungal/mi [Microbiology]; Eye Injuries/co [Complications]; Eye Injuries/et [Etiology]; Female; Humans; Keratitis/dt [Drug Therapy]; *Keratitis/mi [Microbiology]; Keratoplasty, Penetrating; Middle Aged; Natamycin/ad [Administration & Dosage]; *Natamycin/tu [Therapeutic Use]; Pyrimidines/ad [Administration & Dosage]; *Pyrimidines/tu [Therapeutic Use]; Scedosporium/de [Drug Effects]; *Scedosporium/ip [Isolation & Purification]; Treatment Refusal; Triazoles/ad [Administration & Dosage]; *Triazoles/tu [Therapeutic Use]; Turkey; Voriconazole

How ocular surface disease impacts the glaucoma treatment outcome. - Kastelan, Snjezana; Tomic, Martina; Metez Soldo, Kata; Salopek-Rabatic, Jasminka (BioMed research international, 2013)
The treatment goals for glaucoma are lowering the intraocular pressure and preservation of vision. Topical hypotensive drops are the standard form of therapy which is often associated with some symptoms of toxicity, ocular inflammation, allergy, or ocular surface disease (OSD). OSD is a common comorbidity in glaucoma patients, and its prevalence with glaucoma increases with age. Use of topical treatment could additionally increase symptoms of OSD mostly due to preservatives added to multidose medication bottles used to reduce the risk of microbial contamination. This toxicity has been particularly associated with BAK, the most commonly used preservative which damages conjunctival and corneal epithelial cells and significantly aggravates OSD symptoms. OSD adversely affects patients' quality of life causing discomfort and problems with vision which in turn may result in noncompliance, lack of adherence, and eventually visual impairment. In the management of glaucoma patients OSD symptoms should not be overlooked. If they are present, topical glaucoma treatment should be adapted by decreasing the amount of drops instilled daily, using BAK-free or preservative-free medication and lubricants if necessary. Awareness of the presence and importance of OSD will in turn improve patients' adherence and compliance and thus ultimately the preservation of long-term vision.
Keywords: Administration, Topical; Aged; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; *Eye/de [Drug Effects]; Eye/pa [Pathology]; Glaucoma/co [Complications]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pa [Pathology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Preservatives, Pharmaceutical/tu [Therapeutic Use]; *Preservatives, Pharmaceutical/to [Toxicity]; Treatment Outcome

The safety and efficacy of brinzolamide 1%/timolol 0.5% fixed combination versus dorzolamide 2%/timolol 0.5% in patients with open-angle glaucoma or ocular hypertension. - Sezgin Akcay, Betul Ilkay; Guney, Esra; Bozkurt, Kansu Tahir; Unlu, Cihan; Akcali, Gulunay (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2013)
PURPOSE: The aim of this study was to compare the intraocular pressure (IOP) lowering efficacy and to determine patient preference based on ocular discomfort with fixed combination brinzolamide/timolol and fixed combination dorzolamide/timolol in patients with open-angle glaucoma or ocular hypertension who required a change in therapy due to elevated IOP while receiving IOP-lowering medication., METHODS: This was a 3-month, randomized, double-blinded, active-controlled, parallel-group trial. Patients had open-angle glaucoma or ocular hypertension, which could not be controlled with monotherapy and were randomized to twice daily therapy with either brinzolamide 1%/timolol 0.5% or dorzolamide 2%/timolol 0.5%. IOP assessments were taken at 8 AM, 10 AM, and 4 PM at week 2 as well as at months 1, 2, and 3. Patients completed ocular discomfort assessments (based on stinging, burning, feeling of heat or warmth, or sharp pain) on their current IOP lowering therapy at baseline., RESULTS: Of the 114 patients enrolled, 57 received Brinz/Tim and 57 received Dorz/Tim twice daily. Both medications produced statistically relevant IOP reductions, which were similar in both groups at each visit. The IOP reductions with Brinz/Tim ranged from 6.42 to 9.74 mmHg (26.09%-37.46%), whereas Dorz/Tim produced mean IOP reductions ranging from 8.16 to 12.41 mmHg (31.19%-41.44%) (P>0.05). Brinz/Tim showed significantly less ocular irritation (0.5% vs. 15.7%, respectively; P=0.0004) than Dorz/Tim., CONCLUSIONS: Both Brinz/Tim and Dorz/Tim showed similar significant and clinically relevant IOP-lowering efficacy, whereas Brinz/Tim provided superior outcomes in terms of ocular comfort.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cross-Over Studies; Double-Blind Method; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Preference; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiazines/ad [Administration & Dosage]; Thiazines/ae [Adverse Effects]; *Thiazines/tu [Therapeutic Use]; Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

Obstacle avoidance, visual detection performance, and eye-scanning behavior of glaucoma patients in a driving simulator: a preliminary study. - Prado Vega, Rocio; van Leeuwen, Peter M; Rendon Velez, Elizabeth; Lemij, Hans G; de Winter, Joost C F (PloS one, 2013)
The objective of this study was to evaluate differences in driving performance, visual detection performance, and eye-scanning behavior between glaucoma patients and control participants without glaucoma. Glaucoma patients (n = 23) and control participants (n = 12) completed four 5-min driving sessions in a simulator. The participants were instructed to maintain the car in the right lane of a two-lane highway while their speed was automatically maintained at 100 km/h. Additional tasks per session were: Session 1: none, Session 2: verbalization of projected letters, Session 3: avoidance of static obstacles, and Session 4: combined letter verbalization and avoidance of static obstacles. Eye-scanning behavior was recorded with an eye-tracker. Results showed no statistically significant differences between patients and control participants for lane keeping, obstacle avoidance, and eye-scanning behavior. Steering activity, number of missed letters, and letter reaction time were significantly higher for glaucoma patients than for control participants. In conclusion, glaucoma patients were able to avoid objects and maintain a nominal lane keeping performance, but applied more steering input than control participants, and were more likely than control participants to miss peripherally projected stimuli. The eye-tracking results suggest that glaucoma patients did not use extra visual search to compensate for their visual field loss. Limitations of the study, such as small sample size, are discussed.
Keywords: Aged; *Automobile Driving; Case-Control Studies; Computer Simulation; Female; Fixation, Ocular; *Glaucoma/pp [Physiopathology]; Humans; Male; Middle Aged; *Psychomotor Performance; Reaction Time; Surveys and Questionnaires; *Visual Fields

[Glaucoma today: detection and therapeutic progress]. - Baudouin, Christophe; Denoyer, Alexandre; Rostene, William (Biologie aujourd'hui, 2013)
Second leading cause of blindness worldwide, glaucoma is an optic neuropathy related mainly but not exclusively to an increase of intraocular pressure. Angle closure glaucoma is related to a blockade of aqueous humor to the trabecular meshwork, whereas open-angle glaucoma is a degeneration of the trabecular meshwork, the filter that allows aqueous outflow from the eye. Many improvements have been made in terms of diagnosis, follow-up and treatments, although the treatment of glaucoma is restricted to control intraocular pressure, in order to prevent optic nerve degeneration or to stop the progression of the disease toward blindness. The first line therapy is based on topical medications that are administered for the whole life span. Although globally efficient, these treatments, and most likely the preservative included in the excipient to prevent bottle contamination, induce side effects in the long-term that may impair the quality of life, patient compliance or directly induce ocular surface changes like inflammatory cytokine release, or tear film destruction, with further dry eye disease and chronic inflammation. A large body of evidence has been accumulated, showing that benzalkonium chloride, the preservative mainly used, is toxic over the long run and plays a role in such ocular surface impairment. Therefore efforts have been made in the last decade to eliminate or replace this compound, providing safer therapies to the patients. Furthermore, the identification of chemokines as playing a role in the trabecular degeneration has open new directions for treating glaucoma. The blockade of one receptor of CXCL12 has been experimentally shown not only to decrease intraocular pressure but also to prevent trabecular cell degeneration. This is an innovative concept that could allow development of new treatments, more specifically targeting the disease at its onset, rather than attempting to reduce its progression in its later stages. Copyright © Societe de Biologie, 2013.
Keywords: Chemokines/tu [Therapeutic Use]; Diagnostic Techniques, Ophthalmological/td [Trends]; Drug Stability; *Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Mass Screening; Monitoring, Physiologic/mt [Methods]; Ophthalmic Solutions/st [Standards]; Ophthalmic Solutions/tu [Therapeutic Use]; Ophthalmologic Surgical Procedures/td [Trends]; Preservatives, Pharmaceutical/st [Standards]; Preservatives, Pharmaceutical/to [Toxicity]

Comparison of the efficacy and safety of fixed combination travoprost/timolol and dorzolamide/ timolol in patients with primary open-angle glaucoma and ocular hypertension. - Babic, Nikola; Andreic, Veljko; Miljkovic, Aleksandar; Grkovic, Desanka; Jovanovic, Predrag (Srpski arhiv za celokupno lekarstvo, 2013)
INTRODUCTION: Combining two medications in one bottle may improve compliance by reducing the time required to administer drops and the frequency of the total number of medication bottles., OBJECTIVE: To compare the efficacy of reduced intraocular pressure (IOP) and safety of fixed combination travoprost 0.004%/timolol 0.5% vs. fixed combination dorzolamide 2%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension., METHODS: Prospective randomized clinical study included 60 patients divided into 2 groups. Follow-up was done at day 14 and 45 and month 3. IOP measurements were taken at each follow-up examination at 8 am, 10 am and 4 pm., RESULTS: Both fixed combinations reduced IOP significantly compared to initial values at all follow-ups (p < 0.001). Mean pooled IOP at all visits and time points was slightly lower in the travoprost/timolol group compared with the dorzolamide/timolol group (16.13 mmHg vs. 16.15 mmHg). Mean IOP reduction from baseline ranged from -7.46 mmHg to -9.92 mmHg in the travoprost/timolol group and from -6.93 mmHg to -8.93 mmHg for the dorzolamide/timolol group. Mean (+/- standard error of the mean) reduction in diurnal LOP from baseline to 3rd month was 8.96 +/- 2.79 in the travoprost/timolol group versus 8.07 +/- 2.91 in patients receiving dorzolamide/timolol fixed combination (p = 0.196). The most frequent treatment-related adverse events were conjunctival hyperemia in the travoprost/timolol group, and dry eye and foreign body sensation in the dorzolamide/timolol group., CONCLUSION: Travoprost/timolol fixed combination was slightly more effective than dorzolamide/timolol fixed combination in reducing mean diurnal IOP. Travoprost/timolol group resulted in an IOP reduction for up to 1.07 mmHg higher than dorzolamide/timolol group. Both fixed combinations were well tolerated and safe.
Keywords: Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; *Antihypertensive Agents; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Drug Combinations; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle; Humans; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ep [Epidemiology]; *Ocular Hypertension; Patient Compliance; Prospective Studies; Sulfonamides/ae [Adverse Effects]; Sulfonamides/tu [Therapeutic Use]; *Sulfonamides; Thiophenes/ae [Adverse Effects]; Thiophenes/tu [Therapeutic Use]; *Thiophenes; Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]; *Timolol; Travoprost

Psychometrics of a new questionnaire to assess glaucoma adherence: the Glaucoma Treatment Compliance Assessment Tool (an American Ophthalmological Society thesis). - Mansberger, Steven L; Sheppler, Christina R; McClure, Tina M; Vanalstine, Cory L; Swanson, Ingrid L; Stoumbos, Zoey; Lambert, William E (Transactions of the American Ophthalmological Society, 2013)
PURPOSE: To report the psychometrics of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), a new questionnaire designed to assess adherence with glaucoma therapy., METHODS: We developed the questionnaire according to the constructs of the Health Belief Model. We evaluated the questionnaire using data from a cross-sectional study with focus groups (n = 20) and a prospective observational case series (n=58). Principal components analysis provided assessment of construct validity. We repeated the questionnaire after 3 months for test-retest reliability. We evaluated predictive validity using an electronic dosing monitor as an objective measure of adherence., RESULTS: Focus group participants provided 931 statements related to adherence, of which 88.7% (826/931) could be categorized into the constructs of the Health Belief Model. Perceived barriers accounted for 31% (288/931) of statements, cues-to-action 14% (131/931), susceptibility 12% (116/931), benefits 12% (115/931), severity 10% (91/931), and self-efficacy 9% (85/931). The principal components analysis explained 77% of the variance with five components representing Health Belief Model constructs. Reliability analyses showed acceptable Cronbach's alphas (>.70) for four of the seven components (severity, susceptibility, barriers [eye drop administration], and barriers [discomfort]). Predictive validity was high, with several Health Belief Model questions significantly associated (P <.05) with adherence and a correlation coefficient (R (2)) of .40. Test-retest reliability was 90%., CONCLUSION: The GTCAT shows excellent repeatability, content, construct, and predictive validity for glaucoma adherence. A multisite trial is needed to determine whether the results can be generalized and whether the questionnaire accurately measures the effect of interventions to increase adherence.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Attitude to Health; Cross-Sectional Studies; Female; Focus Groups; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Principal Component Analysis; Prospective Studies; Psychometrics; Reproducibility of Results; *Surveys and Questionnaires/st [Standards]

A randomized, prospective study of bimatoprost 0.01% or travoprost/timolol in patients previously treated with latanoprost and timolol to reduce intraocular pressure. - Nixon, Donald R (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2013)
PURPOSE: To compare the efficacy and safety of bimatoprost 0.01% with the fixed combination travoprost 0.004%/timolol 0.5% in subjects with stable intraocular pressure (IOP) control on latanoprost and timolol., METHODS: This was a randomized, prospective, investigator masked, crossover study comparing bimatoprost 0.01% with travoprost/timolol in 40 subjects diagnosed with primary open-angle glaucoma. Subjects were randomized to bimatoprost 0.01% qpm or travoprost/timolol qam and followed for 12 weeks, at which time they were crossed over to the alternate medication and followed for another 12 weeks. Intraocular pressure and hyperemia (rated on a standardized, 5-point photographic scale) were evaluated as change from baseline to 12 weeks following each therapy, and subject preference was elicited at the end of the study., RESULTS: Both treatments were well tolerated and the majority of patients achieved effective IOP control relative to baseline. After 12 weeks of treatment, mean reductions from baseline IOP were -1.68 mmHg OD (right eye) and -1.58 mmHg OS (left eye) with bimatoprost and -0.45 mmHg OD and -0.53 mmHg OS with travoprost/timolol, although the differences between drugs were not statistically significant. Hyperemia scores were significantly higher with the fixed combination of travoprost/timolol than bimatoprost 0.01% as measured at 8 am (both P<0.01). Subject preference at the end of the study was more than 3 to 1 in favor of bimatoprost, with most citing greater tolerability., CONCLUSION: Bimatoprost 0.01% and travoprost/timolol are both effective at reducing IOP in subjects with stable IOP control on latanoprost and timolol, but bimatoprost 0.01% is associated with less hyperemia.
Keywords: Aged; Aged, 80 and over; Amides/ad [Administration & Dosage]; Amides/ae [Adverse Effects]; *Amides/tu [Therapeutic Use]; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Cross-Over Studies; Drug Combinations; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; Hyperemia/ep [Epidemiology]; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Patient Preference; Prospective Studies; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Single-Blind Method; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Travoprost; Treatment Outcome

Amniotic membrane corneal buffering during plaque radiation therapy for anterior uveal melanoma. - Semenova, Ekaterina; Finger, Paul T (Ophthalmic surgery, lasers & imaging retina, 2013)
BACKGROUND AND OBJECTIVE: To report results after amniotic membrane-protected epicorneal plaque brachytherapy for anterior uveal melanoma., PATIENTS AND METHODS: Sixty-three patients were treated with epicorneal radioactive plaques for 5 to 7 days. To prevent corneal damage, eye irritation, and reduce pain, 0.1-mm-thick fresh-frozen amniotic membrane grafts were interposed between the plaque and the cornea during brachytherapy. All amniotic membranes were removed at the end of brachytherapy. Patients were questioned about subjective comfort during treatment and observed for clinical outcomes., RESULTS: Only 4.8% of patients reported pain during brachytherapy. Short-term brachytherapy-related corneal complications including mild keratopathy, corneal epithelial defect, and edema were noted in 41.3% of patients. All corneal complications resolved within 2 weeks. No patients developed corneal melting or opacity during a mean follow-up of 28 months. Local tumor control was achieved in 95.2%., CONCLUSION: Amniotic membrane-buffered epicorneal plaque therapy provided comfort and excellent local tumor control. Copyright 2013, SLACK Incorporated.
Keywords: Adult; Aged; Aged, 80 and over; *Amnion/tr [Transplantation]; Brachytherapy/ae [Adverse Effects]; *Brachytherapy/mt [Methods]; *Cornea/re [Radiation Effects]; Cornea/su [Surgery]; Female; Humans; Male; *Melanoma/rt [Radiotherapy]; Middle Aged; Patient Satisfaction; *Radiation Injuries/pc [Prevention & Control]; *Radiation Protection/mt [Methods]; *Uveal Neoplasms/rt [Radiotherapy]; Visual Acuity

Evaluation of eye drop administration technique in patients with glaucoma or ocular hypertension. - Schwartz, Gail F; Hollander, David A; Williams, Julia M (Current medical research and opinion, 2013)
OBJECTIVE: To evaluate eye drop administration by patients at multiple visits in the setting of a randomized controlled trial., STUDY DESIGN AND METHODS: Patients with glaucoma or ocular hypertension were randomized to 12 weeks of treatment with topical ocular hypotensive medication in a multicenter, investigator-masked trial. At baseline, patients were given a questionnaire for self-assessment of difficulty with drop administration. At baseline and 12 weeks, patients demonstrated drop instillation using a bottle of artificial tears., MAIN OUTCOME MEASURES: Patient self-assessment of difficulty with drop administration and observed patient difficulty with drop administration, defined as bottle touching eye/adnexa, drop missing the ocular surface, or administering more than 1 drop., RESULTS: Of 164 enrolled patients, 50% had previously been treated with ocular hypotensive medication for >=3 years. Only 11.4% of patients reported difficulty with eye drop administration at study entry. At baseline, 18.2% of patients touched their eye/adnexa with the bottle and 10.3% missed the eye. At 12 weeks, 18.5% and 8.6% of patients, respectively, had similar difficulties. Overall, difficulty with drop instillation was observed in 42.1% of patients. Difficulty at both visits was seen in 35.3% of patients who reported difficulty at entry and in 17.2% of patients who denied difficulty. The relative risk of demonstrating difficulty at either visit was 2.0 times greater for patients who self-reported difficulty at study entry (P = 0.004). The relative risk of demonstrating difficulty at week 12 was 3.8 times greater for patients with observed difficulty at baseline (P < 0.001). Limitations of the study design included self-administration of drops to the eye of the patient's choice and observation in an office setting., CONCLUSIONS: Patients with experience instilling topical glaucoma medications continue to have difficulties with eye drop administration, including patients who do not self-report difficulty. The risk of difficulty with eye drop administration is increased in patients who self-report difficulty and in patients who have been previously observed to have difficulty., CLINICAL TRIAL REGISTRY NUMBER: NCT01253902.
Keywords: *Administration, Ophthalmic; Aged; Caregivers; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Medication Adherence; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ad [Administration & Dosage]; Self Administration; Self-Assessment; Surveys and Questionnaires

Patient-related and system-related barriers to glaucoma follow-up in a county hospital population. - Lee, Bradford W; Murakami, Yohko; Duncan, Martin T; Kao, Andrew A; Huang, Jehn-Yu; Lin, Shan; Singh, Kuldev (Investigative ophthalmology & visual science, 2013)
PURPOSE: To identify the barriers to glaucoma follow-up and to assess how ethnicity influences the effect of such barriers among patients in a county hospital population., METHODS: This cross-sectional study included 152 patients, 76 with poor clinic follow-up and 76 with good clinic follow-up, who were recruited at the San Francisco General Hospital glaucoma clinic as part of a case-control study. All subjects were required to be established patients with glaucoma initially seen and diagnosed in the clinic at least 1 year before enrollment. An oral questionnaire pertaining to the barriers to follow-up for glaucoma, as well as patient ethnicity, was administered to all participating subjects. The main outcome measure was the prevalence of significant barriers to follow-up, both overall and stratified by ethnicity., RESULTS: The most prevalent barriers to follow-up included long clinic waiting times (75%), appointment scheduling difficulties (38%), the effect of other medical or physical comorbidities (29%), and difficulties related to medical interpretation (23%). While several barriers were cited as being important across different ethnicities, Latinos and Asian-Pacific Islanders were particularly affected by difficulties related to medical interpretation (P = 0.0001) and long waiting times in the clinic (P = 0.048)., CONCLUSIONS: Understanding patient-reported barriers to glaucoma follow-up and their variation based on ethnicity may give providers insight as to why patients do not adhere to follow-up recommendations. Strategies to improve follow-up may include reduced clinic wait times, simplified appointment scheduling, and provision of appropriate education and counseling regardless of the patient's native language and ethnicity.
Keywords: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; *Delivery of Health Care/es [Ethics]; *Ethnic Groups; Female; Follow-Up Studies; Glaucoma/eh [Ethnology]; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; *Hospitals, County/es [Ethics]; Humans; Male; Middle Aged; Morbidity/td [Trends]; *Patient Compliance/sn [Statistics & Numerical Data]; *Physician-Patient Relations/es [Ethics]; Retrospective Studies; San Francisco/ep [Epidemiology]; Surveys and Questionnaires

Postoperative trendelenburg position for graft adherence after descemet stripping automated endothelial keratoplasty. - Belkin, Avner; Nesher, Ronit; Segev, Fani (Cornea, 2013)
PURPOSE: To present a case of repeated graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) in a post-trabeculectomy eye and to suggest a simple postoperative maneuver to minimize this occurrence., METHODS: A 61-year-old woman presented to our cornea clinic with pseudophakic bullous keratopathy in her left eye 13 years after a trabeculectomy had been performed. After the DSAEK was performed, repeated graft dislocations were observed. When air was seen in the filtering bleb in the immediate postoperative period, it was assumed that it had escaped from the air bubble remaining in the anterior chamber at the end of the surgery. The patient was thus placed in the Trendelenburg position immediately after performing a rebubbling procedure to retain the air bubble in the anterior chamber and away from the filtering bleb., RESULTS: The corneal graft remained centered and clear at postoperative day 1 and remained so at the last follow-up visit 8 months after the surgery had taken place. The patient's intraocular pressure was well controlled with a functional filtering bleb., CONCLUSIONS: Postoperative Trendelenburg positioning is an easily applied maneuver that may promote graft adherence after performing a DSAEK in eyes that have undergone glaucoma surgery.
Keywords: *Descemet Stripping Endothelial Keratoplasty/mt [Methods]; Female; *Glaucoma/su [Surgery]; *Graft Rejection/pc [Prevention & Control]; *Head-Down Tilt; Humans; Middle Aged; Patient Positioning/mt [Methods]; Postoperative Period; Treatment Outcome

Eye drop instillation technique in patients with glaucoma. - Tatham, A J; Sarodia, U; Gatrad, F; Awan, A (Eye (London, England), 2013)
AIMS: To evaluate the technique of eye drop instillation in patients with glaucoma and assess factors associated with a good technique., METHODS: A cross-sectional observational study of 85 participants using self-administered topical medication for glaucoma or ocular hypertension. Patients were asked to demonstrate how they normally instil eye drops using a 5-ml bottle of sterile artificial tear solution. The procedure was recorded and assessed by two masked graders. Whether the patient had been previously shown how to instil drops, the number of eye medications used, and self-perceived difficulty of using drops were also recorded. Univariable logistic regression was performed to relate each variable to drop technique and variables with P<0.2 were included in a multivariable logistic regression analysis., RESULTS: 54.1% (46/85) of patients had a poor drop technique, 11.8% (10/85) missed the eye, 15.3% (13/85) touched the tip of the bottle to the bulbar conjunctiva or cornea, and 27.1% (23/85) touched the eyelid or lashes with the bottle tip. 81.2% (69/85) could not recall being shown how to instil eye drops. In the multivariable model, previous instruction regarding drop instillation technique was significantly associated with good technique (adjusted OR=8.17, 95% CI 2.02-33.05, P=0.003) and increasing age was associated with poor technique (adjusted OR=0.95, 95% CI 0.91-0.99, P=0.017)., CONCLUSIONS: Education relating to eye drop instillation technique is significantly associated with a patient's ability to instil drops correctly. The assessment of a patient's ability to instil eye drops correctly should be a routine part of the glaucoma examination.
Keywords: Aged; Aged, 80 and over; Analysis of Variance; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Humans; Logistic Models; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Patient Education as Topic/st [Standards]; Self Care

Managing glaucoma in Lagos State, Nigeria - availability of Human resources and equipment. - Adekoya, B J; Shah, S P; Adepoju, F G (The Nigerian postgraduate medical journal, 2013)
AIMS AND OBJECTIVES: There is a paucity of data onthe human resourcesand ophthalmic equipmentavailable for the diagnosis and management of glaucoma in Nigeria. This study is aimed at describing the ophthalmic human resources, as well as available and functioning equipment used in diagnosing and managing glaucoma in Lagos State, Nigeria., MATERIALS AND METHODS: This was a prospective multicentre cross sectional study.Data on human resources and equipmentavailable were collected from all government tertiaryand secondary health institutions in the state. One large-practice private eye hospital in the state was included for comparative purposes., RESULTS: The average number of ophthalmologists per hospital was 1.3 and 4.5 in the secondary and tertiary centres respectively, with overall ophthalmologists to population ratio of 1:400,000, and ophthalmic nurses to population ratio of 1:150,000. There were only 2 full time low vision therapists and 3 equipment technicians. Only the private hospital had a dedicated patient counsellor and an eye unit manager. 64% of ophthalmic equipment in the government sector were functioning compared with 100% in the private centre. Overall, equipment to population ratios were; slit lamp=1:517,000, 78/90D lens=1:1,487,000, tonometer=1:660,000, visual field analyser=1:2,380,000, and pachymeter=1:5,950,000., CONCLUSIONS: Current population ratios for ophthalmologists and ophthalmic nurses in the state meets vision 2020 recommendations, but there are shortages of other key human resources such as equipment technicians, low vision therapists and patient counsellors. In addition, equipment required for the management of glaucoma wereinadequate, not available or not functioning. Findings from this study suggest that there is an urgent need for increased government funding to glaucoma services in Lagos State.
Keywords: Cross-Sectional Studies; *Diagnostic Equipment/sn [Statistics & Numerical Data]; *Diagnostic Techniques, Ophthalmological/is [Instrumentation]; Glaucoma/di [Diagnosis]; Glaucoma/ec [Economics]; *Glaucoma; *Health Care Rationing/sn [Statistics & Numerical Data]; Health Services Needs and Demand; *Health Workforce/sn [Statistics & Numerical Data]; Humans; Nigeria; Ophthalmology/og [Organization & Administration]; *Ophthalmology; Prospective Studies; Staff Development/og [Organization & Administration]

Effect of preservative-free tafluprost on keratocytes, sub-basal nerves, and endothelium: a single-blind one-year confocal study on naive or treated glaucoma and hypertensive patients versus a control group. - Rossi, Gemma Caterina Maria; Blini, Mirella; Scudeller, Luigia; Ricciardelli, Gabriella; Depolo, Laura; Amisano, Alberto; Bossolesi, Laura; Pasinetti, Gian Maria; Bianchi, Paolo Emilio (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2013)
PURPOSE: To record the impact of preservative-free Tafluprost on corneal status examined by in vivo confocal microscopy., METHODS: A prospective cohort study on consecutive naive or previously treated patients with a new prescription of preservative-free Tafluprost. All subjects underwent a complete ophthalmic examination [comprehensive of intraocular pressure (IOP) and central corneal thickness (CCT) measurements], and an in vivo corneal confocal microscopy evaluation, at baseline and 12 months later. A healthy control group was selected and examined at the same time., RESULTS: Seventy-five subjects (16 controls, 20 naive, and 39 treated) were enrolled. At baseline, IOP was 16 (13.8-18.6), 21.5 (18-23.7), and 18 (16-22) mmHg, (P=0.01); and CCT did not differ among the groups (P=0.25). Epithelial cells, keratocyte activation, a number of sub-basal nerves, and the grade of nerve tortuosity were similar (P=0.233, 0.11, 0.417, and 0.05, respectively), in naive and controls, while previously treated patients had significantly less epithelial cells and sub-basal corneal nerves (P<0.0001), keratocyte activation, increased number of bead-like formations, and nerve tortuosity (P<0.0001). At month 12, IOP decreased in both patient groups (P<0.001); CCT did not change. Previously treated patients showed an improvement in confocal parameters: increased epithelial cells (P=0.0006), reduced keratocyte activation (P=0.003), increased number of corneal nerves (P=0.0004), decreased number of bead-like formations (P=0.0013), and nerve tortuosity (P=0.0008). Naive patients did not show significant changes., CONCLUSION: The study confirmed the efficacy of preservative-free Tafluprost in reducing IOP, and underlined the drug's safety in naive glaucoma patients with regard to corneal status. In the balance between efficacy and tolerability, formulations with low cytotoxicity may ensure fewer side effects, with higher tolerability and better compliance.
Keywords: Administration, Ophthalmic; Aged; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Case-Control Studies; Cohort Studies; Cornea/de [Drug Effects]; Cornea/ir [Innervation]; Cornea/me [Metabolism]; Corneal Keratocytes/de [Drug Effects]; Corneal Keratocytes/me [Metabolism]; Endothelium, Corneal/de [Drug Effects]; Endothelium, Corneal/me [Metabolism]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Microscopy, Confocal; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Prospective Studies; Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F/ae [Adverse Effects]; *Prostaglandins F/tu [Therapeutic Use]; Single-Blind Method

Adverse events during 2 years of daily wear of silicone hydrogels in children. - Sankaridurg, Padmaja; Chen, Xiang; Naduvilath, Thomas; Lazon de la Jara, Percy; Lin, Zhi; Li, Li; Smith, Earl L 3rd; Ge, Jian; Holden, Brien A (Optometry and vision science : official publication of the American Academy of Optometry, 2013)
PURPOSE: Type and incidence of adverse events and rate of discontinuations for 2 years of daily wear with silicone hydrogel contact lenses in Chinese children with myopia., METHODS: Two hundred forty children aged 7 to 14 years were enrolled in a prospective randomized clinical trial from November 2008 to April 2009. Children with myopia of up to -3.50 diopters (D) spherical equivalent with astigmatism less than or equal to -0.75 D were randomized to one commercial and three experimental lens designs of Lotrafilcon B silicone hydrogel lenses (four groups) used bilaterally on a daily wear, monthly replacement schedule. The main outcome measures were incidence per 100 patient-years (incidence, in percentage) of adverse events and rate of discontinuations., RESULTS: There were no events of microbial keratitis. Fifty-five adverse events (incidence, 14.2%) were seen. There were also 12 recurrent events. The type and incidence percentage were contact lens papillary conjunctivitis (16 events, 4.1%), superior epithelial arcuate lesions (SEALs, six events, 1.5%), corneal erosions (eight events, 2.1%), infiltrative keratitis (five events, 1.3%), asymptomatic infiltrative keratitis (seven events, 1.8%), and asymptomatic infiltrates (13 events, 3.42%). There were differences in the incidence of SEALs between groups (p = 0.023), with the incidence of SEALs being greater with one of the experimental designs. No event resulted in any vision loss. Seventy participants (29.2%) discontinued, with one-third (26 participants, 10.8%) occurring in the first month of lens wear. Discomfort and non-lens-related reasons such as safety concern and disinterest were frequently cited reasons for discontinuations., CONCLUSIONS: Adverse events with daily wear of silicone hydrogels in children were mainly mechanical in nature, and significant infiltrative events were few. The large number of dropouts in the early days of lens wear and their reasons for discontinuation suggest that adaptation and patient motivation are critical for survival in lens wear.
Keywords: Adolescent; *Astigmatism/th [Therapy]; Child; Conjunctivitis, Allergic/ep [Epidemiology]; Conjunctivitis, Allergic/et [Etiology]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Corneal Diseases/ep [Epidemiology]; Corneal Diseases/et [Etiology]; Female; Humans; *Hydrogels; Incidence; Male; *Myopia/th [Therapy]; Patient Dropouts; Prospective Studies; Prosthesis Design; *Silicones; Time Factors

Bridging the language barrier in health awareness. - Opoku, Kennedy; Murdoch, Ian E (JAMA ophthalmology, 2013)
Keywords: *Communication Barriers; Ghana; *Glaucoma/di [Diagnosis]; *Health Knowledge, Attitudes, Practice; *Health Services Accessibility; Humans; *Language; Ophthalmology; Patient Acceptance of Health Care

Clinical characteristics and outcomes of patients admitted with presumed microbial keratitis to a tertiary medical center in Israel. - Lavinsky, Fabio; Avni-Zauberman, Noah; Barequet, Irina S (Arquivos brasileiros de oftalmologia, 2013)
PURPOSES: Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment. The objective of this study is to describe the clinical characteristics and outcomes of patients with presumed microbial keratitis admitted to The Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel., METHODS: A cross-sectional study was conducted, in which the medical records of patients with presumed microbial keratitis admitted during a period of 3 years were reviewed., RESULTS: Keratitis was diagnosed in 276 patients (51% males and 48.9% females). The mean age was 39.29 +/- 22.30 years. The hospital length of stay ranged from 1 to 65 days (mean 5.69 +/- 5.508). Fortified antibiotics were still used at discharge in 72% of the cases. Overall visual acuity improved significantly from the time of admission to the 1st-week follow up visit showing a p<0.001 on the Wilcoxon signed ranks test. Contact lens wearing was present in 36.1% of the patients, although there was no significant relation with severity of the presentation and visual outcome (p>0.05). The degree of hypopyon and cells in the anterior chamber was significantly related to the hospital length of stay (r Spearman=0.31; p<0.001 and r Spearman=0.21; p<.001, respectively) as well as to a worse visual outcome (r Spearman=0.32; p<0.01 and r Spearman=0.18; p=0.01, respectively). Of all patients, 2.3% required an urgent therapeutic penetrating keratoplasty, and 1% underwent evisceration. There was no enucleation., CONCLUSION: Treating keratitis aggressively and assuring patient compliance is imperative for a good final visual outcome. Inpatient treatment may have a positive impact on this outcome.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Contact Lenses; Cross-Sectional Studies; Eye Infections, Bacterial/di [Diagnosis]; Eye Infections, Bacterial/th [Therapy]; Eye Infections, Fungal/di [Diagnosis]; Eye Infections, Fungal/th [Therapy]; Female; Humans; Infant; Infant, Newborn; Israel; *Keratitis/di [Diagnosis]; Keratitis/mi [Microbiology]; *Keratitis/th [Therapy]; Length of Stay; Male; Middle Aged; Tertiary Care Centers; Time Factors; Treatment Outcome; Visual Acuity; Young Adult

Comparison of automated and manual perimetry in patients with blepharoptosis. - Alniemi, Saba T; Pang, Noelene K; Woog, John J; Bradley, Elizabeth A (Ophthalmic plastic and reconstructive surgery, 2013)
PURPOSE: To compare Goldmann manual perimetry and Humphrey automated perimetry for sensitivity in detecting visual field loss, efficiency, and patient preference., METHODS: This prospective study compared Goldmann manual perimetry and Humphrey automated perimetry testing techniques in 20 consecutive preoperative blepharoptosis patients with unilateral or bilateral blepharoptosis with a marginal reflex distance of <=+2.5 mm, no dermatochalasis overhanging the eyelid margin, and no superior visual field defects due to glaucoma, neurologic disease, or other causes. Main outcome measures included efficiency, patient preference, and sensitivity in detecting visual field loss. Institutional review board approval was obtained prior to the start of the study., RESULTS: Goldmann perimetry had significantly shorter examination times (-DELTA6.4 minutes, 95% confidence interval: 4.5-8.3, p < 0.001) and was preferred by most patients (70%). There was no statistically significant difference between the 2 techniques in detecting superior visual field loss at 90degree meridian., CONCLUSIONS: Goldmann manual perimetry for assessing visual field loss in blepharoptosis patients is more efficient than Humphrey automated perimetry and is preferred by patients. Both techniques are sensitive in detecting ptosis-related visual field loss.
Keywords: Adult; Aged; Aged, 80 and over; *Blepharoptosis/co [Complications]; Female; Humans; Male; Middle Aged; Patient Preference; Prospective Studies; Sensitivity and Specificity; *Vision Disorders/di [Diagnosis]; Vision Disorders/et [Etiology]; *Visual Field Tests/mt [Methods]; *Visual Fields; Young Adult

Ocular hypertension after pediatric cataract surgery: baseline characteristics and first-year report. - Lin, Haotian; Chen, Weirong; Luo, Lixia; Zhang, Xinyu; Chen, Jingjing; Lin, Zhuoling; Qu, Bo; Zhan, Jiao; Zheng, Danying; Zhong, Xiaojian; Tian, Zhen; Liu, Yizhi; et al. (PloS one, 2013)
Monitoring intraocular pressure (IOP) is essential for pediatric cataract treatment but always difficult due to lack of cooperation in young children. We present the baseline characteristics and the first-year results of a long-term prospective cohort study, which are aimed to determine the relationship of the incidence of ocular hypertension (OH) in children after cataract surgery during the first-year period and the risk of developing late-onset glaucoma. Children were included with the following criteria: they were <=10 years old and scheduled to undergo cataract surgery with/without intraocular lens implantation; they were compliant with our follow-up protocol, which included monitoring IOP using a Tono-Pen under sedation or anesthesia. Incidence of OH, peak OH value, OH onset time and OH duration within a 12-month period following surgery were measured. In brief, 206 patients (379 eyes) were included and OH developed in 66 of 379 (17.4%) eyes. The mean follow-up period was 14.0+/-3.2 months (median, 12 months; range, 10-16 months). Moreover, 33 of 196 (16.8%) aphakic eyes and 33 of 183 (18.0%) IOL eyes were diagnosed with OH. The peak OH onset times were at 1-week (34/66, 51.5%) and 1-month (14/66, 21.2%) appointments postsurgery. The peak IOP value in the OH eyes was 29.9+/-7.5 mmHg (median, 29 mmHg; range, 21-48 mmHg). The duration of OH was 30.9+/-31.2 days (median, 30 days; range, 3-150 days). OH recurred in 13 eyes with a history of OH diagnosed within 1 month postsurgery (13/54, 24.1%), which needed temporary or long term use of antiglaucoma medications. In conclusion, the incidence of OH in children after cataract surgery was 17.4% during the first-year period. Children who have suffered elevated IOP in the first year after cataract surgery should be followed closely to determine if there is an increased risk of developing late-onset glaucoma.
Keywords: Adolescent; *Cataract Extraction/ae [Adverse Effects]; Child; Child, Preschool; Female; Humans; Male; *Ocular Hypertension/pp [Physiopathology]

What do patients with glaucoma think about personal health records?. - Somner, John E A; Sii, Freda; Bourne, Rupert; Cross, Vinette; Shah, Peter (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2013)
PURPOSE: Putting patients in control of their records is one way of promoting patient centred care and patients with chronic health problems may benefit most from personal health records (PHRs). Glaucoma management is often complicated by incomplete understanding and poor adherence to treatment, two areas which a PHR may help to address. This study aimed to discover what patients with glaucoma think about PHRs and what type of information a glaucoma PHR should contain., METHODS: A consultation exercise using a focus group approach involving 71 participants was undertaken to discuss if a PHR would be useful and what it would be like. Narrative data were collected through written notes and an online forum in addition to transcripts of the focus group feedback session and individual interviews. Recordings were transcribed and analysed with simple thematic analysis facilitated by NVivo software (www.qsrinternational.com)., RESULTS: The consultation exercise indicated enthusiasm for PHRs. Views varied on the best format, some participants strongly favoured electronic records and others preferred a low-tech, paper based format. A comprehensive dataset of 24 items was developed which highlighted areas which are not covered by existing guidance to developers. A model for how PHRs may be useful as an education tool in clinical practice was devised., CONCLUSIONS: Asking patients what they thought about a glaucoma PHR raised challenging questions and adds perspective to predominantly clinician led development. Listening and responding to such viewpoints is fundamental to developing more patient centred PHRs which may act both as health record and self-care educational tool to promote more holistic, efficient glaucoma care. Copyright © 2013 The Authors Ophthalmic & Physiological Optics © 2013 The College of Optometrists.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Focus Groups; *Glaucoma; *Health Knowledge, Attitudes, Practice; *Health Records, Personal/px [Psychology]; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Young Adult

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma. - Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap (Ophthalmology, 2013)
PURPOSE: To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients., DESIGN: Retrospective chart review., PARTICIPANTS: One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center., METHODS: Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines., MAIN OUTCOME MEASURES: Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency., RESULTS: The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts., CONCLUSIONS: Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Academies and Institutes/st [Standards]; *Continuity of Patient Care/sn [Statistics & Numerical Data]; *Delivery of Health Care/st [Standards]; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; *Guideline Adherence/sn [Statistics & Numerical Data]; Humans; *Internship and Residency/sn [Statistics & Numerical Data]; Male; Ophthalmology/ed [Education]; *Ophthalmology/st [Standards]; Patient Education as Topic; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Societies, Medical/st [Standards]; United States

Long-term Supplementation With n-6 and n-3 PUFAs Improves Moderate-to-Severe Keratoconjunctivitis Sicca: A Randomized Double-Blind Clinical Trial. - Sheppard, John D Jr; Singh, Ruhi; McClellan, Andrew J; Weikert, Mitchell P; Scoper, Stephen V; Joly, Thomas J; Whitley, Walter O; Kakkar, Ekta; Pflugfelder, Stephen C (Cornea, 2013)
PURPOSE: Supplementation with gamma-linolenic acid (GLA) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) has been found to decrease the production of disease-relevant inflammatory mediators that are implicated in the pathogenesis of chronic dry eye. This study evaluated the effect of a supplement containing both GLA and n-3 PUFAs on signs and symptoms of moderate-to-severe keratoconjunctivitis sicca in postmenopausal patients., METHODS: This multicenter, double-masked placebo-controlled clinical trial enrolled 38 patients (both eyes) with tear dysfunction who were randomized to supplemental GLA + n-3 PUFAs or placebo for 6 months. Disease parameters, including Ocular Surface Disease Index, Schirmer test, tear breakup time, conjunctival fluorescein and lissamine green staining, and topographic corneal smoothness indexes (surface asymmetry index and surface regularity index), were assessed at baseline and at 4, 12, and 24 weeks. The intensity of dendritic cell CD11c integrin and HLA-DR expression was measured in conjunctival impression cytologies., RESULTS: The Ocular Surface Disease Index score improved with supplementation and was significantly lower than placebo (21 +/- 4 vs. 34 +/- 5) after 24 weeks (P = 0.05, n = 19 per group). The surface asymmetry index was significantly lower in supplement-treated subjects (0.37 +/- 0.03, n = 15) than placebo (0.51 +/- 0.03, n = 16) at 24 weeks (P = 0.005). Placebo treatment also significantly increased HLA-DR intensity by 36% +/- 9% and CD11c by 34% +/- 7% when compared with supplement treatment (n = 19 per group, P = 0.001, 24 weeks). Neither treatment had any effect on tear production, tear breakup time, or corneal or conjunctival staining., CONCLUSIONS: Supplemental GLA and n-3 PUFAs for 6 months improved ocular irritation symptoms, maintained corneal surface smoothness, and inhibited conjunctival dendritic cell maturation in patients with postmenopausal keratoconjunctivitis sicca.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00883649.
Keywords: Adult; Aged; Aged, 80 and over; CD11c Antigen/me [Metabolism]; Conjunctiva/ph [Physiology]; Corneal Topography; Double-Blind Method; Fatty Acids, Omega-3/ae [Adverse Effects]; *Fatty Acids, Omega-3/tu [Therapeutic Use]; Female; Fluorescein/ch [Chemistry]; HLA-DR Antigens/me [Metabolism]; Humans; *Keratoconjunctivitis Sicca/dt [Drug Therapy]; Keratoconjunctivitis Sicca/me [Metabolism]; Lissamine Green Dyes/ch [Chemistry]; Male; Middle Aged; Ophthalmic Solutions; Patient Compliance; Staining and Labeling/mt [Methods]; Tears/ph [Physiology]; Visual Acuity/ph [Physiology]; gamma-Linolenic Acid/ae [Adverse Effects]; *gamma-Linolenic Acid/tu [Therapeutic Use]

Glaucoma medication adherence among African Americans: program development. - Dreer, Laura E; Girkin, Christopher A; Campbell, Lisa; Wood, Andy; Gao, Liyan; Owsley, Cynthia (Optometry and vision science : official publication of the American Academy of Optometry, 2013)
PURPOSE: To elucidate barriers and facilitators related to glaucoma medication adherence among African Americans (AA) with glaucoma and to elicit input from a community-based participatory research team to guide the development of a culturally informed health promotion program for improving glaucoma medication adherence among AAs., METHODS: The nominal group technique (NGT), a highly structured focus group methodology, was implemented with 12 separate groups of AA patients with glaucoma (N = 89) to identify barriers and facilitators related to glaucoma medication usage. Participant rank-ordering votes were summed across groups and categorized into themes. Next, an individually and culturally targeted health promotion program promoting appropriate medication adherence was developed based on focus group results and input from a community-based participatory research team., RESULTS: The top five barriers included problems with forgetfulness, side effects, cost/affordability, eyedrop administration, and the eyedrop schedule. The most salient top five facilitators were fear or thoughts about the consequences of not taking eyedrops; use of memory aids, cues, or strategies; maintaining a regular routine or schedule for eyedrop administration; ability to afford eyedrops; and keeping eyedrops in the same area. The resulting health promotion program was based on a multicomponent empowerment framework that included glaucoma education, motivational interviewing, and problem-solving training to improve glaucoma medication adherence., CONCLUSIONS: Barriers and facilitators related to glaucoma medication adherence among AAs are multifactorial. Based on the NGT themes and input from the community-based participatory research team, a culturally informed health promotion program was designed and holds great promise for improving medication adherence among this vulnerable population.
Keywords: Adult; *African Americans/sn [Statistics & Numerical Data]; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Focus Groups; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; Health Promotion; Humans; Male; Medication Adherence/px [Psychology]; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Program Development

[Avoidance and management of complications in laser in situ keratomileusis]. - Kohnen, T; Klaproth, O K (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2013)
Laser in situ keratomileusis (LASIK) is now considered to be a safe and effective standard procedure for surgical correction of low to medium ametropia. Nevertheless, as in any other surgical intervention complex courses may occur in single rare cases. Possible complications include, but are not limited to, optically effective errors, such as too small or decentered optical zones as well as intraoperative flap cutting errors and postoperative complications, such as inflammation (e.g. diffuse lamellar keratitis, DLK), epithelial or flap folds, epithelial ingrowths or iatrogenic ectasia. Compliance to standards for indications and treatment based on the current scientific knowledge can significantly reduce the occurrence of complications. These standards include adjustment of the optical zone to the mesopic pupil diameter, the application of state of the art eye trackers, careful performance of intraoperative and postoperative procedures by a surgeon experienced in the entire spectrum of ocular surgery, the possibility of treating complications directly on occurrence and, last but not least, conservative patient selection and choice of treatment.
Keywords: Corneal Diseases/di [Diagnosis]; *Corneal Diseases/et [Etiology]; *Corneal Diseases/pc [Prevention & Control]; Humans; *Keratomileusis, Laser In Situ/ae [Adverse Effects]; *Keratomileusis, Laser In Situ/mt [Methods]; *Refractive Errors/co [Complications]

An adherence based cost-consequence model comparing bimatoprost 0.01% to bimatoprost 0.03%. - Wong, William B; Patel, Vaishali D; Kowalski, Jonathan W; Schwartz, Gail (Current medical research and opinion, 2013)
OBJECTIVES: Estimate the long-term direct medical costs and clinical consequences of improved adherence with bimatoprost 0.01% compared to bimatoprost 0.03% in the treatment of glaucoma., METHODS: A cost-consequence model was constructed from the perspective of a US healthcare payer. The model structure included three adherence levels (high, moderate, low) and four mean deviation (MD) defined health states (mild, moderate, severe glaucoma, blindness) for each adherence level. Clinical efficacy in terms of IOP reduction was obtained from the randomized controlled trial comparing bimatoprost 0.01% with bimatoprost 0.03%. Medication adherence was based on observed 12 month rates from an analysis of a nationally representative pharmacy claims database. Patients with high, moderate and low adherence were assumed to receive 100%, 50% and 0% of the IOP reduction observed in the clinical trial, respectively. Each 1 mmHg reduction in IOP was assumed to result in a 10% reduction in the risk of glaucoma progression. Worse glaucoma severity health states were associated with higher medical resource costs. Outcome measures were total costs, proportion of patients who progress and who become blind, and years of blindness. Deterministic sensitivity analyses were performed on uncertain model parameters., RESULTS: The percentage of patients progressing, becoming blind, and the time spent blind slightly favored bimatoprost 0.01%. Improved adherence with bimatoprost 0.01% led to higher costs in the first 2 years; however, starting in year 3 bimatoprost 0.01% became less costly compared to bimatoprost 0.03% with a total reduction in costs reaching US$3433 over a lifetime time horizon. Deterministic sensitivity analyses demonstrated that results were robust, with the majority of analyses favoring bimatoprost 0.01%. Application of 1 year adherence and efficacy over the long term are limitations., CONCLUSIONS: Modeling the effect of greater medication adherence with bimatoprost 0.01% compared with bimatoprost 0.03% suggests that differences may result in improved economic and patient outcomes.
Keywords: Administration, Topical; Amides/ad [Administration & Dosage]; Amides/ec [Economics]; *Amides; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; *Antihypertensive Agents; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/ec [Economics]; Humans; *Models, Biological; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ec [Economics]; *Ophthalmic Solutions; Optic Nerve Diseases/dt [Drug Therapy]; Optic Nerve Diseases/ec [Economics]; Optic Nerve Diseases/pp [Physiopathology]; Optic Nerve Diseases/th [Therapy]; *Optic Nerve Diseases; *Patient Compliance

Outcomes of a vision screening program for underserved populations in the United States. - Friedman, David S; Cassard, Sandra D; Williams, Sherill K; Baldonado, Kira; O'Brien, Rebecca W; Gower, Emily W (Ophthalmic epidemiology, 2013)
PURPOSE: To evaluate which components of a vision screening process are most effective in identifying individuals who need eye care services., METHODS: Subjects visiting a free health clinic were screened using visual acuity and a questionnaire. Persons who failed screening were referred for a professional eye examination., RESULTS: A total of 1380 of 3004 screened persons (46%) screened positive on question(s) or distance visual acuity; 81% of screened positives were referred for an eye exam, <50% of the positives attended the examination, and one-third had >=1 problem requiring intervention or monitoring. The most common problem was distance refractive error that, once corrected, improved vision by two or more lines, followed by glaucoma or glaucoma suspect (8.9%), visually significant cataract (7.2%), and diabetic retinopathy (2.5%). Ninety-four subjects who screened negative ("normal") were examined; nearly half of these had 2+ lines of visual acuity improvement with refraction (from 20/40 or 20/32 to 20/20). Sensitivity for detecting specific eye conditions varied substantially, ranging from 0-83% for individual screening questions. Time since last exam and distance acuity <20/50 were the most sensitive questions for visually significant cataract; however, their specificity was low. No combination of questions and acuity testing had both high sensitivity and specificity., CONCLUSIONS: Vision problems requiring intervention were common among this relatively young population, but no combination of screening questions and vision testing proved effective for screening. More than half of those who screened positive never showed for an examination, indicating that on-site eye exams might be more effective.
Keywords: Adolescent; Adult; *Eye Diseases/di [Diagnosis]; *Eye Diseases/ep [Epidemiology]; False Negative Reactions; Female; Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Predictive Value of Tests; *Program Evaluation; Referral and Consultation; Risk Assessment; Sensitivity and Specificity; Surveys and Questionnaires; United States/ep [Epidemiology]; *Vision Screening/mt [Methods]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]; *Vulnerable Populations/sn [Statistics & Numerical Data]; Young Adult

Oral mucosal grafts: old technique in new light. - Mai, Christian; Bertelmann, Eckart (Ophthalmic research, 2013)
PURPOSE: To present an update on indications and efficacy of oral mucosal grafts in the clinical management of ocular surface diseases focusing on the new developments of the last 5 years., METHODS: Pubmed research on the databases of the years 2007 up to 2012 for the key words mucous membrane graft and eye, fornix reconstruction, eyelid reconstruction, and conjunctival replacement., RESULTS: Well-documented clinical indications for oral mucosal grafting to the ocular surface include correction of restricted socket syndrome, ocular adnexal reconstruction after tumor resection, cicatricial ocular surface diseases and therapy-refractory pterygia. New indications are conjunctival insufficiency after filtrating glaucoma surgery and the combination of mucosa and amniotic membrane grafting for fornix reconstruction. Moreover, different strategies for ex vivo mucous epithelial cell expansion are under discussion., CONCLUSIONS: Oral mucosal grafting is a viable option for the replacement of the conjunctiva. Advantages include easily accessibility of grafts in sufficient size even for repeated procedures and a high stability of the grafts. On the other hand, nasal mucosal grafts are superior for some indications due to the lack of goblet cells in the oral mucosa. Copyright © 2013 S. Karger AG, Basel.
Keywords: *Conjunctival Diseases/su [Surgery]; *Eyelid Diseases/su [Surgery]; Humans; *Mouth Mucosa/tr [Transplantation]; *Ophthalmologic Surgical Procedures; *Reconstructive Surgical Procedures

Seeing you through London 2012: eye care at the Paralympics. - Wilson, Clare M; Thomson, W David; D'Ath, Penny J (British journal of sports medicine, 2013)
BACKGROUND: The provision of eye care services for competitors and support teams is integral to the modern Olympic Games. The eye clinic for the London 2012 Paralympic Games employed a multidisciplinary team of eye care professionals using state-of-the-art instrumentation to provide the highest level of eye care. The detailed organisation of the eye care clinic at London 2012 is described in a companion paper which summarises the eye care clinic during the London 2012 Olympic Games. These two reports will aid in planning eye care clinics at future Games., AIM: This paper summarises the organisation of the eye clinic and provides outline audit data relating to eye conditions encountered during the Paralympic Games., RESULTS: A total of 870 patients representing 102 countries attended the eye clinic. 274 (31.5%) were competitors; the remainder were trainers and support staff. No serious ocular injuries resulted from competitor injury in the field of play during the Paralympic Games, although seven patients were referred urgently to hospital eye services for conditions including orbital cellulitis, retinal detachment, exudative macular degeneration, corneal ulcer, Stevens-Johnson syndrome and macular oedema. A total of 749 spectacles, 14 pairs of contact lenses and 7 low vision aids were dispensed., CONCLUSIONS: By combining excellent facilities and equipment with a multidisciplinary team of eye care professionals, we feel we provided the highest level of eye care, providing a legacy for future Games.
Keywords: Adolescent; Adult; *Ambulatory Care/sn [Statistics & Numerical Data]; *Athletic Injuries/th [Therapy]; *Eye Diseases/th [Therapy]; *Eye Injuries/th [Therapy]; Eyeglasses/sn [Statistics & Numerical Data]; Female; Humans; London; Male; Medical Audit; Middle Aged; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Sports for Persons with Disabilities/sn [Statistics & Numerical Data]; Vision Disorders/et [Etiology]; Vision Disorders/th [Therapy]; Young Adult

Aductive laser iridoplasty and laser goniopuncture after non-perforating trabeculectomy. - D, Lawrence F Jindra M (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2013)
INTRODUCTION: Successful non-perforating trabeculectomy (NPT) results in filtration of aqueous humor out of the anterior chamber and into a filtration bleb, without surgical excision of tissue from the anterior chamber angle, and without penetration into the anterior chamber. The complications of perforating trabeculectomy, due to early postoperative hypotony (shallow anterior chamber, hyphema, macular folds, suprachoroidal effusion, and ciliochoroidal hemorrhage) (3, 4, 5, 6, 7, 8, 9) are regarded by many surgeons as significant risks. Nonperforating surgery has been reported to reduce the incidence of early hypotony-related complications (10), because it has the advantage of creating gradual filtration of aqueous humor, through a thin trabeculodescemetic membrane (TDM), which markedly reduces postoperative complications seen after a conventional trabeculectomy (11), and also has been reported to provide better long-term intraocular pressure (IOP) control (12, 13). NPT is reported to be a procedure with a significant learning curve, sometimes necessitating conversion to perforating trabeculectomy, and requiring careful postoperative monitoring (14, 15, 16, 17). Zimmerman et al. reported filtration of aqueous humor under a filtering bleb, by resecting the roof of Schlemms canal and removing corneal stroma overlying the trabecular meshwork (18) Mermoud et al. reported filtration of aqueous humor under a filtering, bleb by unroofing Schlemms canal and removing corneal stroma overlying the trabecular meshwork as well Descemets membrane (19); he found that resistance across the TDM sometimes increased with time. When this resistance to aqueous humor outflow occurred, Mermoud found TDM resistance could be eliminated by performance of goniopuncture (ab interno Nd:YAG laser membranotomy via gonioprism), to enhance aqueous humor outflow into the filtration bleb. Failure to filter adequately through the TDM is a potential complication following NPT which can result in a rise in intraocular pressure (IOP). In this paper we examine the effectiveness of adjunctive Nd:YAG laser goniopuncture (YGP) in patients who underwent NPT, to reduce post-operative IOP rise, secondary to scarring at or poor aqueous outflow through the TDM. Iris prolapse (IP) is another potential complication following NPT which can result in a rise in IOP. In this paper we examine the effectiveness of adjunctive argon laser peripheral iridoplasty (ALPI) in patients who underwent NPT, to reduce post-operative IOP rise, secondary to IP obstructing outflow across the TDM., BACKGROUND: Nd:YAG laser goniopuncture consists of placing several laser shots on the undersurface of the trabeculodescemetic membrane. The result is a microperforation in this membrane, with flow of aqueous into the filtration bleb, which converts a non-perforating filtration procedure into a partial thickness filtration procedure. In this technique, several high power, multi-burst shots are applied, ab interno, by a Nd:YAG laser via a gonioprism, to the underside of the TDM, to facilitate aqueous outflow out from the anterior chamber. YGP can be effective when increased aqueous outflow is desired postoperatively. After this procedure, patent perforation in the TDM is usually observed gonioscopically, generally accompanied with reduction in IOP, and increase in bleb elevation (in height and in circumferential extent). Argon laser peripheral iridoplasty consists of placing several laser burns on the surface of the peripheral iris to contract the iris stroma, in a centripetal fashion, between the site of the burn and the anterior chamber angle. The result is iris stromal tissue contraction and compaction, movement of IP away from the angle and toward the pupil, which physically widens the angle and clears the synechial apposition of the peripheral iris against the TDM. In this technique, a series of low power, long duration, and large size burns is applied to the iris periphery to contract the iris stroma, to open the angle, and to clear IP causing synechial obstruction of the TDM after successful NPT. Used previously in acute angle closure glaucoma, ALPI may be effective in controlling IOP and clearing corneal edema when systemic and topical anti-glaucoma treatments fail to control high IOP, and when laser peripheral iridotomy (LPI) is not possible (e.g. in cases of severe corneal edema). Additionally, ALPI can be effective in permanently reopening the anterior chamber angle of iridectomized eyes with plateau iris syndrome; in this technique a full 360 degrees ring of spots is often applied, but a more limited area of treatment may also be effective., TECHNIQUE: When a post-operative elevation in IOP was detected in a patients eye which had undergone NPT, careful indentation gonioscopy was performed to examine the TDM at the surgical site. If the peripheral iris was flat, the anterior chamber angle was open, and the TDM did not appear obstructed by IP, YGP was performed. First, the eyes were pre-treated with aproclonodine 1% and pilocarpine 2% (if needed to allow visualization of the TDM). Next, a Nd:YAG laser was set on triple burst mode and shots were applied to the underside of the TDM at the NPT site, using a Goldman 3-mirror lens in the following manner: Energy - 3-5 mJ; Mode - Triple burst. The power and amount of spots were titrated in order to achieve partial or microperforation of TDM at the NPT surgical site, thus resulting in restoration of aqueous outflow into the filtration bleb. When a post-operative elevation in IOP was detected in a patients eye which had undergone NPT and or YGP, careful indentation gonioscopy was performed to examine the TDM at the surgical site. If irreducible synechial IP were detected, which obstructed filtration through the TDM at the NPT surgical site, ALPI was performed. First, the eyes were pre-treated with aproclonodine 1% and pilocarpine 2%. Next, an argon laser was set on blue-green mode and shots were applied to the IP adherent to cornea or to the TDM at the NPT site, using a Goldman 3-mirror lens in the following manner: Spot Size - 500 mM; Duration - 0.5 s; Power - 200 to 400 mW. The power and amount of burns were titrated in order to achieve partial or complete centripetal retraction of the IP from the TDM at the NPT surgical site, causing a clearance of the obstruction to the TDM, thus resulting in restoration of aqueous outflow into the filtration bleb.
Keywords: Humans; *Intraocular Pressure; *Iris/su [Surgery]; *Laser Therapy; *Lasers, Solid-State/tu [Therapeutic Use]; *Trabeculectomy/mt [Methods]

Growth of corneal epithelial cells over in situ therapeutic contact lens after simple limbal epithelial transplantation (SLET). - Bhalekar, Swapnil; Sangwan, Virender S; Basu, Sayan (BMJ case reports, 2013)
An 11-year-old boy underwent simple limbal epithelial transplantation (SLET) from the healthy right eye to his left eye for total limbal stem cell deficiency. One month later, corneal surface epithelialised and whitish plaques overlying the transplants were seen inferiorly. Those plaques were adherent to the surface of the contact lens and underlying corneal surface had smooth elevations. Similar findings were noted in a 23-year man following cyanoacrylate glue application for corneal perforation. On histological and immunohistochemical analysis, cells lining the contact lenses were identified as corneal epithelial cells. These cases illustrate epithelial cell growth on the contact lens and epithelial hyperplasia on corresponding surface of the cornea. Exorbitant proliferation of the epithelial cells may be owing to young age; therefore, early contact lens removal after SLET in young age, can possibly avoid epithelial hyperplasia. This also reiterates the possibility of using contact lens as a scaffold to grow epithelial cells.
Keywords: Burns, Chemical/su [Surgery]; Cell Proliferation; Child; *Cornea/cy [Cytology]; *Corneal Transplantation/mt [Methods]; *Epithelial Cells/cy [Cytology]; Eye Burns/ci [Chemically Induced]; Eye Burns/su [Surgery]; Humans; Keratitis, Herpetic/su [Surgery]; Lens Implantation, Intraocular/mt [Methods]; Lenses, Intraocular; *Limbus Corneae/cy [Cytology]; Male; Tissue Scaffolds; Young Adult

[Glaucoma dynamics in patients who followed monitoring and treatment instructions and in those who didn't]. - Kunin, V D; Redid, A A (Vestnik oftalmologii, 2013)
Clinical course of different stages of primary open-angle glaucoma (POAG) is studied in 216 patients (432 eyes) who followed monitoring and treatment instructions during 13 years and in those who didn't. In patients who did not follow recommendations glaucoma progression was found in 99,4% of patients with initial disease, in 48,7% of cases with advanced stage and in 50% of patients with the end stage of the disease. Patients who followed recommendations of general ophthalmologists and glaucomatologists showed stable course of glaucoma process in 1 patient (0,6%) with initial stage, in 51,3% of patients with advanced stage and in 50% of patients with the end stage of the disease.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Comprehensive Health Care/mt [Methods]; Comprehensive Health Care/og [Organization & Administration]; *Comprehensive Health Care; Diagnostic Techniques, Ophthalmological; Disease Progression; Female; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/px [Psychology]; Glaucoma, Open-Angle/th [Therapy]; *Glaucoma, Open-Angle; Health Knowledge, Attitudes, Practice; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Monitoring, Physiologic/mt [Methods]; Monitoring, Physiologic/px [Psychology]; *Monitoring, Physiologic; Outcome Assessment, Health Care; Patient Compliance/px [Psychology]; Patient Compliance/sn [Statistics & Numerical Data]; *Patient Compliance; Risk Factors

Government-insured routine eye examinations and prevalence of nonrefractive vision problems among elderly. - Jin, Ya-Ping; Buys, Yvonne M; Xiong, Juan; Trope, Graham E (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2013)
OBJECTIVE: To assess whether lack of government-insured annual routine eye examinations was associated with reduced vision health status among elderly Canadians., DESIGN: Cross-sectional survey., PARTICIPANTS: Respondents aged >= 65 years in the Canadian Community Health Survey 2000-2001., METHODS: The prevalence of nonrefractive vision problems (i.e., unable to see close or distance when wearing glasses or contact lenses) between Canadians with and without government-insured annual eye examinations was compared., RESULTS: Uninsured white individuals had a greater prevalence rate of vision problems (8.5%; 95% CI 6.8-10.2) than insured white individuals (6.4%; 95% CI 5.2-7.6) if their household incomes were less than the midlevel. In those with household incomes at the midlevel or higher, the prevalence rate was similar between the insured (4.3%) and uninsured (3.6%; p>0.05). Compared with elderly adults in the mid- to high-income level and living in insured provinces, white elderly adults residing in provinces with no insurance had 50% higher odds of reporting vision problems (adjusted odds ratio [OR] 1.5; 95% CI 1.1-2.0) if their income was less than the midlevel, but a 30% lower likelihood of having vision problems if their income was in the midlevel or higher (adjusted OR 0.7; 95% CI 0.6-1.0). The mean age at diagnosis of glaucoma and cataracts was about 2 years older for uninsured versus insured white individuals. Analyses among non-white individuals were not permitted because of small sample size., CONCLUSIONS: Lack of government-funded annual routine eye examinations is associated with increased levels of nonrefractive vision problems among low-income elderly adults. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; Canada/ep [Epidemiology]; Cross-Sectional Studies; *Eye Diseases/ep [Epidemiology]; Government Programs; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Status Indicators; Health Surveys; Healthcare Disparities/sn [Statistics & Numerical Data]; Humans; *Insurance Coverage/sn [Statistics & Numerical Data]; *National Health Programs; Physical Examination; Prevalence; Social Class; *Vision Screening; *Visually Impaired Persons/sn [Statistics & Numerical Data]

[Prophylaxis and management of complications in penetrating keratoplasty]. - Seitz, B; El-Husseiny, M; Langenbucher, A; Szentmary, N (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2013)
Besides routine postoperative follow-up the prophylaxis of complications in penetrating keratoplasty (PKP) includes special preoperative and intraoperative aspects. Preoperative prophylaxis consists of the therapy of systemic diseases and eyelid abnormalities, determining individual optimal graft size, avoiding PKP in cases of uncontrolled intraocular pressure, avoiding PKP in cases of corneal hydrops, pretreatment of vascularized cornea, amniotic membrane transplantation before PKP in cases of ulcerative keratitis, quality controlled organ-cultured transplants and preoperative counselling by the surgeon to ensure patient compliance. Intraoperative prophylaxis consists of controlled arterial hypotension and complete relaxation during general anesthesia, avoidance of decentration, horizontal torsion and vertical tilt using a non-contact trephination technique (preferably excimer laser) with double-running cross-stitch sutures and application of Flieringa rings in aphakic vitrectomized eyes. Postoperatively, periodical control examinations using fluorescein and blue light are indispensable. All loose sutures have to be removed as early as possible. In cases of herpetic eye disease 2 x 400 mg of oral acyclovir should be administered for at least 1 year. In cases of therapy-resistant epithelial defects 100 % autologous serum eyedrops or amniotic membrane patches are valid options. Immune reactions must be diagnosed and treated immediately with high doses of corticosteroids.
Keywords: *Anti-Inflammatory Agents/tu [Therapeutic Use]; *Eyelid Diseases/et [Etiology]; *Eyelid Diseases/pc [Prevention & Control]; Humans; *Keratitis/et [Etiology]; *Keratitis/pc [Prevention & Control]; *Keratoplasty, Penetrating/ae [Adverse Effects]; *Keratoplasty, Penetrating/mt [Methods]

Glaucoma. - King, Anthony; Azuara-Blanco, Augusto; Tuulonen, Anja (BMJ (Clinical research ed.), 2013)
Comment in (CIN), Comment in (CIN)
Keywords: Blindness/pp [Physiopathology]; *Blindness/pc [Prevention & Control]; Cost-Benefit Analysis; Disease Progression; Female; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; *Prostaglandins A, Synthetic/ad [Administration & Dosage]; Risk Factors; Trabeculectomy/ec [Economics]; Trabeculectomy/mt [Methods]

Patient refusal of glaucoma surgery and associated factors in Lagos, Nigeria. - Adekoya, Bola Josephine; Akinsola, Feyisayo B; Balogun, Bola Grace; Balogun, Modupe Medinat; Ibidapo, Olajumoke O (Middle East African journal of ophthalmology, 2013)
PURPOSE: To determine the prevalence of patient refusal of glaucoma surgery (GSR) and the associated factors in Lagos, Nigeria., MATERIALS AND METHODS: A multicenter cross-sectional survey was conducted in Lagos state, Nigeria. Twelve centres were invited to participate, but data collection was completed in 10. Newly diagnosed glaucoma patients were recruited and interviewed from these sites over a four week period on prior awareness of glaucoma, surgery refusal, and reason(s) for the refusal. Presenting visual acuity was recorded from the patient files. The odds ratio and 95% confidence intervals (CI) were calculated., RESULTS: A total of 208 newly diagnosed glaucoma patients were recruited. Sixty-five (31.2%) patients refused surgery. Fear of surgery (31 (47.7%) patients), and fear of going blind (19 (29.2%) patients) were the most common reasons. The odds ratio of surgery refusal were marital status - not married versus married (2.0; 95% CI, 1.02-3.94), use of traditional medication - users versus non users (2.4; 95% CI, 1.1-5.2), perception of glaucoma causing blindness - no versus yes (3.7; 95% CI, 1.3-10.5), type of institution - government versus private (5.7; 95% CI, 1.3-25.1), and visual acuity in the better eye - normal vision versus visual impairment (2.3; 95% CI, 1.1-4.9). Age, gender, level of education, family history of glaucoma, and prior awareness of the diagnosis of glaucoma, were not significantly associated with surgery refusal. Perception of patients concerning glaucoma blindness was the strongest factor on multivariate analysis., CONCLUSION: GSR was relatively low in this study. Unmarried status, use of traditional medications, perception that glaucoma cannot cause blindness, government hospital patients, and good vision in the better eye were associated with GSR. These factors might help in the clinical setting in identifying appropriate individuals for targeted counseling, as well as the need for increased public awareness about glaucoma.
Keywords: Adult; Aged; Female; *Filtering Surgery/sn [Statistics & Numerical Data]; Glaucoma/di [Diagnosis]; *Glaucoma/su [Surgery]; Health Surveys; Humans; Intraocular Pressure; Male; Middle Aged; Nigeria/ep [Epidemiology]; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patients/px [Psychology]; Surveys and Questionnaires; Treatment Refusal/px [Psychology]; *Treatment Refusal/sn [Statistics & Numerical Data]; Vision Disorders/et [Etiology]; Visual Acuity; Visually Impaired Persons; Young Adult

Teleglaucoma: improving access and efficiency for glaucoma care. - Kassam, Faazil; Yogesan, Kanagasingam; Sogbesan, Enitan; Pasquale, Louis R; Damji, Karim F (Middle East African journal of ophthalmology, 2013)
Teleglaucoma is the application of telemedicine for glaucoma. We review and present the current literature on teleglaucoma; present our experience with teleglaucoma programs in Alberta, Canada and Western Australia; and discuss the challenges and opportunities in this emerging field. Teleglaucoma is a novel area that was first explored a little over a decade ago and early studies highlighted the technical challenges of delivering glaucoma care remotely. Advanced technologies have since emerged that show great promise in providing access to underserviced populations. Additionally, these technologies can improve the efficiency of healthcare systems burdened with an increasing number of patients with glaucoma, and a limited supply of ophthalmologists. Additional benefits of teleglaucoma systems include e-learning and e-research. Further work is needed to fully validate and study the cost and comparative effectiveness of this approach relative to traditional models of healthcare.
Keywords: Alberta; *Delivery of Health Care; Efficiency; *Glaucoma/th [Therapy]; *Health Services Accessibility; Humans; *Telemedicine/mt [Methods]; Western Australia

Compartment syndromes of the optic nerve and open-angle glaucoma. - Killer, Hanspeter Esriel (Journal of glaucoma, 2013)
A compartment is a space or volume that is separated from its environment. The cause for separation can be manifold. It can be expressed as a difference [INCREMENT] in parameters, such as size, area, volume, color or pressure. The border of a compartment can be rigid or flexible (compliance). The optic nerve is located within the subarachnoid space and is covered by the dura mater, the arachnoid and the pia mater that cover the brain as well. As is the brain, the optic nerve is bathed in cerebrospinal fluid (CSF). Optic nerve compartmentalization has been demonstrated in papilledema, anterior ischemic optic neuropathy, posterior ischemic optic neuropathy, and normal tension glaucoma. Anatomically the optic nerve can be described as located in a cul de sac with a steady inflow of CSF from the pituitary cistern via the optic canal. This specific anatomy raises questions concerning the mechanism of CSF recycling from the confined perioptic space.
Keywords: *Cerebrospinal Fluid Pressure; *Compartment Syndromes/et [Etiology]; Compartment Syndromes/pp [Physiopathology]; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure; *Papilledema/et [Etiology]; Papilledema/pp [Physiopathology]

Managed care implications of age-related ocular conditions. - Cardarelli, William J; Smith, Roderick A (The American journal of managed care, 2013)
The economic costs of age-related ocular diseases and vision loss are increasing rapidly as our society ages. In addition to the direct costs of treating age-related eye diseases, elderly persons with vision loss are at significantly increased risk for falls and fractures, experiencing social isolation, and suffering from an array of comorbid medical conditions compared with individuals with normal vision. Recent studies estimate the total economic burden (direct and indirect costs) of adult vision impairment in the United States at $51.4 billion. This figure is expected to increase as the baby boomer generation continues to age. While a number of highly effective new therapies have caused a paradigm shift in the management of several major age-related ocular diseases in recent years, these treatments come at a substantial cost. This article reviews the economic burdens and treatment-related costs of 4 major ocular diseases of aging-glaucoma, age-related macular degeneration, diabetic retinopathy, and dry eye disease-and the implications for managed care.
Keywords: Aged; Antibodies, Monoclonal, Humanized/ec [Economics]; Antibodies, Monoclonal, Humanized/tu [Therapeutic Use]; Bevacizumab; Clinical Trials as Topic; Cyclosporine/ec [Economics]; Cyclosporine/tu [Therapeutic Use]; *Diabetic Retinopathy/ec [Economics]; Diabetic Retinopathy/ep [Epidemiology]; Diabetic Retinopathy/th [Therapy]; *Drug Costs; *Dry Eye Syndromes/ec [Economics]; Dry Eye Syndromes/ep [Epidemiology]; Dry Eye Syndromes/th [Therapy]; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Laser Therapy; Medicare; Medication Adherence; Ranibizumab; Severity of Illness Index; United States; Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]; Vision Disorders/ec [Economics]; *Wet Macular Degeneration/ec [Economics]; Wet Macular Degeneration/ep [Epidemiology]

Current treatment strategies for age-related ocular conditions. - Akpek, Esen K; Smith, Roderick A (The American journal of managed care, 2013)
Treatment for several major age-related ocular diseases has undergone a paradigm shift in recent years. Advances in basic science and clinical research have led to a more thorough understanding of the complex pathophysiology underlying common ocular diseases of aging, and to the development of highly effective new therapies for these conditions. The use of intraocular anti-angiogenic drugs, for example, has transformed the management of neovascular age-related macular degeneration and diabetic retinopathy. Many patients achieve impressive and durable gains in vision with these agents that were unattainable with older treatments. For glaucoma and dry eye disease, clinicians have a variety of pharmacologic and surgical options to choose from. However, significant challenges remain: not all patients respond to treatment, many older patients have difficulty complying with complex drug regimens, frequent office visits put a substantial strain on patients and caregivers, and therapies may cause unpleasant side effects. This article reviews the current treatment landscape for 4 major age-related ocular diseases: age-related macular degeneration, glaucoma, diabetic retinopathy, and dry eye.
Keywords: Aged; Antibodies, Monoclonal, Humanized/tu [Therapeutic Use]; Bevacizumab; Clinical Trials as Topic; Cyclosporine/tu [Therapeutic Use]; Diabetes Mellitus/bl [Blood]; Diabetes Mellitus/dt [Drug Therapy]; *Diabetic Retinopathy/dt [Drug Therapy]; *Diabetic Retinopathy/pc [Prevention & Control]; Disease Progression; Dry Eye Syndromes/et [Etiology]; *Dry Eye Syndromes/th [Therapy]; *Glaucoma/th [Therapy]; Glycated Hemoglobin A/an [Analysis]; Humans; *Macular Degeneration/dt [Drug Therapy]; Medication Adherence; Ophthalmic Solutions/tu [Therapeutic Use]; Ophthalmologic Surgical Procedures; Ranibizumab; Receptors, Vascular Endothelial Growth Factor/tu [Therapeutic Use]; Recombinant Fusion Proteins/tu [Therapeutic Use]; Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]

Killing the amoebae. - Dorgan, Julie; McGoldrick, Alan (Insight (American Society of Ophthalmic Registered Nurses), 2013)
Keywords: *Acanthamoeba Keratitis/dt [Drug Therapy]; Acanthamoeba Keratitis/nu [Nursing]; Acanthamoeba Keratitis/ps [Parasitology]; *Amoeba/de [Drug Effects]; Amoeba/ip [Isolation & Purification]; Animals; *Antiprotozoal Agents/ad [Administration & Dosage]; Cornea/ps [Parasitology]; Cornea/pa [Pathology]; Female; Follow-Up Studies; Humans; Medication Adherence; Ophthalmic Solutions/ad [Administration & Dosage]; Tomography, Optical Coherence; Young Adult

Vision insurance, eye care visits, and vision impairment among working-age adults in the United States. - Li, Yi-Jhen; Xirasagar, Sudha; Pumkam, Chaiporn; Krishnaswamy, Malavika; Bennett, Charles L (JAMA ophthalmology, 2013)
OBJECTIVES: To compare rates of eye care visits and vision impairment among working-age adults with vision insurance vs without, among the total sample of Behavioral Risk Factor Surveillance Survey respondents and among a subsample of respondents who had diagnoses of glaucoma, age-related macular degeneration (ARMD), and/or cataract., DESIGN: Using the Behavioral Risk Factor Surveillance Survey 2008 vision module data, we examined the likelihood of an eye care visit within the past year and of self reported visual impairment among 27 152 adults aged 40 to 65 years and among a subset of 3158 persons (11.6%) with glaucoma, ARMD, and/or cataract. Multivariate logistic regression models were used., RESULTS: About 40% of both the study population and the subsample with glaucoma, ARMD, and/or cataract had no vision insurance. Respondents with vision insurance were more likely than those without to have had eye care visits (general population adjusted odds ratio [AOR], 1.90 [95% CI, 1.89-1.90]; glaucoma-ARMD-cataract subsample AOR, 2.15 [95% CI, 2.13-2.17]), to have no difficulty recognizing friends across the street (general population AOR, 1.24 [95% CI, 1.22-1.26]; eye-disease subsample AOR, 1.45 [95% CI, 1.42-1.49]), and to have no difficulty reading printed matter (general population AOR, 1.34 [95% CI, 1.33-1.35]; eye-disease subsample AOR, 1.37 [95% CI, 1.34-1.39]). Respondents from the total sample who had an eye care visit were better able to recognize friends across the street (AOR, 1.07) and had no difficulty reading printed matter (AOR, 1.70), and respondents from the eye-disease subsample who had an eye care visit also were better able to recognize friends across the street (AOR, 1.71) and had no difficulty reading printed matter (AOR, 1.45)., CONCLUSIONS: Lack of vision insurance impedes eye care utilization, which, in turn, may irrevocably affect vision. Vision insurance for preventive eye care should cease to be a separate insurance benefit and should be mandatory in all health plans.
Keywords: Adult; Aged; Cataract/di [Diagnosis]; Cataract/ep [Epidemiology]; Cataract/pc [Prevention & Control]; Educational Status; Female; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Glaucoma/pc [Prevention & Control]; *Health Services/sn [Statistics & Numerical Data]; Health Services Research; Humans; *Insurance Coverage/sn [Statistics & Numerical Data]; Insurance, Health/sn [Statistics & Numerical Data]; Macular Degeneration/di [Diagnosis]; Macular Degeneration/ep [Epidemiology]; Macular Degeneration/pc [Prevention & Control]; Male; Medically Uninsured; Middle Aged; *Office Visits/sn [Statistics & Numerical Data]; *Ophthalmology/sn [Statistics & Numerical Data]; Preventive Health Services; United States/ep [Epidemiology]; *Vision Disorders/di [Diagnosis]; Vision Disorders/ep [Epidemiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Systematic review of educational interventions to improve glaucoma medication adherence. - Newman-Casey, Paula Anne; Weizer, Jennifer S; Heisler, Michele; Lee, Paul P; Stein, Joshua D (Seminars in ophthalmology, 2013)
Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and two additional studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence/sn [Statistics & Numerical Data]; Patient Acceptance of Health Care; *Patient Education as Topic

Interventions for improving adherence to ocular hypotensive therapy. - Waterman, Heather; Evans, Jennifer R; Gray, Trish A; Henson, David; Harper, Robert (The Cochrane database of systematic reviews, 2013)
BACKGROUND: Poor adherence to therapy is a significant healthcare issue, particularly in patients with chronic disease such as open-angle glaucoma. Treatment failure may necessitate unwarranted changes of medications, increased healthcare expenditure and risk to the patient if surgical intervention is required. Simplifying eye drop regimes, providing adequate information, teaching drop instillation technique and ongoing support according to the patient need may have a positive effect on improving adherence., OBJECTIVES: To summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma., SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (June 1946 to June 2012), EMBASE (June 1980 to June 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (June 1937 to June 2012), PsycINFO (1806 to June 2012), PsycEXTRA (1908 to June 2012), Web of Science (1970 to June 2012), ZETOC (1993 to June 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 26 June 2012. We did not search the National Research Register (NNR) as this resource has now been now archived. We contacted pharmaceutical manufacturers to request unpublished data and searched conference proceedings for the Association for Research in Vision and Ophthalmology (ARVO), and the Annual Congress for the Royal College of Ophthalmologists (RCO)., SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma., DATA COLLECTION AND ANALYSIS: At least two authors independently assessed the search results for eligibility and extracted data for included trials onto specifically designed forms. We did not pool data due to clinical and methodological heterogeneity., MAIN RESULTS: Sixteen trials (1565 participants) met the inclusion criteria. Seven studies investigated some form of patient education. In six of these studies this education was combined with other behavioural change interventions including tailoring daily routines to promote adherence to eye drops. Eight studies compared different drug regimens (one of these trials also compared open and masked monitoring) and one study investigated a reminder device. The studies were of variable quality and some were at considerable risk of bias; in general, the length of follow-up was short at less than six months with only two studies following up to 12 months. Different interventions and outcomes were reported and so it was not possible to produce an overall estimate of effect. There was some evidence from three studies that education combined with personalised interventions, that is, more complex interventions, improved adherence to ocular hypotensive therapy. There was less information on other outcomes such as persistence and intraocular pressure, and no information on visual field defects, quality of life and cost. There was weak evidence as to whether people on simpler drug regimens were more likely to adhere and persist with their ocular hypotensive therapy. A particular problem was the interpretation of cross-over studies, which in general were not reported correctly. One study investigated a reminder device and monitoring but the study was small and inconclusive., AUTHORS' CONCLUSIONS: Although complex interventions consisting of patient education combined with personalised behavioural change interventions, including tailoring daily routines to promote adherence to eye drops, may improve adherence to glaucoma medication, overall there is insufficient evidence to recommend a particular intervention. The interventions varied between studies and none of the included studies reported on the cost of the intervention. Simplified drug regimens also could be of benefit but again the current published studies do not provide conclusive evidence. Future studies should follow up for at least one year, and could benefit from standardised outcomes.
Update of (UOF)
Keywords: Humans; *Medication Adherence; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Patient Education as Topic; Randomized Controlled Trials as Topic; Reminder Systems/is [Instrumentation]

[Transscleral cyclophotocoagulation as primary surgical intervention in glaucoma]. - Winkler, N F K; Funk, J (Klinische Monatsblatter fur Augenheilkunde, 2013)
BACKGROUND: The gold standard of surgical interventions in medically uncontrolled glaucoma is trabeculectomy. Cyclophotocoagulation is often performed only as a secondary/tertiary surgery. Since trabeculectomy demands a high degree of postsurgical compliance to achieve satisfying results, some patients do not qualify for trabeculectomy., PATIENTS AND METHODS: During cyclophotocoagulation, the ciliary processes were coagulated using a transscleral diode laser. 49 eyes of 47 patients (25 women and 22 men) were included in our study. Patients were regularly followed up for 24 months. During follow-up, IOP, best corrected visual acuity and number of antiglaucoma drugs were recorded., RESULTS: The mean age was 69.27 +/- 14.45 years. The diagnosis was open-angle glaucoma in 15 eyes, pseudoexfoliative glaucoma in 12 eyes, secondary rubeotic glaucoma in 7 eyes and secondary glaucoma without further specification in 15 eyes. On average, cyclophotocoagulation reduced intraocular pressure by 14.45 +/- 11.77 mmHg (-42.7%, p < 0.001). Medication could be reduced by 1.31 +/- 1.27 (-52%, p < 0.001). On average, visual acuity deteriorated by 0.383 LogMAR (+/- 0.848, p = 0.004)., CONCLUSION: For selected glaucoma patients, cyclophotocoagulation could be an option as primary surgical intervention to lower intraocular pressure. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Comment in (CIN)
Keywords: Aged; Female; *Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; *Glaucoma/su [Surgery]; Humans; *Light Coagulation/mt [Methods]; Male; Ocular Hypertension/di [Diagnosis]; *Ocular Hypertension/et [Etiology]; *Ocular Hypertension/su [Surgery]; Sclera; Sclerostomy; Treatment Outcome

The association between compliance with recommended follow-up and glaucomatous disease severity in a county hospital population. - Ung, Cindy; Murakami, Yohko; Zhang, Elisa; Alfaro, Tatyana; Zhang, Monica; Seider, Michael I; Singh, Kuldev; Lin, Shan C (American journal of ophthalmology, 2013)
PURPOSE: To assess the association between insufficient follow-up and clinical parameters such as disease severity and medication use among glaucoma patients at a metropolitan county hospital., DESIGN: Cross-sectional study., METHODS: Two-hundred and six patients with established glaucoma were recruited from San Francisco General Hospital. Subjects were classified based on compliance with recommended follow-up examination intervals over the year preceding commencement of the study, as determined by patient medical records. Glaucoma severity was determined based on the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression analysis was used to assess the relationship between adherence with follow-up visits and disease severity., RESULTS: After adjustment for the impact of potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (adjusted OR 1.89, 95% CI 1.21-2.94; P = .01). Subjects who were on glaucoma medications were found to be less adherent to follow-up recommendations (adjusted OR 3.29, 95% CI 1.41-7.65, P = .01)., CONCLUSION: Subjects with poor follow-up adherence were significantly more likely to have severe glaucomatous disease, suggesting that poor follow-up may contribute to disease worsening or, alternatively, those with more severe disease are less inclined to follow up at appropriate intervals. Copyright Published by Elsevier Inc.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; *Continuity of Patient Care/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Delivery of Health Care; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; *Glaucoma/pp [Physiopathology]; Guideline Adherence; *Hospitals, County/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; Medication Adherence; Middle Aged; Office Visits; *Patient Compliance/sn [Statistics & Numerical Data]; Severity of Illness Index; Surveys and Questionnaires

Evaluation of diminished microbial contamination in handling of a novel daily disposable flat pack contact lens. - Nomachi, Miya; Sakanishi, Kotaro; Ichijima, Hideji; Cavanagh, H Dwight (Eye & contact lens, 2013)
PURPOSE: To evaluate the efficacy of a novel daily disposable (DD) flat package in regard to microbial contamination on the anterior and posterior surfaces of a contact lens (CL) during handling of the lens for insertion., METHODS: Four kinds of commercially available general blister-packed daily disposable contact lenses (DD CLs) as controls and a novel Magic 1-day Menicon Flat Pack as a test lens were used for this in vitro study. Lenses were removed from their packages using fingers coated with fluorescein 3 to 5 mum beads or an approximately 7x10(2) to 2x10(3) colony-forming unit (CFU)/mL Staphylococcus aureus suspension. The transfer of fluorescein beads to the surface of the lenses was then observed by fluorescence microscopy. Microbial contamination on the lenses was observed by light microscopy after a 2-day incubation period; and, the number of colonies isolated from the contaminated lenses was determined after 4 days of incubation., RESULTS: The number of fluorescein beads on the Magic lens was significantly less (p<0.05) than that of the general blister-packed control lenses. Adherence of microbial colonies was observed on both inner and outer surfaces of general blister-packed lenses, whereas no colony formation was found on the inner surface of the Magic lens, and the lowest bacterial adherence was observed for the Magic lens., CONCLUSIONS: The data demonstrated that placement of the Magic DD lens onto the eye is accompanied by diminished microbial contamination compared with general blister-packed DD CLs. Eye care professionals; however, should instruct patients to comply with intended use of DD CLs to prevent CL-associated microbial keratitis. In all cases, hand washing is mandated prelens insertion.
Keywords: Bacterial Adhesion; Colony Count, Microbial; *Contact Lenses, Hydrophilic/mi [Microbiology]; *Equipment Contamination; Hand Disinfection; *Staphylococcus aureus/ip [Isolation & Purification]

Targeting the A3 adenosine receptor for glaucoma treatment (review). - Fishman, Pnina; Cohen, Shira; Bar-Yehuda, Sara (Molecular medicine reports, 2013)
Glaucoma is a worldwide disease and the second leading cause of blindness. Current treatments are associated with a number of side-effects and poor compliance, due to the requirement for treatment administration several times a day. These treatments typically aim to lower intraocular pressure (IOP); however, they are unable to protect retinal ganglion cells (RGCs) from undergoing apoptosis, which is the main cause of vision loss. A3 adenosine receptor (A3AR) agonists have been found to protect normal cells from undergoing apoptosis via the downregulation of death signals. Furthermore, A3AR agonists have been reported to have several ophthalmological effects, including the prevention of ganglion cell apoptosis in vitro and in vivo and anti-inflammatory effects in experimental models of autoimmune uveitis. CF101, an orally bioavailable A3AR agonist, has been analyzed in dry eye syndrome phase II clinical trials and was identified to be safe and well tolerated. The anti-inflammatory effect of CF101 was shown to significantly improve corneal staining, tear meniscus and tear break-up time in dry eye patients. In addition, CF101 was found to decrease IOP in patients. The safety and efficacy of CF101, together with its suitability for oral administration, indicates that it has potential as a candidate drug for the treatment of glaucoma.
Keywords: Adenosine/aa [Analogs & Derivatives]; Adenosine/ch [Chemistry]; Adenosine/pd [Pharmacology]; Adenosine/tu [Therapeutic Use]; Adenosine A3 Receptor Agonists/ch [Chemistry]; *Adenosine A3 Receptor Agonists/tu [Therapeutic Use]; Anti-Inflammatory Agents/ch [Chemistry]; Anti-Inflammatory Agents/pd [Pharmacology]; Anti-Inflammatory Agents/tu [Therapeutic Use]; Apoptosis; Dry Eye Syndromes/dt [Drug Therapy]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pa [Pathology]; Humans; Intraocular Pressure/de [Drug Effects]; *Receptor, Adenosine A3/ch [Chemistry]; Receptor, Adenosine A3/me [Metabolism]; Retinal Ganglion Cells/cy [Cytology]

Development and validation of a predictive model for nonadherence with once-daily glaucoma medications. - Chang, Dolly S; Friedman, David S; Frazier, Travis; Plyler, Ryan; Boland, Michael V (Ophthalmology, 2013)
OBJECTIVE: To develop and validate a predictive model to estimate the probability of being nonadherent to topical glaucoma medications., DESIGN: Prospective cohort study., PARTICIPANTS: Patients being treated with once-daily prostaglandin eye drops., METHODS: A predictive model for nonadherence was developed from the Travatan Dosing Aid (TDA) study (n = 196) using stepwise logistic regression. The performance of the TDA-derived model was assessed using a separate cohort of subjects from the Automated Dosing Reminder Study (ADRS; n = 407). The assessment was based on regression coefficients, discrimination, and calibration. We also developed a scoring system from the TDA-derived model to simplify the estimation of risk for clinical use., MAIN OUTCOME MEASURES: Usage of drops was monitored electronically for 3 months in both studies. Adherence was calculated as the percentage of days on which a dose was taken within 4 hours of the average dosing time for that patient. Nonadherence was defined as taking <= 75% prescribed doses within a window starting 2 weeks after the baseline visit until 2 weeks before the follow-up visit., RESULTS: Six factors, including younger age, black race, worse general health status, shorter duration of glaucoma medication therapy, lower self-reported adherence, and admitting to not following doctors' orders, were associated with being nonadherent and were included in the predictive model. The coefficients for the TDA-derived and the ADRS-derived predictive models were similar. The risk scoring system developed from the TDA study had good discrimination (area under the receiver operating characteristic curve of 0.80) and calibration (Hosmer-Lemeshow goodness-of-fit test, P = 0.102) when applied to the ADRS population., CONCLUSIONS: The TDA-derived predictive model for nonadherence performed well in an independent population. A risk scoring system was developed using demographic data and patient responses to 4 questions to provide an estimate of the probability of being nonadherent. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; Cohort Studies; Drug Monitoring; Female; Glaucoma/cl [Classification]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Models, Statistical; Ophthalmic Solutions/ad [Administration & Dosage]; Probability; Prospective Studies; ROC Curve; Risk Assessment; Travoprost

Glaucoma after pediatric cataract surgery in a population with limited access to care. - Baden, Craig; Shija, Fortunate; Lewallen, Susan; Courtright, Paul; Hall, Anthony (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2013)
BACKGROUND: Cataract is a leading cause of childhood blindness in eastern Africa and other resource-constrained regions around the world, and high-quality surgical centers are increasingly responding to this challenge. Despite evidence concerning the ongoing risk of postoperative glaucoma after lensectomy, little is known of the incidence of glaucoma after pediatric cataract surgery in Africa. We sought to evaluate the frequency and predictors of postoperative glaucoma in this setting., METHODS: The medical records of all children who underwent surgery for congenital or developmental cataract between 2003 and 2005 at the Kilimanjaro Christian Medical Centre were retrospectively reviewed to determine the incidence of postoperative glaucoma. Potential risk factors were evaluated by means of logistic regression., RESULTS: Cumulative incidence of glaucoma at 3 years was 6.5% (95% CI, 2.5-16.0), and the annual incidence rate was 2.0 cases per 100 operated eyes (95% confidence interval, 0.74-4.37). Total time of follow-up and absence of primary intraocular lens implantation correlated with risk for postoperative glaucoma, but multivariate analysis could not confirm independent associations., CONCLUSIONS: As cataract surgical rates continue to increase and pediatric ophthalmology centers in Africa progress toward the goals of Vision 2020: The Right to Sight, renewed efforts must be directed toward the long-term postoperative care of all children undergoing operation for pediatric cataract. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
Keywords: Adolescent; Africa/ep [Epidemiology]; *Cataract Extraction; Child; Child, Preschool; Female; *Glaucoma/ep [Epidemiology]; Glaucoma/et [Etiology]; Health Services Accessibility; Humans; Incidence; Infant; Logistic Models; Male; Postoperative Complications; Retrospective Studies; Risk Factors; Tanzania/ep [Epidemiology]

Tolerability of 24-hour intraocular pressure monitoring of a pressure-sensitive contact lens. - Lorenz, Katrin; Korb, Christina; Herzog, Nicola; Vetter, Jan M; Elflein, Heike; Keilani, Munir M; Pfeiffer, Norbert (Journal of glaucoma, 2013)
PURPOSE: To investigate tolerability and safety of a new diagnostic device for 24-hour intraocular pressure monitoring in healthy subjects and age-matched glaucoma patients., PATIENTS AND METHODS: Twenty healthy subjects (group 1) and 20 age-matched glaucoma patients (group 2) were included in this prospective, single-center, open, observational parallel group study. The SENSIMED Triggerfish Sensor is a soft disposable contact lens embedding a telemetry chip and strain gauge sensor for continuous intraocular pressure monitoring. The Sensor was placed in 1 eye for 24 hours. Tolerability was evaluated using a visual analog scale (range, 0 to 100; 0=no discomfort; 100=very severe discomfort). Safety parameters included best corrected visual acuity, pachymetry, epithelial defects, conjunctival erythema, and corneal topography., RESULTS: Mean age was 61.7 years in group 1 and 65.0 years in group 2. Nineteen healthy subjects and 19 glaucoma patients (95%) completed the 24-hour wearing period. Early discontinuation resulted from pain (n=1) or inappropriate fitting of the sensor due to steep corneal radii (n=1). Mean tolerability was 21.8 in group 1 (range, 7 to 67) and 26.8 in group 2 (range, 0 to 71). Corneal epithelial staining (Modified Oxford scale, grade 0 to 4) changed from 0.4 (group 1) and 1.0 (group 2) at baseline to 1.8 (group 1) and 2.8 (group 2) after monitoring. No statistically significant differences could be detected between both groups., CONCLUSIONS: This new pressure-sensitive contact lens is tolerable and safe over a 24-hour wearing period in healthy subjects and glaucoma patients. Both normals and glaucoma patients had a similar safety and tolerability profile.
Keywords: Adult; Aged; *Circadian Rhythm/ph [Physiology]; *Contact Lenses, Hydrophilic; Corneal Pachymetry; Corneal Topography; Equipment Safety; Female; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Monitoring, Ambulatory/ae [Adverse Effects]; *Monitoring, Ambulatory/is [Instrumentation]; Patient Satisfaction; Prospective Studies; Telemetry/is [Instrumentation]; Tonometry, Ocular/ae [Adverse Effects]; *Tonometry, Ocular/is [Instrumentation]; Visual Acuity/ph [Physiology]

Glaucoma medications. - Chae, Bora; Cakiner-Egilmez, Tulay; Desai, Manishi (Insight (American Society of Ophthalmic Registered Nurses), 2013)
Glaucoma is a common eye condition that affects millions of individuals worldwide, making it the second-leading cause of blindness. Because glaucoma is associated with increased IOP level, the primary goal in treatment of glaucoma includes lowering IOP to prevent further progression of the disease. While various surgical interventions exist, medical therapy is currently the first line of treatment. Medical treatment of glaucoma includes topical beta-blockers, alpha-2 agonists, prostaglandins, parasympathomimetics and CAIs. Anti-glaucoma agents help reduce IOP by affecting the production of aqueous humor or increasing the outflow of aqueous through the trabecular or uveoscleral pathway. Choosing an appropriate medical regimen can be challenging and various factors such as efficacy, safety, cost and patient compliance must be considered. First-line treatment is often topical beta-blockers or prostaglandin analogs. However, beta-blocking agents can be associated with systemic side effects and need to be used cautiously in patients with serious concomitant cardiopulmonary disease. Alpha-2 agonists and parasympathomimetics are often considered second- or third-line treatment options but good adjunctive agents. Oral CAIs are often indicated for patients with elevated IOP in an acute setting or for patients resistant to other glaucoma medications and patients who are not good surgical candidates.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Blindness/et [Etiology]; *Blindness/pc [Prevention & Control]; Glaucoma/co [Complications]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure; *Parasympathomimetics/tu [Therapeutic Use]

Seeing you through London 2012: eye care at the Olympics. - D'Ath, Penny J; Thomson, W David; Wilson, Clare M (British journal of sports medicine, 2013)
BACKGROUND: Provision of eye care services for competitors and their support teams has become an integral part of the modern Olympic Games., AIM: To describe the organisation of the eye clinic at London 2012 over a 4-week period and provide outline audit data., METHODS: The clinic employed multidisciplinary eye care professionals and utilised state-of-the-art instrumentation to provide the highest level of eye care., RESULTS: A total of 1406 patients from 154 countries attended the clinic over the Olympic Games, of which, 276 were competitors. All individuals received a comprehensive refractive and ocular health examination. Minor ocular injuries, glaucoma, diabetic retinopathy and macular degeneration were among the conditions detected and managed. Most patients attended the clinic to have their refractive status checked: 973 spectacles and 50 pairs of contact lenses were dispensed., CONCLUSIONS: It is hoped that this account of the provision of eye care at London 2012 will assist with the planning of this service at future events.
Keywords: Adolescent; Adult; Aged; *Ambulatory Care/sn [Statistics & Numerical Data]; Ambulatory Care Facilities/sn [Statistics & Numerical Data]; Anniversaries and Special Events; *Athletes/sn [Statistics & Numerical Data]; Eyeglasses/sd [Supply & Distribution]; Female; Humans; London; Male; Middle Aged; Ophthalmology/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Sports; Sports Medicine/sn [Statistics & Numerical Data]; Vision Disorders/et [Etiology]; *Vision Disorders/th [Therapy]; Vision Tests/sn [Statistics & Numerical Data]; Young Adult

Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia. - Guijarro-Oria, F J; Gutierrez-Diaz, E; Dorado-Lopez-Rosado, A M; Montero-Rodriguez, M; Lago-Llinas, M D; Mencia-Gutierrez, E (Archivos de la Sociedad Espanola de Oftalmologia, 2013)
OBJECTIVES: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery., MATERIAL AND METHODS: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain)., RESULTS: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30 min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was "fairly or very satisfied" in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=.027) in trabeculectomy than in deep sclerectomy patients., CONCLUSIONS: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients. Copyright © 2011 Sociedad Espanola de Oftalmologia. Published by Elsevier Espana. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Anesthesia, Local/mt [Methods]; Cooperative Behavior; Female; *Glaucoma/su [Surgery]; Humans; *Job Satisfaction; Male; Middle Aged; *Patient Satisfaction; Prospective Studies; Tenon Capsule

Improving compliance with eye drop medications. - Pastor, Scott; Harbin, Tom (Missouri medicine, 2013)
Keywords: *Cell Phone; *Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/tu [Therapeutic Use]; *Reminder Systems/is [Instrumentation]

Analysis of the prevalence of cataracts and glaucoma in systemic lupus erythematosus and evaluation of the rheumatologists' practice for the monitoring of glucocorticoid eye toxicity. - Carli, L; Tani, C; Querci, F; Della Rossa, A; Vagnani, S; Baldini, C; Talarico, R; d'Ascanio, A; Neri, R; Tavoni, A G; Bombardieri, S; Mosca, M (Clinical rheumatology, 2013)
Chronic glucocorticoid (GC) therapy is associated with an increased risk of developing cataracts and glaucoma, and recommendations have been developed for monitoring these side effects in patients with rheumatic diseases. The aim of this study was to assess the prevalence of cataracts and glaucoma and the adherence to the existing recommendations for monitoring eye toxicity of chronic GC therapy among systemic lupus erythematosus (SLE) patients in routine clinical practice. Clinical charts of 170 patients were examined, and 34 (20%) of them never underwent an eye assessment. The remaining 136 underwent an eye assessment with an interval of 75 +/- 61.7 months. Only 45 (33%) had received an evaluation during the previous 12 months. All these 170 patients were taking chronic CG therapy at a mean daily dose of 5.4 +/- 2.4 mg prednisone and a mean cumulative dose of 27.6 +/- 20.5 g. Out of the 136 patients with at least one eye assessment, cataracts were observed in 39 patients (29%) and glaucoma in 4 patients (3%). Cataracts were diagnosed at a mean age of 46.5 +/- 10 years; the development of cataracts was associated with age, disease duration, and cumulative GC dose. Glaucoma was diagnosed at a mean age of 40.5 +/- 16 years; due to the small number of patients, no correlations were made. The prevalence of cataracts and glaucoma is higher than in the general population, and these conditions occur early in the life of SLE patients. An association between GC and cataracts is confirmed. The adherence to recommendations is suboptimal as only 33% of patients underwent an eye assessment over the previous 12 months. These data reinforce the need to improve adherence to recommendations for eye monitoring among SLE patients under chronic therapy with GC.
Keywords: Adult; *Cataract/co [Complications]; *Cataract/ep [Epidemiology]; *Eye Diseases/ci [Chemically Induced]; Female; *Glaucoma/co [Complications]; *Glaucoma/ep [Epidemiology]; *Glucocorticoids/ae [Adverse Effects]; Guideline Adherence; Humans; *Lupus Erythematosus, Systemic/co [Complications]; *Lupus Erythematosus, Systemic/ep [Epidemiology]; Male; Middle Aged; Prevalence; Regression Analysis; Retrospective Studies; Rheumatology/mt [Methods]; Rheumatology/st [Standards]; Time Factors

Glaucoma severity and medication adherence in a county hospital population. - Ung, Cindy; Zhang, Elisa; Alfaro, Tatyana; Murakami, Yohko; Zhang, Monica; Seider, Michael I; Lin, Shan C; Singh, Kuldev (Ophthalmology, 2013)
OBJECTIVE: To assess the association between disease severity and adherence with glaucoma medications in a county hospital population., DESIGN: Cross-sectional study., PARTICIPANTS: A total of 126 patients diagnosed with glaucoma receiving intraocular pressure (IOP)-lowering medication were recruited from the San Francisco General Hospital Ophthalmology Clinic., METHODS: Subjects completed an oral questionnaire to assess demographic information, knowledge of glaucoma, and perceptions of glaucoma medication adherence. Glaucoma disease severity was classified according to the American Academy of Ophthalmology's Preferred Practice Pattern guidelines. Medication adherence was measured for each patient by obtaining pharmacy refill data and calculating medication possession ratio (MPR), that is, the ratio of total days' supply of medication during a 365-day period. Adherence was measured retrospectively over the 18-month period before study entry. Subjects with an MPR >80% were considered adherent., MAIN OUTCOME MEASURE: Medication adherence., RESULTS: Subjects with mild or moderate glaucoma were more likely to be nonadherent to their prescribed glaucoma medications than those with severe disease (adjusted odds ratio [OR], 1.54; 95% confidence interval [CI], 1.03-2.31; P = 0.04). Age, gender, race, education level, years of glaucoma, number of medications, and glaucoma diagnosis were not found to be statistically significantly associated with adherence., CONCLUSION: Patients with severe glaucoma were more likely to adhere to their topical IOP-lowering medication regimen than those with milder glaucomatous disease., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Drug Prescriptions/sn [Statistics & Numerical Data]; Female; *Glaucoma/cl [Classification]; *Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; *Hospitals, County/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Outpatient Clinics, Hospital; Retrospective Studies; San Francisco; *Severity of Illness Index; Surveys and Questionnaires; Tonometry, Ocular; Visual Field Tests; Visual Fields

Adherence to NICE guidelines for new glaucoma referrals. - Chaudhary, R; Dhillon, N; Jones, L (Eye (London, England), 2013)
Erratum in (EIN), Comment in (CIN)
Keywords: *Glaucoma/di [Diagnosis]; *Guideline Adherence/st [Standards]; Humans; *Practice Guidelines as Topic; State Medicine; United Kingdom

Screening diabetic and hypertensive patients for ocular pathology using telemedicine technology in rural West Virginia: a retrospective chart review. - Ahmed, Rezwan; Petrany, Stephen; Fry, Russell; Krasnow, Michael (The West Virginia medical journal, 2013)
PURPOSE: There is a disparity between the number of people who need healthcare and availability of medical services in rural areas. This paper describes the experience of using telemedicine technologies for ophthalmologic evaluation in diabetic and hypertensive patients presenting to a community health center in rural West Virginia., METHODS: A registered nurse at a community health center in McDowell County, WV was trained to use a retinal camera to capture high-resolution digital images of the retina. Patients with diabetes or hypertension were screened during their routine primary care visits. Retinal photos were transmitted to an ophthalmologist for review and reports from the screenings were returned with instruction for follow-up care or specialist referral when indicated., FINDINGS: A retrospective chart review of 643 patients with diabetes or hypertension who were screened for ocular problems from October 2003 to December 2009 was completed. 44.8% of patients who were screened in the primary care center were identified as having 1 of 34 types of eye pathology that were previously unknown, of which 33% of patients were recommended to seek prompt attention by a retina consultant or glaucoma specialist for suspected ocular pathology., CONCLUSIONS: Our review demonstrates the actual benefits of telemedicine in the effective screening of diabetic and hypertensive patients for eye pathology, and our experience suggests that using distance medicine and telemedicine technologies is valuable for screening rural populations.
Keywords: Adult; Aged; *Diabetes Complications/di [Diagnosis]; *Eye Diseases/di [Diagnosis]; Eye Diseases/et [Etiology]; Female; Health Services Accessibility; Healthcare Disparities; Humans; *Hypertension/co [Complications]; Male; Middle Aged; Retrospective Studies; *Rural Health Services; *Telemedicine/mt [Methods]

The British Asian community eye study: outline of results on the prevalence of eye disease in British Asians with origins from the Indian subcontinent. - Rauf, Abdul; Malik, Rizwan; Bunce, Catey; Wormald, Richard (Indian journal of ophthalmology, 2013)
BACKGROUND: Asians from the Indian Subcontinent form the largest ethnic minority in the United Kingdom. Data on the prevalence of visually-impairing eye conditions in this population are vital for planning eye health care services., MATERIALS AND METHODS: This survey was based in the two London boroughs with the largest Asian populations. Subjects originating from the Indian Subcontinent were identified from GP practice records. All subjects were asked about demographic details and were given a full ophthalmological examination. The severity of cataract, glaucoma, diabetic retinopathy, and age-related maculopathy was recorded. Blindness was defined as logMAR visual acuity of 0.99 (Snellen equivalence 20/200 in the better eye) or worse, 'low vision' was defined as Snellen equivalence of 20/63 or worse (logMAR 0.5 or higher), and visual impairment was defined as visual acuity worse than 20/40., RESULTS: The median age was 56 years. Two hundred and eighty four subjects did not attend for eye examination. Of the 922 examined, 128 subjects (13.9%) were 'visually impaired,' 39 (4.2%) had 'low vision,' and 6 (0.7%) were bilaterally blind. The overall prevalence of cataract, open-angle glaucoma, age-related macular degeneration, and diabetic retinopathy were 77%, 1.0%, 8.7%, and 8.8%, respectively., CONCLUSION: Visual impairment rates amongst Asians seem to be similar to Caucasian populations in the UK. The prevalence of cataract and diabetic retinopathy is higher, while the risk of ARMD and OAG are comparable. In view of the high cataract prevalence, a more detailed assessment of the visual profile and factors limiting healthcare accessibility in this community are needed.
Keywords: Adult; Age Distribution; Aged; *Asian Continental Ancestry Group; Cross-Sectional Studies; *European Continental Ancestry Group; *Eye Diseases/eh [Ethnology]; Female; Humans; India/eh [Ethnology]; Male; Middle Aged; *Population Surveillance; Prevalence; Sex Distribution; United Kingdom/ep [Epidemiology]

The impact of glaucoma referral refinement criteria on referral to, and first-visit discharge rates from, the hospital eye service: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project. - Ratnarajan, Gokulan; Newsom, Wendy; French, Karen; Kean, Jane; Chang, Lydia; Parker, Mike; Garway-Heath, David F; Bourne, Rupert R A (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2013)
PURPOSE: To assess the impact of referral refinement criteria on the number of patients referred to, and first-visit discharges from, the Hospital Eye Service (HES) in relation to the National Institute for Health & Clinical Excellence (NICE) Glaucoma Guidelines, Joint College Group Guidance (JCG) and the NICE commissioning guidance., METHODS: All low-risk (one risk factor: suspicious optic disc, abnormal visual field (VF), raised intra-ocular pressure (IOP) (22-28 mmHg) or IOP asymmetry (>5 mmHg) and high-risk (more than one risk factor, shallow anterior chamber or IOP >28 mmHg) referrals to the HES from 2006 to 2011 were analysed. Low-risk referrals were seen by Optometrists with a specialist interest in glaucoma and high-risk referrals were referred directly to the HES., RESULTS: Two thousand nine hundred and twelve patient records were analysed. The highest Consultant first-visit discharge rates were for referrals based on IOP alone (45% for IOP 22-28 mmHg) and IOP asymmetry (53%), VF defect alone (46%) and for abnormal IOP and VF (54%). The lowest first-visit discharge rates were for referrals for suspicious optic disc (19%) and IOP >28 mmHg (22%). 73% of patients aged 65-80 and 60% of patients aged >80 who were referred by the OSI due to an IOP between 22-28 mmHg would have satisfied the JCG criteria for non-referral. For patients referred with an IOP >28 mmHg and an otherwise normal examination, adherence to the NICE commissioning guidance would have resulted in 6% fewer referrals. In 2010 this scheme reduced the number of patients attending the HES by 15%, which resulted in a saving of 16 258 (13%)., CONCLUSION: The results support that referrals for a raised IOP alone or in combination with an abnormal VF be classified as low-risk and undergo referral refinement. Adherence to the JCG and the NICE commissioning guidance as onward referral criteria for specialist optometrists in this referral refinement scheme would result in fewer referrals. Copyright Ophthalmic & Physiological Optics © 2013 The College of Optometrists.
Keywords: Aged; Aged, 80 and over; Female; *Glaucoma/di [Diagnosis]; Humans; Male; *Optometry/st [Standards]; *Outpatient Clinics, Hospital/sn [Statistics & Numerical Data]; *Patient Discharge/sn [Statistics & Numerical Data]; *Practice Guidelines as Topic; *Referral and Consultation/sn [Statistics & Numerical Data]; United Kingdom

Acute red eye (non-ulcerative keratitis) associated with mini-scleral contact lens wear for keratoconus. - Bruce, Adrian S; Nguyen, Leanne M (Clinical & experimental optometry, 2013)
Mini-scleral lenses are an increasingly popular contact lens modality; however, there are relatively few reports regarding the unique aspects of their fitting and potential complications. We report a complication of mini-scleral lens wear in a 44-year-old female patient using the lenses for keratoconus. Her mini-scleral contact lenses were non-fenestrated and fitted to vault over the cornea and seal at the periphery. The patient presented with an acute red eye (non-ulcerative keratitis), characterised by unilateral severe conjunctival and limbal hyperaemia, corneal infiltration and pain. Refitting the lens to increase the corneal vault clearance did not prevent recurrence of the keratitis, some five months later. Successful prevention of further episodes of the acute red eye was achieved through improved patient compliance with lens cleaning, disinfection and lens case procedures. Lens hygiene may be particularly important for mini-scleral lenses with a sealed fitting. Copyright © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.
Keywords: Acute Disease; Adult; *Contact Lenses/ae [Adverse Effects]; Female; Humans; *Keratitis/et [Etiology]; *Keratoconus/th [Therapy]; *Sclera

Analysis of pulsatile retinal movements by spectral-domain low-coherence interferometry: influence of age and glaucoma on the pulse wave. - Dion, Carolyne; Singh, Kanwarpal; Ozaki, Tsuneyuki; Lesk, Mark R; Costantino, Santiago (PloS one, 2013)
Recent studies have shown that ocular hemodynamics and eye tissue biomechanical properties play an important role in the pathophysiology of glaucoma. Nevertheless, better, non-invasive methods to assess these characteristics in vivo are essential for a thorough understanding of degenerative mechanisms. Here, we propose to measure ocular tissue movements induced by cardiac pulsations and study the ocular pulse waveform as an indicator of tissue compliance. Using a novel, low-cost and non-invasive device based on spectral-domain low coherence interferometry (SD-LCI), we demonstrate the potential of this technique to differentiate ocular hemodynamic and biomechanical properties. We measured the axial movement of the retina driven by the pulsatile ocular blood flow in 11 young healthy individuals, 12 older healthy individuals and 15 older treated glaucoma patients using our custom-made SD-OCT apparatus. The cardiac pulse was simultaneously measured through the use of an oximeter to allow comparison. Spectral components up to the second harmonic were obtained and analyzed. For the different cohorts, we computed a few parameters that characterize the three groups of individuals by analyzing the movement of the retinal tissue at two locations, using this simple, low-cost interferometric device. Our pilot study indicates that spectral analysis of the fundus pulsation has potential for the study of ocular biomechanical and vascular properties, as well as for the study of ocular disease.
Keywords: Adult; Aged; Eye/bs [Blood Supply]; *Eye/pp [Physiopathology]; Eye Movements/ph [Physiology]; Female; Glaucoma/di [Diagnosis]; *Glaucoma/pp [Physiopathology]; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; *Ocular Physiological Phenomena; Regional Blood Flow/ph [Physiology]; *Retina/pp [Physiopathology]; Tonometry, Ocular/is [Instrumentation]; Tonometry, Ocular/mt [Methods]; Young Adult

Therapeutic uses of prostaglandin F(2alpha) analogues in ocular disease and novel synthetic strategies. - Dams, Iwona; Wasyluk, Jaromir; Prost, Marek; Kutner, Andrzej (Prostaglandins & other lipid mediators, 2013)
The pharmacological management of glaucoma and ocular hypertension has significantly changed over the last 18 years with the introduction of PGF2alpha analogues, more specifically latanoprost (6), travoprost (8), bimatoprost (10) and tafluprost (12). Prostanoids are currently the first-line medicines among ocular antihypertensive drugs in terms of efficacy, safety, patient compliance and medical economy. Their ability to effectively reduce intraocular pressure with once-per-day dosing, ocular tolerability comparable to timolol and general lack of systemic adverse effects have made them the mainstay of pharmacological therapy for glaucoma and ocular hypertension all over the world. The present review reports a novel, convergent and highly diastereoselective method for the synthesis of PGF2alpha analogues from the structurally advanced prostaglandin phenylsulfone (5Z)-(+)-15 and new omega-chain synthons. The biochemistry, clinical efficacy and side effects of four commercially available PGF2alpha analogues, currently used as first-line agents for reducing intraocular pressure in patients with glaucoma or ocular hypertension, are also discussed. Copyright © 2013 Elsevier Inc. All rights reserved.
Keywords: Amides/cs [Chemical Synthesis]; Amides/pd [Pharmacology]; *Antihypertensive Agents/cs [Chemical Synthesis]; *Antihypertensive Agents/pd [Pharmacology]; Bimatoprost; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/cs [Chemical Synthesis]; Cloprostenol/pd [Pharmacology]; *Dinoprost/aa [Analogs & Derivatives]; *Dinoprost/cs [Chemical Synthesis]; *Dinoprost/pd [Pharmacology]; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/me [Metabolism]; Ocular Hypertension/pp [Physiopathology]; Prostaglandins F/cs [Chemical Synthesis]; Prostaglandins F/pd [Pharmacology]; Prostaglandins F, Synthetic/cs [Chemical Synthesis]; Prostaglandins F, Synthetic/pd [Pharmacology]; Randomized Controlled Trials as Topic; Travoprost

The impact of an electronic health record transition on a glaucoma subspecialty practice. - Pandit, Ravi R; Boland, Michael V (Ophthalmology, 2013)
PURPOSE: To assess the impact of an electronic health record (EHR) on patient experience, physician behavior, and clinic workflow in a glaucoma subspecialty clinic., DESIGN: Case-control (before/after) study., PARTICIPANTS: One hundred thirty-one adult patients seeking treatment at a glaucoma subspecialty practice for a nonprocedural office visit who consented to direct observation and 273 patients whose progress through the clinic stations was timed., METHODS: Three time points relative to the EHR transition were evaluated: a 2-week period before the transition, a 2-week period at 2 weeks after the transition, and a 2-week period at 6 months after the transition. At each of these time points, detailed timing of physician actions during the doctor-patient encounter were measured, a survey of patient attitudes regarding their visit and the method of documentation was conducted, and time spent by patients in each of the major aspects of the visit (screening/testing, physician, waiting) was recorded., MAIN OUTCOME MEASURES: Time spent by physicians on the clinical examination, computer, paper records, or multitasking; patient experience of their clinic visit; and time spent by patients at various clinic stations., RESULTS: Two weeks after the transition, physicians spent more time with patients overall compared with baseline (8.4 vs. 11.6 minutes), reviewing paper records (0.2 vs. 0.6 minutes), and on computer-related tasks (2.3 vs. 4.2 minutes). At 6 months after EHR transition, physicians also spent more time compared with baseline on the clinical examination (5.1 vs. 6.4 minutes). There was a relative decrease in the percentage of patient time spent waiting to see the physician, although patients' perceptions of their visit and the EHR remained largely unchanged. Annual clinic volumes also were unaffected by the new EHR., CONCLUSIONS: There were changes in the physician-patient encounter that manifested within 2 weeks of EHR transition and then stabilized, suggesting that although an EHR transition is not without consequences, these can be measured early. Some of these findings, such as increased time dedicated to the clinical examination and the lack of change in patient perception after the switch, were unexpected. This study supports the contention that EHR implementation can be accomplished in an ophthalmology practice without compromising the efficiency of or patient satisfaction with the clinical encounter. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; *Ambulatory Care/sn [Statistics & Numerical Data]; *Ambulatory Care Facilities/og [Organization & Administration]; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; *Health Transition; Humans; Male; *Medical Records Systems, Computerized/og [Organization & Administration]; Middle Aged; Patient Satisfaction; *Physician-Patient Relations; Retrospective Studies

Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study. - Holtzer-Goor, Kim M; Plochg, Thomas; Lemij, Hans G; van Sprundel, Esther; Koopmanschap, Marc A; Klazinga, Niek S (Implementation science : IS, 2013)
BACKGROUND: Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders' perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists., METHODS: A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis., RESULTS: Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents' narratives revealed that: the glaucoma specialists' sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU., CONCLUSIONS: Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a normal step in the professionalization of the substituting professionals is essential, as is implementing the task substitution within the window of opportunity.
Keywords: Attitude of Health Personnel; Feasibility Studies; *Glaucoma/th [Therapy]; Health Services Accessibility; *Hospitalization; Humans; Netherlands; *Optometry/og [Organization & Administration]; Optometry/st [Standards]; *Patient Transfer/sn [Statistics & Numerical Data]; *Primary Health Care/sn [Statistics & Numerical Data]; Qualitative Research; Quality of Health Care

Patient satisfaction: the name of the game?. - White, Andrew; Goldberg, Ivan (Clinical & experimental ophthalmology, 2013)
Comment on (CON)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Patient Satisfaction/sn [Statistics & Numerical Data]

Prevalence and causes of patient dropout after glaucoma surgery. - Gupta, Viney; Chandra, Anuradha; Yogi, Rohit; Sihota, Ramanjit; Singh, Digvijay (Ophthalmic epidemiology, 2013)
PURPOSE: To determine the prevalence of patient dropout after glaucoma surgery and reasons for the same based on patient attitudes and beliefs., DESIGN: A hospital-based retrospective case-control study., METHODS: Clinical and demographic data of patients who failed to attend follow-up within 12 months of their last scheduled appointment after glaucoma surgery were analyzed. These patients were issued recall letters and those who returned were interviewed to establish the reasons for their dropout. A structured interview was conducted to assess the educational and socioeconomic status of the patients, their knowledge and belief regarding glaucoma, their attitude towards surgery and the specific reason for their inability to follow up post-operatively. Control subjects who were regularly followed-up post-operatively were also interviewed., RESULTS: Of 312 patients operated on from 2004-2006, only 92 (30%) patients maintained a 5-year follow-up. Of patients who dropped out, 43 patients responded to the recall letters and were interviewed along with 45 control patients. The demographic profile of those who dropped out was statistically similar to the controls; however, the controls had a significantly better awareness of glaucoma and higher monthly income (p < 0.001 and p = 0.01, respectively). Among those who dropped out, 38 (88%) believed surgery was the cure to the disease in comparison to 12 (46%) controls (p < 0.001)., CONCLUSIONS: Dropout after glaucoma surgery is high among patients from lower socioeconomic strata. Misconceptions regarding surgery as a cure to glaucoma and situational factors are the most common reasons for patient dropout in this population.
Keywords: Adult; Aged; Case-Control Studies; Educational Status; Female; *Glaucoma/su [Surgery]; Health Knowledge, Attitudes, Practice; Humans; India/ep [Epidemiology]; Male; Middle Aged; Patient Dropouts/px [Psychology]; *Patient Dropouts/sn [Statistics & Numerical Data]; Patients/px [Psychology]; Postoperative Period; Prevalence; Retrospective Studies; Social Class; *Trabeculectomy/sn [Statistics & Numerical Data]; Visual Acuity

Prevalence and causes of visual impairment and blindness, cataract surgical coverage and outcomes of cataract surgery in Libya. - Rabiu, Muhammad Mansur; Jenf, Mansour; Fituri, Suad; Choudhury, Abdulhanan; Agbabiaka, Idris; Mousa, Ahmed (Ophthalmic epidemiology, 2013)
PURPOSE: To assess the major causes of avoidable blindness, and outcomes and barriers to cataract services in Libya., METHODS: A stratified multistage cluster random sample study was conducted in the four regions of Libya. Visual acuity and lens assessment were performed on all subjects. Those with presenting visual acuity <6/18 in either or both eyes were further investigated to determine cause(s) of impairment. Barriers to cataract surgery were investigated. Visual outcomes of subjects with surgery performed were assessed., RESULTS: A total of 8538 persons aged >=50 years were examined across the four regions. The prevalence of blindness was 3.25% (3.15% with best correction), which varied across the regions (2.94-3.80%); after adjustment for age and sex, the prevalence was 2.66%. Major causes of blindness were cataract (29%), glaucoma (24%) and other corneal scars (14%). Causes were similar across all regions except in the south. Avoidable causes were responsible for 60.6% of blindness. Major causes of visual impairment were cataract (31.2%), diabetic retinopathy (16.6%) and posterior segment diseases (15.1%). Cataract surgical coverage among those with visual acuity <3/60 was 95.4%, with no sex differences. About 38% of cataract-operated eyes had poor outcome even after best correction (35%). There was poor outcome in 33% of pseudophakic eyes with best correction. The major barriers to service uptake were "waiting for maturity" (26%), "unaware of treatment" (24%) and "God's will/destiny" (17%)., CONCLUSION: Libya needs to improve the quality of cataract surgery across all the regions. The southern region needs improvement in both quality and coverage of services.
Keywords: Age Distribution; Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; *Cataract/ep [Epidemiology]; *Cataract Extraction/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Female; Health Surveys; Humans; Libya/ep [Epidemiology]; Male; Middle Aged; Outcome Assessment, Health Care; Prevalence; Sex Distribution; *Vision, Low/ep [Epidemiology]; Visual Acuity/ph [Physiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Estimation of ocular rigidity in glaucoma using ocular pulse amplitude and pulsatile choroidal blood flow. - Wang, Jing; Freeman, Ellen E; Descovich, Denise; Harasymowycz, Paul J; Kamdeu Fansi, Alvine; Li, Gisele; Lesk, Mark R (Investigative ophthalmology & visual science, 2013)
PURPOSE: Theoretical models and animal studies have suggested that scleral rigidity plays an important role in the pathogenesis of glaucoma. The aim of this study was to present a noninvasive technique for estimating ocular rigidity (E) in vivo, and to compare the estimated rigidity between patients with open-angle glaucoma (OAG); ocular hypertension (OHT); suspect glaucomatous disc (GS); and normal subjects (N). We hypothesized that OHT patients would have higher rigidity., METHODS: All patients underwent measurements of ocular pulse amplitude (OPA) using dynamic contour tonometry, pulsatile choroidal blood flow (ChBFP) using laser Doppler flowmetry; axial length (AL); and assessment of automated visual field mean deviation (MD). The ratio between OPA and ChBFP was calculated according to the Friedenwald's equation of ocular rigidity. The calculated ratio is denoted as (ER). The average ER values of the four diagnostic groups were compared using nonparametric tests. The relationship between ER and other ocular and systemic factors was examined using correlation and regression analysis., RESULTS: A total of 257 subjects were included in the study (56 N, 108 OAG, 48 GS, and 45 OHT). ER correlated negatively with AL and positively with MD, signifying that a lower rigidity was associated with a longer eye and a worse (more negative) MD. ER was also found to be highest in OHT (0.235 +/- 0.16) and lowest in OAG (0.188 +/- 0.14; P = 0.01)., CONCLUSIONS: Estimated coefficient of ocular rigidity by OPA and ChBFP suggested that glaucoma patients had the lowest rigidity and OHT the highest. It supports the idea that a more compliant ocular shell may predispose the optic nerve head to intraocular pressure (IOP)-related damage.
Keywords: Aged; Algorithms; Case-Control Studies; Choroid/bs [Blood Supply]; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Laser-Doppler Flowmetry; Male; Middle Aged; *Ocular Hypertension/pp [Physiopathology]; Pulsatile Flow; Regional Blood Flow; *Sclera/pa [Pathology]; Tonometry, Ocular