Chronic open angle glaucoma: patient awareness of the nature of the disease, topical medication, compliance and the prevalence of systemic symptoms. - Deokule, Sunil; Sadiq, Saghir; Shah, Sunil (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2004)
PURPOSE: To study the awareness of the nature of the disease, compliance with treatment, and prevalence of systemic symptoms in a group of patients with chronic open angle glaucoma (COAG)., METHOD: A structured questionnaire was designed and given to 260 consecutive COAG patients attending a general ophthalmology clinic. Questions related to the increased risk of COAG amongst family members, screening of family members, nature of field defects, variation in IOP, topical treatment and availability of a free eye test for a COAG patient in the UK were asked. Compliance and systemic symptoms were also assessed., RESULTS: Forty-one per cent (107 of 260) of patients in the study group were aware of the increased risk of COAG in family members and 45.5% (118 of 260) of patient's family members had undergone screening for COAG. Seventy-three per cent (191 of 260) of the patients were aware of their own and their family members' entitlement to a free eye test. Seventy-seven per cent of patients claimed full compliance. Thirty per cent of patients were noted to have systemic symptoms., CONCLUSIONS: The awareness of the nature of COAG in this population was low and incidence of perceived drug related systemic symptoms very high. Both of these may contribute to poor compliance.
Keywords: Administration, Topical; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Aged; Aged, 80 and over; *Awareness; Chronic Disease; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/px [Psychology]; Humans; Male; Middle Aged; *Patient Compliance/px [Psychology]; Risk Factors; Surveys and Questionnaires; Vision, Ocular/ph [Physiology]

Medication-related predictors of health-related quality of life in glaucoma patients enrolled in a medicare health maintenance organization. - Balkrishnan, Rajesh; Bond, J Brent; Byerly, Wesley G; Camacho, Fabian T; Anderson, Roger T (The American journal of geriatric pharmacotherapy, 2003)
BACKGROUND: Glaucoma is an important public health concern in the United States, particularly among older adults (aged >or=65 years). Pharmacologic therapy for glaucoma consists mainly of topical eye drops containing beta-blockers or prostaglandin analogs., OBJECTIVE: The goal of this study was to assess the associations between factors of topical medication use (self reported medication compliance, belief in benefit of medication use, usage difficulty, usage assistance, and complexity of medication regimen) and health-related quality of life (HRQOL) in a cross-sectional population of older patients with glaucoma., METHODS: A self-administered, 48-question survey soliciting information on medication-taking behaviors, treatmen-trelated factors, and HRQOL was mailed to members of a Medicare health maintenance organization who were aged >or=65 years and had primary open-angle glaucoma. Two mailings were conducted 4 months apart; the second was sent to members whose responses to the first mailing had not yet been received. The 12-Item Short-Form Health Survey (SF-12) and the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) were used to assess HRQOL. Other questions addressed perceptions of eye drop use in these patients. Multiple regression techniques were used to analyze associations between medication-related factors and HRQOL in this population., RESULTS: The questionnaire was mailed to 589 patients; 375 responded (218 in the first mailing and 157 in the second mailing). A total of 358 responses were complete and analyzable (effective response rate, 62%). After controlling for the effects of other confounders, we found that self reported difficulty in using eye drops was strongly associated with decreased HRQOL (11.5% in VFQ-25 total score and 8.4% in SF-12 mental health score, P<0.05). Other medication-related factors that were examined were not significantly associated with changes in HRQOL., CONCLUSION: Based on our findings, patients aged >or=65 years with glaucoma were likely to have significant comorbidity, which affected both visual and general health and well-being perception. Additionally, a significant proportion of these patients reported difficulty with use of topical medication, which was independently associated with a significant decrease in HRQOL. Care of older patients with glaucoma should incorporate strategies to minimize the difficulty associated with medication use.
Keywords: Administration, Topical; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; *Health Maintenance Organizations/sn [Statistics & Numerical Data]; Humans; Male; *Medicare/sn [Statistics & Numerical Data]; Ophthalmic Solutions; Patient Compliance; *Quality of Life; Regression Analysis; Surveys and Questionnaires; Treatment Outcome; United States

[Treatment of Acanthamoeba keratitis: possibilities, problems, and new approaches]. - Walochnik, Julia; Duchene, Michael; Eibl, Hansjorg; Aspock, Horst (Wiener klinische Wochenschrift, 2003)
Acanthamoeba keratitis is a corneal disease associated predominantly with contact lens wear. The occurrence of Acanthamoeba keratitis has been rising since 1990 in correlation to the growing number of contact lens wearers. To date approximately 2000 cases have been published around the world. Due to the complicated diagnostics, the elaborate treatment and the usually bad compliance of the patients, Acanthamoeba keratitis unfortunately very often takes a serious progression, which may lead to serious visual loss and perforating keratoplasty. Today, local treatment with a combination of polyhexamethylene biguanide (PHMB) and propamidine isethionate (Brolene) is considered the first line therapy for Acanthamoeba keratitis. Alternatively also a combination of propamidine and chlorhexidine or neomycine achieves good therapeutic results. However, the complicated mode of application consistently remains a problem. The intensive local treatment, i.e. hourly application of therapeutics during the first three days day and night makes hospitalization inevitable. Moreover, sufficient efficacy can not always be achieved, and also resistance against propamidine has already been observed. Recently propamidine has sometimes been replaced by hexamidine, which seems to have a greater cysticidal activity. A new path might be struck by the application of alkylphosphocholines. These are phosphocholines esterified to aliphatic alcohols. They exhibit in vitro and in vivo antineoplastic activity and have been shown to be cytotoxic against Leishmania donovani, Trypanosoma cruzi, and Entamoeba histolytica. A recent study has demonstrated that particularly hexadecylphosphocholine is highly effective also against various strains of Acanthamoeba.
Keywords: Acanthamoeba Keratitis/di [Diagnosis]; *Acanthamoeba Keratitis/dt [Drug Therapy]; Acanthamoeba Keratitis/ep [Epidemiology]; *Acanthamoeba Keratitis/et [Etiology]; *Antiprotozoal Agents/ad [Administration & Dosage]; *Benzamidines/ad [Administration & Dosage]; *Biguanides/ad [Administration & Dosage]; *Contact Lens Solutions/ad [Administration & Dosage]; *Contact Lenses/ae [Adverse Effects]; Drug Combinations; Humans; Patient Compliance; Phosphorylcholine/ad [Administration & Dosage]; Treatment Outcome

Quality of life related to visual function in three young adults with mucopolysaccharidoses. - Bergwerk, Katherine L; Rabinowitz, Yaron S; Falk, Rena E (TheScientificWorldJournal, 2003)
The systemic mucopolysaccharidoses are complex syndromes, which may include corneal clouding as a mechanism leading to decreased vision and hence decreased quality of life. This study presents three young adult patients with mucopolysaccharidoses in order to compare their visual status through retrospective chart review, including patient and guardian interview, history, and examination, including a modified form of the VF-14 questionnaire (visual function with 14 questions). When the visual acuity and VF-14 results of the three patients were compared, the results of the VF-14 correlated with the patients" visual acuity status. The two patients who retained clear corneas or underwent penetrating keratoplasty had a wider range of social and physical activities, and an overall better quality of life than did the patient with decreased vision due to opacified corneas. We conclude that close monitoring of the ocular health of patients with storage syndromes that may compromise visual acuity must be stressed, and intervention to insure good vision is of the utmost importance to maintaining a good quality of life for these patients, especially as new therapies assist these patients to achieve increased longevity with better health.
Keywords: Adult; Corneal Opacity/di [Diagnosis]; *Corneal Opacity/et [Etiology]; Corneal Opacity/su [Surgery]; Female; Glaucoma/di [Diagnosis]; *Glaucoma/et [Etiology]; Humans; Intellectual Disability/et [Etiology]; Male; *Mucopolysaccharidoses/co [Complications]; Mucopolysaccharidoses/pp [Physiopathology]; *Quality of Life; Retrospective Studies; Surveys and Questionnaires; Treatment Refusal; Visual Acuity

Evaluation of the comfort of Alphagan P compared with Alphagan in irritated eyes. - Mundorf, Thomas; Wilcox, Katrina A; Ousler, George W 3rd; Welch, Donna; Abelson, Mark B (Advances in therapy, 2003)
The tolerability of brimonidine tartrate 0.15%--referred to as bromonidine-Purite 0.15% in this study--was compared with brimonidine tartrate 0.2% in irritated eyes of healthy volunteers as well as patients with glaucoma or ocular hypertension (N=20) in a 2-week, single-center, randomized, double-masked, crossover study. Participants were evaluated at days 0, 7, 11, and 15. At day 0, they were exposed to a controlled adverse environment (CAE), in which humidity, temperature, and airflow was regulated, for up to 90 minutes. Participants who reported a sufficient level of bilateral ocular discomfort during exposure to the CAE were enrolled in this study and received 1 drop of brimonidine-Purite 0.15% in 1 eye and 1 drop of brimonidine tartrate 0.2% in the contralateral eye. Immediately following instillation, participants were asked to indicate their preference for either study medication. The study medications were not used between days 0 and 7. From day 7 to 10, participants administered either drug bilaterally. On day 11, the treatment was crossed over, and participants were asked to compare the preferred medication with their previous regimen. They continued to administer the drug bilaterally twice daily until day 15, when the preferred medication was again compared with the previous regimen. Following CAE exposure at visit 1, 70.6% of the participants preferred brimonidine-Purite 0.15% over brimonidine tartrate 0.2% and indicated that it was significantly more comfortable than brimonidine tartrate 0.2% (P=.009). When given brimonidine-Purite 0.15% first before switching to brimonidine tartrate 0.2%, 80% of participants preferred brimonidine-Purite 0.15% (P=.012). When given brimonidine tartrate 0.2% first before switching to brimonidine-Purite 0.15%, 85% preferred brimonidine-Purite 0.15% (P=.001). The results of this study suggest that brimonidine-Purite 0.15% is significantly more comfortable than brimonidine tartrate 0.2% in patients with irritated eyes.
Keywords: Administration, Topical; Adult; Aged; Brimonidine Tartrate; Conjunctivitis/di [Diagnosis]; Conjunctivitis/dt [Drug Therapy]; Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Satisfaction; Probability; *Quinoxalines/ad [Administration & Dosage]; Reference Values; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Treatment Outcome

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members. - Lambert, Scott R; Lynn, Michael; Drews-Botsch, Carolyn; DuBois, Lindreth; Wilson, M Edward; Plager, David A; Wheeler, David T; Christiansen, Stephen P; Crouch, Earl R; Buckley, Edward G; Stager, David Jr; Donahue, Sean P (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2003)
BACKGROUND: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization., METHODS: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction., RESULTS: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization., CONCLUSIONS: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.
Keywords: *Aphakia, Postcataract/th [Therapy]; *Cataract/cn [Congenital]; Child, Preschool; *Contact Lenses/px [Psychology]; Female; Humans; Infant; *Lens Implantation, Intraocular/px [Psychology]; Male; Ophthalmology; *Parents/px [Psychology]; Pilot Projects; *Practice Patterns, Physicians'; Random Allocation; Societies, Medical; Treatment Outcome; Visual Acuity

[Compliance of medical treatment in primitive glaucoma open angle]. - Wane, A M; Ndiaye, M R; Wade, A; Ndiaye, P A; Ba, E A; de Medeiros, M E; Ndoye, P A; Ndiaye, C S; Kameni, A (Journal francais d'ophtalmologie, 2003)
INTRODUCTION: Compliance to medical treatment expresses the patient's perception of the disease and the treatment prescribed by the doctors. Lack of compliance endangers chronic glaucoma care, which explains the importance it has been given these last years. The objectives of this survey were to evaluate the compliance of adult patients suffering from primary open angle glaucoma to discover the influential factors., MATERIALS AND METHODS: We conducted a survey at the ophthalmology clinic of Le Dantec Hospital from January 1997 to May 1998 among 31 adults being treated for primary open angle glaucoma. An indirect evaluation of the patients' compliance was made on the basis of a questionnaire after examination of their medical files. It was deemed good, average, or bad depending on: regularity of the patient's visits to the doctors, regularity of the treatment, respect of the doctor's prescription and the prescribed times for taking the medicine. The Chi square independence test was used to study the influence of the following factors: age, sex, residence, socioeconomic status, duration of symptom progression, level of instruction, counseling, and treatment., RESULTS: The patients' mean age was 60.5 years. Compliance was deemed good for 29% of the total cases, average for 32.3%, and bad for 38.7%. Only factors such as the regular visits to the doctor, the regularity of the treatment, and respect of the doctor's prescription and the prescribed times for taking the medicine were found to be influential (p<0.05)., CONCLUSION: The medical treatment of primary open angle glaucoma, whether temporary or permanent, with a maximum of efficacy and a minimum of side-effects requires good compliance on the part of the patient. This compliance in turn requires a good doctor-patient relationship based on effective repeated counseling to educate patients, help them understand the disease, and act on the influential factors.
Keywords: Adult; Aged; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance

Vision related quality of life and topical glaucoma treatment side effects. - Nordmann, Jean-Philippe; Auzanneau, Nadia; Ricard, Severine; Berdeaux, Gilles (Health and quality of life outcomes, 2003)
BACKGROUND: Local tolerance of topical glaucoma treatment is important to achieve a good compliance. The aim of this study was to evaluate the consequences of local anti-glaucoma drug side effects on the vision-related quality of life (QoL)., METHODS: A mail survey was sent to 20,000 homes of a panel representative of the French population asking whether one member of the family was suffering from ocular hypertension (OHT) or glaucoma. (POAG) A computer-assisted telephone interviewing system was used to confirm self-reported glaucoma, to describe the disease and its treatment, and medical item consumption. Vision-related QoL was assessed with the NEI-VFQ-25 (National Eye Institute Visual - Function Questionnaire) and local tolerance with the COMTOL (Comparison of Ophthalmic Medications for TOLerability)., RESULTS: 13,352 homes (66.7%) answered the mail. 581 people declared they were suffering from glaucoma or OHT. Prevalence was 1.8%, increasing with age. 204 patients were selected at random Their NEI-VFQ-25 global score showed an overall good QoL. Two domain scores showed some deterioration: general health and driving. 62.4% of the patients cited at least one local side effect. 25.4% had burning, 20.8% blurred vision and 20.2% tearing. Poor vision related QoL was associated with the presence of local side effects leading to poor perceived treatment satisfaction. Dissatisfied patients visited their ophthalmologist more frequently., CONCLUSION: Based on a representative French sample, poor vision related QoL was associated with topical drug side effects that also impact patient satisfaction and compliance. Longitudinal data collection should be performed to confirm our findings.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; Analysis of Variance; *Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Female; France/ep [Epidemiology]; *Glaucoma/dt [Drug Therapy]; Health Surveys; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Prevalence; *Quality of Life; Socioeconomic Factors; Surveys and Questionnaires; *Visual Acuity/de [Drug Effects]

Vasodilating beta-adrenoceptor blockers as cardiovascular therapeutics. - Toda, Noboru (Pharmacology & therapeutics, 2003)
beta-Adrenoceptor blocking agents (beta-blockers) have been established as therapeutics for treatment of patients with hypertension, ischemic heart diseases, chronic heart failure, arrhythmias, and glaucoma. However, their clinical use is limited because some patients are adversely affected by their side effects. The discovery of cardioselective (beta(1)-selective) blockers has overcome some of the problems. Current retrospective studies have revealed that vasodilating beta-blockers (so-called beta-blockers of the third generation) have advantages over the conventional type of beta-blockers in terms of minimizing the adverse effects and improving the disease-derived dysfunction, thus enhancing the quality of life variables. Some of the possible advantages include improvement of insulin resistance, decrease in low-density lipoprotein cholesterol in association with increase in high-density lipoprotein cholesterol, attenuation of bronchial asthma attack and respiratory dysfunction, alleviation of coronary vasospasm provocation, peripheral circulatory disturbances, and erectile dysfunction, and better patient compliance. Release of nitric oxide, antioxidant action, beta(2)-adrenoceptor activation, Ca(2+) entry blockade, and other mechanisms underlying the vasodilating action may be responsible for the beneficial therapeutic effects of these agents.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Animals; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; *Cardiovascular Diseases/dt [Drug Therapy]; Cardiovascular Diseases/me [Metabolism]; Erectile Dysfunction/ci [Chemically Induced]; Humans; Hypertension/dt [Drug Therapy]; *Lipid Metabolism; Male; Muscle, Smooth, Vascular/de [Drug Effects]; Muscle, Smooth, Vascular/me [Metabolism]; Quality of Life; *Vasodilation/de [Drug Effects]

[How to conduct glaucoma therapy when pressure stays high despite topical treatment?]. - Nordmann, J-P (Journal francais d'ophtalmologie, 2003)
When glaucoma worsens with elevated ocular pressure despite an initial treatment, an additional reduction of pressure is needed. It is necessary to evaluate the cause of the therapeutic failure which could be the consequence of a low compliance from the patient, a poor efficacy of the topical drug or a short or long term drift of this efficacy. Depending on the aetiology, another monotherapy or a combination of treatments should be initiated. The evaluation of the target pressure and the comparison between this pressure and the current pressure of the eye allows to evaluate the likeliness of reaching the target through medical treatment alone or through surgical approach. When medical treatment is possible, it is usual to combine two drugs, one acting on the aqueous humor inflow and the other one on the uveoscleral outflow pathway. If target pressure is lower than what can be expected to be reached with topical treatment, surgery should be proposed to the patient. Laser Argon trabeculoplasty keeps still some indications, like pigmentary or exfoliative glaucoma. Long term stability of the visual field in glaucoma depends more on the reduction of pressure and on its stability than on the choice of medical or surgical approach.
Keywords: *Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure; Treatment Failure

[Management of non penetrating surgery failure]. - Hamard, P (Journal francais d'ophtalmologie, 2003)
Failure of deep sclerectomy with external trabeculectomy is defined as intraocular pressure (IOP) elevation in the post-operative period. This IOP increase is related to obstacles on the outflow pathway, which may be hindered either by internal obstacles (iris incarceration, internal trabecular layers insufficiently permeable to aqueous humor), or by external obstacles (excessive conjunctival scar such as fibrosis or cysts). These obstacles require specific treatment that is not always successful. Pre-, intra- and post-operative care that reduces the incidence of these complications is detailed.
Keywords: *Glaucoma/su [Surgery]; Humans; *Intraocular Pressure; *Postoperative Complications/pc [Prevention & Control]; *Sclera/su [Surgery]; *Trabeculectomy; Treatment Failure

Comparison of adverse events with daily disposable hydrogels and spectacle wear: results from a 12-month prospective clinical trial. - Sankaridurg, Padmaja R; Sweeney, Deborah F; Holden, Brien A; Naduvilath, Thomas; Velala, Indira; Gora, Rashmi; Krishnamachary, Murali; Rao, Gullapalli N (Ophthalmology, 2003)
OBJECTIVE: To evaluate the type and incidence of adverse events seen with daily disposable hydrogel contact lens wear compared with a control (spectacle) group over 12 months., DESIGN: Prospective, randomized, observer-masked, comparative clinical trial., PARTICIPANTS: Two hundred eighty-one myopes with no prior contact lens wear experience were enrolled from August to December 1996. Subjects were 16 to 35 years old and had refractive errors ranging from a -0.75-diopter (D) sphere to a -6.00-D sphere with a cylinder less than -1.00 D., INTERVENTION: Each subject was randomly assigned to wear either bilateral disposable hydrogels on a daily disposable wear schedule or spectacles., MAIN OUTCOME MEASURE: Type and incidence of adverse events from each group. Adverse events were categorized as serious, significant, and nonsignificant based on the potential to cause vision impairment, severity at event, and level of clinical concern., RESULTS: At baseline, 1.6% of eyes had asymptomatic infiltrates that were nonsignificant. During the study, asymptomatic infiltrates were seen in both contact lens and spectacle groups at 20.5 events versus 11.3 events per 100 eyes per year of wear. No significant events were seen with the spectacle group. With the contact lens group, the type and incidence of significant events per 100 eyes per year of lens wear were corneal peripheral ulcer, 2.5 events; infiltrative keratitis, 1.5 events; and papillary conjunctivitis, 1 event. The incidence of both significant and nonsignificant events was greater with the contact lens group (P<0.05). No serious events (i.e., microbial keratitis) were seen in either group. A greater number of subjects were lost to follow-up or permanently discontinued from the contact lens group relative to the spectacle group (33% vs. 17%, P = 0.002). Lens-related problems such as dryness, discomfort, and difficulty with insertion and removal accounted for 27% of discontinuations from the contact lens group. Poor compliance (40%) was the greatest reason for discontinuations from the spectacle group., CONCLUSIONS: No clinically serious events were seen with either group. Only a small percentage of contact lens-wearing eyes presented with significant events, which is promising for daily disposable lens wear. Far more contact lens subjects were lost to follow-up or discontinued. Small, asymptomatic, subepithelial corneal infiltrates of unknown significance were seen in both contact lens- and spectacle-wearing eyes.
Keywords: Adolescent; Adult; Conjunctivitis/ep [Epidemiology]; *Conjunctivitis/et [Etiology]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Disposable Equipment; Double-Blind Method; *Eyeglasses/ae [Adverse Effects]; Female; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Incidence; Keratitis/ep [Epidemiology]; *Keratitis/et [Etiology]; Male; Patient Compliance; Prospective Studies; Prosthesis Fitting

Long anterior zonules and pigment dispersion. - Moroi, Sayoko E; Lark, Kurt K; Sieving, Paul A; Nouri-Mahdavi, Kouros; Schlotzer-Schrehardt, Ursula; Katz, Gregory J; Ritch, Robert (American journal of ophthalmology, 2003)
PURPOSE: To describe pigment dispersion associated with long anterior zonules., DESIGN: Multicenter observational case series., METHODS: Fifteen patients, seven of whom were treated for glaucoma or ocular hypertension, were identified with long anterior zonules and pigment dispersion. Transmission electron microscopy was performed on one anterior capsule specimen., RESULTS: All patients had anterior zonules that inserted centrally on the lens capsule. Signs of pigment dispersion included corneal endothelial pigmentation, loss of the pupillary ruff, and variable trabecular meshwork pigmentation. Ultrasound biomicroscopy verified the lack of posterior iris insertion and concavity. There was no exfoliation material. Transmission electron microscopy showed zonular lamellae with adherent pigment granules, and no exfoliation material., CONCLUSIONS: Long anterior zonules inserted onto the central lens capsule may cause mechanical disruption of the pigment epithelium at the pupillary ruff and central iris leading to pigment dispersion.
Keywords: Adult; Aged; Aged, 80 and over; Exfoliation Syndrome/di [Diagnosis]; *Exfoliation Syndrome/et [Etiology]; *Eye Abnormalities/co [Complications]; Female; Glaucoma/et [Etiology]; Glaucoma/th [Therapy]; Humans; Lens Capsule, Crystalline/ul [Ultrastructure]; *Ligaments/ab [Abnormalities]; Male; Middle Aged; Ocular Hypertension/et [Etiology]; Ocular Hypertension/th [Therapy]

[Glaucoma and ocular hypertension: the importance of intraocular pressure in treatment decisions in France]. - Bron, A; Nordmann, J-P; Baudouin, C; Rouland, J-F; Kadi, A; Sartral, M (Journal francais d'ophtalmologie, 2003)
PURPOSE: Several recent clinical studies have shown the benefit of lowering intraocular pressure in both ocular hypertensive and glaucoma patients. However, in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT), there is no consensus on the value of intraocular pressure (IOP) to be reached to prevent the progression of visual field defects. This IOP value, called target IOP, is defined by the ophthalmologist according to the patient and the progression of the disease, without a clear explicit justification of this decision. In France, ophthalmologists' education is mainly based on scientific meetings and the European Guidelines. This study was conducted to investigate the position of the IOP target in the treatment strategy for patients with glaucoma or OHT., MATERIAL: and methods: A cross-sectional descriptive survey was conducted in France among ophthalmologists in private practice. Patients with simple OHT or with OAG who required an initiation or a modification of treatment were included., RESULTS: We included 1735 patients (805 males, 46.4%) in the study. An OAG was diagnosed in 1338 patients (77.1%) and a simple OHT in 397 patients (22.9%). The patients with OAG were older than the OHT patients (65 years vs 61.7 years, p<0.0001). Most patients (73.5%) were included for treatment modification (77.5% of the patients with OAG and 59.9% of the patients with simple OHT; p<0.0001). The main reason for treatment change was an unsatisfactory IOP value. The main therapeutic objective was to reach a target IOP in 46.0% of the patients. The choice of the ocular hypotensive drugs depended on the IOP value in 51.9% of the patients. When the treatment was modified, monotherapy was preferred in 60.8% of the patients., CONCLUSION: Among ophthalmologists, the main objective for the treatment of patients with simple OHT or with OAG was to reach a target IOP. About half the participants were used to set up a target pressure for their patients. This fairly good ratio shows the comprehensiveness and the adaptation of our colleagues to relatively new concepts in treating and managing patients with ocular hypertension or chronic open-angle glaucoma. If a modification in the treatment was necessary, then monotherapy was preferred. This decision was motivated by the efficacy of the treatment but also by expected better patient compliance.
Keywords: Adult; Aged; Cross-Sectional Studies; Decision Making; Disease Progression; Drug Monitoring; Female; France; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure; Male; Manometry; Middle Aged; Ocular Hypertension/di [Diagnosis]; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmology/ed [Education]; *Ophthalmology/mt [Methods]; Ophthalmology/sn [Statistics & Numerical Data]; Patient Compliance/px [Psychology]; *Patient Selection; Practice Guidelines as Topic; Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'; Private Practice; Risk Factors; Surveys and Questionnaires; Treatment Outcome; Visual Fields

Timolol + latanoprost: new preparation. Last-resort eye drops. - Anonymous (Prescrire international, 2003)
(1) First-line drug treatment of chronic open-angle glaucoma or intraocular hypertonia is based on monotherapy with timolol eye drops. Patients in whom several single-agent treatments have failed can use combinations of timolol + dorzolamide (a carbonic anhydrase inhibitor) or a betablocker + pilocarpine (a parasympathomimetic agent). (2) An eye-drop preparation is now available in which 0.5% timolol is combined with 0.005% latanoprost, a prostaglandin F2alpha analogue. (3) A clinical trial indicated that the timolol + latanoprost combination was more effective than the timolol + dorzolamide combination on intraocular pressure, but the report of this study is too scanty to accept these results at face value. Once-a-day dosing with timolol + latanoprost has not been compared with a betablocker + pilocarpine combination. (4) Patients using the timolol + latanoprost combination are exposed to the adverse effects of both latanoprost (especially ocular irritation and brown iris discoloration) and the betablocker. (5) It is not known whether the once-a-day dosing of the timolol + latanoprost combination is a significant advantage, especially in terms of adherence to treatment. (6) In practice, the arrival of the timolol + latanoprost combination changes virtually nothing for patients with chronic open-angle glaucoma, except for those with no other alternative.
Keywords: Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Clinical Trials as Topic; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/tu [Therapeutic Use]; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

A new measure of patient satisfaction with ocular hypotensive medications: the Treatment Satisfaction Survey for Intraocular Pressure (TSS-IOP). - Atkinson, Mark J; Stewart, William C; Fain, Joel M; Stewart, Jeanette A; Dhawan, Ravinder; Mozaffari, Essy; Lohs, Jan (Health and quality of life outcomes, 2003)
PURPOSE: To validate the treatment-specific Treatment Satisfaction Survey for Intraocular Pressure (TSS-IOP)., METHODS: Item content was developed by 4 heterogeneous patient focus groups (n = 32). Instrument validation involved 250 patients on ocular hypotensive medications recruited from ophthalmology practices in the Southern USA. Participants responded to demographic and test questions during a clinic visit. Standard psychometric analyses were performed on the resulting data., SAMPLE: Of the 412 patients screened, 253 consented to participate, and 250 provided complete datasets. The sample included 44% male (n = 109), 44% Black (n = 109) and 57% brown eyed (n = 142) participants, with a mean age of 64.6 years (SD 13.1) and a history of elevated IOP for an average of 8.4 yrs (SD 7.8). A majority was receiving monotherapy (60%, n = 151)., RESULTS: A PC Factor analysis (w/ varimax rotation) of the 31 items yielded 5 factors (Eigenvalues > 1.0) explaining 70% of the total variance. Weaker and conceptually redundant items were removed and the remaining 15 items reanalyzed. The satisfaction factors were; Eye Irritation (EI; 4 items), Convenience of Use (CofU; 3 items), Ease of Use (EofU; 3 items), Hyperemia (HYP; 3 items), and Medication Effectiveness (EFF; 2 items). Chronbach's Alphas ranged from.80 to.86. Greater distributional skew was found for less common experiences (i.e., HYP & EI with 65% & 48.4% ceilings) than for more common experiences (i.e., EofU, CofU, EFF with 10.8%, 20.8% & 15.9% ceilings). TSS-IOP scales converged with conceptually related scales on a previously validated measure of treatment satisfaction, the TSQM (r =.36 to.77). Evidence of concurrent criterion-related validity was found. Patients' symptomatic ratings of eye irritation, hyperemia and difficulties using the medication correlated with satisfaction on these dimensions (r =.30-.56, all p <.001). Clinicians' ratings of IOP control, severity of side effects and problematic medication use correlated with patients' satisfaction scores on these dimensions (r =.13-.26, all p <.01)., CONCLUSIONS: This study provides initial evidence that the TSS-IOP is a reliable and valid measure, assessing patients' satisfaction with ocular hypotensive medications.
Keywords: Adult; Aged; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Factor Analysis, Statistical; Focus Groups; *Glaucoma/dt [Drug Therapy]; Health Care Surveys; Humans; Intraocular Pressure; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Compliance/px [Psychology]; Patient Compliance/sn [Statistics & Numerical Data]; Patient Satisfaction/sn [Statistics & Numerical Data]; *Patient Satisfaction; *Psychometrics/is [Instrumentation]; Qualitative Research; *Self Administration/px [Psychology]; *Surveys and Questionnaires; United States

Tele-ophthalmology and conventional ophthalmology using a mobile medical unit in remote Greece. - Labiris, G; Fanariotis, M; Christoulakis, C; Petounis, A; Kitsos, G; Aspiotis, M; Psillas, K (Journal of telemedicine and telecare, 2003)
We evaluated the quality of medical services delivered to remote glaucoma patients from a mobile unit. A four-wheel-drive vehicle containing the necessary equipment visited five different remote locations in Greece. During a three-year prospective study, 1205 patients were examined, of whom 230 had glaucoma. The majority of the subjects were examined by the unit's medical staff using the available instrumentation (e.g. slit-lamp and tonometer), while 56 glaucoma subjects were telemedically examined by consultants at the Patissia General Hospital, in Athens. Control data were obtained from a random sample of 260 urban glaucoma patients. A significantly greater proportion of the remote patients had an inadequate awareness of glaucoma (77%) compared with the urban patients (20%). Significantly more remote patients had poorer compliance (68%) in comparison with urban patients (23%). A significantly larger proportion of the remote patients had high intra-ocular pressure (21%) compared with the urban patients (5%). Technical difficulties occurred in the 13 of the 56 telemedical examinations. Mobile medical units can enhance access to medical services and contribute to the health-care of under-served populations.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/th [Therapy]; Greece; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Mobile Health Units; Patient Compliance/px [Psychology]; Patient Education as Topic; Rural Health Services/og [Organization & Administration]; *Telemedicine/mt [Methods]

Intraocular pressure, safety, and quality of life in glaucoma patients switching to latanoprost from monotherapy treatments. - Zimmerman, Thom J; Stewart, William C; Latanoprost Axis Study Group (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2003)
PURPOSE: To evaluate the efficacy, safety and quality of life in ocular hypertensive or open-angle glaucoma patients who required alteration in previous therapy and were changed to latanoprost., METHODS: A prospective, multicenter, active, historical controlled trial in which qualified patients had previous therapy substituted with latanoprost 0.005% and were followed for up to 6 months., RESULTS: 3179 patients were included in the intent-to-treat analysis. In all patients latanoprost reduced the intraocular pressure (IOP) from 20.1 +/- 3.9 to 17.1 +/- 3.5 mm Hg (p< 0.0001) and when compared to previous monotherapies: beta-blockers (-3.0 +/- 3.5, n = 1976), alpha-agonists (-3.6 +/- 3.7, n = 581), miotics (-2.8 +/- 3.0, n = 21), carbonic anhydrase inhibitors (-3.2 +/- 3.5, n = 198), and other prostaglandin analogs (-1.6 +/- 3.7, n = 402). The most common ocular adverse event with latanoprost was conjunctival hyperemia (n = 66, 2.0% incidence) and the most common systemic adverse event was headache (n = 9, 0.2%). Over the 6-month treatment interval 89.8% of patients were maintained on latanoprost. On the solicited symptom survey patients showed a preference for latanoprost compared to previous therapy for several reasons: (depending on the product) dryness, blurred vision, tearing, stinging on instillation, crusting, itching, fatigue, dizziness, despondency and dry mouth (p < 0.005)., CONCLUSION: Latanoprost generally provides reduced IOP, limited side-effects, improvement in many quality of life measures and is maintained in patients who required a substitution from previous monotherapy.
Keywords: Adult; Aged; Chi-Square Distribution; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; *Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Latanoprost; Male; Middle Aged; Patient Compliance/px [Psychology]; Patient Compliance/sn [Statistics & Numerical Data]; Prospective Studies; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; *Prostaglandins F, Synthetic/ae [Adverse Effects]; *Quality of Life/px [Psychology]

[Hormone therapy for ophthalmoprophylaxis]. - Wenderlein, J Matthias; Hensinger, Ellen (Klinische Monatsblatter fur Augenheilkunde, 2003)
BACKGROUND: It has been demonstrated that HRT which was administered directly after the onset of the menopause had vascularprotective and neuroprotective effects. It has therefore hypothesised that eye function could benefit from such treatment., MATERIAL AND METHODS: Visual acuity, intraocular pressure, patient's gynaecological and ophthalmological history, especially HRT were obtained from women visiting the gynaecological and ophthalmological ambulance. Measuring the visus and the intraocular pressure of women with HRT from the gynaecological ambulance was easily undertaken in the neighbouring ophthalmological department. Unfortunately, due to absence of compliance a control group without HRT could not be recruited. Of 514 women, 402 without having had hysterectomy and adnexectomy could be included in the study from which data were received about the menopausal age., RESULTS: In the group of women with cataract HRT over 5 years was administered less often (two times) than in the group of women with glaucoma. Women mainly aged over 70 suffering from age-related conditions such as glaucoma and cataract almost never had HRT. Thus in the following only women aged up to 60 have been of interest. 7 of 10 women being in the menopause for over 10 years with a visus higher than 0.7 received HRT. Only 1 of 10 women had a visual acuity less than 0.4. There was also a correlation between receiving HRT and intraocular pressure. In the group aged up to 60 without taking HRT 19 % had an intraocular pressure above 19. In women with HRT over 5 years this occurred in only 7 %., CONCLUSIONS: Initiating HRT in healthy women shortly after the onset of the menopause may have vascularprotective and neuroprotective effects for the eye. This is supported by the fact that HRT administered for more than 5 years to healthy women aged up to 60 years was associated with better visual acuity and normal intraocular pressure. This is further highlighted by ultrasound scan studies in the literature. Thus an ophthalmoprophylaxis could be expected, which has to be confirmed in prospective studies using suitable control groups.
Keywords: Aged; Cataract/di [Diagnosis]; Cataract/pc [Prevention & Control]; Climacteric/de [Drug Effects]; Female; Glaucoma/di [Diagnosis]; Glaucoma/pc [Prevention & Control]; *Hormone Replacement Therapy; Humans; *Intraocular Pressure/de [Drug Effects]; Long-Term Care; Middle Aged; Patient Care Team; Treatment Outcome; *Visual Acuity/de [Drug Effects]

African American health disparities: glaucoma as a case study. - Kosoko-Lasaki, Omofolasade; Olivier, Mildred M G (International ophthalmology clinics, 2003)
Keywords: *African Americans/sn [Statistics & Numerical Data]; *Glaucoma/eh [Ethnology]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; Health Services Accessibility; Humans; Patient Education as Topic; Socioeconomic Factors; United States/ep [Epidemiology]

Contact lens complications. - Suchecki, Jeanine K; Donshik, Peter; Ehlers, William H (Ophthalmology clinics of North America, 2003)
Complications associated with contact lenses range from mild to severe and occur with all lens modalities. Contact lens wear can cause a change in corneal physiology, which can lead to epithelial, stromal, and endothelial compromise. Other complications include lens deposition, allergic conjunctivitis, giant papillary conjunctivitis, peripheral infiltrates, microbial keratitis, and neovascularization. Pre-existing conditions can contribute to these complications, or they can occur in association with contact lens wear and care regimens. Patient-related factors, such as alteration of the recommended wearing or replacement schedules and noncompliance with recommended contact lens care regimens for economic reasons, convenience, or in error, contribute to contact lens-related complications and have led to difficulty in accurate determination of complication rates among the various lens wear modalities. Complications may require discontinuation of contact lenses, topical therapy, and changes in contact lens wearing schedules, materials, and care solutions. On initial lens fitting and follow-up evaluations, practitioners should review contact lens replacement and cleaning regimens with patients and discuss complications. To avoid serious complications, patients should be reminded to remove their contact lenses as soon as ocular irritation occurs, and to call their eye care practitioner immediately if symptoms persist.
Keywords: Biofilms; Conjunctival Diseases/et [Etiology]; *Contact Lenses/ae [Adverse Effects]; Corneal Diseases/et [Etiology]; Equipment Failure; Humans

Pseudomonas keratitis associated with continuous wear silicone-hydrogel soft contact lens: a case report. - Lee, Kelvin Yoon Chiang; Lim, Li (Eye & contact lens, 2003)
PURPOSE: To report a case of Pseudomonas aeruginosa culture-positive microbial keratitis in a patient wearing continuous-wear silicone hydrogel soft contact lenses., METHODS: A 23-year-old white woman in good health had been wearing silicone hydrogel (lotrafilcon A) soft contact lenses continuously for 26 days when she was examined for a corneal ulcer in her left eye. She had given a history of water jet skiing and diving while wearing her contact lenses. Scrapings of the corneal ulcer were positive for P. aeruginosa, and the patient was treated with fortified topical cefazolin and gentamicin for 1 week and subsequently with topical ciprofloxacin for 2 weeks., RESULTS: The microbial keratitis resolved with successful treatment. However, the patient had a residual visual deficit secondary to stromal scarring., CONCLUSIONS: The recently introduced continuous-wear silicone hydrogel soft contact lenses, with their hyper oxygen permeability (Dk), have been shown to overcome hypoxia-associated complications and to have less P. aeruginosa binding to the corneal epithelium. Our case shows that sight-threatening microbial keratitis can still occur even with silicone hydrogel soft contact lenses. Contact lens practitioners should educate patients on the risk of sight-threatening microbial keratitis, the need for patient compliance, and prompt assessment of contact lens-related complaints.
Keywords: Adult; Cefazolin/tu [Therapeutic Use]; Ciprofloxacin/tu [Therapeutic Use]; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; *Corneal Ulcer/mi [Microbiology]; Drug Therapy, Combination/tu [Therapeutic Use]; Eye Infections, Bacterial/di [Diagnosis]; Eye Infections, Bacterial/dt [Drug Therapy]; Eye Infections, Bacterial/mi [Microbiology]; *Eye Infections, Bacterial; Female; Gentamicins/tu [Therapeutic Use]; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Prosthesis-Related Infections/di [Diagnosis]; Prosthesis-Related Infections/dt [Drug Therapy]; *Prosthesis-Related Infections/et [Etiology]; Pseudomonas Infections/di [Diagnosis]; Pseudomonas Infections/dt [Drug Therapy]; Pseudomonas Infections/mi [Microbiology]; *Pseudomonas Infections; *Pseudomonas aeruginosa/ip [Isolation & Purification]; Silicone Elastomers

Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. - Lee, Paul P; Feldman, Zachary W; Ostermann, Jan; Brown, Derek S; Sloan, Frank A (Ophthalmology, 2003)
OBJECTIVE: To assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases., DESIGN: Longitudinal analysis of Medicare claims data., PARTICIPANTS: Random sample of Medicare beneficiaries aged 65 years or older., METHODS: Beneficiaries were followed between 1991 and 1999, unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened. All claims data (both physician and facility) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations., MAIN OUTCOME MEASURES: Claims submitted by optometrists, ophthalmologists, or other providers of eye care for subjects with diabetes, glaucoma, or age-related macular degeneration (ARMD). Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons (e.g., bad weather)., RESULTS: Among those with diabetes in this population, 50% to 60% had annual eye examinations in a 15-month period. Of those followed for at least 75 months after diagnosis, about three quarters had one or more 15-month gaps between visits. For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes. The patterns for those with ARMD were in between those for diabetes and glaucoma. Over a nine-year period, only slightly over half of persons with at least one of the study conditions complied with practice guidelines., CONCLUSIONS: Annual eye examinations for persons diagnosed with diabetes, glaucoma, and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions. Currently, actual rates of eye examinations for persons diagnosed with the study conditions fall far short of recommended rates. As such, approaches to enhancing longitudinal follow-up of those already in the eye care system are needed.
Keywords: Aged; Aged, 80 and over; Chronic Disease; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/pc [Prevention & Control]; *Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; Glaucoma/di [Diagnosis]; *Glaucoma/pc [Prevention & Control]; Health Care Surveys; *Health Services/sn [Statistics & Numerical Data]; Humans; Longitudinal Studies; Macular Degeneration/di [Diagnosis]; *Macular Degeneration/pc [Prevention & Control]; Medicare/sn [Statistics & Numerical Data]; United States

Assessing the cost-effectiveness of switching from a beta-blocker to latanoprost in the treatment of ocular hypertension. - Costagliola, Ciro; Parmeggiani, Francesco; Sebastiani, Adolfo (Expert opinion on pharmacotherapy, 2003)
Glaucoma is a pathological condition whose most important risk factor is increased intraocular pressure (IOP). The medical treatment of glaucoma essentially consists of compounds that are able to decrease the IOP. The compounds discussed in this review act in a different way, beta-blockers mainly inhibit the production of aqueous humor, whereas latanoprost decreases the resistance in the outflow channels. beta-Blockers are compounds with a well-known efficacy and safety profile and they are fairly inexpensive. Their systemic and local side effects are mainly cardiovascular and pulmonary adverse events, dry eye and keratopathy. Latanoprost, which has recently been introduced into the market, has been shown to be equally as effective, or better in lowering IOP in patients than timolol, although it is more expensive. Systemic reported side effects are anecdotal; local hyperaemia, keratopathy, hypertrichosis, increased pigmentation of eyelashes and iris, uveitis and cystoid macular oedema have been reported. A comparison of costs reveals that a 1-year therapy with timolol ophthalmic solution starts from 11.00 Euros and can reach 146.00 Euros for the most expensive preservative-free 1-day dispenser packages (approximately 13.5 times higher). For latanoprost once-daily administration, the cost for 1 years therapy is 98.55 Euros, approximately six times higher than generic or brand 0.5% timolol applied twice-daily. What are the factors influencing a change in therapy from beta-blockers to latanoprost? The only good reason is represented by a further deterioration in the visual field. This may occur, despite a significant reduction in IOP, because the reached IOP is not sufficient enough to avoid further deterioration because the patient's work or social activities do not allow a correct daily dosage of the compound (bad compliance); or as a result of treatment suspension, because of the development of systemic and/or local side effects. Changes in therapy must always be related to a failing control of the disease, as any therapeutic modification leading to an increase in the number of visits and additional examinations, consequently enhances the costs.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/ec [Economics]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/ec [Economics]; *Antihypertensive Agents/tu [Therapeutic Use]; Cost-Benefit Analysis; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Prostaglandins F, Synthetic/ae [Adverse Effects]; Prostaglandins F, Synthetic/ec [Economics]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Compliance barriers in glaucoma: a systematic classification. - Tsai, James C; McClure, Cori A; Ramos, Sarah E; Schlundt, David G; Pichert, James W (Journal of glaucoma, 2003)
PURPOSE: To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma., METHODS: A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles to medication adherence were elicited. Using hierarchical cluster analysis, the situational descriptions were stratified, grouped, and analyzed by frequency distribution., RESULTS: Seventy-one unique situational obstacles were reported. These were then grouped into 4 defined and separate categories: situational/environmental factors (35 of 71 situations; 49%), medication regimen (23 of 71; 32%), patient factors (11 of 71; 16%), and provider factors (2 of 71; 3%)., CONCLUSION: Significant barriers to compliance exist for patients with glaucoma in addition to those cited by previous ophthalmic studies. A systematic classification (i.e., taxonomy) of these barriers was formulated to assist in optimizing patient education and problem-solving regarding prescribed therapeutic regimens.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cluster Analysis; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; Prospective Studies

Inhaled corticosteroids: past lessons and future issues. - Allen, David B; Bielory, Leonard; Derendorf, Hartmut; Dluhy, Robert; Colice, Gene L; Szefler, Stanley J (The Journal of allergy and clinical immunology, 2003)
Inhaled corticosteroids play a pivotal role in the treatment of asthma. Inhalation permits effective delivery of the corticosteroid in high concentration to target sites within the lung while minimizing systemic exposure. Consequently, the safety profile of inhaled corticosteroids is markedly better than that of oral corticosteroid therapy. However, although it was first thought that direct delivery might eliminate systemic adverse effects, this has not been confirmed by clinical trials and experience. Inhaled corticosteroids are absorbed from the lungs into the systemic circulation, in which they can acutely decrease growth velocity in children, an effect that fortunately appears to be temporary and might have no effect on final adult height. In sufficient dosages, they also produce bone mineral loss leading to osteoporosis and might increase the risk of cataracts, glaucoma, skin atrophy, and vascular changes that increase the risk of ecchymoses. Effective evaluation of the severity and significance of these complications is challenging because highly sensitive tests do not reliably predict clinically significant events, and short-term observations do not predict long-term consequences. Also, compliance wanes with long-term treatment, and susceptibility to a particular adverse event can vary over time, even in the same individual, because of developmental or hormonal changes. This journal supplement will review what has been learned about the safety of inhaled cortico-steroids during the past decade, discussing some of the questions that remain and considering the characteristics of an "ideal" inhaled corticosteroid: one with high local activity in the lung and minimal or no adverse systemic effects.
Keywords: Administration, Inhalation; Adolescent; Adult; *Anti-Asthmatic Agents/ae [Adverse Effects]; Anti-Asthmatic Agents/tu [Therapeutic Use]; *Asthma/dt [Drug Therapy]; Bone Density/de [Drug Effects]; Cataract/ci [Chemically Induced]; Child; Child, Preschool; Ecchymosis/ci [Chemically Induced]; Female; Glaucoma/ci [Chemically Induced]; *Glucocorticoids/ae [Adverse Effects]; Glucocorticoids/tu [Therapeutic Use]; Growth/de [Drug Effects]; Humans; Male; Middle Aged; Osteoporosis/ci [Chemically Induced]

Switching from systemic to the topical carbonic anhydrase inhibitor dorzolamide: effect on the quality of life of glaucoma patients with drug-related side effects. - Nesher, Ronit; Ticho, Uriel (The Israel Medical Association journal : IMAJ, 2003)
BACKGROUND: The frequent systemic side effects associated with the use of systemic carbonic anhydrase inhibitors have adversely affected the compliance to treatment in glaucoma patients, obviating their long-term use. The introduction of the topical CAI dorzolamide has further reduced their use. However, the tolerability of dorzolamide in patients who have been intolerant to systemic CAIs has not been evaluated prospectively., OBJECTIVES: To study the tolerability and efficacy of dorzolamide (a topical CAI) in a selected group of glaucoma and ocular hypertensive patients who have been intolerant to systemic CAI., METHODS: A 3 month prospective study was conducted in 39 patients. Following recruitment, patients were evaluated on the day of switching from systemic CAI to dorzolamide and for five more visits. The SF-36 health assessment questionnaire was used to evaluate changes in well-being and quality of life, and the intraocular pressure was measured periodically., RESULTS: Within 4 weeks of switching from systemic CAI to dorzolamide, the mean health assessment scores improved significantly in seven of the eight categories of the SF-36, and remained generally unchanged for the rest of the study. No significant differences were noted between the mean IOP on day 0 and the following measurements throughout the 84 days of dorzolamide therapy., CONCLUSION: In glaucoma patients who were intolerant to systemic CAI, topical CAI dorzolamide offers a similar efficacy and better tolerability.
Keywords: Aged; Carbonic Anhydrase Inhibitors/pd [Pharmacology]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma, Open-Angle/dt [Drug Therapy]; Health Status Indicators; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Prospective Studies; Quality of Life; Sulfonamides/pd [Pharmacology]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/pd [Pharmacology]; *Thiophenes/tu [Therapeutic Use]

[Efficacy and safety of substituting a twice-daily regimen of timolol with a single daily instillation of nonpreserved beta-blocker in patients with chronic glaucoma or ocular hypertension]. - Bron, A; Chiambaretta, F; Pouliquen, P; Rigal, D; Rouland, J-F (Journal francais d'ophtalmologie, 2003)
AIM: To evaluate the efficacy and safety of a single daily instillation of nonpreserved timolol in patients with chronic glaucoma or ocular hypertension previously treated with a twice-daily regimen of timolol 0.25% or 0.50%., PATIENTS AND METHODS: A prospective open clinical trial was undertaken by 220 ophthalmologists in 435 patients with chronic glaucoma or ocular hypertension controlled with twice-daily instillations of timolol 0.25% or 0.50%. In this population, the previous regimen was substituted with a single daily instillation of preservative-free timolol 0.25% or 0.50% for 3 months. The changes in intraocular pressure (IOP) were recorded as well as local and systemic tolerance and patient compliance., RESULTS: It was found that 398 patients (93.6%) maintained stable IOP: in 92%, IOP increased no more than 2 mmHg. The mean IOP was 17.0 +/- 2.2 mmHg at D0, 16.5 +/- 2.4 mmHg at D28/42 and 16.6 +/- 2.4 mmHg at D84. The proportion of patients with at least one ocular symptom upon instillation or at another time decreased (p<0.0001 and p=0.03, respectively). The proportion of conjunctival hyperemia reduced from 24.4% to 14.6% (p=0.0002). The rate of folliculopapillar reactions and superficial punctate keratitis was halved (p=0.005 and p=0.02, respectively)., CONCLUSION: During this study in daily practice, the switch from a twice-daily regimen of timolol to a once-daily application maintained stable intraocular pressure with a notable improvement in tolerance.
Keywords: *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Aqueous Humor/me [Metabolism]; Chronic Disease; Circadian Rhythm; Comorbidity; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ocular Hypertension/di [Diagnosis]; Ophthalmic Solutions; Patient Acceptance of Health Care; Prospective Studies; Safety; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Practice characteristics and HMO enrollee satisfaction with specialty care: an analysis of patients with glaucoma and diabetic retinopathy. - Escarce, Jose J; Kapur, Kanika; Solomon, Matthew D; Mangione, Carol M; Lee, Paul P; Adams, John L; Wickstrom, Steven L; Quiter, Elaine S (Health services research, 2003)
BACKGROUND: The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential., OBJECTIVE: To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). SUBJECTS/STUDY SETTING: A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices., STUDY DESIGN: We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction., PRINCIPAL FINDINGS: Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction., CONCLUSIONS: Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction.
Keywords: *Diabetic Retinopathy/th [Therapy]; Female; *Glaucoma, Open-Angle/th [Therapy]; Health Care Surveys; Humans; Independent Practice Associations/og [Organization & Administration]; *Independent Practice Associations/st [Standards]; Logistic Models; Male; Middle Aged; Ophthalmology/og [Organization & Administration]; *Ophthalmology/st [Standards]; Optometry/og [Organization & Administration]; *Optometry/st [Standards]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Physician-Patient Relations; Practice Management, Medical/og [Organization & Administration]; *Practice Management, Medical/st [Standards]; *Quality Indicators, Health Care; Surveys and Questionnaires; United States

Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery. - Scuderi, B; Driussi, G B; Chizzolini, M; Salvetat, M L; Beltrame, G (European journal of ophthalmology, 2003)
PURPOSE: To compare the efficacy and tolerance of piroxicam 0.5% ophthalmic solution and diclofenac sodium 0.1% ophthalmic solution in controlling inflammation after phacoemulsification and intraocular lens (IOL) implantation., SETTING: Ophthalmological Department, San Dona di Piave Hospital, Venice, Italy., MATERIALS AND METHODS: Forty consecutive patients--18 men and 22 women--between 55 and 85 years of age (mean age, 75.1 +/- 7.12 years) who were scheduled for cataract extraction with phacoemulsification and IOL implantation were randomized to receive 0.5% piroxicam ophthalmic solution (piroxicam group, 20 patients) or 0.1% diclofenac sodium ophthalmic solution (diclofenac group, 20 patients) for 1 month postoperatively. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) measurements and slit-lamp biomicroscopy for the evaluation of corneal edema, Descemet membrane folds, Tyndall, and cells in the anterior chamber were carried out in all patients 1 day, 4 days, and 1 month postoperatively. Subjective symptoms after the nonsteroidal anti-inflammatory drug (NSAID) ophthalmic solution instillation were assessed using a questionnaire., RESULTS: There were no significant differences between the two groups in postoperative IOP, BCVA, anterior chamber flare and cell levels, corneal edema, or Descemet membrane folds. Ocular discomfort, evaluated as burning or stinging sensation after NSAID ophthalmic solution instillation, was significantly more frequent and intense in the diclofenac-treated eyes. Two eyes in the diclofenac group had a mild transient punctate keratitis., CONCLUSIONS: These results suggest that piroxicam is as effective as diclofenac sodium in preventing inflammation after cataract surgery with IOL implantation, and its better tolerance and safety can provide higher patient compliance.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage]; Anti-Inflammatory Agents, Non-Steroidal/ae [Adverse Effects]; *Diclofenac/ad [Administration & Dosage]; Diclofenac/ae [Adverse Effects]; Double-Blind Method; Female; Humans; Intraocular Pressure/de [Drug Effects]; Lens Implantation, Intraocular; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; *Phacoemulsification; *Piroxicam/ad [Administration & Dosage]; Piroxicam/ae [Adverse Effects]; *Postoperative Complications/pc [Prevention & Control]; Prospective Studies; Safety; Treatment Outcome; *Uveitis, Anterior/pc [Prevention & Control]; Visual Acuity

Patient persistency with pharmacotherapy in the management of glaucoma. - Reardon, G; Schwartz, G F; Mozaffari, E (European journal of ophthalmology, 2003)
PURPOSE: To evaluate persistency with monotherapy in the treatment of glaucoma in patients new to pharmacological management., METHODS: This population-based, retrospective cohort study, using managed care administrative claims data, included patients who were 20 years of age and older and who initiated monotherapy with betaxolol, brimonidine, dorzolamide, latanoprost, or timolol between May 1999 and January 2001. Follow-up continued through January 31, 2001, and prescription refill records for all ocular hypotensive medications were extracted for the full 21-month study period. The primary outcome measures were discontinuation and change (switching/adding on) of the index ocular hypotensive medication. Rates of discontinuation and discontinuation/change were compared using Cox regression methods; survival curves were generated., RESULTS: In all, 14,539 patients were prescribed any ocular hypotensive drug during the study period, and 2850 patients met all inclusion criteria. Patients treated with betaxolol, brimonidine, dorzolamide, or timolol were significantly (p < 0.05) more likely to discontinue and to discontinue/change the index therapy than were those treated with latanoprost. Results were confirmed in analyses adjusted for age and sex., CONCLUSIONS: Patients initially treated with latanoprost monotherapy are more persistent than those who begin treatment with beta-blockers, brimonidine, or the carbonic anhydrase inhibitor dorzolamide. Greater persistency with an initial ocular hypotensive therapy may improve health outcomes and reduce long-term costs to patients and health plans by limiting the increased resource use associated with discontinuations or changes in therapy.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Antihypertensive Agents/ec [Economics]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Cohort Studies; Drug Utilization/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ec [Economics]; Patient Compliance; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Quinoxalines/tu [Therapeutic Use]; Retrospective Studies; Sulfonamides/tu [Therapeutic Use]; Thiophenes/tu [Therapeutic Use]

Vernal keratoconjunctivitis in Thailand. - Kosrirukvongs, Panida; Vichyanond, Pakit; Wongsawad, Warapat (Asian Pacific journal of allergy and immunology, 2003)
A prospective, cross-sectional and randomized cross-over study was conducted to study the clinical features and treatment outcome among Thai patients with vernal keratoconjunctivitis (VKC). History-taking and eye examinations were performed. Mild cases of VKC were given topical antihistamine four times daily. Moderate and severe cases of VKC were treated with topical lodoxamide four times a day. Severe cases of VKC were given topical corticosteroids. Moderate and severe cases of VKC, which were refractory to treatment with either corticosteroids or a mast cell stabilizer had topical cyclosporine 0.5% instilled four times daily. Five patients were exposed to two different treatment regimens in sequence. As main outcome measures, itching, foreign body sensation, photophobia, conjunctival injection, papillae and chemosis were evaluated weekly. The patients with the palpebral type of VKC had daily symptoms, which were more severe and triggered by house-dust with a significant difference among the groups. Limbal VKC was associated with allergic rhinitis more commonly than palpebral VKC. Positive results of skin prick testing to acacia, careless weed, mold, Johnson grass and cow's milk were significantly more common in patients with palpebral VKC. The most common symptoms and signs were found in the mixed type of VKC. Purulent discharge, pannus and lid erythema were found in the palpebral type. Levocabastine hydrochloride was sufficient for mild cases of limbal VKC; lodoxamide for the limbal and mixed types. Prednisolone acetate was the drug of choice in severe cases of any type but only for a short period of time. The success rate of topical cyclosporine in the palpebral type was lower than in the limbal type due to an intolerable burning sensation. Topical cyclosporine used in 4 patients with limbal and palpebral type had a success rate of 100% which was greater than in the lodoxamide group (66.7%, 0%). Compared with topical corticosteroid-treated eyes in one patient, the success rate in topical cyclosporine-treated eyes was not success. Grading the severity of each type of VKC is crucial to obtain good response of any medication and compliance. Topical cyclosporine 0.5% can be an alternative drug to relieve symptoms and signs of VKC in order to avoid steroid-induced glaucoma.
Keywords: Adolescent; Adult; *Anti-Allergic Agents/tu [Therapeutic Use]; *Anti-Inflammatory Agents/tu [Therapeutic Use]; Child; Child, Preschool; Conjunctivitis, Allergic/cl [Classification]; Conjunctivitis, Allergic/di [Diagnosis]; *Conjunctivitis, Allergic/dt [Drug Therapy]; Cross-Over Studies; Cross-Sectional Studies; Female; *Histamine H1 Antagonists/tu [Therapeutic Use]; Humans; *Immunosuppressive Agents/tu [Therapeutic Use]; Male; Prospective Studies; Severity of Illness Index; Thailand

[Infection immunology in silicone hydrogel contact lenses for continuous wear--a review]. - Bialasiewicz, Alexander A (Klinische Monatsblatter fur Augenheilkunde, 2003)
BACKGROUND: The patient's wish for permanent refractive solution and optimal comfort must be weighed against the risk of infections. In order to meet these wishes and the demand for minimising associated risks, hyperoxygen-transmissible silicone hydrogel contact lenses have been developed., METHODS: Colonisation and sensitivity to antibiotics of bacteria in vitro, expression of bacterial ligands of the corneal epithelium (rabbit model), and the morphology of complications in patients have been reported to characterise HOTL., RESULTS: Bacterial adherence to hydrophobic silicone elastomers is low. The reduction of sensitivity towards antibiotics is higher for PMMA-adherent bacteria with respect to the conventional antibiotics compared to the silicone-elastomer adherent bacteria. Colonising bacteria are not significantly different in asymptomatic CL wearers concerning CFU and species: asymptomatic: CNS (54 vs. 47 %), propioni- (43 vs. 48 %), coryne- (6 vs. 10 %) and gram-negative bacteria (2 vs. 3 %), S. aureus (2 vs. 1 %), and in patients with keratitis are not significantly different concerning species: CLARE (H. influenzae, S. pneumoniae), CLPU (S. aureus, S. pneumoniae), IK (P. aeruginosa), however, concerning the CFU (gram-negative) 23.7 % (keratitis) vs. 3.8 %, (asymptomatic), S. pneumoniae 7.6 % vs. 0.6 %. The epithelial expression of bacterial ligands like WGA is lower for HOTL (3230 p/750 micro) than for low oxygen-transmissible (4611 p/750 micro) consistent with a decreased adherence of pseudomonas of 5.31 - 5.98 vs. 5.9 - 7.81 bacteria/cell. Asymptomatic morphological anomalies and keratitis are less frequent in HOTL. Apoptosis-induced desquamation and the central epithelial thickness decreased. In a one-year study of 504 patients wearing continuous wear HOTL for 30 days, corneal staining was seen in 10.6 vs. 10.5 % 30-day 7 day extended wear, infiltrates in 2.3 vs. 4.6 %, epithelial oedema in 3.6 vs. 2.0 % und tarsal conjunctival anomalies in 3.0 vs. 1.6 %. Individual reports on infectious keratitis in HOTL wearers have been published., CONCLUSIONS: Fewer morphological anomalies and a decreased incidence of infections (on the basis of duration of wear) can be associated with the higher oxygen transmission of HOTL. From the clinical point of view, colonisation of HOTL with the same bacterial species as in conventional biomaterials, and the extended wear demand clear patient counseling and vigilant follow-up by an ophthalmologist.
Keywords: Animals; Bacterial Adhesion/de [Drug Effects]; Bacterial Adhesion/im [Immunology]; Bacterial Infections/dt [Drug Therapy]; *Bacterial Infections/im [Immunology]; Bacterial Infections/mi [Microbiology]; *Contact Lenses, Extended-Wear/mi [Microbiology]; Epithelium, Corneal/im [Immunology]; Epithelium, Corneal/mi [Microbiology]; Humans; *Hydrogel, Polyethylene Glycol Dimethacrylate; Microbial Sensitivity Tests; Polymethyl Methacrylate; Prosthesis Design; Prosthesis-Related Infections/dt [Drug Therapy]; *Prosthesis-Related Infections/im [Immunology]; Prosthesis-Related Infections/mi [Microbiology]; Rabbits; *Silicone Elastomers

[Long-term follow-up study on Hunan aqueous drainage implantation combined with mitomycin C for refractory glaucoma]. - Duan, Xuanchu; Jiang, Youqin; Qing, Guoping (Yan ke xue bao = Eye science, 2003)
PURPOSE: To investigate the long-term therapeutic effect of Hunan aqueous drainage (HAD) implantation with and without adjunctive intraoperative mitomycin C (MMC) for refractory glaucoma., METHODS: 154 cases (159 eyes) with refractory glaucoma underwent Hunan aqueous drainage (HAD) implantation from July 1995 to July 2001. Sixty-five eyes were combined with MMC (0.4 mg/ml, 1 to 5 mins). With success defined as the introcular pressure (IOP) greater than 6 mmHg but no greater than 21 mmHg at the last visit., RESULTS: The mean period of postoperative follow-up was 54.6 (range, 12-72) months. The IOP was lowered from preoperative (46.8 +/- 14.5) mmHg to postoperative (16.8 +/- 11.3) mmHg at the 1st year after surgery. The success rate with MMC and without MMC were 90.0%, 77.3% (P < 0.05) at the 1st year, 87.1%, 67.3% (P < 0.05) at the 2nd year, 83.3%, 61.1% (P < 0.05) at the 3rd year, 81.3%, 56.7% (P < 0.05) at the 4th year, and 75.0%, 50.0% (P < 0.05) at the 5th year using Kaplan-Meier life-table analysis. The height of the posterior bleb underwent standardized ocular echography at the 1st year was (3.8 +/- 0.9) mm and (2.1 +/- 1.4) mm, respectively. Ninty-five eyes (81.9%) with visual acuity remained or improved after the surgery (P > 0.05). The most frequent complications for long-term follow-up included elevated IOP (IOP > 22 mmHg) (19.8%), the iris adherent to the proximal orifice of the tube (15.5%), developed cataract formation (12.9%) and so on (P > 0.05). We didn't find any severe complications after using MMC., CONCLUSION: This study suggests that HAD implantation is an effective method in the management of refractory glaucoma in spite of its unneligible complications and combined with MMC can improve the prognosis.
Keywords: Adolescent; Adult; Aged; Child; Female; Follow-Up Studies; Glaucoma/dt [Drug Therapy]; *Glaucoma/su [Surgery]; *Glaucoma Drainage Implants; Humans; Intraocular Pressure; Male; Middle Aged; *Mitomycin/tu [Therapeutic Use]; Visual Acuity

Experience with Cosopt, the fixed combination of timolol and dorzolamide, after switch from free combination of timolol and dorzolamide, in Swiss ophthalmologists' offices. - Gugleta, Konstantin; Orgul, Selim; Flammer, Josef (Current medical research and opinion, 2003)
PURPOSE: To analyse a response to the therapy switch from the concomitant application of beta-blocker and topical carbonic anhydrase inhibitor to the fixed combination of timolol and dorzolamide (Cosopt) in glaucoma/ocular hypertensive patients under everyday, office-practice conditions., PATIENTS AND METHODS: The data source was a survey among practising ophthalmologists in Switzerland assessing their experience with glaucoma patients/ocular hypertensives put for the first time on the fixed combination of timolol and dorzolamide. A total of 98 patients underwent the therapy switch in at least one eye. The intraocular pressure (IOP) change between the baseline visit before switch to the timolol-dorzolamide fixed combination occurred, and the first follow-up control after the switch, served as an indicator of compliance., RESULTS: The IOP decreased on average from 19.43 +/- 5.64 mmHg to 17.97 +/- 3.58 mmHg (p < 0.01). The time to the follow-up visit ranged from 4 to 354 days, and the magnitude of IOP change demonstrated a significant dependence on the time to the follow-up visit, also when corrected for baseline IOP level. A total of 87 (85.3%) continued on the timolol-dorzolamide fixed combination therapy after the first control visit. In 68 of these 98 patients the contralateral eyes underwent the same therapy switch, and their IOP followed an identical pattern of behaviour., CONCLUSION: The average IOP decrease of 1.5 mmHg upon therapy switch to the timolol-dorzolamide fixed combination suggests a better efficacy due to improved compliance. Short-term compliance benefit seems to be more pronounced. The high timolol-dorzolamide fixed combination therapy continuation rate reflects an improvement in compliance and subjectively-perceived convenience.
Keywords: *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cluster Analysis; Drug Combinations; Female; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/tu [Therapeutic Use]; *Ophthalmology/mt [Methods]; Sulfonamides/ad [Administration & Dosage]; *Sulfonamides/tu [Therapeutic Use]; Switzerland; Thiophenes/ad [Administration & Dosage]; *Thiophenes/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]

Comparison of brimonidine/latanoprost and timolol/dorzolamide: two randomized, double-masked, parallel clinical trials. - Zabriskie, Norman; Netland, Peter A; Brimonidine with Latanoprost Study Groups 1 and 2 (Advances in therapy, 2003)
Two double-masked, randomized, parallel, multicenter trials of similar design were conducted to compare the IOP-lowering efficacy of dual therapy with brimonidine 0.2% and latanoprost 0.005% with the fixed combination of timolol 0.5%/dorzolamide 2% in patients with glaucoma or ocular hypertension. The combination of brimonidine and latanoprost produced significantly greater mean IOP reductions at each visit in both trials. In study 1, the mean reduction at peak drug effect after 6 weeks was 9.2 mm Hg (34.7%) with brimonidine and latanoprost and 6.7 mm Hg (26.1%) with timolol/dorzolamide (P=.024); respective reductions at week 12 were 9.0 mm Hg (33.9%) and 6.5 mm Hg (25.3%) (P=.044). At the month 1 visit in study 2, the mean peak IOP reduction was 10.6 mm Hg (39.0%) with dual therapy and 6.3 mm Hg (25.1%) with the fixed combination (P=.001). After 3 months, reductions were 9.1 mm Hg (33.4%) and 6.6 mm Hg (26.3%) (P=.047). In these studies, the combination of brimonidine and latanoprost provided IOP control superior to that of the fixed combination of timolol/dorzolamide.
Keywords: Adult; Aged; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Double-Blind Method; Drug Therapy, Combination; *Exfoliation Syndrome/dt [Drug Therapy]; Exfoliation Syndrome/pp [Physiopathology]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Patient Satisfaction/sn [Statistics & Numerical Data]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Quinoxalines/ad [Administration & Dosage]; Quinoxalines/ae [Adverse Effects]; *Quinoxalines/tu [Therapeutic Use]; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

Patient persistency with ocular prostaglandin therapy: a population-based, retrospective study. - Reardon, Gregory; Schwartz, Gail F; Mozaffari, Essy (Clinical therapeutics, 2003)
BACKGROUND: Open-angle glaucoma affects an estimated 33 million individuals worldwide. An intraocular pressure >21 mm Hg in individuals with no evidence of optic nerve damage is termed ocular hypertension, a risk factor for glaucoma that has been estimated to affect as many as 10% of individuals 40 years of age or older., OBJECTIVE: The purpose of this research was to assess persistency (time on therapy) with prostaglandin analogues in the treatment of glaucoma or ocular hypertension., METHODS: This population-based, retrospective cohort study used the Protocare Sciences managed care database, which includes prescription and medical claims data from multiple managed care organizations. Patients 20 years of age or older who initiated therapy with latanoprost, bimatoprost, or travoprost (index drugs) between April 2001 and June 2002 were included. Patients were required to be continuously enrolled in the same plan for the 180 days preceding index prescription fill. Follow-up continued through June 30, 2002. Two outcome measures were analyzed: (1) discontinuation of the index prostaglandin and (2) either discontinuation or change in the index prostaglandin regimen. Changing therapy was defined as switching to or adding another ocular hypotensive agent. Cox regression models were used to compare rate ratios of discontinuation and discontinuation/change. Patient data were censored on termination of insurance coverage or at the end of the study period., RESULTS: Overall, 7527 patients were prescribed a prostaglandin analogue; 4356 patients met the inclusion criteria (n = 2376, 993, and 987 for latanoprost, bimatoprost, and travoprost, respectively). A total of 58% of patients were women, and 74% were 65 years of age or older. Compared with latanoprost, those treated with bimatoprost were 38% more likely to discontinue and 31% more likely to discontinue/change therapy, and patients treated with travoprost were 36% more likely to discontinue and 29% more likely to discontinue/change therapy (P < 0.001 for each comparison)., CONCLUSION: Latanoprost-treated patients demonstrated significantly (P < 0.001) greater persistency than did those treated with either bimatoprost or travoprost.
Keywords: Administration, Topical; Adult; Aged; Amides; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Cohort Studies; Female; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Lipids/ad [Administration & Dosage]; Lipids/tu [Therapeutic Use]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ophthalmic Solutions; *Patient Compliance; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Prostaglandins, Synthetic/ad [Administration & Dosage]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Self Administration; Travoprost

'This added to my multiple myopia'. - Irwig, Les (BMJ (Clinical research ed.), 2003)
Keywords: Disease Progression; Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; *Patient Participation; Self Administration; Self Care; Trabeculectomy; Treatment Outcome

Fluorometholone in children. - Novack, Gary D (Ophthalmology, 2003)
Comment on (CON)
Keywords: Administration, Topical; Anti-Inflammatory Agents/ad [Administration & Dosage]; *Anti-Inflammatory Agents/ae [Adverse Effects]; Caregivers; Child; Child, Preschool; Fluorometholone/ad [Administration & Dosage]; *Fluorometholone/ae [Adverse Effects]; Glucocorticoids; Humans; *Intraocular Pressure/de [Drug Effects]; *Ocular Hypertension/ci [Chemically Induced]; Patient Compliance

Long-term follow-up after transscleral diode laser photocoagulation in refractory glaucoma. - Pucci, Vincenzo; Tappainer, Federica; Borin, Stefano; Bellucci, Roberto (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2003)
BACKGROUND AND OBJECTIVE: Patients affected by glaucoma refractory to medical or surgical treatment are difficult to treat. The aim of this study was to evaluate the long-term effect of contact transscleral diode laser cyclophotocoagulation (DLPC) on intraocular pressure (IOP) and on visual acuity of these patients., PATIENTS AND METHODS: One hundred and twenty eyes of 107 patients suffering from refractory glaucoma and treated with DLPC were followed at the Eye Clinic of Verona University for an average of 26 +/- 8 months. Mean age was 57 +/- 26 years. IOP, visual acuity, and ocular complications were analyzed., RESULTS: A total of 207 treatments were given. More than one treatment was given in 55 eyes (45.8%). Mean pretreatment IOP was 30.4 +/- 3.1 mm Hg. At the last follow-up, mean IOP was 20.3 +/- 1.8 mm Hg. Mean total medications were reduced from 4.5 +/- 0.5 to 2.3 +/- 0.3. No serious complications occurred in the 207 treatments. Visual acuity remained stable in 66 eyes (55%), improved in 25 eyes (20.8%), and decreased in 29 eyes (24.2%)., CONCLUSIONS: DLPC was effective in lowering IOP in eyes with refractory glaucoma. It also served to reduce the number of antiglaucoma medications, thus improving both the quality of life of the patients and their compliance to therapy. This procedure is relatively safe, very fast and easy to learn. However, careful attention is required to determine the exact position of the ciliary body in malformative glaucoma. Multiple treatments may be required to control IOP. Copyright 2003 S. Karger AG, Basel
Keywords: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anesthetics, Local/ad [Administration & Dosage]; Child; Child, Preschool; Female; Follow-Up Studies; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; Injections; Intraocular Pressure; Intraoperative Complications; Laser Coagulation/ae [Adverse Effects]; *Laser Coagulation; Lidocaine/ad [Administration & Dosage]; Male; Middle Aged; Pain/dt [Drug Therapy]; Pain/et [Etiology]; Reoperation; Treatment Outcome; Visual Acuity

24-hour monitoring of intraocular pressure in glaucoma management: a retrospective review. - Hughes, Edward; Spry, Paul; Diamond, Jeremy (Journal of glaucoma, 2003)
PURPOSE: Diurnal variation in intraocular pressure (IOP) is well recognized, yet important decisions in glaucoma management are frequently made after 1 or 2 IOP measurements. Twenty-four-hour monitoring of IOP may identify IOP variation and spikes. This study determined the value of 24-hour IOP monitoring in routine clinical practice., METHODS: Data were acquired retrospectively from case notes of 29 glaucoma patients sequentially admitted for 24-hour IOP monitoring while taking their established antiglaucoma therapy., RESULTS: While there was no difference between the mean clinic (office) and mean 24-hour IOP measurements, the peak IOP during 24-hour monitoring was on average 4.9 mm Hg higher than the peak clinic IOP (P<0.0001). In 4 (13.8%) patients, the peak IOP over 24 hours was at least 12 mm Hg higher than the clinic peak. Peak IOP values occurred outside normal office hours in 51.7% of patients. Twenty-four-hour IOP monitoring resulted in a change of clinical management in 23 (79.3%) patients, including 13 (44.8%) who were offered trabeculectomy., CONCLUSION: Twenty-four-hour monitoring of IOP frequently led to a change of glaucoma management by identifying IOP fluctuations and spikes. High IOP and wide diurnal IOP variation are considered major risk factors for glaucoma progression, and standard clinic follow-up evaluations failed to identify these phenomena.
Keywords: Adult; Aged; Aged, 80 and over; *Circadian Rhythm; Female; *Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure; Male; Middle Aged; *Monitoring, Physiologic; Office Visits; Retrospective Studies

Why daily wear is still better than extended wear. - Weissman, Barry; Mondino, Bartly J (Eye & contact lens, 2003)
Among the many problems complicating contact lens wear, microbial keratitis is of most concern because of its potential for substantial morbidity. Three decades of basic and clinical research suggest that risk factors include poor care compliance and extended wear through one or multiple sleep cycles. Many believe the latter problem is caused in part or in whole to contact lens-induced hypoxia. New contact lenses, both rigid and soft, have been developed that allow oxygen delivery equivalent to the noncontact lens state, under open-eye conditions and close to the same even for closed-eye conditions. But will such lenses reduce the risk for microbial keratitis? The authors argue that until such a conclusion is reached through clinical trials, the question remains in doubt.
Keywords: *Contact Lenses/sn [Statistics & Numerical Data]; Eye Infections, Bacterial/pc [Prevention & Control]; Humans; Keratitis/pc [Prevention & Control]; Oxygen/me [Metabolism]

Corneal endothelial morphology results in the Menicon Z 30-day continuous-wear contact lens clinical trial. - Barr, Joseph T; Pall, Brian; Szczotka, Loretta B; Mitchell, G Lynn; Gleason, William (Eye & contact lens, 2003)
PURPOSE: This evaluation was conducted as part of a protocol entitled Evaluation of the Menicon Z Rigid Gas Permeable Contact Lens for up to 30 Days Extended Wear. The purpose of the protocol was to compare corneal endothelial morphology changes after wearing rigid gas-permeable (RGP) Menicon Z contact lenses, continuously for up to 30 days, with ACUVUE (Johnson & Johnson Vision Care) hydrogel contact lenses, worn for up to 6 nights of extended wear., METHODS: Sixty patients, who were adapted to RGP daily wear and soft contact lens daily wear, were recruited at two study sites. The thirty subjects who wore RGP daily wear lenses were fitted with the Menicon Z (tisilfocon A, oxygen permeablility [Dk] = 163) RGP contact lens comprised the test group. The control group subjects (n = 30 former users of daily wear soft contact lenses) were fitted with ACUVUE (etafilcon A, Dk = 28) hydrogel contact lenses. After a 2-week adaptation period of daily wear, subjects began extended wear. Endothelial imaging was performed at the two study sites in this multicenter study (University Hospitals of Cleveland/Case Western Reserve University Department of Ophthalmology [CWRU] and The Ohio State University [OSU]). The hydrogel lens group was instructed to wear their lenses for 7 days and 6 nights before discarding the lenses and to sleep with no lenses on the seventh night. The RGP group was permitted to wear the lenses for up to 30 days and 29 consecutive nights before removing the lenses for cleaning and overnight soaking., RESULTS: CWRU had 24 patients (12 soft contact lens and 12 rigid contact lens) and OSU had 21 patients (12 soft contact lens and 9 rigid contact lens) who completed the study and were included in the analyses. Patients who were withdrawn from the study at CWRU included one RGP patient dropped out because of pregnancy; one RGP patient developed vascularized limbal keratitis and discomfort; one could not be fitted with a bitoric RGP; two soft lens patients moved from the area, and one dropped out because of dry eyes. At OSU, four patients dropped out due to discomfort (two in each lens type);one moved from the study area; one decided not to participate soon after the consent visit; one had worries of reduced vision at 6 months; one subject's attitude changed prior to the 6 month visit; and one subject was withdrawn for reasons of poor study schedule compliance., CONCLUSION: The Menicon Z lens wearers in this study did not show significant endothelial cell morphology changes after 1 year of nearly continuous contact lens wear. This finding is particularly important considering the RGP wearers in this study were older by a average of 10 years (mean age approximately 40) and had worn their contact lenses an average of almost 10 years longer than the soft contact lens wearers.
Keywords: Adult; Cell Count; *Contact Lenses, Extended-Wear/sn [Statistics & Numerical Data]; *Endothelium, Corneal/pa [Pathology]; Humans; Patient Satisfaction; Prospective Studies; Refraction, Ocular; Safety; Treatment Outcome; Visual Acuity

Primary open-angle glaucoma in blacks: a review. - Racette, Lyne; Wilson, M Roy; Zangwill, Linda M; Weinreb, Robert N; Sample, Pamela A (Survey of ophthalmology, 2003)
Glaucoma is one of the leading causes of blindness worldwide. Primary open-angle glaucoma (POAG) is the most prevalent form of glaucoma and has a particularly devastating impact in blacks. In the black American population, POAG prevalence is estimated to be six times as high in certain age groups compared to whites. POAG is more likely to result in irreversible blindness, appears approximately 10 years earlier and progresses more rapidly in blacks than in whites. Racial differences in optic disk parameters have been reported and show that blacks have larger optic disks than whites. This finding is robust and may account for the reported differences in other optic disk parameters. The existence of racial differences in intraocular pressure remains to be demonstrated, as conflicting findings are reported in the literature. Intraocular pressure may actually be underestimated in blacks, perhaps because they have thinner corneas. The prevalence of diabetes and hypertension is higher in blacks than in whites, and although no causal relationship has been established between POAG and each of these systemic diseases, some reports suggest that they often occur together, perhaps through an indirect relationship with intraocular pressure. Compounding the problem, there is evidence that blacks are less responsive to both drug and surgical treatment for POAG. Finally, they often have reduced accessibility to treatment and are less aware of the risks of having POAG. This article provides a comprehensive review of the current knowledge pertaining to POAG in blacks.
Keywords: *African Continental Ancestry Group; Developing Countries; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/eh [Ethnology]; Glaucoma, Open-Angle/et [Etiology]; Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure; Prevalence; Risk Factors; United States/ep [Epidemiology]

Expression of functional ICAM-1 on cultured human keratocytes induced by tumor necrosis factor-alpha. - Kumagai, Naoki; Fukuda, Ken; Fujitsu, Youichiro; Nishida, Teruo (Japanese journal of ophthalmology, 2003)
PURPOSE: Leukocytes such as neutrophils contribute to the pathogenesis of corneal ulcer. The effect of the proinflammatory cytokine tumor necrosis factor (TNF)-alpha on the expression of intercellular adhesion molecule (ICAM)-1 by cultured human keratocytes was investigated because the interaction of leukocytes with ICAM-1 expressed on the surface of structural cells mediates leukocyte infiltration into tissue at sites of inflammation., METHODS: Cultured human keratocytes were incubated with various concentrations of TNF-alpha. The surface expression of ICAM-1 was evaluated by whole-cell enzyme-linked immunosorbent assay, flow cytometry, and immunohistochemistry. The abundance of ICAM-1 mRNA in cell lysate was determined by quantitative reverse transcription and polymerase chain reaction analysis. Adhesion of neutrophils to corneal fibroblasts was assayed by measuring the fluorescence of Calcein-AM-labeled neutrophils., RESULTS: Incubation of keratocytes with TNF-alpha induced increased expression of ICAM-1 on the surface of keratocytes in a dose- and time-dependent manner. The abundance of ICAM-1 mRNA in keratocytes was increased by the incubation of cells with TNF-alpha. Exposure of keratocytes to TNF-alpha increased the adherence of human neutrophils to these cells., CONCLUSIONS: Stimulation of keratocytes with TNF-alpha resulted in an increase in the abundance of ICAM-1 mRNA, the cell surface expression of ICAM-1 protein, and enhanced adhesion of neutrophils to these cells. The expression of ICAM-1 on human keratocytes may thus contribute to leukocyte infiltration into the corneal stroma of individuals with inflammatory ocular diseases.
Keywords: Adolescent; Adult; Aged; Cell Adhesion; Cells, Cultured; Child; Child, Preschool; *Corneal Stroma/cy [Cytology]; Dose-Response Relationship, Drug; Enzyme-Linked Immunosorbent Assay; Female; *Fibroblasts/de [Drug Effects]; Fibroblasts/me [Metabolism]; Flow Cytometry; Fluorescent Antibody Technique, Indirect; Humans; *Intercellular Adhesion Molecule-1/bi [Biosynthesis]; Intercellular Adhesion Molecule-1/ge [Genetics]; Male; Middle Aged; Neutrophils/ph [Physiology]; RNA, Messenger/me [Metabolism]; Reverse Transcriptase Polymerase Chain Reaction; Time Factors; *Tumor Necrosis Factor-alpha/pd [Pharmacology]

Effects of educational intervention in waiting room on patient satisfaction. - Oermann, Marilyn H (The Journal of ambulatory care management, 2003)
This study examines the effects of a low-cost educational intervention designed to occupy the waiting time in the clinic on patient satisfaction with the clinic visit. Patients waiting for appointments were randomly assigned to two groups: (1) educational intervention in the clinic waiting room (n = 160) and (2) usual clinic care (no structured education during the waiting time in the clinic; n = 160). There were significant negative correlations between satisfaction with the visit overall and the time patients waited in the clinic waiting room (r = -.17, p = .003) and their total wait time (r = -.16, p = .005). Patients who were taught while they waited in the clinics were more satisfied with their education than the control group (t = 4.26, df = 318, p < 0.001).
Keywords: Adult; Aged; *Appointments and Schedules; Glaucoma/pc [Prevention & Control]; Health Knowledge, Attitudes, Practice; Health Services Research; Humans; Male; Middle Aged; Midwestern United States; *Outpatient Clinics, Hospital/og [Organization & Administration]; Outpatient Clinics, Hospital/st [Standards]; *Outpatients/ed [Education]; *Patient Education as Topic/og [Organization & Administration]; Patient Satisfaction/eh [Ethnology]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Physician-Patient Relations; Program Evaluation; Time Management; Time and Motion Studies; United States; Videotape Recording

Patient preferences for eye drop characteristics: a willingness-to-pay analysis. - Jampel, Henry D; Schwartz, Gail F; Robin, Alan L; Abrams, Donald A; Johnson, Elizabeth; Miller, Rhonda B (Archives of ophthalmology (Chicago, Ill. : 1960), 2003)
OBJECTIVE: To determine the importance that patients place on the characteristics of topical therapy for lowering intraocular pressure., METHODS: We administered a willingness-to-pay instrument to 230 patients from 4 glaucoma subspecialty practices, asking them how much they would be willing to pay to obtain particular characteristics in an eye drop. Data about the subjects' demographics, economic status, attitudes toward eye drops and systemic medications, and symptoms from eye drops were correlated with their willingness to pay using 2-part models., RESULTS: Of our subjects, 169 (77%) were using eye drops to lower their intraocular pressure. Fatigue, blurred vision, and tearing were the most commonly reported symptoms. Eye drop medications most valued by the subjects did not produce blurring, drowsiness, or inhibition of sexual performance; 85% were willing to pay more for an eye drop that did not cause blurring, and on average they were willing to pay 40% more. Higher educational levels and income were generally associated with a willingness to pay more for eye drops with desirable attributes., MAIN OUTCOME MEASURE: Willingness to pay more (in dollars)., CONCLUSIONS: Patient preferences for eye drop characteristics can be assessed using a willingness-to-pay instrument. Patients place differing value on various eye drop characteristics. A better understanding of patient preference could lead to better compliance.
Keywords: Aged; *Antihypertensive Agents/ec [Economics]; Baltimore; Cost-Benefit Analysis; *Drug Therapy/ec [Economics]; Female; Financing, Personal; *Glaucoma/ec [Economics]; Health Services Research; Humans; Male; *Ophthalmic Solutions/ec [Economics]; Patient Acceptance of Health Care; *Patient Satisfaction; Quality of Life; Socioeconomic Factors

Blindness in patients with treated open-angle glaucoma. - Chen, Philip P (Ophthalmology, 2003)
PURPOSE: To investigate blindness in patients with treated open-angle glaucoma (OAG) and risk factors for blindness., DESIGN: Retrospective observational case series., PARTICIPANTS: One hundred eighty-six patients seen between April and November 2000 at the University of Washington Medical Center Eye Clinic, diagnosed in 1975 or later, and treated for at least 2 years for OAG., METHODS: Chart review with evaluation of visual acuity and visual field. Kaplan-Meier survival analysis was used to estimate the risk of blindness in one and both eyes. Variables considered to be possible risk factors for blindness were evaluated using chi-square test, t test, and Cox proportional hazards regression analysis., MAIN OUTCOME MEASURES: Blindness, defined as visual acuity of 20/200 or worse, and/or continuous constriction of the visual field to 20 degrees or less in all four quadrants with a size III4e Goldmann stimulus or the equivalent on automated perimetry, allowing a higher threshold level on one point in one quadrant on automated perimetry., RESULTS: The mean duration of disease was 10.2 +/- 4.9 years. Twelve patients were blind in at least one eye from OAG at diagnosis. Nineteen other patients became blind in at least one eye from OAG, and three patients became bilaterally blind from OAG. The Kaplan-Meier estimate for blindness at 15 years in one eye was 14.6%, and in both eyes was 6.4%. Noncompliance with the treatment regimen (P = 0.016) and worse initial visual field loss (P < 0.0001) were significantly associated with development of blindness. Nonwhite race was associated with blindness (P = 0.014) when all blindness, including that found at diagnosis, was considered in the analysis., CONCLUSIONS: Bilateral blindness from chronic OAG was uncommon in this population of treated patients diagnosed in 1975 or later. Of patients with a blind eye, 39% were blind at diagnosis, and worse visual field loss at diagnosis and noncompliance were associated with development of blindness.
Comment on (CON)
Keywords: *Blindness/et [Etiology]; Chronic Disease; Cohort Studies; Female; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Retrospective Studies; Risk Factors; Time Factors; Visual Acuity; Visual Fields

Conjunctival hyperemia and the use of topical prostaglandins in glaucoma and ocular hypertension. - Feldman, Robert M (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2003)
The prostaglandin derivatives are thought to lower intraocular pressure (IOP) primarily by increasing uveoscleral outflow. The ocular side effect, hyperemia, appears to occur via a secondary, unrelated mechanism. Variations in the IOP-lowering effect and incidence of hyperemia associated with these drugs are a function of their different chemical structures. Among the currently approved prostaglandin derivatives, hyperemia occurs in as many as 50% of patients treated with travoprost and as few as 5% of patients treated with latanoprost. The side effect of hyperemia may be of concern to the ophthalmologist for at least 2 reasons: hyperemia may compromise the outcome of filtration surgery, and it may represent a cosmetic problem to the patient thereby leading to non-compliance. The extent to which hyperemia may contribute to patient noncompliance and the effect of administration of the prostaglandin derivatives on outcome of filtration surgery remain to be determined. Until more definitive data are available, when selecting a prostaglandin analogue for ocular hypotensive therapy, it seems prudent to choose an agent with a low incidence of hyperemia.
Keywords: Administration, Topical; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; *Conjunctiva/bs [Blood Supply]; *Glaucoma/dt [Drug Therapy]; Humans; *Hyperemia/ci [Chemically Induced]; Hyperemia/ep [Epidemiology]; Incidence; Intraocular Pressure/de [Drug Effects]; Latanoprost; *Ocular Hypertension/dt [Drug Therapy]; *Prostaglandins/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ae [Adverse Effects]; Travoprost

Awareness of glaucoma, and health beliefs of patients suffering primary acute angle closure. - Saw, S-M; Gazzard, G; Friedman, D; Foster, P J; Devereux, J G; Wong, M L; Seah, S (The British journal of ophthalmology, 2003)
AIM: To evaluate the factors associated with lack of awareness of glaucoma and late presentation to the doctor in Singapore Chinese patients with acute angle closure (AAC) METHODS: A prospective, hospital based case series of 105 patients aged 35 years and above who presented with a first attack of AAC in a tertiary hospital in Singapore was conducted. A research assistant interviewed all patients face to face in clinic and recorded demographic factors, awareness of glaucoma, and subjective barriers to seeing a doctor. The time from onset of symptoms to presentation at the clinic was noted., RESULTS: Overall, 22.9% of patients had heard of glaucoma. The multivariate adjusted odds ratio (OR) of unawareness of glaucoma in older people (> 60 years) was 1.5 (95% confidence interval (CI) 0.5 to 4.6), 3.2 (95% CI 1.1 to 9.2) for adults who were not working, and 13.8 (95% CI 1.3 to 146.7) for patients who had less than a pre-university education. A significant proportion (31.7%) of patients presented to the doctor 24 hours or more after symptoms occurred. In a multiple logistic regression model, the adjusted OR of late presentation was 8.5 (95% CI 1.04 to 69.5) if there was no car access, 5.0 (95% CI 1.0 to 24.6) if the patients spoke Chinese, and 3.3 (95% CI 0.9 to 11.9) if there was nobody to accompany to hospital., CONCLUSION: Glaucoma awareness among patients suffering AAC was not high. Lack of awareness was associated with increasing age, lack of formal education, and unemployment. A significant proportion of patients seek medical attention late. Risk factors for late presentation include lack of car access, nobody to accompany the patient, and speaking the Chinese language primarily. Health education programmes may help increase the knowledge and awareness of glaucoma.
Keywords: Age Factors; Aged; Analysis of Variance; China/eh [Ethnology]; Educational Status; Employment; Family; Female; *Glaucoma, Angle-Closure/px [Psychology]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Patient Acceptance of Health Care/px [Psychology]; Prospective Studies; Sex Factors; Singapore; Surveys and Questionnaires; Transportation

The efficacy and safety of the timolol/dorzolamide fixed combination vs latanoprost in exfoliation glaucoma. - Konstas, A G P; Kozobolis, V P; Tersis, I; Leech, J; Stewart, W C (Eye (London, England), 2003)
PURPOSE: To evaluate the safety and efficacy of the timolol/dorzolamide fixed combination vs latanoprost 0.005% in exfoliation glaucoma patients., METHODS: We randomized in an observer-masked fashion 65 newly diagnosed exfoliation glaucoma patients to either the timolol/dorzolamide twice daily or latanoprost daily treatment for 2 months and then crossed these over to the other treatment., RESULTS: A total of fifty-four patients completed the study. After 2 months of chronic dosing, the morning intraocular pressure (IOP) (10:00) was reduced from a baseline of 31.2+/-6.5 mmHg to 18.1+/-3.0 with the fixed combination and to 18.9+/-4.1 mmHg with latanoprost (P = 0.21). Six patients were discontinued early from both treatment periods owing to inadequate IOP control and two others were discontinued from latanoprost treatment only. The fixed combination showed a significantly greater incidence of taste perversion (P < 0.001) and stinging upon instillation (P = 0.036), while latanoprost showed a trend for increased conjunctival injection (P = 0.056). However, five patients demonstrated either bradycardia or asthmatic symptoms with initiation of the fixed combination therapy. One patient on latanoprost complained of dizziness. Patient preference was generally given to latanoprost (63 vs 20.3%) mainly because of its once daily dosing (P < 0001)., CONCLUSIONS: This study suggests that both latanoprost and the timolol/dorzolamide fixed combination are efficacious in the treatment of newly diagnosed exfoliation glaucoma.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Patient Satisfaction; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Single-Blind Method; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Cataract surgery and changes in quality of life measures. - Pesudovs, Konrad; Weisinger, Harrison S; Coster, Douglas J (Clinical & experimental optometry, 2003)
BACKGROUND: This study examines whether quality of life measured with non-disease specific instruments is altered by cataract surgery and whether the effect is modulated by the presence of ocular comorbidity or other non-ocular issues., METHODS: Thirteen patients were assessed pre- and at three months post-cataract surgery. Visual disability was measured with the Visual Disability Assessment. Quality of life was measured using two established generic instruments: the Cantril Ladder and the Profile of Mood States (POMS). Subjects were also asked to report any events that may have influenced their quality of life in the three months after surgery., RESULTS: Visual acuity and visual disability were significantly improved by surgery (p < 0.01). Cantril Ladder score was significantly improved after surgery (p = 0.04). The POMS score improved significantly after surgery, only when cases with ocular comorbidity were excluded (p = 0.04). Two cases had a large deterioration in POMS score that was attributable in one case, to the death of a partner and in the other (a patient with severe glaucoma) to depression from the realisation that there was no further potential for visual improvement., DISCUSSION: Quality of life can be measurably improved by cataract surgery. However, this is less likely if ocular comorbidity is present. The use of generic instruments for outcome studies increases the likely influence of external factors on quality of life measures. Disease specific instruments, such as the Visual Disability Assessment, should be used wherever possible in outcomes research.
Keywords: Aged; Aged, 80 and over; *Cataract Extraction/px [Psychology]; Comorbidity; Disability Evaluation; Female; Humans; Male; Middle Aged; Patient Satisfaction; *Quality of Life; Treatment Outcome; *Visual Acuity

Comparison of efficacy and tolerability between two gel-forming timolol maleate ophthalmic solutions in patients with glaucoma or ocular hypertension. - Shibuya, Takashi; Kashiwagi, Kenji; Tsukahara, Shigeo (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 2003)
PURPOSE: To compare two gel-forming timolol maleate ophthalmic solutions, Timoptol XE and Lizmon TG, in regard to efficacy and tolerability in patients with glaucoma or ocular hypertension by means of a patient-masked prospective randomized crossover study., SUBJECTS AND METHODS: A total of 37 patients with glaucoma or ocular hypertension under treatment with antiglaucoma ophthalmic solutions including 0.5% twice-daily timolol maleate participated in this study. Only timolol maleate was withdrawn and either Timoptol XE or Lizmon TG was randomly allocated. After instillation for 1 month, the other ophthalmic solution was subsequently instilled for another month. Routine ophthalmic examination including slit-lamp examination and intraocular pressure (IOP) monitoring was conducted before instillation of gel-forming ophthalmic solutions and just after completing the instillation of each ophthalmic solution. Patient questionnaire surveys were also performed just after completing the instillation of each ophthalmic solution., RESULTS: Mean IOP, just before the withdrawal of timolol ophthalmic solution, was 16.4 +/- 2.9 mm Hg. At the end of Timoptol XE or Lizmon TG instillation, mean IOPs were 16.3 +/- 2.5 or 16.3 +/- 3.0 mm Hg, respectively. The results of the questionnaire survey showed no significant difference between Timoptol XE and Lizmon TG in regard to all survey items. Twenty-nine patients (78.4%) preferred to use gel-forming timolol solutions rather than twice-daily timolol ophthalmic solution. The presence of concurrently used ophthalmic solutions did not effect the incidences of subjective symptoms. The incidences of objective adverse effects were not significantly different between two gel-forming timolol ophthalmic solutions., CONCLUSION: Both gel-forming timolol ophthalmic solutions could be good choices for glaucoma treatment. Copyright 2003 S. Karger AG, Basel
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Over Studies; Female; Gels; *Glaucoma, Angle-Closure/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Patient Compliance; Patient Satisfaction; Prospective Studies; Safety; Single-Blind Method; Surveys and Questionnaires; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Visual Acuity

Fungal and parasitic infections of the eye. - Klotz, S A; Penn, C C; Negvesky, G J; Butrus, S I (Clinical microbiology reviews, 2000)
The unique structure of the human eye as well as exposure of the eye directly to the environment renders it vulnerable to a number of uncommon infectious diseases caused by fungi and parasites. Host defenses directed against these microorganisms, once anatomical barriers are breached, are often insufficient to prevent loss of vision. Therefore, the timely identification and treatment of the involved microorganisms are paramount. The anatomy of the eye and its surrounding structures is presented with an emphasis upon the association of the anatomy with specific infection of fungi and parasites. For example, filamentous fungal infections of the eye are usually due to penetrating trauma by objects contaminated by vegetable matter of the cornea or globe or, by extension, of infection from adjacent paranasal sinuses. Fungal endophthalmitis and chorioretinitis, on the other hand, are usually the result of antecedent fungemia seeding the ocular tissue. Candida spp. are the most common cause of endogenous endophthalmitis, although initial infection with the dimorphic fungi may lead to infection and scarring of the chorioretina. Contact lens wear is associated with keratitis caused by yeasts, filamentous fungi, and Acanthamoebae spp. Most parasitic infections of the eye, however, arise following bloodborne carriage of the microorganism to the eye or adjacent structures.
Keywords: Animals; Eye/ah [Anatomy & Histology]; Eye/im [Immunology]; Eye/pa [Pathology]; Eye Infections, Fungal/ep [Epidemiology]; Eye Infections, Fungal/mi [Microbiology]; Eye Infections, Fungal/pa [Pathology]; Eye Infections, Fungal/pp [Physiopathology]; *Eye Infections, Fungal; Eye Infections, Parasitic/ep [Epidemiology]; Eye Infections, Parasitic/ps [Parasitology]; Eye Infections, Parasitic/pa [Pathology]; Eye Infections, Parasitic/pp [Physiopathology]; *Eye Infections, Parasitic; Fungi/cl [Classification]; Fungi/ip [Isolation & Purification]; Humans

Role of carbohydrate-mediated adherence in cytopathogenic mechanisms of Acanthamoeba. - Cao, Z; Jefferson, D M; Panjwani, N (The Journal of biological chemistry, 1998)
Acanthamoeba keratitis is a vision-threatening corneal infection. The mannose-binding protein of Acanthamoeba is thought to mediate adhesion of parasites to host cells. We characterized the amoeba lectin with respect to its carbohydrate binding properties and the role in amoeba-induced cytopathic effect (CPE). Sugar inhibition assays revealed that the amoeba lectin has the highest affinity for alpha-Man and Man(alpha1-3)Man units. In vitro cytopathic assays indicated that mannose-based saccharides which inhibit amoeba adhesion to corneal epithelial cells were also potent inhibitors of amoeba-induced CPE. Another major finding was that N-acetyl-D-glucosamine (GlcNAc) which does not inhibit adhesion of amoeba to host cells is also an inhibitor of amoeba-induced CPE. The Acanthamoebae are thought to produce CPE by secreting cytotoxic proteinases. By zymography, one metalloproteinase and three serine proteinases were detected in the conditioned media obtained after incubating amoebae with the host cells. The addition of free alpha-Man and GlcNAc to the co-culture media inhibited the secretion of the metalloproteinase and serine proteinases, respectively. In summary, we have shown that the lectin-mediated adhesion of the Acanthamoeba to host cells is a prerequisite for the amoeba-induced cytolysis of target cells and have implicated a contact-dependent metalloproteinase in the cytopathogenic mechanisms of Acanthamoeba.
Keywords: *Acanthamoeba/py [Pathogenicity]; Acanthamoeba Keratitis/ps [Parasitology]; *Acanthamoeba Keratitis/pa [Pathology]; *Acute-Phase Proteins/me [Metabolism]; Animals; *Carrier Proteins/me [Metabolism]; Cell Adhesion/de [Drug Effects]; Humans; Lectins/me [Metabolism]; Mannans/me [Metabolism]; *Mannose/me [Metabolism]; Mannose-Binding Lectins; Rabbits; Serine Proteinase Inhibitors/pd [Pharmacology]

Improving adherence to drug-treatment regimens for glaucoma. - Mansukani, Sharad S (Managed care (Langhorne, Pa.), 2002)
Compliance with glaucoma therapy is relatively poor. Because glaucoma progresses slowly, long-term adherence is crucial to improving clinical and financial outcomes of treatment. Physicians must consider several factors before steps can be taken to promote correct use of medications.
Keywords: Drug Prescriptions; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; Patient Education as Topic; Physician-Patient Relations; Practice Patterns, Physicians'; United States

Considerations in the pharmacoeconomics of glaucoma. - Hirsch, Jan D (Managed care (Langhorne, Pa.), 2002)
Pharmacoeconomic research identifies, measures, and compares the costs and consequences of pharmaceutical product and service utilization. Providing optimal glaucoma care requires planning, based not only on the historically relevant factors of drug safety and efficacy, but also on data relating to the value of medical treatments.
Keywords: Cost-Benefit Analysis; Drug Costs/sn [Statistics & Numerical Data]; *Economics, Pharmaceutical; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Health Care Rationing; Humans; United States

Glaucoma: prevalence, utilization, and economic implications. - Dalzell, Michael D (Managed care (Langhorne, Pa.), 2002)
Keywords: Adult; Aged; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; *Glaucoma/ep [Epidemiology]; Glaucoma/eh [Ethnology]; *Health Services/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; Office Visits/td [Trends]; Prevalence; United States

Geriatric considerations in the diagnosis and management of overactive bladder. - Ouslander, Joseph G (Urology, 2002)
Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients. These factors include mobility disorders, cognitive impairment, bowel habits, and fluid intake. Moreover, OAB often does not occur in isolation in the geriatric population. Estrogen deficiency and sphincter weakness in women, prostatic enlargement and obstruction in men, and impaired bladder contractility in both sexes are common and can have prominent effects on management. The diagnostic evaluation of geriatric patients with OAB can usually be accomplished with a basic assessment, without more invasive and expensive procedures. Treatment depends on numerous factors, ranging from comorbidities and functional status to transportation, finances, and patient and caregiver preferences. Adverse effects of bladder-relaxant medications can be bothersome and exacerbate existing conditions common in older patients (eg, constipation, glaucoma, gastroesophageal reflux, and dementia). Setting realistic goals for treatment and communicating them clearly to older patients and their caregivers are crucial for patient satisfaction. There are myriad opportunities for research designed to improve the management of OAB in the geriatric population.
Keywords: Aged; Aged, 80 and over; Caregivers/px [Psychology]; Comorbidity; Female; *Geriatric Assessment/mt [Methods]; Health Status; Humans; Male; Patient Satisfaction; Quality of Life; Urinary Bladder Diseases/di [Diagnosis]; Urinary Bladder Diseases/th [Therapy]; *Urination Disorders/di [Diagnosis]; *Urination Disorders/th [Therapy]; Urodynamics/ph [Physiology]

Outcome after treatment of congenital unilateral cataract. - Lundvall, Anna; Kugelberg, Ulla (Acta ophthalmologica Scandinavica, 2002)
PURPOSE: To evaluate long-term functional outcome after treatment of congenital unilateral cataract., METHODS: The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. The patients were followed until 4-9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported., RESULTS: Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children., CONCLUSION: Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.
Comment in (CIN)
Keywords: *Cataract/cn [Congenital]; *Cataract Extraction; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity

Studies describe prevalence of blindness, visual impairment among U.S. Hispanics. - Rollins, Gina (Report on medical guidelines & outcomes research, 2002)
Keywords: Adult; Aged; Blindness/ep [Epidemiology]; Blindness/eh [Ethnology]; *Blindness; Cataract/ep [Epidemiology]; Cuba/eh [Ethnology]; Diabetic Retinopathy/ep [Epidemiology]; Female; Glaucoma/ep [Epidemiology]; Health Services Accessibility; Hispanic Americans/sn [Statistics & Numerical Data]; *Hispanic Americans; Humans; Income; Macular Degeneration/ep [Epidemiology]; Male; Mexico/eh [Ethnology]; Middle Aged; Practice Guidelines as Topic; Puerto Rico/eh [Ethnology]; Socioeconomic Factors; South America/eh [Ethnology]; United States/ep [Epidemiology]

[Patient compliance in glaucoma therapy]. - Vogel, A; Pfeiffer, N; Schwenn, O (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2002)
Keywords: Drug Packaging; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Ophthalmic Solutions; Patient Compliance/px [Psychology]; *Patient Compliance; Patient Education as Topic; Self Care/px [Psychology]; Sick Role

[How patients react when glaucoma is diagnosed?]. - Hamelin, N; Blatrix, C; Brion, F; Mathieu, C; Goemaere, I; Nordmann, J P (Journal francais d'ophtalmologie, 2002)
PURPOSE: Evaluate the psychological consequences of announcing the diagnosis of glaucoma., MATERIALS AND METHODS: Two hundred patients completed a 20-item questionnaire designed to analyze the context in which glaucoma was discovered and the patients' reaction to this diagnosis. Behavioral modification in patients and their families are specified as well as their perception of the information received., COMMENTS: Most patients had open-angle glaucoma and showed either an anxious or a passive reaction to the announcement of the diagnosis. Severe anxiety led to prescription of minor tranquilizers or antidepressants in 11% of cases. Nearly half of the patients declared that they had modified their behavior after receiving the diagnosis, indicating a need to play an active role in disease management. A large majority of the patients were conscious of the risk of blindness related to glaucoma; however, they did not feel ill but rather handicapped . Most were dissatisfied with the information provided by their doctor and sought other sources of information., CONCLUSION: Announcing a diagnosis of glaucoma is a decisive step in the physician-patient relationship, known to be important in future treatment compliance. Better adapted information with regular reevaluation of the need for additional information is necessary. The psychological impact should be evaluated regularly in order to promote an active role on the part of the patient and avoid a decline in quality of life.
Keywords: Aged; Antidepressive Agents/tu [Therapeutic Use]; Anxiety/dt [Drug Therapy]; Anxiety/et [Etiology]; *Attitude to Health; Behavior Therapy; Female; Glaucoma/px [Psychology]; *Glaucoma; Glaucoma, Open-Angle/px [Psychology]; Humans; Male; Middle Aged; Patient Compliance; *Physician-Patient Relations; Quality of Life; Surveys and Questionnaires; Tranquilizing Agents/tu [Therapeutic Use]

Another ounce of prevention. Slowly but surely, Medicare coverage of preventive services has grown. Here's an update. - Moore, Kent J (Family practice management, 2002)
Keywords: Aged; Colorectal Neoplasms/di [Diagnosis]; Densitometry/ec [Economics]; Diabetes Mellitus/pc [Prevention & Control]; *Diagnostic Tests, Routine/ec [Economics]; Female; Glaucoma/di [Diagnosis]; Health Services Accessibility/ec [Economics]; *Health Services Accessibility/td [Trends]; Humans; Immunization Programs/ec [Economics]; Male; Mammography/ec [Economics]; *Medicare/td [Trends]; Patient Education as Topic/ec [Economics]; *Preventive Health Services/ec [Economics]; Prostatic Neoplasms/di [Diagnosis]; United States

Patient comfort with combined anterior sub-Tenon's, topical, and intracameral anesthesia versus retrobulbar anesthesia in trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery. - Kansal, Sukesh; Moster, Marlene R; Gomes, Marcia C; Schmidt, Courtland M Jr; Wilson, Richard P (Ophthalmic surgery and lasers, 2002)
PURPOSE: To assess patient comfort using combined anterior sub-Tenon's, topical, and intracameral ("Blitz") anesthesia versus retrobulbar anesthesia in glaucoma surgery., PATIENTS AND METHODS: In this study, 139 consecutive patients who received retrobulbar anesthesia and 139 consecutive patients who received Blitz anesthesia during glaucoma surgery were evaluated in a prospective fashion. The retrobulbar group included 49 trabeculectomies, 36 aqueous shunts, and 54 phacotrabeculectomies. The Blitz group included 49 trabeculectomies, 30 aqueous shunts, and 60 phacotrabeculectomies. Patients were asked to assess their level of ocular pain operatively and postoperatively on a 10-point visual analog scale. The operative and postoperative pain scores and postoperative sedation of patients receiving retrobulbar anesthesia were compared with those of patients receiving Blitz anesthesia during trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery, separately., RESULTS: No statistically significant difference was found in the mean operative or postoperative pain scores between the two groups during trabeculectomy, phacotrabeculectomy, or aqueous shunt surgery., CONCLUSIONS: Blitz anesthesia offers a reasonable alternative to retrobulbar anesthesia for trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery.
Keywords: Aged; *Anesthesia, Local/mt [Methods]; Anesthetics, Local/ad [Administration & Dosage]; Anterior Chamber/de [Drug Effects]; Anterior Chamber/su [Surgery]; Female; *Glaucoma Drainage Implants; Humans; Male; Orbit; Pain Measurement; Pain, Postoperative; *Patient Satisfaction; *Phacoemulsification; Postoperative Complications; *Trabeculectomy

[Evaluation of the quality of life in ophthalmology]. - Bremond-Gignac, D; Tixier, J; Missotten, T; Laroche, L; Beresniak, A (Presse medicale (Paris, France : 1983), 2002)
THE IMPORTANCE OF VISUAL FUNCTION IN THE ASSESSMENT OF QUALITY OF LIFE: The notion of visual function is related to visual acuity but also to many other parameters such as the visual field, perception of colour, contrasts, and the resistance to blinding. These factors are difficult to measure during routine ophthalmic examination but can be assessed during questionnaires on quality of life. MARKERS OF QUALITY OF LIFE IN OPHTHALMOLOGY: Various quality of life questionnaires have been developed in ophthalmology because the non-specific generic instruments appear inadequate. The SF 36 and SF 20 scales, which are generic instruments widely used in many fields, do not adequately explore the problems related to vision. The first efficient instrument is the VF 14, which is a questionnaire specific to ophthalmic diseases, developed by C. Mangione in 1992. This self-administered questionnaire permits calculation of a 0 to 100 score exploring 5 dimensions (long-sight acuity, near-sight acuity, unclear sight, and driving during the day and at night) during 14 activities with 18 questions. It was translated and adapted into French by Gresset in 1997. Today it is the most commonly used questionnaire in ophthalmology, particularly in the assessment of efficacy and impact in surgery. Along the other specific questionnaires developed, there is the NEI-VQF which was created in 1995 to assess vision and the impact of visual problems on the quality of life of patients, independently of an ophthalmic pathology. Many studies have been conducted on various diseases that affect vision, such as diabetes or hypertension. THE LIMITS OF EXISTING INSTRUMENTS: The specific scales appear far more sensitive and specific than generic scales with regard to ophthalmic problems, but they provide less information on the general status of the patient, except for the NEI-VQF. They are limited in some parameters and do not, unfortunately, take into account the patient's age. No specific scale has been developed for children or adolescents, although the impact of vision on daily life is fundamental. The complexity of vision means that the elaboration of an ideal instrument is difficult. However, in the meantime, it is essential that the practitioners continue to use and to test the instruments available in order to improve with regard to pathologies, or in particular sub-groups of the population.
Keywords: Activities of Daily Living; Adolescent; Adult; Aged; Automobile Driving; Blepharoptosis/su [Surgery]; Cataract; Cataract Extraction; Child; Eye Diseases/px [Psychology]; Eye Diseases/th [Therapy]; *Eye Diseases; Glaucoma; Humans; Middle Aged; Patient Satisfaction; *Quality of Life; *Surveys and Questionnaires; Time Factors; Vision Disorders/px [Psychology]; Vision Disorders/th [Therapy]; *Vision Disorders; Vision, Ocular; Visual Acuity; Visual Fields

Causes of non-compliance with drug regimens in glaucoma patients: a qualitative study. - Taylor, Sarah A; Galbraith, Sharon M; Mills, Richard P (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2002)
The purpose of this study was to gain insights into why patients are not compliant with their glaucoma medications. Patients were recruited from lists provided by two ophthalmologists. Each patient had seen a minimum of two ophthalmologists for their glaucoma, and was taking at least two topical medications for glaucoma. Qualitative methodology was utilized, including two focus groups and eleven in-depth interviews in patients' homes. The results showed that forgetfulness was the number one reported reason for non-compliance. Patients did not claim to be non-compliant specifically because of side effects, but they did complain about them. Communication between physicians and patients is a key factor in compliance for glaucoma patients. Specifically, patients would like their physicians to teach them how to instill their eye drops, tell them about new/alternate medications and procedures as they become available, and offer new ways to make their regimen easier. Patients often do not tell their physician if they experience a side effect unless it is intolerable to them, yet they do realize the seriousness of glaucoma, and the consequences of not following their doctor's orders. Finally, while cost was not a reported deterrence to compliance, some patients would prefer less expensive alternatives.
Keywords: Fees, Pharmaceutical; *Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Humans; Ophthalmic Solutions/ec [Economics]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Education as Topic; Physician-Patient Relations; *Surveys and Questionnaires; *Treatment Refusal

Fluorescein-potentiated argon laser therapy improves symptoms and appearance of corneal neovascularization. - Gordon, Y Jerold; Mann, Rupinder K; Mah, Tammy S; Gorin, Michael B (Cornea, 2002)
PURPOSE: To evaluate patients' self-assessment of their symptoms and cosmetic appearance after fluorescein-potentiated argon laser treatment (FPAL) for corneal inflammation associated with neovascularization. To describe the objective effects of FPAL therapy on established corneal neovascularization with secondary corneal edema and lipid keratopathy., METHODS: Fifteen patients with corneal neovascularization resulting from various infectious and traumatic etiologies were enrolled in an open, nonrandomized pilot study. Treatment consisted of repeated sessions of intravenous fluorescein, a photosensitizer, combined with blue-green argon laser applications to abnormal corneal vessels. Patients completed a written survey to grade their symptoms and cosmetic appearance prior to treatment and at the end of the follow-up period. Objective changes in signs after FPAL treatment were described by two nonmasked ophthalmologists after slit-lamp examinations and review of serial corneal photographs., RESULTS: Clinical symptoms of blurred vision (p <or= 0.003), photophobia (p <or= 0.03), and cosmetic appearance ( p <or= 0.02) were found to be significantly improved by the patient's subjective assessment survey. There was a trend toward pain reduction (p <or= 0.06) but no apparent reduction in tearing or foreign body sensation (p <or= ns). Objective signs of corneal edema, neovascularization, and lipid keratopathy appeared to be reduced after FPAL therapy., CONCLUSION: FPAL therapy for corneal neovascularization, edema, and lipid keratopathy resulted in a significant reduction in symptoms and improved quality of life for 14 of 15 (93%) patients. A controlled clinical trial to confirm the reported improvement in signs observed in this pilot study should be considered.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Contrast Media/ad [Administration & Dosage]; *Corneal Neovascularization/su [Surgery]; Female; *Fluorescein/ad [Administration & Dosage]; Humans; Injections, Intravenous; *Laser Therapy/mt [Methods]; Male; Middle Aged; Patient Satisfaction; Pilot Projects; Surveys and Questionnaires; Treatment Outcome

Molecular imaging of perfusion disturbances in glaucoma. - Golubnitschaja, O; Wunderlich, K; Decker, C; Monkemann, H; Schild, H H; Flammer, J (Amino acids, 2002)
Ocular ischemia resulting from perfusion disturbances may play a major role in initiation of glaucoma. Possibly secondary to ischemia autoimmunogenic events are activated in glaucoma patients with increased prevalence of systemic autoimmune diseases. The determination of potential molecular markers in blood leukocytes could be useful for early noninvasive diagnostics of glaucoma. Our study using subtractive hybridization showed altered gene expression in leukocytes of glaucoma patients in comparison to age and sex matched healthy subjects. Subtracted genes encoding lymphocyte IgE receptor (Fc epsilon RII/CD23), T cell-specific tyrosine kinase, thromboxan A2 receptor, alkaline phosphatase and Na(+)/K(+)-ATPase are differentially expressed in circulating leukocytes of glaucoma patients. These genes show expression profiles characteristic for adherent leukocytes which could be an important contributor to blood-brain barrier breakdown which has been found in glaucoma patients.
Keywords: Adult; Aged; Alkaline Phosphatase/ge [Genetics]; Amino Acid Sequence; Base Sequence; *Blood-Brain Barrier/ph [Physiology]; Blood-Brain Barrier/pp [Physiopathology]; Female; *Gene Expression Profiling; Gene Library; *Glaucoma/pp [Physiopathology]; Humans; Hybridization, Genetic; *Ischemia/me [Metabolism]; Leukocytes/cy [Cytology]; *Leukocytes/ph [Physiology]; Male; Middle Aged; Molecular Sequence Data; Protein-Tyrosine Kinases/ge [Genetics]; Receptors, IgE/ge [Genetics]; Receptors, Thromboxane A2, Prostaglandin H2/ge [Genetics]; Sodium-Potassium-Exchanging ATPase/ge [Genetics]

Polyclonal human antibodies reduce bacterial attachment to soft contact lens and corneal cell surfaces. - Rediske, Andrea M; Koenig, Andrea L; Barekzi, Nazir; Ameen, Linda Cash; Slunt, Jeffrey B; Grainger, David W (Biomaterials, 2002)
Bacterial keratitis due to Pseudomonas aeruginosa is a potentially serious complication of extended-wear contact lens use. Adhesion of P. aeruginosa to soft contact lens materials or corneal endothelial cells in the presence of pooled human immunoglobulins and/or neutrophils in artificial tear fluid was studied in vitro as a potential method to treat contact lens-associated infection. Soft hydrophilic contact lens materials equilibrated in sterile saline were soaked in artificial tear fluid for 18 h prior to use. P. aeruginosa IFO 3455 was added to groups of lenses or confluent cultured bovine corneal endothelial cells with varying amounts of human polyclonal immunoglobulin (IgG) and human blood neutrophils or serum albumin as a control. After 2 or 4 h incubation, adherent viable bacteria on lenses were quantified. Fluorescence microscopy was used to assess bacterial adherence to bovine corneal endothelial cells in the presence and absence of IgG and neutrophils. Various concentrations of albumin had no effect on adhesion. Human immunoglobulin solutions (25 mg/ml) reduced P. aeruginosa adhesion by nearly 1 log and 2 logs after 2 and 4 h incubations, respectively. Neutrophils in combination with 25 mg/ml IgG reduced bacterial adhesion approximately 1 log over reduction in adhesion by neutrophils alone. Diluted human IgG (10 mg/ml) did not significantly decrease bacterial adhesion after 2 or 4 h, but did reduce adhesion in combination with human neutrophils at both time points. Similar reductions in amounts of fluorescently labeled bacteria adhered to cultured monolayers of corneal endothelial cells under these conditions were qualitatively observed.
Keywords: Albumins/pd [Pharmacology]; Animals; *Antibodies/pd [Pharmacology]; *Bacterial Adhesion; Cattle; *Contact Lenses/ae [Adverse Effects]; *Cornea/cy [Cytology]; *Cornea/mi [Microbiology]; Endothelium/cy [Cytology]; Humans; Immunoglobulin G/me [Metabolism]; *Keratitis/mi [Microbiology]; *Keratitis/pc [Prevention & Control]; Neutrophils/me [Metabolism]; Neutrophils/mi [Microbiology]; Ophthalmic Solutions/pd [Pharmacology]; Pseudomonas aeruginosa/py [Pathogenicity]; Time Factors

[Use of brimonidine 0.2% in treatment of glaucoma or ocular hypertony after poorly tolerated beta-blocker treatment]. - Titouamane, S; Baudouin, C (Journal francais d'ophtalmologie, 2002)
This study intended to evaluate the advantages of brimonidine tartrate 0.2% (Alphagan((R))), a selective alpha-2 receptor agonist, relaying a poorly tolerated beta-blocker treatment. Effectiveness, as assessed by intraocular pressure, local and general tolerance of the treatment, and the quality of life of the patients included in the study, was compared for these two eye drops. This multicenter and prospective study, performed by 450 ophthalmologists, included 807 adults presenting with glaucoma or ocular hypertony over 8 months. After a poorly tolerated beta-blocker treatment, which had started at least 6 months before, these patients received brimonidine over 8 weeks. At 3 successive visits, intraocular pressure, biomicroscopic examination results, and visual acuity were recorded. A quality-of-life questionnaire evaluating breathlessness, fatigue, depressive mood, loss of appetite, and satisfaction with the treatment was also given to patients. In the 731 patients observed in the study, the analysis concluded a statistically significant decrease in intraocular pressure (-2.5mmHg) and in the cardiovascular parameters during brimonidine treatment: blood pressure was reduced by 3mmHg and 1.1mmHg for systolic and diastolic pressure, respectively. The heart rate rose by 1.7 beats/min. The quality-of-life questionnaire revealed less breathlessness (-26%), fatigue (-24.9%), depressive mood (-19.3%), and better appetite (+8.2%). The feeling of satisfaction with the brimonidine treatment was significantly improved for 95 patients. However, 12% of all patients stopped their treatment because of adverse effects. Brimonidine improved the glaucomatous patients' quality of life, at least in some areas. Improved intraocular pressure could at least in part result from better compliance with the treatment. Brimonidine is an encouraging alternative after an unsatisfactory beta-blocker treatment.
Keywords: *Adrenergic alpha-Agonists/tu [Therapeutic Use]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Appetite; Brimonidine Tartrate; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; Humans; Intraocular Pressure; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/px [Psychology]; Patient Satisfaction; Quality of Life; *Quinoxalines/tu [Therapeutic Use]; Surveys and Questionnaires; Treatment Failure; Treatment Outcome

Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy. - Agarwal, H C; Sharma, T K; Sihota, R; Gulati, V (Journal of postgraduate medicine, 2002)
CONTEXT: Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome., AIMS: To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C., SETTINGS AND DESIGN: In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy., METHODS AND MATERIAL: Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period., STATISTICAL ANALYSIS USED: Chi square test, paired t test, odds ratio, effect size., RESULTS: Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup., CONCLUSIONS: The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.
Keywords: Adult; Chemotherapy, Adjuvant; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure; Male; Middle Aged; *Mitomycin/ad [Administration & Dosage]; Odds Ratio; Postoperative Complications; Preoperative Care; Probability; Prospective Studies; Risk Factors; *Trabeculectomy/mt [Methods]; Treatment Outcome

Eye health in rural Australia. - Madden, Anna C; Simmons, David; McCarty, Catherine A; Khan, Munir A; Taylor, Hugh R (Clinical & experimental ophthalmology, 2002)
A review of the current literature relating to eye health in rural Australia was conducted. Few studies have been undertaken, with most information provided by the Australian Institute of Health and Welfare databases, The National Trachoma and Eye Health Program of 1980 and the Visual Impairment Project in Victoria in the mid 1990s. Key findings were that the rural population has an increased prevalence of pterygium, cataract, ocular trauma and glaucoma, but no difference in refractive error or diabetic retinopathy (although data are limited). Rural residents are more likely to have seen an optometrist but less likely to have seen an ophthalmologist. Interventions have been undertaken in ophthalmologist training to increase the rural workforce and tele-ophthalmology to provide city-based metropolitan ophthalmological support for rural practitioners. Further epidemiological data and evaluated interventions are urgently required to help identify and address the needs of rural Australian communities.
Comment in (CIN)
Keywords: Australia/ep [Epidemiology]; *Eye Diseases/ep [Epidemiology]; Eye Diseases/th [Therapy]; Health Services Accessibility/sn [Statistics & Numerical Data]; Health Surveys; Humans; National Health Programs/sn [Statistics & Numerical Data]; Ophthalmology/sn [Statistics & Numerical Data]; Optometry/sn [Statistics & Numerical Data]; *Rural Health/sn [Statistics & Numerical Data]; Rural Health Services/sn [Statistics & Numerical Data]; Urban Health/sn [Statistics & Numerical Data]; Workforce

Combined therapy of pilocarpine or latanoprost with timolol versus latanoprost monotherapy. - Diestelhorst, Michael; Nordmann, Jean-Philippe; Toris, Carol B (Survey of ophthalmology, 2002)
Adjunctive intraocular pressure (IOP)-lowering therapy is widely used today, as one-third of all patients being treated for glaucoma need additional therapy to reach and maintain healthy IOPs. Timolol, latanoprost, and pilocarpine are three potent drugs that have been used in combination to reduce IOP. Timolol reduces the production rate of aqueous humor to achieve the IOP decrease. Latanoprost and pilocarpine both affect aqueous outflow, although by different mechanisms. The IOP efficacy of combined therapy with timolol and pilocarpine compared with timolol and latanoprost or with latanoprost alone has been investigated in three multicenter, randomized, clinical trials in Europe. This is a review of those published trials. In 2 of the 3 studies, the additional IOP lowering effect of latanoprost 0.005% administered once daily was compared with pilocarpine 2% administered 3 times daily in patients with primary open-angle glaucoma (POAG) or ocular hypertension currently on monotherapy with timolol 0.5% twice daily. These 6-month studies found that the timolol and latanoprost combination reduced IOP more and was better tolerated with fewer side-effects than the timolol and pilocarpine combination. At 6 months, there was no evidence of long-term drift in IOP with timolol and latanoprost. This combined therapy provides an effective and safe option for lowering IOP in glaucoma patients. These results suggest that the timolol/latanoprost combination is preferable to the timolol/pilocarpine combination not only with regard to side effects but also to the magnitude of IOP reduction. Two of the 3 studies compared latanoprost monotherapy with timolol and pilocarpine combined therapy in patients with POAG, various other glaucomas, or ocular hypertension. Treatment was for 6 weeks or 6 months. In both studies, latanoprost was more effective and better tolerated than the combination of timolol and pilocarpine. These results suggest that latanoprost alone should be tried before the addition of pilocarpine to timolol therapy is considered. The convenience of daily administration of a single drop of latanoprost versus multiple drops of timolol and pilocarpine should improve patient compliance.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Therapy, Combination; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; *Muscarinic Agonists/tu [Therapeutic Use]; Ocular Hypertension/dt [Drug Therapy]; *Pilocarpine/tu [Therapeutic Use]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; *Timolol/tu [Therapeutic Use]

The efficacy and safety of unfixed and fixed combinations of latanoprost and other antiglaucoma medications. - Higginbotham, Eve J; Diestelhorst, M; Pfeiffer, N; Rouland, J F; Alm, A (Survey of ophthalmology, 2002)
Adjunctive therapy for the management of glaucoma is commonly used. Unfixed combinations of the prostaglandin analog latanoprost and other glaucoma medications have been demonstrated to effectively lower intraocular pressure (IOP). The range of reported additional reductions in IOP compared to a monotherapy baseline are as follows: latanoprost-timolol (13-37%), latanoprost-pilocarpine 2% (7-14%), latanoprost and carbonic anhydrase inhibitors (15-24.1%), and latanoprost and dipivefrin (15-28%). There is a fixed combination of latanoprost (0.005%) and timolol (0.5%) that has been investigated in Phase III trials in Europe and the United States. In these trials, it was noted that the efficacy of the fixed combination was superior to either of the monotherapy components. After 12 months of follow-up of patients on fixed combination, there was no evidence of long-term drift. The new formulation appears to be safe and does not demonstrate any more side effects than either of the components. The convenience of a fixed combination may enhance patient compliance. Unfixed combination therapy with latanoprost and other antiglaucoma medications and the fixed combination formulation of latanoprost and timolol provide an effective and safe option for lowering IOP in glaucoma patients.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Drug Therapy, Combination; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Mydriatics/tu [Therapeutic Use]; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/tu [Therapeutic Use]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Safety

Measuring persistency and intraocular pressure-controlled days in patients receiving topical glaucoma medications. - Schwartz, Gail F; Platt, Robert (The American journal of managed care, 2002)
Investigators have developed methods to estimate the number of healthy days or symptom-free days in randomized trials or population-based settings. Such measures can be used in cost-effectiveness studies or disease management surveillance. This paper suggests that the concept can be extended to measure intraocular pressure (IOP)-controlled days in glaucoma by combining data from randomized trials on IOP control (ie, whether a target IOP or percent reduction in IOP was achieved) with data from pharmacy database studies on drug persistency. Patients with lower rates of persistency would be expected to experience fewer IOP-controlled days as they switch therapies or discontinue topical therapy altogether. Evaluating IOP-controlled days according to patients' topical glaucoma therapies could improve population-based disease management compared with the use of simpler measures that consider IOP measurements at a single point in time.
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Randomized Controlled Trials as Topic

Discontinuation rates of topical glaucoma medications in a managed care population. - Shaya, Fadia T; Mullins, C Daniel; Wong, Winston; Cho, Jeannie (The American journal of managed care, 2002)
BACKGROUND: Rates of medication discontinuation reflect factors including effectiveness, tolerability, cost, and dosing frequency. Discontinuation data can be useful to physicians and health plan managers as they compare various glaucoma medications., OBJECTIVE: To compare rates of discontinuation of therapy in patients initially prescribed monotherapy with a topical glaucoma medication., METHODS: Members of a managed care plan who filled at least 1 prescription for latanoprost, timolol, or brimonidine during a 30-month period were eligible to participate in this study. Prescription refill records for all glaucoma agents used in the plan were extracted for the study period. Rates of discontinuation of initial glaucoma therapy were compared using Cox regression methods; Kaplan-Meier survival curves were generated., RESULTS: A total of 72,744 prescriptions were eligible, of which 48491 were for study drugs. Latanoprost was the most frequently dispensed therapy (accounting for 49.7% of study drugs), followed by timolol (30.6%), and brimonidine (19.6%). After inclusion and exclusion criteria were applied, 2283 patients were included in analyses. Latanoprost-treated patients were significantly less likely to discontinue medication than were those treated with timolol or brimonidine. Kaplan-Meier survival curves confirmed that latanoprost-treated patients exhibited the greatest persistency with therapy., CONCLUSION: In this managed care setting, rates of discontinuation in patients initially treated with latanoprost were lower than those of patients receiving comparator drugs.
Keywords: Administration, Topical; Adult; *Antihypertensive Agents/ad [Administration & Dosage]; Brimonidine Tartrate; Chi-Square Distribution; Female; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Proportional Hazards Models; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Quinoxalines/ad [Administration & Dosage]; Retrospective Studies; Survival Analysis; Timolol/ad [Administration & Dosage]

Rates of discontinuation and change of glaucoma therapy in a managed care setting. - Spooner, Joshua J; Bullano, Michael F; Ikeda, Laurence I; Cockerham, Tara R; Waugh, William J; Johnson, Thomas; Mozaffari, Essy (The American journal of managed care, 2002)
BACKGROUND: Comparing discontinuation and change rates of glaucoma pharmacotherapies provides insight as to which agents perform more effectively., OBJECTIVE: To quantify the rates of discontinuation and change of different glaucoma therapies., METHODS: This retrospective, observational study using managed care administrative claims data included patients who were between 20 and 64 years of age and received at least 1 prescription for 1 of the following glaucoma agents as monotherapy: betaxolol, brimonidine, latanoprost, or timolol. Patients receiving any glaucoma medication during the 180 days prior to their index prescription were excluded, as were those who did not have continuous plan enrollment during this period. The primary outcome measures were the discontinuation and change (switching/adding on) of the index glaucoma medication. Rates of discontinuation and change were compared using a proportional hazard model., RESULTS: A total of 1006 patients comprised the final study population. Approximately 62% of patients discontinued their index glaucoma medication, and 18% of patients changed to a different therapy within 18 months of starting therapy. Among those discontinuing therapy, latanoprost patients remained on therapy the longest (mean: 217 days) compared to other study cohorts (range: 182 to 184 days). Compared with latanoprost, patients initiated on any of the other agents were more likely to discontinue or change therapy., CONCLUSIONS: This study indicates that latanoprost therapy results in a lower rate of discontinuation or change compared to patients started on betaxolol, brimonidine, or timolol.
Keywords: Adult; *Antihypertensive Agents/ad [Administration & Dosage]; California; Female; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost; Male; *Managed Care Programs; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Proportional Hazards Models; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Retrospective Studies; Survival Analysis

Population-based persistency rates for topical glaucoma medications measured with pharmacy claims data. - Dasgupta, Samaresh; Oates, Vikki; Bookhart, Brahim K; Vaziri, Baze; Schwartz, Gail F; Mozaffari, Essy (The American journal of managed care, 2002)
BACKGROUND: Persistency with drug therapy reflects a number of factors, including patient tolerability of adverse events resulting from therapy and clinician satisfaction with the medication's effectiveness in reducing intraocular pressure., OBJECTIVE: This study assesses persistency with topical glaucoma medications administered as initial therapy by evaluating rates of discontinuation and change in therapy., METHODS: A retrospective cohort study was conducted using pharmacy claims data from 3 geographically diverse healthcare plans. Newly treated glaucoma patients younger than 65 years of age were selected based on an initial glaucoma medication fill during a 12-month period. Patients were followed for persistency, defined as discontinuation or change (switch or add-on) of initial glaucoma therapy; discontinuation of therapy was also evaluated as a separate end point., RESULTS: In all, 1330 patients (followed for 1126 person-years) met the eligibility criteria. Compared with latanoprost users, patients initiated on other topical monotherapies were more likely to discontinue or change therapy, and patients initiated on other topical monotherapies were more likely than latanoprost users to discontinue therapy., CONCLUSION: Population-based data indicate that latanoprost offers superior persistency compared to agents from other popular classes of topical ocular hypotensives.
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Insurance Claim Review; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Proportional Hazards Models; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Retrospective Studies; Self Administration; Survival Analysis

Host-parasite interactions in Staphylococcus aureus keratitis. - Jett, Bradley D; Gilmore, Michael S (DNA and cell biology, 2002)
Ulcerative keratitis is among the leading ocular bacterial infections, and Streptococcus aureus accounts for approximately 25% of cases in some surveys. Although S. aureus expresses numerous virulence factors, many of which are under the control of staphylococcal global regulatory genes, their pathophysiologic roles in keratitis are largely unknown. Similarly, the nature of the host response during S. aureus keratitis is unclear. Following a review of previously published research on the pathophysiology of S. aureus ocular infection, we present the results of a study designed to assess the host-parasite relationship between S. aureus and human corneal epithelial cells (HCECs) in vitro. In this model system, a wild-type S. aureus strain and its isogenic mutants harboring mutations in agr and sar global regulatory genes or fibronectin-binding proteins A and B (fnbAB) were tested for their ability to bind and invade confluent HCEC monolayers. The contribution of host cell factors was assessed by preincubating HCECs with various inhibitory agents. These studies demonstrated that S. aureus not only adhered to the surface of HCECs but was also internalized, as has been previously observed in other nonocular cell lines. Adherence and invasion of HCECs was saturable at 1 h of incubation in the presence of approximately 10(7) CFU per HCEC monolayer (multiplicity of infection approximately 10). A mutant defective in both agr and sar global regulators was not significantly different in invasive capacity compared to its isogenic wild-type parent strain. In contrast, mutations in fibronectin-binding proteins A and B (fnbAB) reduced the invasiveness of S. aureus by 99% compared to the wild-type strain. Pretreatment of HCECs with colchicine had little effect on S. aureus invasion. In sharp contrast, cytochalasin D and genistein were each capable of inhibiting invasion by >99%. In summary, the results of this study point to fibronectin-binding protein as a key S. aureus surface adhesin facilitating invasion of HCECs in vitro. Furthermore, these results suggest an active mechanism for S. aureus internalization by HCECs, likely involving actin polymerization and tyrosine kinase activity. Additional studies are warranted to determine the applicability of these findings in vivo, and to facilitate the rational design of therapeutic agents aimed at blocking the establishment and progression of S. aureus keratitis.
Keywords: *Adhesins, Bacterial; Bacterial Proteins/ge [Genetics]; Bacterial Proteins/ph [Physiology]; Carrier Proteins/ge [Genetics]; Carrier Proteins/ph [Physiology]; Cell Adhesion; Cells, Cultured; Colchicine/pd [Pharmacology]; *Cornea/mi [Microbiology]; Corneal Ulcer/mi [Microbiology]; *Corneal Ulcer/pp [Physiopathology]; Cytochalasin D/pd [Pharmacology]; Epithelial Cells/mi [Microbiology]; Genistein/pd [Pharmacology]; Humans; Microscopy, Fluorescence; Mutation; Staphylococcal Infections/mi [Microbiology]; *Staphylococcal Infections/pp [Physiopathology]; Staphylococcus aureus/ge [Genetics]; *Staphylococcus aureus/py [Pathogenicity]

Management of traumatic hyphema. - Walton, William; Von Hagen, Stanley; Grigorian, Ruben; Zarbin, Marco (Survey of ophthalmology, 2002)
Hyphema (blood in the anterior chamber) can occur after blunt or lacerating trauma, after intraocular surgery, spontaneously (e.g., in conditions such as rubeosis iridis, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, keratouveitis (e.g., herpes zoster), leukemia, hemophilia, von Willebrand disease, and in association with the use of substances that alter platelet or thrombin function (e.g., ethanol, aspirin, warfarin). The purpose of this review is to consider the management of hyphemas that occur after closed globe trauma. Complications of traumatic hyphema include increased intraocular pressure, peripheral anterior synechiae, optic atrophy, corneal bloodstaining, secondary hemorrhage, and accommodative impairment. The reported incidence of secondary anterior chamber hemorrhage, that is, rebleeding, in the setting of traumatic hyphema ranges from 0% to 38%. The risk of secondary hemorrhage may be higher in African-Americans than in whites. Secondary hemorrhage is generally thought to convey a worse visual prognosis, although the outcome may depend more directly on the size of the hyphema and the severity of associated ocular injuries. Some issues involved in managing a patient with hyphema are: use of various medications (e.g., cycloplegics, systemic or topical steroids, antifibrinolytic agents, analgesics, and antiglaucoma medications); the patient's activity level; use of a patch and shield; outpatient vs. inpatient management; and medical vs. surgical management. Special considerations obtain in managing children, patients with hemoglobin S, and patients with hemophilia. It is important to identify and treat associated ocular injuries, which often accompany traumatic hyphema. We consider each of these management issues and refer to the pertinent literature in formulating the following recommendations. We advise routine use of topical cycloplegics and corticosteroids, systemic antifibrinolytic agents or corticosteroids, and a rigid shield. We recommend activity restriction (quiet ambulation) and interdiction of non-steroidal anti-inflammatory agents. If there is no concern regarding compliance (with medication use or activity restrictions), follow-up, or increased risk for complications (e.g., history of sickle cell disease, hemophilia), outpatient management can be offered. Indications for surgical intervention include the presence of corneal blood staining or dangerously increased intraocular pressure despite maximum tolerated medical therapy, among others.
Comment in (CIN)
Keywords: Adrenal Cortex Hormones/tu [Therapeutic Use]; Ambulatory Care; Anemia, Sickle Cell/co [Complications]; *Anterior Chamber/in [Injuries]; Antifibrinolytic Agents/tu [Therapeutic Use]; Bed Rest; Corneal Diseases/et [Etiology]; Humans; Hyphema/et [Etiology]; Hyphema/su [Surgery]; *Hyphema/th [Therapy]; Meta-Analysis as Topic; Ocular Hypertension/et [Etiology]; Pigmentation Disorders/et [Etiology]; Recurrence; Treatment Outcome; *Wounds, Nonpenetrating/co [Complications]

Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss. - Green, Judith; Siddall, Helen; Murdoch, Ian (Social science & medicine (1982), 2002)
Glaucoma is a major cause of preventable sight loss. As there are no obvious symptoms in the early stages, when it is most beneficial to start treatment, the key to reducing undiagnosed glaucoma in the community is better case finding among those at higher risk. This qualitative study aimed to identify triggers to self-referral for glaucoma symptoms in a sample from Britain, and to explore the meaning of symptoms for people living with moderate to severe glaucoma. Participants (N = 28) reported low levels of awareness of glaucoma prior to their diagnosis, and had assumed that symptoms were the 'normal' deterioration of eyesight expected with other morbidity or advancing age. As symptoms have a gradual onset, participants had learnt to cope with diminishing sight ability. However, many reported that such coping was 'at a cost', and that managing in a world designed for the well sighted caused problems for activities of everyday living, work and family life. The salience of these problems was shaped primarily by social factors, which framed both the practical consequences of sight loss and their meaning for respondents. Findings from this study suggest health promotion is a priority to increase public awareness of the existence and symptoms of glaucoma among those at high risk, and that more attention could be given to reducing the environmental and social causes of disability.
Keywords: Activities of Daily Living; *Adaptation, Psychological; Adult; Aged; Aging/ph [Physiology]; Blindness/eh [Ethnology]; *Blindness/px [Psychology]; Cost of Illness; Decision Making; Female; Glaucoma/co [Complications]; Glaucoma/eh [Ethnology]; *Glaucoma/px [Psychology]; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Male; Middle Aged; Patient Acceptance of Health Care/eh [Ethnology]; *Patient Acceptance of Health Care/px [Psychology]; Referral and Consultation; United Kingdom; Vision Tests/sn [Statistics & Numerical Data]; Vision, Low/di [Diagnosis]; Vision, Low/et [Etiology]; *Vision, Low/px [Psychology]

Delayed-onset mycobacterial keratitis after LASIK. - Fulcher, Samuel F A; Fader, Robert C; Rosa, Robert H Jr; Holmes, Gary P (Cornea, 2002)
PURPOSE: To describe the time course, diagnosis, clinical features, and treatment of seven patients with Mycobacterium szulgai keratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK)., METHODS: Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured. Patient recall identified three additional cases by culture and two cases by clinical features alone. Pulsed-field gel electrophoresis (PFGE) was used to type the isolates, and treatment was modified based on susceptibilities., RESULTS: M. szulgai was identified in five patients for whom cultures were performed, but response to empiric therapy based on cultures proved unsatisfactory. The keratitis resolved in all patients with treatment including clarithromycin based on susceptibilities. Medical therapy was sufficient, although one patient required flap amputation. Six of seven patients recovered best-corrected visual acuity (BCVA), while one patient lost one line of BCVA. Two patients lost one line of postoperative uncorrected visual acuity (UCVA), two patients gained one line of UCVA, and three patients recovered postoperative UCVA. PFGE analysis revealed that the M. szulgai strains were identical, and the infection source was contaminated ice used to chill syringes for saline lavage., CONCLUSIONS: Nontuberculous mycobacterial keratitis after LASIK is a diagnostic and management challenge, but outcomes can be preserved with treatment based on susceptibilities. This cluster underscores the importance of adherence to sterile protocol during LASIK.
Keywords: Adult; Anti-Bacterial Agents/tu [Therapeutic Use]; Azithromycin/tu [Therapeutic Use]; Equipment Contamination; Female; Humans; Keratitis/dt [Drug Therapy]; Keratitis/ep [Epidemiology]; *Keratitis/mi [Microbiology]; *Keratomileusis, Laser In Situ/ae [Adverse Effects]; Keratomileusis, Laser In Situ/is [Instrumentation]; Male; Middle Aged; Mycobacterium Infections, Nontuberculous/dt [Drug Therapy]; Mycobacterium Infections, Nontuberculous/ep [Epidemiology]; *Mycobacterium Infections, Nontuberculous/mi [Microbiology]; *Nontuberculous Mycobacteria/ip [Isolation & Purification]; Postoperative Complications/dt [Drug Therapy]; Postoperative Complications/ep [Epidemiology]; *Postoperative Complications/mi [Microbiology]; Risk Factors; Time Factors

Treatment of IOH and risk of visual complications. - Hayreh, Sohan Singh (Archives of internal medicine, 2002)
Comment on (CON), Comment on (CON)
Keywords: Amaurosis Fugax/ci [Chemically Induced]; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; *Blood Pressure/de [Drug Effects]; Diastole/de [Drug Effects]; Drug Administration Schedule; Glaucoma/ci [Chemically Induced]; Humans; *Hypertension/dt [Drug Therapy]; *Hypertension/et [Etiology]; Hypertension/pp [Physiopathology]; Hypertension/px [Psychology]; *Hypertrophy, Left Ventricular/co [Complications]; Hypertrophy, Left Ventricular/pp [Physiopathology]; Male; Middle Aged; *Office Visits; *Optic Neuropathy, Ischemic/ci [Chemically Induced]; Optic Neuropathy, Ischemic/co [Complications]; Prevalence; Systole/de [Drug Effects]; *Vision Disorders/ci [Chemically Induced]; Vision Disorders/ep [Epidemiology]; Vision Disorders/pp [Physiopathology]

Timolol maleate 0.5% versus timolol maleate in gel forming solution 0.5% (Timolol GFS) in open angle glaucoma in India. Preliminary safety and efficacy study. - Kumar, Harsh; Sudan, Rajeev; Sethi, Harinder S; Sony, Parul (Indian journal of ophthalmology, 2002)
PURPOSE: To compare the efficacy and safety profile of Timolol maleate 0.5% versus Timolol gel forming solution (GFS) 0.5% in open angle glaucoma in Indian eyes., METHODS: In a prospective crossover study 52 patients of open angle glaucoma, well controlled intraocular pressure (IOP) on 0.5% timolol maleate solution were switched over to timolol GFS once a day, after a washout period of one month. A diurnal IOP measurement was done after 6 weeks and compared with patients on timolol maleate 0.5% twice a day. In addition, side effects reported or observed were compared., RESULTS: Statistically significant difference was not observed in ocular hypotensive effect of the two treatment. The side-effects in both the treatment groups were similar except for higher incidence of blurring of vision in patients on timolol GFS. The compliance was better with timolol GFS, but was not statistically significant., CONCLUSION: The results of this study suggest that the more convenient 0.5% timolol in gel forming solution can be offered as an equally efficacious and well-tolerated alternative to twice daily 0.5% timolol solution in open angle glaucoma.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Cross-Over Studies; Female; Gels; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; India; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ophthalmic Solutions; Prospective Studies; Safety; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]

Adherence of two strains of Staphylococcus epidermidis to contact lenses. - Garcia-Saenz, Maria Carmen; Arias-Puente, Alfonso; Fresnadillo-Martinez, Maria Jose; Paredes-Garcia, Beatriz (Cornea, 2002)
PURPOSE: To compare the adherence of biofilm-producer and nonbiofilm-producer Staphylococcus epidermidis in vitro to different soft contact lenses (CLs) to study its possible contribution to the pathogenesis of keratitis., METHODS: Strains of S. epidermidis slime-positive ATCC 35984 (biofilm-producer) and slime-negative ATCC 12228 (nonbiofilm-producer) were used with eight types of soft CLs from the four groups determined by the United States Food and Drug Administration (FDA), according to the ionicity and water content. The lenses were incubated overnight with the bacteria, then sonicated and vortexed to separate the adhered bacteria. Quantitative cultures were performed and the results statistically analyzed., RESULTS: Slime-negative strains of S. epidermidis were able to adhere to all CLs but at a lower level than slime-positive strains. There were significant differences in bacterial attachment among the four FDA groups. On the whole, there was higher bacterial adhesion to nonionic and low-water content materials. Contact lenses produced by soft molding were less adherent than CLs produced by either lathe-cutting or spin-casting., CONCLUSIONS: Bacterial biofilm favors bacterial adhesiveness and colonization of soft CLs. Bacterial attachment was less in soft molding CLs (etafilcon A), which provide a more homogeneous and smoother surface.
Keywords: *Bacterial Adhesion/ph [Physiology]; Bacterial Typing Techniques; Biofilms; Colony Count, Microbial; *Contact Lenses, Hydrophilic/mi [Microbiology]; In Vitro Techniques; *Staphylococcus epidermidis/ph [Physiology]

Brimonidine .2% as a replacement for beta blockers in geriatric patients with glaucoma. - Noecker, Robert J; Study Group for the Efficacy of Brimonidine in Geriatric Patients (Advances in therapy, 2002)
This 3-month multicenter, open-label study of 89 geriatric patients with glaucoma evaluated the substitution of brimonidine twice daily for topical beta blockers that had been used for at least 6 months. The primary outcome measures were reduction in intraocular pressure (IOP) from baseline at 2 hours postdose, change in cardiac and respiratory function, quality of life, and patient satisfaction. Patients were queried about adverse events at each visit and completed a quality-of-life questionnaire at the final evaluation. In this cohort with a mean age of 75.4 years, the average duration of topical beta-blocker therapy was 5 years. Brimonidine twice daily produced an additional mean reduction in IOP of 8.2% (1.4 mm Hg; P<.001). Eighty-eight percent of patients (60/68) reported being at least as satisfied with brimonidine as with their previous beta-blocker regimen, and 46% (31/68) reported greater satisfaction with brimonidine. Additionally, 40% of patients (27/68) noted increased energy after the switch, and 43% (29/68) described brimonidine as more soothing than topical beta blockers. In this elderly population, the replacement of topical beta blockers with brimonidine twice daily significantly decreased IOP, improved quality of life, and enhanced patient satisfaction.
Keywords: Adrenergic alpha-Agonists/ad [Administration & Dosage]; *Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Satisfaction; Quality of Life; Quinoxalines/ad [Administration & Dosage]; *Quinoxalines/tu [Therapeutic Use]; Time Factors

The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. - Kass, Michael A; Heuer, Dale K; Higginbotham, Eve J; Johnson, Chris A; Keltner, John L; Miller, J Philip; Parrish, Richard K 2nd; Wilson, M Roy; Gordon, Mae O (Archives of ophthalmology (Chicago, Ill. : 1960), 2002)
BACKGROUND: Primary open-angle glaucoma (POAG) is one of the leading causes of blindness in the United States and worldwide. Three to 6 million people in the United States are at increased risk for developing POAG because of elevated intraocular pressure (IOP), or ocular hypertension. There is no consensus on the efficacy of medical treatment in delaying or preventing the onset of POAG in individuals with elevated IOP. Therefore, we designed a randomized clinical trial, the Ocular Hypertension Treatment Study., OBJECTIVE: To determine the safety and efficacy of topical ocular hypotensive medication in delaying or preventing the onset of POAG., METHODS: A total of 1636 participants with no evidence of glaucomatous damage, aged 40 to 80 years, and with an IOP between 24 mm Hg and 32 mm Hg in one eye and between 21 mm Hg and 32 mm Hg in the other eye were randomized to either observation or treatment with commercially available topical ocular hypotensive medication. The goal in the medication group was to reduce the IOP by 20% or more and to reach an IOP of 24 mm Hg or less., MAIN OUTCOME MEASURES: The primary outcome was the development of reproducible visual field abnormality or reproducible optic disc deterioration attributed to POAG. Abnormalities were determined by masked certified readers at the reading centers, and attribution to POAG was decided by the masked Endpoint Committee., RESULTS: During the course of the study, the mean +/- SD reduction in IOP in the medication group was 22.5% +/- 9.9%. The IOP declined by 4.0% +/- 11.6% in the observation group. At 60 months, the cumulative probability of developing POAG was 4.4% in the medication group and 9.5% in the observation group (hazard ratio, 0.40; 95% confidence interval, 0.27-0.59; P<.0001). There was little evidence of increased systemic or ocular risk associated with ocular hypotensive medication., CONCLUSIONS: Topical ocular hypotensive medication was effective in delaying or preventing the onset of POAG in individuals with elevated IOP. Although this does not imply that all patients with borderline or elevated IOP should receive medication, clinicians should consider initiating treatment for individuals with ocular hypertension who are at moderate or high risk for developing POAG.
Comment in (CIN), Comment in (CIN)
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Double-Blind Method; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/pc [Prevention & Control]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/pc [Prevention & Control]; Ophthalmic Solutions; Optic Disk/pa [Pathology]; Patient Compliance; Safety; Treatment Outcome; Visual Acuity; Visual Fields

Comparison of Goldmann applanation tonometry with the Tonopen for measuring intraocular pressure in a population-based glaucoma survey in rural West Bengal. - Bandyopadhyay, Manas; Raychaudhuri, Amitabha; Lahiri, Saibendu K; Schwartz, Ellen C; Myatt, Mark; Johnson, Gordon J (Ophthalmic epidemiology, 2002)
AIM: This study was undertaken to compare the measurement of intraocular pressure (IOP) in a population-based glaucoma survey by the Goldmann Applanation Tonometer (GAT) and the Tonopen with respect to IOP readings, the time required to measure IOP and subjects' preference for the two instruments. The purpose of the study was to see which of the two instruments could be more suitable in a rural survey, particularly house-to-house, in trying to find cases of advanced glaucoma., METHOD: The study was conducted on a total of 203 subjects as a part of a population-based glaucoma survey. The IOP of one randomly selected eye of each subject was measured, first with the GAT and subsequently with the Tonopen. The time taken for each procedure was noted and subjects' preference was ascertained., RESULTS: The mean of the paired differences between the readings of the two instruments (Tonopen minus GAT) was 1 mm Hg with a standard deviation of 2.28. The Tonopen readings were within +/-3 mm Hg of the GAT readings in 86.2% of eyes. In 7.4% of the eyes the paired differences were > or =+/-5 mm Hg. Measurement of IOP by the Tonopen was much quicker, the mean time difference being 38.7 sec. Subjects' preference for the Tonopen was higher., CONCLUSION: The overall agreement between the measurements of the two instruments was good but a small percentage of large difference (> or = +/-5 mm Hg in 7.4%) may be of concern in a population-based survey. The time to measure IOP and the subjects' preference were strongly in favour of the Tonopen.
Keywords: Aged; Aged, 80 and over; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; Humans; India/ep [Epidemiology]; *Intraocular Pressure; Male; Middle Aged; Patient Satisfaction; Random Allocation; Reproducibility of Results; *Rural Population/sn [Statistics & Numerical Data]; Time Factors; Tonometry, Ocular/is [Instrumentation]; *Tonometry, Ocular/mt [Methods]

A study of patients attending for eye surgery at a rural hospital in the Republic of Benin. - Potter, Andrew R (Tropical doctor, 2002)
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Benin/ep [Epidemiology]; Cataract/pc [Prevention & Control]; Child; Child, Preschool; Eye Diseases/ec [Economics]; *Eye Diseases/pc [Prevention & Control]; *Eye Diseases/su [Surgery]; Female; Glaucoma, Open-Angle/pc [Prevention & Control]; Hospitals, Rural/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; *Office Visits/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Patient Satisfaction; Surveys and Questionnaires; Workload/sn [Statistics & Numerical Data]

[Topical Fk506 in inflammatory corneal and conjunctival diseases. A pilot study]. - Reinhard, Thomas; Reis, Alexander; Mayweg, Susanne; Oberhuber, Hermann; Mathis, Georg; Sundmacher, Rainer (Klinische Monatsblatter fur Augenheilkunde, 2002)
BACKGROUND: Topical corticosteroids are the only effective measure in serious inflammatory corneal and conjunctival diseases. Although results obtained with topical cyclosporin A are encuraging it is not effective in all patients. The mode of action of Fk506 is similar to that of cyclosporin A, i.e. it exerts an inhibitory effect on transcription of interleukin 2 in T lymphocytes. The immunosuppressive potential of Fk506, however, is much larger. Furthermore, it penetrates more easily into cornea and conjunctiva. To find out whether the theoretical advantages of topical Fk506 can be translated into clinical practice, a selected group of patients refractory to conventional therapy was treated in this pilot study., PATIENTS AND METHODS: Fk506 0.06 % was administered initially three times daily in 15 patients with atopic blepharokeratoconjunctivitis, Mooren's ulcer, ocular pemphigoid, Thygeson's superficial punctate keratitis, nummular adenoviral keratitis, graft-versus-host reaction of the conjunctiva and steroid response glaucoma after penetrating keratoplasty., RESULTS: Within a follow-up of 26 +/- 15 weeks improvement was recorded in 5/15 patients and stabilization in 5/15 patients. In two patients progression of the disease was noted (one patient with progression of ocular pemphigoid, another patient with suspected automutilation). Premature withdrawal the drug was judged to be necessary in two patients with ocular surface disorders and in one patient with non-compliance., CONCLUSIONS: Topical Fk506 seems to be a promising new immunosuppressive drug for patients with atopic blepharokeratoconjunctivitis, Thygeson's superficial punctate keratitis and nummular adenoviral keratitis. Exact efficacy in these and other corneal and conjunctival inflammatory diseases has to be determined in randomised clinical studies. Before these studies may start the risk of side-effects must be reduced via an improvement of the drops.
Keywords: Adult; Aged; Aged, 80 and over; Conjunctivitis/di [Diagnosis]; *Conjunctivitis/et [Etiology]; Female; Follow-Up Studies; Humans; *Immunosuppressive Agents/ad [Administration & Dosage]; Immunosuppressive Agents/ae [Adverse Effects]; Interleukin-2/ai [Antagonists & Inhibitors]; Keratitis/di [Diagnosis]; *Keratitis/dt [Drug Therapy]; Keratitis/et [Etiology]; Male; Middle Aged; Ophthalmic Solutions; Pilot Projects; *Tacrolimus/ad [Administration & Dosage]; Tacrolimus/ae [Adverse Effects]; Treatment Outcome

Glaucoma in the developing world. - Murdoch, Ian (Tropical doctor, 2002)
Comment on (CON)
Keywords: Africa; Developing Countries; *Glaucoma/pc [Prevention & Control]; Humans; *Patient Acceptance of Health Care; *Preventive Health Services/og [Organization & Administration]; Preventive Health Services/sn [Statistics & Numerical Data]

Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics. - Rodriguez, Jorge; Sanchez, Rosario; Munoz, Beatriz; West, Sheila K; Broman, Aimee; Snyder, Robert W; Klein, Ronald; Quigley, Harry (Ophthalmology, 2002)
OBJECTIVE: To describe the causes of blindness and visual impairment in a population-based sample of Hispanics., DESIGN: A cross-sectional study., PARTICIPANTS: A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research)., TESTING: Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes., MAIN OUTCOME MEASURES: Causes of visual loss (best-corrected acuity worse than 20/40)., RESULTS: The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant., CONCLUSIONS: Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Arizona/ep [Epidemiology]; *Blindness/eh [Ethnology]; *Blindness/et [Etiology]; Cataract/co [Complications]; Cataract/eh [Ethnology]; Diabetic Retinopathy/co [Complications]; Diabetic Retinopathy/eh [Ethnology]; Female; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/eh [Ethnology]; *Hispanic Americans; Humans; Macular Degeneration/co [Complications]; Macular Degeneration/eh [Ethnology]; Male; Middle Aged; Prevalence; Sex Distribution; *Vision Disorders/eh [Ethnology]; *Vision Disorders/et [Etiology]; Vision Tests; Visual Acuity

Case reports of three atypical infiltrative keratitis events with high DK soft contact lens wear. - Skotnitsky, Cheryl; Jalbert, Isabelle; O'Hare, Nicole; Sweeney, Deborah F; Holden, Brien A (Cornea, 2002)
PURPOSE: We report three atypical infiltrative keratitis events in patients that had successfully worn highly oxygen permeable (Dk) soft contact lenses on an extended wear (EW) schedule for at least 15 months. These cases highlight the role of patient/practitioner education, patient compliance, examination, and appropriate referrals that are required to reduce the risk of complications during lens wear., METHODS AND RESULTS: Each patient had been wearing high Dk soft lenses on an EW schedule with monthly replacement for at least 15 months and presented with severe pain, redness, and photophobia. The events were characterized by focal infiltrate(s) with an overlying epithelial defect in the superior periphery to mid-periphery of the cornea and extensive diffuse infiltration., CONCLUSIONS: The signs and symptoms of each case were more severe than is typically associated with contact lens-related infiltrative keratitis. Because of the slow progression of signs and relatively fast resolution, the cases were not found to be microbial keratitis. Although high Dk soft contact lenses overcome hypoxia-associated complications associated with extended wear, patients and practitioners must be vigilant as adverse events can still occur and in rare instances can be severe. Education and patient compliance are a crucial part of successful management of patients on EW schedules. Constant reinforcement is necessary to ensure patient compliance.
Keywords: Adult; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Epithelium, Corneal/pa [Pathology]; Female; Humans; *Keratitis/et [Etiology]; Keratitis/pa [Pathology]; Oxygen/me [Metabolism]; Silicone Elastomers

Twelve-month evaluation of brimonidine-purite versus brimonidine in patients with glaucoma or ocular hypertension. - Katz, L Jay (Journal of glaucoma, 2002)
PURPOSE: To compare the efficacy and safety of brimonidine-Purite (Alphagan; Allergan, Irvine, CA) 0.15% and 0.2% three times daily with brimonidine (Alphagan) 0.2% three times daily in patients with glaucoma or ocular hypertension., PATIENTS AND METHODS: In this 12-month, randomized, multicenter, double-masked, parallel-group study, patients were randomly assigned to receive brimonidine-Purite 0.15% (n = 381), brimonidine-Purite 0.2% (n = 383), or brimonidine 0.2% (n = 383) three times daily. Visits were conducted before the study, at baseline, at weeks 2 and 6, and at months 3, 6, 9, and 12. Diurnal intraocular pressure was measured at 8 am, 10 am, 3 pm, and 5 pm at baseline, week 6, and at months 3, 6, and 12. Intraocular pressure was also measured at 8 and 10 am at week 2 and month 9. Safety was evaluated by adverse events and other ocular and systemic measures., RESULTS: At baseline, mean intraocular pressure was similar in the three treatment groups. During follow-up, there were no statistically significant among-group differences in mean intraocular pressure or mean changes from baseline intraocular pressure (at peak or trough). The difference in mean intraocular pressure between the brimonidine-Purite-0.15% and brimonidine-0.2% treatment group was less than 1 mm Hg at all time points. The relative percent difference in allergic conjunctivitis was 41% lower in the brimonidine-Purite 0.15% group compared with the brimonidine 0.2% group. The comfort and satisfaction rating significantly favored brimonidine-Purite 0.15%., CONCLUSIONS: Over 12-months, brimonidine-Purite 0.15% and 0.2% provided intraocular pressure lowering comparable with brimonidine 0.2% in patients with glaucoma or ocular hypertension. Brimonidine-Purite 0.15% showed the most favorable safety and tolerability profile with a reduced incidence of allergic conjunctivitis and better satisfaction and comfort rating.
Keywords: Adrenergic alpha-Agonists/ad [Administration & Dosage]; *Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Conjunctivitis, Allergic/pc [Prevention & Control]; Double-Blind Method; Drug Evaluation; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Patient Satisfaction; Preservatives, Pharmaceutical; Quality of Life; Quinoxalines/ad [Administration & Dosage]; *Quinoxalines/tu [Therapeutic Use]; Safety

Progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate (0.02%). - Murthy, Shashidhar; Hawksworth, Nick R; Cree, Ian (Cornea, 2002)
PURPOSE: To report a case of progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate 0.02%., METHODS: A 45-year-old woman was treated for presumed Acanthamoeba keratitis with chlorhexidine gluconate 0.02% and propamidine 0.1% eyedrops., RESULTS: After using the chlorhexidine and propamidine eyedrops for 8 weeks, the patient developed a near total loss of the corneal epithelium and a progressive ulcerative keratitis, which eventually required penetrating keratoplasty. Histopathologic examination of the corneal button showed ulceration and loss of Bowman's membrane, massive loss of keratocytes with apparent apoptosis, and loss of the endothelial cells with inflammatory cells adherent to the remaining cells. These histopathologic findings are similar to those seen in Hibiclens keratopathy. Hibiclens contains chlorhexidine 4% with a detergent. No organisms were seen in sections stained with modified Ziehl-Neelsen, gram, Grocott, or periodic acid-Schiff, and immunohistochemistry showed no significant findings., CONCLUSION: We think that the topical use of chlorhexidine gluconate 0.02% may have resulted in a progressive ulcerative keratitis in our patient.
Keywords: Administration, Topical; Anti-Infective Agents, Local/ad [Administration & Dosage]; *Anti-Infective Agents, Local/ae [Adverse Effects]; Chlorhexidine/ad [Administration & Dosage]; *Chlorhexidine/ae [Adverse Effects]; *Chlorhexidine/aa [Analogs & Derivatives]; *Cornea/de [Drug Effects]; Cornea/pa [Pathology]; Cornea/su [Surgery]; *Corneal Ulcer/ci [Chemically Induced]; Corneal Ulcer/pa [Pathology]; Corneal Ulcer/su [Surgery]; Female; Humans; Keratoplasty, Penetrating; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]

Community screening for eye disease by laypersons: the Hoffberger program. - Quigley, Harry A; Park, Chan Kee; Tracey, Patricia A; Pollack, Irvin P (American journal of ophthalmology, 2002)
PURPOSE: To describe the results of a community-based eye screening program in Baltimore., DESIGN: Cross-sectional study., METHODS: This was a retrospective study of the results of screening both eyes of 5352 persons who presented at multiple community sites. The screening examination had eight risk factor questions, visual acuity measurement, and a screening field test and was carried out by technicians and lay volunteers. Screened persons (screenees) received a definitive eye examination at no out-of-pocket cost, transportation was offered, and inexpensive eyeglasses were provided if needed. The main outcome measures were the rate of appointment keeping and the eye diseases identified. Telephone interviews were used to assess reasons for missing appointments and satisfaction with visits., RESULTS: Screenees had a median age of 45 years, were 71% black, 59% female, and had estimated median annual family income of 24,000 dollars. Among 1331 screenees who scheduled a definitive examination appointment, 552 (41%) completed the visit. Data on definitive diagnosis was available in 480 out of 552 persons (87%). Reasons given for failing to come for definitive examination were: no appointment given (26%), forgot (20%), lack of transportation (9%), and lack of insurance coverage (6%). Of those who accepted a second visit date after defaulting, only 25% (41/167) appeared. Of 17 persons identified with glaucoma at screening, 4 had previously been diagnosed, but had ceased active care., CONCLUSION: After community screening for eye disease, efforts to provide definitive ophthalmic examination were only modestly effective. Failure of screenees to come for examination and loss to follow up were identified as serious problems.
Keywords: Aged; Baltimore/ep [Epidemiology]; Community Health Services; Cross-Sectional Studies; *Eye Diseases/di [Diagnosis]; Eye Diseases/ep [Epidemiology]; Female; Health Personnel; Health Promotion; Health Services Research; Humans; Male; Mass Screening; Middle Aged; Patient Dropouts; Retrospective Studies; Risk Factors; Social Class; Surveys and Questionnaires; *Vision Screening/mt [Methods]; Visual Acuity; Volunteers

Surgical management of epiretinal membrane in young patients. - Benhamou, Nathanael; Massin, Pascale; Spolaore, R; Paques, Michel; Gaudric, Alain (American journal of ophthalmology, 2002)
PURPOSE: To report the outcome of epiretinal membrane (ERM) surgery in young patients., DESIGN: Interventional case series study., METHOD: A retrospective review of 20 young patients who had undergone vitrectomy and epiretinal membrane removal. All patients had a preoperative examination, including fundus biomicroscopy, red free photographs, and fluorescein angiography., RESULTS: Nine patients were males and 11 females (age: 7-26 years; mean: 16.3 years). Follow up ranged from 4-96 months (mean: 21.2 months). The 20 patients comprised 13 cases of idiopathic ERM, six cases in which ERM was associated with ocular inflammation and one case of combined hamartoma of the retina and retinal pigment epithelium (RPE). In 13 cases, the ERM was especially white, thick, and opaque, with localized constriction and severe retinal distortion. Final best-corrected visual acuity (VA) was significantly better than preoperatively (20/50 vs. 20/112), (P = 0.0002). Mean improvement in VA was 4.25 lines and 17 patients gained two or more lines. This improvement was better in secondary than idiopathic ERM (6 lines vs. 3.3). During follow up, five cases of recurrence were observed (25%). In another case, postoperative persistent ocular hypertension required filtering surgery., CONCLUSION: The characteristics of ERM in young patients are quite different in many cases from those in adults in terms of thickness and adherence. Removal of ERM in young patients is feasible and safe although the membrane may focally adhere strongly to retinal vessels. VA usually improves significantly after surgery, but recurrences are more frequent than in adults.
Keywords: Adolescent; Adult; Child; Epiretinal Membrane/pa [Pathology]; *Epiretinal Membrane/su [Surgery]; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Male; Postoperative Complications; Recurrence; Retrospective Studies; Safety; Treatment Outcome; Visual Acuity; *Vitrectomy

New and established topical corticosteroids in dermatology: clinical pharmacology and therapeutic use. - Brazzini, Benedetta; Pimpinelli, Nicola (American journal of clinical dermatology, 2002)
Currently, topical glucocorticosteroids are the most frequently used drugs in dermatologic practice. Over the years, research has focused on strategies to optimize potency and, in particular, the anti-inflammatory and immunosuppressive capacity of these drugs, while minimizing adverse effects. However, 'ideal' topical corticosteroids have not yet been synthesized. They should be able to permeate the stratum corneum and reach adequate concentrations in the skin without reaching high serum concentrations. Such characteristics can be obtained by increasing the natural lipophilicity of corticosteroids, e.g. by esterification. In the past, many structural modifications have been made to improve the efficacy of topical corticosteroids to produce drugs with greater potency, although this has often been associated with a higher likelihood of adverse effects. Betamethasone dipropionate and clobetasol propionate, known as fifth-generation corticosteroids, are a typical example of potent molecules that can control specific dermatoses very rapidly, but which are associated with a high risk of topical and systemic adverse effects. Recently, steroid components have been synthesized that aim to have adequate anti-inflammatory effects and minimal adverse effects. The newest topical corticosteroids used for the treatment of different dermatoses and allergic reactions of the respiratory tract (in particular asthma) are budesonide, mometasone furoate, prednicarbate, the di-esters 17,21-hydrocortisone aceponate and hydrocortisone-17-butyrate-21-propionate, methylprednisolone aceponate, alclometasone dipropionate, and carbothioates such as fluticasone propionate. These new topical corticosteroids are evaluated in the current review, which compares the risk/benefit ratio of each molecule with established agents. The new molecules, compared with the well known and established corticosteroids, generally have a higher anti-inflammatory effect, good compliance among patients (only a once-daily application is needed), rarely induce cross-sensitivity reactions and have weak atrophogenicity.
Keywords: Administration, Topical; Anti-Inflammatory Agents/ae [Adverse Effects]; *Anti-Inflammatory Agents/pd [Pharmacology]; Anti-Inflammatory Agents/tu [Therapeutic Use]; Budesonide/tu [Therapeutic Use]; Drug Compounding; Glaucoma/et [Etiology]; Humans; Hydrocortisone/tu [Therapeutic Use]; Hypertrichosis/et [Etiology]; Risk Assessment; Rosacea/et [Etiology]; *Skin Diseases/dt [Drug Therapy]

An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. - Edelsten, Clive; Lee, Vickie; Bentley, Christopher R; Kanski, Jack J; Graham, Elizabeth M (The British journal of ophthalmology, 2002)
BACKGROUND/AIMS: The clinical course for childhood chronic anterior uveitis can vary from mild, self limiting disease to bilateral blindness. The purpose of this study was to identify those risk factors at onset that predict disease severity., METHODS: A retrospective case note review of all patients with painless anterior uveitis diagnosed from 1982 to 1998. Patients were divided into two cohorts based on route of referral, diagnosis, and compliance with treatment. The standard cohort consisted of only those diagnosed from routine screening of juvenile idiopathic arthritis., RESULTS: Complications-cataract surgery, ocular hypertension treatment, and visual acuity <6/24. Remission: inactive uveitis on no topical treatment for >6 months. Results -163 patients were included. 34 patients (21%) developed at least one complication. The most significant predictor of complications was severe disease at onset (p = 0.001). Other factors included uveitis at the first examination (p = 0.034), membership of the non-standard cohort (p = 0.0001), non-oligoarticular disease (p = 0.02), and late onset arthritis (p = 0.024). Male sex was associated with increased complications in the standard cohort (p = 0.001). Factors predisposing to remission included membership of the standard cohort (p = 0.003), onset after 1990 (p = 0.016), white race (p = 0.015), mild disease onset (p = 0.003), and a long gap between arthritis and uveitis onset (p = 0.015)., CONCLUSIONS: It is possible to characterise the severity of those with childhood chronic anterior uveitis at the onset of disease. The majority of patients remit without visually disabling complications. It may be possible to reduce the complication rate by targeting aggressive immunosuppression on high risk patients before complications develop.
Comment in (CIN)
Keywords: Adolescent; Age of Onset; *Arthritis, Juvenile/co [Complications]; Blindness/et [Etiology]; Child; Child, Preschool; Chronic Disease; Cohort Studies; Disease-Free Survival; Female; Follow-Up Studies; Humans; Infant; Male; Remission Induction; Retrospective Studies; Risk Factors; Sex Factors; Tissue Adhesions/et [Etiology]; Uveitis, Anterior/dt [Drug Therapy]; *Uveitis, Anterior/et [Etiology]

Utilisation of eye care services by urban and rural Australians. - Keeffe, Jill E; Weih, LeAnn M; McCarty, Cathy A; Taylor, Hugh R (The British journal of ophthalmology, 2002)
AIM: To investigate factors related to the use of eye care services in Australia., METHODS: Health, eye care service use, and sociodemographic data were collected in a structured interview of participants in a population based study. All participants had a standard eye examination., RESULTS: Men (OR 1.3 CL 1.02, 1.7), those who spoke Greek (OR 2.1 CL 1.1, 3.8) or Italian (OR 1.9 CL 1.0, 3.3), and those without private health insurance (OR 1.59 CL 1.22, 2.04) were more likely to have not used eye care services. Ophthalmology services were utilised at lower rates in rural areas (OR 0.14 CL 0.09, 0.2). Approximately 40% of participants with undercorrected refractive error, cataract, and undiagnosed glaucoma had seen either an ophthalmologist, optometrist, or both within the last year., CONCLUSION: Despite the similarity in prevalence of eye disease in urban and rural areas, significant differences exist in the utilisation of eye care services. Sex, private health insurance, urban residence, and the ability to converse in English were significant factors associated with eye healthcare service use. Many participants had undiagnosed eye disease despite having seen an eye care provider in the last year.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Ethnic Groups/sn [Statistics & Numerical Data]; Eye Diseases/ep [Epidemiology]; *Eye Diseases/th [Therapy]; Female; Humans; Insurance, Health/sn [Statistics & Numerical Data]; Male; Middle Aged; Ophthalmology/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Prevalence; Regression Analysis; Rural Health/sn [Statistics & Numerical Data]; *Rural Health Services/sn [Statistics & Numerical Data]; Time Factors; Urban Health/sn [Statistics & Numerical Data]; *Urban Health Services/sn [Statistics & Numerical Data]; Victoria/ep [Epidemiology]

Primary drug treatment for glaucoma: beta-blockers versus other medications. - Stamper, Robert L; Wigginton, Stephen A; Higginbotham, Eve J (Survey of ophthalmology, 2002)
This set of Viewpoints articles examines the merits of beta-blockers versus other medications as the primary drug treatment for glaucoma. Ophthalmologists must balance issues such as efficacy, compliance, cost, and side effects when deciding on the appropriate medication to prescribe. Dr. Stamper stresses the advantages of tailoring the choice of medication to the needs of the individual patient. Drs. Wigginton and Higginbotham review the benefits of beta-blockers and present some of the disadvantages of the non-beta-blocker class of medications.
Keywords: Adrenergic alpha-Agonists/ae [Adverse Effects]; Adrenergic alpha-Agonists/ec [Economics]; Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/ec [Economics]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/ec [Economics]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Costs; *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; Prostaglandins/ae [Adverse Effects]; Prostaglandins/ec [Economics]; Prostaglandins/tu [Therapeutic Use]

Effect of Honan balloon compression on peribulbar anesthesia adequacy in cataract surgery. - Ling, Roland; Beigi, Bijan; Quinn, Anthony; Jacob, John (Journal of cataract and refractive surgery, 2002)
PURPOSE: To ascertain whether a Honan balloon is necessary to produce effective peribulbar anesthesia in routine cataract surgery by evaluating its effect on intraocular pressure (IOP), surgeon assessment of the anesthesia's effectiveness, and patients' analgesic experience., SETTING: West of England Eye Unit, Royal Devon and Exeter Hospital, England., METHOD: Fifty eyes of 50 patients having routine phacoemulsification cataract extraction and intraocular lens implantation were randomized to have 10-minute ocular compression with the Honan balloon or no compression after peribulbar anesthesia. A single investigator gave all the peribulbar injections using a standard technique. The IOP was measured immediately before and 10 minutes after the injections. Two surgeons who were blinded to the randomization process performed the surgeries and completed an assessment questionnaire on various aspects of the peribulbar block. The patients also scored their level of analgesia during surgery., RESULTS: In the 26 patients who had Honan balloon compression, there was a significant reduction in IOP (mean 6.2 mm Hg; P <.05). In the 24 patients with no balloon compression, there were no significant changes in IOP 10 minutes after the peribulbar injections. There was no statistically significant difference in the surgeons' scores in any aspect of the peribulbar anesthesia (P >.05). All patients experienced a good level of analgesia., CONCLUSIONS: There was a significant reduction in IOP after Honan balloon ocular compression. However, there was no significant increase in IOP without balloon compression. The use of a Honan balloon did not appear to make a significant difference in the effectiveness of the peribulbar anesthesia to the surgeons or patients.
Keywords: Aged; *Anesthesia, Local/mt [Methods]; Anesthetics, Combined/ad [Administration & Dosage]; *Catheterization; Double-Blind Method; Female; Humans; Injections; *Intraocular Pressure; Lens Implantation, Intraocular; Male; Ocular Hypertension/pc [Prevention & Control]; Orbit; Pain Measurement; Patient Satisfaction; *Phacoemulsification; Prospective Studies

Profile of glaucoma in a major eye hospital in north India. - Das, J; Bhomaj, S; Chaudhuri, Z; Sharma, P; Negi, A; Dasgupta, A (Indian journal of ophthalmology, 2001)
PURPOSE: To study the clinical profile and distribution of various subtypes of glaucoma in a referral practice in North India., METHOD: A retrospective analysis was done of 2425 patients who attended the glaucoma clinic in a tertiary eye-care centre for five years from January 1995 to December 1999. A detailed history was obtained and a thorough examination was performed, including gonioscopy, disc assessment, applanation tonometry and automated perimetry. Diurnal variation of IOP and provocative tests for glaucoma were done where applicable., RESULT: Primary angle closure glaucoma (PACG) was the most common glaucoma subtype. The primary open angle glaucoma (POAG) to the PACG ratio was 37:63. Chronic angle closure glaucoma (CACG) was the most common PACG subtype. The majority of CACG cases were relatively asymptomatic. Male dominance was seen for POAG, juvenile open angle glaucoma (JOAG), CACG, normal tension glaucoma (NTG) and secondary glaucomas. Female dominance was seen for ocular hypertension (OHT), acute or intermittent ACG and developmental glaucomas. The mean age in years at presentation was POAG:60.54 years (males 61.54 years, females 59.01 years) and PACG: 55.13 years (males 57.25 years, females 53.60). The three common secondary glaucomas were: glaucoma secondary to adherent leucoma, aphakic and pseudophakic glaucomas and traumatic glaucomas. Advanced glaucoma was detected in 42 to 53% of patients and bilateral blindness in 8 to 14% of patients in various subtypes., CONCLUSION: Compared to Caucasians, glaucoma patients in North India seem to present nearly a decade earlier and the disease is more advanced at presentation. While PACG is the most commonly encountered glaucoma, NTG and exfoliative glaucoma are relatively rare.
Keywords: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; Gonioscopy; *Hospitals, Special/sn [Statistics & Numerical Data]; Humans; India/ep [Epidemiology]; Infant; Infant, Newborn; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmology; Retrospective Studies; Sex Distribution; Tonometry, Ocular; Visual Field Tests

[Non surgical alternatives in the treatment of the primitive open angle glaucoma]. - Stefan, C; Nenciu, A; Balas, M; Neacsu, A; Lascu, L (Oftalmologia (Bucharest, Romania : 1990), 2001)
Lowering of the intraocular pressure--the main risk factor in glaucoma neuropathy--is the major goal in the treatment for primary open angle glaucoma. The goal of the study is to compare the results of topical administration of the next therapeutical agents: b-blockers, prostaglandin analogs, topical carbonic anhydrase inhibitors and selectives adrenergic a-2 agonists. The studied groups emphasize the efficiency of the first line monotherapy and of the combined therapy, maintaining the quality of life, preserving the visual function, the minimal side effects and the compliance of the patients.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Betaxolol/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Therapy, Combination; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Latanoprost; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/et [Etiology]; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Quality of Life; Sulfonamides/ad [Administration & Dosage]; Thiazines/ad [Administration & Dosage]

[When should glaucoma be surgically treated?]. - Baudouin, C (Journal francais d'ophtalmologie, 2001)
The medical treatment of primary open angle glaucoma has progressively become more and more efficient and safe, and surgery is therefore mostly restricted to failure of and intolerance to antiglaucoma eyedrops. Glaucoma surgery may thus cause severe complications and a high risk of failure has tempered its prognostic. Nevertheless, when efficacious, glaucoma surgery definitively resolves two major pitfalls of medical treatment: patient compliance and eyedrops tolerance. Moreover, new surgical developments of surgery have come from the new technique of non-penetrating deep sclerectomy, which is actually an external trabeculectomy involving removal of the area of maximal resistance to aqueous outflow. This procedure has a very low risk of complications, much lower than that of standard trabeculectomy, but its efficacy is still controversial. Whatever the technique chosen for filtering surgery, antimetabolites may be used in order to limit the risk of postoperative fibrosis, but they also expose to specific, sometimes sight-threatening, complications. Therefore, the most important--and also the most difficult--choice for treating glaucoma patients still remains the best timing for surgery, either excessive, useless, and aggressive medical treatment, or systematic primary surgery.
Keywords: *Glaucoma/su [Surgery]; Humans; Trabeculectomy/mt [Methods]

Fuchs' heterochromic iridocyclitis: a review of 26 cases. - Velilla, S; Dios, E; Herreras, J M; Calonge, M (Ocular immunology and inflammation, 2001)
UNLABELLED: Fuchs' heterochromic iridocyclitis (FHI), an unusual form of uveitis of unknown etiology, is frequently misdiagnosed., PURPOSE: To report the analysis of 26 patients (27 eyes) with FHI who were diagnosed and observed over a period of 1-7 years (mean: 3.42 +/- 2.2 years)., METHODS: Ocular and systemic examinations were performed on all patients., RESULTS: The most common presenting symptom was visual deterioration (42.3%); one patient was affected bilaterally. Characteristic keratic precipitates (100%), cataracts (77.8%), and heterochromia (70.4%) were the major signs. Eleven eyes (40.7%) required cataract surgery. At the initial examination, four eyes (14.8%) had glaucoma, and no new cases of glaucoma developed during the follow-up period. One eye required filtration surgery. Vitrectomy was performed in two eyes (7.4%) because of vitreous opacities. Most patients (73.0%) did not require active treatment; pre- and postoperative anti-inflammatory treatment for cataract extraction was performed successfully to minimize the risk of inflammation. No severe uveitis was seen in any patient after surgery, but visual acuity did not improve greatly after cataract extraction; 54.5% eyes had visual acuity better than 20/40 before surgery, and 45.4% postoperatively., CONCLUSION: Posterior capsule opacification, glaucoma, and vitreous opacity were the major obstacles to visual rehabilitation after cataract surgery in patients with this type of uveitis.
Keywords: Adolescent; Adult; Child; Female; Humans; Iridocyclitis/co [Complications]; Iridocyclitis/di [Diagnosis]; Iridocyclitis/su [Surgery]; *Iridocyclitis; Male; Middle Aged; Visual Acuity

A comparison of the efficacy and tolerability of brimonidine and latanoprost in adults with open-angle glaucoma or ocular hypertension: a three-month, multicenter, randomized, double-masked, parallel-group trial. - DuBiner, H B; Mroz, M; Shapiro, A M; Dirks, M S; Brimonidine vs. Latanoprost Study Group (Clinical therapeutics, 2001)
BACKGROUND: Many physicians recommend either brimonidine or latanoprost as firstline therapy for chronic open-angle glaucoma or ocular hypertension. However, a search of MEDLINE indicates that there have been few head-to-head comparisons of the 2 monotherapies in a clinical setting., OBJECTIVE: This study compared the clinical efficacy and tolerability of brimonidine 0.2% twice daily with those of latanoprost 0.005% once daily as monotherapy in patients with open-angle glaucoma or ocular hypertension., METHODS: In this 3-month, multicenter, double-masked, parallel-group, 4-visit study, treatment-naive and previously treated patients with open-angle glaucoma or ocular hypertension and bilateral intraocular pressure (IOP) after washout of between 22 and 34 mm Hg were randomized to receive either brimonidine or latanoprost. Patients who had received previous treatment with either study drug were excluded from the study. The primary outcome measure was response rate, defined as the percentage of patients achieving > or = 20% reduction in IOP from baseline to month 3. Secondary outcome measures were mean IOP reduction from baseline to month 3 and clinical success, defined as the investigator's recommendation that the patient continue using the assigned study medication., RESULTS: A total of 127 patients (55 treatment naive) were enrolled, 66 in the brimonidine group and 61 in the latanoprost group. After 3 months of treatment, 80% of patients in the brimonidine group and 74% of patients in the latanoprost group had achieved > or = 20% reduction in IOP from baseline. The mean reduction in IOP from baseline at month 3 was 6.8 mm Hg with brimonidine and 6.5 mm Hg with latanoprost (27.8% vs 27.0%, respectively). Among treatment-naive patients, a significantly higher percentage of brimonidine-treated patients achieved > or = 20% decrease in IOP compared with latanoprost-treated patients (88% vs 59%, respectively; P = 0.01). In previously treated patients, a higher percentage of the latanoprost group achieved > or = 20% reduction in IOP compared with the brimonidine group (88% vs 74%, respectively); however, the difference was not statistically significant. Significantly more patients in the brimonidine group achieved clinical success at month 3 compared with patients in the latanoprost group (91% vs 74%; P = 0.01)., CONCLUSIONS: At peak effect, brimonidine twice daily was as effective as latanoprost once daily in lowering IOP. In treatment-naive patients, latanoprost was associated with a significantly higher rate of nonresponse after 3 months of treatment compared with brimonidine. This suggests that brimonidine may be the more reliable choice for first-line therapy of newly diagnosed open-angle glaucoma or ocular hypertension. In previously treated patients, however, latanoprost provided greater mean IOP reduction than did brimonidine. Significantly more patients achieved clinical success with brimonidine monotherapy than with latanoprost monotherapy.
Keywords: Adrenergic alpha-Agonists/ae [Adverse Effects]; *Adrenergic alpha-Agonists/tu [Therapeutic Use]; Aged; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Satisfaction; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Quinoxalines/ae [Adverse Effects]; *Quinoxalines/tu [Therapeutic Use]; Treatment Outcome

Filling the waiting time in the clinic with education about glaucoma. - Oermann, M H; Needham, C A; Dobal, M T; Sinishtaj, L; Lange, M P (Insight (American Society of Ophthalmic Registered Nurses), 2001)
The purpose of this study was to examine the effects of an educational intervention, designed to occupy the waiting time in an eye clinic, on learning about glaucoma and patient satisfaction. Subjects (N = 100) waiting in the eye clinic were randomly assigned to 2 groups: (1) educational intervention and (2) usual clinic care (no structured education during the waiting time in the clinic). Patients who were taught in the clinic had significant gains in knowledge about glaucoma from pretest to posttest and were more satisfied with the education received during the visit.
Keywords: Aged; Female; *Glaucoma; Health Knowledge, Attitudes, Practice; Humans; Male; Michigan; *Patient Education as Topic/mt [Methods]; Patient Satisfaction; Time Factors; Videotape Recording

Contact lens induced keratitis associated with contact lens wear. - Dejaco-Ruhswurm, I; Scholz, U; Hanselmayer, G; Skorpik, C (Acta ophthalmologica Scandinavica, 2001)
PURPOSE: To evaluate clinical characteristics, risk factors, management and outcome of contact lens induced keratitis (CLIK) associated with contact lens wear., METHODS: The study comprised all consecutive patients presenting with contact lens related presumed microbial keratitis during a 12-month period at our department. Detailed demographic data, type of contact lens, duration of lens wear, wearing schedule and lens hygiene were derived from a self-administered questionnaire. Severity of ulcer, corneal scrapings, treatment and final outcome were evaluated., RESULTS: 27 patients with CLIK, some of which may have been sterile peripheral infiltrates, due to contact lens wear were detected. In the majority of the cases patients had used disposable soft contact lenses (89%) and most of them had a daily wearing schedule (78%). 51.8% patients cleaned their lenses regularly. 6 (22%) applied no disinfection since their lenses were disposable on removal. In 3 of our cases with CLIK, penetrating keratoplasty had to be performed., CONCLUSION: Disposable contact lenses seem to have been a predisposing factor for contact lens induced keratitis also when used on a daily wear schedule. Insufficient contact lens care products and/or manufacturing characteristics may be responsible for CLIK, which is also observed in otherwise compliant contact lens users. In 3 of our patients with CLIK keratoplasty became necessary, indicating that contact lens induced keratitis may result in severe corneal complications.
Keywords: Adult; Contact Lens Solutions/tu [Therapeutic Use]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Corneal Ulcer/et [Etiology]; Corneal Ulcer/su [Surgery]; Disinfection/mt [Methods]; Disposable Equipment; Female; Humans; Keratoplasty, Penetrating; Male; Risk Factors; Surveys and Questionnaires; Time Factors; Visual Acuity

[Analysis of eye disease and adaptation of visual aids in low vision patients: review of 1,000 cases]. - Fernandez Guardiola, A; Sierra Jane, I (Archivos de la Sociedad Espanola de Oftalmologia, 2001)
PURPOSE: To study the success of visual rehabilitation in a group of 1,000 patients with low vision., METHOD: Clinical data on visual rehabilitation was studied in 1,000 subsequent patients suffering from visual impairment. Study focused on ocular disease, improvement in visual acuity and successful use of visual aids. A statistical analysis of results is presented., RESULTS: 25 cases dropped out due to issues in primary diagnosis. Remaining 975 patients were assigned to 9 groups: age-related macular degeneration (339) diabetic retinopathy (264 cases), myopic maculopathy (195 cases), glaucoma (96 cases), congenital maculopathy (39 cases), retinal detachment (12 patients), retinitis pigmentosa (13 cases), macular pucker (6 patients) and a miscellaneous group of 11 cases. The overall success in the improvement in visual acuity was 98% except for a group of patients with retinitis pigmentosa where a rate of only 46% success (p<0.01) was observed. 76% of cases finally accepted visual rehabilitation aids., CONCLUSIONS: The usefulness of visual rehabilitation in low vision patients is confirmed, with the exception of retinitis pigmentosa cases, probably due to features of the disease itself. The design of visual aids should be improved in order to benefit a greater number of patients.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; *Lenses; Male; Middle Aged; Patient Satisfaction; Vision, Low/et [Etiology]; *Vision, Low/rh [Rehabilitation]

Patient satisfaction after corneal transplantation. - Uiters, E; van den Borne, B; van der Horst, F G; Volker-Dieben, H J (Cornea, 2001)
PURPOSE: To determine the relationship between objective and subjective outcome measures and patient satisfaction after corneal transplantation., METHODS: Data were collected for 184 patients who underwent a corneal transplantation between 1 and 5 years ago. Only patients with the diagnosis of bullous keratopathy, endothelial decompensation (or Fuchs dystrophy), nonherpetic keratitis, and keratoconus were included. Objective treatment outcome measures, such as clarity of the graft and visual acuity in the grafted eye, were collected prospectively. Visual acuity of the other eye was collected retrospectively by chart review. Subjective outcome measures were derived from a retrospective survey. In addition to assessment of patient satisfaction, the survey provided information regarding subjective outcome measures, such as visual functioning and quality of life., RESULTS: The response rate was 86%. Generally, patients indicated that they were satisfied with the results of the transplantation. Age was negatively related to satisfaction, with older patients being less satisfied. On average, patients with keratoconus were most satisfied. Subjective outcome measures explained 57% of the variance in patient satisfaction, whereas objective factors explained 12%. Receipt of patient education during treatment was the best predictor. Other important variables were quality of life and visual functioning., CONCLUSION: In general, corneal transplantation had a positive effect on objective and subjective outcome measures. Patient satisfaction was better predicted by subjective outcomes than by objective outcomes. Patient education, in particular, proved to be a crucial factor. Objective outcome measures appeared to have a more indirect influence on patient satisfaction.
Keywords: Adult; Aged; Corneal Diseases/su [Surgery]; *Corneal Transplantation; Female; Humans; Male; Middle Aged; Patient Education as Topic; *Patient Satisfaction/sn [Statistics & Numerical Data]; Prospective Studies; Quality of Life; Sickness Impact Profile; Surveys and Questionnaires; Visual Acuity

RNAIII inhibiting peptide (RIP), a global inhibitor of Staphylococcus aureus pathogenesis: structure and function analysis. - Gov, Y; Bitler, A; Dell'Acqua, G; Torres, J V; Balaban, N (Peptides, 2001)
Staphylococcus aureus are gram-positive bacteria that can cause serious diseases in humans and animals. S. aureus infections can be prevented by the heptapeptide RNAIII inhibiting peptide (RIP). RIP was originally isolated from culture supernatants of coagulase negative staphylococci presumed to be S. xylosus. The sequence of RIP was identified as YSPXTNF. Native RIP and its synthetic analogue YSPWTNF have been shown to be effective inhibitors of diseases caused by various strains of S. aureus, including, cellulitis, keratitis, septic arthritis, osteomylitis and mastitis. RIP is therefore considered to be a global inhibitor of S. aureus. We show here that: 1) the amide form of RIP (YSPWTNF-NH2) is highly stable and is therefore the one recommended for use. 2) RIP inhibits S. aureus pathogenesis by inhibiting the synthesis of both agr transcripts RNAII and RNAIII. 3) Although RIP inhibits agr, it also reduces bacterial adherence to mammalian cells and to plastic (tested on HEp2 cells and on polystyrene by fluorescence and atomic force microscopy), suggesting that RIP can be used safely as a therapeutic molecule. 4) RIP derivatives were designed and tested for their ability to inhibit RNAIII in vitro and cellulitis in vivo. Not all peptides that inhibited RNAIII also inhibited an infection in vivo, indicating that studies must be carried out in vivo before considering a peptide to be of therapeutic potential. 5) The RIP derivative containing Lysine and Isoleucine at positions 2 and 4, respectively, inhibited S. aureus infections in vivo (tested on cellulitis), suggesting that both RIP YSPWTNF and its derivative YKPITNF are effective inhibitors of infections caused by S. aureus.
Keywords: *Bacterial Proteins/de [Drug Effects]; *Bacterial Proteins/pd [Pharmacology]; *Cell Adhesion/de [Drug Effects]; Cellulitis/dt [Drug Therapy]; Oligopeptides/ch [Chemistry]; *Oligopeptides/pd [Pharmacology]; Staphylococcus aureus/de [Drug Effects]; *Staphylococcus aureus/py [Pathogenicity]; Structure-Activity Relationship; *Trans-Activators; *Transcription Factors/de [Drug Effects]; Virulence/de [Drug Effects]

Topical plus intracameral lidocaine versus retrobulbar anesthesia in phacotrabeculectomy: prospective randomized study. - Rebolleda, G; Munoz-Negrete, F J; Gutierrez-Ortiz, C (Journal of cataract and refractive surgery, 2001)
PURPOSE: To compare the efficacy and safety of topical and retrobulbar anesthesia for phacotrabeculectomy., SETTING: Hospital Ramon y Cajal, Madrid, Spain., METHODS: This prospective study comprised 60 patients (60 eyes) having phacotrabeculectomy surgery. Patients were randomly assigned to 1 of 2 groups receiving topical anesthesia plus intracameral lidocaine 1% or retrobulbar anesthesia. Patients were asked to document the discomfort they experienced during the administration of the anesthetic agent, during surgery, and postoperatively using a numeric pain scale. Complications and surgical conditions were also evaluated., RESULTS: The retrobulbar group reported significantly more discomfort during administration of the anesthetic agent than the topical group (P < .001). The topical group reported significantly more discomfort intraoperatively (P < .01). Eyelid squeezing and eyeball movement were more common in the topical group; however, neither was a problem to the surgeon. There was no difference in surgical conditions (P = .38) or the postoperative pain scores between the 2 groups (P = .06). One patient receiving topical anesthesia developed a suprachoroidal hemorrhage intraoperatively., CONCLUSIONS: Topical anesthesia supplemented with intracameral lidocaine was an effective alternative to retrobulbar anesthesia for phacotrabeculectomy. Although the degree of patient discomfort was significantly higher during surgery under topical anesthesia, the method avoids the pain and complications associated with a retrobulbar injection.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Anesthesia, Local/mt [Methods]; *Anesthetics, Local/ad [Administration & Dosage]; *Anterior Chamber/de [Drug Effects]; Cataract/co [Complications]; Cataract/th [Therapy]; Female; Glaucoma, Angle-Closure/co [Complications]; Glaucoma, Angle-Closure/su [Surgery]; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/su [Surgery]; Humans; Intraoperative Complications; *Lidocaine/ad [Administration & Dosage]; Male; Middle Aged; *Orbit/de [Drug Effects]; Pain, Postoperative; Patient Satisfaction; *Phacoemulsification; Postoperative Complications; Prospective Studies; Safety; *Trabeculectomy

Cataract surgery under topical anesthesia in patients with coexisting glaucoma. - Jacobi, P C; Dietlein, T S; Jacobi, F K (Journal of cataract and refractive surgery, 2001)
PURPOSE: To evaluate and compare levels of patient discomfort and complications during phacoemulsification with implantation of a foldable intraocular lens (IOL) under topical lidocaine hydrochloride in patients with and without various forms of chronic open-angle and chronic angle-closure glaucoma., SETTING: Two university eye centers in Germany., METHODS: This prospective nonrandomized comparative study comprised 176 eyes of 176 patients with various forms of chronic open-angle glaucoma and chronic angle-closure glaucoma. Eyes with cataract and without a glaucoma diagnosis or history of intraocular surgery served as a control group (n = 212). All patients received a minimum of 5 doses (2 drops per dose) of topical lidocaine hydrochloride 2% before standard temporal clear corneal phacoemulsification and foldable IOL implantation. No intracameral anesthetic injection was given, and no systemic sedatives were used. The main outcome measures were the number of complications and adverse events., RESULTS: The intraoperative complication rate in all patients (n = 388) was capsule tear, 1.3%; zonule tear, 1.8%; vitreous loss, 1.0%; iris prolapse, 0.8%. No statistically significant differences in intraoperative or early postoperative complications were found between the glaucoma and control groups. The mean pain scores of patients were 0.38 +/- 1.1 (SD) in the glaucoma group and 0.36 +/- 0.8 in the control group (P =.21) Patient preference for cataract surgery under topical anesthesia was similar in both groups., CONCLUSIONS: Surgery-related complications and patient discomfort were similar in patients with and without glaucoma who had phacoemulsification and IOL implantation under topical anesthesia. These results indicate that topical anesthesia is safe for routine phacoemulsification with foldable IOL implantation in patients with glaucoma and does not compromise patient comfort.
Keywords: Adult; Aged; Aged, 80 and over; *Anesthesia, Local/mt [Methods]; *Anesthetics, Local/ad [Administration & Dosage]; *Cataract/co [Complications]; Chronic Disease; Female; *Glaucoma, Angle-Closure/co [Complications]; *Glaucoma, Open-Angle/co [Complications]; Humans; Intraoperative Complications; Lens Implantation, Intraocular; *Lidocaine/ad [Administration & Dosage]; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; *Phacoemulsification; Postoperative Complications; Prospective Studies; Safety

[Massive intraocular invasion of conjunctiva by squamous cell carcinoma--a case report]. - Schlote, T; Mielke, J; Rohrbach, J M (Klinische Monatsblatter fur Augenheilkunde, 2001)
BACKGROUND: Squamous cell carcinoma of the conjunctiva is a mostly solitary growing tumor located at the limbus region, which seldom invades the eye. We present an unusual case of conjunctival carcinoma with marked intraocular involvement, which appeared primarily as a chronic inflammation with corneal ulcer., CASE REPORT: A 89-year-old female patient was referred to our institution with a suspected ulcus rodens of the cornea. Since one year a refractory conjunctivitis persisted despite of different local treatment. At first presentation, a marked bacterial keratoconjunctivitis with circular necrosis of the conjunctiva, corneal infiltration and perforation was seen. Visual acuity of the right eye was light perception. The left eye was unremarkable. Enucleation of the right eye was performed. Histopathologic examination revealed the diagnosis of squamous cell carcinoma of the conjunctiva with intraocular involvement. There was a marked infiltration of the choroid even behind the equator. No metastases were found., CONCLUSION: Advanced squamous cell carcinoma associated with superinfection may present as a primary inflammatory process. There may be extensive involvement of the choroid. Metastases are probably rare even in advanced cases of this type of carcinoma.
Keywords: Aged; Aged, 80 and over; *Carcinoma, Squamous Cell/pa [Pathology]; Carcinoma, Squamous Cell/su [Surgery]; Chronic Disease; *Conjunctival Neoplasms/pa [Pathology]; Conjunctival Neoplasms/su [Surgery]; *Cornea/mi [Microbiology]; Cornea/pa [Pathology]; Corneal Ulcer/di [Diagnosis]; *Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/pa [Pathology]; Corneal Ulcer/su [Surgery]; Eye Enucleation; Female; Humans; Neoplasm Recurrence, Local; *Staphylococcal Infections/mi [Microbiology]; Staphylococcus aureus/ip [Isolation & Purification]; Treatment Refusal

[Glaucoma and pitfalls in therapy in the elderly with multiple morbidity from the viewpoint of the geriatrician]. - Weber, P; Svacinova, J (Casopis lekaru ceskych, 2001)
Glaucoma in multi-morbid patients is frequently treated by specialists non-ophthalmologists. The growing number of elderly patients with glaucoma and comparatively small knowledge on this disease among the medical workers brought us to review recent findings on the aetiology, pathogenesis, risks of development and namely the problems of glaucoma treatment, possible drug interactions and their side effects. Considering the growing incidence of glaucoma with age, general practitioners, internists, geriatrists and other specialists will face the problems of drug interactions and global or ophthalmological side effects during the polypharmacological treatment of their multi-morbid seniors. The article gives basic information on the problems of using antiglaucoma drugs and their effects on the organism and eyes. Effects of some foodstuff and medicaments used in therapy of other diseases on the intraocular pressure and glaucoma are also summarise.
Keywords: Aged; Aging/me [Metabolism]; Chronic Disease; Drug Interactions; Glaucoma/co [Complications]; *Glaucoma/dt [Drug Therapy]; Humans; Patient Compliance; Pharmacokinetics

Blindness in Africa: present situation and future needs. - Lewallen, S; Courtright, P (The British journal of ophthalmology, 2001)
AIM: To review the prevalence and causes of blindness in sub-Saharan Africa, the existing services and limitations, and the Vision 2020 goals for the future., METHODS: Methodologically sound population based surveys published in the past 20 years are reviewed and results for prevalence and causes of blindness are tabulated. The current resources and needs according to recent publications and international working groups are described., CONCLUSIONS: Blindness prevalence rates vary widely but the evidence suggests that approximately 1% of Africans are blind. The major cause is cataract; trachoma and glaucoma are also important causes of blindness. The bulk of blindness in the region is preventable or curable. Efforts should focus on eye problems which are universally present and for which there are cost effective remedies, such as cataract and refractive problems and on those problems which occur focally and can be prevented by primary healthcare measures, such as trachoma, onchocerciasis, and vitamin A deficiency. Major development of staffing levels, infrastructure, and community programmes will be necessary to achieve Vision 2020 goals.
Keywords: AIDS-Related Opportunistic Infections/co [Complications]; Africa South of the Sahara/ep [Epidemiology]; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Cataract/co [Complications]; Diabetic Retinopathy/co [Complications]; Eye Injuries/co [Complications]; Female; Forecasting; Glaucoma/co [Complications]; Health Services Accessibility/td [Trends]; Humans; Leprosy/co [Complications]; Male; Needs Assessment/td [Trends]; *Needs Assessment; Onchocerciasis, Ocular/co [Complications]; Patient Acceptance of Health Care; Population Surveillance; Prevalence; Refractive Errors/co [Complications]; Trachoma/co [Complications]; Vitamin A Deficiency/co [Complications]

Changes in attitudes and practices of optometrists in their management of diabetic retinopathy after the release of NHMRC guidelines. National Health and Medical Research Council. - Wright, S E; McKay, R; Taylor, K I; Keeffe, J E; McCarty, C A; Working Group for the Evaluation of NHMRC Retinopathy Guideline Distribution (Clinical & experimental ophthalmology, 2001)
The purpose of this study was to document attitudes and practices of Australian optometrists in their management of diabetic retinopathy prior to the release of the National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for the Management of Diabetic Retinopathy and at two time points following their release. A self-administered questionnaire was mailed to a stratified random sample of 500 Australian optometrists at the three time points. The same sample was used for the first two surveys and a new random sample was drawn for the second follow-up survey. The response to the three questionnaires was 86%, 80% and 84%, respectively. More than 90% of optometrists reported receiving a copy of the guidelines and 82% reported receiving the supplementary Retinopathy Chart. Fifty-seven per cent reported having read the guidelines at least once in entirety and 65% reported that they refer to the Retinopathy Chart at least monthly in their clinical practice. There was a significant decrease in the number of optometrists who reported that patient unwillingness to be dilated and their fear of precipitating angle closure glaucoma were moderate or major barriers to performing dilated ophthalmoscopy. Concomitantly, the percentage of optometrists who reported that they often or always perform dilated ophthalmoscopy on new patients with diabetes increased significantly from 74.5% (95% confidence limit = 70.2, 78.8) to 81.5% (95% confidence limit = 77.5, 85.5). There have been some significant changes in the self-reported management practices of optometrists in relation to diabetic retinopathy since the release of the NHMRC guidelines and Retinopathy Chart.
Keywords: *Attitude to Health; Australia; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/th [Therapy]; Diagnostic Techniques, Ophthalmological; *Health Knowledge, Attitudes, Practice; Humans; National Health Programs/st [Standards]; *Optometry/st [Standards]; *Practice Guidelines as Topic/st [Standards]; *Practice Patterns, Physicians'/st [Standards]; Surveys and Questionnaires

Twenty-four hour intraocular pressure reduction with latanoprost compared with pilocarpine as third-line therapy in exfoliation glaucoma. - Konstas, A G; Lake, S; Maltezos, A C; Holmes, K T; Stewart, W C (Eye (London, England), 2001)
PURPOSE: To compare the 24 hour efficacy of latanoprost 0.005% given every evening with that of pilocarpine 4% given four times daily as third-line therapy in patients with exfoliation glaucoma receiving timolol 0.5% and dorzolamide 2% each given twice daily., METHOD: We enrolled 30 patients with exfoliation glaucoma not adequately controlled on timolol maleate 0.5% and dorzolamide 2%. Each patient underwent a baseline 24 hour intraocular pressure curve testing at 06:00, 10:00, 14:00, 18:00, 22:00 and 02:00 hours. Patients were randomised to receive either latanoprost 0.005% or pilocarpine 4% for a minimum of 8 weeks and were then crossed over to the opposite therapy. Diurnal curve testing was repeated at the end of each treatment., RESULTS: There was a significant decrease from baseline in intraocular pressure at each timepoint for both study medicines (p < 0.016). Latanoprost provided better intraocular pressure control than pilocarpine at daytime measuresments (17.4 vs 19.7 mmHg at 06:00 hours, p < 0.001; 17.8 vs 19.1 mmHg at 10:00 hours, p = 0.04). However, pilocarpine reduced the pressure more than latanoprost at 22:00 hours (18.4 vs 19.5 mmHg, p = 0.016). Overall, the diurnal intraocular pressure was reduced from a baseline of 21.5 +/- 3.7 mmHg to 18.8 +/- 3.1 mmHg on pilocarpine and to 18.0 +/- 3.0 mmHg on latanoprost (p = 0.06). In addition, mean peak pressure was similar between pilocarpine (21.0 +/- 2.9 mmHg) and latanoprost (20.5 +/- 3.8 mmHg) (p = 0.20). Side-effects were similar with the exception of blurred vision, which was only found with pilocarpine (10%). Compliance was more difficult with pilocarpine., CONCLUSION: In exfoliation glaucoma, as a third-line adjunctive therapy added to timolol and dorzolamide, latanoprost and pilocarpine have similar diurnal efficacy. However, latanoprost provides a greater morning pressure reduction.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Circadian Rhythm/ph [Physiology]; Cross-Over Studies; Drug Administration Schedule; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Latanoprost; Male; Middle Aged; Miotics/ae [Adverse Effects]; Miotics/tu [Therapeutic Use]; Muscarinic Agonists/ae [Adverse Effects]; *Muscarinic Agonists/tu [Therapeutic Use]; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Prospective Studies; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Outcome of lens aspiration and intraocular lens implantation in children aged 5 years and under. - Cassidy, L; Rahi, J; Nischal, K; Russell-Eggitt, I; Taylor, D (The British journal of ophthalmology, 2001)
AIMS: To determine the visual outcome and complications of lens aspiration with intraocular lens implantation in children aged 5 years and under., METHODS: The hospital notes of all children aged 5 years and under, who had undergone lens aspiration with intraocular lens implantation between January 1994 and September 1998, and for whom follow up data of at least 1 year were available, were reviewed., RESULTS: Of 50 children who underwent surgery, 45 were eligible based on the follow up criteria. 34 children had bilateral cataracts and, of these, 30 had surgery on both eyes. Cataract was unilateral in 11 cases; thus, 75 eyes of 45 children had surgery. Cataracts were congenital in 28 cases, juvenile in 16, and traumatic in one case. The median age at surgery was 39 months (range 11-70 months). Follow up ranged from 12-64 months (median 36 months). Of 34 children with bilateral disease, 25 (73.5%) had a final best corrected visual acuity of 6/12 or better, while seven (20.5%) achieved 6/18 or less; in one child the vision improved from UCUSUM to CSM but another, who had only one eye operated on, was unable to fix or follow with this eye preoperatively or 2 years postoperatively. Of 11 children with unilateral cataract, five (45.5%) had a final best corrected visual of 6/12 or better, and six (54.5%) 6/18 or less. A mild fibrinous uveitis occurred in 20 (28.2%) eyes in the immediate postoperative period, but resolved with topical steroids. One child had a vitreous wick postoperatively requiring surgical division. Glaucoma, endophthalmitis, or retinal detachment have not been observed so far in any patient postoperatively., CONCLUSION: From this series the authors suggest that, in children aged 5 years and under, lens aspiration with intraocular lens implantation is a safe procedure, with a good visual outcome in the short term. Further studies are needed to investigate these outcomes in the long term.
Keywords: Anti-Inflammatory Agents/tu [Therapeutic Use]; Cataract/et [Etiology]; *Cataract Extraction/mt [Methods]; Child, Preschool; Dexamethasone/tu [Therapeutic Use]; Female; Fixation, Ocular/ph [Physiology]; Humans; Infant; *Lens Implantation, Intraocular/mt [Methods]; Male; Patient Compliance; *Postoperative Complications/th [Therapy]; Retrospective Studies; Treatment Outcome; Visual Acuity

The impact of glaucoma on the quality of life of patients in Norway. II. Patient response correlated to objective data. - Odberg, T; Jakobsen, J E; Hultgren, S J; Halseide, R (Acta ophthalmologica Scandinavica, 2001)
PURPOSE: To elucidate the relationship between the visual difficulties reported by patients treated for glaucoma and their objective functional damage, and to evaluate the reliability of the patient responses., METHODS: Questionnaires concerning quality of life filled in at home by 589 patients treated for chronic open angle glaucoma were correlated to corresponding questionnaires returned from their ophthalmologists., RESULTS: Few of our patients had a visual field damage judged to be of functional significance. There was a weak to moderate association between both visual field defects and decreased visual acuity and self-reported visual difficulties. A high proportion of the patients had normal binocular visual field and a stable disease, raising the suspicion that some of them were treated for ocular hypertension. The agreement between the responses from the patients and the ophthalmologists concerning the topical treatment was good, regarding treatment duration and other diseases of the patients the agreement was moderate., CONCLUSION: The association between subjective visual disability and presence of visual field defects was weak to moderate in our patients treated for glaucoma, and this association was further weakened by adjusting for visual acuity. Some patients might be treated unnecessarily, and a favourable prognosis might be given to most of them. The reliability of the patients in general was good.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Chronic Disease; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Norway; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/dt [Drug Therapy]; Patient Satisfaction; *Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Vision Disorders/di [Diagnosis]; Visual Acuity; Visual Fields

The impact of glaucoma on the quality of life of patients in Norway. I. Results from a self-administered questionnaire. - Odberg, T; Jakobsen, J E; Hultgren, S J; Halseide, R (Acta ophthalmologica Scandinavica, 2001)
PURPOSE: To evaluate the feelings and experiences of patients living with glaucoma., METHODS: A questionnaire was delivered to patients willing to take part, at a regular visit to their ophthalmologist, for filling in anonymously at home. A total of 589 questionnaires were returned., RESULTS: More than 80% reported negative emotions on learning that they had glaucoma, one-third were afraid of going blind. Half the patients had no visual problem at all, 14% complained of poor or very poor vision. This proportion increased with age. One-fourth of the patients on topical medication experienced adverse effects of moderate or high degree. About half the patients being treated with laser or surgery felt their situation had improved afterwards. Nine-tenths of the individuals were satisfied with the information and care given, although their knowledge about glaucoma was rather incomplete. One-fifth missed information, mainly on causes, treatment and prognosis of the disease. The younger patients were more anxious and inquiring, reported more side effects and were less satisfied than the older patients. The women were in general more dissatisfied than the men., CONCLUSION: Giving a patient a diagnosis of glaucoma influences his quality of life negatively. Only half of our patients experienced any visual difficulties, whereas one-fourth reported adverse reactions due to the therapy. Most of the patients were very satisfied with the information and care given. Ophthalmologists in private practice are quite central in the management and care of the glaucoma patients in a medical setting like ours.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Emotions/ph [Physiology]; Female; Filtering Surgery; *Glaucoma/di [Diagnosis]; Glaucoma/px [Psychology]; Glaucoma/su [Surgery]; Humans; Laser Therapy; Male; Middle Aged; Norway; Patient Education as Topic; Patient Satisfaction; *Quality of Life; *Surveys and Questionnaires

[Evaluation of the work time used in outpatient ophthalmology techniques]. - Arias Lopez, M C; Lanuza Garcia, A; Garcia Garcia, N; Ramos Marti, F (Archivos de la Sociedad Espanola de Oftalmologia, 2001)
PURPOSE: To determine the work time used for out-patients seen in the ophthalmology out-patient clinic according to treatment for each diagnosis and examination guidelines. Another objective was to discover the diagnostic related outpatient demand as well as the time spent on each technique., METHOD: We have designed a computer database system that includes examinations, treatments and medical services. Their duration was measured in a random sample of 127 ophthalmology outpatients in the General Hospital of Castellon. Sixty five of the patients had come to their first visit and 62 to the follow-up visits., RESULTS: A new patient spends a mean of 42 minutes and a follow-up patient spends a mean of 27 minutes. The most frequent diagnoses are retinal diseases (30%), cataract (18.6%), glaucoma (11.8%) and ocular motility disorders (11.8%). We present the mean times used by the physician in the ophthalmic techniques used in outpatients., CONCLUSIONS: We have modified the standard times of 30 minutes for the first visit and 15 minutes for the follow-up visit. Data on the work time used for all the ophthalmics techniques in our outpatient clinic are presented. This ophthalmology survey can be used for health care managers to establish the <> and health care plan administration to adapt the resources to the demand.
Keywords: *Ambulatory Care Facilities/sn [Statistics & Numerical Data]; Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; Humans; *Office Visits/sn [Statistics & Numerical Data]; *Ophthalmology/sn [Statistics & Numerical Data]; Time Factors

Therapeutic potential of prostaglandin analogues in glaucoma. - Linden, C (Expert opinion on investigational drugs, 2001)
One of the most recent contributions to the therapeutic arsenal available for the treatment of glaucoma is the prostaglandin (PG) analogues. They represent a new class of ocular hypotensive drugs, targeting the uveoscleral outflow of ocular aqueous humour. Two drugs, latanoprost and unoprostone, are presently commercially available. In terms of intraocular pressure (IOP) reduction, latanoprost is the most powerful drug in clinical use today. The once daily dosing promotes compliance. Additional effect is achieved in combination with other hypotensive drugs, including those that increase trabecular outflow facility. The most frequent side effect is increased iris pigmentation that seems to be irreversible. A low frequency of cystoid macular oedema has been reported, predominantly in patients whose blood-retinal barrier (BRB) is compromised. Systemic side effects are rare. The experience with unoprostone is still much less than that with latanoprost. The ocular hypotensive mechanism of action of unoprostone is not well documented but an increase in uveoscleral outflow may be at least a part of its mode of action. Systemic side effects are rare and the ocular side effects seem to be mild. The ocular hypotensive effect is less than that of latanoprost and may not be suitable for monotherapy. It is widely accepted that the IOP alone is not responsible for the development of glaucomatous visual defects. It remains to be seen if this class of drugs will preserve vision in glaucoma patients better than other classes. More PG analogues are under development for potential clinical use.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cholinergic Agonists/tu [Therapeutic Use]; Drug Therapy, Combination; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Prostaglandins/ae [Adverse Effects]; *Prostaglandins/tu [Therapeutic Use]; Prostaglandins F, Synthetic/tu [Therapeutic Use]

How do you handle special therapeutic requests?. - Ralph, R A (Maryland medicine : MM : a publication of MEDCHI, the Maryland State Medical Society, 2001)
Keywords: Adult; Advertising; Complementary Therapies; Depressive Disorder/dt [Drug Therapy]; Female; Glaucoma/th [Therapy]; Humans; Internet; Male; Middle Aged; *Patient Participation; *Physician-Patient Relations

Deprivation and late presentation of glaucoma: case-control study. - Fraser, S; Bunce, C; Wormald, R; Brunner, E (BMJ (Clinical research ed.), 2001)
OBJECTIVE: To identify socioeconomic risk factors for first presentation advanced glaucomatous visual field loss., DESIGN: Hospital based case-control study with prospective identification of patients., SETTING: Three hospital eye departments., PARTICIPANTS: Consecutive patients newly diagnosed with glaucoma (n=220). Cases (late presenters) were those presenting with advanced glaucoma (n=110), controls were those with early glaucoma (n=110)., RESULTS: Median underprivileged area scores were higher among late presenters (29.5; interquartile range 9.0-42.2) than in the control group (21.3; 6.1-37.4) (P=0.035). Late presenters were more likely to be of lower occupational class (odds ratio adjusted for age and referral centre 20.1 (95% confidence interval 2.6 to 155) for group III compared with group I-II and 86.0 (11.0 to 673 for group IV-V compared with group I-II), to have no access to a car (2.2; 1.2 to 4.0), to have left full time education at age 14 or less (7.5; 2.3 to 24.7), and to be tenants rather than owner occupiers (local authority tenants 3.2; 1.7 to 5.8, private tenants 2.1; 0.7 to 5.8). Effects of deprivation were partly accounted for by family history of glaucoma, time since last visit to an optometrist, and lack of an initial diagnosis of glaucoma by an optometrist., CONCLUSIONS: Area and individual level deprivation were both associated with late presentation of glaucoma. Existing evidence shows that late presentation is an important risk factor for subsequent blindness. Deprived groups thus seem to be at greater risk of going blind from glaucoma. Material deprivation may be associated with more aggressive disease as well as later presentation.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Case-Control Studies; England/ep [Epidemiology]; Female; Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; Glaucoma/pa [Pathology]; Humans; Male; Middle Aged; Odds Ratio; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Poverty; Prospective Studies; Risk Factors; Socioeconomic Factors; Time Factors

Misoprostol therapeutics revisited. - Davies, N M; Longstreth, J; Jamali, F (Pharmacotherapy, 2001)
Misoprostol, a prostaglandin E1 analog, is a racemate of four stereoisomers. On administration it rapidly de-esterifies to its active form, misoprostolic acid. Misoprostolic acid is 85% albumin bound and has a half-life of approximately 30 minutes. It is excreted in urine as inactive metabolites. No significant drug interactions have been reported. Besides its gastrointestinal protective and uterotonic activities, misoprostol regulates various immunologic cascades. It inhibits platelet-activating factor and leukocyte adherence, and modulates adhesion molecule expression. It protects against gut irradiation injury, experimental gastric cancer, enteropathy, and constipation. It improves nutrient absorption in cystic fibrosis. Misoprostol has utility in acetaminophen and ethanol hepatotoxicity, hepatitis, and fibrosis. It is effective in asthmatics and aspirin-sensitive asthmatic and allergic patients. It lowers cholesterol and severity of peripheral vascular diseases, prolongs survival of cardiac and kidney transplantation, synergizes cyclosporine, and protects against cyclosporine-induced renal damage. It works against drug-induced renal damage, interstitial cystitis, lupus nephritis, and hepatorenal syndrome. It is useful in periodontal disease and dental repair. Misoprostol enhances glycosoaminoglycan synthesis in cartilage after injury. It prevents ultraviolet-induced cataracts and reduces intraocular pressure in glaucoma and ocular hypertension. It synergizes antiinflammatory and analgesic effects of diclofenac or colchicine and has been administered to treat trigeminal neuralgic pain. It reduces chemotherapy-induced hair loss and recovery time from burn injury, and is effective in treating sepsis, multiple sclerosis, and pancreatitis.
Keywords: Animals; Anti-Inflammatory Agents, Non-Steroidal/ae [Adverse Effects]; Anti-Ulcer Agents/ad [Administration & Dosage]; Anti-Ulcer Agents/pk [Pharmacokinetics]; Anti-Ulcer Agents/pd [Pharmacology]; *Anti-Ulcer Agents/tu [Therapeutic Use]; Humans; Misoprostol/ad [Administration & Dosage]; Misoprostol/pk [Pharmacokinetics]; Misoprostol/pd [Pharmacology]; *Misoprostol/tu [Therapeutic Use]; Stomach Ulcer/ci [Chemically Induced]; *Stomach Ulcer/pc [Prevention & Control]

[Clinical observation on the effect of 4% pilocarpine gel used one dose per day in the treatment of glaucoma]. - Yie, T; Liang, L; Chen, X (Yan ke xue bao = Eye science, 2000)
PURPOSE: To compare the efficacy and safety of 4% pilocarpine gel(PG) and 1% pilocarpine solution(PS)., METHODS: Twenty cases(40 eyes) with ocular hypertension or primary open angle glaucoma(POAG) in early stage were treated by 4% PG(once per night) and PS(4 times per day). We compared the side-effects and the changes in the intraocular pressure (IOP), pupil size and diopter of 2 groups after medication. Self-control was chosen., RESULTS: The effect of 4% PG on IOP can last 20 hours. The IOP decreasing range of the PG group was from 9.3% to 13.8%, while the PS group was from 12.4% to 16.2%. The decreasing range at 10 AM for four weeks of the PG group was from 11.3% to 17.6% while the PS group was from 17.4% to 19.7%. There is no statistically significant difference between two groups. There are more obvious changes in the pupil size and diopter in the PS group and less complain of blurred vision in the PG group., CONCLUSION: The IOP decreasing effect of 4% PG is comparable with that of 1% PS, but the 4% PG is better than 1% PS as concerning the patient compliance and the side effects. So the 4% PG can be used as a substitute for the 1% PS in the clinic.
Keywords: Adolescent; Adult; Aged; Delayed-Action Preparations; Female; Gels; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/ae [Adverse Effects]

Effect of health education on patients' beliefs about glaucoma and compliance. - Rendell, J (Insight (American Society of Ophthalmic Registered Nurses), 2000)
A pretest-posttest control group experimental design (n = 100) was used to determine the effectiveness of an interactive patient education program compared with a didactic approach for persons with primary open angle glaucoma at a major specialist eye hospital in England. This study used a questionnaire with a knowledge test to explore patients' glaucoma knowledge, a series of vignettes to explore understanding of compliance and health motivation, and health locus of control scales to assess the effect of these variables. The improved posttest results (P = .000) suggest that patients benefit from education programs and that the ophthalmic nurse is an effective patient teacher. The interactive program has no statistically significant difference from the didactic presentation. Other types of interactive programs may prove to be more beneficial.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/px [Psychology]; *Health Education/mt [Methods]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Patient Compliance; Surveys and Questionnaires

Silicone oil-induced secondary glaucoma: a case study. - Orticio, L P (Insight (American Society of Ophthalmic Registered Nurses), 2000)
Silicone oil intraocular tamponade is a widely accepted procedure in the management of complex retinal detachments caused by proliferative diabetic vitreoretinopathy. Silicone oil has a high surface tension that mechanically limits fibrovascular reproliferation resulting in successful retinal reattachments. However, postoperative secondary glaucoma is a relatively frequent complication that may require intensive nursing management focused at intraocular pressure monitoring, positioning compliance, pain management, fluid and electrolyte balance, and glucose control. This article presents the postoperative clinical course of a 51-year-old man with diabetes and recurrent proliferative diabetic vitreoretinopathy who developed secondary glaucoma after silicone oil injection with a dramatic rise in intraocular pressure on the first postoperative day. Nursing management concurrent with medical and surgical management is discussed and the necessary nursing plan of care is identified.
Keywords: Diabetic Retinopathy/co [Complications]; Diabetic Retinopathy/su [Surgery]; Eye Diseases/co [Complications]; Fluorocarbons/tu [Therapeutic Use]; *Glaucoma/ci [Chemically Induced]; Glaucoma/th [Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Nursing Care; Pain Management; Reoperation; Retinal Detachment/et [Etiology]; Retinal Detachment/su [Surgery]; *Silicone Oils/ae [Adverse Effects]; Vitrectomy; Vitreous Body/pa [Pathology]; Water-Electrolyte Balance

[Analysis of glaucoma therapy costs in Poland. I--population of the Mazovian District]. - Czechowicz-Janicka, K; Orlewska, E; Tobota, Z; Anielska, E; Dyczkowska, A (Klinika oczna, 2000)
AIM OF THE STUDY: The purpose of this study was to estimate and evaluate costs of glaucoma therapy in Poland in 1998-2000 years., MATERIAL AND METHODS: 315 patients (591 eyes) including 364 POAG eyes and 227 PACG eyes were evaluated. Progression of the disease was measured in two modes: by changes in the optical nerve disc (c/d) and by IOP level. Duration of the study was 12 months. Total costs (e.g. number of visits, amount of medications used, surgical and laser procedures performed) were calculated on 100 eyes/12 months., RESULTS: Pharmacological therapy constitutes 40-50% of the total costs in both glaucoma types. Timolol was the mostly prescribed drug in POAG, while pilocarpine led in PACG group. Dorzolamide was on the third place, but it generated the biggest part of total costs. Patients with advanced forms of the disease more frequently saw doctor on visits (average 6 visits per year); patients with elevated IOP (> 21 mm Hg) underwent surgical procedures more commonly than these with optical nerve disc changes (c/d > 0.6). The total costs of the therapy of non-advanced cases amounted 70.243 PLN on the average, while in advanced cases it reached the average of 155.230 PLN., CONCLUSION: 1. The total cost of glaucoma therapy depends on progression of the disease. 2. The most cost-generating part is the pharmacological therapy of glaucoma.
Keywords: Adult; Aged; Aged, 80 and over; Costs and Cost Analysis; Disease Progression; Female; *Glaucoma/ec [Economics]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure; Laser Therapy/ec [Economics]; Male; Middle Aged; Office Visits/ec [Economics]; *Pilocarpine/ec [Economics]; Pilocarpine/tu [Therapeutic Use]; Poland; *Sulfonamides/ec [Economics]; Sulfonamides/tu [Therapeutic Use]; *Thiophenes/ec [Economics]; Thiophenes/tu [Therapeutic Use]; *Timolol/ec [Economics]; Timolol/tu [Therapeutic Use]

Contact trans-scleral diode laser cyclophotocoagulation treatment for refractory glaucomas in the Indian population. - Gupta, V; Agarwal, H C (Indian journal of ophthalmology, 2000)
PURPOSE: This study aimed to evaluate the clinical efficacy of contact diode trans-scleral cyclophotocoagulation (TSCPC) for treatment of refractory glaucomas., METHOD: Fifty two eyes of 52 patients, (post-penetrating keratoplasty glaucoma: 16 eyes; adherent leucoma with secondary glaucoma: 8 eyes; aphakic glaucoma: 6 eyes; neovascular glaucoma: 6 eyes; narrow angle glaucoma: 6 eyes; and other secondary glaucomas: 10 eyes) were followed up from 3.5-18 months (average 12 months) after TSCPC. The treatment parameters using the contact G probe were--energy: 3-4J; area: 40 spots spread over 360 degrees; site: 1.2-1.5 mm posterior to limbus. Retreatments (22 eyes; 42%) were given whenever intraocular pressure (IOP) exceeded 22 mmHg despite maximum tolerable topical therapy., RESULTS: IOP decreased from a baseline of 44.7 (+/- 7.3) mmHg to 15 (+/- 3.7) mmHg at first week and was 15.2 +/- (8.2) mmHg at the last follow up. Successful control of IOP (< 22 mmHg) occurred in 30 (58%) eyes after a single treatment and in 48 (92%) eyes following retreatment. Complications included reduction in visual acuity from light perception (LP) only to no light perception (NLP) in two eyes and phthisis bulbi in one eye., CONCLUSION: Contact trans-scleral diode laser cyclophotocoagulation is effective in lowering IOP in eyes with intractable glaucoma with few side effects in Indian subjects.
Keywords: Adolescent; Adult; Ciliary Body/pp [Physiopathology]; *Ciliary Body/su [Surgery]; Female; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; India/ep [Epidemiology]; Intraocular Pressure/ph [Physiology]; *Laser Coagulation/mt [Methods]; Male; Prevalence; Retrospective Studies; Sclera/su [Surgery]; Visual Acuity

[Surgical indications in coexisting cataracts and glaucoma]. - Collignon-Brach, J D; Ravet, O; Robe-Collignon, N (Bulletin de la Societe belge d'ophtalmologie, 2000)
Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.
Keywords: *Cataract/co [Complications]; *Cataract Extraction; *Glaucoma/co [Complications]; *Glaucoma/su [Surgery]; Humans; *Ophthalmologic Surgical Procedures

Topical dorzolamide 2%/timolol 0.5%: a review of its use in the treatment of open-angle glaucoma. - Ormrod, D; McClellan, K (Drugs & aging, 2000)
UNLABELLED: The nonselective beta-blocker timolol and the carbonic anhydrase inhibitor dorzolamide both lower intraocular pressure (IOP). Timolol and dorzolamide have different mechanisms of action and their effects are additive when administered together. Therefore, the 2 drugs are frequently used concomitantly to treat patients with open-angle glaucoma who have not adequately responded to first-line therapy. A barrier to good compliance with concomitant therapy is the need to administer 5 or 6 drops of medication on 2 or 4 occasions during the day. Timolol 0.5% and dorzolamide 2.0% have therefore been combined in a single formulation, reducing the number of administrations required to 2 per day. Clinical trials in patients with glaucoma have demonstrated that dorzolamide 2%/timolol 0.5% (dorzolamide/timolol) is superior to monotherapy with the individual components. When dorzolamide/timolol administered twice daily was compared with concomitant treatment with dorzolamide 2% and timolol 0.5%, each administered twice daily for 90 days, both regimens resulted in marked lowering of trough IOP (measured just before the morning dose) compared with baseline (reduction in IOP = 4.2mm Hg). The effect of the 2 regimens on IOP at all time points, both before treatment and at peak effect (2 hours after treatment), were virtually indistinguishable. When the combined formulation was compared with a concomitant regimen that included dorzolamide 2% 3 times daily and timolol 0.5% twice daily the concomitant regimen was slightly more efficacious than the combined regimen at trough after 90 days: IOP was lowered by 3.6mm Hg in the combined group versus 4.1 mm Hg in the concomitant group. Dorzolamide/timolol has been compared with concomitant administration of timolol 0.5% and the IOP lowering miotic drug, pilocarpine 2.0%. This non-blind patient-preference study found that both regimens reduced IOP. However, the dorzolamide/timolol combination was preferred by the patients because of reduced frequency and severity of adverse effects and less frequent administration. Dorzolamide/timolol was well tolerated in clinical trials, the adverse effects reflected those of the individual components, and no additional tolerability issues were identified. However, the potential for timolol to cause cardiorespiratory effects must be considered when prescribing this combination. Furthermore, dorzolamide is a sulfonamide and can cause allergic reactions in those who are hypersensitive to this class of drug., CONCLUSIONS: Dorzolamide/timolol is a well tolerated and effective fixed combination for lowering IOP in the treatment of open-angle glaucoma and is likely to be useful in those patients who do not respond adequately to first-line monotherapy. Compared with concomitant therapy with the same 2 drugs the primary advantage is convenience, which may lead to improved compliance. Studies of compliance and comparisons with other currently available combination therapies would be useful to fully define the value of the formulation. Nonetheless, dorzolamide combined with timolol in a single applicator system will be a useful addition to the treatment options for glaucoma, a leading cause of preventable blindness.
Keywords: Adrenergic beta-Antagonists/pk [Pharmacokinetics]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/pk [Pharmacokinetics]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/me [Metabolism]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; Sulfonamides/pk [Pharmacokinetics]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/pk [Pharmacokinetics]; *Thiophenes/tu [Therapeutic Use]; Timolol/pk [Pharmacokinetics]; *Timolol/tu [Therapeutic Use]; *Vision, Ocular/de [Drug Effects]; Vision, Ocular/ph [Physiology]

The treatment of herpes simplex virus epithelial keratitis. - Wilhelmus, K R (Transactions of the American Ophthalmological Society, 2000)
PURPOSE: Epithelial keratitis is the most common presentation of ocular infection by herpes simplex virus (HSV). Quantitative assessment of available therapy is needed to guide evidence-based ophthalmology. This study aimed to compare the efficacy of various treatments for dendritic or geographic HSV epithelial keratitis and to evaluate the role of various clinical characteristics on epithelial healing., METHODS: Following a systematic review of the literature, information from clinical trials of HSV dendritic or geographic epithelial keratitis was extracted, and the methodological quality of each study was scored. Methods of epithelial cauterization and curettage were grouped as relatively equivalent physicochemical therapy, and solution and ointment formulations of a given topical antiviral agent were combined. The proportion healed with 1 week of therapy, a scheduled follow-up day that approximated the average time of resolution with antiviral therapy, was selected as the primary outcome based on a masked evaluation of maximum treatment differences in published healing curves. The proportion healed at 14 days was recorded as supplemental information. Fixed-effects and random-effects meta-analysis models were used to obtain summary estimates by pooling results from comparative treatment trials. Hypotheses about which prognostic factors might affect epithelial healing during antiviral therapy were developed by multivariate analysis of the Herpetic Eye Disease Study dataset., RESULTS: After excluding 48 duplicate reports, 14 nonrandomized studies, 15 studies with outdated or similar treatments, and 29 trials lacking sufficient data on healing or accessibility, 76 primary reports were identified. These reports involved 4,251 patients allocated to 93 treatment comparisons of dendritic epithelial keratitis in 28 categories and 9 comparisons of geographic epithelial keratitis in 6 categories. For dendritic keratitis, idoxuridine was better than placebo at 7 days (combined odds ratio [OR], 3.59; 95% confidence interval [CI], 1.92-6.70), and at 14 days (OR, 4.17; 95% CI, 1.33-13.04), but pooling was limited by lack of homogeneity and low study quality. Direct comparisons at 1 week of treatment showed that trifluridine or acyclovir was significantly better than idoxuridine (OR, 3.12 and 4.56; 95% CI, 1.55-6.29 and 2.76-7.52, respectively), and indirect comparisons were also consistent with a clinically significant benefit. Vidarabine was not significantly better than idoxuridine in pooled treatment comparisons at 1 week (OR, 1.20; 95% CI, 0.72-2.00) but was better in 2 indirect comparisons (OR, 4.22 and 4.78; 95% CI, 1.69-10.54 and 2.15-10.65, respectively). At 14 days, trifluridine (OR, 6.05; 95% CI, 2.50-14.66), acyclovir (OR, 2.88; 95% CI, 1.39-4.78), and vidarabine (OR, 1.24; 95% CI, 0.65-2.37) were each better than idoxuridine. Trials of geographic epithelial keratitis also suggested that trifluridine, acyclovir, and vidarabine were more effective that idoxuridine. Other topical antiviral agents, such as bromovinyldeoxuridine, ganciclovir, and foscarnet, appeared equivalent to trifluridine or acyclovir. Oral acyclovir was equivalent to topical antiviral therapy and did not hasten healing when used in combination with topical treatment. Antiviral agents did not increase the speed of healing when compared to debridement but reduced the risk of recrudescent epithelial keratitis. The combination of physicochemical treatment with an antiviral agent seemed to be better than either physicochemical or antiviral treatment alone, but the heterogeneous cauterization and curettage techniques and the various treatment combinations limited valid quantitative summary effect measures. The combination of topical interferon with an antiviral agent was significantly better than antiviral therapy at 7 days (OR, 13.49; 95% CI, 7.39-24.61) but not at 14 days (OR, 2.36; 95% CI, 0.82-6.79). Finding apparent heterogeneity for some pooled estimates suggested that dissimilarities in patients, interventions, outcomes, or other logistical aspects of clinical trials occur across studies., CONCLUSIONS: The available evidence on the acute treatment of presumed HSV epithelial keratitis demonstrates the effectiveness of antiviral treatment and shows the log-logistic healing curve of treated dendritic epithelial keratitis. Topical trifluridine, acyclovir, and vidarabine were significantly more effective than idoxuridine but similar in relative effectiveness for dendritic epithelial keratitis. Physicochemical methods of removing infected corneal epithelium are effective, but adjunctive virucidal agents are needed to avert recrudescent epithelial keratitis. Whether debridement in combination with antiviral therapy is more beneficial than antiviral chemotherapy alone appears likely but remains inconclusive. The combination of topical interferon with an antiviral agent significantly speeds epithelial healing. Future trials of the acute treatment of HSV epithelial keratitis must aim to achieve adequate statistical power for assessing the primary outcome and should consider the effect of lesion size and other characteristics on treatment response.
Keywords: Administration, Topical; Adult; Antiviral Agents/tu [Therapeutic Use]; Debridement; Female; Humans; Interferons/tu [Therapeutic Use]; *Keratitis, Dendritic/th [Therapy]; Male; Middle Aged; Time Factors; Wound Healing/de [Drug Effects]

[Medical treatment of glaucoma]. - Garcia Sanchez , J; Garcia Feijoo , J (Archivos de la Sociedad Espanola de Oftalmologia, 2000)
PURPOSE: this review aims to establish the easiest possible diagram to aid the ophthalmologist in the management of the numerous antiglaucomatous agents that have been increasing our therapeutic group., METHOD: we have analyzed the indications, advantages and inconveniences of the medical treatment successively and have reviewed the criteria used to choose a specific drug based on glaucoma severity, general clinical history of the patient, tolerance, local and general adverse effects., RESULTS: finally, we have also considered the ease of compliance, validity of associations and influence of these factors in the patient's quality of life., CONCLUSIONS: the final therapeutic outline is really an index that aims to facilitate a correct use standard.
Keywords: Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; Parasympathomimetics/tu [Therapeutic Use]; Prostaglandins/tu [Therapeutic Use]

[Relevance of quality of life and treatment compliance measurement in patients with chronic open-angle glaucoma]. - Baudouin, C; Bechetoille, A; Bron, A; Denis, P; Nordmann, J P; Renard, J P; Rouland, J F; Sellem, E; Rigeade, M C; Arnould, B (Journal francais d'ophtalmologie, 2000)
Chronic glaucoma is a severe disease that can induce blindness.Early diagnosis and symptomatic treatment reduce the risk of blindness. Treatment that will be started before the onset of clinical signs and will remain lifelong thereafter is troublesome, and therapeutic compliance is usually poor. Thus, quality of life (QOL) measurement in patients with chronic glaucoma has a particular purpose: to measure patients' perception of the disease and treatment in order to maintain good treatment compliance to ensure therapeutic management efficacy and to preserve visual function. No glaucoma-specific instrument is available in the medical and QOL literature. Various generic(SF-36, SF-20 and SIP) and specific(VAQ, VF-14, NEI-VFQ) QOL questionnaires,one glaucoma-specific symptomatic scale (GSS),and one treatment preference scale (COMTol) have been used to measure QOL in glaucoma patients. These instruments do not sufficiently measure the psychosocial dimension of the disease and the QOL impact of treatment. An instrument able to measure all dimensions needs to be developed in order to help ophthalmologists in the therapeutic management of their patients and to measure QOLin patients in the successive stages of the disease.
Keywords: Attitude to Health; Chronic Disease; *Glaucoma, Open-Angle/px [Psychology]; Glaucoma, Open-Angle/rh [Rehabilitation]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Patient Compliance; *Quality of Life; Reproducibility of Results; Social Adjustment; Surveys and Questionnaires

Role of ultrasound biomicroscopy in managing pseudophakic pupillary block glaucoma. - Sathish, S; MacKinnon, J R; Atta, H R (Journal of cataract and refractive surgery, 2000)
We describe a case of anterior capsule adherence to the iris that occurred after phacoemulsification with in-the-bag intraocular lens (IOL) implantation. This adherence led to the development of pseudophakic pupillary block glaucoma. There were no synechias at the pupillary margin associated with the capsule-iris adherence. Ultrasound biomicroscopy, used to evaluate the anterior segment in vivo, clarified the mechanism of pseudophakic pupillary block. The pupillary block was relieved by a single laser iridotomy.
Comment in (CIN)
Keywords: Aged; *Anterior Eye Segment/dg [Diagnostic Imaging]; Female; Filtering Surgery/mt [Methods]; *Glaucoma, Angle-Closure/dg [Diagnostic Imaging]; Glaucoma, Angle-Closure/et [Etiology]; Glaucoma, Angle-Closure/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; *Iris/dg [Diagnostic Imaging]; Iris/su [Surgery]; Laser Therapy; *Lens Implantation, Intraocular/ae [Adverse Effects]; *Phacoemulsification/ae [Adverse Effects]; *Pseudophakia/co [Complications]; Pseudophakia/dg [Diagnostic Imaging]; Pupil/ph [Physiology]; Reoperation; Ultrasonography

Oral erythromycin treatment for childhood blepharokeratitis. - Meisler, D M; Raizman, M B; Traboulsi, E I (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2000)
Blepharokeratitis is a chronic external ocular and adnexal inflammatory condition marked by erythematous and edematous lid margins, lid margin crusting and scaling, meibomian gland inflammation and inspissation, and conjunctival hyperemia. The associated keratitis usually involves the inferior cornea and is characterized by punctate epithelial keratopathy and marginal stromal infiltrates. The inflammation sometimes leads to corneal thinning, scarring, and vascularization. The standard therapy for adult blepharokeratitis includes lid hygiene, topical cortico-steroid preparations, and topical antibiotics. Oral tetracycline and its analogues, doxycycline and minocycline, are used in adults to treat associated meibomian gland dysfunction. Whereas blepharitis is common in children, blepharokeratitis is rare and is often associated with severe ocular and psychosocial morbidity. Treatment of youths may be problematic because of poor compliance with lid hygiene and therapy that includes drops and ointment.(1) Furthermore, the use of tetracycline and its analogues is contraindicated in children aged less than 8 years because it may cause dental enamel abnormalities. Isolated case reports have suggested that erythromycin may be a reasonable alternative to tetracycline in childhood blepharokeratitis.(2,3) We report on the successful treatment of this condition with oral erythromycin in 5 children.
Keywords: Administration, Oral; *Anti-Bacterial Agents/tu [Therapeutic Use]; Blepharitis/co [Complications]; *Blepharitis/dt [Drug Therapy]; Child; Child, Preschool; Chronic Disease; *Erythromycin/tu [Therapeutic Use]; *Eye Infections, Bacterial/dt [Drug Therapy]; Female; Humans; Keratitis/co [Complications]; *Keratitis/dt [Drug Therapy]; Male

Compliance and viewpoint of glaucoma patients in Greece. - Konstas, A G; Maskaleris, G; Gratsonidis, S; Sardelli, C (Eye (London, England), 2000)
PURPOSE: To document the prevalence of non-compliance and to investigate patients' perceptions concerning glaucoma in a Greek cohort., METHODS: We investigated 100 consecutive patients referred to our glaucoma clinic and already treated for chronic glaucoma. Compliance and patients' insight were ascertained by two independent observers by means of a predetermined questionnaire. All patients were subsequently assessed for their ability to instil their eyedrops accurately., RESULTS: Fifty one per cent of our patients were not aware of the nature of glaucoma, but 80% were afraid it might lead to blindness. Clinically significant non-compliance (more than two doses missed per week) was established in 44% of our patients. Men and those using eyedrops more than 4 times a day were more likely to default. Non-compliant patients exhibited higher mean intraocular pressure (22.9 vs 18.5 mmHg; p > 0.001) and worse visual field loss (10.8 vs 7.0 dB; p = 0.008) compared with compliant patients. Involuntary non-compliance was also common in our group, with only 53% instilling their eye drops accurately., CONCLUSION: Non-compliance is a significant limiting factor in glaucoma therapy in Greece.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Attitude to Health; Chronic Disease; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/px [Psychology]; Greece; Humans; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Self Administration/px [Psychology]; Surveys and Questionnaires; *Treatment Refusal

Patients' acceptance of a switch from dorzolamide to brinzolamide for the treatment of glaucoma in a clinical practice setting. - Barnebey, H; Kwok, S Y (Clinical therapeutics, 2000)
BACKGROUND: The first topically active carbonic anhydrase inhibitor, dorzolamide, was developed to circumvent the adverse systemic effects of oral carbonic anhydrase inhibitors. However, its use has been associated with ocular discomfort., OBJECTIVE: The present study examined the acceptability of brinzolamide, as measured by patients' ratings and stated preferences, in patients with glaucoma previously treated with dorzolamide in the clinical practice setting., METHODS: This was a prospective, open-label, noncomparative study conducted shortly after the approval of brinzolamide. Ophthalmologists in private practice in the continental United States were asked to select patients currently using dorzolamide as their sole or combination therapy for glaucoma. Patients underwent a screening assessment in which they were asked to rate their ocular comfort with dorzolamide on a scale from 1 to 6. Brinzolamide was then substituted for dorzolamide, and patients returned for a follow-up visit approximately 1 to 3 months later. At this visit, patients were asked about ocular comfort, their preferred medication, and whether they thought ocular comfort influenced their adherence to treatment. Intraocular pressure (IOP) was measured at both visits., RESULTS: Valid visit dates (ie, both baseline and follow-up dates) were available for 447 of 501 patients from 68 of 73 sites (range, 1-40 patients per site). Because not all measurements were available for all patients at each visit, the sample size varied for each measurement. Demographic data were not available. The switch to brinzolamide resulted in a mean decrease in IOP of approximately 0.8 mm Hg (P < 0.001, paired t test). Sixty-nine percent of patients (274/397) reported an improvement of > or =1 grade in their comfort rating with brinzolamide versus dorzolamide. The mean (+/- SD) improvement in comfort rating was 1.43 +/- 1.48 grades (P < 0.001, Wilcoxon rank sum test). When patients were asked whether their adherence to treatment was affected by the occurrence of burning and stinging, 43% (173/399) answered affirmatively. Fifty-nine percent (251/424) preferred brinzolamide to dorzolamide. At the end of the study, based on patient preference, physician judgment, and other factors, 73% of responding patients (301/410) continued with brinzolamide therapy., CONCLUSIONS: In this study, the switch from dorzolamide to brinzolamide resulted in overall improvements in comfort and ocular hypotensive efficacy. However, studies using a more rigorous randomized, controlled, crossover design are needed to support these observations.
Keywords: Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Patient Satisfaction; Prospective Studies; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiazines/ae [Adverse Effects]; *Thiazines/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]

[Cataract surgery in children]. - Pavlovic, S (Medicinski pregled, 2000)
INTRODUCTION: Cataract extraction in children has improved and became more popular over the past few decades but, due to particular features of children's eyes, still remains controversial--especially regarding the intraocular lens implantation., INDICATIONS FOR OPERATION: In contrast to adults, indications for cataract surgery in children are much more difficult to determine. Since subjective visual acuity cannot be obtained, greater reliance must be placed on the morphology and location of the lens opacity, and the behavior of the child. Forced preferential looking and visual evoked potentials can be helpful, but they should not be the only criteria., CORRECTION OF POSTOPERATIVE APHAKIA: In management of pediatric cataract, correction of postoperative aphakia is still an incompletely resolved problem. Conventionally, optical correction is achieved by spectacles or contact lenses. The power of both spectacles and contact lenses can be readily adjusted to compensate for ocular growth. The success of both depends significantly on parental compliance and the child's acceptance. Hutchinson reported that 44% children with aphakia stopped wearing glasses or contact lenses 2 months after surgery. Contact lens wearing can also result in a number of corneal complications, including infectious keratitis, corneal vascularization and hypoxic corneal ulceration. IOL implantation is theoretically superior to glasses and contact lenses since it provides almost immediate optical correction which is much more reliable because it does not depend on parental or child's compliance. Still, there are many controversies about IOL implantation in infants and young children like IOL-size, material, IOL power calculation, prevention and management of secondary cataract, as well as long term safety of IOLs in children's eyes. Although short-term anatomic results after cataract extraction and primary IOL implantation in children are excellent and stable, long-term follow-up is necessary to answer questions about the long-term safety of implants in children's eyes., POSTOPERATIVE COMPLICATIONS: A higher incidence of postoperative inflammation and opacification of the optical axis has been reported after pediatric cataract surgery. Posterior capsular opacification is almost an unavoidable complication in children's eyes if the posterior capsule is left intact. Several methods have been proposed in order to keep the optical axis clear in infants and young children. Comparison of posterior capsulectomy with and without anterior vitrectomy showed that posterior capsular opacification rates are diminished only after combined posterior capsulectomy and anterior vitrectomy and not after capsulectomy alone. Posterior capsulorhexis with optic capture seems to effectively prevent posterior capsular opacification. This technique eliminates the need for anterior vitrectomy and ensures the centration of the intraocular lens. Glaucoma and retinal detachment are late complications of pediatric cataract surgery. On average glaucoma develops 6.8 years after cataract operation. Retinal detachment develops several decades after cataract extraction., AMBLYOPIA: The functional results after pediatric cataract surgery depend not only on the anatomic success of the operation and postoperative maintenance of a clear optical axis, but even more on aphakic visual rehabilitation. Children's eyes with cataract severe enough to require cataract extraction usually have some degree of amblyopia already present prior to surgery. In unilateral pseudophakia amblyopia develops postoperatively unless the fellow eye is occluded or optically and/or pharmacologically penalized. Immediate optical correction is desirable because prevention and/or therapy of amblyopia should be initiated directly after surgery. Parental compliance with occlusion therapy and not successful surgery are major determinants of a good visual outcome in unilateral aphakic/pseudophakic children.
Keywords: Aphakia, Postcataract/rh [Rehabilitation]; *Cataract Extraction; Child; Humans

[Iris-claw phakic (Artisan) lens to correct high myopia]. - Malecaze, F; Hulin, H; Bierer, P (Journal francais d'ophtalmologie, 2000)
PURPOSE: To assess the safety and efficacy of the iris claw phakic (6mm Artisan lens) in patients with high myopia., METHODS: Twenty-five eyes with myopia of -7.50 to 16D were implanted with a 6mm artisan lens and followed for 24 months., RESULTS: The mean preoperative spherical equivalent refraction was 13.08+/-3.44D at one year. Mean operative spherical equivalent refraction was 0. 77+/-0.57D and 81.8% of eyes had a spherical equivalent refraction within +/-1.00D. Best spectacle-corrected visual acuity was maintained or improved in 62.5% of cases. No iritis or cataract or glaucoma was observed., CONCLUSION: Implantation with the 6mm Artisan lens is an effective method for reducing or correcting myopia up to -16D. Gains in spectacle corrected visual acuity were common, and results suggested good predictability. Because of the incomplete follow up, we cannot draw conclusions about the long term safety of the 6mm Artisan lens.
Keywords: Adult; Contrast Sensitivity; Data Interpretation, Statistical; Humans; *Iris/su [Surgery]; Lens Implantation, Intraocular; *Lenses, Intraocular; Middle Aged; *Myopia/su [Surgery]; Patient Satisfaction; Refraction, Ocular; Visual Acuity

Changing the paradigm for first-line treatment may result in healthier, happier patients. - Noecker, R J (Journal of ophthalmic nursing & technology, 2000)
Keywords: Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Algorithms; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Decision Trees; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Ophthalmology/mt [Methods]; *Patient Satisfaction; *Patient Selection

Glaucoma incidence in an unselected cohort of diabetic patients: is diabetes mellitus a risk factor for glaucoma? DARTS/MEMO collaboration. Diabetes Audit and Research in Tayside Study. Medicines Monitoring Unit. - Ellis, J D; Evans, J M; Ruta, D A; Baines, P S; Leese, G; MacDonald, T M; Morris, A D (The British journal of ophthalmology, 2000)
AIMS: To evaluate whether diabetes mellitus is a risk factor for the development of primary open angle glaucoma or ocular hypertension (OHT)., METHODS: A historical cohort study of an unselected population comprising all residents of the Tayside region of Scotland was performed using record linkage techniques followed by case note review. Ascertainment of prevalent diabetes was achieved using the Diabetes Audit and Research in Tayside Study (DARTS) validated regional diabetes register. Glaucoma and treated OHT were defined by encashment of community prescriptions and the statutory surgical procedure coding database., RESULTS: The study population comprised 6631 diabetic subjects and 166 144 non-diabetic subjects aged >40 years without glaucoma or OHT at study entry. 65 patients with diabetes and 958 without diabetes were identified as new cases of glaucoma or treated OHT during the 24 month study period, yielding a standardised morbidity ratio of 127 (95% CI, 96-158). Case note review demonstrated non-differential misclassification of prevalent glaucoma and OHT as incident disease (diabetic cohort 20%, non-diabetic cohort 24%; p=0.56) primarily as a result of non-compliance in medically treated disease. Removing misclassified cases and adjusting for age yielded an incidence of primary open angle glaucoma in diabetes of 1.1/1000 patient years (95% CI, 0.89-1. 31) compared to 0.7/1000 patient years (95% CI, 0.54-0.86) in the non-diabetic cohort; RR 1.57 (95% CI, 0.99-2.48)., CONCLUSIONS: This study failed to confirm an association between diabetes mellitus and primary open angle glaucoma and ocular hypertension. A non-significant increase in diagnosed and treated disease in the diabetic population was observed, but evidence was also found that detection bias contributes to this association.
Comment in (CIN)
Keywords: Adult; Bias; Cohort Studies; *Diabetes Complications; Diabetes Mellitus/ep [Epidemiology]; Diabetic Angiopathies/ep [Epidemiology]; Diabetic Angiopathies/et [Etiology]; Female; Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/et [Etiology]; Humans; Incidence; Male; Middle Aged; Ocular Hypertension/ep [Epidemiology]; *Ocular Hypertension/et [Etiology]; Prevalence; Risk Factors; Scotland/ep [Epidemiology]

Emerging perspectives on glaucoma: highlights of a roundtable discussion. - Lee, M D; Fechtner, F R; Fiscella, R G; Singh, K; Stewart, W C (American journal of ophthalmology, 2000)
PURPOSE: To present emerging perspectives on open-angle glaucoma related to patient compliance, current drug therapy, and treatment options., METHODS: Roundtable discussion., RESULTS: The panel discussion identified the following issues about patient compliance:1. It is a common problem in clinical practice and is often underappreciated by physicians.2. It is difficult for clinicians to detect.3. There are several risk factors that increase the probability of noncompliance. 4. Compliance can be improved through education, communication, improvement of the doctor-patient relationship, compliance aids, and simplifying the treatment regimen., CONCLUSION: Patients' compliance with the therapeutic regimen for open-angle glaucoma is very important to the eventual outcome of their disease treatment. Physicians can improve their patients' compliance by a few simple, cost-effective interventions in the clinical setting. When considering different agents as first-line therapies, once-a-day dosing would be optimal for enhancing compliance.
Keywords: Communication; Drug Therapy; Economics, Pharmaceutical; Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Patient Compliance; Patient Education as Topic; Physician-Patient Relations; Risk Factors; Trabeculectomy

Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy. - Mendicino, M E; Lynch, M G; Drack, A; Beck, A D; Harbin, T; Pollard, Z; Vela, M A; Lynn, M J (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2000)
PURPOSE: To compare the visual outcome and refractive status of children with primary congenital glaucoma who underwent 360 degrees trabeculotomy or goniotomy as an initial surgical procedure., METHODS: This retrospective study describes 24 eyes (15 patients) with primary congenital glaucoma that underwent 360 degrees trabeculotomy as the initial procedure and 40 eyes (23 patients) that underwent goniotomy as the initial procedure. Inclusion criteria were: (1) diagnosis of primary congenital glaucoma and initial angle surgery before 1 year of age, (2) no other ocular or systemic diseases, (3) 360 degrees trabeculotomy or goniotomy as the first surgical procedure, and (4) ability to obtain an Allen or Snellen visual acuity. A postoperative vision of 20/50 or better was considered good. Surgical success was defined as an intraocular pressure (IOP) less than 22 mm Hg with or without medication and without evidence of a progressive optic neuropathy., RESULTS: The IOP was successfully controlled in 92% of eyes in the trabeculotomy group and in 58% of eyes in the goniotomy group (P =.004). Of eyes in the trabeculotomy group, 79% had vision of 20/50 or better compared with 53% in the goniotomy group (P =.03). High myopia was more prevalent in the goniotomy group, but this difference was not statistically significant (P =.16). A poor visual outcome was associated with failure of the angle surgery or poor compliance with follow-up and amblyopia therapy., CONCLUSION: For primary congenital glaucoma, 360 degrees trabeculotomy is a highly effective procedure that results in excellent pressure control and is at least as successful as multiple standard procedures. In this study, 360 degrees trabeculotomy resulted in better vision than what is reported in the literature for standard angle procedures.
Keywords: Anterior Chamber/pa [Pathology]; *Anterior Chamber/su [Surgery]; Female; Follow-Up Studies; *Glaucoma/cn [Congenital]; Glaucoma/pa [Pathology]; *Glaucoma/su [Surgery]; Humans; Infant; Infant, Newborn; Intraocular Pressure; Male; Retrospective Studies; *Trabeculectomy/mt [Methods]; Treatment Outcome; *Visual Acuity

Fungal keratitis in a soft contact lens wearer. - Foroozan, R; Eagle, R C Jr; Cohen, E J (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 2000)
PURPOSE: To describe a case of fungal keratitis in a soft contact lens wearer., METHODS AND RESULTS: A 57 year old female, compliant, frequent replacement soft contact lens wearer, with a possible prior history of herpes simplex keratitis, presented with pain and injection of her left eye of four weeks duration. Gram stain of a corneal ulcer of the left eye revealed fungal organisms and cultures grew Fusarium solani. The infiltrate responded to topical and systemic antifungal agents, but a corneal perforation developed which required a therapeutic penetrating keratoplasty., CONCLUSIONS: Fungal infections are a cause of corneal ulcers in contact lens wearers. Despite the use of topical and systemic antifungal agents, fungal ulcers frequently require surgical intervention.
Keywords: Antifungal Agents/ad [Administration & Dosage]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Contact Lenses, Hydrophilic/mi [Microbiology]; Cornea/mi [Microbiology]; Cornea/pa [Pathology]; *Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/pa [Pathology]; Corneal Ulcer/th [Therapy]; Diagnosis, Differential; Eye Infections, Fungal/mi [Microbiology]; Eye Infections, Fungal/pa [Pathology]; Eye Infections, Fungal/th [Therapy]; *Eye Infections, Fungal; Female; *Fusarium/ip [Isolation & Purification]; Humans; Keratoplasty, Penetrating; Middle Aged; *Mycoses/mi [Microbiology]; Mycoses/pa [Pathology]; Mycoses/th [Therapy]; Ophthalmic Solutions; Rupture, Spontaneous; Visual Acuity

[What strategy after three trabeculectomy failures?]. - Hamard, P (Journal francais d'ophtalmologie, 2000)
Three trabeculectomy failures raises the delicate problem of refractory glaucoma with unresponsive ocular hypertony. The therapeutic strategy requires first a careful assessment of the reasons for the previous failures (internal or external obstacles to filtration which might have responded to preventive treatment), then, depending on the patient's age, type of glaucoma, anatomic status of the ocular structures and the visual potential of the eye, a choice has to be made between different surgical techniques aimed at favoring aqueous humor evacuation (trabeculectomy associated with antimetabolites or drainage implant) or destruction of the ciliary body to reduce intraocular pressure by limiting the production of aqueous humor. Choosing between these two possibilities is not an easy task as success rates are highly variable on such eyes and complications are frequent, leading to lower visual acuity in 30 % of the cases. These salvage procedures recall that first line trabeculectomy must be optimized in all cases.
Keywords: *Glaucoma/su [Surgery]; Humans; Reoperation; *Trabeculectomy; Treatment Failure

[Evaluation of results of cataract surgery in patients 90 years and older (in a group of long-lived individuals)]. - Novakova, D; Novak, J; Rozsival, P (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2000)
In a group of 71 patients with cataract aged 90 years or more operated between July 1 1997 and December 31 1998 at the Ophthalmological Clinic, Faculty Hospital Hradec Kralove (operations of 79 eyes) a modified questionnaire was used based on VF 14, to assess the benefit of cataract surgery in patients of this age. Replies were obtained only from 38 questionnaires, completed by the patient with the assistance of relatives. Fourteen questionnaires were supplemented by a letter where the relatives described their view on the benefit of the operation for the patient. To the remainder the questionnaire could not be delivered. Improvement of the quality of life after surgery was recorded in 32 instances, once deterioration and four times the condition did not change. The majority of patients (33, i.e. 87%) would, if there was an opportunity have the operation again, while four patients would not have it and one patient did not know. Two of four patients who would not have another operation had severe senile macular degeneration (SMD) of the fundus, another two suffer in addition to SMD from glaucoma (G) with loss of visual functions already before surgery. The questionnaire method gives a better idea of the benefit of surgery for the patient than mere evaluation of visual acuity. From the results ensues that it is necessary to pay special attention to indications for surgery in patients with severe SMD and indicate surgery very carefully also in other complicating diseases in view of the higher risk of the operation. Patients of this age take a poor effect of cataract surgery very badly, while, on the other hand, a successful operation leads to general improvement of their condition and they respond very favourably.
Keywords: Age Factors; Aged; Cataract Extraction/ae [Adverse Effects]; *Cataract Extraction; Female; Humans; Male; Patient Satisfaction; *Quality of Life; Surveys and Questionnaires; Visual Acuity

Age related compliance of the lamina cribrosa in human eyes. - Albon, J; Purslow, P P; Karwatowski, W S; Easty, D L (The British journal of ophthalmology, 2000)
AIMS: To investigate changes in the mechanical compliance of ex vivo human lamina cribrosa with age., METHODS: A laser scanning confocal microscope was used to image the surface of the fluorescently labelled lamina cribrosa in cadaver eyes. A method was developed to determine changes in the volume and strain of the lamina cribrosa created by increases in pressure. The ability of the lamina cribrosa to reverse its deformation on removal of pressure was also measured., RESULTS: Volume and strain measurements both demonstrated that the lamina cribrosa increased in stiffness with age and the level of pressure applied. The ability of the lamina cribrosa to regain its original shape and size on removal of pressure appeared to decrease with age, demonstrating an age related decrease in resilience of the lamina cribrosa., CONCLUSIONS: The mechanical compliance of the human lamina cribrosa decreased with age. Misalignment of compliant cribriform plates in a young eye may exert a lesser stress on nerve axons, than that exerted by the rigid plates of an elderly lamina cribrosa. The resilience of the lamina cribrosa also decreased with age, suggesting an increased susceptibility to plastic flow and permanent deformation. Such changes may be of importance in the explanation of age related optic neuropathy in primary open angle glaucoma.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Aging/ph [Physiology]; Child; Compliance; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Microscopy, Confocal; Middle Aged; *Optic Disk/ph [Physiology]; Optic Disk/pp [Physiopathology]; Pressure; Rheology

The long-term safety and efficacy of brinzolamide 1.0% (azopt) in patients with primary open-angle glaucoma or ocular hypertension. The Brinzolamide Long-Term Therapy Study Group. - March, W F; Ochsner, K I (American journal of ophthalmology, 2000)
PURPOSE: Oral carbonic anhydrase inhibitors used to treat glaucoma have significant systemic side effects. Brinzolamide 1.0%, a new topical ocular carbonic anhydrase inhibitor, is effective apparently without significant systemic side effects. This study was performed to establish the long-term safety and efficacy of brinzolamide 1.0% two and three times daily for primary open-angle glaucoma and ocular hypertension., METHODS: An 18-month, multicenter, double-masked, parallel, controlled study was conducted. Patients were randomized to brinzolamide two or three times daily or timolol 0.5% twice daily in a 2:2:1 ratio (n = 150, 153, and 75, respectively). Intraocular pressure was measured at 8:00 AM at eligibility and months 1, 3, 6, 9, 12, 15, and 18. Efficacy was based on intraocular pressure reduction from baseline. Safety was also evaluated., RESULTS: All regimens produced clinically relevant and statistically significant (P<.05) intraocular pressure reductions from baseline. Mean changes in intraocular pressure trough measurements ranged from -2.7 to -3.9 mm Hg with brinzolamide twice-daily dosing and -2.8 to -3.8 mm Hg three times daily dosing compared with -4.7 to -5.6 mm Hg with timolol. The intraocular pressure reductions with brinzolamide two and three times daily were clinically and statistically equivalent. One hundred forty-four patients were discontinued from the study after randomization with the most common reasons being the occurrence of an adverse event (46), inadequate intraocular pressure control (23), patient decision unrelated to study medication (11), lost to follow-up (16), and noncompliance (9). Adverse events were nonserious and resolved without sequelae. There were no clinically relevant changes in safety parameters. Brinzolamide produced less ocular discomfort (burning/stinging) than timolol, and total carbonic anhydrase inhibition levels remained below that known to cause systemic side effects., CONCLUSION: Brinzolamide produced significant and equivalent reductions in intraocular pressure when dosed two and three times daily for 18 months. Brinzolamide was safe and well tolerated by patients, with minimal ocular discomfort.
Keywords: Administration, Topical; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Double-Blind Method; Drug Evaluation; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/tu [Therapeutic Use]; Safety; Sulfonamides/ad [Administration & Dosage]; *Sulfonamides/tu [Therapeutic Use]; Thiazines/ad [Administration & Dosage]; *Thiazines/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/tu [Therapeutic Use]

Ocular comfort of brinzolamide 1.0% ophthalmic suspension compared with dorzolamide 2.0% ophthalmic solution: results from two multicenter comfort studies. Brinzolamide Comfort Study Group. - Silver, L H (Survey of ophthalmology, 2000)
Two independent, prospective, multicenter, double-masked, parallel group trials were conducted to compare the ocular comfort of brinzolamide 1.0% administered three times daily (t.i.d.) with t.i.d.-dosed dorzolamide 2.0% in patients with primary open-angle glaucoma or ocular hypertension. Patients were randomized to one of two treatment groups, receiving either brinzolamide 1.0% t.i.d. or dorzolamide 2.0% t.i.d. for 1 week. On the last day of dosing, patients received one drop of masked medication in both eyes, and ocular discomfort (burning or stinging) was evaluated by means of a 4-unit ocular discomfort scale. The incidence and extent of ocular discomfort across both treatment groups were analyzed. The results from both studies were confirmatory and demonstrated that the ocular discomfort score for brinzolamide 1.0% was 1.3 units lower than the score for dorzolamide 2.0%, which was both statistically significant and clinically relevant. In addition, a statistically significantly greater percentage of patients reported no ocular discomfort with brinzolamide 1.0% compared with dorzolamide. A greater percentage of patients receiving dorzolamide 2.0% also reported mild, moderate, severe, and very severe ocular discomfort compared with those treated with brinzolamide 1.0%. The most frequent ocular adverse event reported in the brinzolamide group was transient blurred vision, which ranged from 20% to 25%. Overall, adverse events associated with brinzolamide 1.0% and dorzolamide 2.0% were nonserious, were usually mild, and resolved without treatment. The findings of each study independently demonstrated that brinzolamide 1.0% was significantly more comfortable than dorzolamide 2.0% when instilled in the eye.
Keywords: Adult; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Double-Blind Method; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Patient Satisfaction; Prospective Studies; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Suspensions; Thiazines/ad [Administration & Dosage]; Thiazines/ae [Adverse Effects]; *Thiazines/tu [Therapeutic Use]; Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Treatment Outcome

Preclinical overview of brinzolamide. - DeSantis, L (Survey of ophthalmology, 2000)
The development of topically active carbonic anhydrase inhibitors (CAIs) is a significant recent achievement in glaucoma medical treatment. Brinzolamide, the newest topical CAI, exhibits selectivity, high affinity, and potent inhibitory activity for the carbonic anhydrase type II isozyme (CA-II), which is involved in aqueous humor secretion. These characteristics, along with good ocular bioavailability, make brinzolamide maximally effective in lowering intraocular pressure (IOP) by locally inhibiting CA-II in the ciliary processes and suppressing aqueous humor secretion. Notable among its attributes as a safe and efficacious glaucoma drug is brinzolamide's superior ocular comfort profile because of its optimized suspension formulation at physiologic pH. The degree of tolerability in the eye is considered an important determinant of a patient's willingness to comply with the dosing regimen for a long-term glaucoma medication. Results from the preclinical pharmacologic evaluation of brinzolamide indicated that it acts specifically to inhibit CA without significant other pharmacologic actions that could introduce undesired side effects. Moreover, the typical side effects associated with systemically administered CAIs are expected to occur at a lower incidence or not occur at all with brinzolamide, as its therapeutic dose and low systemic absorption do not produce a problematic level of systemic CA inhibition. Brinzolamide's long tissue half-life in the eye, particularly in the iris-ciliary body, favors a prolonged duration of IOP lowering. This was substantiated in clinical trials, which showed that twice-daily brinzolamide provides as significant an IOP reduction as three-times-daily brinzolamide or dorzolamide in a relatively high percentage of patients. Brinzolamide has been shown by the laser Doppler flowmetry technique to improve blood flow to the optic nerve head in pigmented rabbits after topical administration, without producing an increase of blood pCO2, indicating a potential for a local vasodilatory effect involving the optic nerve head circulation. The mean concentration of brinzolamide found in the retina of pigmented rabbits (0.338 microg equivalents/g) after a single dose of 14C-brinzolamide is sufficient to inhibit CA-II. These data suggest that topical brinzolamide could improve the blood flow in the optic nerve head in humans should it inhibit carbonic anhydrase in that vascular bed. Brinzolamide is a new topically active CAI that is safe and efficacious for reducing intraocular pressure. It offers the convenience of topical dose administration and greater freedom from side effects related to the inhibition of CA seen with the systemic administration of CAIs. Its formulation has been optimized to provide greater comfort upon instillation, and this can result in a higher compliance rate by the patient. Results of studies in animals show that brinzolamide has promise for increasing blood flow to the optic nerve head; however, this requires further assessment in the clinic. Brinzolamide represents a significant technical achievement and an important addition to the medical treatment of glaucoma as both a primary and an adjunctive drug.
Keywords: Absorption; Animals; Blood Flow Velocity/de [Drug Effects]; Carbonic Anhydrase Inhibitors/me [Metabolism]; Carbonic Anhydrase Inhibitors/pk [Pharmacokinetics]; *Carbonic Anhydrase Inhibitors/pd [Pharmacology]; Drug Evaluation, Preclinical; Eye/me [Metabolism]; Half-Life; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/pk [Pharmacokinetics]; Ophthalmic Solutions/pd [Pharmacology]; Rabbits; Sulfonamides/me [Metabolism]; Sulfonamides/pk [Pharmacokinetics]; *Sulfonamides/pd [Pharmacology]; Thiazines/me [Metabolism]; Thiazines/pk [Pharmacokinetics]; *Thiazines/pd [Pharmacology]; Tissue Distribution

[Wound or suture insufficiency complicating penetrating keratoplasty]. - Nolle, B; Halene, M A; Grutters, G; Duncker, G I (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2000)
BACKGROUND: With regard to penetrating keratoplasty methods to culture corneal donor tissues, microsurgical techniques, HLA typing and understanding of basic mechanisms in inflammation and especially graft rejection, and postoperative treatment schedules have been improved in recent years. This now enables successful penetrating keratoplasty in many more patients than previously performed. However, in rare cases relevant problems in wound closure may appear., PATIENTS AND METHODS: A standardized treatment protocol was applied to 1,253 penetrating keratoplasties performed in a single center. Patients were continuously followed up. Simple leakage after corneal grafting was not further analyzed if conservative treatment or additional sutures achieved sufficient wound closure. In 21 cases, however, the causes of large wound dehiscence after corneal grafting were analyzed., RESULTS: During the first week early problems in suturing penetrating keratoplasty in five patients were associated with the instability of the recipients' corneal stroma (stromal thinning in keratoconus or corneal herpes, suture problems in keratomalacia, active herpes keratitis, corneal burns, or rheumatic diseases). Long-term complications in 16 patients were associated with alcoholism, herpes keratitis, rheumatic disorders or traumatic suture defects. Overall, nine patients lost functionally or even anatomically one eye because of wound dehiscence after corneal grafting., CONCLUSIONS: When penetrating keratoplasty is indicated, special attention should be given to (1) the compliance of the patient, (2) sufficient treatment of herpes keratitis or other infections, (3) adequate immunosuppression in autoimmune corneal inflammation, (4) double running continuous sutures as primary suture with sometimes additional single sutures to stabilize the graft, and (5) surgery in time.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; *Keratoplasty, Penetrating/ae [Adverse Effects]; Male; Middle Aged; Risk Factors; *Surgical Wound Dehiscence/et [Etiology]; *Sutures/ae [Adverse Effects]

Congenital unilateral buphthalmos in Walker-Warburg syndrome: a clinicopathological study. - Rehany, U; Segal, Z I; Rumelt, S (Eye (London, England), 1999)
BACKGROUND AND PURPOSE: Walker-Warburg syndrome is a congenital autosomal recessive oculocerebral disorder characterised by hydrocephalus, brain agyria, microphthalmos and retinal dysplasia with or without meningoencephalocele. We describe an unusual finding of congenital unilateral glaucoma and buphthalmos in one eye and microphthalmos in the fellow eye of two neonates with Walker-Warburg syndrome., PATIENTS: Two neonates with Walker-Warburg syndrome and unusual findings of buphthalmos in one eye and a microphthalmic fellow eye are presented., RESULTS: Histological examination of the buphthalmic eyes revealed the presence of mesenchymal tissue in the anterior angle covered by endothelium. No anterior chamber angle was identified in the microphthalmic fellow eye and the iris was adherent to the corneal periphery., CONCLUSIONS: Congenital buphthalmos may also appear in Walker-Warburg syndrome. The buphthalmos may result from later embryonal ocular developmental arrest than that of the microphthalmic eye.
Keywords: *Abnormalities, Multiple; Encephalocele/di [Diagnosis]; Humans; *Hydrophthalmos/pa [Pathology]; Infant, Newborn; Infant, Premature; Male; Meningocele/di [Diagnosis]; *Microphthalmos/pa [Pathology]; Syndrome

Glaucoma awareness and screening uptake in relatives of people with glaucoma. - Eke, T; Reddy, M A; Karwatowski, W S (Eye (London, England), 1999)
PURPOSE: To assess glaucoma awareness and screening uptake in relatives of people with glaucoma., METHODS: A questionnaire was administered to 52 patients with primary open-angle glaucoma. They were asked about their awareness of glaucoma clustering within families, and the need for glaucoma screening in relatives of glaucoma patients. Patients were asked to identify one or more first-degree relatives, aged over 40 years and thus eligible for free glaucoma screening in the United Kingdom. These relatives were mailed a similar questionnaire. In performing the statistical analysis we corrected for possible clustering within families. The study was approved in advance by our local ethics committee, and all participants were informed of the United Kingdom's free screening service afterwards., RESULTS: Ninety relatives were identified, of whom 70 (78%) returned questionnaires. Only 53% of responding relatives thought they were at increased lifetime risk of developing glaucoma. Though 81% of relatives had been screened, many were screened infrequently. We compared the responses of patients' siblings and patients' offspring. Perceived lifetime glaucoma risk was similar in the two groups, but the (older) siblings had a significantly lower awareness of the free screening service (p = 0.03) and attended for screening less frequently (p = 0.07). Uptake of regular, free glaucoma screening at least every 2 years was 57% among offspring and 30% among siblings (p = 0.005). Because of selection bias (good communicators were more likely to be invited to participate) the true rates of glaucoma awareness and screening uptake are almost certainly lower than this., CONCLUSIONS: Relatives of people with glaucoma should be made more aware of the need for glaucoma screening and encouraged to use the free screening service. Older relatives should be particularly targeted.
Keywords: Aged; Aged, 80 and over; Communication; England; Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/ge [Genetics]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Patient Acceptance of Health Care; Risk Assessment; *Vision Screening/px [Psychology]; Vision Screening/sn [Statistics & Numerical Data]

The National Survey of Trabeculectomy. I. Sample and methods. - Edmunds, B; Thompson, J R; Salmon, J F; Wormald, R P (Eye (London, England), 1999)
PURPOSE: The National Survey of Trabeculectomy was designed to evaluate current practices of glaucoma surgery in the United Kingdom and to determine the success and complication rates of trabeculectomy on a national basis. This paper reports the survey methods, levels of consultant activity, waiting times, indications for surgery and the demographic and clinical characteristics of the patient sample., METHODS: Consultant ophthalmologists performing trabeculectomy in the United Kingdom were studied. Four consecutive patients undergoing trabeculectomy under each consultant prior to 18 June 1996 were retrospectively sampled. Patients were followed prospectively and evaluated 6 and 12 months after surgery. Data were collected by self-administered postal questionnaires. To determine the effects of selection and reporting bias a validation study of 14 randomly selected units was also conducted., RESULTS: Three hundred and eighty-two consultants recruited 1454 eligible patients for analysis. The mean age of patients was 69.2 years (standard deviation 10.9) and 51.7% were male. The underlying diagnosis was primary open angle glaucoma in 89.2%, pseudoexfoliation glaucoma in 5.4%, normal tension glaucoma in 3.8% and pigmentary glaucoma in 1.6%. There was advanced visual field damage in 50.5% of the cohort by the time of listing. The main indications for surgery were failure of medication to control intraocular pressure in 57.1%, progressive visual field loss in 26.5% and progressive optic disc damage in 4.8%. Primary surgery was undertaken in 4.8% of patients. In 80% trabeculectomy was performed within 3 months of listing. However, almost a third of consultants considered individual patient's waiting time too long. Validation studies confirmed that systematic bias did not operate in the selection of patients for the survey or in the reporting of outcomes., CONCLUSION: The findings of this survey are representative of current practices of trabeculectomy by consultants throughout the United Kingdom and show considerable variation in practice. Failure to control intraocular pressure with topical medications was the main indication for surgery. Advanced glaucomatous visual field damage was present at the time of surgery in half the sample. Though most patients were operated on within 3 months of listing, almost a third of consultants considered the wait unacceptably long.
Comment in (CIN)
Keywords: Age Factors; Aged; Aged, 80 and over; Female; Follow-Up Studies; *Glaucoma, Open-Angle/su [Surgery]; *Health Care Surveys/mt [Methods]; Humans; Intraocular Pressure; Long-Term Care/mt [Methods]; Male; Middle Aged; Patient Selection; Prospective Studies; Retrospective Studies; State Medicine/sn [Statistics & Numerical Data]; Trabeculectomy/ae [Adverse Effects]; Trabeculectomy/mt [Methods]; *Trabeculectomy/sn [Statistics & Numerical Data]; United Kingdom/ep [Epidemiology]; Waiting Lists

[Corneal transplantation]. - Hovding, G (Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 1999)
The first successful corneal transplantation was done in 1906, when the corneas of a recently deceased boy were transferred to a man blinded by an alkali burn. Since then, improved equipment, microsurgical technique and better methods for treating postoperative complications have greatly improved the prognosis of corneal grafting. Immunological reactions are less frequently seen after keratoplasty than after other types of transplantation, and the graft is also directly accessible for immunosuppressive treatment. Penetrating keratoplasty accounts for more than 95% of all corneal transplantations in Norway, the other procedures being lamellar grafting and epikeratophakia. While keratitis and macula corneae previously were the main indications for keratoplasty, keratoconus is at present the most frequent indication. The prognosis is poorer in eyes with extensive vascularization, lacking sensibility, insufficient tear secretion and marked symblepharon. Due to shortage of suitable donor tissue, the waiting lists for this type of ocular surgery are increasing.
Keywords: Contraindications; Corneal Transplantation/hi [History]; Corneal Transplantation/mt [Methods]; *Corneal Transplantation; Europe; Eye Banks; History, 20th Century; Humans; Prognosis; Tissue and Organ Procurement; Transplantation Conditioning; United States; Waiting Lists

Management of diabetic retinopathy by Australian optometrists. Working Group on Evaluation of NHMRC Retinopathy Guideline Distribution. National Health and Medical Research Council. - McCarty, C A; McKay, R; Keeffe, J E (Australian and New Zealand journal of ophthalmology, 1999)
PURPOSE: To describe current practices related to the management of diabetic retinopathy by Australian optometrists., SETTING AND METHODS: A two-page self-administered questionnaire was mailed to a random sample of 504 Australian optometrists. The survey included questions about the practice (such as size and location); current practice with regard to management of patients with diabetic retinopathy; barriers to use of dilating drops; and a number of patient scenarios related to screening, follow-up and treatment of diabetic retinopathy., RESULTS: Completed questionnaires were returned by 407 of the 473 eligible optometrists (86%). They had been practising optometry between 1 and 50 years (median 14). Of the 243 optometrists who provided details about the location of their practices, 145 (37%) had at least one of their practices in a rural area. The estimated percentage of patients with diagnosed diabetes ranged from 0.5 to 40% (median = 5.0%). Three-hundred and twenty-two optometrists (79%) reported that they would often or almost always ask new patients over the age of 40 whether they have diabetes. The majority of optometrists (n = 387, 95%) would often or almost always ask their new patients with diabetes about their control of blood glucose levels and the majority of optometrists (n = 330, 81%) would often or almost always tell their patients with diabetes about the importance of strict glucose control in delaying retinopathy. The most common barrier to dilated ophthalmoscopy was patients not wanting to be dilated, with 38.1% of optometrists reporting this to be a moderate or major barrier. The next most common barrier was fear of precipitating angle closure glaucoma; 17.1% of optometrists reported this to be a moderate or major barrier, CONCLUSION: The National Health and Medical Research Council (NHMRC) guidelines for the management of diabetic retinopathy are timely in relation to the expressed desire of Australian optometrists to learn more about management of diabetic retinopathy These data will be used prospectively to assess changes in management of patients with diabetic retinopathy as a result of the release of the NHMRC guidelines.
Keywords: Australia; Child; *Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/th [Therapy]; Diagnostic Techniques, Ophthalmological; Health Services Research; Humans; Middle Aged; *Optometry/mt [Methods]; Practice Guidelines as Topic; *Practice Patterns, Physicians'; Random Allocation; Surveys and Questionnaires

The application of teleophthalmology in examining patients with glaucoma: a pilot study. - Tuulonen, A; Ohinmaa, T; Alanko, H I; Hyytinen, P; Juutinen, A; Toppinen, E (Journal of glaucoma, 1999)
PURPOSE: To test the feasibility of teleophthalmology applications in examining patients with glaucoma, test its use for training purposes in an ophthalmology residency program and as a consultation link between primary healthcare unit and university eye clinic, and to introduce a preliminary model for economic assessment of telemedicine application in ophthalmology., METHODS: A video slit-lamp, an automated perimeter, a nonmydriatic fundus camera and a videoconferencing system were installed in a healthcare center in a rural area. Twenty-nine patients with glaucoma were examined in the rural healthcare center instead of the university eye clinic. A control group consisted of 41 glaucoma patients examined at the eye clinic one year earlier. An ophthalmic resident examined the patients together with the local general practitioner. An interactive video consultation was created with the university glaucoma clinic using ISDN connections and special application software., RESULTS: Both patient groups were equally satisfied with the ophthalmic service. Nearly all patients in the telemedicine group (96%) wanted to have their next visit in their own healthcare center instead of the university clinic. The most important reasons were reduction in traveling (97%), costs (92%), and time (92%). The costs of the telemedicine and conventional visits were equal, but decreased traveling saved $55 per visit. However, the quality of the images obtained in the remote center was poorer than that of the images obtained at the university clinic., CONCLUSION: The results of this pilot study indicate that further research with a larger number of patients is warranted to evaluate both methods, technology, and economics of teleophthalmology.
Keywords: Academic Medical Centers; Female; *Glaucoma/di [Diagnosis]; Glaucoma/ec [Economics]; Humans; Internship and Residency; Male; Middle Aged; Nerve Fibers/pa [Pathology]; Ophthalmology/ec [Economics]; Ophthalmology/ed [Education]; *Ophthalmology/mt [Methods]; Optic Disk/pa [Pathology]; Optic Nerve/pa [Pathology]; Patient Satisfaction; Pilot Projects; Primary Health Care/ec [Economics]; Primary Health Care/mt [Methods]; Remote Consultation/ec [Economics]; Remote Consultation/mt [Methods]; Retina/pa [Pathology]; Rural Population; Teaching/mt [Methods]; Telemedicine/ec [Economics]; *Telemedicine/mt [Methods]; Visual Fields

The dorzolamide/timolol combination versus timolol plus pilocarpine: patient preference and impact on daily life. United States Patient Preference Study Group. International Patient Preference Study Group. - Sverrisson, T; Gross, R; Pearson, J; Rusk, C; Adamsons, I (Journal of glaucoma, 1999)
PURPOSE: To compare the 2.0% dorzolamide/0.5% timolol fixed combination (COSOPT; Merck & Co., Whitehouse Station, NJ) to 0.5% timolol plus 2.0% pilocarpine given concomitantly, and to determine patient preference, tolerability, and impact on daily life in patients with elevated intraocular pressure (IOP)., METHODS: Two multi-center, randomized, cross-over, observer masked studies were conducted, one in the United States (97 patients) and one in Europe (93 patients). The Comparison of Ophthalmic Medications for Tolerability questionnaire was used to assess patient preference and perception of side effects and activity limitations resulting from study medications. Intraocular pressure was measured before and 2 hours after the morning dose of study medication (hour 0 and hour 2)., RESULTS: In both studies, among patients with a preference, the combination was preterred to timolol plus pilocarpine by a ratio of 4 to 1. The most commonly cited reason for this preference was side effects. Patients in both studies also reported that the combination interfered significantly less with daily life in terms of side effects and activity limitations. They also reported missing significantly fewer doses of study medication while taking the combination and being significantly more satisfied with it. The efficacy of these two treatments was not significantly different, based on IOP measurements at hour 0 and 2 hours after administration. Patients reported significantly more adverse events while receiving timolol plus pilocarpine in both studies, and in the U.S. study, significantly more patients discontinued therapy while receiving timolol plus pilocarpine than while receiving the combination., CONCLUSION: Compared with timolol plus pilocarpine, patients preferred the combination of 2% dorzolamide/0.5% timolol, and reported less interference in daily activities, better tolerability, and better compliance with therapy.
Keywords: *Activities of Daily Living; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Miotics/ae [Adverse Effects]; Miotics/tu [Therapeutic Use]; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Satisfaction; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Surveys and Questionnaires; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Comparison of dorzolamide and pilocarpine as adjunctive therapy in patients with open-angle glaucoma and ocular hypertension. - Hartenbaum, D; Maloney, S; Vaccarelli, L; Liss, C; Wilson, H; Gormley, G J (Clinical therapeutics, 1999)
Many patients with glaucoma or ocular hypertension initially receive beta-blocker monotherapy to control intraocular pressure (IOP), but some of these patients will require an additional IOP-lowering agent within 1 year. This active-controlled, double-masked, randomized, multicenter, 12-week study compared the effectiveness and tolerability of dorzolamide hydrochloride ophthalmic solution 2% TID with those of pilocarpine hydrochloride 2% QID as adjunctive therapy to timolol maleate ophthalmic gel-forming solution (TG) 0.5% QD as measured by changes in IOP and occurrence of adverse events. One hundred ninety-four patients with open-angle glaucoma or ocular hypertension participated in this study. Their mean age was approximately 63 years. Slightly more than one half were white, and approximately one third were black. After a 3-week run-in period during which all patients received TG 0.5% QD, patients with an IOP of > or = 22 mm Hg at the morning trough measurement were randomly assigned to receive additional double-masked therapy with either dorzolamide or pilocarpine. The primary outcome measure was the mean change in IOP at the morning trough measurement from baseline to week 12. The secondary outcome measure was the mean change in IOP at the morning peak measurement from baseline to week 12. There was no significant difference in IOP-lowering effect between the 2 drugs at either morning trough or morning peak. The mean change in IOP at morning trough was -3.17 mm Hg (-12%) in patients receiving dorzolamide; it was -3.45 mm Hg (-13%) in patients receiving pilocarpine. The mean change in IOP at morning peak was -2.25 mm Hg (-10%) for patients who received dorzolamide and -2.51 mm Hg (-11%) for those who received pilocarpine. In the pilocarpine group, 62 (63%) patients experienced > or =1 adverse event compared with 35 (36%) patients in the dorzolamide group (P < 0.001). Twenty-one (21%) patients in the pilocarpine group discontinued treatment because of an adverse event compared with 2 (2%) patients in the dorzolamide group (P < 0.001). These results demonstrate that dorzolamide and pilocarpine were equally effective as adjunctive therapy in lowering IOP but that dorzolamide was better tolerated.
Keywords: *Adjuvants, Pharmaceutic/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Double-Blind Method; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Parasympathomimetics/ae [Adverse Effects]; Parasympathomimetics/tu [Therapeutic Use]; Patient Dropouts; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Time Factors; Timolol/tu [Therapeutic Use]; Treatment Outcome

Color discrimination, color naming and color preferences in 80-year olds. - Wijk, H; Berg, S; Sivik, L; Steen, B (Aging (Milan, Italy), 1999)
The aim of the present study was to investigate color discrimination, color naming and color preference in a random sample of 80-year-old men and women. Knowledge of color perception in old age can be of value when using color contrast, cues and codes in the environment to promote orientation and function. The color naming test indicated that the colors white, black, yellow, red, blue and green promoted recognition to the highest degree among all subjects. A gender-related difference, in favor of women, occurred in naming five of the mixed colors. Women also used more varied color names than men. Color discrimination was easier in the red and yellow area than in the blue and green area. This result correlates positively with visual function on far sight, and negatively with diagnosis of a cataract. The preference order for seven colors put blue, green and red at the top, and brown at the bottom, hence agreeing with earlier studies, and indicating that the preference order for colors remains relatively stable also in old age. This result should be considered when designing environments for old people.
Keywords: Aged; Aged, 80 and over; *Aging/ph [Physiology]; Cataract/pp [Physiopathology]; Color; *Color Perception; *Discrimination Learning; Female; Glaucoma/pp [Physiopathology]; Humans; Male; *Patient Satisfaction; Photic Stimulation; Sex Factors; Verbal Learning

Intraocular metastases of cutaneous malignant melanoma: a case report and review of the literature. - Ramaesh, K; Marshall, J W; Wharton, S B; Dhillon, B (Eye (London, England), 1999)
Cutaneous malignant melanoma metastatic to the eye is rare but has been documented. The usual presentation is after the diagnosis of disseminated metastases. A 40-year-old Caucasian man presented with floaters and hazy vision due to ocular metastasis. He developed painful intractable rubeotic glaucoma leading to enucleation. Histopathological examination confirmed anterior segment tumour adherent to the iris that was consistent histopathologically with the primary cutaneous melanoma.
Keywords: Adult; *Ciliary Body; Humans; Male; Melanoma/pa [Pathology]; *Melanoma/sc [Secondary]; *Skin Neoplasms/pa [Pathology]; Uveal Neoplasms/pa [Pathology]; *Uveal Neoplasms/sc [Secondary]

Dissatisfaction with cataract surgery in relation to visual results in a population-based study in Sweden. - Monestam, E; Wachtmeister, L (Journal of cataract and refractive surgery, 1999)
PURPOSE: To evaluate dissatisfied patients and those with subjectively worse visual ability after cataract surgery and to analyze how these factors relate to poor visual acuity results (worse than 20/40)., SETTING: Department of Ophthalmology, Norrlands University Hospital, Umea, Sweden., METHODS: A prospective, population-based study of cataract surgery outcome was conducted. All patients (459 surgeries) who had cataract surgery during a 1 year period were studied using self-administered questionnaires and data from patient records. Outcome measures were (1) patient degree of satisfaction with the result, (2) subjective visual ability after surgery of visually demanding tasks such as reading, television viewing, orientation in unfamiliar surroundings, and distance estimation far and near, and (3) visual acuity results., RESULTS: After surgery, 37 of the 459 cases (8%) were dissatisfied. These patients had a significantly lower age-corrected visual acuity in the operated eye than the satisfied patients (P < .0001). Ten percent said 1 or more visual ability was worse after their cataract surgery. Logistic regression analysis revealed that the visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors. Poor visual acuity after surgery in the operated eye was found in 22%, mostly as a result of concurrent age-related maculopathy, diabetes, or glaucoma. Four percent had no improvement in visual acuity in the operated eye., CONCLUSIONS: Dissatisfaction seemed to rely mostly on visual acuity in the operated eye. Low visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors for subjectively worse visual ability after surgery. The degree of satisfaction after cataract surgery and changes in visual ability differed in important ways from visual acuity as a measure of visual function.
Keywords: Activities of Daily Living; Aged; Aged, 80 and over; *Cataract Extraction/sn [Statistics & Numerical Data]; Female; Humans; Male; *Patient Satisfaction/sn [Statistics & Numerical Data]; Prospective Studies; Surveys and Questionnaires; Sweden/ep [Epidemiology]; *Visual Acuity

Penetration of topical ciprofloxacin by presoaked medicated soft contact lenses. - Kalayci, D; Basci, N; Kortunay, S; Hasiripi, H; Bozkurt, A (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1999)
PURPOSE: To assess the penetration of topical ciprofloxacin by a presoaked medicated disposable soft contact lens without topical drop administration., METHODS: Disposable soft contact lenses were presoaked in 0.3% topical ciprofloxacin (Ciloxan, Alcon Laboratories, Fort Worth,TX) for 10-12 hours. Presoaked lenses were placed on the eyes of patients with senile cataracts for 3 hours in group A, 5-6 hours in group B, and 8-12 hours in group C prior to their scheduled lens extraction surgery. Aqueous humor samples were drawn by paracentesis during the operation. Ciprofloxacin concentrations were determined by high pressure liquid chromatography-fluorescence detection., RESULTS: The mean ciprofloxacin concentration was 2.70 +/- 0.98 microg/mL in group A, 1.22 +/- 1.0 microg/mL in group B, and 0.5 +/- 0.2 microg/mL in group C., CONCLUSIONS: Penetration of topical ciprofloxacin is enhanced through a presoaked disposable soft contact lens, and at 3 hours therapeutic levels are obtained. Significant levels of ciprofloxacin are retained through 8-12 hours. This mode of treatment may increase patient compliance compared to frequent topical drop administration, and as a consequence, assure efficient treatment of keratitis, at least for the first 3 hours.
Keywords: Administration, Topical; *Aqueous Humor/me [Metabolism]; Biological Availability; Chromatography, High Pressure Liquid; Ciprofloxacin/ad [Administration & Dosage]; *Ciprofloxacin/pk [Pharmacokinetics]; *Contact Lenses, Hydrophilic; Disposable Equipment; *Drug Delivery Systems; Humans

The SITA perimetric threshold algorithms in glaucoma. - Wild, J M; Pacey, I E; O'Neill, E C; Cunliffe, I A (Investigative ophthalmology & visual science, 1999)
PURPOSE: To determine the within-visit between-algorithm and the within-algorithm between-visit differences in sensitivity for the SITA Standard, SITA Fast, FASTPAC, and Full Threshold algorithms in stable primary open angle glaucoma., METHODS: One designated eye from each of 29 patients (age 67.3 +/- 10.2 years; mean +/- SD) experienced in automated perimetry was examined with the four algorithms on each of three visits, using the Humphrey Field Analyzer 750 and Program 30-2., RESULTS: The group mean Mean Sensitivity was 1.0 dB greater for SITA Standard than Full Threshold (P < 0.001), 0.7 dB greater for SITA Standard than FASTPAC (P < 0.001), 1.6 dB greater for SITA Fast than FASTPAC (P < 0.001), and 0.9 dB greater for SITA Fast than SITA Standard (P < 0.001). The higher pointwise sensitivity for SITA Fast compared to Full Threshold, FASTPAC, and SITA Standard increased with increase in defect depth. The examination duration for SITA Standard was 53% of that for Full Threshold and 50% shorter for SITA Fast compared to FASTPAC (P < 0.001), regardless of age (P = 0.932). The examination duration increased with increase in severity of field loss (P < 0.001), and this increase was proportionately greater for both SITA algorithms (P < 0.001), particularly SITA Fast. The Total and Pattern Deviation probability analyses of both SITA algorithms yielded a statistically greater defect than Full Threshold or FASTPAC (P < 0.001). The within-algorithm between-visit differences were similar between SITA Standard and Full Threshold and between SITA Fast and FASTPAC., CONCLUSIONS: Both SITA algorithms produce a marginally higher differential light sensitivity compared to existing algorithms but with a statistically deeper defect and a marked reduction in examination duration.
Keywords: Adult; Aged; *Algorithms; Cohort Studies; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Male; Middle Aged; Office Visits; Sensitivity and Specificity; Sensory Thresholds; *Vision Disorders/di [Diagnosis]; Vision Disorders/pp [Physiopathology]; *Visual Field Tests/st [Standards]; Visual Fields/ph [Physiology]; *Visual Fields

[Central corneal diseases]. - Frueh, B E (Klinische Monatsblatter fur Augenheilkunde, 1999)
BACKGROUND: Central corneal pathologies can lead to an irreversible decrease of best corrected visual acuity if not diagnosed and treated appropriately. This article reviews the differential diagnosis of central corneal opacities in the newborn, of central infectious corneal ulcers, and the therapy of sterile, central keratolysis., MATERIAL AND METHODS: Authors' personal experience and review of the literature., RESULTS: Flow charts for diagnosis and treatment strategy have been elaborated., CONCLUSIONS: Corneal opacities in newborns create an emergency situation. In order to treat successfully and avoid or diminish amblyopia, it is imperative to rule out congenital glaucoma. The aetiology of central corneal ulcers should always be confirmed by positive cultures to be able to treat specifically. When the standard topic therapy fails, one has to consider rare bacteria, parasites, virus, or patients' compliance. The treatment of central sterile keratolysis in rheumatoid arthritis must be intensive and immunosuppression has to be performed early enough in the course of prevent the formation of a descemetocoele or spontaneous corneal perforation.
Keywords: Arthritis, Rheumatoid/co [Complications]; Arthritis, Rheumatoid/di [Diagnosis]; Arthritis, Rheumatoid/th [Therapy]; *Corneal Diseases/di [Diagnosis]; Corneal Diseases/et [Etiology]; Corneal Diseases/th [Therapy]; Corneal Opacity/di [Diagnosis]; Corneal Opacity/et [Etiology]; Corneal Opacity/th [Therapy]; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/et [Etiology]; Corneal Ulcer/th [Therapy]; Humans; Infant, Newborn; Keratitis/di [Diagnosis]; Keratitis/et [Etiology]; Keratitis/th [Therapy]; Prognosis; Software Design

Acanthamoeba castellanii: characterization of an adhesin molecule. - Kennett, M J; Hook, R R Jr; Franklin, C L; Riley, L K (Experimental parasitology, 1999)
Acanthamoeba castellanii is a free-living protozoan that causes keratitis in humans and has been associated with pneumonia and granulomatous amebic encephalitis in dogs, sheep, and other species. Adherence of the Acanthamoeba to epithelial cells is critical to the pathogenesis of this disease. In this study, several mouse monoclonal antibodies (MAb) generated to whole Acanthamoeba trophozoites identified surface membrane epitopes by ELISA and IFA. Nine antibodies inhibited adherence of [(35)S]-methionine-labeled Acanthamoeba trophozoites to hamster corneal epithelial cells by 27-90%. Sodium periodate treatment, but not proteinase K digestion, of whole Acanthamoeba destroyed epitopes recognized by adherence-inhibiting antibodies such as MAb 7H6, suggesting that the adherence epitopes are carbohydrates. Other antibodies, MAb 2A8 for example, recognized surface membrane peptide epitopes that were proteinase K sensitive and sodium periodate resistant. Purified MAb 2A8 was used in an antigen-capture ELISA with peroxidase-labeled MAb 7H6 and demonstrated that the carbohydrate adhesion molecule was linked to the peptide recognized by MAb 2A8. Both MAbs 7H6 and 2A8 recognized a >207-kDa band on a Western blot of eluant from a MAb 2A8 immunoaffinity column, confirming that MAb 7H6 and MAb 2A8 recognize different epitopes on the same adherence molecule. MAbs 7H6 and 2A8 also identified the adhesion molecule in soluble Acanthamoeba membrane preparations and MAb 2A8 immunoaffinity column eluant by ELISA and Western blot. Neither of these antibodies were inhibited from binding to whole trophozoites nor membrane extracts by mannose or mannan in competitive binding assays. When our Acanthamoeba membrane preparations were electrophoresed and immunoblotted with alpha-d-mannosylated-biotin albumin, no bands were recognized in the >207 kDa range by our adherence-associated antibodies. These results suggest that the Acanthamoeba adhesin is not identical to the mannose binding protein of Acanthamoeba but rather is a distinct surface membrane glycoprotein. Copyright 1999 Academic Press.
Keywords: Acanthamoeba/im [Immunology]; *Acanthamoeba/me [Metabolism]; Animals; *Antibodies, Monoclonal/im [Immunology]; *Antigens, Protozoan/im [Immunology]; Antigens, Protozoan/ip [Isolation & Purification]; Antigens, Surface/im [Immunology]; Antigens, Surface/ip [Isolation & Purification]; Blotting, Western; Cell Adhesion/im [Immunology]; Cell Adhesion Molecules/im [Immunology]; Cell Adhesion Molecules/ip [Isolation & Purification]; *Cell Adhesion Molecules/me [Metabolism]; Cricetinae; Enzyme-Linked Immunosorbent Assay; Epithelial Cells/im [Immunology]; Epithelial Cells/me [Metabolism]; Epitopes/im [Immunology]; Epitopes/ip [Isolation & Purification]; Female; Fluorescent Antibody Technique; Humans; Hybridomas; Mannans/pd [Pharmacology]; Mannose/pd [Pharmacology]; Mice; Mice, Inbred BALB C; Protozoan Proteins/im [Immunology]; Protozoan Proteins/ip [Isolation & Purification]; *Protozoan Proteins/me [Metabolism]

Fluticasone propionate powder and lack of clinically significant effects on hypothalamic-pituitary-adrenal axis and bone mineral density over 2 years in adults with mild asthma. - Li, J T; Ford, L B; Chervinsky, P; Weisberg, S C; Kellerman, D J; Faulkner, K G; Herje, N E; Hamedani, A; Harding, S M; Shah, T (The Journal of allergy and clinical immunology, 1999)
BACKGROUND: Although inhaled corticosteroids are widely used for the treatment of inflammation in asthma, prospective, long-term, placebo-controlled trials characterizing their systemic safety with chronic use are lacking., OBJECTIVE: This study was designed to prospectively evaluate the long-term safety of inhaled fluticasone propionate therapy., METHODS: Fluticasone propionate powder, 500 microgram, or placebo was administered twice daily by means of the Diskhaler for 104 weeks to 64 adults with mild persistent asthma in a randomized, double-blind, parallel-group study. Primary safety variables were measured at baseline and every 6 months thereafter. Although evaluation of efficacy was not an objective of this study, pulmonary function testing was performed at monthly intervals., RESULTS: Two years of treatment with fluticasone propionate had no significant effects on the skeletal system. No clinically significant changes were observed in ophthalmic parameters (glaucoma and posterior subcapsular cataracts). Mean change from baseline in lumbar spine (L1 to L4 ) bone density at week 104 was not significantly different between fluticasone propionate (-0.006 +/- 0.008 g/cm2) and placebo (-0.007 +/- 0.010 g/cm2). Markers of bone formation (serum osteocalcin) and resorption (urinary N-telopeptide) did not differ significantly between treatment groups. The effects of fluticasone propionate treatment on the hypothalamic-pituitary-adrenal axis were minimal, with no alterations in morning plasma cortisol concentrations and minor but statistically significant decreases in poststimulation mean peak plasma cortisol concentrations (P =.021) and 8-hour plasma cortisol area under the curve values (P =.020) at week 104. Drug-related adverse events were primarily topical effects of inhaled corticosteroids. Pulmonary function improved significantly during 2 years of fluticasone propionate treatment., CONCLUSION: Fluticasone propionate powder, 500 microgram twice daily for up to 2 years, was efficacious and well tolerated, with no clinically relevant effects on the hypothalamic-pituitary-adrenal axis, bone density, or ophthalmic parameters in adults with mild asthma.
Keywords: Adolescent; Adult; Androstadienes/ad [Administration & Dosage]; *Androstadienes/pd [Pharmacology]; Anti-Asthmatic Agents/ad [Administration & Dosage]; *Anti-Asthmatic Agents/pd [Pharmacology]; *Asthma/dt [Drug Therapy]; *Asthma/pp [Physiopathology]; Bone Density/de [Drug Effects]; Bone Resorption/dt [Drug Therapy]; Double-Blind Method; Female; Fluticasone; Humans; Hypothalamo-Hypophyseal System/de [Drug Effects]; Male; Middle Aged; Osteogenesis/de [Drug Effects]; Patient Compliance; Pituitary-Adrenal System/de [Drug Effects]; Powders

The Bristol Shared Care Glaucoma Study: reliability of community optometric and hospital eye service test measures. - Spry, P G; Spencer, I C; Sparrow, J M; Peters, T J; Brookes, S T; Gray, S; Baker, I; Furber, J E; Easty, D L (The British journal of ophthalmology, 1999)
BACKGROUND/AIMS: Primary open angle glaucoma patients and glaucoma suspects make up a considerable proportion of outpatient ophthalmological attendances and require lifelong review. Community optometrists can be suitably trained for assessment of glaucoma. This randomised controlled trial aims to assess the ability of community optometrists in the monitoring of this group of patients., METHODS: Measures of cup to disc ratio, visual field score, and intraocular pressure were taken by community optometrists, the hospital eye service and a research clinic reference "gold" standard in 405 stable glaucoma patients and ocular hypertensives. Agreement between and within the three centres was assessed using mean differences and intraclass correlation coefficients. Tolerance limits for a change in status at the level of individual pairs of measurements were also calculated., RESULTS: Compared with a research clinic reference standard, measurements made by community optometrists and those made in the routine hospital eye service were similar. Mean measurement differences and variability were similar across all three groups compared for each of the test variables (IOP, cup to disc ratio, and visual field). Overall, the visual field was found to be the most reliable measurement and the cup to disc ratio the least., CONCLUSIONS: Trained community optometrists are able to make reliable measurements of the factors important in the assessment of glaucoma patients and glaucoma suspects. This clinical ability should allow those optometrists with appropriate training to play a role in the monitoring of suitable patients.
Keywords: *Community Health Services/st [Standards]; England; *Glaucoma/di [Diagnosis]; Hospitalization; Humans; Observer Variation; *Ophthalmology/st [Standards]; Patient Satisfaction; Sensitivity and Specificity; Vision Tests/mt [Methods]; Visual Fields

[The patient with glaucoma and his treatment: is there real perception?]. - Naacke, H; Baudouin, C (Journal francais d'ophtalmologie, 1999)
Keywords: Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Humans; Patient Care Team; *Patient Compliance/px [Psychology]; *Patient Education as Topic

Circumferential perilimbal anesthesia for combined cataract glaucoma surgery. - Anderson, C J (Ophthalmic surgery and lasers, 1999)
BACKGROUND AND OBJECTIVES: A topical-subconjunctival anesthesia technique named circumferential perilimbal anesthesia was tested in a consecutive series of 34 combined cataract and glaucoma cases to determine effectiveness in long duration anterior segment surgery., PATIENTS AND METHODS: The circumferential perilimbal technique for combined surgery involved administration of 4% topical Xylocaine drops and injection of 0.25 cc of 4% Xylocaine subconjunctivally 3-4 mm inferior to the limbus. The inferior subconjunctival anesthesia was then spread 360 degrees around the limbus circumferentially with a smooth forceps. The topical and local anesthetic was supplemented by intravenous preoperative and intraoperative sedative and analgesic medications., RESULTS: All patients had successful phacoemulsification cataract extraction with intraocular lens combined with trabeculectomy. Medical records and postoperative interviews of the combined cataract-glaucoma cases revealed an average surgery time of 46 minutes (range 35 minutes-60 minutes) and only one incident of patient intraoperative pain., CONCLUSION: The circumferential perilimbal technique was an effective anesthesia technique for long duration combined cataract and glaucoma surgery.
Keywords: Aged; *Anesthesia, Local/mt [Methods]; Anesthetics, Local/ad [Administration & Dosage]; Conjunctiva/de [Drug Effects]; Female; Follow-Up Studies; Glaucoma/co [Complications]; *Glaucoma/su [Surgery]; Humans; Injections; Lidocaine/ad [Administration & Dosage]; Male; Orbit/de [Drug Effects]; Patient Satisfaction; *Phacoemulsification; Retrospective Studies; Surveys and Questionnaires; *Trabeculectomy

[Initial clinical experience with deep sclerectomy in ambulatory surgery in glaucoma]. - Pitrova, S; Peskova, H; Lestak, J (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 1999)
Deep sclerectomy is a non-perforating filtering operation used in surgical treatment of open angle glaucomas. The advantage of the operation is the creation of gradual filtration due to the thin trabecular Descement membrane which reduces markedly the risk of development of postoperative complications typical for perforating antiglaucomatous operations. The authors operated at the out-patient department 10 eyes of 8 patients (age 46-81 years). Indications for deep sclerectomy was seven times primary open angle glaucoma (POAG), once capsular glaucoma and twice normotensive glaucoma (NTG). In all eyes deep sclerectomy was indicated because of decompensation of the intraocular pressure with maximum tolerated therapy before surgery. None of the eyes were operated previously. The mean value of intraocular pressure before surgery was 25.1 +/- 6.5 mm Hg. From the results ensues that in nine operated eyes the intraocular pressure at the end of the 6-month follow-up period was compensated without supplementary therapy, only in one eye beta-blockers were prescribed one month after surgery. The cause of failure of filtration was the development of superficial adherence at the site of microperforatiion of the trabecular Descemet membrane which developed during operation. The mean intraocular pressure values at the end of the investigation period were 14.3 +/- 2.8 mm Hg. In two eyes haemorrhage into the anterior chamber was observed on the first day after surgery, the blood was absorbed within 24 hours. Hypotonia in two eyes was only transient and was not associated with a change in the depth of the anterior chamber or other complications. In none of the patients a decline of visual acuity was observed. In three operated eyes a change of refraction was necessary due to discontinuation of miotics after surgery. Deep sclerectomy is a delicate microsurgical technique which calls for experience and skill of the surgeon. The most complicated task is to prevent perforation of the trabecular Descemet membrane during surgery. Provided the surgical technique is perfect, it burdens the patient less than commonly performed perforating antiglaucomatous operations and it can be implemented in the out-patient department.
Keywords: Adult; Aged; Aged, 80 and over; *Ambulatory Surgical Procedures; Female; *Glaucoma/su [Surgery]; Humans; Male; Middle Aged; Postoperative Complications; *Sclerostomy/mt [Methods]

Patient preference, efficacy, and compliance with timolol maleate ophthalmic gel-forming solution versus timolol maleate ophthalmic solution in patients with ocular hypertension or open-angle glaucoma. - Schenker, H; Maloney, S; Liss, C; Gormley, G; Hartenbaum, D (Clinical therapeutics, 1999)
This study was designed to compare timolol maleate ophthalmic gel-forming solution 0.5% (timolol gel) once daily with timolol maleate ophthalmic solution 0.5% (timolol solution) twice daily with respect to patient preference, intraocular pressure (IOP)-lowering effect, and tolerability. A total of 202 patients with ocular hypertension or open-angle glaucoma and an IOP > or = 22 mm Hg were enrolled in this 12-week, randomized, observer-masked, two-period crossover study. Significantly more patients preferred timolol gel to timolol solution (P < 0.001). Ninety-two percent of patients preferring timolol gel strongly agreed or agreed that once-daily dosing was a reason for their preference. Those who preferred timolol solution did so because of fewer side effects. The mean IOP-lowering effects of the 2 treatments were similar at both morning trough and peak time points. The incidence of drug-related adverse experiences was similar (timolol gel 11.4% vs timolol solution 10.9%). Because both treatments were well tolerated and effective in lowering IOP, timolol gel, with its once-daily dosing regimen, should be considered in patients who are candidates for therapy with an ophthalmic beta-blocking agent.
Keywords: *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Blood Pressure; Cross-Over Studies; Female; Gels; *Glaucoma, Open-Angle/dt [Drug Therapy]; Heart Rate; Humans; Intraocular Pressure; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Patient Compliance; Patient Satisfaction; Single-Blind Method; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Enhanced tenascin expression associated with reactive astrocytes in human optic nerve heads with primary open angle glaucoma. - Pena, J D; Varela, H J; Ricard, C S; Hernandez, M R (Experimental eye research, 1999)
Tenascin is a large extracellular matrix glycoprotein expressed in neural and non-neural tissues. In the central nervous system, tenascin is synthesized by astrocytes during development and wound healing, forming barriers and affecting neurite outgrowth. In this study we examined tenascin expression in optic nerve heads of normal and glaucomatous eyes and found that there is upregulation of tenascin mRNA and protein in reactive astrocytes from human glaucomatous optic nerve heads compared to normal age-matched controls. In the prelaminar region there was a band of tenascin immunoreactivity around the blood vessels of glaucomatous, but not in normal eyes. However, tenascin mRNA was only localized to astrocytes, suggesting that astrocytes are the cellular source of tenascin. In the lamina cribrosa, tenascin immunoreactivity and gene expression were localized to astrocytes in the cribriform plates and inside the nerve bundles. In the post-lamina region, tenascin immunoreactivity and gene expression were localized to astrocytes lining the pial septum immediately adjacent to the lamina cribrosa. In normal optic nerve heads, tenascin expression at the mRNA and protein levels was confined to clusters of astrocytes at the level of Bruch's membrane in the prelaminar optic nerve head. In glaucoma, enhanced expression of tenascin may be protective to the axons of the retinal ganglion cells by providing a barrier for humoral and/or blood-borne factors that may cause further neural damage. However, the precise role of tenascin in glaucomatous optic neuropathy is not yet elucidated. Copyright 1999 Academic Press.
Keywords: Aged; Aged, 80 and over; *Astrocytes/me [Metabolism]; Fluorescent Antibody Technique, Indirect; *Glaucoma, Open-Angle/me [Metabolism]; *Glial Fibrillary Acidic Protein/bi [Biosynthesis]; Humans; In Situ Hybridization; Middle Aged; *Optic Disk/me [Metabolism]; RNA, Messenger/me [Metabolism]; *Tenascin/bi [Biosynthesis]

[A clinical observation of the therapeutic effects of pilocarpine gel for treatment of glaucoma]. - Yuan, J; Wei, H ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 1998)
OBJECTIVE: To evaluate whether pilocarpine gel (PG) is better than pilocarpine solution (PS) for treatment of glaucoma., METHODS: 20 cases with glaucoma treated with 4% PG once every night were compared with 20 cases with glaucoma using 1% PS 4 times a day. The intraocular pressure (IOP), pupil diameter and refraction were examined 4 times a day in both groups., RESULTS: The PG could lower IOP by 25% - 37% and the PS by 20% - 25%, the hypotensive effect of PG could last 24 hours. The PG had the strongest hypotensive effect 5 - 13 hours after its application, and a stronger action than PS at 9 a.m. and 11 a.m, this is particularly beneficial for the control of the peak IOP before awaking and in the morning. The strongest action of miosis and accommodation enhancement of PG took place 5 - 8 hours after its application when the patients were sleeping, whereas the PS induced a fluctuating miosis and myopia in the day time. In addition, the PG was more convenient to be used than PS due to its single application for 24 hours., CONCLUSION: The PG has some advantages in the respects of compliance, lowering IOP and side-effects, thus it is worthwhile to promote its manufacture.
Keywords: Adult; Aged; Female; Gels; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Pupil/de [Drug Effects]; Refraction, Ocular

Glaucoma. - Gricar, J A; Wilson, P R; Cave, D G (Managed care interface, 1998)
The routine, easiest-to-treat adult patients with glaucoma utilize 1.80 office visits, 3.34 prescriptions, and 2.02 medical/surgical procedures during the course of a year. Based on data from the PTE-Registry database, this patient group did not receive any hospital admissions or professional inpatient services. Eye surgery was performed at an average rate of 0.08 times per PTE. About 53.5% of all PTEs were treated without the use of prescription drugs. When a drug was prescribed, beta blockers were used most often. In fact, 74.1% of all PTEs treated with a single drug group used a beta blocker.
Keywords: Adolescent; Adult; Cost of Illness; Episode of Care; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Humans; Middle Aged; Office Visits/sn [Statistics & Numerical Data]; Ophthalmology; Personal Health Services/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Severity of Illness Index; United States; Utilization Review

Make glaucoma screening a routine part of DM programs. - Anonymous (Healthcare demand & disease management, 1998)
Physicians who treat patients with glaucoma say there is a serious lack of attention to screening, a deficiency that can lead to blindness for many patients with asthma, diabetes, and heart disease. Here's what your DM program can do about it.
Keywords: *Diagnostic Tests, Routine; *Disease Management; Glaucoma/dt [Drug Therapy]; *Glaucoma/pc [Prevention & Control]; Humans; Patient Compliance; Physical Examination; Risk Factors; United States

Improving the care of glaucoma patients. - Wilson, R P (Journal of ophthalmic nursing & technology, 1998)
Keywords: Aged; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/nu [Nursing]; Glaucoma/px [Psychology]; Humans; *Patient Compliance; Patient Education as Topic/mt [Methods]; Quality Assurance, Health Care/og [Organization & Administration]

Elastosis of the lamina cribrosa in glaucomatous optic neuropathy. - Pena, J D; Netland, P A; Vidal, I; Dorr, D A; Rasky, A; Hernandez, M R (Experimental eye research, 1998)
The purpose of this study was to determine whether elastotic degeneration of the elastin component of the lamina cribrosa occurs in optic neuropathy associated with different types of glaucoma. Human optic nerve heads with primary open-angle, neovascular, chronic angle closure and pseudoexfoliation glaucoma, and with varying duration of disease were compared with age-matched normal eyes, using electron microscopy and immunogold labeling of elastin. The percent area occupied by immunogold-labeled elastin material was determined using a digital image analysis system. In all eyes with a history of glaucoma, elastosis was found in the lamina cribrosa and there was a significantly greater percentage of area occupied by elastin compared with age-matched control eyes (P<0.0001). Among the glaucomatous eyes, pseudoexfoliation glaucoma had the largest area of elastosis, followed by primary open-angle and secondary glaucoma (neovascular and chronic angle closure). In all glaucoma samples, large, confluent elastin aggregates of irregular and varied shapes (elastosis) were observed in the lamina cribrosa and insertion region. These results demonstrate that glaucomatous optic neuropathy is associated with elastosis of the lamina cribrosa, which may contribute to the changes in compliance of the optic nerve heads of glaucomatous eyes. Copyright 1998 Academic Press.
Keywords: Aged; Aged, 80 and over; *Connective Tissue Diseases/et [Etiology]; Connective Tissue Diseases/me [Metabolism]; Elastic Tissue/ch [Chemistry]; *Elastic Tissue/ul [Ultrastructure]; Elastin/an [Analysis]; Female; *Glaucoma/co [Complications]; Humans; Image Processing, Computer-Assisted; Immunohistochemistry; Male; Microscopy, Electron; Middle Aged; Optic Disk/ch [Chemistry]; *Optic Disk/ul [Ultrastructure]; *Optic Nerve Diseases/co [Complications]; Sclera/ch [Chemistry]; Sclera/ul [Ultrastructure]

Role of ophthalmic nurses with visually impaired patients. - Barton, W (Insight (American Society of Ophthalmic Registered Nurses), 1998)
In 1987, it was estimated that over 13 million people in the world were visually impaired, and more than 27 to 35 million were classified as blind. Greater than 6 million visually impaired people live in the United States. There are many causes of visual impairment, including age-related macular degeneration, cataracts, glaucoma, diabetic retinopathy, autoimmune deficiency syndrome, and trauma. Some patients may be helped or visual loss delayed with surgery. Many may have dramatic visual improvement with optical devices, large-print publications, and improved lighting. The ophthalmic nurse may assist in accurately assessing the patient's vision and identifying his or her lifestyle and ability to function independently. Assisting the patient to overcome psychosocial and economic barriers and helping to obtain assistance is critical to enable patients to function independently. Ophthalmic nurses may be instrumental in increasing patients' awareness of community resources and services available to those who are visually impaired.
Keywords: Activities of Daily Living; Humans; *Job Description; Nursing Assessment; *Ophthalmology; Patient Education as Topic; *Specialties, Nursing; Vision Disorders/cl [Classification]; Vision Disorders/ep [Epidemiology]; Vision Disorders/et [Etiology]; *Vision Disorders/nu [Nursing]

Post-penetrating keratoplasty glaucoma: risk factors, management and visual outcome. - Sihota, R; Sharma, N; Panda, A; Aggarwal, H C; Singh, R (Australian and New Zealand journal of ophthalmology, 1998)
PURPOSE: To evaluate the incidence, associated risk factors, graft status and treatment modalities in patients with post-penetrating keratoplasty glaucoma., METHODS: A retrospective analysis of 747 consecutive penetrating keratoplasties was undertaken at a tertiary eye care centre. The frequency of post-penetrating keratoplasty glaucoma was determined and correlated with the pre-operative corneal diagnosis, lens status and associated surgeries performed during penetrating keratoplasty. The response to antiglaucoma therapy (i.e. medical, surgical or cyclo-destructive procedures) and graft outcome was also evaluated., RESULTS: The incidence of post-penetrating keratoplasty glaucoma was 10.6% (79/747). Pre-operative corneal diagnosis of adherent leucomas was significantly associated with the development of postoperative glaucoma. Post-penetrating keratoplasty glaucoma was significantly higher in aphakes (odds ratio (OR) 6.6; confidence interval (CI) 3.81-11.69) compared with phakic or pseudophakic eyes. Associated vitrectomy (OR 2.32; CI 1.16-4.73) and anterior segment reconstruction (OR 3.31; CI 1.43-7.72) were other high-risk factors. Most patients responded to medical therapy (41/79; 51.9%), whereas filtering surgery and cyclo-destructive procedures were performed in 29.1 (23/79) and 19% (15/79) of eyes, respectively. Despite clear grafts in 39 eyes (49.4%), visual acuity of 6/18 or better was achieved in 15 eyes (18.9%)., CONCLUSIONS: A high incidence of post-penetrating keratoplasty glaucoma occurs in eyes with adherent leucomas. Anterior vitrectomy and associated surgeries further accentuate the risk Anti-glaucoma therapy may not achieve optimum visual outcome, despite a clear graft.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Female; Filtering Surgery; Follow-Up Studies; Glaucoma/ep [Epidemiology]; *Glaucoma/et [Etiology]; Glaucoma/th [Therapy]; Humans; Incidence; *Intraocular Pressure; Iris/su [Surgery]; *Keratoplasty, Penetrating/ae [Adverse Effects]; Laser Coagulation; Male; Middle Aged; Odds Ratio; Postoperative Complications/ep [Epidemiology]; Postoperative Complications/et [Etiology]; Postoperative Complications/th [Therapy]; *Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome; *Visual Acuity

Risk factors for noncompliance with glaucoma follow-up visits in a residents' eye clinic. - Kosoko, O; Quigley, H A; Vitale, S; Enger, C; Kerrigan, L; Tielsch, J M (Ophthalmology, 1998)
OBJECTIVE: This study aimed to identify factors associated with compliance with glaucoma follow-up visits., DESIGN: Computer records of a university residents' eye clinic were reviewed to identify a random sample of all persons who had an examination with International Classification of Disease (ICD) 9 coding (ICD9) for glaucoma suspect or glaucoma during a 2-year period (1991-1993) to undergo telephone interview., PARTICIPANTS: Those who were seen at least every 6 months regardless of earlier return instructions were defined as compliant with follow-up (controls, n = 362). Those who had any lapse between visits of longer than 6 months were defined as noncompliant (cases, n = 362)., RESULTS: Interviews were completed for 196 cases and 242 controls. Noncompliant persons were significantly more likely to be suspects for glaucoma rather than to have definite glaucoma and to be dissatisfied with waiting time in the clinic (29.1% vs. 17.8%, P < 0.005) and to state that they did not take their glaucoma medications as prescribed (25.4% vs. 13.4%, P < 0.004). They also were less likely to have been prescribed eyedrop medication. A high percentage of both patients and controls knew that glaucoma can lead to blindness (85.2% and 88.4%, respectively). The most common reasons patients gave for not keeping follow-up visits were the perception that their eye problem was "not serious enough," the cost of examinations, and that the doctor did not tell them to come back., CONCLUSION: Compliance with follow-up visits for glaucoma is associated with markers for early disease. Attempts to improve compliance might focus on improved communication of the seriousness of the disease and improvements in clinic waiting time.
Keywords: Aged; Aged, 80 and over; Case-Control Studies; Female; Follow-Up Studies; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; Internship and Residency; Male; Middle Aged; Ocular Hypertension/px [Psychology]; Ocular Hypertension/th [Therapy]; Office Visits; *Ophthalmology; *Outpatient Clinics, Hospital/sn [Statistics & Numerical Data]; Physician-Patient Relations; Random Allocation; Risk Factors; Surveys and Questionnaires; Treatment Refusal/px [Psychology]; *Treatment Refusal/sn [Statistics & Numerical Data]

[Intraocular pressure self-monitoring in glaucoma patients]. - Draeger, J (Klinische Monatsblatter fur Augenheilkunde, 1998)
Keywords: Glaucoma/px [Psychology]; *Glaucoma/rh [Rehabilitation]; Humans; Intraocular Pressure; Patient Compliance/px [Psychology]; Self Care/px [Psychology]; *Self Care; Tonometry, Ocular/px [Psychology]; *Tonometry, Ocular

[The glaucoma work group--an initiative of the Tubingen University Eye Clinic]. - Erb, C; Stubiger, N; Schuller, S; Rassmann, K (Klinische Monatsblatter fur Augenheilkunde, 1998)
Keywords: Adult; Aged; Curriculum; Female; Germany; Glaucoma/px [Psychology]; *Glaucoma/rh [Rehabilitation]; Glaucoma, Open-Angle/px [Psychology]; Glaucoma, Open-Angle/rh [Rehabilitation]; Hospitals, University; Humans; Male; Middle Aged; Patient Compliance/px [Psychology]; *Patient Education as Topic/mt [Methods]

A multicenter study comparing dorzolamide and pilocarpine as adjunctive therapy to timolol: patient preference and impact on daily life. - Strohmaier, K; Snyder, E; Adamsons, I (Journal of the American Optometric Association, 1998)
BACKGROUND: A multicenter, 4-week, two-period crossover study, comparing 2% dorzolamide three times daily to 2% pilocarpine four times daily as adjunctive therapy to 0.5% timolol twice daily, was conducted on 81 patients with elevated intraocular pressure (IOP). The treatments were evaluated for patient preference, tolerability, impact on daily life, IOP control, and visual-field changes., METHODS: The Comparison of Ophthalmic Medications for Tolerability questionnaire was used to assess patient preference, as well as the perception of side effects and activity limitations resulting from the study medications. IOP measurements and visual-field examinations were obtained at baseline and at the end of each crossover period., RESULTS: Of the 77 patients who participated in both periods, 63 (82%) preferred dorzolamide. Patients who expressed a preference preferred dorzolamide over pilocarpine by a ratio of more than 10:1. Patients reported less interference with their daily life because of side effects and activity limitations while receiving dorzolamide than while receiving pilocarpine. Dorzolamide and pilocarpine were comparably effective in lowering IOP (16% to 17%). Also, significantly more patients reported adverse experiences and discontinued therapy as a result of adverse experiences while receiving pilocarpine than while receiving dorzolamide., CONCLUSION: The results of this multicenter study support those of two previous single-center studies; these results show that dorzolamide was greatly preferred over pilocarpine and had better tolerability and less adverse impact on patients' daily lives than pilocarpine.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Chemotherapy, Adjuvant; Cross-Over Studies; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Miotics/ae [Adverse Effects]; *Miotics/tu [Therapeutic Use]; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Patient Satisfaction; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Quality of Life; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Visual Fields

Sympathetic ophthalmia associated with antecedent adherent leucoma--a rare association. - Dada, T; Kumar, A; Sharma, N (Acta ophthalmologica Scandinavica, 1998)
PURPOSE: To report a rare association of sympathetic ophthalmia with an antecedent adherent leucoma., METHOD: A 40-year-old patient with an adherent leucoma developed sympathetic ophthalmia in the fellow eye, 15 years after the occurrence of a perforated corneal ulcer., RESULTS: Intravenous pulse dexamethasone therapy followed by tapering oral prednisolone led to complete resolution of the disease process in the sympathising eye., CONCLUSION: Patients with an adherent leucoma subsequent to a perforated corneal ulcer may remain at an increased risk of developing sympathetic ophthalmia during their lifetime.
Keywords: Administration, Oral; Adult; *Corneal Opacity/et [Etiology]; *Corneal Ulcer/co [Complications]; Dexamethasone/tu [Therapeutic Use]; Glucocorticoids/tu [Therapeutic Use]; Humans; Infusions, Intravenous; Male; Ophthalmia, Sympathetic/dt [Drug Therapy]; *Ophthalmia, Sympathetic/et [Etiology]; Prednisolone/tu [Therapeutic Use]; Rupture, Spontaneous

Compliance with timolol treatment in glaucoma. - Rotchford, A P; Murphy, K M (Eye (London, England), 1998)
PURPOSE: To assess levels of compliance in elderly patients on timolol eyedrops for glaucoma., METHODS: A postal questionnaire was sent from the general practitioner to 86 patients over 55 years of age on repeat prescriptions for timolol eyedrops. The questionnaire asked details about the duration of treatment, family history, the level of understanding of the disease and the importance of treatment, other regular medication, side-effects attributed to the drops and how often patients omitted their drops. A search of practice and local hospital dispensing data was carried out to assess how frequently monthly repeat prescriptions for timolol eyedrops were dispensed over a 12 month period. This allowed a total volume to be calculated for each patient., RESULTS: Twenty-four per cent of patients admitted to omitting eyedrops either occasionally or frequently. Fifty-one per cent were found to have had insufficient drops dispensed to comply with treatment as prescribed. In non-complaint patients the mean period without drops was 85 days of the year, with a maximum of 165 days., CONCLUSION: Compliance with treatment is poor and patients underestimate their level of defaulting when questioned.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/tu [Therapeutic Use]; Drug Administration Schedule; England; Family Practice; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Male; Middle Aged; Ophthalmic Solutions; *Patient Compliance; *Timolol/ad [Administration & Dosage]; Timolol/tu [Therapeutic Use]

Bacterial biofilm on contact lenses and lens storage cases in wearers with microbial keratitis. - McLaughlin-Borlace, L; Stapleton, F; Matheson, M; Dart, J K (Journal of applied microbiology, 1998)
Bacterial biofilm formation on contact lenses (CLs), and CL storage cases may be a risk factor for CL-associated corneal infection and may explain the persistence of organisms in CL storage cases. This study evaluated biofilm formation on, and microbial contamination of, CLs and CL storage cases from patients with microbial keratitis. Contact lenses and CL storage cases from 20 wearers with microbial keratitis were sampled microbiologically and visualized using scanning electron microscopy (SEM). Culture results from the cornea were also noted. Bacterial biofilm was present more frequently (P < 0.05) on CL storage case surfaces (17/20) compared with CL surfaces (11/20) and biofilm density was significantly greater on case surfaces (P < 0.05). There was no association between poor compliance and microbial contamination of the CL storage case, nor between poor compliance and biofilm formation or density on the CL or CL storage case. Biofilm formation occurred equally frequently with hydrogen peroxide and chlorine release care systems. Microbial keratitis in CL wearers is frequently associated with bacterial biofilm in the CL storage case. Despite the use of current CL disinfection systems, the CL storage case is a favourable environment for proliferation of certain organisms. Biofilm on CLs may prolong the retention time of organisms at the ocular surface and increase their potential pathogenicity.
Keywords: *Biofilms; *Contact Lenses, Extended-Wear/mi [Microbiology]; Humans; *Keratitis/mi [Microbiology]; Microscopy, Electron; Patient Compliance

Medical marijuana. - Marmor, J B (The Western journal of medicine, 1998)
Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several conditions for which there may be therapeutic benefit from marijuana use and that merit further research. Marijuana should be held to the same evaluation standards of safety and efficacy as other drugs (a major flaw in Proposition 215) but should not have to be proved better than current medications for its use to be adopted. The therapeutic window for marijuana and THC between desired effect and unpleasant side effects is narrow and is a major reason for discontinuing use. Although the inhaled route of administration has the benefit of allowing patients to self-titrate the dose, the smoking of crude plant material is problematic. The NIH panel recommended that a high priority be given to the development of a controlled inhaled form of THC. The presence of a naturally occurring cannabinoid-receptor system in the brain suggests that research on selective analogues of THC may be useful to enhance its therapeutic effects and minimize adverse effects.
Keywords: Analgesics; Animals; Antineoplastic Agents/ae [Adverse Effects]; Cachexia/ci [Chemically Induced]; Cachexia/pc [Prevention & Control]; California; *Cannabis/tu [Therapeutic Use]; *Drug Approval/lj [Legislation & Jurisprudence]; Glaucoma/dt [Drug Therapy]; Humans; Muscle Spasticity/dt [Drug Therapy]; Nausea/ci [Chemically Induced]; Nausea/pc [Prevention & Control]; *Phytotherapy; Self Medication/sn [Statistics & Numerical Data]; Vomiting/ci [Chemically Induced]; Vomiting/pc [Prevention & Control]

Combined intraocular and strabismus surgery. - Zwaan, J; al-Sadhan, Y (Ophthalmic surgery and lasers, 1998)
BACKGROUND AND OBJECTIVE: To study the results of combined intraocular and strabismus surgery., PATIENTS AND METHODS: Combined surgery was done in 14 patients. In 10 of these patients, cataract and strabismus surgery were combined. One had a penetrating keratoplasty, and another required placement of a glaucoma valve implant. In one patient trabeculectomy, pupilloplasty, and lensectomy were done, and one patient needed repair of a leaking bleb., RESULTS: The strabismus of most patients was significantly improved. Eleven patients (79%) were orthophoric +/- 10 prism diopters (PD). Visual outcome was good in patients with no structural abnormalities who were compliant with occlusion therapy, if applicable., CONCLUSIONS: Combined intraocular and strabismus surgery has a success rate comparable with that of standard strabismus surgery.
Keywords: Adolescent; Adult; Cataract/co [Complications]; *Cataract Extraction; Child; Child, Preschool; Drainage/is [Instrumentation]; Female; Follow-Up Studies; Glaucoma/co [Complications]; *Glaucoma/su [Surgery]; Humans; Infant; *Keratoplasty, Penetrating; Male; *Prosthesis Implantation; Strabismus/co [Complications]; *Strabismus/su [Surgery]; *Trabeculectomy; Visual Acuity; Vitrectomy

Preoperative features of patients with exfoliation glaucoma and primary open-angle glaucoma. The AHEPA study. - Konstas, A G; Tsatsos, I; Kardasopoulos, A; Bufidis, T; Maskaleris, G (Acta ophthalmologica Scandinavica, 1998)
PURPOSE: To describe and compare the preoperative characteristics of Greek patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG)., METHODS: We prospectively investigated the preoperative features of 100 consecutive patients undergoing filtration surgery for either EXG, or POAG. We compared 74 patients with EXG and 26 with POAG., RESULTS: EXG patients were older (68.2 vs 62.4 years; p<0.05) and more often from the countryside (73%). Both glaucomas showed a preponderance for males, similar frequencies of positive family history and systemic disorders, with the exception of diabetes which was more common in POAG (19.2% vs 5.4%). The first IOP measurement, before treatment, was significantly higher in EXG (40.4 mm Hg) compared with POAG (33.9 mm Hg). Despite a shorter duration of medical therapy (25 vs 65 months) and more topical drugs EXG patients exhibited higher mean preoperative IOP (36 vs 27.8 mm Hg for POAG; p<0.05). EXG patients had significantly worse visual acuity than POAG (0.4 vs 0.6; p<0.05) and worse compliance to medical therapy (48%) compared to POAG (33%)., CONCLUSION: Significant differences in preoperative features distinguish EXG from POAG.
Keywords: Age Distribution; Aged; Exfoliation Syndrome/dt [Drug Therapy]; Exfoliation Syndrome/ep [Epidemiology]; *Exfoliation Syndrome/pp [Physiopathology]; Exfoliation Syndrome/su [Surgery]; Female; Filtering Surgery; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; Incidence; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Patient Compliance; Prospective Studies; Rural Population; Sex Distribution; Visual Acuity/ph [Physiology]

The penetration of ofloxacin into human aqueous humor given by various routes. - Hanioglu-Kargi, S; Basci, N; Soysal, H; Bozkurt, A; Gursel, E; Kayaalp, O (European journal of ophthalmology, 1998)
This study was designed to measure the concentration of ofloxacin in aqueous humor after topical, oral and intravenous administration in 50 patients undergoing cataract extraction. In Group 1, ofloxacin 0.3% eyedrops were topically instilled ten times and the aqueous humor concentration was 2.73 +/- 0.88 microg/ml. In Group 2, ofloxacin 0.3% eyedrops were topically instilled six times and the aqueous humor concentration was 0.84 +/- 0.61 microg/ml. Aqueous humor concentration 12 hours after 200 mg oral dose in Group 3, was 0.38 +/- 0.12 microg/ml. In Group 4, patients were given ofloxacin as a single intravenous 200 mg dose and the aqueous humor concentration 2 hours after the end of infusion was 0.45 +/- 0.11 microg/ml. Concentrations were determined by high performance liquid chromatography (HPLC) with fluorescence detection. There was a significant difference between Group 1 and the other groups, but not between Group 2 and Groups 3, 4. It was concluded that ofloxacin penetrates the corneal and the blood-aqueous barriers and can achieve good aqueous levels when given topically and systematically. Ofloxacin can be applied topically for external bacterial infections such as conjunctivitis and keratitis. Systematically administered ofloxacin reached higher levels than the MIC for some bacteria which cause endophthalmitis.
Keywords: Administration, Oral; Administration, Topical; Aged; Aged, 80 and over; Anti-Infective Agents/ad [Administration & Dosage]; *Anti-Infective Agents/pk [Pharmacokinetics]; Antibiotic Prophylaxis; *Aqueous Humor/me [Metabolism]; Blood-Aqueous Barrier/de [Drug Effects]; Cataract Extraction; Cornea/me [Metabolism]; Female; Humans; Injections, Intravenous; Male; Middle Aged; Ofloxacin/ad [Administration & Dosage]; *Ofloxacin/pk [Pharmacokinetics]; Ophthalmic Solutions; Postoperative Complications/pc [Prevention & Control]; Vitreous Body/me [Metabolism]

Gradual loss of vision. - Reich, J (Australian family physician, 1998)
BACKGROUND: With the increasing age of our population many of the causes of vision loss are becoming more frequent. Not all gradual loss of vision can be considered non urgent and those patients requiring early attention are highlighted., OBJECTIVE: This article discusses the tools available to the general practitioner for the assessment of visual loss as well as the common causes., DISCUSSION: Advances in cataract surgery with improved visual outcome, minimally invasive surgery and a reduction in surgical risk have made this operation the commonest performed in Australia. Blindness from chronic open angle glaucoma and diabetes can be mostly prevented by early diagnosis and compliance with treatment. Age related macular degeneration apart from a small subgroup, is still largely untreatable.
Keywords: Amblyopia/di [Diagnosis]; Cataract/di [Diagnosis]; Chronic Disease; Diabetic Retinopathy/di [Diagnosis]; *Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/th [Therapy]; Humans; Macular Degeneration/di [Diagnosis]; Macular Degeneration/th [Therapy]; Refractive Errors/di [Diagnosis]; Refractive Errors/th [Therapy]; Time Factors; Vision Disorders/di [Diagnosis]; Vision Disorders/th [Therapy]

Patient noncompliance in the managed care setting. The case of medical therapy for glaucoma. - Gurwitz, J H; Yeomans, S M; Glynn, R J; Lewis, B E; Levin, R; Avorn, J (Medical care, 1998)
OBJECTIVES: The authors identify demographic and clinical characteristics associated with noncompliance in patients beginning medical therapy for the treatment of glaucoma in a managed care setting., METHODS: The authors describe a retrospective cohort study in a group-model health maintenance organization in Massachusetts. Patients were members of the health maintenance organization who were newly initiated on topical drug therapy to treat open-angle glaucoma during the period January 1, 1987 through December 31, 1990, who met eligibility requirements, and who had evidence of health services utilization for a 12-month follow-up period. For all study subjects, we determined the number of days without available therapy for glaucoma during the 12-month period. Study subjects who did not fill prescriptions adequate to provide medication to cover at least 80% of days during the study period were considered noncompliant. Logistic regression analysis was used to assess demographic and clinical factors independently associated with noncompliance among patients initiated on medical therapy for the treatment of glaucoma., RESULTS: Of 616 subjects who met inclusion criteria, 152 (24.7%; 95% confidence interval, 21.3%-28.1%) met the study definition for noncompliance. These patients had an average number of days without therapy during the 12-month study period of 103.9 +/- 70.0 days compared with 6.8 +/- 19.5 days for those categorized as compliant. Of a variety of selected demographic and clinical characteristics, having fewer visits with an ophthalmologist during the study period (< 2) was most strongly related to noncompliance (odds ratio 2.99; 95% confidence interval 2.03, 4.40). There were no differences in average intraocular pressure between the compliant and noncompliant groups during the study period., CONCLUSIONS: Noncompliance with prescribed medical therapy for glaucoma was found to be common in a managed care setting characterized by essentially unrestricted access to health care and medications. It remains difficult to identify noncompliant patients based on demographic and clinical characteristics. The use of automated prescription data to identify noncompliant patients is feasible in large managed health care insurance programs where such data are collected routinely for administrative purposes.
Keywords: Adult; Aged; Aged, 80 and over; Cohort Studies; Drug Prescriptions/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Health Maintenance Organizations/sn [Statistics & Numerical Data]; Humans; Logistic Models; Male; Massachusetts; Middle Aged; Retrospective Studies; Self Administration; Time Factors; Treatment Refusal/sn [Statistics & Numerical Data]; *Treatment Refusal

Contact lens associated bacterial keratitis: past, present, and future. - Stern, G A (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1998)
PURPOSE: This paper reviews the medical history of the pathogenesis of contact lens related bacterial keratitis and its relationship to the development of successive generations of soft contact lenses., METHODS: The Methods section presents a literature review and the author's personal experience., RESULTS: Bacterial corneal infections have been a significant complication limiting the overall success of soft contact lenses for visual correction. Experience with different types of lenses has pointed to specific causes for the frequency of infection. However, there has been a general understanding that the health of the patient's epithelium, the patient's lens care practices, and the hypoxic effects of overnight wear each significantly contribute to the development of corneal infection., CONCLUSIONS: A complete understanding of the pathogenesis of contact lens associated bacterial infection would allow the development of strategies to prevent infectious complications of lens wear. Progress appears to have been made with a trend toward fewer and less severe infections. As the possibility of a reasonably priced daily wear disposable lens with better oxygen transmissibility and surface modifications to limit deposits and bacterial adherence evolves, safer lenses will continue to be developed.
Keywords: Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Contact Lenses, Hydrophilic/td [Trends]; Cornea/mi [Microbiology]; Disposable Equipment; Eye Infections, Bacterial/et [Etiology]; *Eye Infections, Bacterial/pc [Prevention & Control]; Forecasting; Humans; Keratitis/et [Etiology]; *Keratitis/pc [Prevention & Control]; Risk Factors

Modulation of bacterial adhesion to hydrogel contact lenses by albumin. - Taylor, R L; Willcox, M D; Williams, T J; Verran, J (Optometry and vision science : official publication of the American Academy of Optometry, 1998)
PURPOSE: The purpose of this investigation was to measure the abilities of Pseudomonas aeruginosa and Staphylococcus epidermidis strains to adhere to two hydrogel lens materials and measure the effect of a protein-coated surface on the number of adhered bacteria., METHODS: Proteins absorbed to contact lenses during sleep were extracted, subjected to sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE), and probed for the presence of albumin. Bacterial adhesion was measured by counting bacteria adherent to contact lenses coated in vitro in increasing concentrations of albumin, examining the ability of albumin in solution to prevent adhesion to albumin-coated lenses, and examining the topography of bacterial adhesion by electron microscopy., RESULTS: Albumin adsorbed to lenses during overnight wear. In vitro studies demonstrated that Polymacon lenses adsorbed more albumin than Etafilcon A lenses. In general, the numbers of adherent bacteria increased with increasing concentration of albumin. Bacteria adhered in higher numbers to Polymacon lenses than Etafilcon A (p < 0.05). P. aeruginosa showed an increased adhesion as the amount of albumin on Etafilcon A lenses increased. There was a decrease in numbers of bacteria adhering per milligram of albumin as the level of albumin increased on Polymacon lenses. Cells tended to adhere to "deposits" on albumin-coated lenses., DISCUSSION: Albumin adsorbed onto the surface of contact lenses modulated the ability of P. aeruginosa and S. epidermidis to adhere. P. aeruginosa is commonly associated with contact lens-associated microbial keratitis, where bacterial adhesion to contact lenses is believed to be an important first step in the pathogenesis of the disease.
Keywords: Adsorption; *Bacterial Adhesion/de [Drug Effects]; Colony Count, Microbial; *Contact Lenses, Hydrophilic/mi [Microbiology]; Electrophoresis, Polyacrylamide Gel; Eye Proteins/ip [Isolation & Purification]; Eye Proteins/me [Metabolism]; Humans; Microscopy, Electron, Scanning; Polyhydroxyethyl Methacrylate/aa [Analogs & Derivatives]; Polyhydroxyethyl Methacrylate/me [Metabolism]; *Polyhydroxyethyl Methacrylate; *Pseudomonas aeruginosa/ph [Physiology]; Pseudomonas aeruginosa/ul [Ultrastructure]; Serum Albumin/ip [Isolation & Purification]; Serum Albumin/me [Metabolism]; *Serum Albumin/pd [Pharmacology]; *Staphylococcus epidermidis/ph [Physiology]; Staphylococcus epidermidis/ul [Ultrastructure]