Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design. - Newman-Casey, Paula Anne; Niziol, Leslie M; Mackenzie, Chamisa K; Resnicow, Kenneth; Lee, Paul P; Musch, David C; Heisler, Michele (Pilot and feasibility studies, 2018)
Background: About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients., Methods: Glaucoma patients taking >= 1 medication will be pre-screened by telephone survey for adherence to their medication(s). Those who self-report poor adherence will be enrolled in a 3-month monitoring period to measure medication adherence using electronic medication monitors. Participants who are non-adherent (take </=80% of their medication doses) over the 3-month run in phase will be eligible for the study. We plan to enroll 57 participants who are non-adherent to their medications. Participants ' adherence will then be continuously measured with electronic medication monitors, by self-report, and via pharmacy refill data over 2 years, during which two successively more resource-intensive components of an intervention aimed to improve medication adherence will be administered. The first component is a 3-month period of reminders (audio and/or visual) and text message or automated phone call if a dose of medication is not taken within a pre-specified time frame. The second component is a 6-month MI-based counseling program with a trained glaucoma counselor. This component uses the eyeGuide, a computer-based personalized behavior change program that enables para-professional staff to provide personalized education and counseling for glaucoma. The primary outcome is change in medication adherence. The secondary outcomes include changes in clinical outcomes (intraocular pressure, IOP, and IOP fluctuation) and psychosocial mediators of adherence (e.g., competence, energy for change and satisfaction). Participants will undergo semi-structured interviews at 12 months to give feedback about the counseling program in order to improve it., Discussion: This pilot study will provide insight into ways to deliver more personalized health care to non-adherent glaucoma patients in order to better support them in managing their chronic disease., Trial registration: Retrospectively registered with ClinicalTrials.gov (NCT03159247).

Glaucoma-Related Differences in Gaze Behavior When Negotiating Obstacles. - Lajoie, Kim; Miller, Andreas B; Strath, Robert A; Neima, David R; Marigold, Daniel S (Translational vision science & technology, 2018)
Purpose: Safe navigation requires avoiding objects. Visual field loss may affect how one visually samples the environment, and may thus contribute to bumping into objects and falls. We tested the hypothesis that gaze strategies and the number of collisions differ between people with glaucoma and normally sighted controls when navigating around obstacles, particularly under multitasking situations., Methods: Twenty persons with moderate-severe glaucoma and 20 normally sighted controls walked around a series of irregularly spaced vertical obstacles under the following three conditions: walking with obstacles only, walking and counting backward to simulate a conversation, and walking while performing a concurrent visual search task to simulate locating a landmark. We quantified gaze patterns and the number of obstacle contacts., Results: Compared with controls, people with glaucoma directed gaze closer to their current position (P < 0.05). They also directed a larger proportion of fixations (in terms of number and duration) to obstacles (P < 0.05). Despite this finding, considerably more people with glaucoma contacted an obstacle (P < 0.05). Multitasking led to changes in gaze behavior in both groups, and this was accompanied by a large increase in obstacle contacts among those with glaucoma (P < 0.05)., Conclusions: Glaucoma alters gaze patterns when negotiating a series of obstacles and increases the likelihood of collisions. Multitasking in this situation exacerbates these changes., Translational Relevance: Understanding glaucoma-related changes in gaze behavior during walking in cluttered environments may provide critical insight for orientation and mobility specialists and guide the design of gaze training interventions to improve mobility.

Compliance to topical anti-glaucoma medications among patients at a tertiary hospital in North India. - Rajurkar, Ketaki; Dubey, Suneeta; Gupta, Parmatma Prasad; John, Denny; Chauhan, Lokesh (Journal of current ophthalmology, 2018)
Purpose: The present study aims to estimate the prevalence of non-compliance and improper drop administration technique among glaucoma patients and describe common obstacles to medication compliance., Methods: A hospital-based cross-sectional study, using standardized questionnaire and direct observation by study personnel was conducted among glaucoma patients aged 18 years and above at a tertiary care charitable eye hospital in North India. 151 consecutive glaucoma patients on medical therapy following up at the glaucoma clinics for at least 6 months were recruited. Non-compliance was defined as missing at-least one drop of medication per week and (or) the inability to accurately describe the medication regimen. Study personnel also assessed drop administration technique during application of eye drops by patients treating ophthalmologist-provided information, including measures of disease stability. Factors such as socioeconomic status, presence of caregiver, and number of medications with their effect on compliance were studied using chi-square statistics., Results: Among 151 patients interviewed, around 49% of patients reported problems in using glaucoma medications, with 16% of them reporting total non-compliance. 35% of patients demonstrated improper drop administration technique. Forgetfulness was cited as the main reason for being non-compliant and had a significant association with non-compliance (P = 0.00). Paying patients were more compliant as compared to subsidized patients (P = 0.05). Disease was more stable in compliant patients compared to non-compliant patients (P = 0.05). No other factor had significant association with compliance (P > 0.05)., Conclusions: Over 50% of the patients surveyed were non-compliant, and 35% demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and aids that minimize forgetfulness, and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence.

Group-based patient education delivered by nurses to meet a clinical standard for glaucoma information provision: the G-TRAIN feasibility study. - Waterman, H; Bull, S; Shaw, M; Richardson, C (Pilot and feasibility studies, 2018)
Background: Globally, glaucoma is the leading cause of irreversible blindness. However, many patients with glaucoma do not understand their disease which reportedly impacts on their ability to manage their condition successfully. The aim of this feasibility study was to undertake research to inform a future randomised controlled trial of the effectiveness of group-based education for patients to improve adherence to glaucoma eyedrops., Methods: Key objectives were to understand current provision of information during routine nurse-led glaucoma consultations, to investigate if it is possible to deliver patient information in line with a clinical standard by training nurses to deliver group-based education in multiple hospital sites and to explore the acceptability of group-based education to nurses and patients compared with usual information provision in consultations. This study employed quantitative and qualitative research methods situated in a sequential design across three hospitals in England and Wales. Current provision of information given to 112 patients with glaucoma across the three hospitals was observed and compared to that recommended in a clinical standard. Then, six nurses were trained to deliver group-based education. Following which, the level of information was assessed again in line with the clinical standard as the group-based education programme was delivered in the three hospitals to 16 patients in total. All nurses and six patients were interviewed to explore experiences of the group-based education sessions., Results: The main area of information provided during routine nurse-led consultations concerned the management of glaucoma and that least covered was about prognosis of the disease and information about support services. Nurses were trained to implement group-based education for patients. Information was provided more often by the nurses about all the items of the clinical standard when delivering group based education. However, patients' motivation to attend were negatively impacted mainly by delays in delivering the education for the third phase and because the majority were established patients. Nurses and patients who participated found it useful and comprehensive., Conclusion: This feasibility study demonstrates that the proposed intervention for the randomised controlled trial, the group-based education, goes beyond current information provision, is in line with that articulated by a clinical standard and is implementable across several sites. This bodes well for a future randomised trial, but the following needs to be taken into account to ensure success: independent implementation of the research, training and delivery at each site, timely provision of the patient education, inclusion of new patients, and consistently delivered nurse training., Trial registration: International Standard Randomised Controlled Trial number, ISRCTN91188805.

Patient satisfaction with care in an urban tertiary referral academic glaucoma clinic in the US. - Peterson, Kristen M; Huisingh, Carrie E; Girkin, Christopher; Owsley, Cynthia; Rhodes, Lindsay A (Patient preference and adherence, 2018)
Background: The purpose of this study was to determine the factors associated with glaucoma patients' satisfaction with their medical care by fellowship-trained glaucoma specialists in an urban tertiary referral clinic in the US., Methods: A total of 110 established patients aged >=60 years with a diagnosis of either primary open angle glaucoma, glaucoma suspect, or ocular hypertension monitored by an ophthalmologist with fellowship training in glaucoma were enrolled at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a general demographics questionnaire along with a Patient Satisfaction Questionnaire-18 (PSQ-18), a Likert scale validated tool. The seven dimensions of patient satisfaction from the PSQ-18 were summarized for the sample overall and by the patients' age, race, employment status, education level, distance travelled from home address to clinic, and glaucoma therapy type. Two-sample t-tests were used to compare group means. Spearman correlation coefficients were used to correlate satisfaction scores with peripheral vision and visual acuity function., Results: Overall, the general satisfaction scores were high (mean 4.62). Patients >=70 years of age had lower general satisfaction with their care (mean 4.5 vs 4.8, p=0.03), the interpersonal manner of their appointment (mean 4.7 vs 4.9, p=0.009), and with their time spent with their doctor (mean 4.4 vs 4.7, p=0.03) than patients aged 60-69 years. Non-European descent patients (47% African descent and 1% other of sample) were more satisfied with the time they spent with the doctor (mean 4.7 vs 4.4, p=0.04) and with the communication during the appointment (mean 4.8 vs 4.6, p=0.04) than European descent patients (52% of sample). Patients with a higher level of education (>high school degree) were less satisfied with the accessibility and convenience of the appointment (mean 4.3 vs <= high school, 4.6, p=0.02). There were no statistically significant differences in patient satisfaction based upon employment status, distance travelled to clinic, prior glaucoma therapy, or visual function., Conclusion: Overall, across all dimensions of the PSQ-18, patients were highly satisfied with the care they received at the urban tertiary care glaucoma clinic.

Glaucoma therapy: preservative-free for all?. - Thygesen, John (Clinical ophthalmology (Auckland, N.Z.), 2018)
Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity is manifest clinically as ocular surface disease (OSD) and has been confirmed in epidemiologic, prospective clinical trials and studies in which patients are switched from preservative-added to preservative-free topical therapy. Such toxicity has implications not only for tolerability, but also for adherence and persistence with therapy that is known to be poor in glaucoma. Glaucoma medication is now widely available in preservative-free formulations, and the question arises as to which patients should receive preservative-free glaucoma therapy in preference to preservative-added medication. A case can be made for several subpopulations of patients who might particularly benefit from preservative-free medication: patients with existing OSD, older patients, younger adult patients, female patients, pediatric and juvenile patients, patients who work in air-conditioned environments or who use electronic screens frequently, patients with medical risk factors for OSD, patients in whom trabecular surgery may become indicated in the future, contact lens users, perhaps patients with Asian ethnicity and patients with severe or treatment-refractory glaucoma. Whilst arguments could be made for selecting patients for preservative-free medication on the basis of their existing risk of OSD, collectively, these patients form a significant proportion of the glaucoma patient population as a whole and, in the absence of any cost premium or positive indication for preservative-added medication, preservative-free glaucoma medication for all patients seems an appropriate strategy.

Relationship between electronically measured medication adherence and vision-related quality of life in a cohort of patients with open-angle glaucoma. - Thompson, Atalie C; Woolson, Sandra; Olsen, Maren K; Danus, Susanne; Bosworth, Hayden B; Muir, Kelly W (BMJ open ophthalmology, 2018)
Objective: To investigate whether electronically measured medication adherence is associated with vision-related quality of life (VRQoL) in patients with open-angle glaucoma., Methods and analysis: This is a 3-year prospective cohort study of 79 subjects with open-angle glaucoma at a Veterans Affairs medical centre. Participants returned a medication event monitoring system (MEMS) for their glaucoma eye-drops and had at least two visits with glaucoma during the study period. Those taking less than 80% of prescribed glaucoma medication doses were considered to be non-adherent. Subjects were interviewed using the National Eye Institute's Visual Function Questionnaire-25 (VFQ-25) at baseline and after 3 years., Results: Thirty per cent (n=24/79) of participants took less than 80% of prescribed doses of their glaucoma medications at baseline. Patients who did not adhere to their medications at baseline had lower mean composite VFQ-25 scores at baseline (70.66+/-20.50 vs 75.91+/-19.12, standardised mean difference=0.27) and after 3 years (71.68+/-21.93 vs 76.25+/-21.67, standardised mean difference=0.21). Visual acuity (P=0.03), but not visual field severity (P=0.13) or medication adherence (P=0.30), was significantly associated with composite VFQ-25 score in an adjusted model., Conclusions: Subjects who were non-adherent to their glaucoma medications at baseline as assessed by a MEMS device reported lower VRQoL than adherent subjects at baseline and after 3 years. However, visual acuity was significantly associated with VRQoL. Future studies should assess whether improved adherence to eye-drops impacts VRQoL in patients with glaucoma.

Expert practice patterns and opinions on corneal cross-linking for infectious keratitis. - Hsia, Yen C; Moe, Caitlin A; Lietman, Thomas M; Keenan, Jeremy D; Rose-Nussbaumer, Jennifer (BMJ open ophthalmology, 2018)
Objective: To assess the current opinion and practice patterns from cornea experts regarding the benefit of corneal cross-linking (CXL) for infectious keratitis (IK)., Methods and analysis: An international survey was distributed to corneal specialists via an internet survey. The survey data collected were analysed with descriptive statistics., Results: A survey was sent to 190 recipients, and 29 (15%) respondents completed the survey with an average of 7 years' experience using CXL. A majority of respondents (66%) used CXL to treat IK due to bacterial, fungal, protozoan or unknown aetiology. Main indications to use CXL as adjuvant therapy were worsening infiltrate diameter or depth despite therapy (74%), followed by antibiotic resistance (68%), corneal thinning (53%), poor compliance with medication (26%) and other reasons (21%). Most respondents felt CXL would be at least moderately helpful as an adjuvant therapy for bacterial (96%) or fungal (75%) keratitis; about half (46%) thought it would be helpful for acanthamoeba keratitis. As sole therapy, fewer respondents believed CXL would be at least moderately helpful to treat bacterial (75%), fungal (58%) and acanthamoeba (43%) keratitis., Conclusion: The survey offered insights into current expert practices and opinions of using CXL as therapy for IK. The results of this survey serve to guide in the design of future clinical studies.

Switching from concomitant therapy to tafluprost/timolol fixed combination. - Inoue, Kenji; Kawashima, Taku; Katakura, Seiki; Shidara, Kyoko; Fujimoto, Takayuki; Kohmoto, Hiromi; Shiokawa, Minako; Moriyama, Ryo; Okayama, Ryoko (Clinical ophthalmology (Auckland, N.Z.), 2018)
Purpose: To evaluate the efficacy and safety of tafluprost/timolol fixed combination (TTFC)., Study design: A prospective clinical study., Methods: Twenty-eight patients (28 eyes) with primary open-angle glaucoma, who had used tafluprost and timolol gel for at least 3 months with good adherence, were enrolled. Concomitant administration of tafluprost and timolol was switched to TTFC without a washout period. The intraocular pressure (IOP), blood pressure, pulse rate, and ocular signs were compared between before switching (baseline), and 4 and 8 weeks after switching. A questionnaire survey was also performed 4 weeks after switching to investigate ocular comfort and patient preferences., Results: The IOP showed no significant change after switching to TTFC (14.8 +/- 2.8, 14.6 +/- 3.4, and 14.8 +/- 3.7 mmHg at baseline, Week 4, and Week 8, respectively). The pulse rate and systolic blood pressure showed no changes, but diastolic blood pressure was significantly lower at Week 8. At baseline, fluorescein staining revealed corneal abnormalities in 3 patients, which resolved by Week 8 in 1 patient. Hyperemia was noted in 2 patients at baseline, and this also resolved by Week 8 in 1 patient. Three patients discontinued study treatment for the following reasons (1 patient each): blurred vision; ocular irritation, eyelid erythema, and asthenopia; and loss to follow-up from Week 8. The questionnaire survey revealed no significant differences between the 2 treatments, although more patients preferred TTFC., Conclusion: Among 28 patients enrolled, only 2 patients discontinued the study treatment due to adverse reactions. In patients whose adherence was considered relatively good to concomitant therapy, switching to TTFC achieved similar IOP control with good safety and a high level of patient acceptance.

A case with corneal perforation due to bacterial concretion derived from lacrimal canaliculitis. - Ishikawa, Sho; Kato, Naoko (American journal of ophthalmology case reports, 2018)
Purpose: To report a case with corneal perforation, presumably due to ocular cicatricial pemphigoid (OCP) and bacterial concretion derived from lacrimal canaliculitis., Observations: A patient with OCP demonstrated adherence of concretion to the cornea of her right eye. She also demonstrated canaliculitis in this eye. We removed a whitish precipitate from the bottom of the corneal ulcer. When we flushed her lacrimal pathway, a marked amount of bacterial concretion and dense mucosa were refluxed from both puncta on the right side. On the next day, corneal perforation was visible from the area where concretion was removed. We performed punctoplasty and removed the bacterial concretion from the lacrimal canaliculus and sac. After the operation, her symptoms improved and corneal perforation recovered., Conclusions and Importance: Both lacrimal canaliculitis and OCP can cause corneal perforation, and adherence of bacterial concretion onto the cornea is very rare. However, once it occurs, corneal perforation can rapidly follow. OCP sometimes causes corneal epithelial damage, which may influence adherence to concretion. Canaliculitis in patients with OCP should be managed carefully.

Dyslipidemia modulates Muller glial sensing and transduction of ambient information. - Lakk, Monika; Vazquez-Chona, Felix; Yarishkin, Oleg; Krizaj, David (Neural regeneration research, 2018)
Unesterified cholesterol controls the fluidity, permeability and electrical properties of eukaryotic cell membranes. Consequently, cholesterol levels in the retina and the brain are tightly regulated whereas depletion or oversupply caused by diet or heredity contribute to neurodegenerative diseases and vision loss. Astroglia play a central role in the biosynthesis, uptake and transport of cholesterol and also drive inflammatory signaling under hypercholesterolemic conditions associated with high-fat diet (diabetes) and neurodegenerative disease. A growing body of evidence shows that unesterified membrane cholesterol modulates the ability of glia to sense and transduce ambient information. Cholesterol-dependence of Muller glia - which function as retinal sentinels for metabolic, mechanical, osmotic and inflammatory signals - is mediated in part by transient receptor potential V4 (TRPV4) channels. Cholesterol supplementation facilitates, whereas depletion suppresses, TRPV4-mediated transduction of temperature and lipid agonists in Muller cells. Acute effects of cholesterol supplementation/depletion on plasma membrane ion channels and calcium homeostasis differ markedly from the effects of chronic dyslipidemia, possibly due to differential modulation of modality-dependent energy barriers associated with the functionality of polymodal channels embedded within lipid rafts. Understanding of cholesterol-dependence of TRP channels is thus providing insight into dyslipidemic pathologies associated with diabetic retinopathy, glaucoma and macular degeneration.

Nanoliposome-Encapsulated Brinzolamide-hydropropyl-beta-cyclodextrin Inclusion Complex: A Potential Therapeutic Ocular Drug-Delivery System. - Wang, Fazhan; Bao, Xingting; Fang, Aiping; Li, Huili; Zhou, Yang; Liu, Yongmei; Jiang, Chunling; Wu, Jinhui; Song, Xiangrong (Frontiers in pharmacology, 2018)
Novel ocular drug delivery systems (NODDSs) remain to be explored to overcome the anatomical and physiological barriers of the eyes. This study was to encapsulate brinzolamide (BRZ)-hydropropyl-beta-cyclodextrin (HP-beta-CD) inclusion complex (HP-beta-CD/BRZ) into nanoliposomes and investigate its potential as one of NODDS to improve BRZ local glaucomatous therapeutic effect. HP-beta-CD/BRZ was firstly prepared to enhance the solubility of poorly water-soluble BRZ. The HP-beta-CD/BRZ loaded nanoliposomes (BCL) were subsequently constructed by thin-film dispersion method. After the optimization of the ratio of BRZ to HP-beta-CD, the optimal BCL showed an average size of 82.29 +/- 6.20 nm, zeta potential of -3.57 +/- 0.46 mV and entrapment efficiency (EE) of 92.50 +/- 2.10% with nearly spherical in shape. The X-ray diffraction (XRD) confirmed the formation of HP-beta-CD/BRZ and BCL. The in vitro release study of BCL was evaluated using the dialysis technique, and BCL showed moderate sustained release. BCL (1 mg/mL BRZ) showed a 9.36-fold increase in the apparent permeability coefficient and had a sustained and enhanced intraocular pressure reduction efficacy when compared with the commercially available formulation (BRZ-Sus) (10 mg/mL BRZ). In conclusion, BCL might have a promising future as a NODDS for glaucoma treatment.

Correction: Pharmacoepidemiological assessment of adherence and influencing co-factors among primary open-angle glaucoma patients-An observational cohort study. - PLOS ONE Staff (PloS one, 2018)
[This corrects the article DOI: 10.1371/journal.pone.0191185.].
Erratum for (EFR)

Microinvasive Glaucoma Surgery: An Evidence-Based Assessment. - Schehlein, Emily M; Kaleem, Mona A; Swamy, Ramya; Saeedi, Osamah J (Expert review of ophthalmology, 2017)
Introduction: The advent of Microinvasive Glaucoma Surgery (MIGS) offers a novel approach in the treatment of glaucoma with the number of procedures developing at an exciting pace., Areas Covered: MIGS procedures aim to lower intraocular pressure (IOP) via four mechanisms: (1) increasing trabecular outflow, (2) increasing outflow via suprachoroidal shunts, (3) reducing aqueous production, and (4) subconjunctival filtration. A comprehensive search for published studies for each Microinvasive Glaucoma Surgery (MIGS) device or procedure was undertaken using the electronic database PubMed. Search terms included 'minimally invasive glaucoma surgery', 'microincisional glaucoma surgery', and 'microinvasive glaucoma surgery'. A manual search for each device or procedure was also performed. After review, randomized control trials and prospective studies were preferentially included., Expert Opinion: These procedures offer several benefits: an improved safety profile allowing for intervention in earlier stages of glaucoma, combination with cataract surgery, and decreased dependence on patient compliance with topical agents. Established MIGS procedures have proven efficacy and more recent devices and procedures show promising results. Despite this, further study is needed to assess the long term IOP-lowering effectiveness of these procedures. Particularly, rigorous study with more randomized control trials and head-to-head comparisons would allow for better informed clinical and surgical decision-making. MIGS offers new solutions for glaucoma treatment.

LONG TERM OUTCOMES OF AUGMENTED TRABECULECTOMY WITH 5-FLUOROURACIL IN NIGERIA. - Olawoye, O O; Ashaye, A O (Journal of the West African College of Surgeons, 2017)
Background: Glaucoma in sub-Saharan Africa has been described as a surgical disease because of the high cost of medical treatment, poor compliance and unavailability of medications., Aim: This study reports the long-term outcomes and complication rates following trabeculectomy with 5-fluorouracil in a case series of Nigerians., Design of study: This was a retrospective, observational, non-comparative case series., Setting: University College Hospital, Ibadan, Nigeria., Methodology: Each patient had complete ophthalmic evaluation. The post-operative intraocular pressure (IOP), visual acuity outcomes and post operative complications were assessed. The World Glaucoma Association consensus on surgical outcome was used to evaluate surgical outcome., Results: Of the 292 patients who presented with glaucoma during this period, a total of 47 eyes of 31 patients (10.6%) had trabeculectomy with 5-FU. The mean presenting intraocular pressure (IOP) was 31.8+/-12.2mmHg. At three years post-operatively, 48.5% achieved complete success without medications while 90.9% achieved success with or without medications at an IOP cut off of <=21mmHg. At the same time point of 3 years and an IOP cut off of <=15mmHg, 63.6% achieved success with or without medications. At a mean post-operative period of 43+/- 19.6 months, (range 12-86 months), mean IOP had reduced from a preoperative mean of 31.8+/-12.2mmHg to 15.4+/-4.7mmHg (P<0.001)., Conclusion: Trabeculectomy with 5-Fluorouracil is effective in the long term in reducing IOP with minimal complications in this population of Nigerians.

Development and pilot-testing of patient decision aid for use among Chinese patients with primary open-angle glaucoma. - Shum, Jennifer W H; Lam, Wendy W T; Choy, Bonnie N K; Chan, Jonathan C H; Ho, Wing Lau; Lai, Jimmy S M (BMJ open ophthalmology, 2017)
Background: A patient decision aid (PDA) is a tool for shared decision making (SDM), which emphasises patient empowerment. It is useful in chronic diseases and when there are multiple, no best single treatment option. Although SDM is prevalent in Western countries, its use is limited in Chinese societies, where the adoption of a paternalistic approach is strong. Here, we report the development, acceptance and pilot test results of a PDA targeted at Chinese patients with primary open-angle glaucoma (POAG)., Methods: We developed a PDA designed for use in Chinese patients with POAG. Recruited subjects were given our PDA. Baseline evaluation included decision conflict scale (DCS), validated glaucoma adherence questionnaires and glaucoma knowledge questionnaire. Subjects were briefed through the PDA and instructed to read it that day. Three to four weeks later, follow-up questionnaire as described above were conducted with the addition of acceptance questionnaires., Results: Data from 65 subjects were available. The PDA was well received among subjects. DCS improved from 48.9+/-20.4 at baseline to 34.3+/-20.3 during follow-up, with P<0.01. Validated medication adherence questionnaires and knowledge showed improvement from baseline, which was statistically significant., Conclusions: The use of PDA among Chinese subjects with POAG demonstrated positive reception and acceptance. Evaluation of its initial effects shows improvement in DCS, medication adherence and glaucoma knowledge. The implementation of SDM and PDA among Chinese subjects with POAG is encouraged. Future studies with randomised design and later evaluation time points can further reveal the impacts of PDA among Chinese subjects with POAG.

A stepping stone in treating dendritic keratitis. - Sheha, Hosam; Tighe, Sean; Cheng, Anny M S; Tseng, Scheffer C G (American journal of ophthalmology case reports, 2017)
Purpose: To report the outcome of self-retained amniotic membrane after debridement in recurrent dendritic keratitis., Observations: A 70-year-old female with a recurrent dendritic corneal ulcer received debridement followed by placement of self-retained amniotic membrane. Five days after treatment, the patient experienced a complete resolution of symptoms, marked reduction of inflammation, complete re-epithelialization of the cornea and improvement of visual acuity. The corneal surface remained stable for 18 months despite noncompliance in using antiviral therapy., Conclusions and importance: Self-retained amniotic membrane after debridement appears effective in treating dendritic keratitis. While early debridement is crucial to remove the infected corneal epithelium, amniotic membrane was shown to enhance the healing without scarring or recurrence. Besides the known anti-inflammatory and anti-scarring effects of the amniotic membrane, it may have a potential topical antiviral effect that warrants further investigation.

Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. - Lazcano-Gomez, Gabriel; Alvarez-Ascencio, Daniela; Haro-Zuno, Cindy; Turati-Acosta, Mauricio; Garcia-Huerta, Magdalena; Jimenez-Arroyo, Jesus; Castaneda-Diez, Rafael; Castillejos-Chevez, Armando; Gonzalez-Salinas, Roberto; Dominguez-Duenas, Francisca; Jimenez-Roman, Jesus (Journal of current glaucoma practice, 2017)
Aim: To determine the glaucoma specialists' preferences for the different brands of topical glaucoma medications available in Mexico., Materials and methods: A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice., Results: Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists' preferences., Conclusion: Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option., Clinical significance: This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition. How to cite this article: Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castaneda-Diez R, Castillejos-Chevez A, Gonzalez-Salinas R, Dominguez-Duenas F, Jimenez-Roman J. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. J Curr Glaucoma Pract 2017;11(3):97-100.

The Impact of Adherence and Instillation Proficiency of Topical Glaucoma Medications on Intraocular Pressure. - Atey, Tesfay Mehari; Shibeshi, Workineh; T Giorgis, Abeba; Asgedom, Solomon Weldegebreal (Journal of ophthalmology, 2017)
Background: The possible sequel of poorly controlled intraocular pressure (IOP) includes treatment failure, unnecessary medication use, and economic burden on patients with glaucoma., Objective: To assess the impact of adherence and instillation technique on IOP control., Methods: A cross-sectional study was conducted on 359 glaucoma patients in Menelik II Hospital from June 1 to July 31, 2015. After conducting a Q-Q analysis, multiple binary logistic analyses, linear regression analyses, and two-tailed paired t-test were conducted to compare IOP in the baseline versus current measurements., Results: Intraocular pressure was controlled in 59.6% of the patients and was relatively well controlled during the study period (mean (M) = 17.911 mmHg, standard deviation (S) = 0.323) compared to the baseline (M = 20.866 mmHg, S = 0.383, t (358) = -6.70, p < 0.0001). A unit increase in the administration technique score resulted in a 0.272 mmHg decrease in IOP (p = 0.03). Moreover, primary angle-closure glaucoma (adjusted odds ratio (AOR) = 0.347, 95% confidence interval (CI): 0.144-0.836) and two medications (AOR = 1.869, 95% CI: 1.259-9.379) were factors affecting IOP., Conclusion: Good instillation technique of the medications was correlated with a reduction in IOP. Consequently, regular assessment of the instillation technique and IOP should be done for better management of the disease.

Gene Acquisition by a Distinct Phyletic Group within Streptococcus pneumoniae Promotes Adhesion to the Ocular Epithelium. - Antic, Irena; Brothers, Kimberly M; Stolzer, Maureen; Lai, Han; Powell, Evan; Eutsey, Rory; Cuevas, Rolando A; Miao, Xinyu; Kowalski, Regis P; Shanks, Robert M Q; Durand, Dannie; Hiller, N Luisa (mSphere, 2017)
Streptococcus pneumoniae (pneumococcus) displays broad tissue tropism and infects multiple body sites in the human host. However, infections of the conjunctiva are limited to strains within a distinct phyletic group with multilocus sequence types ST448, ST344, ST1186, ST1270, and ST2315. In this study, we sequenced the genomes of six pneumococcal strains isolated from eye infections. The conjunctivitis isolates are grouped in a distinct phyletic group together with a subset of nasopharyngeal isolates. The keratitis (infection of the cornea) and endophthalmitis (infection of the vitreous body) isolates are grouped with the remainder of pneumococcal strains. Phenotypic characterization is consistent with morphological differences associated with the distinct phyletic group. Specifically, isolates from the distinct phyletic group form aggregates in planktonic cultures and chain-like structures in biofilms grown on abiotic surfaces. To begin to investigate the association between genotype and epidemiology, we focused on a predicted surface-exposed adhesin (SspB) encoded exclusively by this distinct phyletic group. Phylogenetic analysis of the gene encoding SspB in the context of a streptococcal species tree suggests that sspB was acquired by lateral gene transfer from Streptococcus suis. Furthermore, an sspB deletion mutant displays decreased adherence to cultured cells from the ocular epithelium compared to the isogenic wild-type and complemented strains. Together these findings suggest that acquisition of genes from outside the species has contributed to pneumococcal tissue tropism by enhancing the ability of a subset of strains to infect the ocular epithelium causing conjunctivitis. IMPORTANCE Changes in the gene content of pathogens can modify their ability to colonize and/or survive in different body sites in the human host. In this study, we investigate a gene acquisition event and its role in the pathogenesis of Streptococccus pneumoniae (pneumococcus). Our findings suggest that the gene encoding the predicted surface protein SspB has been transferred from Streptococcus suis (a distantly related streptococcal species) into a distinct set of pneumococcal strains. This group of strains distinguishes itself from the remainder of pneumococcal strains by extensive differences in genomic composition and by the ability to cause conjunctivitis. We find that the presence of sspB increases adherence of pneumococcus to the ocular epithelium. Thus, our data support the hypothesis that a subset of pneumococcal strains has gained genes from neighboring species that enhance their ability to colonize the epithelium of the eye, thus expanding into a new niche.

Characterization of Three Ocular Clinical Isolates of P. aeruginosa: Viability, Biofilm Formation, Adherence, Infectivity, and Effects of Glycyrrhizin. - Peng, Xudong; Ekanayaka, Sandamali A; McClellan, Sharon A; Barrett, Ronald P; Vistisen, Kerry; Hazlett, Linda D (Pathogens (Basel, Switzerland), 2017)
We selectively characterized three isolates from Pseudomonas aeruginosa keratitis patients and how glycyrrhizin (GLY) affected them. Type III toxins were determined using polymerase chain reaction (PCR). Minimum Inhibitory Concentration (MIC) of GLY and assays for its effects on: time kill, bacterial permeability, and biofilm/adhesion were done. In vivo, C57BL/6 (B6) mice were treated topically with GLY after G81007 infection. Clinical score, photography with a slit lamp and RT-PCR were used to assess treatment effects. Isolates expressed exoS and exoT, but not exoU. MIC for all isolates was 40 mg/mL GLY and bacteriostatic effects were seen for G81007 after treatment using time kill assays. From viability testing, GLY treatment significantly increased the number of permeabilized bacteria (live/dead assay). Isolates 070490 and G81007 formed more biofilms compared with R59733 and PAO1 (control). GLY-treated bacteria had diminished biofilm compared with controls for all isolates. GLY reduced adherence of the G81007 isolate to cultured cells and affected specific biofilm associated systems tested by reverse transcription PCR (RT-PCR). In vivo, after G81007 infection, GLY treatment reduced clinical score and messenger RNA (mRNA) expression of IL-1beta, TNF-alpha, CXCL2 and HMGB1. This study provides evidence that GLY is bacteriostatic for G81007. It also affects biofilm production, adherence to cultured cells, and an improved keratitis outcome.

Pattern of Ocular Morbidity in the Elderly Population of Northern India. - Baldev, Vibha Florence; Chopra, Rupali; Batra, Nitin; Singh, Shavinder (Journal of clinical and diagnostic research : JCDR, 2017)
INTRODUCTION: The frequency of eye diseases has been suggested to start increasing around 40 years of age, with an even steeper increase beginning around 60 years of age. Health promotions and curative and rehabilitative services for the visually impaired elderly population should therefore be a priority in the coming years especially in low and middle income countries., AIM: To examine the changing pattern of ocular morbidity in the elderly population of Northern India and to determine the socioeconomic status in relation to ocular morbidities., MATERIALS AND METHODS: A team from the Department of Ophthalmology and Department of Community Medicine, conducted house visits and did a complete eye examination of 450 elderly subjects. They were selected by systematic random sampling from the data base available in the Department of Community Medicine., RESULTS: A total of 900 eyes were examined. Visual impairment and blindness was seen in 135 (30%) and 36 (8%) individuals respectively. The most common cause of blindness was cataract, followed by corneal opacity, glaucoma, refractive error, diabetic retinopathy, macular scar, age related macular degeneration, retinal detachment, retinitis pigmentosa. Visual impairment was more in individuals with low socioeconomic status., CONCLUSION: The results of this study suggest that though cataract remains the main cause of blindness, there is an increase in blindness and visual impairment due to corneal diseases and glaucoma which was not seen earlier. The availability and accessibility to eye care facilities particularly for corneal diseases and glaucoma should be increased to reduce blindness in Northern India.

Glaucoma: Biological Trabecular and Neuroretinal Pathology with Perspectives of Therapy Innovation and Preventive Diagnosis. - Nuzzi, Raffaele; Tridico, Federico (Frontiers in neuroscience, 2017)
Glaucoma is a common degenerative disease affecting retinal ganglion cells (RGC) and optic nerve axons, with progressive and chronic course. It is one of the most important reasons of social blindness in industrialized countries. Glaucoma can lead to the development of irreversible visual field loss, if not treated. Diagnosis may be difficult due to lack of symptoms in early stages of disease. In many cases, when patients arrive at clinical evaluation, a severe neuronal damage may have already occurred. In recent years, newer perspective in glaucoma treatment have emerged. The current research is focusing on finding newer drugs and associations or better delivery systems in order to improve the pharmacological treatment and patient compliance. Moreover, the application of various stem cell types with restorative and neuroprotective intent may be found appealing (intravitreal autologous cellular therapy). Advances are made also in terms of parasurgical treatment, characterized by various laser types and techniques. Moreover, recent research has led to the development of central and peripheral retinal rehabilitation (featuring residing cells reactivation and replacement of defective elements), as well as innovations in diagnosis through more specific and refined methods and inexpensive tests.

When Is Evidence Enough Evidence? A Systematic Review and Meta-Analysis of the Trabectome as a Solo Procedure in Patients with Primary Open-Angle Glaucoma. - Chow, Jeffrey T Y; Hutnik, Cindy M L; Solo, Karla; Malvankar-Mehta, Monali S (Journal of ophthalmology, 2017)
The purpose of this systematic review and meta-analysis was to examine the availability of evidence for one of the earliest available minimally invasive glaucoma surgery (MIGS) procedures, the Trabectome. Various databases were searched up to December 20, 2016, for any published studies assessing the use of the Trabectome as a solo procedure in patients with primary open-angle glaucoma (POAG). The standardized mean differences (SMD) were calculated for the change in intraocular pressure (IOP) and number of glaucoma mediations used at 1-month, 6-month, and 12-month follow-up. After screening, three studies and one abstract with analyzable data were included. The meta-analysis showed statistically significant reductions in IOP and number of glaucoma medications used at all time points. Though the Trabectome as a solo procedure appears to lower IOP and reduces the number of glaucoma medications, more high-quality studies are required to make definitive conclusions. The difficulty of obtaining evidence may be one of the many obstacles that limit a full understanding of the potential safety and/or efficacy benefits compared to standard treatments. The time has come for a thoughtful and integrated approach with stakeholders to determine optimal access to care strategies for our patients.

Anterior 360degree Synechiolysis in a Case of Late Iridocorneal Adhesions after 25-G Vitrectomy: Surgical and Physiopathogenetic Aspects. - Nuzzi, Raffaele; Monteu, Francesca (Case reports in ophthalmology, 2017)
We describe the case of an 86-year-old patient, pseudophakic in both eyes and with high myopia, who had previously had a 25-G vitrectomy with 20% C3F8 used as a tamponade due to a total retinal detachment with choroidal hemorrhages and macular hole. At the postoperative 4-month follow-up, we found 360degree iridocorneal synechiae with elevated intraocular pressure due to angle closure in all sectors, with an adherent retina and in the absence of choroidal hemorrhage/detachment and of corneal edema or endothelial damage. The patient was, therefore, hospitalized to receive 360degree anterior synechiolysis with a single opening to the corneal limbus, like in paracentesis, with topical anesthesia. We have tried to study the possible causes of this case history. However, it should be recognized that the development of iridocorneal synechiae and the rise of intraocular pressure can be a possible complication of air/C3F8 vitrectomy, which cannot be managed with medical therapy. It will be essential to monitor the situation and to hospitalize the patient for surgical synechiolysis to restore the normal anatomy and physiology and to correct the ocular hypertension. During the vitrectomy, we will have to introduce in advance an adequate amount of viscoelastic material in the anterior chamber and to perform a preventive surgical iridectomy, even if the iridocorneal angle is open in all sectors.

Practice patterns for herpes simplex keratitis: A survey of ophthalmologists in Gulf Coast countries. - Alkhayyal, Mashael A; Stone, Donald U (Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society, 2017)
PURPOSE: Herpes simplex is a common cause of visual disability, and there are published evidence-based guidelines for therapy. This survey aims to determine the preferred practice patterns of ophthalmologists in Gulf Coast Countries regarding herpetic eye disease, as well as identify areas of controversy or barriers to acceptance of evidence-based protocols., METHODS: Anonymous web-based survey of ophthalmologists in Saudi Arabia, Bahrain, the United Arab Emirates, and Oman., RESULTS: There were 48 responses to the survey. For a first episode of epithelial dendritic keratitis, 28.2% reported "observation" rather than specific therapy. The majority of respondents utilize oral or topical antiviral for epithelial keratitis, with oral antiviral being the most popular (43.6%). The majority also included a corticosteroid with antiviral for stromal keratitis (83.9%) or iritis (70.3%). Over 90% prescribe a prophylactic antiviral after keratoplasty for herpetic eye disease, although the length of therapy ranged widely from <6 months to indefinite. The perceived risk of recurrent disease was ranked as the most important factor when considering antiviral prophylaxis, followed by risk of adverse effects. Topical cyclosporine was utilized "never or almost never" by 76.9% of respondents., CONCLUSIONS: Most respondents report following evidence-based guidelines. There was less consensus in areas where there are remaining knowledge gaps, such as the length of antiviral prophylaxis after keratoplasty and the potential role for topical cyclosporine.

Nanotechnology-based strategies for treatment of ocular disease. - Weng, Yuhua; Liu, Juan; Jin, Shubin; Guo, Weisheng; Liang, Xingjie; Hu, Zhongbo (Acta pharmaceutica Sinica. B, 2017)
Ocular diseases include various anterior and posterior segment diseases. Due to the unique anatomy and physiology of the eye, efficient ocular drug delivery is a great challenge to researchers and pharmacologists. Although there are conventional noninvasive and invasive treatments, such as eye drops, injections and implants, the current treatments either suffer from low bioavailability or severe adverse ocular effects. Alternatively, the emerging nanoscience and nanotechnology are playing an important role in the development of novel strategies for ocular disease therapy. Various active molecules have been designed to associate with nanocarriers to overcome ocular barriers and intimately interact with specific ocular tissues. In this review, we highlight the recent attempts of nanotechnology-based systems for imaging and treating ocular diseases, such as corneal d iseases, glaucoma, retina diseases, and choroid diseases. Although additional work remains, the progress described herein may pave the way to new, highly effective and important ocular nanomedicines.

Patient satisfaction with fixed-combination bimatoprost/timolol ophthalmic solution: a survey study in patients with glaucoma in China. - Sun, Xinghuai; Lin, Mingkai; Duan, Xuanchu; Zhang, Chun; Ming, Jian (Patient preference and adherence, 2017)
BACKGROUND: Poor adherence to treatment is a problem in glaucoma, and patient dissatisfaction with topical glaucoma medication is a barrier to adherence. The objective of this study was to evaluate glaucoma patients' satisfaction with fixed-combination bimatoprost/timolol ophthalmic solution (BTFC)., METHODS: This observational, multicenter study was conducted in China in adults with glaucoma treated with BTFC for 1-3 months. Five hundred patients answered a questionnaire concerning their demographic characteristics, history of glaucoma and topical glaucoma treatment, and use of BTFC. The primary endpoint was patient satisfaction with BTFC assessed on a 10-point scale (1= very dissatisfied, 10= very satisfied)., RESULTS: Patients received BTFC alone (65%) or with other treatments (35%), most commonly a carbonic anhydrase inhibitor. Most patients (87%) used BTFC as a replacement for other medication, usually a beta-blocker or prostaglandin analog; 13% received BTFC as add-on treatment. Key reasons for initiating BTFC therapy were poor efficacy of previous treatment (72% of patients) and side effects of previous treatment (32% of patients). Most patients agreed or very much agreed that BTFC provided better control of intraocular pressure (85% of patients), had a simpler administration (87% of patients), and was associated with better tolerance and comfort (82% of patients) compared with their previous treatment. Mean satisfaction scores were significantly higher for BTFC than for previous treatments among all patients (7.8 versus 6.0; P<0.0001) and within patient subgroups based on demographic characteristics, pattern of BTFC use, and previous treatment., CONCLUSION: Patients were highly satisfied with BTFC used alone or concomitantly with another topical medication. Patients previously treated with a beta-blocker, prostaglandin analog, carbonic anhydrase inhibitor, alpha-adrenergic agonist, or combination of two medications were more satisfied with BTFC than with their previous treatment. Most reported that intraocular pressure control, tolerability, and ease of administration improved with BTFC.
Comment in (CIN)

Prospective, non-interventional, multicenter study of the intraocular pressure-lowering effects of prostaglandin analog/prostamide-containing therapies in previously treated patients with open-angle glaucoma or ocular hypertension. - Tamcelik, Nevbahar; Izgi, Belgin; Temel, Ahmet; Yildirim, Nilgun; Okka, Mehmet; Ozcan, Altan; Yuksel, Nursen; Elgin, Ufuk; Altan, Cigdem; Ozer, Baris (Clinical ophthalmology (Auckland, N.Z.), 2017)
OBJECTIVE: The objective of this study was to assess the intraocular pressure (IOP)-lowering efficacy, tolerability, safety, and usage patterns of prostaglandin analog/prostamide (PGA/P)-containing topical ocular hypotensives in ocular hypertension (OHT) and primary open-angle glaucoma in the Turkish clinical setting., METHODS: This non-interventional, multicenter study enrolled previously treated patients who failed to achieve target IOP (or experienced unacceptable adverse events [AEs]) and were prescribed a PGA/P-containing IOP-lowering agent. Treatment was initiated at baseline (V1), and patients returned at weeks 4-6 (V2) and 8-12 (V3). The primary efficacy measure was the change in IOP from baseline at V3 in each eye. The secondary measures were physician's assessment of IOP-lowering efficacy, patients (%) reaching target IOP determined at V1, hyperemia score, physician and patient assessment of study treatment tolerability at V3, and AE frequency/severity. A subgroup analysis of patients receiving the most common study treatment was conducted. All analyses were performed using the safety population (patients who received one or more doses and had any data available)., RESULTS: Of 358 enrolled patients, 60.6% had primary open-angle glaucoma, 29.9% had secondary open-angle glaucoma (protocol amendment), and 13.1% had OHT; 13 patients had multiple diagnoses. At V3, the mean IOP change from baseline was >=-4.2 mmHg (>=21.1%). IOP met or was lower than the target in 81.7% of patients, 95% exhibited none to mild conjunctival hyperemia (most common AE), and tolerability was rated good/very good by >91.1% of patients and physicians. The results were similar in patients who received the most common study treatment, bimatoprost 0.03%/timolol 0.5% (bim/tim; n=310)., CONCLUSION: PGA/P-containing medications, including bim/tim, significantly reduced IOP in previously treated patients with open-angle glaucoma or OHT; most reached their target IOP or an IOP even lower than their target and reported good/very good tolerability. PGA/P-containing medications such as bim/tim should be considered as a safe, effective therapeutic option for Turkish patients who exhibit poor response, tolerance, or adherence to their previous therapy.

Switching to preservative-free latanoprost: impact on tolerability and patient satisfaction. - Munoz Negrete, Francisco Jose; Lemij, Hans G; Erb, Carl (Clinical ophthalmology (Auckland, N.Z.), 2017)
Patient satisfaction with glaucoma treatment has been poorly studied to date. Because glaucoma is a chronic condition in which the therapeutic response is dependent on adherence to treatment, patient acceptability is an important factor in achieving satisfactory outcomes. This multicenter, international (Belgium, the Netherlands, and Spain), epidemiological convenience sample survey among patients commencing treatment with preservative-free latanoprost collected data on patient satisfaction with particular regard to tolerability. A total of 1,541 patients were recruited who were predominantly elderly (74% were over 60 years of age) and female (61%). Most of the patients had previously received preserved topical glaucoma medication (69%), 6.7% had previously received preservative-free medication, whereas 24% had not previously been treated for glaucoma. The great majority of patients (>95%) were satisfied with the preservative-free latanoprost treatment. Among the patients who had previously received preserved medication, 73% of patients found preservative-free latanoprost to be better tolerated and 89% found it at least as easy to use as their prior treatment. Patient satisfaction (determined by a 0-100 mm visual analog scale) was improved by 47% on a switch from preserved treatment to preservative-free latanoprost. Intraocular pressure was similar in patients who had previously received preserved (18.3 mmHg), preservative-free (17.8 mmHg) glaucoma medication or who were naive to treatment (20.3 mmHg). Preservative-free latanoprost provided effective reduction of intraocular pressure with better tolerability and patient satisfaction than preserved glaucoma medication. This tolerability profile can be expected to improve adherence to treatment in glaucoma patients.
Erratum in (EIN), Comment in (CIN)

Proposing new indicators for glaucoma healthcare service. - Liang, Yuan Bo; Zhang, Ye; Musch, David C; Congdon, Nathan (Eye and vision (London, England), 2017)
Glaucoma is the first leading cause of irreversible blindness worldwide with increasing importance in public health. Indicators of glaucoma care quality as well as efficiency would benefit public health assessments, but are lacking. We propose three such indicators. First, the glaucoma coverage rate (GCR), which is the number of people known to have glaucoma divided by the total number of people with glaucoma as estimated from population-based studies multiplied by 100%. Second, the glaucoma detection rate (GDR), which is number of newly diagnosed glaucoma patients in one year divided by the population in a defined area in millions. Third, the glaucoma follow-up adherence rate (GFAR), calculated as the number of patients with glaucoma who visit eye care provider(s) at least once a year over the total number of patients with glaucoma in given eye care provider(s) in a specific period. Regularly tracking and reporting these three indicators may help to improve the healthcare system performance at national or regional levels.

A cross-sectional study on compliance with topical glaucoma medication and its associated socioeconomic burden for a Chinese population. - Lui, Man-Hin; Lam, Jason Chun Ho; Kwong, Yi Lee; Wong, Tak Siu; Cheung, Pak Long; Lai, Sherri Shun Yan; Yuen, Pak Lun; Lam, Wai Yiu; Chan, Ho Yan; Wong, Yiu Fai; Lai, Jimmy Shiu Ming; Shih, Kendrick Co (International journal of ophthalmology, 2017)
AIM: To estimate the overall drug compliance for local Chinese glaucoma patients on long-term topical treatment., METHODS: This was a retrospective cross-sectional study. Fifty-seven primary glaucoma patients from the subspecialty clinic of a publicly-funded tertiary care hospital in Hong Kong completed a questionnaire on compliance with topical glaucoma medication, attitude towards glaucoma and therapy and vision related quality of life. Noncompliance was defined as reporting missing more than or equal to 10% of the prescribed topical glaucoma medication during the 2wk immediately prior to the consultation. Relationships between noncompliance and demographics, attitude, disease and treatment status was studied. Cost was estimated with quality of life and direct medical cost involved with noncompliance. Multivariable logistic regression on noncompliance was performed on selected factors., RESULTS: Compliance was calculated as 75% (95% CI: 64%-87%) among 57 subjects (mean age 69y, female 51%). No statistical significant relationship was established between noncompliance and any single factors or outcomes. Age (P=0.048) and forgetfulness (P=0.064) were found to be marginally significant predictive factors on noncompliance in multivariable logistic regression. Noncompliance might be related (P=0.130) to poorer self-rated vision-associated quality of life. The societal cost of noncompliance was estimated to be over 2510 life-years and US$ 3.7 million territory-wide., CONCLUSION: The compliance of Chinese glaucoma patients in Hong Kong is comparable to other parts in the world, and carries detrimental impacts on individual and societal levels. Age and forgetfulness are two possible independent predictors for noncompliance.

A Review of New Medications and Future Directions of Medical Therapies in Glaucoma. - Jiang, Ying; Ondeck, Courtney (Seminars in ophthalmology, 2020)
BACKGROUND: Glaucoma is one of the leading causes of blindness worldwide. Treatment is still largely targeted at lowering intraocular pressure. Intraocular pressures can be lowered through a variety of topical medications, lasers and incisional surgeries. There are currently several classes of topical medications available in the US that are aimed at lowering intraocular pressure through a variety of different mechanisms. Additionally, there have been numerous different formulations and fixed-dose combination medications that offer greatly expanded treatment options over the last several years. The wide variety of topical medications aim to address the issues with compliance, effectiveness and side effect profile that vary among each individual patient and disease. Purpose: Three new topical medications, netarsudil 0.02%, latanoprostene bunod 0.24% and fixed-dose combination netarsudil 0.02% - latanoprost 0.005% have been approved in the US market to treat glaucoma. This review article will summarize the studies looking at their effectiveness and side effect profiles and discuss their utilization in the treatment of glaucoma. Additionally, we will briefly discuss future directions of research in topical glaucoma medications., CONCLUSION: Three new topical glaucoma medications offer additional treatment options for patient with glaucoma. Further research is needed to better understand the utility of sustained release formulations in the treatment of glaucoma.

Corneal Stiffness and Collagen Cross-Linking Proteins in Glaucoma: Potential for Novel Therapeutic Strategy. - Rahman, Najiha; O'Neill, Evelyn; Irnaten, Mustapha; Wallace, Deborah; O'Brien, Colm (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2020)
Biomechanical properties of the cornea have recently emerged as clinically useful in risk assessment of diagnosing glaucoma and predicting disease progression. Corneal hysteresis (CH) is a dynamic tool, which measures viscoelasticity of the cornea. It represents the overall deformability of the cornea, and reduces significantly with age. Low CH has also been associated with optic nerve damage and progression of visual field loss in glaucoma. The extracellular matrix (ECM) constituents of the cornea, trabecular meshwork (TM), sclera, and lamina cribrosa (LC) are similar, as they are predominantly made of fibrillar collagen. This suggests that biomechanical changes in the cornea may also reflect optic nerve compliance in glaucomatous optic neuropathy, and in the known increase of TM tissue stiffness in glaucoma. Increased collagen cross-linking contributes to tissue stiffening throughout the body, which is observed in normal aging and occurs at an accelerated rate in systemic conditions such as fibrotic and cardiovascular diseases, cancer, and glaucoma. We reviewed 3 ECM cross-linking proteins that may have a potential role in the disease process of increased tissue stiffness in glaucoma, including lysyl oxidase (LOX)/lysyl oxidase-like 1 (LOXL1), tissue transglutaminase (TG2), and advanced glycation end products. We also report elevated messenger RNA (mRNA) levels of LOX and TG2 in glaucoma LC cells to support our proposed theory that increased levels of cross-linking proteins in glaucoma play a role in LC tissue stiffness. We highlight areas of research that are needed to better understand the role of cross-linking in glaucoma pathogenesis, leading potentially to a novel therapeutic strategy.

iCareTrack: measuring the appropriateness of eyecare delivery in Australia. - Ho, Kam Chun; Stapleton, Fiona; Wiles, Louise; Hibbert, Peter; White, Andrew; Jalbert, Isabelle (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2020)
PURPOSE: To meet the needs of an ageing population and optimise health expenditure, delivery of care should be based on evidence. However, the level of evidence-based care delivered to patients with eye conditions is rarely assessed. This study thus aimed to determine the percentage of eyecare encounters at which a sample of adult Australians received appropriate care (i.e., eyecare in line with evidence-based or consensus-based guidelines)., METHODS: A cross-sectional retrospective review of optometry practice records was conducted using random stratified (by state) sampling in mainland Australia. Eighty-five clinical indicators were developed from evidence-based clinical practice guideline recommendations and refined by panels of experts using a modified Delphi process. Healthcare records of patients 18 years and over were examined against these indicators, representing appropriate care for three common eye conditions (preventative eyecare, glaucoma, and diabetic eyecare). Encounters occurred in optometry practices that were selected to be representative of the socioeconomic profile of Australian practices. The primary outcome measure was percentage compliance of eyecare delivery against the clinical indicators., RESULTS: From 426 optometry practices contacted by mail or telephone, 90 (21%) replied, 46 proved eligible and 42 were included in the study and visited for data collection. From these 1260 patient records were reviewed. Appropriate eyecare was received by Australian patients at an average of 71% (95%CI 70%, 73%) of eligible encounters. The percentage of appropriateness of eyecare at the condition level for preventative, glaucoma and diabetic eyecare was 81% (95%CI 79%, 83%), 63% (95%CI 61%, 64%), and 69% (95%CI 66%, 73%), respectively. Appropriateness of eyecare delivery was lowest for the domains of history taking and physical examination for all eye conditions., CONCLUSIONS: There were pockets of excellence but consistent delivery of appropriate eyecare needs improvement, and gaps in eyecare delivery should be addressed. Copyright © 2020 The Authors Ophthalmic & Physiological Optics © 2020 The College of Optometrists.

Micelles: Promising Ocular Drug Carriers for Anterior and Posterior Segment Diseases. - Durgun, Meltem Ezgi; Gungor, Sevgi; Ozsoy, Yildiz (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2020)
Micelles have been studied in the targeting of drug substances to different tissues as a nano-sized delivery system for many years. Sustained drug release, ease of production, increased solubility, and bioavailability of drugs with low water solubility are the most important superiorites of micellar carriers. These advantages paved the way for the use of micelles as a drug delivery system in the ocular tissues. The unique anatomical structure of the eye as well as its natural barriers and physiology affect ocular bioavailability of the drugs negatively. Conventional dosage forms can only reach the anterior segment of the eye and are used for the treatment of diseases of this segment. In the treatment of posterior segment diseases, conventional dosage forms are administered sclerally, via an intravitreal injection, or systemically. However, ocular irritation, low patient compliance, and high side effects are also observed. Micellar ocular drug delivery systems have significant promise for the treatment of ocular diseases. The potential of micellar systems ocular drug delivery has been demonstrated by in vivo animal experiments and clinical studies, and they are continuing extensively. In this review, the recent research studies, in which the positive outcomes of micelles for ocular targeting of drugs for both anterior and posterior segment diseases as well as glaucoma has been demonstrated by in vitro, ex vivo, or in vivo studies, are highlighted.

The Sustained Release of Tafluprost with a Drug Delivery System Prevents the Axonal Injury-induced Loss of Retinal Ganglion Cells in Rats. - Sato, Kota; Nakagawa, Yurika; Omodaka, Kazuko; Asada, Hiroyuki; Fujii, Shinobu; Masaki, Kenji; Nakazawa, Toru (Current eye research, 2020)
PURPOSE: To investigated whether a new drug delivery system (DDS) could enable the controlled release of tafluprost and suppress retinal ganglion cell (RGC) death in rats after optic nerve transection (ONT)., METHODS: A DDS containing 0.04%, 0.20% or 1.00% tafluprost, or vehicle, was injected intravitreally in 8-12-week-old male Sprague-Dawley rats 7 days before ONT, and the retinas were extracted 7 days after ONT. For comparison, eye drops containing 0.0015% tafluprost or vehicle were used once a day. The extracted retinas were analyzed with liquid chromatography-tandem mass spectrometry, immunohistochemistry and western blotting., RESULTS: The level of tafluprost acid in the groups that received the 0.20% and 1.00% tafluprost DDSs was stable, and higher than the maximum concentration in the eye drop group, even after 14 days. In the retinas treated with the 1.00% tafluprost DDS, the active form of the drug had a high concentration (~50 times higher than eye drops), but no significant IOP difference compared with its vehicle in this study. The 1.00% tafluprost DDS group also had less cleaved alpha-fodrin and fewer c-Jun-positive cells than the vehicle DDS group., CONCLUSIONS: This study found that a newly developed DDS allowed the controlled release of tafluprost and prevented the loss of RGCs after ONT IOP independently. The duration of drug action on the target site was longer with a tafluprost DDS than with topical instillation and should therefore reduce problems related to lack of patient compliance. This system may also enable new treatments to prevent RGC degeneration in diseases such as glaucoma.

Cost of glaucoma treatment in a developing country over a 5-year period. - Lazcano-Gomez, Gabriel; Ramos-Cadena, Maria de Los Angeles; Torres-Tamayo, Margarita; Hernandez de Oteyza, Alejandra; Turati-Acosta, Mauricio; Jimenez-Roman, Jesus (Medicine, 2016)
The aim of the study was to disclose a realistic estimate of primary open-angle glaucoma treatment, follow-up costs, and patients' monthly glaucoma-economic burden in an ophthalmology hospital in Mexico City.Prospective survey of 462 primary open-angle glaucoma patients from 2007 to 2012 was carried out. Costs from visits, glaucoma follow-up studies, laser, and glaucoma surgical procedures were obtained from hospital pricings. Education, employment, and monthly income were interrogated. Total cost was divided into hypotensive treatment cost, nonpharmacologic treatment cost (laser and surgeries), and follow-up studies and consults. Average wholesale price for drugs analyzed was obtained from IMS Health data; monthly cost was calculated using: Monthly cost = ([average wholesale price/number of drops per eye dropper] x number of daily applications) x 30 days.Patients were classified according to their glaucoma severity, and data were analyzed based on monthly income (average annual exchange rate: 12.85 Mexican pesos = 1 USD). The mean age was 70 +/- 10 years, women = 81%, elementary school = 39%, and unemployed = 53%. Low-income group = 266 patients (57%), 146 with mild glaucoma; moderate-income group = 176 patients (38%), 81 with mild glaucoma; high-income group = 20 patients (4.3%), 10 with mild glaucoma. Patients' monthly average economic burden in glaucoma treatment: low-income patients = 61.5%, moderate-income patients = 19.5%, and high-income patients = 7.9%.Glaucoma-economic burden is substantial not only for health systems, but for the family and the patient. Therefore, screening plans for earlier diagnosis, and health policies that lessen the cost of disease management and increase adherence to treatment, and reduce the prevalence of blindness attributed to glaucoma are essential. These would improve quality of life, reduce personal and national expenditure, and help increase national economy.
Keywords: Aged; Developing Countries; Female; *Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/th [Therapy]; *Health Care Costs; Humans; Male; Mexico; Prospective Studies; Severity of Illness Index

Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria. - Abdull, Mohammed Mahdi; Chandler, Clare; Gilbert, Clare (BMC ophthalmology, 2016)
BACKGROUND: In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment., METHOD: Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management., RESULTS: Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up., CONCLUSION: Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Female; Filtering Surgery; Glaucoma/ep [Epidemiology]; *Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; *Health Behavior; *Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Intraocular Pressure; Male; Nigeria/ep [Epidemiology]; *Patient Acceptance of Health Care/px [Psychology]; Patient Compliance; *Patients/px [Psychology]; Rural Population; Visual Acuity

Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. - Hernandez, R; Burr, J M; Vale, L; Azuara-Blanco, A; Cook, J A; Banister, K; Tuulonen, A; Ryan, M; Surveillance of Ocular Hypertension Study group (The British journal of ophthalmology, 2016)
OBJECTIVE: To assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor., DESIGN: Discrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year glaucoma risk is >=6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive)., SETTING: UK health services perspective., PARTICIPANTS: Simulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4)., MAIN OUTCOME MEASURES: Costs, glaucoma detected, quality-adjusted life years (QALYs)., RESULTS: Treating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost-utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (86 717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence., CONCLUSIONS: For confirmed OHT, glaucoma monitoring more frequently than every 2 years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Keywords: Adult; Costs and Cost Analysis; Disease Progression; Female; *Health Care Costs; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Monitoring, Physiologic/ec [Economics]; *Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/ec [Economics]; Ocular Hypertension/pp [Physiopathology]; *Tonometry, Ocular/ec [Economics]; United Kingdom

System for Rapid, Precise Modulation of Intraocular Pressure, toward Minimally-Invasive In Vivo Measurement of Intracranial Pressure. - Stockslager, Max A; Samuels, Brian C; Allingham, R Rand; Klesmith, Zoe A; Schwaner, Stephen A; Forest, Craig R; Ethier, C Ross (PloS one, 2016)
Pathologic changes in intracranial pressure (ICP) are commonly observed in a variety of medical conditions, including traumatic brain injury, stroke, brain tumors, and glaucoma. However, current ICP measurement techniques are invasive, requiring a lumbar puncture or surgical insertion of a cannula into the cerebrospinal fluid (CSF)-filled ventricles of the brain. A potential alternative approach to ICP measurement leverages the unique anatomy of the central retinal vein, which is exposed to both intraocular pressure (IOP) and ICP as it travels inside the eye and through the optic nerve; manipulating IOP while observing changes in the natural pulsations of the central retinal vein could potentially provide an accurate, indirect measure of ICP. As a step toward implementing this technique, we describe the design, fabrication, and characterization of a system that is capable of manipulating IOP in vivo with <0.1 mmHg resolution and settling times less than 2 seconds. In vitro tests were carried out to characterize system performance. Then, as a proof of concept, we used the system to manipulate IOP in tree shrews (Tupaia belangeri) while video of the retinal vessels was recorded and the caliber of a selected vein was quantified. Modulating IOP using our system elicited a rapid change in the appearance of the retinal vein of interest: IOP was lowered from 10 to 3 mmHg, and retinal vein caliber sharply increased as IOP decreased from 7 to 5 mmHg. Another important feature of this technology is its capability to measure ocular compliance and outflow facility in vivo, as demonstrated in tree shrews. Collectively, these proof-of-concept demonstrations support the utility of this system to manipulate IOP for a variety of useful applications in ocular biomechanics, and provide a framework for further study of the mechanisms of retinal venous pulsation.
Keywords: Animals; Humans; *Intracranial Pressure/ph [Physiology]; *Intraocular Pressure/ph [Physiology]; Shrews; Tonometry, Ocular/is [Instrumentation]; *Tonometry, Ocular/mt [Methods]

[Glaucoma treatment]. - Bluwol, Elisa (La Revue du praticien, 2016)
Glaucomas treatment. Glaucoma is the first cause of blindness in Europe. The purposes of its treatment are lowering intraocular pressure (IOP), but also getting a good patient compliance with a good tolerance and a good ratio cost/effectiveness. Glaucoma treatment should stop optic nerve fiber layer loss and stabilize visual field defects. Medical topic treatment is the first line of treatment, with possible association of drops and absence of benzalkonium chloride for some of them. Four therapeutic classes are available: beta blockers, prostaglandins , alpha-2 agonists and carbonic anhydrase inhibitors. Laser peripheral iridotomy (LPI) can treat occludable angles or angle closure when there is no or only localized peripheral anterior synechia. Laser iridoplasty is indicated in plateau iris when remains an appositional angle closure after LPI. Selective laser trabeculoplasty is an effective tool in lowering IOP and decrease IOP fluctuation. It can be successfully used as primary or adjunctive therapy for the management of both early and advanced glaucoma in primary open angle glaucoma or in angle closure glaucoma after LPI. Surgical approach should be considered after medical and/or laser treatment when glaucomatous visual field defects still progress. Filtering surgeries (non penetrating deep sclerectomy or trabeculectomy) or glaucoma valve implantation are well known for their effectiveness but bleb complications lead to develop blebless procedures called MIGS (mini invasive glaucoma surgery) or, in refractory glaucoma, non invasive surgery devices such as High-intensity focused ultrasound which consist in ultrasonic circular cyclo-coagulation of ciliary body, leading to less long term complication than diode transscleral cyclocoagulation.
Keywords: Europe; Glaucoma/th [Therapy]; *Glaucoma; Glaucoma, Angle-Closure/th [Therapy]; *Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Treatment Outcome

La consultation d'enseignement therapeutique. - Borrero, Patricia; Techer-Arbez, Danielle; Revol, Carole; Camp, Charlene; Rademacher, Catherine (Krankenpflege. Soins infirmiers, 2016)
Keywords: Glaucoma/di [Diagnosis]; *Glaucoma/nu [Nursing]; Glaucoma/th [Therapy]; Humans; Nursing Diagnosis; Patient Compliance; Patient Education as Topic; *Referral and Consultation; Switzerland

A Change in the Causes Precluding Adherence of Glaucoma Medication Regimen: Systemic Analysis over 12 Months. - Kobayashi, Hiroshi (Nippon Ganka Gakkai zasshi, 2016)
Purpose: To study the change in the causes that precluded adherence to glaucoma medication regimen by repeating the importance of the treatment for 1 year and to analyze them by means of systemic classification. Methods: Participants in this study were 230 patients who had been prescribed anti- glaucoma medication for at least six months. Adherence was examined at baseline and at 12 month, and its changes were studied. Adherence was ascertained by means of a predetermined questionnaire. Patients with poor adherence were interviewed with stratified questionnaires to elicit the causes precluding the adherence, which were analyzed with cluster analysis. Results: Two hundred three patients (88.3%) finished this study. Of these, 69 patients reported having poor adherence at baseline and 60 at 12 months (p=0.3). Structured interviews elicited 115 (0.6+/-0.9/individual) and 79 (0.4+/-0.7/individual) unique situational problems, respectively (p=0.0128), which were grouped into four separate and major categories:14 and 5 medication regimen-related factors (p=0.0345), 70 and 54 patients-related factors (p=0.1), and 10 and 6 provider-related factors (p=0.3) at baseline and at 12 months, respectively. There were 21 environmental factors at baseline which reduced to 8 after 1 year, and 10 new ones added to them, resulting in a total of 18 (p=0.6). Conclusions: All situational problems showed a significant reduction after explaining the importance of glaucoma medication. The causes precluding adherence to topical medication regimen may be likely to be multi-dimensional and should be considered in association with each individual patient.
Keywords: Adult; Aged; Aged, 80 and over; Cluster Analysis; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions/tu [Therapeutic Use]; Surveys and Questionnaires

Ocular surface disease incidence in patients with open-angle glaucoma. - Radenkovic, Marija; Stankovic-Babic, Gordana; Jovanovic, Predrag; Djordjevic-Jocic, Jasmina; Trenkic-Bozinovic, Marija (Srpski arhiv za celokupno lekarstvo, 2016)
Introduction: Ocular surface disease (OSD) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sjogren and non-Sjogren) and evaporative (extrinsic and intrinsic) form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride - BAK), which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration., Objective: The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy., Methods: Retrospective analysis of examined patients with open-angle glaucoma was used., Results: Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma). Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed., Conclusion: OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.
Keywords: Adult; Aged; Aged, 80 and over; Dry Eye Syndromes/co [Complications]; *Dry Eye Syndromes/di [Diagnosis]; Female; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Incidence; Male; Middle Aged; Ophthalmic Solutions; Preservatives, Pharmaceutical/ae [Adverse Effects]; Retrospective Studies

Small eye - a small stump which can challenge and tilt a great surgery. - Potop, Vasile (Romanian journal of ophthalmology, 2016)
The small eye suggests an apparently robust anatomy with a more resistant sclera, good trabecular function, good uvea trophicity, a healthy retina, with a full papilla. The volume of these eyes is small. Usually, the volume of the eye is related to the sagittal diameter of the eye. However, the volume of a sphere varies with the third power of the radius of the sphere. These small eyes have a volume smaller than their sagittal diameter suggests. In this volume, highly decreased develop certain anatomical components without having to keep proportions (lens, choroid), and some have a continuous growing volume (lens). On long term, there is a balance inside these eyes despite a disproportion between their components. This internal disproportion inside the small eye can erupt through pressure differences between its structures: pupillary block, angle closure or a disproportionate response in case of typically uncomplicated surgery, which alters the apparent internal balance of these eyes. Seemingly simple surgeries, such as phacoemulsification or filtering surgery can trigger storm (storms occur by differences in atmospheric pressure) with the following characteristics: - intraocular "precipitation" in the form of uveal effusions, massive choroidal hemorrhage exudative retinal detachment, CME - breaks in anatomical barriers, lens posterior capsular tear - deviations courses: aqueous misdirection Surgical operations on these eyes are like a dangerous storm surfing, with risks, incidents, with unpredictable but great experience and courage request.
Keywords: Cataract/th [Therapy]; *Filtering Surgery; Glaucoma/su [Surgery]; Humans; Hyperopia/su [Surgery]; *Intraocular Pressure; *Microphthalmos/co [Complications]; *Microphthalmos/su [Surgery]; *Phacoemulsification

From the Patient's Point of View, How Should Minimally Invasive Glaucoma Surgeries Be Evaluated?. - Cui, Qi N; Singh, Kuldev; Spaeth, George L (American journal of ophthalmology, 2016)
Keywords: *Filtering Surgery/st [Standards]; *Glaucoma/su [Surgery]; Humans; *Minimally Invasive Surgical Procedures/st [Standards]; *Patient Outcome Assessment; *Patient Preference; Sickness Impact Profile

Preference-based disease-specific health-related quality of life instrument for glaucoma: a mixed methods study protocol. - Muratov, Sergei; Podbielski, Dominik W; Jack, Susan M; Ahmed, Iqbal Ike K; Mitchell, Levine A H; Baltaziak, Monika; Xie, Feng (BMJ open, 2016)
INTRODUCTION: A primary objective of healthcare services is to improve patients' health and health-related quality of life (HRQoL). Glaucoma, which affects a substantial proportion of the world population, has a significant detrimental impact on HRQoL. Although there are a number of glaucoma-specific questionnaires to measure HRQoL, none is preference-based which prevent them from being used in health economic evaluation. The proposed study is aimed to develop a preference-based instrument that is capable of capturing important effects specific to glaucoma and treatments on HRQoL and is scored based on the patients' preferences., METHODS: A sequential, exploratory mixed methods design will be used to guide the development and evaluation of the HRQoL instrument. The study consists of several stages to be implemented sequentially: item identification, item selection, validation and valuation. The instrument items will be identified and selected through a literature review and the conduct of a qualitative study. Validation will be conducted to establish psychometric properties of the instrument followed by a valuation exercise to derive utility scores for the health states described., ETHICS AND DISSEMINATION: This study has been approved by the Trillium Health Partners Research Ethics Board (ID number 753). All personal information will be de-identified with the identification code kept in a secured location including the rest of the study data. Only qualified and study-related personnel will be allowed to access the data. The results of the study will be distributed widely through peer-reviewed journals, conferences and internal meetings. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Exercise; Female; *Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Patient Preference; *Psychometrics/mt [Methods]; Qualitative Research; *Quality of Life; Research Design; Severity of Illness Index; Surveys and Questionnaires; Young Adult

Selective laser trabeculoplasty as an initial treatment option for open-angle glaucoma. - Freitas, Ana Lucia; Ushida, Michele; Almeida, Izabela; Dias, Diego T; Dorairaj, Syril; Kanadani, Fabio Nishimura; Prata, Tiago Santos (Arquivos brasileiros de oftalmologia, 2016)
Although eye drops are frequently used as an initial treatment option for open angle glaucoma (OAG), side effects, and poor adherence, among others, may compromise treatment efficacy. In this scenario, laser trabeculoplasty is an interesting therapeutic option for open angle glaucoma cases. Commonly used for many years as a last alternative prior to glaucoma incisional surgery, laser trabeculoplasty has been changing its indication after the advent of selective laser trabeculoplasty (SLT). In the current review, we critically evaluated the published data regarding the use of laser trabeculoplasty as a first treatment option for open angle glaucoma patients. Studies using SLT as a first-line treatment have encouraging findings. One-year efficacy results are comparable to those obtained with prostaglandin analogues, with a good safety profile. Although the laser's effect is known to be transitory, recent data suggest it can be successfully repeated in cases with good response to the first SLT treatment.
Keywords: *Elective Surgical Procedures; *Glaucoma, Open-Angle/su [Surgery]; Humans; *Laser Therapy/mt [Methods]; Randomized Controlled Trials as Topic; *Trabeculectomy/mt [Methods]; Treatment Outcome

Bottle Characteristics of Topical International Glaucoma Medications versus Local Brands in Saudi Arabia. - Al-Jumaian, Nasser; Malik, Rizwan; Khandekar, Rajiv; Al-Humaidan, Abdullah; Al-Madany, Rana; Al-Qahtani, Reham; Altowairqi, Ahmed; Al-Theeb, Abdulwahab; Zaman, Babar; Al-Djasim, Leyla; Craven, E Randy; Edward, Deepak P (Middle East African journal of ophthalmology, 2016)
WHAT IS KNOWN AND OBJECTIVE: Physical bottle characteristics differ of brand name topical glaucoma medications and local generic equivalents. This study compares the bottle characteristics of international topical glaucoma brands versus local brands from the Kingdom of Saudi Arabia., METHODS: Data were collected on bottle drum volume, drop volume, bottle squeezability, bottle tip diameter, labels and instructions, cap color coding, and clarity of the drug label. Density-based calculations of drops in bottle volume were assessed using an analytic balance. Bottle tip diameter was measured using 0.05 mm Vernier calipers. A Likert scale-based questionnaire was used to evaluate the subjective opinions of patients on bottle squeezability, clarity of usage and storage instructions, and the consistency of the cap color coding., RESULTS: The volumes of international brands were statistically significantly higher than the local brands (P < 0.001). A number of drops per bottle and tip diameter were comparable between the international local brands. Cap color coding was inconsistent for international and local brands. Patients were dissatisfied with the label font size. Patients reported that the international and local brands were similar in terms of the ease of opening the bottle, instilling a drop, and the clarity of the instructions; but the local brands were subjectively easier to squeeze than international brands., WHAT IS NEW AND CONCLUSIONS: This is the first study to compare bottle characteristics of local Saudi Arabia brands with international brands. The bottle characteristics and patient feedback were similar between the local and international topical glaucoma medications. However, there were differences between the local and international brands in drug volume, bottle squeezability. Hence, patient compliance and drop dosage may differ based on the origin of manufacture.
Keywords: Administration, Topical; Adolescent; Adult; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ch [Chemistry]; *Drug Packaging/st [Standards]; *Drugs, Generic/ch [Chemistry]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/ch [Chemistry]; *Prescription Drugs/ch [Chemistry]; Prospective Studies; Saudi Arabia; Surveys and Questionnaires

Improvement of the visual field index in clinical glaucoma care. - Cohen, Shawn L; Rosen, Aaron I; Tan, Xianming; Kingdom, Frederick A A (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016)
OBJECTIVE: This article investigates the prevalence and attributes of patients with open-angle glaucoma who exhibit improvement of visual field loss in a clinical setting., DESIGN: We conducted a retrospective chart review of patients in a clinical glaucoma practice., PARTICIPANTS: We identified 719 glaucoma patients with at least 5 SITA strategy visual field tests and a minimum continuous follow-up period of 5 years., METHODS: The change in the slope of the visual field index (VFI) over time was illustrated using histogram analysis for the study eye with the worst VFI at baseline. Multiple variables were analyzed to determine their impact on rates of visual field progression, including sex, age, disease staging, intraocular pressure (IOP), and incisional surgeries. Eyes with severe nonophthalmic and ophthalmic comorbidities were excluded., RESULTS: Considering 582 eligible eyes, 232 (39.9%) showed significantly positive slopes of the VFI as a function of time, 76 (13.1%) showed nonsignificant slopes, and 276 (47.4%) showed significantly negative slopes. In all, 10 eyes (1.7%) demonstrated VFI slope improvement of >=2% per year, whereas 21 (3.6%) demonstrated VFI slope reduction >=2% per year. More advanced disease stage was significantly associated with a negative VFI slope (p < 0.0001). Trabeculectomy and poor compliance were not associated with a negative VFI slope, whereas cataract surgery correlated with higher odds of a negative VFI slope (p = 0.048)., CONCLUSIONS: In a clinical setting, a significant VFI improvement over time was observed over an interval of greater than 5 years. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; Aged, 80 and over; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Retrospective Studies; Tonometry, Ocular; *Trabeculectomy; *Vision Disorders/pp [Physiopathology]; Visual Acuity; Visual Field Tests; *Visual Fields/ph [Physiology]

Frequency of unplanned interventions in patients attending for a presumed routine glaucoma follow-up appointment. - Calafati, Jennifer; Pradhan, Zia S; Birt, Catherine M (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016)
OBJECTIVE: To determine the frequency of patient visits in which an unplanned treatment modification was required in chronic patients attending a glaucoma clinic for routine follow-up and to identify the treatment interventions most commonly employed., DESIGN: Prospective, cross-sectional study., PARTICIPANTS: A total of 630 previously stable patients attending a glaucoma clinic for routine follow-up., METHODS: This was a single-centre survey of all eligible patients returning to an academic glaucoma clinic. Data regarding whether patients' visit remained routine or required intervention, which clinical parameter had changed, and any alterations in treatment regimens were studied., RESULTS: The percentage of patients found to require a change in management was 20.79% (131 of 630 patients); 16.9% were found to have a cause for change because of glaucoma, and the remaining 4% required intervention because of a nonglaucomatous condition. The most common parameter that changed treatment was intraocular pressure (43.87%), followed by visual fields (21.29%). The frequency of abnormal parameters varied within each subtype of glaucoma. The frequency of treatment changes among those with primary open-angle glaucoma was 22.58% compared with 16.5% of glaucoma suspects, 14% of ocular hypertensives, 32% of pseudoexfoliative glaucoma, and 50% of normal tension glaucoma patients. The most common intervention (32.84%) was a change in antiglaucoma medications. The next most frequent interventions were laser procedures (21.90%) and surgery (16.06%)., CONCLUSIONS: This study suggests that a significant minority of patients attending a glaucoma clinic for a routine appointment require treatment modification. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Ambulatory Care; Antihypertensive Agents/tu [Therapeutic Use]; Appointments and Schedules; Cross-Sectional Studies; Exfoliation Syndrome/pp [Physiopathology]; *Exfoliation Syndrome/th [Therapy]; Female; Filtering Surgery/mt [Methods]; Follow-Up Studies; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Intraocular Pressure/ph [Physiology]; Low Tension Glaucoma/pp [Physiopathology]; *Low Tension Glaucoma/th [Therapy]; Male; Middle Aged; Ocular Hypertension/pp [Physiopathology]; *Ocular Hypertension/th [Therapy]; *Precision Medicine; Prospective Studies; Tonometry, Ocular; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Negotiating 'positive' aging in the presence of age-related vision loss (ARVL): The shaping and perpetuation of disability. - McGrath, Colleen; Laliberte Rudman, Debbie; Polgar, Jan; Spafford, Marlee M; Trentham, Barry (Journal of aging studies, 2016)
INTRODUCTION: While previous research has explored the meaning of positive aging discourses from the perspective of older adults, the perspective of older adults aging with a disability has not been studied. In fact the intersection of aging and disability has been largely underexplored in both social gerontology and disability studies., METHOD: This critical ethnography engaged ten older adults aging with vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews. The overarching objective was to understand those attributes that older adults with age-related vision loss perceive as being the markers of a 'good old age.' The authors critically examined how these markers, and their disabling effects, are situated in ageist and disablist social assumptions regarding what it means to 'age well'., RESULTS: The participants' descriptions of the markers of a 'good old age' were organized into five main themes: 1) maintaining independence while negotiating help; 2) responding positively to vision loss; 3) remaining active while managing risk; 4) managing expectations to be compliant, complicit, and cooperative and; 5) striving to maintain efficiency., CONCLUSION: The study findings have provided helpful insights into how the ideas and assumptions that operate in relation to disability and impairment in late life are re-produced among older adults with age-related vision loss and how older adults take on an identity that is consistent with socially embedded norms regarding what it means to 'age well'. Copyright A© 2016 Elsevier Inc. All rights reserved.
Keywords: Adaptation, Psychological; Aged; Aged, 80 and over; *Aging/px [Psychology]; Anthropology, Cultural; Attitude to Health; Diabetic Retinopathy/co [Complications]; *Diabetic Retinopathy/px [Psychology]; Female; Glaucoma/co [Complications]; *Glaucoma/px [Psychology]; Help-Seeking Behavior; Humans; Macular Degeneration/co [Complications]; *Macular Degeneration/px [Psychology]; Male; Narration; Qualitative Research; Vision Disorders/et [Etiology]; *Vision Disorders/px [Psychology]

Resident Compliance With the American Academy of Ophthalmology Preferred Practice Patterns for Primary Open-Angle Glaucoma Suspect. - Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi T; Hwang, Frank S; Yin, Jia (Journal of glaucoma, 2016)
PURPOSE: To study resident compliance with the American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPPs) for primary open-angle glaucoma suspect (POAGS) in a resident ophthalmology clinic., PATIENTS AND METHODS: Two hundred charts were selected for analysis of adult patients with the International Classification of Diseases diagnosis code for POAGS during their initial visit between November 2, 2010 and May 6, 2014 at the Kresge Eye Institute resident clinic. Electronic medical records of clinic visits for POAGS patients were evaluated for documentation and compliance with 17 elements of AAO PPPs., RESULTS: The overall mean compliance was 73.8% for all charts (n=200), 74.4% for first-year residents (n=53), 74.5% for second-year residents (n=38), and 73.3% for third-year residents (n=109). Documentation rates were high (>90%) for 9 elements, which included most elements of physical examination and history. Documentation of ocular history, central corneal thickness, gonioscopy, optic nerve head and retinal nerve fiber layer analysis, and visual field ranged from 40% to 80%. Documentation was lowest for patient education elements which ranged from 0% to 10%. Compliance was not significantly different (P>0.05) between residents or between different resident years for any element., CONCLUSIONS: Residents' compliance was high for most elements of the PPPs for POAGS. We identified elements with poor compliance especially regarding patient education. Adherence to AAO PPPs can be a helpful method of assessing resident performance.
Keywords: *Academies and Institutes; Adult; Aged; Aged, 80 and over; *Education, Medical, Graduate/st [Standards]; Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Guideline Adherence; Humans; *Internship and Residency/st [Standards]; Intraocular Pressure; Male; Middle Aged; *Ophthalmology/ed [Education]; Physicians/st [Standards]; *Practice Patterns, Physicians'; United States; Visual Fields; Young Adult

Multi-stakeholder perspectives of locally commissioned enhanced optometric services. - Baker, H; Harper, R A; Edgar, D F; Lawrenson, J G (BMJ open, 2016)
OBJECTIVES: To explore views of all stakeholders (patients, optometrists, general practitioners (GPs), commissioners and ophthalmologists) regarding the operation of community-based enhanced optometric services., DESIGN: Qualitative study using mixed methods (patient satisfaction surveys, semi-structured telephone interviews and optometrist focus groups)., SETTING: A minor eye conditions scheme (MECS) and glaucoma referral refinement scheme (GRRS) provided by accredited community optometrists., PARTICIPANTS: 189 patients, 25 community optometrists, 4 glaucoma specialist hospital optometrists (GRRS), 5 ophthalmologists, 6 GPs (MECS), 4 commissioners., RESULTS: Overall, 99% (GRRS) and 100% (MECS) patients were satisfied with their optometrists' examination. The vast majority rated the following as 'very good'; examination duration, optometrists' listening skills, explanations of tests and management, patient involvement in decision-making, treating the patient with care and concern. 99% of MECS patients would recommend the service. Manchester optometrists were enthusiastic about GRRS, feeling fortunate to practise in a 'pro-optometry' area. No major negatives were reported, although both schemes were limited to patients resident within certain postcode areas, and some inappropriate GP referrals occurred (MECS). Communication with hospitals was praised in GRRS but was variable, depending on hospital (MECS). Training for both schemes was valuable and appropriate but should be ongoing. MECS GPs were very supportive, reporting the scheme would reduce secondary care referral numbers, although some MECS patients were referred back to GPs for medication. Ophthalmologists (MECS and GRRS) expressed very positive views and widely acknowledged that these new care pathways would reduce unnecessary referrals and shorten patient waiting times. Commissioners felt both schemes met or exceeded expectations in terms of quality of care, allowing patients to be seen quicker and more efficiently., CONCLUSIONS: Locally commissioned schemes can be a positive experience for all involved. With appropriate training, clear referral pathways and good communication, community optometrists can offer high-quality services that are highly acceptable to patients, health professionals and commissioners. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Keywords: *Attitude of Health Personnel; *Community Health Services; *Delivery of Health Care/mt [Methods]; England; Eye Diseases/di [Diagnosis]; *Eye Diseases; General Practitioners; Glaucoma; Humans; Ophthalmologists; Optometrists; *Optometry; *Patient Satisfaction; *Professional Role; Referral and Consultation

Generic glaucoma drop bottle cap colours. - Hallaji, Numan A E; Trope, Graham E (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Canada; Color/st [Standards]; Drug Industry/st [Standards]; Drug Packaging/lj [Legislation & Jurisprudence]; *Drug Packaging/st [Standards]; *Drugs, Generic; *Glaucoma/dt [Drug Therapy]; Humans; Medication Adherence; Ophthalmic Solutions

Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey. - Kyari, Fatima; Nolan, Winifred; Gilbert, Clare (BMJ open, 2016)
PURPOSE OF THE STUDY: Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged >=40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists' practice patterns and their constraints in managing glaucoma., STUDY DESIGN: Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma., RESULTS: 153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiotz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges., CONCLUSIONS: This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients' awareness and education on glaucoma. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Keywords: Adult; Clinical Protocols; Diagnostic Techniques, Ophthalmological/ec [Economics]; Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; *Diagnostic Techniques, Ophthalmological; Female; *Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Health Care Surveys; Humans; Intraocular Pressure; Male; Middle Aged; Nigeria; *Ophthalmologists/ed [Education]; Ophthalmologists/st [Standards]; Ophthalmology/ed [Education]; Ophthalmology/st [Standards]; *Ophthalmology; Optic Disk/pa [Pathology]; Patient Education as Topic; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; *Quality of Health Care/st [Standards]; Trabeculectomy

Design of Novel Ophthalmic Formulation Containing Drug Nanoparticles and Its Usefulness as Anti-glaucoma Drugs. - Nagai, Noriaki (Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan, 2016)
The ophthalmic application of drugs is the primary route of administration for the therapy of glaucoma; however, in traditional formulations, only small amounts of the administered drug penetrate the cornea to reach the desired intraocular tissue due to corneal barriers. Recently, nanoparticulate drug delivery is expected as a technology to overcome the difficulties in delivering drugs across biological barriers (improvement of bioavailability). In this study, we attempted to establish a new method for preparing solid drug nanoparticles by using a bead mill and various additives, and succeeded in preparing a high quality dispersion containing drug nanoparticles. For a more concrete example, a mean particle size of disulfiram (DSF) treated with bead mill is 183 nm. The corneal penetration and corneal residence time of DSF from the ophthalmic dispersion containing DSF nanoparticles were significantly higher than those from a 2-hydroxypropyl-beta-cyclodextrin solution containing DSF (DSF solution). It is known that the administration of DSF has intraocular pressure (IOP)-reducing effects. The IOP-reducing effects of the ophthalmic dispersion containing DSF nanoparticles were significantly greater than those of the DSF solution in rabbits (the IOP was enhanced by placing the rabbits in a dark room for 5 h). In addition, the ophthalmic dispersion containing DSF nanoparticles is better tolerated by corneal epithelial cells than DSF solution. It is possible that dispersions containing DSF nanoparticles provide new possibilities for effectively treating glaucoma, and that ocular drug delivery systems using drug nanoparticles may expand their usage for therapy in the ophthalmologic field.
Keywords: Animals; Biological Availability; Cornea/me [Metabolism]; Disulfiram/ad [Administration & Dosage]; *Disulfiram/ch [Chemistry]; *Disulfiram/me [Metabolism]; Disulfiram/pd [Pharmacology]; *Drug Compounding/mt [Methods]; *Drug Delivery Systems; *Drug Design; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; *Nanoparticles; Ophthalmic Solutions; Particle Size; Rabbits

Rapid Progressive Peripheral Ulcerative Keratitis Associated with Longstanding Rheumatoid Arthritis. - Lee, Won-Seok; Choi, Yun-Jung; Yoo, Wan-Hee (The Journal of rheumatology, 2016)
Keywords: *Arthritis, Rheumatoid/co [Complications]; *Arthritis, Rheumatoid/dg [Diagnostic Imaging]; Arthritis, Rheumatoid/th [Therapy]; *Corneal Ulcer/co [Complications]; *Corneal Ulcer/dg [Diagnostic Imaging]; Corneal Ulcer/th [Therapy]; Disease Progression; Female; Follow-Up Studies; Humans; Middle Aged; Radiography/mt [Methods]; Severity of Illness Index; Slit Lamp Microscopy/mt [Methods]; Treatment Refusal

Acquired anterior staphyloma after corneal ulcer associated with the use of crack. - Vasconcelos, Stefania Barbosa Diniz de; Guerra, Fernanda Machado; Morato, Gisele Macioca; Neves, Nathalia Teles das; Tzelikis, Patrick Frensel (Arquivos brasileiros de oftalmologia, 2016)
We describe an unusual case of acquired anterior staphyloma in a patient addicted to crack cocaine. At the beginning of his crack cocaine abuse, he noticed redness and irritation of his eyes. Over the next 4 months, the patient also noticed the onset of decreasing visual acuity in his right eye (OD). Initially, his visual acuity was light perception in OD, and slit-lamp examination revealed a corneal infiltrate with a peripheral perforation and an iris prolapse. The patient was hospitalized to ensure compliance with the prescribed treatment and was advised to undergo therapeutic keratoplasty; however, the patient left the hospital against medical advice and was lost to follow-up for the next 6 months. He returned with complaints of photophobia and the inability to close his right eyelids. At this time, his cornea had developed an anterior staphyloma and required a sclerokeratoplasty. Following surgery, the patient was again lost to follow-up.
Keywords: Adult; *Corneal Diseases/ci [Chemically Induced]; Corneal Diseases/su [Surgery]; Corneal Transplantation/mt [Methods]; *Corneal Ulcer/ci [Chemically Induced]; *Corneal Ulcer/co [Complications]; Corneal Ulcer/su [Surgery]; *Crack Cocaine/ae [Adverse Effects]; Humans; Male; Scleroplasty/mt [Methods]; Treatment Outcome; Visual Acuity

[Possibilities and limitations of eye drops for glaucoma therapy]. - Lanzl, I M; Poimenidou, M; Spaeth, G L (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2016)
BACKGROUND: In Germany, chronic open-angle glaucoma is mostly treated by daily eye drop application. The possibilities and limitations of this form of therapy are presented. Reasons for the change in the selection of the preferred substances over time are also discussed and the limits of local drug therapy are described., OBJECTIVES: What effects can be expected of the available drugs?, MATERIALS AND METHODS: The article provides a review of the literature from PubMed and clinical experience., RESULTS: In chronic open-angle glaucoma, eye drops containing a single agent can achieve an intraocular pressure decrease of 15-35 % compared to the initial pressure level. This is dependent on the substance and is achievable when used as directed. Difficulties in administration are often observed in older patients where regular use over extended periods of time is required. In addition, there are limits in the achievable pressure reduction by combining several active ingredients. Novel systems are being developed for future applications. The idea is to achieve a continuous slow release of the active substance by surgical application of a biodegradable carrier., CONCLUSION: A treatment regimen which is individually tailored to the individual patient's needs should be developed by the attending physician and the achievement of the set objectives should be monitored at regular intervals. However, restrictions induced by patients due to inadequate adherence or by the drug due to limited efficacy of the drug have to be considered. Therefore, eye drop therapy in open-angle glaucoma is not always sufficient. It should be supplemented in due time by laser or filtering surgery before the affected patients and their optic nerves suffer advanced glaucomatous damage.
Keywords: Administration, Ophthalmic; *Delayed-Action Preparations/ad [Administration & Dosage]; Dose-Response Relationship, Drug; Evidence-Based Medicine; Germany; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Treatment Outcome

Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. - Baker, Helen; Ratnarajan, Gokulan; Harper, Robert A; Edgar, David F; Lawrenson, John G (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2016)
PURPOSE: UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services (EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care., METHODS: The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature., RESULTS: Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success., CONCLUSIONS: The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness. Copyright © 2016 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.
Comment in (CIN), Comment in (CIN)
Keywords: Cataract/di [Diagnosis]; Community Health Services/ec [Economics]; Community Health Services/og [Organization & Administration]; Community Health Services/st [Standards]; Cost-Benefit Analysis; *Eye Diseases/di [Diagnosis]; Glaucoma/di [Diagnosis]; Humans; Optometry/ec [Economics]; Optometry/og [Organization & Administration]; *Optometry/st [Standards]; Patient Satisfaction; United Kingdom

The Wills Eye Glaucoma App: Interest of Patients and Their Caregivers in a Smartphone-based and Tablet-based Glaucoma Application. - Waisbourd, Michael; Dhami, Hermandeep; Zhou, Chen; Hsieh, Michael; Abichandani, Pramod; Pro, Michael J; Moster, Marlene R; Katz, L Jay; Hark, Lisa A; Myers, Jonathan S (Journal of glaucoma, 2016)
PURPOSE: To evaluate the interest of glaucoma patients and their caregivers in a smartphone-based and tablet-based glaucoma application (App), developed by the Wills Eye Glaucoma Research Center in collaboration with Drexel University., MATERIALS AND METHODS: Cross-sectional survey of patients with glaucoma and their caregivers. Main outcome measures are answers to survey questions regarding how receptive participants are to using the Glaucoma App., RESULTS: Fifty subjects completed the survey. The mean age (SD) was 59.5 (+/-17.3) years. A total of 88.6% of the participants lived in a household with access to a smartphone or tablet. The majority (72.3%) of participants would consider downloading the Glaucoma App, and younger participants (<65 y) were more likely to do so compared with their older (>=65 y) counterparts, P=0.025. Participants were more likely to download the App if it was free of charge, compared with a version that costs $3, P=0.018. Although only about one third (37.8%) of participants used eye drop reminders, nearly 3 of 4 (72.9%) participants were receptive to using the automated reminder feature of the Glaucoma App., CONCLUSIONS: Glaucoma patients and their caregivers were very interested in using a Glaucoma App; however, many were not willing to spend $3 for an App they seem to value. The free Wills Eye Glaucoma App currently available on the Apple store, includes educational videos, eye drop and appointment reminders, medical and ocular data storage, visual field tutorial, and intraocular pressure tracker. These features aim to increase patients' level of knowledge about glaucoma and improve their adherence to medication and follow-up appointment recommendations.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; *Caregivers; *Computers, Handheld; Cross-Sectional Studies; Female; *Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence; Middle Aged; *Mobile Applications/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Tonometry, Ocular; Visual Fields

Level of adherence to ocular hypotensive agents and its determinant factors among glaucoma patients in Menelik II Referral Hospital, Ethiopia. - Mehari, Tesfay; Giorgis, Abeba T; Shibeshi, Workineh (BMC ophthalmology, 2016)
BACKGROUND: Good adherence to ocular hypotensive agents is important to control intraocular pressure and hence to prevent progressive glaucomatous optic nerve head damage. Periodic investigation of adherence is crucial in glaucoma treatment. The purpose of this study was to assess level of adherence to ocular hypotensive agents and to identify factors affecting adherence among glaucoma patients at a tertiary public eye care center., METHODS: The study was a hospital-based cross-sectional study that was conducted in Menelik II Referral Hospital from June 1, 2015 to July 31, 2015. A systematic random sampling technique was used to select 359 study participants from the source population. The study patients were interviewed and their medical charts were reviewed using a pretested structured questionnaire. Adherence was assessed using Morisky Medication Adherence Scale - 8 and adherence determinant factors were identified using multivariate binary logistic regression analysis. The association was declared statistically significant at p < 0.05., RESULTS: Among the 359 study glaucoma patients, 42.6 % were adherent to their prescribed hypotensive agents. Higher educational level (AOR = 4.60, 95 % CI: 1.01-21.03, p < 0.049), being self - employed (AOR = 6.14, 95 % CI: 1.37-27.50, p < 0.018) and taking lesser frequency of drops (AOR = 2.89, 95 % CI: 1.25-6.66, p < 0.013) were significantly associated with adherence, whereas being a farmer (AOR = 0.07, 95 % CI: 0.01-0.75, p < 0.028), having very low monthly family income (AOR = 0.22, 95 % CI: 0.06-0.77, p < 0.019) and self - purchasing of medications (AOR = 0.30, 95 % CI: 0.10-0.93, p < 0.036) were significantly associated with non-adherence., CONCLUSIONS: The study has identified the adherence level to the prescribed ocular hypotensive agents to be sub-optimal and is influenced by different factors among glaucoma patients of the public tertiary center. We recommend glaucoma care providers to pay due attention on the importance of adherence.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Educational Status; Employment/sn [Statistics & Numerical Data]; Ethiopia; Female; *Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Multivariate Analysis; Ophthalmic Solutions/tu [Therapeutic Use]; Risk Factors; Socioeconomic Factors; Young Adult

Vision Loss in Older Adults. - Pelletier, Allen L; Rojas-Roldan, Ledy; Coffin, Janis (American family physician, 2016)
Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.
Erratum in (EIN)
Keywords: Aged; Aged, 80 and over; Angiogenesis Inhibitors/tu [Therapeutic Use]; Antihypertensive Agents/tu [Therapeutic Use]; Ascorbic Acid/tu [Therapeutic Use]; Bevacizumab/tu [Therapeutic Use]; Blindness/di [Diagnosis]; Blindness/et [Etiology]; Blindness/th [Therapy]; Cataract/co [Complications]; Cataract/di [Diagnosis]; *Cataract/th [Therapy]; Cataract Extraction; Diabetic Retinopathy/co [Complications]; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/th [Therapy]; Fenofibrate/tu [Therapeutic Use]; Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Hypolipidemic Agents/tu [Therapeutic Use]; Intravitreal Injections; Light Coagulation; Macular Degeneration/co [Complications]; Macular Degeneration/di [Diagnosis]; *Macular Degeneration/th [Therapy]; Mass Screening; Practice Guidelines as Topic; Ranibizumab/tu [Therapeutic Use]; Vision Disorders/di [Diagnosis]; Vision Disorders/et [Etiology]; *Vision Disorders/th [Therapy]; Vision, Low/di [Diagnosis]; Vision, Low/et [Etiology]; Vision, Low/th [Therapy]; Vitamin E/tu [Therapeutic Use]; Vitamins/tu [Therapeutic Use]

[Reasons for intraocular pressure to resist hypotensive therapy in glaucoma patients]. - Onishchenko, A L; Kolbasko, A V; Safronova, M A; Isakov, I N (Vestnik oftalmologii, 2016)
AIM: To study the reasons of intraocular pressure (IOP) resistance to therapy in patients with glaucoma., MATERIAL AND METHODS: During the period 2011-2013 we examined 72 primary glaucoma patients (stage I-III), 44 women and 28 men, aged 49-87 years (65.2+/-2.5 years on average) referred by local ophthalmologists due to poor response to hypotensive therapy., RESULTS: We suggest that glaucoma should be regarded as resistant if, despite combination therapy with three antihypertensive drugs at optimal doses, IOP stays above the target. In the present study, the treatment was found suboptimal in 19.4% of cases. About 45% of all patients (33 patients) demonstrated poor compliance to the prescribed treatment. Resistant glaucoma, as we have defined it, was diagnosed in 33% of cases (pigmentary glaucoma, pseudoexfoliation glaucoma, secondary unrecognized glaucoma, etc.). This group also included patients, in whom b-blockers were initially effective, but then seemed to lose their power., CONCLUSION: 1. The reasons for intraocular pressure to resist hypotensive therapy are often associated with medical inertia (inaccurate diagnosis, inadequate treatment, etc.) and lack of patient compliance. 2. Resistant glaucoma in its true sense accounts for about 35% of cases of IOP being above the target despite conservative treatment. 3. It is advisable that at the time of first presentation, any patient who fails to reach the target IOP is treated as an <> case, until the reasons for his/her resistance are clear.
Comment in (CIN), Comment in (CIN), Comment in (CIN)
Keywords: Aged; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents; *Drug Resistance; Female; Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; *Glaucoma; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Patient Compliance/sn [Statistics & Numerical Data]; Tonometry, Ocular/mt [Methods]; Treatment Outcome

Cost of the medical management and prescription pattern for primary open angle glaucoma (POAG) in Ghana-a retrospective cross-sectional study from three referral facilities. - Ocansey, Stephen; Kyei, Samuel; Diafo, Ama; Darfor, Kwabena Nkansah; Boadi-Kusi, Samuel Bert; Aglobitse, Peter B (BMC health services research, 2016)
BACKGROUND: Glaucoma is the leading cause of irreversible blindness globally, and treatment involves considerable cost to stakeholders in healthcare. However, there is infrequent availability of cost information and patterns of management, especially in developing countries. This study determined the cost of the medical management of POAG, adherence, and pattern of medication prescription in Ghana., METHODS: A retrospective cross-sectional study involving 891 Primary Open Angle Glaucoma (POAG) cases seen in the year 2012 at three referral facilities. Demographics, ocular history, resource consumption, medication, test, surgery and other related cost were extracted from 84 patients who had fully complied with their treatment to calculate total cost (TC) based on 2012 estimates. Glaucoma drugs prescribed to patients who had adhered to all their review visits within the period evident from case folders were recorded and analysed for the prescription pattern., RESULTS: Out of 891 POAG cases seen in 2012, 351(39.4 %) attended all the required review visits, but only 84 (9.4) had fully and continually adhered to all their treatment regimes. They comprised 41(48.8 %) males and 43(51.2 %) females with a mean age of 65 +/- 14.8. Majority of the respondents were elderly above 60 year of age (65.5 %). The total estimated cost for the 84 cases in the year was GH 81,237 ($40,619), comprising GH 72,193 ($36,097) direct medication cost and GH9,045 ($4,523) direct non-medication cost (surgery and test cost), and an average of GH 967 ($484) for a mean visit of 5.6 +/- 1.1 in the year. A total of 673 glaucoma medications had been prescribed for 351 patients for the year, with timolol being the most prescribed (64.19 %) and monotherapy as the most adopted form of therapy (61.06 %). Age and income showed concurrent increase with cost (P <= 0.05)., CONCLUSIONS: Cost of managing glaucoma constitutes a substantial financial burden and influenced the pattern of medication prescription.
Keywords: Aged; Blindness/pc [Prevention & Control]; Costs and Cost Analysis; Cross-Sectional Studies; *Drug Costs; Female; Ghana; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Resources/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure; Male; Middle Aged; *Practice Patterns, Physicians'; Referral and Consultation; Retrospective Studies

Comparison of Self-Reported and Objective Adherence to Antiglaucoma Medications. - Zarnowski, Tomasz; Wyszynska, Anna; Rekas, Marek (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2016)
Keywords: *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure; *Medication Adherence; *Self Report

Right services to right patients at right time in right setting in Tays Eye Centre. - Tuulonen, Anja; Kataja, Marko; Syvanen, Ulla; Miettunen, Sirpa; Uusitalo, Hannu (Acta ophthalmologica, 2016)
PURPOSE: The report describes the concepts behind procedures implemented in Tays Eye Centre to enable improved access to care and improved productivity., METHODS: The strategy was developed in 2009 after hospital district decided to construct a new eye hospital which was opened in 2012. The following principles were implemented: (i) identification of high-volume patient groups: the 'big four' eye diseases accounting for 70% of patient visits and costs: age-related macular degeneration (AMD), glaucoma, retinal diseases and cataract; (ii) stratification and prioritization of patient care based on risk of permanent visual disability; (iii) standardization of services for low-risk patients; (iv) maximization of productivity; and (v) shared care. The impact of the new strategy on access to care and productivity is reported for years 2011-2015., RESULTS: In 2011-2015, the total number of services provided increased 46% while the work contribution increased 15%. The number of referrals increased 76% and the number of outpatient appointments increased 2.5-fold. Simultaneously, the number of delayed follow-up visits decreased to zero. Age-related macular degeneration (AMD) injections increased 1.8-fold. However, after 50% yearly increase in Age-related macular degeneration (AMD) injections, a plateau was reached in 2014 with a 3% decline in 2014-2015 with no changes in treatment indications. In the beginning of 2016, the number of injections has started to increase again (+9% compared to 2015). The total number of surgical procedures increased 98%. The annual number of cataract surgeries increased 64% and bilateral surgeries from 11% to 39%., CONCLUSION: Revised operational concepts and new facilities together with a 15% increase in work contribution led to a 46% increase in overall productivity, improved access to care and the clearance of delayed services. Efforts continue to further refine cost-effective care and to define the appropriate levels of services. Copyright © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Appointments and Schedules; *Delivery of Health Care/og [Organization & Administration]; Finland; *Health Plan Implementation; *Health Services Accessibility/og [Organization & Administration]; *Health Services Needs and Demand/og [Organization & Administration]; *Hospitals, Special/og [Organization & Administration]; Humans; National Health Programs; Ophthalmologic Surgical Procedures/sn [Statistics & Numerical Data]; *Ophthalmology/og [Organization & Administration]; Quality of Health Care; Referral and Consultation/sn [Statistics & Numerical Data]

Study on Incentives for Glaucoma Medication Adherence (SIGMA): study protocol for a randomized controlled trial to increase glaucoma medication adherence using value pricing. - Bilger, Marcel; Wong, Tina T; Howard, Kaye L; Lee, Jia Yi; Toh, Ai Nee; John, Geraldine; Lamoureux, Ecosse L; Finkelstein, Eric A (Trials, 2016)
BACKGROUND: Many glaucoma patients do not adhere to their medication regimens because they fail to internalize the (health) costs of non-adherence, which may not occur until years or decades later. Behavioural economic theory suggests that adherence rates can be improved by offering patients a near-term benefit. Our proposed strategy is to offer adherence-contingent rebates on medication and check-up costs. This form of value pricing (VP) ensures that rebates are granted only to those most likely to benefit. Moreover, by leveraging loss aversion, rebates are expected to generate a stronger behavioural response than equivalent financial rewards., METHODS/DESIGN: The main objective of the Study on Incentives for Glaucoma Medication Adherence (SIGMA) is to test the VP approach relative to usual care (UC) in improving medication adherence. SIGMA is a randomized, controlled, open-label, single-centre superiority trial with two parallel arms. A total of 100 non-adherent (Morisky Medication Adherence Scale <=6) glaucoma patients from the Singapore National Eye Centre are block-randomized (blocking factor: single versus multiple medications users) into the VP and UC arms in a 1:1 ratio. The treatment received by VP patients will be strictly identical to that received by UC patients, with the only exception being that VP patients can earn either a 50 % or 25 % rebate on their glaucoma-related healthcare costs conditional on being adherent on at least 90 % or 75 % of days as measured by a medication event monitoring system. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome is the mean change from baseline in percentage of adherent days at month 6. A day will be counted as adherent when the patients take all their medication(s) within the appropriate dosing windows., DISCUSSION: This trial will provide evidence on whether adherence-contingent rebates can improve medication adherence among non-adherent glaucoma patients, and more generally whether this approach represents a promising strategy to cost-effectively improve chronic disease management., TRIAL REGISTRATION: NCT02271269 . Registered on 19 October 2014.
Keywords: Adult; Aged; Aged, 80 and over; *Drug Costs; Female; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; Glaucoma/px [Psychology]; Health Knowledge, Attitudes, Practice; Humans; *Insurance, Health, Reimbursement; Male; *Medication Adherence; Middle Aged; *Motivation; *Office Visits/ec [Economics]; Research Design; Risk Assessment; Risk Factors; Singapore; Time Factors; Treatment Outcome; *Value-Based Health Insurance/ec [Economics]; Young Adult

Accessibility of ophthalmic healthcare for residents of an offshore island-an example of integrated delivery system. - Chen, Li-Ju; Chang, Yun-Jau; Shieh, Chun-Fu; Yu, Jy-Haw; Yang, Ming-Chin (BMC health services research, 2016)
BACKGROUND: To assess the utilization of and satisfaction with ophthalmic healthcare provided by integrated delivery system (IDS) since 2000 and vision-related quality of life (VRQoL) for residents of an offshore island of Taiwan., METHODS: Facilitators interviewed residents (age >= 50 years) with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) for VRQoL and a questionnaire on clinical information, ophthalmic care utilization and satisfaction., RESULTS: A total of 841 participants (response rate 93.4 %, 841/900) completed the questionnaire survey. Mean age was 63.7 (+/-10. 7) years. The common eye diseases were cataract (44.7 %), dry eye (15.5 %), and glaucoma (8.7 %). Among the participants, 61.0 % sought ophthalmic care under the IDS in the past year and 17.6 % experienced unmet ophthalmic needs in the past 6 months. Satisfaction with ophthalmic care under the IDS was 88.1 %. Determinants of dissatisfaction under the IDS were distance to healthcare facility and VRQoL. Predictors of VRQoL included age, residential area, marital status, occupation, comorbid condition, commercial insurance, household income, cataracts and glaucoma., CONCLUSIONS: The implementation of IDS improves accessibility of ophthalmic care for residents of an offshore island. Geographic proximity to avail healthcare facility and VRQoL affect satisfaction with the IDS.
Keywords: Aged; Aged, 80 and over; Delivery of Health Care, Integrated/sn [Statistics & Numerical Data]; Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; Female; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; National Health Programs; Ophthalmology; *Patient Satisfaction; *Quality of Life; Regression Analysis; Surveys and Questionnaires; Taiwan; *Vision, Ocular

[Pay attention to the fine management of the diagnosis and treatment of glaucoma]. - Wang, N L ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2016)
During the clinical practice of glaucoma, the fine management is needed in patient's eye history taking, clinical material organization, the standardization, normalization, advantage complement of clinical examination and compliance evaluation of anti-glaucoma medication. The fine management of the glaucoma diagnosis and treatment will enable the greatest extent of visual protection.(Chin J Ophthalmol, 2016, 52: 401-403).
Keywords: *Disease Management; *Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans

Predictors of Nonadherence to Topical Intraocular Pressure Reduction Medications Among Medicare Members: A Claims-Based Retrospective Cohort Study. - Sheer, Richard; Bunniran, Suvapun; Uribe, Claudia; Fiscella, Richard G; Patel, Vaishali D; Chandwani, Hitesh S (Journal of managed care & specialty pharmacy, 2016)
BACKGROUND: Reported adherence rates with ocular hypotensive medications typically range from 51% to 56% over the first year of therapy. As intraocular pressure (IOP) reduction slows the progression of vision loss from glaucoma, early identification of nonadherent members is crucial to effective disease management., OBJECTIVES: To (a) identify member characteristics and other factors related to nonadherence with topical IOP-lowering medications available in administrative claims data and (b) create a predictive model incorporating these variables., METHODS: This retrospective cohort study analyzed data from Humana's administrative claims database. The study cohort included members aged 65-89 years enrolled in a Medicare Advantage Prescription Drug plan (MAPD; medical and pharmacy benefits), with > 1 topical IOP-lowering medication claims between January 2011 and September 2012 and a minimum of 24 months of continuous enrollment-12 months before and 12 months after the initial (index) prescription claim for a topical IOP-lowering medication. Adherence was defined as the proportion of days covered (PDC) with drug supply (calculated from the number of drops per bottle and dose) over the first year after the index prescription. Members with PDC > 0.80 were considered adherent, while members with PDC < 0.80 were considered nonadherent. Multivariable stepwise logistic regression with backward elimination was used to construct a predictive model for the likelihood of nonadherence (PDC < 0.80). The model was developed using 28 input variables*#x2013;10 variables were retained in the final model., RESULTS: 73,256 MAPD members were included in this study; most (69%) of these members were continuing topical IOP-lowering medication users. The proportion of patients adherent (PDC > 0.80) to IOP-lowering medications was 51%. The study sample was split, using a 2:1 ratio, into a development sample (n = 48,840 members) and a validation sample (n=24,416 members). The model performed equally well in the development sample and the validation sample (area under the curve = 0.71 for development and validation sets), making it appear robust in this Medicare population. In the final predictive model, characteristics increasing the likelihood (P < 0.01) of nonadherence to IOP-lowering medication within the MAPD population included index IOP prescription filled through mail order, higher medical costs during the pre-index period, being a new IOP-lowering medication user, and being male. Characteristics that lowered the likelihood of nonadherence included advanced age, higher pharmacy costs during the pre-index period, receiving a low-income subsidy, residing in the South, and a previous diagnosis of open-angle glaucoma or history of glaucoma surgery., CONCLUSIONS: Nonadherence to topical IOP-lowering medication can be predicted with 10 commonly available demographic, clinical, and treatment-related variables generally available in administrative claims data for an MAPD population. Given that this predictive model was constructed using these generally available data, it could potentially be replicated by other health plans for use in predicting nonadherence to topical IOP-lowering medications among MAPD plan members. This predictive model can be used to identify members that are likely to be nonadherent in order to target interventions intended to improve ocular hypotensive medication adherence., DISCLOSURES: Funding for this study was contributed by Allergan. Comprehensive Health Insights was contracted by Allergan to conduct this study. Sheer, Bunniran, and Uribe are employed by Comprehensive Health Insights/Humana and own stock in Humana. Fiscella, Chandwani, and Patel are employed by Allergan. Study concept and design were contributed by Sheer, Fiscella, and Patel, along with Bunniran and Uribe. Sheer and Bunniran took the lead in data collection, and data interpretation was performed by Bunniran and Uribe, along with the other authors. The manuscript was written and revised by Sheer, Bunniran, Chandwani, and Uribe, with assistance from Fiscella and Patel.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cohort Studies; Female; Forecasting; Humans; Insurance Claim Review; *Intraocular Pressure/de [Drug Effects]; Male; *Medicare Part C/td [Trends]; *Medication Adherence; *Medication Therapy Management/td [Trends]; Retrospective Studies; United States/ep [Epidemiology]

Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population. - Pleet, Alexander; Sulewski, Melanie; Salowe, Rebecca J; Fertig, Raymond; Salinas, Julia; Rhodes, Allison; Merritt Iii, William; Natesh, Vikas; Huang, Jiayan; Gudiseva, Harini V; Collins, David W; Chavali, Venkata Ramana Murthy; et al. (Ophthalmic epidemiology, 2016)
PURPOSE: To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population., METHODS: This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors., RESULTS: Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pre-treatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP >=21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups., CONCLUSION: Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.
Keywords: *African Americans/sn [Statistics & Numerical Data]; Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; *Blindness/eh [Ethnology]; Case-Control Studies; Disease Progression; Female; *Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/eh [Ethnology]; Humans; Male; Middle Aged; Risk Factors; United States/ep [Epidemiology]; Visual Acuity

Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario. - Johnson, Davin; El-Defrawy, Sherif R; Hollands, Simon; Hurst, Jonathan; Law, Christine; Li, Cody; Baxter, Stephanie; Campbell, Erica de L P; Campbell, Robert J (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016)
OBJECTIVE: To report on patterns of optometry prescribing and adherence to prescribing regulations at a tertiary care ophthalmology centre., DESIGN: Prospective cohort study., PARTICIPANTS: All new referrals from optometrists and other health care professionals to the emergency eye care service (n = 1965) between July 2011 and June 2012, as well as optometry referrals to 2 subspecialty services (glaucoma [n = 71] and cornea [n = 212])., METHODS: In our primary analysis, the frequency of prescribing and classes of medications prescribed were reported and compared amongst various referral sources to the emergency eye care service. As a secondary analysis, we reported frequency of prescribing in optometry referrals to 2 subspecialty clinics. Adherence to prescribing guidelines was reported for all optometry referrals., RESULTS: Of 296 referrals from optometrists to the emergency eye care service, 20 (6.8%) had received a prescription medication; this was significantly less compared to emergency and family physicians (p < 0.001). Topical antibiotics were the most frequently prescribed medication class. The frequency of prescribing by optometrists was 5.2% (11/212) and 4.2% (3/71) for patients referred to the cornea and glaucoma services, respectively. Among those patients referred after being given a prescription for a glaucoma medication by an optometrist, 89% cases (8/9) did not adhere to prescribing regulations., CONCLUSIONS: After the introduction of prescribing privileges, optometrists prescribe a variety of medications in their practices. Current prescribing guidelines are not always followed in practice, suggesting that continued study and collaboration is necessary to create an optimal model of interdisciplinary care that provides access to the highest quality of care. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Comment in (CIN), Comment in (CIN)
Keywords: Cohort Studies; *Drug Prescriptions/sn [Statistics & Numerical Data]; Emergency Medical Services; Female; Guideline Adherence; Health Care Surveys; Health Services Research; Humans; Male; Middle Aged; Ontario/ep [Epidemiology]; *Optometrists/sn [Statistics & Numerical Data]; *Physicians/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prospective Studies; Referral and Consultation/sn [Statistics & Numerical Data]; *Tertiary Care Centers/sn [Statistics & Numerical Data]

[Is there a need for a therapeutic education with patients suffering with open-angle glaucoma? Preliminary inquiry regarding knowledge and patient adherence]. - Dugast, P; Thiboust, P; Blumen-Ohana, E; Nordmann, J-P (Journal francais d'ophtalmologie, 2016)
PURPOSE: To evaluate the knowledge and compliance of patients with open-angle glaucoma in order to propose an approach by therapeutic education, validated for other chronic pathologies., METHODS: A questionnaire-based interview of all patients in the waiting room of the glaucoma center is performed by the same health care professional., RESULTS: Out of 200 patients, 73% know they will need to be treated throughout their lives and 95% are aware of the risk of blindness in the absence of appropriate treatment. However, 16% respond that they can be cured, and 54% believe that treatment can save their eyesight. Knowledge increases with the length of follow-up of patients at the glaucoma center beyond one year, but the progress is still insufficient in their confidence that treatment can save their eyesight (36% to 57%), and in the decrease in the number of patients who forget their treatment (56% to 30%)., CONCLUSION: Cognitive knowledge is insufficient to encourage the patient to comply with treatment. It is necessary to consider therapeutic patient education (TPE) techniques, such as described by WHO, in group and/or individual sessions, aimed at building the patient's confidence that treatment can delay the progression of the disease and blindness, strengthening his/her capacity to properly administer the eye drops, managing his/her treatment and coping with frequent side effects. Within this framework, our knowledge of the patients' representations of their glaucoma and its treatment must improve. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; Blindness/et [Etiology]; Disease Progression; Female; Glaucoma, Open-Angle/et [Etiology]; Glaucoma, Open-Angle/th [Therapy]; *Glaucoma, Open-Angle; Humans; Knowledge; Male; Middle Aged; *Needs Assessment; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; Patient Education as Topic/st [Standards]; *Patient Education as Topic; Perception; Surveys and Questionnaires

Glaucoma treatment adherence at a United Kingdom general practice. - Tse, A P; Shah, M; Jamal, N; Shaikh, A (Eye (London, England), 2016)
Purpose To estimate patient adherence with glaucoma therapy and identify factors associated with adherence using computerised patient prescribing records. Methods Identification of patients diagnosed with glaucoma, ocular hypertension or suspect glaucoma and/or prescribed topical glaucoma medications registered at a United Kingdom general practice with 13 422 patients. Adherence was defined as the average difference in the actual number of prescriptions collected annually compared to twelve prescriptions required annually (one bottle per month) over the duration of treatment. Results Overall, 278 patients were identified of which 139 (50%) were male. The average age was 72 years (range: 22-100). A total of 206 patients (74%) were prescribed glaucoma treatment. Adherence varied significantly between age groups with younger patients demonstrating poorest adherence (P=0.0347). There was no statistical difference when comparing medication class, diagnosis, co-morbidities, or the number of drops being taken. Conclusions Glaucoma treatment adherence improves with increasing age. Older patients require more prescriptions and may be experiencing drop wastage. Younger patients should be targeted with educational interventions to improve their understanding of glaucoma, and older patients for drop technique review. General practices are well placed to provide such interventions.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Databases, Factual; *Drug Prescriptions/sn [Statistics & Numerical Data]; Female; General Practice; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Risk Factors; United Kingdom/ep [Epidemiology]; Young Adult

Selective Laser Trabeculoplasty as Primary Treatment for Open-Angle Glaucoma. - Kadasi, Laith M; Wagdi, Safa; Miller, Kimberly V (Rhode Island medical journal (2013), 2016)
Open-angle glaucoma is a silent, chronic disorder which results in progressive and permanent vision loss. Designing the optimal treatment regimen can be particularly challenging in the management of high-risk patients with frequent loss to follow-up or a longstanding history of medication noncompliance. In this article we aim to review fundamental techniques in glaucoma diagnosis and treatment with emphasis on the strengths and weaknesses of selective laser trabeculoplasty, a technique in modern therapy which may mold the future of primary treatment in open angle glaucoma management. [Full article available at http://rimed.org/rimedicaljournal-2016-06.asp, free with no login].
Keywords: Chronic Disease; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Gonioscopy; Humans; Intraocular Pressure; Laser Therapy/ae [Adverse Effects]; *Laser Therapy/mt [Methods]; Risk Factors; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy/mt [Methods]; Treatment Outcome; Visual Fields

[Early adherence to anti-glaucoma therapy: An observational study]. - Belhassen, Manon; Laforest, Laurent; Licaj, Idlir; Van Ganse, Eric (Therapie, 2016)
OBJECTIVES: Glaucoma is a major cause of blindness, preventable by a regular therapy. Thus, a good knowledge of patients' adherence to preventive therapy is critical to improve disease management. Early persistence to first-line glaucoma therapy is poorly documented in France. We verified to what extent first-line glaucoma therapy was interrupted within the 12 months following initiation and how this interruption varied with patients' characteristics and drug classes., METHODS: Patients newly-treated with chronic glaucoma therapy (prostaglandins, beta-blockers alone or combined with another therapy, and topical carbonic anhydrase inhibitors) between 2005 and 2008 were identified in the French National Claims data (1/97th random sample). Twelve-month persistence was defined by the presence of the first-line drug class (>=1dispensation) between the 12th and 24th months following initiation. Twelve-month persistence was compared between patients according to the first-line drug classes and baseline characteristics. Proportion of days covered (12 months) and number of quarters with initiated drug class (24 months) were also studied., RESULTS: Among 5331 patients initiated with chronic glaucoma therapy in monotherapy (63% aged >=60 years old, 57% females), initiated therapy mainly consisted of prostaglandins (43%) and beta-blockers alone (32%). Only 45% of the patients were persistent to first-line therapy 12 months after initiation. Salient differences in persistence rates appeared between drug classes (P<0.0001): from 59% with prostaglandins to 26% for topical carbonic anhydrase inhibitors. Better results also appeared for prostaglandins with other dimensions of adherence. Non-persistent patients were more likely younger than 40, or conversely aged>=80 (P<0.0001). They were also more likely to necessitate social assistance for therapy (P=0.0007). No salient difference appeared as to gender., CONCLUSIONS: Our findings confirm the low early persistence of first-line therapy, despite better results for prostaglandins. Education of patients and identification of barriers to adherence could contribute to improve quality of care. Copyright © 2016 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Female; France; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Prostaglandins/tu [Therapeutic Use]

[Compliance with medical treatment in primary open-angle glaucoma in Lome]. - Santos, M A K; Ayena, D K; Kuaovi, K R; Vonor, K; Djagnikpo, A; Balo, K P (Journal francais d'ophtalmologie, 2016)
OBJECTIVE: To assess the compliance rate among glaucoma patients with medical treatment, to investigate the factors influencing their attitude and survey their expectations vis-a-vis the doctor., PATIENTS AND METHODS: This is a prospective descriptive study conducted in four eye clinics in Lome from January 2013 to July 2013. It included all glaucoma patients aged 40 years and above who have been under medical treatment for at least 6 months, with no history of surgical treatment of glaucoma. The evaluation was performed on the basis of a questionnaire. Compliance was rated good, fair or poor according to the regularity of treatment, compliance with the prescribed dosage and schedule of instillations, good instillation technique and compliance with follow-up visits. Patients consented to participate in the survey., RESULTS: A total of 107 patients responded to our questionnaire. There were 43 men and 64 women with a sex ratio (M/F) of 0.67. The mean age was 52.40+/-11.03 years. In total, 7.5% of patients were illiterate. Compliance rate was estimated good in 10.3% of cases, fair in 65.4% of cases, and poor in 24.3% of cases. Only the regularity of treatment, schedule adherence and good instillation technique, as well as compliance with monitoring visits were found as significant factors (P<0.05). Concerning patients' expectations vis-a-vis the doctor, 49.5% said they expected nothing from the doctor, 12.1% were hoping for advice and moral support, and 11.2% were hoping for the prescription of effective but less expensive eye drops., CONCLUSION: A good compliance rate was very low. The improvement of this compliance rate requires better information, education and communication for behavior change, and it also requires a higher quality of care and accessibility of anti-glaucoma drugs. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Surveys and Questionnaires; Togo/ep [Epidemiology]

Glaucoma. - Gupta, Divakar; Chen, Philip P (American family physician, 2016)
Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary open-angle glaucoma and primary angle-closure glaucoma, affect more than 2 million Americans and are increasing in prevalence. Many patients with glaucoma are asymptomatic and do not know they have the disease. Risk factors for primary open-angle glaucoma include older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus. Risk factors for primary angle-closure glaucoma include older age, Asian descent, and female sex. Advanced disease at initial presentation and treatment nonadherence put patients with glaucoma at risk of disease progression to blindness. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting. Regular eye examinations for adults are recommended by the American Academy of Ophthalmology, with the interval depending on patient age and risk factors. Diagnosis of glaucoma requires careful optic nerve evaluation and functional studies assessing a patient's visual field. The goal of treatment with eye drops, laser therapy, or surgery is to slow visual field loss by lowering intraocular pressure. Family physicians can contribute to lowering morbidity from glaucoma through early identification of high-risk patients and by emphasizing treatment adherence in patients with glaucoma.
Keywords: *Adrenergic alpha-Agonists/tu [Therapeutic Use]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Age Factors; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; *Cholinergic Agonists/tu [Therapeutic Use]; Diabetes Mellitus/ep [Epidemiology]; Ethnic Groups/sn [Statistics & Numerical Data]; Glaucoma, Angle-Closure/di [Diagnosis]; *Glaucoma, Angle-Closure/dt [Drug Therapy]; Glaucoma, Angle-Closure/ep [Epidemiology]; Glaucoma, Angle-Closure/pp [Physiopathology]; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Mass Screening; Practice Guidelines as Topic; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Risk Assessment; Risk Factors

Branched Peptide, B2088, Disrupts the Supramolecular Organization of Lipopolysaccharides and Sensitizes the Gram-negative Bacteria. - Lakshminarayanan, Rajamani; Tan, Wei Xiang; Aung, Thet Tun; Goh, Eunice Tze Leng; Muruganantham, Nandhakumar; Li, Jianguo; Chang, Jamie Ya Ting; Dikshit, Neha; Saraswathi, Padmanabhan; Lim, Rayne Rui; Kang, Tse Siang; Balamuralidhar, Vanniarajan; et al. (Scientific reports, 2016)
Dissecting the complexities of branched peptide-lipopolysaccharides (LPS) interactions provide rationale for the development of non-cytotoxic antibiotic adjuvants. Using various biophysical methods, we show that the branched peptide, B2088, binds to lipid A and disrupts the supramolecular organization of LPS. The disruption of outer membrane in an intact bacterium was demonstrated by fluorescence spectroscopy and checkerboard assays, the latter confirming strong to moderate synergism between B2088 and various classes of antibiotics. The potency of synergistic combinations of B2088 and antibiotics was further established by time-kill kinetics, mammalian cell culture infections model and in vivo model of bacterial keratitis. Importantly, B2088 did not show any cytotoxicity to corneal epithelial cells for at least 96 h continuous exposure or hemolytic activity even at 20 mg/ml. Peptide congeners containing norvaline, phenylalanine and tyrosine (instead of valine in B2088) displayed better synergism compared to other substitutions. We propose that high affinity and subsequent disruption of the supramolecular assembly of LPS by the branched peptides are vital for the development of non-cytotoxic antibiotic adjuvants that can enhance the accessibility of conventional antibiotics to the intracellular targets, decrease the antibiotic consumption and holds promise in averting antibiotic resistance.
Keywords: Animals; Anti-Bacterial Agents/pd [Pharmacology]; *Antimicrobial Cationic Peptides/ad [Administration & Dosage]; Antimicrobial Cationic Peptides/pd [Pharmacology]; Bacterial Load/de [Drug Effects]; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; *Gram-Negative Bacteria/de [Drug Effects]; Gram-Negative Bacteria/me [Metabolism]; *Gram-Negative Bacterial Infections/dt [Drug Therapy]; Humans; *Keratitis/dt [Drug Therapy]; Keratitis/mi [Microbiology]; *Lipopolysaccharides/ch [Chemistry]; Lipopolysaccharides/me [Metabolism]; Mice; Molecular Dynamics Simulation; Spectrometry, Fluorescence

Predictors, Resource Utilization, and Short-term Costs of Laser Trabeculoplasty Versus Medication Management in Open-Angle Glaucoma. - Schultz, Neil M; Wong, William B; Coleman, Anne L; Malone, Daniel C (American journal of ophthalmology, 2016)
PURPOSE: Adjunctive laser trabeculoplasty (LT) is an alternative to topical medications for open-angle glaucoma (OAG). The purpose was to: (1) identify predictors of LT vs glaucoma medication treatment; and (2) estimate the resource utilization and short-term costs associated with LT vs medication management., DESIGN: Retrospective administrative claims analysis., METHODS: Medical and pharmacy claims data between 2007 and 2012 were analyzed to identify prostaglandin analogue monotherapy OAG patients with an index date LT claim or second medication class claim. Patients were followed for 12 months pre-index and 24 months post-index. Predictive LT attributes included age, sex, employment status, medication adherence, comorbidity status, and geographic region. Short-term costs included glaucoma-specific and comprehensive healthcare encounters. Cohort comparisons were analyzed using chi(2) and Student t tests, logistic regression (predictive), and generalized linear models (cost)., RESULTS: The study included 4743 LT and 16 484 medication patients. Baseline demographics were similar but significant differences were identified for comorbidities, adherence, and geography. Younger age (odds ratio [OR]: 1.21; P < .001), low adherence (OR: 1.18; P = .001), high comorbidities (OR: 1.12; P = .006), and region (OR: 1.50; P < .001) significantly predicted LT receipt. Within LT patients, 60% did not have a pharmacy claim 45 days post-index; by 2 years, this reduced to 20%. LT attributed significantly higher medical ($2684 vs $1980; P < .0001), lower pharmacy ($807 vs $1467; P < .0001), and greater overall costs ($3441 vs $3408; P = .325)., CONCLUSIONS: Poor adherence, younger age, and more comorbidities were predictors of receiving LT. Despite the potential for LT to address adherence, most patients had a medication claim within 2 years. Overall, LT does not provide glaucoma-specific cost savings. Copyright © 2016 Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/su [Surgery]; Health Care Costs; Humans; Insurance, Health/sn [Statistics & Numerical Data]; Logistic Models; Male; Middle Aged; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Trabeculectomy/ec [Economics]; *Trabeculectomy/mt [Methods]

Six-Month Intraocular Pressure Reduction with a Topical Bimatoprost Ocular Insert: Results of a Phase II Randomized Controlled Study. - Brandt, James D; Sall, Kenneth; DuBiner, Harvey; Benza, Robert; Alster, Yair; Walker, Gary; Semba, Charles P; Collaborators (Ophthalmology, 2016)
PURPOSE: Improving adherence to manage elevated intraocular pressure (IOP) remains an unmet need. A topical bimatoprost ocular insert was compared with twice-daily timolol eye drops in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) treated for 6 months., DESIGN: Parallel-arm, multicenter, double-masked, randomized, controlled trial., PARTICIPANTS: One hundred thirty adult OAG or OHT patients., METHODS: Eligible patients were randomized 1:1 to receive a bimatoprost insert plus artificial tears twice daily or a placebo insert plus timolol (0.5% solution) twice daily for 6 months after a screening washout period. Diurnal IOP measurements (at 0, 2, and 8 hours) were obtained at baseline; weeks 2, 6, and 12; and months 4, 5, and 6. Key eligibility included washout IOP of 23 mmHg or more at time 0, IOP of 20 mmHg or more at 2 and 8 hours, and IOP of 34 mmHg or less at all time points; no prior incisional surgery for OAG or OHT; and no known nonresponders to prostaglandins., MAIN OUTCOME MEASURES: The primary efficacy end point examined the difference in mean change from baseline in diurnal IOPs (point estimate, 95% confidence interval) across 9 coprimary end points at weeks 2, 6, and 12 comparing the bimatoprost arm with the timolol arm using a noninferiority margin of 1.5 mmHg. Secondary end points were diurnal IOP measurements at months 4, 5, and 6 and adverse events (AEs)., RESULTS: A mean reduction from baseline IOP of -3.2 to -6.4 mmHg was observed for the bimatoprost group compared with -4.2 to -6.4 mmHg for the timolol group over 6 months. The study met the noninferiority definition at 2 of 9 time points but was underpowered for the observed treatment effect. Adverse events were consistent with bimatoprost or timolol exposure; no unexpected ocular AEs were observed. Primary retention rate of the insert was 88.5% of patients at 6 months., CONCLUSIONS: Clinically relevant reduction in mean IOP was observed over 6 months with a bimatoprost ocular insert and seems to be safe and well tolerated. The topically applied bimatoprost insert may provide an alternative to daily eye drops to improve adherence, consistency of delivery, and reduction of elevated IOP. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost/ae [Adverse Effects]; *Bimatoprost/tu [Therapeutic Use]; Delayed-Action Preparations; Double-Blind Method; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Prospective Studies; Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]; Tonometry, Ocular

Single clear corneal incision for glaucoma drainage device shortening in pediatric glaucoma. - Radke, Phillip M; Bitrian, Elena; Grajewski, Alana L (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2016)
Glaucoma drainage devices are commonly used for management of glaucoma in adults and children. With time, the position of the tube can change and cause damage such as corneal scarring, iris or lens contact, and uveitis. Most of these problems can be improved with tube shortening and/or excision of adherent iris or fibrous tissue. We describe a surgical technique that uses a single clear corneal incision to externalize and trim the shunt in pediatric patients. The technique has a short surgical. We review the indications and outcomes for this procedure in 13 eyes of 12 children who required shunt revision. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.
Keywords: Child; Child, Preschool; *Cornea/su [Surgery]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; *Glaucoma Drainage Implants; Humans; Infant; Intraocular Pressure/ph [Physiology]; *Ophthalmologic Surgical Procedures; *Prosthesis Failure; Prosthesis Implantation/mt [Methods]; Reoperation; Suture Techniques

Infections after keratoprosthesis. - Davies, Emma; Chodosh, James (Current opinion in ophthalmology, 2016)
PURPOSE OF REVIEW: The purpose is to provide an overview of the recent advancements in the diagnosis and treatment of microbial keratitis and endophthalmitis after keratoprosthesis implantation., RECENT FINDINGS: The addition of vancomycin daily to a fluoroquinolone in the postoperative management of keratoprosthesis patients successfully reduced the number of cases of bacterial keratitis and endophthalmitis with an increased number of fungal infections now documented both in the United States and abroad., SUMMARY: Compliance with the regimen of a fluoroquinolone and vancomycin daily for life after keratoprosthesis implantation should be stressed with the patient. Further research is needed to investigate whether intermittent use of 5% povidone-iodine and frequent replacement of the bandage contact lens could reduce fungal infection after keratoprosthesis surgery. Future advancements in the Boston keratoprosthesis design and/or postoperative management are needed to further reduce infection after keratoprosthesis placement.
Keywords: *Anti-Bacterial Agents/tu [Therapeutic Use]; Artificial Organs; Cornea/su [Surgery]; Endophthalmitis/di [Diagnosis]; *Endophthalmitis/et [Etiology]; Endophthalmitis/th [Therapy]; Eye Infections, Bacterial/di [Diagnosis]; *Eye Infections, Bacterial/et [Etiology]; Eye Infections, Bacterial/th [Therapy]; Eye Infections, Fungal/di [Diagnosis]; *Eye Infections, Fungal/et [Etiology]; Eye Infections, Fungal/th [Therapy]; Humans; Keratitis/di [Diagnosis]; *Keratitis/et [Etiology]; Keratitis/th [Therapy]; *Postoperative Complications/mi [Microbiology]; *Prostheses and Implants/ae [Adverse Effects]; *Prosthesis Implantation/ae [Adverse Effects]; Retrospective Studies

Quality of Life in Glaucoma: A Review of the Literature. - Quaranta, Luciano; Riva, Ivano; Gerardi, Chiara; Oddone, Francesco; Floriani, Irene; Konstas, Anastasios G P (Advances in therapy, 2016)
The ultimate goal of glaucoma management is the preservation of patients' visual function and quality of life (QoL). The disease itself as well as the medical or surgical treatment can have an enormous impact on a patient's QoL. Even the mere diagnosis of a chronic, irreversible, potentially blinding disorder can adversely affect the patient's sense of well-being and QoL by eliciting significant anxiety. Patients with primary open-angle glaucoma rarely present with visual symptoms, at least early in the course of the disease. A better understanding of patient-reported QoL can improve patient-physician interaction and enhance treatment adherence by customizing treatment options based on individual patient profile, thus optimizing long-term prognosis. These aspects are summarized and critically appraised in this article.
Erratum in (EIN)
Keywords: Disease Management; Glaucoma/di [Diagnosis]; Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; *Glaucoma; Humans; *Patient Care Planning; Prognosis; *Quality of Life; Visual Field Tests

Glaucoma Disparities in the Hispanic Population. - Nathan, Niraj; Joos, Karen M (Seminars in ophthalmology, 2016)
The Hispanic population is the United States' largest minority and one of the fastest growing as well. In the next 30 to 40 years, the proportion of open-angle glaucoma patients represented by Hispanics is expected to dramatically rise. Here we examine the unique considerations and challenges of glaucoma care in this population, from demographics to risk factors to treatments and outcomes. Currently, access to care and the under-diagnosis of glaucoma in this population are significant issues that look only to grow in significance as the glaucoma burden continues to grow. Additionally, utilization of medical and surgical therapy remains lower in Hispanics than in many other ethnic groups. Understanding and proactively addressing the unique challenges in the screening and treatment of Hispanics will be of utmost importance to providing effective care to this population.
Keywords: *Glaucoma/eh [Ethnology]; Glaucoma/th [Therapy]; Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility/sn [Statistics & Numerical Data]; *Health Status Disparities; *Hispanic Americans/sn [Statistics & Numerical Data]; Humans; Risk Factors

Glaucoma: the patient's perspective. - Imrie, Claire; Tatham, Andrew J (The British journal of general practice : the journal of the Royal College of General Practitioners, 2016)
Keywords: Age Factors; *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; Health Behavior; Humans; *Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; Patient Education as Topic; Referral and Consultation

Preservative-free tafluprost/timolol fixed combination: a new opportunity in the treatment of glaucoma. - Konstas, Anastasios G P; Hollo, Gabor (Expert opinion on pharmacotherapy, 2016)
INTRODUCTION: Medical therapy of glaucoma aims to maintain the patient's visual function and quality of life. This generally commences with monotherapy, but it is often difficult to reach the predetermined target pressure with this approach. Fixed combinations (FCs) are therefore selected as the next step of the medical therapy algorithm. By employing a prostaglandin/timolol fixed combination (PTFC) the desired target 24-hour intraocular pressure can be reached in many glaucoma patients with the convenience of once-a-day administration and the associated high rate of adherence., AREAS COVERED: The current role and value of FCs in the medical therapy of glaucoma is critically appraised. Special attention is paid to the PTFCs and the emerging role of preservative-free PTFCs. This review summarizes existing information on the efficacy and tolerability of the new preservative-free tafluprost/timolol FC (Taptiqom R)., EXPERT OPINION: The preservative-free tafluprost/timolol FC represents a promising stepwise treatment option for those patients whose intraocular pressure is insufficiently controlled with available monotherapy options. This novel FC has the potential to substantially improve glaucoma management and through evolution of the current glaucoma treatment paradigm, to become a core therapeutic option in the future. Nonetheless, future research is needed to better delineate the therapeutic role of current and future preservative-free FCs in glaucoma therapy.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Disease Management; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Ocular Hypertension/dt [Drug Therapy]; Preservatives, Pharmaceutical/ch [Chemistry]; *Prostaglandins F/ad [Administration & Dosage]; Prostaglandins F/ae [Adverse Effects]; Quality of Life; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]

Eye Care Disparities and Health-Related Consequences in Elderly Patients with Age-Related Eye Disease. - Umfress, Allison C; Brantley, Milam A Jr (Seminars in ophthalmology, 2016)
The elderly population in the United States (age 65 and older) is growing rapidly, estimated by the U.S. Census Department to reach 83.7 million by 2050.(1) Visual impairment increases with age among all racial and ethnic groups.(2) In the elderly, the most common culprits for vision loss are cataract, glaucoma, and age-related macular degeneration (AMD). (2) In the developed world, vision loss from cataract has been dramatically reduced by increased access to cataract surgery. However, AMD and glaucoma lead to irreversible vision loss without early diagnosis and intervention. In the U.S., cases of AMD are expected to double by 2050, reaching 17.8 million among patients age 50 or older.(3) Similarly, cases of glaucoma are expected to reach 5.5 million by 2050, an increase of over 90% from 2014.(3) The visually impaired elderly face disparities in access to eye care, and subsequent general medical and psychosocial complications.
Keywords: Aged; Aged, 80 and over; *Aging; *Eye Diseases/ep [Epidemiology]; Health Services Accessibility; *Health Status; *Healthcare Disparities/sn [Statistics & Numerical Data]; Humans; *Vision Disorders/ep [Epidemiology]; Visually Impaired Persons/sn [Statistics & Numerical Data]

Ocular Stem Cell Research from Basic Science to Clinical Application: A Report from Zhongshan Ophthalmic Center Ocular Stem Cell Symposium. - Ouyang, Hong; Goldberg, Jeffrey L; Chen, Shuyi; Li, Wei; Xu, Guo-Tong; Li, Wei; Zhang, Kang; Nussenblatt, Robert B; Liu, Yizhi; Xie, Ting; Chan, Chi-Chao; Zack, Donald J (International journal of molecular sciences, 2016)
Stem cells hold promise for treating a wide variety of diseases, including degenerative disorders of the eye. The eye is an ideal organ for stem cell therapy because of its relative immunological privilege, surgical accessibility, and its being a self-contained system. The eye also has many potential target diseases amenable to stem cell-based treatment, such as corneal limbal stem cell deficiency, glaucoma, age-related macular degeneration (AMD), and retinitis pigmentosa (RP). Among them, AMD and glaucoma are the two most common diseases, affecting over 200 million people worldwide. Recent results on the clinical trial of retinal pigment epithelial (RPE) cells from human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs) in treating dry AMD and Stargardt's disease in the US, Japan, England, and China have generated great excitement and hope. This marks the beginning of the ocular stem cell therapy era. The recent Zhongshan Ophthalmic Center Ocular Stem Cell Symposium discussed the potential applications of various stem cell types in stem cell-based therapies, drug discoveries and tissue engineering for treating ocular diseases.
Keywords: Animals; Embryonic Stem Cells/cy [Cytology]; Embryonic Stem Cells/tr [Transplantation]; Humans; Induced Pluripotent Stem Cells/cy [Cytology]; Induced Pluripotent Stem Cells/tr [Transplantation]; *Retinal Diseases/th [Therapy]; *Retinal Pigment Epithelium/cy [Cytology]; *Stem Cell Transplantation

Patient satisfaction in the Peterborough community specialist optometrist in glaucoma shared-care scheme. - Roberts, H W; Sood, M; Sood, S; Kotecha, A; Ramirez-Florez, S (Eye (London, England), 2016)
Comment on (CON)
Keywords: Glaucoma; Humans; *Optometrists; Optometry; *Patient Satisfaction; Specialization

User-centered Design of the eyeGuide: A Tailored Glaucoma Behavior Change Program. - Killeen, Olivia J; MacKenzie, Chamisa; Heisler, Michele; Resnicow, Ken; Lee, Paul P; Newman-Casey, Paula Anne (Journal of glaucoma, 2016)
PURPOSE: We employed user-centered design to refine a prototype of the eyeGuide, a novel, tailored behavior change program intended to improve medication adherence among glaucoma patients., PATIENTS: Glaucoma patients age 40 years and above prescribed >=1 glaucoma medication were included., METHODS: The eyeGuide consists of tailored educational content and tailored testimonials in which patients share how they were able to overcome barriers to improve their medication adherence. A hybrid of semistructured diagnostic and pretesting interviews were used to refine the content of the eyeGuide. Purpose ful sampling was used to recruit a study population representative of the glaucoma patient population. Interviews were conducted until thematic saturation was reached. Interviews were audiorecorded and transcribed verbatim. Three researchers analyzed the transcripts, generated a codebook, and identified key themes using NVivo 10.0 to further refine the eyeGuide., RESULTS: Twenty-one glaucoma patients were interviewed; mean age 72+/-12.4 years, 5 (24%) African Americans, 9 (43%) with poor self-reported adherence, 10 (47.6%) age 75 years and above, 10 (47.6%) with poor vision, and 9 (42.9%) women. Qualitative analysis identified 5 important themes for improving glaucoma self-management: social support, patient-provider relationship, medication routine, patients' beliefs about disease and treatment, and eye drop instillation. All participants expressed satisfaction with in-person delivery of the eyeGuide and preferred this to a Web-based module. Participant feedback resulted in revised content., CONCLUSIONS: User-centered design generated improvements in the eyeGuide that would not have been possible without patient input. Participants expressed satisfaction with the tailored content.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions; *Patient Education as Topic; Patient Satisfaction; Surveys and Questionnaires

Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill. - Kumar, Jaya B; Bosworth, Hayden B; Sleath, Betsy; Woolson, Sandra; Olsen, Maren; Danus, Susanne; Muir, Kelly W (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2016)
PURPOSE: Glaucoma medications reduce the risk of progressive visual field loss, but adherence to these medications is often poor. A better understanding of the appropriate metrics for quantifying glaucoma medication adherence is needed. We describe and compare different means of quantifying glaucoma medication adherence., METHODS: Adults with glaucoma were enrolled in a prospective 2-site study. Participants completed a self-report instrument and received electronic medication monitors to use for ~3 months. Pharmacy records were queried regarding requested refills over the monitoring period; medication possession ratio (MPR) was calculated., RESULTS: Of the 137 total participants, those who answered "Very confident" to the question, "How confident are you that you always remember to use your glaucoma medications?" and "No" to the question, "In the past 4 weeks, did you ever forget to take your medicine?" were more likely [odds ratio (OR) 2.78, 95% confidence interval (CI) 1.19-6.52] to take >=80% of the prescribed doses according to electronic medication monitors. Mean MPR was 1.49, standard deviation (SD) 0.82, range 0.1-5.31. The proportion of participants taking greater than or equal to 80% of the prescribed doses according to the electronic monitors was 59% for participants with MPR <1.2 (n = 27), 63% for participants with MPR 1.2-1.8 (n = 27), and 88% for MPR >1.8 (n = 25)., CONCLUSIONS: Asking about confidence may be a good method of screening for poor adherence for glaucoma medication. MPR may be an inadequate representation of glaucoma medication adherence.
Keywords: Adult; Aged; Aged, 80 and over; Drug Monitoring; *Drug Prescriptions/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Middle Aged; *Pharmaceutical Services/sn [Statistics & Numerical Data]; *Self Report

Capsular hook-assisted implantation of modified capsular tension ring. - Khokhar, Sudarshan; Gupta, Shikha; Nayak, Bhagabat; Gogia, Varun (BMJ case reports, 2016)
A 16-year-old boy presented with decrease of vision over a period of 2 years. On examination, he was diagnosed to have microspherophakia with lenticular myopia with secondary glaucoma in both eyes. He was treated by lens aspiration and two-point capsular support using a modified capsular tension ring (M-CTR) and capsular tension segment (CTS) sutured to the sclera along with implantation of a foldable intraocular lens inside the bag. Lens aspiration was performed without artificial capsular hook support of the bag, as the lens was soft and vitreous was formed. However, M-CTR rotation into the bag was fraught with repeated adherence of the advancing end of the M-CTR into the loose bag causing simultaneous rotation of the bag with the rotation of the ring resulting in transient increase in bag subluxation. Capsular hooks provided appropriate countertraction to the unsupported bag, thus facilitating easy insertion and rotation of the ring into the bag. Copyright 2016 BMJ Publishing Group Ltd.
Keywords: Adolescent; Corneal Diseases/co [Complications]; *Corneal Diseases/su [Surgery]; Ectopia Lentis/co [Complications]; *Ectopia Lentis/su [Surgery]; Glaucoma/co [Complications]; *Glaucoma/su [Surgery]; Humans; *Iris/ab [Abnormalities]; Iris/su [Surgery]; *Lens Capsule, Crystalline/su [Surgery]; *Lens Implantation, Intraocular/mt [Methods]; Lens Subluxation/su [Surgery]; Lenses, Intraocular; Male; Microsurgery; Myopia/et [Etiology]; Phacoemulsification/mt [Methods]; Sclera

Visual Rehabilitation in Pediatric Aphakia. - Repka, Michael X (Developments in ophthalmology, 2016)
The management of childhood cataract begins at the initial contact with the family and typically extends far into the child's future. Decisions affecting long-term care and visual outcomes are often made in these initial preoperative encounters. Treatment will vary depending on whether the cataract is unilateral or bilateral and whether it is infantile onset or later. Thorough discussion of the treatment options is needed, especially with description of the life-long management issues for the child. Visual outcomes will vary, with the best visual acuity results being observed in older children with bilateral cataracts. Visual rehabilitation of children with unilateral cataract requires use of a contact lens or an intraocular lens (IOL) for the best result with a chance for binocularity. Only about 50% of eyes with unilateral infantile cataract will develop vision of better than 20/200. For bilateral cataracts, both contacts and IOLs can be used, as well as aphakic glasses. Excellent visual outcomes are typical unless glaucoma develops, which occurs in up to 30% of cases. Cataract surgery after 1 year of age is associated with substantially better visual outcomes. The use of an IOL is most commonly accepted and performed for cataract in one or both eyes after 1 year of age. Prior to 1 year of age, significantly more secondary surgical procedures are required to manage opacification of the optical axis with the use of an IOL compared with the use of surgery and contact lens correction. Amblyopia therapy for unilateral cataract needs be continuous from the time of surgery until at least 8 years of age. It is often difficult to perform this therapy over such a long time period, with compliance with less than 30% of prescribed time during infancy at 5 years after surgery. Copyright © 2016 S. Karger AG, Basel.
Keywords: Adolescent; Aphakia, Postcataract/et [Etiology]; *Aphakia, Postcataract/rh [Rehabilitation]; *Cataract Extraction; Child; Child, Preschool; *Contact Lenses; *Eyeglasses; Humans; Infant; Infant, Newborn; *Lens Implantation, Intraocular; Vision Disorders/et [Etiology]; *Vision Disorders/rh [Rehabilitation]; Vision, Binocular/ph [Physiology]; Visual Acuity/ph [Physiology]

Refusal of Trabeculectomy for the Fellow Eye in Collaborative Initial Glaucoma Treatment Study (CIGTS) Participants. - Gupta, Divakar; Musch, David C; Niziol, Leslie M; Chen, Philip P (American journal of ophthalmology, 2016)
PURPOSE: To understand the reasons for refusal of fellow eye surgical treatment for glaucoma after first eye trabeculectomy., DESIGN: Post hoc analysis of data collected in a multicenter, randomized clinical trial., METHODS: Data from participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS) who were randomized to and underwent initial trabeculectomy on their study eye, and whose fellow eye was eligible for surgical treatment, were analyzed. Participant demographic data and characteristics, surgical data from the study eye, and quality-of-life survey results were compared between groups that received or refused trabeculectomy in their fellow eye. The main outcome measure was patient refusal of fellow eye surgery for glaucoma., RESULTS: Of 159 participants who were randomized to and underwent trabeculectomy on their study eye and had a fellow eye that was eligible for surgery, 30 (19%) refused fellow eye surgery. Eligible patients who refused fellow eye trabeculectomy did not differ significantly in visual function or local eye symptoms from those that underwent fellow eye trabeculectomy (all P > .05). In a multivariable analysis of data, increased fellow eye preoperative intraocular pressure (IOP) was associated with decreased odds (OR = 0.89, P = .0188), study eye hypotony at 3 months postoperatively was associated with increased odds (OR = 7.24, P = .0125), and argon suture lysis procedure was associated with decreased odds (OR = 0.38, P = .0385) of surgery refusal., CONCLUSIONS: Refusal of fellow eye surgery was not uncommonly encountered in the CIGTS. Those who refused fellow eye surgery had lower fellow eye IOP and were more likely to have had hypotony after study eye trabeculectomy. Copyright © 2016 Elsevier Inc. All rights reserved.
Keywords: Aged; Antihypertensive Agents/tu [Therapeutic Use]; Female; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/px [Psychology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Postoperative Complications; Quality of Life; Surveys and Questionnaires; *Trabeculectomy; *Treatment Refusal/sn [Statistics & Numerical Data]

Communication Predicts Medication Self-Efficacy in Glaucoma Patients. - Carpenter, Delesha M; Blalock, Susan J; Sayner, Robyn; Muir, Kelly W; Robin, Alan L; Hartnett, Mary Elizabeth; Giangiacomo, Annette L; Tudor, Gail E; Sleath, Betsy L (Optometry and vision science : official publication of the American Academy of Optometry, 2016)
PURPOSE: Medication self-efficacy, or patients' confidence that they can perform medication-related behaviors, is associated with better glaucoma medication adherence. Little is known about how to enhance glaucoma patients' medication self-efficacy. Our purpose is to examine whether patient-provider communication increases glaucoma patients' medication self-efficacy., METHODS: During an 8-month cohort study of 279 glaucoma patients and 15 providers, two office visits were videotape-recorded, transcribed, and coded for six patient-provider communication behaviors. A validated scale was used at baseline and 8-month follow-up to assess patients' confidence in overcoming adherence barriers (adherence barriers self-efficacy) and carrying out tasks to use eye drops correctly (eye drop task self-efficacy). We ran two generalized estimating equations to examine whether more frequent patient-provider communication during office visits predicted increased patient adherence barriers self-efficacy and eye drop task self-efficacy at 8-month follow-up., RESULTS: For each additional topic providers educated about, patients reported an average increase of 0.35 in self-efficacy in overcoming adherence barriers (p < 0.001). Patients also reported an average increase of 1.01 points in eye drop task self-efficacy when providers asked about patients' views of glaucoma and its treatment versus not (p < 0.001). Patients who asked more medication questions (p < 0.001) and African-American patients (p < 0.05) reported lower adherence barriers self-efficacy by 0.30 and 2.15 points, respectively. Women had a 0.63 lower eye drop task self-efficacy than men (p < 0.05)., CONCLUSIONS: When providers educate glaucoma patients and assess patient views about glaucoma and its treatment, patients report higher medication self-efficacy. Providers should be aware that patients who ask more medication questions may have less confidence in their ability to overcome barriers to adherence.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Female; *Glaucoma/dt [Drug Therapy]; *Health Communication/mt [Methods]; Humans; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions; *Patient Education as Topic/mt [Methods]; *Physician-Patient Relations; Self Efficacy; Surveys and Questionnaires; Young Adult

Tenons Patch Graft in the Management of Large Corneal Perforations. - Korah, Sanita; Selvin, Satheesh S T; Pradhan, Zia S; Jacob, Pushpa; Kuriakose, Thomas (Cornea, 2016)
PURPOSE: To describe a technique to manage corneal perforations between 3 and 6 mm in size using autologous Tenons tissue with cyanoacrylate glue and a bandage contact lens., METHODS: A thin layer of Tenons capsule harvested from the patient's own eye is used to seal the perforation and act as a scaffold. The Tenons patch graft is spread over the perforation and held in place by the application of cyanoacrylate glue. A bandage contact lens is then placed on the eye., RESULTS: A 6-year retrospective review of 28 patients who underwent this procedure was performed. One patient was lost to follow-up. Of the 27 patients who were followed up, 20 healed completely, with an adherent leucoma and preservation of the anterior chamber. The condition of one patient (with a perforated Pseudomonas corneal ulcer) progressively worsened despite maximum medical therapy and had to undergo evisceration., CONCLUSIONS: This procedure makes use of easily available autologous Tenons tissue in patients with corneal perforations too large to be managed with cyanoacrylate glue alone, to preserve eyeball morphology. A corneal transplant can then be done when the cornea has healed.
Keywords: Adult; Aged; Bandages; *Corneal Perforation/su [Surgery]; Enbucrilate/tu [Therapeutic Use]; Female; Follow-Up Studies; Humans; Male; Middle Aged; *Ophthalmologic Surgical Procedures; Retrospective Studies; *Tenon Capsule/tr [Transplantation]; Tissue Adhesives/tu [Therapeutic Use]; Tissue and Organ Procurement; Wound Healing

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project. - Waisbourd, Michael; Shafa, Anousheh; Delvadia, Radha; Sembhi, Harjeet; Molineaux, Jeanne; Henderer, Jeffery; Pizzi, Laura T; Myers, Jonathan S; Hark, Lisa A; Katz, L Jay (Journal of glaucoma, 2016)
PURPOSE: To report the outcomes of bilateral, same-day laser peripheral iridotomy (LPI) in the Philadelphia Glaucoma Detection and Treatment Project., METHODS: The Philadelphia Glaucoma Detection and Treatment Project was a community-based initiative aimed to improve detection, management, treatment, and follow-up care of individuals at high risk for glaucoma. This novel project performed LPI, where 2 eyes received laser therapy on the same day. Of the 1649 patients examined between January 1, 2013 and May 31, 2014, patients who underwent bilateral, same-day LPI were included in our analysis. Main outcome measures were visual acuity, intraocular pressure (IOP), and postoperative complication rates., RESULTS: A total of 132 eyes of 66 patients underwent bilateral, same-day LPI. Mean visual acuity remained unchanged following treatment (P=0.85). Eight patients (12.1%) had IOP spikes >5 mm Hg following treatment, and 4 patients (6.1%) spiked >10 mm Hg. IOP returned to normal in all but 1 patient, who was diagnosed with chronic angle-closure glaucoma. Hyphema was reported in 2 patients (3%) and glare in 1 patient (1.5%). Thirteen patients (19.7%) had repeat LPI treatment. All patients successfully tolerated LPI treatment without serious complications., CONCLUSIONS: Performing bilateral, same-day LPI was well tolerated in a large community-based, glaucoma detection and treatment project. Applying this treatment strategy may be considered in similar settings, where patients' access to eye care is limited and it may be a cost-effective strategy.
Keywords: Aged; Aged, 80 and over; Female; Glaucoma, Angle-Closure/di [Diagnosis]; *Glaucoma, Angle-Closure/su [Surgery]; Health Services Accessibility; Humans; Intraocular Pressure; *Iridectomy/mt [Methods]; *Iris/su [Surgery]; *Laser Therapy/mt [Methods]; Male; Middle Aged; Philadelphia; Postoperative Complications/su [Surgery]; Time Factors; Tonometry, Ocular; Visual Acuity

Improving Access to Eye Care among Persons at High-Risk of Glaucoma in Philadelphia--Design and Methodology: The Philadelphia Glaucoma Detection and Treatment Project. - Hark, Lisa; Waisbourd, Michael; Myers, Jonathan S; Henderer, Jeffrey; Crews, John E; Saaddine, Jinan B; Molineaux, Jeanne; Johnson, Deiana; Sembhi, Harjeet; Stratford, Shayla; Suleiman, Ayman; Pizzi, Laura; et al. (Ophthalmic epidemiology, 2016)
PURPOSE: The Wills Eye Glaucoma Research Center initiated a 2-year demonstration project to develop and implement a community-based intervention to improve detection and management of glaucoma in Philadelphia., METHODS: The glaucoma detection examination consisted of: ocular, medical, and family history; visual acuity testing; corneal pachymetry; biomicroscopy of the anterior segment; intraocular pressure (IOP) measurement; gonioscopy; funduscopy; automated visual field testing; and fundus-color photography. Treatment included laser surgery and/or IOP-lowering medication. A cost analysis was conducted to understand resource requirements. Outcome measures included; prevalence of glaucoma-related pathology and other eye diseases among high-risk populations; the impact of educational workshops on level of knowledge about glaucoma (assessed by pre- and post-test evaluation); and patient satisfaction of the glaucoma detection examinations in the community (assessed by satisfaction survey). Treatment outcome measures were change in IOP at 4-6 weeks and 4-6 months following selective laser trabeculoplasty treatment, deepening of the anterior chamber angle following laser-peripheral iridotomy treatment, and rate of adherence to recommended follow-up examinations. Cost outcomes included total program costs, cost per case of glaucoma detected, and cost per case of ocular disease detected., RESULTS: This project enrolled 1649 participants (African Americans aged 50+ years, adults 60+ years and individuals with a family history of glaucoma). A total of 1074 individuals attended a glaucoma educational workshop and 1508 scheduled glaucoma detection examination appointments in the community setting., CONCLUSIONS: The Philadelphia Glaucoma Detection and Treatment Project aimed to improve access and use of eye care and to provide a model for a targeted community-based glaucoma program.
Keywords: *Community Health Services/og [Organization & Administration]; Continuity of Patient Care; *Diagnostic Techniques, Ophthalmological; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/su [Surgery]; Gonioscopy; Health Behavior; Health Care Costs; *Health Services Accessibility/og [Organization & Administration]; Hospitals, Special; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmology/og [Organization & Administration]; Philadelphia; *Research Design; Risk Factors; Tonometry, Ocular; Trabeculectomy/mt [Methods]; Visual Acuity/ph [Physiology]; Visual Field Tests; *Vulnerable Populations

Glaucoma Patient Treatment Preferences. - SooHoo, Jeffrey R; Golas, Liliya; Marando, Catherine M; Seibold, Leonard K; Pantcheva, Mina B; Ramulu, Pradeep Y; Kahook, Malik Y (Ophthalmology, 2016)
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Filtering Surgery/mt [Methods]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure; Male; Ophthalmic Solutions; *Patient Preference; Treatment Outcome

Microbial Contamination of Periorbital Tissues and Accessories of Children. - Cheung, Sin Wan; Boost, Maureen; Shi, Guang Sen; Cho, Pauline (Optometry and vision science : official publication of the American Academy of Optometry, 2016)
PURPOSE: To investigate normal flora of children with and without orthokeratology (ortho-k) treatment, and the associations between carriage of Staphylococcus aureus and Gram-negative rods with contamination of contact lenses and lens cases in ortho-k subjects and with spectacles of control subjects., METHODS: Twenty-three ortho-k subjects (treatment >12 months) and 20 control myopic subjects aged 7-14 years were recruited. Samples were collected from four sites surrounding the left eye (lower conjunctiva, upper and lower eyelids, and eyelashes) for all subjects, spectacles for control subjects and contact lens accessories for ortho-k subjects. Samples were cultured, total numbers enumerated, and isolates identified using chromogenic agars., RESULTS: Ortho-k subjects had significantly less total isolates in the conjunctiva than controls (p = 0.009). Otherwise, carriage rates in normal flora levels of the peri-orbital tissues were not significantly different between the two groups (p > 0.19). The total isolates and carriage rates of normal flora on spectacles, contact lenses, and lens cases were similar to those identified on the skin tissues. Small numbers of bacteria were identified from the multipurpose solution of two ortho-k subjects. Although the association between the carriage of S. aureus with contamination of accessories was statistically significant only in control subjects (p = 0.03), ortho-k subjects not yielding S. aureus and Gram-negative rods from samples of their peri-orbital tissues tended to be less likely to have these organisms in their accessories. No Pseudomonas was isolated from any of the sites sampled and no Acinetobacter was isolated from any of the accessories., CONCLUSIONS: Ortho-k may lower the total number of bacteria in conjunctiva due to the use of solution and lenses, but the physiologic effect of this treatment on the types of normal flora in children was minimal and should not increase the risk of microbial keratitis in children with good compliance.
Keywords: Adolescent; Child; *Conjunctiva/mi [Microbiology]; *Contact Lenses/mi [Microbiology]; *Equipment Contamination; *Eyelids/mi [Microbiology]; Female; *Gram-Negative Bacteria/gd [Growth & Development]; Gram-Negative Bacteria/ip [Isolation & Purification]; Humans; Male; Myopia/th [Therapy]; Orthokeratologic Procedures/is [Instrumentation]; *Orthokeratologic Procedures; *Staphylococcus aureus/gd [Growth & Development]; Staphylococcus aureus/ip [Isolation & Purification]

Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care. - Pizzi, Laura T; Tran, Judie; Shafa, Anousheh; Waisbourd, Michael; Hark, Lisa; Murchison, Ann P; Dai, Yang; Mayro, Eileen L; Haller, Julia A (Applied health economics and health policy, 2016)
BACKGROUND: Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma., OBJECTIVES: The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence., METHODS: This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios., RESULTS: Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56., CONCLUSIONS: A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
Keywords: Adult; Aged; Aged, 80 and over; *Appointments and Schedules; Cost-Benefit Analysis; Female; *Glaucoma/ec [Economics]; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Patient Compliance; Prospective Studies; *Reminder Systems/ec [Economics]; *Telephone; United States

Psychological Aspects of Glaucoma. - Jeong, Ah Reum; Kim, Chan Yun; Kang, Min Hee; Kim, Na Rae (The Journal of nervous and mental disease, 2016)
Glaucoma is a group of optic neuropathies that is more prevalent among the elderly population and commonly associates with comorbidities, including mental disorders in that population. This article reviews the relationship between glaucoma and mental disorders. In it, we discuss the coexistence of glaucoma and mental illnesses, including Alzheimer's disease, depression, and personality disorder. We also focus on the proper treatment approaches for glaucoma patients with mental comorbidity and poor treatment adherence. We summarize some cautiously recommended psychotherapeutic medications, while also discussing the psychologically adverse effects of antiglaucoma medications.
Keywords: *Comorbidity; Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; *Glaucoma/px [Psychology]; Humans; Mental Disorders/ci [Chemically Induced]; Mental Disorders/ep [Epidemiology]; *Mental Disorders/px [Psychology]

A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy. - Mokhles, Palwasha; Schouten, Jan S A G; Beckers, Henny J M; Azuara-Blanco, Augusto; Tuulonen, Anja; Webers, Carroll A B (Journal of glaucoma, 2016)
PURPOSE: Glaucoma patients are still at risk of becoming blind. It is of clinical significance to determine the risk of blindness and its causes to prevent its occurrence. This systematic review estimates the number of treated glaucoma patients with end-of-life visual impairment (VI) and blindness and the factors that are associated with this., METHODS: A systematic literature search in relevant databases was conducted in August 2014 on end-of-life VI. A total of 2574 articles were identified, of which 5 on end-of-life VI. Several data items were extracted from the reports and presented in tables., RESULTS: All studies had a retrospective design. A considerable number of glaucoma patients were found to be blind at the end of their life; with up to 24% unilateral and 10% bilateral blindness. The following factors were associated with blindness: (1) baseline severity of visual field loss: advanced stage of glaucoma or substantial visual field loss at the initial visit; (2) factors influencing progression: fluctuation of intraocular pressure (IOP) during treatment, presence of pseudoexfoliation, poor patient compliance, higher IOP; (3) longer time period: longer duration of disease and older age at death because of a longer life expectancy; and (4) coexistence of other ocular pathology., CONCLUSIONS: Further prevention of blindness in glaucoma patients is needed. To reach this goal, it is important to address the risk factors for blindness identified in this review, especially those that can be modified, such as advanced disease at diagnosis, high and fluctuating IOP, and poor compliance.
Keywords: Blindness/di [Diagnosis]; *Blindness/ep [Epidemiology]; Blindness/th [Therapy]; Epidemiologic Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure/ph [Physiology]; Retrospective Studies; Risk Factors; Terminal Care/sn [Statistics & Numerical Data]; *Terminal Care; Tonometry, Ocular; Vision, Low/di [Diagnosis]; *Vision, Low/ep [Epidemiology]; Vision, Low/th [Therapy]; Visual Fields; *Visually Impaired Persons/sn [Statistics & Numerical Data]

The Maccabi Glaucoma Study: Treatment Patterns and Persistence With Glaucoma Therapy in a Large Israeli Health Maintenance Organization. - Goldshtein, Inbal; Shalev, Varda; Zigman, Nir; Chodick, Gabriel; Levkovitch-Verbin, Hani (Journal of glaucoma, 2016)
PURPOSE: To describe treatment patterns, adherence, and persistence with initial therapy among glaucoma patients in the community., MATERIALS AND METHODS: A population-based historical prospective cohort study, using the electronic medical databases of Maccabi Healthcare Services, a 2 million member health maintenance organization in Israel. Newly diagnosed glaucoma patients between 2003 and 2010, who purchased at least 1 antiglaucoma medication, were followed up to December 31, 2012. Outcome measures included medication adherence analyzed by proportion of days covered by drugs during follow-up time, and persistence with initial therapy measured by time until switch or discontinuation of first-line therapy., RESULTS: A total of 5934 incident definite glaucoma patients were identified, 13% of whom were nonadherent with therapy (covered <20% of the follow-up time), and only 25% exhibited high adherence (covered at least 80% of the follow-up period). Adherence was positively associated with female sex, age, socioeconomic status, frequent follow-up visits, and higher baseline intraocular pressure. Lower median adherence (P<0.01) was observed among patients of normal tension glaucoma (52%) and angle closure (59%) as compared with open angle (65%) and exfoliation glaucoma (68%). Patients treated by glaucoma specialists had similar adherence to those treated by general ophthalmologists (proportion of days covered=65% vs. 63%, P=0.42). Persistence with initial line of therapy varied by type of medication, with prostaglandin initiators exhibiting the highest persistence (13% reduced likelihood of switch or discontinuation as compared with beta-blockers, P<0.01) and alpha-agonists the lowest persistence (39% increased likelihood of switch or discontinuation as compared with beta-blockers, P<0.01)., CONCLUSIONS: This large-scale analysis of real-world use of glaucoma medications reveals that adherence to glaucoma therapy is associated with medication type, patient's sex, age, socioeconomic status, type of glaucoma, follow-up visits, and baseline intraocular pressure.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Databases, Factual; Female; *Glaucoma/dt [Drug Therapy]; *Health Maintenance Organizations/sn [Statistics & Numerical Data]; Humans; *Intraocular Pressure/de [Drug Effects]; Israel; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Prospective Studies

Structural characteristics of the optic nerve head influencing human retinal venous pulsations. - Lam, Jonathan; Chan, Geoffrey; Morgan, William H; Hazelton, Martin; Betz-Stablein, Brigid; Cringle, Stephen J; Yu, Dao Yi (Experimental eye research, 2016)
The relationship between structural characteristics of the optic nerve head and venous pulsations in the human eye remain unknown. Using photoplethysmographic techniques we investigated whether properties of the human retinal veins and their surrounding structures influence venous pulsation. 448 locations of venous pulsation were analysed from 26 normal human eyes. Green channel densitometry derived from video recordings of venous pulsations were used to generate a map of venous pulsation amplitudes along retinal veins. Optical coherence tomography was used to perform quantitative measurements of tissue characteristics at sites of high and low amplitude points as well as in a second analysis, at maximal amplitude pulsation sites from superior and inferior halves of the eyes. Structural characteristics measured included venous diameter, distance from pulsation point to cup margin, vessel length from pulsation point to vein exit, tissue thickness overlying vein, optic disc diameter and presence of a proximal arteriovenous crossing. Increasing venous pulsation amplitudes were associated with larger applied ophthalmodynamometry force, increasing venous diameter, and decreasing absolute cup margin distance (all p < 0.001). Increasing distance of maximal amplitude pulsation point to cup margin was associated with the presence of a proximal arteriovenous crossing, increasing venous diameter, and decreasing tissue depth (all p <= 0.001). Venous diameter and tissue depth alter venous compliance, which is likely to be a major factor determining sites of venous pulsation. Copyright © 2016 Elsevier Ltd. All rights reserved.
Keywords: Adult; Aged; Female; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ocular Hypertension/pp [Physiopathology]; *Optic Disk/ah [Anatomy & Histology]; Optic Disk/bs [Blood Supply]; *Pulsatile Flow/ph [Physiology]; *Regional Blood Flow/ph [Physiology]; *Retinal Vein/ph [Physiology]; Tomography, Optical Coherence; Young Adult

Effects of multipurpose solutions on the adhesion of Acanthamoeba to rigid gas permeable contact lenses. - Lee, Ga-Hyun; Yu, Hak-Sun; Lee, Ji-Eun (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2016)
PURPOSE: To evaluate the effect of multipurpose contact lens care solutions (MPSs) on the adhesion of Acanthamoeba to rigid gas permeable (RGP) contact lenses., METHODS: Acanthamoeba castellanii (AC) trophozoites were inoculated onto untreated RGP contact lenses (FP, Extra, or Menicon Z), and numbers of trophozoites adhering to lenses were counted under a phase contrast microscope at 18 h post-inoculation (controls). Similarly, adhering trophozoites were counted at 6 h post-inoculation on each of the three RGP lens types with one of three MPSs (Boston Simplus, Menicare Plus, and O2 Care). Scanning electron microscopic examinations were performed to compare lens surfaces., RESULTS: Adhesion of AC trophozoites to untreated FP was greater than to untreated Extra or Menicon Z. Surfaces of Extra and Menicon Z lenses were waxier, smoother, and more homogeneous than those of FP lenses. After treatment with Boston Simplus, adhesion of AC trophozoites was significantly reduced for all lens types as compared with controls (p < 0.0001). Treatments with Menicare Plus or O2 Care reduced the number of adherent AC trophozoites significantly on FP lenses only as compared with controls (p < 0.0001)., CONCLUSIONS: The adhesion rates of AC trophozoites to RGP lenses depended on lens surfaces. Boston Simplus reduced the adhesion rate of AC trophozoites more than Menicare Plus or O2 Care. Appropriate RGP lens and MPS selection could decrease the prevalence of Acanthamoeba keratitis. Copyright © 2016 The Authors Ophthalmic & Physiological Optics © 2016 The College of Optometrists.
Keywords: *Acanthamoeba castellanii/de [Drug Effects]; Analysis of Variance; *Bacterial Adhesion/de [Drug Effects]; *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses/mi [Microbiology]; *Disinfectants/pd [Pharmacology]; Humans; Microscopy, Electron

Controlled Release of Antibiotics From Vitamin E-Loaded Silicone-Hydrogel Contact Lenses. - Paradiso, Patrizia; Serro, Ana Paula; Saramago, Benilde; Colaco, Rogerio; Chauhan, Anuj (Journal of pharmaceutical sciences, 2016)
Symptoms of bacterial and fungal keratitis are typically treated through the frequent application of antibiotic and antifungal eye drops. The high frequency of half hourly or hourly eye drop administration required to treat these indications is tedious and could reduce compliance. Here, we combine in vitro experiments with a mathematical model to develop therapeutic soft contact lenses to cure keratitis by extended release of suitable drugs. We specifically focus on increasing the release duration of levofloxacin and chlorhexidine from 1-DAY ACUVUE( R) TrueEye TM and ACUVUE OASYS( R) contact lenses by incorporating vitamin E diffusion barriers. Results show that 20% of vitamin E loading in the contact lens increases the release duration of levofloxacin to 100 h and 50 h from 1-DAY ACUVUE( R) TrueEye TM and ACUVUE OASYS( R), respectively, which is a 3- and 6-fold increase, respectively, for the 2 lenses. For chlorhexidine, the increase is 2.5- and 10-fold, for the TrueEye TM and OASYS( R), respectively, to 130 h and 170 h. The mass of drug loaded in the lenses can be controlled to achieve a daily release comparable to the commonly prescribed eye drop therapy. The vitamin E-loaded lenses retain all critical properties for in vivo use. Copyright © 2016 American Pharmacists Association R. Published by Elsevier Inc. All rights reserved.
Keywords: *Anti-Bacterial Agents/ad [Administration & Dosage]; Anti-Bacterial Agents/ch [Chemistry]; Chlorhexidine/ad [Administration & Dosage]; Chlorhexidine/ch [Chemistry]; Contact Lenses, Hydrophilic; *Delayed-Action Preparations/ad [Administration & Dosage]; Delayed-Action Preparations/ch [Chemistry]; Diffusion; *Drug Delivery Systems/mt [Methods]; Humans; *Hydrogel, Polyethylene Glycol Dimethacrylate/ad [Administration & Dosage]; Hydrogel, Polyethylene Glycol Dimethacrylate/ch [Chemistry]; Keratitis/dt [Drug Therapy]; Levofloxacin/ad [Administration & Dosage]; Levofloxacin/ch [Chemistry]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ch [Chemistry]; *Silicones/ad [Administration & Dosage]; Silicones/ch [Chemistry]; *Vitamin E/ad [Administration & Dosage]; Vitamin E/ch [Chemistry]

Update on the Medical Treatment of Primary Open-Angle Glaucoma. - Cheema, Anjum; Chang, Robert T; Shrivastava, Anurag; Singh, Kuldev (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2016)
Glaucoma comprises a group of progressive, neurodegenerative disorders characterized by retinal ganglion cell death and nerve fiber layer atrophy. Several randomized controlled trials have consistently demonstrated the efficacy of intraocular pressure lowering to slow or halt the measurable progression of the disease. Medical therapy, in places where it is easily accessible, is often the primary method to lower intraocular pressure. We review the medical options currently available and possible future options currently in development. The 5 contemporary classes of topical agents in use include prostaglandin analogs, beta blockers, carbonic anhydrase inhibitors, alpha agonists, and cholinergics. In addition, several fixed combination agents are commercially available. Agents from each of these classes have unique mechanisms of action, adverse effects, and other characteristics that impact how they are used in clinical practice. Despite the plethora of medical options available, there are limitations to topical ophthalmic therapy such as the high rate of noncompliance and local and systemic adverse effects. Alternate and sustained drug delivery models, such as injectable agents and punctal plug delivery systems, may in the future alleviate some such concerns and lead to increased efficacy of treatment while minimizing adverse effects.
Keywords: Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cholinergic Agents/tu [Therapeutic Use]; Clinical Trials as Topic; Drug Therapy, Combination; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Prostaglandins, Synthetic/tu [Therapeutic Use]

[Social Law Entitlements and Compensations for Visually Impaired Patients in Germany, Focussed on Glaucoma]. - Stamm, C C (Klinische Monatsblatter fur Augenheilkunde, 2016)
Although prevention of progression is the most important issue in the treatment of glaucoma patients, information on visual aids and social law entitlements is also helpful. In this article, the main aspects of compensation for visual impairment are outlined so that you can competently support your patients, without much effort, with helpful tips and appropriate instructions. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Germany; *Glaucoma/ec [Economics]; *Health Services Accessibility/ec [Economics]; *Health Services Accessibility/lj [Legislation & Jurisprudence]; Humans; Patient Rights/lj [Legislation & Jurisprudence]; Social Medicine/ec [Economics]; Social Medicine/lj [Legislation & Jurisprudence]; *Social Welfare/ec [Economics]; *Social Welfare/lj [Legislation & Jurisprudence]; *Visually Impaired Persons/lj [Legislation & Jurisprudence]

[Complexities of Medical Glaucoma Therapy--the Elderly Patient in Focus]. - Dietlein, T S; Rosentreter, A; Lappas, A (Klinische Monatsblatter fur Augenheilkunde, 2016)
In order to treat glaucoma with medication successfully, the patient needs to participate actively in the process. "Adherence", formerly "compliance", describes the willingness and capacity to follow the prescribed regimen every day. It is not trivial to measure adherence and persistence, as this quite often relies on self reports by the patient or speculations by the physician. Hence, the overall reported adherence may vary from 5 to 95 %. In general, the following categories have been defined for reduced adherence: medication-related factors, patient-related factors, environmental factors and social factors. Age has been found to intensify or modify many of these factors. Older adults often face various challenges, due to motor disabilities, reduced visual acuity or impaired cognitive capabilities. In patients with movement disorders or tactile limitations, the target area can be reached more successfully with standard eye drop bottles than with single-use dose units. This should be considered if antiglaucoma eye drops are prescribed in the elderly. Frequency of application is a main factor influencing adherence. Monotherapy--as provided with prostaglandins--or drops with a fixed combination have proven to support adherence significantly. A significant boost for self-monitoring activities is initiated by the growing market of electronic devices, like smartphones. For instance, they can provide acoustic alarms as reminders to apply the eye drops. It is evident that any external support or disease-related information by family members, the medical practitioners, support groups or even electronic devices may improve adherence and persistence, even in patients with severe impairments. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Drug Monitoring/mt [Methods]; Drug Monitoring/px [Psychology]; Female; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Health Services for the Aged/og [Organization & Administration]; Humans; Male; *Medication Adherence/px [Psychology]; *Reminder Systems; *Self Care/mt [Methods]; Self Care/px [Psychology]

[Communication Strategies in Dealing with Patients with Glaucoma]. - Sandner, J (Klinische Monatsblatter fur Augenheilkunde, 2016)
When patients with glaucoma meet doctors and their assistants in a doctor's office or a hospital all hope that this contact will be trouble-free, helpful, perhaps even happy and conducted in a constructive spirit. But this is not always the case. Words and gestures may accidently hurt or reject the patient. Often the communication results in harm instead of help and healing. For this reason, it is worthwhile to have a glimpse behind the curtain of the difficult interactions between people. The rules of communication in the medical context will help to facilitate the contact between doctors and patients. Verbal and non-verbal communication play an important role, for example in how to address the individual patient, as well as the timing and wording. Expertise in communication is a key qualification for medical professionals! Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Communication; Germany; *Glaucoma/di [Diagnosis]; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; *Health Communication/mt [Methods]; *Patient Education as Topic/mt [Methods]; *Patient Satisfaction; *Physician-Patient Relations

Wait times and volume of cataract surgery in Ontario: 2000-2012. - Szigiato, Andrei-Alexandru; Trope, Graham E; Jin, Yaping; Buys, Yvonne M (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016)
OBJECTIVE: To review cataract surgery trends and wait times in Ontario., DESIGN: Retrospective analysis of health records., METHODS: Ontario Health Insurance Plan billing service claims between 2000 and 2012 were analyzed for the yearly number of cataract surgeries, alone and in combination with other procedures. The number of Ontarians with cataracts was estimated by applying composite prevalence curves derived from published population data. This was then used to calculate the yearly number of procedures per 1000 Ontarians with cataracts., RESULTS: Per 1000 people with cataract, the rate of cataract extraction increased 18.9% overall from 2000 to 2012, increasing by 38.3% from 2000 to 2006 and decreasing by 14.6% from 2006 to 2012. Mean wait times for cataract surgery decreased by 45.8% from 2006 to 2009 and increased 28.5% from 2009 to 2013. The proportion of surgeries that were same-day bilateral cataract extraction increased 2.21-fold from 2000 to 2012 but represented only 0.82% of total cataract surgeries in 2012. In 2000, 3% of cataract surgeries were combined with other procedures, and this decreased to 1.8% in 2012. Of these combinations, the rates of combined glaucoma filtration procedures decreased by 44.3%, anterior vitrectomy decreased by 32.5%, posterior vitrectomy increased by 58.3%, and corneal transplantation decreased by 10.7% during this time period., CONCLUSIONS: The yearly rate of cataract surgery has decreased since 2006, and wait times have increased from 2009. Same-day bilateral cataract extraction represented less than 1% of the total cataract surgical volume. Rates of cataract combined with posterior vitrectomy have increased (58%), whereas anterior vitrectomy at the time of cataract surgery decreased (33%). Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: *Cataract/ep [Epidemiology]; *Cataract Extraction/sn [Statistics & Numerical Data]; Cataract Extraction/td [Trends]; Female; Humans; Male; National Health Programs/sn [Statistics & Numerical Data]; Ontario/ep [Epidemiology]; Ophthalmology/sn [Statistics & Numerical Data]; Retrospective Studies; *Waiting Lists

Overcoming Barriers to Eye Care: Patient Response to a Medical Social Worker in a Glaucoma Service. - Fudemberg, Scott J; Amarasekera, Dilru C; Silverstein, Marlee H; Linder, Kathryn M; Heffner, Paul; Hark, Lisa A; Waisbourd, Michael (Journal of community health, 2016)
This paper investigates the patient response to a medical social worker in a glaucoma clinic. The literature suggests that medical social workers are effective in a variety of health care settings, yet the efficacy of a medical social worker in an adult ophthalmic setting has not been studied. We present the results of a retrospective chart review of 50 patients with glaucoma referred to a medical social worker between January 5, 2015 and June 31, 2015 in an outpatient clinic of an urban eye hospital. Clinical and demographic data, as well as the data from a quality of care questionnaire, were collected for each patient. Patients rated their interaction with the medical social worker as highly positive (mean = 4.75, 5-point Likert scale), and nearly 90 % of patients expressed interest in future contact with the social worker. Additionally, most patients reported that the social worker resolved the issues they were facing (61.1 %), supported them in seeing their ophthalmologist (70.6 %), and helped them to manage their glaucoma (69.7 %). Reported barriers to glaucoma care were emotional distress; cost of office visits and medications; lack of medical insurance; transportation; poor medication adherence; impairment of daily activities; follow-up adherence; and language. As vision loss from glaucoma is irreversible, it is important to detect and treat patients at early stages of the disease. Therefore, it is imperative for patients to regularly visit their eye care providers and adhere to treatment and follow-up recommendations. This study suggests that a medical social worker could play a pivotal role in helping patients with glaucoma overcome barriers to treatment and facilitate disease management.
Keywords: Aged; Aged, 80 and over; Female; *Glaucoma/th [Therapy]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; Ophthalmology; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Social Workers

Emerging drugs to treat glaucoma: targeting prostaglandin F and E receptors. - Lusthaus, Jed Asher; Goldberg, Ivan (Expert opinion on emerging drugs, 2016)
INTRODUCTION: Commercially available prostaglandin analogues (PGAs) activate the prostaglandin F receptor (FP) reducing intraocular pressure (IOP), thereby stabilizing glaucomatous optic neuropathy. Poor adherence with eye drops and intolerance impact treatment success., AREAS COVERED: We review developments in drug formulation and delivery, including punctal plugs, topical ring inserts, subconjunctival injections and inserts, and intraocular inserts. We also outline research into new fixed dose combinations that include prostaglandin analogues and preservative-free versions of established agents., EXPERT OPINION: Glaucoma is a chronic, usually progressive disease that causes irreversible visual loss. As its prevalence increases exponentially with age, it has significant implications as the population ages. Health resources need to meet increased demand for glaucoma management resources, including monitoring and treating glaucoma suspects and patients and supporting those who have suffered visual disability. Several promising therapies are under investigation. Sustained-release prostaglandin analogues using alternate delivery methods are encouraging. Delivery routes may be more invasive than topical drops. Nanotechnological-release delivery of prostaglandin analogues could lower IOP effectively. Approaches like this would eliminate many of the adherence issues associated with daily topical PGA eye drop use.
Keywords: Animals; Drug Combinations; Drug Delivery Systems; *Drug Design; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Glaucoma/pa [Pathology]; Humans; Intraocular Pressure/de [Drug Effects]; Medication Adherence; Prostaglandins, Synthetic/ad [Administration & Dosage]; Prostaglandins, Synthetic/pd [Pharmacology]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Receptors, Prostaglandin/de [Drug Effects]; Receptors, Prostaglandin/me [Metabolism]; Receptors, Prostaglandin E/de [Drug Effects]; Receptors, Prostaglandin E/me [Metabolism]

Consecutive bilateral decompression retinopathy after mitomycin C trabeculectomy: a case report. - Figueiredo, Ana Raquel Marcos; Sampaio, Isabel Coutinho; Meneres, Maria Joao Fernandes Dos Santos; Spaeth, George L (Journal of medical case reports, 2016)
BACKGROUND: After a successful trabeculectomy, a sudden intraocular pressure decrease may alter the intracranial to intraocular pressure ratio and cause decompression retinopathy. Frequent Valsalva maneuvers may also play a role in its pathogenesis. This condition may manifest as multiple retinal hemorrhages, edema of the optic disc, macular edema, or a sudden decrease in visual acuity postoperatively. Outcomes for patients are usually good, with spontaneous resolution occurring within a matter of weeks. It has been rarely reported in the literature as a bilateral condition., CASE PRESENTATION: We present a case of consecutive bilateral decompression retinopathy in a 54-year-old severely obese Caucasian woman (body mass index 37 kg/m(2)) with open angle glaucoma and a poor history of medical therapeutic compliance, who chose surgical treatment based on her inability to consistently use ocular drops. Our patient underwent a trabeculectomy with mitomycin C in both eyes, with surgeries taking place 3 months apart. After the first surgery, 2 weeks postoperatively, she complained of decreased visual acuity. Examination of her right eye fundus revealed multiple retinal hemorrhages and disc edema. There was a similar pattern in her left eye, this time including maculopathy. Her visual acuity and fundoscopic changes resolved spontaneously over a period of a month in both cases. Currently, our patient has well-controlled bilateral intraocular pressure, ranging between 14 and 16 mmHg, without hypotensive medication., CONCLUSIONS: Decompression retinopathy is a potential complication after glaucoma surgery, but has rarely been described as a bilateral consecutive condition. A comprehensive approach could help to anticipate its occurrence and manage it.
Keywords: Cross-Linking Reagents/tu [Therapeutic Use]; Decompression; Female; Glaucoma, Open-Angle/su [Surgery]; Humans; Middle Aged; Mitomycin/tu [Therapeutic Use]; Papilledema/et [Etiology]; *Retinal Diseases/et [Etiology]; Retinal Hemorrhage/et [Etiology]; *Trabeculectomy/ae [Adverse Effects]

Intrastromal corneal ring segments delay corneal grafting in patients with keratoconus. - Beniz, Luiz Arthur F; Queiroz, Gustavo H; Queiroz, Carlos F; Lopes, Wanessa L; Moraes, Leiser F; Beniz, Jose (Arquivos brasileiros de oftalmologia, 2016)
PURPOSE: To assess the impact of intrastromal corneal ring segments (ICRS) as a surgical alternative to corneal grafting in patients with keratoconus who were scheduled for a corneal transplant., METHODS: This single-surgeon, single-center, retrospective, observational case series study included 19 eyes of 18 patients (mean age, 23.36 +/- 6.22 years) with a confirmed diagnosis of keratoconus. These patients were enrolled from the State of Goias, Brazil corneal graft waiting list. Following extensive pre-operative testing, including the measurement of best-corrected visual acuity (BCVA), applanation tonometry, biomicroscopy, funduscopy, pachymetry, and corneal topography, patients were implanted with Keraring R ICRS. Patients underwent clinical examination at postoperative days 1, 7, 30, 90, and 180 and were examined again 2 years following surgery., RESULTS: At the 2-year cut-off following ICRS implantation (mean follow-up, 28.72 +/- 4.71 months), there was a statistically significant improvement in BCVA (logMAR) from 0.59 +/- 0.35 preoperatively to 0.35 +/- 0.45 postoperatively ( p <0.01). Three of 19 eyes (15.8%) still required keratoplasty. In the remaining patients (84.2%), BCVA was managed with spectacles (52.6%) or contact lenses (31.6%). One patient developed infectious keratitis, requiring removal of ICR at the first postoperative visit., CONCLUSION: ICRS implantation may be a surgical alternative to keratoplasty in patients with keratoconus. This procedure may delay or even eliminate the need for keratoplasty in such patients.
Keywords: Adolescent; Adult; *Corneal Stroma/su [Surgery]; Corneal Topography; *Corneal Transplantation; Female; Humans; *Keratoconus/su [Surgery]; Male; Postoperative Period; *Prostheses and Implants; *Prosthesis Implantation; Reproducibility of Results; Retrospective Studies; Time Factors; Treatment Outcome; Visual Acuity; Waiting Lists; Young Adult

Sociodemographic status of severely disabled and visually impaired elderly people in Turkey. - Kivanc, Sertac Argun; Akova-Budak, Berna; Olcaysu, Osman Okan; Cevik, Sadik Gorkem (Arquivos brasileiros de oftalmologia, 2016)
PURPOSE: To identify the prevalence of ophthalmologic diseases in elderly patients who had been classified as severely disabled and to identify the ophthalmologic conditions leading to visual impairment and blindness., METHODS: The medical records of 2806 patients who had applied to the Health Board of the Erzurum Region Training and Research Hospital between January 2011 and December 2012 were reviewed. One hundred ninety-nine patients aged >64 years who were classified as severely disabled with disability rates of over 50%, and who were unable to care for themselves or to move and/or communicate without help were included in the study., RESULTS: The most frequently seen disabilities were neurological (47.2%) and those resulting from eye diseases (17.1%). The most common ophthalmologic diseases were cataract, glaucoma, and age-related macular degeneration. The mean right and left eye visual acuities were 1.17 +/- 1.10 logMAR and 1.13 +/- 1.0 logMAR, respectively. Of the 60 patients with ophthalmologic diseases or conditions, 33 were blind (visual acuity worse than 20/400) and 10 were visually impaired (visual acuity worse than 20/70 but better than 20/400). Cataracts were the main cause of blindness. The mean age of the patients who were still being followed up at the time of application to the disability board was significantly lower than that of the others (p =0.015). Seventy-nine percent of the blind patients were from rural areas, and 88% of these had no regular follow-up. Among the blind and visually impaired, significantly more patients from urban areas had social security insurance (SSI) than those from rural areas (p =0.043). Nearly 64% of the blind patients were women. The follow-up rate was significantly lower in women (p =0.025). According to multinomial logistic regression analysis, the visually impaired and blind patients were more likely to have lower follow-up rates than the other types of severely disabled patients (OR: 0.231, 95% Cl: 0.077-0.688, p=0.009)., CONCLUSIONS: Blindness gives rise to severe disability, and the most common ophthalmologic diseases that cause severe disabilities in elderly patients are cataract, glaucoma, and age-related macular degeneration. Sociodemographic factors that may affect the accessibility of visually impaired and blind people to health services include their place of residence and gender.
Keywords: Age Distribution; Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Disability Evaluation; *Eye Diseases/ep [Epidemiology]; Female; Humans; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Sex Distribution; Social Security/sn [Statistics & Numerical Data]; Socioeconomic Factors; Turkey/ep [Epidemiology]; Visual Acuity; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Improving the user experience of patient versions of clinical guidelines: user testing of a Scottish Intercollegiate Guideline Network (SIGN) patient version. - Fearns, Naomi; Graham, Karen; Johnston, Gordon; Service, Duncan (BMC health services research, 2016)
BACKGROUND: Guideline producers are increasingly producing versions of guidelines for the public, and knowledge of what the public want from them is also increasing. The aim of this study was to user test a patient version of a SIGN clinical guideline that was designed based on preliminary work for the DECIDE project. SIGN is the leading national guideline producer in Scotland., METHODS: People with a diagnosis of glaucoma and non-professional carers were recruited from across Scotland. User testing was conducted using a think-aloud protocol method. Each session was conducted by one interviewer and one observer. All sessions were recorded and transcribed. The data was analysed, problems with the guideline were identified and resolved and key findings were themed using a user experience model., RESULTS: Thirteen user testing sessions with people with glaucoma and one with a carer were conducted. Key facilitators of desirability and usability identified include clear branding as a patient version and a clearly described purpose, audience and contents page. Other facilitators include a "friendly" tone which is achieved by the use of colour, quotes, icons, simple language and charts, and brief chunked text. The value and usefulness of the patient guideline was influenced by its ability to: inform the public, link information to actions, and empower people in their interaction with healthcare professionals. Participants were disappointed by the lack of information on treatment in the patient version, which was outside its scope. Information on the evidence based guideline production process and the involvement of appropriately skilled professionals was key to the credibility of the guideline. Lack of awareness of guidelines and guideline producing bodies, is a potentially serious threat to findability/accessibility., CONCLUSIONS: It is important for guideline producers to maximise the user experience of the public when they access patient versions of guidelines, particularly given the current low level of access and awareness. One size does not fit all and guideline producers need to strike a balance between keeping the patient version simple and providing sufficient information to facilitate shared decision making and empower the public. Guideline producers may find the results of this study useful in designing their own patient versions.
Keywords: Aged; Aged, 80 and over; Attitude of Health Personnel; Awareness; Caregivers/px [Psychology]; Decision Making; Evidence-Based Medicine; Female; Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; Health Personnel; Humans; Male; Models, Theoretical; Observer Variation; Patient Education as Topic/mt [Methods]; *Patient Education as Topic/st [Standards]; Patient Satisfaction; *Practice Guidelines as Topic/st [Standards]; Professional-Patient Relations; Quality Improvement; Scotland

Nanoparticle cross-linked collagen shields for sustained delivery of pilocarpine hydrochloride. - Agban, Yosra; Lian, Jiaxin; Prabakar, Sujay; Seyfoddin, Ali; Rupenthal, Ilva D (International journal of pharmaceutics, 2016)
Glaucoma is a common progressive eye disorder which remains the second leading cause of blindness worldwide. Current therapy involves frequent administration of eye drops which often results in poor patient adherence and therapeutic outcomes. The aim of this study was to overcome these limitations by developing a novel nanoparticle cross-linked collagen shield for sustained delivery of pilocarpine hydrochloride (PHCl). Three metal oxide nanoparticles (NPs); titanium dioxide (TiO2), zinc oxide (ZnO) and polyvinylpyrrolidone (PVP) capped zinc oxide (ZnO/PVP), were evaluated for their cytotoxicity as well as shield transparency before selecting ZnO/PVP NPs as the ideal candidate. Cross-linked collagen shields were then characterized for their mechanical strength, swelling capacity and bioadhesive properties, with ZnO/PVP NP cross-linked shields showing the most favorable characteristics compared to plain films. The shield with the best properties was then loaded with PHCl and in vitro release of zinc ions as well as PHCl was measured without and with further cross-linking by ultraviolet irradiation. The concentration of zinc ions released was well below the IC50 rendering them safe for ocular use. Moreover, collagen shields cross-linked with ZnO/PVP NPs released PHCl over a period of 14 days offering a promising sustained release treatment option for glaucoma. Copyright © 2016 Elsevier B.V. All rights reserved.
Keywords: Adhesiveness; Animals; Cattle; Cell Line; Cell Survival/de [Drug Effects]; *Collagen/ad [Administration & Dosage]; Collagen/ch [Chemistry]; Cornea/ch [Chemistry]; Delayed-Action Preparations/ad [Administration & Dosage]; Delayed-Action Preparations/ch [Chemistry]; Humans; *Metal Nanoparticles/ad [Administration & Dosage]; Metal Nanoparticles/ch [Chemistry]; Miotics/ad [Administration & Dosage]; Miotics/ch [Chemistry]; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/ch [Chemistry]; *Povidone/ad [Administration & Dosage]; Povidone/ch [Chemistry]; *Titanium/ad [Administration & Dosage]; Titanium/ch [Chemistry]; *Zinc Oxide/ad [Administration & Dosage]; Zinc Oxide/ch [Chemistry]

Strategies to estimate the characteristics of 24-hour IOP curves of treated glaucoma patients during office hours. - Colombo, Leonardo; Fogagnolo, Paolo; Montesano, Giovanni; De Cilla, Stefano; Orzalesi, Nicola; Rossetti, Luca (BMC ophthalmology, 2016)
BACKGROUND: It is known that office-hour measurements might not adequately estimate IOP mean, peaks and fluctuations in healthy subjects. The purpose of the present study is to verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP) in treated POAG patients., METHODS: The 24-hour IOP curves of 70 eyes of 70 caucasian patients with treated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine (TonoPen XL) and sitting (Goldmann tonometer) positions. The ability of five strategies to estimate IOP mean, peak and fluctuation was evaluated. Each method was analyzed both with regression of the estimate error on the real value and with "hit or miss" analysis., RESULTS: The least biased estimate of the Peak IOP was obtained using measurements from both supine and sitting positions, also yielding the highest rate of correct predictions (which was significantly different from 3 of the remaining 4 strategies proposed, p < 0.05). Strategies obtained from the combination of supine, sitting and peak measurements resulted to be least biased for the Mean IOP and the IOP Fluctuation estimate, but all strategies were not found significantly different in terms of correct prediction rate (the only significant difference being between the two strategies based on sitting or supine measurements only, with the former being the one with the highest correct prediction rate)., CONCLUSIONS: The results of this study remark the concept that IOP is a dynamic parameter and that intensive measurement is helpful in determining its characteristics. All office-hour strategies showed a very poor performance of in correctly predicting the considered parameters within the thresholds used in this paper, all scoring a correct prediction rate below 52%.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate/tu [Therapeutic Use]; *Circadian Rhythm/ph [Physiology]; Drug Combinations; 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; Office Visits; Physicians' Offices; Posture; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Timolol/tu [Therapeutic Use]; Tonometry, Ocular

Customized humanoptics silicone iris prosthesis in eyes with posttraumatic iris loss: outcomes and complications. - Spitzer, Martin Stephan; Nessmann, Anja; Wagner, Julia; Yoeruek, Efdal; Bartz-Schmidt, Karl Ulrich; Szurman, Peter; Szurman, Gesine B (Acta ophthalmologica, 2016)
PURPOSE: Posttraumatic partial or total iris defects often cause significant debilitating glare, photophobia, decreased vision and cosmetic problems. Currently, the best cosmetic results can be obtained with a customized silicone iris prosthesis. However, little is known about the functional results and the rate of complication if this type of iris prosthesis is implanted into severely traumatized eyes. The aim of this study is to analyse the functional and cosmetic outcomes as well as complications after Artificial Iris implantation., METHODS: A consecutive series of 34 patients who received a customized silicone iris prosthesis after severe globe injury with total or sub-total iris loss was analysed retrospectively. Additionally, patients were interviewed regarding change in subjective complaints., RESULTS: Median follow-up was 24 months (range 12.0-48.8). Mean visual acuity prior to Artificial Iris implantation was 1.1 logMAR (range 0.3-2.6). Five patients (15%) had pre-existing glaucoma and eight patients (24%) had pre-existing hypotony. Visual acuity 12 months after surgery was 1.4 logMAR (range 0.2-2.6). Complications included newly diagnosed glaucoma in three eyes (9%) and hypotony in three eyes (9%), persisting intraocular inflammation or macular oedema in seven patients (21%), and corneal endothelial decompensation requiring corneal transplantation in six patients (18%). Patients' satisfaction increased by reducing glare and enhanced cosmetic appearance., CONCLUSION: The customized silicone iris prosthesis is an individualized treatment approach with appealing cosmetic results. Therefore, especially traumatized eyes with highly different posttraumatic conditions could benefit. However, in some patients, the implantation of this device may cause an increase of intraocular pressure, corneal endothelial decompensation or persisting inflammation. Copyright © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: *Artificial Organs; *Eye Injuries, Penetrating/su [Surgery]; Follow-Up Studies; Humans; *Intraoperative Complications; *Iris/in [Injuries]; Patient Satisfaction; *Postoperative Complications; *Prosthesis Implantation; *Silicone Elastomers; Treatment Outcome; Visual Acuity/ph [Physiology]

Using a patient-centered approach to benefit-harm assessment in treatment decision-making: a case study in uveitis. - Yu, Tsung; Holbrook, Janet T; Thorne, Jennifer E; Puhan, Milo A (Pharmacoepidemiology and drug safety, 2016)
BACKGROUND: Synthesizing evidence from comparative effectiveness trials can be difficult because multiple outcomes of different importance are to be considered. The goal of this study was to demonstrate an approach to conducting quantitative benefit-harm assessment that considers patient preferences., METHODS: We conducted a benefit-harm assessment using data from the Multicenter Uveitis Steroid Treatment Trial that compared corticosteroid implant versus systemic corticosteroids and immunosuppression in non-infectious intermediate, posterior, and panuveitis. We focused on clinical outcomes considered important to patients, including visual acuity, development of cataracts/glaucoma, need for eye surgery, prescription-requiring hypertension, hyperlipidemia, and infections. Patient preferences elicited in a recent survey were then incorporated into our assessment of the benefit-harm balance., RESULTS: Benefit-harm metrics were calculated for each time point that summarized the numbers of outcomes, caused or prevented by implant therapy versus systemic therapy if 1000 patients were treated. The benefit-harm metric was -129 (95% confidence interval: -242 to -14), -317 (-436 to -196), -390 (-514 to -264), and -526 (-687 to -368) at 6, 12, 18, and 24 months follow up, respectively, suggesting that systemic therapy may have a better benefit-harm balance. However, measures of quality of life for patients treated with implant therapy were found to be better than patients treated with systemic therapy over the same time period., CONCLUSIONS: Results of benefit-harm assessment were different from the prospectively collected quality of life data during trial follow up. Future studies should explore the reasons for such discrepancies and the strength and weakness of each method to assess treatment benefits and harms. Copyright © 2016 John Wiley & Sons, Ltd.
Keywords: Clinical Decision-Making; *Comparative Effectiveness Research/mt [Methods]; Drug Implants; Follow-Up Studies; *Glucocorticoids/ad [Administration & Dosage]; Glucocorticoids/ae [Adverse Effects]; Humans; Patient Preference; *Patient-Centered Care/mt [Methods]; Quality of Life; Randomized Controlled Trials as Topic; Time Factors; *Uveitis/dt [Drug Therapy]

The Effect of Eye Drop Technique Education in Patients With Glaucoma. - Carpenter, Delesha M; Sayner, Robyn; Blalock, Susan J; Muir, Kelly W; Hartnett, Mary Elizabeth; Lawrence, Scott D; Giangiacomo, Annette L; Goldsmith, Jason A; Tudor, Gail E; Robin, Alan L; Sleath, Betsy L (Health communication, 2016)
Education about how to administer eye drops may improve a patient's ability to instill his or her eye drops correctly. Our objectives were to (a) document the methods providers use to educate glaucoma patients about eye drop technique; (b) determine whether eye drop technique education varies by provider and patient characteristics; and (c) evaluate whether education predicts improved patient technique. We conducted an 8-month longitudinal study of 279 glaucoma patients and 15 providers in which we recorded on videotape the content of glaucoma office visits at two time points (baseline and 4- to 6-week follow-up) and videotaped patient eye drop technique at three time points (baseline, 4- to 6-week follow-up, and 8-month follow-up). Mann-Whitney rank sum tests were used to determine whether education was associated with improved patient eye drop technique over time. Ninety-four patients (34%) received technique education at either visit; 31% received verbal education and 10% received a technique demonstration. Only 24 patients (47%) who were new to eye drops received technique education at the baseline visit. Patients who were new to drops at baseline (p = .008) and patients who asked a question about drops (p < .001) were more likely to receive technique education. Education was not associated with improved technique. Eye drop technique education occurs infrequently during glaucoma office visits. Future studies should compare the effectiveness of different educational methods, such as patient demonstration versus provider verbal instruction, to determine which method is best at improving patient eye drop technique.
Keywords: Adult; Aged; Female; *Glaucoma/dt [Drug Therapy]; *Health Communication; Humans; Longitudinal Studies; Male; Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmologists; *Patient Education as Topic; *Self Administration; Surveys and Questionnaires; Videotape Recording

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma. - Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M (JAMA ophthalmology, 2016)
IMPORTANCE: The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood., OBJECTIVE: To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma., DESIGN, SETTING, AND PARTICIPANTS: Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015., MAIN OUTCOMES AND MEASURES: Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person., RESULTS: Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P < .001) and home health aide visits (OR, 1.27; 95% CI, 1.13-1.43; P < .001) compared with Medicare beneficiaries without glaucoma. Furthermore, patients with glaucoma with self-reported visual disability were more likely to report depression (OR, 1.47; 95% CI, 1.26-1.71; P < .001), falls (OR, 1.34; 95% CI, 1.09-1.66; P = .006), and difficulty walking (OR, 1.22; 95% CI, 1.02-1.45; P = .03) compared with those without self-reported visual disability. In the risk-adjusted model, Medicare beneficiaries with glaucoma incurred an additional $2903 (95% CI, $2247-$3558; P < .001) annual total health care costs and $2599 (95% CI, $1985-$3212; P < .001) higher costs for nonoutpatient services compared with Medicare beneficiaries without glaucoma., CONCLUSIONS AND RELEVANCE: Glaucoma is associated with greater use of inpatient and home health aide services and with higher annual total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.
Comment in (CIN)
Keywords: Aged; Aged, 80 and over; Confidence Intervals; Consumer Behavior; Female; Glaucoma/di [Diagnosis]; *Glaucoma/ec [Economics]; Glaucoma/th [Therapy]; *Health Care Costs; Hospitalization/ec [Economics]; Hospitalization/sn [Statistics & Numerical Data]; Humans; Incidence; Logistic Models; Longitudinal Studies; Male; *Medicare/sn [Statistics & Numerical Data]; Odds Ratio; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Risk Assessment; *Self Report; Socioeconomic Factors; United States

Saccadic vector optokinetic perimetry in children with neurodisability or isolated visual pathway lesions: observational cohort study. - Tailor, Vijay; Glaze, Selina; Unwin, Hilary; Bowman, Richard; Thompson, Graham; Dahlmann-Noor, Annegret (The British journal of ophthalmology, 2016)
BACKGROUND/AIMS: Children and adults with neurological impairments are often not able to access conventional perimetry; however, information about the visual field is valuable. A new technology, saccadic vector optokinetic perimetry (SVOP), may have improved accessibility, but its accuracy has not been evaluated. We aimed to explore accessibility, testability and accuracy of SVOP in children with neurodisability or isolated visual pathway deficits., METHODS: Cohort study; recruitment October 2013-May 2014, at children's eye clinics at a tertiary referral centre and a regional Child Development Centre; full orthoptic assessment, SVOP (central 30degree of the visual field) and confrontation visual fields (CVF). Group 1: age 1-16 years, neurodisability (n=16), group 2: age 10-16 years, confirmed or suspected visual field defect (n=21); group 2 also completed Goldmann visual field testing (GVFT)., RESULTS: Group 1: testability with a full 40-point test protocol is 12.5%; with reduced test protocols, testability is 100%, but plots may be clinically meaningless. Children (44%) and parents/carers (62.5%) find the test easy. SVOP and CVF agree in 50%. Group 2: testability is 62% for the 40-point protocol, and 90.5% for reduced protocols. Corneal changes in childhood glaucoma interfere with SVOP testing. All children and parents/carers find SVOP easy. Overall agreement with GVFT is 64.7%., CONCLUSIONS: While SVOP is highly accessible to children, many cannot complete a full 40-point test. Agreement with current standard tests is moderate to poor. Abnormal saccades cause an apparent non-specific visual field defect. In children with glaucoma or nystagmus SVOP calibration often fails. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Keywords: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; *Nervous System Diseases/di [Diagnosis]; Nervous System Diseases/pp [Physiopathology]; Nervous System Diseases/rh [Rehabilitation]; Retrospective Studies; *Saccades/ph [Physiology]; *Vision Disorders/di [Diagnosis]; Vision Disorders/pp [Physiopathology]; Vision Disorders/rh [Rehabilitation]; *Visual Field Tests/mt [Methods]; *Visual Fields/ph [Physiology]; *Visual Pathways/ph [Physiology]

Inter-Rater Agreement in the Assessment of Video Recordings of Eye Drop Instillation by Glaucoma Patients. - Park, Meghan S; Patel, Marguerite M; Sarezky, Daniel; Rojas, Carin; Choo, Clara; Choi, Michael; Liu, Dachao; Rademaker, Alfred W; Tanna, Angelo P (PloS one, 2016)
PURPOSE: To create a standardized method for evaluating the video recordings of patients self-instilling eye drops and to determine the level of agreement of eye drop instillation efficacy, safety and efficiency ratings by three masked graders., DESIGN: Prospective cross-sectional study., PARTICIPANTS: 78 patients with open-angle glaucoma or ocular hypertension who had at least 6 months of experience with the use of eye drop medications., METHODS: Participants were video recorded while self-instilling artificial tears sequentially to both eyes. Three masked observers graded these video recordings on three criteria: efficacy (the determination of whether an eye drop was instilled on the ocular surface), safety (assessment of whether the tip of the medication bottle made contact with the ocular surface or eyelids), and efficiency (the number of eye drops expressed from the bottle)., MAIN OUTCOME MEASURES: After grading the video recordings based on efficacy, safety, and efficiency, kappa statistics were used to estimate inter-rater agreement., RESULTS: The mean kappa level of agreement for efficacy, safety, and efficiency was 0.64 (95% confidence interval (CI), 0.42-0.87), 0.73 (95% CI, 0.58-0.88), and 0.62 (95% CI, 0.42-0.81), respectively., CONCLUSIONS: We demonstrated good inter-rater reproducibility of the masked analysis of video recordings of patients self-instilling eye drops based on three criteria: efficiency, safety, and efficacy.
Keywords: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Ocular Hypertension/pc [Prevention & Control]; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/tu [Therapeutic Use]; Outcome Assessment, Health Care/mt [Methods]; Outcome Assessment, Health Care/sn [Statistics & Numerical Data]; Prospective Studies; Reproducibility of Results; Self Administration; *Video Recording/mt [Methods]

Effectiveness of Glaucoma Counseling on Rates of Follow-up and Glaucoma Knowledge in a South Indian Population. - Do, Anna T; Pillai, Manju R; Balakrishnan, Vijayakumar; Chang, Robert T; Robin, Alan L; Singh, Kuldev; Lee, Bradford W (American journal of ophthalmology, 2016)
PURPOSE: To evaluate the impact of traditional counseling and patient-centered counseling, either alone or with recorded audio counseling reinforcement, on glaucoma knowledge and clinical follow-up., DESIGN: Prospective randomized controlled trial., METHODS: Newly diagnosed adult glaucoma patients were randomized to 1 of 3 categories of glaucoma counseling: traditional counseling, patient-centered counseling, or patient-centered counseling with audio counseling reinforcement. Demographic and clinical information from each subject was ascertained, and all subjects completed the Glaucoma Knowledge Assessment before and after counseling sessions at the time of diagnosis and at 1-month follow-up. Patients were instructed to return to clinic for routine follow-up at 1, 3, 6, 9, and 12 months after enrollment. A multivariate logistic regression model was used to determine factors associated with appropriate clinical follow-up., RESULTS: Overall, only 13.5% of subjects had appropriate clinical follow-up at 1 year, defined as attending at least 3 follow-up visits during that interval, and there was no significant difference between counseling groups. The mean glaucoma knowledge assessment score (GKAS) improved by 77.6% with the initial counseling intervention (P < .0001), decreased by 17.4% within a 1-month period following initial counseling, and improved by 22.8% (P < .001) after the second counseling intervention. Monthly household income over 2500 rupees, GKAS greater than 5 after initial counseling, and undergoing any ocular surgical procedure were all independent predictors of appropriate follow-up., CONCLUSION: While all 3 counseling methods resulted in transient improvement of patient knowledge regarding glaucomatous disease, follow-up rates were poor for all groups. Poor retention of glaucoma knowledge may impact the likelihood of patient follow-up, and reinforcement with repeated counseling may be beneficial with regard to both disease knowledge and follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Counseling/mt [Methods]; Female; Follow-Up Studies; *Glaucoma, Angle-Closure/th [Therapy]; *Glaucoma, Open-Angle/th [Therapy]; *Health Knowledge, Attitudes, Practice; Humans; India; Intraocular Pressure; Male; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; Patient-Centered Care/mt [Methods]; Prospective Studies; Risk Factors; Treatment Outcome; Visual Acuity/ph [Physiology]

The Safety of Orthokeratology--A Systematic Review. - Liu, Yue M; Xie, Peiying (Eye & contact lens, 2016)
OBJECTIVES: The aim of this review is to evaluate the ocular safety of orthokeratology (OrthoK) treatment of myopia correction and retardation., DATA SOURCES: Clinical studies published in English and Chinese were identified from MEDLINE, EMBASE CNKI, CQVIP, and WANFANG DATA (all from 1980 to April 2015). The reference lists of the studies and the Science Citation Index were also searched., SELECTION CRITERIA: Relevant clinical studies including case series, case reports, patient/practitioner surveys, retrospective and prospective cohort studies, and clinical trials were all included in the review. The material of OrthoK lenses was limited to gas-permeable lens., MAIN RESULTS: This review incorporated a total of 170 publications, including 58 English and 112 Chinese literature. The risk of microbial keratitis in overnight OrthoK was similar to that of other overnight modality. The most common complication was corneal staining. Other clinically insignificant side effects included epithelial iron deposit, prominent fribrillary lines, and transient changes of corneal biomechanical properties. There was no long-term effect of OrthoK on corneal endothelium., CONCLUSIONS: There is sufficient evidence to suggest that OrthoK is a safe option for myopia correction and retardation. Long-term success of OrthoK treatment requires a combination of proper lens fitting, rigorous compliance to lens care regimen, good adherence to routine follow-ups, and timely treatment of complications.
Keywords: Child; Child, Preschool; Clinical Studies as Topic; Contact Lenses/ae [Adverse Effects]; *Contact Lenses; Corneal Diseases/et [Etiology]; Eye Infections/et [Etiology]; Humans; Myopia/pc [Prevention & Control]; *Myopia/th [Therapy]; Orthokeratologic Procedures/ae [Adverse Effects]; *Orthokeratologic Procedures/mt [Methods]; Visual Acuity

Association of Socioeconomic Status with Eye Health Among Women With and Without Diabetes. - Norris, Keri L; Beckles, Gloria L; Chou, Chiu-Fang; Zhang, Xinzhi; Saaddine, Jinan (Journal of women's health (2002), 2016)
OBJECTIVE: To investigate the association between socioeconomic position (SEP) and poor eye health among women., MATERIALS AND METHODS: We included the 7,708 women aged >= 40 years who participated in the 2008 National Health Interview Survey. We defined poor eye health as self-reported age-related eye diseases (AREDs; cataract, glaucoma, macular degeneration, or diabetic retinopathy) or visual impairment (VI). We identified diagnosed diabetes by self-report. We measured SEP by education attained and annual household income. We conducted logistic regression analyses while controlling for demographic, clinical, behavioral, and healthcare access variables., RESULTS: The age-standardized prevalence of VI and ARED was significantly higher among women with diagnosed diabetes than among those without diagnosed diabetes, 29.8% versus 14.4% and 34.1% versus 20.8%, respectively (p < 0.05 for both). The prevalence of VI and ARED increased with decreasing SEP, but the trends were only significant among women without diabetes. After multivariable adjustment, education and income were significantly associated with VI but not with ARED. We found no interaction with diagnosed diabetes., CONCLUSIONS: SEP was inversely associated with VI but not with ARED. We found no interaction with diagnosed diabetes.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Cataract/ep [Epidemiology]; Cross-Sectional Studies; Diabetes Mellitus/ep [Epidemiology]; Diabetic Retinopathy/ep [Epidemiology]; *Educational Status; *Eye Diseases/ep [Epidemiology]; Female; Health Services Accessibility; *Healthcare Disparities; Humans; Income; Macular Degeneration/ep [Epidemiology]; Middle Aged; Prevalence; Self Report; *Social Class; Socioeconomic Factors; United States/ep [Epidemiology]; *Vision Disorders/ep [Epidemiology]

Risk factors for contact lens-related microbial keratitis in Singapore. - Lim, C H L; Carnt, N A; Farook, M; Lam, J; Tan, D T; Mehta, J S; Stapleton, F (Eye (London, England), 2016)
PURPOSE: To investigate independent risk factors for contact lens-related microbial keratitis in Singapore and estimate their impact on disease load., METHODS: Cases were contact lens wearers presenting to Singapore National Eye Centre with microbial keratitis between 2008 and 2010. Community contact lens wearers were recruited as controls. All wearers completed a previously validated questionnaire describing contact lens wear history, hygiene and compliance habits, and demographics. Risk factors significant in univariate analysis (P<0.2) were evaluated in a multivariate model., RESULTS: In all, 58 cases of microbial keratitis and 152 contemporaneous controls were identified. When controlling for other variables, Chinese had a 7 x lower risk compared with other races (95% CI: 2.3-21.3, P=0.001). Those aged between 25 and 44 years were at 3 x increased risk compared with younger wearers (95% CI: 1.1-9.6, P=0.04). Occasional overnight contact lens wear (less often than one night per week) was associated with a 4 x higher risk (95% CI: 1.2-15.4, P=0.03) compared with daily use. Not washing hands before handling was associated with a 13 x increased risk (95% CI: 1.9-84.8, P=0.008). Use of multipurpose solution A carried a 16 x higher risk compared with hydrogen peroxide (95% CI: 1.5-174.0, P=0.02). The combined PAR% for modifiable risk factors (occasional overnight wear, not washing of hands, and MPS A) was 82%., CONCLUSIONS: Consistent with previous findings, independent risk factors for contact lens-related microbial keratitis include poor hand hygiene, occasional overnight wear, and type of lens care solution. Prolonged overnight or extended contact lens use was infrequent in this population.
Keywords: Adolescent; Adult; Aged; *Contact Lenses/ae [Adverse Effects]; *Corneal Ulcer/ep [Epidemiology]; Corneal Ulcer/mi [Microbiology]; *Eye Infections, Bacterial/ep [Epidemiology]; Eye Infections, Bacterial/mi [Microbiology]; Female; Humans; Male; Middle Aged; Pseudomonas Infections/ep [Epidemiology]; Pseudomonas Infections/mi [Microbiology]; Risk Factors; Serratia Infections/ep [Epidemiology]; Serratia Infections/mi [Microbiology]; Singapore/ep [Epidemiology]; Staphylococcal Infections/ep [Epidemiology]; Staphylococcal Infections/mi [Microbiology]; Surveys and Questionnaires; Young Adult

Global Survey of Corneal Transplantation and Eye Banking. - Gain, Philippe; Jullienne, Remy; He, Zhiguo; Aldossary, Mansour; Acquart, Sophie; Cognasse, Fabrice; Thuret, Gilles (JAMA ophthalmology, 2016)
IMPORTANCE: Corneal transplantation restores visual function when visual impairment caused by a corneal disease becomes too severe. It is considered the world's most frequent type of transplantation, but, to our knowledge, there are no exhaustive data allowing measurement of supply and demand, although such data are essential in defining local, national, and global strategies to fight corneal blindness., OBJECTIVE: To describe the worldwide situation of corneal transplantation supply and demand., DESIGN, SETTING, AND PARTICIPANTS: Data were collected between August 2012 and August 2013 from a systematic review of published literature in parallel with national and international reports on corneal transplantation and eye banking. In a second step, eye bank staff and/or corneal surgeons were interviewed on their local activities. Interviews were performed during international ophthalmology or eye-banking congresses or by telephone or email. Countries' national supply/demand status was classified using a 7-grade system. Data were collected from 148 countries., MAIN OUTCOMES AND MEASURES: Corneal transplantation and corneal procurements per capita in each country., RESULTS: In 2012, we identified 184,576 corneal transplants performed in 116 countries. These were procured from 283,530 corneas and stored in 742 eye banks. The top indications were Fuchs dystrophy (39% of all corneal transplants performed), a primary corneal edema mostly affecting elderly individuals; keratoconus (27%), a corneal disease that slowly deforms the cornea in young people; and sequellae of infectious keratitis (20%). The United States, with 199.10-6 corneal transplants per capita, had the highest transplantation rate, followed by Lebanon (122.10-6) and Canada (117.10-6), while the median of the 116 transplanting countries was 19.10-6. Corneas were procured in only 82 countries. Only the United States and Sri Lanka exported large numbers of donor corneas. About 53% of the world's population had no access to corneal transplantation., CONCLUSIONS AND RELEVANCE: Our survey globally quantified the considerable shortage of corneal graft tissue, with only 1 cornea available for 70 needed. Efforts to encourage cornea donation must continue in all countries, but it is also essential to develop alternative and/or complementary solutions, such as corneal bioengineering.
Keywords: *Cornea; Corneal Diseases/rh [Rehabilitation]; *Corneal Transplantation/sn [Statistics & Numerical Data]; *Eye Banks/sn [Statistics & Numerical Data]; *Global Health/sn [Statistics & Numerical Data]; Health Surveys; Humans; Religion; Surveys and Questionnaires; *Tissue Donors/sd [Supply & Distribution]; Tissue and Organ Procurement/lj [Legislation & Jurisprudence]; *Tissue and Organ Procurement/sn [Statistics & Numerical Data]; Waiting Lists

Compliance of Glaucoma Patients to Ocular Hypotensive Medications Among the Saudi Population. - Osman, Essam A; Alqarni, Bader Ahmed Mousa; AlHasani, Sara Salem Humaid; Al Harbi, Shatha Saleh Suliman; Gikandi, Priscilla Wairimu; Mousa, Ahmed (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2016)
PURPOSE: To evaluate the compliance of glaucoma patients to medical treatment and its impact on the intraocular pressure (IOP) and to verify the associated risk factors for noncompliance., METHODS: All recruited patients were examined at the ophthalmology clinics of King Abdulaziz University Hospital, Riyadh, Saudi Arabia between May and August 2012. Patients were interviewed and subjected to answer a questionnaire that was developed based on a pilot test. Collected data included age, gender, number of prescribed drugs, and different reasons for noncompliance to the prescribed drugs., RESULTS: Noncompliance was detected in 18 (19.4%) of the recruited patients. Factors associated with noncompliance demonstrated a trend toward older patients, males, patients with lower IOP at presentation, higher cup to disc ratio, and drug self-administering patients. However, the only statistically significant characteristic was being under lifelong medications (P = 0.005)., CONCLUSION: Noncompliance was detected in around one-fifth of our glaucoma patients, particularly, the older group. Awareness programs, maintaining good patient-physician relationship, and personalizing treatment can lead to better adherence to treatment.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Compliance/px [Psychology]; *Patient Compliance/sn [Statistics & Numerical Data]; Risk Factors; Saudi Arabia; Young Adult

Comparison of the intraocular pressure-lowering effect and safety of brimonidine/timolol fixed combination and 0.5% timolol in normal-tension glaucoma patients. - Kim, Joon Mo; Kim, Tae-Woo; Kim, Chan Yun; Kim, Hwang Ki; Park, Ki Ho (Japanese journal of ophthalmology, 2016)
PURPOSE: To compare the therapeutic efficacy and safety of brimonidine/timolol fixed-combination (BTFC) and 0.5% timolol ophthalmic solution in normal-tension glaucoma (NTG) patients., METHODS: This was a multi-institution, randomized, active-controlled, open-label, parallel-group study. After a full ophthalmic and glaucoma examination, a total of 110 NTG patients--55 undergoing therapy with BTFC and 55 0.5%, with timolol--participated in this study. Among them, 1 failed to meet the inclusion/exclusion criteria, 10 revoked their consent to participate in the study, 3 had adverse reactions, and 1 had a drug adherence rate of less than 70%. Ultimately, a total of 95 patients--48 in the BTFC group and 47 in the 0.5% timolol group--completed the study. The study visits took place at baseline and at 4 and 12 weeks. Diurnal IOP was measured at 9 a.m., 11 a.m., and 5 p.m. during the baseline visit and the visit at 12 weeks after eye-drop instillation. At each follow-up visit, compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the investigators., RESULTS: The average difference in IOP change measured at 11 a.m. 12 weeks after administration between the two groups was 2.10 +/- 2.59 mmHg. The BTFC group had a better IOP-lowering effect at all time points than did the 0.5% timolol group. The ratio of patients whose average IOP had decreased by >20% after 4 and 12 weeks was 50 and 56% in the BTFC group, respectively, whereas it was 29.41 and 23.53% in the 0.5% timolol group, respectively (p = 0.034, <0.001)., CONCLUSIONS: BTFC has a superior IOP-lowering effect than 0.5% timolol in NTG patients.
Keywords: Administration, Topical; Aged; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate/ae [Adverse Effects]; *Brimonidine Tartrate/tu [Therapeutic Use]; Corneal Pachymetry; Drug Combinations; Female; Humans; *Intraocular Pressure/de [Drug Effects]; *Low Tension Glaucoma/dt [Drug Therapy]; Low Tension Glaucoma/pp [Physiopathology]; Male; Middle Aged; Ophthalmic Solutions; Prospective Studies; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Tonometry, Ocular

[Preservative-free glaucoma treatment : Selection of the correct treatment in 1 min]. - Pfennigsdorf, S; Eschstruth, P (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2016)
BACKGROUND: The presence of preservatives in topical glaucoma treatments may impact ocular surface function and structure. For treatment to be effective, side effects need to be minimized, in order to promote compliance and allow continuation of therapy. Therefore, in daily clinical practice, it needs to be decided on an individual basis whether a preservative-free treatment is required., OBJECTIVE: This study aimed to develop a questionnaire which helps to quickly and easily identify patients who require preservative-free treatment., MATERIALS AND METHODS: A questionnaire was prepared to collect relevant clinical findings needed to make a therapeutic decision (preservative-free required? Yes/No). Moreover, a rating scheme was developed to enable efficient final assessment of the collected data. To check their practicability in daily clinical practice, both instruments were tested in 11 ophthalmological centers in Germany., RESULTS: The questionnaire and rating scheme were easy to use, integrated efficiently into everyday routine, and performed in about 1 min. Data of 1150 glaucoma patients were collected and preservative-free eyedrops recommended for 586 (51 %). Parameters most frequently associated with such a recommendation were a reduced tear film break-up time of < 10 s (87.5 %) or marked corneal staining (65.5 %)., CONCLUSION: The presented approach helps to decide within 1 min, in daily clinical practice, whether preservative-free glaucoma threatment should be recommended. Individualized therapy decisions can thus be made, allowing goal-oriented use of preservative-free antiglaucomatosa. This might help to promote compliance and lead to reduced progression of glaucoma.
Keywords: Adult; Aged; Aged, 80 and over; Benzalkonium Compounds/ad [Administration & Dosage]; Benzalkonium Compounds/ch [Chemistry]; *Clinical Decision-Making/mt [Methods]; Female; Germany/ep [Epidemiology]; *Glaucoma/dt [Drug Therapy]; *Glaucoma/ep [Epidemiology]; Humans; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ch [Chemistry]; Patient Preference; Patient Selection; *Preservatives, Pharmaceutical/ad [Administration & Dosage]; Preservatives, Pharmaceutical/ch [Chemistry]; Prevalence; Reproducibility of Results; Sensitivity and Specificity; *Surveys and Questionnaires

Assessing the Role of the Family/Support System Perspective in Patients With Glaucoma. - Shtein, Roni M; Newman-Casey, Paula A; Herndon, Leon; Coleman, Anne L; Lee, Paul P (Journal of glaucoma, 2016)
PURPOSE: To investigate the role of the family/friends support system for patients with glaucoma and their perspective on barriers to effective glaucoma management., METHODS: Six focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 31 participants; 68% (21/31) were family members and friends of glaucoma patients with poor vision and 32% (10/31) were support system individuals of patients with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme., RESULTS: A total of 134 relevant comments were made in the 6 focus groups and 72% of relevant comments were made by individuals providing support for patients with poor vision. Family members and friends mentioned the following areas of concern regarding patients' glaucoma care: patient education (19.4%), doctor-patient relationship (17.9%), their own lack of involvement in the patient's medical care (17.2%), frustration with glaucoma and with the patient (14.9%), patient dependency on caregivers (14.9%), patient frustration with the disease (10.4%), and sex differences in coping mechanisms (5.2%)., CONCLUSIONS: Support system individuals tend to be minimally involved in the patient's glaucoma status and care. This is especially true for support system members of patients with glaucoma who maintain good vision and those who do not have any other personal experiences with difficulties from glaucoma. Many of these family members express an interest in acquiring more education about glaucoma and becoming more involved in the patient's glaucoma care.
Keywords: Adult; *Caregivers/px [Psychology]; *Family/px [Psychology]; Female; Focus Groups; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure; *Physician-Patient Relations

Adherence With the Use of Target Intraocular Pressure for Glaucoma Patients in a Large University Practice. - Solano-Moncada, Francisco; Dymerska, Malgorzata; Jefferys, Joan L; Quigley, Harry A (Journal of glaucoma, 2016)
PURPOSE: To determine how often glaucoma specialists set a target intraocular pressure (IOP) and how they respond when the target is not achieved., METHODS: We reviewed 250 randomly selected charts of glaucoma patients seen by 5 glaucoma specialists to identify whether a target IOP was specifically set and to detail the plan of action when the target was exceeded., RESULTS: A target IOP was present for at least 1 eye in 66% of patients (165/250). Among the patients of 5 physicians, the percentage with a target IOP for both eyes ranged from 90% to 34%. Half of eyes with no target had an explaining feature, whereas the other half did not. The study visit IOP exceeded the target in at least 1 eye in 29% (50/173) of patients. When the target was not met, 66% (33/50) had a notation of action taken, with no significant difference among physicians in whether any action was taken (P=0.64). The significant differences among the 5 physicians in the use of target IOP were potentially associated with patient demographic and clinical features, such as age, race, treatment intensity, and visual field damage, which differed among the 5 practices (all P<0.05)., CONCLUSIONS: Target IOP was recorded in the large majority of patient charts, but its use varied by physician and patient characteristics. On nearly one third of visits, IOP exceeded the target, indicating the need for active decision-making and management changes.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmology; *Practice Patterns, Physicians'; Quality Control; Retrospective Studies; Student Health Services; Tonometry, Ocular; Workforce

Shared Care in Monitoring Stable Glaucoma Patients: A Randomized Controlled Trial. - Holtzer-Goor, Kim M; van Vliet, Ellen J; van Sprundel, Esther; Plochg, Thomas; Koopmanschap, Marc A; Klazinga, Niek S; Lemij, Hans G (Journal of glaucoma, 2016)
PURPOSE: Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual., PATIENTS AND METHODS: This randomized controlled trial included stable glaucoma patients and patients at risk for developing glaucoma. Patients in the Usual Care group (n=410) were seen by glaucoma specialists. In the glaucoma follow-up unit group (n=405), patients visited the glaucoma follow-up unit twice followed by a visit to a glaucoma specialist. The main outcome measures were: compliance to the working protocol by glaucoma follow-up unit employees; difference in intraocular pressure between baseline and at >=18 months; and patient satisfaction., RESULTS: Glaucoma follow-up unit employees closely adhered to the working protocol for the measurement of intraocular pressure, visual acuity and GDx (>=97.5% of all visits). Humphrey Field Analyzer examinations were not performed as frequently as prescribed by the working protocol, but more often than in the Usual Care group. In a small minority of patients that required back-referral, the protocol was disregarded, notably when criteria were only slightly exceeded. There was no statistically significant difference in changes in intraocular pressure between the 2 treatment groups (P=0.854). Patients were slightly more satisfied with the glaucoma follow-up unit employees than with the glaucoma specialists (scores: 8.56 vs. 8.40; P=0.006)., CONCLUSIONS: In general, the hospital-based shared care glaucoma follow-up closely observed its working protocol and patients preferred it slightly over the usual care provided by medical doctors. The glaucoma follow-up unit operated satisfactorily and might serve as a model for shared care strategies elsewhere.
Keywords: Aged; Female; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Monitoring, Physiologic; Ophthalmic Assistants/og [Organization & Administration]; Ophthalmic Assistants/st [Standards]; Ophthalmology/og [Organization & Administration]; Ophthalmology/st [Standards]; Optometry/og [Organization & Administration]; Optometry/st [Standards]; *Patient Care Team/og [Organization & Administration]; Patient Satisfaction; Patient-Centered Care; *Quality Assurance, Health Care; *Quality of Health Care/st [Standards]; Tonometry, Ocular; Visual Acuity

Barriers to Receiving Follow-Up Eye Care and Detection of Non-Glaucomatous Ocular Pathology in the Philadelphia Glaucoma Detection and Treatment Project. - Zheng, Cindy X; Hu, Wanda D; Tran, Judie; Siam, Linda; Berardi, Giuliana G; Sembhi, Harjeet; Hark, Lisa A; Katz, L Jay; Waisbourd, Michael (Journal of community health, 2016)
This cross-sectional study aimed to evaluate adherence rates and identify barriers to receiving follow-up eye care in participants diagnosed with significant non-glaucomatous eye pathology in the Philadelphia Glaucoma Detection and Treatment Project. This community-based project aimed to improve detection, management, treatment, and follow-up eye care of individuals at high risk for glaucoma in community-based settings. Participants throughout Philadelphia, Pennsylvania, USA were enrolled. After a comprehensive eye examination, follow-up recommendations were given to each participant. A telephone survey was administered to individuals diagnosed with non-glaucomatous ocular pathology 3 months after initial eye examination to assess rates of follow-up and to evaluate potential barriers to follow-up. Of the 1649 participants enrolled in this project, 249 (15 %) were diagnosed with significant non-glaucomatous ocular pathology requiring follow-up care. There were 143 (57 %) who responded to the telephone survey. Respondents had a median age of 72 years, and were predominately female (69 %) and African-American (64 %). Of the respondents, 36 (25 %) attended a follow-up appointment. Participants who did not remember the results of their examinations, did not remember their recommendations, and had not seen an eye doctor within the past year were less likely to make a follow-up appointment (P = 0.04, 0.001 and 0.005, respectively). The Philadelphia Glaucoma Detection and Treatment Program was able to detect a significant amount of non-glaucomatous ocular pathology requiring follow-up care. Actual follow-up rates were sub-optimal. Further research is needed to determine interventions to overcome barriers and increase adherence with follow-up recommendations.
Keywords: Adult; Aftercare/sn [Statistics & Numerical Data]; *Aftercare; Aged; Aged, 80 and over; Cross-Sectional Studies; *Eye Diseases/di [Diagnosis]; Female; Health Care Surveys; *Health Services Accessibility; Humans; Male; Middle Aged; Philadelphia

Does patient comfort influence the choice of tonometer for the measurement of intraocular pressure?. - Ugalahi, Mary O; Seidu, Mukaila A; Olusanya, Bolutife A; Baiyeroju, Aderonke M (International ophthalmology, 2016)
The purpose of this study was to compare patient comfort and preference between the use of Icare tonometer and Goldmann applanation tonometer for the measurement of intraocular pressure (IOP). This was a prospective study carried out at the Eye clinic of the University College Hospital, Ibadan on volunteers aged 18 years and above. Demographic information of the participants was collected using a proforma. All participants had Icare tonometry and Goldmann applanation tonometry (GAT) performed on them in sequence within a 15-min period. After the measurements, participants were asked to report their assessment of the level of comfort with each method and to state their preferred choice for IOP measurement. One hundred subjects participated in the study; 45 (45 %) were males, and the mean age was 47.1 (+/- 17.4) years. Forty-three subjects (43 %) reported that Icare was either much more comfortable or more comfortable than GAT, while 31 (31 %) stated that Goldmann applanation was either much more or more comfortable. Twenty-six participants (26 %) reported that the level of comfort was the same with the two instruments. With regard to which of the instruments will be preferred for IOP check at another clinic visit, 53 (53 %) of the respondents preferred the Goldmann applanation tonometer. Some of the participants preferred GAT because they believed it was more sophisticated, while the main reported reason for preferring Icare was the stinging sensation of the anesthetic eye drop when using GAT. Although more participants reported the Icare tonometer to be more comfortable, the Goldmann tonometer was preferred by majority of the respondents.
Keywords: Adult; Cross-Sectional Studies; Female; Humans; *Intraocular Pressure; Male; Middle Aged; *Ocular Hypertension/di [Diagnosis]; *Patient Comfort; Patient Preference/sn [Statistics & Numerical Data]; Prospective Studies; *Tonometry, Ocular/is [Instrumentation]; Young Adult

Why Patients With Glaucoma Lose Vision: The Patient Perspective. - Newman-Casey, Paula A; Shtein, Roni M; Coleman, Anne L; Herndon, Leon; Lee, Paul P (Journal of glaucoma, 2016)
PURPOSE: To explore why glaucoma patients believe that glaucoma continues to cause vision loss despite the availability of effective treatment., METHODS: Nine focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 56 participants, 31 with poor vision and 25 with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme., RESULTS: A total of 474 relevant comments were made in the 9 focus groups. Focus groups elicited 305 comments about barriers to glaucoma management including issues with adherence (30%), the doctor-patient relationship (21%), knowledge about glaucoma (19%), personal support systems (19%), and barriers to health care delivery such as cost and insurance (11%). A total of 101 comments were made regarding feelings about glaucoma and 58 comments were made regarding beliefs about disease and treatment., CONCLUSIONS: These focus groups brought up many issues surrounding barriers to glaucoma treatment, perceived susceptibility to glaucoma, perceived benefits to treatment, and the emotional response to living with glaucoma. There is a need to create a more comprehensive chronic disease management approach for patients with glaucoma to address both the concrete and emotional issues identified in these focus group discussions.
Keywords: Adult; Aged; Aged, 80 and over; Blindness/ep [Epidemiology]; *Blindness/et [Etiology]; Blindness/px [Psychology]; Female; Focus Groups; Glaucoma/co [Complications]; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; Humans; Incidence; *Intraocular Pressure; Male; Middle Aged; *Physician-Patient Relations; *Risk Assessment/mt [Methods]; United States/ep [Epidemiology]; *Visual Acuity

Distance- and near-visual impairment in rural Chinese adults in Kailu, Inner Mongolia. - Cheng, Fang; Shan, Li; Song, Wulian; Fan, Pan; Yuan, Huiping (Acta ophthalmologica, 2016)
PURPOSE: To investigate the prevalence and causes of distance-visual impairment and near-vision impairment in a rural Chinese population in Inner Mongolia., METHODS: A population-based, cross-sectional study design was used to identify visual impairment in the Chinese aged 40 years and older living in Kailu County, Inner Mongolia. Low vision, blindness and near-visual impairment (NVI) were defined according to World Health Organization (WHO) criteria., RESULTS: The overall prevalence of blindness and visual impairment based on the presenting visual acuity (VA) was 2.2% (95% CI: 1.8-2.6) and 9.8% (95% CI: 8.9-10.6), respectively, and was adjusted to 0.9% (95% CI: 0.6-1.2) and 4.7% (95% CI: 4.1-5.3) using best-corrected visual acuity (BCVA), respectively. Taking the presenting VA into consideration, the leading cause of visual impairment and blindness was cataract (40.3%, 40.9%), followed by uncorrected refractive error (26.6%, 28.2%). According to the BCVA, the main cause of visual impairment and blindness was cataract (48.3%, 41.3%) followed by glaucoma (19.0%, 23.9%). Among the examined subjects, 80.3% had NVI, and 51.7% had presbyopia. Major barriers reported by NVI persons without near correction were lack of money to purchase prescription glasses and poor quality of the available ones (43.2%)., CONCLUSION: Visual impairment is a serious public health problem, and the main causes leading to visual impairment are treatable and preventable in the rural Chinese population in Inner Mongolia. Presbyopia, together with the low rate of spectacles and lack of appropriate refractive and presbyopia spectacles, is highly prevalent in rural China. Copyright © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Adult; *Asian Continental Ancestry Group/eh [Ethnology]; *Blindness/ep [Epidemiology]; Cataract/ep [Epidemiology]; China/ep [Epidemiology]; Cross-Sectional Studies; Eyeglasses/sn [Statistics & Numerical Data]; Eyeglasses/sd [Supply & Distribution]; Female; Glaucoma/ep [Epidemiology]; Humans; Male; Middle Aged; Prevalence; *Rural Population/sn [Statistics & Numerical Data]; *Vision, Low/ep [Epidemiology]; Visual Acuity/ph [Physiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Longitudinal Andhra Pradesh Eye Disease Study: rationale, study design and research methodology. - Khanna, Rohit C; Murthy, Gudlavalleti Vs; Marmamula, Srinivas; Mettla, Asha Latha; Giridhar, Pyda; Banerjee, Seema; Shekhar, Konegari; Chakrabarti, Subhabrata; Gilbert, Clare; Rao, Gullapalli N; Andhra Pradesh Eye Disease Study Group (Clinical & experimental ophthalmology, 2016)
BACKGROUND: The rationale, objectives, study design and procedures for the longitudinal Andhra Pradesh Eye Disease Study are described., DESIGN: A longitudinal cohort study was carried out., PARTICIPANTS: Participants include surviving cohort from the rural component of Andhra Pradesh Eye Disease Study., METHODS: During 1996-2000, Andhra Pradesh Eye Disease Survey was conducted in three rural (n = 7771) and one urban (n = 2522) areas (now called Andhra Pradesh Eye Disease Study 1). In 2009-2010, a feasibility exercise (Andhra Pradesh Eye Disease Study 2) for a longitudinal study (Andhra Pradesh Eye Disease Study 3) was undertaken in the rural clusters only, as urban clusters no longer existed. In Andhra Pradesh Eye Disease Study 3, a detailed interview will be carried out to collect data on sociodemographic factors, ocular and systemic history, risk factors, visual function, knowledge of eye diseases and barriers to accessing services. All participants will also undergo a comprehensive eye examination including photography of lens, optic disc and retina, Optic Coherence Tomography of the posterior segment, anthropometry, blood pressure and frailty measures., MAIN OUTCOME MEASURES: Measures include estimates of the incidence of visual impairment and age-related eye disease (lens opacities, glaucoma and age-related macular degeneration) and the progression of eye disease (lens opacities and myopia) and associated risk factors., RESULTS: Of the 7771 respondents examined in rural areas in Andhra Pradesh Eye Disease Study 1, 5447 (70.1%) participants were traced in Andhra Pradesh Eye Disease Study 2. These participants will be re-examined., CONCLUSIONS: Andhra Pradesh Eye Disease Study 3 will provide data on the incidence and progression of visual impairment and major eye diseases and their associated risk factors in India. The study will provide further evidence to aid planning eye care services. Copyright © 2015 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Adult; Anthropometry; Blood Pressure/ph [Physiology]; *Developing Countries; Disease Progression; *Eye Diseases/ep [Epidemiology]; Female; Humans; Incidence; India/ep [Epidemiology]; Longitudinal Studies; Male; Research Design; Risk Factors; *Rural Population/sn [Statistics & Numerical Data]; Tomography, Optical Coherence; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Use of Scleral Lenses and Miniscleral Lenses After Penetrating Keratoplasty. - Barnett, Melissa; Lien, Vivian; Li, Jennifer Y; Durbin-Johnson, Blythe; Mannis, Mark J (Eye & contact lens, 2016)
PURPOSE: To examine the clinical outcomes of scleral lenses for visual rehabilitation after penetrating keratoplasty (PK)., METHODS: A retrospective review was conducted for 34 patients (48 eyes) who had a history of prior PK and were fit with scleral lenses between October 2009 and December 2013 at the UC Davis Eye Center., RESULTS: The most common initial indication for PK was keratoconus in 27 eyes (56%). Thirty-three eyes (69%) had previously been fit with other types of contact lenses, with small-diameter rigid gas-permeable lenses being the most common. The improvement in best-corrected visual acuity with a scleral lens compared with prior spectacle refraction or other contact lens was a mean of two best-corrected visual acuity lines. Forty-four eyes (91.7%) achieved functional vision with best scleral lens-corrected visual acuities of 20/40 or better. Patients who continued wearing scleral lenses were significantly more likely to report "good" subjective vision compared with patients who abandoned scleral lens wear (P=0.009), although change in objective best-corrected visual acuity did not differ significantly. There were no cases of infectious keratitis. Six eyes (12.5%) developed graft rejection; 3 were able to resume scleral lens wear. Nineteen eyes (39.5%) discontinued scleral lens wear for various reasons, the most common reason for discontinuation of lens wear was difficulty with scleral lens insertion or removal (8 eyes, 42.1%)., CONCLUSION: Scleral lenses are effective and safe in patients who have had PK. There was a mean gain in visual acuity, with the majority of patients achieving 20/40 vision or better. The patient's subjective perception of vision was a significant factor in determining whether scleral lens wear was continued or abandoned.
Keywords: Adult; Aged; Aged, 80 and over; *Contact Lenses; *Corneal Diseases/su [Surgery]; Female; Humans; *Keratoplasty, Penetrating; Male; Middle Aged; Patient Satisfaction; Prosthesis Fitting; Retrospective Studies; *Sclera; Vision Disorders/pp [Physiopathology]; *Vision Disorders/rh [Rehabilitation]; Visual Acuity/ph [Physiology]

Improvement of Subjective Symptoms and Eye Complications When Changing From 2-Week Frequent Replacement to Daily Disposable Contact Lenses in a Subscriber Membership System. - Ichijima, Hideji; Karino, Seiko; Sakata, Hiroyuki; Cavanagh, H Dwight (Eye & contact lens, 2016)
PURPOSE: Subjective symptoms and other eye complications were assessed and retrospectively compared in patients belonging to a proprietary membership system who switched from 2-week frequent replacement (2WFR) wear to daily disposable (DD) lens use., METHODS: Questionnaire responses were completed by all patients for a 5-year interval between October 2008 and September 2013 from 83 wearers in three Japanese clinics (59 female and 24 male; average age: 33.4+/-10.9 years). Complications were recorded for each patient at times of reexamination., RESULTS: Over the 5-year observation period, the 83 patients wore lenses for more than 26 months. The average duration of use of 2WFR lenses was 14.5+/-2.7 days/lens (n=83) and subsequently 1.03+/-0.12 days/lens (n=83) for DD lenses. Compliance with the duration of use was consistently good as monitored by requests for lens resupply in both wearing modalities. The subjective complaint of dryness tended to consistently show improvement by the change to DD wear: 18.1% vs. 30.1% (P=0.10, Fisher exact test). Among eye complications noted in each group, the occurrence of superficial punctate keratitis (SPK) was significantly decreased in DD wear: 9.6% vs. 26.5% (P=0.008, Fisher exact test). The main reasons given by patients for changing to DD wear were (1) "DD lens wear was more hygienic" (78.6%) and (2) "DD lens use is more convenient for travel/business trips" (64.3%). Comments after the switch in wear were (1) "easy and convenient" (95.7%) and (2) "I don't have to worry about expiration dates" on solutions (57.1%). Overall, 95.7% of wearers making the change answered as "satisfied" and "mostly satisfied.", CONCLUSIONS: In the subscription membership program, which provided free lens replacement and/or reexamination, individual compliance with duration of wear in 2WFR wear cycles was good; however, these patients switching to DD wear tended to have improvement in their subjective complaints of dryness and objectively demonstrated a significant reduction of SPK at follow-up examinations.
Keywords: Adolescent; Adult; Contact Lenses, Extended-Wear/sd [Supply & Distribution]; *Contact Lenses, Extended-Wear; Contact Lenses, Hydrophilic/sd [Supply & Distribution]; *Contact Lenses, Hydrophilic; *Disposable Equipment; Eye Diseases/et [Etiology]; Eye Diseases/pp [Physiopathology]; *Eye Diseases/th [Therapy]; Female; Humans; Male; Middle Aged; Patient Compliance/sn [Statistics & Numerical Data]; Prescriptions; Retrospective Studies; Surveys and Questionnaires; Time Factors; *Vision, Ocular/ph [Physiology]; Visual Acuity/ph [Physiology]

Characterization of Glaucoma Medication Adherence in Kaiser Permanente Southern California. - Jones, Jason P; Fong, Donald S; Fang, Ervin N; Mesirov, Claire A; Patel, Vaishali (Journal of glaucoma, 2016)
PURPOSE: To describe adherence to glaucoma medications., PATIENTS AND METHODS: Medication adherence was investigated using the computerized records of Kaiser Permanente Southern California, a group model health maintenance organization that provides care to 3.4 million residents of Southern California. Eligible glaucoma patients were diagnosed between 2005 and 2009 and had medical and prescription drug coverage between 2005 and 2009. Utilization and adherence parameters were calculated for each of the 5 years from the incident date., RESULTS: A total of 17,943 newly diagnosed glaucoma patients were identified between the years 2005 and 2009. Of patients diagnosed with glaucoma in 2005, 71% were continuously eligible for 5 years. Medication adherence was calculated using a medication possession ratio. Adherence was bimodal and not normal in distribution. Overall, the mean age of the entire group was 66 years, with 56% being 65 years of age or older. The high adherence group tended to be older, more likely to be female, and more likely to be white. The low adherent group (younger) tended to have more and worse diabetes, renal disease, myocardial infarction, and stroke., CONCLUSIONS: The shape of the adherence distribution appears bimodal, so analysis based on parametric measures may not be appropriate. Investigations of adherence should probably be performed separately for the low, mid, and high groups.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; California; Female; *Glaucoma/dt [Drug Therapy]; Health Maintenance Organizations/sn [Statistics & Numerical Data]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged

Feasibility, Patient Acceptability, and Preliminary Efficacy of a Culturally Informed, Health Promotion Program to Improve Glaucoma Medication Adherence Among African Americans: "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL). - Dreer, Laura E; Owsley, Cynthia; Campbell, Lisa; Gao, Liyan; Wood, Andy; Girkin, Christopher A (Current eye research, 2016)
PURPOSE/AIMS: To examine the feasibility, patient acceptability, and preliminary effectiveness of a culturally informed, health promotion program designed to improve glaucoma medication adherence among African American's (AA's) with glaucoma., MATERIALS/METHODS: A sample of 11 AA glaucoma patients (mean age 61 years; 73% women and 27% men) completed a culturally informed and individually tailored, health promotion program developed for AAs titled, "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL)©. The aim of the brief 4-week program is to enhance glaucoma medication adherence through a combination of education, motivational interviewing (MI), and problem-solving training (PST). Feasibility was assessed on the basis of patient satisfaction with the program, number of sessions completed, and length of sessions. Preliminary efficacy was evaluated using a pre-post design to determine whether the program improved objective glaucoma medication adherence via an electronic Travalert dosing aid as well as satisfaction with aspects of glaucoma treatment, health beliefs about medications, glaucoma symptoms, emotional well-being, and intraocular pressure., RESULTS: Overall patient satisfaction and acceptability was high for the program, interactions with the health educator, program materials, and the length of sessions. Feasibility was also supported given the need for the program, success in recruitment/retention, and ease of implementing the program with AA glaucoma patients in clinic and/or over the telephone. In terms of preliminary efficacy, patients showed significant pre-post improvements in objective medication adherence rates by 15% (p = 0.03), self-efficacy for glaucoma management (p = 0.02), ease of use in administering eye drops (p = 0.03), glaucoma treatment satisfaction (p = 0.05), beliefs about the necessity of taking glaucoma medications (p = 0.05), and functional visual ocular symptoms (p = 0.03)., CONCLUSIONS: (GOAL)© holds great promise toward improving glaucoma medication adherence and beliefs among AA's with glaucoma.
Keywords: *African Americans; *Antihypertensive Agents/ad [Administration & Dosage]; Feasibility Studies; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; Health Knowledge, Attitudes, Practice; *Health Promotion/mt [Methods]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Patient Satisfaction; Surveys and Questionnaires; Treatment Outcome

Microcystic Macular Changes in Primary Open-angle Glaucoma. - Wen, Joanne C; Freedman, Sharon F; El-Dairi, Mays A; Asrani, Sanjay (Journal of glaucoma, 2016)
PURPOSE: To describe microcystic macular changes in patients with moderate to advanced primary open-angle glaucoma., PATIENTS AND METHODS: Eleven eyes of 6 unrelated patients were retrospectively identified based on a disproportionately preserved macular thickness on optical coherence tomography (OCT) despite severe peripapillary retinal nerve fiber layer thinning. Patient demographic, history, and examination findings were reviewed., RESULTS: All identified patients were African American, relatively young (mean age, 43.8 y) and 5 of the 6 patients were males. Examination of individual macular OCT sections through areas of disproportionately preserved macular thickness invariably demonstrated numerous small cystic cavities within the inner nuclear layer. These microcystic changes were seen in areas of the macula that corresponded with areas of glaucoma-related ganglion cell loss, therefore mimicking the normal appearance of retinal thickness in the macular region. No other retinal pathologies were identified on the macular OCT to account for these changes., CONCLUSIONS: This study describes microcystic macular changes in mostly young, African American males with moderate to advanced primary open-angle glaucoma. Vitreous adherence to the internal limiting membrane preventing retinal collapse is a proposed mechanism. The disproportionately preserved macular volume may confound the diagnosis of glaucoma in these patients.
Keywords: Adult; African Americans/eh [Ethnology]; Cysts/di [Diagnosis]; *Cysts/et [Etiology]; Cysts/rh [Rehabilitation]; Female; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/di [Diagnosis]; Humans; Intraocular Pressure; Macula Lutea/pa [Pathology]; Male; Middle Aged; *Nerve Fibers/pa [Pathology]; Retinal Diseases/di [Diagnosis]; Retinal Diseases/eh [Ethnology]; *Retinal Diseases/et [Etiology]; *Retinal Ganglion Cells/pa [Pathology]; Retrospective Studies; Tomography, Optical Coherence/mt [Methods]

Rho Kinase Inhibitors and Novel Ocular Drug Delivery Systems- A Revolutionary Step Towards the Treatment of Glaucoma. - Abbhi, Vasudha; Piplani, Poonam (Current drug delivery, 2016)
BACKGROUND: Glaucoma is an ocular disorder characterized by optic nerve damage which ultimately causes a progressive and an irreversible loss of vision, often characterized by an elevated intraocular pressure. Lowering the intraocular pressure (IOP) is the mainstay for glaucoma treatment but the neuroprotective agents would represent a promising class as the next-generation therapy., EVIDENCE SYNTHESIS: Protein kinases are involved considerably in signal transduction pathways confirmed by various mechanisms giving the evidence of Rho-kinase to be a versatile therapeutic target. Rho associated protein kinases also known as ROCK are serine/threonine kinases, belonging to the Ras superfamily of GTPases. The activation of Rho Kinase results in various actin-myosin arbitrated processes where contraction of actomyosin in the resident trabecular meshwork (TM) cells and extracellular matrix is responsible for the outflow of aqueous humour. Another major drawback of the currently available antiglaucoma drugs is their topical use which poses a problem for patient compliance. The patient intolerability and adherence to the existing therapy therefore call for newer drug delivery systems that would increase the clinical efficacy of the drugs., CONCLUSION: The neuroprotective agents are not considered suitable to be administered through the traditional topical or oral route. This complementary drug therapy requires a delivery system that could release the drug to the optic nerve in a sustained manner and also increase patient compliance and tolerability. This review summarizes the use of ROCK inhibitors that could prevent the damage to the optic nerve along with the reduction in IOP and novel drug delivery systems to increase the efficacy of the drugs.
Keywords: Administration, Ophthalmic; *Drug Delivery Systems; Drugs, Investigational/ad [Administration & Dosage]; *Glaucoma/dt [Drug Therapy]; Humans; *Protein Kinase Inhibitors/ad [Administration & Dosage]; *rho-Associated Kinases/ai [Antagonists & Inhibitors]

CHALLENGES IN THE MANAGEMENT OF GLAUCOMA IN A DEVELOPING COUNTRY; A QUALITATIVE STUDY OF PROVIDERS' PERSPECTIVES. - Adekoya, B J; Adepoju, F G; Moshood, K F; Balarabe, A H (Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 2015)
BACKGROUND: Glaucoma management is challenging to patients as well as to the eye care providers. The study is aimed at describing the challenges faced by providers using qualitative methods., METHODS: In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative methods. This was done using semi-structured, open ended questions to explore the providers' perspective on glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients, and recommendations for improving glaucoma services. The discussions were recorded with the aid of a micro-cassette recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes were identified. Quotes that reflect the themes and sub-themes were then identified in the data., RESULTS: In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority were of the opinion that glaucoma is a significant burden constituting about 35% of outpatient visits. Identified patient related challenges include; late presentation, lack of glaucoma awareness, delay in referral from optometrists, and poor compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and counterfeiting of drugs were the major challenges related to medical treatment. Majority of the participants agreed that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced the patients will be compliant. Some respondents considered the current number of glaucoma surgeries as adequate, while some think otherwise. Reasons put forward for reluctance to offer glaucoma surgery include; late presentation, lack of patient satisfaction, complications of surgery, and negative publicity., CONCLUSION: Even though the challenges in the management of glaucoma in developing countries are many, they are not insurmountable. There is need for concerted and integrated efforts involving all cadres of eye care practitioners, patients, institutions and governments to address this important eye disease. Improved awareness, provision of adequate equipment, availability and affordability of medications, need for training and retraining of eye care providers are all important measures that can lead to better management of the glaucoma patient.
Keywords: Adult; *Attitude of Health Personnel; Developing Countries; Disease Management; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; *Health Personnel/sn [Statistics & Numerical Data]; *Health Services Needs and Demand/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; Nigeria; Ophthalmology/st [Standards]; Patient Satisfaction; Qualitative Research; Referral and Consultation/sn [Statistics & Numerical Data]

A cloud-based system for automatic glaucoma screening. - Fengshou Yin; Damon Wing Kee Wong; Ying Quan; Ai Ping Yow; Ngan Meng Tan; Gopalakrishnan, Kavitha; Beng Hai Lee; Yanwu Xu; Zhuo Zhang; Jun Cheng; Jiang Liu (Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference, 2015)
In recent years, there has been increasing interest in the use of automatic computer-based systems for the detection of eye diseases including glaucoma. However, these systems are usually standalone software with basic functions only, limiting their usage in a large scale. In this paper, we introduce an online cloud-based system for automatic glaucoma screening through the use of medical image-based pattern classification technologies. It is designed in a hybrid cloud pattern to offer both accessibility and enhanced security. Raw data including patient's medical condition and fundus image, and resultant medical reports are collected and distributed through the public cloud tier. In the private cloud tier, automatic analysis and assessment of colour retinal fundus images are performed. The ubiquitous anywhere access nature of the system through the cloud platform facilitates a more efficient and cost-effective means of glaucoma screening, allowing the disease to be detected earlier and enabling early intervention for more efficient intervention and disease management.
Keywords: Algorithms; Diagnostic Techniques, Ophthalmological; Fundus Oculi; *Glaucoma; Humans; Software

Epidemiology and etiological diagnosis of infective keratitis in eastern region of Nepal. - Sitoula, R P; Singh, S K; Mahaseth, V; Sharma, A; Labh, R K (Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH, 2015)
OBJECTIVE: This study aimed to determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in patients presenting to Biratnagar Eye Hospital (Nepal)., METHODS: All patients presenting to Biratnagar Eye Hospital between January 1 and December 31, 2011 with corneal ulceration were retrospectively reviewed. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined and corneal scrapping and cultures were carried out., RESULTS: Over one year period 1644 patients with corneal ulcer were evaluated, out of which 76.6% of patients were in the age range of 30 to 69 years and 65% of patients had presenting visual acuity less than 3/60. Ocular trauma was the most common cause of keratitis accounting for 60.3% of corneal ulcer and majority of the patients (40%) presented after 2 weeks of symptoms. Among corneal scraping positive cases 1150 (70%) showed fungus, 73 (4.4%) showed bacteria and 20 (1.2%) showed both bacterial and fungus., CONCLUSION: Corneal ulcer continues to be one of the leading causes of preventable blindness in this region. Lack of awareness about gravity of this disease, financial constraints and geographic barriers remain the major reasons for delay in seeking proper medical help. Copyright © NEPjOPH.
Keywords: Adult; Aged; Bacteria/ip [Isolation & Purification]; Cornea/mi [Microbiology]; *Corneal Ulcer/ep [Epidemiology]; Corneal Ulcer/mi [Microbiology]; *Eye Infections, Bacterial/ep [Epidemiology]; Eye Infections, Bacterial/mi [Microbiology]; Female; Fungi/ip [Isolation & Purification]; Hospitals, Special; Humans; Male; Middle Aged; Nepal/ep [Epidemiology]; Ophthalmology; Retrospective Studies; Risk Factors

Qualitative investigation of patients' experience of a glaucoma virtual clinic in a specialist ophthalmic hospital in London, UK. - Kotecha, Aachal; Bonstein, Karen; Cable, Richard; Cammack, Jocelyn; Clipston, Jane; Foster, Paul (BMJ open, 2015)
OBJECTIVES: To explore how patients felt about delivery of care in a novel technician-delivered virtual clinic compared with delivery of care in a doctor-delivered model., DESIGN: A qualitative investigation using one-to-one interviews before and after patients' appointments at either the standard outpatient glaucoma clinic or the new technician-delivered virtual glaucoma clinic (Glaucoma Screening and Stable Monitoring Service, GSMS)., SETTING: A glaucoma clinic based in a tertiary ophthalmic specialist hospital in London., PARTICIPANTS: 43 patients (38 Caucasian, 5 African/Afro-Caribbean) were interviewed prior to their glaucoma appointment; 38 patients were interviewed between 4 and 6 weeks after their appointment. Consecutive patients were identified from patient reception lists and telephoned prior to their appointment inviting them to participate., RESULTS: Trust in the patient-provider relationship emerged as a key theme in patients' acceptance of not being seen in a traditional doctor-delivered service. Patients who were well informed regarding their glaucoma status and low risk of progression to sight loss were more accepting of the GSMS. Patients valued the reassurance received through effective communication with their healthcare practitioner at the time of their appointment., CONCLUSIONS: This study suggests that patients are accepting of moving to a model of service delivery whereby the doctor is removed from the consultation as long as they are informed about the status of their condition and reassured by the interaction with staff they meet. This study highlights the importance of patient engagement when introducing new models of service delivery. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Keywords: Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities; Appointments and Schedules; Communication; Counseling; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/px [Psychology]; Humans; Interviews as Topic; London; Male; Middle Aged; *Patient Participation; Patient Satisfaction; *Physician-Patient Relations; Qualitative Research; Specialization; Tertiary Care Centers; *Trust/px [Psychology]

Primary care physicians' role perception and self-reported performance in glaucoma care: a survey study. - Rotshtein, Albina; Karkabi, Khaled; Geyer, Orna; Cohen Castel, Orit (BMC research notes, 2015)
BACKGROUND: Glaucoma is a leading cause of blindness. The participation of primary care physicians (PCPs) in glaucoma care may improve health outcomes for glaucoma patients., OBJECTIVES: To investigate PCPs' attitudes towards their role in glaucoma care, perceived barriers, and self-reported performance in glaucoma management., METHODS: PCPs working in the Haifa and Western Galilee District of Clalit Health Services, Israel's largest Health Maintenance Organization (HMO) were asked to complete a self-administered structured questionnaire. Physicians were asked to rate their agreement with statements describing the PCP's role in glaucoma care, and to state how often they behave accordingly in their practice. In addition, physicians were asked to rate the extent that factors such as time constraints and knowledge gaps impede their performance in glaucoma care., RESULTS: Eighty-two physicians completed the questionnaire. The majority thought that PCPs have a major role in early detection of glaucoma (99 %), discussing the importance of adherence to treatment (93 %), and encouraging patients to make regular visits to their ophthalmologist (99 %). However, only 30 % reported asking patients about family history of glaucoma, 64 % reported discussing adherence to treatment, and only 35 % stated that they explain how to use eye drops, while most of respondents (87 %) regularly provide refill prescriptions for glaucoma medications. Sixty percent claimed that during their residency they had not acquired adequate knowledge and competence to allow them to take proper care of glaucoma patients. The main barriers reported were lack of time (43 %), lack of knowledge regarding treatment options and recommended follow-up (46 %), and not being familiar with glaucoma medications' side effects (54 %)., CONCLUSIONS: There is a gap between PCPs' perceptions of their role in glaucoma care and their report on actual performance in early detection and management of glaucoma. Further research is needed to develop and assess interventions that aim at closing this gap.
Keywords: Adult; Clinical Competence; Female; *Glaucoma/th [Therapy]; Health Knowledge, Attitudes, Practice; Humans; Israel; Male; Middle Aged; *Physician's Role; *Physicians, Primary Care/sn [Statistics & Numerical Data]; Practice Patterns, Physicians'; *Surveys and Questionnaires

Impact of a Brief Educational Intervention on Glaucoma Persistence: A Randomized Controlled Clinical Trial. - Djafari, Fawzia; Lesk, Mark R; Giguere, Charles-Edouard; Siam, Ghada; Freeman, Ellen E (Ophthalmic epidemiology, 2015)
PURPOSE: To determine whether two sessions of a glaucoma educational intervention resulted in better persistence to glaucoma eye drop therapy compared to normal care., METHODS: A total of 165 patients newly diagnosed with glaucoma who required eye drop therapy were recruited into a randomized clinical trial from the glaucoma clinic at Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients were randomized to either an immediate intervention or normal care. The intervention consisted of two 60-90 minute sessions of education on glaucoma and its management, given in a small group format by a non-practicing ophthalmologist. Persistence to glaucoma medication was examined for 1 year by the use of Hospital medical records and by pharmacy claims records from the Regie de l'assurance maladie du Quebec (Quebec Health Insurance Program). A questionnaire was administered, and medication possession ratio calculated. The primary outcome was persistence, defined as having medication available at least 75% of the time. Secondary outcomes included eye drop instillation technique and perception of the importance of eye drop therapy., RESULTS: The intervention group achieved better persistence to eye drop therapy, as 77% of controls and 89% of people receiving the intervention were persistent (p = 0.049). The intervention also resulted in better eye drop instillation technique (p < 0.001) and greater perception of the importance of eye drop therapy (p < 0.001)., CONCLUSIONS: Brief instructional sessions offered to newly diagnosed glaucoma patients can result in better persistence rates over 1-year follow-up. Strategies to permanently offer these types of initiatives should be considered.
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Promotion; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; *Patient Education as Topic; Surveys and Questionnaires

A comparative study of glaucoma referrals in Southeast Scotland: effect of the new general ophthalmic service contract, Eyecare integration pilot programme and NICE guidelines. - El-Assal, Karim; Foulds, Jonathan; Dobson, Stuart; Sanders, Roshini (BMC ophthalmology, 2015)
BACKGROUND: Glaucoma is a progressive disease responsible for the second commonest cause of blindness in the UK. Identifying appropriate patients for hospital care remains an ongoing challenge for all UK hospital glaucoma services. The purpose of our study is to evaluate accuracy and outcome of community optometry referrals before and after implementation of the new general ophthalmic service contract in 2006, the Eyecare Integration Programme pilot in 2008 and the effect of NICE guidelines in glaucoma in 2009, over a 12-year period, METHODS: A retrospective case analysis using a glaucoma electronic patient record was performed encompassing two six-year periods, 2000-2006 (Group A), and 2007-2012 (Group B)., RESULTS: One thousand six hundred twenty-two new patients' records were analysed. Waiting times reduced from 12.3 to 9.4 weeks. Significantly more patients kept first appointment (p = 0.0002) in group B. Glaucoma symptoms were significantly more in group A (p <0.0001) and only three patients lost Snellen' visual acuity before appointment in group B compared to 12 in group A. Documentation of intraocular pressure was made in 74.1% of Group A and 75.9% of Group B, optic disc appearance in 85.4% of Group A, and 93% of Group B and visual fields in 84.4% of Group A and 81.3% of Group B. Significantly less normal (p < 0,0001), more glaucoma suspects (p < 0.0001), more open angle glaucoma (p = 0.0006) and fewer other conditions (p = 0.0024) were present in group B, compared to group A., CONCLUSION: Patients were referred earlier with shorter waiting times for hospital appointments with the new Scottish general ophthalmic service and Eyecare Integration Programme. Additionally there were fewer false positive referrals with more diagnosis of glaucomatous disease. We discuss the benefits of these national screening and referral pathways together with their limitations and further refinements.
Keywords: Adult; Aged; Aged, 80 and over; Contracts; *Delivery of Health Care, Integrated/og [Organization & Administration]; Documentation/sn [Statistics & Numerical Data]; Female; *Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Guideline Adherence; *Hospital Departments/st [Standards]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; National Health Programs/og [Organization & Administration]; *National Health Programs/st [Standards]; Ophthalmology/st [Standards]; Ophthalmoscopy; *Optometry/st [Standards]; Pilot Projects; *Practice Guidelines as Topic/st [Standards]; Referral and Consultation/og [Organization & Administration]; *Referral and Consultation/st [Standards]; Retrospective Studies; Scotland/ep [Epidemiology]; Tonometry, Ocular; Visual Field Tests; Visual Fields; Waiting Lists

[A review of safety and efficacy of levofloxacin 0.5% ophthalmic solution in the treatment of external ocular infections and in prophylaxis of postoperative endophthalmitis]. - Lazicka-Galecka, Monika; Galecki, Tomasz; Szaflik, Jacek P (Klinika oczna, 2015)
Levofloxacin 0.5% ophthalmic solution is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram positive and negative bacteria. For those reasons it is highly effective in treating common external infections of the eye including blepharitis, conjunctivitis, keratitis. In terms of microbial eradication and clinical cure rate it is significantly more effective than ofloxacin 0.3% ophthalmic solution, and non inferior to moxifloxacin ophthalmic solution. After topical administration of levofloxacin 0.5% ophthalmic solution it achieves concentration exceeding MIC90 for most clinically relevant pathogenes in tears, conjunctiva, cornea as well as anterior chamber. Thus it can be used in prophylaxis in patients undergoing ocular surgery. Because of its postantibiotic effect and high concentration in tears three times daily regimen is as effective as most frequent administration in patients with conjunctivitis, which leads to better compliance. Despite the wide use of topical and systemic levofloxacin, most common ocular pathogens remain clinically susceptible. Topical levofloxacin is well tolerated, it rarely causes systemic or ocular adverse events with the majority of treatment-related adverse effects being of mild to moderate severity. It also does not effect the wound healing.
Keywords: *Anti-Bacterial Agents/ad [Administration & Dosage]; *Endophthalmitis/dt [Drug Therapy]; Endophthalmitis/pc [Prevention & Control]; *Eye Infections, Bacterial/dt [Drug Therapy]; Humans; *Levofloxacin/ad [Administration & Dosage]; Postoperative Complications/pc [Prevention & Control]; *Surgical Wound Infection/dt [Drug Therapy]; Surgical Wound Infection/pc [Prevention & Control]

[Complications of corneal lamellar refractive surgery]. - Kohnen, T; Remy, M (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2015)
Techniques available for corneal lamellar refractive surgery are laser-assisted in situ keratomileusis (LASIK) using a microkeratome or femtosecond laser incision followed by excimer laser corneal ablation, and femtosecond laser-assisted refractive lenticule extraction (ReLEx). These treatments are nowadays considered to be safe and effective standard procedures for surgical correction of mild to moderate ametropia. Possible complications include too small or decentered optical zones, intraoperative flap cutting errors and postoperative inflammation (e.g. diffuse lamellar keratitis, DLK), epithelial or flap folds, epithelial ingrowths or iatrogenic ectasia. The occurrence of complications may be significantly reduced by compliance to corresponding standards of indication and treatment that are based on current scientific knowledge.
Keywords: Corneal Diseases/di [Diagnosis]; *Corneal Diseases/et [Etiology]; *Corneal Diseases/th [Therapy]; Evidence-Based Medicine; Eye Injuries/di [Diagnosis]; Eye Injuries/et [Etiology]; *Eye Injuries/th [Therapy]; Humans; *Keratomileusis, Laser In Situ/ae [Adverse Effects]; Treatment Outcome; Vision Disorders/di [Diagnosis]; Vision Disorders/et [Etiology]; Vision Disorders/pc [Prevention & Control]

Human Factors and Ophthalmic Drug Packaging: Time for a Global Standard. - Brandt, James D (Ophthalmology, 2015)
Comment on (CON), Comment on (CON), Comment in (CIN)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Communication; *Drug Packaging/st [Standards]; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence; *Physician-Patient Relations

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design. - Owsley, Cynthia; Rhodes, Lindsay A; McGwin, Gerald Jr; Mennemeyer, Stephen T; Bregantini, Mary; Patel, Nita; Wiley, Demond M; LaRussa, Frank; Box, Dan; Saaddine, Jinan; Crews, John E; Girkin, Christopher A (International journal for equity in health, 2015)
BACKGROUND: Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans., METHODS/DESIGN: We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist's diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients' knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY's impact on Walmart pharmacy prescription rates., DISCUSSION: As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.
Keywords: Adult; *African Americans; Aged; Alabama; Female; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Hypertension/co [Complications]; Male; Middle Aged; Primary Health Care/mt [Methods]; *Primary Health Care/st [Standards]; Prospective Studies; Surveys and Questionnaires; *Telemedicine/mt [Methods]

Differentiation of human ESCs to retinal ganglion cells using a CRISPR engineered reporter cell line. - Sluch, Valentin M; Davis, Chung-ha O; Ranganathan, Vinod; Kerr, Justin M; Krick, Kellin; Martin, Russ; Berlinicke, Cynthia A; Marsh-Armstrong, Nicholas; Diamond, Jeffrey S; Mao, Hai-Quan; Zack, Donald J (Scientific reports, 2015)
Retinal ganglion cell (RGC) injury and cell death from glaucoma and other forms of optic nerve disease is a major cause of irreversible vision loss and blindness. Human pluripotent stem cell (hPSC)-derived RGCs could provide a source of cells for the development of novel therapeutic molecules as well as for potential cell-based therapies. In addition, such cells could provide insights into human RGC development, gene regulation, and neuronal biology. Here, we report a simple, adherent cell culture protocol for differentiation of hPSCs to RGCs using a CRISPR-engineered RGC fluorescent reporter stem cell line. Fluorescence-activated cell sorting of the differentiated cultures yields a highly purified population of cells that express a range of RGC-enriched markers and exhibit morphological and physiological properties typical of RGCs. Additionally, we demonstrate that aligned nanofiber matrices can be used to guide the axonal outgrowth of hPSC-derived RGCs for in vitro optic nerve-like modeling. Lastly, using this protocol we identified forskolin as a potent promoter of RGC differentiation.
Keywords: Animals; *CRISPR-Cas Systems/ge [Genetics]; *Cell Differentiation/ge [Genetics]; Cell Line; Cells, Cultured; Embryonic Stem Cells/cy [Cytology]; *Embryonic Stem Cells/me [Metabolism]; Gene Expression; *Genetic Engineering/mt [Methods]; Humans; Immunohistochemistry; Membrane Potentials/ge [Genetics]; Mice; Microscopy, Fluorescence; Retinal Ganglion Cells/cy [Cytology]; *Retinal Ganglion Cells/me [Metabolism]; Retinal Ganglion Cells/ph [Physiology]; Reverse Transcriptase Polymerase Chain Reaction; Thy-1 Antigens/me [Metabolism]; Time Factors; Transcription Factor Brn-3B/ge [Genetics]; Transcription Factor Brn-3B/me [Metabolism]

Effect of benzalkonium chloride-free travoprost on intraocular pressure and ocular surface symptoms in patients with glaucoma previously on latanoprost: an open-label study. - Lopes, Joao F; Hubatsch, Douglas A; Amaris, Patricia (BMC ophthalmology, 2015)
BACKGROUND: Prostaglandin analogs reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension; however, these medications may affect the ocular surface and elicit ocular discomfort when preserved with benzalkonium chloride (BAK)., METHODS: This was an open-label, single-arm study conducted in Latin America from February 2012 to May 2013. Patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost 0.005 % were transitioned to receive once-daily BAK-free travoprost 0.004 % containing polyquaternium-1 (Travatan R preserved with POLYQUAD R [PQ], Alcon Laboratories, Inc; Fort Worth, TX) for 12 weeks. Mean change in IOP from baseline (primary efficacy endpoint) and the percentage of patients who achieved a target IOP of <=18 mmHg were evaluated at all on-therapy visits. Ocular hyperemia, patient preference, and self-projected adherence were assessed at week 12. Adverse events (AEs) were monitored throughout the study., RESULTS: All enrolled patients were included in the analysis (n = 191); the majority of patients (90.6 %, n = 173/191) completed the study. Mean (SD) patient age was 67.5 (11.3) years, and mean baseline IOP was 14.8 mmHg. Mean IOP was reduced by 0.94 mmHg at week 6 and by 1.09 mmHg at week 12 (P < 0.001 for both). A greater percentage of patients achieved a target IOP of <=18 mmHg at week 6 (93.1 %; n = 163/175) and week 12 (93.3 %; n = 166/178) compared with baseline (89.5 %; n = 171/191). There was a 10.5 % increase in the percentage of patients with "none/trace" amounts of hyperemia. Most patients preferred the study medication (81.5 %; n = 141/173) and were confident that they would adhere to their preferred medication (90.8 %; n = 157/173). No serious AEs were reported, and eye irritation (3.7 %; n = 7/191) was the most common treatment-related AE., CONCLUSIONS: Transitioning from BAK-containing latanoprost 0.005 % to BAK-free travoprost 0.004 % preserved with PQ reduced IOP in patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost. BAK-free travoprost 0.004 % is a viable alternative for patients who require switching their IOP-lowering medications because of tolerability issues., TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01510145.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; *Benzalkonium Compounds; Conjunctival Diseases/ci [Chemically Induced]; Corneal Diseases/ci [Chemically Induced]; Drug Substitution; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Preservatives, Pharmaceutical; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Tonometry, Ocular; Travoprost/ae [Adverse Effects]; *Travoprost/tu [Therapeutic Use]; Young Adult

Outcome Preferences in Patients With Noninfectious Uveitis: Results of a Best-Worst Scaling Study. - Yu, Tsung; Holbrook, Janet T; Thorne, Jennifer E; Flynn, Terry N; Van Natta, Mark L; Puhan, Milo A (Investigative ophthalmology & visual science, 2015)
PURPOSE: To estimate patient preferences regarding potential adverse outcomes of local versus systemic corticosteroid therapies for noninfectious uveitis by using a best-worst scaling (BWS) approach., METHODS: Local and systemic therapies are alternatives for noninfectious uveitis that have different potential adverse outcomes. Patients participating in the Multicenter Uveitis Steroid Treatment Trial Follow-up Study (MUST FS) and additional patients with a history of noninfectious uveitis treated at two academic medical centers (Johns Hopkins University and University of Pennsylvania) were surveyed about their preferences regarding six adverse outcomes deemed important to patients. Using "case 1" BWS, patients were asked to repeatedly select the most and least worrying from a list of outcomes (in the survey three outcomes per task)., RESULTS: Eighty-two patients in the MUST FS and 100 patients treated at the academic medical centers completed the survey. According to BWS, patients were more likely to select vision not meeting the requirement for driving (individual BWS score: median = 3, interquartile range, 0-5), development of glaucoma (2, 1-4), and needing eye surgery (1, 0-3) as the most worrying outcomes as compared to needing medicine for high blood pressure/cholesterol (-2, -4 to 0), development of cataracts (-2, -3 to -1), or infection (sinusitis) (-3, -5 to 0). Larger BWS scores indicated the outcomes were more worrying to patients., CONCLUSIONS: Patients with noninfectious uveitis considered impaired vision, development of glaucoma, and need for eye surgery worrying adverse outcomes, which suggests that it is especially desirable to avoid these outcomes if possible. (ClinicalTrials.gov number, NCT00132691.)
Keywords: Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Preference/px [Psychology]; Patient Preference/sn [Statistics & Numerical Data]; *Patient Preference; Surveys and Questionnaires; Treatment Outcome; Uveitis/co [Complications]; Uveitis/dt [Drug Therapy]; *Uveitis/px [Psychology]

A survey for the need of translational aids among Canadian ophthalmologists. - Mednick, Zale D; Cao, Kathy; Braga-Mele, Rosa (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2015)
OBJECTIVE: To conduct a needs assessment survey of Canadian ophthalmologists to determine whether there is a requirement for translational aids in ophthalmology, and if so, the content, format, and languages to include., DESIGN: Anonymous voluntary online needs assessment questionnaire., PARTICIPANTS: A total of 139 ophthalmologists completed the online needs assessment questionnaire., METHODS: An anonymous voluntary online survey in English and French was distributed to 700 active members (practicing Canadian ophthalmologists) of the Canadian Ophthalmological Society. Data were collected regarding the potential utility of translational aids, as well as the contents and languages that should be included if such aids were to be created. Level of support for translational aids, as well as the contents and languages of potential translational aids, was assessed., RESULTS: The survey response rate was 19.9% (139/700). The majority of the respondents (130/139, 93.5%) have encountered difficulty in communicating with patients because of language barrier, and 88.5% (123/139) would benefit from having a list of ophthalmologic terms translated into several of Canada's most popular languages. The top 10 languages that the respondents indicated would be most beneficial are (in descending order): Chinese, Hindi, Spanish, Punjabi, Italian, Portuguese, Arabic, Greek, Cree, and Vietnamese. The survey responses provided a comprehensive list of the most useful ophthalmologic symptoms, instructions to patients, and diagnoses to be translated. Most respondents (120/139, 86.3%) believed that having basic information pamphlets on specific ocular conditions translated into several languages would benefit their practice; the top 3 conditions were cataract, glaucoma, and age-related macular degeneration. Producing the translational aids in both paper and electronic format was found to be the most favoured (89/139, 64.0%)., CONCLUSIONS: Canadian ophthalmologists believe they would benefit from translational aids. The results of this survey provide a framework for the creation of such aids. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Canada/ep [Epidemiology]; *Communication Barriers; Culture; Health Surveys; Healthcare Disparities; Humans; *Language; *Needs Assessment/sn [Statistics & Numerical Data]; *Ophthalmology/sn [Statistics & Numerical Data]; Patient Acceptance of Health Care; Physician-Patient Relations; Societies, Medical/sn [Statistics & Numerical Data]; Surveys and Questionnaires; *Translating

Living with glaucoma: a qualitative study of functional implications and patients' coping behaviours. - Glen, Fiona C; Crabb, David P (BMC ophthalmology, 2015)
BACKGROUND: Sight loss from glaucoma can have a significant impact on functioning and performing everyday activities, but this varies between patients. The purpose of this study was to explore whether patients with glaucoma use different coping strategies in response to their vision loss., METHODS: Audio-recorded semi-structured interviews were conducted with 16 patients (median age: 71 [interquartile range [IQR]: 68 to 77 years]; 50 % female) about their experiences of living with glaucoma. Patients had their glaucoma diagnosis for at least 5 years (range: 6 to 29 years) and had a range of disease severities (median best eye Mean Deviation was -9.1 dB [IQR: -12.9 to -4.1 dB]). A framework approach to analysis was taken whereby data was indexed using manual and computer-assisted methods, with codes applied to depict areas of functioning perceived to be impacted by glaucoma and coping behaviours used in response to these difficulties., RESULTS: In order to maintain independence, some patients increased confidence by making practical changes such as adjusting lighting, using handrails and magnifying glasses, or actively changed aspects of their behaviour such as moving their head and eyes towards known areas of vision loss. Support from friends and family was often used, although some people worried about becoming a burden. Others imposed self-restrictions or gave up activities, thus compromising well-being and independence. Certain coping strategies were linked to time since diagnosis and location of vision loss. The type and quality of information received during clinical appointments, and the potential benefits of communication with other patients, emerged as other important themes., CONCLUSIONS: Results from this qualitative study suggest that the adoption of certain coping behaviours and techniques may help some glaucomatous patients to adapt to their condition. An awareness of coping and adaptive strategies, in addition to the usual clinical tests, may provide a better insight into the impact of disease and help inform future educational and management strategies for glaucoma.
Keywords: Activities of Daily Living; *Adaptation, Psychological; Aged; Attitude to Health; Disability Evaluation; Female; *Glaucoma/px [Psychology]; Humans; Intraocular Pressure/ph [Physiology]; Male; *Patient Acceptance of Health Care/px [Psychology]; *Vision, Low/px [Psychology]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

The temperament and character personality profile of the glaucoma patient. - Cakmak, Harun; Altinyazar, Vesile; Yilmaz, Suzan Guven; Omurlu, Imran Kurt; Kocaturk, Tolga; Yazici, Alper; Degirmenci, Cumali; Dundar, Sema Oruc; Ates, Halil (BMC ophthalmology, 2015)
BACKGROUND: To determine the temperament and character profile of glaucoma patients., METHODS: A total of 234 patients (104 with primary open angle glaucoma, and 130 control subjects without any ocular disease) were selected for this prospective, cross-sectional study. All the participants underwent a comprehensive ophthalmological examination, including the best corrected visual acuity, intraocular pressure measurement, gonioscopy, and visual field analysis. All the participants were given the Turkish version of the Temperament and Character Inventory (TCI). The TCI is a self-reported evaluate, with 240 true/false items measuring four domains of temperament; harm avoidance (HA), persistence (PS), novelty seeking (NS), reward dependence (RD), and three domains of character; self-transcendence (ST), cooperativeness (C), self-directedness (SD)., RESULTS: The glaucoma patients achieved the higher scores than the controls for the HA and SD dimensions (p < 0.001 and p = 0.033). The glaucoma patients scored lower than the controls for the NS, P and ST dimensions (p < 0.001, p < 0.001 and p = 0.002). There were no differences in the RD and C scores between the patients and the controls (p = 0.944 and p = 0.343). There was no correlation between the duration of illness and the TCI dimensions. Disease severity was positively associated with HA (r = 0,220, p = 0,025) and the anticipatory worry (r = 0.227, p = 0.021) dimension., CONCLUSIONS: Glaucoma patients had a different personality profile to healthy individuals. This may affect treatment compliance and is also important when coping with maladaptive patient attitudes.
Keywords: Aged; *Character; Cross-Sectional Studies; Female; *Glaucoma, Open-Angle/px [Psychology]; Humans; Intraocular Pressure; Male; Medication Adherence; Middle Aged; *Personality Assessment; Prospective Studies; *Temperament; Visual Acuity

Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment. - Tafida, A; Kyari, F; Abdull, M M; Sivasubramaniam, S; Murthy, G V S; Kana, I; Gilbert, Clare E; Nigeria National Survey of Blindness and Visual Impairment Study Group (Ophthalmic epidemiology, 2015)
PURPOSE: Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria., METHODS: Participants >=40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA <6/12 in either eye. Causes of vision loss were determined using World Health Organization guidelines. Households were categorized into three levels of poverty based on literacy and occupation at household level., RESULTS: A total of 569/13,591 participants were blind (PVA <3/60, better eye; prevalence 4.2%, 95% confidence interval [CI] 3.8-4.6%). Prevalences of blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%)., CONCLUSION: In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.
Keywords: Adult; Age Distribution; *Blindness/ep [Epidemiology]; Cross-Sectional Studies; Eye Diseases/ep [Epidemiology]; Female; Health Services Accessibility; Health Surveys; Humans; Male; Middle Aged; Nigeria/ep [Epidemiology]; Occupations; *Poverty/sn [Statistics & Numerical Data]; Prevalence; Sex Distribution; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Failure of Glaucoma Follow-up Compliance. - Ung, Cindy; Spaeth, George L; Lin, Shan C; Singh, Kuldev (American journal of ophthalmology, 2015)
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Patient Compliance

Comparative Knowledge and Behavior of Contact Lens Care between Medical and Non-Medical Students. - Leeamornsiri, Supinda; Titawattanakul, Yothin (Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015)
OBJECTIVE: To compare knowledge and behavior of contact lens care between medical and non-medical students., MATERIAL AND METHOD: Cross sectional study. Participants consisted of 200 medical students (M) and 200 non-medical students (N) who wore contact lenses within the recent one year. A structured questionnaire was filled in by subjects., RESULTS: Approximately 50% of participants had been contact lens wearers for less than one year The purposes ofwearing lenses included vision correction (73.6%) and cosmetic (26.4%). Non-medical students wore color lenses significantly more than medical students. Non-medical students bought lenses from internet and markets significantly more than medical students did. For the knowledge component, the contact lens-related complications which participants can name were significantly different in both groups including allergic conjunctivitis (M: 73.2%, N: 61.3%), corneal abrasion (M: 58%, N: 36.7%), corneal ulcer (M: 61.6%, N: 45.7%), and corneal neovascularization (M: 29.8%, N: 18%). The behavior that participants had differed significantly in both groups were included rinsing lenses with tap water (M: 19.7%, N: 29.8%), and washing hands before handling lenses (M: 82.7%, N: 71%). The five common improper behaviors of lens care were similar in both groups and included wearing lenses longer than recommended, not changing lens storage solution daily, swimming while wearing lenses, using tap waterfor rising lenses and not washing hands before handling lenses., CONCLUSION: Medical students had better knowledge and behavior of contact lens care than non-medical students. However, both groups ofstudents still lacked adequate knowledge and were non-compliant with contact lens care instruction.
Keywords: Adolescent; Adult; Contact Lens Solutions; *Contact Lenses/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Female; Hand Hygiene/sn [Statistics & Numerical Data]; *Health Behavior; *Health Knowledge, Attitudes, Practice; Humans; Internet; Male; *Students/sn [Statistics & Numerical Data]; Students, Medical/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Young Adult

Therapeutic Effects of Sodium Hyaluronate on Ocular Surface Damage Induced by Benzalkonium Chloride Preserved Anti-glaucoma Medications. - Liu, Xing; Yu, Fen-Fen; Zhong, Yi-Min; Guo, Xin-Xing; Mao, Zhen (Chinese medical journal, 2015)
BACKGROUND: Long-term use of benzalkonium chloride (BAC)-preserved drugs is often associated with ocular surface toxicity. Ocular surface symptoms had a substantial impact on the glaucoma patients' quality of life and compliance. This study aimed to investigate the effects of sodium hyaluronate (SH) on ocular surface toxicity induced by BAC-preserved anti-glaucoma medications treatment., METHODS: Fifty-eight patients (101 eyes), who received topical BAC-preserved anti-glaucoma medications treatment and met the severe dry eye criteria, were included in the analysis. All patients were maintained the original topical anti-glaucoma treatment. In the SH-treated group (56 eyes), unpreserved 0.3% SH eye drops were administered with 3 times daily for 90 days. In the control group (55 eyes), phosphate-buffered saline were administered with 3 times daily for 90 days. Ocular Surface Disease Index (OSDI) questionnaire, break-up time (BUT) test, corneal fluorescein staining, corneal and conjunctival rose Bengal staining, Schirmer test, and conjunctiva impression cytology were performed sequentially on days 0 and 91., RESULTS: Compared with the control group, SH-treated group showed decrease in OSDI scores (Kruskal-Wallis test: H = 38.668, P < 0.001), fluorescein and rose Bengal scores (Wilcoxon signed-ranks test: z = -3.843, P < 0.001, and z = -3.508, P < 0.001, respectively), increase in tear film BUT (t-test: t = -10.994, P < 0.001) and aqueous tear production (t-test: t = -10.328, P < 0.001) on day 91. The goblet cell density was increased (t-test: t = -9.981, P < 0.001), and the morphology of the conjunctival epithelium were also improved after SH treatment., CONCLUSIONS: SH significantly improved both symptoms and signs of ocular surface damage in patients with BAC-preserved anti-glaucoma medications treatment. SH could be proposed as a new attempt to reduce ocular surface toxicity, and alleviate symptoms of ocular surface damage in BAC-preserved anti-glaucoma medications treatment.
Keywords: Adolescent; Adult; Aged; *Benzalkonium Compounds/ae [Adverse Effects]; Dry Eye Syndromes/ci [Chemically Induced]; Dry Eye Syndromes/pc [Prevention & Control]; *Eye/de [Drug Effects]; Eye Injuries/ci [Chemically Induced]; *Eye Injuries/pc [Prevention & Control]; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Hyaluronic Acid/tu [Therapeutic Use]; Male; Middle Aged; Young Adult

Glaucoma Medications Update: How to Improve Compliance and Adherence. - Cakiner-Egilmez, Tulay (Insight (American Society of Ophthalmic Registered Nurses), 2015)
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure; *Medication Adherence; *Patient Compliance

Comparing the effectiveness of selective laser trabeculoplasty with topical medication as initial treatment (the Glaucoma Initial Treatment Study): study protocol for a randomised controlled trial. - Lamoureux, Ecosse L; Mcintosh, Rachel; Constantinou, Marios; Fenwick, Eva K; Xie, Jing; Casson, Robert; Finkelstein, Eric; Goldberg, Ivan; Healey, Paul; Thomas, Ravi; Ang, Ghee Soon; Pesudovs, Konrad; et al. (Trials, 2015)
BACKGROUND: Glaucoma is the leading cause of irreversible blindness in the world. Estimated to affect 60 million people worldwide, this figure is expected to rise to 80 million by 2020. Untreated, glaucoma leads to visual decay and eventually to blindness, and can significantly reduce quality of life. First-line treatment in patients with primary open-angle glaucoma and exfoliative glaucoma is topical medical therapy with ocular hypotensives as eye drops. However, eye drops have several disadvantages including cost, possible local and systemic side effects, and adherence and perseverance issues. Randomised controlled trials have demonstrated that selective laser trabeculoplasty is equally as effective in lowering intraocular pressure as eye drops. However, the impact of these two treatment modalities from the patient and economic perspectives has not been adequately determined. Thus, it remains unclear whether topical medical therapy or selective laser trabeculoplasty should be recommended as first-line treatment for glaucoma., METHODS/DESIGN: This protocol describes an international, multi-centre, randomised controlled trial to determine the optimum first-line therapy for people with primary open-angle glaucoma and exfoliative glaucoma. This study will compare the effect of selective laser trabeculoplasty and topical medication with respect to patients' generic and glaucoma-specific quality of life. The trial will also provide a detailed cost-effectiveness analysis and compare the clinical effectiveness with respect to the degree of intraocular pressure lowering and rates of treatment failure. Research coordinators in each centre will identify and recruit previously untreated patients with primary open-angle glaucoma and exfoliative glaucoma. Those who meet the eligibility criteria will be invited to enter a randomised controlled trial with either selective laser trabeculoplasty or topical ocular hypotensive therapy, according to a stepped regimen. Outcome assessment will be measured at 6 weeks and at 6, 12, and 24 months post-treatment. Regular clinic follow-ups will continue as clinically indicated between study outcome visits., DISCUSSION: The Glaucoma Initial Treatment Study is the first multi-centred RCT to determine the optimum first-line therapy for people with glaucoma. Our trial will have an unprecedented capacity to meaningfully transform the treatment and management of glaucoma in Australia and overseas., TRIAL REGISTRATION: ACTRN12611000720910; Date registered: 11 July 2011.
Keywords: Administration, Ophthalmic; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/ec [Economics]; Clinical Protocols; Cost-Benefit Analysis; Drug Costs; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; *Intraocular Pressure/de [Drug Effects]; Laser Therapy/ae [Adverse Effects]; Laser Therapy/ec [Economics]; Laser Therapy/is [Instrumentation]; *Laser Therapy/mt [Methods]; Ophthalmic Solutions; Research Design; Time Factors; Trabeculectomy/ae [Adverse Effects]; Trabeculectomy/ec [Economics]; Trabeculectomy/is [Instrumentation]; *Trabeculectomy/mt [Methods]; Treatment Outcome; *Vision, Ocular/de [Drug Effects]

A novel eye drop application monitor to assess patient compliance with a prescribed regimen: a pilot study. - Eaton, A M; Gordon, G M; Konowal, A; Allen, A; Allen, M; Sgarlata, A; Gao, G; Wafapoor, H; Avery, R L (Eye (London, England), 2015)
PURPOSE: To assess the ability of a novel imaging device to allow physicians to personalize therapeutic regimens based on objective patient drop administration data., METHODS: A novel imaging system was used to record video of the drop technique of subjects in clinic (n=25) or at home (n=17) for 1 week. Video assessment by a reading center was compared with patient reporting and their prescribed regimen with respect to how many drops were applied and how many landed in the eye., RESULTS: Reading center assessment of both drops dispensed and drops landing in the eye was significantly different from the prescribed regimen in the clinic (Pd=0.005, Pi<0.001, respectively) and at-home arms (Pd=0.003, Pi<0.001, respectively)., CONCLUSIONS: This imaging system is a powerful tool to help physicians tailor patient therapy more accurately, to help researchers evaluate new drop therapies with objective rather than subjective data, and to potentially facilitate better patient training for improved drug delivery.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Drug Delivery Systems/is [Instrumentation]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Middle Aged; Monitoring, Physiologic; Ophthalmic Solutions; Pilot Projects; Prospective Studies; Self Administration; Surveys and Questionnaires; *Video Recording/is [Instrumentation]; Young Adult

Applying the resources and supports in self-management framework to examine ophthalmologist-patient communication and glaucoma medication adherence. - Sleath, B; Carpenter, D M; Blalock, S J; Sayner, R; Muir, K W; Slota, C; Giangiacomo, A L; Hartnett, M E; Tudor, G; Robin, A L (Health education research, 2015)
Little is known about how ophthalmologist-patient communication over time is associated with glaucoma patient long-term adherence. The purpose of our study was to examine the association between provider use of components of the resources and supports in self-management model when communicating with patients and adherence to glaucoma medications measured electronically over an 8-month period. In this longitudinal prospective cohort study, the main variables studied were ophthalmologist communication-individualized assessment, collaborative goal setting and skills enhancement. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited from six ophthalmology clinics. Patients' baseline and next follow-up visits were videotape-recorded. Patients were interviewed after their visits. Patients used medication event monitoring systems (MEMS) for 8 months after enrollment into the study, and adherence was measured electronically using MEMS for 240 days after their visits. Two hundred and seventy-nine patients participated. Patient race and regimen complexity were negatively associated with glaucoma medication adherence over an 8-month period. Provider communication behaviors, including providing education and positive reinforcement, can improve patient adherence to glaucoma medications over an 8-month period. Copyright © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Keywords: Adult; Aged; *Communication; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Middle Aged; *Physician-Patient Relations; Surveys and Questionnaires; Videotape Recording

Patterns of Glaucoma Medication Adherence over Four Years of Follow-Up. - Newman-Casey, Paula Anne; Blachley, Taylor; Lee, Paul P; Heisler, Michele; Farris, Karen B; Stein, Joshua D (Ophthalmology, 2015)
PURPOSE: To assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up., DESIGN: Retrospective, longitudinal cohort analysis., PARTICIPANTS: Beneficiaries aged >=40 years who were enrolled in a United States (US)-managed care plan for >=7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma., METHODS: For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses., MAIN OUTCOME MEASURES: Patterns of glaucoma medication adherence., RESULTS: Of the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (beta = -0.06/dollar, P = 0.03)., CONCLUSIONS: For most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Managed Care Programs/sn [Statistics & Numerical Data]; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Retrospective Studies

Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment. - Abdull, Mohammed M; Gilbert, Clare C; Evans, Jennifer (BMC ophthalmology, 2015)
BACKGROUND: To determine the stage of primary open angle glaucoma at presentation at a tertiary eye unit, to assess patient's knowledge of glaucoma and acceptance and subsequent adherence to treatment., METHOD: Information collected prospectively on new glaucoma patients aged 30 or more years included distance from residence and what they knew about glaucoma and its treatment. Treatment offered took account of disease severity and socioeconomic factors. Reasons for not accepting surgery were recorded. At follow up intraocular pressure (IOP) was measured and adherence to medication assessed verbally. Four categories of severity were defined based on visual acuity and visual fields defects in the worse eye., RESULTS: 131 patients were recruited (mean age 52.8 years; 62% male). Most attended because of symptoms (70%). Mean IOP in affected eyes was 31.9+/-SD 12.4 and mean vertical cup:disc ratio was 0.8. 99 eyes (47%) had a visual acuity of light perception or worse. Risk factors for advanced/end-stage disease were age >50 years, living >10 km from the hospital, some awareness of glaucoma, not being literate, being unemployed and presenting with symptoms. In multivariable analysis older age and poor knowledge of glaucoma remained independent risk factors. 75 were offered trabeculectomy: five agreed but only one underwent surgery. Reasons for rejecting surgery were fear (37%), preferred medical treatment (27 %) and cost (15 %). 32/85 (24 %) participants started on topical medication attended follow up. 72% reported excellent compliance but only 56% of glaucomatous eyes had IOPs less than 21 mmHg., CONCLUSIONS: To prevent glaucoma blindness strategies are required which promote earlier detection, with counselling to promote acceptance of and adherence to treatment.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/su [Surgery]; Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Nigeria/ep [Epidemiology]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patient Compliance/sn [Statistics & Numerical Data]; Prospective Studies; Risk Factors; Trabeculectomy; Visual Acuity/ph [Physiology]; Visual Field Tests; Visual Fields/ph [Physiology]

Ability of Bottle Cap Color to Facilitate Accurate Patient-Physician Communication Regarding Medication Identity in Patients with Glaucoma. - Dave, Pujan; Villarreal, Guadalupe Jr; Friedman, David S; Kahook, Malik Y; Ramulu, Pradeep Y (Ophthalmology, 2015)
PURPOSE: To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly among individuals who may have acquired color vision deficiency from glaucoma., DESIGN: Cross-sectional, clinical study., PARTICIPANTS: Patients aged >=18 years with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of >=20/400, and no concurrent conditions that may affect color vision., METHODS: A total of 100 patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were then presented to 3 physicians. Physicians matched each color descriptor to the medication they thought the descriptor was describing., MAIN OUTCOME MEASURES: Frequency of patient-physician agreement, occurring when all 3 physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI)., RESULTS: Subjects had a mean age of 69 (+/-11) years, with VF mean deviation of -4.7 (+/-6.0) and -10.9 (+/-8.4) decibels (dB) in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic; Alcon Laboratories Inc., Fort Worth, TX], brinzolamide/brimonidine [Simbrinza; Alcon Laboratories Inc.], and latanoprost [Xalatan; Pfizer, Inc., New York, NY]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (P < 0.001). Extent of color vision deficiency and color descriptor heterogeneity significantly predicted agreement in multivariate models (odds of agreement = 0.90 per 1 point decrement in HRR score, P < 0.001; odds of agreement = 0.30 for medications exhibiting high heterogeneity [>=11 descriptors], P = 0.007)., CONCLUSIONS: Physician understanding of patient medication use based solely on bottle cap color is frequently incorrect, particularly in patients with glaucoma who may have color vision deficiency. Errors based on communication using bottle cap color alone may be common and could lead to confusion and harm. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Comment in (CIN)
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Color; Color Perception Tests; *Communication; Cross-Sectional Studies; *Drug Packaging/st [Standards]; Drug Utilization; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; Medication Errors/pc [Prevention & Control]; Middle Aged; Ophthalmic Solutions; *Physician-Patient Relations; Surveys and Questionnaires; Visual Acuity

The Impact of Multimedia Education on Uptake of Comprehensive Eye Examinations in Rural China: A Randomized, Controlled Trial. - Dan, Aihua; Raubvogel, Graham; Chen, Tingting; Ye, Tiantian; Jin, Ling; Xiao, Baixiang; Sanchez, Ana; Congdon, Nathan (Ophthalmic epidemiology, 2015)
PURPOSE: To study the effect of multimedia education on acceptance of comprehensive eye examinations (CEEs), critical for detecting glaucoma and diabetic eye disease, among rural Chinese patients using a randomized, controlled design., METHODS: Patients aged >=40 years were recruited from 52 routine clinic sessions (26 intervention, 26 control) conducted at seven rural hospitals in Guangdong, China. Subjects answered demographic questionnaires, were tested on knowledge about CEEs and chronic eye disease, and were told the cost of examination (range US$0-8). At intervention sessions, subjects were cluster-randomized to view a 10-minute video on the value of CEEs and retested. Control subjects were not retested. Trial outcomes were acceptance of CEEs (primary outcome) and final knowledge scores (secondary outcome)., RESULTS: At baseline, >70% (p = 0.70) of both intervention (n = 241, 61.2 +/- 12.3 years) and control (n = 218, 58.4 +/- 11.7 years) subjects answered no knowledge questions correctly, but mean scores on the test (maximum 5 points) increased by 1.39 (standard deviation 0.12) points (p < 0.001) after viewing the video. Intervention (73.0%) and control (72.9%) subjects did not differ in acceptance of CEEs (p > 0.50). In mixed-effect logistic regression models, acceptance of CEEs was associated with availability of free CEEs (odds ratio 18.3, 95% confidence interval 1.32-253.0), but not group assignment or knowledge score. Acceptance was 97.5% (79/81) when free exams were offered., CONCLUSIONS: Education increased knowledge about but not acceptance of CEEs, which was generally high. Making CEEs free could further increase acceptance.
Keywords: Adult; Aged; Asian Continental Ancestry Group/eh [Ethnology]; China/ep [Epidemiology]; Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/ep [Epidemiology]; Female; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; *Health Knowledge, Attitudes, Practice; *Health Promotion/mt [Methods]; Humans; Male; Middle Aged; *Multimedia; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patient Education as Topic/mt [Methods]; *Physical Examination/sn [Statistics & Numerical Data]; *Rural Population/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Vision Tests

The Capacity of Eye Care Services for Patients with Glaucoma in Botswana. - Razai, Mohammad S; Jackson, Daniel J; Falama, Rosemary; Mongwa, Matlhogonolo; Mutapanduwa, Mishell G; Baemisi, Chao; Josiah, Engelinah; Nkomazana, Oathokwa; Lehasa, Alice; Brealey, Evelyn; Jankowski, Deborah; White, Andrew J R; et al. (Ophthalmic epidemiology, 2015)
PURPOSE: To evaluate current delivery of glaucoma care in Botswana; in particular, the service infrastructure available and glaucoma-related workload., METHODS: A multi-center cross-sectional study was undertaken comprising government eye care institutions and ophthalmic personnel across Botswana. Data on human resources, equipment types and numbers, diagnostic criteria routinely used, treatments routinely provided, and new and repeat glaucoma consultations were obtained through quantitative and qualitative surveys., RESULTS: In 27 government eye care institutions there were two general ophthalmologists, neither of whom had a subspecialty interest in glaucoma, 64 ophthalmic nurses, two optometrists, one low vision therapist, one refractionist, and two equipment technicians. Only 8.5% of available ophthalmic human resources were taken up with provision of glaucoma care. About 1/3 of hospitals did not have tonometers, most primary hospitals lacked slit lamp biomicroscopes and most hospitals lacked sensitive diagnostic equipment. A diagnosis of glaucoma was made by either an ophthalmic nurse or an ophthalmologist, but only 10% of institutions could meet recommendations for follow-up assessment. Topical glaucoma medications were prescribed by almost all hospital clinics, usually by ophthalmic nurses. Drug choices were largely determined by local availability. Glaucoma surgery accounted for 0.8% of total eye operations. Glaucoma patients took up 8.5% of total clinic visits. The total number of glaucoma visits was highest in the two hospitals with ophthalmologists. New glaucoma cases took up 10.3% of total glaucoma visits., CONCLUSION: This study highlights the challenges faced in caring for glaucoma patients in Botswana; in particular, lack of professional human resources, equipment and availability of effective treatments.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Botswana/ep [Epidemiology]; Cross-Sectional Studies; Delivery of Health Care/og [Organization & Administration]; *Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; *Glaucoma/th [Therapy]; *Health Personnel/sn [Statistics & Numerical Data]; *Health Services Accessibility; Health Services Needs and Demand; Health Workforce/og [Organization & Administration]; *Health Workforce/sn [Statistics & Numerical Data]; Humans; National Health Programs/sn [Statistics & Numerical Data]; Ophthalmology/og [Organization & Administration]; *Ophthalmology; Optometry/og [Organization & Administration]; *Optometry; Surveys and Questionnaires

A comparison of measures used to describe adherence to glaucoma medication in a randomised controlled trial. - Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Holland, Richard; Broadway, David C (Clinical trials (London, England), 2015)
BACKGROUND: Understanding the magnitude of non-adherence in pre-marketing clinical trials and clinical practice is essential. However, accurately measuring non-adherence to medication is problematic, and the variety of adherence measures and/or calculation methods has led to highly variable results., PURPOSE: To compare commonly used methods for measuring adherence to eye drop therapy in order to assess which methods achieve the most complete datasets over an 8-month monitoring period, to quantify the magnitude of variance in adherence estimations and to review the different methods used to calculate or interpret adherence data., METHODS: Adherence was measured electronically for 8 months by participants administering eye drops using a Travalert R dosing aid. The mean number of Travalert dosing aid recorded doses administered over the monitoring period was used to calculate a percentage adherence score. In addition, the value of graphically presenting Travalert dosing aid data to classify patterns of adherence behaviour was explored. The validated Morisky Measure of Adherence Scale and questions requesting participants to report the Frequency of Missed Doses were two measures of self-reported adherence calculated for each participant. Finally, medication possession ratio was calculated from expected repeat prescription orders compared with actual repeat prescription orders., RESULTS: For the 208 recruited participants, self-reported adherence was the most reliable method of collecting complete datasets over the 8-month period; 16% of self-reported adherence data were missing compared with 45% of Travalert dosing aid data missing at 8 months. The mean adherence measured over the monitoring period by the Travalert dosing aid was 77%. When adherence measures were dichotomised into adherent and non-adherent groups, the Travalert dosing aid found 54% of participants were adherent, compared to 60% Morisky Measure of Adherence Scale and 57% Frequency of Missed Dose self-report measures. However, there was poor agreement between the Travalert dosing aid measured adherence and self-report measures. Medication possession ratio was not a reliable measure of persistence with medication. Graphical Travalert dosing aid data presentation provided additional information about participant behaviour by indicating that most non-adherence was due to participants taking drug holidays rather than missing occasional doses., CONCLUSION: The analysis provided evidence about the inconsistencies between different monitoring strategies and adherence measures. Furthermore, the analysis highlighted the difficulties in collecting complete data for studies investigating chronic, slowly progressive conditions that require long-term follow-up. Future adherence studies could use multiple methods for quantifying and classifying adherence in parallel, both to maximise precision of adherence estimates and to facilitate comparison between studies. However, the authors are cautious of the effect of using multiple adherence measures on participant behaviour and their potential reactivity effects is an area for future research. Copyright © The Author(s) 2015.
Keywords: Aged; Aged, 80 and over; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Medication Adherence/sn [Statistics & Numerical Data]; *Medication Adherence; Middle Aged; *Ophthalmic Solutions/tu [Therapeutic Use]; Research Design; United Kingdom

[Description of the case of Cogan syndrome]. - Semik-Grabarczyk, Elzbieta; Hrycek, Antoni (Wiadomosci lekarskie (Warsaw, Poland : 1960), 2015)
Cogan syndrome is a persistent disease with the autoimmunologic background connected with vasculitis. It can be diagnosed by symptoms such as interstitial keratitis, optic nerve dysfunction and nervus acusticus dysfunction with subsequent hearing impairment or deafness. In its course, such systemic symptoms frequently occur: exhaustion, weight loss and joint pain. Due to the rare occurrence of Cogan syndrome and vast obstacles in diagnosing it, the case of34 years old patient with Cogan syndrome is discussed.
Keywords: Adult; *Cogan Syndrome/di [Diagnosis]; Female; Humans

Barriers to Follow-Up and Strategies to Improve Adherence to Appointments for Care of Chronic Eye Diseases. - Thompson, Atalie C; Thompson, Matthew O; Young, David L; Lin, Richard C; Sanislo, Steven R; Moshfeghi, Darius M; Singh, Kuldev (Investigative ophthalmology & visual science, 2015)
PURPOSE: To understand factors associated with poor attendance of follow-up appointments for care of glaucoma (GL), AMD, and diabetic retinopathy (DR) in a tertiary referral center, and to identify strategies to improve adherence., METHODS: Cross-sectional study of 240 adults attending follow-up appointments for GL, AMD, or DR. Cases (N = 102) were patients with poor follow-up who missed and failed to reschedule an appointment within 1 month of the recommended follow-up date during the preceding year. Controls (N = 138) were patients who completed the assigned follow-up. Data regarding the factors impacting adherence to appointments were collected via an orally administered questionnaire. Multivariate logistic regression was performed to determine factors associated with poor follow-up., RESULTS: In a multivariate logistic regression model, independent factors significantly associated with poor follow-up included incorrectly answering more than 50% of questions about eye disease (adjusted odds ratio [OR] = 3.24, P = 0.001), legal blindness (adjusted OR 2.64, P = 0.013), the presence of glaucomatous versus retinal disease (adjusted OR 2.06, P = 0.013), and difficulty for the study subject and/or escort taking time away from work for the appointments (adjusted OR 1.80, P = 0.049). Subjects identified the following strategies to improve follow-up: contact with others having the same eye condition (41.3%), greater education regarding eye disease (40.8%), and improved transportation services to the clinic (44.6%)., CONCLUSIONS: Low disease knowledge scores, legal blindness, and difficulty getting time away from work for appointments adversely impacted follow-up independent of eye disease diagnosis. Improvements in patient education, transportation services, and clinic efficiency may increase adherence to recommended appointment intervals.
Keywords: Adult; *Appointments and Schedules; Chronic Disease; Cross-Sectional Studies; *Delivery of Health Care/st [Standards]; Delivery of Health Care/td [Trends]; *Eye Diseases/th [Therapy]; Follow-Up Studies; Humans; *Patient Compliance/sn [Statistics & Numerical Data]; *Practice Guidelines as Topic; Retrospective Studies; Surveys and Questionnaires; United States

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors. - Sayner, Robyn; Carpenter, Delesha M; Blalock, Susan J; Robin, Alan L; Muir, Kelly W; Hartnett, Mary Elizabeth; Giangiacomo, Annette L; Tudor, Gail; Sleath, Betsy (Clinical therapeutics, 2015)
PURPOSE: Glaucoma medications can improve clinical outcomes when patients adhere to their medication regimen. Providers often ask patients with glaucoma to self-report their adherence, but the accuracy of self-reporting has received little scientific attention. The purpose of this article was to compare a self-reported medication adherence measure with adherence data collected from Medication Event Monitoring Systems (MEMS) electronic monitors. An additional goal was to identify which patient characteristics were associated with overreporting adherence on the self-reported measure., METHODS: English-speaking adult patients with glaucoma were recruited from 6 ophthalmology practices for this observational cohort study. Patients were interviewed after their initial visit and were given MEMS contains, which recorded adherence over a 60-day period. MEMS percent adherence measured the percentage of the prescribed number of doses taken. MEMS-measured timing adherence assessed the percent doses taken on time. Patients self-reported adherence to their glaucoma medications on a visual analog scale (VAS) ~60 days after the baseline visit. Bivariate analyses and logistic regressions were used to analyze the data. Self-reported medication adherence on the VAS was plotted against MEMS adherence to illustrate the discrepancy between self-reported and electronically monitored adherence., FINDINGS: The analyses included 240 patients who returned their MEMS containers and self-reported medication adherence at the 60-day follow-up visit. Compared with MEMS-measured percent adherence, 31% of patients (n = 75) overestimated their adherence on the VAS. Compared with MEMS-measured timing adherence, 74% (n = 177) of patients overestimated their adherence. For the MEMS-measured percent adherence, logistic regression revealed that patients who were newly prescribed glaucoma medications were significantly more likely to overreport adherence on the VAS (odds ratio, 3.07 [95% CI, 1.22-7.75]). For the MEMS-measured timing adherence, being male (chi(2) test, 6.78; P = 0.009) and being prescribed glaucoma medications dosed multiple times daily (chi(2) test, 4.02; P = 0.045) were significantly associated with patients overreporting adherence. However, only male sex remained a significant predictor of overreporting adherence in the logistic regression (odds ratio, 4.05 [95% CI, 1.73-9.47])., IMPLICATIONS: Many patients with glaucoma, especially those newly diagnosed, overestimated their medication adherence. Because patients were likely to overreport the percent doses taken and timing adherence, providers may want to ask patients additional questions about when they take their glaucoma medications to potentially detect issues with taking these medications on time. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
Keywords: Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Drug Monitoring/is [Instrumentation]; *Drug Monitoring/mt [Methods]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Self Report/st [Standards]; Socioeconomic Factors; Surveys and Questionnaires; United States; Visual Analog Scale

Pharmacotherapy and Adherence Issues in Treating Elderly Patients with Glaucoma. - Broadway, David C; Cate, Heidi (Drugs & aging, 2015)
Glaucoma is a leading cause of visual morbidity throughout the world and is an age-related condition, the prevalence of which rises significantly with increasing age. Glaucoma, a condition affecting the optic nerve, has a variety of subtypes with multiple aetiological factors, the most important of which are intraocular pressure (IOP) and increasing age. Treatment by lowering of IOP is the only current method, for which there is evidence, by which the rate of progressive visual deterioration can be slowed or halted. Although there are surgical and laser treatments that are efficacious in lowering IOP, the most common manner in which patients with glaucoma control their IOP is with administration of daily topical ocular hypotensive drugs (eye drops). The variety of topical drugs utilised in the management of glaucoma all have the potential to have adverse effects and/or interactions with concomitant medications, many of which may be used for other age-related conditions. Adherence with appropriate medicines has a major effect on the outcome of medical conditions and this aspect applies to the management of glaucoma. There are certain specific issues that relate to the administration of topical agents, with respect to both adverse effects and adherence. Although many suspect poor adherence in elderly patients with glaucoma, relative to younger patients, adequate evidence for this is lacking. Furthermore, the manner by which adherence issues could be improved remains inadequately understood and poorly addressed. The aims of this article were to review, from a clinical perspective, the medical therapies currently used for glaucoma and discuss adherence issues with respect to the population of patients with glaucoma, who tend to be relatively elderly.
Keywords: Age Factors; Aged; Antihypertensive Agents/ad [Administration & Dosage]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Medication Adherence; Ophthalmic Solutions

Management and Prevention of Herpes Zoster Ocular Disease. - Cohen, Elisabeth J (Cornea, 2015)
Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus (VZV) in people who have had chicken pox, usually resulting in a painful, unilateral, dermatomal, vesicular rash. Herpes zoster ophthalmicus occurs when the first division of cranial nerve V is involved. HZ is common, with approximately 1 million new cases per year in the United States, and occurs in 1 in 3 persons. Although the rate of HZ increases with age, over half of all cases occur under the age of 60 years. Complications of herpes zoster ophthalmicus include eye disease, postherpetic neuralgia (PHN), and strokes. VZV has also been found in temporal arteritis biopsies. There is growing evidence that HZ is followed by chronic active VZV infection contributing to these complications. In view of this, and the efficacy of suppressive antiviral treatment in reducing recurrent herpes simplex keratitis, a randomized controlled trial of suppressive valacyclovir to reduce new or worsening anterior segment disease and/or PHN is needed. The zoster vaccine (ZV) is safe and effective in reducing the burden of illness, severity of PHN, and incidence of HZ. It is Centers for Disease Control and Prevention recommended for persons aged 60 years and above without impaired cellular immunity, and Food and Drug Administration approved for those aged 50 and older. It is most effective in preventing HZ in recipients in their 50s. Because of underusage of the ZV, it has not impacted the epidemiology of the disease. Barriers to its use include cost, variable reimbursement, frozen storage, and lack of a strong recommendation by doctors.
Keywords: Age of Onset; Antiviral Agents/tu [Therapeutic Use]; *Herpes Zoster Ophthalmicus/di [Diagnosis]; *Herpes Zoster Ophthalmicus/pc [Prevention & Control]; Herpes Zoster Vaccine/ad [Administration & Dosage]; *Herpesvirus 3, Human/ph [Physiology]; Humans; Middle Aged; Virus Activation/ph [Physiology]; Virus Latency

Improving Medication Adherence to Reduce Vision Loss in Patients with Glaucoma: Low Hanging Fruit?. - Morse, Alan R (Ophthalmology, 2015)
Comment on (CON)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]

[Preservative-free betaxolol for POAG patients: evaluation of hypotensive effect and ocular surface safety]. - Onischenko, A L; Dimaksyan, M V; Kolbasko, A V; Zilina, N M (Vestnik oftalmologii, 2015)
AIM: To evaluate ocular surface changes in patients with primary open-angle glaucoma (POAG) as well as the hypotensive effect of preservative-free betaxolol eye drops., MATERIAL AND METHODS: A total of 22 patients (42 eyes) aged 55-83 with POAG stage I-II were examined. All of them were switched from betaxolol b.i.d. to its preservative-free analogue (Xonef BK). The baseline examination included visual acuity measurement, Morisky-Green test (questionnaire), Norn test, Schirmer's test, lissamine green staining, and ocular tonometry. The latter was repeated 2 and 4 weeks after the drug had been switched, while the whole complex--2 months after the beginning of the study., RESULTS: The total tear production in POAG patients under betaxolol therapy was 19.1 +/- 10.6 mm. After the 2 months of preservative-free betaxolol use there were no statistically significant changes in Schirmer's test results (p = 0.248). Tear film break-up time (Norn test) improved from 7.8 +/- 0.5 secto 9.8 +/- 0.8 sec (p = 0.067) as well as the results of lissamine green staining (W = 90.0, p < 0.022). In the Morisky-Green Test betaxolol patients scored only 2.6 +/- 0.05 points on average, thus showing non-compliance. After the 2 months of preservative-free betaxolol instillations the scores increased up to 3.1 +/- 0.07 (p = 0.04). According to Dunnett's test, used for multiple comparisons, intraocular pressure did not change significantly in either of the study periods (baseline and follow-up measurements at weeks 2, 4, and 8 were taken into account)., CONCLUSION: The study proves Xonef BK safe, effective, and appropriate in all types of glaucoma.
Keywords: Adrenergic beta-1 Receptor Antagonists/ad [Administration & Dosage]; Adrenergic beta-1 Receptor Antagonists/ae [Adverse Effects]; Aged; Betaxolol/ad [Administration & Dosage]; Betaxolol/ae [Adverse Effects]; *Betaxolol; Drug Monitoring; Female; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ophthalmic Solutions; Tears/me [Metabolism]; Tonometry, Ocular/mt [Methods]; Treatment Outcome

The Utility of Cap Color and Bottle Characteristics for Topical Glaucoma Therapy. - Marando, Catherine M; Seibold, Leonard K; SooHoo, Jeffrey R; Pantcheva, Mina B; Ramulu, Pradeep Y; Kahook, Malik Y (Ophthalmology, 2015)
Comment in (CIN)
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; *Drug Packaging/st [Standards]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Medication Errors/pc [Prevention & Control]; Middle Aged; Ophthalmic Solutions; Surveys and Questionnaires

Glaucoma awareness and access to healthcare: perceptions among glaucoma patients in Tanzania. - Gilmour-White, Jeremy A; Shah, Peter; Cross, Vinette; Makupa, William; Philippin, Heiko (Postgraduate medical journal, 2015)
OBJECTIVE: To investigate the barriers to access to eye health services for patients with glaucoma in Tanzania with the aim of identifying key areas for improvement and further research., DESIGN: Qualitative investigation using face-to-face semi-structured interviews with patients recruited from the Kilimanjaro Christian Medical Centre (KCMC) outpatient eye clinic. This project is part of the international strategy of the Research into Glaucoma and Ethnicity (ReGAE) programme., METHODS: Interviews were conducted with the help of a translator; all data were transcribed in Swahili and then translated into English. Manual coding and qualitative analysis was used to identify major themes and relevant concepts. Data were collected during May and June 2013., MAIN OUTCOME MEASURES: Qualitative data on glaucoma awareness and access to healthcare., RESULTS: 12 patients (7 men, 5 women) of mean age 67.5 years (range 53-86 years) were interviewed. All participants had a previous diagnosis of glaucoma and no other eye conditions. The understanding of glaucoma was limited and the capacity for healthcare providers to improve glaucoma knowledge seemed underused. Participants had particular difficulty in understanding the aetiology and chronicity of the disease. Socioeconomic factors also posed significant barriers to service usage., CONCLUSIONS: Among many barriers to access to health services for patients with glaucoma, knowledge of the condition was identified as a key issue. Enhancing the understanding of glaucoma may improve access by triggering earlier presentation, informing those at risk and improving adherence to treatment. This is an area for further research with potential for improving service provision. Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Keywords: Adult; Aged; Awareness; *Delivery of Health Care/og [Organization & Administration]; Female; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; *Glaucoma/pc [Prevention & Control]; Health Knowledge, Attitudes, Practice; *Health Services Accessibility/og [Organization & Administration]; Humans; Male; Middle Aged; *Optometry/og [Organization & Administration]; Patient Education as Topic; Primary Health Care/og [Organization & Administration]; Qualitative Research; Tanzania/ep [Epidemiology]

Evolution of Corneal Transplantation in the Province of Quebec From 2000 to 2011. - Robert, Marie-Claude; Choronzey, Marie-Eve; Lapointe, Julie; Gauvin Meunier, Louis-Pierre; Harissi-Dagher, Mona; Germain, Marc; Mabon, Michele; Brunette, Isabelle (Cornea, 2015)
PURPOSE: The goal of this study was to determine the changes in surgical techniques and leading indications for corneal transplantations performed in the last decade. The impact of administrative changes of corneal banking in Quebec was also evaluated., METHODS: The records of all corneal transplantations performed between January 2000 and December 2011 in the territory subserved by the Quebec Eye Bank and Hema-Quebec (Quebec, Canada) were retrospectively reviewed., RESULTS: A total of 3459 corneal transplantations were performed between 2000 and 2011. The rate of corneal transplantation more than doubled from 234 grafts per year in 2000 to 592 grafts per year in 2011. Imported tissue represented 40% of grafted corneas. Increases in tissue importation were seen in 2003 and 2009 to address local tissue shortage and peaks in wait time. The average wait time decreased from 434 +/- 456 days (2000-2008) to 418 +/- 551 days (2009-2011) (P = 0.01). The leading surgical indications were Fuchs endothelial corneal dystrophy (27%), pseudophakic corneal edema (26%), keratoconus (13%), and viral keratitis (8%). Regrafts represented 25% of procedures. Descemet stripping automated endothelial keratoplasty became the preferred technique for endothelial diseases, surpassing penetrating keratoplasty in 2011., CONCLUSIONS: The surgical indications and techniques used for corneal transplantation in Quebec reflected those of the literature. However, long wait times and corneal tissue shortages mandated significant changes in the organization of the Quebec Eye Bank. Partnering with a larger agency responsible for tissue and blood donation coordination (Hema-Quebec) had a positive impact on yearly transplantation rates and wait times.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; *Corneal Diseases/ep [Epidemiology]; *Corneal Transplantation/td [Trends]; Eye Banks/sn [Statistics & Numerical Data]; Female; Humans; Infant; Male; Middle Aged; Quebec/ep [Epidemiology]; Reoperation; Retrospective Studies; Tissue Donors/sn [Statistics & Numerical Data]; Transplant Recipients/sn [Statistics & Numerical Data]; Waiting Lists

Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D. - Blumberg, Dana M; Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; De Moraes, C Gustavo (JAMA ophthalmology, 2015)
IMPORTANCE: Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability., OBJECTIVES: To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence., DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim., INTERVENTION: Effect of the implementation of the Medicare Part D drug benefit., MAIN OUTCOMES AND MEASURES: The change in cost-related nonadherence and the change in cost-reduction strategies., RESULTS: Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0% to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<$30000), self-reported visual disability, and a smaller Lawton index., CONCLUSIONS AND RELEVANCE: After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.
Keywords: Aged; Antihypertensive Agents/ec [Economics]; Consumer Behavior/ec [Economics]; *Consumer Behavior/sn [Statistics & Numerical Data]; *Cost Savings/ec [Economics]; Cross-Sectional Studies; *Drug Costs; Drug Utilization/ec [Economics]; Female; Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; *Glaucoma/px [Psychology]; Health Plan Implementation; Humans; Male; *Medicare Part D/ec [Economics]; *Medication Adherence/px [Psychology]; United States

Fixed-combination treatments for intraocular hypertension in Chinese patients - focus on bimatoprost-timolol. - Fang, Yuan; Ling, Zhihong; Sun, Xinghuai (Drug design, development and therapy, 2015)
Glaucoma is a common eye disease that can lead to irreversible vision loss if left untreated. The early diagnosis and treatment of primary open-angle glaucoma is challenging, and visual impairment in Chinese glaucoma patients is a serious concern. Most of these patients need more than one topical antiglaucoma agent to control their intraocular pressures (IOPs). In the People's Republic of China, the daily cost of different glaucoma medication varies greatly, and the treatment habits differ throughout the country. Prostaglandin analogs (PGAs) are recommended as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Fixed-combination drops, particularly PGA-based fixed combinations, have recently been developed and used in patients with progression or who have failed to achieve their target IOPs. Here, we reviewed the current literature on the use of bimatoprost-timolol fixed combination (BTFC) in the People's Republic of China. BTFC has achieved good efficacy and tolerability in Chinese clinical trials. In addition, BTFC is more cost effective compared with other fixed combinations available in the People's Republic of China. Fixed-combination drops may offer benefits, such as keeping the ocular surface healthy, convenience of administration, and improvement in long-term adherence and quality of life. Therefore, BTFC has great potential for the treatment of Chinese glaucoma patients. However, the long-term efficacy of BTFC, comparisons of BTFC with other fixed-combination drugs, and treatment adherence and persistence with treatment in Chinese patients are unknown and will require further study.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Asian Continental Ancestry Group; Bimatoprost/ae [Adverse Effects]; *Bimatoprost/tu [Therapeutic Use]; China; Drug Combinations; Glaucoma/dt [Drug Therapy]; Humans; *Ocular Hypertension/dt [Drug Therapy]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Patient satisfaction with Peninsula Optometry Community Glaucoma Scheme. - Levy, S; Booth, A (Eye (London, England), 2015)
Comment in (CIN)
Keywords: Community Health Services/og [Organization & Administration]; *Community Health Services/st [Standards]; *Delivery of Health Care/st [Standards]; *Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; Humans; Intraocular Pressure; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/th [Therapy]; Ophthalmology/og [Organization & Administration]; Ophthalmology/st [Standards]; Optometry/og [Organization & Administration]; *Optometry/st [Standards]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Surveys and Questionnaires; United Kingdom

The utility of an artificial substitute to improve corneal sensitivity in glaucomatous patients on chronic therapy with prostaglandin analogs. - Vagge, Aldo; Bonino, Michele; Rolando, Maurizio; Macri, Angelo; Traverso, Carlo E; Iester, Michele (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2015)
PURPOSE: To evaluate whether a tear substitute can improve corneal subepithelial nerve plexus and corneal sensitivity in glaucomatous patients., METHODS: This study was prospective, longitudinal, and single arm. Twenty glaucomatous patients were recruited. All the patients were treated with a prostaglandin analog with preservative for at least 1 year. Preservative-free artificial tears (0.5% tamarind seed polysaccharide 0.5( R) eye drops single-dose preservative free [Oftagen]) were prescribed thrice per day. The participants were subjected to clinical and instrumental evaluation at baseline (T0), after 1 month (T1) and after 3 months (T3) of treatment. All patients were examined with a digital corneal confocal laser-scanning microscope (HRT II Rostock Cornea Module; Heidelberg Engineering GmbH) and Cochet-Bonnet corneal esthesiometer., RESULTS: After the artificial substitute, corneal and conjunctival sensitivity significantly (P < 0.001) improved at T1 and T3 compared to the baseline. A significant correlation was found between break-up time and both central corneal sensitivity and the number of fibers., CONCLUSION: The use of a preservative-free artificial substitute in association with a topical therapy with chronic preservative could increase the compliance of patients.
Keywords: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local/ad [Administration & Dosage]; Anti-Infective Agents, Local/ae [Adverse Effects]; Benzalkonium Compounds/ad [Administration & Dosage]; Benzalkonium Compounds/ae [Adverse Effects]; *Conjunctiva/de [Drug Effects]; Conjunctiva/ir [Innervation]; Conjunctiva/ph [Physiology]; *Cornea/de [Drug Effects]; Cornea/ir [Innervation]; Cornea/ph [Physiology]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pp [Physiopathology]; Humans; Longitudinal Studies; *Lubricant Eye Drops/ad [Administration & Dosage]; Lubricant Eye Drops/pk [Pharmacokinetics]; Male; Microscopy, Confocal/mt [Methods]; Middle Aged; Ophthalmic Solutions; Preservatives, Pharmaceutical/ad [Administration & Dosage]; Preservatives, Pharmaceutical/ae [Adverse Effects]; Prospective Studies; *Prostaglandins, Synthetic/ad [Administration & Dosage]

Prospective Evaluation of Acupuncture as Treatment for Glaucoma. - Law, Simon K; Lowe, Starrie; Law, Samuel M; Giaconi, JoAnn A; Coleman, Anne L; Caprioli, Joseph (American journal of ophthalmology, 2015)
PURPOSE: To evaluate acupuncture as treatment for glaucoma., DESIGN: Prospective double-masked randomized crossover study., METHODS: setting: Clinical practice., POPULATION: One eye per patient with primary open-angle glaucoma and stable intraocular pressure (IOP)., INTERVENTION: Patients were randomized to receive 1 acupuncture series (12 sessions with either eye-related [eye-points] or non-eye-related [non-eye-points] acupoints) and then crossed over to receive the other series., OUTCOME MEASURES: IOP, blood pressure (BP), heart rate (HR), best-corrected visual acuity (BCVA), visual field (VF), optic disc and peripapillary retinal nerve fiber layer (RNFL) measurements, compliance, and adverse reactions. Probability to detect 3 mm Hg IOP difference between series was 90%., RESULTS: Twenty-two patients volunteered and 11 (50.0%) completed the study; 8 (36.4%) did not complete treatment owing to changes of health, moving away, lack of transportation, or family crisis; and 3(13.6%) were withdrawn owing to needle sensitivity or IOP elevation (8 mm Hg) in the contralateral eye. After an acupuncture session, mean IOP increased slightly with both eye-points (from 12.9 +/- 1.8 mm Hg to 13.6 +/- 2.0 mm Hg, P = .019) and non-eye-points (from 13.0 +/- 1.5 mm Hg to 13.5 +/- 1.7 mm Hg, P = .073) series. HR, diurnal IOP, and BCVA showed no statistically significant changes after 12 sessions of either series. Systolic and diastolic BP were reduced after 12 sessions of non-eye-points series (P = .040, P = .002, respectively). Optic disc, RNFL, and VF showed no statistically significant changes., CONCLUSIONS: Acupuncture has no overall effect on diurnal IOP or BCVA but may temporally increase the IOP immediately after a treatment session. BP is lowered by acupuncture with non-eye-points, but not with eye-points. Compliance and adverse event rates were low. Copyright © 2015 Elsevier Inc. All rights reserved.
Keywords: *Acupuncture Therapy/mt [Methods]; Adult; Aged; Aged, 80 and over; Cross-Over Studies; Double-Blind Method; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Intraocular Pressure; Male; Middle Aged; Pilot Projects; Prospective Studies; Retinal Ganglion Cells/pa [Pathology]; Tomography, Optical Coherence; Tonometry, Ocular; Treatment Outcome; Visual Fields

The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey. - Newman-Casey, Paula Anne; Robin, Alan L; Blachley, Taylor; Farris, Karen; Heisler, Michele; Resnicow, Ken; Lee, Paul P (Ophthalmology, 2015)
PURPOSE: To evaluate the frequency of 11 commonly cited barriers to optimal glaucoma medication adherence among glaucoma patients and to identify barriers contributing to poor adherence., DESIGN: Prospective, cross-sectional survey., PARTICIPANTS: One hundred ninety adults with glaucoma taking 1 or more glaucoma medication who received care in glaucoma clinics in Ann Arbor, Michigan, and Baltimore, Maryland., METHODS: Participants completed a survey on demographic and disease characteristics, barriers to optimal glaucoma medication adherence, interest in an eye drop aid, and self-reported adherence (measured by the Morisky Adherence Scale). Descriptive statistics and logistic regression analyses were performed., MAIN OUTCOME MEASURES: Frequency and number of barriers to adherence among both adherent and nonadherent patients. Odds ratios (ORs) with 95% confidence intervals (CIs) identifying barriers associated with poor adherence., RESULTS: Twenty-seven percent of the sample reported poor adherence. Sixty-one percent of all participants cited multiple barriers and 10% cited a single barrier as impediments to optimal adherence. Twenty-nine percent of subjects cited no barriers, although only 13% of patients who cited no barriers were nonadherent. Among nonadherent patients, 31% or more cited each of the 11 barriers as important. Logistic regression analysis, adjusted for age, revealed that the following barriers were associated with higher odds of nonadherence: decreased self-efficacy (OR, 4.7; 95% CI, 2.2-9.7; P <= 0.0001), difficulty instilling drops (OR, 2.3; 95% CI, 1.1-4.9; P = 0.03), forgetfulness (OR, 5.6; 95% CI, 2.6-12.1; P <= 0.0001), and difficulties with the medication schedule (OR, 2.9; 95% CI, 1.4-6.0; P = 0.006). For each additional barrier cited as important, there was a 10% increased odds of being nonadherent (OR, 1.1; 95% CI, 1.0-1.2; P = 0.01)., CONCLUSIONS: Each of the 11 barriers was important to at least 30% of surveyed patients with poor adherence, with most identifying multiple barriers to adherence. Low self-efficacy, forgetfulness, and difficulty with drop administration and the medication schedule were barriers associated with poor adherence. Interventions to improve medication adherence must address each patient's unique set of barriers. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Comment in (CIN)
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Educational Status; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Status; Health Surveys; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Maryland; *Medication Adherence/sn [Statistics & Numerical Data]; Michigan; Middle Aged; Ophthalmic Solutions; Prospective Studies; Surveys and Questionnaires

Evaluating the trabecular micro-bypass stent combined with phacoemulsification compared to phacoemulsification alone. - El Wardani, M; Bergin, C; Achache, F; Sharkawi, E (Klinische Monatsblatter fur Augenheilkunde, 2015)
AIM: The aim of this study was to assess the effect of iStent (trabecular micro-bypass stent) implantation in combination with phacoemulsification on IOP and glaucoma medications and to compare this to the outcome of phacoemulsification alone., PATIENTS AND METHODS: A retrospective consecutive comparative review was undertaken. 131 eyes with ocular hypertension and medically controlled glaucoma underwent phacoemulsification alone (n=78 group I) or combined with gonioscopic-guided implantation of one iStent (n=31, group II) or two iStents (n=22, group III). Patients were assessed at postoperative weeks 1, 3 and 6, and months 3 and 6. Pre- and post-operative measures included visual acuity, IOP and glaucoma medications., RESULTS: Post-operatively at 6 months, mean IOP decreased from 16.3 mmHg to 14.2 mmHg in group I (p<0.01), from 16.7 mmHg to 15.1 mmHg in group II (p<0.16) and from 17.0 to 13.8 in group III (p=0.05). Mean glaucoma medication decreased from 1.9 to 1.6 in group I (8%, p=0.12), from 2.5 to 0.8 in group II (27%, p=0.04), and from 2.1 to 1.0 in group III (45%, p<0.01)., CONCLUSIONS: iStent implantation resulted in similar IOP reduction to phacoemulsification alone but achieved a significantly greater reduction in glaucoma medications. This may improve compliance and quality of life, and reduce health care costs in patients with early to moderate glaucoma. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Combined Modality Therapy/is [Instrumentation]; Combined Modality Therapy/mt [Methods]; Equipment Design; Equipment Failure Analysis; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/su [Surgery]; Humans; Male; Miniaturization; *Phacoemulsification/is [Instrumentation]; *Phacoemulsification/mt [Methods]; Retrospective Studies; *Stents; Treatment Outcome