Imagining eye care in India (2018 Lalit Prakash Agarwal lecture). - Das, Taraprasad; Panda, Lapam (Indian journal of ophthalmology, 2018)
India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995-2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the "old" tradition of empathy and the "new" technology of analytics, is required to imagine the future of eye care in India.
Keywords: *Diagnostic Imaging/mt [Methods]; Diagnostic Imaging/td [Trends]; *Diagnostic Techniques, Ophthalmological/td [Trends]; *Eye Diseases/di [Diagnosis]; Humans; India

Efficacy of the combination of carteolol hydrochloride + latanoprost in the treatment of glaucoma and ocular hypertension. - Soares, Rebecca Russ; Razeghinejad, M Reza (Expert opinion on pharmacotherapy, 2018)
INTRODUCTION: The only evidence-based mechanism for prevention and treatment of glaucomatous optic neuropathy is decreasing the intraocular pressure (IOP). Prescribing multiple ocular hypotensive agents, such as the combination of carteolol and latanoprost, may synergistically improve IOP; however, doing so may increase the complexity of a medication regimen, in turn, impairing patient adherence. Fixed-combination glaucoma medications offer convenience and effectiveness. New to this class of glaucoma medication is fixed combination carteolol-latanoprost (FCCL). Area covered: This review intends to give the reader a better understanding of the efficacy of the combination of carteolol and latanoprost separately, and where FCCL fits into the vast medical arsenal of IOP drops. Furthermore, it outlines the particular pharmacologic mechanisms targeted, the pharmacokinetics, effectiveness, the advantages of fixed-combination administration, and tolerability. Expert opinion: The combination of carteolol and latanoprost, separately or in a fixed-combination, is more effective than either drug alone. Given the early stage in development of FCCL, it has yet to be determined how FCCL compares to other fixed-combination medications. However, pending further approval, fixed-combination carteolol-latanoprost may represent a reasonable alternative for a patient whose IOP is inadequately controlled on a prostaglandin analog alone and for whom a simplified combination is preferred.
Keywords: Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; Carteolol/pk [Pharmacokinetics]; Carteolol/pd [Pharmacology]; *Carteolol/tu [Therapeutic Use]; *Drug Therapy, Combination/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Latanoprost/pk [Pharmacokinetics]; Latanoprost/pd [Pharmacology]; *Latanoprost/tu [Therapeutic Use]; Male; *Ocular Hypertension/dt [Drug Therapy]; Treatment Outcome

A review on recent drug delivery systems for posterior segment of eye. - Nayak, Kritika; Misra, Manju (Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2018)
Eye is the unique sense organ with complex and sophisticated anatomy and physiology. Being most instrumental for vision, it is secured by varied protective barriers; ranging from static (membranous) to dynamic (vascular) barrier. Although these barriers are very efficient to protect eye from exogenous substances and external stress, it is caught by various irreversible vision impairing ailments like cataract, conjunctivitis, glaucoma, uveitis, diabetic retinopathy (DR), diabetic macular edema (DME), age related macular degeneration (AMD), cytomegalovirus (CMV) retinitis, retinitis pigmentosa (RP), retinal vein occlusion (RVO), endophthalmitis affecting both anterior and posterior segment of eye. The treatment needed to reach the site of action is restricted by its characteristic barriers. The protective mechanism turns into hurdles when it comes to drug delivery especially in case of posterior segment of eye. Most common and preferable routes for ocular drug delivery are topical and systemic routes owing to their compliance and non-invasive nature, however they turned inefficient in delivering drugs to posterior segment. Currently, other local routes like intraocular and periocular (subconjunctival, subtenon, posterior juxtascleral, retrobulbar, peribulbar) are being explored and are showing positive outcomes in terms of symptomatic relief for a certain time period. But as these are invasive techniques, they also have some hidden long-term drawbacks on other side. Various advancements have been achieved till date in delivery of drug to posterior segment of eye, however despite these advancements; there is need of non-invasive or preferably less invasive technique considering prolonged treatments for such ailments. At times, dependency on invasive techniques may cause problems like patient incompliance, inflammation, contact cataract, retinal detachment, endophthalmitis etc. Here, in this review, barriers in ocular delivery, routes and recent advances in drug delivery to eye including patented commercial formulations with emphasis on posterior segment will be discussed. Copyright © 2018. Published by Elsevier Masson SAS.
Keywords: Administration, Ophthalmic; Animals; *Drug Delivery Systems; Drug Design; *Eye/me [Metabolism]; Eye/pp [Physiopathology]; *Eye Diseases/dt [Drug Therapy]; Eye Diseases/pp [Physiopathology]; Humans; Pharmaceutical Preparations/ad [Administration & Dosage]; Pharmaceutical Preparations/me [Metabolism]; Tissue Distribution

Healthcare Utilization by Glaucoma Patients in a Team Care Model. - Damento, Gena M; Winkler, Nelson S; Hodge, David O; Khanna, Sunil S; Khanna, Cheryl L (Seminars in ophthalmology, 2018)
PURPOSE: To determine the effect of a glaucoma team care model on resource utilization and efficiency in glaucoma management., METHODS: Retrospective cohort study of 358 patients diagnosed and treated for glaucoma. Analysis included number of patient visits, diagnostic tests, and glaucoma procedures performed before (2005-2007) and after (2008-2010) implementation of a team care model in 2008. Patients not involved in the model served as controls., RESULTS: Number of patient visits did not change significantly after model implementation (p > .05). Diagnostic tests significantly increased in comprehensive ophthalmologist and glaucoma subspecialist groups 25 months after diagnosis (p = .03 and p = .001). Procedures increased for glaucoma subspecialists but was not statistically significant (p = .06). Optometrists used billing codes with significantly lower reimbursement than other providers (p < .001)., CONCLUSIONS: Team care model had neutral effect on patient visits and increased testing. Continued evaluation of this model is required to determine its effect on disease progression and outcomes.
Keywords: Aged; Female; Follow-Up Studies; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Ophthalmologists/st [Standards]; *Patient Acceptance of Health Care; *Practice Patterns, Physicians'; Retrospective Studies

Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic. - Stanley, Jordan; Huisingh, Carrie E; Swain, Thomas A; McGwin, Gerald Jr; Owsley, Cynthia; Girkin, Christopher A; Rhodes, Lindsay A (Journal of glaucoma, 2018)
PURPOSE: To determine the level of adherence to the American Academy of Ophthalmology preferred practice pattern (PPP) guidelines for quality primary open-angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists., METHODS: Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients' charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis., RESULTS: Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus examination 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. in total, 32.8% of patients were seen once, whereas the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%; P=0.0346), review of systems (100.0% vs. 97.5%; P=0.0346), gonioscopy (60.0% vs. 22.0%; P<0.001), CCT (94.2% vs. 77.1%; P<0.001), visual field (97.5% vs. 40.7%; P<0.001), and target IOP (22.4% vs. 1.7%; P<0.001) compared with single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% vs. 68.9%; P<0.001) and had an established target IOP (35.1% vs. 1.4%; P<0.001) compared with POAGS patients., CONCLUSIONS: Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing dilated fundus examination, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.
Keywords: Academies and Institutes; Aged; Ambulatory Care Facilities; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Gonioscopy; *Guideline Adherence/st [Standards]; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ophthalmology/st [Standards]; *Optometrists/st [Standards]; Patient Compliance; Physical Examination; Pilot Projects; *Practice Patterns, Physicians'/st [Standards]; Tonometry, Ocular; Visual Field Tests; Visual Fields/ph [Physiology]

Reconsidering the Postoperative Day 0 Visit for Retina Surgery. - Ringeisen, Alexander L; Parke, David Wilkin 3rd (Ophthalmic surgery, lasers & imaging retina, 2018)
BACKGROUND AND OBJECTIVE: This study compares outcomes of patients who were examined on postoperative (PO) day 0 and PO day 1 following retina surgery., PATIENTS AND METHODS: A nonrandomized, comparative, retrospective series of one vitreoretinal surgeon was conducted on 166 patients with a PO day 0 visit (approximately 5 hours following surgery) and 428 patients with a PO day 1 visit., RESULTS: Among patients examined at PO day 0, 4.6% had hypotony (intraocular pressure [IOP] <= 5 mm Hg) and 1.8% needed intervention for elevated IOP (IOP >= 30 mm Hg) compared with 1.6% and 4.0% of patients, respectively, examined on PO day 1., CONCLUSION: Following retina surgery, there is a similar percentage of patients with abnormal IOP when patients are examined on PO day 0 when compared with PO day 1. However, the rate of hypotony was statistically higher on PO day 0, and there was a trend toward more elevated IOP on PO day 1. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e52-e56.]. Copyright 2018, SLACK Incorporated.
Keywords: Female; Follow-Up Studies; Humans; Incidence; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/ep [Epidemiology]; Ocular Hypertension/pp [Physiopathology]; *Ocular Hypotension/di [Diagnosis]; Ocular Hypotension/ep [Epidemiology]; Ocular Hypotension/pp [Physiopathology]; *Office Visits/sn [Statistics & Numerical Data]; *Postoperative Complications; Postoperative Period; *Retinal Diseases/su [Surgery]; Retrospective Studies; Time Factors; United States/ep [Epidemiology]; *Vitreoretinal Surgery/mt [Methods]

Glaucoma Drugs in the Pipeline. - Kaufman, Paul L; Mohr, Mary E; Riccomini, Scott P; Rasmussen, Carol A (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2018)
Glaucoma is a chronic disease that can be challenging to treat for both patients and physicians. Most patients will require more than 1 medication over time to maintain their intraocular pressure (IOP) at a physiologically benign level. Patients may become refractory to existing compounds and many struggle with adherence to multiple topical drop regimens. The field of glaucoma therapeutics has been advancing rapidly with an emphasis on compounds comprising multiple molecules/mechanisms of action that offer additivity and are complementary to current therapeutics. Several new topical drop compounds directly targeting the trabecular meshwork (TM)/Schlemm canal/conventional outflow pathway to reduce outflow resistance have obtained US Food and Drug Administration approval in the past year. These include rho kinase inhibitors and nitric oxide donating compounds. Alternative therapies that offer long-term IOP lowering while removing the patient from the drug delivery system are moving forward in development. These include gene therapy and stem cell strategies, which could ease or eliminate the burden of topical drop self-administration for several years. Additionally, a variety of novel formulations and devices are in development that aim for controlled, steady state delivery of therapeutics over periods of months. The future of glaucoma therapy is focusing on an increase in specificity for the individual patient: their type of glaucoma; underlying mechanisms; genetic make-up; comorbid conditions; and rate of progression. Maintaining functional vision and improving patient outcomes remains the goal in glaucoma therapeutics. The current collection of novel therapeutics offers an expanded set of tools to achieve that goal. Copyright 2018 Asia-Pacific Academy of Ophthalmology.
Keywords: Adenosine/ag [Agonists]; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Delayed-Action Preparations/tu [Therapeutic Use]; Drug Implants; *Genetic Therapy/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/ph [Physiology]; *Molecular Targeted Therapy/mt [Methods]; Nitric Oxide Donors/tu [Therapeutic Use]; Prostaglandins/tu [Therapeutic Use]; Protein Kinase Inhibitors/tu [Therapeutic Use]; rho-Associated Kinases/ai [Antagonists & Inhibitors]

A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery. - Zhao, Peter Y; Rahmathullah, Raheem; Stagg, Brian C; Almobarak, Faisal; Edward, Deepak P; Robin, Alan L; Stein, Joshua D (JAMA ophthalmology, 2018)
Importance: Medical and surgical interventions for glaucoma are effective only if they are affordable to patients. Little is known about how affordable glaucoma interventions are in developing and developed countries., Objective: To compare the prices of topical glaucoma medications, laser trabeculoplasty, and trabeculectomy relative with median annual household income (MA-HHI) for countries worldwide., Design, Setting and Participants: Cross-sectional observational study. For each country, we obtained prices for glaucoma medications, laser trabeculoplasty, and trabeculectomy using government pricing data, drug databases, physician fee schedules, academic publications, and communications with local ophthalmologists. Prices were adjusted for purchasing power parity and inflation to 2016 US dollars, and annual therapy prices were examined relative to the MA-HHI. Interventions costing less than 2.5% of the MA-HHI were considered affordable., Main Outcomes and Measures: Daily cost for topical glaucoma medications, cost of annual therapy with glaucoma medications, laser trabeculoplasty, and trabeculectomy relative to MA-HHI in each country., Results: Data were obtained from 38 countries, including 17 developed countries and 21 developing countries, as classified by the World Economic Outlook. We observed considerable variability in intervention prices compared with MA-HHI across the countries and across interventions, ranging from 0.1% to 5% of MA-HHI for timolol, 0.1% to 27% for latanoprost, 0.2% to 17% for laser trabeculoplasty, and 0.3% to 42% for trabeculectomy. Timolol was the most affordable medication in all countries studied and was 2.5% or more of MA-HHI in only 2 countries (5%). The annual cost of latanoprost was 2.5% or more of MA-HHI in 15 countries (41%) (15 developing countries [75%] and no developed countries). The cost of laser trabeculoplasty was 2.5% or more of the MA-HHI in 15 countries (44%) (11 developing countries [65%] and 4 developed countries [24%]). The cost of trabeculectomy was 2.5% or more of the MA-HHI in 28 countries (78%) (18 developing countries [95%] and 10 developed countries [59%]). In 18 countries (53%), laser trabeculoplasty cost less than a 3-year latanoprost supply., Conclusions and Relevance: For many patients worldwide, the costs of medical, laser, and incisional surgical interventions were 2.5% or more of the MA-HHI. Successfully reducing global blindness from glaucoma requires addressing multiple contributing factors, including making glaucoma interventions more affordable.
Comment in (CIN)
Keywords: Administration, Ophthalmic; *Antihypertensive Agents/ec [Economics]; Costs and Cost Analysis; Cross-Sectional Studies; Drug Costs; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; Glaucoma/su [Surgery]; *Glaucoma/th [Therapy]; Global Health; Health Services Accessibility/ec [Economics]; Humans; Income; Intraocular Pressure; *Laser Coagulation/ec [Economics]; Latanoprost/ec [Economics]; Male; Middle Aged; Timolol/ec [Economics]; *Trabeculectomy/ec [Economics]

The Glaucoma Intensive Treatment Study (GITS), a randomized clinical trial: design, methodology and baseline data. - Bengtsson, Boel; Heijl, Anders; Johannesson, Gauti; Andersson-Geimer, Sabina; Aspberg, Johan; Linden, Christina (Acta ophthalmologica, 2018)
PURPOSE: The primary objective of the ongoing Glaucoma Intensive Treatment Study (GITS) is to evaluate the effectiveness of immediate intensive treatment in comparison with the commonly recommended stepped regimen on the predicted visual field. The two treatment arms are also being compared regarding quality of life (QoL), intraocular pressure (IOP) reduction, frequency of reported side-effects, adverse events and adherence to prescribed treatment., DESIGN: A randomized, two-centre, prospective open-labelled treatment trial for open-angle glaucoma., PARTICIPANTS: Individuals aged 40-78 years with previously untreated and newly diagnosed glaucoma with early to moderate visual field loss were eligible., METHODS: Patients were randomized to initial treatment either using drug monotherapy in accordance with common glaucoma guidelines or using a more intensive approach including eyedrops containing drugs from three different classes combined with 360degree laser trabeculoplasty. The patients are to be followed for 5 years at visits including standard automated perimetry, optical coherence tomography (OPT) and tonometry. Change of treatment is allowed and decided upon jointly with the patient as in conventional glaucoma management., MAIN OUTCOME: The estimated predicted preserved visual field and QoL at end of expected lifetime., RESULTS: A total of 242 patients, 45% females, mean age 68 years, were randomized. The median untreated IOP was 24 mm Hg, and the median visual field index (VFI), indicating the percentage of a full field, was 92%., CONCLUSION: Glaucoma Intensive Treatment Study is a clinical trial in which two groups of patients randomized to different initial intensities of IOP-reducing treatment are being compared with regard to rate of visual field progression and prediction of serious glaucomatous visual field loss at estimated at end of life. Copyright © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Adult; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Follow-Up Studies; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Prospective Studies; Quality of Life; *Trabeculectomy/mt [Methods]; Treatment Outcome; Visual Acuity; *Visual Fields

[The role of fixed dose combinations in the treatment of primary open-angle glaucoma]. - Petrov, S Yu; Zinina, V S; Volzhanin, A V (Vestnik oftalmologii, 2018)
A great number of patients with primary open-angle glaucoma require combination therapy with several hypotensive drugs of different pharmacological groups to efficiently compensate the intraocular pressure (IOP) and prevent further development of glaucoma. Although glaucoma treatment usually starts with monotherapy, several preparations administered simultaneously have stronger hypotensive effect further increased by their additive action. However, the increased frequency of instillations may lead to drug washout and decreased patient compliance. Fixed dose combinations (FDCs) are a pharmacological form of eye drops that combines two or more active drugs in a single dosage form. The frequency of FDCs administration does not exceed two per day, which is convenient for long-term application and helps improve patient compliance. FDCs tolerability tends to be higher than that of simultaneous instillations of separate monotherapy drugs, while the hypotensive in clinical trials is comparable, in some real practice trials is superior. A review of existing studies showed that FDCs are superior to monotherapy in terms of cost-effectiveness. The use of FDCs was found to be beneficial for glaucoma treatment from the viewpoints of both reaching the target IOP for preserving visual functions in glaucoma patients, and minimizing the long-term treatment costs.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; *Antihypertensive Agents; Drug Combinations; *Glaucoma; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle; Humans; Intraocular Pressure; *Ocular Hypertension; Timolol; Tonometry, Ocular

Differences in Tertiary Glaucoma Care in the Veterans Affairs Health Care System. - Lee, Aaron Y; Lee, Cecilia S; Pieters, Matthew; Maa, April Y; Cockerham, Glenn; Lynch, Mary G (JAMA ophthalmology, 2018)
Importance: Glaucoma is a common cause of visual impairment in the Veterans Affairs (VA) health care system, but to our knowledge, no data exist concerning tertiary glaucoma care (ie, laser and filtering surgery)., Objective: To determine whether the rate of tertiary glaucoma care differs among veterans cared for through the 4 different eye care delivery models that are present in the VA: optometry-only clinics, ophthalmology-only clinics, clinics with optometry and ophthalmology functioning as a single integrated clinic with ophthalmology as the lead, and clinics with optometry and ophthalmology functioning as separate clinics., Design, Setting, and Participants: In this retrospective review of the Veterans Health Administration Support Service Center database, 490926 veterans with a glaucoma-related diagnosis received care from 136 VA medical centers during fiscal year 2016. Demographic and baseline clinical factors, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, and Current Procedural Terminology codes, and the rates of glaucoma surgery procedures were extracted from the database. The organizational structure of each VA eye clinic was obtained. Univariate and multivariate regression analyses were performed for log percent for laser peripheral iridotomy (LPI), laser trabeculoplasty (LTP), and filtering surgery., Main Outcomes and Measures: Rates of LPI, LTP, and filtering surgery., Results: Of the 490926 veterans with a glaucoma-related diagnosis, 465842 (94.9%) were male, 309677 (63.1%) were white, and 203243 (41.4%) were aged 65 to 74 years. The rate of LPI was 0.30%, 0.28%, 0.67%, and 0.69% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of LTP was 0.31%, 1.06%, 0.93%, and 0.92% in care delivery models that included optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). The rate of filtering surgery was 0.32%, 0.51%, 0.69%, and 0.60% in optometry-only clinics, ophthalmology-only clinics, integrated clinics, and separated clinics, respectively (P < .001). Multivariate regression analyses showed that these differences remained significantly different even after adjusting for potential confounders., Conclusions and Relevance: Disparities exist in the use of tertiary glaucoma services within the VA, and different care delivery models may play a role. Outcomes of glaucoma care for the different models of eye care delivery were not analyzed in this study.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities; Female; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; *Iris/su [Surgery]; Laser Therapy; Male; Middle Aged; Ophthalmology/sn [Statistics & Numerical Data]; Optometry/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Retrospective Studies; *Tertiary Healthcare/sn [Statistics & Numerical Data]; *Trabeculectomy; United States; *United States Department of Veterans Affairs/sn [Statistics & Numerical Data]

Eye care utilisation in Newfoundland and Labrador: access barriers and vision health outcomes. - Lee, Elizabeth Y; Cui, Kangping; Trope, Graham E; Buys, Yvonne M; Chan, Christina H; Thavorn, Kednapa; Jin, Ya-Ping (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2018)
OBJECTIVE: Our prior study revealed significantly lower use of eye care providers in Newfoundland and Labrador (NFLD). This study reports factors associated with this low use and related vision health outcomes., DESIGN: Cross-sectional survey., PARTICIPANTS: A total of 14 925 Caucasian respondents to the Canadian Community Health Survey - Healthy Aging 2008/2009 aged >=65 years., METHODS: Univariate and multivariate analyses were performed using self-reported survey data., RESULTS: NFLD, along with 3 other provinces, does not insure seniors for routine eye examinations. Among seniors without self-reported glaucoma, cataracts, and diabetes, the use of eye care providers in NFLD (36.3%) is the lowest compared with provinces with (50.7%, p < 0.05) and without (42.2%, p > 0.05) government-insured eye examinations. Among seniors with known eye disease insured for eye care in all provinces, eye care utilisation in NFLD (63.1%) is still the lowest across all provinces (69.4%-71.3%, p > 0.05). Compared with the national average, NFLD seniors have significantly higher proportions of low income (61.7% vs 47.4%), no postsecondary education (53.6% vs 42.2%), and rural residency (40.6% vs 18.9%). These factors are all associated with low levels of eye care utilisation. Compared with insured provinces, NFLD has a significantly lower prevalence of self-reported cataracts (16.7% vs 23.1) and glaucoma (3.8% vs 7.0%), and a slightly higher prevalence of presenting visual impairment (4.0% vs 3.5%)., CONCLUSIONS: Lack of government insurance, low socioeconomic status, and living in nonurbanised areas all contribute to the underutilisation of eye care providers in NFLD. This underutilisation appears to be associated with reduced detection of eye diseases. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; Cross-Sectional Studies; Female; *Health Services Accessibility/og [Organization & Administration]; *Health Surveys/mt [Methods]; *Healthcare Disparities/ec [Economics]; Humans; *Insurance Coverage/ec [Economics]; Male; Middle Aged; National Health Programs; Newfoundland and Labrador; *Ophthalmology/og [Organization & Administration]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Vision Disorders/ec [Economics]; *Vision Disorders/th [Therapy]

Corneal Infections Associated with Sleeping in Contact Lenses - Six Cases, United States, 2016-2018. - Cope, Jennifer R; Konne, Nuadum Muriel; Jacobs, Deborah S; Dhaliwal, Deepinder K; Rhee, Michelle K; Yin, Jia; Steinemann, Thomas L (MMWR. Morbidity and mortality weekly report, 2018)
Contact lenses, when worn and cared for properly, are a safe and effective form of vision correction used by an estimated 45 million Americans. However, contact lens wearers are at risk for contact lens-related eye infections, especially when wearers do not practice proper contact lens wear and care habits. These infections, affecting the cornea and known as microbial keratitis (Figure), can lead to serious adverse health outcomes. Because contact lenses are regulated by the Food and Drug Administration (FDA) as medical devices, contact lens-related corneal infections should be reported to FDA as an adverse event. To illustrate their serious health implications, six cases of contact lens-related corneal infection, in which sleeping in lenses was reported as the main risk factor, are presented. Consequences of infection reported among the identified cases included the need for frequent administration of antibiotic eye drops, multiple follow-up medical appointments, and permanent eye damage. Health education measures directed toward contact lens wearers should emphasize raising awareness of the risks of sleeping in contact lenses as well as adherence to all recommendations for the wear and care of contact lenses. Additional measures are needed to educate eye care professionals about the need to report contact lens-related corneal infections to MedWatch, the FDA Safety Information and Adverse Event Reporting program (https://www.fda.gov/MedWatch/).
Keywords: Adolescent; Adult; *Contact Lenses/ae [Adverse Effects]; Contact Lenses/px [Psychology]; *Corneal Diseases/di [Diagnosis]; Corneal Diseases/ep [Epidemiology]; *Eye Infections/di [Diagnosis]; Eye Infections/ep [Epidemiology]; Female; Humans; Male; Middle Aged; *Risk-Taking; *Sleep; United States/ep [Epidemiology]

Usage of glaucoma-specific patient-reported outcome measures (PROMs) in the Singapore context: a qualitative scoping exercise. - Hee, Owen Kim; Thng, Zheng-Xian; Zhu, Hong-Yuan; Lamoureux, Ecosse Luc (BMC ophthalmology, 2018)
BACKGROUND: Despite the increasing emphasis on the role of glaucoma-specific patient-reported outcome measures (PROMs) as relevant outcome measures for the impact of glaucoma and its intervention on patients' daily lives, the feasibility of implementing PROMs in the routine clinical setting in Singapore remains undefined. We aim to evaluate the comprehensibility, acceptability, and relevance of four glaucoma-specific PROMs at healthcare professionals' and patients' level in a Singapore context., METHODS: Sixteen ophthalmic healthcare professionals and 24 glaucoma patients, with average age 60 years (SD = 15), were invited from a tertiary hospital in Singapore. Semi-structured interviews were conducted to explore participants' perceptions on the content and administration of four glaucoma-specific PROMs - the Glaucoma Quality of Life-15, Glaucoma Symptom Identifier, Independent Mobility Questionnaire and Treatment Satisfaction Survey of Intra-ocular Pressure. Semi-structured interviews were hand transcribed, and analysed thematically. Each participant filled out a feasibility survey at the end of interview., RESULTS: 79% of glaucoma patients and 94% of glaucoma healthcare professionals felt selected PROMs relevant to patients. 63% of glaucoma patients and 50% of healthcare professionals felt that selected PROMs were sufficiently comprehensive for clinical use. 46% of glaucoma patients and 56% of healthcare professionals felt selected PROMs were user-friendly., CONCLUSIONS: Using PROMs in the Singapore clinical setting receives promising support from both healthcare professionals and patients. The identified potential barriers tailored to Singapore clinical setting will help successful implementation of PROMs into routine clinical care.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Feasibility Studies; Female; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Patient Reported Outcome Measures; Quality of Life; Singapore/ep [Epidemiology]; *Surveys and Questionnaires/st [Standards]

Identification and description of controlled clinical trials published in Spanish Ophthalmology Journals. - Loezar, Cristobal; Madrid, Eva; Jahr, Catalina; Daviu, Antonio; Ahumada, Herman; Pardo-Hernandez, Hector; Keller, Eva; Bonfill, Xavier (Ophthalmic epidemiology, 2018)
PURPOSE: Properly conducted controlled clinical trials (CCTs) provide the highest level of evidence for optimising decision-making in healthcare. Electronic search strategies do not exhaustively retrieve them, because of issues related to indexing, exclusion of journals in languages other than English, among others. A handsearch approach is therefore warranted. We aimed to identify all CCTs published in Ophthalmology journals in Spain, to describe their main features, and to submit them to the Cochrane Register of CCTs (CENTRAL)., METHODS: After identifying all Spanish Ophthalmology Journals, we conducted a systematic handsearch following Cochrane guidelines. When appropriate, results were compared against electronic searches. A descriptive analysis was completed, including risk of bias assessment., RESULTS: We identified 18 eligible journals; 10 074 original articles, editorials, letters to the editor, abstracts and conference proceedings were assessed via handsearching for inclusion. Of these, 136 were subject to title and abstract screening, after which 102 were classified as CCTs. We identified three articles via electronic searches that had not been detected via handsearch, for a total of 105 CCTs. Among these, the most investigated pathologies were cataracts (32/105; 30.5%) and glaucoma (23/105 21.9%). Regarding risk of bias, 104/105 (99.0%) were deemed as "high risk of bias", mainly due to flaws in sequence generation and allocation concealment. 15/105 (14.3%) mentioned conflicts of interest, half of which had something to declare. No CCT reported adherence to CONSORT., CONCLUSION: Spanish Ophthalmology journals publish a low number of CCTs, with limited methodological quality. Handsearching was more sensitive than the electronic searching. Abbreviations CCT: Controlled clinical trial.
Keywords: *Controlled Clinical Trials as Topic; *Decision Making; *Eye Diseases/th [Therapy]; Humans; *Ophthalmology; *Periodicals as Topic; Spain

Therapy for Open-Angle Glaucoma. - Marshall, Leisa L; Hayslett, Renee L; Stevens, Gregg A (The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2018)
OBJECTIVE: Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG)., DATA SOURCES: Articles indexed in PubMed, Scopus, and Cochrane Library in the last 10 years using the key words "glaucoma," "open-angle glaucoma," and "'open-angle glaucoma' AND 'treatment.'" Primary sources were used to locate additional resources. ClinicalTrials. gov was used to locate unpublished studies., STUDY SELECTION AND DATA EXTRACTION: Eighty-one publications were reviewed and criteria supporting the primary objective were used to identify useful resources., DATA SYNTHESIS: The literature included practice guidelines, review articles, original research articles, and product prescribing information for POAG., CONCLUSION: The POAG optic neuropathies result in optic disk damage and visual field loss. Ophthalmic medication therapy retards glaucoma progression, but many older patients require multiple medications to preserve vision and quality of life. An agent from the ophthalmic prostaglandin analog class is used as initial therapy in current practice because of the convenience of once-a-day administration and lower incidence of systemic side effects and slightly increased efficacy compared with other available ophthalmic medication classes. The other ophthalmic medication classes used in clinical practice include the beta-adrenergic blocking agents, the alpha-2 adrenergic agonists, and the carbonic anhydrase inhibitors. Proper ophthalmic eye-drop administration and medication adherence are imperative for preserving vision in POAG. Selective laser trabeculoplasty is a viable alternative to ophthalmic medications either initially or if a patient experiences ocular or systemic side effects from medication therapy. A modified prostaglandin analog was approved by the Food and Drug Administration in November 2017; its role in clinical practice is still evolving.
Keywords: *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/de [Drug Effects]; *Ophthalmic Solutions/tu [Therapeutic Use]; Trabeculectomy

Characteristics of Patients Receiving Treatment Who Deny A Diagnosis Glaucoma or Elevated Intraocular Pressure in the United States. - Lowry, Eugene A; Mansberger, Steven L (Journal of glaucoma, 2018)
PURPOSE: The purpose of this study was to determine the proportion of patients in the US population who are receiving long-term intraocular pressure (IOP)-lowering medication, but, deny having a diagnosis of glaucoma or elevated IOP., MATERIALS AND METHODS: The National Health and Nutrition Examination Survey (NHANES) is a home-based survey of a cross-sectional, representative, stratified sample of the US population every 2 years. Questions on prescription medication use are asked in every survey cycle, and patients were questioned whether they had ever been diagnosed with glaucoma or elevated IOP in the 2005-2006 and 2007-2008 surveys. During these 2 cycles, there were 7081 participants over age 40 of whom 135 endorse at least one year of topical IOP-lowering medication and were included in the final study., RESULTS: A total of 8.8% of Americans taking IOP-lowering medications for at least one year denied a diagnosis of glaucoma or high eye pressure. Patients taking more medications were more likely to endorse their diagnosis., CONCLUSIONS: Over 150,000 Americans being treated for glaucoma or ocular hypertension may be unaware or deny a glaucoma diagnosis. Improving this awareness may enhance adherence. Patient awareness of their diagnosis is essential to quality care.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Awareness; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; United States

Impact of Ocular Compatible Lipoids and Castor Oil in Fabrication of Brimonidine Tartrate Nanoemulsions by 33 Full Factorial Design. - Rimple; Newton, Maria J (Recent patents on inflammation & allergy drug discovery, 2018)
BACKGROUND: Brimonidine Tartrate (BRT) is used in the treatment of glaucoma. Brimonidine tartrate nanoemulsion was fabricated in this research work to enhance the permeability through barriers and faster onset of action and therapeutic effect., OBJECTIVE: To fabricate an ocular compatible nanoemulsion of brimonidine tartrate by using surfactant and co-surfactants., METHODS: The experimental work involved compatibility studies by using FTIR, DSC and crystallinity study by XRD. The prepared nanoemulsion was studied by photon correlation spectroscopy by Malvern S90 for the particle size analysis and characterized for Z average value (d.nm.) and PDI. Further studies were conducted by laser light scattering technique by delsanano common and TEM., RESULTS: The study demonstrated that the formulations BN2, BN3, BN10 demonstrated the z average value of 19.48, 22.14,26.50 d.nm. With 0.337, 0.270, 0.289 PDI respectively, the formulae BN2, BN3, BN10 demonstrated the distribution average diameter (nm) of 376.8 + 258.4, 542.8 + 494.4, 398.8 + 263.9 with the diameter of 267.5, 298.5, 272.7, respectively. The zeta potential of BN10 was -21.26 mV and other parameters such as TEM and drug release studies were also reported., CONCLUSION: The nanoemulsion of brimonidine tartrate was prepared successfully by using castor oil, Lipoid S75 (Fat free soybean phospholipids with 70% phosphatidylcholine), Lipoid E80 (Egg phospholipids with 80% phosphatidylcholine) and PF- 68. The optimised formula demonstrated the lower droplet size, satisfactory zeta potential, and high drug loading and reproducible drug release profile. Brimonididne taratarate is reported in various recent patents for various applications and is the potential candidate for future therapy. Nanoemulsion is widely explored as potential alternatives for conventional ophthalmic formulation based approaches. It enhances the ocular bioavailability by reducing the drug protein binding, increasing the corneal resident time, enhancing the drug permeability and providing a sustained drug release.It reported a significant increase in therapeutic efficacy for various chronic ocular disease states of both the anterior and posterior ocular segments. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
Keywords: Administration, Ophthalmic; Biological Availability; *Brimonidine Tartrate/ch [Chemistry]; Brimonidine Tartrate/tu [Therapeutic Use]; Castor Oil/ch [Chemistry]; Chemistry, Pharmaceutical; *Delayed-Action Preparations/ch [Chemistry]; Drug Carriers; *Glaucoma/dt [Drug Therapy]; Humans; *Nanostructures/ch [Chemistry]; Patents as Topic; *Phospholipids/ch [Chemistry]; Soybeans

Comparison of Goldmann applanation, non-contact, dynamic contour and tonopen tonometry measurements in healthy and glaucomatous eyes, and effect of central corneal thickness on the measurement results. - Yildiz, Aydin; Yasar, Tekin (Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2018)
Aim To compare the correlation of intraocular pressure (IOP) measurements obtained using Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), dynamic contour tonometer (DCT) and tono-pen (TP) in glaucomatous and healthy eyes, and to investigate the effect of central corneal thickness (CCT) on the measurements. Methods One hundred eyes of 100 glaucoma patients and 50 eyes of 50 healthy individuals were compared. In all of the eyes, CCT was evaluated using ultrasonic pachymeter. IOP was measured using NCT, TP, DCT and GAT, respectively. IOP measurements and correlation of these measurements with CCT were calculated using Pearson and intra-group correlation analysis. Results In the glaucoma group, the mean IOP was 16.42 +/- 2.80 mmHg with NCT, 17.12 +/- 2.49 mmHg with TP, 18.27 +/- 2.62 mmHg with DCT and 16.08 +/- 3.00 mmHg with GAT. The mean CCT was 532.15 +/- 39.08 mum. In normal individuals, mean IOP was 14.64 +/- 2.20 mmHg with NCT, 15.32 +/- 1.85 mmHg with TP, 16.72 +/- 2.31 mmHg with DCT and 14.16 +/- 2.80 mmHg with GAT. The mean CCT was 538.40 +/- 31.64 mum. Conclusion A strong compliance between NCT and GAT has been observed. NCT can be used instead of GAT. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.
Keywords: Adult; Aged; Aged, 80 and over; *Cornea; Eye/pp [Physiopathology]; Female; *Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure; Male; Manometry; Middle Aged; *Tonometry, Ocular/mt [Methods]

Determinants of medication adherence to topical ocular hypotensives and application of health belief model among glaucoma patients visiting a tertiary care hospital in coastal Karnataka, India. - Kaup, Soujanya; Oomman, Sithara Sara; Shivalli, Siddharudha (Indian journal of ophthalmology, 2018)
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; India; *Intraocular Pressure; *Medication Adherence; *Tertiary Care Centers

Cerebrospinal fluid and vitreous body exposure to orally administered tafamidis in hereditary ATTRV30M (p.TTRV50M) amyloidosis patients. - Monteiro, Cecilia; Martins da Silva, Ana; Ferreira, Natalia; Mesgarzadeh, Jaleh; Novais, Marta; Coelho, Teresa; Kelly, Jeffery W (Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis, 2018)
Hereditary transthyretin (TTR) amyloidosis associated with the TTRV30M (p.TTRV50M) mutation presents predominantly as an axonal polyneuropathy, with variable involvement of other organs. Serious central nervous system (CNS) and eye manifestations, including stroke, dementia, vitreous opacities and glaucoma, have been reported in untreated V30M TTR amyloidosis patients, and in these patients after treatment with liver transplantation (LT). Distinct therapies for V30M TTR amyloidosis developed during the last decade exhibit promising results in slowing the peripheral and autonomic nervous system pathology. However, the effect of these therapies on the CNS and eye manifestations of V30M TTR amyloidosis is not known. Herein, we show that in a small cohort of patients taking tafamidis orally (20 mg tafamidis meglumine daily) we could detect this small molecule in the cerebrospinal fluid (CSF) and the vitreous body. In the CSF, the ratio of TTR tetramer to tafamidis was =2:1, leading to a moderate kinetic stabilization of TTR in the CSF of these patients. Our data suggest that tafamidis can cross the CSF-blood and eye-blood barriers. Future studies comparing CNS and eye manifestations in patients treated with LT, kinetic stabilizers or TTR lowering drugs are essential to understand the clinical effect of our observations.
Keywords: Administration, Oral; Adult; *Amyloid Neuropathies, Familial/dt [Drug Therapy]; *Amyloid Neuropathies, Familial/me [Metabolism]; Amyloid Neuropathies, Familial/su [Surgery]; *Benzoxazoles/ad [Administration & Dosage]; *Benzoxazoles/pk [Pharmacokinetics]; *Cerebrospinal Fluid/me [Metabolism]; Chromatography, High Pressure Liquid; Female; Humans; Liver Transplantation; Male; Mutation/ge [Genetics]; Prealbumin/me [Metabolism]; *Vitreous Body/me [Metabolism]

Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII). - Chew, Fiona L M; Salowi, Mohamad Aziz; Mustari, Zuraidah; Husni, Mohd Aziz; Hussein, Elias; Adnan, Tassha Hilda; Ngah, Nor Fariza; Limburg, Hans; Goh, Pik-Pin (PloS one, 2018)
BACKGROUND: Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique., METHODS: Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed., RESULTS: A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively., CONCLUSION: Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
Keywords: Aged; Aged, 80 and over; Blindness/di [Diagnosis]; *Blindness/ep [Epidemiology]; Female; Humans; Malaysia/ep [Epidemiology]; Male; Middle Aged; Prevalence; Risk Factors; Vision Disorders/di [Diagnosis]; *Vision Disorders/ep [Epidemiology]; Visual Acuity

Glaucoma and Quality of Life. - Biggerstaff, Kristin Schmid; Lin, Albert (International ophthalmology clinics, 2018)
Keywords: Activities of Daily Living/px [Psychology]; *Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; Humans; Outcome Assessment, Health Care/mt [Methods]; Patient Satisfaction; *Quality of Life; *Sickness Impact Profile

The Effect of an Educational Intervention on Adherence to Intraocular Pressure-Lowering Medications in a Large Cohort of Older Adults with Glaucoma. - Fiscella, Richard; Caplan, Eleanor; Kamble, Pravin; Bunniran, Suvapun; Uribe, Claudia; Chandwani, Hitesh (Journal of managed care & specialty pharmacy, 2018)
BACKGROUND: Glaucoma is a progressive, irreversible disease that can lead to vision loss and lower quality of life if treatment is not optimized. Effective glaucoma therapies are available to lower intraocular pressure (IOP) and minimize or delay disease progression. Nonetheless, adherence to treatment remains suboptimal for many patients., OBJECTIVE: To identify potentially nonadherent patients and evaluate the effect of patient- and physician-centric educational interventions on adherence by using a validated predictive model of nonadherence to glaucoma medication., METHODS: This prospective, randomized, controlled, and interventional study included Humana Medicare Advantage Prescription Drug plan patients with a glaucoma diagnosis between May and October 2014, >= 1 pharmacy claim for glaucoma medication, and >= 50% likelihood of nonadherence. Patients and physicians were randomized to cohorts A (no interventions), B (physician intervention), or C (patient and physician interventions). Physicians in cohorts B and C received information on the model, adherence, and patient profiles at baseline and months 3, 6, and 9. Patients in cohort C received educational materials on glaucoma and adherence (same schedule). The primary outcome was the proportion of days covered (PDC) with medication over 12 months. Adherence was defined as PDC >= 0.80., RESULTS: Overall, 23,306 patients and 2,955 physicians were eligible. After excluding physicians with < 3 nonadherent patients, each cohort included 200 physicians and 600 patients. Mean PDC was 0.54-0.56 across cohorts. At 12 months, >= 90.5% of physicians and >= 75.5% of patients remained in the study; mean PDC was 0.53-0.54 across cohorts. No statistically significant between-cohort differences in PDC and adherence were observed., CONCLUSIONS: Intensive educational mailings to patients and their physicians did not improve PDC or adherence in this large population of potentially nonadherent patients with glaucoma. Findings highlight the difficulty of improving adherence in a disease that requires lifelong therapy despite being largely asymptomatic and can inform development of future interventions aimed at improving adherence to glaucoma therapy., DISCLOSURES: This study was sponsored by Allergan plc (Dublin, Ireland). Fiscella and Chandwani are employees of Allergan plc. Caplan, Kamble, Bunniran, and Uribe are employees of Comprehensive Health Insights, a Humana company. The authors did not receive honoraria or other payments for authorship.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Disease Progression; Female; Forecasting; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Humans; Intraocular Pressure/de [Drug Effects]; Ireland; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Medication Therapy Management/ec [Economics]; *Medication Therapy Management/og [Organization & Administration]; Models, Theoretical; *Patient Education as Topic/ec [Economics]; Prospective Studies; Quality of Life

Herpetic eye disease study: lessons learned. - Kalezic, Tanja; Mazen, Mostafa; Kuklinski, Eric; Asbell, Penny (Current opinion in ophthalmology, 2018)
PURPOSE OF REVIEW: Ophthalmic herpes simplex virus (HSV) of the anterior segment is responsible for a range of corneal complications such as scarring, thinning, neovascularization, and severe loss of vision. This review provides current guidelines for treating anterior segment disease related to HSV., RECENT FINDINGS: We first review findings from the Herpetic Eye Disease Study (HEDS) clinical trials, and then review new topical and antiviral therapies developed since the HEDS studies. The development of vaccines to prevent recurrent episodes of herpetic infection is briefly reviewed. New corneal surgical procedures, developed since HEDS, may put patients at risk for ocular HSV disease: cross-linking and excimer refractive surgery., SUMMARY: HEDS established the standard of HSV ocular therapy and is still valid today. However, newer antivirals may provide easier compliance with improved bioavailability, efficacy, dosage, and tolerability. Further research is needed to prevent latency of HSV, decrease recurrences, and more effectively treat necrotizing keratitis associated with HSV.
Keywords: *Antiviral Agents/tu [Therapeutic Use]; *Eye Infections, Viral/dt [Drug Therapy]; Eye Infections, Viral/pc [Prevention & Control]; Herpes Simplex Virus Vaccines/ad [Administration & Dosage]; Humans; *Keratitis, Herpetic/dt [Drug Therapy]; Keratitis, Herpetic/pc [Prevention & Control]; Recurrence; Simplexvirus/py [Pathogenicity]

Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria. - Abdull, Mohammed M; Broadway, David C; Evans, Jennifer; Kyari, Fatima; Muazu, Fatima; Gilbert, Clare (Clinical & experimental ophthalmology, 2018)
IMPORTANCE: To investigate the safety, effectiveness and follow-up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria., BACKGROUND: There is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor., DESIGN: Prospective case series., PARTICIPANTS: New glaucoma patients where surgical intervention was recommended., METHODS: A diode 810 nm laser G-probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits., MAIN OUTCOME MEASURES: IOP < 22 mmHg, change in >=2 lines of Snellen visual acuity (VA), and complications., RESULTS: 201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re-treated. Mean pre-treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7-45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months., CONCLUSIONS AND RELEVANCE: Transscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short-term preservation of vision and minimal complications. Poor follow-up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow-up is less critical. Copyright © 2018 The Authors Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Ciliary Body/su [Surgery]; Female; Follow-Up Studies; Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; *Intraocular Pressure/ph [Physiology]; *Laser Coagulation/mt [Methods]; *Lasers, Semiconductor/tu [Therapeutic Use]; Male; Middle Aged; Nigeria/ep [Epidemiology]; Prevalence; Prospective Studies; *Sclera/su [Surgery]; Treatment Outcome; Visual Acuity; *Visual Fields/ph [Physiology]; Young Adult

Various therapies for ocular surface diseases. - Gheorghe, Alina; Rosoga, Ancuta Teodora; Mrini, Fildys; Vargau, Iulia; Gherghiceanu, Florentina (Romanian journal of ophthalmology, 2018)
This paper aims to discuss various therapeutical strategies (corneal cross-linking, amniotic membrane transplantation with or without autologous serum application, medical regenerative therapy) for treating ocular surface diseases according to medical indications, etiology, local and general status of the patient. Besides the evolution and treatment of the lesions induced by corneal foreign body, ocular burns, neurotrophic keratitis, pterygium removal, Mooren's ulcer, this paper also follows and evaluates the migration, stratification and development of corneal epithelium. Of course, the success of the treatment depended on the therapeutic approach, the cause of the disease, the status of the eye and the patients' compliance. All cases presented had good results, proving once again, that a well-chosen therapeutic approach ensures the improvement or cure for many ocular surface diseases nowadays., ABBREVIATIONS: BVCA = best corrected visual acuity, OCT = optical coherence tomography, CLX = corneal cross-linking.
Keywords: Amnion; *Corneal Ulcer/pa [Pathology]; Epithelium, Corneal; *Eye Diseases/th [Therapy]; Humans; Visual Acuity

Preference-based Glaucoma-specific Health-related Quality of Life Instrument: Development of the Health Utility for Glaucoma. - Muratov, Sergei; Podbielski, Dominik W; Kennedy, Kevin; Jack, Susan M; Pemberton, Julia; Ahmed, Iqbal I K; Baltaziak, Monika; Xie, Feng (Journal of glaucoma, 2018)
PURPOSE: To develop a descriptive system for a glaucoma-specific preference-based health-related quality of life (HRQoL) instrument: the Health Utility for Glaucoma (HUG-5)., METHODS: The descriptive system was developed in 2 stages: item identification and item selection. A systematic literature review of HRQoL assessment of glaucoma was conducted using a comprehensive search strategy. Purpose ful sampling was used to recruit patients with different clinical characteristics. Relevant items were presented to glaucoma patients through face-to-face, semistructured interviews. Framework methodology was applied to analyze interview content. The recurring themes identified through an iterative content analysis represented topics of most importance and relevance to patients. These themes formed the domains of the HUG-5 descriptive system. Three versions of the descriptive system, differing in explanatory detail, were pilot tested using a focus group., RESULTS: The literature review identified 19 articles which contained 266 items. These items were included for the full-text review and were used to develop an interview guide. From 12 patient interviews, 22 themes were identified and grouped into 5 domains that informed the 5 questions of the descriptive system. The HUG-5 measures visual discomfort, mobility, daily life activities, emotional well-being, and social activities. Each question has 5 response levels that range from "no problem" to "severe problem." The focus group comprised 7 additional patients unanimously preferred the version that contained detailed, specific examples to support each question., CONCLUSIONS: A 5-domain descriptive system of a glaucoma-specific preference-based instrument, the HUG-5, was developed and remains to be evaluated for validity and reliability in the glaucoma patient population.
Keywords: Aged; Female; Focus Groups; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Patient Acceptance of Health Care/px [Psychology]; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patient Acceptance of Health Care; Patient Preference/px [Psychology]; Patient Preference/sn [Statistics & Numerical Data]; *Patient Preference; *Quality of Life; Reproducibility of Results; Surveys and Questionnaires

Referral to Low Vision Services for Glaucoma Patients: Referral Criteria and Barriers. - Kaleem, Mona A; West, Sheila K; Im, Lily; Swenor, Bonnielin K (Journal of glaucoma, 2018)
PURPOSE: To determine what criteria are being used by glaucoma specialists to refer patients to low vision services (LVS) and to identify potential barriers to LVS referral., METHODS: A survey was emailed to members of the American Glaucoma Society (AGS). The number and percentage of responses to each survey question were examined., RESULTS: Reported criteria for referral included difficulty performing activities related to vision (78%), degree of visual field loss (63%), and difficulty with orientation and mobility (27%). Reported barriers to LVS referral included patients not expressing difficulty with activities related to vision (34%), not having enough time to counsel patients during clinic visits (32%), and perceiving that patients would not be able to afford LVS even if they were referred (31%)., CONCLUSIONS: Among glaucoma specialists, patient-reported difficulties with vision-related activities were the most common criteria used for LVS referral. Reported barriers to LVS referral, including perceived patient economic restraints and insufficient time to counsel patients during clinic visits, need to be addressed through appropriate interventions.
Keywords: Adult; Communication Barriers; Female; Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; Glaucoma/th [Therapy]; Humans; Intraocular Pressure; Male; Patient Acceptance of Health Care/px [Psychology]; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Physician-Patient Relations; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; *Referral and Consultation/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Vision Disorders/di [Diagnosis]; *Vision Disorders/ep [Epidemiology]; Vision Disorders/et [Etiology]; Vision Disorders/th [Therapy]; Vision, Low/di [Diagnosis]; *Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]; Vision, Low/th [Therapy]; Visual Field Tests

Fungal keratitis caused by Laetisaria arvalis. - Dudeja, Lakshey; Jeganathan, Lakshmipriya; Prajna, N Venkatesh; Prajna, Lalitha (Indian journal of medical microbiology, 2018)
A 53-year-old female presented with keratitis (right eye) after fall of insect 10 days back. The ulcer worsened in spite of aggressive treatment with topical natamycin (5%) and amphotericin-B (0.15%) eye drops and finally perforated. Iris tissue sealed the perforation site, and ulcer healed with formation of adherent leucoma. This case represents first reported case of keratitis caused by Laetisaria arvalis and stresses on aggressive course of keratitis caused by this fungus. Importance of DNA sequencing in identification of unidentified fungal species is also highlighted.
Keywords: Amphotericin B/tu [Therapeutic Use]; *Antifungal Agents/tu [Therapeutic Use]; *Basidiomycota/de [Drug Effects]; Basidiomycota/ge [Genetics]; *Basidiomycota/ip [Isolation & Purification]; *Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; *Eye Infections, Fungal/dt [Drug Therapy]; Eye Infections, Fungal/mi [Microbiology]; Female; Humans; *Keratitis/dt [Drug Therapy]; Keratitis/mi [Microbiology]; Middle Aged; Natamycin/tu [Therapeutic Use]

The Role of Microbiota in Retinal Disease. - Rowan, Sheldon; Taylor, Allen (Advances in experimental medicine and biology, 2018)
The ten years since the first publications on the human microbiome project have brought enormous attention and insight into the role of the human microbiome in health and disease. Connections between populations of microbiota and ocular disease are now being established, and increased accessibility to microbiome research and insights into other diseases is expected to yield enormous information in the coming years. With the characterization of the ocular microbiome, important insights have already been made regarding corneal and conjunctival tissues. Roles for non-ocular microbiomes in complex retinal diseases are now being evaluated. For example, the gut microbiome has been implicated in the pathogenesis of uveitis. This short review will summarize the few studies linking gut or oral microbiota to diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (AMD). We will also conjecture where the most significant findings still remain to be elucidated. Finally, we will propose the gut-retina axis, related but distinct from the gut-brain axis.
Keywords: Animals; Conjunctiva/mi [Microbiology]; Cornea/mi [Microbiology]; Diabetic Retinopathy/mi [Microbiology]; Diabetic Retinopathy/pc [Prevention & Control]; Disease Models, Animal; Gastrointestinal Microbiome/de [Drug Effects]; Gastrointestinal Microbiome/ph [Physiology]; Germ-Free Life; Glaucoma/mi [Microbiology]; Humans; Macular Degeneration/mi [Microbiology]; Metformin/pd [Pharmacology]; Mice; *Microbiota/ph [Physiology]; Mouth/mi [Microbiology]; *Retinal Diseases/mi [Microbiology]; Uveitis/mi [Microbiology]

Glaucoma Adherence-From Theriac to the Future. - Kinast, Robert M; Mansberger, Steven L (American journal of ophthalmology, 2018)
Keywords: *Antihypertensive Agents/hi [History]; Antihypertensive Agents/tu [Therapeutic Use]; Glaucoma/dt [Drug Therapy]; *Glaucoma/hi [History]; *History of Pharmacy; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; *Medication Adherence; *Ophthalmology/hi [History]

Cannabis in End-of-Life Care: Examining Attitudes and Practices of Palliative Care Providers. - Luba, Rachel; Earleywine, Mitch; Farmer, Stacey; Slavin, Melissa (Journal of psychoactive drugs, 2018)
Medical cannabis research has become quite extensive, with indications ranging from glaucoma to chemotherapy-induced nausea. Despite increased interest in cannabis' potential medical uses, research barriers, cannabis legislation, stigma, and lack of dissemination of data contribute to low adoption for some medical populations. Of interest, cannabis use appears low in palliative care settings, with few guidelines available to palliative care providers. The present study sought to examine the attitudes, beliefs, and practices of palliative care providers regarding the use of cannabis for terminally ill patients. Palliative care providers (N = 426) completed a one-time online survey assessing these attitudes, beliefs, and practices. Results demonstrated that palliative care providers endorse cannabis for a wide range of palliative care symptoms, end-of-life care generally, and as an adjuvant medication. Nevertheless, the gap between these beliefs and actual recommendation or prescription appears vast. Many who support the use of cannabis in palliative care do not recommend it as a treatment. These data suggest recommendations for healthcare providers and palliative care organizations.
Keywords: Adult; Attitude of Health Personnel; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; *Health Personnel/sn [Statistics & Numerical Data]; Humans; Male; *Medical Marijuana/tu [Therapeutic Use]; Middle Aged; *Palliative Care/mt [Methods]; *Terminal Care/mt [Methods]

Effect of a punctal plug on ocular surface disease in patients using topical prostaglandin analogues: a randomized controlled trial. - Sherwin, Justin C; Ratnarajan, Gokulan; Elahi, Babar; Bilkiewicz-Pawelec, Anna; Salmon, John F (Clinical & experimental ophthalmology, 2018)
IMPORTANCE: Ocular surface disease (OSD) is common and can reduce treatment compliance and quality of life., BACKGROUND: To determine whether a punctal plug improves OSD and reduces intraocular pressure (IOP) in patients using prostaglandin analogue monotherapy., DESIGN: Randomized controlled trial., PARTICIPANTS: Sixty eligible subjects aged >18 years with symptomatic OSD from glaucoma clinics were invited to participate. Lacrimal or glaucoma surgery, lid malposition and contact lens wear were exclusion criteria., METHODS: One eye received an inferior punctal plug, leaving the fellow eye as a control., MAIN OUTCOME MEASURES: Ocular surface disease index (OSDI), tear film breakup time (TF-BUT), Oxford cornea score, tear osmolarity and IOP were compared at baseline and 6 weeks by masked investigators., RESULTS: From 60 eligible, 48 (80.0%) participated (mean age 69.6 years; 60.0% female). OSDI reduced following plug insertion (mean difference [MD] 14.5, 95% confidence interval [CI] 5.06-23.94, P < 0.001). Compared to control eyes, in eyes receiving plugs the TF-BUT increased (MD 2.3 s, 95% CI 1.4-3.2, P < 0.001), the Oxford cornea score decreased (MD 0.5, 95% CI 0.3-0.7, P < 0.001), and tear osmolarity decreased (MD 10 mOsm/L, 95% CI 3.5-16.5, P = 0.003). Punctal plugs resulted in a significantly lowered IOP (MD 1.5 mmHg, 95% CI 0.1-2.9, P = 0.032). Sub-group analyses showed similar efficacy regardless of prostaglandin preservative status or lubricant drop use. Plugs were well tolerated but extrusion occurred in 8.5%, and epiphora increased in 6.5% eyes., CONCLUSIONS AND RELEVANCE: Punctal plug insertion improves subjective and objective measures of OSD and results in a reduced IOP in patients with symptomatic ocular surface disease using prostaglandin analogue monotherapy. Copyright © 2018 Royal Australian and New Zealand College of Ophthalmologists.
Comment in (CIN), Comment in (CIN)
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; Dry Eye Syndromes/co [Complications]; Dry Eye Syndromes/pp [Physiopathology]; *Dry Eye Syndromes/th [Therapy]; Female; Glaucoma/co [Complications]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; *Intraocular Pressure/ph [Physiology]; Lacrimal Apparatus; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Prostaglandins, Synthetic/ad [Administration & Dosage]; *Punctal Plugs; *Quality of Life; Treatment Outcome

Zika and the Eye: Pieces of a Puzzle. - de Oliveira Dias, Joao Rafael; Ventura, Camila V; de Paula Freitas, Bruno; Prazeres, Juliana; Ventura, Liana O; Bravo-Filho, Vasco; Aleman, Tomas; Ko, Albert Icksang; Zin, Andrea; Belfort, Rubens Jr; Maia, Mauricio; Zika Virus Study Group (Progress in retinal and eye research, 2018)
Zika virus (ZIKV) is an arbovirus mainly transmitted to humans by mosquitoes from Aedes genus. Other ways of transmission include the perinatal and sexual routes, blood transfusion, and laboratory exposure. Although the first human cases were registered in 1952 in African countries, outbreaks were only reported since 2007, when entire Pacific islands were affected. In March 2015, the first cases of ZIKV acute infection were notified in Brazil and, to date, 48 countries and territories in the Americas have confirmed local mosquito-borne transmission of ZIKV. Until 2015, ZIKV infection was thought to only cause asymptomatic or mild exanthematous febrile infections. However, after explosive ZIKV outbreaks in Polynesia and Latin American countries, it was confirmed that ZIKV could also lead to Guillain-Barre syndrome and congenital birth abnormalities. These abnormalities, which can include neurologic, ophthalmologic, audiologic, and skeletal findings, are now considered congenital Zika syndrome (CZS). Brain abnormalities in CZS include cerebral calcifications, malformations of cortical development, ventriculomegaly, lissencephaly, hypoplasia of the cerebellum and brainstem. The ocular findings, which are present in up to 70% of infants with CZS, include iris coloboma, lens subluxation, cataract, congenital glaucoma, and especially posterior segment findings. Loss of retinal pigment epithelium, the presence of a thin choroid, a perivascular choroidal inflammatory infiltrate, and atrophic changes within the optic nerve were seen in histologic analyses of eyes from deceased fetuses. To date, there is no ZIKV licensed vaccines or antiviral therapies are available for treatment. Preventive measures include individual protection from mosquito bites, control of mosquito populations and the use of barriers measures such as condoms during sexual intercourse or sexual abstinence for couples either at risk or after confirmed infection. A literature review based on studies that analyzed ocular findings in mothers and infants with CZS, with or without microcephaly, was conducted and a theoretical pathophysiologic explanation for ZIKV-ocular abnormalities was formulated. Copyright © 2018 Elsevier Ltd. All rights reserved.
Keywords: Eye Infections, Viral/co [Complications]; *Eye Infections, Viral/cn [Congenital]; Eye Infections, Viral/tm [Transmission]; Female; Humans; Microcephaly/co [Complications]; Microcephaly/vi [Virology]; Pregnancy; *Pregnancy Complications, Infectious/vi [Virology]; Zika Virus/py [Pathogenicity]; *Zika Virus; Zika Virus Infection/co [Complications]; *Zika Virus Infection/cn [Congenital]; Zika Virus Infection/tm [Transmission]

Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults. - Sharafeldin, Noha; Kawaguchi, Atsushi; Sundaram, Aishwarya; Campbell, Sandy; Rudnisky, Chris; Weis, Ezekiel; Tennant, Matthew T S; Damji, Karim F (The British journal of ophthalmology, 2018)
BACKGROUND/AIMS: Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration., METHODS: Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease., RESULTS: Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings., CONCLUSIONS: This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology. Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: Chronic Disease; *Cost-Benefit Analysis/ec [Economics]; *Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/ec [Economics]; *Diagnostic Techniques, Ophthalmological/ec [Economics]; *Glaucoma/di [Diagnosis]; Glaucoma/ec [Economics]; Humans; *Macular Degeneration/di [Diagnosis]; Macular Degeneration/ec [Economics]; Mass Screening/ec [Economics]; Quality-Adjusted Life Years; *Telemedicine/ec [Economics]

Delivery of therapeutics for deep-seated ocular conditions - status quo. - Nguyen, Hubert; Eng, Shawn; Ngo, Thanh; Dass, Crispin R (The Journal of pharmacy and pharmacology, 2018)
OBJECTIVES: There is a need for research into designing effective pharmaceutical systems for delivering therapeutic drugs to the posterior of the eye for glaucoma-related pathology, macular degeneration, diabetic retinopathy, macular oedema, retinitis and choroiditis. Conventionally, eye drops have been extensively utilised for topical drug delivery to the anterior segment of the eye, but are less effective for delivery of therapeutics to the back of the eye due to significant barriers hampering drug penetration into the target intraocular tissue. This review explores some of the current and novel delivery systems employed to deliver therapeutics to the back of the eye such as those using liposomes, ocular implants, in situ gels, and nanoparticles, and how they can overcome some of these limitations., KEY FINDINGS: Issues such as blinking, precorneal fluid drainage, tear dilution and turnover, conjunctiva and nasal drug absorption, the corneal epithelium, vitreous drug clearance, and the blood-ocular barriers are reviewed and discussed., SUMMARY: Further studies are needed to address their shortcomings such as drug compatibility and stability, economic viability and patient compliance. Copyright © 2018 Royal Pharmaceutical Society.
Keywords: Biological Availability; Drug Carriers/ch [Chemistry]; Drug Carriers/pk [Pharmacokinetics]; *Drug Delivery Systems/mt [Methods]; Drug Design; *Eye/de [Drug Effects]; Eye/me [Metabolism]; *Eye Diseases/dt [Drug Therapy]; Humans; Liposomes; Nanoparticles/ch [Chemistry]

[Trabecular micro-invasive glaucoma surgery : Procedures and clinical results]. - Junemann, A G M; Rejdak, R; Hohberger, B (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2018)
The management of glaucoma therapy to reduce intraocular pressure commonly consists of a gradual approach with local monotherapy, combined therapy, laser surgery and finally filtration surgery. The local side effects of glaucoma medications and the lack of adherence and persistence to the medical therapy as well as the complication profile of the established glaucoma surgical techniques justify the introduction of new surgical procedures. Micro-invasive glaucoma surgery (MIGS) is a promising new surgical approach. Microstents can reduce the medication burden and prolong the need for filtration surgery. This review article presents the different trabecular implants (iStent, iStent inject, HydrusTM Microstent) in detail and discusses the effectiveness and safety of the procedures based on the currently available data.
Keywords: *Filtering Surgery; Glaucoma/su [Surgery]; *Glaucoma; *Glaucoma Drainage Implants; Humans; Intraocular Pressure; Tonometry, Ocular

CO2 laser-assisted sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. A 1-year follow-up. - Jankowska-Szmul, Judyta; Dobrowolski, Dariusz; Wylegala, Edward (Acta ophthalmologica, 2018)
PURPOSE: To report on the efficacy and safety of CO2 laser-assisted sclerectomy surgery (CLASS) compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma., METHODS: One hundred and thirty-one patients underwent CLASS (66 patients) or trabeculectomy (65 patients) and were followed up for 12 months. 'Complete success' was defined as intraocular pressure (IOP) between 10 and 18 mmHg and reduced by at least 30% from the baseline without medications, while 'qualified success' was compliant with the above criteria with or without the medications., RESULTS: Comparing CLASS with trabeculectomy at 1 year, the mean IOP reduction rate was 32.6 +/- 10.8% versus 40.6 +/- 15.9% (p < 0.001) and the average use of medications was 1.4 +/- 1.4 versus 0.7 +/- 1.1 (p < 0.05). At 12 months, the complete success rate was 35% for CLASS versus 60% for trabeculectomy (p < 0.01), while the qualified success rate was 74% versus 75%, respectively, with no significant difference in qualified success rate between the groups at any time-point (p > 0.05). Compared with CLASS, patients after trabeculectomy developed a higher rate of early complications (9.1% versus 29.2%, p = 0.004), higher endothelial cell density (ECD) loss (1.4 +/- 1.4% versus 6.5 +/- 4.8%, p < 0.001), higher astigmatism (0.0 +/- 0.1 versus 0.1 +/- 0.2, p < 0.001) and significant visual acuity deterioration (0.1 +/- 0.1; range 0-2 lines versus 0.4 +/- 0.6; range 0-3 lines, p = 0.016)., CONCLUSION: Although CLASS shows a less potent hypotensive effect, it is similar to trabeculectomy in the qualified success rate and offers the reduction in medications up to 12 months. With a more attractive complications profile, CLASS may be an alternative to trabeculectomy, especially at the earlier glaucoma stage and in patients with a low ECD. Copyright © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Aged; Exfoliation Syndrome/di [Diagnosis]; Exfoliation Syndrome/pp [Physiopathology]; *Exfoliation Syndrome/su [Surgery]; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Gonioscopy; Humans; *Intraocular Pressure/ph [Physiology]; *Lasers, Gas/tu [Therapeutic Use]; Male; Middle Aged; Prospective Studies; *Sclerostomy/mt [Methods]; *Trabeculectomy/mt [Methods]; Treatment Outcome; *Visual Acuity

A Review of the Clinical Usefulness of Selective Laser Trabeculoplasty in Exfoliative Glaucoma. - Katsanos, Andreas; Konstas, Anastasios G; Mikropoulos, Dimitrios G; Quaranta, Luciano; Voudouragkaki, Irini C; Athanasopoulos, Georgios P; Asproudis, Ioannis; Teus, Miguel A (Advances in therapy, 2018)
In the last decade, selective laser trabeculoplasty (SLT) has been commonly used in the management of several different types of glaucoma, as either primary or adjunct therapy. The technique has an excellent safety profile and is at least as effective as argon laser trabeculoplasty. Although the actual mechanism of action of SLT remains unclear, evidence has shown that it does not induce morphologically evident trabecular meshwork alterations. SLT's non-disruptive mode of action offers the advantage of repeatability. Exfoliation glaucoma (XFG) is a secondary open-angle glaucoma with unfavorable intraocular pressure (IOP) characteristics, which typically carries a poorer long-term prognosis than primary open-angle glaucoma. Consequently, patients with XFG often need multiple medications to achieve IOP levels that prevent disease progression. Because complicated pharmacotherapy regimens undermine the long-term tolerability and compliance of patients with XFG, options such as SLT may decrease the burden of multiple therapies and ultimately improve prognosis. In fact, SLT may be a particularly attractive option in XFG because the pigment-laden trabecular tissue of these patients enhances the absorption of laser energy and thus augments the biologic effects induced by this treatment. The current article reviews the postulated mechanisms of action of SLT, discusses practical aspects of SLT therapy, and examines selected peer-reviewed literature pertaining to the clinical usefulness of this modality in XFG patients.
Keywords: *Exfoliation Syndrome/su [Surgery]; Humans; *Laser Therapy/mt [Methods]; Trabeculectomy/ae [Adverse Effects]; Trabeculectomy/is [Instrumentation]; Trabeculectomy/mt [Methods]; *Trabeculectomy; Treatment Outcome

Policy implications of regional variations in eye disease detection and treatment on Prince Edward Island: a repeated cross-sectional analysis, 2010-2012. - Khan, A M; Trope, G E; Wedge, R; Buys, Y M; El-Defrawy, S; Chen, Q; Jin, Y P (BMC health services research, 2018)
BACKGROUND: In Canada, government insurance covers eye care services provided by ophthalmologists and other physicians. However, government coverage for services provided by optometrists, non-medical school trained primary eye care providers, varies regionally. Little is known about the impact of a funding model in which ophthalmologist services are government-insured but services provided by optometrists are not, on eye care utilization and eye disease detection and treatment. We aimed to address this question by examining geographic variations in eye care service utilization on Prince Edward Island (PEI)., METHODS: PEI physician-billing data from 2010 to 2012 was analyzed across five distinct geographic regions (Charlottetown, Summerside, Prince, Queens & Kings and Stratford). The residential location of patients and practice locations of eye care providers were identified using the first three digits of their respective postal code. Age-standardized rates were computed for comparisons across different regions., RESULTS: There were six ophthalmologists practicing on PEI, five with offices in Charlottetown. Twenty optometrists practiced on the island with offices across the province. Stratford is closest and Prince farthest from Charlottetown. Age-standardized utilization rates of ophthalmologists per 100 populations were 10.44 in Charlottetown and 10.90 in Stratford, which was significantly higher than in other regions (7.74-8.92; p < 0.05). The disparities were most pronounced amongst the elderly. The prevalence of glaucoma visits was higher in Charlottetown (6.10%) and Stratford (6.38%) and lower in other regions. A similar pattern was observed for the prevalence of cataract visits. While the prevalence of diabetes visits was higher in Prince and Summerside, the utilization of ophthalmologists by people with diabetes was almost twice as high in Charlottetown (6.49%) than in Prince (3.88%)., CONCLUSIONS: The observed discrepancies in vision care utilization across geographic regions were likely attributed to barriers in accessing government-insured, geographically concentrated ophthalmologists, as opposed to a reflection of the true differences in eye disease occurrence. The lower prevalence of glaucoma visits in regions farther away from ophthalmologist offices may result in delayed detection and blindness in this population. Encouraging ophthalmologists to work in other areas of the province and/or to publicly fund services provided by optometrists may mitigate the observed disparities., TRIAL REGISTRATION: Not applicable.
Keywords: Adult; Aged; *Cataract/di [Diagnosis]; Cataract/th [Therapy]; Cross-Sectional Studies; Female; *Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; Health Personnel; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Services Research; Humans; Insurance Coverage; Male; Middle Aged; Ophthalmology/og [Organization & Administration]; *Ophthalmology; Optometry/og [Organization & Administration]; *Optometry; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prince Edward Island

Flavonoids as acetylcholinesterase inhibitors: Current therapeutic standing and future prospects. - Khan, Haroon; Marya; Amin, Surriya; Kamal, Mohammad Amjad; Patel, Seema (Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2018)
BACKGROUND: Acetylcholinesterase (AChE), a serine hydrolase, is primarily responsible for the termination of signal transmission in the cholinergic system, owing to its outstanding hydrolyzing potential. Its substrate acetylcholine (ACh), is a neurotransmitter of the cholinergic system, with a predominant effect on motor neurons involved in memory formation. So, by decreasing the activity of this enzyme by employment of specific inhibitors, a number of motor neuron disorders such as myasthenia gravis, glaucoma, Lewy body dementia, and Alzheimer's disease, among others, can be treated. However, the current-available AChE inhibitors have several limitations in terms of efficacy, therapeutic range, and safety., SCOPE AND APPROACH: Primarily due to the non-compliance of current therapies, new, effective and safe inhibitors are being searched for, especially those which act through multiple receptor sites, but do not elicit undesirable effects. In this regard, the evaluation of phytochemicals such as flavonoids, can be a rational approach. The therapeutic potential of flavonoids has already been recognized agaisnt several ailments. This review deals with various plant-derived flavonoids, their preclinical potential as AChE inhibitors, in established assays, possible mechanisms of action, and structural activity relationship (SAR)., RESULTS AND CONCLUSIONS: Subsequently, a number of plant-derived flavonoids with outstanding efficacy and potency as AChE inhibitors, the mechanistic, their safety profiles, and pharmacokinetic attributes have been discussed. Through derivatization of these reported flavonoids, some limitation in efficacy or pharmacokinetic parameters can be addressed. The selected flavonoids ought to be tested in clinical studies to discover new neuro-therapeutic candidates. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
Keywords: Animals; Cholinesterase Inhibitors/ch [Chemistry]; Cholinesterase Inhibitors/ip [Isolation & Purification]; *Cholinesterase Inhibitors/pd [Pharmacology]; Drug Discovery; Flavonoids/ch [Chemistry]; Flavonoids/ip [Isolation & Purification]; *Flavonoids/pd [Pharmacology]; Humans; Structure-Activity Relationship

Comparative cost evaluation of brand name and generic ophthalmology medications in Ontario. - Popovic, Marko; Chan, Clara; Lattanzio, Nisha; El-Defrawy, Sherif; Schlenker, Matthew B (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2018)
Medication cost for the same indication can vary considerably and can affect patient compliance. In this comparative cost analysis of commonly prescribed ophthalmology medications, the differences in cost between generic and brand name medications as well as different medications within an individual drug class were evaluated. Eye preparations from the Ontario Drug Benefit Formulary were identified, and further agents commonly prescribed by ophthalmologists were included. The standardized prescription drug cost, which includes the cost of the medication, mark-up, and dispensing cost, was provided by Ontario Shoppers Drug Mart stores in July 2016 for 103 common medications using typical dosages and durations. Based on medication class, the highest and lowest cost medications were antiallergy agents (Zaditor [ketotifen], Vasocon [naphazoline]), antibiotic ophthalmic solutions (Vigamox [moxifloxacin], generic ciprofloxacin), oral antibiotics (Cipro [ciprofloxacin], generic cephalexin), antibiotic ophthalmic ointments (generic erythromycin, Tobrex [tobramycin]), antiviral treatment (Valtrex [oral valacyclovir], Viroptic [topical trifluridine]), blepharitis treatment (Zithromax [oral azithromycin], generic oral tetracycline), beta-adrenergic inhibitors (Timoptic [topical timolol], generic topical timolol), topical prostaglandin analogues (Xalatan [latanoprost], generic travoprost), oral carbonic anhydrase inhibitors (methazolamide, acetazolamide), topical carbonic anhydrase solutions (Trusopt preservative-free [dorzolamide], Azopt [brinzolamide]), topical alpha-adrenergic agonists (Alphagan [brimonidine], generic brimonidine), topical muscarinic agonists (Isopto carpine [pilocarpine], Diocarpine [pilocarpine]), topical combination glaucoma agents (Cosopt [dorzolamide-timolol], generic dorzolamide-timolol), topical lubricants (Lacri-lube, Isopto tears), topical nonsteroidal anti-inflammatory drugs (Acuvail [ketorolac], Ilevro [nepafenac]), and steroids (Durezol [difluprednate], Pred mild [prednisolone]). Substantial cost differences exist between ophthalmology medications of the same class. We encourage ophthalmologists to be aware of the associated costs of the medications they prescribe and to use this information in their decision making. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: *Antihypertensive Agents/ec [Economics]; Antihypertensive Agents/tu [Therapeutic Use]; Costs and Cost Analysis; *Drug Costs/sn [Statistics & Numerical Data]; *Drugs, Generic/ec [Economics]; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Humans; Ontario; *Ophthalmology/ec [Economics]

Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe in 2015: magnitude, temporal trends and projections. - Bourne, Rupert R A; Jonas, Jost B; Bron, Alain M; Cicinelli, Maria Vittoria; Das, Aditi; Flaxman, Seth R; Friedman, David S; Keeffe, Jill E; Kempen, John H; Leasher, Janet; Limburg, Hans; Naidoo, Kovin; et al. (The British journal of ophthalmology, 2018)
BACKGROUND: Within a surveillance of the prevalence and causes of vision impairment in high-income regions and Central/Eastern Europe, we update figures through 2015 and forecast expected values in 2020., METHODS: Based on a systematic review of medical literature, prevalence of blindness, moderate and severe vision impairment (MSVI), mild vision impairment and presbyopia was estimated for 1990, 2010, 2015, and 2020., RESULTS: Age-standardised prevalence of blindness and MSVI for all ages decreased from 1990 to 2015 from 0.26% (0.10-0.46) to 0.15% (0.06-0.26) and from 1.74% (0.76-2.94) to 1.27% (0.55-2.17), respectively. In 2015, the number of individuals affected by blindness, MSVI and mild vision impairment ranged from 70 000, 630 000 and 610 000, respectively, in Australasia to 980 000, 7.46 million and 7.25 million, respectively, in North America and 1.16 million, 9.61 million and 9.47 million, respectively, in Western Europe. In 2015, cataract was the most common cause for blindness, followed by age-related macular degeneration (AMD), glaucoma, uncorrected refractive error, diabetic retinopathy and cornea-related disorders, with declining burden from cataract and AMD over time. Uncorrected refractive error was the leading cause of MSVI., CONCLUSIONS: While continuing to advance control of cataract and AMD as the leading causes of blindness remains a high priority, overcoming barriers to uptake of refractive error services would address approximately half of the MSVI burden. New data on burden of presbyopia identify this entity as an important public health problem in this population. Additional research on better treatments, better implementation with existing tools and ongoing surveillance of the problem is needed. Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: *Blindness/ep [Epidemiology]; Cataract/co [Complications]; Developed Countries; Diabetic Retinopathy/co [Complications]; Europe/ep [Epidemiology]; Female; Glaucoma/co [Complications]; Humans; Macular Degeneration/co [Complications]; Refractive Errors/co [Complications]

Blindness and Visual Impairment Profile and Rapid Assessment of Avoidable Blindness in South East Asia: Analysis of New Data. 2017 APAO Holmes Lecture. - Das, Taraprasad (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2018)
PURPOSE: The International Agency for Prevention of Blindness (IAPB) South East Asia region (SEAR) that consists of 11 countries contains 26% of the world's population (1,761,000,000). In this region 12 million are blind and 78.5 million are visually impaired. This amounts to 30% of global blindness and 32% of global visual impairment., DESIGN: Rapid assessment of avoidable blindness (RAAB) survey analysis., METHODS: RAAB, either a repeat or a first time survey, was completed in 8 countries in this decade (2010 onwards). These include Bangladesh, Bhutan, India, Indonesia, Maldives, Sri Lanka, Thailand, and Timor Leste., RESULTS: Cataract is the principal cause of blindness and severe visual impairment in all countries. Refractive error is the principal cause of moderate visual impairment in 4 countries: Bangladesh, India, Maldives, and Sri Lanka; cataract continues to be the principal cause of moderate visual impairment in 4 other countries: Bhutan, Indonesia, Thailand, and Timor Leste. Outcome of cataract surgery is suboptimal in the Maldives and Timor Leste., CONCLUSIONS: Rigorous focus is necessary to improve cataract surgery outcomes and correction of refractive error without neglecting the quality of care. At the same time allowances must be made for care of the emerging causes of visual impairment and blindness such as glaucoma and posterior segment disorders, particularly diabetic retinopathy. Copyright 2018 Asia-Pacific Academy of Ophthalmology.
Keywords: Asia, Southeastern/ep [Epidemiology]; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Blindness/pc [Prevention & Control]; Cataract/co [Complications]; Delivery of Health Care/st [Standards]; Health Services Accessibility/st [Standards]; Humans; Prevalence; Refractive Errors/co [Complications]; *Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]; Vision, Low/pc [Prevention & Control]

How do paper and electronic records compare for completeness? A three centre study. - Wu, Clara Hoi Ka; Luk, Sheila M H; Holder, Richard L; Rodrigues, Zena; Ahmed, Faisal; Murdoch, Ian (Eye (London, England), 2018)
OBJECTIVES: Medical records are legal documentation of patients' care hence must be accurate and complete for both medical and legal purposes. Electronic patient record (EPR) systems aim to improve the accuracy of documentation, provide better organisation and access of data. This study compares the completeness of traditional note records and EPR in glaucoma patients., METHODS: Using criteria from the April 2009 National Institute for Health and Care Excellence (NICE) guidelines completeness of data entry was compared between EPR and paper notes in three units. Moorfields Eye Hospital (City Road) uses the Openeyes EPR. Bedford Hospital (Moorfields Eye Centre) and Western Eye Hospital use the Medisoft EPR. The standard was set at 100% compliance for predetermined parameters., RESULTS: One hundred seventy paper notes and 270 electronic records were analysed. With the exception of central corneal thickness (p = 0.31), all other key parameters were more consistently recorded in the paper records than in the EPR. Intraocular pressure (p = 0.004), anterior chamber configuration and depth assessments using gonioscopy (p < 0.001), fundus examination (p = 0.015), past medical history (p < 0.001), medication including glaucoma medication (p < 0.001) and drug allergies (p < 0.001)., CONCLUSIONS: Our results show that paper records are significantly more complete than EPR. This is the case for two different EPRs and three separate sites. We propose additional training to aid data-collection; improving the design of EPRs by investigating factors such as layout and use of forced choice fields.
Erratum in (EIN), Comment in (CIN), Comment in (CIN)
Keywords: Electronic Health Records/st [Standards]; *Glaucoma/th [Therapy]; Humans; *Medical Records/st [Standards]; *Ophthalmology/sn [Statistics & Numerical Data]

Projection of Eye Disease Burden in Singapore. - Ansah, John P; Koh, Victoria; de Korne, Dirk F; Bayer, Steffen; Pan, Chong; Thiyagarajan, Jayabaskar; Matchar, David B; Lamoureux, Ecosse; Quek, Desmond (Annals of the Academy of Medicine, Singapore, 2018)
INTRODUCTION: Singapore's ageing population is likely to see an increase in chronic eye conditions in the future. This study aimed to estimate the burden of eye diseases among resident Singaporeans stratified for age and ethnicity by 2040., MATERIALS AND METHODS: Prevalence data on myopia, epiretinal membrane (ERM), retinal vein occlusion (RVO), age macular degeneration (AMD), diabetic retinopathy (DR), cataract, glaucoma and refractive error (RE) by age cohorts and educational attainment from the Singapore Epidemiology of Eye Diseases (SEED) study were applied to population estimates from the Singapore population model., RESULTS: All eye conditions are projected to increase by 2040. Myopia and RE will remain the most prevalent condition, at 2.393 million (2.32 to 2.41 million) cases, representing a 58% increase from 2015. It is followed by cataract and ERM, with 1.33 million (1.31 to 1.35 million), representing an 81% increase, and 0.54 million (0.53 to 0.549 million) cases representing a 97% increase, respectively. Eye conditions that will see the greatest increase from 2015 to 2040 in the Chinese are: DR (112%), glaucoma (100%) and ERM (91.4%). For Malays, DR (154%), ERM (136%), and cataract (122%) cases are expected to increase the most while for Indians, ERM (112%), AMD (101%), and cataract (87%) are estimated to increase the most in the same period., CONCLUSION: Results indicate that the burden for all eye diseases is expected to increase significantly into the future, but at different rates. These projections can facilitate the planning efforts of both policymakers and healthcare providers in the development and provision of infrastructure and resources to adequately meet the eye care needs of the population. By stratifying for age and ethnicity, high risk groups may be identified and targeted interventions may be implemented.
Keywords: Adult; Age Factors; Aged; Chronic Disease; *Cost of Illness; Ethnic Groups; Eye Diseases/di [Diagnosis]; Eye Diseases/ec [Economics]; Eye Diseases/eh [Ethnology]; *Eye Diseases; Female; *Health Care Rationing; *Health Planning/og [Organization & Administration]; Humans; Male; Middle Aged; Needs Assessment; Prevalence; Risk Factors; Singapore/ep [Epidemiology]

In Vivo Analysis of Prostaglandins-induced Ocular Surface and Periocular Adnexa Modifications in Patients with Glaucoma. - DI Staso, Silvio; Agnifili, Luca; Cecannecchia, Sara; DI Gregorio, Angela; Ciancaglini, Marco (In vivo (Athens, Greece), 2018)
BACKGROUND/AIM: Prostaglandin analogues (PGAs) are a first-line medical treatment for glaucoma because of their powerful intraocular pressure (IOP) lowering effect, few systemic side-effects (SEs), and the once daily administration. Despite the high systemic safety profile, the chronic use of PGAs may induce periocular and ocular surface (OS)-related side effects, which affect a significant proportion of glaucomatous patients. In this review, we summarize the current knowledge about SEs of PGAs on periocular structures and OS, and their implications in clinical practice., MATERIALS AND METHODS: A comprehensive literature search on the PubMed platform was performed. Two hundred fifty articles fulfilling key words were identified, of which 180 were excluded since they did not concern the effects of PGAs on the periocular tissues and OS, or because of their limited relevance. The following key words were used and combined, to narrow-down the literature: "prostaglandin" and "ocular surface," which identified 184 unique publications, of which 68 were selected; "prostaglandin" and "periocular" which identified 46 unique publications, of which 11 were selected. An additional search was conducted using "prostaglandin" and "Meibomian glands (MGs)", which identified twenty unique publications, of which 8 were selected. Thus, a total of 70 articles were chosen based on their relevance and were included in this review., RESULTS: Prostaglandin-associated peri-orbitopathy, skin pigmentation and hypertrichosis, eyelash growth, and MGs dysfunction are the most frequent modifications of periocular tissues. They are induced by the tissue accumulation of PGAs, and FP receptor stimulation. Without preservatives, PGAs act as stimulators of conjunctival goblet cells, which are the main source of ocular surface mucoproteins, and seem to increase conjunctival epithelium microcysts proposed as in vivo hallmark of the trans-scleral aqueous humour outflow. Additional PGA-induced modifications can be recognized in the cornea, corneo-scleral limbus, conjunctival stroma and, conjunctiva-associated lymphoid tissue, mainly appearing as inflammatory changes. OS epithelia desquamation, chemosis, apoptosis, dendritic cell activation, conjunctival or episcleral vasodilation, and sub-basal nerve plexus disruption were also described in patients receiving preserved PGAs., CONCLUSION: PGAs induce several modifications of the OS structures and adnexa; nonetheless, none of them significantly reduces the local safety profile of this class of drugs. Moreover, the OS changes do not affect the IOP lowering efficacy of PGAs. On these bases, local SEs of PGAs should not discourage clinicians in using this class of medications because of their efficacy, the systemic safety profile, and the better adherence. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
Keywords: Animals; *Conjunctiva/de [Drug Effects]; *Conjunctiva/pa [Pathology]; Corneal Stroma; Endothelium, Corneal/de [Drug Effects]; Endothelium, Corneal/me [Metabolism]; Endothelium, Corneal/pa [Pathology]; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; *Glaucoma/pa [Pathology]; Goblet Cells/de [Drug Effects]; Goblet Cells/me [Metabolism]; Goblet Cells/pa [Pathology]; Humans; Meibomian Glands/me [Metabolism]; Meibomian Glands/pa [Pathology]; Microscopy, Confocal; Prostaglandins, Synthetic/pd [Pharmacology]; *Prostaglandins, Synthetic/tu [Therapeutic Use]

Patient Acceptance of Sustained Glaucoma Treatment Strategies. - Varadaraj, Varshini; Kahook, Malik Y; Ramulu, Pradeep Y; Pitha, Ian F (Journal of glaucoma, 2018)
PURPOSE: To assess patient acceptance of different methods for delivering sustained-release, intraocular pressure (IOP)-lowering medications., METHODS: Electronic surveys were administered to 150 patients at 2 glaucoma clinics. Participants were questioned on their willingness to accept: (1) drug-eluting contact lenses, (2) ring inserts (3) punctal plugs, and (4) subconjunctival injections as alternatives to IOP-lowering eye drops based on various success levels. Multivariable logistic regression models determined the association between device type and treatment acceptance adjusting for age, sex, study site, cost burden of drops, and previous contact lens use., RESULTS: The majority (69%) of participants were 55 to 74 years of age, and white (65%), and half were female. The majority of participants would accept contacts (59%), rings (51%), plugs (57%), and subconjunctival injections (52%) if they obviated glaucoma surgery; fewer would accept these devices if they reduced (23% to 35%) or eliminated (27% to 42%) drops. Most participants would also accept contacts (56%), plugs (55%), and subconjunctival injections (53%) if they were more effective than eye drops, whereas only 47% would accept a ring; fewer would accept any device if it were equally or less effective than drops. Participants were also 36% (95% confidence interval=0.44-0.92; P=0.02) less likely to accept rings and 32% (95% confidence interval=0.47-0.98; P=0.04) less likely to accept subconjunctival injections as compared with contacts., CONCLUSION: Most glaucoma patients considered sustained drug-delivery modalities acceptable alternatives to IOP-lowering eye drops, but only when they were said to obviate surgery or demonstrate greater efficacy than eye drops.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Contact Lenses/ae [Adverse Effects]; Contact Lenses/px [Psychology]; Contact Lenses/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Delayed-Action Preparations/ad [Administration & Dosage]; Drug Delivery Systems/ae [Adverse Effects]; Drug Delivery Systems/px [Psychology]; Drug Delivery Systems/sn [Statistics & Numerical Data]; *Drug Delivery Systems; Female; Glaucoma/ep [Epidemiology]; *Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Glaucoma Drainage Implants/ae [Adverse Effects]; Glaucoma Drainage Implants/px [Psychology]; Glaucoma Drainage Implants/sn [Statistics & Numerical Data]; *Glaucoma Drainage Implants; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Patient Compliance/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Tonometry, Ocular

Optometry-facilitated teleophthalmology: an audit of the first year in Western Australia. - Bartnik, Stephen E; Copeland, Stephen P; Aicken, Angela J; Turner, Angus W (Clinical & experimental optometry, 2018)
BACKGROUND: Lions Outback Vision has run a state-wide teleophthalmology service since 2011. In September 2015 the Australian federal government introduced a Medicare reimbursement for optometry-facilitated teleophthalmology consultations under specific circumstances. This audit demonstrates the first 12 months experience with this scheme. We aim to provide practical insights for others looking to embed a telemedicine program as part of delivering outreach clinical services., METHODS: A 12-month retrospective audit was performed between September 2015 and August 2016, inclusive. A research officer used a specifically designed data extraction tool to record information from all teleophthalmology consultations performed in the time period. The primary outcome was the diagnosis at the end of the teleophthalmology consultation. Secondary outcome measures included the number of teleconsultations, cataract surgery rate, remoteness area of patients referred and imaging accompanying the referral., RESULTS: In the 12-month period, 709 patients were referred resulting in 683 teleophthalmology teleconsultations. Cataract was the most frequent diagnosis (n = 287, 42.7 per cent), followed by glaucoma (n = 77, 11 per cent), age-related macular degeneration (n = 30, 4.4 per cent) and diabetic retinopathy (n = 26, 3.8 per cent). Of those who had teleconsultations, 98.6 per cent were from Outer Regional, Remote or Very Remote Australia. One or more accompanying images or investigations were part of 349 (49 per cent) teleconsultations, most commonly optical coherence tomography (215, 30 per cent) and fundus photography (148, 21 per cent). Face-to-face consultations were undertaken at an outreach clinic in 23 (3.4 per cent) cases, to determine the diagnosis. There were no statistically significant factors associated with attendance at teleophthalmology consultation, or for successfully undergoing cataract surgery., CONCLUSION: Teleophthalmology is a valuable adjunct to regional outreach ophthalmology services, providing patients with increased access to specialist care for a wide range of ophthalmic conditions, and more efficient access to surgical care. Copyright © 2018 Optometry Australia.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; *Delivery of Health Care/sn [Statistics & Numerical Data]; *Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; Female; *Health Services Accessibility; Humans; Male; *Medical Audit; Middle Aged; *Ophthalmology/sn [Statistics & Numerical Data]; *Optometry/sn [Statistics & Numerical Data]; Referral and Consultation; Retrospective Studies; Rural Population; *Telemedicine/sn [Statistics & Numerical Data]; Western Australia

Analysing barriers to service improvement using a multi-level theory of innovation: the case of glaucoma outpatient clinics. - Turner, Simon; Vasilakis, Christos; Utley, Martin; Foster, Paul; Kotecha, Aachal; Fulop, Naomi J (Sociology of health & illness, 2018)
The development and implementation of innovation by healthcare providers is understood as a multi-determinant and multi-level process. Theories at different analytical levels (i.e. micro and organisational) are needed to capture the processes that influence innovation by providers. This article combines a micro theory of innovation, actor-network theory, with organisational level processes using the 'resource based view of the firm'. It examines the influence of, and interplay between, innovation-seeking teams (micro) and underlying organisational capabilities (meso) during innovation processes. We used ethnographic methods to study service innovations in relation to ophthalmology services run by a specialist English NHS Trust at multiple locations. Operational research techniques were used to support the ethnographic methods by mapping the care process in the existing and redesigned clinics. Deficiencies in organisational capabilities for supporting innovation were identified, including manager-clinician relations and organisation-wide resources. The article concludes that actor-network theory can be combined with the resource-based view to highlight the influence of organisational capabilities on the management of innovation. Equally, actor-network theory helps to address the lack of theory in the resource-based view on the micro practices of implementing change. Copyright © 2018 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
Keywords: *Ambulatory Care Facilities; Anthropology, Cultural; *Delivery of Health Care/mt [Methods]; *Diffusion of Innovation; Efficiency, Organizational; *Glaucoma; Health Personnel; Health Services Research; Humans; *Organizational Innovation; State Medicine/og [Organization & Administration]; United Kingdom

Eye Drop Dispenser Type and Medication Possession Ratio in Patients With Glaucoma: Single-Use Containers Versus Multiple-Use Bottles. - Na, Kun-Hoo; Yoo, Chungkwon; Park, Ji-Hye; Kim, Yong Yeon (American journal of ophthalmology, 2018)
PURPOSE: To determine whether the consumption of topical glaucoma medication is influenced by the type of eye drop dispenser., DESIGN: Retrospective cohort study., METHODS: We examined 366 patients with open-angle glaucoma or ocular hypertension who were bilaterally treated with 0.0015% tafluprost or 2% dorzolamide/0.5% timolol fixed combination (DTFC). The patients were grouped by the type of dispenser and content of eye drops used: (1) tafluprost in bottles (T-Bottle group); (2) tafluprost in unit-dose pipettes (T-Unit group); (3) DTFC in bottles (C-Bottle group); and (4) DTFC in unit-dose pipettes (C-Unit group). We evaluated the medication possession ratio (MPR) among groups, and factors associated with over-consumption (MPR > 1.2) or under-consumption (MPR < 0.8) in multinomial logistic regression., RESULTS: The mean MPR was 1.49 (range, 0.69-2.91) in the T-Bottle group, 0.91 (range, 0.32-1.27) in the T-Unit group, 1.25 (range, 0.51-2.60) in the C-Bottle group, and 0.96 (range, 0.36-1.60) in the C-Unit group. The Bottle groups demonstrated higher mean values and wider ranges of MPR compared to the Unit groups. The MPR interval at which the largest number of patients were found was 1.0-1.4 in the Bottle groups and 0.8-1.2 in the Unit groups. Bottle-type dispenser (odds ratio [OR] 64.02), tafluprost medication (OR 2.84), and older age (OR 1.03) were associated with over-consumption, whereas no factor was correlated with under-consumption., CONCLUSIONS: The type of eye drop dispenser affects the consumption of glaucoma medication. Physicians should consider the type of eye drop dispenser when assessing glaucoma medication adherence. Copyright © 2018 Elsevier Inc. All rights reserved.
Keywords: Administration, Ophthalmic; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Drug Combinations; *Drug Packaging; *Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; *Prostaglandins F/ad [Administration & Dosage]; Retrospective Studies; *Sulfonamides/ad [Administration & Dosage]; *Thiophenes/ad [Administration & Dosage]; *Timolol/ad [Administration & Dosage]

Association between meibomian gland dysfunction and compliance of topical prostaglandin analogs in patients with normal tension glaucoma. - Lee, Tae Hee; Sung, Mi Sun; Heo, Hwan; Park, Sang Woo (PloS one, 2018)
PURPOSE: The aim of this study was to investigate the association between tear film and meibomian gland parameters in patients with normal tension glaucoma (NTG), who underwent topical prostaglandin analog (PGA) monotherapy, and medication compliance., METHODS: Ocular surface disease index (OSDI), Schirmer's test, tear film break-up time (TBUT), keratoepitheliopathy (KEP) score with fluorescein, and meibomian gland parameters were assessed in 45 eyes of 45 patients with NTG (NTG group), who received topical PGA monotherapy for more than 1 year. The results were compared to those of 40 eyes of 40 normal subjects (control group). Medication compliance was assessed by an 8-item Morisky Medication Adherence Scale (MMAS-8). Multiple logistic regression analysis was used to identify the factors associated with medication compliance., RESULTS: There was a significant difference in OSDI (P = 0.043), Schirmer's test (P < 0.001), TBUT (P < 0.001), KEP score (P = 0.015) and all meibomian gland parameters (all P < 0.001) between two groups. When the NTG group was divided into compliant and non-compliant groups based on the scores of MMAS-8, 30 (75%) patients were classified into the compliant group. Multiple logistic regression analysis revealed that the lid margin score (OR, 0.256; 95% CI, 0.072-0.908, P = 0.035), meibum score (OR, 0.144; 95% CI, 0.023-0.915, P = 0.04), and meibo score (OR, 0.344; 95% CI, 0.140-0.845, P = 0.02) were significant factors associated with compliance in patients with NTG. The meibomian gland parameters showed a negative correlation with medication compliance (all P < 0.005)., CONCLUSIONS: Malfunction of the meibomian glands can be an important clinical finding associated with compliance of PGA monotherapy in patients with NTG.
Keywords: Administration, Topical; Cross-Sectional Studies; Female; Humans; *Low Tension Glaucoma/dt [Drug Therapy]; *Low Tension Glaucoma/pp [Physiopathology]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; *Meibomian Glands/de [Drug Effects]; *Meibomian Glands/pp [Physiopathology]; Middle Aged; *Prostaglandins, Synthetic/ad [Administration & Dosage]; *Prostaglandins, Synthetic/pd [Pharmacology]; Prostaglandins, Synthetic/tu [Therapeutic Use]; Tears/de [Drug Effects]

Temporal Expression of Genes in Biofilm-Forming Ocular Candida albicans Isolated From Patients With Keratitis and Orbital Cellulitis. - Ranjith, Konduri; Kalyana Chakravarthy, Sama; Adicherla, HariKrishna; Sharma, Savitri; Shivaji, Sisinthy (Investigative ophthalmology & visual science, 2018)
Purpose: To study antibiotic susceptibility and biofilm-forming potential of ocular isolates of Candida albicans along with gene expression., Methods: Seven clinical isolates of C. albicans (keratitis-6 and orbital cellulitis-1) were evaluated. Biofilm formation in one isolate was monitored by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Expression of 27 genes (real-time PCR) associated with biofilm formation and virulence was compared between biofilm-positive and biofilm-negative ocular C. albicans isolates. The temporal expression (4 to 72 hours) of the 27 overexpressed genes was also determined. Similar studies were also done with biofilm-positive and biofilm-negative nonocular C. albicans., Results: Four of seven ocular C. albicans isolates exhibited the potential to form biofilm, one of which was resistant to three antifungals, whereas three were susceptible to all. SEM studies indicated that biofilm increased from two to three adherent layers of cells at 24 hours to multiple layers by 72 hours. CLSM showed that biofilm thickness increased from 5.2 mum at 24 hours to 17.98 mum at 72 hours. Upregulation of 27 genes involved in virulence and biofilm formation was observed both in the ocular and nonocular C. albicans positive for biofilm formation and compared to the respective non-biofilm-forming C. albicans. The results also indicated similarity in expression of genes between biofilm-forming ocular and nonocular pathogenic C. albicans. Temporal expression of the 27 genes (involved in adhesion, initiation, maturation, and dispersal stages of biofilm) in the biofilm-positive ocular isolate indicated that expression pattern followed four different patterns., Conclusions: This is the first study showing similarity in expression of genes in biofilm-forming ocular and nonocular isolates of C. albicans, suggesting that upregulated genes could serve as a potential target for developing therapeutic strategies.
Keywords: Antifungal Agents/pd [Pharmacology]; *Biofilms; Candida albicans/ip [Isolation & Purification]; *Candida albicans/ph [Physiology]; Candida albicans/ul [Ultrastructure]; Candidiasis/mi [Microbiology]; *Eye Infections, Fungal/mi [Microbiology]; *Gene Expression Regulation, Fungal/ph [Physiology]; *Genes, Fungal/ge [Genetics]; Humans; *Keratitis/mi [Microbiology]; Microbial Sensitivity Tests; Microscopy, Confocal; Microscopy, Electron, Scanning; *Orbital Cellulitis/mi [Microbiology]; Real-Time Polymerase Chain Reaction

The Role of Minimally Invasive Glaucoma Surgery Devices in the Management of Glaucoma. - Fingeret, Murray; Dickerson, Jaime E Jr (Optometry and vision science : official publication of the American Academy of Optometry, 2018)
SIGNIFICANCE: Noncompliance is a problem affecting glaucoma patients. Approaches to improve adherence include the use of drug-delivery systems and safer forms of surgery. Minimally invasive glaucoma surgery (MIGS) has reduced complications, particularly in combination with cataract surgery, and with its good intraocular pressure (IOP) reduction may reduce or eliminate glaucoma medications.Glaucoma is a progressive disease and a leading cause of irreversible blindness. Elevated IOP is the most important risk factor, but effective medical management is dependent on patient adherence. This review summarizes the adherence problem in glaucoma and the efforts, including MIGS, to provide effective IOP control that is not dependent on patient compliance. The current understanding of patient adherence to pharmacological treatment of glaucoma is discussed including the challenges facing glaucoma patients. Historical approaches to providing IOP control in a sustained and reliable way are presented culminating in a review of the burgeoning use of MIGS devices.It is estimated that, in the United States, 27% of prescriptions written, across all medications, are not filled or are filled but not taken. For ocular hypotensive medications, even when filled, a large percentage (which varies widely by study) are not instilled as prescribed. To address this problem, methods for sustained drug delivery have been and continue to be developed, as well as surgical and laser approaches. Most recently, MIGS devices have gained popularity because of the ease of implantation during cataract surgery, favorable safety profile, and the possibility for effective and long-lasting IOP lowering, as well as the reduction or elimination of need for IOP-lowering medication.Poor adherence to treatment is relatively common among glaucoma patients and is associated with progression of disease. Recommending MIGS implantation during cataract surgery may offer optometrists a valuable treatment option in managing glaucoma patients, particularly where good adherence is in doubt.
Erratum in (EIN)
Keywords: Cataract Extraction; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Glaucoma Drainage Implants; Humans; *Intraocular Pressure/ph [Physiology]; *Minimally Invasive Surgical Procedures; Patient Compliance

Psychometric Properties of the Glaucoma Treatment Compliance Assessment Tool (GTCAT) in a Brazilian Population. - Abe, Ricardo Y; Wen, Lorena de Campos; Barker, Gordon T; Mansberger, Steven L (Journal of glaucoma, 2018)
PURPOSE: To determine the psychometric properties of a reduced version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), which was translated to Brazilian Portuguese., PATIENTS AND METHODS: We translated into Portuguese the GTCAT using validated techniques and administered it to a group of glaucoma patients using at least 1 ocular hypotensive eye drop medication. We used principal components analysis to determine construct validity, Rasch analysis, and Cronbach alpha for internal consistency reliability, frequency analysis for floor and ceiling effects, and Spearman rho for test-retest reliability., RESULTS: We included 76 glaucoma patients. Principal component analysis loaded 14 questions into 7 components that were consistent with the Health Belief Model. The components were related to "barriers due to lack of drops," "self-efficacy," "experience of negative effects of the disease," "well-being," "general glaucoma knowledge," "glaucoma symptoms," and "cues-to-action." No statements had floor or ceiling effects, and all statements had acceptable test-retest reliability. Components had internal consistency Cronbach alpha reliability between 0.125 and 0.794. and average Spearman rho reliability was 0.73, ranging from 0.44 to 1.00. According to Rasch analysis, the mean (+/-SD) of the person measures was 0.24+/-0.15 logits, person separation index was 0.58, and person reliability 0.25., CONCLUSIONS: The Portuguese-translated version of the GTCAT showed acceptable psychometric properties. With further refinement, clinicians and researchers could use it to better investigate glaucoma adherence issues in the Brazilian population.
Keywords: Administration, Ophthalmic; Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Brazil; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Language; Male; Middle Aged; Ophthalmic Solutions; *Patient Compliance; Principal Component Analysis; *Psychometrics/mt [Methods]; Reproducibility of Results; Surveys and Questionnaires

Exploring the frequency and location of prescribing errors in the use of topical glaucoma medications. - Lakhani, Bansri K; King, Anthony J (Clinical & experimental ophthalmology, 2018)
IMPORTANCE: Very little is known about health-care professional related prescribing errors within the glaucoma setting., BACKGROUND: This study aims to quantify these errors and to explore where they occur along the prescribing pathway., DESIGN: Cross-sectional study of patients attending a specialty glaucoma clinic over a 5-month period., PARTICIPANTS: Data was collected for 109 patients., METHODS: We compared glaucoma drop regimes from four different sources: As documented in the hospital notes for the last appointment, the letter sent to the General Practitioner (GP), patient's self-reporting and bottles/prescriptions brought to the clinic appointment., MAIN OUTCOME MEASURES: Discrepancies were identified and errors were grouped into one of four categories depending on where in the prescribing pathway they occurred: Incorrect prescribing of the drops by the clinician, incorrect prescribing of the drops by the GP/failure to provide a repeat prescription, incorrect dispensing of the drops by the pharmacist and possible non-adherence by the patient., RESULTS: There was a total of 217 individual prescription items involving 266 active ingredients. Seventy-one prescription items out of 217 (33%) had an error, of this 53 (75%) were due to possible patient non-adherence and 18 (25%) were process related errors made by health-care professionals., CONCLUSIONS AND RELEVANCE: An error was identified in 33% of prescriptions. About 8.3% of prescriptions had a health-care professional related process error. These errors are preventable and recognition of these is important to maximize drop adherence and minimize disease progression, requiring increased consultations and interventions with quality of life and health economic consequences. Copyright © 2018 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; *Drug Prescriptions/sn [Statistics & Numerical Data]; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Errors/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions; Pharmacists/st [Standards]; *Professional Role; *Quality of Life; Time Factors

Improving Follow-up and Reducing Barriers for Eye Screenings in Communities: The SToP Glaucoma Study. - Zhao, Di; Guallar, Eliseo; Bowie, Janice V; Swenor, Bonnielin; Gajwani, Prateek; Kanwar, Natasha; Friedman, David S (American journal of ophthalmology, 2018)
PURPOSE: To evaluate factors associated with attendance to follow-up ophthalmic care, and to assess the impact of strategies to improve follow-up., DESIGN: Cross-sectional study., METHODS: This is an ongoing study to develop an eye screening paradigm, focusing on African Americans >=50 years of age at multiple urban community sites in Baltimore, Maryland. Several strategies were employed aiming to increase follow-up attendance rates. Multivariable logistic regression was used to evaluate the associations between demographic, medical, and ocular factors with follow-up rate., RESULTS: The total number of referred patients presenting for a free eye examination (attendance rate) during the first phase, during the second phase, and overall was 686 (55.0%), 199 (63.8%), and 885 (57.0%), respectively. In fully adjusted models, the odds ratio (95% confidence intervals) for attending the follow-up visit was 1.82 (1.19, 2.79) for screening in second phase vs first phase, 0.62 (0.39, 0.99) for screening sites that were 3 to <5 miles vs <1 mile from the hospital, 1.70 (1.12, 2.59) in patients with body mass index >= 30 vs < 25 kg/m2, 2.03 (1.28, 3.21) in patients with presenting visual acuity < 20/40 vs >= 20/40, and 2.32 (1.24, 4.34) for patients with an abnormal vs normal macula., CONCLUSIONS: Obesity, short distance between screening sites and hospital, poor presenting visual acuity in the better eye, and an abnormal macula on fundus photography were associated with increased follow-up rate. Implementation of a combination of strategies effectively increased the follow-up rate. Wider adoption of these strategies in other screening programs has the potential to reduce the burden of visual impairment. Copyright © 2018 Elsevier Inc. All rights reserved.
Keywords: African Americans/eh [Ethnology]; Aged; Baltimore; *Community Health Services/og [Organization & Administration]; Cross-Sectional Studies; Female; Follow-Up Studies; Glaucoma/di [Diagnosis]; Glaucoma/eh [Ethnology]; *Glaucoma/pc [Prevention & Control]; *Health Services Accessibility/og [Organization & Administration]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Odds Ratio; Vision Disorders/di [Diagnosis]; Vision Disorders/eh [Ethnology]; Vision Disorders/pc [Prevention & Control]; *Vision Screening/og [Organization & Administration]; Visual Acuity/ph [Physiology]

Factors Associated with Patient Satisfaction in an Outpatient Glaucoma Population. - Rahmatnejad, Kamran; Myers, Jonathan S; Falls, Megan E; Myers, Sarah R; Waisbourd, Michael; Hark, Lisa A (Seminars in ophthalmology, 2018)
PURPOSE: To determine what metrics might impact satisfaction survey responses., METHODS: A 37-question survey was administered to 249 participants. Responses were correlated to demographics, clinical factors, weather conditions, and examination timing., RESULTS: Sample consists of 55.4% female and 73.9% white, and mean age was 65.1 years. Participants were assigned to: completely satisfied (77.9%) or not completely satisfied (22.1%) groups based on their rating of glaucoma specialist on a scale of 1-10, while 10 considered "completely satisfied" and less than 10 "not completely satisfied." Complete satisfaction was associated with ability to schedule appointments early, phone calls answered/returned same day, shorter perceived wait time, and better communication skills of ophthalmologist (p < 0.05). Completely satisfied participants reported their ophthalmologist spent enough time with them, listened carefully, and communicated in an understandable way (p < 0.05)., CONCLUSIONS: The majority of factors found to be associated with patient satisfaction were related to characteristics of the ophthalmologists and their office.
Keywords: Aged; Cross-Sectional Studies; Female; *Glaucoma/px [Psychology]; Humans; Male; Middle Aged; *Outpatients; *Patient Satisfaction; *Surveys and Questionnaires

Advanced glaucoma at presentation is associated with poor follow-up among glaucoma patients attending a tertiary eye facility in Southern Nigeria. - Momoh, Rita Omoso; Bunce, Catey; Oko-Oboh, Gregrey Agbonvihele; Gilbert, Clare E (Ophthalmic epidemiology, 2018)
PURPOSE: Globally, particularly in Africa, poor compliance with medication is a major problem in glaucoma management but little is known about follow-up rates among African glaucoma patients. The aim of this study was to determine rates of follow-up among glaucoma patients attending a tertiary hospital in southern Nigeria and investigate predictors of poor follow-up., METHODS: Data were extracted from medical records of new glaucoma patients who attended the hospital between June 2011 and May 2013. Socio-demographic and clinical parameters (visual acuity; stage of glaucoma) recorded at diagnosis were extracted using a pre-tested form. Follow-up was defined as good if they had attended within 9 months of the study date, inadequate when the last follow-up was more than 9 months and failed if they did not attend any follow-up or the most recent visit was more than 14 months from the study date. Univariate and multivariable analyses were undertaken to explore predictors of poor follow-up (inadequate plus failed)., RESULTS: Three hundred forty-eight patients were recruited, 54% were male and the mean age was 52.7 (range 16-88) years. Follow-up was as follows: good 28.4%, inadequate 46.6%, failed 25%. Overall, 71.6% had poor follow-up. Independent predictors of poor follow-up were poorer visual acuity (OR 3.85, 95% confidence interval (CI) 1.25-11.80 for visual impairment; OR 4.11, 95% CI 1.32-12.81 for blind) and end-stage glaucoma (OR 3.55 (1.31-9.62), p = 0.01)., CONCLUSION: Enhanced counselling of patients with moderate to advanced glaucoma and visual impairment is required to improve follow-up and hence glaucoma management.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Disease Progression; Female; Follow-Up Studies; Glaucoma/co [Complications]; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Humans; Incidence; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Nigeria/ep [Epidemiology]; Prognosis; Retrospective Studies; *Tertiary Care Centers/sn [Statistics & Numerical Data]; Time Factors; *Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]; Vision, Low/pp [Physiopathology]; *Visual Acuity; Young Adult

Pharmacoepidemiological assessment of adherence and influencing co-factors among primary open-angle glaucoma patients-An observational cohort study. - Frech, Stefanie; Kreft, Daniel; Guthoff, Rudolf F; Doblhammer, Gabriele (PloS one, 2018)
The goal of this study was to assess the adherence of primary open-angle glaucoma (POAG) patients to medication, and to determine co-factors influencing adherence, using a representative sample of members of the largest German public health insurer. The observational cohort study was based on a longitudinal data set from 2010-2013 and included 250,000 insured persons aged 50 and older with 10,120 diagnosed POAG patients. Uni- and multivariate analysis was performed to investigate several aspects of glaucoma, such as prevalence, adherence, and co-factors influencing adherence. The main outcome measured adherence with prescriptions filled within a year. Multivariate panel regression analysis was used to determine the co-factors influencing this adherence. Prevalence of POAG was 3.36% [CI: 3.28-3.43%], with 2.91% [CI: 2.81-3.01%] for males and 3.71% [CI: 3.61-3.81%] for females, increasing with age. The mean level of adherence in terms of prescriptions filled was 66.5% [CI: 65.50-67.60%]. The results of this analysis revealed a significant influence of age, duration of the disease, care need, distance to death, and multimorbidity as co-factors of non-adherence, whereas gender had no influence. The analysis provided detailed information about POAG health care aspects concerning prevalence and adherence. The most endangered risk groups for non-adherence were patients aged 50-59, patients older than 80 years, patients with a longer duration of POAG, patients with care needs, and patients with three or more severe diseases in addition to glaucoma. To know the predictors responsible for an increased risk to develop POAG is of importance for all persons involved in health care management. Therefore effective strategies to increase awareness of patients and medical care personnel about non-adherence and the importance of a regular and continuous medication to avoid further nerve fiber damage and possible blindness have to be developed.
Erratum in (EIN)
Keywords: Aged; Aged, 80 and over; Cohort Studies; Comorbidity; Female; Germany/ep [Epidemiology]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Male; *Medication Adherence; Middle Aged; Multivariate Analysis; Pharmacoepidemiology; Prevalence; Risk Factors

Association between allergic diseases and ophthalmologic diseases, including cataracts and glaucoma, using the Korean National Health and Nutrition Examination Survey 2010-2012: A STROBE-compliant article. - Lee, Young Bok; Lee, Ji Hyun; Kang, Min Ji; Choi, Jin Young; Kim, Jin-Wou; Yu, Dong Soo; Han, Kyung Do; Park, Yong Gyu (The Journal of dermatology, 2018)
This study investigated the association between allergic diseases and comorbid ophthalmologic diseases. We enrolled 14 776 participants who were at least 19 years of age. Multiple logistic regression analyses were used to evaluate the odds ratios for cataracts and glaucoma according to the presence of allergic diseases. Atopic dermatitis was not associated with the development of cataracts and glaucoma. However, asthma and allergic rhinitis were significantly associated with cataracts (hazard ratio [HR] = 1.511, 95% confidence interval [CI] = 1.120-2.039 and HR = 1.565, 95% CI = 1.192-2.054, respectively). This study examined a nationwide, population-based survey, and concluded that cataracts were significantly associated with asthma and allergic rhinitis but not with atopic dermatitis. Efforts should be made to reduce the risk of ophthalmologic complications when treating patients with allergic diseases. Copyright © 2018 Japanese Dermatological Association.
Keywords: Adult; *Asthma/ep [Epidemiology]; *Cataract/ep [Epidemiology]; Comorbidity; Cross-Sectional Studies; *Dermatitis, Atopic/ep [Epidemiology]; Female; *Glaucoma/ep [Epidemiology]; Humans; Male; Middle Aged; *Nutrition Surveys/sn [Statistics & Numerical Data]; Prevalence; Republic of Korea/ep [Epidemiology]; *Rhinitis, Allergic/ep [Epidemiology]; Risk Factors; Young Adult

Ophthalmic gels: Past, present and future. - Al-Kinani, Ali A; Zidan, Ghada; Elsaid, Naba; Seyfoddin, Ali; Alani, Adam W G; Alany, Raid G (Advanced drug delivery reviews, 2018)
Aqueous gels formulated using hydrophilic polymers (hydrogels) along with those based on stimuli responsive polymers (in situ gelling or gel forming systems) continue to attract increasing interest for various eye health-related applications. They allow the incorporation of a variety of ophthalmic pharmaceuticals to achieve therapeutic levels of drugs and bioactives at target ocular sites. The integration of sophisticated drug delivery technologies such as nanotechnology-based ones with intelligent and environment responsive systems can extend current treatment duration to provide more clinically relevant time courses (weeks and months instead of hours and days) which will inevitably reduce dose frequency, increase patient compliance and improve clinical outcomes. Novel applications and design of contact lenses and intracanalicular delivery devices along with the move towards integrating gels into various drug delivery devices like intraocular pumps, injections and implants has the potential to reduce comorbidities caused by glaucoma, corneal keratopathy, cataract, diabetic retinopathies and age-related macular degeneration. This review describes ophthalmic gelling systems with emphasis on mechanism of gel formation and application in ophthalmology. It provides a critical appraisal of the techniques and methods used in the characterization of ophthalmic preformed gels and in situ gelling systems along with a thorough insight into the safety and biocompatibility of these systems. Newly developed ophthalmic gels, hydrogels, preformed gels and in situ gelling systems including the latest in the area of stimuli responsive gels, molecularly imprinted gels, nanogels, 3D printed hydrogels; 3D printed devices comprising ophthalmic gels are covered. Finally, new applications of gels in the production of artificial corneas, corneal wound healing and hydrogel contact lenses are described. Copyright © 2017 Elsevier B.V. All rights reserved.
Keywords: Drug Delivery Systems; Gels/pd [Pharmacology]; Humans; *Ophthalmic Solutions/pd [Pharmacology]; Polymers/pd [Pharmacology]; Printing, Three-Dimensional; *Wound Healing/de [Drug Effects]

Resource Planning in Glaucoma: A Tool to Evaluate Glaucoma Service Capacity. - Batra, Ruchika; Sharma, Hannah E; Elaraoud, Ibrahim; Mohamed, Shabbir (Seminars in ophthalmology, 2018)
BACKGROUND: The National Patient Safety Agency (2009) publication advising timely follow-up of patients with established glaucoma followed several reported instances of visual loss due to postponed appointments and patients lost to follow-up. The Royal College of Ophthalmologists Quality Standards Development Group stated that all hospital appointments should occur within 15% of the intended follow-up period., AIM: To determine whether: 1. Glaucoma follow-up appointments at a teaching hospital occur within the requested time 2. Appointments are requested at appropriate intervals based on the NICE Guidelines 3. The capacity of the glaucoma service is adequate Methods: A two-part audit was undertaken of 98 and 99 consecutive patients respectively attending specialist glaucoma clinics. In the first part, the reasons for delayed appointments were recorded. In the second part the requested follow-up was compared with NICE guidelines where applicable. Based on the findings, changes were implemented and a re-audit of 100 patients was carried out., RESULTS: The initial audit found that although clinical decisions regarding follow-up intervals were 100% compliant with NICE guidelines where applicable, 24% of appointments were delayed beyond 15% of the requested period, due to administrative errors and inadequate capacity, leading to significant clinical deterioration in two patients. Following the introduction of an electronic appointment tracker and increased clinical capacity created by extra clinics and clinicians, the re-audit found a marked decrease in the percentage of appointments being delayed (9%)., CONCLUSIONS: This audit is a useful tool to evaluate glaucoma service provision, assist in resource planning for the service and bring about change in a non-confrontational way. It can be widely applied and adapted for use in other medical specialities.
Keywords: *Appointments and Schedules; *Benchmarking/mt [Methods]; Female; *Glaucoma, Open-Angle/th [Therapy]; *Hospitals, University/og [Organization & Administration]; Humans; Intraocular Pressure; Male; *Management Audit/mt [Methods]; *Ophthalmology/st [Standards]; Patient Compliance; *Referral and Consultation/st [Standards]

Adherence of Pseudomonas aeruginosa onto surfactant-laden contact lenses. - Mosuela, Reynalyn; Mustafa, Shelan; Gould, Simon; Hassanin, Hany; Alany, Raid G; ElShaer, Amr (Colloids and surfaces. B, Biointerfaces, 2018)
There is an immense research interest to utilise contact lens (CLs) as a popular platform for ocular drug delivery. However, CLs are the major predisposing factors of bacterial keratitis which is commonly caused by adhesion of microbes such as Pseudomonas aeruginosa and Staphylococcus epidermidis. The aim of the current study is to explore the effect of surfactants; Poloxamer 188, Polysorbate 80 and Tetronic R 90R4 (at 0.25% - 3% v/v) on the characteristics of CLs and on the adhesion abilities of Pseudomonas aeruginosa to the lenses' surfaces. CLs were formulated using a hydrophilic monomer; 2-hydroxyethyl methacrylate (HEMA) together with silicone-based polymer such as Poly dimethyl siloxane (PDMS) or 3,3,3-trifluoropropylsilane (FSA) then lenses were polymerized under UV light. The formulated CLs with surfactants were found to have an increased equilibrium water content (EWC) due to hydrophilic moiety present in surfactants. A relationship was deduced between EWC and surface contact angle of lenses containing surfactants; where an increased EWC was associated with a decrease in contact angle reflecting a more hydrophilic surfaces of CLs. Apart from the 3% Polysorbate 80 (p<.0001) CLs, all other formulations had light transmission values over 80%. Lenses with surfactants were found to have lower bacterial ATP concentration than lenses without surfactants. Poloxamer 188 in FSA lenses reduced bacterial adhesion from 4.22x10-4+/-1.30x10-4 pM to 1.03x10-4+/-4.86x10-5 pM, a reduction by 75.59% when compared to the control lenses (p=.002). Moreover, 1% Tetronic R 90R4 in PDMS showed a reduction by 57.17% in ATP concentration. Polysorbate 80 in FSA exhibited the least bacterial adhesion with an average bacterial ATP concentration of 3.85x10-5+/-2.61x10-5 pM; i.e 90.88% less bacterial ATP than control lenses (p=.001). Bioluminescence studies demonstrated a decrease in Pseudomonas aeruginosa adhesion to CLs containing surfactants without impairing the optical and mechanical characteristics of the lenses. Copyright © 2017 Elsevier B.V. All rights reserved.
Keywords: Adenosine Triphosphate/an [Analysis]; Adenosine Triphosphate/me [Metabolism]; Bacterial Adhesion/de [Drug Effects]; Bacterial Load; *Contact Lenses, Hydrophilic/mi [Microbiology]; Dimethylpolysiloxanes/ch [Chemistry]; *Ethylenediamines/pd [Pharmacology]; Methacrylates/ch [Chemistry]; *Poloxamer/pd [Pharmacology]; *Polysorbates/pd [Pharmacology]; *Pseudomonas aeruginosa/de [Drug Effects]; Pseudomonas aeruginosa/gd [Growth & Development]; Pseudomonas aeruginosa/me [Metabolism]; Surface Properties; *Surface-Active Agents/pd [Pharmacology]; Ultraviolet Rays; Water/ch [Chemistry]

Shared Cared for Stable Glaucoma Patients: Economic Benefits and Patient-centered Outcomes of a Feasibility Trial. - Goh, David; de Korne, Dirk F; Ho, Henrietta; Mathur, Ranjana; Chakraborty, Bibhas; Van Hai, Nguyen; Wai, Charity; Perera, Shamira; Aung, Tin; Wong, Tien Y; Lamoureux, Ecosse L (Journal of glaucoma, 2018)
PURPOSE: The purpose of this article is to assess the quality of care and economic benefits of a shared care model managing patients with stable glaucoma in a primary eye care (PEC) clinic compared with a tertiary specialist outpatient clinic (SOC) in Singapore., PATIENTS AND METHODS: A randomized equivalence feasibility trial was preformed comparing the PEC with SOC models. Participants recruited from the SOC had no visual field progression or change in management for at least 3 years, were on a maximum of a single glaucoma medication, had no previous tube-shunt implant and were at least 3-year posttrabeculectomy surgery.Primary outcomes were clinical assessment and management, economic benefits, and patient satisfaction. Differences were analyzed using equivalence testing and generalized odds ratios., RESULTS: The trial included 233 patients, consisting of 42.1% glaucoma disc suspects (PEC: 47.4%; SOC: 36.8%), 27.5% primary angle closure suspects (PEC: 25.0%; SOC: 29.9%), 13.7% with ocular hypertension (PEC: 13.8%; SOC: 13.7%), 3.9% with primary angle closure glaucoma (PEC: 4.3%; SOC: 3.4%), and 3.0% with primary open angle glaucoma (PEC: 1.7%; SOC: 4.3%). Glaucoma clinical care for patients at PEC was as good as SOC [rate difference, 6.83%; 95% confidence interval (CI), 2.84-11.12) and management (rate difference, 7.69%; 95% CI, 3.21-12.17). In 23 cases (9.9%), 5.2% at PEC and 14.5% at SOC, there was disconcordance with the gold standard of senior consultant. Patient satisfaction at the PEC was equally high when compared with SOC (generalized odds ratio, 1.43; CI, 0.50-2.00). Direct costs per patient visit were 43% lower at PEC compared with SOC., CONCLUSION: Managing stable glaucoma patients at a primary care setting is a cost saving, safe, and effective shared care while enhancing professional collaboration between hospital and community settings.
Keywords: Adult; Aged; *Clinical Decision-Making/mt [Methods]; *Cost-Benefit Analysis; Feasibility Studies; Female; Glaucoma, Angle-Closure/ec [Economics]; *Glaucoma, Angle-Closure/th [Therapy]; Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure/ph [Physiology]; Middle Aged; Ocular Hypertension/ec [Economics]; Ocular Hypertension/th [Therapy]; *Patient Outcome Assessment; Patient Satisfaction; Patient-Centered Care; Quality of Health Care; Singapore; Visual Fields/ph [Physiology]

Antimicrobial efficacy of a novel povidone iodine contact lens disinfection system. - Yamasaki, Katsuhide; Saito, Fumio; Ota, Ritsue; Kilvington, Simon (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2018)
PURPOSE: Contact lens (CL) wear is a risk factor for the acquisition of microbial keratitis. Accordingly, compliance to manufacturers' recommended hygiene and disinfection procedures are vital to safe (CL) use. In this study we evaluated a novel povidone-iodine (PI) (CL) disinfection system (cleadew, Ophtecs Corporation, Japan) against a range of bacterial, fungal and Acanthamoeba., METHODS: Antimicrobial assays were conducted according to ISO 14729 using the recommended strains of bacteria and fungi, with and without the presence of organic soil. Regrowth of bacteria and fungi in the disinfection system was also examined. The activity on biofilms formed from Stenotrophomonas maltophilia and Achromobacter sp. was evaluated. Efficacy against A. castellanii trophozoites and cysts was also investigated., RESULTS: The PI system gave >4 log10 kill of all bacteria and fungi following the manufacturer's recommended disinfection and cleaning time of 4h, with or without the presence of organic soil. No regrowth of organisms was found after 14days in the neutralized solution. In the biofilm studies the system resulted in at least a 7 log10 reduction in viability of bacteria. For Acanthamoeba, >3 log10 kill of trophozoites and 1.1-2.8 log10 kill for the cyst stage was obtained., CONCLUSIONS: The PI system effective against a variety of pathogenic microorganisms under a range of test conditions. Strict compliance to recommended CL hygiene procedures is essential for safe CL wear. The use of care systems such as PI, with broad spectrum antimicrobial activity, may aid in the prevention of potentially sight threatening microbial keratitis. Copyright © 2017. Published by Elsevier Ltd.
Keywords: Anti-Infective Agents, Local/pd [Pharmacology]; Bacteria/de [Drug Effects]; *Bacteria/ip [Isolation & Purification]; Biofilms; *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses; *Disinfection/mt [Methods]; Eye Infections, Bacterial/mi [Microbiology]; *Eye Infections, Bacterial/pc [Prevention & Control]; Humans; Keratitis/mi [Microbiology]; *Keratitis/pc [Prevention & Control]; *Povidone-Iodine/pd [Pharmacology]

Application of the ISNT rules on retinal nerve fibre layer thickness and neuroretinal rim area in healthy myopic eyes. - Qiu, Kunliang; Wang, Geng; Lu, Xuehui; Zhang, Riping; Sun, Lixia; Zhang, Mingzhi (Acta ophthalmologica, 2018)
PURPOSE: We determined the applicability of inferior > superior > nasal > temporal (ISNT) rules on retinal nerve fibre layer (RNFL) thickness and rim area and evaluated the impact of various ocular factors on the performance of the ISNT rules in healthy myopic eyes., METHODS: A total of 138 eyes from 138 healthy myopic subjects were included in this cross-sectional observational study. The peripapillary RNFL and optic disc in each eye were imaged with Cirrus HD optical coherence tomography (OCT) and Heidelberg Retina Tomograph II (HRT2), respectively. The performance of the inferior > superior (IS), inferior > superior > nasal > temporal (IST) and ISNT rules on RNFL thickness and rim area was determined and compared between low-to-moderate myopia and high myopia. The effects of ocular factors [including axial length, disc area, disc tilt, disc torsion, disc-fovea angle (DFA) and retina artery angle] on the performance of ISNT rules were evaluated with logistic regression analysis., RESULTS: The mean axial length and refractive error were 25.57 +/- 1.09 mm (range, 22.52-28.77 mm) and -5.12 +/- 2.30 D [range, -9.63 to -0.50 dioptres (D)], respectively. Sixty-three per cent of the healthy eyes were compliant with the ISNT rule on rim area, while ISNT rule on RNFL thickness was followed in only 11.6% of the included eyes. For rim area, smaller disc area was significantly associated with increased compliance of the IS rule (odds ratio: 0.46, p = 0.039), IST rule (odds ratio: 0.46, p = 0.037) and ISNT rule (odds ratio: 0.44, p = 0.030). For RNFL thickness, greater DFA was significantly associated with increased compliance of the IS and IST rules (odds ratio: 1.30, p < 0.001; odds ratio: 1.19, p = 0.006, respectively)., CONCLUSION: In healthy myopic subjects, 88.4% and 37% of eyes did not comply with the ISNT rule on RNFL thickness and rim area, respectively. Due to significant low compliance in healthy eyes, the ISNT rule and its variants have limited potential utility in diagnosing glaucoma in myopic subjects. Copyright © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Adolescent; Adult; Axial Length, Eye; Cross-Sectional Studies; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Likelihood Functions; Male; *Myopia/co [Complications]; *Nerve Fibers/pa [Pathology]; Ophthalmoscopy; *Optic Nerve Diseases/di [Diagnosis]; *Retinal Ganglion Cells/pa [Pathology]; Tomography, Optical Coherence; Visual Fields/ph [Physiology]; Young Adult

Drop instillation and glaucoma. - Davis, Scott A; Sleath, Betsy; Carpenter, Delesha M; Blalock, Susan J; Muir, Kelly W; Budenz, Donald L (Current opinion in ophthalmology, 2018)
PURPOSE OF REVIEW: To describe the current state of knowledge regarding glaucoma patients' eye drop technique, interventions attempting to improve eye drop technique, and methods for assessing eye drop technique., RECENT FINDINGS: In observational studies, between 18.2 and 80% of patients contaminate their eye drop bottle by touching their eye or face, 11.3-60.6% do not instill exactly one drop, and 6.8-37.3% miss the eye with the drop. Factors significantly associated with poorer technique include older age, lack of instruction on eye drop technique, female sex, arthritis, more severe visual field defect, lack of positive reinforcement to take eye drops, lower educational level, low self-efficacy, and being seen at a clinic rather than a private practice. Among intervention studies, four of five studies using a mechanical device and three of four studies using educational interventions to improve technique showed positive results, but none of the studies were randomized controlled trials., SUMMARY: Poor eye drop technique is a significant impediment to achieving good control of intraocular pressure in glaucoma. Both mechanical device interventions and educational interventions offer promise to improve patients' technique, but studies with stronger designs need to be done followed by introduction into clinical practice.
Keywords: *Administration, Ophthalmic; *Antihypertensive Agents/ad [Administration & Dosage]; Drug Packaging; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Education as Topic; Tonometry, Ocular

Moving From Clinic to Home: What the Future Holds for Ophthalmic Telemedicine. - Holekamp, Nancy M (American journal of ophthalmology, 2018)
PURPOSE: To describe the expanding role of telemedicine in healthcare, the key criteria required for a successful device and program implementation, and the current and future role of home monitoring in ophthalmology., DESIGN: Expert perspective., METHODS: Analysis with real-world interpretation of home monitoring technologies, including current adoption barriers and expanded future demands based on demographic and market forces., RESULTS: Remote patient monitoring represents a paradigm shift in the way physicians care for patients. Success depends on meeting several criteria, among which are a recognized value proposition to the physician, robust device performance validation, ease of use for the patient, reliability of connectivity, safe and secure data transmission, and economic feasibility. Ophthalmic diseases, such as age-related macular degeneration, glaucoma, and diabetic retinopathy, are ideal candidates for home monitoring practice integration. Established home monitoring technology is already facilitating early detection and improved visual outcomes for patients with age-related macular degeneration. Future innovation currently underway or on the horizon will continue to evolve and expand the footprint of telemedicine within ophthalmology., CONCLUSION: Home monitoring has the potential to enhance the patient-physician relationship and to positively impact visual acuity outcomes in ophthalmic diseases. Advances in technology, demographic shifts, market changes, and patient demand for personalized medicine will require physicians to embrace technology in new and diverse ways, perhaps facilitating widespread adoption of home monitoring technology platforms. Copyright © 2017 Elsevier Inc. All rights reserved.
Keywords: Ambulatory Care Facilities; Biomedical Technology; *Delivery of Health Care/td [Trends]; *Eye Diseases/th [Therapy]; Home Care Services; Humans; Monitoring, Physiologic; *Ophthalmology/td [Trends]; *Telemedicine/td [Trends]

Patient satisfaction with health care services at a national institute of ophthalmology. - Van Huy, Nguyen; Dung, Nguyen Ngoc; Thang, Cao Duc; Hanh, Le Thuy (The International journal of health planning and management, 2018)
Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross-sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment-on-demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area. Copyright © 2017 John Wiley & Sons, Ltd.
Keywords: Academies and Institutes; Adult; Cross-Sectional Studies; Educational Status; *Eye Diseases/th [Therapy]; Female; Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Ophthalmology/st [Standards]; Patient Satisfaction; Rural Population/sn [Statistics & Numerical Data]; Sex Factors; Surveys and Questionnaires; Urban Population/sn [Statistics & Numerical Data]; Vietnam

Tele-Ophthalmology for Age-Related Macular Degeneration and Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis. - Kawaguchi, Atsushi; Sharafeldin, Noha; Sundaram, Aishwarya; Campbell, Sandy; Tennant, Matthew; Rudnisky, Christopher; Weis, Ezekiel; Damji, Karim F (Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2018)
BACKGROUND: To synthesize high-quality evidence to compare traditional in-person screening and tele-ophthalmology screening., METHODS: Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. The intervention of interest was any type of tele-ophthalmology, including screening of diseases using remote devices. Studies involved patients receiving care from any trained provider via tele-ophthalmology, compared with those receiving equivalent face-to-face care. A search was executed on the following databases: Medline, EMBASE, EBM Reviews, Global Health, EBSCO-CINAHL, SCOPUS, ProQuest Dissertations and Theses Global, OCLC Papers First, and Web of Science Core Collection. Six outcomes of care for age-related macular degeneration (AMD), diabetic retinopathy (DR), or glaucoma were measured and analyzed., RESULTS: Two hundred thirty-seven records were assessed at the full-text level; six RCTs fulfilled inclusion criteria and were included in this review. Four studies involved participants with diabetes mellitus, and two studies examined choroidal neovascularization in AMD. Only data of detection of disease and participation in the screening program were used for the meta-analysis. Tele-ophthalmology had a 14% higher odds to detect disease than traditional examination; however, the result was not statistically significant (n = 2,012, odds ratio: 1.14, 95% confidence interval (CI): 0.52-2.53, p = 0.74). Meta-analysis results show that odds of having DR screening in the tele-ophthalmology group was 13.15 (95% CI: 8.01-21.61; p < 0.001) compared to the traditional screening program., CONCLUSIONS: The current evidence suggests that tele-ophthalmology for DR and age-related macular degeneration is as effective as in-person examination and potentially increases patient participation in screening.
Keywords: Diabetic Retinopathy/di [Diagnosis]; *Eye Diseases/di [Diagnosis]; Glaucoma/di [Diagnosis]; Humans; Macular Degeneration/di [Diagnosis]; *Mass Screening/mt [Methods]; Mass Screening/st [Standards]; *Ophthalmology/mt [Methods]; Ophthalmology/st [Standards]; Patient Satisfaction; Randomized Controlled Trials as Topic; Reference Books; *Telemedicine/mt [Methods]; Time Factors; Visual Acuity

Barriers to glaucoma case finding as perceived by optometrists in Ireland. - Barrett, Catriona; O'Brien, Colm; Butler, John S; Loughman, James (Clinical & experimental optometry, 2018)
BACKGROUND: This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system., METHODS: A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practise in Ireland. The survey included 10 five-level Likert items exploring potential barriers to glaucoma detection and a free-text box for participants to comment more broadly., RESULTS: One hundred and ninety-nine optometrists (27 per cent of registrants) responded to the survey. Among the barriers identified, there was notable agreement (71 per cent) with the need for extra training on glaucoma detection. Logistic regression showed that optometrists without postgraduate qualifications were more likely to agree with the need for extra training (OR 3.2, 95 per cent CI 1.3-8.1). Respondents largely agreed (61 per cent) that patient unwillingness to pay additional fees for supplementary glaucoma-specific tests was also a barrier. Appointment times of less than 30 minutes were significantly associated with six of the 10 proposed barriers to glaucoma detection. A logistic regression analysis (n = 179) confirmed that the time allotted per appointment was a significant predictor of the agreement time of optometrists as a barrier (chi2 [1] = 13.52, p < 0.001). Multiple linear regression showed that optometrists with less experience, charging lower fees, and working in large multiples or franchised practices have the shortest appointment times., CONCLUSION: The strong link found between postgraduate education and the confidence of optometrists in detecting glaucoma indicates that optometrists wishing to increase their scope of practice in the new legislative environment in Ireland may more actively seek training in areas of interest. The responses also indicate a lack of funding for the level of diagnostic testing required for accurate glaucoma diagnosis. Recent increases in the state's eye examination fees look likely to address the identified time and financial barriers to glaucoma detection in Ireland. Future work should look to analyse the effects of increased funding on optometric case finding for glaucoma. Copyright © 2017 Optometry Australia.
Keywords: *Delivery of Health Care/og [Organization & Administration]; *Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; *Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ep [Epidemiology]; *Health Knowledge, Attitudes, Practice; Humans; Ireland/ep [Epidemiology]; Morbidity/td [Trends]; *Optometrists/st [Standards]; *Optometry; Retrospective Studies; Surveys and Questionnaires; Workforce

Glaucoma Australia educational impact study: a randomized short-term clinical trial evaluating the association between glaucoma education and patient knowledge, anxiety and treatment satisfaction. - Skalicky, Simon E; D'Mellow, Guy; House, Philip; Fenwick, Eva; Glaucoma Australia Educational Impact Study Contributors (Clinical & experimental ophthalmology, 2018)
IMPORTANCE: Targeted education may impact glaucoma patients' clinical experience., BACKGROUND: The aim of this study was to measure the impact of patient-centred glaucoma-related education on knowledge, anxiety and treatment satisfaction., DESIGN: This was a multicentre Australia-wide randomized clinical trial., PARTICIPANTS: One hundred one newly diagnosed glaucoma patients were randomized 1:1 to intervention or control groups., METHODS: Those randomized to the Glaucoma Australia educational intervention received telephone-based counselling about glaucoma followed by mail-out information, in addition to usual care and information from their treating ophthalmologist. The control group received only usual care and information from their treating ophthalmologist. Surveys were administered at baseline and 4 weeks following intervention., MAIN OUTCOME MEASURES: The Auckland Glaucoma Knowledge Questionnaire measured glaucoma-related knowledge. The Hospital Anxiety and Depression Scale and Eye-Drop Satisfaction Questionnaire measured anxiety and patient treatment satisfaction, respectively., RESULTS: Mean age was 64.7 +/- 11.1 years, and 52 (51.5%) were male. There was no noticeable increase in knowledge levels in the control group (mean difference: 0.04 logits, P = 0.7), compared with a 0.49-logit (P = 0.02) increase in knowledge levels in the intervention group. Between-group comparison showed a non-significant increase in knowledge (0.45 logits, P = 0.07) comparing intervention participants with controls. Intervention participants experienced a statistically significant decrease in anxiety compared to controls (-0.60 logits, P = 0.02). No between-group difference was found in Eye-Drop Satisfaction Questionnaire scores., CONCLUSIONS AND RELEVANCE: Patient-centred glaucoma-related education and support services may improve knowledge and can reduce anxiety for newly diagnosed glaucoma patients. All glaucoma patients should be adequately counselled about the nature of the disease and its management. Copyright © 2017 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Anxiety/di [Diagnosis]; Anxiety/et [Etiology]; *Anxiety/pc [Prevention & Control]; Australia; *Early Diagnosis; Female; Follow-Up Studies; Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; *Glaucoma/pc [Prevention & Control]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Patient Education as Topic/mt [Methods]; *Patient Satisfaction; Prospective Studies; Surveys and Questionnaires; Time Factors

Indications and graft survival analysis in optical penetrating keratoplasty in a tertiary care center in North India: a 5-year study. - Arya, Sudesh Kumar; Raj, Amit; Bamotra, Ravi Kant; Bhatti, Anubha; Deswal, Jyoti; Sindhu, Meenakshi (International ophthalmology, 2018)
PURPOSE: To study the indications and variables correlating with graft survival in optical penetrating keratoplasty in a tertiary care hospital in north India., PARTICIPANTS: All patients who underwent optical keratoplasty, except those undergoing lamellar grafts, tectonic grafts transplants and penetrating keratoplasty done for therapeutic purposes were included in the study. Patients with follow-up less than 2 years were excluded from the study., MATERIALS AND METHODS: Data were obtained by reviewing the records of 101 patients who underwent optical penetrating keratoplasty from 2008 to 2013 for various indications., RESULTS: Out of 101 patients who underwent optical penetrating keratoplasty, 71 were males and 30 were females. The mean age of the recipient was 48.53 years with range 1-82 years. The main indications were previous failed graft (29.7%), healed keratitis except HSV (15.8%), pseudophakic or aphakic bullous keratopathy (14.8%), corneal dystrophies/degenerations (12.9%), adherent leucoma (9.9%), post-HSV scars (8.9%), and others like anterior staphyloma, congenital corneal opacities, buphthalmos and keratoconus (7.9%). The graft survival rate was 67.33% at 1-year follow-up and 59.4% at 2-year follow-up. The mean survival time of the grafts was 22.42 months. The mean time for graft failure was 7.12 (+/-0.9) months., CONCLUSION: One- and 2-year survival of grafts at our center is lower as compared to western studies, probably due to higher percentage of poor prognosis indications for surgery and a relative scarcity of excellent-quality donor corneas.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; *Corneal Diseases/su [Surgery]; Endothelial Cells/cy [Cytology]; Female; *Graft Survival; Humans; India; Infant; Kaplan-Meier Estimate; Keratoplasty, Penetrating/mt [Methods]; *Keratoplasty, Penetrating; Male; Middle Aged; Retrospective Studies; Suture Techniques; Tertiary Care Centers; Visual Acuity; Young Adult

Selective laser trabeculoplasty as replacement therapy in medically controlled glaucoma patients. - De Keyser, Myrjam; De Belder, Maya; De Belder, Jonas; De Groot, Veva (Acta ophthalmologica, 2018)
PURPOSE: We examined selective laser trabeculoplasty (SLT) as a replacement therapy for medically controlled open-angle glaucoma (OAG) or ocular hypertensive patients., METHODS: A prospective randomized interventional clinical trial on 143 glaucoma patients. Patients were randomized to either receiving SLT or to the control group that continued on pressure lowering medication. Data were recorded 1 hr, 1 week, 1, 3, 6, 12 and 18 months after SLT. Primary outcome was number of medications at 12 and 18 months while maintaining a predetermined target intraocular pressure (IOP)., RESULTS: Selective laser trabeculoplasty (SLT) reduced number of medications from a mean of 1.5 at baseline, to 0.35 after 12 months and 0.29 after 18 months. Meanwhile, SLT achieved more than 20% IOP lowering in 95% of eyes and more than 30% IOP lowering in 86% of eyes after 18 months. Seventy-seven per cent of our eyes no longer needed any medication after SLT at 18 months., CONCLUSION: Selective laser trabeculoplasty (SLT) enabled a reduction in number of medications while maintaining good IOP control. Selective laser trabeculoplasty (SLT) was able to completely replace medical therapy in 77% of eyes after 18 months. Selective laser trabeculoplasty (SLT) as replacement therapy may reduce local and systemic side-effects and prevent adherence issues. Copyright © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Follow-Up Studies; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; *Intraocular Pressure/ph [Physiology]; *Laser Therapy/mt [Methods]; *Lasers, Solid-State/tu [Therapeutic Use]; Male; Prospective Studies; Time Factors; *Trabeculectomy/mt [Methods]; Treatment Outcome; *Visual Acuity

Barriers to Glaucoma Medication Compliance Among Veterans: Dry Eye Symptoms and Anxiety Disorders. - Stringham, Jack; Ashkenazy, Noy; Galor, Anat; Wellik, Sarah R (Eye & contact lens, 2018)
OBJECTIVE: To identify barriers to compliance of medical treatment for glaucoma among veterans., METHODS: Patients with glaucoma from the Miami Veterans Affairs Eye Clinic (n=74) filled out a 63-question survey regarding dry eye symptoms, concurrent systemic disease, and medications. The association between glaucoma medical compliance was defined as self-reported adherence to drop regimens greater than 75% of the time., RESULTS: Eighty percent of veterans (n=59) reported compliance with glaucoma therapy. Dry eye symptoms (as defined by Dry Eye Questionnaire 5 score >=6) were reported by 39% (n=29), and their presence was associated with decreased compliance (63% vs. 89%, P=0.007). Anxiety and posttraumatic stress syndrome (PTSD) were also associated with significant noncompliance (64% vs. 83%, P=0.05 and 58% vs. 84%, P=0.02, respectively). Other studied factors including demographics, depression (P=0.11), and glaucoma regimens did not play a significant role in glaucoma medication compliance., CONCLUSIONS: Dry eye symptoms, PTSD, and anxiety were associated with decreased compliance to medical treatment of glaucoma. Identifying and treating underlying ocular surface disease and anxiety disorders may lead to increased adherence to glaucoma treatment.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; *Anxiety Disorders/ep [Epidemiology]; Anxiety Disorders/et [Etiology]; *Dry Eye Syndromes/ep [Epidemiology]; Dry Eye Syndromes/et [Etiology]; Florida/ep [Epidemiology]; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Glaucoma/px [Psychology]; Humans; Incidence; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence; Surveys and Questionnaires; Time Factors; *Veterans

Systematic Review of Knowledge Assessments for Glaucoma Patients. - Peralta, Esteban; Muir, Kelly W; Rosdahl, Jullia A (Seminars in ophthalmology, 2018)
Glaucoma is a chronic eye disease affecting millions of people worldwide; it is frequently treated with daily eyedrop medications when patients are asymptomatic. Patient education is an essential feature for adherence to treatments. Developing useful patient education interventions is predicated on understanding what glaucoma patients know about their disease and identifying gaps in their knowledge. Thirteen studies that have measured and described glaucoma patient knowledge using questionnaires were identified from the literature, including cross-sectional studies of disease knowledge and studies evaluating the efficacy of an educational intervention, both randomized controlled and observational. All studies found significant knowledge gaps in glaucoma patients. Both the controlled studies and the observational studies supported the efficacy of various educational interventions for improving glaucoma knowledge.
Keywords: Cross-Sectional Studies; Glaucoma/dt [Drug Therapy]; Glaucoma/et [Etiology]; *Glaucoma; *Health Knowledge, Attitudes, Practice; Humans; Medication Adherence/px [Psychology]; Medication Adherence/sn [Statistics & Numerical Data]; *Medication Adherence; Patient Education as Topic/mt [Methods]; Patient Preference; Quality of Life

Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors: A STROBE-compliant article. - He, Ye; Tian, Ying; Song, Weitao; Su, Ting; Jiang, Haibo; Xia, Xiaobo (Medicine, 2017)
This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating neovascular glaucoma (NVG) and to analyze the factors influencing the surgical success rate. This is a retrospective review of 40 eyes of 40 NVG patients who underwent AGV implantation at Xiangya Hospital of Central South University, China, between January 2014 and December 2016. Pre- and postoperative intraocular pressure (IOP), visual acuity, surgical success rate, medications, and complications were observed. Surgical success criteria were defined as IOP <=21 and >6 mm Hg with or without additional medications. Kaplan-Meier survival curves and Multivariate cox regression analysis were used to examine success rates and risk factors for surgical outcomes. The mean follow-up period was 8.88 +/- 3.12 months (range: 3-17). IOP declined at each visit postoperatively and it was statistically significant (P < .001). An average of 3.55 +/- 0.86 drugs was applied preoperatively, while an average of 0.64 +/- 0.90 drugs was used postoperatively, with the difference being of statistical significance (P < .05). The complete surgical success rate of 3, 6, and 12 months after the operation was 85%, 75%, and 65%, respectively. Meanwhile, the qualified success rate of 3, 6, and 12 months after the operation was 85%, 80%, and 77.5%, respectively. The multivariate cox regression analysis showed that age (hazard ratio: 3.717, 7.246; 95% confidence interval: 1.149-12.048, 1.349-38.461; P = .028, .021) was influencing factors for complete success rate and qualified success rate among all NVG patients. Gender, previous operation history, primary disease, and preoperative IOP were found to be not significant.AGV implantation is an effective and safe surgical method to treat NVG. Age is an important factor influencing the surgical success rate.
Keywords: Adult; Age Factors; Aged; China; Female; *Glaucoma Drainage Implants; *Glaucoma, Neovascular/su [Surgery]; Humans; Intraocular Pressure; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications/ep [Epidemiology]; Retrospective Studies; Sex Factors; Visual Acuity

Predicted patient demand for a new delivery system for glaucoma medicine. - Ozdemir, Semra; Wong, Tina T; Allingham, Robert Rand; Finkelstein, Eric A (Medicine, 2017)
Sustained-release drug delivery systems that replace the need for daily glaucoma medications will improve outcomes for those who are nonadherent and reduce the inconvenience of having to take medications on a recurring basis. The objective is to estimate uptake (i.e., demand) for a new technology that delivers sustained-release glaucoma medication and to investigate how uptake varies by product attributes, physician recommendations, peer adoption (i.e., percentage of patients seen in a clinic using the new technology), and patient characteristics. In a web-enabled discrete-choice experiment survey, glaucoma patients in the United States were asked to choose between continuing eye drop use or purchasing the new delivery system. In a cross-sectional web-enabled survey, ophthalmologists were asked their likelihood of recommending the new technology based on product and patient characteristics.Study participants were 500 glaucoma patients who were on topical administration of daily eye drops and 155 ophthalmologists who practice in the US.Main outcomes were predicted uptake for patients and likelihood of recommending a new drug delivery system for ophthalmologists. Logistic models were used to analyze the choice data.Uptake was estimated to be 18% at an annual cost of $1000 and to be 24% when the cost was $500. A physician's recommendation increased uptake by 6% to 12%, whereas an increase in peer adoption from 5% to 50% increased uptake by 3% to 7%. Patients aged >= 65 and those with lower income were more likely to remain on eye drops. Physicians were more likely to recommend a product if the interval between administrations is 6 months or longer and when long-term safety and efficacy data are available. They were less likely to recommend it to patients with lower income and no adherence problems. Results suggest a significant interest in an injectable solution or other sustained-release alternatives to daily eye drops. However, in this survey, patient uptake was greatly influenced by out-of-pocket cost and the interval between treatment administrations. Few physicians were willing to recommend sustained-release technology if the treatment interval was less than 3 months.
Keywords: Administration, Topical; Adult; Aged; Cross-Sectional Studies; Delayed-Action Preparations; Drug Delivery Systems; Female; *Forecasting; Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; *Health Services Needs and Demand/td [Trends]; Humans; Logistic Models; Male; Medication Adherence; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmologists/px [Psychology]; *Patient Preference/sn [Statistics & Numerical Data]; Surveys and Questionnaires; United States

Antiglaucomatous treatments and ocular surface. - Lajmi, Houda; Ben Jalel, Wady; Hmaied, Wassim; Zahaf, Amin; Ben Achour, Besma; El Fekih, Lamia (La Tunisie medicale, 2017)
BACKGROUND: the antiglaucomatous treatments interact with the ocular surface and can induce its alteration which may affect the therapeutic results Aim : to describe the interactions between the ocular surface and anti-glaucoma medications and to propose practical attitudes to prevent and manage this issue., METHODS: a retrospective study about 100 patients with a primary opened angle glaucoma treated with anti-glaucomatous drops containing preservatives. We performed an exhaustive examination of the ocular surface with fluorescein instillation to search superficial punctuate keratitis and to evaluate the break up time. All patients had a Schirmer test I., RESULTS: our patients were under monotherapy in 46% ,two medications in 36%, three medications in 11% and four medications in 7% .Beta-blockers were statistically related to the conjunctival hyperaemia (p = 0.014), BUT alteration (p = 0.001) and Schirmer test <= 5 mm (p = 0.0001). Prostaglandin analogues were statistically related to a Schirmer test <= 5 mm (p = 0.02). The use of more than two anti-glaucomatous medications was linked to the severity of the clinical signs., CONCLUSIONS: anti glaucoma drops affect the ocular surface through several mechanisms: allergic reaction, direct and indirect toxicity of the active agents as well as their preservatives. The risk is increased by the prior ocular surface abnormalities in these patients. This disease influences the quality of life and leads to poor adherence to treatment.
Keywords: Aged; Aged, 80 and over; *Cornea/de [Drug Effects]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Preservatives, Pharmaceutical/pd [Pharmacology]; Retrospective Studies; Surface Properties/de [Drug Effects]

Diagnostic accuracy research in glaucoma is still incompletely reported: An application of Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015. - Michelessi, Manuele; Lucenteforte, Ersilia; Miele, Alba; Oddone, Francesco; Crescioli, Giada; Fameli, Valeria; Korevaar, Daniel A; Virgili, Gianni (PloS one, 2017)
BACKGROUND: Research has shown a modest adherence of diagnostic test accuracy (DTA) studies in glaucoma to the Standards for Reporting of Diagnostic Accuracy Studies (STARD). We have applied the updated 30-item STARD 2015 checklist to a set of studies included in a Cochrane DTA systematic review of imaging tools for diagnosing manifest glaucoma., METHODS: Three pairs of reviewers, including one senior reviewer who assessed all studies, independently checked the adherence of each study to STARD 2015. Adherence was analyzed on an individual-item basis. Logistic regression was used to evaluate the effect of publication year and impact factor on adherence., RESULTS: We included 106 DTA studies, published between 2003-2014 in journals with a median impact factor of 2.6. Overall adherence was 54.1% for 3,286 individual rating across 31 items, with a mean of 16.8 (SD: 3.1; range 8-23) items per study. Large variability in adherence to reporting standards was detected across individual STARD 2015 items, ranging from 0 to 100%. Nine items (1: identification as diagnostic accuracy study in title/abstract; 6: eligibility criteria; 10: index test (a) and reference standard (b) definition; 12: cut-off definitions for index test (a) and reference standard (b); 14: estimation of diagnostic accuracy measures; 21a: severity spectrum of diseased; 23: cross-tabulation of the index and reference standard results) were adequately reported in more than 90% of the studies. Conversely, 10 items (3: scientific and clinical background of the index test; 11: rationale for the reference standard; 13b: blinding of index test results; 17: analyses of variability; 18; sample size calculation; 19: study flow diagram; 20: baseline characteristics of participants; 28: registration number and registry; 29: availability of study protocol; 30: sources of funding) were adequately reported in less than 30% of the studies. Only four items showed a statistically significant improvement over time: missing data (16), baseline characteristics of participants (20), estimates of diagnostic accuracy (24) and sources of funding (30)., CONCLUSIONS: Adherence to STARD 2015 among DTA studies in glaucoma research is incomplete, and only modestly increasing over time.
Keywords: *Glaucoma/di [Diagnosis]; *Guideline Adherence; Humans; Journal Impact Factor; *Publishing

Patient-Physician Communication on Medication Cost during Glaucoma Visits. - Slota, Catherine; Davis, Scott A; Blalock, Susan J; Carpenter, Delesha M; Muir, Kelly W; Robin, Alan L; Sleath, Betsy (Optometry and vision science : official publication of the American Academy of Optometry, 2017)
SIGNIFICANCE: This article is the first to investigate the nature of medication cost discussions between ophthalmologists and glaucoma patients. Only 87 of the 275 office visits analyzed had a discussion of medication cost. Providers should consider discussing medication cost with patients to identify potential cost-related barriers to medication use., PURPOSE: Glaucoma is an incurable chronic eye disease affecting a growing portion of the aging population. Some of the most commonly utilized treatments require lifelong use, requiring high patient adherence to ensure effectiveness. There are numerous barriers to glaucoma treatment adherence in the literature, including cost. The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits., METHODS: This was a mixed-methods secondary analysis of video-recorded participant office visits (n = 275) from a larger observational study of glaucoma communication. We analyzed medical information, demographic characteristics, and interviewer-administrated questionnaires, as well as verbatim transcripts of interviews., RESULTS: Only 87 participants discussed medication cost during their glaucoma office visit. The majority of the subjects who discussed cost had mild disease severity (51%), took one glaucoma medication (63%), and had Medicare (49%) as well as a form of prescription insurance (78%). The majority of glaucoma office visits did not discuss medication cost, and providers often did not ask about cost problems. Of the few conversations related to cost, most focused on providers offering potential solutions (n = 50), medical and prescription service coverage (n = 41), and brand or generic medication choices (n = 41)., CONCLUSIONS: Our findings are similar to previous studies showing few patients have conversations with providers about the cost of glaucoma medications. Providers should consider bringing up medication cost during glaucoma office visits to prompt a discussion of potential cost-related barriers to medication use.
Erratum in (EIN)
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ec [Economics]; *Communication; *Drug Costs; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; Humans; Male; Middle Aged; Office Visits; *Ophthalmologists/sn [Statistics & Numerical Data]; Patient Compliance; *Patient Participation/sn [Statistics & Numerical Data]; *Physician-Patient Relations

New pharmacotherapy for the treatment of glaucoma. - Schehlein, Emily M; Novack, Gary; Robin, Alan L (Expert opinion on pharmacotherapy, 2017)
INTRODUCTION: Glaucoma is the second leading cause of blindness in the world and current pharmacotherapies for glaucoma have remained relatively unchanged (with the exception of fixed combinations of previously available medications) since the mid-1990s with the development of prostaglandin analogues. Now, with both new formulations and new classes of medications with novel mechanisms of action, the medical therapy of glaucoma may be heralding a new dawn in medical management. Areas covered: This review outlines new topical therapies for intraocular pressure (IOP) lowering treatment, in addition to new formulations, preservative-free options, and advances in glaucoma medical therapy delivery. We performed a comprehensive search for published studies for glaucoma medical therapy using the electronic database PubMed. A manual search for each therapy or delivery system was also performed. Expert commentary: These advances in glaucoma therapy have the potential to overcome many barriers to glaucoma's medical care, particularly in terms of adherence. However, both time and research are needed to prove the relative efficacy and safety of these new pharmacotherapies and products, helping us decide their role in the treatment of elevated intraocular pressure. We are hopeful that these new developments in therapy may bring more options for glaucoma medical therapy.
Keywords: Databases, Factual; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Prostaglandins/pd [Pharmacology]; Prostaglandins/tu [Therapeutic Use]; Protein Kinase Inhibitors/pd [Pharmacology]; Protein Kinase Inhibitors/tu [Therapeutic Use]; Purinergic P1 Receptor Agonists/pd [Pharmacology]; Purinergic P1 Receptor Agonists/tu [Therapeutic Use]; RNA, Small Interfering/tu [Therapeutic Use]; rho-Associated Kinases/ai [Antagonists & Inhibitors]; rho-Associated Kinases/me [Metabolism]

Comparisons of Self-reported Glaucoma Medication Adherence With a New Wireless Device: A Pilot Study. - Gatwood, Justin D; Johnson, Jordan; Jerkins, Brian (Journal of glaucoma, 2017)
PURPOSE: To compare use of topical medications between a wireless monitoring device and validated self-reported measures of glaucoma medication adherence., PATIENTS AND METHODS: This study involved adults from a group ophthalmology practice diagnosed with and being medicinally treated for glaucoma who were not scheduled for a surgery during the study period. Subjects were required to use a new wireless device to dispense their glaucoma medication for 2 months, and were surveyed at baseline and immediately following the study to assess mobile phone use, glaucoma-related self-efficacy, and medication adherence., RESULTS: Complete data (survey and accurate device recordings) were available for 23 subjects at both baseline and endpoint. Median adherence, as measured by the device, was 82% and dropped slightly between 30-day periods, from 83% to 77%. Similarly, the percent adherent (dosing at least 75% of the time) dropped significantly between months according to both the device (78.3% and 52.2%) and a self-reported measure (63% and 56%). Kappa statistics indicated low agreement between the device and self-report when classifying adherent status. A majority of subjects interviewed found the device easy to use, indicated that it did not interfere with medication-taking or normal activities, and were not bothered by their physician knowing when medication was dispensed., CONCLUSION: In this pilot, nearly all Kali Drop devices performed as expected, providing real-time data on medication use over a 60-day period. Data suggested that self-reported and electronic estimates of glaucoma medication use differ, but additional testing of this new device is needed to corroborate the data observed.
Keywords: Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Pilot Projects; Prospective Studies; Self Report; Surveys and Questionnaires

STARD 2015 was reproducible in a large set of studies on glaucoma. - Virgili, Gianni; Michelessi, Manuele; Miele, Alba; Oddone, Francesco; Crescioli, Giada; Fameli, Valeria; Lucenteforte, Ersilia (PloS one, 2017)
AIM: To investigate the reproducibility of the updated Standards for the Reporting of Diagnostic Accuracy Studies tool (STARD 2015) in a set of 106 studies included in a Cochrane diagnostic test accuracy (DTA) systematic review of imaging tests for diagnosing manifest glaucoma., METHODS: One senior rater with DTA methodological and clinical expertise used STARD 2015 on all studies, and each of three raters with different training profiles assessed about a third of the studies., RESULTS: Raw agreement was very good or almost perfect between the senior rater and an ophthalmology resident with DTA methods training, acceptable with a clinical rater with little DTA methods training, and only moderate with a pharmacology researcher with general, but not DTA, systematic review training and no clinical expertise. The relationship between adherence with STARD 2015 and methodological quality with QUADAS 2 was only partial and difficult to investigate, suggesting that raters used substantial context knowledge in risk of bias assessment., CONCLUSIONS: STARD 2015 proved to be reproducible in this specific research field, provided that both clinical and DTA methodological expertise are achieved through training of its users.
Keywords: Data Accuracy; *Diagnostic Tests, Routine/st [Standards]; *Glaucoma/di [Diagnosis]; Humans; Observer Variation; Reproducibility of Results; Research Design/st [Standards]

Safety of Fixed drug Combination in Post -Operative Cataract Patients, at Tertiary Care Centre - In South India. - Vidyadevi, M; Anuradha, A; Rashmi, G; Shilpa, R; Nishath, S (Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH, 2017)
INTRODUCTION: Cataract is any opacification in lens or its capsule, which accounts for about 50% of treatable blindness worldwide. The prevalence of cataract in India is about 62.6%. The incidence of post operative endophthalmitis ranges from 0.05% - 0.14% and so the use of post-operative antibiotics and steroids is necessary to control infection and prevent inflammation. Fixed drug combinations not only cut the cost but also the dosage and improve the compliance of patients in the immediate post operative period. In this regard, the present study was conducted with the aim of studying the efficacy of using fixed drug combination (Difluprednate and Moxifloxacin) in reducing ocular inflammation and pain in post-operative patients undergoing cataract surgery., METHODOLOGY: Study design: Prospective interventional study, in which 749 eyes underwent SICS with IOL. All of them were treated with Difluprednate and Moxifloxacin, combination eye drops postoperatively 4 times a day, and reviewed on day 1, 5 and once in two weeks up to 6 weeks., RESULTS: Out of 749 eyes, 730 were normal, 10 eyes had minimal raise in IOP in the range of 21 mmHg-31mmHg (considering 21mmHg as baseline) which decreased without any intervention within 3 weeks and only 9 eyes had raise in IOP of more than 31mmHg, which did not decrease in spite of discontinuing the drops and needed anti-glaucoma treatment., CONCLUSION: Our study clearly shows that fixed drug combination of antibiotic and steroid does not cause raised IOP in about 97% of cases of SICS in the post-operative period and also improves the compliance of the patients. Copyright © NEPjOPH.
Keywords: Anti-Bacterial Agents/ad [Administration & Dosage]; *Cataract Extraction; Dose-Response Relationship, Drug; Drug Combinations; *Endophthalmitis/dt [Drug Therapy]; Endophthalmitis/ep [Epidemiology]; Female; Fluprednisolone/ad [Administration & Dosage]; *Fluprednisolone/aa [Analogs & Derivatives]; Follow-Up Studies; Glucocorticoids/ad [Administration & Dosage]; Humans; Incidence; India/ep [Epidemiology]; Intraocular Pressure/de [Drug Effects]; Male; *Moxifloxacin/ad [Administration & Dosage]; Ophthalmic Solutions; *Postoperative Care/mt [Methods]; *Postoperative Complications/dt [Drug Therapy]; Postoperative Complications/ep [Epidemiology]; Prospective Studies; *Tertiary Care Centers

Assessment of eye drop instillation technique in glaucoma patients. - Gomes, Beatriz Fiuza; Paredes, Angela Flores; Madeira, Nathalia; Moraes, Haroldo Vieira Jr; Santhiago, Marcony R (Arquivos brasileiros de oftalmologia, 2017)
Purpose:: To study the technique of eye drop instillation in glaucoma patients and identify independent factors that may influence their performance., Methods:: In this cross-sectional study, 71 consecutive patients with glaucoma or ocular hypertension, self-administering topical anti-glaucoma medications for >=6 months were evaluated. All patients instilled a tear substitute into the eye with the worst eyesight using the technique normally used at home. The following parameters were evaluated: age, number of years receiving treatment with ocular hypotensive eye drops, time spent to instill the first drop, number of drops instilled, correct location of the eye drops, contact of the bottle with the eye, closing of the eyelids or occlusion of the tear punctum, and asepsis of the hands., Results:: The mean age of the patients was 66 +/- 10.8 years, and patients were on ocular hypotensive drugs for 11.3 +/- 7.3 (range, 2-35) years. Only 28% of the patients were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact). Touching the tip of the bottle to the globe or periocular tissue occurred in 62% of the patients. In 49% of the patients, the eye drops fell on the eyelids or cheek. Two or more drops were squeezed by 27% of the patients., Conclusions:: The majority of glaucoma patients were unable to correctly instill eye drops. Age was an independent factor associated with eye drop instillation performance.
Keywords: Adult; Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Humans; Instillation, Drug; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Patient Education as Topic; Time Factors; Visual Acuity

Recurrent herpetic keratitis despite antiviral prophylaxis: A virological and pharmacological study. - Rousseau, Antoine; Boutolleau, David; Titier, Karine; Bourcier, Tristan; Chiquet, Christophe; Weber, Michel; Colin, Joseph; Gueudry, Julie; M'Garrech, Mohamed; Bodaghi, Bahram; Burrel, Sonia; Agut, Henri; et al. (Antiviral research, 2017)
Recurrent herpes simplex keratitis (HSK) is a leading infectious cause of blindness in industrialized countries. Antiviral prophylaxis (AVP) may fail to prevent recurrence of HSK due to viral resistance, inadequate dosing, or poor patient compliance. In this prospective multicenter study, we enrolled immunocompetent patients with recurrent HSK despite AVP. Ocular samples were tested by PCR for herpes simplex virus 1 (HSV-1). HSV-1 drug resistance was assessed with a genotypic assay based on UL23 and UL30 gene sequencing. After curative full dose valacyclovir (VACV) treatment was started, peak and trough acyclovir (ACV) plasma concentrations were measured, and patient compliance to AVP was assessed with a questionnaire. The study sample was comprised of 43 patients. Six (14%) patients were positive for HSV-1 using PCR, of whom 5 (83%) harbored genotypically ACV-resistant (ACVR) virus, due to mutations in UL23 (n = 4) or UL30 (n = 1). Disease duration was statistically significantly longer in patients with viral resistance compared to other HSK patients [35.5 +/- 23.4 years (range, 6.8-68.4 years) versus 11.1 +/- 12.3 years (range, 0.8-56.3 year) respectively; Mann-Whitney p = 0.01)]. While patients were treated with full dose VACV, trough ACV plasma concentrations were below the threshold for ACV sensitivity in 9.5% of cases, and compliance was poor in 5.3% of cases. To summarize, HSV-1 resistance to ACV seems to be a significant cause of failure of prophylaxis in patients with HSK and is associated with longer disease duration. Most PCR-positive samples contained genotypically ACVR virus and identification may aid in adapting treatment. Incomplete 24-h drug coverage may also explain some cases of failure of prophylaxis. Copyright © 2017 Elsevier B.V. All rights reserved.
Keywords: Acyclovir/ad [Administration & Dosage]; Acyclovir/aa [Analogs & Derivatives]; Acyclovir/bl [Blood]; Acyclovir/tu [Therapeutic Use]; Adolescent; Adult; Aged; *Antiviral Agents/ad [Administration & Dosage]; *Antiviral Agents/bl [Blood]; Antiviral Agents/tu [Therapeutic Use]; Child; Child, Preschool; Drug Resistance, Viral/ge [Genetics]; Female; Herpes Simplex/dt [Drug Therapy]; Herpes Simplex/vi [Virology]; *Herpesvirus 1, Human/de [Drug Effects]; Herpesvirus 1, Human/ge [Genetics]; Herpesvirus 1, Human/ip [Isolation & Purification]; Humans; Infant; Keratitis, Herpetic/dt [Drug Therapy]; Keratitis, Herpetic/ep [Epidemiology]; Keratitis, Herpetic/et [Etiology]; *Keratitis, Herpetic/vi [Virology]; Male; Middle Aged; Polymerase Chain Reaction; Prospective Studies; Recurrence; Tears/vi [Virology]; Valacyclovir; Valine/ad [Administration & Dosage]; Valine/aa [Analogs & Derivatives]; Valine/tu [Therapeutic Use]; Young Adult

Development and characterisation of electrospun timolol maleate-loaded polymeric contact lens coatings containing various permeation enhancers. - Mehta, Prina; Al-Kinani, Ali A; Arshad, Muhammad Sohail; Chang, Ming-Wei; Alany, Raid G; Ahmad, Zeeshan (International journal of pharmaceutics, 2017)
Despite exponential growth in research relating to sustained and controlled ocular drug delivery, anatomical and chemical barriers of the eye still pose formulation challenges. Nanotechnology integration into the pharmaceutical industry has aided efforts in potential ocular drug device development. Here, the integration and in vitro effect of four different permeation enhancers (PEs) on the release of anti-glaucoma drug timolol maleate (TM) from polymeric nanofiber formulations is explored. Electrohydrodynamic (EHD) engineering, more specifically electrospinning, was used to engineer nanofibers (NFs) which coated the exterior of contact lenses. Parameters used for engineering included flow rates ranging from 8 to 15muL/min and a novel EHD deposition system was used; capable of hosting four lenses, masked template and a ground electrode to direct charged atomised structures. SEM analysis of the electrospun structures confirmed the presence of smooth nano-fibers; whilst thermal analysis confirmed the stability of all formulations. In vitro release studies demonstrated a triphasic release; initial burst release with two subsequent sustained release phases with most of the drug being released after 24h (86.7%) Biological evaluation studies confirmed the tolerability of all formulations tested with release kinetics modelling results showing drug release was via quasi-Fickian or Fickian diffusion. There were evident differences (p<0.05) in TM release dependant on permeation enhancer. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.
Keywords: *Contact Lenses; *Drug Delivery Systems; Drug Liberation; Humans; Polymers; *Timolol/ad [Administration & Dosage]

Novel Glaucoma Drug Delivery Devices. - Lin, Michael M; Ciolino, Joseph B; Pasquale, Louis R (International ophthalmology clinics, 2017)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Contact Lenses; *Drug Delivery Systems/mt [Methods]; Drug Implants; *Glaucoma/dt [Drug Therapy]; Humans; Intravitreal Injections; *Ocular Hypertension/dt [Drug Therapy]; Patient Acceptance of Health Care

Awareness and practices regarding eye diseases among patients with diabetes: a cross sectional analysis of the CoDiab-VD cohort. - Konstantinidis, Lazaros; Carron, Tania; de Ancos, Eva; Chinet, Leonie; Hagon-Traub, Isabelle; Zuercher, Emilie; Peytremann-Bridevaux, Isabelle (BMC endocrine disorders, 2017)
BACKGROUND: The increasing prevalence of diabetes is leading to a rise of eye diseases, augmenting the risk of sight-threatening complications. The aim of this study was to evaluate prevalence, awareness and practices regarding eye diseases among patients with diabetes in the canton of Vaud, Switzerland., METHODS: A cohort of 323 patients with diabetes completed a self-administered questionnaire assessing prevalence, awareness and practices regarding eye diseases, besides health status and quality of care measures. Descriptive analyses followed by exploratory subgroup analyses and linear regressions were performed to investigate factors associated with awareness and practices., RESULTS: While diabetic retinopathy was reported by 40.9% of patients with type 1 diabetes and 9.8% of patients with type 2 diabetes, 35.8% and 12.6% of all participants reported cataract and glaucoma, respectively. Awareness that diabetes could damage the eyes was reported by almost all participants; the majority was also aware of the importance of glycemic control and regular eye examination in preventing eye diseases. In contrast, only 70.5% of participants underwent an eye examination by an ophthalmologist during the past year. Eye examination was associated with better patients' awareness. Barriers mentioned by patients revealed a lack of knowledge about screening guidelines, in particular regarding the preventive nature of eye examinations., CONCLUSIONS: Despite high levels of awareness regarding diabetic eye diseases, a significant proportion of patients with diabetes did not report annual eye examination. Both healthcare strategic efforts targeting the promotion of regular eye examination and initiatives aiming at improving knowledge of screening guidelines should be encouraged., TRIAL REGISTRATION: ClinicalTrials.gov on 9th July 2013, identifier NCT01902043 (retrospectively registered).
Keywords: Aged; Cohort Studies; Cross-Sectional Studies; *Diabetes Complications/ep [Epidemiology]; *Diabetic Retinopathy/ep [Epidemiology]; Eye Diseases/co [Complications]; *Eye Diseases/ep [Epidemiology]; Female; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Prevalence; Switzerland/ep [Epidemiology]

Evaluating the Quality of Life of Glaucoma Patients Using the State-Trait Anxiety Inventory. - Otori, Yasumasa; Takahashi, Genichiro; Urashima, Mitsuyoshi; Kuwayama, Yasuaki; Quality of Life Improvement Committee (Journal of glaucoma, 2017)
PURPOSE: To evaluate anxiety felt by glaucoma patients., PATIENTS AND METHODS: In total, 472 glaucoma patients responded to a questionnaire on anxiety, subjective symptoms, and vision-related quality of life (VR-QOL) associated with glaucoma. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI), state anxiety (STAI-State) subscale along with our novel questionnaire, assessing visual function and subjective symptoms, specialized for glaucoma. VR-QOL was evaluated using 5 subitems from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Adherence to ophthalmic antiglaucoma agents was confirmed. As indexes of visual function, corrected visual acuity (measured by eye chart), mean deviation (MD) score (measured with static perimetry), and 4 thresholds at the center of vision were determined. Stages were classified according to the Aulhorn Classification. From the STAI-State scores, the prevalence of anxiety in glaucoma patients was evaluated. We analyzed the correlation between the STAI-State and VFQ-25, anxiety, subjective symptoms, adherence, and visual function indexes., RESULTS: In total, 78% of glaucoma patients experienced at least an intermediate level of anxiety. The STAI-State correlated significantly with anxiety and subjective symptoms as measured by our novel questionnaire, particularly for questions "current anxiety about loss of vision" and "current anxiety in life" (r=0.468 and 0.500; both P<0.0001). However, STAI-State correlated weakly with VFQ-25, and not at all with visual function indexes and adherence., CONCLUSIONS: Many glaucoma patients feel anxiety. The STAI-State is correlated with the VR-QOL and anxiety in glaucoma patients, making it useful for understanding the anxiety present in glaucoma patients.
Keywords: Adult; Aged; Aged, 80 and over; *Anxiety/px [Psychology]; Female; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; Humans; Intraocular Pressure; Male; Middle Aged; *Psychiatric Status Rating Scales; *Quality of Life/px [Psychology]; Sickness Impact Profile; Surveys and Questionnaires; Visual Acuity/ph [Physiology]; Visual Field Tests; Visual Fields/ph [Physiology]

Can Adapted Motivational Interviewing Improve Uptake of Surgical or Laser Treatment for Glaucoma in Nigeria: Randomized Controlled Trial. - Abdull, Mohammed M; McCambridge, Jim; Evans, Jennifer; Muazu, Fatima; Gilbert, Clare (Journal of glaucoma, 2017)
PURPOSE: To assess whether adapted motivational interviewing (MI) has any impact on the proportion of participants who subsequently underwent surgery or laser treatment for glaucoma., MATERIALS AND METHODS: A single site randomized controlled trial in Bauchi, Nigeria. Participants were new patients with a confirmed diagnosis of primary open-angle glaucoma in 1 or both eyes, where surgery or laser was recommended. Intervention was a session of MI adapted for glaucoma and the local context, using an interview guide based on local qualitative research. Participants were randomly allocated to intervention or usual care. Usual care was routine explanation by an ophthalmologist and an educational pamphlet. After the interview, a 12-item Working Alliance Inventory questionnaire was administered to patient-interviewer pairs to assess the collaborative relationship., RESULTS: Two hundred seventy-six glaucoma patients participated; 70% males. One hundred thirty-five (49%) were assigned to adapted MI and 141 to usual care. All received the intervention as allocated. Uptake (ie, the proportion who underwent treatment) of laser or surgery in the MI group was 52% compared with 45% in the usual care group (risk difference 7.2%; 95% confidence interval, -4.5% to 18.9%). Mean Working Alliance Inventory scores were 68.0 for interviewers and 68.5 for participants with a combined reliability coefficient of 93.9% (ie, high internal consistency and reliability)., CONCLUSIONS: We observed only a small increase in the uptake of surgery or laser with MI compared with usual care which was not statistically significant. Although only 1 in 2 patients accepted surgery or laser in this trial, this is a much higher proportion than in other studies.
Keywords: Adolescent; Adult; Aged; Counseling; Female; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; Laser Therapy/sn [Statistics & Numerical Data]; *Laser Therapy; Male; Middle Aged; *Motivational Interviewing; Nigeria; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Reproducibility of Results; Surveys and Questionnaires; *Trabeculectomy/sn [Statistics & Numerical Data]; Young Adult

Changing Initial Glaucoma Medical Therapy Increases Healthcare Resource Utilization. - Trese, Matthew G J; Lewis, Andrew W; Blachley, Taylor S; Stein, Joshua D; Moroi, Sayoko E (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2017)
PURPOSE: To determine the frequency and economic impact of changing initial glaucoma therapy for patients with newly diagnosed open-angle glaucoma (OAG) or ocular hypertension (OHT)., METHODS: This retrospective longitudinal cohort study identified individuals within a large managed care network in the United States, who were newly diagnosed with OAG or OHT from 2001 to 2012 and were prescribed either a topical beta blocker (BB) or a prostaglandin analog (PGA). Claims data were analyzed over the 12-month period following their index prescription to determine physician prescribing habits, healthcare resource utilization patterns, and sociodemographic factors which may have contributed to changing the initial treatment strategy., RESULTS: A total of 15,019 beneficiaries were identified with newly diagnosed OAG or OHT and whose index therapy was either a topical BB or PGA. Among these enrollees 80.9% were started on PGAs, while 19.1% were started on BBs. Of these beneficiaries, 29.2% of those started on PGAs and 39.5% of those started on BBs underwent a change in therapy within 12 months of their index prescription. Those in the topical BB treatment group had a 38% increased odds of changing glaucoma therapy relative to those started on PGAs (odds ratio [OR] 0.61, 95% CI:0.56-0.68). Patients who changed therapy required more frequent office visits (P < 0.0001) and incurred higher median eye care related charges (P < 0.0001) compared to those who remained on the index therapy unchanged., CONCLUSIONS: Changing initial ocular hypotensive therapy is common. Individuals who undergo a change in therapy required more frequent face-to-face monitoring and incurred higher healthcare related costs. Identifying strategies capable of optimizing the process of initiating ocular hypotensive therapy are appealing and possess the potential to improve patient outcomes and reduce healthcare costs.
Keywords: Administration, Topical; *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ec [Economics]; Aged; Cohort Studies; Drug Substitution/ec [Economics]; Drug Substitution/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ec [Economics]; Health Care Costs/sn [Statistics & Numerical Data]; Humans; Longitudinal Studies; Male; Managed Care Programs/ec [Economics]; Managed Care Programs/sn [Statistics & Numerical Data]; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ec [Economics]; Office Visits/sn [Statistics & Numerical Data]; Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; *Prostaglandins, Synthetic/ad [Administration & Dosage]; Prostaglandins, Synthetic/ec [Economics]; Retrospective Studies; Time Factors; United States

Effect of Multipurpose Solution Combined With Autophagy Inhibitors on Adhesion of Acanthamoeba trophozoites to Silicone Hydrogel Contact Lenses. - Lee, Seung-Mok; Lee, Da-In; Park, Sung-Hee; Yu, Hak-Sun; Lee, Ji-Eun; Lee, Jong-Soo (Cornea, 2017)
PURPOSE: The aim of the study was to evaluate the effect of multipurpose contact lens (CL) solution (MPS) combined with autophagy inhibitors on the adhesion properties of Acanthamoeba castellanii (AC) trophozoites to silicone hydrogel CLs., METHODS: AC trophozoites were inoculated onto discs trimmed from a silicone hydrogel CL with plasma surface treatment. After 18 hours, the number of adherent AC trophozoites on the CL treated with MPS was counted under phase-contrast microscopy. We analyzed the efficacy of MPS combined with autophagy inhibitors, 3-methyladenine (0.1, 1, and 5 mM) and chloroquine (10, 100 muM, and 1 mM), on Acanthamoeba adhesion by electron microscopy., RESULTS: Adhesion of AC trophozoites to the CL treated with MPS (average number of trophozoites adhered to the CL: 61.2 +/- 8.1) was significantly lower compared with that of the CL treated without MPS (83.8 +/- 10.2) (P = 0.027). In MPS application, the number of adhered AC trophozoites treated with 3-methyladenine [8.2 +/- 2.5 for 5 mM (P = 0.008)] or chloroquine [19.4 +/- 7.6 for 100 muM (P = 0.038) and 5.3 +/- 1.9 for 1 mM (P = 0.001)] was significantly reduced compared with the sample without autophagy inhibitors. However, the number of adherent AC trophozoites was not significantly reduced in less than 5 mM in 3-methyladenine [50.4 +/- 5.1 for 0.1 mM (P = 0.084) and 43.1 +/- 5.0 for 1 mM (P = 0.079)] and 100 muM in chloroquine [40.6 +/- 13.5 for 10 muM (P = 0.075)]. 3-methyladenine induced blebby structures or disrupted the membranes of AC trophozoites. AC trophozoites treated with chloroquine showed undigested organelles in the cytoplasm of Acanthamoeba cells., CONCLUSIONS: MPS combined with 3-methyladenine or chloroquine reduced the adhesion rate of AC trophozoites rather than MPS containing only polyhexamethylene biguanide. Appropriate concentrations of autophagy inhibitors, 3-methyladenine and chloroquine, added to commercial MPS should be considered to decrease the clinical rate of Acanthamoeba keratitis.
Keywords: *Acanthamoeba castellanii/de [Drug Effects]; Adenine/aa [Analogs & Derivatives]; Adenine/pd [Pharmacology]; *Amebicides/pd [Pharmacology]; *Autophagy/de [Drug Effects]; *Bacterial Adhesion/de [Drug Effects]; Chloroquine/pd [Pharmacology]; *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses, Hydrophilic/ps [Parasitology]; Hydrogel, Polyethylene Glycol Dimethacrylate; Microscopy, Electron/mt [Methods]; Silicones; Trophozoites/de [Drug Effects]

Tacrolimus eye drops as monotherapy for vernal keratoconjunctivitis: a randomized controlled trial. - Muller, Eduardo Gayger; Santos, Myrna Serapiao Dos; Freitas, Denise; Gomes, Jose Alvaro Pereira; Belfort, Rubens Jr (Arquivos brasileiros de oftalmologia, 2017)
PURPOSE: To assess the efficacy of monotherapy using tacrolimus eye drops versus sodium cromoglycate for the treatment of vernal keratoconjunctivitis (VKC)., METHODS: Randomized double-masked controlled trial comparing the efficacy of tacrolimus 0.03% eye drops t.i.d. (Group 1) with sodium cromoglycate 4% eye drops t.i.d. (Group 2) for the symptomatic control of VKC at days 0, 15, 30, 45, and 90 of follow-up. Visual acuity, intraocular pressure, and other complications were evaluated to assess safety and side effects., RESULTS: In total, 16 patients were included, with 8 enrolled in each group. Two patients from Group 2 were excluded from the analysis at days 45 and 90 because of corticosteroid use. Most patients were male (81.8%) and presented with limbal VKC (56.3%). There were statistically significant differences in favor of tacrolimus in the following severity scores: itching at day 90 (p=0.001); foreign body sensation at day 15 (p=0.042); photophobia at day 30 (p=0.041); keratitis at day 30 (p=0.048); and limbal activity at days 15 (p=0.011), 30 (p=0.007), and 45 (p=0.015). No relevant adverse effects were reported, except for a burning sensation with tacrolimus, though this did not compromise treatment compliance., CONCLUSION: Treatment with tacrolimus was superior to sodium cromoglycate when comparing severity scores for symptoms of itching, foreign body sensation, and photophobia, as well as for signs of limbal inflammatory activity and keratitis.
Keywords: Adolescent; Child; *Conjunctivitis, Allergic/dt [Drug Therapy]; Conjunctivitis, Allergic/pa [Pathology]; Cromolyn Sodium/tu [Therapeutic Use]; Double-Blind Method; Female; Humans; *Immunosuppressive Agents/tu [Therapeutic Use]; Male; Ophthalmic Solutions/tu [Therapeutic Use]; Severity of Illness Index; Statistics, Nonparametric; *Tacrolimus/tu [Therapeutic Use]; Time Factors; Treatment Outcome; Visual Acuity

Peripapillary retinal splitting visualized on OCT in glaucoma and glaucoma suspect patients. - Grewal, Dilraj S; Merlau, Daniel J; Giri, Pushpanjali; Munk, Marion R; Fawzi, Amani A; Jampol, Lee M; Tanna, Angelo P (PloS one, 2017)
PURPOSE: To identify the risk factors for development of peripapillary retinal splitting (schisis) in patients with glaucoma or suspicion of glaucoma., SETTING: Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL., METHODS: In this institutional cross-sectional study, 495 patients (990 eyes) who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering) optic nerve head (ONH) imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers., MAIN OUTCOME MEASURES: Presence of peripapillary retinal splitting identified on OCT raster scans., RESULTS: Eleven of 990 glaucoma and glaucoma suspect eyes (1.1%) of 7 patients (2 females, 5 males, mean age 64.5 +/- 9.2 years) had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6%) were glaucoma suspects, 3 (42.9%) had primary open-angle glaucoma, 1 (14.3%) had chronic angle-closure glaucoma and 1 (14.3%) had pigmentary glaucoma. 7/11 (63.6%) eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5%) had beta-zone peripapillary atrophy., CONCLUSIONS: We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.
Keywords: Cross-Sectional Studies; *Glaucoma/dg [Diagnostic Imaging]; *Retina/dg [Diagnostic Imaging]; *Tomography, Optical Coherence/mt [Methods]

[Ophthalmological health care of the institutionalized elderly : The OVIS study]. - Fang, P P; Schnetzer, A; Kupitz, D G; Gobel, A P; Kohnen, T; Reinhard, T; Lorenz, B; Hoerauf, H; Wagenfeld, L; Auffarth, G; Schaub, F; Thieme, H; et al. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2017)
BACKGROUND: Due to demographic change and societal transformation the number of elderly persons living in retirement homes is growing in Germany. Access to health care is more complicated in the setting of nursing homes. Different regional studies suggest unmet ophthalmological health care needs in institutionalized elderly people. This study assessed the current ophthalmological health care structure and supply status in nursing homes in Germany., METHODS: This prospective, multicenter cross-sectional study was conducted by 14 study centers in Germany. Elderly people living in 32 nursing homes were included after approval by the local institutional review boards. A standardized examination was performed which included a detailed medical and ocular history, refraction, visual acuity testing, tonometry, biomicroscopy and dilated funduscopy. Unmet ophthalmological health care needs were documented and the data were analyzed descriptively and via logistic regression modelling., RESULTS: A total of 600 participants (434 women and 166 men) aged 50-104 years were examined of which 368 (61%) had ophthalmological conditions requiring treatment. The most prevalent findings were cataracts (315; 53%), disorders of the eyelids (127; 21%), dry eye disease (57; 10%) and posterior capsule opacification (43; 7%). In 63 (11%) of the participants glaucoma was suspected and 55 (9%) of the examined population had a known diagnosis of glaucoma, of whom one third was not on any or on insufficient anti-glaucomatous therapy. 236 (39%) showed signs of age-related macular degeneration (AMD). Only 52% of the examined cohort had been examined by an ophthalmologist within the last 5 years and 39% stated that they would currently not be able to consult an ophthalmologist. Reported barriers were mainly transport and lack of support., CONCLUSION: This study demonstrates considerable unmet ophthalmological health care needs of the institutionalized elderly in Germany. Novel and reformed models of specialist care provision have to be developed.
Keywords: Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; *Eye Diseases/di [Diagnosis]; Eye Diseases/ep [Epidemiology]; *Eye Diseases/th [Therapy]; Female; Germany; *Health Services Accessibility/sn [Statistics & Numerical Data]; *Health Services Needs and Demand/sn [Statistics & Numerical Data]; *Homes for the Aged/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; *Nursing Homes/sn [Statistics & Numerical Data]; *Ophthalmology/sn [Statistics & Numerical Data]

Can Home Monitoring Allow Earlier Detection of Rapid Visual Field Progression in Glaucoma?. - Anderson, Andrew J; Bedggood, Phillip A; George Kong, Yu Xiang; Martin, Keith R; Vingrys, Algis J (Ophthalmology, 2017)
PURPOSE: Recent developments in electronic technology are making it possible to home monitor the sensitivity of the central visual field using portable devices. We used simulations to investigate whether the higher test frequency afforded by home monitoring improves the early detection of rapid visual field loss in glaucoma and how any benefits might be affected by imperfect compliance or increased variability in the home-monitoring test., DESIGN: Computer simulation, with parameter selection confirmed with a cohort study., PARTICIPANTS: A total of 43 patients with treated glaucoma (both open-angle and closed-angle), ocular hypertension or glaucoma suspects (mean age, 71 years; range, 37-89 years), were followed in the cohort study., METHODS: We simulated series (n = 100 000) of visual fields for patients with stable glaucoma and patients with progressing glaucoma for 2 in-clinic (yearly and 6-monthly) and 3 home-monitoring (monthly, fortnightly, and weekly) schedules, each running over a 5-year period. Various percentages of home-monitored fields were omitted at random to simulate reduced compliance, and the variability of the home monitored fields also was manipulated. We used previously published variability characteristics for perimetry and confirmed their appropriateness for a home-monitoring device by measuring the device's retest variability at 2 months in a cohort of 43 patients. The criterion for flagging progression in our simulation was a significant slope of the ordinary least squares regression of a simulated patient's mean deviation (MD) data., MAIN OUTCOME MEASURES: The sensitivity for identifying rapid visual field loss (-2 decibels [dB]/year loss of MD)., RESULTS: Although a sensitivity of 0.8 for rapid field loss was achieved after 2.5 years of 6-monthly testing in the clinic, weekly home monitoring achieved this by 0.9 years despite moderate test compliance of 63%. The improved performance of weekly home monitoring over 6-monthly clinical testing was retained even when home monitoring was assumed to produce more variable test results or be associated with low patient compliance., CONCLUSIONS: Detecting rapid visual field progression may be improved using a home-monitoring strategy, even when compliance is imperfect. The cost-benefit of such an approach is yet to be demonstrated, however. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; Cohort Studies; Computer Simulation; Disease Progression; Early Diagnosis; Female; Follow-Up Studies; *Glaucoma, Angle-Closure/di [Diagnosis]; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Monitoring, Physiologic; Ocular Hypertension/di [Diagnosis]; Sensitivity and Specificity; *Vision Disorders/di [Diagnosis]; Visual Field Tests/mt [Methods]; *Visual Fields

Development and validation of a real-time PCR assay for the detection of clinical acanthamoebae. - Karsenti, Nessika; Lau, Rachel; Purssell, Andrew; Chong-Kit, Ann; Cunanan, Marlou; Gasgas, Jason; Tian, Jinfang; Wang, Amanda; Ralevski, Filip; Boggild, Andrea K (BMC research notes, 2017)
BACKGROUND: Suboptimal agreement between molecular assays for the detection of Acanthamoeba spp. in clinical specimens has been demonstrated, and poor assay sensitivity directly imperils the vision of those affected by amoebic keratitis (AK) through delayed diagnosis. We sought to develop and validate a single Taqman real time PCR assay targeting the Acanthamoeba 18S rRNA gene that could be used to enhance sensitivity and specificity when paired with reference assays., METHODS: Biobanked DNA from surplus delinked AK clinical specimens and 10 ATCC strains of Acanthamoeba was extracted. Sequence alignment of 66 18S rRNA regions from 12 species of Acanthamoeba known to cause keratitis informed design of a new TaqMan primer set. Performance of the new assay was compared to the 2 assays used currently in our laboratory., RESULTS: Among 24 Acanthamoeba-positive and 83 negative specimens by the CDC reference standard, performance characteristics of the newly designed primer set were as follows: sensitivity 100%, specificity 94%, PPV 82.8%, and NPV 100%. Compared to culture, sensitivity of the new primer set was 100%, and specificity 96%. No cross-reactivity of the primer set to non-acanthamoebae, including Balamuthia and Naegleria, was found., CONCLUSIONS: We have validated a real time PCR assay for the diagnosis of AK, and in doing so, have overcome important barriers to rapid and sensitive detection of acanthamoebae, including limited sensitivity and specificity of commonly used assays.
Keywords: *Acanthamoeba; *Acanthamoeba Keratitis; *Biological Assay/mt [Methods]; Biological Assay/st [Standards]; Humans; *Real-Time Polymerase Chain Reaction/mt [Methods]; Real-Time Polymerase Chain Reaction/st [Standards]; Sensitivity and Specificity

Prescribing Trends in a Glaucoma Clinic and Adherence to EGS Guidelines: A Retrospective, Non-Interventional, Single-Center UK Study. - Fajgenbaum, Mark; Ansari, Ejaz (Advances in therapy, 2017)
INTRODUCTION: The purpose of this study was to determine prescribing trends in a specialist glaucoma clinic in the UK. Specifically, the aims were to determine which drugs were prescribed as first-, second-, and third-line treatment, the persistence of first-, second-, and third-line treatment regimens, and the proportion of treatment decisions conforming to the European Glaucoma Society (EGS) guidelines., METHODS: A retrospective, non-interventional, single-center, case-note review was performed on a cohort of consecutive patients presenting to a specialist glaucoma clinic for follow-up. Inclusion criteria for the study were (1) a diagnosis of primary open-angle glaucoma or ocular hypertension, (2) glaucoma management entirely within the unit, and (3) minimum of 2 years of follow-up., RESULTS: A total of 114 case notes met the inclusion criteria. Mean age was 71 years (range 40-95 years). Mean length of follow-up was 56 months (range 24-180 months). Prostaglandin analogues (PGA) were the most popular first-line treatment in 73% of patients. As second-line treatment, PGA were again the predominant class, prescribed in 87% of cases, whereas beta-blockers (BB) were prescribed in 70% of cases. Carbonic anhydrase inhibitors (CAI) and alpha-2 agonists (AA) were more popular in third-line regimens. Second-line treatment was introduced at a mean of 28.0 months after first-line treatment (range 1-120 months, 95% CI 22.1-33.9 months). Third-line treatment was introduced at a mean of 22.9 months after second-line treatment (range 1-96 months, 95% CI 17.1-28.8 months). Breaches to EGS guidelines were most common for third-line treatment and included duplication of drug classes., DISCUSSION: There was a clear hierarchy of PGA as first-line, BB as second-line, while CAI and AA were considered third-line choices. First-line choices were generally in line with EGS guidelines. There was a tendency to breach guidelines by escalating treatment in dual steps rather than single steps (especially in third-line treatment). Combination drops were popular. In third-line treatment there was an increased incidence of prescribing errors. This data is important in terms of informing patients of the expected treatment course, to remind clinicians about best practice, and also to guide comparisons of cost-effectiveness with other treatment modalities.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; *Drug Prescriptions/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Practice Guidelines as Topic; *Practice Patterns, Physicians'/td [Trends]; Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies

The Ketogenic Diet: Making a Comeback. - Walczyk, Thomas; Wick, Jeannette Y (The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2017)
Americans have embraced a large number of diets in an attempt to manage obesity, improve quality of life, and address specific health problems. Among diets developed to address health problems, the ketogenic diet has had a long and variable history. Developed in the 1920s by a faith healer to help children with epilepsy, this diet induces a state that mimics carbohydrate starvation. As medications became available and effectively addressed seizures, the diet fell out of favor. During the last few decades, researchers and clinicians have learned that it can be useful in children and adults with refractory epilepsy and a variety of other conditions. Once again, pharmacists may encounter patients who are employing dietary management of serious health problems. This very high-fat diet almost eliminates carbohydrates from the patient's food selection. The result is the substitution of ketone bodies as a source of energy. Today's ketogenic diet has been modified with scientifically proven adjustments to increase palatability and help with adherence. Effective for some forms of epilepsy, the ketogenic diet also seems to have some utility in Alzheimer's disease, Parkinson's disease, and glaucoma, and many Americans are using it to lose weight. Consultant pharmacists may field questions about this diet, its potential to correct or alleviate health conditions, and its limitations. The article discusses the ketogenic diet's strengths, limitations, potential mechanisms, and use in a number of conditions with an emphasis on the elderly.
Keywords: Alzheimer Disease/dh [Diet Therapy]; Animals; Consultants; Diet, Ketogenic/ae [Adverse Effects]; *Diet, Ketogenic; Epilepsy/dh [Diet Therapy]; Glaucoma/dh [Diet Therapy]; Humans; Parkinson Disease/dh [Diet Therapy]; Pharmacists

Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma. - Sapru, Saloni; Berktold, Jennifer; Crews, John E; Katz, L Jay; Hark, Lisa; Girkin, Christopher A; Owsley, Cynthia; Francis, Brittney; Saaddine, Jinan B (Evaluation and program planning, 2017)
INTRODUCTION: Glaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma., METHODS: The RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions., DISCUSSION: By targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17-19%) - a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive., CONCLUSIONS: Evaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets. Copyright © 2017 Elsevier Ltd. All rights reserved.
Keywords: Adult; *Community Networks; Female; Glaucoma/th [Therapy]; *Glaucoma; Health Promotion; *Health Services Accessibility; Humans; Male; Middle Aged; Program Evaluation; Telemedicine

Adherence to Follow-up Recommendations Among Individuals in the Philadelphia Glaucoma Detection and Treatment Project. - Hark, Lisa A; Leiby, Benjamin E; Waisbourd, Michael; Myers, Jonathan S; Fudemberg, Scott J; Mantravadi, Anand V; Dai, Yang; Gilligan, John P; Resende, Arthur F; Katz, L Jay (Journal of glaucoma, 2017)
PURPOSE: To evaluate rates of adherence to free follow-up eye exam appointments among participants in the Philadelphia Glaucoma Detection and Treatment Project., PATIENTS AND METHODS: Ophthalmologists and testing equipment were brought directly to participants at risk for glaucoma at 43 community sites in Philadelphia. Those diagnosed with glaucoma-related pathology were recommended to return for follow-up to be reexamined on site. Rates of adherence and clinical and demographic risk factors for adherence were evaluated., RESULTS: Five hundred thirty-one participants were diagnosed with glaucoma-related conditions and recommended to attend community-based follow-up exams. Follow-up adherence rate was 61.2% (n=325/531). Significant factors associated with greater eye exam appointment adherence, based on our univariable analysis, included final diagnosis of glaucoma (risk ratio [RR]=1.33; 95% confidence interval [CI], 1.13-1.57), male sex (RR=1.19; 95% CI, 1.04-1.36), white race (RR=1.26; 95% CI, 1.08-1.48), age (RR=1.17; 95% CI, 1.00-1.37) recommendation for glaucoma medication (RR=1.52; 95% CI, 1.35-1.71), recommendation for laser peripheral iridotomy (RR=1.18; 95% CI, 1.02-1.35), diagnosis of age-related macular degeneration (RR=1.42; 95% CI, 1.13-1.77) and an increased intraocular pressure (>22 mm Hg in the worse eye) (RR=1.23; 95% CI, 1.06-1.42). On the basis of our multivariable model, diagnosis, sex, and recommended glaucoma medications were significantly associated with follow-up adherence., CONCLUSIONS: This study demonstrates that individuals living in underserved urban communities would take advantage of free eye exams in community sites and return for follow-up eye exams in these same settings. Future studies could investigate interventions to improve eye exam appointment adherence in community-based settings to detect glaucoma-eye conditions.
Keywords: Aged; Appointments and Schedules; Community Health Services/og [Organization & Administration]; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Health Care Surveys; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure/ph [Physiology]; Laser Therapy; Male; Middle Aged; Ophthalmologic Surgical Procedures; *Patient Compliance/sn [Statistics & Numerical Data]; Philadelphia; Retrospective Studies; Risk Factors

Brimonidine and brinzolamide for treating glaucoma and ocular hypertension; a safety evaluation. - Lusthaus, Jed Asher; Goldberg, Ivan (Expert opinion on drug safety, 2017)
INTRODUCTION: Brimonidine tartrate and brinzolamide eye drops are often used as third and fourth line treatment options to reduce intraocular pressure (IOP) in the management of glaucoma and ocular hypertension. Better tolerated, more effective topical agents requiring once daily instillation including prostaglandin analogues and beta-blockers usually are preferred as initial therapy, unless there are contraindications. Brimonidine and brinzolamide are often required owing to progressive glaucoma or intolerances to or ineffectiveness of front-line agents. Areas covered: We review the safety of formulations containing brimonidine tartrate and/or brinzolamide. Safety considerations for these agents in higher risk populations are highlighted. Expert opinion: Each class of ocular hypotensive eye drop has a unique set of possible side effects. Brimonidine might have neuro-protective capabilities and offer reasonable IOP control, but its use is limited by a relatively high rate of ocular allergy, hyperemia and discomfort. Brinzolamide is generally well tolerated, but often lacks efficacy. The introduction of brimonidine/brinzolamide fixed combination suspension improves adherence (by simplifying the medical regimen) and reduces preservative load on the ocular surface. New drug delivery systems incorporating brimonidine and brinzolamide are in development and promise to improve the safety profiles of both drugs.
Keywords: Administration, Ophthalmic; Animals; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Brimonidine Tartrate/ad [Administration & Dosage]; *Brimonidine Tartrate/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Drug Delivery Systems; Glaucoma/dt [Drug Therapy]; *Glaucoma; Humans; Ocular Hypertension/dt [Drug Therapy]; Sulfonamides/ad [Administration & Dosage]; *Sulfonamides/ae [Adverse Effects]; Thiazines/ad [Administration & Dosage]; *Thiazines/ae [Adverse Effects]

The Current State of Teleophthalmology in the United States. - Rathi, Siddarth; Tsui, Edmund; Mehta, Nitish; Zahid, Sarwar; Schuman, Joel S (Ophthalmology, 2017)
Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via "store and forward" methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Comment in (CIN), Comment in (CIN)
Keywords: Ambulatory Care; Diabetic Retinopathy/di [Diagnosis]; Glaucoma/di [Diagnosis]; Hospitals; Humans; Macular Degeneration/di [Diagnosis]; Ophthalmology/mt [Methods]; *Ophthalmology/td [Trends]; Patient Satisfaction; Retinopathy of Prematurity/di [Diagnosis]; Telemedicine/mt [Methods]; *Telemedicine/td [Trends]; United States

Developing a children's glaucoma passport: mapping innovations in healthcare. - Bruynseels, A; Cross, V; Sii, F; Shah, P; Abbott, J (Eye (London, England), 2017)
Keywords: Child; *Diffusion of Innovation; Disease Management; *Glaucoma/th [Therapy]; Health Promotion/mt [Methods]; Humans; *Medical Records; Patient Education as Topic/mt [Methods]; Patient Participation; Self Care

Analysis of a Physician-led, Team-based Care Model for the Treatment of Glaucoma. - Winkler, Nelson S; Damento, Gena M; Khanna, Sunil S; Hodge, David O; Khanna, Cheryl L (Journal of glaucoma, 2017)
PURPOSE: To determine the effect of a protocol for a new physician-led, team-based glaucoma care model implemented in 2008 at Mayo Clinic's campus in Rochester, Minnesota (MCR), to increase conformance with the American Academy of Ophthalmology (AAO) Preferred Practice Pattern guidelines for treatment of primary open-angle glaucoma., METHODS: Records of 591 patients with newly diagnosed glaucoma were assessed retrospectively for the completion of 9 AAO Preferred Practice Pattern recommended metrics including measured corneal thickness, intraocular pressure (IOP), cup to disk ratio, visual acuity, recorded IOP target, gonioscopy, fundus photos, ocular coherence tomography, and visual field in the 3 years before and 3 years after protocol implementation. Treatment by the glaucoma care team at MCR was compared with treatment at a community-based general ophthalmology practice and with a group of comprehensive ophthalmologists at MCR without team care, which served as controls., RESULTS: Adherence to AAO recommendations increased for the documentation of target IOP (+24%, 42.6% to 66.7%; P=0.007), gonioscopy (+27%, 66.7% to 93.3%; P<=0.001), fundus photos (+29%, 44.4% to 73.3%; P<=0.001), and ocular coherence tomography (+20%, 48.1% to 68.0%; P=0.02) after protocol initiation. No change in pattern of testing occurred in the control groups without team care during the same time period. Type and severity of glaucoma were similar between MCR and community practice., CONCLUSIONS: An increase in compliance with AAO guidelines was found after implementation of our protocol for a physician-led, team-based care model to standardize glaucoma care among providers.
Keywords: Adult; Aged; Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; Gonioscopy; Guideline Adherence; Health Plan Implementation; Humans; Intraocular Pressure/ph [Physiology]; Male; *Ophthalmologists/og [Organization & Administration]; Ophthalmology/st [Standards]; *Optometry/og [Organization & Administration]; *Patient Care Team/og [Organization & Administration]; *Practice Patterns, Physicians'; Retrospective Studies; Societies, Medical/og [Organization & Administration]; Tonometry, Ocular; United States; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Review: Emerging strategies for antimicrobial drug delivery to the ocular surface: Implications for infectious keratitis. - Sharma, Ajay; Taniguchi, Jonathan (The ocular surface, 2017)
Infectious keratitis is a medical emergency that can cause severe visual morbidity if not treated promptly. Depending upon the causative microorganism, effective management of infectious keratitis requires frequent application of antibacterial, antifungal, or antiviral eye drops, which may have low bioavailability, undesirable side effects, and poor patient compliance. Ocular formulations of antimicrobials that can increase corneal permeation and provide extended presence on ocular surface are being developed. Such formulations include nanoparticles, mucoadhesives, in situ forming hydrogels, and contact lenses. Testing of these formulations in in vitro models and ex vivo excised corneas, and in vivo rabbit testing have demonstrated increased bioavailability and extended presence on the cornea. Many of these formulations have also demonstrated success in treating infectious keratitis in animal models. However, the majority of studies have evaluated fluoroquinolone antibacterials, and more studies are needed to test the delivery of antifungal drugs. Moreover, additional efficacy data in animal models and future studies in humans to determine the duration of inhibitory concentrations of these antimicrobials in tear fluid will be required to prove the effectiveness of these formulations for clinical management of infectious keratitis. Copyright © 2017 Elsevier Inc. All rights reserved.
Keywords: Animals; Anti-Infective Agents; Cornea; Eye Infections, Bacterial; Humans; *Keratitis

Decision-making Impairments in Primary Angle-closure Glaucoma Patients. - Pu, Hui; Wang, Yong; Wei, Qiang; Ma, Hui-Juan; Hu, Pan-Pan; Li, Shou-Ling; Pang, Hong-Bo; Tian, Yang-Hua; Wang, Kai (Chinese medical journal, 2017)
BACKGROUND: Primary angle-closure glaucoma (PACG) is a common eye disease and a common cause of blindness. Inappropriate medical decisions severely affect the prognosis. This study investigated decision-making under risk in PACG patients., METHODS: Thirty patients with first acute attack of PACG before surgery and thirty healthy controls were included in the study. Decision-making under risk was evaluated with the game of dice task (GDT). The results of Eysenck Personality Questionnaire (EPQ) and GDT between PACG patients and healthy controls were compared., RESULTS: Risky decisions in PACG patients were more than those in healthy controls as measured by mean score of GDT (12.47 +/- 5.72 vs. 4.33 +/- 3.30, P< 0.001). Higher neuroticism score in EPQ was found in PACG patients compared to healthy controls (14.97 +/- 3.93 vs. 9.90 +/- 4.49, P< 0.001). Neuroticism scores in EPQ were associated with decision-making performance (r = 0.417, P = 0.001)., CONCLUSIONS: Neuroticism positively correlated with risky decisions. Decision-making might be influenced by neuroticism. Future studies will show whether therapy compliance will be improved by emotional management and psychological intervention in PACG patients.
Keywords: Adult; Aged; Decision Making/ph [Physiology]; Female; *Glaucoma, Angle-Closure/pp [Physiopathology]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Surveys and Questionnaires; Young Adult

Thermosensitive hydrogel as an in situ gelling antimicrobial ocular dressing. - Mohammed, S; Chouhan, Gurpreet; Anuforom, Olachi; Cooke, Megan; Walsh, Anna; Morgan-Warren, Peter; Jenkins, Mike; de Cogan, Felicity (Materials science & engineering. C, Materials for biological applications, 2017)
Microbial keratitis is a severe ocular condition and one of the most prevalent causes of corneal scarring and associated blindness worldwide. Risk factors include contact lens use, ocular trauma, ocular surface disease and immunosuppression. Initial clinical management mandates intensive (hourly or more frequent) topical administration of broad spectrum antimicrobial therapy for at least 48h, which may require hospital admission, followed by tailored therapy based on microbiological investigation and the institution of strategies to reduce inflammation and promote healing. In this work we report an ocular wound dressing which can encapsulate and give sustained release of different antibiotics. The use of this dressing would allow patients to have eye drops on a 4 hourly basis, thereby facilitating treatment compliance and reducing hospital admissions. Copyright © 2017 Elsevier B.V. All rights reserved.
Keywords: *Anti-Infective Agents/ch [Chemistry]; Bandages; Hydrogels; Keratitis; Ophthalmic Solutions

[Perception of glaucoma and therapeutic adherence: A multicenter observational study]. - Chiche, A; Martin, G; Brasnu de Cenival, E; Rousseau, A; Giocanti, A; Fel, A; Kallel, S; Lombardi, M; Hamard, P; Baudouin, C; Labbe, A (Journal francais d'ophtalmologie, 2017)
INTRODUCTION: The purpose of this study was to evaluate medication adherence of glaucoma patients through the "Glaucoma treatment compliance assessment tool (GTCAT)" questionnaire and to correlate the results with clinical parameters., PATIENTS AND METHODS: This multicenter prospective observational study was performed in the Departement hospitalo-universitaire (DHU) Sight Restore, Paris, France. All patients had been followed for chronic open angle glaucoma (COAG) for at least 3 years. A French version of the GTCAT questionnaire was administered to patients. The results were correlated with clinical parameters of glaucoma, such as duration of disease, medications used, intraocular pressure (IOP) and mean deviation (MD) of the most recent visual field., RESULTS: Seventy-three patients were included in our study, with 60.9% declaring that they fully adhered to the treatment. There was a correlation between the amount of days missing treatment and difficulties using the eye drops. The main cause of missing the drops was forgetfulness (75%), followed by unavailability of the drop when it was time to take it (37.5%). The impact of glaucoma on quality of life was correlated to the amount of adverse effects of topical medications. The patient's perception of the importance of preserving vision was correlated to the level of confidence in the physician concerning the diagnosis of glaucoma., CONCLUSION: In glaucoma patients, the use of the GTCAT questionnaire confirmed the complex relationship between the patient, the disease and its treatment, and even his or her relationship with the ophthalmologist. These results emphasized the importance of therapeutic education but also the negative role of side effects of the eye drops on treatment adherence in glaucoma patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Keywords: Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Attitude to Health; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; *Glaucoma/px [Psychology]; Humans; Male; Medication Adherence/px [Psychology]; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; Paris/ep [Epidemiology]; *Perception; Surveys and Questionnaires

Decade-Long Profile of Imaging Biomarker Use in Ophthalmic Clinical Trials. - Villani, Edoardo; Massaro, Domenico; Scaramuzzi, Matteo; Hamrah, Pedram; Medeiros, Felipe A; Nucci, Paolo (Investigative ophthalmology & visual science, 2017)
Purpose: The purpose of this study was to investigate the use of imaging biomarkers in published clinical trials (CTs) in ophthalmology and its eventual changes during the past 10 years., Methods: We sampled from published CTs in the fields of cornea, retina, and glaucoma between 2005-2006 and 2015-2016. Data collected included year of publication, phase, subspecialty, location, compliance with Consolidated Standards for Reporting Trials, impact factor, presence and use of imaging biomarkers (diagnostic, prognostic and predictive; primary and secondary surrogate endpoints), and use of centralized reading centers., Results: We included 652 articles for analysis, equally distributed in three timeframes (2005-2006, 2010-2011, and 2015-2016), mainly reporting phase IV CTs and trials on procedures (42.2% and 35.4%, respectively). Imaging biomarkers were included in 46.3% of the analyzed CTs and their use significantly increased over time (P < 0.05). Optical coherence tomography was the most frequently used device (27.7%), whereas diagnostic biomarkers and secondary surrogate endpoints were the most frequent biomarker types (19.5% and 22.5%, respectively). Early-phase CTs showed an increase in the use of biomarkers for patient selection and stratification over time (P < 0.05), but not in the use of imaging surrogate endpoints (P = 0.90). Only 3 of 59 (5.1%) of phase III CTs included primary surrogate imaging endpoints, whereas secondary surrogate imaging endpoints were present in 50.8% of these trials (P < 0.001). Retinal CTs had the highest prevalence for each type of imaging biomarker (P < 0.001). Reading centers were used in 52 of 302 CTs (17.2%), with no significant time-related increase., Conclusions: Imaging biomarkers are increasingly used in published CTs in ophthalmology. Additional efforts, including centralized reading centers, are needed to improve their validation and use, allowing a wider use of these tools as primary surrogate endpoints in phase III CTs.
Keywords: *Clinical Trials as Topic; *Diagnostic Techniques, Ophthalmological/td [Trends]; *Endpoint Determination/mt [Methods]; *Eye Diseases/di [Diagnosis]; *Forecasting; Humans; *Ophthalmology; Prognosis

[Complex treatment results in a congenital glaucoma patient (case report)]. - Fabrikantov, O L; Nikolashin, S I; Matrosova, Yu V; Kozlov, V A; Kopylov, A E; Pirogova, E S (Vestnik oftalmologii, 2017)
Early diagnosis of congenital glaucoma allows surgery to be performed at the stage of reversible glaucomatous alterations of the optic disc and retina. In primary congenital glaucoma, the main reason for visual acuity reduction following surgical stabilization of the intraocular pressure are corneal changes. These include an increased corneal diameter, Haab's striae, areas of thickening and a greater posterior elevation. The resultant irregular astigmatism leads to amblyopia and a marked decrease in visual acuity. Active pleoptic treatment started from a very early age in children operated on for compensated congenital glaucoma provides them an opportunity to achieve high visual acuity and full rehabilitation.
Keywords: Aftercare; Antihypertensive Agents/tu [Therapeutic Use]; Combined Modality Therapy/mt [Methods]; Corneal Injuries/dg [Diagnostic Imaging]; Corneal Injuries/et [Etiology]; Glaucoma/cn [Congenital]; Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Glaucoma/su [Surgery]; *Glaucoma; Humans; Infant; Male; Medication Adherence; Monitoring, Physiologic/mt [Methods]; Ocular Hypertension/co [Complications]; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/th [Therapy]; *Sclerostomy/mt [Methods]; Tonometry, Ocular/mt [Methods]; *Trabeculectomy/mt [Methods]; Treatment Outcome; Visual Acuity

Establishing a Regional Glaucoma Physician Collaborative to Improve Quality of Care. - Ehrlich, Joshua R; Wentzloff, Jeffrey N; Imami, Nauman R; Blachley, Taylor S; Stein, Joshua D; Lee, Paul P; Weizer, Jennifer S (American journal of ophthalmology, 2017)
PURPOSE: Improving adherence to practice guidelines can improve patient safety and quality of care. We sought to establish a regional glaucoma physician collaborative to evaluate and improve adherence to the American Academy of Ophthalmology's Primary Open-angle Glaucoma (POAG) Preferred Practice Pattern (PPP) guidelines., DESIGN: Prospective interventional study., METHODS: The collaborative consisted of 13 glaucoma specialists from 3 practices in Michigan. All consecutive POAG new patient visits were reviewed from each study site to determine physician adherence to the 13 major examination elements of the PPP. In phase 1 of the study, physician adherence rates for each of the recommended examination elements were combined and averaged for all groups. Averages for the collaborative were reported to each site, and each physician received his or her individual adherence rates. Physicians discussed strategies to improve overall adherence to the PPP. Adherence rates were collected in phase 2 to determine if feedback and sharing of strategies resulted in improved adherence., RESULTS: A total of 274 new POAG patient visits from phase 1 and 280 visits from phase 2 were reviewed. After accounting for multiple comparisons, overall improvement approached statistical significance for the evaluation of visual function (91.2% to 96.1%, P < .02) and target intraocular pressure determination (73.7% to 83.2%, P < .01). Improvement for other measures that had a high rate of adherence at baseline (eg, ocular history, pupil examination, and central corneal thickness measurement) was not statistically significant., CONCLUSIONS: It is feasible to establish a regional glaucoma physician collaborative to improve standardization of care for patients with newly diagnosed POAG. Copyright © 2017 Elsevier Inc. All rights reserved.
Keywords: *Glaucoma, Open-Angle/th [Therapy]; *Guideline Adherence/td [Trends]; Humans; Intraocular Pressure; Michigan; *Ophthalmology/st [Standards]; *Practice Patterns, Physicians'/st [Standards]; Prospective Studies; *Quality Improvement

Influence of Pilocarpine and Timolol on Human Meibomian Gland Epithelial Cells. - Zhang, Yi; Kam, Wendy R; Liu, Yang; Chen, Xiaomin; Sullivan, David A (Cornea, 2017)
PURPOSE: Investigators have discovered that topical antiglaucoma drugs may induce meibomian gland dysfunction. This response may contribute to the dry eye disease commonly found in patients with glaucoma taking such medications. We hypothesize that drug action involves a direct effect on human meibomian gland epithelial cells (HMGECs). To test this hypothesis, we examined the influence of the antiglaucoma drugs, pilocarpine and timolol, on the morphology, survival, proliferation, and differentiation of HMGECs., METHODS: Immortalized (I) HMGECs (n = 2-3 wells/treatment/experiment) were cultured with multiple concentrations of pilocarpine or timolol for up to 7 days. Experiments included positive controls for proliferation (epidermal growth factor and bovine pituitary extract) and differentiation (azithromycin). Cells were enumerated using a hemocytometer and evaluated for morphology, neutral lipid staining, and lysosome accumulation., RESULTS: Our results demonstrate that pilocarpine and timolol cause a dose-dependent decrease in the survival of IHMGECs. The clinically used concentrations are toxic and lead to cell atrophy, poor adherence, or death. By contrast, drug levels that are known to accumulate within the conjunctiva, adjacent to the meibomian glands, do not influence IHMGEC survival. These latter concentrations also have no effect on IHMGEC proliferation or differentiation, and they do not interfere with the ability of azithromycin to stimulate cellular neutral lipid and lysosome accumulation. This dose of pilocarpine, though, did suppress the epidermal growth factor+bovine pituitary extract-induced proliferation of IHMGECs., CONCLUSIONS: Our results support our hypothesis and demonstrate that these antiglaucoma drugs, pilocarpine and timolol, have direct effects on HMGECs that may influence their morphology, survival, and proliferative capacity.
Keywords: *Adrenergic beta-Antagonists/to [Toxicity]; Antihypertensive Agents/to [Toxicity]; Cell Differentiation/de [Drug Effects]; Cell Line; Cell Proliferation/de [Drug Effects]; Cell Survival/de [Drug Effects]; Dose-Response Relationship, Drug; Epidermal Growth Factor/me [Metabolism]; *Epithelial Cells/de [Drug Effects]; Epithelial Cells/me [Metabolism]; Humans; Lipid Metabolism/ph [Physiology]; Lysosomes/me [Metabolism]; *Meibomian Glands/de [Drug Effects]; Meibomian Glands/me [Metabolism]; *Muscarinic Agonists/to [Toxicity]; *Pilocarpine/to [Toxicity]; Signal Transduction; *Timolol/to [Toxicity]

Achievements and Limits of Current Medical Therapy of Glaucoma. - Kalouda, Pelagia; Keskini, Christina; Anastasopoulos, Eleftherios; Topouzis, Fotis (Developments in ophthalmology, 2017)
Prescribing medical therapy for the treatment of glaucoma can be a complex process since many parameters should be taken into consideration regarding its achievements and limits. Today, a variety of options, including multiple drug classes and multiple agents within classes, are available to the clinician, but caution should be given to their side effects and contraindications. Glaucoma patients with preexisting ocular surface disease should be treated with caution, and preferably with preservative-free formulations, as there is an increased risk for symptom deterioration. The development and use of fixed-combination therapies has reduced the preservative-related side effects that threaten patient adherence and has minimized the washout effect of multiple instillations. Adherence to medical treatment is not only crucial to its efficacy but also to its cost-effectiveness. Further factors to consider are that there are patients who are nonresponders to treatment, and also that the target intraocular pressure (IOP) cannot be reached in all patients, regardless of the response to treatment. The progression of damage can occur even under maximum medical treatment or maximally tolerated medical treatment, and regardless of whether low IOP levels are reached. Furthermore, there is some conflict between medical treatment and quality of life due to long-term everyday use and to side effects of treatment. New molecules and new delivery systems are being investigated to open new horizons in glaucoma management. Although the general rule is to initiate glaucoma management with medical treatment, the limits of medical therapy should be considered to identify those patients in need of surgical management. Copyright © 2017 S. Karger AG, Basel.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Ophthalmic Solutions

Willingness to Use Mobile Health in Glaucoma Patients. - Dai, Miaomiao; Xu, Jianan; Lin, Jialiu; Wang, Zhonghao; Huang, Wenmin; Huang, Jingjing (Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2017)
INTRODUCTION: Development of mobile health (m-health) in China carries tremendous potential, especially for glaucoma, one of the major chronic ophthalmic diseases afflicting millions of people. However, little research has been undertaken to investigate the willingness of glaucoma patients to use m-health and the factors influencing their decisions., SUBJECTS AND METHODS: This was a cross-sectional study. A self-administered or face-to-face interview survey was performed on 1,487 patients with glaucoma at the outpatient glaucoma service, Zhongshan Ophthalmic Center, Sun Yat-sen University. Questionnaires captured patients' demographic data, WeChat access, and willingness to receive m-health. The data were analyzed by single factor chi-square test. Multiple logistic regression revealed the motivators and barriers to accept m-health adoption., RESULTS: One thousand ninety-seven valid questionnaires were obtained. Seven hundred twenty-five respondents (66.1%) were willing to participate in m-health programs. 65.4% were younger than 60 years old. 40.9% had travel time from home to hospital of >3 h. 63.6% had more than four follow-up visits for glaucoma. 86.5% experienced trouble events during clinic visits. The overall WeChat usage rate was 61.7%. Age, travel time, number of visits, trouble events in clinic, and WeChat access in patients with glaucoma were related to the willingness to use m-health (p < 0.05)., CONCLUSIONS: Most patients with glaucoma were willing to participate in m-health programs, which are essential to increasing and improving access to care.
Keywords: Adult; Age Factors; Aged; China; Cross-Sectional Studies; Female; Glaucoma/co [Complications]; *Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Health Services Accessibility; Humans; Interviews as Topic; Jet Lag Syndrome; Male; Middle Aged; *Patient Preference; Socioeconomic Factors; *Telemedicine/og [Organization & Administration]; Transportation

Cost-effectiveness and cost utility of community screening for glaucoma in urban India. - John, Denny; Parikh, Rajul (Public health, 2017)
OBJECTIVES: Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India., STUDY DESIGN: A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India., METHODS: Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted., RESULTS: The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme., CONCLUSIONS: In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Keywords: Adult; Aged; Cost-Benefit Analysis; Glaucoma/ep [Epidemiology]; *Glaucoma/pc [Prevention & Control]; Health Care Costs; Humans; India/ep [Epidemiology]; Middle Aged; Prevalence; Program Evaluation; *Urban Health Services/ec [Economics]; *Vision Screening/ec [Economics]

Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes. - Ayalew, Menen; Tilahun, Yonas; Holsclaw, Doug; Indaram, Maanasa; Stoller, Nicole E; Keenan, Jeremy D; Rose-Nussbaumer, Jennifer (Cornea, 2017)
PURPOSE: To describe the indications, visual acuity outcomes, and graft survival after penetrating keratoplasty (PKP) in Addis Ababa, Ethiopia., METHODS: The medical records of patients who underwent PKP at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The prespecified outcomes were graft survival, visual acuity, and complication rates., RESULTS: A total of 321 patients underwent PKP during the study period and were included in the analysis. Indications for surgery were trachoma or leukoma in 141 (44%), keratoconus in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), previous graft failure in 18 (6%), active ulcer, burn, or perforation in 9 (3%), and others in 7 (2%). The graft survival rate was 80% overall at 2 years but varied considerably depending on the indication for surgery. Uncorrected visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.09 (SD 0.67) to mean logarithm of the minimum angle of resolution of 1.53 (SD 1.03) at 2 years. A number of factors affected the visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses postoperatively. Complication rates were high with infectious keratitis being the most common., CONCLUSIONS: PKP is becoming a viable treatment for corneal opacity in developing countries. However, the high burden of disease and lack of corrective lenses remain significant obstacles to overcome.
Comment in (CIN)
Keywords: Adolescent; Adult; Aged; Corneal Opacity/pp [Physiopathology]; *Corneal Opacity/su [Surgery]; Developing Countries; Ethiopia; Eye Banks/sn [Statistics & Numerical Data]; Female; Graft Survival/ph [Physiology]; Humans; Intraoperative Complications; *Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Referral and Consultation; Retrospective Studies; Tertiary Care Centers/sn [Statistics & Numerical Data]; Tissue Donors; Visual Acuity/ph [Physiology]; Young Adult

Novel Pharmacologic Candidates for Treatment of Primary Open-Angle Glaucoma. - Lu, Louise J; Tsai, James C; Liu, Ji (The Yale journal of biology and medicine, 2017)
Primary open-angle glaucoma (OAG) affects approximately 45 million people worldwide and more than 2.5 million people aged 40 years or older in the United States. Pharmacologic treatment for glaucoma is directed towards lowering intraocular pressure (IOP) to slow disease progression and delay visual field loss. Current medical treatment options for the lowering of IOP include the following classes of topical medications: beta-adrenergic antagonists, alpha-adrenergic agonists, cholinergic agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. Issues with existing drugs include failure to achieve target IOP with monotherapy, drug-related side effects, and low patient compliance with multiple daily administration of eye drops. In recent years, the scientific and medical community has seen encouraging development of novel classes of drugs for primary OAG, the majority of which lower IOP by targeting the trabecular meshwork outflow pathway to increase aqueous humor outflow. Among the most promising new pharmacologic candidates are rho kinase inhibitors including ripasudil (K-115), netarsudil (AR-13324), and AMA0076; adenosine receptor agonists including trabodenoson (INO-8875); and modified prostaglandin analogs including latanoprostene bunod (LBN, BOL-303259-X) and ONO-9054. This study aims to systematically review and summarize the most recent developments in clinical trials for new pharmacologic options for the treatment of primary open-angle glaucoma.
Keywords: *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/en [Enzymology]; Humans; Intraocular Pressure/de [Drug Effects]; Isoquinolines/tu [Therapeutic Use]; Oxepins/tu [Therapeutic Use]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Sulfonamides/tu [Therapeutic Use]; rho-Associated Kinases/ai [Antagonists & Inhibitors]; rho-Associated Kinases/me [Metabolism]

Nonmedical Out-of-Pocket Patient and Companion Expenditures Associated With Glaucoma Care. - Schehlein, Emily M; Im, Lily T; Robin, Alan L; Onukwugha, Eberechukwu; Saeedi, Osamah J (Journal of glaucoma, 2017)
PURPOSE: Nonmedical out-of-pocket cost to both patients and their companions of office visits for routine glaucoma care has not been extensively studied in the United States. We evaluate potential key predictors of patient expenditures that are critical to assessing the cost-effectiveness of glaucoma health care delivery., MATERIALS AND METHODS: In total, 300 patients responded to the survey in 3 clinics in 2 clinical practice settings. Main outcome measures included both average visit and yearly expenditures., RESULTS: Of the 300 patients, the majority were female (n=187, 62.3%) and African American (n=171, 57.0%). The median age was 66 years. The median [range; mean (SD)] expenditure per patient visit was $22.10 ($11.1, $42.9; $44.1 (72.8)). Patients with companions paid $38.77 more in average visit expenditure (beta: 0.87, P<0.001). The average visit expenditure for retired patients was $17.37 less when compared with nonretired patients (beta: -0.4, P=0.004). Patients living in a rural or suburban area paid $43.91 and $14.13 more per visit, respectively (beta: 0.73, P=0.0004; beta: 0.31, P=0.03), compared with patients living in an urban area. Patients with noncommercial insurance paid $24.01 less in average visit expenditure (beta: -0.66, P=0.0008). The median yearly patient expenditure was $96.70 [$44.6, $222.7; $210.4 (333.9)]. Patients with companions paid $192.37 more in yearly expenditure (beta: 0.9, P<0.001) than those without companions, whereas retired patients paid $80.83 less in yearly expenditure (beta: -0.39, P=0.03) than nonretirees. Patients with noncommercial insurance paid $109.34 less in yearly expenditure (beta: -0.63, P=0.01)., CONCLUSIONS: Although a small part of the total cost of glaucoma care, nonmedical out-of-pocket costs constitute a substantial noncovered medical expense to most patients in the United States. Patients who are employed, come with companions, live in nonurban areas, or are on Medicare have greater expenditures.
Keywords: Aged; Female; *Financing, Personal/ec [Economics]; *Friends; *Glaucoma/ec [Economics]; *Health Expenditures/sn [Statistics & Numerical Data]; Humans; Linear Models; Male; Middle Aged; Office Visits/ec [Economics]; Rural Population/sn [Statistics & Numerical Data]; United States; Urban Population/sn [Statistics & Numerical Data]

[Risk factors for contact lens-related microbial keratitis: A multicenter case-control study]. - Becmeur, P H; Abry, F; Bourcier, T; Meyer, N; Sauer, A; <> (Journal francais d'ophtalmologie, 2017)
PURPOSE: Currently, the most feared complication by ophthalmologists of contact lens (CL) wear is microbial keratitis (MK), even though its incidence remains low. It is also a significant financial burden for society. This study aimed to identify the risk factors for CL-related MK especially with regard to hygiene and pattern of use, in a large, prospective, multicenter, case-control study., METHODS: A multicenter retrospective case-control study was designed. The CL-related MK subpopulation (case) was compared with healthy CL wearers (control) using a 52-item anonymous questionnaire designed to determine subject demographics, lens wear history, lens type and disinfection solution, fitting, patient education, hygiene and maintenance of contact lenses, and patient history. Univariate logistic regression analysis was performed to compare both groups., RESULTS: The study included 497 cases and 364 controls. The risk factors associated with the greatest increased odds of CL-related MK were as follows: extended wear (OR=2.96 [1.65-5.33], P<0.001), occasional overnight lens use (OR=6.37 [4,55-8.90], P<0.001), fitting by an optician (OR=1.97 [1.38-2.83], P<0.001), absence of ophthalmologic exam (OR=6.56 [2-22], P<0.01) or no training in handling the contact lens (OR=4.47 [2.27-8.77], P<0.01), use of optician's disinfection solution (OR=5.55 [3.12-9.85], P<0.001), mixing solutions ("topping off") (OR=4.68 [2.73-8.04], P<0.001), no case replacement (OR=3.95 [2.28-6.82] P<0.01), no compliance with hygiene rules and smoking (OR=2.29 [1.67-3.14], P<0.01). The protective factors associated with the greatest reduction in OR were female gender (OR=0.49 [0.36-0.66], P<0.01), hypermetropia (OR=0.28 [0.16-0.48], P=0.01), rigid contact lens wear, fitting by an ophthalmologist, written and verbal instruction, and daily case maintenance., CONCLUSION: The knowledge of these risks factors incentivizes action at all levels to reduce the incidence of MK, from the prescriber to the patient, including the type of CL, case and contact lens solution. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Child; *Contact Lenses/ae [Adverse Effects]; Contact Lenses/mi [Microbiology]; Contact Lenses/sn [Statistics & Numerical Data]; *Eye Infections, Bacterial/ep [Epidemiology]; *Eye Infections, Bacterial/et [Etiology]; Eye Infections, Bacterial/mi [Microbiology]; Female; France/ep [Epidemiology]; Humans; *Keratitis/ep [Epidemiology]; *Keratitis/et [Etiology]; Keratitis/mi [Microbiology]; Male; Middle Aged; Retrospective Studies; Risk Factors; Young Adult

A prospective, randomised, placebo-controlled, double-masked, three-armed, multicentre phase II/III trial for the Study of a Topical Treatment of Ischaemic Central Retinal Vein Occlusion to Prevent Neovascular Glaucoma - the STRONG study: study protocol for a randomised controlled trial. - Lorenz, Katrin; Scheller, Yvonne; Bell, Katharina; Grus, Franz; Ponto, Katharina A; Bock, Felix; Cursiefen, Claus; Flach, Jens; Gehring, Marta; Peto, Tunde; Silva, Rufino; Tal, Yossi; et al. (Trials, 2017)
BACKGROUND: Neovascular glaucoma (NVG) is rare, comprising only 3.9% of all glaucoma cases. The most common cause of NVG is ischaemic central retinal vein occlusion (iCRVO). NVG frequently results in blindness and painful end-stage glaucomatous damage leading to the need for enucleation. Currently, there is no preventive therapy for NVG following iCRVO. Rescue treatments have severe drawbacks. Accordingly, there is a great need for preventing the often visually devastating outcomes of NVG. The STRONG study is designed to test whether the topically active anti-angiogenic agent aganirsen is able to inhibit the formation of neovascularisation leading to the development of secondary NVG in eyes with iCRVO. At the same time, STRONG will provide important information on the natural course of iCRVO and NVG in a large and well-characterised cohort of such patients., METHODS/DESIGN: This protocol describes a phase II/III, prospective, randomised, placebo-controlled, double-masked, three-armed multicentre study for the investigation of aganirsen, a new topical treatment for iCRVO in order to prevent NVG. The study will evaluate the efficacy of two different doses of this newly developed antisense oligonucleotide formulated in an eye emulsion to avoid new vessel formation by blocking insulin receptor substrate-1 (IRS)-1. This leads to subsequent down-regulation of both angiogenic as well as proinflammatory growth factors such as vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF). Eligible patients (n = 333) will be treated with topical aganirsen or placebo for a period of 24 weeks. They will also be invited to participate in substudies involving analysis of gonioscopic images, detection of biomarkers for NVG and risk factors for iCRVO., DISCUSSION: The STRONG study has the potential to offer a new treatment modality for patients suffering from iCRVO with a high risk of developing NVG. The topical administration can reduce patients' burden and risk related to rescue treatment, such as destructive laser treatment or enucleation, but requires a high level of patient compliance., TRIAL REGISTRATION: EudraCT: 2014-000239-18; ClinicalTrials.gov, ID: NCT02947867 . (Registered on 15 October 2016); see also http://strong-nvg.com .
Keywords: Administration, Ophthalmic; *Angiogenesis Inhibitors/ad [Administration & Dosage]; Angiogenesis Inhibitors/ae [Adverse Effects]; Clinical Protocols; Double-Blind Method; Europe; Glaucoma, Neovascular/et [Etiology]; Glaucoma, Neovascular/ge [Genetics]; Glaucoma, Neovascular/me [Metabolism]; *Glaucoma, Neovascular/pc [Prevention & Control]; Gonioscopy; Humans; Insulin Receptor Substrate Proteins/ge [Genetics]; Insulin Receptor Substrate Proteins/me [Metabolism]; Intraocular Pressure/de [Drug Effects]; *Neovascularization, Pathologic; *Oligonucleotides/ad [Administration & Dosage]; Oligonucleotides/ae [Adverse Effects]; Ophthalmic Solutions; Prospective Studies; Research Design; Retinal Neovascularization/et [Etiology]; Retinal Neovascularization/ge [Genetics]; Retinal Neovascularization/me [Metabolism]; *Retinal Neovascularization/pc [Prevention & Control]; Retinal Vein Occlusion/co [Complications]; *Retinal Vein Occlusion/dt [Drug Therapy]; Retinal Vein Occlusion/ge [Genetics]; Retinal Vein Occlusion/me [Metabolism]; Signal Transduction/de [Drug Effects]; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha/me [Metabolism]; Vascular Endothelial Growth Factor A/me [Metabolism]

Monitoring daily intraocular pressure fluctuations with self-tonometry in healthy subjects. - Querat, Laurence; Chen, Enping (Acta ophthalmologica, 2017)
PURPOSE: To evaluate the accuracy of the intraocular pressure (IOP) measured by healthy subjects with icare R Home and to observe the IOP fluctuation and pattern of IOP fluctuation in healthy subjects over three consecutive days., METHODS: Sixty healthy subjects were recruited to the study. IOP was measured by the subjects themselves and by study staff using icare R Home tonometers on visits 1 and 2, as well as by study staff using Goldmann applanation tonometry (GAT). Furthermore, the subjects measured their IOP at home for three consecutive days., RESULTS: Twenty-three per cent of the study eyes were excluded in the statistical analysis due to dropout or non-compliance to the schedule. Approximately 70% of the icare R Home measurements were within 3 mmHg of the GAT measurements. Ten to 16% of the study eyes had IOP peaks outside office hours. Sixty-three per cent of the study eyes had different IOP patterns on consecutive days., CONCLUSION: Rebound self-tonometry appears to be accurate and could be used to monitor short- and long-term IOP variations. The difference between IOP patterns on consecutive days raises questions as to the certainty of a single IOP measurement as a measure of treatment effect. Copyright © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Healthy Volunteers; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Monitoring, Physiologic/mt [Methods]; Prospective Studies; Reproducibility of Results; *Tonometry, Ocular/mt [Methods]; Young Adult

A Mixed-Methods Evaluation of a Community-Based Glaucoma Check Service in Hackney, London, UK. - Holdsworth, Elizabeth; Datta, Jessica; Marks, Dalya; Kuper, Hannah; Lee, Helen; Leamon, Shaun; Lindfield, Robert; Wormald, Richard; Clarke, Jonathan; Elkarmouty, Ahmed; Macdowall, Wendy (Ophthalmic epidemiology, 2017)
PURPOSE: To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40-65 years, resident in Hackney, London, United Kingdom., METHODS: The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service., RESULTS: A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was 9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination., CONCLUSION: This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.
Keywords: Adult; Aged; *Clinical Audit/mt [Methods]; Feasibility Studies; Female; *Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Humans; Incidence; London/ep [Epidemiology]; Male; Middle Aged; Patient Participation; *Patient Satisfaction; *Primary Health Care/mt [Methods]; Prospective Studies; *Referral and Consultation; *Vision Screening/mt [Methods]

Treatment patterns and medication adherence of patients with glaucoma in South Korea. - Kim, Chan Yun; Park, Ki Ho; Ahn, Jaehong; Ahn, Myung-Douk; Cha, Soon Cheol; Kim, Ho Soong; Kim, Joon Mo; Kim, Moon Jung; Kim, Tae-Woo; Kim, Yong Yeon; Lee, Ji Woong; Park, Sang-Woo; et al. (The British journal of ophthalmology, 2017)
BACKGROUND/AIMS: This study aimed to investigate treatment patterns and medication adherence of glaucoma. It also identified key factors associated with non-adherence., METHODS: It was a cross-sectional, observational study. Patients who use eye-drops for <=2 years were recruited at 15 eye clinics from March to November 2013. Data were collected through self-administered questionnaires and medical chart review. Medication adherence was evaluated using patients' self-report on pill count and defined as patients' administering drug for >=80% of prescribed days. Medication adherence rate was calculated by dividing actual number of administration from total prescribed number of administration for 7 days. Patients whose self-reported prescription was different from total daily doses of physicians' prescription were considered as non-adherent., RESULTS: A total of 1050 patients included, and medication adherence rate was evaluated in 1046 patients whose verification of adherence was available. Of the total, 27.4% were non-adherent, and the medication adherence rates of the total, the adherent, and the non-adherent were 90.6+/-17.8%, 96.8+/-5.5% and 56.6+/-24.7%, respectively. The most commonly used medication was prostaglandin (PGA) alone and the second was combination of two-class (beta-blocker and carbonic anhydrase inhibitor (CAI)) and three-class combination of PGA, beta-blocker and CAI followed. In multivariate analysis, the risk of non-adherence was 1.466 times greater in males than in females (95% CI 1.106 to 1.943) and 1.328-fold greater as the daily number of administration was increased (95% CI 1.186 to 1.487)., CONCLUSION: Approximately, one-third of the patients were non-adherent, and males and increased daily number of administration were associated with non-adherence. It highlights that more systematic treatment strategies should be considered for better medication adherence, leading to effective glaucoma management. 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: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Drug Monitoring/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; Humans; Incidence; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Prospective Studies; Republic of Korea/ep [Epidemiology]; Surveys and Questionnaires

[Relationships among illness perceptions, medication beliefs and medication adherence in primary angle closure glaucoma patients]. - Jiang, H; Zhao, L; Yang, L; Cai, H Y ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2017)
Objective: To investigate the relationships among illness perception, medication beliefs and medication adherence in primary angle closure glaucoma patients. Methods: It was a cross-sectional study. Morisky 8-item Medication Adherence Questionnaire Chinese Revised, the Brief Illness Perceptions Questionnaire, the Specific Section of the Beliefs about Medicine Questionnaire Chinese Revised were administered to 156 primary angle closure glaucoma patients from Tianjin Eye Hospital. Chi-square test was used to analyze the types of glaucoma, gender, prescription complexity, medicine schedule, other disease and course of disease between the group of adherence and non-adherence. Pearson correlation method was used to analyze the correlations among the illness perception, necessity belief, concerns belief and medication adherence. Structural equation model was used to analyze the mediational role of medication belief between illness perception and medication adherence. Results: In the 156 primary angle closure glaucoma patients being investigated, 37 male and 119 female, the average age was (61.3+/-8.3) years old. The medication adherence of patients was 83 (53.2%) , the medication non-adherence of patients was 73 (46.8%) . It was showed that prescription complexity and medicine schedule were significantly correlated with medicine adherence (chi(2)=13.64, 11.31; P<0.05); gender, other disease and course of disease were not correlated with medication adherence (chi(2)=1.02, 1.73, 6.08; P>0.05). The scores of illness perception were positively correlated with the necessity belief of medication scores, the scores of concerns belief (r=0.18 0.45, P<0.05), and were negatively associated with medication adherence (r=-0.22, P<0.01). The concerns belief of medication scores were negatively correlated with the medication adherence (r=-0.47, P<0.01). Concerns belief mediates the relationship between illness perception and medication adherence wholly (chi(2)/df=1.73, RMSEA=0.069, NNFI=0.98, CFI=0.98, IFI=0.98) . Conclusions: The types of medicines and the number of glaucoma medication used have a significant influence to the medication adherence in the patients with primary angle closure glaucoma. The patients with greater illness perception performed greater non-adherence can be explained by their higher concerns blief. (Chin J Ophthalmol, 2017, 53: 109-114).
Keywords: Aged; Cross-Sectional Studies; Drug Administration Schedule; Drug Therapy, Combination/sn [Statistics & Numerical Data]; Female; *Glaucoma, Angle-Closure/dt [Drug Therapy]; *Glaucoma, Angle-Closure/px [Psychology]; *Health Knowledge, Attitudes, Practice; Humans; Male; *Medication Adherence/px [Psychology]; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Perception; Surveys and Questionnaires

[Focus on popular science education of glaucoma and reduce glaucomatous low vision and blindness]. - Sun, X H ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2017)
The prevention of blindness caused by glaucoma is a difficult task. In order to accomplish the task better, we need the participation of whole society and popularize relevant medical knowledge. Popular science and related knowledge of glaucoma are needed to the people especially for high risk population. If people know glaucoma better and actively join the screening of glaucoma, we can find and diagnose glaucoma earlier, avoid late treatment and reduce the glaucomatous visual function impairment. For patients who had been diagnosed with glaucoma, they should aware and accept new medical concept and technique through systemic popular science education. They should actively participate the whole procedure of the disease management and improve their compliance and confidence. Academic organization of ophthalmology should participate and guide the patient education, improve the individualized comprehensive health care for the diagnosis and treatment and third-order health care system that is suitable for the condition of our country, help improving the prognosis of glaucoma and life quality related to vision for advanced and late glaucoma. (Chin J Ophthalmol, 2017, 53: 81-84).
Keywords: Aged; Blindness/et [Etiology]; *Blindness/pc [Prevention & Control]; China; Female; *Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; *Health Education/mt [Methods]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Patient Education as Topic/mt [Methods]; Patient Participation; Quality of Life; *Science/ed [Education]; Vision, Low/et [Etiology]; *Vision, Low/pc [Prevention & Control]

Evaluation of moderate and severe blepharoptosis correction using the interdigitated part of the frontalis muscle and orbicularis oculi muscle suspension technique: A cohort study of 235 cases. - Wang, Tailing; Li, Xiuqi; Wang, Xiao; Wang, Qianwen; Li, Wuyan; Zhou, Lu; Song, Weiming; Wang, Jiaqi (Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2017)
BACKGROUND: Blepharoptosis is defined as an abnormally low-lying upper eyelid margin in the primary gaze, causing vertical narrowing of the palpebral fissure. It is difficult to achieve consistently satisfactory results in moderate or severe cases despite many surgical methods being available to correct them., METHODS: Between January 2001 and December 2014, a retrospective cohort study was conducted using medical records and perioperative photographs of 235 patients. All the patients, having presented with moderate or severe bilateral or unilateral blepharoptosis, underwent blepharoptosis correction with the interdigitated orbicularis oculi-frontalis muscle flap suspension technique and contemporaneous double-eyelid surgery. The results, including complications, were followed up and evaluated., RESULTS: The mean age of the patients was 17.4 years (range 3-50 years). The follow-up period ranged from 6 months to 8 years, with a mean follow-up of 13 months. Long-term postoperative complications included undercorrection (3.0%), overcorrection (0.7%) and eyelid fold deformity (4.0%). No ectropion, entropion, fornix conjunctival prolapse or exposure keratitis was noted., CONCLUSIONS: Blepharoptosis correction with interdigitated orbicularis oculi-frontalis muscle flap suspension is an effective technique for the management of moderate or severe blepharoptosis. The results demonstrated very low complication rates and substantial cosmetic and functional improvement using simple manipulation. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Adolescent; Adult; *Blepharoptosis/su [Surgery]; Child; Child, Preschool; Eyelids/su [Surgery]; *Facial Muscles/tr [Transplantation]; Female; Humans; Male; Middle Aged; *Oculomotor Muscles/tr [Transplantation]; Patient Satisfaction; Retrospective Studies; *Surgical Flaps; Suture Techniques; Treatment Outcome; Young Adult

African American Patient Preferences for Glaucoma Education. - Sleath, Betsy; Davis, Scott; Sayner, Robyn; Carpenter, Delesha M; Johnson, Terence; Blalock, Susan J; Robin, Alan L (Optometry and vision science : official publication of the American Academy of Optometry, 2017)
PURPOSE: The objectives of the study were to examine (a) the types of questions that African American patients have about glaucoma for their providers and (b) how patients' sociodemographic characteristics are associated with where and from whom they would like to learn about glaucoma and glaucoma medications., METHODS: Forty-nine adult African American patients with glaucoma were recruited at a private ophthalmology clinic where they completed a questionnaire for this cross-sectional study., RESULTS: African American patients had a mean of 3.9 questions for their ophthalmologists; the questions that patients checked as having most often were "What is my prognosis with glaucoma?" (49%) and "What is my intraocular pressure?" (45%). Seventy-six percent of patients preferred that an educational program about glaucoma be offered at the doctor's office and 39% preferred it be offered at a community or senior citizen center. Ninety percent said that the education program should be offered by doctors. Patients under the age of 70 were significantly more likely to want a program on the Internet than patients age 70 and over (Pearson chi = 4.7, P = .03). If an educational program was developed patients reported being most interested in the following topics, glaucoma medications (84%), what is glaucoma and what does it mean to have it? (83%)., CONCLUSIONS: African American patients have many questions about glaucoma for their eye care providers. African American patients would prefer glaucoma educational programs be offered at their provider's office. Our findings could be used to develop educational programs for African American patients with glaucoma.
Keywords: Adolescent; Adult; African Americans/px [Psychology]; African Americans/sn [Statistics & Numerical Data]; *African Americans; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Female; *Glaucoma/co [Complications]; Glaucoma/dt [Drug Therapy]; Health Services Needs and Demand; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Needs Assessment/sn [Statistics & Numerical Data]; *Patient Education as Topic/sn [Statistics & Numerical Data]; *Patient Preference/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Young Adult

The physical properties of generic latanoprost ophthalmic solutions are not identical. - Kolko, Miriam; Koch Jensen, Peter (Acta ophthalmologica, 2017)
PURPOSE: To compare various characteristics of Xalatan R and five generic latanoprost ophthalmic solutions., METHODS: Drop size, volume, pH values, buffer capacity, viscosity, hardness of bottles and costs were determined. Drop sizes were measured in triplicates by micropipettes, and the number of drops counted in three separate bottles of each generic product was determined. pH values were measured in triplicates by a calibrated pH meter. Buffer capacity was exploited by titrating known quantities of strong base into 2.5 ml of each brand and interpolated to neutral pH. Kinematic viscosity was determined by linear regression of timed gravity flow from a vertical syringe through a 21-G cannula. The hardness of the bottles was evaluated by gradually increasing tension on a hook placed around each bottle until a drop was expelled reading the tension on an attached spring scale., RESULTS: Drop sizes and the number of drops in the bottles varied significantly between the generic drugs. The control value of pH in the brand version (Xalatan R ) was markedly lower compared to the generic latanoprost products. Titration of Xalatan R to neutrality required substantially more NaOH compared to the generic latanoprost products. Finally, the viscosity revealed a significant variability between brands. Remarkable differences were found in bottle shapes, bottle hardness and costs of the latanoprost generics., CONCLUSION: Generic latanoprost eye drops should not be considered identical to the original brand version as regards to drop size, volumes, pH values, buffer capacity, viscosity, hardness of bottles and costs. It is likely that these issues affect compliance and intraocular pressure (IOP)-lowering effect. Therefore, re-evaluation of the requirements for introducing generic eye drops seems reasonable. Copyright © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ch [Chemistry]; *Drug Costs; *Drugs, Generic; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Ophthalmic Solutions; Prostaglandins F, Synthetic/ad [Administration & Dosage]; *Prostaglandins F, Synthetic/ch [Chemistry]; Prostaglandins F, Synthetic/ec [Economics]; Tonometry, Ocular

The interrelation between hypothyroidism and glaucoma: a critical review and meta-analyses. - Thvilum, Marianne; Brandt, Frans; Brix, Thomas Heiberg; Hegedus, Laszlo (Acta ophthalmologica, 2017)
Data on the association between hypothyroidism and glaucoma are conflicting. We sought to shed light on this by conducting a critical review and meta-analyses. The meta-analyses were conducted in adherence with the widely accepted MOOSE guidelines. Using the Medical Subject Heading (MeSH) terms: hypothyroidism, myxoedema and glaucoma or intraocular pressure, case-control studies, cohort studies and cross-sectional studies were identified (PubMed) and reviewed. Using meta-analysis, the relative risk (RR) of coexistence of glaucoma and hypothyroidism was calculated. Based on the literature search, thirteen studies fulfilled the inclusion criteria and could be categorized into two groups based on the exposure. The designs of the studies varied considerably, and there was heterogeneity related to lack of power, weak phenotype classifications and length of follow-up. Eight studies had glaucoma (5757 patients) as exposure and hypothyroidism as outcome. Among these, we found a non-significantly increased risk of hypothyroidism associated with glaucoma (RR 1.65; 95% confidence interval [CI]: 0.97-2.82). Based on five studies (168 006 patients) with hypothyroidism as exposure and glaucoma as outcome, we found the risk of glaucoma to be significantly increased (RR 1.33; 95% CI: 1.13-1.58). Based on these meta-analyses, there seems to be an association between hypothyroidism and glaucoma, which does not seem to be the case between glaucoma and hypothyroidism. However, larger scale studies with better phenotype classification, longer follow-up and taking comorbidity and other biases into consideration are needed to address a potential causal relationship. Copyright © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Keywords: *Glaucoma/et [Etiology]; Glaucoma/pp [Physiopathology]; Humans; *Hypothyroidism/co [Complications]; *Intraocular Pressure; Risk Factors

A national survey of the use of pachymeters by optometrists in Scotland: experience, views and barriers to use. - Goudie, Colin; Pronin, Savva; Court, Helen; Pooley, Janet; Tatham, Andrew J (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2017)
PURPOSE: Thin central corneal thickness (CCT) is a risk factor for glaucoma. In 2016 all optometry practices in Scotland were provided with pachymeters aiming to improve risk assessment and accuracy of referrals to secondary care. We examined optometrists' experience and views of pachymetry, including perceived barriers to pachymetry in primary care., METHODS: A questionnaire was sent using the REDCap electronic data capture tool to all 1264 optometrists registered with NHS Education for Scotland (NES). The questionnaire evaluated year of qualification, previous pachymetry training, confidence performing and interpreting pachymetry, and perceived indications for and barriers to use., RESULTS: Respondents numbered 418 out of 1264 (33%) optometrists, of whom 56% had previous training in pachymetry. Those that had previous training were significantly more likely to report pachymetry to be useful, with median (inter-quartile range) usefulness score of 86 (71-98) where 0 indicated not at all useful, and 100 extremely useful, vs 76 (58-90), Wilcoxon-Mann-Whitney test, z = -4.67, p < 0.01. There are no valid scales for adjusting intraocular pressure (IOP) using CCT, however 45% of respondents reported using a scale. Optometrists planned to use pachymetry when assessing patients with ocular hypertension or suspected glaucoma. The greatest perceived barrier was the process of decontaminating or cleaning the pachymeter between patients, followed by lack of time and lack of training., CONCLUSIONS: Although the majority of optometrists were interested in performing pachymetry, many lacked confidence in performing and interpreting the results. Forty-one percent of those who reported training in pachymetry still used non-validated scales to convert IOP measurements illustrating the need for further training. Copyright © 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists.
Keywords: *Cornea/dg [Diagnostic Imaging]; *Corneal Pachymetry/sn [Statistics & Numerical Data]; Female; *Glaucoma/di [Diagnosis]; *Guideline Adherence; Humans; Male; Optometrists/st [Standards]; *Optometrists/sn [Statistics & Numerical Data]; Retrospective Studies; Scotland; *Surveys and Questionnaires

Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage. - Kyari, Fatima; Gilbert, Clare; Blanchet, Karl; Wormald, Richard (The British journal of ophthalmology, 2017)
Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be glaucoma blind. Available evidence indicates that the health system in Nigeria is failing to meet the needs of patients with glaucoma. Based on evidence, we propose future directions for improving services for glaucoma care in Nigeria, and the implications for policy and programmes to control glaucoma blindness, using a health system-oriented approach. Three complementary strategies are required: (i) strengthening clinical services for glaucoma-by developing models of glaucoma care, improving clinical treatment options, making medicines and equipment available, financing glaucoma care and training eye care workers; (ii) introducing initiatives for earlier detection of glaucoma in the clinic and approaches in the community and (iii) strengthening health system governance. Glaucoma is a complex disease to manage and addressing it as a public health problem is challenging. However, we need to change the paradigm to recognise that glaucoma is a potentially avoidable cause of blindness in Africa. 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: Blindness/pc [Prevention & Control]; *Delivery of Health Care/og [Organization & Administration]; Delivery of Health Care/st [Standards]; Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; *Glaucoma; Health Services Accessibility/og [Organization & Administration]; Health Services Needs and Demand; Humans; Nigeria; *Optometry/og [Organization & Administration]; Optometry/st [Standards]; *Universal Health Insurance/og [Organization & Administration]

Mediterranean diet adherence by patients with primary open angle glaucoma. - Abreu-Reyes, J A; Alvarez-Luis, D; Arteaga-Hernandez, V; Sanchez-Mendez, M; Abreu-Gonzalez, R (Archivos de la Sociedad Espanola de Oftalmologia, 2017)
OBJECTIVE: To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG)., MATERIALS AND METHODS: An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone., RESULTS: A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases., CONCLUSION: Patients who are affected by POAG have moderate adherence to the Mediterranean diet. Copyright © 2017 Sociedad Espanola de Oftalmologia. Publicado por Elsevier Espana, S.L.U. All rights reserved.
Keywords: Aged; *Diet, Mediterranean; Female; *Glaucoma, Open-Angle/dh [Diet Therapy]; Humans; Male; *Patient Compliance/sn [Statistics & Numerical Data]; Self Report

Electronic Referrals and Digital Imaging Systems in Ophthalmology: A Global Perspective. - Jeganathan, V Swetha E; Hall, H Nikki; Sanders, Roshini (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2017)
Ophthalmology departments face intensifying pressure to expedite sight-saving treatments and reduce the global burden of disease. The use of electronic communication systems, digital imaging, and redesigned service care models is imperative for addressing such demands. The recently developed Scottish Eyecare Integration Project involves an electronic referral system from community optometry to the hospital ophthalmology department using National Health Service (NHS) email with digital ophthalmic images attached, via a virtual private network connection. The benefits over the previous system include reduced waiting times, improved triage, e-diagnosis in 20% without the need for hospital attendance, and rapid electronic feedback to referrers. We draw on the experience of the Scottish Eyecare Integration Project and discuss the global applications of this and other advances in teleophthalmology. We focus particularly on the implications for management and screening of chronic disease, such as glaucoma and diabetic eye disease, and ophthalmic disease, such as retinopathy of prematurity where diagnosis is almost entirely and critically dependent on fundus appearance. Currently in Scotland, approximately 75% of all referrals are electronic from community to hospital. The Scottish Eyecare Integration Project is globally the first of its kind and unique in a national health service. Such speedy, safe, and efficient models of communication are geographically sensitive to service provision, especially in remote and rural regions. Along with advances in teleophthalmology, such systems promote the earlier detection of sight-threatening disease and safe follow-up of non-sight-threatening disease in the community. Copyright© 2017 Asia-Pacific Academy of Ophthalmology.
Keywords: Delivery of Health Care, Integrated/og [Organization & Administration]; *Electronic Health Records; *Eye Diseases/di [Diagnosis]; Health Services Accessibility/og [Organization & Administration]; Humans; Image Processing, Computer-Assisted/mt [Methods]; Mass Screening/og [Organization & Administration]; *Ophthalmology/og [Organization & Administration]; Optometry/og [Organization & Administration]; *Referral and Consultation/og [Organization & Administration]; *Remote Consultation/og [Organization & Administration]; Scotland

The Pathway From Genes to Gene Therapy in Glaucoma: A Review of Possibilities for Using Genes as Glaucoma Drugs. - Borras, Teresa (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2017)
Treatment of diseases with gene therapy is advancing rapidly. The use of gene therapy has expanded from the original concept of re-placing the mutated gene causing the disease to the use of genes to con-trol nonphysiological levels of expression or to modify pathways known to affect the disease. Genes offer numerous advantages over conventional drugs. They have longer duration of action and are more specific. Genes can be delivered to the target site by naked DNA, cells, nonviral, and viral vectors. The enormous progress of the past decade in molecular bi-ology and delivery systems has provided ways for targeting genes to the intended cell/tissue and safe, long-term vectors. The eye is an ideal organ for gene therapy. It is easily accessible and it is an immune-privileged site. Currently, there are clinical trials for diseases affecting practically every tissue of the eye, including those to restore vision in patients with Leber congenital amaurosis. However, the number of eye trials compared with those for systemic diseases is quite low (1.8%). Nevertheless, judg-ing by the vast amount of ongoing preclinical studies, it is expected that such number will increase considerably in the near future. One area of great need for eye gene therapy is glaucoma, where a long-term gene drug would eliminate daily applications and compliance issues. Here, we review the current state of gene therapy for glaucoma and the possibilities for treating the trabecular meshwork to lower intraocular pressure and the retinal ganglion cells to protect them from neurodegeneration. Copyright© 2017 Asia-Pacific Academy of Ophthalmology.
Keywords: Clinical Trials as Topic; Gene Expression Regulation; Gene Transfer Techniques; *Genetic Therapy/mt [Methods]; Glaucoma/ge [Genetics]; *Glaucoma/th [Therapy]; Humans; Neurodegenerative Diseases/th [Therapy]; Ocular Hypertension/th [Therapy]; Retinal Degeneration/th [Therapy]

Comparison of EX-PRESS Shunt and Trabeculectomy With Mitomycin-C in Congenital and Juvenile Glaucoma. - Nash, David L; Crouch, Eric R; Crouch, Earl R Jr (Journal of glaucoma, 2017)
PURPOSE: To compare efficacy and safety of EX-PRESS mini glaucoma shunt (Alcon) and trabeculectomy with mitomycin-C (MMC) in the management of pediatric glaucoma., METHODS: The authors retrospectively reviewed patients from a single pediatric ophthalmology practice with either congenital or juvenile glaucoma who underwent surgical treatment with either trabeculectomy or EX-PRESS shunt insertion with MMC. Postoperative intraocular pressure at 6, 18, and 36 months, medication requirements, visual acuities, postoperative interventions, complications, and noncompliance with medications or follow-up was reviewed., RESULTS: A total of 42 cases of glaucoma with either trabeculectomy or EX-PRESS shunt were identified for review (n trabeculectomy=25, n EX-PRESS=17). At 6 months, 62.5% of trabeculectomies and 94.1% of EX-PRESS shunts met criteria for success (P=0.0281). At 18 months, 38.1% of trabeculectomies and 81.3% of EX-PRESS shunts met criteria for success (P=0.0178). At 36 months, trabeculectomies had a success rate of 33.3% versus 66.7% for EX-PRESS shunts (P=0.321). The average decrease in medications postoperatively was 0.375 and 1.63 for trabeculectomy and EX-PRESS shunt, respectively (P=0.06). Preoperative visual acuities compared with postoperative best-corrected visual acuities before additional surgery demonstrated a slight average worsening of 0.11 logMAR in trabeculectomy patients and an average improvement of 0.56 logMAR in EX-PRESS shunt patients (P=0.0037)., CONCLUSIONS: In this review, patients with pediatric glaucoma managed with EX-PRESS shunt with MMC compared with trabeculectomy with MMC appear to have better intraocular pressure control, better visual acuities, and fewer complications and reoperations.
Keywords: Adolescent; *Alkylating Agents/ad [Administration & Dosage]; Child; Child, Preschool; Combined Modality Therapy; Female; Glaucoma/et [Etiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; *Glaucoma Drainage Implants; Humans; Hydrophthalmos/et [Etiology]; Hydrophthalmos/pp [Physiopathology]; *Hydrophthalmos/th [Therapy]; Infant; Infant, Newborn; Intraocular Pressure/ph [Physiology]; Male; *Mitomycin/ad [Administration & Dosage]; Postoperative Period; Prosthesis Implantation; Retrospective Studies; Tonometry, Ocular; *Trabeculectomy/mt [Methods]; Treatment Outcome; Young Adult

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome. - Foot, B; MacEwen, C (Eye (London, England), 2017)
Purpose To determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 12-month period. Methods Patients with deterioration in vision in at least one eye of 3 lines of Snellen acuity or 15 letters on ETDRS chart or deterioration in visual field deviation of 3 decibels due to health service initiated delay in review or care were ascertained through the BOSU using prospective active surveillance involving all UK consultant ophthalmologists. Demographic details, diagnosis, cause and length of delay, and vision loss were then sought by questionnaire. Results 238 cases reported between March 2015 and February 2016. 197/238 questionnaires were returned (83%). Twenty-eight reports were out of the study period or did not meet the case definition. Median age was 76 years (range: 1 to 98 years). Median delay was 22 weeks (range: 2 days to 51/2 years). Seventy two per cent experienced permanent reduction in visual acuity, 23% permanent deterioration in visual field. Main diagnoses were Glaucoma 42%, Age-related Macular Degeneration (AMD) 23%, and Diabetic Retinopathy (DR) 16%. Eighteen patients were eligible for Severely Sight Impaired (SSI) or Sight Impaired (SI) registration. Main causes were delayed follow-up (76%), lost referral (7%), and delayed treatment (8%). Conclusion Patients are suffering preventable harm due to health service initiated delay leading to permanently reduced vision. This is occurring in patients of all ages, but most consistently in those with chronic conditions. Delayed follow-up or review is the cause in the majority of cases indicating a lack of capacity within the hospital eye service.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; *Delivery of Health Care/td [Trends]; Female; *Hospitals/st [Standards]; Humans; Infant; Male; Middle Aged; *Ophthalmology; *Patient Satisfaction; *Professional Autonomy; Prospective Studies; *Referral and Consultation; Surveys and Questionnaires; United Kingdom; *Vision Disorders/th [Therapy]; Young Adult

Polymeric micelles for ocular drug delivery: From structural frameworks to recent preclinical studies. - Mandal, Abhirup; Bisht, Rohit; Rupenthal, Ilva D; Mitra, Ashim K (Journal of controlled release : official journal of the Controlled Release Society, 2017)
Effective intraocular drug delivery poses a major challenge due to the presence of various elimination mechanisms and physiological barriers that result in low ocular bioavailability after topical application. Over the past decades, polymeric micelles have emerged as one of the most promising drug delivery platforms for the management of ocular diseases affecting the anterior (dry eye syndrome) and posterior (age-related macular degeneration, diabetic retinopathy and glaucoma) segments of the eye. Promising preclinical efficacy results from both in-vitro and in-vivo animal studies have led to their steady progression through clinical trials. The mucoadhesive nature of these polymeric micelles results in enhanced contact with the ocular surface while their small size allows better tissue penetration. Most importantly, being highly water soluble, these polymeric micelles generate clear aqueous solutions which allows easy application in the form of eye drops without any vision interference. Enhanced stability, larger cargo capacity, non-toxicity, ease of surface modification and controlled drug release are additional advantages with polymeric micelles. Finally, simple and cost effective fabrication techniques render their industrial acceptance relatively high. This review summarizes structural frameworks, methods of preparation, physicochemical properties, patented inventions and recent advances of these micelles as effective carriers for ocular drug delivery highlighting their performance in preclinical studies. Copyright © 2017 Elsevier B.V. All rights reserved.
Keywords: Administration, Ophthalmic; Animals; Biological Availability; Drug Carriers/ad [Administration & Dosage]; *Drug Carriers/ch [Chemistry]; Drug Delivery Systems/mt [Methods]; Dry Eye Syndromes/dt [Drug Therapy]; Eye/me [Metabolism]; Eye Diseases/dt [Drug Therapy]; Humans; *Micelles; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ch [Chemistry]; *Pharmaceutical Preparations/ad [Administration & Dosage]; Pharmaceutical Preparations/ch [Chemistry]; Polymers/ad [Administration & Dosage]; *Polymers/ch [Chemistry]; Solubility

[New Developments in Cataract Surgery]. - Dick, H B; Schultz, T (Klinische Monatsblatter fur Augenheilkunde, 2017)
Recent technological innovations in cataract surgery have made the procedure even more precise and safe and the odds of having a highly satisfied patient even higher. These innovations include visualisation systems - such as intraoperative aberrometry - which are particularly helpful when it comes to implanting toric IOLs, where even a slight rotation or misalignment can significantly reduce the postoperative visual quality. Another way to ensure the exact positioning of a toric IOL is to create a mark by making an intrastromal incision using the femtosecond laser. The latter technology has increased the precision of capsulotomy and other steps of the operation and has been successfully employed in patients with a challenging clinical profile, including paediatric and hypermature cataracts. The femtosecond laser, however, induces an increase in intraocular prostaglandins, which can lead to miosis. Applying topical NSAIDs before starting surgery has proved to be effective in coping with the consequences of the increase in prostaglandins. Good vision without using glasses for near, intermediate and far distances remains a goal for many patients. IOLs with extended depths of focus (EDOF) technology can provide this comfort - to some but not all patients. An intraocular sensor, Eyemate, that is implanted during cataract surgery, enables the glaucoma patient to check his or her IOP at any time and improves the management of glaucoma and its main risk factor, elevated IOP. Several methods - drugs or nutritive agents - are said to prevent cataractogenesis. These studies have probably to be taken with the proverbial grain of salt. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Aberrometry/mt [Methods]; Aberrometry/td [Trends]; *Cataract Extraction/mt [Methods]; *Cataract Extraction/td [Trends]; Diffusion of Innovation; Humans; Intraocular Pressure; Laser Therapy/mt [Methods]; Laser Therapy/td [Trends]; Lenses, Intraocular; Optics and Photonics; Patient Satisfaction; Refraction, Ocular

[Selective laser trabeculoplasty: Effect of number of preoperative topical glaucoma medications on pressure lowering and success rate]. - Bonnel, S; Fenolland, J-R; Marill, A-F; Gaillard, R; Rosenberg, R; Theillac, V; Mazharian, A; Giraud, J-M; Renard, J-P (Journal francais d'ophtalmologie, 2017)
PURPOSE: To evaluate the lowering of intraocular pressure (IOP) one year after SLT and to assess if differences are related to number of pre-SLT topical treatments in ocular hypertension (OHT) and primary open angle glaucoma (POAG) patients., METHODS: Retrospective review of 106 eyes of 13 OHT and 93 POAG patients treated by SLT for insufficient IOP control, allergy, discomfort or non-compliance to glaucoma medications, excluding patients with less than 1 year of follow-up after SLT. IOP was measured by applanation before and at 1, 6 and 12 months after SLT., RESULTS: Hundred and six eyes untreated (n=13), or treated with one (n=25), two (n=40) or three or more (n=28) glaucoma medications were included. Mean IOP decreased from 19.4+/-3.6mmHg preoperatively to 15.7+/-3.1mmHg at 12 months, which corresponds to an average decrease of 18.8%. At 1 year, 62.2% (n=66) were responders (IOP reduction>=3mmHg): 92.3% without medications (n=12), 68% with one (n=17), 57.5% with two (n=23) and 50% with three or more medications (n=14). Their average IOP decreased from 20.7+/-3.4 to 15.2+/-2.9mmHg (26.6%), respectively from 20.8+/-2.6 to 15.8+/-3.2 (25%) without medications, 20.6+/-3.2 to 14.9+/-3.7 (27.3%) with one, 20.8+/-4.1 to 15.5+/-3.3 (25.1%) with two and 20.7+/-3.2 to 14.4+/-2.4mmHg (29.7%) with three medications., CONCLUSIONS: The number of responders seems to be greater in OHT and POAG patients without or with few glaucoma medications, but the IOP reduction seems to be similar regardless of the number of glaucoma medications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; Combined Modality Therapy; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; *Intraocular Pressure/de [Drug Effects]; *Laser Therapy/mt [Methods]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; *Ocular Hypertension/su [Surgery]; Preoperative Care/mt [Methods]; Preoperative Period; Retrospective Studies; *Trabeculectomy/mt [Methods]; Treatment Outcome

[Role of the aging visual system in glaucoma]. - Unterlauft, J D; Bohm, M R R (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2017)
BACKGROUND: Glaucoma is the second leading cause of blindness worldwide and is usually diagnosed in higher age groups. The goal was to survey how patient age influences the development of glaucoma., MATERIALS AND METHODS: A web-based search on aging of the visual system and its influence on glaucoma was performed and the most important results are summarized., RESULTS: The prevalence of glaucoma rises with age. Aging processes of the trabecular meshwork and the uveoscleral outflow pathway lead to a rise in the intraocular pressure. Chronically elevated intraocular pressure leads to remodelling of the lamina cribrosa and narrowing of its pores through which ganglion cell axons leave the eye. Age-dependent glia cell, mitochondria and immune system alterations are discussed to influence glaucoma. Patient age and further age-related nonophthalmological systemic diseases also influence adherence and persistence to the prescribed therapy., CONCLUSIONS: Aging is an important risk factor for developing glaucoma and is a main factor which influences therapy and course of the disease. At this point in time it remains unclear to which extent additional factors determine the development of glaucoma.
Keywords: Age Distribution; Aged; Aged, 80 and over; *Aging/pa [Pathology]; *Anterior Eye Segment/pa [Pathology]; Evidence-Based Medicine; Female; Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; *Glaucoma/pa [Pathology]; Humans; Male; Middle Aged; Prevalence; Risk Factors

Psycho-ophthalmology: Contributions of Health psychology to the assessment and treatment of glaucoma. - Mendez-Ulrich, Jorge Luis; Sanz, Antoni (Psychology & health, 2017)
BACKGROUND: Asymptomatic in its early stages, glaucoma is the second leading cause of blindness worldwide. While psychosocial factors are taken into consideration for a host of diseases such as cancer, heart disease and autoimmune conditions, to date, psychological issues have been ignored in the clinical management of glaucoma., OBJECTIVE: This work reviews the most relevant contributions from a health psychology perspective for the assessment and treatment of glaucoma, which is emerging in the field of psycho-ophthalmology., METHOD: To provide scientific evidence regarding contributions of psychology to the comprehension of glaucoma, a bibliographic review of three databases (Psicodoc, PsycInfo and Medline) was conducted, spanning the period between 1940 and 2016., RESULTS: This review yielded a total of 66 studies published in the period analysed and identified three areas where health psychology has made substantive contributions to glaucoma screening, monitoring and treatment: the emotional impact on patients suffering from glaucoma, the adherence to treatment and the effects of stress on intraocular pressure., CONCLUSIONS: A health psychology approach for research and therapy of glaucoma must focus on the management of the negative affect associated with the diagnosis, the optimisation of treatment adherence and the stress management of the intraocular pressure measurements.
Keywords: *Behavioral Medicine; Glaucoma/di [Diagnosis]; *Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; Humans; Ophthalmology

Adherence to Fixed-Combination Versus Unfixed Travoprost 0.004%/Timolol 0.5% for Glaucoma or Ocular Hypertension: A Randomized Trial. - Barnebey, Howard S; Robin, Alan L (American journal of ophthalmology, 2017)
PURPOSE: To assess adherence to treatment with fixed-combination travoprost 0.004%/timolol 0.5% (TTFC) compared with separate containers of travoprost 0.004% and timolol 0.5% (TRAV+TIM; unfixed) using electronic dosing aids., DESIGN: Randomized, controlled, observer-masked clinical trial., METHODS: setting: Two US clinical sites., PATIENT POPULATION: Eligible patients were adults diagnosed with open-angle glaucoma or ocular hypertension. Patients (n = 81) were sequentially randomized 1:1 to receive TTFC or TRAV+TIM for 12 months., INTERVENTION: TTFC was administered once daily in the morning or evening with a single dosing aid. Patients randomized to TRAV+TIM administered TRAV once daily in the evening and TIM once daily in the morning using separate dosing aids., MAIN OUTCOME MEASURE: Adherence with administered medication, as recorded by the dosing aids., RESULTS: Mean +/- SD patient age was 60 +/- 10 years; most patients were male and white. Compared with TRAV+TIM (n = 40), patients receiving TTFC (n = 41) were consistently adherent on a greater percentage of days through month 12 (60% vs 43%). At months 1, 3, 6, and 12, 80% adherence was achieved by 71% vs 38%, 53% vs 30%, 45% vs 16%, and 32% vs 11% of patients receiving TTFC vs TRAV+TIM, respectively. Significantly more patients were adherent on >=80% of days with TTFC compared with TRAV+TIM (P < .001 to P = .041). Both treatments reduced IOP from baseline, and no safety issues were identified in either group. Ocular hyperemia was the most common treatment-related adverse event (n = 3/group)., CONCLUSIONS: Patients receiving TTFC maintained better treatment adherence compared with patients receiving TRAV+TIM through 12 months of on-therapy evaluation. This suggests that, for patients requiring multiple IOP-lowering medications, a fixed combination may provide improved long-term adherence compared with unfixed therapy. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Instillation, Drug; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; *Patient Compliance; Single-Blind Method; Time Factors; *Timolol/ad [Administration & Dosage]; Tonometry, Ocular; *Travoprost/ad [Administration & Dosage]; Treatment Outcome

Referral to Low Vision Services for Glaucoma Patients: Referral Patterns and Characteristics of Those Who Refer. - Kaleem, Mona A; West, Sheila K; Im, Lily T; Swenor, Bonnielin K (Journal of glaucoma, 2017)
PURPOSE: To identify characteristics of ophthalmologists and practices who refer glaucoma patients to low vision services (LVS)., MATERIALS AND METHODS: An online survey was distributed to members of the American Glaucoma Society. The survey queried demographics of responders and their clinical practices, criteria and barriers to referral to LVS. Survey responders were categorized as high referrers if they reported referring >5 patients to LVS and low referrers if they referred <=5. chi and Fischer exact tests were used to compare characteristics between high and low referrers. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals and determine factors associated with referrer status., RESULTS: High referrers to LVS tended to have >10 patients per month who had already seen a low vision provider (53% vs. 10%, P<0.001), reported following the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) recommendations for LVS referrals (38% vs. 18%, P=0.011), and expressed satisfaction with their current referral practices (86% vs. 70%, P=0.049). In the fully adjusted model those who followed PPP were 2.5 times more likely to report being a high referrer as compared with a low referrer (95% confidence interval, 1.1-5.3). However, only 22% of ophthalmologists reported following these guidelines in their practice. The number of years in practice, practice location or type, volume of patients seen each week, and distance to a low vision clinic were not associated with referral., CONCLUSIONS: Familiarity with PPP guidelines may positively influence LVS referral practices.
Keywords: Aged; Female; *Glaucoma/rh [Rehabilitation]; Humans; Intraocular Pressure; Male; Middle Aged; *Ophthalmologists/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; *Referral and Consultation/sn [Statistics & Numerical Data]; Surveys and Questionnaires; *Vision, Low/rh [Rehabilitation]

Neuroprotection for glaucoma: Requirements for clinical translation. - Levin, Leonard A; Crowe, Megan E; Quigley, Harry A; Lasker/IRRF Initiative on Astrocytes and Glaucomatous Neurodegeneration Participants (Experimental eye research, 2017)
Within the field of glaucoma research, neuroprotection is defined as slowing the functional loss in glaucoma by a mechanism independent of lowering of intraocular pressure. There is currently a great potential for research surrounding neuroprotection as it relates to glaucoma. Anatomical targets for neuroprotection should focus on upstream rather than downstream factors, and could include any part of the retinal ganglion cell, the glia, especially astrocytes or Muller cells, and vasculature. The great number of anatomical targets is exceeded only by the number of possible biochemical pathways and potential treatments. Successful treatment may be accomplished through the targeting of one or even a combination of multiple pathways. Once a treatment is shown effective in vitro, it should be evaluated in vivo with carefully chosen animal models and studied in sufficient numbers to detect statistically and clinically significant effects. Such a drug should have few systemic side effects and its delivery should be optimized so as to encourage compliance. There are still a multitude of possible screens available to test the efficacy of a neuroprotective drug and a single gold standard is ideal for the accurate assessment and comparison of new drugs. Future studies in neuroprotection should investigate the genetic component of the disease, novel pharmaceutical agents for new or known pathways, modulations of scleral biomechanics, and relation to research of other complex disorders of the central nervous system. Copyright © 2016 Elsevier Ltd. All rights reserved.
Keywords: Animals; *Astrocytes/ph [Physiology]; Axons/ph [Physiology]; *Glaucoma/dt [Drug Therapy]; Humans; *Neuroprotection/de [Drug Effects]; *Neuroprotective Agents/tu [Therapeutic Use]; *Optic Nerve Diseases/dt [Drug Therapy]; *Retinal Ganglion Cells/de [Drug Effects]; Retinal Ganglion Cells/ph [Physiology]; *Translational Medical Research

Understanding the reasons for loss to follow-up in patients with glaucoma at a tertiary referral teaching hospital in Korea. - Kim, Young Kook; Jeoung, Jin Wook; Park, Ki Ho (The British journal of ophthalmology, 2017)
BACKGROUND/AIMS: To assess the reasons and factors for discontinuation of follow-up among patients with glaucoma at a tertiary referral teaching hospital in Seoul, Korea., METHODS: We identified all adult patients with glaucoma (>=18 years), who had visited the glaucoma clinic of Seoul National University Hospital between April 2012 and March 2014 and had missed an appointment by at least 12 months. These patients were traced via cellular phone, and their true status and reasons for discontinuation of follow-up were documented., RESULTS: A total of 6848 patients with glaucoma (3512 men and 3336 women) were considered. Among them, 247 (3.61%) had missed a scheduled appointment by 12 months or more. Among 230 (93.1%) who were successfully traced, 4 (1.7%) had died and 96 (41.7%) had self-transferred to another glaucoma clinic. Of the 130 patients left, 123 (94.6%) had treatment and follow-up interruptions, and 7 (5.4%) had been treated with alternative medicine. The two main reasons cited for treatment and follow-up interruptions were lack of understanding regarding the necessity of follow-up (46.3%) and unawareness of appointment schedule (30.9%). In stepwise linear regression analysis, older age (p=0.001. beta=0.13), male gender (p=0.013, beta=0.08) and lower baseline intraocular pressure (p=0.005, beta=0.11) were independently associated with follow-up loss involving treatment interruptions., CONCLUSIONS: This study's results emphasise the need for ongoing educational support and improved appointment notification, especially for the elderly, men and patients with low baseline intraocular pressure. 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; Aftercare; Aged; Case-Control Studies; Female; *Glaucoma/th [Therapy]; Hospitals, Teaching; Humans; Male; Middle Aged; *Patient Compliance; Patient Dropouts/sn [Statistics & Numerical Data]; Patient Satisfaction; Republic of Korea; Surveys and Questionnaires; Tertiary Care Centers/sn [Statistics & Numerical Data]; Young Adult

Minimally invasive glaucoma surgery as primary stand-alone surgery for glaucoma. - Kerr, Nathan M; Wang, Jing; Barton, Keith (Clinical & experimental ophthalmology, 2017)
Recently, many new devices and procedures have been developed to lower intraocular pressure in a less invasive and purportedly safer manner than traditional glaucoma surgery. These new devices might encourage an earlier transition to surgery and reduce the long-term commitment to topical glaucoma medications with their associated compliance and intolerance issues. Although often seen as an adjunct to cataract surgery, a growing body of evidence suggests that primary minimally invasive glaucoma surgery may be a viable initial treatment option. New studies have shown that primary ab interno trabeculectomy (Trabectome, NeoMedix Inc., Tustin, CA, USA), trabecular micro-bypass stent insertion (iStent and iStent Inject, Glaukos Corporation, Laguna Hills, CA, USA), canalicular scaffolding (Hydrus, Invantis Inc., Irvine CA, USA), the ab interno gel Implant (XEN, Allergan, Dublin, Ireland) or supraciliary stenting (CyPass Micro-Stent, Alcon, Fort Worth, TX, USA) may lower the lowering intraocular pressure and/or topical medication burden in phakic or pseudophakic patients with glaucoma. This effect seems to last at least 12 months but reliable cost-effectiveness and quality of life indicators have not yet been established by investigator-initiated randomized trials of sufficient size and duration. Copyright © 2016 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: *Filtering Surgery/mt [Methods]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; *Intraocular Pressure; *Minimally Invasive Surgical Procedures/mt [Methods]

Adaptive optics optical coherence tomography in glaucoma. - Dong, Zachary M; Wollstein, Gadi; Wang, Bo; Schuman, Joel S (Progress in retinal and eye research, 2017)
Since the introduction of commercial optical coherence tomography (OCT) systems, the ophthalmic imaging modality has rapidly expanded and it has since changed the paradigm of visualization of the retina and revolutionized the management and diagnosis of neuro-retinal diseases, including glaucoma. OCT remains a dynamic and evolving imaging modality, growing from time-domain OCT to the improved spectral-domain OCT, adapting novel image analysis and processing methods, and onto the newer swept-source OCT and the implementation of adaptive optics (AO) into OCT. The incorporation of AO into ophthalmic imaging modalities has enhanced OCT by improving image resolution and quality, particularly in the posterior segment of the eye. Although OCT previously captured in-vivo cross-sectional images with unparalleled high resolution in the axial direction, monochromatic aberrations of the eye limit transverse or lateral resolution to about 15-20 mum and reduce overall image quality. In pairing AO technology with OCT, it is now possible to obtain diffraction-limited resolution images of the optic nerve head and retina in three-dimensions, increasing resolution down to a theoretical 3 mum3. It is now possible to visualize discrete structures within the posterior eye, such as photoreceptors, retinal nerve fiber layer bundles, the lamina cribrosa, and other structures relevant to glaucoma. Despite its limitations and barriers to widespread commercialization, the expanding role of AO in OCT is propelling this technology into clinical trials and onto becoming an invaluable modality in the clinician's arsenal. Copyright © 2016 Elsevier Ltd. All rights reserved.
Keywords: Equipment Design; *Glaucoma/di [Diagnosis]; Humans; *Lenses; *Tomography, Optical Coherence/is [Instrumentation]

Glaucoma patient-provider communication about vision quality-of-life. - Sleath, Betsy; Sayner, Robyn; Vitko, Michelle; Carpenter, Delesha M; Blalock, Susan J; Muir, Kelly W; Giangiacomo, Annette L; Hartnett, Mary Elizabeth; Robin, Alan L (Patient education and counseling, 2017)
OBJECTIVE: The purpose of this study was to: (a) describe the extent to which ophthalmologists and glaucoma patients discuss vision quality-of-life during office visits, and (b) examine the association between patient and ophthalmologist characteristics and provider-patient communication about vision quality-of-life., METHODS: Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits were video-tape recorded and quality-of-life communication variables were coded. Generalized estimating equations were used to analyze the data., RESULTS: Two hundred and seventy-nine patients participated. Specific glaucoma quality-of-life domains were discussed during only 13% of visits. Older patients were significantly more likely to discuss one or more vision quality-of-life domains than younger patients. African American patients were significantly less likely to make statements about their vision quality-of-life and providers were less likely to ask them one or more vision quality-of-life questions than non-African American patients., CONCLUSION: Eye care providers and patients infrequently discussed the patient's vision quality-of-life during glaucoma visits. African American patients were less likely to communicate about vision quality-of-life than non-African American patients., PRACTICE IMPLICATIONS: Eye care providers should make sure to discuss vision quality-of-life with glaucoma patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Communication; Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Humans; Middle Aged; Office Visits; *Patient-Centered Care/mt [Methods]; Physician-Patient Relations; *Quality of Life; Socioeconomic Factors; Videotape Recording; Young Adult

Glaucoma: Hot Topics in Pharmacology. - Balendra, Shiama I; Shah, Parth Arvind; Jain, Mishank; Grzybowski, Andrzej; Cordeiro, Maria F (Current pharmaceutical design, 2017)
BACKGROUND: Glaucoma comprises a group of neurodegenerative diseases resulting in retinal ganglion cell death within the optic nerve head. It is projected to affect almost 80 million people worldwide by 2020. The condition's asymptomatic nature translates to over half of glaucoma sufferers being unaware of their condition. By the time of diagnosis, irreversible blindness is likely to have occurred. Prime areas of glaucoma research therefore include identification and optimization of risk factors for the disease, accurate and early diagnostic tools and novel therapeutic methods., METHODS: The goal of this review was to summarize main areas of latest glaucoma research into risk factors of glaucoma, diagnostic tools and treatments. PubMed was used to search for terms including glaucoma risk factors, glaucoma diagnostics, glaucoma treatment, glaucoma drug delivery and glaucoma IOP., RESULTS: The evidence for risk factors of low CSF pressure, IOP, smoking, vascular risk factors and light toxicity is described. Latest diagnostic and monitoring techniques for glaucoma include SD-OCT, DARC and IOP telemetry. Current and emerging medical and surgical treatments in glaucoma are discussed. Rho kinase inhibitors have the potential to both lower IOP and also provide neuroprotection, several of which are in clinical trials. Several other new medical treatments such as calcium channel blockers and neurotrophic agents also have the capacity to provide neuroprotection. Minimally Invasive Glaucoma Surgery (MIGS) devices provide an improved safety profile compared to traditional trabeculectomy; the latest ab interno and ab externo devices are described. Novel drug delivery methods, including punctual plugs and contact lenses, help overcome the challenges with patient adherence., CONCLUSION: The ultimate goals are to reduce the individual patient risk factors associated with glaucoma, diagnose the condition early and to find treatments that not only reduce IOP but also reverse neurodegeneration of RGCs. The usage of combinations of novel medical and surgical treatments may help maximize IOP reduction and neuroprotection. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
Keywords: *Calcium Channel Blockers/tu [Therapeutic Use]; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; Humans; *Neuroprotective Agents/tu [Therapeutic Use]; Risk Factors

New classes of glaucoma medications. - Schehlein, Emily M; Novack, Gary D; Robin, Alan L (Current opinion in ophthalmology, 2017)
PURPOSE OF REVIEW: To discuss recent advances in the medical management of glaucoma and to highlight future medical therapies currently in development., RECENT FINDINGS: In 1996, latanoprost (Xalatan) was approved in the United States as a new chemical entity and new class (prostaglandin analogs) for the topical treatment of ocular hypertension and glaucoma. In the period from the late 1990s-2010s, while there were additional new chemical entities, fixed dose combinations, and formulation improvements, there were no new classes of ocular hypotensive medications approved worldwide. We summarize new pharmacological treatments that are currently in clinical trials - new classes, new molecules and new delivery systems., SUMMARY: Although challenges in medical treatment of glaucoma exist, particularly in patient adherence, medical therapy remains the first line treatment for almost all glaucoma patients. Few new medications for glaucoma therapy are currently available for our patients, but multiple drugs with novel mechanisms of action, new formulations, and new delivery mechanisms are currently in development.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Drug Combinations; Drug Delivery Systems; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Purinergic P1 Receptor Agonists/tu [Therapeutic Use]; RNA, Small Interfering/tu [Therapeutic Use]; Receptors, Prostaglandin/ag [Agonists]; rho-Associated Kinases/ai [Antagonists & Inhibitors]

Increasing healthcare costs: can we influence the costs of glaucoma care?. - Toteberg-Harms, Marc; Berlin, Michael S; Meier-Gibbons, Frances (Current opinion in ophthalmology, 2017)
PURPOSE OF REVIEW: Despite a decrease in real average growth rates per capita since 2009, healthcare costs continue to rise worldwide. Numerous patient-related and doctor-related factors have contributed to this rise. Glaucoma is the leading cause of irreversible blindness and requires chronic, usually lifelong treatment. As with other chronic diseases, the adherence to prescribed treatment is often low and maybe influenced by the cost of the therapy. The purpose of this review is to seek potential solutions to best control the escalating costs of glaucoma care., RECENT FINDINGS: The studies we selected for this review can be divided into four different categories: costs of diagnostic tests; costs of direct comparisons between drugs or laser and conventional surgery; patient-related factors (such as adherence); and general aspects regarding costs: theoretical models and calculations., SUMMARY: It is challenging to find reliable studies concerning this subject matter. As patients are under the umbrellas of variously organized healthcare systems which span different cultures, the costs between countries are difficult to compare. However, one common aspect to lower costs in glaucoma care is to improve patient adherence. Theoretical models with actual patient studies could enable cost reductions by comparing multiple diagnostic and therapeutic scenarios. VIDEO ABSTRACT: http://links.lww.com/COOP/A22.
Keywords: Antihypertensive Agents/ec [Economics]; Delivery of Health Care/ec [Economics]; Diagnostic Techniques, Ophthalmological/ec [Economics]; Economics, Pharmaceutical; *Glaucoma/ec [Economics]; *Health Care Costs; Humans; Models, Theoretical; Ophthalmologic Surgical Procedures/ec [Economics]; Patient Compliance

Attributes Associated with Adherence to Glaucoma Medical Therapy and its Effects on Glaucoma Outcomes: An Evidence-Based Review and Potential Strategies to Improve Adherence. - Joseph, Arun; Pasquale, Louis R (Seminars in ophthalmology, 2017)
The treatment paradigm in glaucoma classically starts with exhausting all medical therapy prior to proceeding with laser or incisional surgery, although laser-first and surgery-first strategies have been explored in randomized clinical trials. Although glaucoma drops are proven to work well to lower intraocular pressure, slow the conversion from ocular hypertension, and slow the progression of disease in early open angle glaucoma, adherence to treatment is likely optimum in the randomized clinical trials that support these claims. In real-world scenarios, medical therapy often fails and practitioners are forced to proceed with more invasive treatment modalities to slow the progression of this blinding disease. This review aims to take an evidence-based approach to study the risk factors for poor adherence in glaucoma patients, to determine whether poor adherence is, in fact, associated with worse outcomes, and to seek potential strategies to improve adherence in these patients.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Evidence-Based Medicine; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Medication Adherence/sn [Statistics & Numerical Data]; Patient Education as Topic; Reminder Systems; Risk Factors; Tonometry, Ocular; Treatment Outcome

Lipid nanoparticles (SLN, NLC): Overcoming the anatomical and physiological barriers of the eye - Part II - Ocular drug-loaded lipid nanoparticles. - Sanchez-Lopez, E; Espina, M; Doktorovova, S; Souto, E B; Garcia, M L (European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V, 2017)
In the recent decades, various controlled delivery systems have been introduced with the aim to improve solubility, stability and bioavailability of poorly absorbed drugs. Among all, lipid nanoparticles gather interesting properties as drug or gene delivery carriers. These systems, composed either of solid lipids (SLN) or of solid and liquid lipids (NLC) stabilized with surfactants, combine the advantages of other colloidal particles such as polymeric nanoparticles, fat emulsions and liposomes avoiding their main disadvantages. Lipid nanoparticles represent an interesting approach for eye drug delivery as they can improve the corneal absorption of drugs enhancing their bioavailability. The Generally Recognized as Safe status of formulation excipients, the scaling-up facilities and the possibility of sterilization, make them suitable for industrial production. In this review, the latest findings, potential applications, and challenges related to the use of lipid nanoparticles for ocular drug delivery are comprehensively discussed. Copyright © 2016 Elsevier B.V. All rights reserved.
Keywords: Acyclovir/ad [Administration & Dosage]; Adrenal Cortex Hormones/ad [Administration & Dosage]; Anti-Bacterial Agents/ad [Administration & Dosage]; Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage]; Antifungal Agents/ad [Administration & Dosage]; Antiviral Agents/ad [Administration & Dosage]; Biological Availability; Colloids/ch [Chemistry]; *Drug Carriers/ch [Chemistry]; Drug Stability; Excipients; *Eye/de [Drug Effects]; Eye Infections/dt [Drug Therapy]; Genetic Therapy/mt [Methods]; Glaucoma/dt [Drug Therapy]; Humans; Immunosuppressive Agents/ch [Chemistry]; *Lipids/ad [Administration & Dosage]; Lipids/ch [Chemistry]; Liposomes/ch [Chemistry]; Macular Degeneration; Metal Nanoparticles/ch [Chemistry]; *Nanoparticles/ch [Chemistry]; Polymers/ch [Chemistry]; Solubility; Surface-Active Agents/ch [Chemistry]; Triglycerides/ch [Chemistry]; Vitreous Body/de [Drug Effects]

Virtual clinics in glaucoma care: face-to-face versus remote decision-making. - Clarke, Jonathan; Puertas, Renata; Kotecha, Aachal; Foster, Paul J; Barton, Keith (The British journal of ophthalmology, 2017)
BACKGROUND/AIMS: To examine the agreement in clinical decisions of glaucoma status made in a virtual glaucoma clinic with those made during a face-to-face consultation., METHODS: A trained nurse and technicians entered data prospectively for 204 patients into a proforma. A subsequent face-to-face clinical assessment was completed by either a glaucoma consultant or fellow. Proformas were reviewed remotely by one of two additional glaucoma consultants, and 12 months later, by the clinicians who had undertaken the original clinical examination. The interobserver and intraobserver decision-making agreements of virtual assessment versus standard care were calculated., RESULTS: We identified adverse disagreement between face-to-face and virtual review in 7/204 (3.4%, 95% CI 0.9% to 5.9%) patients, where virtual review failed to predict a need to accelerated follow-up identified in face-to-face review. Misclassification events were rare, occurring in 1.9% (95% CI 0.3% to 3.8%) of assessments. Interobserver kappa (95% CI) showed only fair agreement (0.24 (0.04 to 0.43)); this improved to moderate agreement when only consultant decisions were compared against each other (kappa=0.41 (0.16 to 0.65)). The intraobserver agreement kappa (95% CI) for the consultant was 0.274 (0.073 to 0.476), and that for the fellow was 0.264 (0.031 to 0.497)., CONCLUSIONS: The low rate of adverse misclassification, combined with the slowly progressive nature of most glaucoma, and the fact that patients will all be regularly reassessed, suggests that virtual clinics offer a safe, logistically viable option for selected patients with 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; Aged; Aged, 80 and over; Appointments and Schedules; *Decision Making; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; *Ophthalmology/mt [Methods]; *Outpatient Clinics, Hospital/og [Organization & Administration]; Prospective Studies; ROC Curve; *Referral and Consultation; Time Factors

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans. - Saeedi, Osamah; Ashraf, Hasan; Slade, Eric P; Medoff, Deborah R; Li, Lan; Friedman, David S; Kreyenbuhl, Julie (American journal of ophthalmology, 2017)
PURPOSE: To assess trends in prevalence of diagnosed ocular disease and use of eye care services in the Veterans Affairs (VA) health care system., DESIGN: Prevalence study., METHODS: We performed a retrospective study of all eligible veterans in the VA Capitol Health Care Network from 2007 to 2011. The VA database was used to abstract demographic and socioeconomic variables, including age, race, sex, marital status, service connection, prescription copay, homelessness, and VA facility. Primary outcome measures were the prevalence of diagnosed ocular disease and use of eye care. Ocular diagnoses were determined by International Classification of Diseases, 9th revision codes and use by prescription medication fills, visits to eye care clinics, and cataract surgery frequency., RESULTS: The average age of veterans ranged from 59.8-60.9, most veterans were male (88.1-89.8%), and there was a high proportion of African Americans (29.5-30%). The prevalence of all ocular diagnoses increased from 20.5% in 2007 to 23.3% in 2011 (P < .01), a 13.7% increase. Similarly, the prevalence of diagnosed cataract increased by 35.7% (P = .02) from 7.1% in 2007 to 9.6% in 2011. Diagnosed glaucoma prevalence increased by 9.4% (P = .03) from 6.7 to 7.4%. The percent of patients seen in eye clinics increased 11.6%% in the 5-year study period to 24.0% in fiscal year 2011 (P = .05). The use of ophthalmic medications increased 20% (P < .01). The rate of cataract surgery did not change significantly during the study period., CONCLUSIONS: The prevalence of diagnosed eye conditions among American Veterans is increasing, as is the use of eye care services. Cataract surgery rates did not increase, which may indicate a need to increase availability of these services. Copyright A© 2016 Elsevier Inc. All rights reserved.
Keywords: Cross-Sectional Studies; *Ethnic Groups; Eye Diseases/di [Diagnosis]; *Eye Diseases/eh [Ethnology]; Female; Follow-Up Studies; Humans; Male; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Retrospective Studies; United States; *United States Department of Veterans Affairs/sn [Statistics & Numerical Data]; *Veterans

Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial. - Cook, Paul F; Schmiege, Sarah J; Mansberger, Steven L; Sheppler, Christina; Kammer, Jeffrey; Fitzgerald, Timothy; Kahook, Malik Y (Psychology & health, 2017)
OBJECTIVE: Nonadherence reduces glaucoma treatment efficacy. Motivational interviewing (MI) is a well-studied adherence intervention, but has not been tested in glaucoma. Reminder interventions also may improve adherence., DESIGN: 201 patients with glaucoma or ocular hypertension were urn-randomised to receive MI delivered by an ophthalmic technician (OT), usual care or a minimal behavioural intervention (reminder calls)., MAIN OUTCOME MEASURES: Outcomes included electronic monitoring with Medication Event Monitoring System (MEMS) bottles, two self-report adherence measures, patient satisfaction and clinical outcomes. Multilevel modelling was used to test differences in MEMS results by group over time; ANCOVA was used to compare groups on other measures., RESULTS: Reminder calls increased adherence compared to usual care based on MEMS, p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on most measures, with observable differences in behaviour between groups. All groups had high baseline adherence that limited opportunities for change., CONCLUSION: Reminder calls, but not MI, led to better adherence than usual care. Although a large literature supports MI, reminder calls might be a cost-effective intervention for patients with high baseline adherence. Replication is needed with less adherent participants.
Keywords: Aged; *Behavior Therapy/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Male; *Medication Adherence/px [Psychology]; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Motivational Interviewing; Patient Satisfaction/sn [Statistics & Numerical Data]; *Reminder Systems; Self Report; Treatment Outcome

Ultrasound-mediated ocular delivery of therapeutic agents: a review. - Lafond, Maxime; Aptel, Florent; Mestas, Jean-Louis; Lafon, Cyril (Expert opinion on drug delivery, 2017)
INTRODUCTION: Due to numerous anatomical and physiological barriers, ocular drug delivery remains a major limitation in the treatment of diseases such as glaucoma, macular degeneration or inflammatory diseases. To date, only invasive approaches provide clinically effective results. Ultrasound can be defined as the propagation of a high-frequency sound wave exposing the propagation media to mechanical and thermal effects. Ultrasound has been proposed as a non-invasive physical agent for increasing therapeutic agent delivery in various fields of medicine. Areas covered: An update on recent advances in transscleral and transcorneal ultrasound-mediated drug delivery is presented. Efficient drug delivery is achieved in vitro, ex vivo and in vivo for various types of materials. Numerous studies indicate that efficacy is related to cavitation. Although slight reversible effects can be observed on the corneal epithelium, efficient drug delivery can be performed without causing damage to the cornea. Expert opinion: Recent developments prove the potential of ultrasound-mediated ocular drug delivery. Cavitation appears to be a preponderant mechanism, opening a way to treatment monitoring by cavitation measurement. Even if no clinical studies have yet been performed, the promising results summarized here are promoting developments toward clinical applications, particularly in assessing the safety of the technique.
Keywords: Cornea/me [Metabolism]; *Drug Delivery Systems; *Eye Diseases/dt [Drug Therapy]; Humans; Pharmaceutical Preparations/ad [Administration & Dosage]; *Ultrasonography/mt [Methods]

Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania. - Fies, Achim; Furahini, Godfrey; Bowman, Richard; Bauer, Jacqueline; Dithmar, Stefan; Philippin, Heiko (The British journal of ophthalmology, 2017)
AIM: To evaluate goniotomy, trabeculotomy, transscleral cyclophotocoagulation (TSCPC) and trabeculectomy as initial procedures in children with primary childhood glaucoma from Northern Tanzania., METHODS: A retrospective analysis of consecutive interventions for primary childhood glaucoma from 2000 to 2013 was conducted at the Kilimanjaro Christian Medical Centre. Success was defined as postoperative intraocular pressure (IOP) below 22 mmHg. Success rates, IOP, visual acuity (VA), subsequent interventions and potential risk factors for failure were reported for the respective interventions., RESULTS: The study included 116 eyes of 70 children (age 4.6+/-5.9 years) with primary childhood glaucoma; 46 (65.7%) children were male. The preoperative IOP was 33.1+/-10.2 mmHg, the preoperative cup/disc (CD) ratio 0.71+/-0.3 and the corneal diameter 13.3+/-1.4 mm. As a primary intervention, 61 (52.6%) eyes underwent goniotomy, 10 (8.6%) eyes trabeculotomy, 12 (10.3%) TSCPC and 33 (28.4%) trabeculectomy. Follow-up data after 12 months were available for 63 (54.3%) eyes. Success rates at 12 months were 38% (goniotomy), 30% (trabeculotomy), 17% (TSCPC) and 64% (trabeculectomy). All interventions achieved a statistically significant IOP reduction at 3, 6 and 12 months, except for trabeculotomy after 6 months and TSCPC at all time points. Postoperative endophthalmitis occurred in one child treated with trabeculectomy. VA in 82% of all eyes was maintained or had improved after 12 months., CONCLUSIONS: Based on the success rates of this retrospective analysis, goniotomy or trabeculotomy for younger and trabeculectomy for older children can be recommended in our setting to reduce IOP. Late presentation in combination with advanced glaucomatous damage as well as erratic postoperative follow-up and treatment were likely factors that compromised overall success rates. More efforts are necessary to detect the blinding disease earlier and improve adherence to follow-up. 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: Child; Child, Preschool; Female; Follow-Up Studies; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Humans; Infant; Intraocular Pressure/ph [Physiology]; *Light Coagulation/mt [Methods]; Male; Optic Nerve Diseases/su [Surgery]; Postoperative Complications; Retrospective Studies; Tanzania; Tonometry, Ocular; *Trabeculectomy/mt [Methods]; Treatment Outcome; Visual Acuity/ph [Physiology]

A Randomized Controlled Trial to Determine the Effect of Inhaled Corticosteroid on Intraocular Pressure in Open-Angle Glaucoma and Ocular Hypertension: The ICOUGH Study. - Moss, Edward B; Buys, Yvonne M; Low, Stephanie A; Yuen, Darana; Jin, Ya-Ping; Chapman, Kenneth R; Trope, Graham E (Journal of glaucoma, 2017)
PURPOSE: The purpose of this study was to determine the risk of a steroid pressure response from inhaled corticosteroids., PATIENTS AND METHODS: This randomized, double-masked, placebo-controlled trial included 22 adults with well-controlled open-angle glaucoma or ocular hypertension. Consenting participants were randomized to a 6-week course of twice-daily fluticasone propionate 250-mug metered-dose inhaler or saline placebo metered-dose inhaler. Biweekly clinic visits included masked Goldmann applanation tonometry and assessment to identify adverse effects. Primary outcome was mean intraocular pressure (IOP) at week 6. Secondary outcomes included IOP elevation of >20% at 2 consecutive visits, adherence, side effects, and logMAR visual acuity., RESULTS: A total of 10 patients in each arm completed the study. There were no statistically significant differences in IOP between groups at baseline (14.3+/-3.0 and 15.6+/-3.6 mm Hg in steroid and placebo groups, respectively, P=0.39) or at week 6 (14.7+/-2.4 and 14.8+/-3.8 mm Hg in steroid and placebo groups, respectively, P=0.92). Adherence was >80% for all participants. There were no statistically significant differences between groups in any secondary measures. One patient in the steroid group met the secondary end point of >20% elevation in IOP (IOP increased from baseline of 9 to 11 mm Hg at weeks 2 and 4)., CONCLUSIONS: We found no clinically significant increase in mean IOP in patients with well-controlled open-angle glaucoma and ocular hypertension after 6 weeks of twice-daily inhaled fluticasone propionate compared with inhaled placebo. No participants exceeded their individualized target IOP. There were no differences in secondary outcomes.
Keywords: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; *Anti-Inflammatory Agents/ad [Administration & Dosage]; Antihypertensive Agents/tu [Therapeutic Use]; Double-Blind Method; Female; *Fluticasone/ad [Administration & Dosage]; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glucocorticoids/ad [Administration & Dosage]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Nebulizers and Vaporizers; Ocular Hypertension/dt [Drug Therapy]; Tonometry, Ocular; Young Adult

Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China. - Yang, Ke; Jin, Ling; Li, Li; Zeng, Siming; Dan, Aihua; Chen, Tingting; Wang, Xiuqin; Li, Guirong; Congdon, Nathan (The British journal of ophthalmology, 2017)
PURPOSE: To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there., METHODS: Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points)., RESULTS: Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (<=6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up., CONCLUSIONS: Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up. 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; China/ep [Epidemiology]; Female; Follow-Up Studies; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Health Knowledge, Attitudes, Practice; Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure; Logistic Models; Male; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; Risk Factors; Rural Population/sn [Statistics & Numerical Data]; Socioeconomic Factors; *Trabeculectomy/sn [Statistics & Numerical Data]; Visual Acuity

Medical management of glaucoma: focus on ophthalmologic drug delivery systems of timolol maleate. - Sah, Abhishek K; Suresh, Preeti K (Artificial cells, nanomedicine, and biotechnology, 2017)
Eye is a vital organ of our body and any complication not only poses the risk of serious medical condition but also economic burden on the individual. Timolol maleate is one of the preferable therapeutic agents for the management of glaucoma. Globally, eye drops are among the most common and popular conventional formulations, but they are also associated with some limitations in terms of therapeutic response, bioavailability, dosing frequency and poor patient compliance. Present paper gives an overview of the drug delivery systems developed for management of glaucoma, advances and novel approaches with special emphasis on timolol drug delivery.
Keywords: Antihypertensive Agents/pk [Pharmacokinetics]; *Antihypertensive Agents/pd [Pharmacology]; Biological Availability; *Disease Management; *Drug Delivery Systems/mt [Methods]; Emulsions; Epithelium, Corneal/de [Drug Effects]; Epithelium, Corneal/me [Metabolism]; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pp [Physiopathology]; Humans; Hydrogels/ch [Chemistry]; Hydrogels/me [Metabolism]; Intraocular Pressure/de [Drug Effects]; Microspheres; Nanoparticles/ch [Chemistry]; Nanoparticles/me [Metabolism]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/me [Metabolism]; Ocular Hypertension/pp [Physiopathology]; Ophthalmic Solutions/ch [Chemistry]; Ophthalmic Solutions/me [Metabolism]; Ophthalmic Solutions/tu [Therapeutic Use]; Permeability; Polymers/ch [Chemistry]; Polymers/me [Metabolism]; Timolol/pk [Pharmacokinetics]; *Timolol/pd [Pharmacology]

Corneal Pseudodendritic Lesions Masquerading as Herpetic Keratitis in a Patient With Tyrosinemia Type I. - Gulmez Sevim, Duygu; Gumus, Koray; Cavanagh, H Dwight (Eye & contact lens, 2017)
OBJECTIVE: To describe the clinical findings of a patient with tyrosinemia type I with noncompliance to a protein-restricted diet, treated with 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC)., METHODS: Clinical findings at the initial examination and after strict compliance to a protein-restricted diet after 4 weeks follow-up are described in a patient with tyrosinemia type I on NTBC treatment, who had been treated with presumed herpetic keratitis., RESULTS: A 10-year-old girl diagnosed with hereditary tyrosinemia type I and on NTBC treatment presented with photophobia and ocular discomfort in both eyes. An ophthalmologic examination demonstrated bilateral dendritiform epithelial lesions in the central cornea, staining faintly with fluorescein. These lesions were subsequently intermittently treated with topical antivirals for presumed herpes simplex virus keratitis and lubricant eye drops for 9 months without resolution; however, when strict compliance with a protein-restricted diet was instituted, nearly a complete resolution of the lesions was noted at the 4-week follow-up., CONCLUSIONS: Although type II tyrosinemia is known to have corneal involvement, the natural course of tyrosinemia type I has not been shown to have corneal involvement. Corneal involvement in type I tyrosinemia may be an indicator of dietary noncompliance and may show complete resolution with a strict compliance to protein-restricted diet only.
Keywords: Child; *Cornea/pa [Pathology]; *Dendritic Cells/pa [Pathology]; Diagnosis, Differential; Eye Infections, Viral/co [Complications]; *Eye Infections, Viral/di [Diagnosis]; Female; Fluorescein/pd [Pharmacology]; Fluorescent Dyes/pd [Pharmacology]; Humans; Keratitis, Herpetic/co [Complications]; *Keratitis, Herpetic/di [Diagnosis]; Microscopy, Confocal; *Tyrosinemias/co [Complications]

Management of Corneal Bee Sting Injuries. - Rai, Ruju R; Gonzalez-Gonzalez, Luis A; Papakostas, Thanos D; Siracuse-Lee, Donna; Dunphy, Robert; Fanciullo, Lisa; Cakiner-Egilmez, Tulay; Daly, Mary K (Seminars in ophthalmology, 2017)
PURPOSE: To review the management of keratitis after corneal bee stings and to report a case of deep stromal corneal infiltrate secondary to a retained bee stinger managed conservatively in a patient who presented three days after unsanitary manipulation of the stinger apparatus., METHODS: Case report and review of literature., RESULTS: A 57-year-old male beekeeper was evaluated for pain, blurry vision, and photosensitivity after a corneal bee sting. Of note, the venom sac had been removed with dirty tweezers three days prior to his visit. On exam, a focal infiltrate with diffuse edema was seen surrounding a retained bee stinger in the peripheral cornea. Trace cells in the anterior chamber were also noted. Based on a high suspicion for infectious keratitis, a conservative treatment strategy was elected. Administration of broad-spectrum topical antibiotics with concomitant abstention of corticosteroids led to rapid resolution of the symptoms. Over 16 months of follow-up, the stinger has remained in situ without migration and the patient has maintained 20/20 visual acuity without complications. There is debate on the preferred method for the management of corneal injury secondary to bee stings, especially when it is associated with a retained stinger. We herein present our findings in our appraisal of reported cases., CONCLUSION: In the aftermath of an ocular bee sting, close surveillance for inflammation and infection is essential. Individual manifestations of these injuries vary in timing, type, and severity; therefore, the accessibility of the stinger and the evolving clinical picture should guide therapeutic decisions.
Keywords: Administration, Topical; *Anti-Bacterial Agents/ad [Administration & Dosage]; *Cornea/dg [Diagnostic Imaging]; Corneal Injuries/di [Diagnosis]; *Corneal Injuries/th [Therapy]; Corneal Pachymetry; Drug Therapy, Combination; Eye Foreign Bodies/di [Diagnosis]; *Eye Foreign Bodies/th [Therapy]; Follow-Up Studies; *Glucocorticoids/ad [Administration & Dosage]; Humans; Insect Bites and Stings/di [Diagnosis]; *Insect Bites and Stings/th [Therapy]; Male; Middle Aged; Tomography, Optical Coherence; Visual Acuity

Once-Daily Netarsudil/Latanoprost Fixed-Dose Combination for Elevated Intraocular Pressure in the Randomized Phase 3 MERCURY-2 Study. - Walters, Thomas R; Ahmed, Iqbal Ike K; Lewis, Richard A; Usner, Dale W; Lopez, Jae; Kopczynski, Casey C; Heah, Theresa; MERCURY-2 Study Group (Ophthalmology. Glaucoma, 2019)
PURPOSE: To compare the ocular hypotensive efficacy and safety of a once-daily (pm) fixed-dose combination (FDC) product containing netarsudil 0.02% and latanoprost 0.005% with monotherapy with netarsudil or latanoprost. Netarsudil is a Rho kinase inhibitor that lowers intraocular pressure (IOP) primarily by increasing trabecular (conventional) outflow. Latanoprost is the most frequently prescribed of the prostaglandin analogs, which lower IOP primarily by increasing uveoscleral outflow., DESIGN: Three-month, double-masked, randomized (1:1:1), phase 3, superiority study., PARTICIPANTS: Patients had unmedicated IOP > 20 to <36 mmHg at 8:00 am and met other standard criteria for open-angle glaucoma and ocular hypertension., METHODS: Randomization to once-daily (pm) netarsudil/latanoprost FDC, netarsudil, or latanoprost for 3 months., MAIN OUTCOME MEASURES: Mean IOP at 8:00 am, 10:00 am, and 4:00 pm at week 2, week 6, and month 3 (intent-to-treat). Statistical superiority was concluded if the P value for the comparison of netarsudil/latanoprost FDC with each component was <0.05 and the difference in mean IOP (netarsudil/latanoprost FDC minus comparator) was <0 for all time points at all visits. Safety was recorded throughout the treatment period., RESULTS: A total of 750 patients were enrolled, with 90.2%, 89.4%, and 94.4% completing 3 months of treatment with netarsudil/latanoprost FDC, netarsudil, and latanoprost, respectively. Least-squares mean treated IOP ranged from 15.3 to 16.5 mmHg for netarsudil/latanoprost FDC, 17.4 to 19.8 mmHg for netarsudil, and 17.1 to 18.1 mmHg for latanoprost. Netarsudil/latanoprost FDC met the criteria for superiority to each active component at all 9 time points (all P < 0.0001), lowering IOP by an additional 2.2 to 3.3 mmHg versus netarsudil and an additional 1.5 to 2.4 mmHg versus latanoprost. At month 3, the proportion of patients achieving mean diurnal IOP <= 15 mmHg was 42.1% for netarsudil/latanoprost FDC, 15.8% for netarsudil, and 18.3% for latanoprost. No treatment-related serious adverse event (AE) was observed. Treatment-related systemic AEs were minimal. The most frequent ocular AE was conjunctival hyperemia (netarsudil/latanoprost FDC, 54.5%; netarsudil, 42.7%; latanoprost, 22.3%), which was generally mild., CONCLUSIONS: Once-daily netarsudil/latanoprost FDC demonstrated IOP reductions that were statistically and clinically superior to its individual components at all 9 time points over 3 months, with tolerable ocular safety. This FDC offers a reduced treatment burden that may improve adherence and clinical outcomes. Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Factors Affecting Adherence to Topical Glaucoma Therapy: A Quantitative and Qualitative Pilot Study Analysis in Sydney, Australia. - Spencer, Sascha K R; Shulruf, Boaz; McPherson, Zachary E; Zhang, Helen; Lee, Mitchell B; Francis, Ian C; Bank, Allan; Coroneo, Minas T; Agar, Ashish (Ophthalmology. Glaucoma, 2019)
PURPOSE: To assess which factors in the lives and disease of patients with glaucoma affect their adherence to topical glaucoma therapy and the quantitative significance of this effect. To assess qualitatively the most influential barriers to adherence from the perspective of the patient., DESIGN: Multicenter, prospective, cross-sectional pilot study., PARTICIPANTS: A total of 145 patients, attending outpatient metropolitan glaucoma clinics in Sydney, Australia, who were prescribed topical glaucoma medications., METHODS: A structured interview-based questionnaire was conducted with 145 individuals using glaucoma eye drops that had been prescribed at least 2 weeks previously. The questionnaire involved 2 novel questions on adherence, 29 questions on factors identified or postulated in the literature as affecting adherence for quantitative analysis, and 1 open-response question on patient-identified causes of nonadherence for qualitative analysis. This questionnaire represents the broadest coverage of factors hypothesized to affect adherence in a single study in the glaucoma medication adherence literature to date., MAIN OUTCOME MEASURES: Adherence rate, risk factors for poor adherence, and patient-identified barriers to adherence., RESULTS: In response to the question "How many days have you missed a drop in the last 2 weeks," 69.7% of patients reported total adherence. Four factors were significantly related to an increased likelihood of reporting having missed drops in the last 2 weeks. These were difficulty applying drops (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.02-5.44; P < 0.05), a past or current diagnosis of depression (OR, 3.61; 95% CI, 1.53-8.52; P < 0.01), patient self-rating of own memory <= 7 of 10 (OR, 3.15; 95% CI, 1.36-7.30; P < 0.01), and self-reported motivation score <= 6 of 10 (OR, 10.94; 95% CI, 3.00-39.81; P < 0.01). Patient understanding of glaucoma, ethnicity, and socioeconomic status were among the 25 factors found not to have a statistically significant correlation with adherence., CONCLUSIONS: There is a significant proportion of patients taking their topical glaucoma medications less often than prescribed. Adherence to topical glaucoma therapies is negatively correlated to several factors: difficulty applying drops, a past or current diagnosis of depression, poor self-rating of own memory, and poor self-rating of own motivation. These may prove useful in designing interventions to improve adherence in these patients. Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Adherence to World Glaucoma Association Guidelines for Surgical Trials in the Era of Microinvasive Glaucoma Surgeries. - Mathew, David J; McKay, Bryon R; Basilious, Alfred; Belkin, Avner; Trope, Graham E; Buys, Yvonne M (Ophthalmology. Glaucoma, 2019)
PURPOSE: To determine how well microinvasive glaucoma surgical (MIGS) trials conform to the World Glaucoma Association (WGA) guidelines. Lack of well-designed MIGS studies hinders meaningful evaluation of these technologies., DESIGN: Cross-sectional literature survey., METHODS: Using a predefined search strategy, the following databases were searched for comparative trials involving MIGS in the English peer-reviewed literature from January 1, 2000, through June 21, 2018: Medline, EMBASE, BIOSIS, Cochrane, and Web of Science. From the WGA guidelines, 53 outcomes were selected for evaluation: methodology (n = 31), definition of success (n = 7), ethics (n = 10), postoperative complications (n = 1), economic evaluation (n = 1), and statistical reporting (n = 3). Each article was assessed by 2 reviewers; differences were resolved by consensus., RESULTS: Twenty-five eligible publications were identified: 10 randomized controlled trials (RCTs) and 15 nonrandomized comparative trials (non-RCTs). The mean follow-up was 19.9+/-11.6 months (range, 6-48 months). The mean number of outcomes adhering to the WGA guidelines of the 53 evaluated was 24.2+/-6.1 (45.6% compliance): 28.0+/-6.2 (52.8%) and 21.6+/-4.7 (40.8%) for RCTs and non-RCTs, respectively (P = 0.01). Mean percent compliance for each subsection were: methodology, 48.8%; definition of success, 21.1%; ethics, 55.6%; postoperative complications, 88%; economic evaluation, 0%; and statistical reporting, 37.3%. In 16 studies (64%), at least 1 author reported an association with the industry. Thirty-two percent of studies reported an author being a shareholder. Twenty-four percent of studies had an industry employee author. The primary intraocular pressure (IOP) end point was defined as both an upper limit and percentage reduction in only 4 studies (16%; 1 RCT, 3 non-RCTs). An IOP-based survival curve was provided in 7 studies (28%; none of the RCTs). Two studies (8%) included an IOP scatterplot. Twelve studies (48%) reported 95% confidence intervals. Only 4 studies (16%) used the mean of 3 diurnal IOP readings as the baseline IOP., CONCLUSIONS: Published comparative MIGS trials show low adherence (45.6%) to the WGA guidelines. Development of standardized methodology and outcomes could enhance interpretation and transparency of study results and facilitate comparisons between trials. Authors and journals should be encouraged to follow the WGA guidelines. Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Eye-Drop Abstinence in Glaucoma Patients Admitted to the Hospital Service: A Single Institution Assessment. - Nanda, Tavish; Tierney, Patrick; Blumberg, Dana M (Ophthalmology. Glaucoma, 2019)
PURPOSE: Anecdotally, many patients admitted to an inpatient general medicine service do not have their glaucoma eye drops started. The purpose of this study was to determine the extent of eye-drop abstinence after inpatient admission., DESIGN: Retrospective, cross-sectional, hospital-based study., PARTICIPANTS: Four hundred seventy-five patients admitted to the general medicine regional hospital service from January 2016 through February 2018 with a known past medical diagnosis of or active outpatient medications for glaucoma., METHODS: The combination of an administrative database and cross-referenced patient charts were reviewed for demographic data, past medical problems, inpatient orders, intake history and physical, length of stay, and admitting diagnosis., MAIN OUTCOME MEASURES: The effect of (1) outpatient glaucoma drops reconciliation and (2) recognition of glaucoma as a pertinent past medical problem in a patient's intake history and physical on inpatient eye-drop administration. The overall rate of eye-drop abstinence also was recorded., RESULTS: Of 475 patients, 46.3% were women, with an average age of 80.2 years (standard deviation, 11.1 years). Average length of stay was 4.61 days (standard deviation, 3.7 days). In total, 63.8% achieved successful administration of medication on the hospital floor, resulting in a 36.2% eye-drop abstinence rate during the hospital stay. Three hundred eighty-six of 475 patients (81.3%) achieved successful glaucoma medication reconciliation. Patients with successful reconciliation had a significantly different rate of eye-drop administration (73.3% vs. 21.0%; P <= 0.001). Recognition of glaucoma in the history and physical occurred in only 42.5% of patients. There was a significant difference in eye-drop administration when glaucoma was included in the history and physical (75.7% vs. 55.0%; P <= 0.001)., CONCLUSIONS: Glaucoma treatment incurs a high rate of medication noncompliance, especially in the elderly. The present study demonstrates that more than one third of patients admitted to an academic medical center do not receive their glaucoma medications. Patients discharged to nursing homes, subacute rehabilitation, and assisted living facilities rely on appropriate discharge medication reconciliation, resulting in forced abstinence during transition of care. An emphasis on appropriate medical reconciliation and recognition of glaucoma as a pertinent past medical problem will improve rates of eye-drop discontinuation on inpatient admission significantly. Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Comparison of microbiome isolated from the conjunctiva, contact lens and lens storage case of symptomatic and asymptomatic contact lens users. - Raksha, L; Shantala, G B; Gangashettappa, Nagaraju; Ambica, R; Sinha, Deepa (Iranian journal of microbiology, 2019)
Background and Objectives: Contact lenses (CLs) are increasingly being used for cosmetic or therapeutic purposes. Lack of compliance and poor hygiene towards lens care is strongly associated with microbial contamination and has been proved to result in eye infections. The present study was done to compare the microbial flora between symptomatic and asymptomatic contact lens users. The study also attempts to analyze the contact lens hygiene practices of CL users., Materials and Methods: Six samples each were collected from both the eyes, CLs and lens cases of 40 CL users (n=240) divided into two groups based on symptoms present asasymptomatic CL users and symptomatic CL users. Organisms were identified using standard microbiological techniques., Results: The proportion GNB obtained in symptomatic CL users was significantly higher when compared to asymptomatic CL users (p-value= <0.003). In 56.2% eyes, the microbial flora of conjunctiva was similar to either the contact lens isolate/storage case. Enterococcal microbial keratitis was seen in one case., Conclusion: There was significant microbial contamination present in CL users despite compliance to contact lens hygiene practices. There were a significant number of bacteria (p-value <0.001) present which were resistant to ampicillin, amoxicillin-clavulanate, and cefotaxime in both the groups. Copyright© 2019 Iranian Neuroscience Society.

Albumin Levels in Tear Film Modulate the Bioavailability of Medically-Relevant Topical Drugs. - Sebbag, Lionel; Moody, Leah M; Mochel, Jonathan P (Frontiers in pharmacology, 2019)
The breakdown of blood-tear barrier that occurs with ocular pathology allows for large amounts of albumin to leak into the tear fluid. This process likely represents an important restriction to drug absorption in ophthalmology, as only the unbound drug is transported across the ocular tissue barriers to exert its pharmacologic effect. We aimed to investigate the effects of albumin levels in tears on the bioavailability of two commonly used ophthalmic drugs: tropicamide, an antimuscarinic that produces mydriasis and cycloplegia, and latanoprost, a PGF2alpha analog used for the treatment of glaucoma. Eight female beagle dogs underwent a randomized, vehicle-controlled crossover trial. For each dog, one eye received 30 microl of artificial tears (control) or canine albumin (0.4 or 1.5%) at random, immediately followed by 30 microl of 1% tropicamide (2 days, 24 h washout) or 0.005% latanoprost (2 days, 72 h washout) in both eyes. Pupil diameter (digital caliper) and intraocular pressure (IOP; rebound tonometry) were recorded at various times following drug administration (0 to 480 min) and compared between both groups with a mixed model for repeated measures. Albumin in tears had a significant impact on pupillary diameter for both tropicamide (P <= 0.001) and latanoprost (P <= 0.047), with no differences noted between 0.4% and 1.5% concentrations. Reduction in the maximal effect (pupil size) and overall drug exposure (area under the effect time-curve of pupil size over time) were significant for tropicamide (6.2-8.5% on average, P <= 0.006) but not for latanoprost (P >= 0.663). The IOP, only measured in eyes receiving latanoprost, was not significantly impacted by the addition of either 0.4% (P = 0.242) or 1.5% albumin (P = 0.879). Albumin in tear film, previously shown to leak from the conjunctival vasculature in diseased eyes, may bind to topically administered drugs and reduces their intraocular penetration and bioavailability. Further investigations in clinical patients and other commonly used ophthalmic medications are warranted. Copyright © 2020 Sebbag, Moody and Mochel.

Maximum Medical Therapy: Brinzolamide/Brimonidine And Travoprost/Timolol Fixed-Dose Combinations In Glaucoma And Ocular Hypertension. - Lerner, S Fabian; Oddone, Francesco; Lu, Da-Wen; Sanseau, Ana; Guarro, Merce; Ridolfi, Antonia; Hubatsch, Douglas (Clinical ophthalmology (Auckland, N.Z.), 2019)
Introduction: Maximal medical therapy (MMT) is the use of >=3 classes of topical anti-glaucoma agents to achieve maximal intraocular pressure (IOP) reduction while minimizing adverse effects and compliance challenges., Purpose: To evaluate the additive IOP-lowering effect of twice-daily brinzolamide 1%/brimonidine 0.2% fixed-dose combination (BBFC) used adjunctively with once daily travoprost 0.004%/timolol 0.5% fixed-dose combination (TTFC) in patients with open-angle glaucoma (OAG)/ocular hypertension (OHT)., Methods: In this phase IV, double-masked study, patients on TTFC for >=28 days, aged >=18 years, with mean IOP >=19 and <=28 mmHg in at least 1 eye were randomized to receive BBFC+TTFC (n=67) or vehicle+TTFC (n=67) for 6 weeks. The primary endpoint was mean change in diurnal IOP from baseline (BL, averaged over 09:00 and 11:00) at Week 6., Results: The study was terminated prematurely due to recruitment challenges. BL mean IOP was similar in both groups (BBFC+TTFC: 21.6+/-1.78 mmHg; vehicle+TTFC: 21.8+/-1.90 mmHg). Mean change in diurnal IOP from BL at Week 6 was greater with BBFC+TTFC (-4.25 mmHg, 95% confidence interval [CI]: -4.7, -3.8) than with vehicle+TTFC (-2.11 mmHg, 95% CI: -2.6, -1.6, treatment difference, -2.15 mmHg (95% CI: -2.8, -1.5; P<0.001). Ocular adverse events (AEs) were reported in 11.9% of patients given BBFC+TTFC and 7.5% of patients given vehicle+TTFC. The AE with highest frequency was punctate keratitis (3%) in the BBFC+TTFC group; eye irritation (3%) in the vehicle+TTFC group., Conclusion: BBFC+TTFC as MMT demonstrated clinically relevant and statistically significant reductions in mean diurnal IOP in patients with OAG/OHT. AEs were consistent with known safety profiles of individual medications. Copyright © 2019 Lerner et al.

Conjunctiva Necrosis Following Subconjunctival Amphotericin B Injection in Fungal Keratitis. - Han Shu, Tham; Hussein, Adil; Kursiah, Mohd Razali (Cureus, 2019)
A 30-year-old Bangladeshi gentleman presented with history of sand entering his left eye and was diagnosed as having fungal keratitis by private ophthalmologist. He was treated with three doses of conventional subconjunctival amphotericin B injections (1.5 mg of amphotericin B and 1.2 mg of deoxycholate) over the inferior bulbar conjunctiva and topical antibiotics. Subsequently, he developed conjunctival necrosis over the site of injections and there was no clinical improvement of the keratitis. He was then treated with intensive antifungal and antibiotics eye drops. Debridement of epithelial plug was done and he was given intracameral amphotericin B injection. There was gradual improvement observed then with conjunctival epithelialization. The conjunctival tissue was completely healed after three months along with the corneal ulcer. Subconjunctival injection of Amphotericin B (AMB) may be considered as an adjunct therapy in severe fungal keratitis to address the issue of compliance. Close monitoring is needed due to its known complication of scleritis, scleral thinning and conjunctival necrosis. Liposomal AMB which is known to cause less toxicity given via subconjunctival injection in human subjects needs to be further studied. Copyright © 2019, Han Shu et al.

Successful Treatment of Corneal Opacification with Associated Thickened Epithelium by Simple Peeling: Acquired Corneal Subepithelial Hypertrophy (ACSH). - Al-Rajhi, A A; Helmi, H A; Alkatan, H M; Al-Obailan, M; Al-Rajhi, A (Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society, 2019)
Purpose: To study clinical and histopathological findings of corneal opacification caused by thickened epithelium leading to reduced vision and topographical changes and to evaluate the outcome of its removal., Methods: Twelve patients (17 eyes) with central, paracentral or peripheral corneal opacification were reviewed to obtain their visual acuity, describe their slit lamp (SL) appearance (depth, extent and density) and document their topographic changes before and after peeling of the epithelium under SL or surgical removal under the microscope. Specimens of six cases were available for histopathological examination and immunohistochemical staining., Results: Most of the eye opacifications were secondary to corneal procedures in 10 [Penetrating keratoplasty (PKP) in 7 for congenital glaucoma, keratoconus or adherent leukoma - usually over graft-host junction -, Photorefractive keratectomy (PRK) in 2 and Phototherapeutic keratectomy in one], chronic inflammation following trachoma or non-specific causes (3), and herpetic scar (1). Three cases were considered to be idiopathic. All cases presented with decreased vision, astigmatism or changes in topography or refraction. Their vision, clinical symptoms and topography improved after treatment. Histopathologically, all six cases shared findings that are similar to what have been described as peripheral hypertrophic subepithelial corneal degeneration (PHSCD) rather than Salzmann's nodular degeneration. None of the cases showed inflammation or subepithelial pannus formation in the excised tissue. However, our cases did not fit into the diagnosis of PHSCD because of the location of the corneal opacification (being peripheral in 41% of the corneas, the presence of underlying primary etiologic factors in 82% of the eyes and the bilateral occurrence in 5 patients., Conclusions: Meticulous SL examination aided by corneal imaging may accurately diagnose and determine the depth of corneal opacification as a cause for reduced vision. Histopathologically, the removed tissue is similar to PHSCD, but cases differ in their clinical profile. Peeling the thickened epithelial/subepithelial tissue is curative in most patients, improves visual and clinical outcome and avoids unnecessary corneal grafting. Copyright © 2019 Production and hosting by Elsevier B.V. on behalf of Saudi Ophthalmological Society, King Saud University.

Targeted Drug Delivery Systems for the Treatment of Glaucoma: Most Advanced Systems Review. - Cegielska, Olga; Sajkiewicz, Pawel (Polymers, 2019)
Each year, new glaucoma drug delivery systems are developed. Due to the chronic nature of the disease, it requires the inconvenient daily administration of medications. As a result of their elution from the eye surface and penetration to the bloodstream through undesired permeation routes, the bioavailability of active compounds is low, and systemic side effects occur. Despite numerous publications on glaucoma drug carriers of controlled drug release kinetics, only part of them consider drug permeation routes and, thus, carriers' location, as an important factor affecting drug delivery. In this paper, we try to demonstrate the importance of the delivery proximal to glaucoma drug targets. The targeted delivery can significantly improve drug bioavailability, reduce side effects, and increase patients' compliance compared to both commercial and scientifically developed formulations that can spread over the eye surface or stay in contact with conjunctival sac. We present a selection of glaucoma drug carriers intended to be placed on cornea or injected into the aqueous humor and that have been made by advanced materials using hi-tech forming methods, allowing for effective and convenient sustained antiglaucoma drug delivery.

Mobility-Related Gaze Training in Individuals With Glaucoma: A Proof-of-Concept Study. - Gunn, Shaila M; Lajoie, Kim; Zebehazy, Kim T; Strath, Robert A; Neima, David R; Marigold, Daniel S (Translational vision science & technology, 2019)
Purpose: Older adults with glaucoma show inappropriate gaze strategies during routine mobility tasks. Furthermore, glaucoma is a risk factor for falling and colliding with objects when walking. However, effective interventions to rectify these strategies and prevent these adverse events are scarce. We designed a gaze training program with the goal of providing proof-of-concept that we could modify mobility-related gaze behavior in this population., Methods: A total of 13 individuals with moderate glaucoma participated in this study. We taught participants general and task-specific gaze strategies over two 1-hour sessions. To determine the efficacy of this gaze training program, participants performed walking tasks that required accurate foot placement onto targets and circumventing obstacles before and after training. We used a mobile eye tracker to quantify gaze and a motion-capture system to quantify body movement., Results: After training, we found changes in the timing between gaze shifts away from targets relative to stepping on them (P < 0.05). In the obstacle negotiation task, we found a greater range of gaze shifts early in walking trials and changes in the timing between gaze shifts away from obstacles after training (P < 0.05), each suggesting better route planning. A posttraining reduction in foot-placement error and obstacle collisions accompanied these changes (P < 0.05)., Conclusions: Our results demonstrated that it is possible to modify mobility-related gaze behavior and mobility performance in older adults with glaucoma., Translational Relevance: This study provides proof-of-concept for a gaze training program for glaucoma. A larger, randomized controlled trial is warranted. Copyright 2019 The Authors.

Investigation of medication adherence and reasons for poor adherence in patients on long-term glaucoma treatment regimes. - McClelland, Julie F; Bodle, Lynne; Little, Julie-Anne (Patient preference and adherence, 2019)
Purpose: Long-term treatment adherence for a chronic asymptomatic condition is a demanding task for many patients. Treating progressive glaucoma can also be confounding for physicians, particularly when management relies on assumption of adherence. This study investigated associations between self-reported adherence and frequency of medication changes due to glaucoma progression., Methods: A total of 128 participants with primary open angle glaucoma were recruited from glaucoma clinics in Flinders Eye Center, South Australia, and completed confidential questionnaires. Information was obtained regarding beliefs about glaucoma and their treatment. Adherence was assessed using the four-item Morisky, Green and Levine Medication Adherence Questionnaire (MGL). Medical records were analyzed for the number of medication changes, due to glaucoma progression., Results: Adherence to topical glaucoma medication was categorized as 'high' in 41.4% (Morisky, Green and Levine (MGL). Data were analyzed for behaviors affecting adherence, history of adherence, and reasons for changed adherence. Chi-squared test demonstrated that there was no significant association noted between adherence and changes in medication regime (chi2 (2,128)=0.968, P=0.915); however, a significantly lower adherence was detected if participants had difficulties with their drop regime (chi2 (2,128)=7.24, P=0.027) or had help with drop insertion (chi2 (1,128)=9.77, P=0.008)., Conclusion: This study revealed a higher rate of non-adherence than has previously been demonstrated in other studies. This may be attributed to the unique design of the confidential questionnaire and the independent and sympathetic questioning techniques used. Further work to develop a specific glaucoma medication adherence questionnaire would be valuable to enhance glaucoma management.

Barriers to adoption of a personal health record in an ophthalmic setting: lessons from implementation of a Glaucoma Patient Passport. - Badran, Imad; Bruynseels, Alice; Khan, Salim; Sii, Freda; Shah, Peter (Clinical ophthalmology (Auckland, N.Z.), 2019)
Purpose: Self-care in chronic disease is increasingly important. In glaucoma services, there is an unmet need for a self-care tool such as a patient passport. This study aims to evaluate adoption of a new self-care tool, the Glaucoma Patient Passport (GPP) within a tertiary hospital glaucoma service., Patients and methods: The GPP was designed following consultation exercises between patients and clinicians at the first and second UK National Glaucoma Think Tanks. A patient questionnaire, comprising a mixed methods quantitative and qualitative research approach was used to explore the utility of GPP, patient attitude to GPP and barriers to adoption, 6 months after GPP receipt., Results: GPP feedback was received from 62 patients. On-going utilization of the GPP after receipt was high, at 84%, with patients most commonly using the GPP at home, to "look for information." Seventy-three percent reported improved knowledge of glaucoma care since using the GPP, with two-thirds (63%) reporting that the GPP had improved their glaucoma care. Three main themes were identified in exploring barriers to GPP adoption; clinician involvement in GPP use, GPP size, and GPP use in visual impairment., Conclusion: Implementation and adoption of the world's first GPP were a success. GPP utility was high and patient attitudes were predominantly positive, with improved self-care. However, several areas were identified for future GPP improvement. The GPP has the potential to improve patient self-care in glaucoma, bridging the care gap created by the increased workload in glaucoma services.

Amphiphilic Acrylic Nanoparticles Containing the Poloxamer Star Bayfit R 10WF15 as Ophthalmic Drug Carriers. - Gomez-Ballesteros, Miguel; Andres-Guerrero, Vanessa; Parra, Francisco Jesus; Marinich, Jorge; de-Las-Heras, Beatriz; Molina-Martinez, Irene Teresa; Vazquez-Lasa, Blanca; San Roman, Julio; Herrero-Vanrell, Rocio (Polymers, 2019)
Topical application of drops containing ocular drugs is the preferred non-invasive route to treat diseases that affect the anterior segment of the eye. However, the formulation of eye drops is a major challenge for pharmacists since the access of drugs to ocular tissues is restricted by several barriers. Acetazolamide (ACZ) is a carbonic anhydrase inhibitor used orally for the treatment of ocular hypertension in glaucoma. However, large ACZ doses are needed which results in systemic side effects. Recently, we synthesized copolymers based on 2-hydroxyethyl methacrylate (HEMA) and a functionalized three-arm poloxamer star (Bayfit-MA). The new material (HEMA/Bayfit-MA) was engineered to be transformed into nanoparticles without the use of surfactants, which represents a significant step forward in developing new ophthalmic drug delivery platforms. Acetazolamide-loaded nanocarriers (ACZ-NPs) were prepared via dialysis (224 +/- 19 nm, -17.2 +/- 0.4 mV). The in vitro release rate of ACZ was constant over 24 h (cumulative delivery of ACZ: 83.3 +/- 8.4%). Following standard specifications, ACZ-NPs were not cytotoxic in vitro in cornea, conjunctiva, and macrophages. In normotensive rabbits, ACZ-NPs generated a significant intraocular pressure reduction compared to a conventional solution of ACZ (16.4% versus 9.6%) with the same dose of the hypotensive drug (20 microg). In comparison to previously reported studies, this formulation reduced intraocular pressure with a lower dose of ACZ. In summary, HEMA:Bayfit-MA nanoparticles may be a promising system for ocular topical treatments, showing an enhanced ocular bioavailability of ACZ after a single instillation on the ocular surface.

Scleral fixation of a dexamethasone intravitreal implant in a case of subluxated bag-intraocular lens complex. - Rangel, Carlos M; Moreno, Nathalia J; Parra, M Margarita (Therapeutic advances in ophthalmology, 2019)
Macular edema is a condition of retinal tissue treated with anti-inflammatory agents including placement of an intravitreal sustained-release dexamethasone device, designed to deliver a controlled amount of the medication for a prolonged time, representing an excellent therapy. Nonetheless, the implantation cannot be carried out without an anatomical barrier, such as the presence of posterior capsular support, lens, or intraocular lens. The absence of these barriers could lead to several complications, due to migration of the device from the vitreous cavity to the anterior chamber, causing corneal endothelial damage, corneal edema, glaucoma, and uveitis, among others. In consequence, a large number of patients cannot be treated with this useful surgical tool, resulting in chronicity of macular edema and severe visual acuity impairment. Therefore, we modified the conventional technique, through scleral fixation of the device providing a continuous delivering of dexamethasone, avoiding its migration to the anterior chamber in a patient without capsular support.

Evaluation of Automatic Monitoring of Instillation Adherence Using Eye Dropper Bottle Sensor and Deep Learning in Patients With Glaucoma. - Nishimura, Kazuaki; Tabuchi, Hitoshi; Nakakura, Shunsuke; Nakatani, Yoshiki; Yorihiro, Akira; Hasegawa, Shouichi; Tanabe, Hirotaka; Noguchi, Asuka; Aoki, Ryota; Kiuchi, Yoshiaki (Translational vision science & technology, 2019)
Purpose: We developed and evaluated an eye dropper bottle sensor system comprising motion sensor with automatic motion waveform analysis using deep learning (DL) to accurately measure adherence of patients with antiglaucoma ophthalmic solution therapy., Methods: We enrolled 20 patients with open-angle glaucoma who were treated with either latanoprost ophthalmic solution 0.005% or latanoprost-timolol maleate fixed combination ophthalmic solution in both eyes. An eye dropper bottle sensor was installed at patients' homes, and they were asked to instill the medication and manually record each instillation time for 3 days. Waveform data were automatically collected from the eye dropper bottle sensor and judged as a complete instillation by the DL instillation assessment model. We compared the instillation times captured on the waveform data with those on each patient's record form. In addition, we also calculated instillation movement duration from Waveform data., Results: The developed eye bottle sensor detected all 60 instillation events (100%). Mean difference between patient and eye bottle sensor recorded time was 1 +/- 1.22 (range, 0-3) minutes. Additionally, mean instillation movement duration was 16.1 +/- 14.4 (range, 4-43) seconds. Two-way ANOVA revealed a significant difference in instillation movement duration among patients (P < 0.001) and across days (P < 0.001)., Conclusion: The eye dropper bottle sensor system developed by us can be used for automatic monitoring of instillation adherence in patients with glaucoma., Translational Relevance: We believe that our eye dropper bottle sensor system will accurately measure adherence of all glaucoma patients as well as help glaucoma treatment.

Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life. - Negri, Letizia; Ferreras, Antonio; Iester, Michele (Journal of ophthalmology, 2019)
Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients' quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.

A theory-driven qualitative study exploring issues relating to adherence to topical glaucoma medications. - McDonald, Stephanie; Ferguson, Eamonn; Hagger, Martin S; Foss, Alexander J E; King, Anthony J (Patient preference and adherence, 2019)
Purpose: Investigating patients' perceptions of their illness can provide important insights into the experience and management of the illness and associated treatment, and enhance understanding of variations in adherence to prescribed medication. The Common-Sense Model of Self-Regulation (CSM) provides a theoretical framework for the study of illness cognitions, health behavior, and adherence to health recommendations. The aim of this study was to use the CSM to investigate the experience of glaucoma and its treatment from the patients' perspective, and to apply these insights to classify and clarify issues related to nonadherence with treatment., Patients and methods: A qualitative investigation using semi-structured interviews took place in two outpatient glaucoma clinics. Thirty-three patients with primary open-angle glaucoma using hypotensive eye drops participated in the study. Deductive content analysis was used to analyze the interview data., Results: Issues relating to nonadherence with hypotensive eye drops and patients' experience with their glaucoma and treatment were identified. Treatment schedule and patient factors were classified as common barriers to adherence. Further themes include experienced symptoms of glaucoma, illness coherence, and the emotional and practical consequences of the illness., Conclusion: Findings provide important insights into the emotional and practical outcomes of glaucoma for patients, perceived symptoms of the illness, and insights into patient memory and cognition. These findings provide supporting evidence for the importance of conducting theoretically driven qualitative investigations of patients' experience with glaucoma and their treatment, and provide suggestions on key issues that need to be addressed in future multidimensional interventions aimed at improving adherence and patient quality of life.

Lessons from glaucoma: rethinking the fluid-brain barriers in common neurodegenerative disorders. - Carreras, Francisco Javier (Neural regeneration research, 2019)
Glaucoma has been recently characterized as a member of the group of anoikis-related diseases. Anoikis, a form of apoptosis, can be triggered by the unfastening of adherent junctions present in astrocytes. In those areas of the central nervous system in which the soma of the neurons or their axons and dendrites are metabolically dependent on the activity of astrocytes, a derangement of the lactate shuttle caused by a separation between the plasma membranes of neurons and astrocytes would result in metabolic impairment of the neurons themselves. In glaucoma, the triggering event has been attributed to the posterior deviation of aqueous humor towards the astrocyte-rich prelaminar tissue of the optic nerve head. The mean calcium content in the aqueous is able to interfere with calcium-dependent adherent junctions and induce anoikis of the astrocytes. As the cerebrospinal fluid has a similar base calcium concentration, a shunt of cerebrospinal fluid through the cerebral parenchyma would be able to interfere in the astrocytic architecture with dire consequences to the metabolically dependent neurons. Here the similitude between glaucoma, amyotrophic lateral sclerosis and Alzheimer's disease are discussed and the concept of the break in the fluid-brain barrier, as an event separated from the blood-brain barrier, is stressed.

Indications, Clinical Outcomes, and Survival Rate of Pediatric Penetrating Keratoplasty in Suburban Malaysia: A 10-year Experience. - Mun-Wei, Lam; Md Said, Haslinda; Punitan, Rajendran; Ibrahim, Mohtar; Shatriah, Ismail (Cureus, 2018)
Purpose To describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty. Methodology A retrospective review of medical records was performed on children younger than 17 years of age who had undergone penetrating keratoplasty in Hospital Universiti Sains Malaysia from January 2008 to December 2017. We recorded demographic data, presenting visual acuity, indications, final visual acuity, and graft survival at 12 months into the postoperative period. Results Sixteen eyes of 14 children had penetrating keratoplasty. Mean age was 7.8 +/- 5.9 years. Both genders were equally affected. The main indications were infective keratitis (56.25%), congenital corneal opacity (18.75%) and trauma (12.50%). There were 62.50% of patients who had a preoperative visual acuity worse than 6/60. Fifty percent had other combined procedures during the surgery, including lens aspiration, peripheral iridectomy, pupilloplasty and glaucoma tube implant. Best corrected visual acuity of 6/12 or better was achieved in 18.75% of patients. A hazy graft was noted in 68.75% of patients, and was attributed to graft rejection, glaucoma and graft failure. There was a statistically significant association between the presence of vascularized cornea, intraocular inflammation and combined surgery with survival rate of the graft at one-year postoperative period (p < 0.05). Conclusions Infective keratitis is the main indication for penetrating keratoplasty in our pediatric patients. Good visual outcome was documented in a small percentage of the patients. Amblyopia and hazy graft were the main barriers to success in this group of patients. Vascularized cornea, inflammation and combined surgery had significantly affected the survival rate of the grafts in our series.

Daylight-Mediated, Passive, and Sustained Release of the Glaucoma Drug Timolol from a Contact Lens. - Mu, Changhua; Shi, Meng; Liu, Ping; Chen, Lu; Marriott, Gerard (ACS central science, 2018)
Timolol, a potent inhibitor of beta-adrenergic receptors (betaARs), is a first-line drug for decreasing the intraocular pressure (IOP) of patients with glaucoma. Timolol is administered using 0.5% eye-drop solutions at >3 x 107 times the inhibitory concentration (k i) for betaARs. This high dose is wasteful and triggers off-target effects that increase medication noncompliance. Here, we introduce contact lenses that release timolol to the eye throughout the day during passive exposures to natural daylight at a more therapeutically relevant concentration (>3000 k i). Timolol is coupled to the polymer of the contact lens via a photocleavable caged cross-linker and is released exclusively to the surrounding fluid after the 400-430 nm mediated cleavage of the cross-linking group. Studies conducted in a preclinical mouse model of glaucoma show photoreleased timolol is effective as authentic timolol in reducing IOP. Our studies highlight several advantages of daylight-mediated release of timolol from lenses compared to eye-drops. First, fitted contact lenses exposed to natural daylight release sufficient timolol to sustain the inhibition of betaARs over a 10 h period. Second, the contact lenses inhibit betaARs in the eye using only 5.7% of the timolol within a single eye-drop. Third, the lenses allow the patient to passively control the amount of timolol released from the lens-for example, early morning exposure to outdoor sunlight would release enough timolol to maximally reduce the IOP, whereas subsequent periodic exposures to indoor daylight would release sufficient timolol to overcome the effects of its spontaneous dissociation from betaARs. Fourth, our lenses are disposable, designed for single day use, and manufactured at a low cost.

The Role of Pneumococcal Virulence Factors in Ocular Infectious Diseases. - Benton, Angela H; Marquart, Mary E (Interdisciplinary perspectives on infectious diseases, 2018)
Streptococcus pneumoniae is a gram-positive, facultatively anaerobic pathogen that can cause severe infections such as pneumonia, meningitis, septicemia, and middle ear infections. It is also one of the top pathogens contributing to bacterial keratitis and conjunctivitis. Though two pneumococcal vaccines exist for the prevention of nonocular diseases, they do little to fully prevent ocular infections. This pathogen has several virulence factors that wreak havoc on the conjunctiva, cornea, and intraocular system. Polysaccharide capsule aids in the evasion of host complement system. Pneumolysin (PLY) is a cholesterol-dependent cytolysin that acts as pore-forming toxin. Neuraminidases assist in adherence and colonization by exposing cell surface receptors to the pneumococcus. Zinc metalloproteinases contribute to evasion of the immune system and disease severity. The main purpose of this review is to consolidate the multiple studies that have been conducted on several pneumococcal virulence factors and the role each plays in conjunctivitis, keratitis, and endophthalmitis.

Better tolerance of preservative-free latanoprost compared to preserved glaucoma eye drops: the 12-month real-life FREE study. - Economou, Mario A; Laukeland, Helene Kolstad; Grabska-Liberek, Iwona; Rouland, Jean-Francois (Clinical ophthalmology (Auckland, N.Z.), 2018)
Background: Lack of efficacy due to bad compliance caused by intolerance issues is the main reason for a change to a better tolerated ocular treatment, such as using preservative-free (PF) eye drops., Aim: To assess the efficacy and local tolerance after 12 months and patient satisfaction regarding local treatment tolerance and handling at inclusion and after 6 months of PF latanoprost compared to preserved glaucoma eye drops., Methods: This was an international, prospective, and observational real-life study. Up to three visits, one at inclusion and two follow-up visits (one after 6 and one after 12 months) were planned. Efficacy, local tolerance, and patient satisfaction were the main evaluation criteria., Results: Data from 721 patients were available for the statistical analysis. Overall, 64.8% (467/721) of patients switched treatment before inclusion: 62.2% in the preserved and 68.9% in the PF latanoprost group. IOP values were similar between PF latanoprost and preserved eye drops and remained stable at all visits. Ocular signs and symptoms improved after switching to PF latanoprost; the prevalence of conjunctival hyperemia was significantly lower (P=0.0015) at both follow-up visits. At follow-up visit 1, 49.5% of the patients who switched to PF latanoprost decreased or stopped the use of artificial tears. Satisfaction regarding tolerance in patients using PF latanoprost improved significantly after the switch from preserved eye drops to PF latanoprost (88.9% and 42.5%, respectively, P<0.0001)., Conclusion: This first real-life study showed that PF latanoprost was as efficacious but better tolerated than preserved eye drops over a sustained period of 12 months, while providing a significantly higher patient satisfaction and potentially allowing improvement in the patient's daily life.

Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet's Stripping Automated Endothelial Keratoplasty. - Rana, Mrinal; Shah, Sunil; Pandey, Pravin; Masood, Imran (Journal of current glaucoma practice, 2018)
We describe a new modified technique to release the peripheral iridocorneal adhesions that formed after Descemet stripping automated endothelial keratoplasty. The usual technique of goniosynechialysis was modified and performed using endoscopic fiber-optic light and camera probe to aid visualization of the adherent iris tissue and carry out uneventful 270 degrees release of adhesions. The iris tissue was gently pulled away using micro forceps. The modified technique was conceptualized, as the view from the cornea was very poor due to recent lamellar surgery and corneal oedema secondary to poorly controlled intraocular pressure. The blocked trabecular meshwork system was successfully recanalized, which allowed an adequate control of intraocular pressure. The graft survived the insult and cornea gained complete clarity giving the patient the desired vision and improved quality of life. How to cite this article: Rana M, Shah S, Pandey P, Masood I. Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet's Stripping Automated Endothelial Keratoplasty. J Curr Glaucoma Pract 2018;12(2):90-93.

Profile of netarsudil ophthalmic solution and its potential in the treatment of open-angle glaucoma: evidence to date. - Dasso, Lily; Al-Khaled, Tala; Sonty, Sriram; Aref, Ahmad A (Clinical ophthalmology (Auckland, N.Z.), 2018)
Netarsudil ophthalmic solution is a novel topical intraocular pressure (IOP)-lowering agent that has recently been approved by the US Food and Drug Administration (FDA) for the treatment of ocular hypertension and open-angle glaucoma. Its unique pharmacology allows for IOP lowering as a result of direct reduction in trabecular outflow resistance in addition to a decrease in episcleral venous pressure and aqueous humor production. The efficacy of netarsudil has been shown in animal studies and human clinical trials. It has been shown to be noninferior to the therapy with topical timolol in individuals with baseline IOP <25 mmHg. Importantly, netarsudil has been shown to reduce IOP to the same degree, regardless of baseline levels. There are no known systemic safety issues associated with netarsudil. The most common local adverse effects relate to conjunctival hyperemia. The once-daily dosing schedule is advantageous for individuals who have difficulties with medication adherence. Further studies of a combination of netarsudil and latanoprost agents are currently underway.

Pluripotent Stem Cell-Based Approaches to Explore and Treat Optic Neuropathies. - Rabesandratana, Oriane; Goureau, Olivier; Orieux, Gael (Frontiers in neuroscience, 2018)
Sight is a major sense for human and visual impairment profoundly affects quality of life, especially retinal degenerative diseases which are the leading cause of irreversible blindness worldwide. As for other neurodegenerative disorders, almost all retinal dystrophies are characterized by the specific loss of one or two cell types, such as retinal ganglion cells, photoreceptor cells, or retinal pigmented epithelial cells. This feature is a critical point when dealing with cell replacement strategies considering that the preservation of other cell types and retinal circuitry is a prerequisite. Retinal ganglion cells are particularly vulnerable to degenerative process and glaucoma, the most common optic neuropathy, is a frequent retinal dystrophy. Cell replacement has been proposed as a potential approach to take on the challenge of visual restoration, but its application to optic neuropathies is particularly challenging. Many obstacles need to be overcome before any clinical application. Beyond their survival and differentiation, engrafted cells have to reconnect with both upstream synaptic retinal cell partners and specific targets in the brain. To date, reconnection of retinal ganglion cells with distal central targets appears unrealistic since central nervous system is refractory to regenerative processes. Significant progress on the understanding of molecular mechanisms that prevent central nervous system regeneration offer hope to overcome this obstacle in the future. At the same time, emergence of reprogramming of human somatic cells into pluripotent stem cells has facilitated both the generation of new source of cells with therapeutic potential and the development of innovative methods for the generation of transplantable cells. In this review, we discuss the feasibility of stem cell-based strategies applied to retinal ganglion cells and optic nerve impairment. We present the different strategies for the generation, characterization and the delivery of transplantable retinal ganglion cells derived from pluripotent stem cells. The relevance of pluripotent stem cell-derived retinal organoid and retinal ganglion cells for disease modeling or drug screening will be also introduced in the context of optic neuropathies.

Prevention of Progression in Myopia: A Systematic Review. - Vagge, Aldo; Ferro Desideri, Lorenzo; Nucci, Paolo; Serafino, Massimiliano; Giannaccare, Giuseppe; Traverso, Carlo E (Diseases (Basel, Switzerland), 2018)
The prevalence of myopia has increased worldwide in recent decades and now is endemic over the entire industrial world. This increase is mainly caused by changes in lifestyle and behavior. In particular, the amount of outdoor activities and near work would display an important role in the pathogenesis of the disease. Several strategies have been reported as effective. Spectacles and contact lenses have shown only slight results in the prevention of myopia and similarly ortokerathology should not be considered as a first-line strategy, given the high risk of infectious keratitis and the relatively low compliance for the patients. Thus, to date, atropine ophthalmic drops seem to be the most effective treatment for slowing the progression of myopia, although the exact mechanism of the effect of treatment is still uncertain. In particular, low-dose atropine (0.01%) was proven to be an effective and safe treatment in the long term due to the lowest rebound effect with negligible side effects.

Changes in adherence and associated factors among patients on newly introduced prostaglandin analog and timolol fixed-combination therapy. - Hasebe, Yuka; Kashiwagi, Kenji; Tsumura, Toyoaki; Suzuki, Yasuyuki; Yoshikawa, Keiji; Suzumura, Hirotaka; Maeda, Toshine; Takeda, Ryuji; Saito, Hitomi; Araie, Makoto (Patient preference and adherence, 2018)
Purpose: We investigated patient adherence and factors related to a newly introduced prostaglandin analog and timolol fixed-combination eye drops (PGTFC)., Patients and methods: The Glaucoma Research on Adherence to fixed-Combination Eye drops in Japan (GRACE) study group performed a nationwide prospective questionnaire survey. Participants in this study were patients with glaucoma who were scheduled to receive any type of PGTFC for the first time. The participants answered a questionnaire on the day of PGTFC introduction and again at a return visit 4-6 weeks after PGTFC introduction. The physicians in charge were asked to complete a separate questionnaire on the day of PGTFC introduction. One of two leaflets was randomly delivered to each participant before the description of the PGTFC. One leaflet explained how to correctly instill the eye drops, and the other explained the clinical meaning of intraocular pressure reduction in addition to explaining how to correctly instill the eye drops. Nonadherence was defined as forgetting to instill the eye drops one or more times during the week before the return visit., Results: In total, 3,597 patients (age, 68.4+/-12.2 years) met the study protocol requirements. PGTFC introduction significantly reduced the number of antiglaucoma eye drops from 1.93+/-0.78 to 1.34+/-0.54 (P<0.0001) and significantly improved adherence (P<0.00001). Factors significantly associated with nonadherence at the return visit included a history of nonadherence as reported by either the patient or their physician before introduction, acceptable instillation times as reported by the patient, and burdensome eye drop instillation as reported by the patient. No significant difference was observed between the two leaflets in terms of their effects on adherence., Conclusion: PGTFC significantly improved adherence and some of the factors that were significantly associated with adherence., Registration number: UMIN000013696.

Glaucoma, dementia, and the "precipice of care": transitions between states of medication adherence. - Read, Simon; Waterman, Heather; Morgan, James E; Harper, Robert A; Spencer, Anne Fiona; Stanford, Penelope (Patient preference and adherence, 2018)
Purpose: "She wouldn't remember. Even when I go through, and she's decided to go to bed, I'll say I'll come and do her drops. If I didn't say that, they wouldn't be done." Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals., Methods: Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities., Results: Using Pound's synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration., Conclusion: Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines.

Old and New Drug Classes Expanding To Include Glaucoma Treatments. - Kish, Troy (P & T : a peer-reviewed journal for formulary management, 2018)
Poor patient adherence is fueling keen interest in the development of drugs for glaucoma management. Several long-acting formulations of existing medications are in the early stages of development, as are new therapeutic classes such as guanylate cyclase activators.

Evolution of Glaucoma Surgery in the Last 25 Years. - Bar-David, Laura; Blumenthal, Eytan Z (Rambam Maimonides medical journal, 2018)
Glaucoma is a chronic neurodegenerative optic nerve disease. Treatment is intended to prevent the development and progression of optic nerve damage by lowering intraocular pressure (IOP). Current therapy options include topical/systemic drugs that increase aqueous humor outflow or decrease its production, laser therapy that targets the trabecular meshwork and ciliary body, and incisional surgery. Trabeculectomy as well as glaucoma drainage devices are often performed, given their high efficacy in lowering IOP. However, the significant risk profile with potential sight-threatening complications has motivated glaucoma experts to create alternative surgeries to treat glaucoma. Minimally invasive glaucoma surgery (MIGS) is defined by: micro-invasive approach, minimal tissue trauma, high safety profile, and rapid recovery. The new devices might promote an earlier transition from medical/laser therapy to surgery, and therefore decrease the side effects associated with long-term use of topical medications as well as deal with the limited adherence of patients to their regimens. This review presents the surgical options available for glaucoma patients and their evolution over the past 25 years.

Efficacy and Safety of Switching from Tafluprost to a Tafluprost/Timolol Fixed Combination in Patients With Primary Open-Angle Glaucoma. - Inoue, Kenji; Ueda, Takeaki; Ishida, Kyoko; Tomita, Goji (The open ophthalmology journal, 2018)
Background: The Tafluprost/Timolol Fixed Combination (TTFC) has demonstrated efficacy and safety in reducing Intraocular Pressure (IOP). However, direct comparisons of switching from tafluprost to TTFC are limited., Objective: To investigate the efficacy and safety of switching from tafluprost to TTFC in patients with Primary Open-Angle Glaucoma (POAG)., Methods: Thirty-four eyes (34 patients) with POAG that did not achieve adequate IOP reduction on tafluprost were switched to TTFC with no washout period. IOP, systolic/diastolic blood pressure and pulse rate were measured 1 and 3 months later and compared with baseline values. All participants were asked about specific adverse reactions after 1 and 3 months of treatment. Patients also completed a questionnaire about preference and adherence after 1 month of treatment., Results: Mean IOP after 1 and 3 months was significantly lower than at baseline (14.2 +/- 2.1 mmHg and 14.1 +/- 2.3 mmHg, respectively, vs 16.0 +/- 2.0 mmHg, P < 0.0001). Systolic/diastolic blood pressure and pulse rate were not significantly different from baseline after 1 and 3 months. The questionnaire indicated that the frequency of missing a dose was not different before (27.3%) or after (18.2%) switching to TTFC (P = 0.2371). There were five reports of adverse reactions (14.7%), including a corneal epithelium disorder, ocular irritation, skin irritation at the wrist, and chest pain. Two patients (5.9%) withdrew because of adverse reactions., Conclusion: Switching from tafluprost to TTFC achieved IOP control safely and was well accepted by patients.