EyePACS: an adaptable telemedicine system for diabetic retinopathy screening. - Cuadros, Jorge; Bresnick, George (Journal of diabetes science and technology, 2009)
BACKGROUND: Annual retinal screening of patients with diabetes is the standard clinical practice to prevent visual impairment and blindness from diabetic retinopathy. Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings can effectively detect sight-threatening retinopathy and significantly increase compliance with annual retinal exams. EyePACS is a license-free Web-based DRS system designed to simplify the process of image capture, transmission, and review. The system provides a flexible platform for collaboration among clinicians about diabetic retinopathy., METHODS: Primary clinic personnel (i.e., nursing, technical, or administrative staff) are trained and certified by the EyePACS program to acquire retinal images from standard digital retinal cameras. Relevant clinical data and eight high-resolution images per patient (two external and six retinal images) are encrypted and transmitted to a secure Internet server, using a standard computer and Web browser. Images are then interpreted by certified EyePACS reviewers or local eye care providers who are certified through the EyePACS Retinopathy Grading System. Reports indicating retinopathy level and referral recommendations are transmitted back to primary care providers through the EyePACS Web site or through interfaces between EyePACS and Health Level 7-compliant electronic medical records or chronic disease registries., RESULTS: The pilot phase of the EyePACS DRS program in California (2005-2006) recorded 3562 encounters. Since 2006, EyePACS has been expanded to over 120 primary care sites throughout California and elsewhere recording over 34,000 DRSs. The overall rate of referral is 8.21% for sight-threatening retinopathy and 7.83% for other conditions (e.g., cataract and glaucoma)., CONCLUSION: The use of license-free Web-based software, standard interfaces, and flexible protocols has allowed primary care providers to adopt retinopathy screening with minimal effort and resources. Copyright 2009 Diabetes Technology Society.
Keywords: *Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/pa [Pathology]; Electronic Health Records; Humans; Internet; *Mass Screening/is [Instrumentation]; *Mass Screening/mt [Methods]; Referral and Consultation; Remote Consultation; Retrospective Studies; Severity of Illness Index; Software; *Telemedicine/is [Instrumentation]; *Telemedicine/mt [Methods]

Hydroxypropyl cellulose ophthalmic inserts (lacrisert) reduce the signs and symptoms of dry eye syndrome and improve patient quality of life. - McDonald, Marguerite; D'Aversa, Gerard; Perry, Henry D; Wittpenn, John R; Donnenfeld, Eric D; Nelinson, Donald S (Transactions of the American Ophthalmological Society, 2009)
PURPOSE: A multicenter, 2-visit, open-label, 4-week study was conducted to determine the acceptability of hydroxypropyl cellulose ophthalmic inserts in adult patients with a history of dry eye syndrome (DES)., METHODS: At visit 1, patients (N = 520) were evaluated, screened by slit-lamp biomicroscopy, and completed the Ocular Surface Disease Index (OSDI), a validated measure of quality of life. Patients were trained in the proper placement and use of hydroxypropyl cellulose ophthalmic inserts and were contacted by telephone on day 3 of the study. At week 4, patients were given a clinical evaluation and completed a second questionnaire. Answers determined changes in symptoms and quality of life. Adverse events were monitored throughout the study., RESULTS: Four hundred eighteen patients completed the study and reported significant improvements in discomfort, burning, dryness, grittiness, stinging, and light sensitivity (P = .05) after 4 weeks use of hydroxypropyl cellulose ophthalmic inserts. Significant improvements in clinical signs (keratitis, conjunctival staining, and tear volume) were reported. Contact lens wearers reported significant improvements similar to nonwearers, with a strong trend toward improvement in light sensitivity. Mean OSDI total scores, measuring quality of life, significantly improved by 21.3% (from 41.8 +/- 22.38 to 32.9 +/- 21.97, P < or = .0215). The most commonly reported adverse event leading to discontinuation was blurred vision, observed in 8.7% of patients (n = 45). Compliance during the study was good; 41.5% of subjects were fully compliant. Of the 58.5% of subjects who missed doses, the majority (69.4%) missed only one to five., CONCLUSIONS: Hydroxypropyl cellulose ophthalmic inserts significantly reduced symptoms and clinical signs of moderate to severe DES. They also significantly improved DES in patients wearing contact lenses. Patients experienced a statistically significant improvement in quality of life, as measured by the OSDI, of 21.3%.
Keywords: Activities of Daily Living; Cellulose/ad [Administration & Dosage]; Cellulose/ae [Adverse Effects]; *Cellulose/aa [Analogs & Derivatives]; Contact Lenses; *Drug Delivery Systems/mt [Methods]; Humans; Middle Aged; Patient Compliance; Photosensitivity Disorders/dt [Drug Therapy]; Photosensitivity Disorders/et [Etiology]; *Quality of Life; Surveys and Questionnaires; Treatment Outcome; Vision Disorders/ci [Chemically Induced]; Xerophthalmia/co [Complications]; *Xerophthalmia/dt [Drug Therapy]; *Xerophthalmia/pp [Physiopathology]

Root cause analysis of the fusarium keratitis epidemic of 2004-2006 and prescriptions for preventing future epidemics. - Bullock, John D (Transactions of the American Ophthalmological Society, 2009)
PURPOSE: A root cause analysis of the Fusarium keratitis epidemic of 2004-2006 was performed., METHODS: Three US Food and Drug Administration (FDA) documents were analyzed. Poisson and case-control studies were performed on outbreak data from Singapore. Irreversible thermochromic labels were applied to cartons of contact lens solution bottles, which were then subjected to elevated temperatures., RESULTS: The 1997 FDA guidance document concerning storage temperatures of contact lens care products predicted temperature-related solution instability. Bausch & Lomb (B&L) requested FDA approval for ReNu with MoistureLoc, claiming that it was substantially equivalent to other products. FDA Form 483 stated that cases of ReNu-related Fusarium keratitis from Asia had not been reported, the removal of the product from the Asian markets was unreported, and B&L had not performed biocidal testing on samples associated with Asian cases. The outbreak in Singapore could have been recognized after only 3 cases (Pr = .0067). The cause of the Singapore outbreak could have been determined after the recognition of only 3 (P = .0429), 5 (95% confidence interval [CI], 1.15-126.0), or 15 cases (95% CI, 1.60-14.1). Thermochromic labels can irreversibly change color when exposed to elevated temperatures, thus warning of potential antimicrobial failure., CONCLUSIONS: The worldwide Fusarium keratitis epidemic of 2004-2006 could, theoretically, have been prevented entirely, recognized much earlier, or mitigated by much more rigorous oversight by the FDA, by strict adherence by B&L to FDA guidelines and requirements, by the application of basic statistical methods, and/or by the use of temperature indication technology. The lessons learned from a root cause analysis of this pharmacologic catastrophy may help avert or mitigate future epidemics.
Keywords: Asia/ep [Epidemiology]; *Contact Lens Solutions/ae [Adverse Effects]; *Disease Outbreaks/pc [Prevention & Control]; Drug Stability; Drug Storage; *Fusarium; Global Health; Guideline Adherence; Hot Temperature/ae [Adverse Effects]; Humans; Keratitis/ci [Chemically Induced]; *Keratitis/ep [Epidemiology]; *Keratitis/mi [Microbiology]; *Mycoses; *Primary Prevention/mt [Methods]; Statistics as Topic/mt [Methods]; United States/ep [Epidemiology]; United States Food and Drug Administration

The role of patient inexperience in medication discontinuation: a retrospective analysis of medication nonpersistence in seven chronic illnesses. - Vanelli, Mark; Pedan, Alex; Liu, Nan; Hoar, Jennifer; Messier, Denise; Kiarsis, Keith (Clinical therapeutics, 2009)
BACKGROUND: Previous studies have reported that patients who are medication naive in some medication classes have a higher risk of medication discontinuation during the first 30 days of treatment and shorter median times to discontinuation than do medication-experienced patients., OBJECTIVES: This study compared the risk of discontinuation during the first 30 days after the index fill and the median time to discontinuation for medication-naive and medication-experienced patients who were prescribed drugs for asthma, diabetes mellitus, high cholesterol, cardiovascular disease, breast cancer, glaucoma, or osteoporosis., METHODS: Deidentified outpatient pharmacy records from 4 large US retail chains were searched for patients who had obtained a prescription for one of the index medications between January 1, 2007, and January 31, 2007. Included medication classes were asthma inhalers, asthma pills, oral breast-cancer agents, cardiovascular medications, oral antidiabetic medications, insulin, glaucoma drops, osteoporosis medications, and statins. Patients were divided into 2 groups: those for whom an in-class medication was not dispensed in the previous 180 days were identified as medication naive, and those for whom an in-class medication was dispensed during this period were identified as medication experienced. Discontinuation was defined as being >30 days late for a scheduled refill. Time to discontinuation was measured using Kaplan-Meier analysis during a 360-day follow-up period., RESULTS: Data for 2.17 million patients who received prescriptions from 3821 pharmacies were analyzed. During the first 30 days of therapy, rates of discontinuation for medication-naive patients were 17.4% to 42.6% higher than for medication-experienced patients, and their median times to discontinuation were 14.2% to 28.9% as long. The difference in persistence between medication-naive and medication-experienced patients emerged during the first 30 days of medication use, after which rates of discontinuation were relatively consistent. Patients prescribed nonoral medications for diabetes mellitus (insulin), asthma (inhalers), and glaucoma (drops) had an especially high risk of discontinuation during the first month of treatment., CONCLUSION: This study found that medicationnaive patients had a higher risk of discontinuation during the first 30 days of therapy than did medicationexperienced patients, regardless of the medication class prescribed, leading to shorter median times to discontinuation. Copyright 2009 Excerpta Medica Inc. All rights reserved.
Keywords: Adult; Age Factors; Aged; Asthma/dt [Drug Therapy]; Asthma/ep [Epidemiology]; Breast Neoplasms/dt [Drug Therapy]; Breast Neoplasms/ep [Epidemiology]; Cardiovascular Diseases/ep [Epidemiology]; Cardiovascular Diseases/et [Etiology]; *Chronic Disease/dt [Drug Therapy]; Chronic Disease/ec [Economics]; Diabetes Mellitus/dt [Drug Therapy]; Diabetes Mellitus/ep [Epidemiology]; Drug Costs; Factor Analysis, Statistical; Female; Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Humans; Hypercholesterolemia/dt [Drug Therapy]; Hypercholesterolemia/ep [Epidemiology]; Insurance, Pharmaceutical Services/sn [Statistics & Numerical Data]; Kaplan-Meier Estimate; Male; Middle Aged; Osteoporosis/dt [Drug Therapy]; Osteoporosis/ep [Epidemiology]; *Patient Compliance/sn [Statistics & Numerical Data]; Pharmaceutical Preparations/ad [Administration & Dosage]; Pharmacies/sn [Statistics & Numerical Data]; Prescriptions/sn [Statistics & Numerical Data]; Retrospective Studies; United States/ep [Epidemiology]

[Case report: Acanthamoeba keratitis]. - Ertabaklar, Hatice; Dayanir, Volkan; Apaydin, Pinar; Ertug, Sema; Walochnik, Julia (Turkiye parazitolojii dergisi, 2009)
Acanthamoeba keratitis (AK) is an opportunistic protozoan infection caused by the pathogenic Acanthamoeba and associated with soft contact lens wear. If untreated, it can cause serious visual disability. A 23 year-old female wearing soft contact lenses applied to the Department of Ophthalmology of the Aydin Adnan Menderes University School of Medicine, with symptoms of redness, pain and blurred vision of both eyes. She was given a diagnosis of AK on clinical and laboratory grounds. The agent isolated was found to be T4 genotype "Acanthamoeba castellani". The patient regained visual ability following treatment. Although contact lens wear is the major risk factor for Acanthamoeba keratitis, the disease is usually seen unilaterally whereas in our case a bilateral involvement was observed. Great care should be practiced during contact lens use and there should be strict adherence to hygienic conditions if infections affecting the eye are to be avoided.
Keywords: *Acanthamoeba Keratitis/et [Etiology]; Acanthamoeba Keratitis/ps [Parasitology]; Acanthamoeba castellanii/cl [Classification]; Acanthamoeba castellanii/ge [Genetics]; *Acanthamoeba castellanii/ip [Isolation & Purification]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Female; Genotype; Humans; Young Adult

Readability of prescription labels and medication recall in a population of tertiary referral glaucoma patients. - O'Hare, Fleur; Jeganathan, V Swetha E; Rokahr, Catherine G; Rogers, Sophie L; Crowston, Jonathan G (Clinical & experimental ophthalmology, 2009)
PURPOSE: To evaluate readability of eye drop labels and accurate recall of prescription instructions in a glaucoma population., METHODS: A hospital-based, cross-sectional study. A trained, interviewer examined patient ability to read standard and larger font medication labels. A questionnaire was administered to ascertain accurate recall of prescribed eye drops. Clinical information was obtained through independent chart review. Glaucoma severity was classified according to a glaucoma staging system. The setting for the study was the glaucoma outpatient clinic, Royal Victorian Eye and Ear Hospital (Melbourne, Australia), a major tertiary referral centre. A total of 200 glaucoma patients (96.2% response), aged 45-90 years, on eye drops took part in the study. Non-English-speaking patients were excluded. The main outcome measure was the ability to read prescribed medication labels and accurately recall treatment regime was compared with glaucoma severity and the number of eye drops., RESULTS: Of the glaucoma patients, 12% were unable to read standard pharmacy labels. Only 5.5% were unable to read the larger font labels. Of the patients, 32% were not able to accurately recall the type of drops or prescribed frequency of instillation. An inability to read standard labels was associated with a threefold reduction in the likelihood of accurate medication recall (95% confidence intervals, 1.40-7.66, P < 0.05). Patients with three or more types of eye drops were five times less likely to recall their medications (95% confidence interval, 0.07-0.57, P < 0.05)., CONCLUSIONS: Inability to read or recall prescribed eye drops was associated with glaucoma severity and the number of prescribed eye drops. These factors may impact significantly on patients' adherence to glaucoma medications.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Comprehension; Cross-Sectional Studies; Disease Progression; *Drug Labeling/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pa [Pathology]; *Glaucoma/px [Psychology]; Hospitals, General; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; *Mental Recall; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Reading; Surveys and Questionnaires

Hyperemia-associated costs of medication changes in glaucoma patients treated initially with prostaglandin analogs. - Schwartz, Gail F; Tan, Jason; Kotak, Sameer (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2009)
AIMS: To develop a model to estimate and compare the cost of changing therapy due to hyperemia in glaucoma patients treated initially either with latanoprost, bimatoprost, or travoprost monotherapy., METHODS: Data collected from the HealthCore Integrated Research Database, as part of the Glaucoma Adherence and Persistency Study (GAPS), were used to populate the model. Patients with a documented diagnosis of glaucoma who were newly treated (no ocular hypotensive medication and no glaucoma-related procedure during 6 months before first prescription) with latanoprost, bimatoprost, or travoprost monotherapy were identified. The time horizon for the base-case model was the duration of chart abstraction (mean = 4.1 years); a 3-month model also was developed. Physician-reported rates of hyperemia were obtained from chart reviews of 300 patients. Transition rates reflected events related to reports of hyperemia where a physician-driven change (switch or discontinuation) in therapy was documented. The per-patient direct cost (2008) due to hyperemia-driven change in therapy was calculated as the sum of the cost of the initial prescription plus the cost of the office visit where the patient was evaluated and the decision to change therapy was made. Costs were stratified by whether patients were hyperemia free or discontinued the initial therapy due to hyperemia., RESULTS: From the sample of 13,977 newly treated patients, 8,743 patients were started on a prostaglandin monotherapy only. Of these, 5,726 received latanoprost, 1,633 were treated with bimatoprost, and 1,384 received travoprost index monotherapy. Across all treatment groups, costs among hyperemia-free patients were US$73.67 versus US$140.02 for those who discontinued the initial prostaglandin due to hyperemia. Per-patient costs were lowest in the group treated initially with latanoprost. For the base-case model, with latanoprost as the reference, total per-patient incremental costs due to hyperemia-driven change in therapy were US$5.92 for bimatoprost and US$5.43 for travoprost. Results were not highly sensitive to increases either in the incidence of hyperemia among latanoprost-treated patients or in the cost of latanoprost., CONCLUSIONS: Hyperemia results in increased overall costs in patients treated with latanoprost, bimatoprost, and travoprost. Treatment with latanoprost is associated with lower hyperemia-related costs than treatment with bimatoprost or travoprost.
Keywords: Amides/ae [Adverse Effects]; Amides/ec [Economics]; Amides/tu [Therapeutic Use]; *Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/ec [Economics]; Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ae [Adverse Effects]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/ec [Economics]; Cloprostenol/tu [Therapeutic Use]; Costs and Cost Analysis; Databases, Factual; Drug Costs; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Humans; Hyperemia/ci [Chemically Induced]; *Hyperemia/ec [Economics]; Latanoprost; *Models, Economic; Prostaglandins F, Synthetic/ae [Adverse Effects]; Prostaglandins F, Synthetic/ec [Economics]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Travoprost

Reduction in length of hospitalisation for microbial keratitis patients: a prospective study. - Jimmy, Lim Wei Kheong; Barkham, Timothy; Ming, Chen Qian; Lim, Lynda; Lin, Jia; Hong, Goh Lay; Jin, Heng Wee (International journal of health care quality assurance, 2009)
PURPOSE: Prolonged hospital stay in the course of management of microbial keratitis patients has been a burden to the resources of a multi-disciplinary tertiary hospital. The paper aims to evaluate the impact of streamlining the workflow and increased cross-disciplinary interactions on the average length of hospitalisation. It also seeks to study secondary outcomes including the average time for initiation of therapy, microbial culture positive rate, patients' satisfaction and resource savings., DESIGN/METHODOLOGY/APPROACH: The authors employed the model of clinical practice improvement (CPI) (New South Wales Health Department) methodology for a systematic approach to improve processes of care and service delivery. A team consisting of ophthalmologist, microbiologist, pharmacist and nursing staff was formed to brainstorm and highlight the problems. A new workflow was formulated and data were prospectively collected to evaluate and to identify areas where improvements could be made., FINDINGS: The average length of hospitalisation stay was reduced from 7.43 to 5.93 days with a mean difference of 1.50 +/- 0.63 days (p < 0.05). The microbial keratitis culture positive rate increased from 54.6 to 73.0 per cent (p > 0.05). The average time taken to initiate antibiotic eye drops after first contact with the doctor was 26.1 minutes (n = 28), and 74.4 per cent of the patients surveyed were satisfied with their length of stay., RESEARCH LIMITATIONS/IMPLICATIONS: Intervention was carried out on the top 20 per cent of areas for improvement after voting by the team members., PRACTICAL IMPLICATIONS: The reduction in average length of hospitalisation can be improved by strict adherence to a formulated workflow and coordinated cross-disciplinary interactions., ORIGINALITY/VALUE: The management protocol discussed in the paper for microbial keratitis enables more effective and efficient treatment for the inpatients. Increased cross-discipline and nursing coordination decreases length of hospitalisation of microbial keratitis patients and achieve better care for these patients.
Keywords: Bacterial Infections/di [Diagnosis]; *Bacterial Infections/th [Therapy]; Humans; Interdisciplinary Communication; Keratitis/di [Diagnosis]; *Keratitis/mi [Microbiology]; *Keratitis/th [Therapy]; *Length of Stay; New South Wales; Organizational Case Studies; *Outcome and Process Assessment, Health Care/mt [Methods]; Prospective Studies; Workflow

[Rehabilitation of patients with burn injury to the eye]. - Makarov, P V; Kataev, M G; Gundorova, R A; Slepova, O S; Chernetskii, I S; Balaian, T G (Vestnik oftalmologii, 2009)
Based on the analysis of the results of treatment in patients with severe and particularly severe burn injuries to the eye, the authors developed principles in the rehabilitation of such patients. The rehabilitation period was divided into 4 stages: 1) treatment of burn injury (removal of necrotic tissues; revascularization of the outer membrane of the eyeball; prevention of cicatricial deformity of the eyelids); 2) treatment of burn disease complications (blood blepharorrhaphy, soft contact lenses, maximum antihypertensive therapy, treatment of cataract and glaucoma); 3) reconstruction of the eyelids, conjunctival vaults, eyeball surface (transplantation of autologous skin flaps, oral mucosa, fixation of leukoma with the automucosa, autocartilage); 4) functional rehabilitation (limbic transplantation, keratoplasty, keratic replacement with a Fedorov-Zuyev prosthesis). The use of the scheme in clinical practice can achieve a considerable reduction in the time of rehabilitation and the rate of functional and anatomic death of the injured eye and improve the functional outcomes of treatment in patients with severe and especially severe burn injury to the eye.
Keywords: *Debridement/mt [Methods]; Eye Burns/di [Diagnosis]; *Eye Burns/rh [Rehabilitation]; Female; Follow-Up Studies; Humans; Male; *Ophthalmologic Surgical Procedures/mt [Methods]; Patient Satisfaction; *Reconstructive Surgical Procedures/mt [Methods]; Trauma Severity Indices; Treatment Outcome

[New developments in glaucoma medical treatment]. - Munoz-Negrete, F J; Perez-Lopez, M; Won Kim, H R; Rebolleda, G (Archivos de la Sociedad Espanola de Oftalmologia, 2009)
The medical treatment of glaucoma has undergone significant development in recent years. Research in this field is focused on improving pre-existing drugs and on the development of new molecules. In relation to commercial drugs, there is a trend to improve local tolerance, using less toxic preservatives as in the case of sofZIA in travoprost, and eliminating the preservatives as in tafluprost. The development of new, fixed combinations of commercial drugs could also enhance their administration and therapeutic compliance. There is also intense research activity in the search for new therapeutic groups for glaucoma treatment. Calcium channel-blockers such as lomerizine do not seem to affect systemic hypotension, while topical calcium-blockers like flunarizine and iganidipine are also under research. Endothelin 1 antagonists such as sulfisoxazole and bunazosine could be also useful in the treatment of glaucoma. In the renin angiotensin system, angiotensin (1-7) and olmesartan are under investigation for use in glaucoma patients. Trabecular drugs such as Rho-kinase inhibitors could be effective on the pathogenic mechanism of primary open angle glaucoma. Finally, topical mifepristone, an antagonist of glucocorticoid receptors, is under evaluation for corticosteroid-induced elevated intraocular pressure (Arch Soc Esp Oftalmol 2009; 84: 491-500).
Keywords: Angiotensin Receptor Antagonists; Calcium Channel Blockers/tu [Therapeutic Use]; Endothelins/ai [Antagonists & Inhibitors]; *Glaucoma/dt [Drug Therapy]; Humans; Prostaglandins/ag [Agonists]; Receptors, Angiotensin/ag [Agonists]

[Compliance and ignorance in glaucoma in Romanian patients]. - Dumitrica, Diana Melinte; Stefan, Cornel (Oftalmologia (Bucharest, Romania : 1990), 2009)
The compliance to treatment of glaucoma patient has a big importance on the long term vision preservation, as well as on the quality of life of our patients. Unknowing and misunderstanding of disease real implications and the importance of the treatment are present in out every day practice in our patients. We want to identify and analyze these aspects in a glaucoma group of Romanian patients, knowing the implications of socio-economic aspects.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Glaucoma/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence/sn [Statistics & Numerical Data]; *Patient Compliance/sn [Statistics & Numerical Data]; Physician-Patient Relations; Quality of Life; Reproducibility of Results; Romania/ep [Epidemiology]; Surveys and Questionnaires

Xal-Ease: impact of an ocular hypotensive delivery device on ease of eyedrop administration, patient compliance, and satisfaction. - Nordmann, Jean-Philippe; Baudouin, Christophe; Bron, Alain; Denis, Philippe; Rouland, Jean-Francois; Sellem, Eric; Renard, Jean-Paul (European journal of ophthalmology, 2009)
PURPOSE: To measure the impact of the Xal-Ease delivery device on ease of eyedrop administration and on treatment compliance and satisfaction., METHODS: This prospective, multicenter, randomized, comparative, crossover study was conducted at 43 sites in France. Eligible subjects were >18 years of age, were diagnosed with primary open-angle glaucoma or ocular hypertension, had been treated with latanoprost or fixed-combination latanoprost/timolol for >or=3 months prior to enrollment, and did not require a therapy change. Subjects used either Xal-Ease or the dropper bottle for 4 weeks and then switched to the alternate delivery method for the next 4 weeks. Subjects completed questionnaires after 1 and 4 weeks in each treatment period., RESULTS: In all, 211 subjects were enrolled, 107 to the Xal-Ease/dropper bottle group and 104 to the dropper bottle/Xal-Ease group. Baseline demographic and ocular characteristics were similar. Use of Xal-Ease made it significantly less likely that the subject would need someone to help with drop instillation (6.9% vs 18.1%, respectively; p<0.001) and reduced the problem of the tip of the bottle touching the eye (3.2% vs 35.6%, respectively; p<0.001). Reported compliance rates were very high and similar across groups during both treatment periods. After 1 month of use during both treatment periods, more than 70% of subjects reported global satisfaction with Xal-Ease to their physicians. No adverse events associated with the use of Xal-Ease were noted., CONCLUSIONS: Xal-Ease generally makes administration of latanoprost or fixed-combination latanoprost/timolol easier compared with the dropper bottle.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Over Studies; *Drug Delivery Systems/is [Instrumentation]; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Latanoprost; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; *Patient Satisfaction; Prospective Studies; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Surveys and Questionnaires; Timolol/ad [Administration & Dosage]

Gender inequality in vision loss and eye diseases: evidence from the Sultanate of Oman. - Khandekar, Rajiv; Mohammed, A J (Indian journal of ophthalmology, 2009)
PURPOSE: The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman., STUDY DESIGN: Retrospective review of data collection instruments., MATERIALS AND METHOD: The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools., RESULTS: In 1996, the prevalence of bilateral blindness in > or = 40 years of age was higher in females [Odd's Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 - 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 - 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 - 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant.But males were associated with higher prevalence of cataract [OR = 1.26 (95% CI 1.00 - 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls., CONCLUSIONS: Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.
Keywords: Adult; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Cataract/co [Complications]; *Cataract/ep [Epidemiology]; Female; Glaucoma/co [Complications]; *Glaucoma/ep [Epidemiology]; Humans; Male; Oman/ep [Epidemiology]; Prevalence; Retrospective Studies; Risk Factors; Sex Distribution; Trachoma/co [Complications]; *Trachoma/ep [Epidemiology]

Intravitreal bevacizumab for neovascular glaucoma. - Vasudev, Deepta; Blair, Michael P; Galasso, John; Kapur, Rashmi; Vajaranant, Thasarat (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2009)
PURPOSE: To report 6-month and 1 year outcomes of eyes treated for neovascular glaucoma (NVG) with intravitreal bevacizumab injection and panretinal laser (PRP) compared to those receiving PRP alone., DESIGN: retrospective, consecutive case series., METHODS: Charts of patients with NVG from retinal ischemia and at least 6 months of follow-up were reviewed. Patients were treated with one injection of 1.25 mg intravitreal bevacizumab followed by PRP or with PRP alone. The primary outcome was the long-term angle anatomy. Secondary measures included intraocular pressure (IOP), visual acuity, patient compliance, and control of systemic diseases., RESULTS: Fourteen eyes of 12 patients treated with bevacizumab and PRP and 15 eyes of 11 patients treated with PRP alone were included in the study. Mean sectors of open angle at baseline was 1.31 in the bevacizumab group and 1.47 in the retinal ablation group (P = 0.73). Mean sectors of open angle was 2.14 and 1.18 in the bevacizumab and retinal ablation groups, respectively (P < 0.05) at 6-month follow-up, and 2.27 and 1.18, respectively (P < 0.05) at 1-year follow-up. Mean baseline IOP was 32.3 mmHg (+/-14.8) in the bevacizumab group and 31.8 mmHg (+/-13) in the PRP group (P = 0.75). At 6-month follow-up, the mean IOP was 18.28 mmHg (+/-10) in the bevacizumab group and 23.33 mmHg (+/-14.6) in the PRP group (P = 0.05), and 19.12 mmHg (+/-6.8) and 26.2 mmHg (+/-18) (P = 0.1), respectively at 1-year follow-up. Nineteen patients were judged to be noncompliant, 10 had uncontrolled diabetes and 7 had uncontrolled hypertension., CONCLUSIONS: This study documents better long-term preservation of open angle and IOP control in eyes receiving bevacizumab along with PRP. We stress that NVG is still associated with poor visual acuity outcomes.
Keywords: Angiogenesis Inhibitors/ad [Administration & Dosage]; *Angiogenesis Inhibitors/tu [Therapeutic Use]; Antibodies, Monoclonal/ad [Administration & Dosage]; *Antibodies, Monoclonal/tu [Therapeutic Use]; Antibodies, Monoclonal, Humanized; Bevacizumab; Combined Modality Therapy; *Glaucoma, Neovascular/dt [Drug Therapy]; Glaucoma, Neovascular/su [Surgery]; Humans; Injections; Intraocular Pressure; Laser Coagulation/mt [Methods]; Middle Aged; Patient Compliance; Retina/su [Surgery]; Retrospective Studies; Visual Acuity; Vitreous Body

[Shortage of ocular health care in the public system: a population-based study]. - Castagno, Victor Delpizzo; Fassa, Anaclaudia Gastal; da Silva, Marcelo Cozzensa; Carret, Maria Laura Vidal (Cadernos de saude publica, 2009)
This cross-sectional population-based study investigated the prevalence of eye care services utilization and the association with socioeconomic and demographic factors, need for health care, and type of service payment. The study evaluated 2,960 adults aged 20 and older. In the previous 5 years, 46% of the sample and 30% of those aged 50 and older had not visited an eye care service. Among the persons who used a service, 18% went to an optical store and only 17% used the public health system. The main reason for using eye care services was poor vision (69.5%). Lack of money (29%) and time (24.6%) were the most frequently cited reasons for non-utilization. Age, education, and economic status were directly associated with the outcome. Female gender, cataract, glaucoma, prescription eyewear, and private appointments were also associated with the outcome. It is necessary to increase the public health system's role, integrating ocular health with all levels of health care, expanding participation by other health professionals, and intensifying screening and prevention of eye problems.
Keywords: Adult; Age Factors; Aged; Brazil; Cross-Sectional Studies; Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; *Eye Diseases; Female; *Health Services Accessibility/sn [Statistics & Numerical Data]; *Health Services Research; Humans; Income; Male; Middle Aged; *Primary Health Care/sn [Statistics & Numerical Data]; Sex Factors; Young Adult

Childhood eye diseases in southwestern Nigeria: a tertiary hospital study. - Onakpoya, Oluwatoyin Helen; Adeoye, Adenike Odunmorayo (Clinics (Sao Paulo, Brazil), 2009)
BACKGROUND: Eye diseases are important cause of medical consultation in children, with the spectrum varying in different localities. This study aimed to determine the spectrum of childhood eye diseases in a tertiary hospital serving rural and semi-rural communities., METHODS: We conducted a retrospective review of all patients less than 15 years old who presented to the eye clinic of Wesley Guild Hospital Ilesa, Nigeria between January 2001 and December 2006. Data on age at presentation, age at onset of disease, sex and diagnosis were collected and analyzed using SPSS. A p value less than 0.05 was considered statistically significant., RESULTS: We evaluated the reports of 286 children, with a male:female ratio of 1:1.1. Children aged 11-15 years made up the largest group (p=0.013). Ocular trauma (21.7%), allergic conjunctivitis (17.8%), infections of the eye and its adnexa (15.4%) and refractive errors (14.3%) were the most common conditions. Ocular injury was more common in males (p=0.002) and children aged 6-10 years, and 87.1% of these cases were a closed globe injury. Infections were seen more commonly among females and children aged 0-5 years, with keratitis representing 40.9% of these cases. Congenital eye disease represented 13.3% of childhood eye diseases., CONCLUSION: The prevalent childhood eye diseases recorded here can lead to absenteeism from school and are potentially blinding. Health education aimed at the prevention of ocular trauma and prompt presentation for the management of other eye diseases should be encouraged.
Keywords: Adolescent; Age Distribution; Child; Child, Preschool; Eye Diseases/cl [Classification]; *Eye Diseases/ep [Epidemiology]; Female; Humans; Infant; Infant, Newborn; Male; Nigeria/ep [Epidemiology]; Prevalence; Retrospective Studies; Rural Population/sn [Statistics & Numerical Data]; Sex Distribution

A clinician's guide to the assessment and management of nonadherence in glaucoma. - Budenz, Donald L (Ophthalmology, 2009)
PURPOSE: To apply lessons learned in the treatment of systemic hypertension to the problem of nonadherence in glaucoma medical therapy., CLINICAL RELEVANCE: Although physicians recognize that nonadherence with glaucoma medication is a problem, most lack the skill set to identify nonadherent patients, to identify the causes of nonadherence, and to provide solutions to address nonadherence., METHODS: A PubMed search was conducted using the terms "adherence" OR "compliance" AND "hypertension," with the following limitations: title, English language, humans, from 2000 through 2009. Other studies identified outside of the PubMed search were included if relevant., RESULTS: Studies from the systemic hypertension literature suggest that simplifying medication regimens, lowering costs, and patient education about the disease and the importance of taking medications are successful strategies for improving adherence. In addition, good family or social support, frequent physician visits, and pairing medication administration with specific activities (such as meals or brushing one's teeth) can help improve adherence., CONCLUSIONS: The body of literature on adherence interventions in chronic diseases such as systemic hypertension shows that although many interventions have been tested and evaluated, only some are successful. Paradigms derived from behavioral medicine and nursing offer valuable lessons on how to motivate patients to change behavior, but these activities require skill sets not traditionally taught in medical school. Just as there are myriad causes of nonadherence, the interventions most likely will need to be multifaceted and tailored to the individual patient., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Allied Health Personnel/px [Psychology]; *Antihypertensive Agents/ad [Administration & Dosage]; Blindness/pc [Prevention & Control]; *Glaucoma/dt [Drug Therapy]; Health Behavior; Humans; Motivation; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/px [Psychology]; Patient Education as Topic; Physician-Patient Relations

Patient-centered communication to assess and enhance patient adherence to glaucoma medication. - Hahn, Steven R (Ophthalmology, 2009)
TOPIC: Using an understanding of a patient's difficulty in revealing nonadherence and patient-centered communication skills to identify and address barriers to adherence to glaucoma medication regimens., CLINICAL RELEVANCE: In addition to cost and logistical difficulties with obtaining and administering medicine, a patient's adherence to medication is influenced by the balance between the perceived need for medication and concerns about taking medication., METHODS: This article is based on both the author's clinical experience and peer-reviewed research on effective doctor-patient communication and assessment and management of nonadherence., RESULTS: Three strategies have been identified that help physicians to detect and address problems with adherence: (1) a 4-step adherence assessment interview designed to detect nonadherence that decreases patient resistance to revealing nonadherence by applying a shared decision-making process and mitigating social undesirability; (2) asking open-ended questions in ask-tell-ask sequences; and (3) tailoring interventions to the patient's stage of readiness for change., CONCLUSIONS: Patients conceal nonadherence because they want to be thought of by their physicians as good patients. They are driven to nonadherence by an imbalance between their perceived need for medication and their concerns about taking it. Patient-centered communication techniques can engage the patient in shared decision making about medication, thereby redefining the good patient as someone who works with his or her health care provider to address adherence barriers. Those barriers can be explored with open-ended questions designed to elicit the patient's understanding and concerns, to provide information, and to assess change in the patient's understanding and attitudes. Communication will be more effective if it is based on the patient's stage of readiness to adopt adherent self-management practices., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Communication; *Glaucoma/dt [Drug Therapy]; Health Behavior; Humans; Motivation; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/px [Psychology]; Patient Education as Topic; *Patient-Centered Care; *Physician-Patient Relations

A comprehensive perspective on patient adherence to topical glaucoma therapy. - Tsai, James C (Ophthalmology, 2009)
TOPIC: Risk factors for poor adherence or nonadherence to topical glaucoma medication regimens., CLINICAL RELEVANCE: Poor adherence to glaucoma medication regimens may be associated with subsequent visual loss and irreversible optic nerve damage., METHODS: A literature search was performed using the words "glaucoma AND adherence AND risk" and "glaucoma AND compliance AND risk," limited to those studies in English and focused on care in the United States. Publications from well-regarded journals in this field were reviewed, and a focused summary of the literature is presented., RESULTS: There are a myriad of adherence barriers inherent to the glaucoma patient population. Although most of these obstacles are common in the elderly (e.g., reduced cognition, musculoskeletal problems, and transportation difficulties), older age has not been shown to be a consistent risk factor for poor adherence to glaucoma medication regimens. Other expected barriers, such as medication cost, limited health insurance, disease severity, and role of complicated dosing regimens, have varied effects based on the patient population studied and the definition of adherence. Poor medication adherence also is associated with decreased adherence to follow-up medical visit schedules. A systematic taxonomy of adherence barriers has been formulated. In addition, subanalyses from the Glaucoma Adherence and Persistency Study identified 8 variables that affect adherence to glaucoma medication regimens as well as several characteristics that support the importance of and associations between doctor-patient communications., CONCLUSIONS: Recent studies have provided valuable insights into the many factors that increase the risk(s) for poor adherence in patients prescribed glaucoma medications. Four major types of barriers to effective patient adherence (medication regimen, patient factors, provider factors, and situational or environmental factors) have been identified. Addressing these specific barriers will require a tailored, patient-centered approach., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; Blindness/pc [Prevention & Control]; Delivery of Health Care; Drug Administration Schedule; Drug Costs; Educational Status; *Glaucoma/dt [Drug Therapy]; Health Education; Health Knowledge, Attitudes, Practice; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ec [Economics]; *Patient Compliance/sn [Statistics & Numerical Data]; Risk Factors

Introduction: new insights on enhancing adherence to topical glaucoma medications. - Friedman, David S (Ophthalmology, 2009)
Keywords: Administration, Topical; *Antihypertensive Agents/ad [Administration & Dosage]; Blindness/pc [Prevention & Control]; *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance

Interventions improve poor adherence with once daily glaucoma medications in electronically monitored patients. - Okeke, Constance O; Quigley, Harry A; Jampel, Henry D; Ying, Gui-shuang; Plyler, Ryan J; Jiang, Yuzhen; Friedman, David S (Ophthalmology, 2009)
PURPOSE: To investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma., DESIGN: Randomized controlled clinical trial., PARTICIPANTS: Sixty-six patients with glaucoma being treated with a prostaglandin analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007., METHODS: In an observational study, participants who took 75% or fewer doses (as measured using the travoprost Dosing Aid [DA]) during an initial 3-month period were randomized into 2 groups. The intervention group watched an educational video, reviewed current barriers to drop-taking and possible solutions with a study coordinator, received regular phone call reminders, and had audible and visible reminders activated on their DA devices. The control group was told to take drops as prescribed and received no additional intervention., MAIN OUTCOME MEASURES: Change in drop use adherence as determined by the DA device., RESULTS: In the 3-month observation period before randomization, intervention group patients had used a mean of 54+/-17% of scheduled doses, and this increased to 73+/-22% during the following 3-month period (P<0.001, n = 35). The control mean adherence rate of 46+/-23% at baseline was statistically unchanged during the follow-up observation period (51+/-30%, P = 0.16, n = 31). In a multivariate analysis, intervention, baseline compliance rate of <50%, and white ethnicity were predictors of improved adherence during the 3 months of intervention. The intraocular pressure (IOP) of the intervention and control groups did not change between months 3 and 6 after intervention (P = 0.96, 0.34, respectively), and there was no correlation of IOP change with adherence rate change between both groups (Pearson correlation r = 0.06, P = 0.51)., CONCLUSIONS: A multifaceted intervention significantly increased adherence with glaucoma medications. Those with improved adherence were in the intervention group, had very low adherence rates at baseline, and were white. IOP did not correlate with adherence. Further research is needed to determine which components of this intervention were most effective.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; *Drug Monitoring/is [Instrumentation]; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; *Patient Education as Topic/mt [Methods]; Prospective Studies; Travoprost; Video Recording

Comparison of ICare, dynamic contour tonometer, and ocular response analyzer with Goldmann applanation tonometer in patients with glaucoma. - Vandewalle, Evelien; Vandenbroeck, Sofie; Stalmans, Ingeborg; Zeyen, Thierry (European journal of ophthalmology, 2009)
PURPOSE: To compare the intraocular pressure (IOP) readings taken by ICare, Pascal dynamic contour tonometer (DCT), and ocular response analyzer (ORA) with those taken by Goldmann applanation tonometer (GAT). We sought to evaluate the influence of central corneal thickness (CCT) on IOP measurements and to compare patients' preferences for the four tonometers., METHODS: In this prospective study, 93 eyes from 93 patients were examined. Patients were randomly divided into 4 groups to vary the order in which the tonometers were applied. CCT was measured with an ultrasound pachymeter., RESULTS: The average CCT was 558+/-47.4 microm. The mean +/- standard deviation IOP for GAT, ICare, DCT, and ORA (Goldmann-correlated IOP) (ORA(GC)) were 15.1+/-4.8, 15.7+/-5.7, 18.2+/-5.1, and 18.3+/-6.6 mmHg, respectively. There was no significant difference between the mean IOP obtained with GAT and ICare (p=0.14). There was also no difference in IOP levels between the mean IOP obtained with DCT and ORA (p=0.26). There was no correlation between IOP measurements and CCT for the 4 instruments. Bland-Altman graphs showed disagreement between the measurements taken by GAT and the other instruments. There was no significant difference in patients' preference among the 4 instruments (p=0.48)., CONCLUSIONS: IOP readings from ICare were consistent with those from GAT, whereas DCT readings correspond well to ORA(GC) measurements. DCT and ORA readings both overestimated the GAT readings. There was no correlation between the IOP measurements and the CCT for the 4 instruments. There was no significant difference in patients' preference among the 4 instruments.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Cornea/dg [Diagnostic Imaging]; Female; *Glaucoma, Angle-Closure/di [Diagnosis]; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Patient Satisfaction; Prospective Studies; *Tonometry, Ocular/is [Instrumentation]; Tonometry, Ocular/mt [Methods]; Ultrasonography; Young Adult

Novel 3D computer-automated threshold Amsler grid visual field testing of scotomas in patients with glaucoma. - Nguyen, Dieuthu T; Fahimi, Ali; Fink, Wolfgang; Nazemi, Paul P; Kim, Janet K; Sadun, Alfredo A (European journal of ophthalmology, 2009)
PURPOSE: Three-dimensional (3D) computer-automated threshold Amsler grid testing was used to identify and characterize scotomas typical of glaucoma., METHODS: The 3D test exhibits a grid on a computer screen at a preselected grayscale and angular resolution, and allows patients to trace those areas on the grid that are missing in their visual field using a touch screen. Eleven eyes in patients with an established diagnosis of glaucoma were examined according to the above protocol. A total of 23 eyes from normal subjects were used as controls. The 5-minute test required that patients repeatedly outline scotomas on a touch screen with varied displays of contrast while maintaining their gaze on a central fixation marker. A 3D depiction of the visual field defects was then obtained that was further characterized by the location, shape, extent, depth, and slope of the scotomas., RESULTS: In this pilot study, the 3D depiction of visual field loss demonstrated paracentral, superior and inferior altitudinal, and nasal step defects consistent with glaucomatous damage. The 3D depiction showed a shape, extent, depth, and slope that are consistent with the severity of damage., CONCLUSIONS: The 3D test identified and characterized scotomas typical of glaucoma. The test provides several advantages over conventional perimetry including additional information through 3D depiction of scotomas with the addition of contrast sensitivity and a higher angular/spatial resolution. Improved patient compliance and reliability through shorter testing time and potential interactive accessibility and distribution over the Internet further characterize the test.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; *Imaging, Three-Dimensional/mt [Methods]; Intraocular Pressure; Male; Middle Aged; Pilot Projects; *Scotoma/di [Diagnosis]; Visual Acuity; *Visual Field Tests/is [Instrumentation]; *Visual Fields

Risk factors for contact lens bacterial contamination during continuous wear. - Szczotka-Flynn, Loretta B; Bajaksouzian, Saralee; Jacobs, Michael R; Rimm, Alfred (Optometry and vision science : official publication of the American Academy of Optometry, 2009)
PURPOSE: Microbial contamination of contact lenses is associated with corneal infection and inflammation. This study determined the microbiological, clinical, and demographic factors that are associated with bacterial contamination of a silicone hydrogel contact lens when worn for continuous wear (CW)., METHODS: Two hundred five healthy subjects were enrolled in the Longitudinal Analysis of Silicone Hydrogel Contact Lens Study and were fitted with lotrafilcon A lenses for monthly CW and followed for 1 year. Lenses were aseptically removed after 1 week and 4 months of wear and cultured using an agar sandwich technique. Lids and conjunctiva were routinely cultured at baseline and after 1 week and 4 months of CW. Lenses and ocular sites were considered to have substantial microbial bioburden when they harbored pathogenic organisms or high levels of commensal organisms. Univariate and multivariate logistic regression analyses were conducted to examine whether substantial conjunctival or lid bioburden, subject demographics, lens-wearing history, symptoms, and biomicroscopic signs were associated with lens bioburden., RESULTS: About one third (32.4%) of subjects had substantial bacterial bioburden in either eye across multiple visits. Over half (53.2%) and about one tenth (11.7%) of subjects had substantial lid and conjunctival bioburden, respectively, and 11.2% discontinued because of discomfort. The adjusted odds ratios (and 95% confidence intervals) for presence of substantial lens bioburden were 2.49 (1.17-5.30), 4.24 (1.45-12.40), and 4.11 (1.17-14.46) for substantial lid bioburden, substantial conjunctival bioburden, and lens discomfort, respectively., CONCLUSIONS: Bacterial contamination of silicone hydrogel contact lenses is common during CW. Substantial lens bioburden is associated with discomfort precluding successful CW. The presence of substantial lid and conjunctival bioburden is associated with a 2.5-fold and more than fourfold greater risk of substantial lens bioburden and is likely the major route of contamination.
Keywords: Adolescent; Adult; *Bacteria/ip [Isolation & Purification]; Cohort Studies; Colony Count, Microbial; Conjunctiva/mi [Microbiology]; *Contact Lenses, Extended-Wear/mi [Microbiology]; *Contact Lenses, Hydrophilic/mi [Microbiology]; *Equipment Contamination; Eyelids/mi [Microbiology]; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Hydrogels; Longitudinal Studies; Middle Aged; Multivariate Analysis; Office Visits; Prospective Studies; Risk Factors; Silicones; Young Adult

Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice. - Friedman, David S; Hahn, Steven R; Quigley, Harry A; Kotak, Sameer; Kim, Elizabeth; Onofrey, Meaghan; Eagan, Corey; Mardekian, Jack (Ophthalmology, 2009)
PURPOSE: To assess doctor-patient communication in patients with glaucoma., DESIGN: Observational cohort study., PARTICIPANTS: Twenty-three ophthalmologists and 50 patients with glaucoma., METHODS: Doctor-patient encounters were audio- and videotaped and analyzed using validated sociolinguistic approaches. After the visit, the doctor and the patient completed questionnaires, and patients were interviewed using a semistructured, patient-centered protocol., MAIN OUTCOME MEASURES: Summary statistics about doctor-patient encounters, assessment of alignment of attitudes between patients and doctors, and patient admission to missing doses., RESULTS: Physicians spent an average of 8.0 (standard deviation [SD], 3.1; median, 7.8) minutes in the room with the patient and an average of 5.8 (SD, 2.4; median, 7.5) minutes talking with the patient, delivering 70% of all spoken words and asking two thirds of all questions. Glaucoma-related discussion occupied 50% of talk time and was focused primarily on examinations and treatment (25%). One third of discussions addressed ocular issues other than glaucoma. Virtually all physician questions (94%) were closed ended. Most patient questions were about intraocular pressure (20% of visits), details of the medication regimen (20%), disease status (14%), and testing (12%). Although physicians and patients were aligned in believing that the physician should control the visit agenda, physicians tended to support greater physician control of decision making than did patients. Physicians failed to identify most patients who admitted to missing doses, a surrogate for nonadherence, stating that 10 of 13 in this category were taking drops "all" or "most" of the time. Physician interviews detected 3 of the 11 patients whose postvisit questionnaire indicated missing a dose in the last week compared with 11 of the 11 detected by the postvisit research interview. Patients who stated they had missed doses recently reported being less satisfied with the doctor-patient encounter than those who did not., CONCLUSIONS: Doctor-patient dialogue was universally physician centered; physicians spoke 70% of the words and asked closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses. A minority of physicians ever asked patients if they had questions. In contrast with the patient-centered research interview, doctors' physician-centered communication failed to identify most patients who had missed doses.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cohort Studies; *Communication; Female; *Glaucoma/dt [Drug Therapy]; Health Behavior; Humans; Male; Middle Aged; Motivation; *Patient Compliance/px [Psychology]; Patient Education as Topic; *Patient-Centered Care; *Physician-Patient Relations; Surveys and Questionnaires; Video Recording

The need and total cost of Finnish eyecare services: a simulation model for 2005-2040. - Tuulonen, Anja; Salminen, Hannu; Linna, Miika; Perkola, Markku (Acta ophthalmologica, 2009)
PURPOSE: The aims of this study were: (i) to create a structural simulation model capable of predicting the future need and cost of eyecare services in Finland; and (ii) to test and rank different policy alternatives for access to care and the required physician workforce., METHODS: Using the system dynamics approach, the number and cost of patients with cataract, glaucoma, diabetic retinopathy and age-related macular degeneration (AMD) were described with causal-loop diagrams and were then translated into a set of mathematical equations to build a computer simulation model. Mathematically, the problem was formulated as a set of differential equations that were solved numerically with specialized software. The validity of the model was tested against prevalence and administrative historical data. The costs covered by the public sector in Finland were obtained from 2003 from the Finnish Hospital Discharge Register (including outpatient care), the Finnish Social Insurance Institution and a survey of hospital price lists. Different levels of access to public care were then simulated in four eye diseases, for which the model estimated the need for services and resources and their costs in the years 2005-2040., RESULTS: The model forecasted that the adoption of the 2005 national 'access to care' criteria for cataract surgery would shorten waiting lists. If the workload of Finnish ophthalmologists were kept at the 2003 level, the graduation rate of new ophthalmologists would have to increase by 75% from the current level. If all glaucoma patients were followed in the public sector in future, even this increase in training would not meet the demand for physician workforce. The current model indicated that the screening frequency of diabetes can be increased without large sacrifices in terms of costs. AMD therapy has a significant role in the allocation of future resources in eyecare. The modelling study predicted that ageing alone will increase the costs of eyecare during the next four decades in Finland by about 1% per year in real terms (undiscounted and without inflation of unit costs). The increases in total yearly costs were on average 8.6% between 2001 and 2003., CONCLUSIONS: The results of this modelling study indicate that policy initiatives, such as defining criteria for access to care, can have substantial implications on the demand for care and waiting times whereas the effect of ageing alone was relatively small. Measures to control several other factors - such as the adoption and price level of new technologies, treatments and practice patterns - will be at least equally important in order to restrain healthcare costs effectively.
Keywords: Computer Simulation; Finland; *Health Care Costs; Health Services Accessibility; *Health Services Needs and Demand; Humans; *Models, Economic; *Models, Organizational; *Ophthalmology/ec [Economics]

Boston keratoprosthesis outcomes and complications. - Chew, Hall F; Ayres, Brandon D; Hammersmith, Kristin M; Rapuano, Christopher J; Laibson, Peter R; Myers, Jonathan S; Jin, Ya-Ping; Cohen, Elisabeth J (Cornea, 2009)
PURPOSE: To evaluate the outcomes of the Boston Keratoprosthesis (KPro) at our institution., METHODS: A computerized database retrospectively identified all patients who received a Boston KPro from August 2005 to October 2007., RESULTS: There were 37 patients, 24 (65%) were male. Mean age was 66.3 years (median 69 years, range: 24-93 years; SD = 18.1 years). Mean follow-up was 16 months (range: 6-28 months; SD = 6.0 months). There were 36 type 1 (97%) and 1 type 2 (3%) KPros. The primary indication was failed penetrating keratoplasty in 29 patients (78%)-22 (59%) from multiple failures. Preoperative comorbidities included glaucoma [27 patients (73%)] and limbal stem cell deficiency [13 patients (35%)]. No intraoperative complications occurred. Postoperative complications included retroprosthetic membrane [24 patients (65%)], increased intraocular pressure [14 patients (38%)], glaucoma progression [5 patients (13.5%)], and endophthalmitis [4 patients (11%)-3 who discontinued prophylactic antibiotics secondary to compliance]. Thirty-six KPros (97%) were retained-1 type 2 KPro (3%) in a patient with ocular cicatricial pemphigoid extruded and was replaced. Mean best-corrected visual acuities were counting fingers preoperatively (range: light perception to 20/100) and 20/90 at last follow-up (range: light perception to 20/25). At last follow-up, 31 patients (84%) improved 2 lines or greater-3 patients (8%) had worse vision., CONCLUSIONS: Retention rates were excellent, and best-corrected visual acuities improved in the vast majority of patients. Complications can occur and require frequent follow-up to monitor and treat glaucoma progression, endophthalmitis, and inflammation. Patient compliance is of paramount importance. Despite the potential complications, the Boston KPro provides visual improvement in patients with an otherwise poor prognosis.
Keywords: Adult; Aged; Aged, 80 and over; *Artificial Organs; *Cornea; Corneal Diseases/su [Surgery]; Female; Graft Survival/ph [Physiology]; Humans; *Intraoperative Complications; Male; Middle Aged; *Postoperative Complications; *Prostheses and Implants; *Prosthesis Implantation; Retrospective Studies; Treatment Outcome; Visual Acuity/ph [Physiology]

Glaucoma club: a successful model to educate glaucoma patients. - Kong, Xiangmei; Chen, Xueli; Sun, Xinghuai; Xiao, Ming; Zuo, Lei; Guo, Wenyi (Clinical & experimental ophthalmology, 2009)
Keywords: Adult; Aged; Aged, 80 and over; China; Female; *Glaucoma; Humans; Male; Middle Aged; *Models, Educational; *Ophthalmology/ed [Education]; Patient Compliance; *Patient Education as Topic/mt [Methods]; Physician-Patient Relations; *Self-Help Groups/og [Organization & Administration]; Societies, Medical/og [Organization & Administration]; Young Adult

Notable role of glaucoma club on patients' knowledge of glaucoma. - Chen, Xueli; Chen, Yuhong; Sun, Xinghuai (Clinical & experimental ophthalmology, 2009)
PURPOSE: To assess how general glaucoma patients understand their disease compared with patients from the Shanghai Glaucoma Club and various influencing factors as well. Shanghai Glaucoma Club was further evaluated to determine its efficacy on its members' understanding and knowledge of glaucoma., METHODS: A total of 301 glaucoma patients in Shanghai Glaucoma Club and 314 general glaucoma patients were investigated by a questionnaire, composed of three parts and consisting of 20 questions. The first part asked questions about 'level of cognition about glaucoma', the second part was about 'compliance of medication and follow-up', and the third part was about 'life style and habit'. Answers were graded on each question and scores were summed up separately for each part and as a total. Differences of scores and influencing effects were analysed using multivariate linear regression (stepwise) between the two groups., RESULTS: The average total scores of the general glaucoma patients and the glaucoma club members were 19.6 +/- 5.4 and 23.8 +/- 4.0 (t = -11.14 P < 0.01), respectively. After multivariate linear regression adjustment for the effects of age, diagnosis and educational level glaucoma club members still had 3.73 points edge over the general patients.(t = 8.14, P < 0.01). The club was shown to be the strongest positive factor influencing patients' cognition. Patients in Shanghai Glaucoma Club understood the nature and course of glaucoma significantly better than the general glaucoma patients (t = 10.97, P < 0.01) and also lived healthier lives (t = 7.55, P < 0.01). The level of background education was found to be a positive influencing factor although age was negatively correlated with total score. Primary glaucoma patients demonstrated better cognition of their diseases compared with secondary glaucoma patients, and those patients unaware of their type of glaucoma produced lower scores., CONCLUSIONS: This study demonstrated significant differences regarding the basic understanding of glaucoma between two groups: general glaucoma patients and members of the Shanghai Glaucoma Club. Club members presented with better cognition of glaucoma and self-management compared with general glaucoma patients. Therefore, the Shanghai Glaucoma Club is an effective medium to improve patients' knowledge of disease and compliance for medication.
Keywords: Adult; Aged; China; Educational Status; Female; *Glaucoma; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Ophthalmology/ed [Education]; Patient Compliance; *Patient Education as Topic; *Self-Help Groups/og [Organization & Administration]; Surveys and Questionnaires

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes. - Parihar, Jitendra K S; Vats, Devendra P; Maggon, Rakesh; Mathur, Vijay; Singh, Anirudh; Mishra, Sanjay K (Indian journal of ophthalmology, 2009)
AIM: To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes., SETTINGS AND DESIGN: Retrospective interventional case series study., MATERIALS AND METHODS: Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months, RESULTS: Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 +/- 15.7 mm Hg to 19.6 +/- 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV., CONCLUSION: The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.
Comment in (CIN), Comment in (CIN)
Keywords: Adult; *Anterior Chamber/su [Surgery]; *Cataract/co [Complications]; Follow-Up Studies; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; *Glaucoma Drainage Implants; Humans; *Intraocular Pressure/ph [Physiology]; *Keratoplasty, Penetrating/mt [Methods]; Lens Implantation, Intraocular/mt [Methods]; Middle Aged; Patient Satisfaction; Phacoemulsification/mt [Methods]; Retrospective Studies; Time Factors; Treatment Outcome

[Use of fibrin glue in ocular surgery]. - Dal Pizzol, Melissa Manfroi; Roggia, Murilo Felix; Kwitko, Sergio; Marinho, Diane Ruschel; Rymer, Samuel (Arquivos brasileiros de oftalmologia, 2009)
PURPOSE: To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries., METHODS: A retrospective and non-comparative case series study. 161 eyes were evaluated. The mean age was 51.8 years. Fibrin glue (Beriplast--Aventis Behring, Germany) was used in all patients for tissue adherence or incisional closure., RESULTS: Main preoperatives diseases were pterygium (76 patients), superior limbic keratoconjunctivitis (4 patients), limbal tumor (4 patients), conjunctivochalasis (21 patients), bullous keratopathy (31 patients), limbal stem cell deficiency (7 patients), alkali injury (6 patients), Stevens-Johnson syndrome (2 patients), cataract (5 patients) and glaucoma (5 patients). Complications occurred in 28 patients (17.4%). Detachment of the fixed tissue and granulomatous foreign body reaction were the main complications. Detachment occurred in 10 cases (5.6%) (7 in amniotic membrane transplantation in bullous keratopathy, 2 in autologous conjunctival grafting for pterygium surgery, 1 in autologous limbal transplantation in a Stevens-Johnson syndrome). Granulomatous foreign body reaction was described in 9 patients (5.6%) (5 in amniotic membrane transplantation due to acute alkali injury, 1 in autologous limbal graft due to chronic burn injury, and 3 in autologous conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery., CONCLUSION: Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation or incisional closure presenting low rates of complications in ocular surface and anterior segment surgeries.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Brazil; Child; Child, Preschool; Eye Diseases/cl [Classification]; *Eye Diseases/su [Surgery]; *Fibrin Tissue Adhesive/ae [Adverse Effects]; Fibrin Tissue Adhesive/tu [Therapeutic Use]; Granuloma, Foreign-Body/ci [Chemically Induced]; Humans; Middle Aged; Ophthalmologic Surgical Procedures/cl [Classification]; Ophthalmologic Surgical Procedures/mt [Methods]; *Ophthalmologic Surgical Procedures; Retrospective Studies; Time Factors; *Tissue Adhesives/ae [Adverse Effects]; Tissue Adhesives/tu [Therapeutic Use]; Young Adult

[Awareness and quality of life in patients with glaucoma]. - Skorkovska, K; Cesnekova, T; Skorkovska, S (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2009)
PURPOSE: To test the Czech version of a validated questionnaire in assessing health-related quality of life in patients with glaucoma and also determine the level of understanding of their disease., METHODS: Quality of life was assessed using the NEI-VFQ 25 (National Eye Institute - Visual Function Questionnaire) in 20 patients with open-angle glaucoma. Results of the questionnaire were processed by standardized methods and a score between 0 and 100 was assigned to each of the 12 subscales, where 100 represents the best possible score on the scale and 0 represents the worst. The awareness of patients about glaucoma was elicited by 9 questions concerning the origin, course, diagnostic methods and prognosis of glaucoma., RESULTS: The lowest scores in our study group were associated with the subscales of general vision (61.4 +/- 19.7), mental health (61.4 +/- 17.4), role limitations (72.1 +/- 26.7), and dependency (58.3 +/- 23). Our knowledge inquiry revealed poor level of knowledge about glaucoma in our study group., CONCLUSIONS: in our study, the NEI-VFQ 25 proved to be useful and the scores comparable to the results published abroad. The results of our knowledge inquiry suggest that there is an urgent need for patients to receive more information. Patients who are more knowledgeable of their condition are more likely to be adherent to treatment.
Keywords: Aged; Aged, 80 and over; *Attitude to Health; *Glaucoma, Open-Angle/px [Psychology]; Humans; Middle Aged; *Patient Education as Topic; *Quality of Life; Surveys and Questionnaires

Smoothing the intraocular pressure roller coaster: a new goal?. - Jay Katz, L; Myers, Jonathan S (American journal of ophthalmology, 2009)
Comment on (CON)
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Patient Compliance; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Risk Factors; *Timolol/tu [Therapeutic Use]; Tonometry, Ocular; Treatment Outcome

Brinzolamide/timolol fixed combination: a new ocular suspension for the treatment of open-angle glaucoma and ocular hypertension. - Hollo, Gabor; Bozkurt, Banu; Irkec, Murat (Expert opinion on pharmacotherapy, 2009)
For the treatment of open-angle glaucoma, the most frequent cause of irreversible visual loss, fixed combinations of different topical intraocular pressure (IOP) lowering molecules have gained an important role in recent years. The use of fixed combinations reduces the number of daily instillations, which promotes adherence to the prescribed medication and diminishes the exposition of the ocular surface to preservatives. The fixed combination of brinzolamide and timolol was recently approved by the European Medicines Agency (EMEA) and is now available in several countries in Europe. It contains two molecules widely used to treat glaucoma: timolol 0.5% (5 mg/ml) and brinzolamide 1% (10 mg/ml) in ophthalmic suspension formulation. This fixed combination is approved for twice-daily instillation to reduce elevated IOP in open-angle glaucoma and ocular hypertension. The brinzolamide/timolol fixed combination provides an approximately 30-33% IOP reduction from the untreated baseline IOP of 25-27 mmHg; thus, it is more potent than either of its ingredients alone. It is similarly effective but better tolerated than the dorzolamide/timolol fixed combination, which consists of molecules from the same pharmacological classes. The brinzolamide/timolol fixed combination can be used by itself as a separate therapy, but owing to the additivity of its ingredients to IOP-lowering drugs belonging to other classes, it may also be administered adjunctive to other IOP-reducing molecules, most importantly topical prostaglandin analogues. The ocular and systemic tolerance of the brinzolamide/ timolol fixed combination was reported favorable in Phase III studies, but no long-term clinical experience with this preparation is available at present.
Keywords: Administration, Topical; Antihypertensive Agents/pk [Pharmacokinetics]; Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/pk [Pharmacokinetics]; Carbonic Anhydrase Inhibitors/pd [Pharmacology]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Sulfonamides/pk [Pharmacokinetics]; Sulfonamides/pd [Pharmacology]; *Sulfonamides/tu [Therapeutic Use]; Suspensions; Thiazines/pk [Pharmacokinetics]; Thiazines/pd [Pharmacology]; *Thiazines/tu [Therapeutic Use]; Timolol/pk [Pharmacokinetics]; Timolol/pd [Pharmacology]; *Timolol/tu [Therapeutic Use]

The PCP's role in chronic open-angle glaucoma. - Lin, Albert P; Orengo-Nania, Silvia; Braun, Ursula K (Geriatrics, 2009)
Chronic open-angle glaucoma is a leading cause of blindness and visual impairment in older adults. Optic nerve damage and the associated peripheral and subsequent central vision loss are irreversible, but early diagnosis and treatment will give patients the best chance to maintain functional vision and quality of life. Primary care physicians can assist with the diagnosis of glaucoma by making appropriate referrals for routine ophthalmic examinations, especially in patients with risk factors for glaucoma. Medication adherence and persistence may also be enhanced by discussing strategies to improve medication use and efficacy in the primary care setting. Recognition of adverse reactions from glaucoma medications and surgeries will allow proper management of these potentially serious conditions. Patients with advanced visual deficits can still benefit from treatment as well as low-vision and supportive care and should be referred for an ophthalmic evaluation. With an understanding of comprehensive glaucoma management, primary care physicians play an invaluable role in assisting their patients with effective and timely therapy that will result in improved outcomes.
Keywords: Aged; Blindness/et [Etiology]; *Blindness/pc [Prevention & Control]; Diagnostic Techniques, Ophthalmological; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Primary Health Care; Referral and Consultation

Long-term surgical outcomes of primary congenital glaucoma in China. - Zhang, Xiulan; Du, Shaolin; Fan, Qian; Peng, Shouxiong; Yu, Minbin; Ge, Jian (Clinics (Sao Paulo, Brazil), 2009)
OBJECTIVE: To evaluate the long-term outcomes of three surgical procedures for the treatment of primary congenital glaucoma (PCG)., INTRODUCTION: PCG is one of the main causes of blindness in children. There is a paucity of contemporary data on PCG in China., METHODS: A retrospective study of 48 patients (81 eyes) with PCG who underwent primary trabeculectomy, trabeculotomy, or combined trabeculotomy and trabeculectomy (CTT)., RESULTS: All patients were less than 4 years (yrs) of age, with a mean age of 2.08 +/- 1.23 yrs. The mean duration of follow-up was 5.49 +/- 3.09 yrs. The difference in success rates among the three surgical procedures at 1, 3, 6 and 9 yrs was not statistically significant (p = 0.492). However, in patients with over 4 yrs of follow-up, Kaplan-Meier survival analysis revealed that the success rates of trabeculectomy and CTT declined more slowly than that of trabeculotomy. Among the patients, 66.22% acquired good vision (VA > 0.4), 17.57% acquired fair vision (VA = 0.1 - 0.3), and 16.22% acquired poor vision (VA < 0.1). The patients with good vision were mostly in the successful surgery group. Myopia was more prevalent postoperatively (p = 0.009). Reductions in the cup-disc ratio and corneal diameter were only seen in the successful surgery group (p = 0.000). In addition, the successful surgery group contained more patients that complied with a regular follow-up routine (p = 0.002)., DISCUSSION: Our cases were all primary surgeries. Primary trabeculectomy was performed in many cases because no treatment was sought until an advanced stage of disease had been reached., CONCLUSIONS: In contrast to most reports, in the present study, trabeculectomy and CTT achieved higher long-term success rates than trabeculotomy. The patients with successful surgical results had better vision. Compliance with a routine of regular follow-up may increase the chances of a successful surgical outcome.
Keywords: Child; Child, Preschool; China; Epidemiologic Methods; *Glaucoma/cn [Congenital]; *Glaucoma/su [Surgery]; Humans; Infant; Intraocular Pressure/ph [Physiology]; Long-Term Care; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy/mt [Methods]; Treatment Outcome

[Preliminary clinical study of Descemet's stripping with endothelial keratoplasty for bullous keratopathy]. - Huang, Ting; Wang, Yu-juan; Gao, Na; Chen, Jia-qi ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2009)
OBJECTIVE: To investigate the indications, surgical procedure, clinical efficacy, and the prevention and management of complications of Descemet's stripping with endothelial keratoplasty (DSEK) for bullous keratopathy., METHODS: In the nonrandomized retrospective consecutive case series, 8 patients (8 eyes) with bullous keratopathy at Zhongshan Ophthalmic Center between September 2006 and October 2007 underwent DSEK surgery. During the surgical procedure, the Descemet's membrane and abnormal endothelial layer were stripped from the central recipient posterior surface with 7.75 mm diameter, and then a specially designed scraper was used to roughen the peripheral recipient posterior stroma. Other surgical techniques were the same with routine DSEK surgery. The adherence of the donor lenticule to the recipient posterior stroma and postoperative donor lenticule dislocation were monitored in the early stage after surgery. Best spectacle-corrected visual acuity (BSCVA), graft clearance, corneal astigmatism and endothelial cell density (ECD) were observed over a 3-9 months follow-up period., RESULTS: All donor lenticules were well adherent to the recipient posterior stroma and no graft dislocation occurred postoperatively. One patient had papillary block glaucoma at 1-day, and relieved after 48 hours postoperative. All grafts remained transparent, and had improved visual acuity. BSCVA was 0.3 - 0.7 postoperative. Six patients with preoperative pain had been pain free after DSEK procedure. Mean corneal astigmatism was (1.90 +/- 0.70) diopter (D). Mean ECD was (2014 +/- 192) cells/mm(2)., CONCLUSIONS: Compared with deep lamellar endothelial keratoplasty (DLEK), DSEK procedure is technically easier and less traumatic to recipient cornea and anterior chamber structures. The skill of roughening the peripheral recipient posterior stroma should prevent postoperative graft dislocation effectively.
Keywords: Adult; Aged; *Corneal Diseases/su [Surgery]; *Descemet Membrane/su [Surgery]; *Descemet Stripping Endothelial Keratoplasty; Endothelium, Corneal/tr [Transplantation]; Female; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Treatment Outcome

[The management of glaucoma patients in Romania: analysis of an evaluation questionnaire]. - Chiselita, D; Apreutesei, Nicoleta (Oftalmologia (Bucharest, Romania : 1990), 2009)
PURPOSE: To evaluate the situation of glaucoma patients' management in Romania., METHOD: A questionnaire was presented to 400 ophthalmologists with experience in glaucoma management; they have responded anonymously to 32 questions. The obtained data were subject to statistical analysis (mean, standard deviation, statistical significance)., RESULTS: 327 ophthalmologists have responded; 70% have more than 10 years of practice; 50% are each managing 100 to 500 glaucoma patients. 2/3 of participants are using the Goldmann aplanotonometer, 38% are assessing visual field in automated perimetry, 61% are examining the optic discs using an direct ophthalmoscope and 80% are currently performing gonioscopy. 55% are treating ocular hypertension under special circumstances, 93% are using initial monotherapy, 3/4 are using prostaglandin derivates as initial therapy and 79% are resorting to fixed combinations when the initial monotherapy has become inefficient. Most participants desire to use modern diagnostic methods and treatments in glaucoma, to continuously improve the education in glaucoma management and to collaborate efficiently with other healthcare partners., CONCLUSIONS: The questionnaire has provided useful information on the quality of glaucoma patients care in Romania; if it is periodically repeated (with necessary updates) it will reflect the dynamic of this issue in our country
Keywords: *Clinical Competence/st [Standards]; *Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Patient Compliance; *Physician's Role; Quality of Health Care/st [Standards]; Romania; *Surveys and Questionnaires

The impact of a glaucoma nurse specialist role on glaucoma waiting lists. - Slight, Carol; Marsden, Janet; Raynel, Susanne (Nursing praxis in New Zealand inc, 2009)
Over the last two decades there has been an increasing demand on health care services. This has led to increased waiting lists and waiting times to access public hospital services. In ophthalmic practice an aging population and technological advances have been major contributors to this situation. The challenge for health care providers is how to manage waiting lists within the resources provided and targets set by Elective Services, a department of the Ministry of Health (MoH). The Ministerial Taskforce on Nursing (1998) highlighted that nurses are an underutilised resource. Subsequent to the Ministerial Taskforce, the availability of interim funding from Elective Services and a skilled speciality nursing workforce the Ophthalmology Department at a large metropolitan hospital was able to implement an advanced nursing role with respect to glaucoma management. Early diagnosis is important in reducing the risk of permanent visual impairment from primary open angle glaucoma; therefore the length of time to diagnosis can have long term implications for the patient. Patients for the 'nurse-led' glaucoma clinic were recruited from specific categories of glaucoma patients on the waiting list. An audit of the impact on the waiting list was undertaken periodically over a two year period. The audit following the introduction of the clinical nurse specialist clinic shows a marked reduction in waiting list numbers and length of time waiting for first specialist assessment for glaucoma. The implementation of this role proved to be successful and has subsequently become a permanent nurse specialist position in the ophthalmology department.
Keywords: Aged; Early Diagnosis; Glaucoma/di [Diagnosis]; *Glaucoma/nu [Nursing]; *Health Services Accessibility; Humans; New Zealand; *Nurse Clinicians; *Nursing Audit; *Waiting Lists

In-office diagnostic equipment rental. - Anonymous (Optometry (St. Louis, Mo.), 2009)
Keywords: *Diagnostic Equipment/ec [Economics]; *Glaucoma/di [Diagnosis]; Humans; *Leasing, Property/og [Organization & Administration]; *Office Visits; *Optometry/ec [Economics]; *Optometry/is [Instrumentation]

Ophthalmologist attitudes regarding fixed combination treatment for glaucoma in the European Union. - Stewart, William C; Kruft, Bonnie; Nelson, Lindsay A; Stewart, Jeanette A (European journal of ophthalmology, 2009)
PURPOSE: To survey ophthalmologists in the European Union to determine their fixed combination (FC) preferences., METHODS: A multiple-choice survey was sent to randomly chosen ophthalmologists throughout the European Union and bordering countries by electronic mail delivery. Ophthalmologists were resent the survey on two more occasions if no response was obtained., RESULTS: In total, 50 surveys were received from 530 distributed (9.4% response) from 16 countries. More ophthalmologists prescribed an FC as second (80%) or third choice (64%) therapy than first choice (30%, p=0.0036). As first (p<0.0001) and third choice (p=0.011), the dorzolamide/timolol FC was most commonly prescribed, while as second choice the latanoprost/timolol FC (p<0.0001) was most popular. Overall, 98% (49/50) of doctors believed FC therapy improved patient care most often by better compliance (n=49) and quality of life(n=48, p<0.0001). Most ophthalmologists believed that there was a difference in efficacy between the FC products (32/50, 64%) with the most effective being the bimatoprost/timolol FC (n=12, 24%, p=0.029). However, fewer ophthalmologists perceived safety differences between the products (34/50, 68%). For prostaglandins, dosing time was suggested in the morning by 18 (36%) ophthalmologists and in the evening by 24 (48%) (p=0.35)., CONCLUSIONS: FCs in the European Union are a potentially popular method to reduce intraocular pressure, being prescribed most commonly as second or third choice therapy. The perceived advantages to FC therapy are greater adherence to the medicine and improved patient quality of life.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Attitude of Health Personnel; Brimonidine Tartrate; *Drug Combinations; European Union; *Glaucoma/dt [Drug Therapy]; Health Care Surveys; Humans; *Intraocular Pressure/de [Drug Effects]; *Ophthalmology/sn [Statistics & Numerical Data]; Patient Compliance; Pilocarpine/ad [Administration & Dosage]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Quality of Life; Quinoxalines/ad [Administration & Dosage]; Sulfonamides/ad [Administration & Dosage]; Surveys and Questionnaires; Thiophenes/ad [Administration & Dosage]; Timolol/ad [Administration & Dosage]

Gene therapy targeting glaucoma: where are we?. - Liu, Xuyang; Rasmussen, Carol A; Gabelt, B'ann T; Brandt, Curtis R; Kaufman, Paul L (Survey of ophthalmology, 2009)
In a chronic disease such as glaucoma, a therapy that provides a long lasting local effect with minimal systemic side effects, while circumventing the issue of patient compliance, is very attractive. The field of gene therapy is growing rapidly and ocular applications are expanding. Our understanding of the molecular pathogenesis of glaucoma is leading to greater specificity in ocular tissue targeting. Improvements in gene delivery techniques, refinement of vector construction methods, and development of better animal models combine to bring this potential therapy closer to reality.
Keywords: Animals; Disease Models, Animal; Gene Transfer Techniques; *Genetic Therapy/mt [Methods]; Genetic Therapy/td [Trends]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure; *Optic Nerve Diseases/th [Therapy]

Self-tonometry in glaucoma management--past, present and future. - Liang, Steve Y-W; Lee, Graham A; Shields, David (Survey of ophthalmology, 2009)
Glaucoma is the leading cause of irreversible blindness in the world. Diagnosis and management of glaucoma is significantly associated with intraocular pressure, but contemporary office-based measurements are not sufficient to discover diurnal changes and spikes, nor do they demonstrate the effect of medication and compliance. Patient-directed self-tonometry can be taken throughout the day and is therefore the subject of much discussion and research. In this article we review the history of self-tonometry devices and present technologies for the future.
Erratum in (EIN)
Keywords: Circadian Rhythm/ph [Physiology]; *Glaucoma/di [Diagnosis]; Humans; *Intraocular Pressure/ph [Physiology]; *Monitoring, Ambulatory/td [Trends]; Reproducibility of Results; *Self Care/td [Trends]; Tonometry, Ocular/is [Instrumentation]; *Tonometry, Ocular/td [Trends]

Creating patient value in glaucoma care: applying quality costing and care delivery value chain approaches--a five-year case study in the Rotterdam Eye Hospital. - de Korne, Dirk F; Sol, Kees; Custers, Thomas; van Sprundel, Esther; van Ineveld, B Martin; Lemij, Hans G; Klazinga, Niek S (International journal of health care quality assurance, 2009)
PURPOSE: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains., DESIGN/METHODOLOGY/APPROACH: In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands., FINDINGS: The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non-compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion "patient value" needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes., RESEARCH LIMITATIONS/IMPLICATIONS: The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings., ORIGINALITY/VALUE: QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.
Keywords: Costs and Cost Analysis; Data Collection; Delivery of Health Care/ec [Economics]; *Delivery of Health Care/og [Organization & Administration]; *Glaucoma/th [Therapy]; Health Services Accessibility/og [Organization & Administration]; Health Services Needs and Demand/og [Organization & Administration]; Humans; Netherlands; *Organizational Case Studies; *Patient Satisfaction; Process Assessment, Health Care/og [Organization & Administration]; Quality Indicators, Health Care/og [Organization & Administration]; Quality of Health Care/ec [Economics]; *Quality of Health Care/og [Organization & Administration]; Reimbursement, Incentive; Retrospective Studies

Registered nurse-led Group Medical Appointments for preoperative cataract patients. - Burlew-Quartey, Julie A (Insight (American Society of Ophthalmic Registered Nurses), 2009)
In summary, our findings have found the Registered Nurse Led Group Medical Appointments for preoperative cataract patients to be very beneficial for both our patients and providers. This type of preoperative education fully utilizes the expertise of the CRNO in a way that is professionally rewarding to the nurse and adds value to the entire ophthalmic team. Due to the success of this program, we are now considering building a nurse led group educational program that would meet the needs of our patients with macular degeneration and glaucoma. Additionally, as a result of this study a new position (0.75 FTE) was created in the Ophthalmology Department at Palo Alto Medical Foundation for an Ophthalmic Nurse Educator.
Keywords: *Appointments and Schedules; *Cataract Extraction/nu [Nursing]; Georgia; Humans; *Nursing, Supervisory/og [Organization & Administration]; *Practice Guidelines as Topic; *Preoperative Care/nu [Nursing]

Effect of selected antihypertensives, antidiabetics, statins and diuretics on adjunctive medical treatment of glaucoma: a population based study. - Iskedjian, M; Walker, J H; Desjardins, O; Robin, A L; Covert, D W; Bergamini, M V W; Einarson, T R (Current medical research and opinion, 2009)
BACKGROUND: The prevalence of open angle glaucoma increases with age, with many patients also receiving medications for non-ocular systemic diseases. Little is known about how systemic medications impact on the need for adjunctive therapy with prostaglandin analogues (PGA)., OBJECTIVES: To evaluate whether systemic medications for hypertension, cholesterol, or glucose influence the need for adjunctive intraocular pressure (IOP) lowering medications in patients using PGAs., METHODS: Pharmaceutical records from the Quebec prescription database provided a sample of patients receiving prescriptions for bimatoprost, latanoprost, or travoprost, from which subjects receiving > or =1 prescription for antihypertensives, antidiabetics. diuretics, and statins were identified. Chi-square tests compared proportions using PGAs to those using PGAs + adjunctive therapy, based on the use or non-use of systemic medications; a logistic regression was performed post hoc to adjust for gender and age., RESULTS: Of the 8548 evaluated patients (all using PGAs); 2934 (34.3%) took none of the studied systemic drugs. For the 5614 patients taking systemic medications, significantly fewer (p < 0.001) required an additional IOP lowering medication if taking a systemic antihypertensive medication. The use of a statin or a diabetic medication, alone or in combination, in addition to a PGA, made no significant difference in the need for adjunct glaucoma therapy. Individual drugs associated with significantly less utilization of adjunctive glaucoma medications were calcium-channel blockers, angiotensin-converting enzyme (ACE), and combination antihypertensive therapies., DISCUSSION: A profound association between systemic antihypertensive use and a reduced need for adjunct topical IOP lowering medications in patients using the same prostaglandin analogue for at least one year was found., LIMITATIONS: The use of a prescription claims database without patient compliance or patient outcomes may not reflect actual patient medication use. In addition, these findings may not be applicable to all patients initiating prostaglandin analogues., CONCLUSIONS: In this real-world population-based evaluation, a significant association exists between using systemic antihypertensive medications and reduced use of adjunctive IOP lowering therapies. These results confirm findings from previous studies suggesting an IOP lowering effect with systemic agents or some synergy with topical therapies.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/pd [Pharmacology]; Antihypertensive Agents/tu [Therapeutic Use]; Databases as Topic; Diuretics/ad [Administration & Dosage]; *Diuretics/pd [Pharmacology]; Diuretics/tu [Therapeutic Use]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors/ad [Administration & Dosage]; *Hydroxymethylglutaryl-CoA Reductase Inhibitors/pd [Pharmacology]; Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use]; Hypoglycemic Agents/ad [Administration & Dosage]; *Hypoglycemic Agents/pd [Pharmacology]; Hypoglycemic Agents/tu [Therapeutic Use]; Male; Middle Aged; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Quebec; Young Adult

[Natural physical factors of the Kuban' Black Sea coastal area in the rehabilitative treatment of children with psoriasis and concomitant ophthalmoherpes]. - Katkhanova, O A; Sakhnov, S N (Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury, 2009)
The primary objective of this study was to optimize the process of remedial treatment at health reports of Sochi, Gelendzhik, and Anapa by introducing sun, air, and sea water baths in the system of sanatorium-and-spa treatment of the children with various nosologic forms of psoriasis and concomitant ophthalmoherpes that necessitated keratoplastic surgery. The study included children at the age of 7-13 years with plaque and nummular psoriasis vulgaris who received rehabilitative treatment after keratoplasty for ophthalmoherpes. The children were randomly allocated to two groups. One comprised patients based at the specialized children's sanatoria "Yunost", "Vulan", and "Bimlyuk" (Roszdrav) (group 1, n = 278). Patients of the control group were given conventional treatment in municipal outpatient settings in compliance with the existing standards (group 2, n = 278). The study showed a 2.39-fold decrease of the psoriasis area and severity index (PASI) in the children of group 1 compared with its 1.38-fold decrease in group 2. It is concluded that a combination of natural physical factors of the Kuban' Black Sea coastal area has highly beneficial effect on the outcome of postoperative treatment of children with plaque and nummular psoriasis vulgaris and concomitant ophthalmoherpes responsible for corneal ulceration that requires corrective keratoplastic surgery.
Keywords: Adolescent; Balneology; Child; Combined Modality Therapy; Humans; Keratitis, Herpetic/co [Complications]; Keratitis, Herpetic/rh [Rehabilitation]; *Keratitis, Herpetic/th [Therapy]; Psoriasis/co [Complications]; Psoriasis/rh [Rehabilitation]; *Psoriasis/th [Therapy]; Russia

[Is it possible to combine fixed therapeutic associations?]. - Nordmann, J-P (Journal francais d'ophtalmologie, 2009)
The number of fixed associations to treat intraocular pressure has increased over the recent years, to improve patient's treatment adherence. They are generally considered as comparable to the same components administered separately with, in some cases, less side effects. It could thus be appealing to combine fixed associations to reduce these side effects and retain efficacy. However, almost all fixed associations contain timolol, a beta blocker, with a risk of an excessive beta blocking dose and related systemic adverse drug reactions. Several fixed-associations contain a prostaglandin analogue. Their combination would not have a superior efficacy to one fixed combination taken alone. Furthermore, an increased risk or incidence of adverse drug reactions would appear. Specific clinical studies are required before recommending their use in daily clinical practice.
Keywords: Drug Combinations; Drug Therapy, Combination; *Glaucoma/dt [Drug Therapy]; Humans

[Improving management of glaucoma's risk factors]. - Sellem, E (Journal francais d'ophtalmologie, 2009)
Lowering intra-ocular pressure is always a necessity to treat glaucoma. Others identified risks factors may be fought, with the hope to favourably act on the disease: arteriosclerosis worsening parameters, low diastolic arterial pressure, vasospastic or sleep apnea syndrome, inverse pupillary block in pigmentary dispersion. On the other hand, ignoring a noctural closure of the irido-corneal angle or a non-compliance to the medical treatment may lead to glaucoma worsening.
Keywords: Glaucoma/et [Etiology]; *Glaucoma/pc [Prevention & Control]; Humans; Risk Factors; Risk Management

[Relationship with the glaucomatous patient: how to announce glaucoma to the patient]. - Ginies, P (Journal francais d'ophtalmologie, 2009)
Announcement of a chronic disease, always, is a difficult task in the physician professional activity. For glaucoma, its possible impact on their vision and quality of life are a source of anxiety for most patients. The message should be simple and comprehensible, but accurate, to ensure long term compliance to follow-up and treatment. Announcement should be tailored to the patient personality and psychological profile. The clinician should know his own personality, but his patient's personality also, to guarantee successful information and communication and a good quality patient-clinician relationship. Simple rules to be applied are described.
Keywords: Adaptation, Psychological; Glaucoma/px [Psychology]; *Glaucoma; Humans; *Ophthalmology; *Physician-Patient Relations; *Truth Disclosure

[Intraocular pressure measurement in children]. - Bresson-Dumont, H (Journal francais d'ophtalmologie, 2009)
Intraocular pressure (IOP) measurement in children is often difficult to perform because younger children are non-compliant and resisting the examination. Normal IOP in children is not well established yet because in the studies reporting about IOP, the instruments used and clinical conditions have varied. Non contact tonometer often overestimates IOP in blinking children and is not always reliable. But all the others measurement techniques use contact (GAT, Perkins, Tono-Pen, ORA, RBT), and are not always suitable and easy-touse. Under general anaesthesia, mean IOP measured with Perkins applanation tonometer is under 8 mmHg before age of 3 months and under 12 mmHg between ages of 6 and 9 months. After, IOP shows an increasing trend with age of 1 mmHg per year up to 12 years. Some studies have proposed as normal pediatric IOP: To=0.71 x age (years) +10, up to age 10. Then, IOP tends to approach adult levels by 12 years of age. However pediatric glaucoma is rare: congenital glaucoma, before age of 3 years, autosomal dominant juvenile glaucoma, with family history of glaucoma and elevated IOP, or secondary glaucoma with special context. Thus, hypertony has to be confirmed by another measurement technique, correlated to central corneal thickness, and clinical examination (optic nerve head and visual field).
Keywords: Child; *Glaucoma/di [Diagnosis]; *Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure; *Tonometry, Ocular

N-Acetylcarnosine sustained drug delivery eye drops to control the signs of ageless vision: glare sensitivity, cataract amelioration and quality of vision currently available treatment for the challenging 50,000-patient population. - Babizhayev, Mark A; Burke, Leslie; Micans, Philip; Richer, Stuart P (Clinical interventions in aging, 2009)
BACKGROUND: Innovative Vision Products, Inc. (IVP)'s scientists developed the lubricant eye drops (Can-C) designed as 1% N-acetylcarnosine (NAC) prodrug of L-carnosine containing a mucoadhesive cellulose-based compound combined with corneal absorption promoters in a sustained drug delivery system. Only the natural L-isomeric form of NAC raw material was specifically synthesized at the cGMP facility and employed for the manufacturing of Can-C eye drops., OBJECTIVE AND STUDY DESIGN: In the present clinical study the authors assessed vision before and after 9 month term of topical ocular administration of NAC lubricant eye drops or placebo in 75 symptomatic patients with age-related uncomplicated cataracts in one or both eyes, with acuity in one eye of 20/40 or worse (best-corrected distance), and no previous cataract surgery in either eye and no other ocular abnormality and 72 noncataract subjects ranged in age from 54 to 78 years., SETTING: Subjects in these subsample groups have reported complaints of glare and wanted to administer eye drops to get quick eye relief and quality of vision for their daily activities including driving and computer works. Following 9 months of treatment with NAC lubricant eye drops, most patients' glare scores were improved or returned to normal in disability glare tests with Halometer DG. Improvement in disability glare was accompanied with independent improvement in acuity. Furthermore, patients with the poorest pretreatment vision were as likely to regain certain better visual function after 9 months of treatment with N-acetylcarnosine lubricant eye drops as those with the worth pretreatment vision., PATIENTS OR OTHER PARTICIPANTS: The authors made a reference to electronic records of the product sales to patients who have been made the repurchase of the Can-C eye drops since December 2001., INTERVENTION: Based on this analysis of recorded adjustments to inventory, various parameters were analyzed during the continued repurchase behavior program, including testimonials from buyers. With these figures, researchers judged on the patients' compliance rate to self-administer NAC eye-drops., MAIN OUTCOME MEASURE AND RESULTS: The ophthalmic drug showed potential for the non-surgical treatment of age-related cataracts for participants after controlling for age, gender and daily activities and on a combined basis of repurchases behavior reports in more than 50,000 various cohort survivors, has been demonstrated to have a high efficacy and good tolerability for prevention and treatment of visual impairment determined for the older population with relative stable pattern of causes for blindness and visual impairment. The mechanisms of prevention and reversal of cataracts with NAC ophthalmic drug are considered which include prevention by the intraocular released carnosine of free-radical-induced inactivation of proprietary lens antioxidant enzymes (superoxide dismutase); prevention of carbohydrate and metal-catalyzed autooxidation of ascorbic acid-induced cross-linking glycation reactions to the lens proteins; transglycation properties of carnosine, allowing it to compete for the glycating agent, protecting proteins (lens crystallins) against modification; universal antioxidant and scavenging activity towards lipid hydroperoxides, aldehydes and oxygen radicals; activation with l-carnosine ingredient of proteasome activity in the lens; chaperone-like disaggregating to lens crystallins activity of NAC and of its bioactivated principal carnosine. Blindness incidence increased with advancing age, such as cataract and glaucoma, which are by far the commonest causes of blindness in our sample and in all age groups, glaucomatous neurodegeneration can be treated with developed NAC autoinduction prodrug eye drops equipped with corneal absorption promoters. The common blinding affections presenting in developed countries such as, senile macular degeneration, hereditary chorioretinal dystrophies, diabetic retinopathy are poorly represented in our current summary of vital-statistics and will be reported inherent in next N-acetylcarnosine ophthalmic drug studies., CONCLUSION: The authors present evidence, about why only a certain kind of NAC is safe, and why only certain formulas designed by IVP for drug discovery are efficacious in the prevention and treatment of senile cataract for long-term use. Overall cumulated studies demonstrate that the designed by IVP new vision-saving drug NAC eye drops help the aging eye to recover by improving its clarity, glare sensitivity, color perception and overall vision.
Keywords: Aged; Aged, 80 and over; Carnosine/ad [Administration & Dosage]; *Carnosine/aa [Analogs & Derivatives]; Carnosine/pd [Pharmacology]; *Cataract/dt [Drug Therapy]; Delayed-Action Preparations; Female; *Glare; Humans; Macular Degeneration/dt [Drug Therapy]; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Vision, Ocular/de [Drug Effects]

Epidemiological characteristics, predisposing factors and microbiological profiles of infectious corneal ulcers: the Portsmouth corneal ulcer study. - Ibrahim, Y W; Boase, D L; Cree, I A (The British journal of ophthalmology, 2009)
AIM: The aim of the study was to identify the epidemiological characteristics, predisposing factors, and the clinical and microbiological diagnosis of infectious corneal ulcers in a population based in southern England., METHODS: A retrospective review was undertaken of the medical records of patients presenting with infectious corneal ulcers at the eye casualty department of Queen Alexandra Hospital, Portsmouth, UK, between January 1997 and December 2003., RESULTS: A total of 1786 patients presented with infectious corneal ulcers, with a mean age of 45 years and female predominance (54.5%). Contact lens wear was the main predisposing factor in 554 patients (31%). Corneal scrapes from 1254 patients grew positive cultures in 800 patients. Gram-positive bacteria accounted for 696 (71.1%) of the total 979 bacterial isolates, while Gram-negative bacteria accounted for 283 (28.9%) with the predominance of Pseudomonas aeruginosa. Nine out of 11 patients with Acanthamoeba keratitis were contact lens wearers. The majority of patients 1728 (96.8%) sought medical help more than once and 34 patients (1.9%) had poor visual outcome. Follow-up was completed in 1633 patients (91.4%) with an average of 11.5 days., CONCLUSIONS: Wearing contact lenses remains the most important risk factor for infectious corneal ulcers. Reduction of the rate and severity of infectious keratitis requires continuous education of patients, and of professionals.
Keywords: Acanthamoeba Keratitis/ep [Epidemiology]; Acanthamoeba Keratitis/et [Etiology]; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Contact Lenses/ae [Adverse Effects]; *Corneal Ulcer/ep [Epidemiology]; Corneal Ulcer/et [Etiology]; Corneal Ulcer/pp [Physiopathology]; England/ep [Epidemiology]; Eye Infections, Bacterial/ep [Epidemiology]; Eye Infections, Bacterial/et [Etiology]; Female; Humans; Male; Middle Aged; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Retrospective Studies; Risk Factors; Sex Factors; Visual Acuity; Young Adult

[Surgical solution to vitreous floaters visual problem]. - Martinez-Sanz, F; Velarde, J I; Casuso, P; Fernandez-Cotero, J N (Archivos de la Sociedad Espanola de Oftalmologia, 2009)
PURPOSE: To evaluate the role of 25 gauge pars-plana vitrectomy (25G-PPV), after a careful patient selection, when we find highly annoying vitreous floaters and to question if this is an ethical therapeutic option., METHODS: A retrospective study of eight eyes (seven patients) aged 58+/-14 years old (range 42-78) high myopes and pseudophakes who underwent 25G-PPV. Clinical data and visual acuity were studied at six to twelve months follow-up. Health-related functioning and quality of life was measured with the 39-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39)., RESULTS: No complications were observed. All patients were satisfied. Safety at third month was 100% and 37.5% improved one or more lines of visual acuity., CONCLUSIONS: Vitreous floaters can be often undervaluated by ophthalmologists, resulting in no intervention. Conventional 20 gauge PPV after a carefully examination can be an effective option for some authors. 25G-PPV incorporates also advantages as the early recovery, with little complications in pseudophakic eyes.
Keywords: Adrenal Cortex Hormones/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Eye Diseases/px [Psychology]; *Eye Diseases/su [Surgery]; Female; Humans; Laser Coagulation; Male; Middle Aged; Ocular Hypertension/co [Complications]; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypotension/co [Complications]; Ocular Hypotension/dt [Drug Therapy]; Patient Satisfaction; Pseudophakia/co [Complications]; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Vitrectomy/es [Ethics]; Vitrectomy/mt [Methods]; Vitrectomy/px [Psychology]; *Vitrectomy; *Vitreous Body/su [Surgery]

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients. - Sleath, Betsy; Ballinger, Rex; Covert, David; Robin, Alan L; Byrd, John E; Tudor, Gail (The American journal of geriatric pharmacotherapy, 2009)
OBJECTIVE: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients., METHODS: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week., RESULTS: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37-93 years]; black race, 45.4%; white race, 44.0%; "other" or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported > or =1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were "drops fall on cheek" (29.1%), "too many drops come out" (20.6%), and "hard to read print" (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05)., CONCLUSION: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.
Keywords: African Americans/sn [Statistics & Numerical Data]; Aged; Aged, 80 and over; European Continental Ancestry Group/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; Health Care Surveys; Humans; Logistic Models; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Odds Ratio; *Outpatients/sn [Statistics & Numerical Data]; Risk Assessment; Risk Factors; Surveys and Questionnaires; United States; *Veterans/sn [Statistics & Numerical Data]

Non-compliance in glaucoma treatment: a Hong Kong perspective. - Pong, Jeffrey; Lai, Jimmy (Acta ophthalmologica, 2009)
Keywords: Aged; *Glaucoma/dt [Drug Therapy]; Hong Kong; Humans; Middle Aged; *Patient Compliance

Literacy and informed consent: a case for literacy screening in glaucoma research. - Muir, Kelly W; Lee, Paul P (Archives of ophthalmology (Chicago, Ill. : 1960), 2009)
Keywords: *Biomedical Research; Clinical Trials as Topic; *Educational Status; *Glaucoma/co [Complications]; Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; Humans; *Informed Consent; Mental Competency; *Patient Participation

Will improvement of knowledge lead to improvement of compliance with glaucoma medication?. - Mansouri, Kaweh; Shaarawy, Tarek (Acta ophthalmologica, 2009)
Comment on (CON)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; *Patient Education as Topic

Why do patients with improved visual acuity drop out of RGP contact lens use? Ten-year follow-up results in patients with scarred corneas. - Ozkan, Berna; Elibol, Orhan; Yuksel, Nursen; Altintas, Ozgul; Karabas, Levent; Caglar, Yusuf (European journal of ophthalmology, 2009)
PURPOSE: To evaluate the long-term results of rigid gas permeable (RGP) contact lenses and to investigate the reasons for patient dissatisfaction with this therapy., METHODS: Records of 17 patients (20 eyes) who started using RGP contact lenses for correction of irregular astigmatism due to scarred corneas between 1995 and 1996 were evaluated retrospectively. Best-corrected visual acuities with or without RGP contact lenses were noted. The mean duration of contact lens use, reasons for discontinuation of therapy, and treatment methods preferred over contact lens use were evaluated., RESULTS: The irregular astigmatisms were induced by herpetic keratitis (3 eyes), corneal trauma (5 eyes), and previous corneal infections (12 eyes). All of the patients had increase in visual acuity with RGP contact lenses (p=0.000). At the end of the follow-up it was found that only one patient was still using RGP contact lenses (5%). The mean duration for contact lens use was 21.42+/-4.53 SE months (2-72 months). The reasons for dropping out contact lenses were intervening surgical procedures (57.8%), loss of patient motivation (26.3%), recurrent punctate epitheliopathy (10.5%), and herpes simplex keratitis reactivation (5.2%)., CONCLUSIONS: RGP contact lens use is a successful method of increasing visual acuity in scarred corneas. However, patients with good visual acuity in the fellow eye find it hard to remain motivated for RGP contact lens use in the unhealthy eye. Furthermore, patients prefer permanent treatment methods even though these methods would result in decreased visual acuity.
Keywords: Adolescent; Adult; Astigmatism/pp [Physiopathology]; Astigmatism/th [Therapy]; Child; *Contact Lenses/sn [Statistics & Numerical Data]; Corneal Diseases/pp [Physiopathology]; *Corneal Diseases/th [Therapy]; Female; Humans; Male; Middle Aged; Motivation; *Patient Dropouts/sn [Statistics & Numerical Data]; Retrospective Studies; *Visual Acuity/ph [Physiology]; Young Adult

Factors affecting compliance with eye drop therapy for glaucoma in a multicultural outpatient setting. - Curtis, Cheryl; Lo, Eva; Ooi, Linda; Bennett, Lydia; Long, Janet (Contemporary nurse, 2009)
Ophthalmic nurses at Sydney Hospital Sydney Eye Hospital aimed to assess and evaluate the knowledge and resulting behaviours of patients using eye drop therapy for glaucoma and the effect that using interpreters or English speaking family members had on patients' understanding and compliance. Non-compliance is known to lead to progression of the disease with resulting loss of vision. The study showed that patients undergoing long-term therapy for glaucoma have areas of non-compliance that may not be apparent to staff who see them in a clinic setting. It also showed that ineffectual use or missed doses of eye drops occur in both male and female groups, young and older groups and those from non-English and English speaking backgrounds. This is in spite of the same patients' assurances that they have received clear instructions. It has been shown that the use of interpreters or English speaking family members has not affected compliance. This study has shown that even patients who have been on therapy for over 12 months are likely to benefit from continuing education and reinforcement of good technique. Poor understanding of glaucoma in the over 65 age group was not associated with a higher rate of non-compliance.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Ambulatory Care; *Cultural Diversity; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; New South Wales; *Ophthalmic Solutions; *Patient Compliance; Surveys and Questionnaires; Young Adult

Risk factors for poor adherence to eyedrops in electronically monitored patients with glaucoma. - Friedman, David S; Okeke, Constance O; Jampel, Henry D; Ying, Gui-shuang; Plyler, Ryan J; Jiang, Yuzhen; Quigley, Harry A (Ophthalmology, 2009)
PURPOSE: To identify risk factors for poor adherence to topical once daily therapy for glaucoma., DESIGN: Prospective, observational cohort study., PARTICIPANTS: A total of 196 patients with glaucoma who were being treated with a prostaglandin analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007., METHODS: Demographics, ocular history, and responses to interview questions about glaucoma knowledge, health beliefs, and drop-taking behaviors were obtained from each patient. All patients used the Travatan Dosing Aid (DA; Alcon Laboratories Inc., Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months, and the data of drop use were downloaded using software provided with the DA. Patients taking 75% of doses., MAIN OUTCOME MEASURES: Risk factors for poor adherence., RESULTS: Eighty-seven patients (44.4% of the 196 subjects with evaluable data at 3 months) used the DA on 75% or less of the monitored days. In univariate analysis, poorer adherers were more likely to be <50 or >or=80 years of age, to be African American, to report less than excellent health, to report higher amounts of depression, to have lower income, and to be treated at the Scheie Eye Institute. Multivariate analysis (adjusting for education and income) found that age, race/ethnicity, and less than excellent health were associated with poor adherence., CONCLUSIONS: Those who failed to take more than 75% of eyedrop doses were more likely to be African American and to report poor health. Those in the youngest and oldest age groups were less adherent, although this finding was not always statistically significant. Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Age Factors; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Drug Monitoring/is [Instrumentation]; Ethnic Groups; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/eh [Ethnology]; Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/eh [Ethnology]; *Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Risk Factors; Surveys and Questionnaires; Travoprost

Interventions for improving adherence to ocular hypotensive therapy. - Gray, Trish A; Orton, Lois C; Henson, David; Harper, Robert; Waterman, Heather (The Cochrane database of systematic reviews, 2009)
BACKGROUND: Poor adherence to therapy is a significant healthcare issue, particularly in patients with chronic disease such as open angle glaucoma. Treatment failure may necessitate unwarranted changes of medications, increased healthcare expenditure and risk to the patient if surgical intervention is required. Simplifying eye drop regimes, providing adequate information and ongoing support according to patient need, may have a positive effect on improving adherence., OBJECTIVES: To summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma., SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ZETOC and OpenSIGLE. In addition, we searched research registers of ongoing studies. We contacted pharmaceutical manufacturers to request unpublished data and searched conference proceedings for the Association for Research in Vision and Ophthalmology (ARVO), and the Annual Congress for the Royal College of Ophthalmologists (RCO). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 15 January 2009., SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma., DATA COLLECTION AND ANALYSIS: At least two authors independently assessed the search results for eligibility and extracted data for included trials onto specifically designed forms. We calculated the mean difference for continuous data and relative risks for dichotomous data. Where appropriate, we pooled data using a fixed-effect model., MAIN RESULTS: Eight trials met the inclusion criteria. There was considerable heterogeneity of interventions and reported outcome measures and therefore, meta-analysis was limited to two studies. Overall, studies were not of high quality due to small sample sizes, missing data and short term follow-up. Three of five drug comparison studies provided evidence that reducing the frequency of drops can improve adherence. However, the study that compared the least frequent regime with one of the most complicated, showed no difference in reported adherence. A small study of thirteen patients found a reminder device beneficial to adherence levels yet only one of two studies involving education and individualised care planning was found to be successful., AUTHORS' CONCLUSIONS: Interventions involving simplified dosing regimes, reminder devices, education and individualised care planning, did show improvements in adherence rates. However, due to inadequate methodological quality and heterogeneity of study design we are unable to advocate any particular interventions at this time.
Update in (UIN)
Keywords: Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Randomized Controlled Trials as Topic

Personality traits, depression, and objectively measured adherence to once-daily prostaglandin analog medication in glaucoma. - Hollo, Gabor; Kothy, Peter; Geczy, Anna; Vargha, Peter (Journal of glaucoma, 2009)
PURPOSE: To investigate the influence of personality traits, depression, and training on objectively measured adherence to once-daily prostaglandin analog medication., METHODS: Adherence was measured with the Travalert Dosing Aid on 58 consecutive, regularly followed-up glaucoma patients already on self-administered travoprost. Before the 3-month data-collection period all patients received training on use of the device. Psychologic characteristics were measured using the State-Trait Anxiety Inventory, Eysenck Personality Questionnaire, and Beck Hopeless Scale and Depression Inventory. An adherent day was defined as travoprost instillation at 9 PM +/-2 hours., RESULTS: Adherence was 77% for the total period. Social desirability was higher than normal (U test, P<0.0001). Seven patients (12.1%) showed mild-to-moderate depression, which was not significantly associated with decreased adherence (Kruskal-Wallis test, P=0.071). Severity of glaucoma, number of ocular and systemic medications, satisfaction with the recording device, and socio-economic characteristics had no influence on adherence., CONCLUSIONS: Objective ly measured adherence to once-daily prostaglandin analog medication was good, and not influenced by treatment characteristics or patient factors including mild-to-moderate depression. The elevated social desirability suggests that self-reported adherence is not a reliable measure of adherence in glaucoma.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; *Anxiety Disorders/px [Psychology]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; *Depressive Disorder/px [Psychology]; Drug Monitoring/is [Instrumentation]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/px [Psychology]; Ocular Hypertension/dt [Drug Therapy]; Patient Education as Topic; *Personality Disorders/px [Psychology]; Surveys and Questionnaires; Travoprost

Cost of illness of glaucoma: a critical and systematic review. - Fiscella, Richard G; Lee, Jeff; Davis, Elizabeth J H; Walt, John (PharmacoEconomics, 2009)
Cost-of-illness studies determine the total financial burden of a disease by considering direct and indirect costs, including medication, diagnostics and surgery. Studies of resource use and costs associated with primary open-angle glaucoma have used varying methodologies. Most have focused on consumption of healthcare resources at various stages of disease to anticipate costs. The direct costs associated with the disease often continue to increase as glaucoma progresses from the earliest to most advanced stages. Determinations of the costs associated with glaucoma progression and prevention should also incorporate the chance of patient non-compliance with treatment. Since glaucoma severity most often correlates with increased costs, minimizing or halting visual field loss and increasing patient treatment compliance may all contribute to a reduction in the overall economic burden of glaucoma.
Keywords: Canada; Cost of Illness; Europe; *Glaucoma/dt [Drug Therapy]; *Glaucoma/ec [Economics]; Humans; United States

Determinants of adherence to glaucoma medical therapy in a long-term patient population. - Djafari, Fawzia; Lesk, Mark R; Harasymowycz, Paul J; Desjardins, Daniel; Lachaine, Jean (Journal of glaucoma, 2009)
PURPOSE: Estimate patient adherence to glaucoma medications and identify potential determinants of nonadherence., DESIGN: Descriptive study., METHODS: Two hundred patients with open angle glaucoma, ocular hypertension, or glaucoma suspects were interviewed regarding their glaucoma and its treatment and their charts were reviewed. Their ophthalmologist completed a brief assessment form. Drug utilization data were extracted from the provincial drug program database. Patients were defined as adherent if they filled at least 75% of the prescribed medication necessary for their treatment., RESULTS: Data were available for 181 patients. About 62.9% were female and the mean age (+/-SD) was 75.1+/-8.8 years. The mean number of years of glaucoma treatment was 10.7+/-9.3. Self-reported treatment adherence was 88.3%. On the basis of the drug database, the proportion of patients who were adherent to treatment was 71.8%. According to physicians, 74.6% of patients were adherent. Among patients considered by physicians as nonadherent, 71.1% (32/45) were adherent and among patients predicted as adherent, 72.1% (98/136) were adherent. There was no significant difference in adherence according to age, sex, education, and income. However, patients using fewer agents (P=0.041), who were widowed (P=0.041), or who lived alone (P=0.042) were more adherent. Patients using prostaglandins analogs or beta-blockers were more adherent than those using carbonic anhydrase inhibitors (P<0.05)., CONCLUSIONS: Fewer medications, use of prostaglandin analogs or beta-blockers, living alone, and being widowed were significantly associated with adherence. Physicians were unable to significantly predict which patients are adherent.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/cl [Classification]; Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Ocular Hypertension/dt [Drug Therapy]; *Patient Compliance/sn [Statistics & Numerical Data]; Surveys and Questionnaires

The impact of ocular adverse effects in patients treated with topical prostaglandin analogs: changes in prescription patterns and patient persistence. - Zimmerman, Thom J; Hahn, Steven R; Gelb, Laurie; Tan, Hiangkiat; Kim, Elizabeth E (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2009)
PURPOSE: To document patient/physician perceptions of adverse effects and their relationship to medication changes among patients prescribed prostaglandin analogs., METHODS: Medical/pharmacy claims (private U.S. health network) identified patients filling initial topical ocular hypotensive prescriptions from 2001 to 2004; 300 open-angle glaucoma patients prescribed a prostaglandin analog and 103 ophthalmologists were selected by algorithm for telephone interviews. Medical charts for 225/300 interviewed and 75 non-interviewed patients were abstracted. Medication patterns were assessed in pharmacy claims data. Frequency of adverse effects noted by physicians and associations with medication change decisions were examined in charted data. Patients' experiences with adverse effects were compiled from surveys., RESULTS: In patients treated with latanoprost (N = 4,071), bimatoprost (N = 1,199), or travoprost (N = 1,001), continuous refill of medication through 1 year was seen in 11%, 9%, and 5% of patients, respectively (P = 0.0001; retrospective pharmacy claims). Adverse effects were the second most common reasons noted by physicians for switching medications after lack of efficacy (19% vs. 43%, respectively). Adverse effects were noted in 65% of patient charts. Hyperemia was the most common adverse effect occurring with at least one other adverse effect in 48% of patients with the condition., CONCLUSIONS: Ocular adverse effects, particularly hyperemia, negatively affect patient continuation with therapy and switching.
Keywords: Administration, Topical; Adult; Amides/ae [Adverse Effects]; Amides/tu [Therapeutic Use]; *Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ae [Adverse Effects]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Databases, Factual; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; Latanoprost; Ophthalmic Solutions; *Patient Compliance/sn [Statistics & Numerical Data]; Pharmaceutical Services; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prescription Drugs; Prostaglandins F, Synthetic/ae [Adverse Effects]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; *Prostaglandins, Synthetic/ae [Adverse Effects]; Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Travoprost

Best practice contact lens care: a review of the Asia Pacific Contact Lens Care Summit. - Sweeney, Deborah; Holden, Brien; Evans, Kylie; Ng, Venice; Cho, Pauline (Clinical & experimental optometry, 2009)
Contact lens hygiene has long been recognised as key to the prevention of contact-lens associated infection and inflammation. Microbial keratitis (MK) is the only serious and potentially sight-threatening contact lens adverse event. International studies including recent research in Asia Pacific show that MK is rare but, as the consequences can be severe, it is important to minimise the risk factors. Studies continue to show that one of the key risk factors is lens and lens case hygiene. Therefore, it is also useful to review the behaviour of our patients, to see how closely they follow the recommended hygiene practices. Recent studies in various regions have shown that patients' lens care habits do not meet a required standard. Patients can become complacent and thus non-compliant with lens care instructions. Furthermore, they do not understand the high risk of some behaviour and they are not hearing the practitioner when instructions and reminders are given. Further education is important to improve patient compliance and safety. The Asia Pacific Contact Lens Care Summit held in Singapore urged the industry and practitioners to restore the emphasis of proper lens care, including the 'rub and rinse' technique, and developed a new set of guidelines to help eye-care professionals educate their patients on the importance of proper contact lens care to avoid eye infections. The summit also presented the latest research on how to avoid corneal staining, another important element of contact lens care. This review provides a summary of the summit presentations and the science behind these guidelines.
Keywords: Contact Lens Solutions; Contact Lenses/ae [Adverse Effects]; *Contact Lenses; Eye Infections/et [Etiology]; Eye Infections/pc [Prevention & Control]; *Guidelines as Topic; Humans; *Hygiene; Keratitis/et [Etiology]; Keratitis/pc [Prevention & Control]; Patient Compliance; Patient Education as Topic

Variability of intraocular pressure measurements in observation participants in the ocular hypertension treatment study. - Bhorade, Anjali M; Gordon, Mae O; Wilson, Brad; Weinreb, Robert N; Kass, Michael A; Ocular Hypertension Treatment Study Group (Ophthalmology, 2009)
PURPOSE: To describe variability of intraocular pressure (IOP) measurements within the same eye and between right and left eyes over a 60-month period in participants in the Ocular Hypertension Treatment Study., DESIGN: Analysis of data from a prospective, randomized clinical trial., PARTICIPANTS: Eight hundred ten participants randomized to the observation group., METHODS: Intraocular pressure measurements were obtained at the baseline visit and every 6 months thereafter. Pearson correlation coefficients were calculated for IOP measurements in the same eye between visits and for IOP measurements between right and left eyes of participants at each visit. Differences in IOP measurements between visits are reported in percent change (>15%, >20%, and >30%) and in millimeters of mercury (<3 mmHg, 3-5 mmHg, and >5 mmHg). The effects of regression to the mean, consistency in time of day, and sequence of IOP measurement of right and left eyes were examined., MAIN OUTCOME MEASURES: Correlation of IOP measurements between consecutive 6-month visits., RESULTS: The correlation of IOP measurements within the same eye between consecutive visits was r = 0.62, whereas the correlation of IOP measurements between right and left eyes at the same visit was r = 0.72. Thirteen percent of eyes had >20% change in IOP between consecutive visits. Sixty-six percent of eyes had a change in IOP within 3 mmHg, and 10% of eyes had a change in IOP >5 mmHg between visits. Eyes with a higher baseline IOP had a lower IOP at 6 months. There was a stronger correlation of IOP measured within 2 hours of the time of day between visits (r = 0.56) than >2 hours apart (r = 0.39). IOP of the right eye, which was measured first, was 0.3+/-2.8 mmHg higher than the left eye., CONCLUSIONS: The variability of IOP measurements in the same eye between consecutive visits is moderate and is greater than the variability of IOP measurements between right and left eyes at the same visit. Factors affecting the variability of IOP measurement include regression to the mean, time of day, and measurement order. Knowledge of variability in IOP and its measurements may help clinicians establish a more accurate baseline IOP, target IOP, and assessment of medication effect.
Erratum in (EIN)
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Circadian Rhythm/ph [Physiology]; Female; Follow-Up Studies; *Functional Laterality/ph [Physiology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Observation; Ocular Hypertension/dt [Drug Therapy]; *Ocular Hypertension/pp [Physiopathology]; Office Visits; Prospective Studies; Tonometry, Ocular

Switching within glaucoma medication class. - Law, Simon K (Current opinion in ophthalmology, 2009)
PURPOSE OF REVIEW: In the current medical care environment, switching within class is often demanded by cost consideration, medical insurance coverage, or formulary restriction. With many choices of drugs available within a glaucoma medication class, questions exist whether switching within class is beneficial. The purpose of this article is to provide a clinical update on the feasibility of switching among the frequently used drugs within glaucoma medication class., RECENT FINDINGS: Although efficacies of medications within a therapeutic class are similar and significant differences are generally not observed in clinical trials, response to medication often varies among individual patients in a clinical practice. Such variation may be secondary to differences in drug-receptor interactions, patient's compliance and tolerability to medical treatment, or bioavailability of the medication in individual ocular condition. In addition, switching within class is often necessary to minimize the systemic or local adverse reactions from the active or inactive ingredients of the medication., SUMMARY: In addition to keeping up-to-date with the efficacy and safety profiles of drugs within each glaucoma medication class, clinicians should familiarize themselves with the different formulations available, preservative systems used, generics availability and compatibility, and the local insurance formulary restriction to deliver an effective glaucoma management.
Keywords: Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Feasibility Studies; *Glaucoma/dt [Drug Therapy]; Humans; Parasympathomimetics/tu [Therapeutic Use]; Prostaglandins/tu [Therapeutic Use]; Retreatment

Pharmacotherapy compliance in patients with ocular hypertension or primary open-angle glaucoma. - Traverso, Carlo E; Walt, John G; Stern, Lee S; Dolgitser, Margarita (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2009)
PURPOSE: The aim of this study was to compare rates of pharmacotherapy coverage in patients with ocular hypertension (OH) and patients with primary open-angle glaucoma (POAG)., METHODS: Retrospective cohort study analysis of a nationally representative, multimanaged health plan database (PharMetrics; 1998-2005) which included 4818 medicated OH patients and 52,985 medicated POAG patients with at least 1 year of continuous enrollment and at least one prescription for IOP-lowering medication during the first year of follow-up. Patients selected for the current study were nested within the cohort of OH patients (n = 36,767) and POAG patients (n =72,412) previously reported. Of the previously reported OH cohort, only 13.1% of patients filled at least one prescription, as compared to 73.2% of the previously reported POAG cohort. Medication coverage was defined as the percent of days during which a patient was in possession of IOP-lowering therapy over the first year of follow-up (medication coverage = number of covered days/365). Compliant patients were defined as those with >or= 75th percentile medication coverage., RESULTS: POAG patients had slightly longer mean length of enrollment in the database (2.5 years, SD = 1.2) than did OH patients (2.4 years, SD = 1.1; P < 0.0001). The mean medication coverage was 50% for the POAG cohort (SD = 0.26) and 40% for the OH cohort (SD = 0.25; P < 0.0001). In multivariate models controlling for key covariates of interest, POAG patients were 1.9 (95% CI: 1.7 to 2.0) times more likely to be compliant with their pharmacotherapy than OH patients., CONCLUSION: In general, pharmacotherapy coverage was poor. Patients with POAG, a more severe condition, were significantly more covered with pharmacotherapies than patients with OH. It is important to implement strategies to help improve patient coverage prior to occurrence of more severe disease.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cohort Studies; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Male; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ep [Epidemiology]; *Patient Compliance; Retrospective Studies

First-year treatment patterns among new initiators of topical prostaglandin analogs. - Schmier, Jordana K; Covert, David W; Robin, Alan L (Current medical research and opinion, 2009)
OBJECTIVE: To evaluate treatment patterns and costs among new initiators of topical prostaglandin analogs in a managed-care population., RESEARCH DESIGN AND METHODS: Annual costs were modeled using multiple inputs. A retrospective cohort design was used to identify treatment patterns for pharmacotherapy. The study population was identified from pharmacy claims for patients who met study inclusion criteria (patients initiating prostaglandin analog monotherapy). Published studies were used to estimate visit-related resource use and costs were obtained from published and standard sources., RESULTS: In the cohort analysis, a total of 12 202 patients met study criteria: 2275 received bimatoprost, 7347 received latanoprost and 2580 received travoprost (1808 used the original formulation and 772 used the newer preservative formulation). Of patients meeting study criteria, 50% stopped all glaucoma therapy, 6% switched from their initial prostaglandin therapy, and the remaining 44% stayed on their initial prostaglandin for 1 year. Of patients remaining on prostaglandin analog monotherapy for 1 year, 22.7% of bimatoprost patients, 19.8% of latanoprost patients and 17.9% of travoprost patients (19.7% for the original formulation and 13.7% for the new formulation) required adjunctive therapy. Of those requiring adjunctive therapy, the median number of days until starting adjunctive therapy was 53 days for bimatoprost patients, 63 days for latanoprost patients and 83 days for travoprost patients (70.5 days for the original formulation and 109 days for the new formulation). The resources used at each visit were estimated at $424 for an initial visit and $70 for follow-up visits. Estimated first-year costs were $1294, $1199, and $1186 for patients initiating therapy with bimatoprost, latanoprost, and travoprost, respectively. Estimated travoprost costs were higher for the original formulation ($1203) than for the new formulation ($1160). Sensitivity analyses suggested that the cost estimates are robust to changes in costs and use of adjunctive therapies., LIMITATIONS: The use of a claims database without compliance data or clinical outcomes and the selection of new initiators of topical prostaglandin analogs limits the findings and does not allow projecting outcomes to all glaucoma patients., CONCLUSIONS: Use of adjunctive therapy in glaucoma is an important driver of glaucoma management costs. Based on the results of this study, it is possible that longer duration of monotherapy with prostaglandin analogs may be associated with lower annual costs. Further study should be conducted to validate these findings.
Keywords: Administration, Topical; Adult; African Continental Ancestry Group/sn [Statistics & Numerical Data]; Aged; Amides/ad [Administration & Dosage]; Amides/ec [Economics]; Amides/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/ec [Economics]; Cloprostenol/tu [Therapeutic Use]; Cohort Studies; Cost of Illness; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/ep [Epidemiology]; Hispanic Americans/sn [Statistics & Numerical Data]; Humans; Latanoprost; Male; Middle Aged; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ec [Economics]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; *Prostaglandins, Synthetic/ad [Administration & Dosage]; Prostaglandins, Synthetic/ec [Economics]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Travoprost; United States

A comparison of the intervisit intraocular pressure fluctuation after 180 and 360 degrees of selective laser trabeculoplasty (SLT) as a primary therapy in primary open angle glaucoma and ocular hypertension. - Prasad, Navin; Murthy, Shashidhar; Dagianis, John J; Latina, Mark A (Journal of glaucoma, 2009)
OBJECTIVE: To determine and compare the effect of 180 and 360 degrees of selective laser trabeculoplasty (SLT) treatment as a primary therapy on the intervisit intraocular pressure (IOP) fluctuation in patients followed up for a period of 2 years without any further medical or surgical intervention., METHODS: Retrospective chart review of patients with ocular hypertension and primary open angle glaucoma who received SLT as primary therapy without any subsequent medical or surgical intervention. IOP before SLT and postlaser IOP at all the visits during the follow-up period of months 6 to 24 was determined. The standard deviation (SD) of the mean IOP was used as a surrogate for IOP fluctuation., RESULTS: Forty-one eyes were treated by SLT, 19 eyes in the 180-degree group and 22 eyes in the 360-degree group. The mean reduction in IOP at 2 years was 28% in 180-degree group and 35% in 360-degree SLT group. After the SLT, the 360-degree SLT group had a lower IOP fluctuation compared with the 180-degree SLT group over the follow-up period of months 6 to 24. The percentage of eyes with intervisit IOP fluctuation (SD) <or=2 mm Hg during the same follow-up period was significantly greater in 360-degree SLT treatment group (86%) than in the 180-degree SLT treatment group (52%), P=0.03. The odds of achieving IOP fluctuation <or=2 mm Hg were 5.7 times greater with 360 degrees than with 180-degree SLT during the follow-up period of months 6 to 24., CONCLUSIONS: This study suggests that 360-degree SLT is more efficacious in achieving smaller IOP fluctuations than treatment with 180-degree SLT.
Keywords: Aged; *Circadian Rhythm/ph [Physiology]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; *Intraocular Pressure/ph [Physiology]; *Laser Therapy/mt [Methods]; Male; Middle Aged; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/su [Surgery]; *Office Visits; Retrospective Studies; Tonometry, Ocular/mt [Methods]; *Trabeculectomy/mt [Methods]; Treatment Outcome

[Cultural adaptation and validation into Spanish of the Glaucoma Symptom Scale (GSS)]. - Ruiz, Miguel A; Pardo, Antonio; Martinez de la Casa, Jose M; Polo, Vicente; Esquirol, Jordi; Soto, Javier (Medicina clinica, 2009)
BACKGROUND AND OBJECTIVE: To describe the process of the cultural and psychometric adaptation (validation) into Spanish of the Glaucoma Symptom Scale (GSS) in order to measure the impact of glaucoma symptoms, and inform about the psychometric properties., MATERIAL AND METHOD: The study was supervised by a 6-member expert panel. After forward and backward translations in duplicate, a Spanish version was obtained which was administered to three samples: a 16-patient sample to check comprehenssion and face validity, a 100-patient sample to check structural validity (factor analysis and reliability) and, finally, a 387-patient sample for assessing construct and discrimination validity., RESULTS: The questionnaire yielded 2 dimensions, which are not exactly the same as the ones in the original study. Reliability was high (alpha=0.82), and correlation between even-odd items was high too (r=0.92). The scale discriminated between lower and upper quartile groups (p<0.001). The average on non visual symptoms was higher than on visual ones (p=0.001), showing more inconvenience of the former. There were differences between compliant and non-compliant patients (p=0.004), but a lack of agreement between self-reported measures was also found. We found differences between patients with one or 2 drops treatments (p=0.0014)., CONCLUSIONS: The results showed acceptable psychometric properties and they make available to health professionals a new instrument to assess glaucoma symptoms, taking into account the patient perspective.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Cultural Characteristics; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Humans; Language; Male; Middle Aged; Patient Compliance; Psychometrics; *Surveys and Questionnaires; Young Adult

Utility assessment among patients of primary angle closure/glaucoma in China: a preliminary study. - Sun, X; Zhang, S; Wang, N; Liang, Y; Wang, L; Fan, S; Sun, L (The British journal of ophthalmology, 2009)
AIM: To evaluate utility values among patients of primary angle closure/glaucoma (PAC/G) in a local hospital in China, and the factors influencing the quality of their lives., METHODS: A cross-sectional study. Utility values were measured using the time trade-off (TTO) and standard gamble (gamble for blindness) methods. Standard face-to-face interviews were conducted. Results of ophthalmic examinations were recorded., RESULTS: One hundred and six patients were recruited, 16 (15.1%) male and 90 (84.9%) female, mean age 63.21 years (SD 7.46). Fifty-five (50.9%) patients had a history of acute angle closure (AAC). The mean duration from glaucoma diagnosed to the day of interview was 7.69 (3.30) months. All participants underwent laser therapy, and 12 patients (11.3%) also received trabeculectomies. The mean utility value was 0.75 (0.14) (95% CI 0.73 to 0.78) with the TTO technique and 0.80 (0.08) (95% CI 0.78 to 0.81) with the standard gamble (SG) technique. The correlation between the two values was significant (p<0.001). Age, educational status, better best-corrected visual acuity (BCVA), worse BCVA and better visual field had significant effects on the utility values. Patients' self-evaluation of the impact of PAC/G upon their lives correlated with the TTO utility values (p = 0.008) and not with the SG utility values (p = 0.652)., CONCLUSION: The mean TTO utility score of the studied population is 0.75. The utility value is directly dependent on age, the degree of visual function loss and educational status. It is likely that patients find the TTO method easier to comprehend than the SG method.
Keywords: Aged; *Blindness/ep [Epidemiology]; Blindness/px [Psychology]; China/ep [Epidemiology]; Cross-Sectional Studies; Female; *Glaucoma, Angle-Closure/ep [Epidemiology]; Glaucoma, Angle-Closure/px [Psychology]; Humans; Male; Middle Aged; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Quality of Life/px [Psychology]; Severity of Illness Index; Surveys and Questionnaires; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Intraocular pressure reduction in the untreated fellow eye after selective laser trabeculoplasty. - Rhodes, Kyle M; Weinstein, Rebecca; Saltzmann, Robert M; Aggarwal, Nalini; Kooner, Karanjit S; Petroll, W Matthew; Whitson, Jess T (Current medical research and opinion, 2009)
OBJECTIVE: To investigate the effect of selective laser trabeculoplasty (SLT) on the intraocular pressure (IOP) of untreated fellow eyes in patients with open-angle glaucoma., STUDY DESIGN: Retrospective chart review., PATIENTS AND METHODS: Charts of all patients who underwent SLT at the University of Texas Southwestern Medical Center at Dallas between September 2003 and May 2006 were reviewed. Each patient had IOP measurements by Goldmann applanation tonometry in both eyes preoperatively, and at 1 hour, 2 weeks, 3 months, and 6 months postoperatively. Patient age, gender, diagnosis, central corneal thickness (CCT), previous intraocular surgeries, and degrees of laser treatment were tabulated for each patient. Patients with a history of previous glaucoma surgery in either eye were excluded as were those who underwent any change in glaucoma medications or further laser or surgical intervention in either eye within 6 months of SLT. Data were analyzed using a paired two-tailed t-test, an unpaired two-tailed t-test, ANOVA, and linear regression., RESULTS: A total of 43 patients were included through 6 months of follow-up. Mean reduction in IOP in the treated eye was 3.9 +/- 0.6 mmHg or 18.8% (p < 0.001) at final exam. Mean IOP reduction in the fellow untreated eye was 2.1 +/- 0.5 mmHg or 11.2% (p < 0.01). Patients with higher preoperative IOPs had a greater reduction in IOP in both eyes (p < 0.001 for treated eyes, and p = 0.02 for untreated eyes). Patients who were on a larger number of glaucoma medications preoperatively had a greater response in both eyes (treated eye p = 0.002, untreated eye p = 0.008). There was no significant difference in IOP response in either eye based on age, gender, CCT, degrees of treatment, or phakic status., CONCLUSIONS: SLT produces a sustained and statistically significant IOP reduction in the fellow untreated eyes of patients with open-angle glaucoma. The results of our study support a biological mechanism of action for SLT. Limitations of this study include its retrospective design, relatively small sample size, a possible effect of increased compliance with medical therapy following SLT, and an inherent bias of excluding patients who underwent a change in medications or further laser or surgical therapy during the period under review.
Keywords: Aged; Aged, 80 and over; Humans; *Intraocular Pressure; *Laser Therapy; Middle Aged; *Trabeculectomy

Anti-angiogenic drugs as an adjunctive therapy in the surgical treatment of diabetic retinopathy. - Figueroa, Marta S; Contreras, Ines; Noval, Susana (Current diabetes reviews, 2009)
Anti-VEGF drugs may be employed in the surgical treatment of diabetic retinopathy: 1. Prior to surgery. The intravitreal injection of anti-VEGF drugs leads to a significant reduction of neovascularization, with a reduction in the adherence of the fibrovascular complex to the retina. This simplifies viscodelamination and reduces intraoperative bleeding during delamination and segmentation. To minimize the risk of tractional retinal detachment due to the contraction of fibrovascular tissue, vitrectomy must be performed within one week after the injection. 2. To decrease the risk of postoperative bleeding. Recurrent vitreous hemorrhages after vitrectomy are often due to small bleeding from persistent neovascularization. The injection of anti-VEGF drugs at the end of vitrectomy could prevent bleeding from these vessels by blocking the pro-inflammatory stimulus of the surgical procedure. 3. To treat postoperative vitreous hemorrhage. The intravitreal injection of anti-VEGF drugs in patients with postoperative bleeding leads to resolution of the hemorrhage. 4. To treat rubeosis iridis. In eyes with complete panretinal photocoagulation, the combination of cryotherapy and intravitreal anti-VEGF injection in the same surgical procedure produces a disappearance of iris neovascularization together with a long term effect with no recurrences. In neovascular glaucoma, anti-VEGF drugs can also facilitate filtrating surgery.
Keywords: *Angiogenesis Inhibitors/tu [Therapeutic Use]; Combined Modality Therapy; *Diabetic Retinopathy/dt [Drug Therapy]; *Diabetic Retinopathy/su [Surgery]; Humans; Light Coagulation/ae [Adverse Effects]; Light Coagulation/mt [Methods]; Postoperative Complications/dt [Drug Therapy]; Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]; *Vitrectomy/mt [Methods]

Improving the prediction of medication compliance: the example of bisphosphonates for osteoporosis. - Curtis, Jeffrey R; Xi, Juan; Westfall, Andrew O; Cheng, Hong; Lyles, Kenneth; Saag, Kenneth G; Delzell, Elizabeth (Medical care, 2009)
INTRODUCTION: Administrative claims data have a limited ability to identify persons with high compliance to oral bisphosphonates. We tested whether adding information on compliance with other drugs used to treat chronic, asymptomatic conditions would improve the predictive ability of administrative data to identify adherent individuals., METHODS: Using data from a large, US healthcare organization, we identified new bisphosphonate users and their 1-year compliance to oral bisphosphonates, quantified by the Medication Possession Ratio (MPR). Multivariable logistic regression models evaluated the relationship between high bisphosphonate compliance (MPR >or=80%) and patient demographics, comorbidities, and health services utilization. To these logistic regression models, we evaluated the incremental change in the area under the receiver operator curve (AUC) after adding information regarding compliance with other drug classes. These included antihyperlipidemics (statins), antihypertensives, antidepressants, oral diabetes agents, and glaucoma medications. Results from the logistic regression models were evaluated in parallel using recursive partitioning trees with 10-fold cross-validation., RESULTS: Among 101,038 new bisphosphonate users, administrative data identified numerous nonmedication factors (eg, age, gender, use of preventive services) significantly associated with high bisphosphonate compliance at 1 year. However, all these factors in aggregate had low discriminant ability to identify persons highly adherent with bisphosphonates (AUC = 0.62). For persons who were new users of >or=1 of the other asymptomatic condition drugs, MPR data on the other drugs substantially improved the prediction of high bisphosphonate compliance. The impact on prediction was largest for concomitant statin users (AUC = 0.70)., CONCLUSIONS: Information on compliance with drugs used to treat chronic asymptomatic conditions improves the prediction of compliance with oral bisphosphonates. This information may help identify persons who should receive targeted interventions to promote compliance to osteoporosis medications.
Keywords: Administration, Oral; Age Factors; Aged; Antidepressive Agents/tu [Therapeutic Use]; Antihypertensive Agents/tu [Therapeutic Use]; Bone Density Conservation Agents/ad [Administration & Dosage]; *Bone Density Conservation Agents/tu [Therapeutic Use]; *Chronic Disease/dt [Drug Therapy]; Comorbidity; Diphosphonates/ad [Administration & Dosage]; *Diphosphonates/tu [Therapeutic Use]; Female; Humans; Hypoglycemic Agents/tu [Therapeutic Use]; Hypolipidemic Agents/tu [Therapeutic Use]; Insurance Claim Review; Insurance, Pharmaceutical Services; Logistic Models; Male; *Medication Adherence/px [Psychology]; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Osteoporosis/dt [Drug Therapy]; *Preventive Health Services/sn [Statistics & Numerical Data]; Sex Factors; United States

An in vivo confocal microscopy analysis of effects of topical antiglaucoma therapy with preservative on corneal innervation and morphology. - Martone, Gianluca; Frezzotti, Paolo; Tosi, Gian Marco; Traversi, Claudio; Mittica, Vincenzo; Malandrini, Alex; Pichierri, Patrizia; Balestrazzi, Angelo; Motolese, Paolo Alfonso; Motolese, Ilaria; Motolese, Edoardo (American journal of ophthalmology, 2009)
PURPOSE: To evaluate the long-term effects of preservative-free and preservative-containing antiglaucoma eye drops on the tear secretion and ocular surface., DESIGN: Comparative retrospective study., METHODS: A total of 84 patients with bilateral primary open-angle glaucoma or ocular hypertension divided into 5 groups according to type of topical hypotensive therapy and 20 healthy age-matched volunteers were studied. Clinical tests (corneal sensitivity, Schirmer I test, and lachrymal film break-up time), and in vivo confocal microscopy were performed in all patients., RESULTS: A significant reduction of the scores was found between groups on topical hypotensive therapy and the control group in all clinical parameters studied (P < .05). In particular, the clinical scores were significantly lower in the preservative medication groups than in the preservative-free group (P < .05). The density of superficial epithelial cells was reduced in all glaucomatous patients, except for the preservative-free group (P > .05), with respect to control subjects (P < .001). On the contrary, the density of basal epithelial cells of glaucomatous preservative therapy groups was higher than control and preservative-free groups (P < .05). Stromal keratocyte activation and the number of beads were higher in all glaucoma preservative groups (P < .05). The number of sub-basal nerves was lower in all glaucoma groups than in the control group (P < .05) and tortuosity was significantly higher in glaucoma than control groups (P < .05). Reflectivity of fibers did not show any significant difference between the 6 groups (P < .05)., CONCLUSIONS: Glaucomatous patients with chronic treatment show ocular surface alterations. The development of nontoxic antiglaucoma treatment may reduce damage to the ocular surface and improve the compliance and the adherence in the medical therapy.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Benzalkonium Compounds/ad [Administration & Dosage]; Cell Count; *Cornea/ir [Innervation]; Drug Combinations; Epithelium, Corneal/de [Drug Effects]; Epithelium, Corneal/pa [Pathology]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Microscopy, Confocal; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Nerve/de [Drug Effects]; Ophthalmic Nerve/pa [Pathology]; *Preservatives, Pharmaceutical/ad [Administration & Dosage]; Preservatives, Pharmaceutical/ae [Adverse Effects]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Retrospective Studies; Timolol/ad [Administration & Dosage]

[Fluctuation of intraocular pressure in 24-hour telemonitoring compared to tonometry during normal office hours]. - Jurgens, C; Antal, S; Henrici, K; Grossjohann, R; Tost, F H (Klinische Monatsblatter fur Augenheilkunde, 2009)
BACKGROUND: Elevated intraocular pressure (IOP) is a clinically relevant factor in glaucoma progression. As a dynamic parameter the IOP depends on various internal and exogenic influencing factors. Therefore, we analysed intraindividual IOD variations between ambulant care and 24-h home-monitoring using self-tonometry., PATIENTS AND METHODS: This study is based on paper-based glaucoma cards of 25 patients with primary open angle glaucoma. Additionally, all patients participated in a telemedical home-monitoring study with self-measurements of IOP and blood pressure stored in an electronic patient record. The glaucoma cards contained a total number of 409 IOP values with documentation periods from 0.5 to 10 years. In the teletonometry project all 25 patients were observed for 6 months with 1490 recorded IOP values. Statistical analysis was performed with SPSS software., RESULTS: Average IOP values for all 25 glaucoma patients were 16.3 +/- 2.9 mmHg for both eyes in glaucoma card documentation, whereas the electronic patient records showed IOP averages of 18.9 +/- 4.7 mmHg for right eyes and 18.2 +/- 4.4 mmHg for left eyes. Corresponding to the practice opening hours the glaucoma cards contained no IOP records from 12:00 pm to 01:30 pm as well as between 06:00 pm and 07:15 am. In these time periods 17 % of all IOP values recorded in 24-hour teletonometry were higher than 20 mmHg. However, statistical analysis and clinical evaluation of device parameters and measurement characteristics revealed sporadic measuring errors., CONCLUSIONS: The additional involvement of self-tonometry in telemedical 24-h home-monitoring is a feasible method to record and detect intraday IOP fluctuations. Compared to single IOP measurements documented in common paper-based glaucoma cards, the 24-h electronic patient record showed more frequent circadian IOP variations. As a result, self-tonometry and home-monitoring can be a useful link to fill the gap between singular ambulant IOP measurement and hospitalisation with 24-hour IOP profiles.
Keywords: Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure; Male; Middle Aged; *Monitoring, Ambulatory/mt [Methods]; *Office Visits; Reproducibility of Results; Sensitivity and Specificity; *Telemedicine/mt [Methods]; *Tonometry, Ocular/mt [Methods]

Knowledge about glaucoma and barriers to follow-up care in a community glaucoma screening program. - Altangerel, Undraa; Nallamshetty, Hema S; Uhler, Tara; Fontanarosa, Joann; Steinmann, William C; Almodin, Juliana M; Chen, Brian H; Henderer, Jeffrey D (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2009)
OBJECTIVE: To assess perceived barriers to glaucoma follow-up care, including the lack of glaucoma knowledge and the lack of health care access, among participants in a community glaucoma screening program., DESIGN: Community survey., PARTICIPANTS: Two hundred forty-three consecutive participants in a series of free glaucoma screenings between November 2002 and August 2003., METHODS: The survey consisted of 20 questions designed to elicit knowledge of glaucoma and perception of potential barriers to follow-up care. Our aim was to find correlations between patient demographics and knowledge of glaucoma as well as perceived potential barriers to follow-up care. The data were analyzed using SPSS, v. 10.1., RESULTS: The average age of the respondents was 70 years, and females predominated (66%). About half of the respondents knew of an eye doctor in their neighborhood, and 60% had had an eye examination in the past year. Two hundred twenty-two (91%) indicated they could get to an eye doctor if the screening examination indicated they needed a follow-up examination. Two hundred twenty (90.5%) had medical insurance. One hundred seventy-eight (73%) of the participants had heard of glaucoma; 71 (29%) identified an accurate definition of glaucoma. The level of education and the language spoken at home were correlated with both glaucoma awareness (p < 0.001; p < 0.001) and knowledge of an accurate definition of glaucoma (p < 0.001; p < 0.025)., CONCLUSIONS: In this population, a lack of adequate education about glaucoma may be more significantly associated with poor follow-up rates than a lack of access to care in those identified as glaucoma suspects.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Attitude to Health; Child; *Diagnostic Techniques, Ophthalmological; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; *Health Knowledge, Attitudes, Practice; *Health Services Accessibility; Health Services Research; Health Surveys; Humans; Male; Middle Aged; Surveys and Questionnaires

Blueberry eye: acquired total anterior staphyloma after a fungal corneal ulcer. - Grieser, Eric J; Tuli, Sonal S; Chabi, Almira; Schultz, Scott; Downer, Donald (Cornea, 2009)
PURPOSES: The purposes of this study were to report the presentation and management of an acquired total anterior staphyloma that resulted from a fungal corneal ulcer and to discuss its pathogenesis., METHODS: Observational case report. Clinical observation and surgical intervention of a patient who developed a total anterior staphyloma after a partially treated fungal corneal ulcer., RESULTS: The patient presented with a large traumatic fungal ulcer but was poorly compliant with follow-up and medications. He subsequently presented with a large total anterior staphyloma that resulted from perforation of the ulcer with plugging of the defect with iris and formation of a pseudocornea over the iris. The anterior staphyloma measured 15 x 16 mm and progressed to a stage where the patient was unable to close his eyelids and required a sclerokeratoplasty. Currently, vision is poor from amblyopia and a cloudy graft; however, the eye is intact and comfortable., CONCLUSIONS: Anterior staphylomas usually result from untreated fungal ulcers in developing nations. Poor compliance with medications and follow-up was the cause of our patient's anterior staphyloma. Sclerokeratoplasty can restore the globe structurally but has poor visual prognosis.
Keywords: Amblyopia/co [Complications]; Antifungal Agents/tu [Therapeutic Use]; *Corneal Diseases/et [Etiology]; Corneal Diseases/pa [Pathology]; Corneal Diseases/su [Surgery]; Corneal Transplantation; *Corneal Ulcer/co [Complications]; *Corneal Ulcer/mi [Microbiology]; Humans; Male; Middle Aged; *Mycoses/co [Complications]; Mycoses/dt [Drug Therapy]; Patient Compliance; Sclera/su [Surgery]; Vision, Low/et [Etiology]

Intraocular pressure control and fluctuation: the effect of treatment with selective laser trabeculoplasty. - Nagar, M; Luhishi, E; Shah, N (The British journal of ophthalmology, 2009)
AIMS: To evaluate the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) control and diurnal tension curves of patients with open-angle glaucoma (OAG) and ocular hypertension (OHT), and to compare this effect with that of latanoprost., METHODS: Forty patients were randomised to receive either SLT or latanoprost. IOP control was evaluated by comparing pretreatment values with post-treatment measurements on day 3, week 1, month 1 and 4-6 months; success was defined as 20% decrease in IOP. Tension curves were plotted prior to treatment and 4-6 months afterwards; success was 50% reduction in fluctuation., RESULTS: SLT decreased pressure by 4.7 mm Hg on average (95% CI 3.6 to 5.7 mm Hg; p<0.01). The reduction was similar for latanoprost at all follow-ups except month 1; 75% of SLT patients and 73% of latanoprost patients achieved success in IOP control (p = 0.4). SLT significantly reduced IOP fluctuation, but latanoprost was more effective (3.6 mm Hg, 95% CI 3.2 to 3.9 mm Hg vs 2.5 mm Hg, 95% CI 2.2 to 2.9 mm Hg for SLT; p = 0.04). Success in fluctuation reduction was 50% for SLT and 83% for latanoprost (p = 0.045)., CONCLUSIONS: Both SLT and latanoprost had a significant impact on IOP control and fluctuation. While latanoprost may be more likely to reduce IOP fluctuation, SLT has the benefit of being a one-time intervention not requiring ongoing patient compliance.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Circadian Rhythm/ph [Physiology]; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Laser Therapy/mt [Methods]; Latanoprost; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/su [Surgery]; Prospective Studies; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Single-Blind Method; *Trabeculectomy/mt [Methods]; Treatment Outcome

Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. - Okeke, Constance O; Quigley, Harry A; Jampel, Henry D; Ying, Gui-shuang; Plyler, Ryan J; Jiang, Yuzhen; Friedman, David S (Ophthalmology, 2009)
PURPOSE: To assess patient adherence and behaviors with topical once-daily therapy for glaucoma., DESIGN: Prospective, observational cohort study., PARTICIPANTS: One hundred ninety-six patients with glaucoma who were being treated with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007., METHODS: Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit., MAIN OUTCOME MEASURES: Assessment of adherence and patterns of drop usage as indicated by the DA., RESULTS: A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (+/-standard deviation) adherence rate was 0.71 (+/-0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19)., CONCLUSIONS: Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor., FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Attitude to Health; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cohort Studies; Drug Monitoring/is [Instrumentation]; Female; Follow-Up Studies; *Glaucoma, Angle-Closure/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; Prospective Studies; Surveys and Questionnaires; Travoprost

Patient-reported barriers to glaucoma medication access, use, and adherence in southern India. - Sleath, Betsy L; Krishnadas, R; Cho, Minhee; Robin, Alan L; Mehta, Rakhi; Covert, David; Tudor, Gail (Indian journal of ophthalmology, 2009)
The objectives of the study were to (a) describe the different types of problems that patients in southern India reported having when taking their glaucoma medications and (b) examine the relationship between patient reported-problems in taking their glaucoma medications and the self-reported patient adherence. A survey was conducted by clinical staff on 243 glaucoma patients who were on at least one glaucoma medication in an eye clinic in southern India. We found that 42% of patients reported one or more problems in using their glaucoma medications. Approximately 6% of patients reported being less than 100% adherent in the past week. Unmarried patients and patients who reported difficulty squeezing the bottle and difficulty opening the bottle were significantly more likely to report nonadherence.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Attitude to Health; *Drug Utilization/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Services Research; Humans; India/ep [Epidemiology]; Male; *Medication Errors/sn [Statistics & Numerical Data]; *Patient Compliance/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Urban Population/sn [Statistics & Numerical Data]

An assessment of readiness for behaviour change in patients prescribed ocular hypotensive therapy. - Schwartz, G F; Plake, K S; Mychaskiw, M A (Eye (London, England), 2009)
OBJECTIVES: To compare responses in two patient populations with a questionnaire developed to identify those prescribed ocular hypotensive medication whose adherence may need improvement and who may be ready to change., METHODS: The content/face validity of a 62-item, self-administered questionnaire was confirmed by nine glaucoma specialists. Questions concerned demographics, health and medications, use of/problems with medications, and visual function. The questionnaire was administered anonymously to 102 consecutive patients in a glaucoma referral practice ('glaucoma practice') and 100 from a multispecialty ophthalmology practice ('multispecialty practice'). All participants were prescribed >or=1 ocular hypotensive medication and had no previous trabeculectomy., RESULTS: Patients in the glaucoma practice were more likely to be younger, African-American, and better educated (P<0.05 for each). In both, >80% had glaucoma with >60% diagnosed >or=3 years previously. Most (glaucoma, multispecialty: 87, 93%) reported administering drops every day, but more in the multispecialty practice reported administering drops at the same time every day (79, 92%; P<0.05). Number of adherence problems (mean, 1/patient) and adherence scores (mean, 24; possible scale range, 0-25) were similar. Common adherence barriers were falling asleep and forgetting when the regular schedule changed or when travelling. In the glaucoma practice, the number of adherence problems was correlated with adherence score (r=-0.611; P<0.0001) and number of side effects (r=0.349; P<0.0001)., CONCLUSIONS: Similarities between patient populations limited our ability to compare responses between groups or to propose adherence counselling tailored to specific demographics. Until such recommendations are possible, physicians should incorporate adherence counselling broadly into their practices.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Attitude to Health; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence/px [Psychology]; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Models, Theoretical; Reproducibility of Results; Surveys and Questionnaires/st [Standards]

Prostaglandin analogues in the anterior eye: their pressure lowering action and side effects. - Cracknell, Kathryn P B; Grierson, Ian (Experimental eye research, 2009)
Topical application of prostaglandin (PG) analogues are currently the most commonly used intraocular pressure lowering drugs in glaucoma. They have been available since the mid 1990's, and are efficacious and generally well tolerated, the compliance rates are good due to the once a day application regime. The mode of action of PGs is by increasing the aqueous humour outflow primarily via the uveoscleral route, and also (but to a lesser degree) the conventional trabecular meshwork pathway. Increased outflow is primarily accomplished by remodelling the extracellular matrix components in both of the outflow pathways. PGs are associated with very few systemic side effects. The side effects of concern are all concentrated in the eye. Conjunctival hyperaemia is a common mild but transient complication. Since the development of this class of drug the most worrying and unusual side effect is a change in the pigmentation of the melanin-containing tissues close to the application site, i.e. eyelid skin, eyelashes and iris. As the prostaglandin induced iris darkening (PIID) is irreversible on cessation of the drugs it was of particular concern. We report here the findings from many studies which strongly indicate that there are no histopathological changes occurring in the iris tissue that has developed the darkening side effect. The only definitive change that has been detected in the cases of PIID is a small enlargement of the size of the existing melanin granule population and it has been shown that this change in melanin granule size is sufficient to account for the PIID. These findings point to the conclusion that the darkening developed following PG use is of a purely cosmetic effect with little or no serious consequences.
Keywords: *Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/pd [Pharmacology]; *Eye Diseases/ci [Chemically Induced]; Humans; *Hyperpigmentation/ci [Chemically Induced]; *Intraocular Pressure/de [Drug Effects]; Iris Diseases/ci [Chemically Induced]; *Prostaglandins, Synthetic/ae [Adverse Effects]; Prostaglandins, Synthetic/pd [Pharmacology]

Prevalence and determinants of non-adherence to topical hypotensive treatment in Dutch glaucoma patients. - Olthoff, Christine M G; Hoevenaars, Juliette G M M; van den Borne, Bart W; Webers, Carroll A B; Schouten, Jan S A G (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2009)
BACKGROUND: To assess the prevalence and determinants of non-adherence to topical hypotensive treatment in glaucoma patients in order to support interventions targeting enhancement of patient adherence., METHODS: One-hundred and sixty-six glaucoma patients, recruited by nationwide multi-stage sampling, filled in an extensive and carefully developed questionnaire covering various theoretically relevant determinants of patient adherence which were categorized as psychosocial aspects, barriers and skills., RESULTS: Prevalence of self-reported non-adherence was 27.3%. Younger patients (<55 years of age) had a higher risk of being non-adherent. Forgetfulness, unavailability of eye drops and difficulties with holding the bottle above the eye when applying the eye drops were the most cited reasons for non-adherence. Fifty percent of the patients indicated that they required more information on the correct administration of eye drops. There was no association between non-adherence and sex, level of education, type of insurance, duration of disease or family history of glaucoma., CONCLUSIONS: Non-adherence to topical glaucoma medication is fairly common. Aids that minimize forgetfulness and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence before advancing to other therapies with additional risks and costs.
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; Drug Costs; Female; *Glaucoma/dt [Drug Therapy]; *Glaucoma/ep [Epidemiology]; Humans; Male; Middle Aged; Netherlands/ep [Epidemiology]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ec [Economics]; *Patient Compliance/sn [Statistics & Numerical Data]; Prevalence; Psychology; Risk Factors; Self Administration/sn [Statistics & Numerical Data]; Surveys and Questionnaires

Trabeculectomy with an active postoperative regimen: results and resource utilization. - Taube, Amelie B; Niemela, Pekka; Alm, Albert (Acta ophthalmologica, 2009)
PURPOSE: To evaluate intraocular pressure (IOP) and resource utilization after trabeculectomy, using an active postoperative regimen, in a Swedish population., METHODS: A retrospective analysis was performed on the patient charts of all patients who underwent trabeculectomy in a Swedish university hospital during 1 year (November 2000-December 2001). Trabeculectomy was performed in 34 eyes and trabeculectomy in combination with phacoemulsification in 10 eyes. Intraocular pressure, visual acuity, complications and numbers of injections of 5-fluorouracil, suture removal, needling procedures and visits to ophthalmologists were recorded for 2 years., RESULTS: Mean IOP before surgery was 30.4 mmHg (standard deviation [SD] 9.5) in eyes with capsular glaucoma and 28.7 mmHg (SD 9.3) in eyes with primary open-angle glaucoma. Mean IOP after 2 years was 15.3 mmHg (SD 3.9) in all eyes. Intraocular pressure of < 18 mmHg was achieved in 65% of the eyes after 2 years, as was IOP < or = 13 mmHg in 37%. Flap or suture manipulation was performed in 41 of 44 eyes. Needling procedures were carried out a mean of 2.3 times in 31 eyes. The mean number of visits to an ophthalmologist was 14.1 during the first postoperative year and 4.4 during the second., CONCLUSIONS: The results were encouraging, with few complications and modest resource utilization.
Keywords: Aged; Conjunctiva; Female; Fluorouracil/ad [Administration & Dosage]; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; Glaucoma, Open-Angle/su [Surgery]; Humans; Injections; Intraocular Pressure; Male; Middle Aged; Office Visits/sn [Statistics & Numerical Data]; Ophthalmology/mt [Methods]; Phacoemulsification; *Postoperative Care; Retrospective Studies; Surgical Flaps; Suture Techniques; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy; Treatment Outcome; Visual Acuity

Persistency with medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994-2005. - Owen, C G; Carey, I M; de Wilde, S; Whincup, P H; Wormald, R; Cook, D G (Eye (London, England), 2009)
PURPOSE: To examine trends and demographic factors affecting persistence with ocular hypotensive therapy, from a period before prostaglandins were available to when they were the most common therapy., METHODS: Computerised patient records from 94 general practices across the United Kingdom, identified 5670 registered patients newly prescribed an ocular hypotensive drug (1993-2005). Persistence was defined as continuing therapy without a 90-day gap in prescription for (i) any ocular hypotensive and (ii) initial monotherapy. Time to failure with the treatment was compared using proportional hazard analyses, adjusted for age, gender, practice, year of initial treatment, and a sociodemographic indicator. Study findings were set in the context of a review of the literature., RESULTS: Percentage persistent at 1-year rose after 1997 when prostaglandins were introduced; from 61% in 1994-1996 to 70% in 2002-2004. Persistence with any treatment did not differ between those initiated on beta-blockers compared to prostaglandins (1.05, 95% CI 0.93-1.17). However, 20% of subjects initiated on beta-blockers received a prostaglandin by 1 year. Conversely, 8% of those initiated on prostaglandins received a beta-blocker. When failure with initial therapy was considered, beta-blockers appeared worse (1.35, 95% CI 1.21-1.50); this was consistent with findings from six studies in the review (1.40, 95% CI 1.34-1.46). Neither gender nor social factors were associated with persistence, but younger subjects (35-64 years) were significantly more likely to fail as were those over 85 years., CONCLUSIONS: Introduction of prostaglandins may explain an improvement in persistence over a decade. However, whether the higher cost of initiating patients on prostaglandins is justified remains questionable unless clinically indicated.
Keywords: *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Medical Records; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Proportional Hazards Models; *Prostaglandins/tu [Therapeutic Use]; United Kingdom

Sustained delivery of timolol maleate from poly(lactic-co-glycolic acid)/poly(lactic acid) microspheres for over 3 months. - Bertram, James P; Saluja, Sandeep S; McKain, Jodi; Lavik, Erin B (Journal of microencapsulation, 2009)
It is estimated that 2.2 million people have glaucoma in the US and 67 million people worldwide. The majority of cases are associated with elevated intraocular pressure (IOP) and decreasing IOP eliminates or greatly reduces degeneration in most cases, including cases in which the IOP is in the normal range but optic neuropathy occurs. Timolol maleate has the longest record of safety and efficacy to lower IOP and is administered via eye drops one or more times per day. Unfortunately, compliance is poor across patient populations leading to degeneration. Patients typically see their ophthalmologist once every 3-4 months. If one could administer a long-acting treatment while in the doctor's office, one might overcome the compliance issue and effectively preserve sight. The critical step is to develop a formulation for timolol maleate that leads to sustained delivery for greater than 90 days and would permit a different treatment paradigm, namely subconjunctival administration once every 3-4 months. By using a 50 : 50 blend of PLGA 502H and PLA, this study was able to fabricate microspheres that delivered timolol maleate continually over 107 days, well within the time frame needed to make subconjunctival administration feasible and permit a new approach to treating glaucoma and diseases of the eye more broadly.
Erratum in (EIN)
Keywords: *Delayed-Action Preparations/ch [Chemistry]; Eye Diseases/dt [Drug Therapy]; Humans; *Lactic Acid; *Microspheres; Polyesters; *Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; *Polymers; *Timolol/ad [Administration & Dosage]

Barriers to adherence with glaucoma medications: a qualitative research study. - Lacey, J; Cate, H; Broadway, D C (Eye (London, England), 2009)
PURPOSE: Glaucoma is initially asymptomatic, but untreated can result in progressive visual field loss and eventual blindness. With adequate therapy progression can be halted, but poor adherence with medical therapy is a significant issue requiring further research. The aim of the present study was to gain a better understanding of the obstacles to, and the motivations for, adherence with glaucoma medication and explore potential methods to improve adherence., METHODS: Participants had moderate/severe glaucoma diagnosed for >1 year, had seen >or=2 NHS ophthalmologists, and were prescribed >or=2 topical medications. Qualitative methodology was utilized to investigate aspects of adherence. Recruited patients either attended a focus group or had a home-based semi-structured interview. The transcripts were member-checked and the resulting data were analysed using 'Framework' analysis. The analysis was verified by a co-investigator and NVIVO Software was used to check data reliability., RESULTS: Multiple obstacles to adherence were identified, including poor education, lack of motivation, forgetfulness, drop application, and other practical issues, together with specific individual and age differences. Motivation for adherence was determined by fear of blindness and a faith in drop efficacy., CONCLUSIONS: Specific obstacles to adherence with anti-glaucomatous therapy should be identified as early as possible after diagnosis. A tailored approach to patient care with initial education about the consequences of non-adherence and longer-term feedback about drop efficacy may improve patients' motivations for adherence. Future research should focus on investigating methods by which initial education about glaucoma and its management should best be delivered to patients.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Blindness/pc [Prevention & Control]; Female; Focus Groups; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Male; Medication Adherence/px [Psychology]; *Medication Adherence; Middle Aged; Motivation; Qualitative Research; Surveys and Questionnaires

Exploring glaucoma awareness and the utilization of primary eye care services: community perceived barriers among elderly African Caribbeans in Chapeltown, Leeds. - Awobem, J F; Cassels-Brown, A; Buchan, J C; Hughes, K A (Eye (London, England), 2009)
Comment on (CON)
Keywords: *African Continental Ancestry Group; Aged; Caribbean Region/eh [Ethnology]; England/ep [Epidemiology]; *Glaucoma/th [Therapy]; Health Knowledge, Attitudes, Practice; Humans; *Patient Acceptance of Health Care/eh [Ethnology]

Comparison of topical fixed-combination fortified vancomycin-amikacin (VA solution) to conventional separate therapy in the treatment of bacterial corneal ulcer. - Chiang, C-C; Lin, J-M; Chen, W-L; Chiu, Y-T; Tsai, Y-Y (Eye (London, England), 2009)
PURPOSE: In an in vitro study, fixed-combination fortified vancomycin and amikacin ophthalmic solutions (VA solution) had the same potency and stable physical properties as the separate components. In this retrospective clinical study, we evaluated the efficacy of the topical VA solution in the treatment of bacterial corneal ulcer and comparison with separate topical fortified vancomycin and amikacin., METHODS: Separate topical fortified eye drops was used prior to January 2004 and switched to the VA solution afterwards in the treatment of bacterial corneal ulcer. The medical records of 223 patients diagnosed with bacterial corneal ulcers between January 2002 and December 2005 were reviewed retrospectively. There were 122 patients in the VA group and 101 in the separate group. Cure was defined as complete healing of the ulcer accompanied by a nonprogressive stromal infiltrate on two consecutive visits., RESULTS: No significant difference was found between the VA and separate therapy group. The mean treatment duration was 15.4 days in the VA group and 16.1 days in the separate therapy group. The average hospital stay was 5.4 days (VA) and 7.2 days (separate antibiotics). Stromal infiltration regressed significantly without further expansion in both groups. All corneal ulcers completely re-epithelialized without complications related to drugs., CONCLUSION: VA solution provided similar efficacy to the conventional separate therapy in the treatment of bacterial corneal ulcers; however, it is more convenient and tolerable, promotes patient's compliance, avoids the washout effect, and reduces nurse utilization. Hence, VA solution is a good alternative to separate therapy.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Amikacin/ad [Administration & Dosage]; Amikacin/tu [Therapeutic Use]; *Anti-Bacterial Agents/ad [Administration & Dosage]; Anti-Bacterial Agents/tu [Therapeutic Use]; Chemistry, Pharmaceutical; Child; *Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; Drug Combinations; Drug Therapy, Combination; *Eye Infections, Bacterial/dt [Drug Therapy]; Eye Infections, Bacterial/mi [Microbiology]; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Risk Factors; Treatment Outcome; *Vancomycin/ad [Administration & Dosage]; Vancomycin/tu [Therapeutic Use]; Young Adult

Characteristics of and risk factors for contact lens-related microbial keratitis in a tertiary referral hospital. - Edwards, K; Keay, L; Naduvilath, T; Snibson, G; Taylor, H; Stapleton, F (Eye (London, England), 2009)
AIM: A retrospective case-control study was conducted at a tertiary referral hospital to determine the characteristics of and risk factors for contact lens (CL) related presumed microbial keratitis., METHODS: Two hundred and ninety-one cases of presumed microbial keratitis were retrospectively identified over a 2-year period. Records were reviewed for a history of CL wear and, where identified, CL, demographic, and clinical data were collected. Lens wearing controls (n=186) were identified by a community telephone survey. Multiple logistic regression estimated risk factors for infection and vision loss., RESULTS: Ninety-nine (34%) new cases of presumed microbial keratitis were associated with CL wear. Overnight soft CL use was associated with an increased risk of infection compared to daily disposable CL wear (odds ratio (OR): 8.03, 95% confidence interval (CI): 1.82-35.46). Compared with older CL wearers, 15-24 year olds had a 3.5 times greater risk of infection (OR, 95% CI: 1.7-7.4). Of the 84 cases with available data, 24 (29%) lost two or more lines of best-corrected visual acuity. Delaying treatment by 49-72 h had a 4.5 times (OR, 95% CI: 1.4-14.9) greater risk of visual loss compared to seeking treatment early. Of the 99 cases of infection, 88 were scraped and 78% (69/88) of these returned a positive culture. Gram-positive bacteria were the predominant causative organisms., CONCLUSION: Overnight use of CL and youth carry a greater risk of infection. Practitioners should reinforce the importance of proper CL care at all times, and early presentation following the onset of symptoms.
Keywords: Adolescent; Adult; Blindness/mi [Microbiology]; *Contact Lenses/ae [Adverse Effects]; Epidemiologic Methods; *Eye Infections/et [Etiology]; Female; Humans; *Keratitis/mi [Microbiology]; Male; Middle Aged; Patient Acceptance of Health Care; Seasons; Travel; Young Adult

[Therapeutic contact lenses and the advantages of high Dk materials]. - Coral-Ghanem, Cleusa; Ghanem, Vinicius Coral; Ghanem, Ramon Coral (Arquivos brasileiros de oftalmologia, 2008)
Therapeutic contact lenses are useful in a variety of ocular surface diseases. Their main indications are: to relieve the pain; protect ocular surface; promote corneal healing and epithelial regeneration; seal a leaking corneal wound and deliver ophthalmic drugs on the ocular surface. There are several kinds of lens designs and materials, and their choice is dependent on the specific disease to be treated, the duration of treatment and the physiologic needs of the diseased cornea. Bullous keratopathy, recurrent epithelial erosion syndrome, dry eye and postoperative epithelial defects are amongst their indications. Therapeutic contact lenses should not be indicated in the presence of active infectious keratitis or when the patient is not compliant. Corneal neovascularization, giant papillary conjunctivitis and infectious keratitis are serious complications, which can be prevented by correctly fitting and maintaining the therapeutic contact lenses. Silicon-hydrogel therapeutic contact lenses, due to their higher oxygen permeability, allow extended wear schedules, decreasing the need for frequent lens replacement.
Keywords: *Contact Lenses; *Corneal Diseases/th [Therapy]; Disinfection; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; *Oxygen/me [Metabolism]; Permeability; Silicon

[Obstacles to medication compliance for patients with glaucoma]. - Kowal, Malgorzata; Choragiewicz, Tomasz; Mietlicka, Katarzyna; Wyszynska, Anna; Zarnowski, Tomasz (Klinika oczna, 2008)
PURPOSE: Aim of the study was to identify obstacles to medication adherence (compliance) for patients with glaucoma., MATERIAL AND METHODS: A prospective case series of structured interviews were conducted in 150 patients with glaucoma. (75 patients treated in the glaucoma out-patient clinic of the Department of Ophthalmology, Medical University, Lublin, Poland and 75 patients treated in regional out-patient clinics). Questionnaire of an anonymous survey, formulated on the basis of the publication: Tsai J.C. et al. "Compliance barriers in glaucoma: a systematic classification", J. Glaucoma. 2003, 12, 393-398., RESULTS: The results of the survey showed omissions of particular doses of medications in 62.7% of patients from regional outpatient clinics and in 35.3% of patients treated at the Department of Ophthalmology. It was shown that 32.7% of respondents from regional outpatient clinics and 8.7% from the Department of Ophthalmology Glaucoma Clinic declared remaining without antiglaucoma drops for more than one day. As reasons for omissions of single doses of the medications: forgetfulness (54.7%), too many doses of medications (10%) and little knowledge about the disease (10%) were usually pointed. According to the respondents: little knowledge (32%) and financial factors (22%) are the main causes of medications withdrawal for longer time., CONCLUSIONS: The most common obstacles to medication compliance for patients with glaucoma include: forgetfulness, low level of knowledge about the disease, financial factors and too many doses of the medications. Fewer doses and the presence of a supporting person have a positive influence on compliance.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Attitude to Health; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; *Health Behavior; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; Poland/ep [Epidemiology]; Surveys and Questionnaires; Treatment Refusal/sn [Statistics & Numerical Data]

[Fixed combinations of glaucoma medications]. - Calugaru, D; Calugaru, M (Oftalmologia (Bucharest, Romania : 1990), 2008)
Fixed combinations represent a combination of two ocular hypotensive agents into one single ophthalmic solution. Current commercially available fixed combinations used in glaucoma treatment include Combigan, Cosopt, Xalcom, Duotrav and Ganfort. Statistically significant superiority of the ocular hipotensive efficacy of the fixed combinations vs monotherapy with the two individual constituents is present connected with Cosopt and Xalcom. It also exists vs timolol ophthalmic solution relative to Combigan, Duotrav and Ganfort but is missing within these fixed combinations vs brimonidine, travatan and bimatoprost respectively. A slight reduction, that is clinically and statistically insignificant relative to fixed combination efficacy vs the nonfixed combinations (e.g. concomitant but separate administration of the two individual components) is acceptable when this is balanced by potential benefits of the fixed combinations therapy (improved tolerability and convenience,increased compliance,cost and time economies,decreased washout effect and reduced exposure to preservatives).
Keywords: Amides/ad [Administration & Dosage]; *Antihypertensive Agents/ad [Administration & Dosage]; Bimatoprost; Brimonidine Tartrate; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; Drug Combinations; Drug Therapy, Combination; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Ophthalmic Solutions/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Quinoxalines/ad [Administration & Dosage]; Sulfonamides/ad [Administration & Dosage]; Thiophenes/ad [Administration & Dosage]; Timolol/ad [Administration & Dosage]; Travoprost; Treatment Outcome

[Compliance in glaucoma]. - Stefan, C; Dumitrica, Diana Melinte (Oftalmologia (Bucharest, Romania : 1990), 2008)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Patient Education as Topic; Practice Guidelines as Topic; Quality of Life

Safety and efficacy of inhaled corticosteroids (ICS) in children with asthma. - Petrisko, Maria A; Skoner, Jonathan D; Skoner, David P (The Journal of asthma : official journal of the Association for the Care of Asthma, 2008)
Inhaled corticosteroids (ICS) are the guideline-preferred preventative therapy for persistent asthma of all severity levels and for all ages, including children. While these drugs are unquestionably efficacious, concerns of adverse systemic effects limit patient compliance with treatment regimens and thus the attainable benefits. Suppression of bone growth, bone density, and HPA axis function, in addition to cataract formation and elevated intraocular pressure/glaucoma, have been associated with ICS use. This review will focus on recent developments in the safety and efficacy of ICS as compared to oral CS corticosteroids and the achievement of a balance between risk and benefit in optimizing ICS therapy.
Keywords: Administration, Inhalation; *Adrenal Cortex Hormones/ad [Administration & Dosage]; Adrenal Cortex Hormones/ae [Adverse Effects]; *Asthma/dt [Drug Therapy]; Asthma/pp [Physiopathology]; Bone Density/de [Drug Effects]; Child; Growth/de [Drug Effects]; Humans; Hypothalamo-Hypophyseal System/de [Drug Effects]; Pituitary-Adrenal System/de [Drug Effects]

Physician beliefs and behaviors related to glaucoma treatment adherence: the Glaucoma Adherence and Persistency Study. - Gelb, Laurie; Friedman, David S; Quigley, Harry A; Lyon, David W; Tan, Jason; Kim, Elizabeth E; Zimmerman, Thom J; Hahn, Steven R (Journal of glaucoma, 2008)
PURPOSE: Patient adherence with topical glaucoma therapy is recognized as suboptimal. Though some studies have associated physician/patient interaction with adherence, little systematic research has explored the ophthalmologist's perspective of this interaction. Telephone interviews with physicians treating glaucoma were conducted to ascertain the extent to which multivariate analysis of physician demographics, beliefs, and behaviors could reveal differences potentially relevant to future adherence with topical glaucoma therapy for primary open-angle glaucoma, in conjunction with other phases of the Glaucoma Adherence and Persistency Study (GAPS)., METHODS: Structured interviews were conducted with 103 ophthalmologists treating significant numbers of primary open-angle glaucoma patients in a national managed care network. To the maximum extent possible, eligible patients of physicians interviewed were included in the other GAPS phases (claims analysis, patient surveys, and medical chart reviews)., RESULTS: Physicians reported a wide range of beliefs and behaviors regarding patients' medication adherence, but beliefs and behaviors were linked. The segmentation analysis yielded 3 clusters of physicians, which we have described on the basis of their predominant beliefs as "reactives," "skeptics," and "idealists." The "idealists," though the smallest group, more often reported beliefs and behaviors that may be more positively associated with patient adherence, especially in the context of other GAPS findings., CONCLUSIONS: Physician vigilance for opportunities to detect and address nonadherence is suggested, as is interventional research on the basis of the constructs identified.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Attitude to Health; Databases, Factual; Drug Utilization Review; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Insurance Claim Review; Managed Care Programs/sn [Statistics & Numerical Data]; *Patient Compliance; Physician-Patient Relations; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Retrospective Studies

[Tardive juvenile glaucoma]. - Armegioiu, Monica; Craiu, Andreea; Beraru, Vlad; Constantin, Camelia; Malcea, Cristina (Oftalmologia (Bucharest, Romania : 1990), 2008)
The authors present the case of a young woman with the diagnosis of late juvenile glaucoma. The treatment began in the very moment of the diagnosis but the lack of compliance, as well as the associated risk factors, led to a evolution difficult to control only through medical therapy, which is why we also used laser and surgical treatment. At present, the anatomical and functional status is stable but the long-term prognosis is reserved.
Keywords: Adult; Diagnosis, Differential; Female; *Glaucoma, Angle-Closure/di [Diagnosis]; Glaucoma, Angle-Closure/pp [Physiopathology]; Glaucoma, Angle-Closure/su [Surgery]; *Glaucoma, Angle-Closure/th [Therapy]; Humans; *Intraocular Pressure; Laser Therapy; Microscopy, Acoustic; Prognosis; Refraction, Ocular; Risk Factors; Trabeculectomy; Treatment Outcome; Visual Acuity

Alabama Black Belt eye care--optometry giving back. - Sanspree, Mary Jean; Allison, Carol; Goldblatt, Stephanie Hardwick; Pevsner, Diane (Optometry (St. Louis, Mo.), 2008)
PURPOSE: The aim of this study was to describe the process used to meet the vision needs, as well as other health problems related to eye disease, of individuals in the rural Black Belt region of Alabama. This model includes a multidisciplinary collaborative effort that has developed into a replicable vision care delivery system., DESIGN: This study was a descriptive research study., METHOD: Vision and health evaluations were made available to residents of rural counties with a specific focus on an area in Alabama known as the "Black Belt." The model for the project was designed with input from the collaborative partners who were responsible for each health and vision station. Participants in the Rural Alabama Diabetes and Glaucoma Initiative (RADGI) study involved 1,765 black women, 619 black men, and 315 others., RESULTS: The study included 2,699 participants in 7 counties. The reported ages of the patients ranged from 5 to 97 years, with a mean age of 44. Of the 2,699 patients, 39% (1,053) were found to have a visual acuity of < or =20/40. Spectacles were prescribed for 56% of the patients who required correction other than reading glasses. There was a 19% (513) referral rate for glaucoma. There was a 2.7% (73) referral rate for diabetic retinopathy. Two hundred sixteen patients presented with cataracts (8%) and were referred to eye care providers for follow-up evaluations. The 9.9% of patients who were known diabetics (267) were referred to either a general physician familiar with the patient history or, if no general physician was reported by the patient, another local physician for evaluation. Because there were no subspecialists in these local communities, the 10% of the patients (270) who were undiagnosed diabetics but showed the risk factor of a hemoglobin A1c greater than 7% were referred to a general physician or local emergency room for follow-up care. One thousand fifty-five patients (35.9%) with a blood pressure of greater than 140/90 mmHg were referred to a physician or to the emergency room as indicated either by systolic less than 140 and diastolic greater than 90., CONCLUSIONS: Based on the success of the RADGI project, the project was found to be a sound design for implementing a vision care delivery system in economically distressed rural areas that will address health disparities, barriers to health care, health care access, and patient clinical and educational follow-up.
Keywords: Adult; *African Continental Ancestry Group; Alabama; *Delivery of Health Care/sn [Statistics & Numerical Data]; European Continental Ancestry Group; *Eye Diseases/th [Therapy]; Eyeglasses/ec [Economics]; Geography; Humans; Indians, North American; *Optometry/sn [Statistics & Numerical Data]; *Poverty; Rural Health; Social Responsibility; Visual Acuity

Assessment of patient opinions of different clinical tests used in the management of glaucoma. - Gardiner, Stuart K; Demirel, Shaban (Ophthalmology, 2008)
PURPOSE: To compare different tests used in the clinical management of glaucoma, with respect to the testing experience for patients undergoing each test., DESIGN: Evaluation of diagnostic tests., PARTICIPANTS: A total of 101 subjects with high-risk ocular hypertension or early glaucoma., METHODS: Subjects were asked to give their opinion on 7 tests used clinically in glaucoma management by assigning each a score between 0 (absolute dislike) and 10 (perfect satisfaction)., MAIN OUTCOME MEASURE: Tests were ranked for each subject from 1 (favorite test) to 7 (least favorite test) on the basis of patient-assigned scores., RESULTS: Goldmann applanation tonometry for measurement of intraocular pressure was ranked significantly better than any other test (median rank 2.5, P<or=0.01). This was followed by confocal scanning laser ophthalmoscopy using a Heidelberg Retina Tomograph (median rank 3.3); frequency doubling technology perimetry (4.0); multifocal visual evoked potential (4.0); optic nerve photography (4.3); and standard automated perimetry (4.8). Short-wavelength automated perimetry was ranked significantly worse than any other test (median rank 5.3, P</=0.04)., CONCLUSIONS: In many cases, statistically significant differences were found between the patients' opinions of the tests. Information on this issue has to date largely been anecdotal or subjective. To our knowledge, this is the most comprehensive study to assess and compare the patient experience when undergoing these tests., FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
Keywords: Adult; Aged; Aged, 80 and over; *Diagnostic Techniques, Ophthalmological; Evoked Potentials; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ophthalmoscopy; *Patient Satisfaction/sn [Statistics & Numerical Data]; Tomography; Tonometry, Ocular; Visual Field Tests

A review of additivity to prostaglandin analogs: fixed and unfixed combinations. - Tabet, Rania; Stewart, William C; Feldman, Robert; Konstas, Anastasios G P (Survey of ophthalmology, 2008)
Prostaglandin analogs are currently the first-line agents in the medical treatment of glaucoma. Frequently, more than one drug is needed to control intraocular pressure. Beta-blockers, topical carbonic anhydrase inhibitors, and alpha-adrenergic agonists are commonly used in addition to prostaglandin analogs. Topical carbonic anhydrase inhibitors are more effective in lowering intraocular pressure at trough than alpha-adrenergic agonists. Although similarly effective as topical carbonic anhydrase inhibitors during the day, adequate nocturnal intraocular pressure reduction with beta-blockers is controversial. Three fixed combinations of prostaglandins with timolol (0.005% latanoprost with 0.5% timolol, 0.004% travoprost with 0.5% timolol, and 0.03% bimatoprost with 0.5% timolol) are available. Fixed-combination therapy has advantages over multi-drop, multi-bottle therapy in terms of patient convenience and adherence without sacrificing the additive effects of the unfixed combinations. In countries where they are available, fixed combinations of prostaglandins/beta-blockers may become second-line treatment. Fixed and unfixed adjunctive combinations with prostaglandin analogs have demonstrated, in multiple comparative studies, to be effective, but none has been shown to be an ideal combination.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Drug Combinations; *Drug Therapy, Combination; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Adherence and persistence with glaucoma therapy. - Schwartz, Gail F; Quigley, Harry A (Survey of ophthalmology, 2008)
Adherence and persistence with chronic therapies is crucial to prevent disease progression, such as in glaucoma. Patients report high rates of adherence, which are not supported by pharmacy claims analysis. This article reviews the literature regarding methods to assess adherence and persistence and the patient behaviors that pose challenges to proper treatment. Rates for persistence are generally below 50% at 1 year. Differentiating efficacy of eyedrops from lack of adherence presently confounds ophthalmic treatment. Additionally, as intraocular pressure (IOP) can appear controlled by short-term adherence, the physician can be fooled into believing the patient's glaucoma is well-controlled. Likewise, when progressive worsening is noted despite good IOP control, it can be problematic whether the patient's target pressure needs to be lowered or adherence needs to be improved. White-coat adherence is common, in which patient adherence rises sharply 1 week before the appointment with the physician, then declines rapidly following the appointment. White-coat adherence may make it difficult to assess IOP control over the longer term; cycling behavior with medication use is well-documented. Adherence and persistence rates differ by class of drug, with higher rates associated with prostaglandin use. We review findings from The Glaucoma Adherence and Persistency Study that identified behaviors associated with poor adherence. Greater physician awareness of adherence and persistence issues is necessary in order to help the patient become more adherent.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; Disease Progression; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; *Medication Adherence

Glaucoma care: the patients' perspective. What do patients want?. - Schuman, Joel S (The British journal of ophthalmology, 2008)
Comment on (CON)
Keywords: Delivery of Health Care/ec [Economics]; *Delivery of Health Care/st [Standards]; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Health Services Accessibility/ec [Economics]; Health Services Accessibility/st [Standards]; Humans; *Patient Satisfaction; Time Factors

[Satisfaction and compliance of ocular hypertensive and glaucoma patients topically treated with a combination therapy]. - Bron, A; Baudouin, C; Denis, P; Nordmann, J-P; Renard, J-P; Rouland, J-F; Sellem, E (Journal francais d'ophtalmologie, 2008)
OBJECTIVES: To evaluate satisfaction and compliance in glaucoma and ocular hypertensive patients receiving a fixed combination treatment., MATERIALS AND METHODS: After instilling a fixed combination, patients were asked to fill out a questionnaire about their satisfaction and compliance at baseline and 15 days after the onset of new therapy., RESULTS: 1693 glaucoma patients (G) and 621 ocular hypertensive (OHT) patients were included. Mean age was 65.6+/-11.7 years. Onset of disease was 7.2+/-6.6 years and 5.2+/-4.9 years for G and OHT patients, respectively. Insufficient efficacy of the previous topical treatment (monotherapy in 55% of cases) was the main cause for shifting to a fixed combination in 70% of cases. Satisfaction was increased in 15% of the patients and compliance was increased in 25% of the patients., DISCUSSION: Fixed combination provides an easier regimen and therefore encourages better compliance, a key issue in a chronic disease such as glaucoma.
Keywords: *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; *Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Patient Compliance; *Patient Satisfaction; Prospective Studies; *Prostaglandins/ad [Administration & Dosage]; Prostaglandins/tu [Therapeutic Use]; Treatment Outcome

[Advantages of fixed combinations]. - Lachkar, Y (Journal francais d'ophtalmologie, 2008)
Fixed combinations are indicated in the treatment of glaucoma and ocular hypertension when monotherapy does not sufficiently reduce IOP. Fixed combinations show better efficacy than the instillation of each separate component and are at least equivalent to the administration of both components in a separate association. They simplify treatment, increase compliance and quality of life, and decrease exposure to preservatives. Although they are less aggressive for patients when a new drug needs to be added, the use of fixed combinations should not decrease the follow-up.
Keywords: Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; *Glaucoma/dt [Drug Therapy]; Humans

[The physician-patient relationship in glaucoma]. - Hamelin, N (Journal francais d'ophtalmologie, 2008)
Healthcare of chronic pathologies, especially in glaucoma, which is asymptomatic for a long period of time, is based on a good, confident relationship between physicians and patients. This relationship has to be created, maintained, and reinforced throughout follow-up. The patient's information source is to a large extent the physician, who must provide all the necessary information concerning the disease, including the definition, prognosis, follow-up, and treatment. How the information is transmitted should be personally adapted to patients, taking into account their own and their family's psychological reactions. It is also important to keep in mind the factors influencing poor compliance when talking to our patients.
Keywords: Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Humans; *Physician-Patient Relations

A novel approach to glaucoma screening and education in Nepal. - Thapa, Suman S; Kelley, Kurt H; Rens, Ger V; Paudyal, Indira; Chang, Lan (BMC ophthalmology, 2008)
BACKGROUND: Glaucoma is a major cause of blindness worldwide and an increasingly significant global health problem. Glaucoma prevention and management efforts have been challenging due to inherent difficulty in developing a simple and cost-effective screening plan, limited access to health care and educational resources, poverty, and inadequate knowledge of the disease, particularly in developing countries. Starting in 2004 the Tilganga Eye Centre in Kathmandu, Nepal has provided targeted glaucoma screening, treatment, and education through a combination of clinical outreach programs and educational activities for patients., METHODS: A simple, age-based glaucoma screening algorithm was incorporated into three one-day cataract screening clinics. Using this algorithm, patients who were newly diagnosed with glaucoma were referred to TEC, where medication and surgery were provided free of charge through private donor funding. In addition, we describe two ongoing educational programs for increasing glaucoma awareness: an annual Glaucoma Awareness Week (which includes free screening, treatment, and counseling), and a repeating lecture series which generates new counselors., RESULTS: From 2004 to 2007 screening at the annual Glaucoma Awareness Week resulted in the diagnosis of 120 individuals with glaucoma, or 7.6% of total registrants. Attendance increased annually with a trend toward an increasing number of returning patients but a decreasing percentage of newly diagnosed patients, though the absolute numbers have remained relatively stable (range 21 to 38). Data from the three one-day screening clinics in 2006 show that approximately 2 to 4% of patients 50 years of age or older per clinic were newly diagnosed with POAG., CONCLUSION: This multi-faceted approach appears to successfully identify individuals with glaucoma and provide treatment to those who would otherwise not be able to afford it. While more data is needed to validate this model, specifically regarding the effectiveness of educational activities, long-term visual outcomes, and medication compliance, it may serve as a useful framework for other developing countries with similarly limited resources.
Keywords: Algorithms; Counseling; *Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; *Health Education/mt [Methods]; Humans; *Mass Screening/mt [Methods]; Mass Screening/sn [Statistics & Numerical Data]; Middle Aged; Nepal; *Patient Education as Topic/mt [Methods]; Referral and Consultation; Trabeculectomy; Uncompensated Care

The treatment of normal-tension glaucoma. - Desai, Priya V; Caprioli, Joseph (Progress in brain research, 2008)
Normal-tension glaucoma (NTG) is generally defined as visual field loss and optic nerve defects consistent with glaucoma and an intraocular pressure (IOP) that does not exceed 21 mmHg (Allingham, R.R., Damji, K., Freedman, S., Moroi, S., Shafranov, G., Shields, M.B. (2005). In: Pine J. and Murphy J. (Eds.), Shields' Textbook of Glaucoma, 5th edn., Lippincott Williams & Wilkins, Philadelphia, PA, pp. 197-207, Chapter 11). If a patient has an atypical presentation (unilateral disease, decreased central visual acuity or visual field loss not consistent with optic disk appearance) then the clinician should rule out medical or neurologic etiologies. IOP-dependent and IOP-independent mechanisms play a role in NTG nerve damage. The exact mechanisms of IOP-independent damage are not currently known. Research has shown that vascular etiologies, such as vascular insufficiency and vasospasm, may be possible mechanisms for IOP-independent damage. The mainstay of glaucoma treatment remains robust IOP reduction. The chief goal of ongoing glaucoma research is to more clearly identify IOP-independent mechanisms of damage and to find neuroprotective treatment strategies to prevent retinal ganglion cell death and consequent visual loss.
Keywords: Aged; Cornea/pa [Pathology]; Disease Progression; Glaucoma/di [Diagnosis]; Glaucoma/pa [Pathology]; Glaucoma/th [Therapy]; *Glaucoma; Humans; *Intraocular Pressure; Middle Aged; Optic Disk/pa [Pathology]; Patient Compliance; Risk Factors; Tomography; Visual Fields/ph [Physiology]

Predictors of and barriers associated with poor follow-up in patients with glaucoma in South India. - Lee, Bradford W; Sathyan, Parthasarathi; John, Rajesh K; Singh, Kuldev; Robin, Alan L (Archives of ophthalmology (Chicago, Ill. : 1960), 2008)
OBJECTIVES: To determine predictors of and reasons for poor longitudinal glaucoma follow-up in South India., METHODS: This 1-to-1, matched, case-control study enrolled 300 patients with established glaucoma. We defined cases (poor follow-up) and controls (good follow-up) based on number of and maximum interval between glaucoma follow-up visits attended in the preceding year. We collected data by oral questionnaire and used stepwise multivariate logistic regression to calculate odds ratios (ORs) for poor follow-up., RESULTS: Adjusting for age and sex, independent predictors of poor follow-up included lack of formal education (adjusted OR, 4.13; 95% confidence interval [CI], 1.44-11.90), no use of prescribed glaucoma medications (adjusted OR, 2.17; 95% CI, 1.06-4.43), and belief that follow-up is less important if one uses glaucoma medications and has no noticeable visual changes (adjusted OR, 10.59; 95% CI, 3.74-29.97). Age, sex, and disease severity were not significant predictors. The most prevalent barriers to follow-up were belief that there was no problem with one's eyes (44.4%) and lack of escort (19.7%)., CONCLUSIONS: Knowing predictors of poor follow-up can help identify patients who need individualized strategies to improve follow-up. Because believing one's eyes are problem-free and lacking escorts are significant barriers to follow-up, novel strategies in patient education (eg, intensive counseling, audiovisual aides, and patient support groups) and escort provision may improve longitudinal glaucoma follow-up and disease management.
Keywords: Case-Control Studies; Confidence Intervals; Delivery of Health Care; Developing Countries; Female; Follow-Up Studies; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/su [Surgery]; *Health Services Accessibility/st [Standards]; Health Services Accessibility/td [Trends]; Humans; India; Intraocular Pressure/ph [Physiology]; Logistic Models; Male; Monitoring, Physiologic/st [Standards]; Monitoring, Physiologic/td [Trends]; Multivariate Analysis; Postoperative Care; Predictive Value of Tests; Risk Assessment; Severity of Illness Index; Socioeconomic Factors; Surveys and Questionnaires; *Tonometry, Ocular/sn [Statistics & Numerical Data]

Can a public health intervention improve awareness and health-seeking behaviour for glaucoma?. - Baker, H; Murdoch, I E (The British journal of ophthalmology, 2008)
AIM: To investigate whether a public education campaign can increase awareness and change help-seeking behaviour with respect to ocular health in an Indian population., METHODS: A health knowledge questionnaire was used investigating and assessing the health campaign. The health campaign comprised four components: (1) television, (2) local press, (3) local radio and (4) places of worship. The target population were Indian residents in Southall, Ealing aged 60+. The aim was to get people to go and have their eyes tested at their local optometric practice. Optometric practices within the borough of Ealing collected sight-test data for the study over 6 months before and after the advertising campaign., RESULTS: The repeat in-depth glaucoma knowledge questionnaire showed a significant increase in the number of people who had heard of glaucoma rising from 22% to 53%. Before intervention, most people had heard about glaucoma from their GP, friend or relative. After intervention, the majority (69%) had heard of glaucoma from the radio., CONCLUSION: This study has shown a significant increase in awareness from using different kinds of media and has shown radio to be the most effective in our target community. Although the campaign has raised awareness, this study has not shown a change in health-seeking behaviour.
Keywords: Adult; Aged; Aged, 80 and over; Female; *Glaucoma/di [Diagnosis]; Glaucoma/eh [Ethnology]; Health Behavior/eh [Ethnology]; Health Knowledge, Attitudes, Practice; *Health Promotion/mt [Methods]; Humans; Male; Middle Aged; Patient Acceptance of Health Care/eh [Ethnology]; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Persuasive Communication; Program Evaluation; Surveys and Questionnaires

The effect of timolol maleate on tear film break-up time in Nigerians. - Fasina, O; Ashaye, A O; Ajayi, B G K (African journal of medicine and medical sciences, 2008)
The aim of this study was to evaluate the effect of Timolol maleate on tear film break-up time in a Nigerian population. 192 eyes of 96 subjects were examined in a hospital based case-control study after being administered pre-coded questionnaires. The mean tear film break-up time was measured. There was significant difference (t = 10.164, P < 0.001) in the mean break-up time of cases (10.45 secs) and controls (30.18 secs). Half of the cases had some ocular discomfort with the instillation of Timolol maleate, a significant number of them having just been commenced on the medication (chi2 = 8.889, P = 0.003). Long-term instillation of Timolol maleate impairs tear film stability. The ocular discomfort experienced by patients on Timolol may contribute to poor drug compliance observed in patients on chronic drug therapy. Regular screening of patients on Timolol maleate for tear film instability and dry eyes is important and drug manufacturers should explore the possibility of incorporating artificial tears in Timolol maleate preparation.
Keywords: *Adrenergic beta-Agonists/pd [Pharmacology]; Adult; Aged; Case-Control Studies; Dry Eye Syndromes/ci [Chemically Induced]; Dry Eye Syndromes/di [Diagnosis]; Eye/de [Drug Effects]; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Nigeria; Surveys and Questionnaires; *Tears/de [Drug Effects]; Time Factors; *Timolol/pd [Pharmacology]; Timolol/tu [Therapeutic Use]

Unhealthy drinking patterns and receipt of preventive medical services by older adults. - Merrick, Elizabeth L; Hodgkin, Dominic; Garnick, Deborah W; Horgan, Constance M; Panas, Lee; Ryan, Marian; Saitz, Richard; Blow, Frederic C (Journal of general internal medicine, 2008)
BACKGROUND: Preventive service use among older adults is suboptimal. Unhealthy drinking may constitute a risk factor for failure to receive these services., OBJECTIVES: To determine the relationship between unhealthy drinking and receipt of recommended preventive services among elderly Medicare beneficiaries, applying the framework of current alcohol consumption guidelines., DESIGN/METHODS: The data source is the nationally representative 2003 Medicare Current Beneficiary Survey. The sample included community-dwelling, fee-for-service Medicare beneficiaries 65 years and older (N = 10,523). Based on self-reported drinking, respondents were categorized as nondrinkers, within-guidelines drinkers, exceeding monthly but not daily limits, or heavy episodic drinkers. Using survey and claims data, influenza vaccination, pneumonia vaccination, glaucoma screening, and mammogram receipt were determined. Bivariate and logistic regression analyses were conducted., RESULTS: Overall, 70.3% received flu vaccination and 49% received glaucoma screening during the year, 66.8% received pneumonia vaccination, and 56.2% of women received a mammogram over 2 years. In logistic regression, heavy episodic drinking was associated with lower likelihood of service receipt compared to drinking within guidelines: flu vaccination (OR 0.75, CI 0.59-0.96), glaucoma screening (OR 0.74, CI 0.58-0.95), and pneumonia vaccination (OR 0.75, CI 0.59-0.96). Nondrinkers when compared with those reporting drinking within guidelines were less likely to receive a mammogram (OR 0.83, CI 0.69-1.00)., CONCLUSIONS: Heavy episodic drinking is associated with lower likelihood of receiving several preventive services. Practitioners should be encouraged to screen all elders regarding alcohol intake and in addition to appropriate intervention, consider elders reporting heavy episodic drinking at higher risk for non-receipt of preventive services.
Keywords: Aged; Aged, 80 and over; *Alcoholism/ep [Epidemiology]; Cross-Sectional Studies; Female; Glaucoma/di [Diagnosis]; Humans; Influenza Vaccines/tu [Therapeutic Use]; Male; *Medicare; Odds Ratio; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Pneumococcal Vaccines/tu [Therapeutic Use]; *Preventive Health Services/sn [Statistics & Numerical Data]; United States/ep [Epidemiology]

Multicenter study of compliance and drop administration in glaucoma. - Kholdebarin, Ramin; Campbell, Robert J; Jin, Ya-Ping; Buys, Yvonne M (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2008)
BACKGROUND: Poor compliance with medication is a major concern in the management of glaucoma. Improper administration technique can lead to contamination and inaccurate dosing. This study estimates the prevalence and predictors of noncompliance and improper administration technique among Canadian glaucoma patients., METHODS: Data were collected using a standardized questionnaire. Noncompliance was defined as missing at least 1 drop of medication per week and (or) the inability to accurately describe the medication regimen. Patients were asked to indicate the most common reason for missing medication. Study personnel assessed drop administration technique as patients were applying eye drops. Physicians provided information, including measures of disease stability, regarding the patient's glaucoma. Predictors were assessed using odds ratios from a logistic regression model., RESULTS: 500 patients from 10 centers across Canada participated in the study. Of these, 25.6% reported missing at least 1 drop of medication per week, and 4.2% were unable to accurately describe their medication regimen. The overall proportion of noncompliance was 27.9%. With regard to drop administration, 6.8% missed their eye and 28.8% contaminated the bottle tip; overall, 33.8% demonstrated improper technique. The most common reasons given for missing eye drops were "forgetfulness" and "being away from drops." Formal education limited to elementary school and treatment duration of <5 years increased patient-reported noncompliance. Factors associated with improper administration technique were age 60 years and older and formal education limited to elementary school., INTERPRETATION: Over 50% of the patients surveyed were either noncompliant or demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and instructed on proper drop administration.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Canada; Female; *Glaucoma/dt [Drug Therapy]; Health Services Research; Humans; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Treatment Refusal

Addressing steroid phobia: improving the risk-benefit ratio with new agents. - Skoner, Jonathan D; Schaffner, Timothy J; Schad, Christine A; Kwon, Anessa Ye Kyung Antionette; Skoner, David P (Allergy and asthma proceedings, 2008)
Inhaled corticosteroids (ICSs) are the preferred first-line preventative therapy for asthma of all severity levels. Although these drugs have been proven efficacious, concerns of adverse systemic affects due to both long- and short-term use continue to limit patient compliance with dosing regimens. Deficits in bone growth, bone density, and hypothalamic-pituitary-adrenal axis function, in addition to cataract formation and elevated intraocular pressure/glaucoma, have been associated with ICS use in some studies. Although some of these studies were flawed, featured drugs that are less commonly prescribed today, or both, adverse effects from chronic ICSs use are still a cause of concern today. Current therapies are designed to be efficacious at minimal doses, limiting potential side effects, increasing adherence, and improving asthma control.
Keywords: Administration, Inhalation; Adrenal Cortex Hormones/ad [Administration & Dosage]; *Adrenal Cortex Hormones/ae [Adverse Effects]; Anti-Asthmatic Agents/ad [Administration & Dosage]; *Anti-Asthmatic Agents/ae [Adverse Effects]; *Asthma/dt [Drug Therapy]; Body Height/de [Drug Effects]; Bone Density/de [Drug Effects]; Dose-Response Relationship, Drug; Eye/de [Drug Effects]; Humans; Hypothalamo-Hypophyseal System/de [Drug Effects]; Pituitary-Adrenal System/de [Drug Effects]; Risk Assessment; Treatment Outcome

[Pegaptanib sodium one-year treatment study for neovascular age-related macular degeneration]. - Tano, Yasuo; Pegaptanib Sodium Multi-center Study Group (Nippon Ganka Gakkai zasshi, 2008)
PURPOSE: To evaluate the safety and efficacy of intravitreal administration of pegaptanib sodium in Japanese patients with age-related macular degeneration associated with subfoveal choroidal neovascularization., METHODS: Ninety-five male and female patients (mean age 72.5 years.) were assigned randomly in a double-masked manner to receive 0.3 or 1 mg of pegaptanib sodium every 6 weeks over a 48-week period. Efficacy was assessed by visual acuity change from baseline as the proportion of patients who lost fewer than 15 letters at week 54 using the Early Treatment Diabetic Retinopathy Study chart., RESULTS: The group that received 0.3 mg pegaptanib experienced a mean loss of 3.8 letters; 78.7% (37/47) of patients lost fewer than 15 letters. The 1 mg group had a change of -4.3 letters and the proportion that lost 15 letters was 72.9% (35/48). The proportion of patients whose visual acuity was unchanged or improved was 46.8% (22/47) and 43.8% (21/48) in the 0.3 and 1 mg groups, respectively. The majority of adverse events with possible, probable, or unknown relationship to pegaptanib were related to the intravitreal injection, such as mild conjunctival hemorrhage (0.3 mg: 76.6%, 1 mg: 77.1%) and superficial punctuate keratitis by sterilization (0.3 mg: 29.8%, 1 mg: 39.6%) at the injection site. Compliance with the study treatment of 9 intravitre al injections was as high as 87.2% and 85.4% for patients receiving 0.3 and 1 mg, respectively., CONCLUSION: Intravitreal injection of sodium pegaptanib every 6 weeks produced clinically significant stabilization of visual acuity for one year in more than 70% of patients with age-related macular degeneration, with good treatment compliance.
Keywords: Aged; *Aptamers, Nucleotide/ad [Administration & Dosage]; *Choroidal Neovascularization/co [Complications]; Double-Blind Method; Female; Humans; Injections; *Macular Degeneration/dt [Drug Therapy]; Macular Degeneration/pp [Physiopathology]; Male; *Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]; Visual Acuity; Vitreous Body

Glaucoma care and clinical profile in Priest Hospital, Thailand. - Sothornwit, Nisa; Jenchitr, Watanee; Pongprayoon, Chalao (Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2008)
OBJECTIVE: To assess the prevalence, mechanism and status of glaucoma, and to investigate the magnitude of visual impairment from glaucoma and its relating factors in Buddhist priest and novices., MATERIAL AND METHOD: Cross-sectional study of 190 patients treated in Glaucoma service, Priest hospital was performed. One hundred thirty seven patients with glaucoma and suspected glaucoma had comprehensive ophthalmic examination included interview on medical and ocular history, visual acuity, applanation tonometry, gonioscopy, optic disc, visual field evaluation, and retinal nerve fiber layer thickness measurement (Stratus Optical Coherence Tomography; Stratus OCT)., RESULTS: Glaucoma was diagnosed in 106 (77%) patients (181 eyes); 31 patients (23%) were glaucoma suspects. Open angle glaucoma (OAG) was found in 53 (50%) cases and classified into 36 (33%) primary open angle glaucoma and 17 (16%) normal tension glaucoma (NTG). Five (4.6%) patients had pseudoexfoliative glaucoma, 24 (23%) had primary angle-closure glaucoma (PACG), 10 (9.4%) had angle-closure glaucoma secondary to other causes (SACG), seven (6.6%) had secondary open angle glaucoma and seven (6.6%) were diagnosed of juvenile glaucoma. Among 31 glaucoma suspects, 18 cases were diagnosed based on disc appearance, eight based on intraocular pressure (IOP), two based on visual field and three cases had primary angle closure (PAC). The prevalence of glaucoma increased with age, with the highest prevalence (33%) in the age range 71 to 80 years. The Glaucoma service of Priest hospital diagnosed glaucoma in 53% of the priest. Rate of glaucoma was higher in priest from rural area than those from Bangkok and urban area. The mean baseline IOP was 26.5 +/- 14.7 mmHg. The mean treated IOP was 14.5 +/- 7.9 mmHg. The average mean deviation (MD) was -14.45 +/- 11.11. OCT showed average RNFL thickness of 70.8 +/- 35.6 microm. Glaucoma medications was received by 72% of the priest, 18% had laser treatment, and 22 % had glaucoma surgery. At diagnosis, two patients were blind according to WHO criteria, 29 (28%) patients were unilaterally blind, and seven (6.5%) had low vision. After treatment, 31 (29%) patients had unilateral blindness and none had bilateral blindness. The main associated diseases were hypertension, dyslipidemia, and diabetes. Transportation and financial condition were the major barriers in receiving eye care., CONCLUSIONS: OAG comprised 50% of all glaucoma, 23% of PACG, and 16% of all subtypes of secondary glaucoma. The prevalence of glaucoma in priest rose significantly with age. In the treated glaucoma patients, 47% retained good visual outcome. Delayed diagnosis was a major factor for unsatisfactory outcome as 28% of patients had monocular blindness at diagnosis and 53% were previously unaware of their disease.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Cross-Sectional Studies; Female; Glaucoma/co [Complications]; Glaucoma/dt [Drug Therapy]; *Glaucoma/ep [Epidemiology]; Health Status Indicators; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Prevalence; Quality of Health Care; Thailand/ep [Epidemiology]; Treatment Outcome; *Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]

Views of glaucoma patients on provision of follow-up care; an assessment of patient preferences by conjoint analysis. - Bhargava, J S; Bhan-Bhargava, A; Foss, A J E; King, A J (The British journal of ophthalmology, 2008)
AIMS: To determine patients' preferences for provision of glaucoma follow-up services examining preferences for location, access and personnel for delivery of this care., METHODS: 100 patient patients attending the glaucoma outpatient clinic for follow-up review underwent an interview-based assessment during which they completed the visual function questionnaire 25 and ranking of scenario options for provision of follow-up care for their glaucoma. Percentage preferences for aspects of care offered in the conjoint analysis scenario packages and generation of utility values for each of the factor levels included in the scenario design were calculated., RESULTS: Travel time and training of health professional were the most important factors for patients (accounting for over 60%) of their preference. Utility scores were generated for each factor, with shorter travel time and examination by a doctor being the most important features to the patients. Patients who lived furthest from the hospital and had severe visual disability considered the number of visits to complete an episode to be an important feature., CONCLUSION: Patients ideally would like to travel a short distance and be seen by a doctor when being followed up for their glaucoma.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Continuity of Patient Care; Delivery of Health Care/og [Organization & Administration]; *Delivery of Health Care/st [Standards]; Female; *Glaucoma/th [Therapy]; Health Care Surveys; Health Services Accessibility; Humans; Male; Middle Aged; *Patient Satisfaction; Regression Analysis; Time Factors

[Portrait of the artist as a sick man. Rheumatological pathography of James Joyce (1882-1941)]. - Ventura, L (Reumatismo, 2008)
James Joyce, unanimously considered one of the greatest novelists of the 20th century, suffered from several diseases. A series of adverse circumstances progressively deteriorated his health, already precarious because of his very disorderly life habits. Aim of the present study is to summarize the various organic diseases Joyce suffered during his lifetime, as long as the main diagnostic conclusions found in scientific literature. Severe eye problems, caused by recurrent iritis attacks even complicated by glaucoma and cataracts, led him almost to blindness. Undernourishment and irregular eating, great anxiety and alcohol abuse were the major causes of the peptic ulcer which tortured him for many years, causing his final death. To these conditions should also be added dental caries, venereal diseases and recurrent polyarthritis. The hypothesis according which Joyce suffered from neurosyphilis is still debated and should be sufficiently demonstrated, whereas a spondyloarthropathy, either Reiter's syndrome or ankylosing spondylitis, appears more likely. Therapies against these diseases, easily treated today, did not result efficient because of his poor compliance, as well as the state of the art of medical science during his lifetime. A detailed paleopathologic study of Joyce's human remains could allow to solve the diagnostic doubts concerning his main disease.
Keywords: *Famous Persons; History, 19th Century; History, 20th Century; Ireland; *Rheumatology/hi [History]

German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye. - Erb, Carl; Gast, Ulrike; Schremmer, Dieter (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2008)
BACKGROUND: The purpose of this register was to determine the links between glaucoma, age, concomitant disease, medication, and dry eye in a large group of glaucoma patients., METHODS: A total of 20,506 patients from 900 centers across Germany were included. The first 30 consecutive glaucoma patients at each center were recruited. Epidemiological data as well as information on glaucoma, medication, concomitant diseases, dry eye, and local symptoms were elicited by means of a questionnaire. We analyzed primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigmentary glaucoma (PDG)., RESULTS: According to the register data, more women develop dry eye and glaucoma than men (56.9 vs. 45.7%). The most frequent concomitant systemic diseases were hypertension (48.1%), diabetes mellitus (22.5%), and dry mouth, nose, and skin (11.3%). As expected, the highest incidence of dry eye was found in those patients with dry mouth, nose, and skin. Dry eye occurred with dissimilar frequencies in association with the various glaucoma types: PEX>POAG>PDG. The incidence of dry eye increases with age. The gender difference in the occurrence of dry eye becomes apparent from the age of 50. Dry eye occurred more frequently when three or more antiglaucoma drugs were used and increased with the duration of glaucoma disease., CONCLUSIONS: We publish the first results from the German Glaucoma and Dry Eye Register. We found that the occurrence of dry eye is linked to several factors. Thus, the type of glaucoma has an impact on the risk of dry eye. The quantity of eye drops applied also plays a role in the development of the dry eye syndrome if more than three medications are used. While POAG is usually treated with one drug, PEX and PDG tend to be treated with multiple drugs. The gender difference in the occurrence of dry eye becomes apparent from the age 50 years. Because of the vicious circle of dry eye, antiglaucoma eye drops containing benzalkonium chloride compromises patient compliance. The results of the register are therefore of key relevance for the care of glaucoma patients.
Keywords: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Diabetes Complications; Drug Therapy, Combination; Dry Eye Syndromes/ci [Chemically Induced]; *Dry Eye Syndromes/co [Complications]; Dry Eye Syndromes/di [Diagnosis]; Dry Eye Syndromes/ep [Epidemiology]; *Exfoliation Syndrome/co [Complications]; Female; Germany; Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; *Glaucoma, Open-Angle/co [Complications]; Humans; Hypertension/co [Complications]; Hypertension/ep [Epidemiology]; Incidence; Male; Middle Aged; Ophthalmic Solutions/ae [Adverse Effects]; *Registries; Risk Factors; Sex Distribution; Time Factors; Vascular Diseases/et [Etiology]; Young Adult

[Socioeconomic profile of individuals presenting with glaucoma in the service of ophthalmology of the University Hospital of the Federal University of Juiz de Fora--Minas Gerais--Brazil]. - Ventura, Antonio Guilherme G de M (Arquivos brasileiros de oftalmologia, 2008)
Comment on (CON)
Keywords: Brazil; *Glaucoma/dt [Drug Therapy]; Health Services Accessibility; Hospitals, University; Humans; *Medication Systems; *Ophthalmology; *Program Development

A case of fungal keratitis: a clinical and in vivo confocal microscopy assessment. - Miller, William L; Giannoni, Amber Gaume; Perrigin, Judith (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2008)
A presumed case of fungal keratitis is presented. Confocal images highlight the advantage of using such technology to follow therapeutic progress, particularly when standard laboratory testing is inconclusive. This case also demonstrates the importance of continued patient education regarding overall compliance and lens care.
Keywords: Adult; Anti-Infective Agents/tu [Therapeutic Use]; Antifungal Agents/tu [Therapeutic Use]; Aza Compounds/tu [Therapeutic Use]; *Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; Drug Therapy, Combination; *Eye Infections, Fungal/di [Diagnosis]; Eye Infections, Fungal/dt [Drug Therapy]; Eye Infections, Fungal/mi [Microbiology]; Fluoroquinolones; Fusarium; Humans; Male; Microscopy, Confocal; Moxifloxacin; *Mycoses/di [Diagnosis]; Mycoses/dt [Drug Therapy]; Mycoses/mi [Microbiology]; Natamycin/tu [Therapeutic Use]; Quinolines/tu [Therapeutic Use]; Tobramycin/tu [Therapeutic Use]

Side effects of commonly used glaucoma medications: comparison of tolerability, chance of discontinuation, and patient satisfaction. - Beckers, Henny J M; Schouten, Jan S A G; Webers, Carroll A B; van der Valk, Rikkert; Hendrikse, Fred (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2008)
BACKGROUND: To compare the tolerability of commonly prescribed topical glaucoma medications by determining frequency and bother of side effects, patient satisfaction with their medication, and the chance of discontinuation of eye drops., METHODS: The tolerability of topical glaucoma medication was studied in glaucoma patients from nine hospitals. The frequency and severity of side effects was investigated together with patient satisfaction with the medication and the probability to change medication due to reported side effects. To register side effects of topical glaucoma medication, patients were requested to fill in a questionnaire based on "the Comparison of Ophthalmic Medications for Tolerability" (COMTOL) questionnaire supplemented with items based on the most frequently observed and severe side effects., RESULTS: The number of patients responding was 3,333 (87%). Most patients (79%) were satisfied with their eye medication. The median score for ocular side effects was 58 on a scale ranging from 0 to 320. The probability that medication would be changed by the ophthalmologist at the next visit due to reported side effects occurring since the patients' last or last but one visit to the ophthalmologist was 9%. The most frequently prescribed drugs were timolol, latanoprost, and the fixed combinations of dorzolamide/timolol (Cosopt) and latanoprost/timolol (Xalcom). Only small differences in tolerability were found between these drugs., CONCLUSIONS: The tolerability of timolol, latanoprost, and the fixed combinations of latanoprost/timolol (Xalcom) and dorzolamide/timolol (Cosopt) seem to be comparable. Patients are satisfied with their glaucoma medication and have a low chance of discontinuation of eye drops due to side effects.
Keywords: Administration, Topical; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ae [Adverse Effects]; Drug Combinations; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/ae [Adverse Effects]; *Patient Compliance; *Patient Satisfaction; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/ae [Adverse Effects]; Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; Surveys and Questionnaires; Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]

Detrimental effect of preservatives in eyedrops: implications for the treatment of glaucoma. - Baudouin, Christophe (Acta ophthalmologica, 2008)
Antiglaucoma medications are often associated with ocular adverse reactions such as dry eye, and burning or stinging sensations. These undesirable effects may lead to treatment discontinuation and reduced quality of life in patients with glaucoma. Antiglaucoma medications usually contain benzalkonium chloride (BAK) as a preservative. Animal studies, in vitro studies and in vivo experiments have demonstrated various adverse effects of BAK. Clinical studies have also shown an increased incidence of adverse events with BAK and have demonstrated that the withdrawal of preservatives reduces these effects. Collectively, these data suggest that preservative-free antiglaucoma treatments have clinically relevant benefits for patients.
Keywords: Animals; Benzalkonium Compounds/ad [Administration & Dosage]; *Benzalkonium Compounds/ae [Adverse Effects]; *Eye/de [Drug Effects]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Ophthalmic Solutions/ae [Adverse Effects]; *Ophthalmic Solutions/ch [Chemistry]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; *Preservatives, Pharmaceutical/ae [Adverse Effects]; Quality of Life

Improving eye drop treatment for glaucoma through better adherence. - Quigley, Harry A (Optometry and vision science : official publication of the American Academy of Optometry, 2008)
Keywords: Blindness/pc [Prevention & Control]; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance; Patient Dropouts

[Noncompliance with drug therapy for glaucoma]. - Castro, Aldemar Nemesio Brandao Vilela de; Mesquita, Wander Araujo (Arquivos brasileiros de oftalmologia, 2008)
INTRODUCTION: The treatment of glaucoma is made initially with the use of eyedrops, with the purpose to decrease intraocular pressure and to minimize the damages to the optic nerve. The lack of compliance with drug therapy can be influenced by factors related to patients, doctors and medicines., PURPOSES: To estimate the rate of noncompliance with the treatment with antiglaucoma eyedrops and to verify the intervenience of possible factors for noncompliance., METHODS: A study of the transversal type was carried out, in the Ophthalmologic Clinic of the Hospital Governador Israel Pinheiro, in Belo Horizonte, Minas Gerais. Questionnaires were applied to 102 glaucoma patients to collect information about the level of noncompliance and the intervenience of possible factors for noncompliance with drug therapy., RESULTS: The rate of noncompliance was 21.5%. The factors: not using the eyedrops due to money shortage (p=0.035) and accomplishment of corrective surgery (p=0.049), significantly contributed to noncompliance., CONCLUSION: More than one fifth of the glaucoma patients does not follow the drug treatment in an adequate way. Donation of eyedrops to all the glaucoma patients without favorable economic conditions, governmental actions for the reduction of the prices of the eyedrops, information on the continuity of the use of the eyedrops after the accomplishment of corrective surgeries would help to decrease the rates of noncompliance.
Keywords: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; Humans; Male; Medication Adherence/px [Psychology]; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ae [Adverse Effects]; *Ophthalmic Solutions/tu [Therapeutic Use]; Risk Factors; Socioeconomic Factors; Surveys and Questionnaires; Timolol/tu [Therapeutic Use]

Will improvement of knowledge lead to improvement of compliance with glaucoma medication?. - Hoevenaars, Juliette G M M; Schouten, Jan S A G; van den Borne, Bart; Beckers, Henny J M; Webers, Carroll A B (Acta ophthalmologica, 2008)
PURPOSE: To identify specific items on knowledge and need for information that could be used to improve compliance with glaucoma medication., METHODS: Forty-four randomly selected ophthalmologists assigned 166 consecutive glaucoma patients to complete a questionnaire. The questionnaire was developed systematically based on focus group interviews, consultation of experts and a pilot test. Items included knowledge about glaucoma and its treatment, need for information and compliance with therapy., RESULTS: No statistically significant correlation was found between the total level of knowledge and compliance. Concerning knowledge of glaucoma, one out of 19 items had a statistically significant negative correlation with compliance. Concerning knowledge of glaucoma treatment, one out of 18 items had a statistically significant positive correlation with compliance. Regarding total need for information, no statistically significant correlation with compliance was found. Three out of 22 items had a statistically significant positive correlation with compliance., CONCLUSION: Given the number of related items, their direction and limited strength of correlation and the difficulty of hypothesizing a causal relation for some items, it is unlikely that further improving knowledge will greatly improve compliance with glaucoma medication. Interventions focused on attitude and discipline may be of more benefit in improving compliance with therapy.
Keywords: Cross-Sectional Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/et [Etiology]; *Glaucoma/pp [Physiopathology]; *Health Knowledge, Attitudes, Practice; Humans; *Patient Compliance; Surveys and Questionnaires

Functional health literacy in patients with glaucoma in urban settings. - Juzych, Mark S; Randhawa, Sandeep; Shukairy, Aman; Kaushal, Padmini; Gupta, Anju; Shalauta, Nadia (Archives of ophthalmology (Chicago, Ill. : 1960), 2008)
OBJECTIVE: To assess the relationship between health literacy and compliance, disease awareness, and disease progression in patients with glaucoma., METHODS: A cross-sectional observational study of 204 English-speaking patients treated for glaucoma for at least 1 year at Kresge Eye Institute was conducted. Health literacy was assessed using the standardized Test of Functional Health Literacy in Adults (TOFHLA). An oral questionnaire assessed patients' demographic information and glaucoma understanding. A retrospective medical record review was conducted to record parameters indicating glaucoma severity., RESULTS: One hundred two participants (50%) were categorized as having poor functional health literacy (mean [SD] TOFHLA score, 18.4 [7.5]) and 102 participants (50%) had adequate health literacy (mean [SD] TOFHLA score, 42.8 [5.1]). The poor health literacy group showed significant differences in income, education, medication compliance, glaucoma understanding, and missed appointments compared with the adequate health literacy group (P < .001). Patients with poor health literacy showed a greater visual field loss on initial presentation (mean deviation [SD], -10.58 [9.3] dB) compared with the adequate health literacy group (mean deviation [SD], -7.79 [6.9] dB; P = .02) and significantly worse visual field parameters when comparing pattern SDs on the recent and the initial visual fields (pattern SD change [SD], 0.19 [2.5] dB in the poor health literacy group vs -0.7 [2.2] dB in the adequate health literacy group; P = .02)., CONCLUSIONS: Patients with poor health literacy had poorer compliance, worse disease understanding, and greater disease progression compared with the adequate health literacy group, highlighting the need to promote health literacy in patients with glaucoma.
Keywords: Aged; Cross-Sectional Studies; Disease Progression; Educational Measurement; Educational Status; Female; *Glaucoma/ep [Epidemiology]; *Health Knowledge, Attitudes, Practice; Health Services Research; Health Surveys; Humans; Income; Male; Michigan/ep [Epidemiology]; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; *Patient Education as Topic/sn [Statistics & Numerical Data]; Surveys and Questionnaires; *Urban Population/sn [Statistics & Numerical Data]

Burden and predictors of undetected eye disease in Mexican-Americans: the Los Angeles Latino Eye Study. - Varma, Rohit; Mohanty, Sarita A; Deneen, Jennifer; Wu, Joanne; Azen, Stanley P; LALES Group (Medical care, 2008)
BACKGROUND: Latinos have one of the highest rates of visual impairment associated with eye disease in the United States. Although little is known about the prevalence and risk of undetected eye disease (UED) in this population, it is known that Latinos encounter disproportionate barriers in accessing health care, which may influence the burden of UED., OBJECTIVE: To estimate the burden and to evaluate factors associated with UED among Latinos, a majority of whom were Mexican-American., RESEARCH DESIGN: Population-based, cross-sectional study. A detailed interview and eye examination were performed on participants., SUBJECTS: A sample of 6,357 Latinos (95% of whom had Mexican ancestry), aged >or=40, in 6 census tracts in Los Angeles, California., MAIN OUTCOME MEASURE: UED (macular degeneration, glaucoma, diabetic retinopathy, cataract, and refractive error) was defined as those persons with eye disease and no reported history of that eye disease., RESULTS: Fifty-three percent (3,349 of 6,357) of the participants had eye disease. Sixty-three percent (2,095 of 3,349) of them had UED. Major risk factors for UED included older age [odds ratio (OR): 4.7 (age >or=80)], having diabetes mellitus (OR: 3.3), never having had an eye examination (OR: 2.4), being uninsured (OR: 1.6), lower educational attainment (OR: 1.4), and low acculturation (OR: 1.3)., CONCLUSIONS: These findings provide evidence of the burden of UED among Latinos. Interventions that address the modifiable risk factors (lack of insurance, never having had an eye examination, etc.) may improve detection of eye disease and decrease the burden of visual impairment in this high-risk minority population.
Keywords: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Diabetes Complications/eh [Ethnology]; Eye Diseases/di [Diagnosis]; *Eye Diseases/eh [Ethnology]; Eye Diseases/et [Etiology]; Female; *Health Services Accessibility/sn [Statistics & Numerical Data]; Healthcare Disparities; Humans; Interviews as Topic; Los Angeles/ep [Epidemiology]; Male; *Mexican Americans/sn [Statistics & Numerical Data]; Middle Aged; *Patient Acceptance of Health Care/eh [Ethnology]; Risk Factors; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Clinical evaluation of succinylated collagen bandage lenses for ophthalmic applications. - Hadassah, J; Prakash, D; Sehgal, P K; Agarwal, A; Bhuvaneshwari, N (Ophthalmic research, 2008)
AIM: To study whether succinylated collagen bandage lenses (SCBL) prepared from modified bovine collagen (succinylated collagen) can replace other bandage lenses presently employed to treat various corneal conditions like filamentary keratitis, dry eyes, recurrent corneal erosions, foreign body removal and epithelial trauma., METHODS: This observational case study included 32 patients (22 female and 10 male): 8 patients for filamentary keratitis (25%), 10 patients for dry eyes (31%), 4 patients for recurrent corneal erosions (13%), 7 patients for foreign body removal (22%) and 3 patients for epithelial trauma (9%). Their eyes were evaluated for biocompatibility, in vivo transparency, patient comfort, corneal fit, best corrected visual acuity (BCVA), tear fluid level and dissolution rate of SCBL. This was carried out over a 24-hour period of time., RESULTS: SCBL exhibited good transparency and remained transparent throughout the period of study (between 0 and 24 h) in the eyes of patients. SCBL did not cause any irritation, discomfort and foreign body sensation in the eye and eyes remained comfortable throughout the experiment. BCVA in the control group of patients was 1.00 (20/20). Mean (+/-SD) BCVA before inserting SCBL (in decimal equivalent) was 0.31 (20/60) +/- 0.18 (range 0.1- 0.66). BCVA (+/-SD) changed to 0.25 (20/80) +/- 0.18 4 h after the application of SCBL and 0.27 (20/70) +/- 0.18 24 h after the application of SCBL, with a safety index of 1.20. The mean (+/-SD) tear fluid level before application of SCBL was 11.9 +/- 5.39 h (range 3-24 mm) and changed to 13.9 +/- 5.68 h (range 5-28 mm) after 4 h of application of SCBL and 15.9 +/- 5.72 h (range 7-30 mm) after 24 h with a safety index of 13 mm. The mean (+/-SD) dissolution rate of SCBL in the control group of patients was 17.8 +/- 8.65 h (range 10-24 h) and the mean (+/-SD) dissolution rate in the experimental group was 22.2 +/- 9.29 h (range 10-24 h). We report the use of SCBL in various corneal conditions., CONCLUSION: The present study showed that SCBL has complete corneal fit and good comfort in human eyes. Transparency was maintained for a longer period along with fair visual acuity and improvement in tear fluid levels. The disadvantages of other bandage lenses presently used to treat various corneal conditions could be overcome by the use of SCBL lenses. Copyright 2008 S. Karger AG, Basel.
Keywords: Adolescent; Adult; Aged; *Collagen; *Contact Lenses; *Corneal Diseases/th [Therapy]; Female; Humans; Male; Middle Aged; *Occlusive Dressings; Patient Satisfaction; *Succinic Acid; Tears/ph [Physiology]; Visual Acuity/ph [Physiology]; Wound Healing/ph [Physiology]

Characteristics of patients who dropout from a glaucoma clinic. - Ashaye, Adeyinka O; Adeoye, Adenike O (Journal of glaucoma, 2008)
PURPOSE: To find the dropout rate and identify the clinical characteristics of patients who drop out in the first year of follow-up from a glaucoma clinic., DESIGN: Descriptive hospital-based study at a tertiary hospital eye department., METHODS: Clinical characteristics of consecutive patients newly diagnosed with glaucoma who dropped out (n=452) were compared with patients who did not drop out (n=295) within 12 months., RESULTS: The rate of dropout from follow-up was 60.5% within 1 year; 43.1% of the study group dropped out after their first follow-up visit. The dropout rate was high in all age groups, but higher in the age groups 21 to 30 years, 41 to 50 years, and over 70 years. Males had a higher dropout rate than females (78.6% vs. 34.5%). Dropout rate was higher among those with mild/moderate glaucoma than those with severe disease (88.2% vs. 37.2%); those who lived further away from the hospital than those who lived nearer to the hospital (72.5% vs. 40.8%), those who were referred from screening clinics for nonblinding eye disease compared with those referred because of a blinding eye disease (72.2% vs. 58.9%). More patients (63.8%) unsure of their family eye disease history dropped out, compared with 34.3% of those with positive family history of glaucoma and other potentially blinding diseases. More patients who had no systemic disease dropped out, than those with systemic disease (54.6% vs. 39.6%); whereas patients on 2 medications or more had a higher dropout rate than those on less than 2 medications (68.1% vs. 52.1%). Of the study factors, those that were statistically significantly associated with dropping out of follow-up from the glaucoma clinic were age, sex, place of domicile, diagnosis at referral, severity of disease, family history, and polydrug use., CONCLUSIONS: The dropout rate from this glaucoma clinic in the first year was high (60.5%). Patients who were more likely to dropout were younger patients, male, those who travelled far distances to the clinic, those with mild to moderate glaucoma, those with no family history of blinding eye diseases, and patients taking 2 or more eyedrops. Patients who seem to perceive their problems as not serious dropped out of follow-up. These findings have great implications in planning future studies and intervention to improve the follow-up of glaucoma patients in the study area.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Female; Follow-Up Studies; *Glaucoma, Angle-Closure/ep [Epidemiology]; Glaucoma, Angle-Closure/px [Psychology]; *Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/px [Psychology]; Humans; Male; Middle Aged; Nigeria/ep [Epidemiology]; *Outpatient Clinics, Hospital/sn [Statistics & Numerical Data]; Patient Dropouts/px [Psychology]; *Patient Dropouts/sn [Statistics & Numerical Data]; Retrospective Studies; Sex Distribution; Treatment Refusal

Referral pathways and management of contact lens-related microbial keratitis in Australia and New Zealand. - Keay, Lisa; Edwards, Katie; Stapleton, Fiona (Clinical & experimental ophthalmology, 2008)
BACKGROUND: We examine the referral pathways and treatment for contact lens-related microbial keratitis in Australia and New Zealand., METHODS: Cases were reported in May 2003-September 2004; data on presentation, referral and treatment collected from practitioners and via patient interview. Severity was graded, 1-week cure rate estimated, delays in treatment and medications documented. Hospital and private clinic managements were compared., RESULTS: A total of 297 eligible cases were reported; detailed information on treatment and referral pathways was available on a subset of these cases. Presentation was to optometrists (81/200, 41%), general practitioners (GPs) (69/200, 34%) or emergency departments (46/200, 23%). Optometrists referred to private ophthalmologists (47/79, 60%) more often than hospitals (27/79, 34%). GPs initiated treatment (39/68, 57%) but also referred to hospitals (22/68, 32%) and to private ophthalmologists (7/68, 10%). Of all cases, 67% (195/297) were managed in hospitals (29% admitted, 87/297). Hospitalized cases were predominantly managed with fortified aminoglycoside/cephalosporin (66/81, 82%) and others fluoroquinolones (168/195, 86%). Steroids were used in 36% (98/276) commencing on day 5 (median, interquartile range = 3-7). One-week cure rate was 60% (49/82) in private clinics, 72% (62/86) for hospital outpatient cases and 37% (25/67, P < 0.001) for inpatient cases, which were more severe diseases (47%, 52% and 0% mild, respectively). Delays (>/=12 h) receiving therapy were experienced by 33% (55/168) because of initial inappropriate treatment (48/55), time delays (7/55) but not remoteness (P = 0.6)., CONCLUSIONS: The majority of treatment is via hospital clinics, but milder disease is managed in private clinics. The referral process via optometrists, GPs and emergency departments is generally efficient; however, one-third of cases experienced some delays before receiving appropriate therapy highlighting the need for timely diagnosis.
Comment in (CIN)
Keywords: Adolescent; Adult; Ambulatory Care; Australia; *Contact Lenses/ae [Adverse Effects]; Emergency Medical Services; Family Practice; Health Services Accessibility; Hospitalization; Humans; Keratitis/di [Diagnosis]; Keratitis/et [Etiology]; *Keratitis/mi [Microbiology]; *Keratitis/th [Therapy]; Middle Aged; New Zealand; Optometry; Pilot Projects; *Referral and Consultation; Time Factors

Travoprost/timolol fixed combination. - Herceg, Michael; Noecker, Robert (Expert opinion on pharmacotherapy, 2008)
BACKGROUND: Travoprost and timolol are topical ocular hypotensive medications that have been used in the treatment of glaucoma. The fixed combination eye drop, Duotrav (travoprost 0.004% and timolol maleate 0.5%), has recently been introduced into the market., OBJECTIVE: In this paper, the results of clinical trials and existing data on the performance of travoprost/timolol are discussed and analyzed., METHODS: Appopriate studies for review were identified using PubMed. Studies selected for review compared efficacy and side-effect profile of fixed combination travoprost/timolol with travoprost and timolol used concomitantly, latanoprost and timolol used concomitantly, fixed combination latanoprost/timolol, travoprost alone and timolol alone., RESULTS/CONCLUSION: Fixed combination eye drops such as travoprost/timolol offer the potential benefits of increased patient adherence, reduced exposure to preservatives, and reduced cost.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/pk [Pharmacokinetics]; *Antihypertensive Agents/tu [Therapeutic Use]; Clinical Trials as Topic; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/pk [Pharmacokinetics]; Cloprostenol/tu [Therapeutic Use]; Drug Combinations; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; Timolol/ad [Administration & Dosage]; Timolol/pk [Pharmacokinetics]; *Timolol/tu [Therapeutic Use]; Travoprost

Treatment of glaucoma patients with insufficient intraocular pressure control: a survey of German ophthalmologists in private practice. - Vorwerk, Christian; Thelen, Ulrich; Buchholz, Patricia; Kimmich, Friedemann (Current medical research and opinion, 2008)
OBJECTIVE: To assess the degree to which glaucoma treatment guidelines have been incorporated into daily practices and to describe the therapeutic practices chosen for patients with insufficient intraocular pressure (IOP) control., METHODS: Ophthalmologists in private practice in Germany were surveyed to obtain information about patients who exhibited unsatisfactory progress with IOP-lowering pharmacotherapy. Using a questionnaire, physicians provided data concerning treatment difficulty, target IOP, number and type of medications used, two most recent IOP readings, and optic nerve head and visual field observations., RESULTS: Of the 853 patients analyzed, primary open-angle glaucoma was the diagnosis for 67.1%, and other diagnoses included ocular hypertension, normal tension glaucoma, and pseudoexfoliation glaucoma. Target IOP levels had been determined for 95.5% of patients, and not achieving the target pressure was identified as a treatment difficulty for 81.0% of patients. Of patients on monotherapy, beta-blockers were prescribed most often (42.3%). Of all patients, 53.3% were treated with two or more agents as either fixed or non-fixed combinations. The non-fixed combination of a prostaglandin and carbonic anhydrase inhibitor was the most frequently prescribed dual therapy (19.2%). Non-fixed prostaglandin plus beta-blocker was used by 18.0% of dual therapy patients, whereas the available fixed combination was used by 10.5%. Non-compliance was identified as a cause of unsatisfactory IOP-lowering in 26.8% of all patients. This study is limited by its descriptive, non-interventional design., CONCLUSIONS: Treatment alterations are necessary to achieve sufficient IOP control in some patients. If these patients were to take advantage of more aggressive therapies as outlined by treatment guidelines, including newer formulations and fixed combination preparations, both efficacy and compliance may be improved.
Keywords: *Adrenergic beta-Antagonists/ad [Administration & Dosage]; Aged; Aged, 80 and over; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Germany; *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Care Surveys; Humans; *Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmology/mt [Methods]; Patient Compliance/sn [Statistics & Numerical Data]; Practice Guidelines as Topic; Practice Patterns, Physicians'/st [Standards]; Private Practice; Prognosis; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Risk Assessment; Severity of Illness Index; Surveys and Questionnaires; Tonometry, Ocular; Treatment Failure

[The role of patient compliance in the management of glaucoma]. - Popovic Suic, Smiljka; Cerovski, Branimir; Jukic, Tomislav (Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti, 2008)
AIM: The aim of the study was to evaluate patient cooperation in glaucoma treatment., METHODS: We evaluated data collected by an anonymous questionnare from 98 glaucoma patients who answered 6 questions regarding their compliance and persistence in glaucoma treatment., RESULTS: Study results revealed 50% of patients to fail taking their antiglaucoma therapy regularly. Patients on monotherapy showed better compliance and higher level of satisfaction with treatment than those on combination antiglaucoma therapy consisting of 2 or 3 eyedrops. Discontinuation of persistence was recorded in 31% of patients, whereas 51% of patients did not present for control visits every six months as suggested by their ophthalmologist., CONCLUSION: Patients are more compliant and persistent with antiglaucoma monotherapy than with combined therapy. Greater compliance and persistence with ocular hypotensive therapy may improve the outcomes in glaucoma.
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance

Detection of virulence factors in Pseudomonas aeruginosa strains isolated from contact lens-associated corneal ulcers. - Pinna, Antonio; Usai, Donatella; Sechi, Leonardo A; Molicotti, Paola; Zanetti, Stefania; Carta, Arturo (Cornea, 2008)
PURPOSE: In microbial keratitis associated with contact lens use, Pseudomonas is the most common etiologic agent. The purpose of this study was to report on the microbiological findings of 8 P. aeruginosa strains isolated from contact lens-associated corneal ulcers., METHODS: Scrapings from contact lens-related corneal ulcers were inoculated for culture. Identification and antibiotic susceptibility testing were performed by using the Vitek system (bioMerieux). The Pseudomonas' ability to form biofilm; produce gelatinase, elastase, and alkaline protease; and adhere to and invade human corneal epithelial cells was studied. Polymerase chain reaction with enterobacterial repetitive intergenic consensus primers (ERIC-PCR) was used to establish clonal relationship between the different isolates., RESULTS: All the strains showed multiple antibiotic resistance (resistance to 4 or more antibiotics), but all were susceptible to aminoglycosides and fluoroquinolones. Biofilm production was weak in 5 cases and absent in the remaining 3 cases. All isolates were able to produce alkaline protease and gelatinase but not elastase. Adherence to human corneal epithelial cells was poor (0-15 bacteria/cell) in 5 cases and medium (16-60 bacteria/cell) in 3 cases. Five isolates were found to be efficient invaders (>1000 CFU/mL). ERIC-PCR showed 8 different genetic patterns., CONCLUSIONS: Because multiresistant Pseudomonas isolates are common, we recommend antibiotic susceptibility testing in all cases of Pseudomonas keratitis so that, if there is no response to initial empiric treatment, antibiotics can be modified according to susceptibility results. The ability to produce alkaline protease and gelatinase and invade the corneal epithelium may play a major role in the pathogenesis of contact lens-related P. aeruginosa keratitis. Also, ERIC-PCR seems to be an inexpensive, fast, reproducible, and discriminatory DNA typing tool for effective epidemiologic surveillance of P. aeruginosa isolates potentially transmissible between patients with ocular infections.
Keywords: Adolescent; Adult; Bacterial Adhesion/ph [Physiology]; Bacterial Proteins/me [Metabolism]; Bacterial Typing Techniques; Biofilms; Colony Count, Microbial; *Contact Lenses/mi [Microbiology]; *Corneal Ulcer/mi [Microbiology]; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Endopeptidases/me [Metabolism]; *Eye Infections, Bacterial/mi [Microbiology]; Female; Gelatinases/me [Metabolism]; Humans; Male; Microbial Sensitivity Tests; Pancreatic Elastase/me [Metabolism]; Polymerase Chain Reaction; *Pseudomonas Infections/mi [Microbiology]; Pseudomonas aeruginosa/cl [Classification]; Pseudomonas aeruginosa/ip [Isolation & Purification]; *Pseudomonas aeruginosa/ph [Physiology]; Virulence; *Virulence Factors/me [Metabolism]

A multicentre evaluation of the effect of patient education on acceptance of hyperaemia associated with bimatoprost therapy for glaucoma or ocular hypertension. - Trattler, William; Noecker, Robert J; Earl, Melissa L (Advances in therapy, 2008)
INTRODUCTION: The aim of this study was to evaluate the incidence of hyperaemia in patients using bimatoprost and to determine if simple interventions result in increased understanding of glaucoma and hyperaemia., METHODS: This was a multicentre, open-label, evaluator-masked clinical trial of 106 patients. Prior to enrolling in the trial, patients were washed out from any ocular hypotensive medications and prescribed bimatoprost daily in the evening for 6 weeks. Patients were randomised to one of two groups: intervention and no intervention. Patients in the intervention group (n=63) were given a fact sheet explaining the importance of reducing intraocular pressure (IOP) and the efficacy of bimatoprost, while patients in the no intervention group (n=43) were instructed only to instil bimatoprost daily and were given no additional instructions., RESULTS: As graded by the masked investigators, conjunctival hyperaemia peaked 1 day after commencing bimatoprost, with a mean of 1.2 (0=none, 0.5=trace, 1=mild, 2=moderate, 3=severe). By day 7, hyperaemia levels were approximately trace (0.79) and continued to decrease throughout the study. There were no significant differences between groups in mean conjunctival hyperaemia at any study visit (P> or =0.215). At every visit, patients in the intervention group were significantly more likely than patients in the no intervention group to report that lowering IOP was very important for preserving vision (P< or =0.001). At week 6, 98% of patients in the intervention group reported that IOP-lowering was very important for preserving vision, compared with 76% of patients who did not receive the intervention (P< or =0.001). Patients in the intervention group were more likely than patients in the no intervention group to be willing to continue to use bimatoprost, despite hyperaemia. This difference was statistically significant at day 1 (P=0.003)., CONCLUSION: Patients were not bothered by the trace.mild hyperaemia associated with bimatoprost therapy. Patient education can improve patient acceptance of a prescribed regimen and potentially increase compliance.
Keywords: Aged; Amides/ad [Administration & Dosage]; Amides/ae [Adverse Effects]; *Amides/tu [Therapeutic Use]; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Female; Glaucoma/dt [Drug Therapy]; Humans; *Hyperemia/ci [Chemically Induced]; Intraocular Pressure; Male; *Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; *Patient Education as Topic/mt [Methods]

Barriers to glaucoma drug delivery. - Ghate, Deepta; Edelhauser, Henry F (Journal of glaucoma, 2008)
Topical medications remain the mainstay of glaucoma treatment. This review will aim to cover the pharmacokinetics of topically applied drops, the ocular barriers to drug delivery, and the role of ophthalmic drug formulation in enhancing drug delivery to the target tissue while minimizing side effects and increasing patient compliance. Recent advances in surgical techniques, therapeutic approaches, and material sciences have produced exciting new therapies for ocular diseases. The development of new vehicles and drug formulations that require less patient compliance is also discussed, as are the routes of drug delivery for neuroprotection.
Keywords: Absorption; Administration, Topical; Animals; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/pk [Pharmacokinetics]; Biological Availability; *Drug Delivery Systems; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/pk [Pharmacokinetics]; Pharmaceutical Vehicles

Glaucoma and on-road driving performance. - Haymes, Sharon A; LeBlanc, Raymond P; Nicolela, Marcelo T; Chiasson, Lorraine A; Chauhan, Balwantray C (Investigative ophthalmology & visual science, 2008)
PURPOSE: To investigate the on-road driving performance of patients with glaucoma., METHODS: The sample comprised 20 patients with glaucoma and 20 subjects with normal vision, all licensed drivers, matched for age and sex. Driving performance was tested over a 10-km route incorporating 55 standardized maneuvers and skills through residential and business districts of Halifax, Nova Scotia, Canada. Testing was conducted by a professional driving instructor and assessed by an occupational therapist certified in driver rehabilitation, masked to participant group membership and level of vision. Main outcome measures were total number of satisfactory maneuvers and skills, overall rating, and incidence of at-fault critical interventions (application of the dual brake and/or steering override by the driving instructor to prevent a potentially unsafe maneuver). Measures of visual function included visual acuity, contrast sensitivity, and visual fields (Humphrey Field Analyzer; Carl Zeiss Meditec, Inc., Dublin, CA; mean deviation [MD] and binocular Esterman points)., RESULTS: There was no significant difference between patients with glaucoma (mean MD = -1.7 dB [SD 2.2] and -6.5 dB [SD 4.9], better and worse eyes, respectively) and control subjects in total satisfactory maneuvers and skills (P = 0.65), or overall rating (P = 0.60). However, 12 (60%) patients with glaucoma had one or more at-fault critical interventions, compared with 4 (20%) control subjects (odds ratio = 6.00, 95% CI, 1.46-24.69; higher still after adjustment for age, sex, medications and driving exposure), the predominant reason being failure to see and yield to a pedestrian. In the glaucoma group, worse-eye MD was associated with the overall rating of driving (r = 0.66, P = 0.002)., CONCLUSIONS: This sample of patients with glaucoma with slight to moderate visual field impairment performed many real-world driving maneuvers safely. However, they were six times as likely as subjects with normal vision to have a driving instructor intervene for reasons suggesting difficulty with detection of peripheral obstacles and hazards and reaction to unexpected events.
Keywords: Aged; *Automobile Driving/st [Standards]; Female; *Glaucoma/pp [Physiopathology]; Humans; Male; Middle Aged; Severity of Illness Index; Single-Blind Method; Vision, Ocular; Visual Fields

Doctor-patient communication, health-related beliefs, and adherence in glaucoma results from the Glaucoma Adherence and Persistency Study. - Friedman, David S; Hahn, Steven R; Gelb, Laurie; Tan, Jason; Shah, Sonali N; Kim, Elizabeth E; Zimmerman, Thom J; Quigley, Harry A (Ophthalmology, 2008)
OBJECTIVE: To use multiple data sources to determine drivers of patient adherence to topical ocular hypotensive therapy., DESIGN: Retrospective database and chart reviews in combination with prospective patient surveys. Diverse medical environments where insured patients in the research database seek care., PARTICIPANTS: Three hundred patients with a new claim diagnosis for open-angle glaucoma who initially were prescribed one of three prostaglandins and 103 physicians participating in the same medical plans., METHODS: A structured interview addressing self-reported adherence, experiences with medication, communication with the physician, and health-related beliefs associated with adherence behavior was administered to surveyed patients. Phone interviews were conducted with participating ophthalmologists., MAIN OUTCOME MEASURE: Of adherence, medication possession ratio., RESULTS: Eight variables were associated independently with a lower medication possession ratio: (1) hearing all of what you know about glaucoma from your doctor (compared with some or nothing); (2) not believing that reduced vision is a risk of not taking medication as recommended; (3) having a problem paying for medications; (4) difficulty while traveling or away from home; (5) not acknowledging stinging and burning; (6) being nonwhite; (7) receiving samples; and (8) not receiving a phone call visit reminder. The multivariate model explained 21% of the variance., CONCLUSIONS: These findings indicate that doctor-patient communications and health-related beliefs of patients contribute to patient adherence. Patient learning styles that are associated with less concern about the future effects of glaucoma and the risks of not taking medications are associated with lower adherence. Specifically, knowledge about potential vision loss from glaucoma is a critical element that tends to be missed by more passive doctor-dependent patients who tend to be poorly adherent. These findings suggest that educational efforts in the office may improve patient adherence to medical therapies.
Keywords: Adult; *Antihypertensive Agents/tu [Therapeutic Use]; *Attitude to Health; Communication; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Male; *Patient Compliance; *Physician-Patient Relations; Prospective Studies; Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies

Corneal hysteresis but not corneal thickness correlates with optic nerve surface compliance in glaucoma patients. - Wells, Anthony P; Garway-Heath, David F; Poostchi, Ali; Wong, Tracey; Chan, Kenneth C Y; Sachdev, Nisha (Investigative ophthalmology & visual science, 2008)
PURPOSE: To investigate relationships between acute intraocular pressure (IOP)-induced optic nerve head surface deformation and corneal hysteresis and thickness in glaucomatous and nonglaucomatous human eyes., METHODS: This was a prospective experimental study of 100 subjects (38 with glaucoma, 62 without glaucoma). Data collected included spherical equivalent, optic disc diameter, central corneal thickness (CCT), axial length, cylinder, Goldmann IOP, Pascal IOP, and ocular pulse amplitude and ocular response analyzer (ORA) measurements of corneal hysteresis (CH). Elevation of IOP was induced in the right eye of each subject with a modified LASIK suction ring to an average of 64 mm Hg for less than 30 seconds. Heidelberg Retina Tomography II (HRT) was used to map the optic nerve surface before and during IOP elevation. Mean cup depth was calculated using built-in HRT data analysis software. Change in optic disc depth during IOP elevation was calculated for all right eyes, and tests for correlation with the parameters listed were performed., RESULTS: Both CH and CCT were lower in the glaucoma group (8.8 mm Hg and 532 microm) than in the control group (9.6 mm Hg, P = 0.012; 551 microm, P = 0.011, respectively). There were no statistically significant differences in spherical equivalent, cylinder, axial length, optic disc size, or ocular pulse amplitude between the glaucoma and the control groups. There was no difference between the amount of IOP elevation between the two groups (P = 0.41), and the average difference in mean cup depth between baseline (mean cup depth, 247 microm) and during IOP elevation was 33 microm (29.8 microm in glaucoma and 36.1 microm in control; P = 0.5). Multiple variable analysis, controlling for age and sex, showed that CH was correlated with mean cup depth increase (P = 0.032). This relationship persisted (P = 0.032) after controlling for glaucoma status in addition to age and sex. Other factors, including CCT (P = 0.3), axial length (P = 0.9), ocular pulse amplitude (P = 0.22), and spherical equivalent (P = 0.38), were not significant in this model., CONCLUSIONS: In the glaucoma patients but not the control patients, CH but not CCT or other anterior segment parameters was associated with increased deformation of the optic nerve surface during transient elevations of IOP. (ClinicalTrials.gov number, NCT00328835.).
Keywords: *Compliance; *Cornea/pp [Physiopathology]; Diagnostic Techniques, Ophthalmological; Extracellular Matrix/ph [Physiology]; Female; *Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ocular Hypertension/pp [Physiopathology]; *Optic Disk/pp [Physiopathology]; *Optic Nerve Diseases/pp [Physiopathology]; Prospective Studies; Stress, Mechanical; Tonometry, Ocular

[Aniridia intraocular lenses in eyes with traumatic iris defects]. - Schmitz, K; Viestenz, A; Meller, D; Behrens-Baumann, W; Steuhl, K-P (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2008)
BACKGROUND: Globe injuries frequently are the cause of permanent loss of visual function. Especially ruptures of the globe have a 50 times lower chance of achieving a final visual acuity better than 20/200 as compared to contusions of the globe. Besides injury to the retina and choroids, injury of the iris-lens diaphragm plays an important role for visual rehabilitation (10% iris defects and 1% aniridia after blunt trauma). Against this background the surgical results after implantation of aniridia intraocular lenses were investigated., PATIENTS AND METHODS: Eleven patients (41.9+/-19.6 years of age) after globe injury (three ruptures of the globe, eight penetrating injuries with trauma of the iris) were implanted with an aniridia IOL., RESULTS: The implantation of an aniridia IOL was performed on average 1.0+/-0.6 years (range: 0.4-2.3 years) after the primary injury. In ten eyes an aniridia IOL model HMK ANI 2 (Ophtec/Polytech) was implanted and in one eye an aniridia IOL model 67 (Morcher). Most patients were very satisfied with the results achieved (average corrected visual acuity 0.48; 0.05-1.0). Of the operated eyes, 63% reached a visual acuity > or = 0.4. All patients noticed a significant reduction in glare disability as compared to the preoperative condition. The incidence of secondary glaucoma remained unchanged after the secondary implantation. One patient demonstrated retinal detachment 3 months after receiving the secondary implant, which was successfully treated with vitrectomy and gas tamponade., CONCLUSIONS: The implantation of aniridia IOLs seems to be a beneficial therapeutic option in post-traumatic eyes with partial or complete aniridia and aphakia with good visual recovery. During the postoperative follow-up special attention must be paid to sufficient regulation of intraocular pressure and to the retinal situation.
Keywords: Adult; Aged; Aphakia/px [Psychology]; Aphakia/rh [Rehabilitation]; Corneal Transplantation/px [Psychology]; *Eye Injuries/px [Psychology]; Eye Injuries/su [Surgery]; Follow-Up Studies; Humans; *Iris/in [Injuries]; *Lenses, Intraocular/px [Psychology]; Male; Middle Aged; Patient Satisfaction; *Polymethyl Methacrylate; Prosthesis Design; *Quality of Life/px [Psychology]; Reoperation; Retrospective Studies; Visual Acuity

[Midterm patient satisfaction following mitomycin C-assisted trabeculectomy]. - Schild, A M; Jordan, J F; Konen, W; Krieglstein, G K; Dietlein, T S (Klinische Monatsblatter fur Augenheilkunde, 2008)
BACKGROUND: There are few published data on patient satisfaction following glaucoma surgery. The aim of our study was to investigate factors influencing patient satisfaction more than one year after trabeculectomy with mitomycin C., MATERIAL AND METHODS: We sent a two-page questionnaire to 61 female glaucoma patients who had consecutively undergone filtering surgery with MMC at the Department of Ophthalmology, University of Cologne, requesting anonymous replies (mean follow-up 19.2+/-2.5 months)., RESULTS: The response rate was 79%. There was no significant inverse correlation between patient satisfaction and recent IOP values, redness of the eye, local irritation or foreign body sensation. There was a significant correlation between patient satisfaction and visual function, a significant inverse correlation between frequency of visits to the ophthalmologist and frequency of eye drop application. A weak, insignificant inverse correlation was found between satisfaction and number of topical medications., CONCLUSIONS: Patient satisfaction seems to correlate primarily with practical impact on everyday life, visual function, frequency of eye drop application and visits to the eye doctor being identified as the major issues. Local symptoms related to the filtering bleb seem to have a minor influence on patient satisfaction.
Keywords: Aged; Female; Follow-Up Studies; Humans; Intraocular Pressure; Male; Middle Aged; *Mitomycin/ad [Administration & Dosage]; Ophthalmic Solutions; *Patient Satisfaction; Postoperative Complications/et [Etiology]; Prospective Studies; *Trabeculectomy/mt [Methods]

Clinical chronopharmacology in the elderly. - Bruguerolle, Bernard (Chronobiology international, 2008)
The behavior and effects of medications may be modified in the elderly. Factors contributing to such alterations may involve differences in drug pharmacokinetics and response and/or social and economic factors that affect nutrition and compliance to medications. Many studies have been devoted to such factors, but most of them have not taken into account chronopharmacologic data. Indeed, drug-administration time constitutes an additional factor of variability in drug response in the elderly. Biological rhythm-dependent differences in the kinetics and dynamics of medications seem to be diminished or altered with aging. Chronopathological (rhythmic aspects of disease) data in the elderly are of particular importance, taking into account frequently associated diseases, such as chronic obstructive pulmonary disease, cancer, diabetes, glaucoma, hypertension, and inflammatory conditions, among others. Although some chronobiological data are available, chronopharmacologic phenomena have yet to be extensively investigated in the elderly. Most of the sparse studies concern drug chronokinetics, but the data found in the literature do not reveal a clear trend in the age-related changes. Chronokinetic variations in the elderly, compared to young adults, suggest an amplification of the administration-time effects, as demonstrated for digoxin; dampening, as demonstrated for indomethacin; or detection of administration-time effects only in aged but not in young subjects, as found for others medications. Additional studies are needed to better understand the influence of age on the chronokinetics of medications. Moreover, the literature on possible administration-time differences in drug dynamics in the elderly is also very sparse. Altered receptor and/or post-receptor properties and impaired sensitivity of homeostatic mechanisms have yet to be studied from a chronopharmacological point of view. Thus, additional studies are needed to properly understand how drug responses in the elderly may vary in relation to the circadian timing of medications.
Keywords: Aged; *Chronobiology Phenomena; Disease; Health; Humans; Kinetics; Pharmaceutical Preparations

Managed care and the impact of glaucoma. - Reeder, Claiborne E; Franklin, Meg; Bramley, Thomas J (The American journal of managed care, 2008)
Changes in the healthcare system, population demographics, and treatment alternatives have contributed to an emerging awareness of glaucoma among managed care organizations. Early diagnosis and treatment are essential to thwarting the personal and economic consequences of end-stage glaucoma. Despite recognition of the need for early intervention and therapy, the literature suggests a great need still exists for improvements in lowering intraocular pressure, managing appropriate follow-up, and improving adherence to current glaucoma medication regimens. As the elderly population continues to increase, these issues will intensify and present further problems for the healthcare system. The purpose of this introductory manuscript is to highlight the literature on the clinical and economic impact of glaucoma and its importance to the managed care community. The remainder of the supplement will focus on the current management of glaucoma and the potential role of neuroprotection in this patient population.
Keywords: Aged; Glaucoma/ec [Economics]; *Glaucoma/pc [Prevention & Control]; Health Care Costs; Humans; *Managed Care Programs; Mass Screening; Middle Aged; Patient Compliance; Practice Guidelines as Topic; United States

Current management of glaucoma and the need for complete therapy. - McKinnon, Stuart J; Goldberg, Lawrence D; Peeples, Patti; Walt, John G; Bramley, Thomas J (The American journal of managed care, 2008)
Glaucoma is a long-term ocular neuropathy defined by optic disc or retinal nerve fiber structural abnormalities and visual field abnormality. Primary open-angle glaucoma is the most common type of glaucoma. Currently available treatments, initiated in a stepwise process, focus on intraocular pressure (IOP) reduction, and initially include topical drug therapy (single then multidrug combinations), followed by laser then surgical treatment. Topical prostaglandin analogues or beta-adrenergic receptor blockers are first used, followed by alpha-agonists or topical carbonic anhydrase inhibitors, and infrequently, cholinergic agonists and oral therapy. Limitations to existing topical IOP-reducing medications include continued disease progression in glaucoma patients with normal IOP, treatment failure, and low rates of compliance and persistence. Therapeutic agents under investigation include neuroprotectants, which target the disease process manifested by death of retinal ganglion cells, axonal loss, and irreversible loss of vision. Neuroprotectants may be used alone or in combination with IOPreducing therapy (a treatment strategy called complete therapy). Memantine, an N-methyl-D-aspartate receptor blocker currently approved for dementia, is the neuroprotectant farthest along in the process seeking regulatory approval for glaucoma treatment and has a favorable safety profile because of its selective mechanism of action. Several other neuroprotectants are in early stage investigation. Complete therapy provides hope for improved outcomes by reducing the significant morbidity and economic consequences that occur as a result of neurodegeneration and disease progression.
Keywords: *Antihypertensive Agents/tu [Therapeutic Use]; *Blindness/pc [Prevention & Control]; Disease Progression; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/th [Therapy]; Humans; Managed Care Programs; Mass Screening; Neuroprotective Agents/tu [Therapeutic Use]; Patient Compliance; United States

Inter-visit intraocular pressure range: an alternative parameter for assessing intraocular pressure control in clinical trials. - Varma, Rohit; Hwang, Lie-Ju; Grunden, John W; Bean, Gerald W (American journal of ophthalmology, 2008)
PURPOSE: To evaluate whether inter-visit intraocular pressure (IOP) range, which reflects extreme and potentially damaging IOP fluctuations, provides additional information on IOP control compared to mean IOP., DESIGN: Post hoc analysis of Xalatan/Lumigan/Travatan study data, a masked-evaluator, randomized, parallel-group comparison of 12-week efficacy of latanoprost, bimatoprost, and travoprost in open-angle glaucoma/ocular hypertension patients., METHODS: Pretreatment inter-visit IOP range defined as highest IOP minus lowest IOP at screening, safety check, and baseline (six measurements); posttreatment inter-visit IOP range defined as highest IOP minus lowest IOP at weeks two, six, and 12 or early termination (nine measurements). Ranges dichotomized as "high" (>6 mm Hg) vs "low" (< or =6 mm Hg)., RESULTS: Included were 410 patients (latanoprost, 136; bimatoprost, 136; travoprost, 138). Each resulted in significant mean IOP range reductions during 12 weeks. Pretreatment inter-visit IOP range was associated with African-American race, male gender, and presence of visual field defect (P < .05 for all). Percentages with high pretreatment inter-visit IOP ranges were comparable across treatments (63% to 64%). High posttreatment inter-visit IOP range was seen in 21% (28/136), 28% (38/136), and 36% (50/138) of latanoprost, bimatoprost, and travoprost groups, respectively (P = .016, overall; P = .005, latanoprost vs travoprost). High posttreatment inter-visit IOP range was associated with African-American race, high pretreatment inter-visit IOP range, and treatment with travoprost vs latanoprost (P < .05 for all)., CONCLUSIONS: Given that high inter-visit IOP range is associated with risk factors for glaucomatous damage and that such differences cannot be evaluated using mean IOPs, inter-visit IOP range may be another useful approach to assessing IOP control in clinical trials.
Keywords: Aged; Amides/tu [Therapeutic Use]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Double-Blind Method; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/eh [Ethnology]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Lipids/tu [Therapeutic Use]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/eh [Ethnology]; Office Visits; Ophthalmic Solutions/tu [Therapeutic Use]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Risk Factors; Travoprost; Treatment Outcome

Prostaglandin analogues for ophthalmic use: a cost-effectiveness analysis. - Lachaine, Jean; Hodge, William G; Steffensen, Isabella; Murray, Christine; Barnes, David; Foerster, Vicki; Ducruet, Thierry; Mensinkai, Shaila (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2008)
BACKGROUND: The objective of this study was to perform an economic analysis of the cost-effectiveness of prostaglandin analogues for the treatment of increased intraocular pressure (IOP). Prostaglandin analogues for ophthalmic use are more costly than alternative agents for the lowering of IOP. An important policy decision is whether to support continued open listing of these agents or to restrict them to limited use status., METHODS: The cost-effectiveness of prostaglandin analogues was assessed using a decision analytic model. Latanoprost was compared with timolol, dorzolamide, and brimonidine, and travoprost was compared with timolol separately. The effectiveness data used for this economic analysis were the number of millilitres of mercury of IOP reduction compared with baseline and the incidence of adverse events resulting in a withdrawal of the patient from the study. Sensitivity analyses were conducted to assess the robustness of the study results., RESULTS: Compared with latanoprost, dorzolamide was not a cost-effective strategy. Compared with brimonidine, latanoprost provided a higher IOP reduction with an incremental cost-effectiveness ratio of $16.17 (base case), but the additional IOP reduction with latanoprost was obtained at a cost higher than the average cost per millimetre of mercury reduction obtained with brimonidine. Compared with timolol, latanoprost and travoprost had a positive incremental cost-effectiveness ratio of $34.48 and $39.06, respectively., INTERPRETATION: For the first-line treatment of glaucoma and elevated IOP, latanoprost is a more cost-effective strategy than dorzolamide and brimonidine. Latanoprost and travoprost are more effective than timolol but also more expensive. For those for whom timolol is not contraindicated, it would be preferable, from a cost-effectiveness standpoint, to initiate treatment with timolol and reserve the prostaglandin analogues as an alternative treatment or as add-on therapy for patients not achieving a clinical response with timolol. Better treatment compliance associated with these analogues improves their cost-effectiveness.
Keywords: *Antihypertensive Agents/ec [Economics]; Antihypertensive Agents/tu [Therapeutic Use]; Cost-Benefit Analysis; *Drug Costs; Economics, Pharmaceutical; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; Humans; Intraocular Pressure/de [Drug Effects]; *Ophthalmic Solutions/ec [Economics]; *Prostaglandins, Synthetic/ec [Economics]; Prostaglandins, Synthetic/tu [Therapeutic Use]

Long-term corneal retention of trichomes from bamboo shoots. - Wang, Teng-Yi; Chiang, Shang-Yi; Chang, Cheng-Jong (Cornea, 2008)
PURPOSE: To describe a rare case of corneal injury by trichomes of bamboo shoots., METHODS: A 58-year-old woman rubbed her right eye after touching a bamboo shoot, not knowing that there were many trichomes adherent to her hands. Severe conjunctival congestion and chemosis developed immediately but subsided the next day without visual impairment. Many trichomes were incidentally found to be embedded in the subepithelial region of the cornea on a routine slit-lamp examination. Three days after partial removal of the trichomes under a microscope, the epithelium had healed completely., RESULTS: Histopathologic examination showed bamboo trichomes in the epithelial scraping without inflammation., CONCLUSIONS: Trichomes of bamboo shoots may affect and stay in the cornea without significant inflammation because of their inert nature.
Keywords: Conjunctival Diseases/et [Etiology]; *Corneal Injuries; Eye Foreign Bodies/di [Diagnosis]; *Eye Foreign Bodies/et [Etiology]; Eye Foreign Bodies/su [Surgery]; Eye Injuries, Penetrating/di [Diagnosis]; *Eye Injuries, Penetrating/et [Etiology]; Eye Injuries, Penetrating/su [Surgery]; Female; Humans; Middle Aged; Pain/et [Etiology]; *Plant Shoots/ae [Adverse Effects]; *Sasa

Comparison of the iCare rebound tonometer and the Goldmann applanation tonometer over a wide IOP range. - Munkwitz, S; Elkarmouty, A; Hoffmann, E M; Pfeiffer, N; Thieme, H (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2008)
BACKGROUND: The aim of this study was to compare the intraocular pressure (IOP) results measured by the iCare rebound tonometer with those obtained by the Goldmann applanation tonometer (GAT) over a wide range of IOP values. Furthermore, the comfort level of the iCare measurement was evaluated., METHOD: The study included 75 eyes of 75 patients. The patients were divided into three groups (7-15 mmHg n = 25, 16-22 mmHg n = 25, 23-60 mmHg n = 25). The measurements were taken by two independent observers in a masked fashion. All patients were asked about discomfort during the iCare measurement. To establish the agreement between the two devices, a Bland-Altman analysis was performed., RESULTS: Overall, the 95% confidence interval of the differences between the two devices was -8.67 to 10.25 mmHg and in 62.7%, the iCare measurement was within +/-3 mmHg of the GAT measurements. The distribution of the differences in IOP was similar, from 7-22 mmHg. In the higher IOP range (23-60 mmHg), however, the deviation was almost twice as large. The measurement with the iCare tonometer was well tolerated; 100% of the patients denied any discomfort., CONCLUSIONS: The iCare tonometer is a mobile alternative to GAT in a low to moderate IOP range, but our findings show a greater deviation than previously reported. In high IOP values, measurements with the iCare tonometer do not correlate well with GAT.
Keywords: Equipment Design; Female; Humans; *Intraocular Pressure; Male; Middle Aged; Observer Variation; *Ocular Hypertension/di [Diagnosis]; Patient Satisfaction; Reproducibility of Results; *Tonometry, Ocular/is [Instrumentation]; Tonometry, Ocular/mt [Methods]

Efficacy and safety of bimatoprost/timolol fixed combination in the treatment of glaucoma or ocular hypertension. - Martinez, Antonio; Sanchez, Manuel (Expert opinion on pharmacotherapy, 2008)
When a single medication does not adequately control intraocular pressure, additional intraocular hypotensive agents are often added to the therapeutic regime. However, regimen complexity has been associated with reduced patient compliance. Treatment with a fixed combination may, therefore, increase compliance as a result of simplifying the dosage regimen. Bimatoprost/timolol fixed combination (BTFC) combines two clinically effective agents that decrease elevated intraocular pressure by independent mechanisms. In two clinical studies, BTFC was more effective than its individual components. Furthermore, in a non-inferiority study BTFC has been shown to be as effective as the association of its individual components. BTFC was clinically effective and generally well tolerated, with no unexpected adverse reactions reported for the BTFC compared with those reported for bimatoprost or timolol monotherapies.
Keywords: Amides/ae [Adverse Effects]; Amides/pk [Pharmacokinetics]; *Amides/tu [Therapeutic Use]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/pk [Pharmacokinetics]; *Antihypertensive Agents/tu [Therapeutic Use]; Bimatoprost; Blood Pressure/de [Drug Effects]; Cloprostenol/ae [Adverse Effects]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/pk [Pharmacokinetics]; Cloprostenol/tu [Therapeutic Use]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pp [Physiopathology]; Humans; Lipids/ae [Adverse Effects]; Lipids/pk [Pharmacokinetics]; *Lipids/tu [Therapeutic Use]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/me [Metabolism]; Ocular Hypertension/pp [Physiopathology]; Timolol/ae [Adverse Effects]; Timolol/pk [Pharmacokinetics]; *Timolol/tu [Therapeutic Use]; Treatment Outcome

Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. - Terry, Mark A; Shamie, Neda; Chen, Edwin S; Hoar, Karen L; Friend, Daniel J (Ophthalmology, 2008)
PURPOSE: Endothelial keratoplasty is an exciting alternative to full-thickness penetrating keratoplasty for replacing the diseased endothelium, yet 3 of the major complications seen are dislocation of the donor tissue, primary graft failure (PGF), and pupillary block from the residual, supportive air bubble. Surgical strategies were developed to reduce the likelihood of occurrence of these complications in our first 200 consecutive Descemet's stripping automated endothelial keratoplasty (DSAEK) cases., DESIGN: Prospective, noncomparative, interventional case series., PARTICIPANTS: Two hundred eyes of 172 patients with corneal edema., METHODS: An institutional review board-approved, prospective protocol of endothelial keratoplasty was initiated. Four different surgeons performed DSAEK for the initial 200 consecutive cases using a technique of peripheral recipient bed scraping for donor edge adherence and leaving a residual supportive air bubble, which was freely mobile, and <or=9 mm in diameter. The incidence of early postoperative complications was then determined., MAIN OUTCOME MEASURES: Postoperative donor graft dislocation, iatrogenic PGF, and pupillary block glaucoma., RESULTS: There were only 3 dislocations into the anterior chamber in this series of 200 consecutive eyes (1.5% dislocation rate) and all were successfully reattached with a second air bubble. There were no dislocations in the last 115 consecutive cases. There were two cases of donors that were attached but decentered in this series. There were no PGFs. There was not a single case of pupillary block in the entire series., CONCLUSION: The surgical technique described in this series, which utilized peripheral recipient bed scraping, has an acceptably low dislocation rate (1.5%) and yielded no cases of iatrogenic PGF. The complication of pupillary block was never seen in this series, likely due to our technique of utilizing a freely mobile, <or=9 mm residual air bubble at the conclusion of surgery.
Keywords: Adult; Aged; Aged, 80 and over; Anterior Chamber/su [Surgery]; Blister/su [Surgery]; *Corneal Transplantation/mt [Methods]; *Descemet Membrane/su [Surgery]; *Endothelium, Corneal/tr [Transplantation]; Female; Fuchs' Endothelial Dystrophy/su [Surgery]; *Graft Rejection/pc [Prevention & Control]; Graft Survival; Humans; *Iatrogenic Disease/pc [Prevention & Control]; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Prospective Studies; *Pupil Disorders/pc [Prevention & Control]; Tissue Donors

Success rates for switching to dorzolamide/timolol fixed combination in timolol responders who are insufficiently controlled by latanoprost monotherapy. - Sonty, Sriram; Henry, J Charles; Sharpe, Elizabeth D; Weiss, Mark J; Stewart, Jeanette A; Nelson, Lindsay A; Stewart, William C (Acta ophthalmologica, 2008)
PURPOSE: We aimed to investigate the safety and efficacy of dorzolamide/timolol fixed combination (DTFC) in timolol responders with ocular hypertension or open-angle glaucoma who switched to DTFC because of insufficient control on latanoprost., METHODS: We carried out a prospective, open-label cohort study with an active-historical control in which qualifying patients must have been treated with latanoprost monotherapy for at least 4 weeks, must have demonstrated insufficiently controlled intraocular pressure (IOP) (> or = 19 mmHg at 08.00 hours), and must have shown a decrease in IOP at 2 hours after timolol instillation of > or = 3 mmHg or > or = 15%. Patients then began DTFC dosed at 08.00 hours and 20.00 hours and discontinued latanoprost. Patients were evaluated again after 4 and 12 weeks., RESULTS: In 57 patients IOP was further reduced by 2.4 +/- 3.3 mmHg at 08.00 hours (p < 0.0001) and by 3.5 +/- 3.3 mmHg at 10.00 hours (p < 0.0001) after switching to DTFC. Responses to the Comparison of Ophthalmic Medications for Tolerability (COMTol) questionnaire showed no difference between DTFC and latanoprost for in terms of overall preference, typical daily activities, limitation of activities, compliance, satisfaction or quality of life (p > 0.05). However, greater frequency in burning and/or stinging (p < 0.0001) and bitter taste (p < 0.0001) were observed with DTFC, whereas unusual taste (p = 0.02) and itchy eyes (p = 0.05) were associated with latanoprost., CONCLUSIONS: This study suggests that patients who are insufficiently controlled on latanoprost monotherapy, and who are timolol responders, can generally achieve further IOP reduction and similar tolerance levels when changed to DTFC.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Cohort Studies; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Satisfaction; Prospective Studies; Quality of Life; *Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ae [Adverse Effects]; Surveys and Questionnaires; *Thiophenes/ad [Administration & Dosage]; Thiophenes/ae [Adverse Effects]; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Treatment Outcome

Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study. - Musch, David C; Gillespie, Brenda W; Niziol, Leslie M; Cashwell, L Frank; Lichter, Paul R; Collaborative Initial Glaucoma Treatment Study Group (Ophthalmology, 2008)
PURPOSE: To evaluate, both at initial glaucoma diagnosis and during treatment, the role of demographic and clinical factors on intraocular pressure (IOP)., DESIGN: Cohort study of patients enrolled in a randomized clinical trial., PARTICIPANTS: Six hundred seven patients with newly diagnosed open-angle glaucoma (OAG) were enrolled at 14 centers in the United States., METHODS: After randomization to initial surgery or medications, patients were followed at 6-month intervals. Intraocular pressure was measured by Goldmann applanation tonometry. Predictive factors for IOP at baseline and during follow-up were analyzed using linear mixed models., MAIN OUTCOME MEASURE: Intraocular pressure at baseline and during follow-up., RESULTS: The mean baseline IOP was 27.5 mmHg (standard deviation, 5.6 mmHg). Predictive factors for higher baseline IOP included younger age (0.7 mmHg per 10 years), male gender (2.4 mmHg higher than females), pseudoexfoliative glaucoma (5.4 mmHg higher than primary OAG), and pupillary defect (2.2 mmHg higher than those without a defect). During 9 years of follow-up, both surgery and medications dramatically reduced IOP from baseline levels, but the extent of IOP reduction was consistently greater in the surgery group. Over follow-up years 2 through 9, mean IOP was 15.0 versus 17.2 mmHg for surgery versus medicine, respectively. Predictive associations with higher IOP during follow-up included higher baseline IOP (P<0.0001), worse baseline visual field (mean deviation; P<0.0001), and lower level of education (P = 0.0019). Treatment effect was modified by smoking status: nonsmokers treated surgically had lower IOP than smokers treated surgically (14.6 vs. 16.7 mmHg, respectively; P = 0.0013). Clinical center effects were significant (P<0.0001) in both the baseline and follow-up models., CONCLUSIONS: In this large cohort of newly diagnosed glaucoma patients, predictors of pretreatment IOP and IOP measurements over 9 years of follow-up were identified. Our findings lend credence to the postulate that sociodemographic, economic, compliance, or other environmental influences play a role in IOP control during treatment.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Exfoliation Syndrome/th [Therapy]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Risk Factors; Tonometry, Ocular; Trabeculectomy/mt [Methods]

Visual acuity outcomes after cataract extraction in adult latinos. The Los Angeles Latino Eye Study. - Baranano, Anne E; Wu, Joanne; Mazhar, Kashif; Azen, Stanley P; Varma, Rohit; Los Angeles Latino Eye Study Group (Ophthalmology, 2008)
PURPOSE: To determine prevalence, primary causes, and risk indicators of visual impairment in cataract-operated eyes., DESIGN: Population-based cross-sectional study of adult Latinos., PARTICIPANTS: Two hundred sixty-one participants with cataract extraction., METHODS: Participants underwent an in-home interview and a comprehensive ophthalmologic examination. Visual impairment in the cataract-operated eye was defined by presenting visual acuity (PVA) of 20/40 or less or best-corrected visual acuity (BCVA) of 20/40 or less. The association of cataract extraction status (aphakic, pseudophakic) and severity of visual impairment was evaluated. Risk indicators associated with visual impairment by BCVA in the worse-seeing cataract-operated eye were evaluated., MAIN OUTCOME MEASURES: Visual acuity, causes of visual impairment, and risk indicators associated with visual impairment., RESULTS: Of the 261 participants with at least one cataract extraction and a complete clinical examination, 100 (38%) participants had undergone a unilateral extraction and 161 (62%) had undergone bilateral extractions. The prevalence of visual impairment was 41% (n = 107) defined by BCVA and 60.5% (n = 158) defined by PVA in the worse-seeing cataract-operated eye, and 32.2% (n = 136) defined by BCVA versus 48.1% (n = 203) defined by PVA in all cataract-operated eyes. Uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy were the primary causes of visual impairment, accounting for 49% in worse-seeing cataract-operated eyes and 57% in all cataract-operated eyes. Self-reported history of glaucoma, barriers to eye care, and unmarried participants were independent risk indicators associated with visual impairment (P<0.05)., CONCLUSIONS: Despite cataract surgery, a significant proportion of participants had residual visual impairment. Refractive correction eliminated visual impairment in 15% to 20% of the participants, demonstrating the need for regular ophthalmologic examinations in cataract-operated patients.
Keywords: Activities of Daily Living; Adult; Aphakia, Postcataract/eh [Ethnology]; *Cataract Extraction; Cross-Sectional Studies; Female; Health Surveys; *Hispanic Americans/eh [Ethnology]; Humans; Los Angeles/ep [Epidemiology]; Male; Outcome and Process Assessment, Health Care; Prevalence; Pseudophakia/eh [Ethnology]; Risk Factors; Sickness Impact Profile; Surveys and Questionnaires; *Vision Disorders/eh [Ethnology]; Vision Disorders/et [Etiology]; *Visual Acuity/ph [Physiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

The impact of anchor point on utilities for 5 common ophthalmic diseases. - Lee, Bryan S; Kymes, Steven M; Nease, Robert F Jr; Sumner, Walton; Siegfried, Carla J; Gordon, Mae O (Ophthalmology, 2008)
PURPOSE: To elicit utilities on a perfect health and perfect vision scale for 5 common eye diseases., DESIGN: Cross-sectional observational preference study., PARTICIPANTS: We included 434 patients: 58 with diabetic retinopathy, 99 with glaucoma, 44 with age-related macular degeneration (AMD), 124 with cataract; 109 with refractive error., TESTING: Standard gamble utilities were estimated using a computer-based preference assessment interview platform., MAIN OUTCOME MEASURES: Standard gamble utilities, a quality-of-life measure that examines the willingness to accept a risk of death or unilateral blindness in return for perfect health or perfect vision., RESULTS: Using the standard policy scale, where health equivalent to death is 0 and perfect health is 1, participants with asymptomatic diabetic retinopathy had a utility of 0.93. By comparison, symptomatic diabetics had a further utility loss of 0.14. Asymptomatic glaucoma participants had a utility of 0.92 with a decrease of 0.03 for early field loss and a further decrease of 0.03 with central field loss. Participants with AMD who had > or =20/100 better-eye visual acuity reported a utility of 0.89, whereas those with more severe AMD reported 0.76. However, neither clinical cataract opacity score nor refractive error correlated with utility. Adjustment for age and comorbidity did not alter these relationships. For the same participants, utilities measured with different anchor points-monocular blindness as 0 and perfect vision as 1-were lower, especially among participants with increased disease severity. The difference between utility assessed on this perfect vision-blindness scale and the perfect health-death scale ranged from 0.04 for those with severe refractive error to 0.19 for symptomatic diabetics and 0.37 for those with severe AMD., CONCLUSIONS: This paper elicits utilities with different anchor points from a previously unreported sample of 434 patients. Lower utility scores normally imply greater benefit with successful treatment or prevention of disease, but switching from the conventional policy scale to the perfect vision scale also consistently results in lower scores. Because most previous ophthalmic studies have used perfect vision as the upper anchor, the resulting utilities may not have been accurate.
Keywords: Adult; Aged; *Cataract/px [Psychology]; Cross-Sectional Studies; *Diabetic Retinopathy/px [Psychology]; Female; *Glaucoma/px [Psychology]; Humans; *Macular Degeneration/px [Psychology]; Male; Middle Aged; Patient Acceptance of Health Care; *Quality of Life/px [Psychology]; *Refractive Errors/px [Psychology]; Risk Assessment; *Sickness Impact Profile

Biological principals and clinical potentials of limbal epithelial stem cells. - Notara, Maria; Daniels, Julie T (Cell and tissue research, 2008)
In this review, we describe a population of adult stem cells that are currently being successfully used in the clinic to treat blinding ocular surface disease, namely limbal epithelial stem cells (LESC). The function and characteristics of LESC and the challenges faced in making use of their therapeutic potential will be examined. The cornea on the front surface of the eye provides our window on the world. The consistency and functionality of the outer-most corneal epithelium is essential for vision. A population of LESC are responsible for replenishing the epithelium throughout life by providing a constant supply of daughter cells that replace those constantly removed from the ocular surface during normal wear and tear and following injury. LESC deficiency results in corneal inflammation, opacification, vascularisation and severe discomfort. The transplantation of cultured LESC is one of only a few examples of the successful use of adult stem cell therapy in patients. The clinical precedence for the use of stem cell therapy and the ready accessibility of a transparent stem cell niche make the cornea a unique model for the study of adult stem cells in health and disease.
Keywords: Animals; Cell Communication; *Epithelial Cells/cy [Cytology]; Epithelial Cells/me [Metabolism]; Humans; *Limbus Corneae/cy [Cytology]; Limbus Corneae/me [Metabolism]; Stem Cell Niche/me [Metabolism]; *Stem Cells/cy [Cytology]; *Stem Cells/me [Metabolism]; Stromal Cells/cy [Cytology]

The quality of reporting of diagnostic accuracy studies of optical coherence tomography in glaucoma. - Johnson, Zoe K; Siddiqui, M A Rehman; Azuara-Blanco, Augusto (Ophthalmology, 2007)
OBJECTIVE: To evaluate the quality of reporting of diagnostic accuracy studies using optical coherence tomography (OCT) in glaucoma., DESIGN: Descriptive series of published studies., PARTICIPANTS: Published studies reporting a measure of the diagnostic accuracy of OCT for glaucoma., METHODS: Review of English language papers reporting measures of diagnostic accuracy of OCT for glaucoma. Papers were identified from a Medline literature search performed in June 2006. Articles were appraised using the 25 items provided by the Standards for Reporting of Diagnostic Accuracy (STARD) initiative. Each item was recorded as full, partially, or not reported., MAIN OUTCOME MEASURES: Degree of compliance with the STARD guidelines., RESULTS: Thirty papers were appraised. Eight papers (26.7%) fully reported more than half of the STARD items. The lowest number of fully reported items in a study was 5 and the highest was 17. Descriptions of key aspects of methodology frequently were missing. For example, details of participant sampling (e.g., consecutive or random selection) were described in only 8 (26.7%) of 30 publications. Measures of statistical uncertainty were reported in 18 (60%) of 30 publications. No single STARD item was fully reported by all the papers., CONCLUSIONS: The standard of reporting of diagnostic accuracy studies in glaucoma using OCT was suboptimal. It is hoped that adoption of the STARD guidelines will lead to an improvement in reporting of diagnostic accuracy studies, enabling clearer evidence to be produced for the usefulness of OCT for the diagnosis of glaucoma.
Keywords: *Diagnostic Techniques, Ophthalmological/st [Standards]; *Glaucoma/di [Diagnosis]; Guideline Adherence; Humans; *Nerve Fibers/pa [Pathology]; *Periodicals as Topic/st [Standards]; Practice Guidelines as Topic/st [Standards]; *Publishing/st [Standards]; Reproducibility of Results; Research Design; *Retinal Ganglion Cells/pa [Pathology]; *Tomography, Optical Coherence/st [Standards]

An evaluation of how glaucoma patients use topical medications: a pilot study. - Tsai, Tony; Robin, Alan L; Smith, Judson P 3rd (Transactions of the American Ophthalmological Society, 2007)
PURPOSE: Multiple factors can influence patients' adherence to topical ophthalmic intraocular pressure-lowering medications. An important factor that is often overlooked is the method of eye drop administration, including the handling, storing, and actual administering of eye drops. These aspects of patients' eye drop administration, which may be strongly related to the success of prescribed therapies, are evaluated., METHODS: A 2-page questionnaire was distributed to 253 sequential glaucoma patients at the time of their regular clinical visit with one of two geographically distinct glaucoma specialists. In addition to providing demographic data, the patients were asked to complete a 2-page questionnaire about their current use of eye drops., RESULTS: The study participants had a mean age of 71.5 years (SD, 15.1 years) and were predominantly female (59.8%) and white (72.6%). Approximately 17% of them relied on others for the administration of drops and most commonly cited inadequate vision and trouble with manual dexterity leading to this dependency. Of those who self-administered drops, only 16.3% used a mirror. The most common location for administration was the bedroom (46.8%), followed by the bathroom (23.4%) and kitchen (16.1%). Almost 16% reported "rarely" or "never" washing their hands., CONCLUSIONS: Although most individuals may have little difficulty with the use, storage, and handling of eye drops, this study demonstrates that broad variation in reported practices exists. This finding suggests a need for better instruction in eye drop administration and illuminates some of the methodological problems that could be overcome to reduce patients' frustration, improve compliance, and increase efficacy.
Keywords: Aged; Aged, 80 and over; Continental Population Groups/sn [Statistics & Numerical Data]; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance/sn [Statistics & Numerical Data]; Pilot Projects; Surveys and Questionnaires; Treatment Refusal/sn [Statistics & Numerical Data]; *Tropical Medicine/mt [Methods]; *Tropical Medicine/sn [Statistics & Numerical Data]

Problems of management of primary congenital glaucoma in Benin City, Nigeria. - Omoti, A E; Uhumwangho, O M (The Nigerian postgraduate medical journal, 2007)
OBJECTIVES: To determine the problems encountered in the management of primary congenital glaucoma in developing countries., METHODS: A prospective study of new patients with a diagnosis of primary congenital glaucoma attending the eye clinic of the University of Benin Teaching hospital, Benin City, Nigeria over a 5 year period, from July 2001 to June 2006. The age, sex, presenting complaints and duration were recorded. They were examined by the aid of a pen torch, hand-held slit lamp and direct ophthalmoscope. Intraocular pressure and corneal diameter were measured under anaesthesia. The patients were followed up till June 2006 and the problems encountered in management were recorded., RESULTS: Eight children comprising 5 males (62.5%) and 3 females (37.5%) with primary congenital glaucoma were seen. All the patients (100%) presented with buphthalmos and 7 (87.5%) had corneal opacity. Four (50%) accepted surgery but only 2 (25%) eventually had surgery. Maximum follow-up was 7 months., CONCLUSION: Presentation with features of advanced disease, poor acceptability of surgery, poor follow-up and low surgical rate are problems associated with the management of congenital glaucoma in Benin City, Nigeria.
Keywords: Child; Child, Preschool; Female; Follow-Up Studies; *Glaucoma/cn [Congenital]; Glaucoma/di [Diagnosis]; *Glaucoma/su [Surgery]; *Health Services Accessibility; Hospitals, University; Humans; Infant; Male; Nigeria; *Patient Acceptance of Health Care; Prospective Studies; Treatment Outcome; *Urban Health

[Socioeconomic profile of individuals presenting with glaucoma in the service of ophthalmology of the University Hospital of the Federal University of Juiz de Fora - Minas Gerais - Brazil]. - Ramalho, Cristiana Moraes; Ribeiro, Lucio Nei; Olivieri, Lucrecia Santos; Silva, Jaqueline Aparecida da; Vale, Thiago Cardoso; Duque, Wesley de Paula (Arquivos brasileiros de oftalmologia, 2007)
PURPOSE: To assess the socioeconomic profile of individuals presenting with primary glaucoma at the ophthalmology service of the university hospital of the Feredal University of Juiz de Fora (MG), Brazil., METHODS: Submission of a questionnaire to 100 individuals during consultation in the ophthalmology service of the university hospital of Federal University of Juiz de Fora (MG), Brazil., RESULTS: Eighty-four per cent of individuals were pensioners or retired, 86% had a monthly income of 1 to 2 salaries, 29% had been spending 26 to 75 reais per month with glaucoma therapy, 78% presented with comorbidities and 41% had already abandoned treatment due to financial difficulties in buying the medication., CONCLUSION: The low-socioeconomic-level studied population presents with therapeutic compliance difficulties mainly due to financial situation and presence of comorbidities. The authors reinforce the urgent need of adopting sociopolitical measures that facilitate access to antiglaucoma medication, which prompts a better therapeutic compliance.
Comment in (CIN)
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Brazil/ep [Epidemiology]; Comorbidity; Cost of Illness; *Delivery of Health Care; Diabetes Mellitus/ep [Epidemiology]; Female; *Glaucoma/ec [Economics]; Glaucoma/ep [Epidemiology]; Glaucoma/th [Therapy]; Hospitals, University; Humans; Hypertension/ep [Epidemiology]; Male; Middle Aged; *Ophthalmology; Retirement/ec [Economics]; Retirement/sn [Statistics & Numerical Data]; Socioeconomic Factors; Surveys and Questionnaires; Treatment Refusal/sn [Statistics & Numerical Data]

["Vision through the hands": experience of a project]. - Ventura, Roberta; Ventura, Liana; Brandt, Carlos; Ferraz, Daniel; Ventura, Bruna (Arquivos brasileiros de oftalmologia, 2007)
PURPOSE: The Project "Vision through the hands" was performed by the Altino Ventura Foundation, with the purpose of investigating the present child situation with multiple disabilities in the state of Pernambuco, Brazil., METHODS: Birth and social conditions, social problems, and difficulty in accessing the specialized services were evaluated, aiming to collect relevant data with the goal of posterior implantation of a specialized diagnosis and treatment center. Ophthalmologic care and proper treatment were offered., RESULTS: Three hundred and nine children from five reference institutions in disabilities were attended, on six non consecutive days. All cases underwent ophthalmologic examinations and parent interviews. During the waiting time between the ophthalmologic visits and parent interviews the patients performed activities with artists. A multidisciplinary team of 31 professionals was available. According to parent information 83.1% of the patients were considered included in the society and only 45.4% attended school (normal or special). The difficulty to get access to ophthalmologic service was reported by 51.1%. Two hundred and seventy children with multiple disabilities were identified, 154 (56.2%) of whom underwent an ophthalmologic examination for the first time, and 33.0% had low visual acuity (inferior to 20/60 Snellen). The most frequent diagnoses were: refraction error, strabismus, ambliopia, alterations of optic nerve (glaucoma and atrophy), and cataract. Eighty-four glasses were prescribed., CONCLUSION: This project was pioneer in the region, allowing to obtain the information about important problems regarding multiple disabilities, and making possible ophthalmologic care and specialized treatment to the children.
Keywords: Adolescent; Adult; Amblyopia/di [Diagnosis]; Amblyopia/ep [Epidemiology]; Brazil/ep [Epidemiology]; Child; Child, Preschool; Cross-Sectional Studies; *Disability Evaluation; Eyeglasses; Female; Health Promotion; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Infant; Male; *Ophthalmology/sn [Statistics & Numerical Data]; Program Evaluation; Prospective Studies; Refractive Errors/di [Diagnosis]; Refractive Errors/ep [Epidemiology]; Social Conditions; Strabismus/di [Diagnosis]; Strabismus/ep [Epidemiology]; *Vision Disorders/di [Diagnosis]; Vision Disorders/ep [Epidemiology]; Vision Disorders/th [Therapy]; *Vision Screening; Visual Acuity/ph [Physiology]

[Glaucoma in the over-eighties]. - Detry-Morel, M (Journal francais d'ophtalmologie, 2007)
Due to the recent rapid increase in the aging population, glaucoma in the over-eighties population will become a significant problem of ocular health in the coming decades. It is important to determine the natural effects of aging on the optic nerve head and aqueous humor dynamics in these patients for early diagnosis and monitoring of glaucoma. Its characteristics, context, management, and treatment are very perceptibly different from those of the younger glaucomatous patient. For many reasons, such as its frequent association with macular age-related degeneration, diagnosis of glaucoma in the over-eighties may be difficult. Management of the over-eighties glaucoma is frequently difficult and time-consuming. Less aggressive than in a younger patient and based on topical medications in most cases, it must be discussed case by case and will be based on the general context, the quality of compliance, and especially on the potential consequences of the glaucomatous visual-field defects on the patient's quality of life. In any case, overtreatment as well as treatments that are too complex must be avoided. Given the reduced metabolism in the very elderly, the safest medications must also be selected. It is important to always consider glaucoma medications as part of the patient's medicine regimen. Associated risk factors, especially concomitant systemic hypotension, will be simultaneously treated. Laser trabeculoplasties probably have broader indications than in younger patients. Except for phacoextraction, which is very frequently helpful in controlling IOP, incisional filtering procedures or laser diode cyclophotocoagulations remain infrequently indicated in over-eighties glaucoma patients.
Keywords: Age Factors; Aged, 80 and over; Aging; Antihypertensive Agents/tu [Therapeutic Use]; Glaucoma/di [Diagnosis]; Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; *Glaucoma; Humans; Neurodegenerative Diseases/co [Complications]; Quality of Life

[Serious corneal complication after ptosis surgery: six case reports]. - Maalouf, T; George, J-L (Journal francais d'ophtalmologie, 2007)
PURPOSE: To assess the occurrence of serious corneal complications in ptosis surgery and identify their determining factors., PATIENTS AND METHODS: Retrospective study conducted on 3,500 patients over 20 years. All the clinical and etiological types of ptosis were treated in compliance with operative contraindications. All four techniques of ptosis surgery were performed (anterior levator resection, the anterior levator aponeurotic approach, Muller's muscle shortening, and brow suspension). Data regarding serious corneal complications were collected using hospital patient records., RESULTS: Six serious corneal complications were noted in four males and two females. Evisceration was necessary in two cases and prolonged hospital care in four cases, requiring occasional medial tarsorrhaphy surgery. Complications were observed in malformed congenital ptosis associated with an oculomotor disorder and in one case of congenital III paralysis. Young age seems to be a particular risk. Corneal complications can occur long after initial surgery. Predisposing factors were noted such as an associated oculomotor disorder, blepharoconjunctivitis, severe eye dryness, and specific working environments., CONCLUSION: Serious corneal complications in ptosis surgery are rare. However, a risk may occur long after initial surgery. Congenital malformation ptosis associated with oculomotor disorder seems to present a higher risk of corneal complication in combination with specific predisposing factors.
Keywords: Adolescent; Adult; *Blepharoplasty/ae [Adverse Effects]; Blepharoptosis/cn [Congenital]; *Blepharoptosis/su [Surgery]; Child; Child, Preschool; Contraindications; *Corneal Injuries; *Corneal Ulcer/et [Etiology]; Eye Enucleation; Female; Humans; Male; Reoperation; Retrospective Studies; Risk Factors; Treatment Outcome

An information session for glaucoma patients. - Blondeau, Pierre; Esper, Philip; Mazerolle, Eric (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2007)
BACKGROUND: A 2-hour information session to improve understanding and compliance was offered to glaucoma patients. Three studies are presented regarding the participants, their satisfaction with the presentation, and their retention of information., METHODS: One hundred consecutive patients were invited to participate. Age, sex, race, travelling distance, type of glaucoma, number of medications, duration of glaucoma, laser trabeculoplasty, trabeculectomy, medical conditions, visual acuity, visual field mean deviation, and pattern standard deviation (PSD) were documented. At the conclusion of the session, patient satisfaction was determined using a questionnaire. Responses to 6 glaucoma-related questions were requested prior to the session and again at 1, 4, and 10 months afterwards. The effects of age, sex, duration of glaucoma, drops applied, and compliance were analysed., RESULTS: The invitation was accepted by 65.2% of all subjects, including 93.4% of those who had been undergoing therapy for less than 1 year. Factors identified in nonparticipation were advanced age, a longer duration of glaucoma, coronary heart disease, and worse PSD in the worse eye. Transportation was the main reason for nonparticipation. Patient satisfaction was excellent, and 99% indicated that they would recommend the clinic to friends with glaucoma. Patient knowledge increased and persisted throughout the 10 months. Older participants had lower scores., INTERPRETATION: Most patients wanted to participate in the information session. Participants subjectively felt that the session was useful. It improved their knowledge of glaucoma, and has the potential to increase patient compliance.
Keywords: Aged; Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Patient Compliance; *Patient Education as Topic/og [Organization & Administration]; Patient Participation; Patient Satisfaction; Surveys and Questionnaires

Use of fixed-dose combination drugs for the treatment of glaucoma. - Khouri, Albert S; Realini, Tony; Fechtner, Robert D (Drugs & aging, 2007)
Glaucoma is a leading cause of irreversible visual loss. This potentially blinding disease is a progressive optic neuropathy associated with elevated intraocular pressure (IOP). Initial therapy for glaucoma typically consists of topical medications or laser treatment to lower IOP. Frequently, more than one medication is required to achieve adequate control of IOP. However, more medications means more bottles and greater complexity for the patient. There are several potential benefits of fixed combination medications compared with using the individual components separately. These include a reduction in the total number of drops and preservative instilled per day, cost savings, improved tolerability and compliance and avoiding the washout effect resulting from rapid-sequence instillation of multiple drops. Attempts to develop effective fixed combinations of glaucoma medications date back several decades. In recent years, fixed combinations of commonly paired drugs have been approved by various regulatory bodies in different countries and have gained wide acceptance. Current commercially available, fixed combination drugs include the topical beta-adrenoceptor antagonist timolol 0.5% combined with a prostaglandin, a topical carbonic anhydrase inhibitor or an alpha-adrenoceptor agonist. Although there is no uniformity among registration trial designs, most published literature compares the efficacy of the fixed combination to the individual components and to concomitant use of both components. Various factors inherent to study design such as medication run-in, washout periods and peak and trough effects have to be taken into consideration when analysing the demonstrated efficacy of fixed combinations. Fixed combination treatments offer effective IOP control while reducing the washout effect and exposure to preservatives. They are also convenient. However, fixed combinations also remove the possibility of titrating the individual components both in terms of concentration and timing of administration. In addition, fixed combinations might not always provide the same efficacy as proper use of the individual components. The clinician must make individualised assessments when weighing the convenience of these medications against their limitations for specific patients.
Keywords: Administration, Topical; Adrenergic alpha-Agonists/ad [Administration & Dosage]; Adrenergic alpha-Agonists/ae [Adverse Effects]; Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; *Antihypertensive Agents; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; Geriatrics; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions; Patient Compliance; Prostaglandins/ad [Administration & Dosage]; Prostaglandins/ae [Adverse Effects]; Prostaglandins/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Does the blood-brain barrier play a role in Glaucoma?. - Grieshaber, Matthias C; Flammer, Josef (Survey of ophthalmology, 2007)
The optic nerve head, although part of the central nervous system, lacks classical blood-brain barrier properties. The tissue of Elschnig does not totally separate the optic nerve head from fenestrated peripapillary choriocapillaries. The microvessels in the prelaminar region of the optic nerve head have less effective barriers than those in the laminar or retrolaminar regions. In glaucoma, the blood-brain barrier in the optic nerve head may even be weaker. Incomplete blood-brain barrier renders circulating molecules, such as endothelin-1 (ET-1), direct access to smooth vascular muscle cells and pericytes both in the prelaminar part of the optic nerve head and to adjacent retinal tissue. This potentially leads to some vasoconstriction as observed in the peri-papillary retinal vessel in glaucoma patients. In extreme situations, this may provoke retinal vein occlusion. The direct access of these molecules also influences the barrier function. If, simultaneously, ET-1 reduces endothelial tight-junctions and matrix-metalloproteinase (MMP)-9 degrades the basement membrane, not only macromolecules but even red blood cells may cross the blood-brain barrier and lead to what is clinically observed as optic disk hemorrhages.
Keywords: *Blood-Brain Barrier/ph [Physiology]; *Glaucoma/pp [Physiopathology]; Humans; Optic Disk/bs [Blood Supply]; Optic Disk/pp [Physiopathology]; Peripheral Vascular Diseases/pp [Physiopathology]

Microbial keratitis and the role of rub and rinsing. - Butcko, Victoria; McMahon, Timothy T; Joslin, Charlotte E; Jones, Lyndon (Eye & contact lens, 2007)
Recent outbreaks of microbial keratitis in contact lens wearers have involved various pathogens, including Acanthamoeba and Fusarium species. Specific reasons for the marked increase in microbial keratitis, particularly those involving species typically rarely involved in contact lens infection, remain unknown. Possible contributing factors include inadequacies of various multipurpose solutions against certain pathogens; inadequate lens care hygiene, including elimination of the digital rubbing step; poor contact lens storage case hygiene; and the introduction of new soft contact lens materials that may promote adherence of certain pathogens, particularly when a digital rubbing step is eliminated. Although there is some conflict of opinion in the literature regarding the necessity for a mechanical rub during lens cleaning and disinfection, growing evidence supports the reestablishment of a digital rub component to multipurpose solution lens care systems. This article reviews the literature on whether such a process should be recommended to contact lens wearers.
Keywords: Acanthamoeba Keratitis/et [Etiology]; Acanthamoeba Keratitis/pc [Prevention & Control]; *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses/ae [Adverse Effects]; *Eye Infections/et [Etiology]; Eye Infections, Bacterial/et [Etiology]; Eye Infections, Bacterial/pc [Prevention & Control]; Eye Infections, Parasitic/et [Etiology]; Eye Infections, Parasitic/pc [Prevention & Control]; Humans; *Hygiene; *Keratitis/mi [Microbiology]; *Keratitis/pc [Prevention & Control]

Infectious keratitis: what have we learned?. - Levy, Brian (Eye & contact lens, 2007)
Contact lenses for correction of refractive error provide for one of the safest and most effective methods of intervention of any of the medical devices. Despite the relatively low incidence of adverse outcomes, when these do occur they may be associated with serious morbidity. Consistent with this risk, albeit relatively low, the industry has made great strides in understanding the complexities of the effect of the lens on the ocular environment, leading to materials and solutions which if used correctly could potentially lower morbidity significantly. Recent outbreaks of unusual adverse events related to multifaceted issues of lens wear, compliance and lens care, have led to a systematic review of contact lenses and their relationship to the ocular environment. This article reviews the data that has emerged in terms of contact lens use, the microbiology associated with their use, the physiology related to potential adverse events and the epidemiology associated with corneal infection secondary to lens wear. The review is intended to dispel assumptions that have been made without sufficient data to support them. Additionally this paper provides a systematic review of current scientific data which is intended to be used in current and future endeavors to lower morbidity even further.
Keywords: Contact Lens Solutions/ae [Adverse Effects]; Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses/ae [Adverse Effects]; Cornea/de [Drug Effects]; *Eye Infections, Bacterial/et [Etiology]; *Eye Infections, Fungal/et [Etiology]; Fusarium; Humans; *Keratitis/mi [Microbiology]; Keratitis/pc [Prevention & Control]; Mycoses/et [Etiology]; Patient Compliance; Serratia Infections/et [Etiology]; Serratia marcescens

Using pharmacy claims data to study adherence to glaucoma medications: methodology and findings of the Glaucoma Adherence and Persistency Study (GAPS). - Friedman, David S; Quigley, Harry A; Gelb, Laurie; Tan, Jason; Margolis, Jay; Shah, Sonali N; Kim, Elizabeth E; Zimmerman, Thom; Hahn, Steven R (Investigative ophthalmology & visual science, 2007)
PURPOSE: To develop methods for investigating adherence to glaucoma medications by using a modified claims data-based measure of adherence, validation by chart review, and patient and physician interviews., METHODS: Data from administrative claims of 13,956 subjects receiving an initial glaucoma medication, and data from overlapping samples of 300 patients' charts, 300 interviews of patients, and 103 interviews of physicians were analyzed and compared., RESULTS: The mean medication possession ratio (MPR) was 0.64 (median 0.57) for the 13,956 subjects. Although 59% potentially had an ocular hypotensive agent at 12 months, only 10% had such medication available continuously. Chart review revealed that 31% of subjects "new to therapy" in claims data had actually been previously treated; and that 90% of the 17% who had medication added to initial monotherapy were misclassified by claims-based algorithms as medication switches or no change. Twenty percent of surveyed patients received samples on a regular basis and had lower MPR than those who did not (P < 0.05)., CONCLUSIONS: Large pharmacy databases offer insight into medication usage but are vulnerable to errors from sampling (since patients who receive samples will be considered to have poor adherence), misidentification of newly treated patients, and misclassification of added versus switched medications. That a large proportion of patients stop and restart medications makes MPR a robust measure of adherence over time that reflects the resumption of medication after a gap in adherence. The data confirm that adherence to treatment with glaucoma medications is poor, similar to adherence in patients with other chronic diseases.
Keywords: Adult; *Antihypertensive Agents; Databases, Factual; *Drug Prescriptions/sn [Statistics & Numerical Data]; *Drug Utilization Review/mt [Methods]; Female; *Glaucoma/dt [Drug Therapy]; Health Services Research; Health Surveys; Humans; *Insurance Claim Review/sn [Statistics & Numerical Data]; Male; Managed Care Programs/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; *Patient Compliance/sn [Statistics & Numerical Data]; Retrospective Studies

Once daily drop regimes help reduce involuntary non-compliance. - Buchan, John Cameron; Siddiqui, Salina; Gilmour, David (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2007)
Comment on (CON)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Drug Administration Schedule; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; Surveys and Questionnaires

Estimated first-year costs of prostaglandin analogs with/without adjunctive therapy for glaucoma management: a United States perspective. - Schmier, Jordana K; Covert, David W; Robin, Alan L (Current medical research and opinion, 2007)
OBJECTIVE: To evaluate costs associated with prostaglandin analogs among newly-diagnosed glaucoma patients in a managed-care population., RESEARCH DESIGN AND METHODS: A cost minimization model compared annual costs for patients initiating therapy with one of the three prostaglandin analogs (bimatoprost, latanoprost, travoprost). The study cohort was identified from pharmacy claims and eligibility files of patients who met study inclusion criteria. Annual costs were estimated for patients initiating therapy with each prostaglandin based on treatment patterns and medication use over the year. Costs for outpatient physician visits and medications were estimated from standard sources., RESULTS: A total of 4444 patients met study criteria: 674 received travoprost, 729 received bimatoprost, and 3041 received latanoprost. More than 80% stayed on monotherapy for 1 year (82.9% of travoprost patients, 82.8% of bimatoprost patients, and 80.5% of latanoprost patients). Of those who required adjunctive therapy, the average number of days until starting adjunctive therapy was 130 days for travoprost patients, 94 days for bimatoprost patients, and 104 days for latanoprost patients. Average annual costs were $1198, $1290, and $1217 for patients treated with travoprost, bimatoprost, and latanoprost, respectively., CONCLUSIONS: The use of adjunctive therapy in glaucoma is an important driver of glaucoma management costs. This study demonstrates that the longer duration of monotherapy and the likelihood to use single rather than combination adjunctive agents contribute to lower annual costs among patients starting on travoprost compared with the other available prostaglandin analogs. Study limitations include the lack of clinical indicators in the study database; further, results may not be generalizable to patients who discontinue prostaglandin analogs or to the population of patients with glaucoma as a whole. Future studies with clinical and compliance indicators would further identify distinctions among treatment regimens.
Keywords: Cohort Studies; *Drug Costs; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Insurance Claim Review; *Prostaglandins/ec [Economics]; Prostaglandins/tu [Therapeutic Use]; United States

Persistency rates for prostaglandin and other hypotensive eyedrops: population-based study using pharmacy claims data. - Rait, Julian L; Adena, Michael A (Clinical & experimental ophthalmology, 2007)
BACKGROUND: Effective management of ocular hypertension requires patients to be persistent with their treatment regimen. We evaluated patients' persistency with hypotensive eyedrops commonly used to treat glaucoma and ocular hypertension., METHODS: This large, population-based, retrospective, cohort study used pharmacy claims data for concessional patients from the Australian Pharmaceutical Benefits Scheme (July 1999-June 2005). Resupply rates for prostaglandins, beta-blockers, alpha-agonists and carbonic anhydrase inhibitors were analysed using life tables and Cox regression. Two populations, based on patients' supply histories, were examined: (i) 'new to this eyedrop'- patients who had used other hypotensive eyedrops before (presumably, previously diagnosed with glaucoma or ocular hypertension); and (ii) 'new to any eyedrop'- patients who were using their first hypotensive eyedrop (presumably, newly diagnosed with glaucoma or ocular hypertension)., RESULTS: Data were obtained for 14,359,618 supplies of commonly used hypotensive eyedrops to 357,099 concessional patients. For both populations, resupply rates were highest for prostaglandins or the dorzolamide-timolol combination eyedrops, compared with beta-blockers, alpha-agonists or carbonic anhydrase inhibitors. Among the prostaglandins, there was no significant difference in the risk of ceasing supply between latanoprost and bimatoprost, but the risk was significantly higher for travoprost., CONCLUSIONS: Based on resupply rates from a national pharmacy claims database, patients supplied with ocular hypotensive eyedrops were most persistent with prostaglandin (bimatoprost, latanoprost and travoprost) and dorzolamide-timolol combination eyedrops. Among the prostaglandins, persistency was highest with, and similar between, bimatoprost and latanoprost. Persistency should be taken into account when selecting the most appropriate eyedrop to treat glaucoma and ocular hypertension.
Comment in (CIN)
Keywords: Adrenergic Agents/ad [Administration & Dosage]; *Adrenergic Agents/tu [Therapeutic Use]; Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Agonists/tu [Therapeutic Use]; Australia; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; *Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Cohort Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Insurance Claim Reporting/sn [Statistics & Numerical Data]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/px [Psychology]; Ophthalmic Solutions; *Patient Compliance; Pharmaceutical Services/sn [Statistics & Numerical Data]; Prostaglandins/ad [Administration & Dosage]; *Prostaglandins/tu [Therapeutic Use]; Retrospective Studies

Does persistency truly equate to compliance?. - Best, Stephen J (Clinical & experimental ophthalmology, 2007)
Comment on (CON)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance

Depressive symptomatology, medication persistence, and associated healthcare costs in older adults with glaucoma. - Jayawant, Sujata S; Bhosle, Monali J; Anderson, Roger T; Balkrishnan, Rajesh (Journal of glaucoma, 2007)
PURPOSE: Depressive symptoms may impact patients' medication use behavior and utilization of healthcare services. This study examined association between depressive symptoms and Glaucoma medication-related persistence and predictors of associated healthcare charges in older adults with primary open angle Glaucoma., METHODS: This study used a retrospective cohort of older adults with primary open angle Glaucoma who completed health status assessment, used Glaucoma medications, and were enrolled in a Medicare Health Maintenance Organization. Baseline assessment surveyed patients on demographics, healthcare service utilization in year before enrollment, lifestyle, and quality of life. Demographic, clinical, and utilization-related economic variables were retrieved from administrative claims database of patients' Health Maintenance Organization. Survival techniques were used to measure time to discontinuation (persistence) and Center for Epidemiologic Studies Depression Scale a 20-item self-reporting scale assessed depressive symptomatology on a range of 0 to 60. Associations were examined using mixed-model regression approach. Sensitivity analysis that considered log-transformed and untransformed specifications of cost variable tested model appropriateness., RESULTS: In total 268 patients were followed for 2 years (N=536). After controlling for potential confounders and temporal effects, depressive symptomatology was associated with decreased Glaucoma medication-related persistence (P<0.005). Patients who lived alone and had cardiovascular disease showed higher odds of experiencing depressive symptoms (P<0.005). Healthcare charges increased with number of comorbidities and prescriptions (P<0.005)., CONCLUSIONS: Presence of depressive symptoms in patients lead to poor Glaucoma medication use behavior. Healthcare expenditures increased for patients with increase in comorbidities. Plan enrollees' risk assessment offers advantage of improving health outcomes and reduces healthcare utilization.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Depressive Disorder/co [Complications]; Drug Prescriptions; Drug Utilization; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; *Health Care Costs; Health Maintenance Organizations/sn [Statistics & Numerical Data]; *Health Services/sn [Statistics & Numerical Data]; Health Services Research; Humans; Male; *Patient Compliance/sn [Statistics & Numerical Data]; Retrospective Studies

Ocular comfort of combination glaucoma therapies: brimonidine 0.2%/timolol 0.5% compared with dorzolamide 2%/timolol 0.5%. - Chan, Kenny; Testa, Madalena; McCluskey, Peter (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2007)
PURPOSE: Successful management of glaucoma and ocular hypertension requires patient compliance with the therapeutic regimen. Because ocular discomfort affects compliance, we compared the comfort of brimonidine 0.2%/timolol 0.5% and dorzolamide 2%/timolol 0.5%., METHODS: In this single-centre, randomized, double-masked, internally controlled/paired-eye study, 30 subjects without a significant ocular surface disease received brimonidine 0.2%/timolol 0.5% in 1 eye and dorzolamide 2%/timolol 0.5% in the fellow eye. They evaluated discomfort at 30-40 s and 5 min postinstillation., RESULTS: At 30-40 s, brimonidine 0.2%/timolol 0.5% provided significantly lower mean ocular discomfort scores than dorzolamide 2%/timolol 0.5% (P < 0.0001). This pattern persisted at 5 min but was not statistically significant. Significant differences were seen in the subjects' determination of the more comfortable treatment (P < 0.0001): brimonidine 0.2%/timolol 0.5% was rated as more comfortable than dorzolamide 2%/timolol 0.5% by 80% of subjects at 30-40 s and by 27% at 5 min. Only 10% of subjects at each time point rated dorzolamide 2%/timolol 0.5% as more comfortable. The remaining subjects reported no preference at either time point. No adverse events were reported., CONCLUSIONS: Brimonidine 0.2%/timolol 0.5% was significantly more comfortable than dorzolamide 2%/timolol 0.5% upon instillation. Patients with ocular hypertension or glaucoma may be more compliant with brimonidine 0.2%/timolol 0.5% treatment.
Keywords: Administration, Topical; Adult; Aged; *Antihypertensive Agents/ae [Adverse Effects]; Brimonidine Tartrate; Double-Blind Method; Drug Combinations; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Patient Compliance; Patient Satisfaction; *Quinoxalines/ae [Adverse Effects]; *Sulfonamides/ae [Adverse Effects]; *Thiophenes/ae [Adverse Effects]; *Timolol/ae [Adverse Effects]

Corneal ulcers associated with aerosolized crack cocaine use. - Ghosheh, Faris R; Ehlers, Justis P; Ayres, Brandon D; Hammersmith, Kristin M; Rapuano, Christopher J; Cohen, Elisabeth J (Cornea, 2007)
PURPOSE: We report 4 cases of corneal ulcers associated with drug abuse. The pathogenesis of these ulcers and management of these patients are also reviewed., METHODS: Review of all cases of corneal ulcers associated with drug abuse seen at our institution from July 2006 to December 2006., RESULTS: Four patients with corneal ulcers associated with crack cocaine use were reviewed. All corneal ulcers were cultured, and the patients were admitted to the hospital for intensive topical antibiotic treatment. Each patient received comprehensive health care, including medical and substance abuse consultations. Streptococcal organisms were found in 3 cases and Capnocytophaga and Brevibacterium casei in 1 patient. The infections responded to antibiotic treatment. Two patients needed a lateral tarsorrhaphy for persistent epithelial defects., CONCLUSIONS: Aerosolized crack cocaine use can be associated with the development of corneal ulcers. Drug abuse provides additional challenges for management. Not only treatment of their infections but also the overall poor health of the patients and increased risk of noncompliance need to be addressed. Comprehensive care may provide the patient the opportunity to discontinue their substance abuse, improve their overall health, and prevent future corneal complications.
Keywords: Adult; Aerosols; Anti-Bacterial Agents/tu [Therapeutic Use]; Brevibacterium/ip [Isolation & Purification]; Capnocytophaga/ip [Isolation & Purification]; *Cocaine-Related Disorders/co [Complications]; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; *Corneal Ulcer/et [Etiology]; *Crack Cocaine/ae [Adverse Effects]; Drug Therapy, Combination; Eye Infections, Bacterial/di [Diagnosis]; Eye Infections, Bacterial/dt [Drug Therapy]; *Eye Infections, Bacterial/et [Etiology]; Female; Gram-Negative Bacterial Infections/di [Diagnosis]; Gram-Negative Bacterial Infections/dt [Drug Therapy]; *Gram-Negative Bacterial Infections/et [Etiology]; Humans; Middle Aged; Streptococcal Infections/di [Diagnosis]; Streptococcal Infections/dt [Drug Therapy]; *Streptococcal Infections/et [Etiology]; Streptococcus/ip [Isolation & Purification]

Medication adherence and health care costs with the introduction of latanoprost therapy for glaucoma in a Medicare managed care population. - Bhosle, Monali J; Reardon, Gregory; Camacho, Fabian T; Anderson, Roger T; Balkrishnan, Rajesh (The American journal of geriatric pharmacotherapy, 2007)
BACKGROUND: Latanoprost, a prostaglandin inhibitor, is increasingly being used in the therapeutic management of glaucoma. However, there is scant literature examining the cost and outcome ramifications of latanoprost., OBJECTIVES: This study examined the medication use behavior (medication-related persistence and adherence rates) and costs associated with the introduction of latanoprost therapy in a treatment-naive older population (aged >or=65 years) enrolled in Medicare., METHODS: The study employed a retrospective observational cohort design and used administrative claims data from a Medicare health maintenance organization (HMO), which offered complete coverage to enrollees, including prescription benefits. The case group consisted of patients with glaucoma who began latanoprost therapy. The control group consisted of enrollees with glaucoma who started any therapy other than latanoprost. Both groups were followed up for 1 year before and after initiation of therapy. Bivariate and multivariate techniques incorporating health care utilization in the year before the start of new therapy were used to determine the study outcomes., RESULTS: The case group comprised 101 patients (mean age, 77.60 years), while the control group included 168 patients (mean age, 77.59 years). There were no significant differences across the 2 groups with respect to age, sex, general health scores on the 12 item Short-Form Health Survey, severity of comorbidity, or the proportion of respondents with perception of worsened health. Introduction of latanoprost therapy was associated with higher medication persistence (hazard ratio, 0.90; 95% CI, 0.68-0.98) and adherence rates (mean [SD], 0.51 [0.26] vs 0.40 [0.25]; P < 0.001) compared with patients starting other glaucoma medication. Furthermore, there were no additional increases in total health care costs in the entire population associated with the introduction of latanoprost therapy, after adjusting for group and time effects, as well as other confounders (mean [SD], $4718.24 [$8982.92] vs $4046.55 [$6505.39])., CONCLUSIONS: Latanoprost therapy offered improved medication use behavior in these older adults enrolled in a Medicare HMO. There were no significant additional increases in overall health care costs as a result of introduction of latanoprost therapy, after adjusting for group and time effects, as well as other baseline confounders in this study cohort.
Keywords: Aged; Cohort Studies; Costs and Cost Analysis; Drug Therapy, Combination; Female; *Glaucoma/dt [Drug Therapy]; *Health Care Costs; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; *Managed Care Programs/ec [Economics]; *Medicare/ec [Economics]; Ocular Hypertension/dt [Drug Therapy]; *Patient Compliance; Proportional Hazards Models; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Survival Analysis; Terminology as Topic; Treatment Outcome

Corneal gene therapy. - Klausner, Eytan A; Peer, Dan; Chapman, Robert L; Multack, Richard F; Andurkar, Shridhar V (Journal of controlled release : official journal of the Controlled Release Society, 2007)
Gene therapy to the cornea can potentially correct inherited and acquired diseases of the cornea. Factors that facilitate corneal gene delivery are the accessibility and transparency of the cornea, its stability ex vivo and the immune privilege of the eye. Initial corneal gene delivery studies characterized the relationship between intraocular modes of administration and location of reporter gene expression. The challenge of achieving effective topical gene transfer, presumably due to tear flow, blinking and low penetration of the vector through epithlelial tight junctions left no alternative but invasive administration to the anterior chamber and corneal stroma. DNA vaccination, RNA interference and gene transfer of cytokines, growth factors and enzymes modulated the corneal microenvironment. Positive results were obtained in preclinical studies for prevention and treatment of corneal graft rejection, neovascularization, haze and herpetic stromal keratitis. These studies, corneal gene delivery systems and modes of administration, and considerations regarding the choice of animal species used are the focus of this review. Opportunities in the field of corneal gene therapy lie in expanding the array of corneal diseases investigated and in the implementation of recent designs of safer vectors with reduced immunogenicity and longer duration of gene expression.
Keywords: Animals; Cornea/ph [Physiology]; *Corneal Diseases/th [Therapy]; Corneal Dystrophies, Hereditary/th [Therapy]; Corneal Transplantation; Gene Transfer Techniques; *Genetic Therapy; Genetic Vectors; Graft Rejection/pc [Prevention & Control]; Humans; Models, Biological

Ultrastructural analysis of slime positive & slime negative Staphylococcus epidermidis isolates in infectious keratitis. - Nayak, N; Nag, T C; Satpathy, G; Ray, S B (The Indian journal of medical research, 2007)
BACKGROUND & OBJECTIVE: Slime is a major determinant of Staphylococcus epidermidis adherence. The established methods of laboratory detection of slime production by this organism i.e., Christensen's tube method and congo red agar plate method, can both yield inconclusive and/or intermediate results. We, therefore tried to find out electronmicroscopically the localization of slime in relation to the bacterial cell wall and look for the effect, if any of the slime location on the staphylococcal adherence as well as on the quantum of slime production., METHODS: A total of 132 coagulase negative staphylococci from cases of infectious keratitis were identified as S. epidermidis following the recommended protocol. Slime was detected both by Christensen's tube method and congo red agar plate method. Antibiotic sensitivity testing was performed by standardized disc diffusion method. Adherence of the organisms to artificial surfaces was determined by a quantitative method and transmission electron microscopy was carried out by the conventional techniques., RESULTS: Of the total 132 isolates, 57 (43.2%) were slime positive and 75 (56.8%) were slime negative. Twenty seven (47.4%) of the 57 slime producing organisms were multi drug resistant as compared to only 12 (16%) of 75 nonslime-producing organisms (P<0.001). A majority i.e., 45 (78.9%) of 57 adherent organisms were slime producers as against 12 (16%) of 75 nonadherent organisms. Electron microscopic study revealed a thick viscid layer of slime anchoring to the bacterial cell wall, especially in adherent organisms and those yielding positive slime test. Some of the organisms showed loose nonadherent slime and those were mostly nonadherent to artificial surfaces., INTERPRETATION & CONCLUSION: Slime and multi drug resistance were the important virulence factors of S. epidermidis in bacterial keratitis. It was the adherent slime (i.e., slime in intimate association with the bacterial cell wall as shown by electron microscopy) only, which was responsible for resistance to multiple antibiotics and for the adhesion phenomenon observed in the quantitative slime test.
Keywords: Agar/ch [Chemistry]; Animals; Anti-Bacterial Agents/ch [Chemistry]; Anti-Bacterial Agents/pd [Pharmacology]; Bacterial Adhesion; Cell Wall/me [Metabolism]; Congo Red/pd [Pharmacology]; Humans; *Keratitis/mi [Microbiology]; Microbial Sensitivity Tests; Microscopy, Electron, Transmission; *Staphylococcus epidermidis/me [Metabolism]; Virulence Factors

A gap analysis approach to assess patient persistence with glaucoma medication. - Lee, Paul P; Walt, John G; Chiang, Tina H; Guckian, Angela; Keener, John (American journal of ophthalmology, 2007)
PURPOSE: To develop an alternative method for analysis of patient persistence with prescribed medications using the prostaglandin class of intraocular pressure (IOP)-lowering drugs as a model., DESIGN: A retrospective study of prescription refill patterns., METHODS: Patients with a pharmacy claim for a 2.5 ml bottle of latanoprost, travoprost, or bimatoprost between September 1, 2002 and December 31, 2002 were identified from a retail pharmacy database and were followed up for 12 months. Three separate analyses defined gaps in therapy as spans in excess of 45, 60, or 120 days without a refill for the same medication. Patients were categorized by the number of gaps in therapy and the cumulative length of gaps. A Kaplan-Meier analysis was conducted using a 120-day allowable refill period., RESULTS: For refill periods of 45, 60, and 120 days, 10.6%, 28.6%, and 77.5% of patients, respectively, had no gaps in therapy, and 32.6%, 53.4%, and 86.5%, respectively, had 30 days or fewer off therapy annually. According to the 45-day threshold analysis, 50.7% of patients had three or more gaps vs 18.5% in the 60-day analysis and none in the 120-day analysis. The Kaplan-Meier curve shows 88.6% and 76.1% of patients were persistent for 120 days and one year, respectively., CONCLUSIONS: Compared with Kaplan-Meier survival curves, the gap analysis approach may better parallel clinical experience with patient persistence, in which patients stop and restart medications for a variety of reasons over time. This method also may help to identify avenues for investigation of lack of persistency among many patients.
Keywords: Amides/ad [Administration & Dosage]; *Antihypertensive Agents/ad [Administration & Dosage]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; *Drug Prescriptions/sn [Statistics & Numerical Data]; *Drug Utilization/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Lipids/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; *Pharmacies/sn [Statistics & Numerical Data]; Preferred Provider Organizations/sn [Statistics & Numerical Data]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Retrospective Studies; Travoprost

Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. - Robin, Alan L; Novack, Gary D; Covert, David W; Crockett, R Stephens; Marcic, Tania S (American journal of ophthalmology, 2007)
PURPOSE: To determine with electronic monitoring an objective measurement of adherence in two populations of subjects: those using once-daily prostaglandin analogs as sole ocular hypotensive therapy (one-drug group) and those requiring an adjunctive medicine to the prostaglandin analog (two-drug group)., DESIGN: Single-site, open-label, nonrandomized, parallel design of 60 days., METHODS: Sixty-two consecutive adult subjects with a diagnosis of open-angle glaucoma (OAG) or ocular hypertension: 31 were taking one drug and 31 were taking two drugs. An electronic event medication monitoring device was used to record each bottle opening. The main outcome measures were dosing errors (number of under-adherence or over-adherence events) and coverage (proportion of pharmacologic duration covered by dosing) relative to the ophthalmologist-prescribed regimen., RESULTS: Adherence to the prostaglandins once daily was good in both groups by all measures (<or=10% of subjects with more than five dosing errors and mean coverage of 97.2% +/- 6.1%). Adherence to the second medication in the two-drug group was poorer (37% of subjects with more than five dosing errors and mean coverage of 85.6% +/- 12.6%). For the subjects using beta-adrenoceptor antagonists, 24.8% +/- 18.4% of doses were taken at less than 10-hour intervals (over-adherence)., CONCLUSIONS: The incorporation of a time component in electronic monitoring provides more information than prescription refill rate or other methods. We found that more complex dosing regimens result in poorer adherence, although once-daily drugs in a complex dosing regimen were found to have good adherence.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Drug Monitoring/is [Instrumentation]; *Drug Prescriptions/sn [Statistics & Numerical Data]; Drug Therapy, Combination; *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]; *Patient Compliance/sn [Statistics & Numerical Data]; Time Factors

Development of the conceptual framework for the Eye-Drop Satisfaction Questionnaire (EDSQ) in glaucoma using a qualitative study. - Nordmann, Jean-Philippe; Denis, Philippe; Vigneux, Marc; Trudeau, Elyse; Guillemin, Isabelle; Berdeaux, Gilles (BMC health services research, 2007)
BACKGROUND: Compliance is a major issue in glaucoma care. It is usually poor in glaucomatous patients, and may ultimately result in an acceleration of the disease progression and a risk of blindness. Reasons for this poor compliance are complex and multifactorial, amongst which patient satisfaction can be counted. The objective of this study was to develop a questionnaire to assess patient satisfaction and compliance with eye-drop treatment., METHODS: A qualitative study was carried out to develop the questionnaire. An interview guide was developed based on a literature review. Structured interviews of fifteen French and English patients with primary open-angle glaucoma or intraocular hypertension were conducted by trained interviewers of the native language of the interviewees. General concepts and subconcepts were identified from the transcripts. The questionnaire was developed using the patient verbatim, and submitted to six patients (French and English) for cognitive debriefing. Following patients' comments, items were modified and restructured, and a pilot questionnaire was designed., RESULTS: Analysis of data from the interviews with patients and clinicians resulted in the elicitation of concepts related to patient satisfaction and compliance with glaucomatous treatment. These were further refined and used to generate a test questionnaire, which consisted of 46 items grouped into 6 domains: patient characteristics, treatment characteristics, patient-clinician relationship, patient experience with the disease and the treatment, interaction between the patient and the treatment, and patient knowledge of the disease and the treatment., CONCLUSION: The Eye-Drop Satisfaction Questionnaire (EDSQ) conceptual framework and items were developed simultaneously in French and in English. This questionnaire could be used to evaluate patient satisfaction and compliance with eye-drop treatment and would facilitate the identification of patients at risk of being non-compliant prior to clinical trials or innovative device tests. A psychometric study is under way to validate the questionnaire.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Female; France; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/ec [Economics]; Humans; Male; Middle Aged; Motivation; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance/px [Psychology]; Patient Education as Topic; *Patient Satisfaction/sn [Statistics & Numerical Data]; *Physician-Patient Relations; Qualitative Research; Risk Factors; Socioeconomic Factors; *Surveys and Questionnaires; United Kingdom

[Five years retrospective study of latanoprost glaucoma treatment]. - Zavorkova, M; Susicky, P (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2007)
AIM: The authors evaluated their five years experience with 0.005% latanoprost (Xalatan) glaucoma treatment. They monitored the latanoprost efficiency to lower the intraocular pressure (IOP) and its capability to maintain the target IOP in the long term., PATIENTS AND METHOD: The group consisted of 118 patients (231 eyes) who are treated for glaucoma with latanoprost. The follow up period was at least 3 years. The patients were checked each three months and the results of the IOP measurement for the study purpose were included once a year., RESULTS: The IOP before the latanoprost treatment was 23.4 +/- 5.3 mm Hg. The IOP after 1-year latanoprost treatment was 17.6 +/- 3.2 mm Hg, after 2 years 17.7 +/- 3.9 mm Hg, after 3 years 17.1 +/- 3.1 mm Hg, after 4 years 17.1 +/- 3.2 mm Hg, and after 5 years 17.6 +/- 3.8 mm Hg. The average IOP during the latanoprost treatment was 17.4 +/- 3.4 mm Hg, the average lowering of the IOP after the start of the latanoprost treatment was by 6.0 mm Hg. The IOP lowering by 30 % against the IOP value at the time of glaucoma diagnose was reached after 3 years in 82 % (189 out of 231) eyes, after 5 years in 83 % (54 out of 65) eyes., CONCLUSION: Our five years experience confirmed, that latanoptost is a drug significantly lowering and in the long term maintaining the IOP level. As a great advantage, we appreciate the simple application and good compliance.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Liposomal amphotericin B eye drops to treat fungal keratitis: physico-chemical and formulation stability. - Morand, K; Bartoletti, A C; Bochot, A; Barratt, G; Brandely, M L; Chast, F (International journal of pharmaceutics, 2007)
Local fungal infections with Candida, Fusarium, Curvularia and Aspergillus can lead to serious ulceration of the cornea and must be treated rapidly. The current treatment consists of 0.15% (w/v) amphotericin B eye drops prepared from Fungizone, containing deoxycholate, irritant for the cornea, which reduces patient compliance. Eye drops based on liposomal amphotericin B (AmBisome would be a convenient alternative; however, according to the manufacturer's instructions, AmBisome can only be kept refrigerated for 1 week after reconstitution. A longer shelf-life at ambient temperature would be preferable for a preparation made in a hospital pharmacy and delivered to patients. Thus, the possibility of storing an ophthalmic preparation of 0.5% (w/v) liposomal amphotericin B after reconstitution was investigated. After 6 months at room temperature or at +2-8 degrees C, the hydrodynamic diameter measured by quasi-elastic light scattering remained constant at 108 +/- 30 nm with a polydispersity index lower than 0.15. Amphotericin B content, checked by a validated HPLC method, was maintained between 94 and 107%. Amphotericin B and soy phosphatidylcholine proportions remained constant, indicating that the liposomes remained intact and retained the drug. These results show the feasibility of an ophthalmic preparation based on liposomal amphotericin B developed in hospital pharmacies.
Keywords: Administration, Topical; Amphotericin B/ad [Administration & Dosage]; *Amphotericin B/ch [Chemistry]; Antifungal Agents/ad [Administration & Dosage]; *Antifungal Agents/ch [Chemistry]; Chromatography, High Pressure Liquid; Corneal Ulcer/dt [Drug Therapy]; Drug Compounding; Drug Stability; Drug Storage; Eye Infections, Fungal/dt [Drug Therapy]; Humans; Light; Ophthalmic Solutions; Scattering, Radiation; Temperature

Pediatric keratoplasty in India: indications and outcomes. - Sharma, Namrata; Prakash, Gaurav; Titiyal, Jeewan S; Tandon, Radhika; Vajpayee, Rasik B (Cornea, 2007)
PURPOSE: To analyze the indications and outcomes of pediatric corneal transplantation surgery in a tertiary eye care center in the developing world., METHODS: In this longitudinal, retrospective study involving continuous cases, the records of 168 eyes of 154 children undergoing keratoplasty at a tertiary care center's specialized keratoplasty clinic during a 7-year period (1998-2004) were reviewed. The demography, etiology of opacification, visual acuity, and other findings were recorded. Intraoperative and postoperative details were reviewed. Major postoperative outcomes analyzed were visual acuity, graft survival, causes of graft failure, and follow-up duration., RESULTS: Infectious keratitis (43%) was the most common indication for keratoplasty, followed by congenital glaucoma (16.6%) and corneal trauma (11.2%). Overall 77% graft survival was seen at 36 months, and better graft outcome was associated with younger age and longer regular follow-up. Postoperatively, a best-corrected visual acuity (BCVA) > 20/200 could be achieved in only 30.1% of eyes at the last follow-up. Graft failure was seen in 18.4% of eyes, with graft infection being the most frequent cause (50%). Moreover, graft infection was the most common cause of graft failure in all age groups., CONCLUSIONS: In the developing world, infectious keratitis is the most common indication for pediatric keratoplasty and the most frequent cause of its failure.
Keywords: Adolescent; Child; Child, Preschool; *Corneal Diseases/ep [Epidemiology]; Corneal Diseases/su [Surgery]; Developing Countries; Female; Follow-Up Studies; Graft Survival; Humans; India/ep [Epidemiology]; Infant; *Keratoplasty, Penetrating/sn [Statistics & Numerical Data]; Male; Patient Compliance; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity

Risk factors for noncompliance with follow-up among normal-tension glaucoma suspects. - Ngan, Rose; Lam, Deborah L; Mudumbai, Raghu C; Chen, Philip P (American journal of ophthalmology, 2007)
PURPOSE: To evaluate noncompliance with follow-up in normal-tension glaucoma (NTG) suspects., DESIGN: Retrospective cohort study., METHODS: We reviewed 203 patient charts at a university eye clinic, identified as NTG suspects from a database of optic disk photographs. Noncompliance was defined as less than one year of follow-up and/or fewer than two completed visual field (VF) tests., RESULTS: Twenty-two patients (11%) were excluded because at least two VF tests were not ordered. The 181 patients analyzed included 45 (25%) non-Whites and 16 (9%) non-English speakers. Eighty-three patients (46%) were noncompliant. These patients were significantly younger (50.5 +/- 15.0 years vs 55.1 +/- 12.8 years; P = .028), were more likely to speak English (P = .023), and were more likely to have no or unknown health insurance (P < .001)., CONCLUSIONS: Almost half of NTG suspects lacked appropriate follow-up. Lack of health insurance may be a significant barrier to compliance with follow-up in this population.
Keywords: Clinical Competence; Disease Progression; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Office Visits/td [Trends]; Optic Disk/pa [Pathology]; Patient Education as Topic; Physician-Patient Relations; Retrospective Studies; Risk Factors; *Treatment Refusal/sn [Statistics & Numerical Data]; Visual Field Tests; Visual Fields

[Increasing compliance in glaucoma patients through education ]. - Cochereau, I (Journal francais d'ophtalmologie, 2007)
Compliance is a major issue in glaucoma, a chronic and asymptomatic disease. The management of the disease by the patient himself is a key point in the prognosis of glaucoma. Ophthalmologists can increase glaucoma patient compliance through education and medicopsychological assistance.
Keywords: *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; *Patient Compliance; *Patient Education as Topic; Quality of Life

[What should we think? Is selective trabeculoplasty more effective than conventional argon laser trabeculoplasty?]. - Lefrancois, A (Journal francais d'ophtalmologie, 2007)
The long-term effectiveness of selective laser trabeculoplasty is equivalent to argon laser trabeculoplasty. Easy to use and relatively safe, selective laser trabeculoplasty is a good alternative for medical treatment, particularly in cases of poor compliance.
Keywords: *Glaucoma/su [Surgery]; Humans; *Laser Therapy; *Trabeculectomy/mt [Methods]

Practice patterns of Canadian glaucoma specialists: planning for the next generation. - Schertzer, Robert M; Orton, Tanya; Pratt, Dan (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2007)
BACKGROUND: To identify practice patterns of Canadian glaucoma specialists in order to begin identifying the needs of the work force to care for the next generation of glaucoma patients., METHODS: Survey of 130 Canadian glaucoma specialists whose names were obtained from the Canadian Ophthalmological Society specialist list., RESULTS: The response rate was 62% (81/130); 77% (62/81) considered themselves glaucoma specialists, but only 77% (48/62) of these had at least 1 year of formal glaucoma training. Specialists had a mean of 6.4 half days per month in the operating room, devoting the majority of their surgical time to glaucoma but performing more cataract surgery than glaucoma surgery. Forty percent of glaucoma specialists do not perform glaucoma drainage implant surgery. All the respondents stated that wait time for emergency care was within hours, but only 21% could perform their nonurgent cases within the benchmark set in this study of 4 weeks, wait times averaging 9.2 (range: 3-24) weeks. Forty-eight percent of the glaucoma specialists were not satisfied with their mix of clinical, laser, surgery, and nonophthalmology activities. Forty-four percent plan to decrease their clinical load over the next 5 years: 23% plan to increase their teaching, 19% their research, and 35% plan to devote less time to ophthalmology over the next 5 years., INTERPRETATION: Forty-eight percent of glaucoma specialists had concerns regarding timely intervention for semiurgent care, in that only 21% of these cases are performed within 1 month of a confirmed need for surgery. With a benchmark that surgery be performed within 1 month in patients whose glaucoma is progressing despite medical, laser, or prior incisional surgical care, we do not have adequate resources to care for current glaucoma needs. With the aging population and ongoing attrition of ophthalmologists, we need to plan for improved access to glaucoma surgery.
Keywords: Canada; *Glaucoma; Health Services Needs and Demand/sn [Statistics & Numerical Data]; Health Services Research; Health Surveys; *Health Workforce; Humans; Job Satisfaction; *Ophthalmology; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Quality of Life; Societies, Medical/sn [Statistics & Numerical Data]; *Specialization; Waiting Lists

Cochlear implant in Cogan's syndrome. - Vishwakarma, Rajesh; Shawn, T Joseph (European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2007)
Post-lingual deafness is a stressful condition which is rendered even more painful by the sudden emotional isolation that the patient suffers. Cogan's syndrome is a rare autoimmune cause for post-lingual deafness characterized by non-syphilitic interstitial keratitis, bilateral audio vestibular deficiencies and systemic vasculitis. World over very few cases of Cogan's syndrome have been reported. Cochlear implant surgery in such a patient is a challenging but highly satisfactory experience due to the multitude of clinical problems the patient faces. This demands a proper work up, meticulous surgery and stringent post-operative follow-up. Here we present a patient with atypical Cogan's syndrome, diabetes mellitus and hypothyroidism. She went into a major depression with suicidal tendency following the complete loss of hearing. We performed cochlear implant surgery in this patient, but not before facing several clinical obstacles, helped by a dedicated team consisting of a rheumatologist, endocrinologist, neurophysician, psychiatrist, anaesthetists and audiologist. The results are extremely satisfying for the patient and all the people involved. This case underlines the prime importance of hearing in maintaining the psychological well being of a human being.
Keywords: Anti-Inflammatory Agents/tu [Therapeutic Use]; Atrophy/co [Complications]; Atrophy/pa [Pathology]; *Cochlear Implants; *Deafness/su [Surgery]; Deafness/th [Therapy]; *Diabetes Complications/co [Complications]; Diabetes Complications/di [Diagnosis]; Ear/pa [Pathology]; Endolymphatic Hydrops/co [Complications]; Endolymphatic Hydrops/pa [Pathology]; Female; Humans; Hypoglycemic Agents/tu [Therapeutic Use]; *Hypothyroidism/co [Complications]; Keratitis/co [Complications]; Middle Aged; Social Isolation; Syndrome; Temporal Bone/pa [Pathology]; Time Factors; *Verbal Behavior; Vertigo/co [Complications]

[Comparison of the efficiency and safety of the two methods, LASIK and ICL in mild and high hyperopia correction--part two]. - Horackova, M; Vlkova, E; Loukotova, V; Hlinomazova, Z (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2007)
The problems of mild and high hyperopia surgical correction are complicated and an individual approach is needed. The aim of the study was to evaluate long-term efficiency and safety of two types of refractive procedures in mild and high hyperopia correction: LASIK and ICL (phakic intraocular posterior chamber contact lens) implantation. The authors evaluated a group of 37 eyes of 20 patients; the average age was 36.3 years +/- 11.8 (SD) and the follow-up period was 28.1 months +/- 10.2 (SD) after LASIK procedure, and a group of 21 eyes of 13 patients; the average age was 28.6 years +/- 6.1 (SD) and the follow-up period 30.4 months +/- 20.9 (SD) after the ICL implantation. They compared occurrence of preoperative, intraoperative and postoperative complications in both methods. They specified the efficiency and safety of the procedure by means of so called efficiency and safety index. With a questionnaire they evaluated the patient's subjective satisfaction with the refractive procedure. In the group of hyperopic LASIK, they proved statistically significant appearance of the refractive error regression, number of performed re-operations, appearance of the peroperative decentration of the photoablation zone and induced astigmatism (p < 0.05). In the ICL group, the repeated preoperative sessions for Nd-YAG laser iridotomies were necessary. Postoperatively, the appearance of keratitis striata, syndrome of the late pigment dispersion, and glare were statistically significant (p < 0.05). The authors also demonstrated higher efficiency and safety of the ICL implantation method comparing to LASIK during the whole follow up period (p < 0.05), and also higher subjective satisfaction after ICL implantation. Comparing the intraocular procedure (ICL) to the laser method (LASIK), in mild and high hyperopia correction, the higher efficiency and safety was achieved by ICL implantation.
Keywords: Adult; Humans; *Hyperopia/su [Surgery]; Keratomileusis, Laser In Situ/ae [Adverse Effects]; *Keratomileusis, Laser In Situ; Lens Implantation, Intraocular/ae [Adverse Effects]; *Lens Implantation, Intraocular; Patient Satisfaction; Postoperative Complications

Examination of first-degree relatives of patients with glaucoma: a randomized trial of strategies to increase use in an eye hospital in Africa. - Munachonga, Elijah Mutoloki; Hall, Anthony Bennett; Courtright, Paul (Ophthalmic epidemiology, 2007)
OBJECTIVE: To determine the best approach to examine first-degree relatives (FDR) of glaucoma patients in a rural African setting., METHODS: Randomized controlled trial of FDR aged 40 years and older of (index) open angle glaucoma patients who presented to KCMC Hospital. Two strategies of uptake were tested. The main outcome measure was FDR presentation for examination for glaucoma., RESULTS: From 182 index cases, 484 FDR were enrolled in the study, 256 randomized to free examination, and 228 randomized to standard (pay) examination. Overall, 8.1% (95% CI: 5.7-10.5) came for examination. FDR who were offered examination free of charge were 1.87 times (95% CI: 0.94-3.73) more likely to present than those offered standard examination. Among those offered free examination, living near the hospital was associated with presentation (OR=2.85; 95% CI: 1.10-7.36) whereas among those offered standard examination the association with residence was weak (OR=2.27; 95% CI: 0.72-7.15)., CONCLUSIONS: Providing good quality counseling of index cases and offering glaucoma examination free of charge is not sufficient to reach those at risk of glaucoma, suggesting that the indirect costs of accessing services are significant barriers to use of examination services. Other means of encouraging FDR to come for glaucoma examination should be investigated.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; *Family Health; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/eh [Ethnology]; *Health Services/sn [Statistics & Numerical Data]; *Health Services Accessibility/sn [Statistics & Numerical Data]; *Hospitals, Special/sn [Statistics & Numerical Data]; Humans; Male; Middle Aged; *Ophthalmology/sn [Statistics & Numerical Data]; Physical Examination; Tanzania/ep [Epidemiology]

Fixed-combination and emerging glaucoma therapies. - Woodward, David F; Chen, June (Expert opinion on emerging drugs, 2007)
Ocular hypotensive agents are the only approved pharmacotherapy for glaucoma. Despite significant advances during the past two decades, a large proportion of glaucoma patients require more than one drug. The most recent additions to the armamentarium of antiglaucoma drugs are fixed-combination products for the glaucoma patient who is insufficiently responsive to monotherapy. Fixed-combination products have the combined efficacy of two ocular hypotensive drugs, and the convenience of a two-drug treatment regimen in a single container, which may aid patient adherence to treatment. Available fixed-combination products consist of timolol 0.5% as an invariant with brimonidine 0.2%, dorzolamide 2%, travoprost 0.004%, latanoprost 0.005% or bimatoprost 0.03%. Research on more advanced antiglaucoma medications continues. Promising new directions appear to be the Rho-kinase inhibitors, microtubule-disrupting agents, serotonergics and cannabimimetics. Efforts continue to improve existing antiglaucoma drugs in an attempt to design second-generation cholinomimetics, adrenergics, prostaglandins and prostamides.
Keywords: Cholinergic Agents/ad [Administration & Dosage]; *Drug Combinations; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pa [Pathology]; Humans; Protein Kinase Inhibitors/ad [Administration & Dosage]

Keep an eye out for glaucoma. - Kowing, Dianne; Kester, Elizabeth (The Nurse practitioner, 2007)
Keywords: Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; Humans; Ophthalmic Solutions/ae [Adverse Effects]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance

Clinical experience in the treatment of normal tension glaucoma with latanoprost in Germany. - Thelen, Ulrich; Weiler, Winfried; Kirchhoff, Elisabeth; Fuchs, Heinz-Bernhard; Stewart, William C (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2007)
AIMS: The aim of this analysis was to evaluate the general ophthalmologist's experience in using latanoprost to treat normal tension glaucoma (NTG) patients., METHODS: NTG patients included in this study were part of an observational cohort of patients that were changed from previous therapy to latanoprost in Germany., RESULTS: This study included 200 NTG glaucoma patients who were being treated with latanoprost monotherapy (average duration, 1.2 +/- 1.4 years) and had 6 months of follow-up. At the beginning of the observation period, patients had an average intraocular pressure (IOP) of 15.2 +/- 2.5 mmHg and after 6 months, 15.0 +/- 2.4 mmHg (P = 0.769). Eight (8) patients (4.0%) were discontinued from latanoprost during the observation period, with the most common reason noted as the need for further IOP reduction (n = 7; 3.5%). Twenty-four (24) patients (12.0%) noted at least one ocular adverse event during the observation period, with the most common reason noted as burning/stinging (n = 9; 4.5%) or conjunctival hyperemia (n = 9; 4.5%)., CONCLUSIONS: This study suggests that patients with NTG who are already treated with latanoprost monotherapy should continue to have, over a short-term follow-up, generally stable IOPs, low side-effect incidence, and discontinuations, as well as "very good" to "excellent" physician ratings of patient efficacy, tolerability, and satisfaction.
Keywords: Aged; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Conjunctiva/bs [Blood Supply]; Female; Follow-Up Studies; Germany; *Glaucoma/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ophthalmic Solutions; Patient Satisfaction; Prostaglandins F, Synthetic/ae [Adverse Effects]; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Evaluation of practice patterns for the care of open-angle glaucoma compared with claims data: the Glaucoma Adherence and Persistency Study. - Quigley, Harry A; Friedman, David S; Hahn, Steven R (Ophthalmology, 2007)
OBJECTIVE: To perform a chart review to measure the validity of large claims databases in estimating patient cooperation with eyedrop therapy and to assess physician adherence with guidelines for a preferred practice pattern (PPP) using a new metric., DESIGN: Claims database analysis, chart review, and telephone survey., PARTICIPANTS: From 10,260 persons who were recently prescribed a prostaglandin eyedrop for open-angle glaucoma (OAG), a sample of 300 charts (3650 visits) was selected for detailed abstraction., METHODS: Database review of pharmacy refill, diagnostic testing, and visit information, with chart review of a sample of patients from the database and interviews with an overlapping sample of patients and physicians., MAIN OUTCOME MEASURES: The individual patient medication possession ratio (MPR), an index estimating the proportion of time that patients have prescribed drug available for use, frequency of examination findings present in charts, and associations between MPR and physician adherence to a PPP., RESULTS: Chart data confirm that the claims database accurately identified the specific glaucoma eyedrop prescribed, but often identified long-term OAG patients as being new to treatment. Physicians frequently used billing codes for OAG in patients with normal visual field tests. Physicians varied dramatically in their adherence to the PPP, performing intraocular pressure measurements, disc evaluations and imaging, and visual field tests on 90% of OAG patients, but carrying out gonioscopy, central corneal thickness measurement, and setting of target intraocular pressure (IOP) on half of patients., CONCLUSIONS: Large claims databases permit conclusions regarding patient cooperation with glaucoma eyedrop therapy, but they should be used cautiously in imputing severity of disease and prior treatment history. Physician adherence to practice guidelines varied substantially; thus, scoring systems for physician behavior have promise in measuring outcome improvements related to better care.
Comment in (CIN)
Keywords: Amides/ad [Administration & Dosage]; *Antihypertensive Agents/ad [Administration & Dosage]; Bimatoprost; Cloprostenol/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; Drug Prescriptions/sn [Statistics & Numerical Data]; *Drug Utilization/sn [Statistics & Numerical Data]; Female; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Guideline Adherence/sn [Statistics & Numerical Data]; Health Services Research; Health Surveys; Humans; *Insurance Claim Review/sn [Statistics & Numerical Data]; Intraocular Pressure; Latanoprost; Lipids/ad [Administration & Dosage]; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Optic Disk/pa [Pathology]; Optic Nerve Diseases/di [Diagnosis]; *Patient Compliance/sn [Statistics & Numerical Data]; Practice Guidelines as Topic/st [Standards]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Travoprost; United States; Visual Fields

Ocular carteolol: a review of its use in the management of glaucoma and ocular hypertension. - Henness, Sheridan; Swainston Harrison, Tracy; Keating, Gillian M (Drugs & aging, 2007)
Ocular carteolol (Mikelan), Teoptic, Ocupress) is a nonselective beta-adrenoceptor antagonist with intrinsic sympathomimetic activity (ISA). Ocular carteolol effectively reduces intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH). Twice-daily administration of standard carteolol has generally similar IOP-lowering efficacy to other ocular beta-adrenoceptor antagonists such as timolol, betaxolol and metipranolol in patients with OAG or OH. In addition, long-term treatment with carteolol has similar efficacy to timolol and betaxolol in terms of reducing IOP and maintaining visual fields in patients with newly diagnosed primary OAG (POAG). The new long-acting formulation of once-daily carteolol has equivalent efficacy to the standard formulation of carteolol administered twice daily in patients with OAG or OH. Both the standard and long-acting formulations of ocular carteolol are generally well tolerated in terms of topical adverse effects involving the eyes or systemic adverse effects involving the cardiovascular system. Thus, twice-daily carteolol is a well established option in the treatment of glaucoma and OH, and the new once-daily formulation of long-acting carteolol offers similar efficacy and tolerability with a potential for improved patient adherence.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Carteolol/ae [Adverse Effects]; *Carteolol/tu [Therapeutic Use]; Clinical Trials as Topic; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Instillation, Drug; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Treatment Outcome