Smart Electronic Eyedrop Bottle for Unobtrusive Monitoring of Glaucoma Medication Adherence. - Aguilar-Rivera, Marcelo; Erudaitius, Dieanira T; Wu, Vincent M; Tantiongloc, Justin C; Kang, Dae Y; Coleman, Todd P; Baxter, Sally L; Weinreb, Robert N (Sensors (Basel, Switzerland), 2020)
Glaucoma, the leading cause of irreversible blindness, affects >70 million people worldwide. Lowering intraocular pressure via topical administration of eye drops is the most common first-line therapy for glaucoma. This treatment paradigm has notoriously high non-adherence rates: ranging from 30% to 80%. The advent of smart phone enabled technologies creates promise for improving eyedrop adherence. However, previous eyedrop electronic monitoring solutions had awkward medication bottle adjuncts and crude software for monitoring the administration of a drop that adversely affected their ability to foster sustainable improvements in adherence. The current work begins to address this unmet need for wireless technology by creating a "smart drop" bottle. This medication bottle is instrumented with sensing electronics that enable detection of each eyedrop administered while maintaining the shape and size of the bottle. This is achieved by a thin electronic force sensor wrapped around the bottle and underneath the label, interfaced with a thin electronic circuit underneath the bottle that allows for detection and wireless transmission to a smart-phone application. We demonstrate 100% success rate of wireless communication over 75 feet with <1% false positive and false negative rates of single drop deliveries, thus providing a viable solution for eyedrop monitoring for glaucoma patients.
Keywords: Electronics; Glaucoma/dt [Drug Therapy]; *Glaucoma; Humans; Intraocular Pressure; *Medication Adherence; Ophthalmic Solutions

Safety and Efficacy of Scleral Lenses for Keratoconus. - Fuller, Daniel G; Wang, Yueren (Optometry and vision science : official publication of the American Academy of Optometry, 2020)
SIGNIFICANCE: This study affirms the long-term safety and efficacy of scleral contact lens use in patients with keratoconus., PURPOSE: This study aimed to evaluate the safety and efficacy of contemporary scleral contact lenses in the visual rehabilitation of the keratoconic population., METHODS: A retrospective study of keratoconic subjects examined between 2013 and 2018 was conducted. Subjects were included regardless of age, sex, pre-existing morbidity, or scleral lens design. Only eyes fit successfully with scleral contact lenses for >=1 year were included. Exclusion criteria were prior corneal surgery, dystrophy, degeneration, and trauma., RESULTS: A total of 157 eyes of 86 subjects met the study criteria. The mean Keratoconus Severity Score at initial fitting was 3.6 +/- 1.0. Lenses were gas-permeable and nonfenestrated, with a mean overall diameter of 15.8 +/- 0.6 mm and 70.1% toric scleral periphery. Physiological adverse events occurred in 9.6% of eyes, including microbial keratitis (0.6%), phlyctenulosis (0.6%), corneal abrasion (1.3%), contact lens-induced acute red eye (1.3%), corneal infiltrative events (1.3%), pingueculitis (1.3%), and hydrops (3.2%). Lens-related adverse events were documented in 55.4% of eyes. Adverse events related to surface issues included poor wetting in 1.9%, handling in 3.8%, reservoir fogging in 7.0%, lens intolerance in 7.6%, deposit in 8.9%, and broken lenses in 26.1% of eyes. The most common management strategies involved refits (54.0% of interventions), patient reeducation (29.5%), medical treatment (5.5%), surgical referral (6.8%), adjustment to wear time (2.5%), surface treatment (1.2%), and lens replacement (0.6%). Best-corrected distance logMAR visual acuity improved significantly from a mean of 0.50 in spectacles to a mean of 0.08 in scleral lenses (P < .0001). During the study period, 14.6% of eyes lost best-corrected scleral lens visual acuity, all from keratoconus progression., CONCLUSIONS: Consistent with other groups, our study demonstrates excellent safety and efficacy of scleral contact lenses in subjects with keratoconus.
Keywords: Adolescent; Adult; *Contact Lenses; Equipment Safety; Female; Humans; Keratoconus/pp [Physiopathology]; *Keratoconus/th [Therapy]; Male; Middle Aged; Patient Compliance; Prosthesis Fitting; Refraction, Ocular/ph [Physiology]; Retrospective Studies; *Sclera; Treatment Outcome; Visual Acuity/ph [Physiology]; Young Adult

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months. - Jones, Pete R; Campbell, Peter; Callaghan, Tamsin; Jones, Lee; Asfaw, Daniel S; Edgar, David F; Crabb, David P (American journal of ophthalmology, 2021)
PURPOSE: To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma., DESIGN: Prospective longitudinal feasibility and reliability study., METHODS: Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye)., RESULTS: All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than +/-3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320)., CONCLUSIONS: Home monitoring of VFs is viable for some patients and may provide clinically useful data. Copyright © 2020 Elsevier Inc. All rights reserved.
Keywords: Aged; *Computers, Handheld; Female; Follow-Up Studies; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Male; Middle Aged; *Monitoring, Ambulatory/mt [Methods]; *Patient Compliance/sn [Statistics & Numerical Data]; Pilot Projects; Prospective Studies; Reproducibility of Results; *Visual Field Tests/is [Instrumentation]; *Visual Fields/ph [Physiology]

Dorzolamide/Timolol Fixed Combination: Learning from the Past and Looking Toward the Future. - Konstas, Anastasios G; Schmetterer, Leopold; Katsanos, Andreas; Hutnik, Cindy M L; Hollo, Gabor; Quaranta, Luciano; Teus, Miguel A; Uusitalo, Hannu; Pfeiffer, Norbert; Katz, L Jay (Advances in therapy, 2021)
The key clinical attributes of preserved dorzolamide/timolol fixed combination (DTFC) and the emerging potential of preservative-free (PF) DTFC are reviewed with published evidence and clinical experience. The indications and role of DTFC in current glaucoma management are critically discussed. Preserved DTFC became the first intraocular pressure (IOP)-lowering fixed combination (FC) approved by the US Food and Drug Administration (FDA) and remains one of most commonly used medications worldwide. The pharmacological properties of DTFC reflect those of its two time-tested constituents, i.e., the carbonic anhydrase inhibitor dorzolamide and the non-selective beta-blocker timolol. In regulatory studies DTFC lowers IOP on average by 9 mmHg (32.7%) at peak and by 7.7 mmHg (27%) at trough. In trials DTFC shows equivalence to unfixed concomitant therapy, but in real-life practice it may prove superior owing to enhanced convenience, elimination of the washout effect from the second drop, improved tolerability, and better adherence. PF DTFC became the first PF FC approved, first in unit-dose pipettes, and more recently in a multidose format. Cumulative evidence has confirmed that PF DTFC is at least equivalent in efficacy to preserved DTFC and provides a tangible clinical benefit to patients with glaucoma suffering from ocular surface disease by improving tolerability and adherence. Finally, we identify areas that warrant further investigation with preserved and PF DTFC.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors; Drug Combinations; Humans; Intraocular Pressure; Ocular Hypertension/dt [Drug Therapy]; *Ocular Hypertension; Sulfonamides; Thiophenes; *Timolol; Tonometry, Ocular

A Glaucoma-Specific Brief Motivational Interviewing Training Program for Ophthalmology Para-professionals: Assessment of Feasibility and Initial Patient Impact. - Newman-Casey, Paula Anne; Killeen, Olivia; Miller, Sarah; MacKenzie, Chamisa; Niziol, Leslie M; Resnicow, Ken; Creswell, John W; Cook, Paul; Heisler, Michele (Health communication, 2020)
Our objective was to test the feasibility of, fidelity to, and initial impact of a brief, glaucoma-specific motivational interviewing (MI) training program for ophthalmic para-professionals. This prospective, mixed-methods study had two components, one for staff and one for patients. Staff fidelity to MI principles was graded through audio-recorded encounters after initial and final training sessions. After training, patients graded staff for adherence to autonomy supportive care. Semi-structured interviews with para-professionals elicited feedback about the training and about their ability to implement MI in the clinic. The impact on patient satisfaction with staff communication, eye drop instillation self-efficacy, and overall health activation was assessed using a survey pre- and post-training. Para-professionals met two of three program goals for MI skills and improved in their overall scores for MI fidelity. Para-professionals noted lack of time in the clinic as a significant barrier to implementing counseling. Patient satisfaction with staff communication increased after the training (p = 0.04) among patients who rated their staff above the mean for providing autonomy supportive care. The intervention did not improve patients' eye drop instillation self-efficacy or overall health activation. Training para-professional staff in brief, glaucoma-specific MI techniques is feasible and may improve patient satisfaction, though dedicated time in clinic is needed to implement MI counseling into glaucoma practice.
Keywords: Adult; *Communication; Feasibility Studies; Female; *Glaucoma/th [Therapy]; *Health Personnel; Humans; Interviews as Topic; Male; *Motivational Interviewing; *Ophthalmology/ed [Education]; *Patient Satisfaction; Prospective Studies; Self Efficacy; Surveys and Questionnaires

A Survey of Glaucoma Surgery Practice Patterns in the Veterans Health Administration. - Olivieri, Daniel J; Lynch, Mary G; Cockerham, Glenn C; Greenberg, Paul B (Military medicine, 2020)
INTRODUCTION: Glaucoma surgical practice patterns are not well described in the United States (US). This study aims to evaluate the indications for and potential barriers to glaucoma surgery in the Veterans Health Administration (VHA)., MATERIALS AND METHODS: An anonymous 10-question survey using REDCap (Nashville, TN) software was sent by mail (with web link) and email to ophthalmology chiefs at the 86 academically affiliated Veterans Affairs Medical Centers (VAMCs). Academic-affiliated VAMCs were selected because of their patient range and role in ophthalmic education. Non-responders received two reminder e-mails and two phone calls; the survey was closed after 6 weeks. The data were analyzed using descriptive statistics., RESULTS: The response rate was 45% (39/86). Most respondents (92%) worked in an integrated eye clinic with both ophthalmology and optometry services. Almost half of the respondents (49%; 19/39) believed that laser trabeculoplasty (LTP) was an option for initial glaucoma therapy. Noncompliance was a commonly reported indication for LTP (95%), tube shunt procedures (65%), micro-invasive glaucoma surgery (59%), and trabeculectomy (48.7%). One third of the respondents believed that there were delays in glaucoma care. The respondents noted that significant barriers in access to surgery included lack of transportation (69%), scheduling challenges (62%), and delayed referral (62%)., CONCLUSION: This survey of glaucoma surgery practice patterns highlights the growing role of LTP and suggests that non-compliance and access remain significant barriers to glaucoma surgical care within the VHA. Copyright © The Association of Military Surgeons of the United States. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Keywords: Glaucoma/su [Surgery]; *Glaucoma; Humans; Ophthalmology; Surveys and Questionnaires; *Trabeculectomy; United States; *Veterans Health

Persistence and treatment patterns of fixed combination drugs for glaucoma: a retrospective claims database study in Japan. - Kashiwagi, Kenji; Chono, Eriko; Koesters, Sarah; Yap, Poh Sin (BMC ophthalmology, 2020)
BACKGROUND: Poor persistence with glaucoma therapy can lead to disease progression and subsequent blindness. Persistence with second-line glaucoma combination treatment in a Japanese real-world setting and whether it differed from fixed and unfixed combination drugs was investigated., METHODS: This was a retrospective, non-interventional, cohort study using data from a Japanese medical claims database. Patients with glaucoma aged >=20 years with a first drug claim for glaucoma treatment between 01 July 2005 and 30 October 2014 and with data for > 6 months before and after this first prescription were included. The primary endpoint was duration of drug persistence among glaucoma patients with and without the use of fixed combination drugs in the year following initiation of second-line combination treatment., RESULTS: Of 1403 patients included in the analysis, 364 (25.94%) received fixed combination drugs and 1039 (74.06%) received unfixed combination drugs as second-line treatment. Baseline characteristics were generally comparable between the groups. A total of 39.01% of patients on fixed combination drugs, compared with 41.67% of patients on unfixed combination drugs, persisted on their glaucoma drugs 12 months post second-index date. Median persistence durations for the fixed combination drugs and unfixed combination drugs groups were 6 (95% confidence interval [CI]: 5-8) and 7 months (95% CI 6-9), respectively. Patients who received prostaglandin analogs (PGAs) were the most persistent with their treatment (n = 99, 12.84%). Patients diagnosed with primary open-angle glaucoma were less likely to experience treatment modification (hazard ratio [HR]: 0.800, 95% CI 0.649-0.986, P = 0.036), while those diagnosed with secondary glaucoma were more likely to experience treatment modification (HR: 1.678, 95% CI 1.231-2.288, P = 0.001) compared with glaucoma suspects., CONCLUSIONS: In this retrospective claims database study, the persistence rate of second-line glaucoma combination treatment was low, with no difference in persistence between glaucoma patients receiving unfixed combination drugs compared with fixed combination drugs. Patients on PGA showed greater persistence rates compared with other treatments.
Keywords: Adult; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Databases, Factual; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Insurance, Health, Reimbursement; *Intraocular Pressure/de [Drug Effects]; Japan; Male; Medication Adherence; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies; Timolol/tu [Therapeutic Use]; Universal Health Insurance

Comparative efficacy and cost-utility of combined cataract and minimally invasive glaucoma surgery in primary open-angle glaucoma. - Bartelt-Hofer, Jose; Flessa, Steffen (International ophthalmology, 2020)
PURPOSE: To assess the comparative efficacy and the long-term cost-utility of alternative minimally invasive glaucoma surgeries (MIGSs) when combined with cataract surgery in patients with primary open-angle glaucoma (POAG)., METHODS: Treatment effects, as measured by the 1-year reduction in intraocular pressure (IOP), were estimated with an adjusted indirect treatment comparison. Evidence from randomized clinical trials was identified for four different MIGS methods. A disease-transition model was developed by capturing clinically relevant POAG stages and the expected natural disease evolution. Outcomes of the disease-transition model were the comparative utility [quality-adjusted life years (QALYs)], cost and cost-utility of included strategies in a lifetime horizon., RESULTS: Estimated 1-year IOP reductions were: cataract surgery - 2.05 mmHg (95% CI - 3.38; - 0.72), one trabecular micro-bypass stent - 3.15 mmHg (95% CI - 5.66; - 0.64), two trabecular micro-bypass stents - 4.85 mmHg (95% CI - 7.71; - 1.99) and intracanalicular scaffold - 2.25 mmHg (95% CI - 4.87; 0.37). Discounted outcomes from the disease-transition model appraised the strategy of two trabecular micro-bypass stents with cataract surgery in the moderate POAG stage as the one providing the greatest added value, with 10,955 per additional QALY. Improved outcomes were seen when assessing MIGS in the moderate POAG stage., CONCLUSIONS: When indirectly comparing alternative MIGS methods combined with cataract surgery, the option of two trabecular micro-bypass stents showed both a superior efficacy and long-term cost-utility from a German perspective. Moreover, outcomes of the disease-transition model suggest POAG patients to beneficiate the most from an earlier intervention in the moderate stage contrary to waiting until an advanced disease is present.
Keywords: *Cataract/co [Complications]; Cataract/ec [Economics]; *Cataract Extraction/mt [Methods]; Cost-Benefit Analysis; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Minimally Invasive Surgical Procedures/ec [Economics]; *Minimally Invasive Surgical Procedures/mt [Methods]; *Patient Acceptance of Health Care; Trabeculectomy/ec [Economics]; *Trabeculectomy/mt [Methods]; *Visual Acuity

Glaucoma care and follow-up in sub-Saharan Africa: Is there a need for modification of counselling practices to improve awareness, knowledge and treatment acceptance profiles? A prospective cross-sectional study. - Uche, Nkechi Judith; Udeh, Nnenma N; Chuka-Okosa, Chimdi M; Kizor-Akaraiwe, Nkiru N; Uche, Enoch O (International ophthalmology, 2020)
BACKGROUND: Blindness from glaucoma is prevalent in parts of Africa. Lack of awareness, late diagnosis, poor acceptance and compliance to treatment as well as unorthodox care practices are among many contributing factors. Strategies that improve glaucoma awareness and treatment acceptance are required to resolve this trend., PURPOSE: To evaluate the influence of counselling on glaucoma awareness, willingness to accept glaucoma surgery and eye care practices among primary open-angle glaucoma patients on medical treatment., METHODS: A prospective cross-sectional interviewer-administered questionnaire-based study evaluating the demographics, glaucoma awareness, acceptance of operative care and use of traditional eye medications among patients with primary open-angle glaucoma on medical treatment followed up over a 12-month period., RESULTS: A total of 120 eligible participants were recruited. Glaucoma awareness and basic knowledge were 93.3 and 12%, respectively. Educational attainment and positive family history were associated with glaucoma awareness (p = 0.027 and p = 0.042, respectively). Seventy-five (62.5%) participants accepted glaucoma surgery as a treatment option. However, the duration of medical treatment was inversely related to the acceptance of glaucoma surgery (odds ratio = - 0.390, p = 0.009). Twelve (10.5%) participants use traditional eye medication for their current eye problem., CONCLUSION: Glaucoma counselling should be performed with a content template that delivers all relevant information to patients and caregivers. This will bridge gaps in knowledge and improve the early presentation, acceptance of glaucoma surgery and eye care practices.
Keywords: Adult; Africa South of the Sahara/ep [Epidemiology]; Aged; Aged, 80 and over; *Awareness; Cross-Sectional Studies; Female; *Filtering Surgery/mt [Methods]; Follow-Up Studies; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; *Health Knowledge, Attitudes, Practice; Humans; Incidence; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Patient Acceptance of Health Care; *Patient Compliance; Prospective Studies; Risk Factors; Time Factors

A global review of publicly available datasets for ophthalmological imaging: barriers to access, usability, and generalisability. - Khan, Saad M; Liu, Xiaoxuan; Nath, Siddharth; Korot, Edward; Faes, Livia; Wagner, Siegfried K; Keane, Pearse A; Sebire, Neil J; Burton, Matthew J; Denniston, Alastair K (The Lancet. Digital health, 2021)
Health data that are publicly available are valuable resources for digital health research. Several public datasets containing ophthalmological imaging have been frequently used in machine learning research; however, the total number of datasets containing ophthalmological health information and their respective content is unclear. This Review aimed to identify all publicly available ophthalmological imaging datasets, detail their accessibility, describe which diseases and populations are represented, and report on the completeness of the associated metadata. With the use of MEDLINE, Google's search engine, and Google Dataset Search, we identified 94 open access datasets containing 507 724 images and 125 videos from 122 364 patients. Most datasets originated from Asia, North America, and Europe. Disease populations were unevenly represented, with glaucoma, diabetic retinopathy, and age-related macular degeneration disproportionately overrepresented in comparison with other eye diseases. The reporting of basic demographic characteristics such as age, sex, and ethnicity was poor, even at the aggregate level. This Review provides greater visibility for ophthalmological datasets that are publicly available as powerful resources for research. Our paper also exposes an increasing divide in the representation of different population and disease groups in health data repositories. The improved reporting of metadata would enable researchers to access the most appropriate datasets for their needs and maximise the potential of such resources. Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Erratum in (EIN)
Keywords: *Databases, Factual; *Datasets as Topic; *Diagnostic Imaging/mt [Methods]; *Eye Diseases/dg [Diagnostic Imaging]; Humans; Metadata/st [Standards]; *Ophthalmology

Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents. - Helbig, Christian; Wollny, Anja; Altiner, Attila; Diener, Annette; Kohlen, Juliane; Ritzke, Manuela; Frech, Stefanie; Guthoff, Rudolf F (Klinische Monatsblatter fur Augenheilkunde, 2021)
BACKGROUND: Primary open-angle glaucoma (POAG) is still one of the most common causes of impaired vision worldwide, despite the further development of therapy options, and can lead to blindness. Micro-invasive glaucoma surgery (MIGS) using stents aims at reducing intraocular pressure (IOP), as it is the main risk factor. With regard to adherence and adverse drug reactions it also aims at reducing the drug burden on patients. The study investigates under everyday conditions the criteria according to which ophthalmologists in Germany select patients for MIGS using stents. In addition, it will be investigated which patients (could) benefit most from the therapy., MATERIAL AND METHODS: In this qualitative study, 11 narrative interviews were conducted between May 2017 and July 2018 with ophthalmologists working in the hospital or in a private practice. They were interviewed on their experiences in the treatment of POAG with microstents. The interviews were analysed by an interdisciplinary team using the qualitative content analysis., RESULTS: The stages of therapy escalation form the frame of reference for patient selection in MIGS using stents. Only if the IOP cannot be sufficiently reduced by drop therapy or when this causes drug-related side effects that are intolerable for the patients, stents are apparently used as the next higher escalation stage. The intensive post-operative medication and the frequent check-up appointments are perceived as barriers by the interviewees, especially for people with or without disabilities, who are dependent on external help and/or those living in rural areas. The active cooperation of the patients in the demanding aftercare seems to be indispensable for the ophthalmologists. In addition, necessary revisions are sometimes stressful for patients (physical/psychological) and doctors (work organisation/therapy). Against the background of the organisational and economic challenges in the outpatient spectrum of tasks, especially physicians in private practice seem to weigh up carefully for which patients microstent therapy would be reasonable., CONCLUSION: In view of the therapeutic requirements, the current microstent therapy seems to be used in a selected, adherent patient group. Further qualitative and quantitative studies (in other health care regions and structures) are necessary to verify and extend the available results. Copyright Thieme. All rights reserved.
Keywords: Germany; Glaucoma, Open-Angle/su [Surgery]; *Glaucoma, Open-Angle; Humans; Intraocular Pressure; Patient Selection; Stents; Tonometry, Ocular

Survey of Ehlers-Danlos Patients' ophthalmic surgery experiences. - Louie, Anita; Meyerle, Catherine; Francomano, Clair; Srikumaran, Divya; Merali, Farhan; Doyle, Jefferson J; Bower, Kraig; Bloom, Lara; Boland, Michael V; Mahoney, Nicholas; Daoud, Yassine; Singman, Eric L (Molecular genetics & genomic medicine, 2020)
BACKGROUND: Ehlers-Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients., METHODS: Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists., RESULTS: Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%-refractive, 33%-lens/cataract, 33%-retina, 59%-strabismus, 23%- oculoplastics, 0%-cornea, and 25%-glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis., CONCLUSIONS: Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery. Copyright © 2020 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.
Keywords: Ehlers-Danlos Syndrome/ep [Epidemiology]; Ehlers-Danlos Syndrome/ge [Genetics]; *Ehlers-Danlos Syndrome/su [Surgery]; Humans; *Ophthalmologic Surgical Procedures/ae [Adverse Effects]; Ophthalmologic Surgical Procedures/cl [Classification]; Ophthalmologic Surgical Procedures/px [Psychology]; Ophthalmologic Surgical Procedures/sn [Statistics & Numerical Data]; *Patient Reported Outcome Measures; Patient Satisfaction/sn [Statistics & Numerical Data]; *Postoperative Complications/ep [Epidemiology]

Cluster-randomised trial of community-based screening for eye disease in adults in Nepal: the Village-Integrated Eye Worker Trial II (VIEW II) trial protocol. - O'Brien, Kieran S; Stevens, Valerie M; Byanju, Raghunandan; Kandel, Ram Prasad; Bhandari, Gopal; Bhandari, Sadhan; Melo, Jason S; Porco, Travis C; Lietman, Thomas M; Keenan, Jeremy D; Group Information for the VIEW II Study Group (BMJ open, 2020)
INTRODUCTION: The majority of blindness worldwide could be prevented or reversed with early diagnosis and treatment, yet identifying at-risk and prevalent cases of eye disease and linking them with care remain important obstacles to addressing this burden. Leading causes of blindness like glaucoma, diabetic retinopathy and age-related macular degeneration have detectable early asymptomatic phases and can cause irreversible vision loss. Mass screening for such diseases could reduce visual impairment at the population level., METHODS AND ANALYSIS: This protocol describes a parallel-group cluster-randomised trial designed to determine whether community-based screening for glaucoma, diabetic retinopathy and age-related macular degeneration reduces population-level visual impairment in Nepal. A door-to-door population census is conducted in all study communities. All adults aged >=60 years have visual acuity tested at the census visit, and those meeting referral criteria are referred to a local eye care facility for further diagnosis and management. Communities are subsequently randomised to a community-based screening programme or to no additional intervention. The intervention consists of a single round of screening including intraocular pressure and optical coherence tomography assessment of all adults >=60 years old with enhanced linkage to care for participants meeting referral criteria. Four years after implementation of the intervention, masked outcome assessors conduct a repeat census to collect data on the primary outcome, visual acuity. Individuals with incident visual impairment receive a comprehensive ophthalmological examination to determine the cause of visual impairment. Outcomes are compared by treatment arm according to the originally assigned intervention., ETHICS AND DISSEMINATION: The trial has received ethical approval from the University of California San Francisco Institutional Review Board, Nepal Netra Jyoti Sangh and the Nepal Health Research Council. Results of this trial will be disseminated through publication in peer-reviewed journals and presentation at local and international meetings., TRIAL REGISTRATION NUMBER: NCT03752840. Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Adult; Aged; Humans; *Mass Screening; Middle Aged; Nepal; Randomized Controlled Trials as Topic; San Francisco; Vision, Low/di [Diagnosis]; *Vision, Low

Online Survey of Digital Reading by Adults with Low Vision. - Wu, Yueh-Hsun; Granquist, Christina; Gage, Rachel; Crossland, Michael D; Legge, Gordon E (Optometry and vision science : official publication of the American Academy of Optometry, 2020)
SIGNIFICANCE: Access to digital text is increasingly widespread, but its impact on low-vision reading is not well understood., PURPOSE: We conducted an online survey of people with low vision to determine what assistive technologies they use for visual reading, their preferred text characteristics, and the time they devote to reading digital and hard-copy text., METHODS: One hundred thirty-three low-vision participants completed an online survey. Participants reported the nature and history of their low vision, their usage of different assistive technologies, and time devoted to five visual reading activities., RESULTS: The three largest diagnostic categories were albinism (n = 36), retinitis pigmentosa (n = 20), and glaucoma (n = 15). Mean self-reported acuity was 0.93 logMAR (range, 0.1 to 1.6 logMAR). Mean age was 46 years (range, 18 to 98 years). Participants reported on percentage time spent reading using vision, audio, or touch (braille). Seventy-five percent of our participants did more than 50% of their reading visually. Across five categories of reading activities-work or education, news, pleasure, spot reading, and social networking-participants reported more time spent on digital reading than hard-copy reading. Eighty-nine percent of our participants used at least one technology from each of our two major categories of assistive technologies (digital content magnifiers and hard-copy content magnifiers) for visual reading., CONCLUSIONS: Despite the growing availability of digital text in audio or braille formats, our findings from an online sample of people with low vision indicate the continuing importance of visual reading. Our participants continue to use technology to access both hard-copy and digital text, but more time is devoted to digital reading. Our findings highlight the need for continued research and development of technology to enhance visual reading accessibility.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Communications Media; Diagnostic Tests, Routine; Eyeglasses; Female; Health Surveys; Humans; Male; Middle Aged; Mobile Applications; *Reading; *Self-Help Devices; *Vision, Low/pp [Physiopathology]; Visual Acuity/ph [Physiology]; Young Adult

New strategies for the management of ocular surface disease in glaucoma patients. - Voicu, Laura; Salim, Sarwat (Current opinion in ophthalmology, 2021)
PURPOSE OF REVIEW: Glaucoma patients commonly suffer from ocular surface disease (OSD). As treatment strategies, medications and devices for the treatment of OSD as well as glaucoma surgical approaches evolve rapidly, it is important to consider their application to these patients., RECENT FINDINGS: OSD in glaucoma patients may lead to reduced reliability of diagnostic tests, decreased medication compliance, poor surgical outcomes, and overall decreased quality of life. Chronic use of topical glaucoma medications has been linked to the development of limbal stem cell deficiency, and the role of preservatives in OSD continues to be demonstrated. Preservative free glaucoma medications as well as new anti-inflammatory agents for the treatment of OSD are now available. Omega-3 fatty acid supplementation and punctal plugs have been shown to benefit glaucoma patients with OSD. Drop burden may be reduced through the use of the new sustained-release delivery systems, selective laser trabeculoplasty, and minimally invasive glaucoma surgery., SUMMARY: There are multiple emerging strategies for managing OSD that may be applied to patients with glaucoma. With continued research and clinical experiences, we hope to better understand the multifaceted relationship between glaucoma and OSD and develop evidence-based algorithms for the management of these complex patients. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Anti-Inflammatory Agents/tu [Therapeutic Use]; Antihypertensive Agents/tu [Therapeutic Use]; *Conjunctival Diseases/th [Therapy]; *Corneal Diseases/th [Therapy]; *Dry Eye Syndromes/th [Therapy]; *Eyelid Diseases/th [Therapy]; *Glaucoma/co [Complications]; Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/ph [Physiology]; *Lacrimal Apparatus Diseases/th [Therapy]; Preservatives, Pharmaceutical/tu [Therapeutic Use]; Quality of Life

Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas?. - Sihota, Ramanjit; Shakrawal, Jyoti; Sidhu, Talvir; Sharma, Ajay K; Dada, Tanuj; Pandey, Veena (International ophthalmology, 2020)
PURPOSE: Evaluation of the intraocular pressure (IOP) lowering efficacy of trabeculectomies over > 10 years and their ability to stabilize glaucomatous optic neuropathy., METHODS: In total, 181 eyes (136 patients), which underwent trabeculectomy (10 min surgery) at least 10 years prior and were on regular follow-up, were evaluated. Qualified/complete success was taken as criteria A: IOP <= 12 mmHg, B: IOP <= 15 mmHg and C: IOP <= 18 mmHg, with all > 5 mmHg, with/without medications. Target IOP in advanced glaucoma is about 10 mmHg, therefore trabeculectomy 10-10-10 challenge!, RESULTS: The mean age of patients was 46.32 +/- 11.50 years. Absolute success was 50.27%, 54.14% and 59.66% according to criteria A, B and C at last follow-up, while qualified success was 70.11%, 81.77% and 96.13%. An IOP of <= 12 mmHg was noted in 34, 64.15%, PACG eyes, 14, 73.68%, POAG, 15, 65.22%, JOAG and 64, 74.42%, secondary glaucoma eyes. The reduction in IOP overall was 64.83 +/- 16.80% at last review and was 59.47 +/- 16.07% in PACG, 62.40 +/- 17.72% in POAG, 71.89 +/- 8.50% in JOAG and 67.74 +/- 18.10% in secondary glaucoma eyes. "Target" IOP was achieved in 97.29% of early glaucoma, 85.71% moderate glaucoma and 70% severe glaucoma eyes. 97.24% of patients were perimetrically stable. 2.21% of eyes post-trabeculectomy had a shallow anterior chamber needing surgical intervention. Visual acuity was maintained or better in 93.92% of patients, with a cataract surgery performed in 6.63% eyes. A repeat trabeculectomy was performed in 3.31% of eyes., CONCLUSION: Trabeculectomy 10-10-10 is achievable in the long term, with few complications or repeat surgical interventions in the majority of POAG, PACG, JOAG and secondary glaucomas. Therefore, trabeculectomy should not be relegated to a last resort, but should be undertaken as soon as possible, if medical therapy is inadequate, unaffordable or compliance is an issue.
Keywords: Cross-Sectional Studies; Female; Follow-Up Studies; *Forecasting; Glaucoma, Angle-Closure/co [Complications]; Glaucoma, Angle-Closure/pp [Physiopathology]; *Glaucoma, Angle-Closure/su [Surgery]; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Optic Nerve Diseases/et [Etiology]; *Optic Nerve Diseases/pc [Prevention & Control]; Retrospective Studies; *Trabeculectomy/mt [Methods]; Treatment Outcome; Visual Acuity

Tackling the NHS glaucoma clinic backlog issue. - Broadway, David Charles; Tibbenham, Karen (Eye (London, England), 2019)
BACKGROUND/OBJECTIVES: to determine whether mass case review, carried out by glaucoma sub-specialist consultants, for patients for whom there was insufficient clinic capacity, could aid reduction of the glaucoma clinic appointment backlog., SUBJECTS/METHODS: patient hospital notes were reviewed by a glaucoma fellowship trained consultant and a decision was made as to whether the planned review was appropriate. Decisions were made with respect to timing, clinic-type and necessity for follow-up, together with an assessment as to whether visual field testing was required., RESULTS: in a 3-year study a total of 9290 cases were included in the study. After consultant review, 5521 (59.5%) patients were kept within the hospital eye service (HES) and an additional 1350 (14.5%) had their next appointment delayed, 384 (4%) were discharged to specialist community glaucoma optometrists and 2035 (22%) were discharged to their standard community optometrists. Overall, therefore 26% of patients were discharged from the HES. Of the planned 9290 appointments, simultaneous visual field testing had been planned for 5393 patients (58%), but after consultant review only 65% (n = 3482) of these were considered necessary, reducing the number of required visual field tests by 35% (n = 1911)., CONCLUSIONS: the authors suggest that ophthalmology departments experiencing significant clinic appointment backlog issues, consider utilising trained glaucoma sub-specialist consultants to review planned follow-up management of patients within a backlog deficit.
Keywords: *Continuity of Patient Care/og [Organization & Administration]; *Delivery of Health Care/og [Organization & Administration]; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Health Policy; *Health Services Accessibility/og [Organization & Administration]; Humans; Intraocular Pressure; Male; Medical Audit; Middle Aged; *Ophthalmology/og [Organization & Administration]; Referral and Consultation; Specialization; State Medicine; United Kingdom/ep [Epidemiology]; Visual Field Tests; Visual Fields; *Waiting Lists

Deconstructing aqueous humor outflow - The last 50 years. - Kaufman, Paul L (Experimental eye research, 2020)
Herein partially summarizes one scientist-clinician's wanderings through the jungles of primate aqueous humor outflow over the past ~45 years. Totally removing the iris has no effect on outflow facility or its response to pilocarpine, whereas disinserting the ciliary muscle (CM) from the scleral spur/trabecular meshwork (TM) completely abolishes pilocarpine's effect. Epinephrine increases facility in CM disinserted eyes. Cytochalasins and latrunculins increase outflow facility, subthreshold doses of cytochalasins and epinephrine given together increase facility, and phalloidin, which has no effect on facility, partially blocks the effect of both cytochalasins and epinephrine. H-7, ML7, Y27632 and nitric oxide - donating compounds all increase facility, consistent with a mechanosensitive TM/SC. Adenosine A1 agonists increase and angiotensin II decrease facility. OCT and optical imaging techniques now permit visualization and digital recording of the distal outflow pathways in real time. Prostaglandin (PG) F2alpha analogues increase the synthesis and release of matrix metalloproteinases by the CM cells, causing remodeling and thinning of the interbundle extracellular matrix (ECM), thereby increasing uveoscleral outflow and reducing IOP. Combination molecules (one molecule, two or more effects) and fixed combination products (two molecules in one bottle) simplify drug regimens for patients. Gene and stem cell therapies to enhance aqueous outflow have been successful in laboratory models and may fill an unmet need in terms of patient compliance, taking the patient out of the delivery system. Functional transfer of genes inhibiting the rho cascade or decoupling actin from myosin increase facility, while genes preferentially expressed in the glaucomatous TM decrease facility. In live NHP, reporter genes are expressed for 2+ years in the TM after a single intracameral injection, with no adverse reaction. However, except for one recent report, injection of facility-effective genes in monkey organ cultured anterior segments (MOCAS) have no effect in live NHP. While intracameral injection of an FIV. BOVPGFS-myc.GFP PGF synthase vector construct reproducibly induces an ~2 mmHg reduction in IOP, the effect is much less than that of topical PGF2 analogue eyedrops, and dissipates after 5 months. The turnoff mechanism has yet to be defeated, although proteasome inhibition enhances reporter gene expression in MOCAS. Intracanalicular injection might minimize off-target effects that activate turn-off mechanisms. An AD-P21 vector injected sub-tenon is effective in 'right-timing' wound healing after trabeculectomy in live laser-induced glaucomatous monkeys. In human (H)OCAS, depletion of TM cells by saponification eliminates the aqueous flow response to pressure elevation, which can be restored by either cultured TM cells or by IPSC-derived TM cells. There were many other steps along the way, but much was accomplished, biologically and therapeutically over the past half century of research and development focused on one very small but complex ocular apparatus. I am deeply grateful for this award, named for a giant in our field that none of us can live up to. Copyright © 2020. Published by Elsevier Ltd.
Keywords: Animals; *Aqueous Humor/me [Metabolism]; Cells, Cultured; *Ciliary Body/me [Metabolism]; Ciliary Body/pa [Pathology]; *Extracellular Matrix/me [Metabolism]; Glaucoma/me [Metabolism]; Glaucoma/pa [Pathology]; *Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Organ Culture Techniques; *Trabecular Meshwork/me [Metabolism]; Trabecular Meshwork/pa [Pathology]

Orbital Diffuse Large B-Cell Lymphoma Initially Presenting as Neovascular Glaucoma. - Aldaas, Khalid M; Randall, Cara; Eftekhari, Kian; Zhang, Alice Y (Ophthalmic plastic and reconstructive surgery, 2020)
Orbital lymphoma can result in rapid loss of vision if not diagnosed and treated in a timely manner. This patient presented with rapid visual loss and on examination had a rubeosis iridis with a hyphema as well as neovascular glaucoma with vitreous hemorrhage. His medical history included systemic diffuse large B-cell lymphoma and a workup ultimately revealed an orbital mass in the body of the optic nerve. Optic nerve biopsy demonstrated diffuse large B-cell lymphoma. To the authors' knowledge, neovascular glaucoma as the presentation of an extraocular diffuse large B-cell lymphoma has not been reported previously. Lymphomas of the orbit and its adnexa constitute roughly 1% of all non-Hodgkin lymphoma. Most cases are marginal-zone B-cell lymphomas, with the second most common being diffuse large B-cell lymphomas. Orbital lymphomas can rapidly progress to complete visual loss when not diagnosed early. The authors report a patient who presented with rapid visual loss due to hyphema, rubeosis iridis, neovascular glaucoma and vitreous hemorrhage secondary to orbital diffuse large B-cell lymphoma. Research methods were adherent to the ethical principles outlined in the Declaration of Helsinki as amended in 2013. The collection and evaluation of protected patient health information was Health Insurance Portability and Accountability Act compliant. The authors report a case of lymphoma metastatic to the optic nerve masquerading as neovascular glaucoma with vitreous hemorrhage.
Keywords: Glaucoma, Neovascular/di [Diagnosis]; Glaucoma, Neovascular/et [Etiology]; *Glaucoma, Neovascular; Humans; *Lymphoma, B-Cell, Marginal Zone; Lymphoma, Large B-Cell, Diffuse/di [Diagnosis]; *Lymphoma, Large B-Cell, Diffuse; Orbit; Orbital Neoplasms/di [Diagnosis]; *Orbital Neoplasms

Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States. - Patel, Sadiq Y; Mehrotra, Ateev; Huskamp, Haiden A; Uscher-Pines, Lori; Ganguli, Ishani; Barnett, Michael Lawrence (Health affairs (Project Hope), 2021)
Coronavirus disease 2019 (COVID-19) spurred a rapid rise in telemedicine, but it is unclear how use has varied by clinical and patient factors during the pandemic. We examined the variation in total outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020. During the pandemic, 30.1 percent of all visits were provided via telemedicine, and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. Telemedicine use was lower in communities with higher rates of poverty (31.9 percent versus 27.9 percent for the lowest and highest quartiles of poverty rate, respectively). Across specialties, the use of any telemedicine during the pandemic ranged from 68 percent of endocrinologists to 9 percent of ophthalmologists. Across common conditions, the percentage of visits provided during the pandemic via telemedicine ranged from 53 percent for depression to 3 percent for glaucoma. Higher rates of telemedicine use for common conditions were associated with smaller decreases in total weekly visits during the pandemic.
Keywords: Adult; *Ambulatory Care/sn [Statistics & Numerical Data]; *COVID-19; Female; Health Services Accessibility; Humans; Male; Medicare Part C; Middle Aged; Poverty; *Primary Health Care; *Telemedicine; United States

Adult patient access to electronic health records. - Ammenwerth, Elske; Neyer, Stefanie; Horbst, Alexander; Mueller, Gerhard; Siebert, Uwe; Schnell-Inderst, Petra (The Cochrane database of systematic reviews, 2021)
BACKGROUND: To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR)., OBJECTIVES: Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute)., SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020., SELECTION CRITERIA: Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition., DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures., MAIN RESULTS: We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent., AUTHORS' CONCLUSIONS: The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons. Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Keywords: Adult; Asthma/th [Therapy]; Bias; Blood Glucose/an [Analysis]; Comprehension; Diabetes Mellitus/bl [Blood]; Diabetes Mellitus/di [Diagnosis]; Electronic Health Records/sn [Statistics & Numerical Data]; *Electronic Health Records; Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand/sn [Statistics & Numerical Data]; Heart Failure/th [Therapy]; Humans; Hypertension/th [Therapy]; Middle Aged; Patient Access to Records/sn [Statistics & Numerical Data]; *Patient Access to Records; Patient Compliance; Patient Participation; Patient Satisfaction; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome

Text Parsing-Based Identification of Patients with Poor Glaucoma Medication Adherence in the Electronic Health Record. - Hamid, Mohammed S; Valicevic, Autumn; Brenneman, Brianne; Niziol, Leslie M; Stein, Joshua D; Newman-Casey, Paula Anne (American journal of ophthalmology, 2021)
PURPOSE: To assess the feasibility of automated text parsing screening of physician notes in the electronic health record (EHR) to identify glaucoma patients with poor medication compliance., DESIGN: Cross-sectional study., METHODS: An automated EHR extraction identified a cohort of patients at the University of Michigan with a diagnosis of glaucoma, >=40 years old, taking >=1 glaucoma medication, and having no cognitive impairment. Self-reported medication adherence was assessed with 2 validated instruments: the Chang scale and the Morisky medication adherence scale. In tandem, a text parsing tool that abstracted data from the EHR was used to search for combinations of the following words in patient visit notes: "not," "non," "n't," "no," or "poor" accompanied by "adherence," "adherent, "adhering," "compliance," "compliant," or "complying." The proportion of patients with self-reported poor adherence was compared between the EHR extraction and text parsing identification using a Fisher exact test., RESULTS: Among 736 participants, 20.0% (n = 147) self-reported poor adherence and 6.1% (n = 45) had EHR documentation of poor adherence (P < .0001). Using text parsing as a pre-screening tool, 22 of the 45 patients (48.9%) with non-adherence identified by text parsing also self-reported poor medication adherence compared to the 20.0% by self-report overall (P < .0001)., CONCLUSIONS: Text parsing physician notes to identify patients' noncompliance to their medications identified a larger proportion of patients who then self-reported poor medication adherence than an automated EHR pull alone but was limited by the small number of patients identified. Optimizing the documentation of medication adherence would maximize the utility of this automated approach to identify medication noncompliance. Copyright © 2020 Elsevier Inc. All rights reserved.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; *Electronic Health Records; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions/tu [Therapeutic Use]; Self Report; Surveys and Questionnaires; *Text Messaging

Philadelphia glaucoma detection and treatment project: ocular outcomes and adherence to follow-up at a single health centre. - Adeghate, Jennifer O; Hark, Lisa A; Brown, Helayna; Henderer, Jeffrey D; Waisbourd, Michael; Molineaux, Jeanne; Malik, Kunal; Maity, Alisha; Chuang, Danielle; Donches, Katherine; Heres, Caroline; Eburuoh, Rita; et al. (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2019)
OBJECTIVES: To determine ocular outcomes and factors associated with adherence to ophthalmic follow-up in a medically underserved population at a single health centre in Philadelphia., DESIGN: Retrospective chart review., PARTICIPANTS: Patients from a community glaucoma screening program., METHODS: Chart review was conducted for participants who received a complete eye examination at the Philadelphia District Health Center 5 between January 1, 2012 and May 31, 2014 within the Philadelphia Glaucoma Detection and Treatment Project. Multivariate logistic regression was used to determine factors related to ophthalmic follow-up adherence., RESULTS: A total of 249 participants completed an eye examination (mean age=57.7 +/- 6.9 years). Most were African American (n=220; 88.4%); female (n=129; 51.8%). Forty-seven participants (18.9%) received glaucoma-related diagnoses, 20 (8.0%) were prescribed ocular medication, and 26 (10.4%) underwent laser therapy. Ninety (36.1%) attended their recommended follow-up eye examination at the health centre. Glaucoma-related diagnosis (p <= 0.001), recommendation of a 4- to 6-week follow-up period (p < 0.001), prescribed eye drops (p < 0.001), or received laser therapy (p=0.047) were factors most predictive of ophthalmic follow-up adherence., CONCLUSIONS: The collaborative effort of eye care providers and health centres offers an important opportunity to detect, treat, and manage glaucoma and other ocular pathology in medically underserved communities. Having a glaucoma-related diagnosis, initiating treatment, and scheduling regular follow-up visits are the most important factors influencing adherence to follow-up eye appointments. Copyright © 2019 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aftercare; Aged; Antihypertensive Agents/tu [Therapeutic Use]; Community Health Services/mt [Methods]; *Community Health Services; Female; Follow-Up Studies; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure/ph [Physiology]; Laser Coagulation; Male; Medically Underserved Area; Middle Aged; *Patient Compliance/sn [Statistics & Numerical Data]; Philadelphia; Retrospective Studies; Tonometry, Ocular; Trabeculectomy; Visual Acuity

Current and emerging fixed combination therapies in glaucoma: a safety and tolerability review. - Konstas, Anastasios G; Schmetterer, Leopold; Costa, Vital P; Hollo, Gabor; Katsanos, Andreas; Denis, Philippe; Quaranta, Luciano; Irkec, Murat; Castejon, Miguel A; Teus, Miguel A; Robin, Alan L (Expert opinion on drug safety, 2020)
INTRODUCTION: Fixed dose combinations (FCs) represent a potentially valuable treatment strategy in glaucoma management. Fixed combinations not only improve adherence by reducing the medication burden, but also decrease the total amount of potentially deleterious preservatives an eye is exposed to., AREAS COVERED: We provide a critical review of selected evidence on both the safety and tolerability of presently available and emerging glaucoma FCs. There is convincing short-term safety and tolerability evidence on intraocular pressure (IOP)-lowering FCs compared to that of monotherapies and, to a lesser degree, to that of concomitant, equivalent combination therapies. In contrast, there is a scarcity of trials evaluating the long-term efficacy and safety of glaucoma FCs and no conclusive data on the reduction of adverse events with FCs., EXPERT OPINION: It is vital for clinicians to carefully weigh the efficacy, safety, tolerability, and adherence of IOP-lowering FCs. Given the number of currently available and emerging FC therapy options in glaucoma, as well as the complexities of incorporating them in the various combination therapy regimens, successful stepwise therapy remains often elusive.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ae [Adverse Effects]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Medication Adherence; Preservatives, Pharmaceutical/ae [Adverse Effects]; Preservatives, Pharmaceutical/ch [Chemistry]

Intraocular pressure reduction with once-a-day application of a new prostaglandin eye drop: a pilot placebo-controlled study in 12 patients. - Caruso, Ciro; Pacente, Luigi; Troiano, Pasquale; Ostacolo, Carmine; D'Andrea, Luca; Bartollino, Silvia; Costagliola, Ciro (International ophthalmology, 2020)
PURPOSE: To assess the ocular hypotensive effect of 15-keto fluprostenol, the oxidized metabolite of travoprost, on glaucoma patients, through a randomized double-masked placebo-controlled study., METHODS: Twelve patients with ocular normal tension glaucoma (NTG) (intraocular pressure [IOP] < 22 mmHg) were enrolled. In order to ensure patient compliance to treatment, all study subjects were hospitalized. In each patient, the eye to be submitted to the treatments was randomly chosen. After hospital admission (day 1), those patients received for 5 days at 8 P.M. either one drop of 15-keto fluprostenol (35 mug/ml) or one drop of placebo. IOP evaluation was performed within 8 A.M. and 8 P.M. for 6 days. Furthermore, we performed a determination of cardiovascular parameters before and after the treatments., RESULTS: Starting with the first IOP measurement after the first treatment (8 A.M. on day 2), IOP was reduced of about 14% in the eyes treated 15-keto fluprostenol, in comparison with baseline IOP values of 15-keto fluprostenol-treated patients. The IOP reduction in the 15-keto fluprostenol-treated group was significantly compared to placebo group (p < 0.05) starting from day 3 till day 6 of the study. Except for mild hyperemia in one 15-keto fluprostenol-treated eye, no other side effects were observed or reported by the enrolled patients., CONCLUSIONS: The travoprost metabolite 15-keto fluprostenol was effective in decrease IOP and maintained IOP reduction along 5 days of treatment. The 15-keto fluprostenol can be developed as a good candidate for once-a-day NTG patients' treatment.
Keywords: Adult; Aged; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Pilot Projects; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Treatment Outcome

Predicting Adherence With the Glaucoma Treatment Compliance Assessment Tool. - Sanchez, Facundo G; Mansberger, Steven L; Newman-Casey, Paula A (Journal of glaucoma, 2020)
PReCIS:: Univariate and multivariable models using the Glaucoma Treatment Compliance Assessment Tool (GTCAT) statements identified multiple, patient-specific factors associated with adherence that could be used to inform personalized interventions to optimize glaucoma adherence., PURPOSE: The purpose of this study was to determine the health behavior factors related to glaucoma adherence in patients with self-reported poor adherence., METHODS: A research coordinator used the Chang Adherence Measure and the Morisky Medication Adherence Scale to identify subjects with poor self-reported glaucoma medication adherence and enrolled them in a 3-month study to electronically monitor medication adherence. At enrollment, the coordinator administered the GTCAT. We calculated the percentage of prescribed doses taken over a 3-month period using an electronic dose monitor (AdhereTech). We used Rasch analysis, and univariate and multivariable regression to determine the GTCAT statements that predicted electronically monitored adherence., RESULTS: The mean adherence was 73.8% (SD=21.04%, range: 13% to 100%). Rasch analysis showed that the GTCAT had a good overall fit and no differential bias (Anderson likelihood ratio test >0.05). Multiple GTCAT statements were associated with adherence, which represented increased knowledge, increased cues-to-action, decreased barriers, less depression, and increased self-efficacy (P<0.09 for each). The full GTCAT or a subset of statements had a high association with adherence (R range: 0.44 to 0.51, P<0.005 for all). The GTCAT identified >50% of patients who wanted more education about glaucoma; >68% who did not use reminders; and >40% who reported having difficulty using the eye drops., CONCLUSIONS: The GTCAT identified multiple factors associated with adherence. Clinicians and researchers could use this tool to identify specific barriers to adherence and develop potential interventions to improve adherence.
Keywords: Administration, Ophthalmic; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Models, Statistical; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ophthalmic Solutions; Patient Acceptance of Health Care; Patient Compliance; Predictive Value of Tests; Surveys and Questionnaires

The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes. - Funk, Ian T; Strelow, Bryan A; Klifto, Meredith R; Knight, O'Rese J; Van Buren, Eric; Lin, Feng-Chang; Fleischman, David (Journal of glaucoma, 2020)
PReCIS:: This study addresses the paucity of literature examining glaucoma patients' distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments., PURPOSE: To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance., METHODS AND PARTICIPANTS: Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson chi, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up., RESULTS: In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t(197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t(144)=-2.193; P<0.05)., CONCLUSIONS: Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.
Keywords: Adult; *Aftercare/sn [Statistics & Numerical Data]; Aged; Aged, 80 and over; Ambulatory Care Facilities; Female; Follow-Up Studies; *Glaucoma Drainage Implants; Glaucoma, Angle-Closure/pp [Physiopathology]; *Glaucoma, Angle-Closure/su [Surgery]; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Health Services Accessibility; Humans; Intraocular Pressure/ph [Physiology]; Lost to Follow-Up; Male; Middle Aged; Postoperative Care; Retrospective Studies; *Trabeculectomy; *Travel/sn [Statistics & Numerical Data]; Treatment Outcome; United States; Young Adult

Development of besifloxacin HCl loaded nanofibrous ocular inserts for the treatment of bacterial keratitis: In vitro, ex vivo and in vivo evaluation. - Polat, H Kerem; Bozdag Pehlivan, Sibel; Ozkul, Ceren; Calamak, Semih; Ozturk, Naile; Aytekin, Eren; Firat, Aysegul; Ulubayram, Kezban; Kocabeyoglu, Sibel; Irkec, Murat; Calis, Sema (International journal of pharmaceutics, 2020)
Novel drug delivery systems have emerged to treat bacterial keratitis, an acute infection of the cornea. In this study, besifloxacin HCl loaded insert formulations were designed and investigated in vitro, ex vivo and in vivo for the treatment of bacterial keratitis. Besifloxacin HCl (BH) or BH-hydroxypropyl-beta-cyclodextrin (HP-beta-CD) complex containing poly(caprolactone)/polyethylene glycol (PLC/PEG) fibrous inserts were prepared with an electrospinning method. These fibrous inserts were coated with mucoadhesive polymers such as sodium alginate (SA) or thiolated sodium alginate (TSA). Developed inserts compared to commercially available drug and it was found that coating of the insert surfaces with SA and TSA, increases bioadhesion of the formulations. Insert formulations showed a burst release in the first 2 days followed by a slow-release profile. Ex vivo transport studies showed that HP-beta-CD possessed a drug delivery level close to the commercial drug. Both TSA coated inserts as well as inserts containing HP-beta-CD-drug complex were effectively reducing bacterial keratitis in rabbit eyes upon single-dose application compared to multiple dosing with the commercial drug. Consequently, TSA coated inserts as well as the inserts containing HP-beta-CD-drug complex, may be potential alternatives to conventional market product by reducing the application frequency in the clinic leading to increased patient compliance. Copyright © 2020 Elsevier B.V. All rights reserved.
Keywords: 2-Hydroxypropyl-beta-cyclodextrin/ch [Chemistry]; Alginates/ch [Chemistry]; Animals; Anti-Bacterial Agents/ad [Administration & Dosage]; *Anti-Bacterial Agents/pd [Pharmacology]; Azepines/ad [Administration & Dosage]; *Azepines/pd [Pharmacology]; Bacteriological Techniques; Cell Survival; Dose-Response Relationship, Drug; *Drug Delivery Systems/mt [Methods]; Drug Liberation; Female; Fluoroquinolones/ad [Administration & Dosage]; *Fluoroquinolones/pd [Pharmacology]; Humans; *Keratitis/dt [Drug Therapy]; Keratitis/mi [Microbiology]; Male; *Nanofibers/ch [Chemistry]; Polyesters/ch [Chemistry]; Polyethylene Glycols/ch [Chemistry]; Rabbits; Technology, Pharmaceutical/mt [Methods]

Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study. - Waterman, Heather; Read, Simon; Morgan, James Edwards; Gillespie, David; Nollett, Claire; Allen, Davina; Weiss, Marjorie; Anderson, Pippa (The British journal of ophthalmology, 2020)
BACKGROUND/AIMS: Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops., METHODS: A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways., RESULTS: Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation., CONCLUSIONS: The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption., TRIAL REGISTRATION NUMBER: ISRCTNID:ISRCTN75888393. Copyright © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ec [Economics]; *Critical Pathways; *Drug Costs; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/ec [Economics]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; *Latanoprost/ad [Administration & Dosage]; Latanoprost/ec [Economics]; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions/ec [Economics]; Prospective Studies; Tonometry, Ocular

Impact of Video Education on Patient Knowledge, Anxiety, and Satisfaction in Selective Laser Trabeculoplasty: A Pilot Study. - Robbins, Cason B; Wisely, C Ellis; Rosdahl, Jullia A; Muir, Kelly W; Gupta, Divakar (Journal of glaucoma, 2020)
PReCIS:: In patients undergoing selective laser trabeculoplasty, preoperative video education did not improve patient knowledge regarding the procedure, decrease anxiety, or increase satisfaction, as these metrics were already favorable across all patients in this study., PURPOSE: To assess the effect of an educational video on patient knowledge, anxiety, and satisfaction at a selective laser trabeculoplasty (SLT) procedure visit., MATERIALS AND METHODS: This is a prospective, randomized trial. Patients at a single academic medical center completed a survey at their procedure visit for SLT; patients were randomized to view an educational video or no video before survey administration. Knowledge was assessed with a 10-item questionnaire. The 6-item State-Trait Anxiety Inventory scale (STAI-6) assessed anxiety (score >40 defined significant anxiety). Perceptions of visit quality were assessed using a Likert scale., RESULTS: Twenty-two patients were randomized into video (n=11) and control (n=11) groups. No difference in knowledge was observed between groups (83.6% control vs. 82.7% video group, P=0.635). No patient had significant anxiety (STAI-6 range, 20 to 40, average 29) and scores were similar between groups (P=0.385). Overall, patients had positive perceptions of visit quality, and there was no significant difference between groups (P=0.999)., CONCLUSION: Patients undergoing SLT had high levels of knowledge, low levels of anxiety, and high levels of satisfaction. In this clinical setting, an educational video seemed to have no additional benefit on these metrics and thus, may be omitted. Further research may be directed toward optimizing patient education regarding SLT, particularly in settings with poor health literacy, limited resources, or limited access to glaucoma specialists.
Keywords: Adult; Aged; Aged, 80 and over; *Anxiety/px [Psychology]; Female; *Glaucoma/su [Surgery]; *Health Knowledge, Attitudes, Practice; Health Services Research; Humans; Intraocular Pressure/ph [Physiology]; Lasers, Semiconductor/tu [Therapeutic Use]; Male; Middle Aged; *Patient Education as Topic/sn [Statistics & Numerical Data]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Physician-Patient Relations; Pilot Projects; Preoperative Care/mt [Methods]; Prospective Studies; Surveys and Questionnaires; *Trabeculectomy/mt [Methods]; *Video Recording/sn [Statistics & Numerical Data]

Phase 3, Randomized, 20-Month Study of Bimatoprost Implant in Open-Angle Glaucoma and Ocular Hypertension (ARTEMIS 1). - Medeiros, Felipe A; Walters, Thomas R; Kolko, Miriam; Coote, Michael; Bejanian, Marina; Goodkin, Margot L; Guo, Qiang; Zhang, Jane; Robinson, Michael R; Weinreb, Robert N; ARTEMIS 1 Study Group (Ophthalmology, 2020)
PURPOSE: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of 10- and 15-mug bimatoprost implant in subjects with open-angle glaucoma (OAG) and ocular hypertension (OHT) after initial and repeated administrations., DESIGN: Randomized, 20-month, multicenter, subject- and efficacy evaluator-masked, parallel-group, phase 3 clinical study., PARTICIPANTS: Adults with OAG or OHT in each eye, open iridocorneal angle inferiorly in the study eye, and study eye baseline IOP (hour 0; 8 am) of 22-32 mmHg after washout., METHODS: Study eyes received bimatoprost implant 10 mug (n = 198) or 15 mug (n = 198) on day 1 with readministration at weeks 16 and 32, or twice-daily topical timolol maleate 0.5% (n = 198). Intraocular pressure was measured at hours 0 and 2 at each visit., MAIN OUTCOME MEASURES: Primary end points were IOP and change from baseline IOP through week 12. Safety measures included treatment-emergent adverse events (TEAEs) and corneal endothelial cell density (CECD)., RESULTS: Both dose strengths of bimatoprost implant were noninferior to timolol in IOP lowering after each administration. Mean diurnal IOP was 24.0, 24.2, and 23.9 mmHg at baseline and from 16.5-17.2, 16.5-17.0, and 17.1-17.5 mmHg through week 12 in the 10-mug implant, 15-mug implant, and timolol groups, respectively. The incidence of corneal and inflammatory TEAEs of interest (e.g., corneal endothelial cell loss, iritis) was higher with bimatoprost implant than timolol and highest with the 15-mug dose strength. Incidence of corneal TEAEs increased after repeated treatment; with 3 administrations at fixed 16-week intervals, incidence of >=20% CECD loss was 10.2% (10-mug implant) and 21.8% (15-mug implant). Mean best-corrected visual acuity (BCVA) was stable; 3 implant-treated subjects with corneal TEAEs had >2-line BCVA loss at their last visit., CONCLUSIONS: Both dose strengths of bimatoprost implant met the primary end point of noninferiority to timolol through week 12. One year after 3 administrations, IOP was controlled in most subjects without additional treatment. The risk-benefit assessment favored the 10-mug implant over the 15-mug implant. Ongoing studies are evaluating other administration regimens to reduce the potential for CECD loss. The bimatoprost implant has potential to improve adherence and reduce treatment burden in glaucoma. Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Bimatoprost/ad [Administration & Dosage]; Double-Blind Method; Drug Implants; Female; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Timolol/tu [Therapeutic Use]; Tonometry, Ocular; Vitreous Body/de [Drug Effects]; Young Adult

Is Mental Stress the Primary Cause of Glaucoma?. - Sabel, Bernhard A; Lehnigk, Luisa (Klinische Monatsblatter fur Augenheilkunde, 2021)
The prognosis of going blind is very stressful for patients diagnosed with "glaucoma". Worries and fear of losing independence is a constant mental burden, with secondary risks of depression and social isolation. But stress is not only a result of glaucoma but also a possible cause (risk factor). This should not be surprising, given that chronic stress can trigger "psychosomatic" organ dysfunctions anywhere in the body. Why should the organ "eye" be an exception? Indeed, glaucoma patients often suspect that severe emotional stress caused their visual field loss or "foggy vision". The hypothesis that stress is a possible cause of glaucoma is supported by different observations: (i) acute and chronic stress increases intraocular pressure and (ii) long-term stress can lead to vascular dysregulation of the microcirculation in the eye and brain ("Flammer's syndrome"), leading to partial hypoxia and hypoglycaemia (hypo-metabolism). Even if nerve cells do not die, they may then become inactive ("silent" neurons). (iii) Degenerative changes have been reported in the brain of glaucoma patients, affecting not only anterograde or transsynaptic areas of the central visual pathway, but degeneration is also found (iv) in brain areas involved in emotional appraisal and the physiological regulation of stress hormones. There are also psychological hints indicating that stress is a cause of glaucoma: (v) Glaucoma patients with Flammer's syndrome show typical personality traits that are associated with low stress resilience: they often have cold hands or feet, are ambitious (professionally successful), perfectionistic, obsessive, brooding and worrying a lot. (vi) If stress hormone levels and inflammation parameters are reduced in glaucoma patients by relaxation with meditation, this correlates with normalisation of intraocular pressure, and yet another clue is that (vii) visual field improvements after non-invasive current stimulation therapy, that are known to improve circulation and neuronal synchronisation, are much most effective in patients with stress resilient personalities. An appreciation of stress as a "cause" of glaucoma suggests that in addition to standard therapy (i) stress reduction through relaxation techniques should be recommended (e.g. meditation), and (ii) self-medication compliance should not be induced by kindling anxiety and worries with negative communication ("You will go blind!"), but communication should be positive ("The prognosis is optimistic"). Copyright Thieme. All rights reserved.
Keywords: *Glaucoma; Humans; Intraocular Pressure; Tonometry, Ocular; Visual Field Tests; Visual Pathways

[Antiangiogenic therapy of neovascular age-related macular degeneration]. - Fayzrakhmanov, R R; Voropaev, V Yu; Sukhanova, A V; Shatalova, E O (Vestnik oftalmologii, 2021)
The problem associated with the prevalence of retinal diseases, and age-related macular degeneration (AMD) in particular, is undoubtedly relevant. This aspect is based on steadily growing statistics on morbidity, a high number of randomized controlled trials (RCT) and published real world data (RWD). The analysis of RCT results being published by researchers on 15.05.19 showed 2915 studies were registered on the subject of retinal diseases; that exceeds the number of studies on glaucoma by approximately 1.38 times (2118 studies) and conjunctival lesions by 2.37 times (1230 studies). AMD is one of the leading causes of irreversible vision loss and blindness; its neovascular form leads to blindness in 80-90% of all cases. Even though the topic of nAMD therapy is widely highlighted in modern ophthalmology, today there are many aspects that require targeted solutions. The main controversial issues that determine the complexity of therapy and patient management include discrepancies in determination of reference points (disease activity criteria) for implementation of anti-VEGF dosing regimens, patients' compliance, prioritization issues in treatment, its continuity with potential for the increase of intervals between injections and monitoring visits.
Keywords: Angiogenesis Inhibitors/tu [Therapeutic Use]; Humans; Intravitreal Injections; Macular Degeneration/di [Diagnosis]; Macular Degeneration/dt [Drug Therapy]; *Macular Degeneration; Ranibizumab/tu [Therapeutic Use]; Treatment Outcome; Vascular Endothelial Growth Factor A; Visual Acuity; Wet Macular Degeneration/di [Diagnosis]; Wet Macular Degeneration/dt [Drug Therapy]; *Wet Macular Degeneration

Is laser trabeculoplasty the new star in glaucoma treatment?. - Toteberg-Harms, Marc; Meier-Gibbons, Frances (Current opinion in ophthalmology, 2021)
PURPOSE OF REVIEW: For decades, laser trabeculoplasty has been a well-proven therapeutic option in glaucoma management, and more recently, it has only gained in popularity. One reason for such popularity is that selective laser trabeculoplasty (SLT) is a therapy independent of patient adherence, which is typically low among glaucoma patients. Consequently, the number of studies on SLT has multiplied throughout the past years. This review provides an overview of studies on SLT from the last 12 months., RECENT FINDINGS: The studies on treatment outcome show a wide range of success rates of SLT reaching between 18 and 88%; however, study designs differ and many studies are not directly comparable. The prospective laser trabeculoplasty for open-angle glaucoma and ocular hypertension (LiGHT) trial has demonstrated good efficacy of SLT - 75% of the eyes achieved their target pressure without drops and 58% after a single SLT., SUMMARY: SLT has proven to be effective in lowering IOP with satisfactory success rates even after single SLT. SLT is repeatable independent of patient's adherence. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; *Laser Therapy/mt [Methods]; *Lasers, Solid-State/tu [Therapeutic Use]; Ocular Hypertension/pp [Physiopathology]; Ocular Hypertension/su [Surgery]; *Trabecular Meshwork/su [Surgery]; *Trabeculectomy/mt [Methods]

Adherence Studies with Short Follow-up Do Not Suffice for a Chronic Disease Like Open-Angle Glaucoma. - Kashaf, Michael Saheb; Jampel, Henry D (Ophthalmology. Glaucoma, 2020)
Comment on (CON)
Keywords: Chronic Disease; Follow-Up Studies; *Glaucoma; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle; Humans; Medication Adherence; *Mentoring; Pilot Projects

Eyeing the Extracellular Matrix in Vascular Development and Microvascular Diseases and Bridging the Divide between Vascular Mechanics and Function. - Chaqour, Brahim; Karrasch, Charles (International journal of molecular sciences, 2020)
The extracellular matrix (ECM) is critical in all aspects of vascular development and health: supporting cell anchorage, providing structure, organization and mechanical stability, and serving as a sink for growth factors and sustained survival signals. Abnormal changes in ECM protein expression, organization, and/or properties, and the ensuing changes in vascular compliance affect vasodilator responses, microvascular pressure transmission, and collateral perfusion. The changes in microvascular compliance are independent factors initiating, driving, and/or exacerbating a plethora of microvascular diseases of the eye including diabetic retinopathy (DR) and vitreoretinopathy, retinopathy of prematurity (ROP), wet age-related macular degeneration (AMD), and neovascular glaucoma. Congruently, one of the major challenges with most vascular regenerative therapies utilizing localized growth factor, endothelial progenitor, or genetically engineered cell delivery, is the regeneration of blood vessels with physiological compliance properties. Interestingly, vascular cells sense physical forces, including the stiffness of their ECM, through mechanosensitive integrins, their associated proteins and the actomyosin cytoskeleton, which generates biochemical signals that culminate in a rapid expression of matricellular proteins such as cellular communication network 1 (CCN1) and CCN2 (aka connective tissue growth factor or CTGF). Loss or gain of function of these proteins alters genetic programs of cell growth, ECM biosynthesis, and intercellular signaling, that culminate in changes in cell behavior, polarization, and barrier function. In particular, the function of the matricellular protein CCN2/CTGF is critical during retinal vessel development and regeneration wherein new blood vessels form and invest a preformed avascular neural retina following putative gradients of matrix stiffness. These observations underscore the need for further in-depth characterization of the ECM-derived cues that dictate structural and functional properties of the microvasculature, along with the development of new therapeutic strategies addressing the ECM-dependent regulation of pathophysiological stiffening of blood vessels in ischemic retinopathies.
Keywords: Animals; Biomechanical Phenomena; Blood Vessels/em [Embryology]; *Blood Vessels/gd [Growth & Development]; *Blood Vessels/pp [Physiopathology]; *Extracellular Matrix/me [Metabolism]; *Eye/bs [Blood Supply]; Eye/em [Embryology]; *Eye/pa [Pathology]; Eye/pp [Physiopathology]; Eye Diseases/pa [Pathology]; Humans; *Microvessels/pa [Pathology]; *Microvessels/pp [Physiopathology]

European study of the efficacy of a cross-linked gel stent for the treatment of glaucoma. - Fea, Antonio M; Bron, Alain M; Economou, Mario A; Laffi, Gianluca; Martini, Enrico; Figus, Michele; Oddone, Francesco (Journal of cataract and refractive surgery, 2020)
PURPOSE: To investigate the efficacy and safety of a cross-linked gel stent (XEN45) with or without cataract surgery in the treatment of glaucoma patients., SETTING: Five university hospitals., DESIGN: Prospective multicenter clinical trial., METHODS: Patients with glaucoma inadequately controlled by treatment or poor compliance or intolerance to topical therapy were included. Patients were divided into those who had an implant only (Solo Group; phakic and pseudophakic patients) and those who had an implant combined with cataract surgery (Combo Group). Differences in mean intraocular pressure (IOP) and number of medications between the baseline preoperative visit and study end (12 months), and the rate of qualified and complete success, were evaluated., RESULTS: The Solo Group comprised 115 glaucoma patients (43 phakic and 72 pseudophakic) and the Combo Group comprised 56 patients. Compared with baseline, mean IOP (23.9 +/- 7.6 to 15.5 +/- 3.9) and number of medications (3.0 +/- 1.1 to 0.5 +/- 1.0) decreased significantly at 12-month follow-up (P < .001 for both). A >20% and >30% reduction in IOP from baseline was achieved by 72.3% and 52.6% of patients, respectively. IOP at 1 week postoperatively was a predictor of success, and the needling rate was inversely correlated with early postoperative IOP. The number of preoperative medications and patient age were not significantly associated with failure., CONCLUSIONS: Insertion of a cross-linked gel stent alone or combined with phacoemulsification might be effective and safe in the treatment of open-angle glaucoma, with a substantial reduction in IOP and number of medications.
Keywords: Aged; Aged, 80 and over; Europe; Female; Follow-Up Studies; *Glaucoma Drainage Implants; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Prospective Studies; *Stents; Tonometry, Ocular; Treatment Outcome; Visual Acuity/ph [Physiology]

Beliefs and Attitudes of Ophthalmologists Regarding SLT as First Line Therapy for Glaucoma. - Bonafede, Lucas; Sanvicente, Carina T; Hark, Lisa A; Tran, Judie; Tran, Evelyn; Zhang, Qiang; Costello, Rose; Myers, Jonathan S; Katz, L Jay (Journal of glaucoma, 2020)
PRECIS: Targeted educational interventions for physicians may be useful in increasing adoption of selective laser trabeculoplasty (SLT) as first line therapy for the treatment of glaucoma., PURPOSE: SLT is a safe and effective first line treatment for glaucoma, however, it is underutilized. To evaluate barriers for the widespread adoption of this procedure, we assessed the beliefs and attitudes of ophthalmologists. We developed an educational intervention directed to physicians to increase the consideration of SLT earlier in the glaucoma treatment paradigm., SUBJECTS AND METHODS: In this prospective study, an online survey and educational slide presentation was sent to a group of comprehensive ophthalmologists, ophthalmology residents, and glaucoma specialists. Subjects were asked to respond to questions regarding their beliefs and attitudes towards SLT before and after watching the educational slide presentation., RESULTS: A total of 53 subjects were enrolled. Before watching the slide presentation, 85% of subjects stated they offer SLT to newly diagnosed patients, although only 28% preferred it over medications. While 52% of physicians reported between 0% and 10% of their newly diagnosed patients receive laser therapy, 47% said they would use it as a first line therapy for all or most newly diagnosed glaucoma patients. Most subjects (94%) stated the educational slide presentation convinced them that SLT is appropriate as a first line therapy for treatment of open angle glaucoma., CONCLUSIONS: A better understanding of the barriers for utilizing SLT as a first line therapy provides valuable information to help increase the adoption of this safe and effective procedure. A targeted educational intervention may improve acceptance of SLT as first line therapy for open angle glaucoma.
Keywords: Attitude of Health Personnel; Female; Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; *Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Intraocular Pressure/ph [Physiology]; *Laser Therapy/mt [Methods]; *Lasers, Solid-State/tu [Therapeutic Use]; Male; Middle Aged; *Ophthalmologists/px [Psychology]; Prospective Studies; Surveys and Questionnaires; *Trabeculectomy/mt [Methods]; Treatment Outcome

Medication Adherence and Liquid Level Tracking System for Healthcare Provider Feedback. - Payne, Nolan; Gangwani, Rahul; Barton, Kira; Sample, Alanson P; Cain, Stephen M; Burke, David T; Newman-Casey, Paula Anne; Shorter, K Alex (Sensors (Basel, Switzerland), 2020)
A common problem for healthcare providers is accurately tracking patients' adherence to medication and providing real-time feedback on the management of their medication regimen. This is a particular problem for eye drop medications, as the current commercially available monitors focus on measuring adherence to pills, and not to eye drops. This work presents an intelligent bottle sleeve that slides onto a prescription eye drop medication bottle. The intelligent sleeve is capable of detecting eye drop use, measuring fluid level, and sending use information to a healthcare team to facilitate intervention. The electronics embedded into the sleeve measure fluid level, dropper orientation, the state of the dropper top (on/off), and rates of angular motion during an application. The sleeve was tested with ten patients (age >=65) and successfully identified and timestamped 94% of use events. On-board processing enabled event detection and the measurement of fluid levels at a 0.4 mL resolution. These data were communicated to the healthcare team using Bluetooth and Wi-Fi in real-time, enabling rapid feedback to the subject. The healthcare team can therefore monitor a log of medication use behavior to make informed decisions on treatment or support for the patient.
Keywords: Algorithms; Glaucoma/dt [Drug Therapy]; Health Personnel/sn [Statistics & Numerical Data]; Humans; Machine Learning; *Medication Adherence/sn [Statistics & Numerical Data]; *Ophthalmic Solutions/tu [Therapeutic Use]

[Professor ZHANG Ren's clinical experience of acupuncture for glaucoma]. - Liu, Jian; Xu, Hong; Zhang, Jin; Ying, Jia-Wei; Shen, Feng-Jiao (Zhongguo zhen jiu = Chinese acupuncture & moxibustion, 2020)
Professor ZHANG Ren's clinical experience of acupuncture for glaucoma is summarized. Professor ZHANG believes that key pathogenesis of glaucoma is stagnation of qi and blood in the eyes, obstruction of xuanfu in the eyes, and obstruction of meridians. The treatment should focus on the eye, with smoothing the liver and keeping functional state of six-fu as priority; he also emphasizes the acupoint selection based on the combination of disease differentiation and syndrome differentiation, and pays attention to the application of acupuncture method of promoting qi circulation and inducting qi movement. Professor ZHANG proposes that the patients should be treated according to different types, and stresses the importance of using comprehensive treatment and emotional adjustment method, as well as early intervention, long-term adherence and regular treatment.
Keywords: Acupuncture Points; *Acupuncture Therapy; Glaucoma/th [Therapy]; *Glaucoma; Humans; Male; *Meridians; Syndrome

Follow-up Adherence and Barriers to Care for Pediatric Glaucomas at a Tertiary Care Center. - Mikolajczyk, Brian; Greenberg, Ethan R; Fuher, Hannah; Berres, Michael; May, Laura L; Areaux, Raymond G Jr (American journal of ophthalmology, 2021)
PURPOSE: To determine the percent adherence to follow-up for patients with pediatric glaucomas seen at a tertiary care center and to elucidate risk factors., DESIGN: Retrospective cohort study., METHODS: Patients with pediatric glaucomas seen at the University of Minnesota over 8.5 years were classified as adherent, nonadherent, or lost to tertiary follow-up if they followed up within 0-30 days, between 31 and 180 days, or later than 180 days of the recommended appointment time or never, respectively., RESULTS: Of 176 patients analyzed, 95 (54%) were adherent (51% male; mean [standard deviation (SD)] age: 56.1 [59.8] months), 5 (3%) were nonadherent (20% male; mean [SD] age: 25.0 [35.8] months), and 76 (43%) were lost to tertiary follow-up (55% male; mean [SD] age: 58.9 [53.1] months). Multiple logistic regression analysis of variables that were significant in isolation revealed that only race (white: odds ratio, 3.58; 95% confidence interval, 1.42-9.05; P = .007) and distance from the eye clinic (per 50 miles: odds ratio, 0.79; 95% confidence interval, 0.67-0.92; P = .003) significantly impacted adherence., CONCLUSIONS: This is the first study of adherence to follow-up recommendations for patients with pediatric glaucomas. Percent adherence to follow-up appointments was alarmingly low, and decreased adherence was observed with non-white race and increased distance to the eye clinic. Physicians should consider these risk factors when risk-stratifying patients with pediatric glaucomas for nonadherence to follow-up. Additional studies to improve adherence through interventions that reduce biases and barriers to follow-up are needed. Copyright © 2020 Elsevier Inc. All rights reserved.
Keywords: *Aftercare/sn [Statistics & Numerical Data]; Ambulatory Care Facilities/sn [Statistics & Numerical Data]; Appointments and Schedules; Child, Preschool; Continuity of Patient Care/sn [Statistics & Numerical Data]; Female; *Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; *Hydrophthalmos/di [Diagnosis]; Hydrophthalmos/th [Therapy]; Infant; Intraocular Pressure/ph [Physiology]; Lost to Follow-Up; Male; Medication Adherence; *Patient Compliance/sn [Statistics & Numerical Data]; Retrospective Studies; Surveys and Questionnaires; Tertiary Care Centers/sn [Statistics & Numerical Data]; Visual Acuity/ph [Physiology]

Identification and molecular characterization of Subramaniula asteroides causing human fungal keratitis: a case report. - Cultrera, Rosario; Torelli, Riccardo; Sarnicola, Caterina; Segala, Daniela; Mengoli, Andrea; Chiaretto, Giuseppina; Perri, Paolo; Sanguinetti, Maurizio (BMC infectious diseases, 2021)
BACKGROUND: Keratitis due to by filamentous fungi are not easy to diagnose thus causing a delay in correct therapy. There are many descriptions of keratitis due to Candida, Fusarium and Aspergillus genera. Subramaniula genus has only recently been reported to cause human infections and there are few descriptions of eye infections due to this filamentous fungus. Diagnosis of fungal keratitis is usually based on microscopic and cultural techniques of samples obtained by corneal swabbing or scraping. Considering the amount of time required to obtain culture results it is wise to use other diagnostic methods, such as molecular analyses. Therapeutic options against these fungi are limited by low tissue penetration in the eye due to ocular barriers. We describe the first case of S. asteroides human keratitis treated with isavuconazole., CASE PRESENTATION: We describe a rare case of fungal keratitis unresponsive to antimicrobial treatment in a 65-year-old male patient without a history of diabetes or immunological diseases. He reported that the onset of symptoms occurred during a long holiday in Cape Verde Island. Initial treatment with topical antibiotics associated to steroids were ineffective, allowing a slow clinical progression of disease to corneal perforation. On admission in our Hospital, slit-lamp examination of the left eye showed conjunctival congestion and hyperemia, a large inferior corneal ulceration with brown pigment, corneal edema, about 3 mm of hypopyon and irido-lenticular synechiae. The slow clinical progression of the disease to corneal perforation and the aspect of the ulcer were consistent with a mycotic etiology. Molecular methods used on fungal colonies isolated by Sabouraud's dextrose agar cultures allowed the identification of Subramaniula asteroids from corneal scraping. Antimicrobial test showed a good susceptibility of this filamentous fungus to voriconazole and isavuconazole. Moreover, this fungal keratitis was successfully treated with isavuconazole, without side effects, observing a progressive clinical improvement., CONCLUSIONS: Molecular methods may be useful for the identification of filamentous fungal keratitis on scraping samples thus shortening the time of diagnosis. Systemic therapy by isavuconazole could be useful to treat the filamentous fungal keratitis, reducing the possible adverse effects due to the use of voriconazole by systemic administration.
Keywords: Aged; Antifungal Agents/ad [Administration & Dosage]; Antifungal Agents/tu [Therapeutic Use]; *Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; Diagnosis, Differential; *Eye Infections, Fungal/di [Diagnosis]; Eye Infections, Fungal/dt [Drug Therapy]; Eye Infections, Fungal/mi [Microbiology]; Humans; Male; Nitriles/ad [Administration & Dosage]; Nitriles/tu [Therapeutic Use]; Ophthalmic Solutions; Pyridines/ad [Administration & Dosage]; Pyridines/tu [Therapeutic Use]; *Sordariales/ip [Isolation & Purification]; Triazoles/ad [Administration & Dosage]; Triazoles/tu [Therapeutic Use]

Glaucoma in Adults-Screening, Diagnosis, and Management: A Review. - Stein, Joshua D; Khawaja, Anthony P; Weizer, Jennifer S (JAMA, 2021)
Importance: Glaucoma is the most common cause of irreversible blindness worldwide. Many patients with glaucoma are asymptomatic early in the disease course. Primary care clinicians should know which patients to refer to an eye care professional for a complete eye examination to check for signs of glaucoma and to determine what systemic conditions or medications can increase a patient's risk of glaucoma. Open-angle and narrow-angle forms of glaucoma are reviewed, including a description of the pathophysiology, risk factors, screening, disease monitoring, and treatment options., Observations: Glaucoma is a chronic progressive optic neuropathy, characterized by damage to the optic nerve and retinal nerve fiber layer, that can lead to permanent loss of peripheral or central vision. Intraocular pressure is the only known modifiable risk factor. Other important risk factors include older age, nonwhite race, and a family history of glaucoma. Several systemic medical conditions and medications including corticosteroids, anticholinergics, certain antidepressants, and topiramate may predispose patients to glaucoma. There are 2 broad categories of glaucoma, open-angle and angle-closure glaucoma. Diagnostic testing to assess for glaucoma and to monitor for disease progression includes measurement of intraocular pressure, perimetry, and optical coherence tomography. Treatment of glaucoma involves lowering intraocular pressure. This can be achieved with various classes of glaucoma medications as well as laser and incisional surgical procedures., Conclusions and Relevance: Vision loss from glaucoma can be minimized by recognizing systemic conditions and medications that increase a patient's risk of glaucoma and referring high-risk patients for a complete ophthalmologic examination. Clinicians should ensure that patients remain adherent with taking glaucoma medications and should monitor for adverse events from medical or surgical interventions used to treat glaucoma.
Keywords: Adult; Disease Progression; Eye/ah [Anatomy & Histology]; Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Glaucoma/th [Therapy]; *Glaucoma; Humans; *Intraocular Pressure; Mass Screening; Prognosis; Risk Factors; Vision Disorders/et [Etiology]; Vision Disorders/pc [Prevention & Control]

Tele-glaucoma versus clinical evaluation: The New Jersey Health Foundation Prospective Clinical Study. - Chandrasekaran, Subhashini; Kass, William; Thangamathesvaran, Loka; Mendez, Nicole; Khouri, Peter; Szirth, Bernard C; Khouri, Albert S (Journal of telemedicine and telecare, 2020)
INTRODUCTION: Glaucoma, the second most common cause of blindness, is normally detected in clinic. With technological improvements, tele-glaucoma exams can identify these changes off-site. The quality of tele-glaucoma exams needs to be compared with that of traditional exams. This study's purpose was to validate the tele-glaucoma programme, which allows a physician comprehensive access to patients' data, by comparing results to clinical examinations., METHODS: A prospective study of 107 subjects evaluated in clinic and then tele-glaucoma stations, which consisted of non-mydriatic fundus photography, puff-tonometry, auto-refraction and Optical Coherence Tomography (OCT). The OCT captured central corneal thickness, angle anatomy, cup-to-disc ratio (CDR), retinal nerve fibre layer distribution and posterior-pole ganglion cell complex data., RESULTS: Intraocular pressure (IOP) comparisons between clinical and tele-glaucoma exams had strong positive Pearson correlation coefficients (0.8248 OD, 0.8672 OS). Strong positive correlations were seen for CDR (0.7835 OD, 0.8082 OS) as well as diagnosis (glaucoma, no glaucoma or glaucoma suspect). A moderate positive correlation was seen for return to clinic time (RTC). Tele-glaucoma had an average lower RTC (2.7 vs 3.9 months). Tele-glaucoma was more likely to elicit a non-glaucomatous diagnosis not found in clinic vs a diagnosis found only in clinic (18% vs 5% of subjects)., DISCUSSION: Tele-glaucoma allows for detecting glaucoma remotely. These advancements alleviate patient difficulties with obtaining adequate glaucoma screenings and helps ophthalmologists triage patients with more severe pathology. Our study indicates that our tele-glaucoma protocol is comparable to a clinical exam in its ability to detect glaucoma. Further studies will be needed for off-site testing and transferring data separately for analysis.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Diagnostic Techniques, Ophthalmological; Female; *Glaucoma/di [Diagnosis]; Health Services Accessibility; Humans; Intraocular Pressure; Male; Middle Aged; New Jersey; Photography; Prospective Studies; Sensitivity and Specificity; *Telemedicine/og [Organization & Administration]; Waiting Lists; Young Adult

Algorithms for Diagnosis of Diabetic Retinopathy and Diabetic Macula Edema- A Review. - Suriyasekeran, Karkuzhali; Santhanamahalingam, Senthilkumar; Duraisamy, Manimegalai (Advances in experimental medicine and biology, 2021)
Human eye is one of the important organs in human body, with iris, pupil, sclera, cornea, lens, retina and optic nerve. Many important eye diseases as well as systemic diseases manifest themselves in the retina. The most widespread causes of blindness in the industrialized world are glaucoma, Age Related Macular Degeneration (ARMD), Diabetic Retinopathy (DR) and Diabetic Macula Edema (DME). The development of a retinal image analysis system is a demanding research topic for early detection, progression analysis and diagnosis of eye diseases. Early diagnosis and treatment of retinal diseases are essential to prevent vision loss. The huge and growing number of retinal disease affected patients, cost of current hospital-based detection methods (by eye care specialists) and scarcity in the number of ophthalmologists are the barriers to achieve the recommended screening compliance in the patient who is at the risk of retinal diseases. Developing an automated system which uses pattern recognition, computer vision and machine learning to diagnose retinal diseases is a potential solution to this problem. Damage to the tiny blood vessels in the retina in the posterior part of the eye due to diabetes is named as DR. Diabetes is a disease which occurs when the pancreas does not secrete enough insulin or the body does not utilize it properly. This disease slowly affects the circulatory system including that of the retina. As diabetes intensifies, the vision of a patient may start deteriorating and leading to DR. The retinal landmarks like OD and blood vessels, white lesions and red lesions are segmented to develop automated screening system for DR. DME is an advanced symptom of DR that can lead to irreversible vision loss. DME is a general term defined as retinal thickening or exudates present within 2 disk diameter of the fovea center; it can either focal or diffuse DME in distribution. In this paper, review the algorithms used in diagnosis of DR and DME.
Keywords: Algorithms; *Diabetes Mellitus; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy; Edema; Humans; Macular Edema/di [Diagnosis]; *Macular Edema; Retina

The ACE2-deficient mouse: A model for a cytokine storm-driven inflammation. - Wang, Junyi; Kaplan, Nihal; Wysocki, Jan; Yang, Wending; Lu, Kurt; Peng, Han; Batlle, Daniel; Lavker, Robert M (FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 2020)
Angiotensin converting enzyme 2 (ACE2) plays an important role in inflammation, which is attributable at least, in part, to the conversion of the pro-inflammatory angiotensin (Ang) II peptide into angiotensin 1-7 (Ang 1-7), a peptide which opposes the actions of AngII. ACE2 and AngII are present in many tissues but information on the cornea is lacking. We observed that mice deficient in the Ace2 gene (Ace2-/- ), developed a cloudy cornea phenotype as they aged. Haze occupied the central cornea, accompanied by corneal edema and neovascularization. In severe cases with marked chronic inflammation, a cell-fate switch from a transparent corneal epithelium to a keratinized, stratified squamous, psoriasiform-like epidermis was observed. The stroma contained a large number of CD11c, CD68, and CD3 positive cells. Corneal epithelial debridement experiments in young ACE2-deficient mice showed normal appearing corneas, devoid of haze. We hypothesized, however, that these mice are "primed" for a corneal inflammatory response, which once initiated, would persist. In vitro studies reveal that interleukins (IL-1a, IL-1b), chemokines (CCL2, CXCL8), and TNF-alpha, are all significantly elevated, resulting in a cytokine storm-like phenotype. This phenotype could be partially rescued by treatment with the AngII type 1 receptor (AT1R) antagonist, losartan, suggesting that the observed effect was mediated by AngII acting on its main receptor. Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes human ACE2 as the receptor for entry with subsequent downregulation of ACE2, corneal inflammation in Ace2-/- mice may have a similar mechanism with that in COVID-19 patients. Thus the Ace2-/- cornea, because of easy accessibility, may provide an attractive model to explore the molecular mechanisms, immunological changes, and treatment modalities in patients with COVID-19. Copyright © 2020 Federation of American Societies for Experimental Biology.
Keywords: Angiotensin II/me [Metabolism]; *Angiotensin-Converting Enzyme 2/ge [Genetics]; Animals; COVID-19; Cells, Cultured; Chemokines/me [Metabolism]; *Cornea/pa [Pathology]; *Cytokine Release Syndrome/pp [Physiopathology]; *Disease Models, Animal; Epithelial Cells/me [Metabolism]; Humans; Interleukins/me [Metabolism]; Mice; Mice, Inbred C57BL; Mice, Knockout; SARS-CoV-2; THP-1 Cells; Tumor Necrosis Factor-alpha/me [Metabolism]

Fixed-Dose Combination of Netarsudil and Latanoprost in Ocular Hypertension and Open-Angle Glaucoma: Pooled Efficacy/Safety Analysis of Phase 3 MERCURY-1 and -2. - Asrani, Sanjay; Bacharach, Jason; Holland, Edward; McKee, Hayley; Sheng, Huan; Lewis, Richard A; Kopczynski, Casey C; Heah, Theresa (Advances in therapy, 2020)
INTRODUCTION: New open-angle glaucoma (OAG) and ocular hypertension (OHT) therapies that reduce treatment burden and improve outcomes relative to currently available agents are needed. Netarsudil, a novel Rho kinase inhibitor approved by the US Food and Drug Administration, reduces intraocular pressure (IOP) by increasing trabecular outflow. Two phase 3 superiority studies compared a fixed-dose combination (FDC) of netarsudil and the prostaglandin latanoprost with each active component for IOP-lowering efficacy., METHODS: Pooled efficacy and safety data were analyzed from MERCURY-1 and -2 studies in patients with OAG or OHT. Patients instilled one drop of netarsudil (0.02%)/latanoprost (0.005%) FDC (n = 483), netarsudil (0.02%, n = 499), or latanoprost (0.005%, n = 486) into each eye once-daily between 20:00 and 22:00. IOP was measured at 08:00, 10:00, and 16:00 at weeks 2, 6, and the primary endpoint at month 3., RESULTS: Baseline mean diurnal IOP was 23.6, 23.6, and 23.5 mmHg in netarsudil/latanoprost FDC, netarsudil, and latanoprost groups, respectively. Mean diurnal IOP in each group was 15.3, 18.1, and 17.5 mmHg at week 2, 15.7, 18.4, and 17.4 mmHg at week 6, and 15.8, 18.4, and 17.3 mmHg at week 12. The netarsudil/latanoprost FDC met criteria for superiority compared with each active component (p < 0.0001 for all nine time points). At month 3, among patients randomized to netarsudil/latanoprost FDC or latanoprost, 58.4% vs 37.3% (p < 0.0001) achieved IOP <= 16 mmHg. Among patients randomized to netarsudil/latanoprost FDC or netarsudil or latanoprost, 30.9% vs 5.9% (p < 0.0001) vs 8.5% (p < 0.0001) achieved at least a 40% reduction from baseline in mean diurnal IOP. Pooled safety results were consistent with individual MERCURY studies., CONCLUSION: Once-daily netarsudil/latanoprost FDC produced statistically significant and clinically relevant reductions in mean IOP that were statistically superior to IOP reductions achieved by netarsudil and latanoprost monotherapy. Results of the pooled efficacy and safety analyses were consistent with the individual studies., TRIAL REGISTRATION: ClinicalTrials.gov identifiers, NCT02558400 and NCT02674854.
Keywords: Aged; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Benzoates/ae [Adverse Effects]; *Benzoates/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost/ae [Adverse Effects]; *Latanoprost/tu [Therapeutic Use]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ae [Adverse Effects]; *Ophthalmic Solutions/tu [Therapeutic Use]; Tonometry, Ocular; United States; United States Food and Drug Administration; beta-Alanine/ae [Adverse Effects]; *beta-Alanine/aa [Analogs & Derivatives]; beta-Alanine/tu [Therapeutic Use]

Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria. - Taryam, Manal Omran; Rabiu, Muhammad M; Muhammad, Nasiru; Oladigbolu, Kehinde; Abdurrahman, Halima (The British journal of ophthalmology, 2020)
AIM: To generate data on blindness and visual impairment for planning and monitoring a comprehensive eye care programme in Katsina state of Nigeria., METHOD: A rapid assessment of avoidable blindness (RAAB) survey methodology was used to select 3120 persons aged 50 years and over. The sample was selected using a multistage cluster randomised sampling. Each participant had visual acuity and lens assessment. Persons with vision less than 6/12 in any eye were assessed for the cause of visual impairment. Persons with cataract were asked why they had not had surgery. Data were captured electronically with the mRAAB Android-based software and analysed with STATA V.14 software., RESULTS: A response rate of 90.1% was achieved. The age-sex adjusted blindness prevalence was 5.3% (95% CI 5.2% to 5.3%). Women were 30% more likely to be blind (OR 1.3, 95% CI 1.2 to 1.3). The principal causes of blindness were cataract (70%), other posterior segment (12%) and glaucoma (7%); 86.7% of blindness was avoidable. The prevalence of cataract blindness is 2.6% (95% CI 2.5% to 2.6%) with higher odds in women (OR 1.2, 95% CI 1.2 to 1.3, p<0.005). The cataract surgical coverage <6/60 for persons was 28.2% and women were 45% less likely to have had cataract surgery (OR 0.55, 95% CI 0.34 to 0.78, p<0.005). The major barriers to cataract surgery are lack of felt need and the cost of services., CONCLUSION: Katsina state of Nigeria has high burden of avoidable blindness affecting more women. The state eye care programme should have cataract services that are more accessible, affordable and gender sensitive. Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; *Cataract Extraction/ae [Adverse Effects]; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Nigeria/ep [Epidemiology]; *Postoperative Complications; Prevalence; Retrospective Studies; *Risk Assessment/mt [Methods]; Risk Factors; *Vision Disorders/ep [Epidemiology]; Vision Disorders/et [Etiology]

Stable Fabrication of Zwitterionic Coating Based on Copper-Phenolic Networks on Contact Lens with Improved Surface Wettability and Broad-Spectrum Antimicrobial Activity. - Liu, Gongyan; Li, Kaijun; Wang, Haibo; Ma, Li; Yu, Ling; Nie, Yu (ACS applied materials & interfaces, 2020)
Ocular dryness and contact lens(CL)-related microbial keratitis (MK) are two major risks of wearing CLs. The development of multifunctional surface coating for CLs with excellent hydrating and antimicrobial properties is a practical strategy to improve the comfort of CL wearers and to prevent corneal infection. Here, we develop zwitterionic and antimicrobial metal-phenolic networks (MPNs) based on the coordination of copper ions (CuII) and the poly(carboxylbetaine-co-dopamine methacrylamide) copolymer (PCBDA), which can be easily one-step prepared onto CLs due to the near-universal adherent properties of catechol groups. The zwitterionic and antifouling carboxybetaine (CB) groups of the CuII-PCBDA coating can significantly increase the wettability of CLs and reduce their protein adsorptions, resulting in a lens surface that is more water retentive and with lower protein binding to prevent tear film evaporation and eye dryness. In addition, since the immobilized copper ions in the MPNs impart them with ion-mediated antimicrobial activity, the CuII-PCBDA coating exhibits a strong and broad-spectrum antimicrobial activity against MK related pathogenic microbes, including bacteria, such as Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus, and fungi, such as Candida albicans. Compared with a pristine CL, the CuII-PCBDA-coated CL effectively inhibited biofilm formation even after daily exposure to the above microbial environment for 14 days. Notably, the CuII-PCBDA coating developed in this study is not only biocompatible with 100% cell viability following direct contact with human corneal epithelial cells (HCECs) for 48 h but also maintains the optical clarity of the native CLs. Thus, the CuII-PCBDA coating has a great application potential for the development of a multifunctional surface coating for CLs for increased CL comfort and prevention of MK.
Keywords: Adsorption/de [Drug Effects]; Anti-Infective Agents/cs [Chemical Synthesis]; *Anti-Infective Agents/ch [Chemistry]; Anti-Infective Agents/pd [Pharmacology]; Bacterial Adhesion/de [Drug Effects]; Coated Materials, Biocompatible/cs [Chemical Synthesis]; *Coated Materials, Biocompatible/ch [Chemistry]; Coated Materials, Biocompatible/pd [Pharmacology]; *Contact Lenses/mi [Microbiology]; Copper/ch [Chemistry]; Escherichia coli/de [Drug Effects]; Escherichia coli/py [Pathogenicity]; Humans; Phenols/ch [Chemistry]; Pseudomonas aeruginosa/de [Drug Effects]; Pseudomonas aeruginosa/py [Pathogenicity]; Staphylococcus aureus/de [Drug Effects]; Staphylococcus aureus/py [Pathogenicity]; Surface Properties; *Wettability/de [Drug Effects]

Small interfering RNAs (siRNAs) based gene silencing strategies for the treatment of glaucoma: Recent advancements and future perspectives. - Naik, Santoshi; Shreya, Ajjappla Basavaraj; Raychaudhuri, Ruchira; Pandey, Abhijeet; Lewis, Shaila A; Hazarika, Manali; Bhandary, Sulatha V; Rao, Bola Sadashiva Satish; Mutalik, Srinivas (Life sciences, 2021)
RNA-interference-based mechanisms, especially the use of small interfering RNAs (siRNAs), have been under investigation for the treatment of several ailments and have shown promising results for ocular diseases including glaucoma. The eye, being a confined compartment, serves as a good target for the delivery of siRNAs. This review focuses on siRNA-based strategies for gene silencing to treat glaucoma. We have discussed the ocular structures and barriers to gene therapy (tear film, corneal, conjunctival, vitreous, and blood ocular barriers), methods of administration for ocular gene delivery (topical instillation, periocular, intracameral, intravitreal, subretinal, and suprachoroidal routes) and various viral and non-viral vectors in siRNA-based therapy for glaucoma. The components and mechanism of siRNA-based gene silencing have been mentioned briefly followed by the basic strategies and challenges faced during siRNA therapeutics development. We have emphasized different therapeutic targets for glaucoma which have been under research by scientists and the current siRNA-based drugs used in glaucoma treatment. We also mention briefly strategies for siRNA-based treatment after glaucoma surgery. Copyright © 2020. Published by Elsevier Inc.
Keywords: Animals; Eye/pa [Pathology]; *Gene Silencing; Gene Transfer Techniques; Genetic Therapy; *Glaucoma/ge [Genetics]; *Glaucoma/th [Therapy]; Humans; *RNA, Small Interfering/me [Metabolism]

Reduced administration frequency for the treatment of fungal keratitis: a sustained natamycin release from a micellar solution. - Guo, Yiyuan; Karimi, Fatemeh; Fu, Qiang; G Qiao, Greg; Zhang, Hong (Expert opinion on drug delivery, 2020)
Background: Natamycin is the only topical ophthalmic antifungal drug approved by the Food and Drug Administration (FDA) of the United States, but has unsatisfactory factors such as high dosing frequency. Methods: We report the synthesis and preparation of self-assembled poly(ethylene glycol)-block-poly(glycidyl methacrylate) (PEG-b-PGMA) micelles. These nanoparticles exhibit sustained delivery of a hydrophobic natamycin by topical administration on eye due to the hydrolysable properties of PGMA segments of micelle. Hydrolysis of glycidyl groups within a physiologically relevant environment provides an additional driving force for drug release by generation of hydrophilic hydroxyl groups to 'push' the encapsulated hydrophobic drug away from the resultant hydrophilic domains and into surrounding environment. Results: In vitro and in vivo results revealed that the self-assembled micelles and the encapsulated natamycin were not cytotoxic and the released drug have strong antifungal ability to Candida albicans. Importantly, sustained natamycin release from micelles leads to the reduced administration frequency of natamycin from 8 times per day to 3 times per day in rabbits suffering from fungal keratitis (FK). Conclusion: This study demonstrates a facile method that can greatly reduce dosing frequency of natamycin administration and thus improve long-term patient compliance.
Keywords: Administration, Topical; Animals; *Antifungal Agents/ad [Administration & Dosage]; Drug Liberation; *Eye Infections, Fungal/dt [Drug Therapy]; Humans; *Keratitis/dt [Drug Therapy]; Micelles; Nanoparticles/ch [Chemistry]; *Natamycin/ad [Administration & Dosage]; Rabbits

Controlled in vitro delivery of voriconazole and diclofenac to the cornea using contact lenses for the treatment of Acanthamoeba keratitis. - Morgan, Sian R; Pilia, Nicole; Hewitt, Melissa; Moses, Rachael L; Moseley, Ryan; Lewis, Philip N; Morrison, Peter W J; Kelly, Steven L; Parker, Josie E; Whitaker, David; Quantock, Andrew J; Heard, Charles M (International journal of pharmaceutics, 2020)
Acanthamoeba keratitis is caused by a protozoal infection of the cornea, with 80% of cases involving the improper use of contact lenses. The infection causes intense pain and is potentially blinding. However, early diagnosis improves treatment efficacy and the chances of healing. Despite the apparent accessibility of the cornea, patients do not always respond well to current eye drop treatments largely due to rapid dose loss due to blinking and nasolacrimal drainage. Here, the topical drug delivery of voriconazole alone and in combination with diclofenac via drug-loaded contact lenses, were investigated in vitro. The contact lenses were applied onto excised porcine eyeballs and maintained at 32 degreeC under constant irrigation, with simulated tear fluid applied to mimic in vivo conditions. The drug delivered to the corneas was quantified by HPLC analysis. The system was further tested in terms of cytotoxicity and a scratch wound repopulation model, using resident cell types. Sustained drug delivery to the cornea was achieved and for voriconazole, the MIC against Acanthamoeba castellanii was attained alone and in combination with diclofenac. MTT and scratch wound data showed reasonable cell proliferation and wound repopulation at the drug doses used, supporting further development of the system to treat Acanthamoeba keratitis. Copyright © 2020 Elsevier B.V. All rights reserved.
Keywords: *Acanthamoeba/de [Drug Effects]; *Acanthamoeba Keratitis/dt [Drug Therapy]; Acanthamoeba Keratitis/ps [Parasitology]; Administration, Ophthalmic; Animals; *Contact Lenses, Hydrophilic; Cornea/me [Metabolism]; Cornea/ps [Parasitology]; *Diclofenac/ad [Administration & Dosage]; Diclofenac/pk [Pharmacokinetics]; Disease Models, Animal; Drug Combinations; Drug Liberation; Humans; Hydrogels/ch [Chemistry]; Parasitic Sensitivity Tests; Swine; *Voriconazole/ad [Administration & Dosage]; Voriconazole/pk [Pharmacokinetics]

Prevalence and causes of vision loss in East Asia in 2015: magnitude, temporal trends and projections. - Cheng, Ching-Yu; Wang, Ningli; Wong, Tien Y; Congdon, Nathan; He, Mingguang; Wang, Ya Xing; Braithwaite, Tasanee; Casson, Robert J; Cicinelli, Maria Vittoria; Das, Aditi; Flaxman, Seth R; Jonas, Jost B; et al. (The British journal of ophthalmology, 2020)
BACKGROUND: To determine the prevalence and causes of blindness and vision impairment (VI) in East Asia in 2015 and to forecast the trend to 2020., METHODS: Through a systematic literature review and meta-analysis, we estimated prevalence of blindness (presenting visual acuity <3/60 in the better eye), moderate-to-severe vision impairment (MSVI; 3/60<=presenting visual acuity <6/18), mild vision impairment (mild VI: 6/18<=presenting visual acuity <6/12) and uncorrected presbyopia for 1990, 2010, 2015 and 2020. A total of 44 population-based studies were included., RESULTS: In 2015, age-standardised prevalence of blindness, MSVI, mild VI and uncorrected presbyopia was 0.37% (80% uncertainty interval (UI) 0.12%-0.68%), 3.06% (80% UI 1.35%-5.16%) and 2.65% (80% UI 0.92%-4.91%), 32.91% (80% UI 18.72%-48.47%), respectively, in East Asia. Cataract was the leading cause of blindness (43.6%), followed by uncorrected refractive error (12.9%), glaucoma, age-related macular degeneration, corneal diseases, trachoma and diabetic retinopathy (DR). The leading cause for MSVI was uncorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, corneal disease, trachoma and DR. The burden of VI due to uncorrected refractive error, cataracts, glaucoma and DR has continued to rise over the decades reported., CONCLUSIONS: Addressing the public healthcare barriers for cataract and uncorrected refractive error can help eliminate almost 57% of all blindness cases in this region. Therefore, public healthcare efforts should be focused on effective screening and effective patient education, with access to high-quality healthcare. Copyright © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: *Blindness/ep [Epidemiology]; Far East/ep [Epidemiology]; Humans; Prevalence; *Visual Acuity

A STROBE-compliant case-control study: Effects of cumulative doses of topical atropine on intraocular pressure and myopia progression. - Yu, Teng-Chieh; Wu, Tzu-En; Wang, Yuan-Shen; Cheng, Shen-Fu; Liou, Shiow-Wen (Medicine, 2020)
Topical atropine has become a mainstream treatment of myopia throughout East and Southeast Asia, but it is uncertain whether long-term topical atropine therapy induces intraocular pressure (IOP) elevation and subsequent development of glaucoma. We then prospectively examined the effects of long-term atropine treatment on IOP.Our case series collected 186 myopic children who were younger than 16 years of age. Complete ocular examination data, IOP and refractive status measurements beginning in 2008 were collected for all participants. Participants were divided into two groups: 121 children who received atropine therapy at various concentrations were classified as the treated group, whereas 65 children who did not receive atropine therapy were classified as the untreated (reference) group. In the treated group, clinicians prescribed different concentrations of atropine eye drops according to their discretion with regard to the severity of myopia on each visit of the patient. We then calculated the cumulative dose of atropine therapy from 2008 to the patients' last follow-up in 2009. Furthermore, the treated group was then further divided into low- and high-refractive-error groups of nearly equal size for further analysis. There were no significant differences for the baseline refractive errors and IOPs between the treated and untreated groups. Both the low- and high-cumulative atropine dosage subgroups showed significantly lower myopic progression than the untreated group, but there was no significant difference between the two subgroups in terms of different cumulative dosages. All groups, including the untreated group, showed an increase of mean IOP at the last follow-up, but both low- and high-cumulative atropine dosage subgroups experienced a smaller increase of IOP. The mean IOP of all atropine-treated groups showed no significant increase in either low- or high-refractive-error eyes. This study revealed that topical atropine eye drops do not induce ocular hypertension and are effective for slowing the progression of myopia. The treatment effects are not correlated with the cumulative atropine dosages.
Keywords: Atropine/ad [Administration & Dosage]; *Atropine/tu [Therapeutic Use]; Case-Control Studies; Child; Female; Glaucoma; Humans; Intraocular Pressure; Longitudinal Studies; Male; Muscarinic Antagonists/ad [Administration & Dosage]; *Muscarinic Antagonists/tu [Therapeutic Use]; *Myopia, Degenerative/dt [Drug Therapy]; Myopia, Degenerative/pp [Physiopathology]; Ophthalmic Solutions; Prospective Studies; Tonometry, Ocular

Current and new pharmacotherapeutic approaches for glaucoma. - Shalaby, Wesam Shamseldin; Shankar, Vikram; Razeghinejad, Reza; Katz, L Jay (Expert opinion on pharmacotherapy, 2020)
INTRODUCTION: Glaucoma is the leading cause of irreversible blindness worldwide. Medical therapy is the main line of treatment of open-angle glaucoma (OAG) and ocular hypertension. Despite the expansion of the glaucoma lineup with the newly approved medication classes, many barriers and issues still exist with topical therapy. Novel non-topical drug delivery may address such issues, adding more options to glaucoma pharmacotherapy., AREAS COVERED: This review outlines current topical therapies for glaucoma, in addition to new medications under trials. The issues with topical therapy, in general, are discussed, as well as the new non-topical drug delivery systems. The authors performed a comprehensive search for published studies on glaucoma medical therapy using the electronic database of PubMed and manual search for each medication and non-topical delivery options. The extra- and intraocular delivery methods and the new topical glaucoma medications under research are covered., EXPERT OPINION: Medical management of glaucoma represents a challenge for both patients and clinicians. Noncompliance (e.g. difficulty with administering the eye drops), cost, side effects, and intraocular pressure fluctuation are the major problems with topical therapy. To overcome such barriers, research should continue in developing new medications and innovation of non-topical drug delivery systems.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Delivery Systems; *Glaucoma/dt [Drug Therapy]; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Medication Adherence; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/tu [Therapeutic Use]

Assessing Health Care Burden in Glaucoma Patients with and Without Physical or Mental Comorbidities. - Serbin, Michael; Devine, Beth; Campbell, Joanna; Basu, Anirban (Journal of managed care & specialty pharmacy, 2020)
BACKGROUND: Glaucoma is a collection of eye diseases that damage the eye's optic nerve resulting in vision loss and blindness. Treatment for glaucoma is primarily pharmacologic; however, studies have shown patients have difficulty adhering to topical regimens. The reasons for potentially poor adherence are numerous, including influence from a myriad of either physical or mental comorbid conditions faced by many glaucoma patients. Neither adherence nor associated outcomes have been estimated in these 2 groups of glaucoma patients., OBJECTIVES: To (a) characterize glaucoma patients with and without select physical or mental comorbidities and (b) estimate differences between the 2 groups for 3 types of outcomes: health care resource use (HCRU; office-based/outpatient-based provider visits, emergency room visits, inpatient stays, home health provider days, prescription fills); health care expenditures; and health-related quality of life (HRQoL) as measured by the physical and mental component scores of the Short Form-12., METHODS: We used first-year data from each glaucoma patient's 2-year panel survey in the Medical Expenditure Panel Survey (MEPS) database, 2003-2014. Two groups were created using ICD-9-CM codes collected by MEPS to compare glaucoma patients with and without at least 1 selected physical or mental comorbid condition. Between-group comparisons in the outcomes of interest (HCRU, expenditure, HRQoL) were estimated using multivariable regression analyses while adjusting for socio-demographic and clinical characteristics at baseline., RESULTS: We identified 2,928 unique glaucoma patients during the 11 years of collected data, including 1,539 (53%) who had at least 1 physical or mental comorbid condition of interest. Comparing those with at least 1 select physical or mental comorbidity to those without (n = 1,389), unadjusted HCRU and expenditures were greater in patients with a physical or mental comorbidity (all P < 0.05). After adjustment, significant associations with increased HCRU remained for office-based provider visits and home health provider days (each P < 0.01). Average total expenditures were $12,324 in those with comorbidities and $8,590 for those without. HRQoL (unadjusted and adjusted) was lower in those with a physical or mental comorbid condition (all P < 0.05)., CONCLUSIONS: Some differences in HCRU and expenditures were accounted for by differences in baseline characteristics between those with and those without 1 or more physical or mental comorbid conditions, but differences remained after adjustment. Results suggest that glaucoma patients with physical and mental comorbidities may experience greater HCRU and associated expenditures, and lower HRQoL, when compared with glaucoma patients without these comorbidities With this knowledge, future work may include estimating the effect of the number of these comorbid conditions on each of the 3 types of outcomes., DISCLOSURES: This study received funding support from Allergan. During the time this work was conducted, Serbin was a postdoctoral fellow who was supported by a training grant from Allergan to the University of Washington. Campbell is an employee of Allergan. Serbin, Devine, and Basu each have nothing to disclose. This study was presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research Meeting; May 20-24, 2017; Boston, MA.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Comorbidity; *Cost of Illness; Female; *Glaucoma/ec [Economics]; Glaucoma/th [Therapy]; *Health Care Costs/sn [Statistics & Numerical Data]; Humans; Infant; Male; Medication Adherence; Mental Disorders/ep [Epidemiology]; Middle Aged; Quality of Life; Young Adult

Pathophysiology and Treatment of Diffuse Lamellar Keratitis. - Wilson, Steven E; de Oliveira, Rodrigo Carlos (Journal of refractive surgery (Thorofare, N.J. : 1995), 2020)
PURPOSE: To review cytokine- and chemokine-mediated mechanisms of diffuse lamellar keratitis (DLK) after lamellar corneal surgical procedures., METHODS: Review of the basic science and clinical literature., RESULTS: DLK can occur early or late (months to decades) after all lamellar corneal surgeries, including laser in situ keratomileusis, small incision lenticule extraction, anterior lamellar keratoplasty, and Descemet's stripping automated endothelial keratoplasty. It is most commonly triggered by epithelial injury during or after lamellar surgery, which leads to the release of interleukin (IL)-1alpha, IL-1beta, and tumor necrosis factor (TNF)-alpha from the epithelium and into the stroma. These chemokines directly attract inflammatory cells into the cornea from the limbal blood vessels and also bind to receptors on keratocytes and corneal fibroblasts where myriad chemokines are upregulated that also chemotactically attract monocytes, macrophages, granulocytes, lymphocytes, and other bone marrow-derived cells into the corneal stroma. Other factors that can trigger DLK include retained blood in the interface, endotoxins and other toxins, and excessive keratocyte necrosis caused by femtosecond lasers. Infiltrating cells show a preference to enter any lamellar interface in the cornea, regardless of the time since surgery, because of the ease of movement toward the chemotactic attractants relative to the surrounding stroma with intact collagen lamellae and stromal cells that serve as relative barriers impeding motility. The mainstay of treatment is topical corticosteroids, but severe cases may also be treated with flap lift irrigation and systemic corticosteroids., CONCLUSIONS: DLK can occur early or late after any lamellar corneal surgical procedure and is most commonly triggered by epithelial-stromal-bone marrow-derived cellular interactions mediated by corneal cytokines and chemokines. [J Refract Surg. 2020;36(2):124-130.]. Copyright 2020, SLACK Incorporated.
Keywords: Cornea/su [Surgery]; Cytokines/ph [Physiology]; Glucocorticoids/tu [Therapeutic Use]; Humans; *Keratitis/dt [Drug Therapy]; Keratitis/et [Etiology]; *Keratitis/pp [Physiopathology]; Ophthalmologic Surgical Procedures/ae [Adverse Effects]

Recent avenues in Novel Patient-Friendly Techniques for the Treatment of Diabetes. - Dubey, Sunil Kumar; Alexander, Amit; Pradhyut, K Sai; Agrawal, Mukta; Jain, Rupesh; Saha, Ranendra Narayana; Singhvi, Gautam; Saraf, Swarnlata; Saraf, Shailendra (Current drug delivery, 2020)
BACKGROUND: Diabetes is one of the most common chronic metabolic disorders which affect the quality of human life worldwide. As per the WHO report, between 1980 to 2014, the number of diabetes patients increases from 108 million to 422 million, with a global prevalence rate of 8.5% per year. Diabetes is the prime reason behind various other diseases like kidney failure, stroke, heart disorders, glaucoma, etc. It is recognized as the seventh leading cause of death throughout the world. The available therapies are painful (insulin injections) and inconvenient due to higher dosing frequency. Thus, to find out a promising and convenient treatment, extensive investigations are carried out globally by combining novel carrier system (like microparticle, microneedle, nanocarrier, microbeads etc.) and delivery devices (insulin pump, stimuli-responsive device, inhalation system, bioadhesive patch, insulin pen etc.) for more precise diagnosis and painless or less invasive treatment of disease., OBJECTIVE: The review article is made with an objective to compile information about various upcoming and existing modern technologies developed to provide greater patient compliance and reduce the undesirable side effect of the drug. These devices evade the necessity of daily insulin injection and offer a rapid onset of action, which sustained for a prolonged duration of time to achieve a better therapeutic effect., CONCLUSION: Despite numerous advantages, various commercialized approaches, like Afrezza (inhalation insulin) have been a failure in recent years. Such results call for more potential work to develop a promising system. The novel approaches range from the delivery of non-insulin blood glucose lowering agents to insulin-based therapy with minimal invasion are highly desirable. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
Keywords: *Diabetes Mellitus, Type 1/dt [Drug Therapy]; *Diabetes Mellitus, Type 2/dt [Drug Therapy]; *Drug Delivery Systems; Humans; Hypoglycemic Agents/ad [Administration & Dosage]; Hypoglycemic Agents/ae [Adverse Effects]; *Hypoglycemic Agents/tu [Therapeutic Use]

Determining patient preferences in a glaucoma service: A discrete choice experiment. - Lu, Thomas Chengxuan; Angell, Blake; Dunn, Hamish; Ford, Belinda; White, Andrew; Keay, Lisa (Clinical & experimental ophthalmology, 2019)
IMPORTANCE: Patient perspectives are crucial in informing design of acceptable services., BACKGROUND: This study determined patient preferences in glaucoma care., DESIGN: A discrete choice experiment was used to evaluate the relative importance of out-of-pocket costs, waiting time, continuity of care, service location and expertise., PARTICIPANTS: Ninety-eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney., METHODS: Twelve choice-tasks were presented in random order and forced-choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0)., MAIN OUTCOME MEASURES: The relative importance and the likelihood of choosing services with each attribute were determined. Willingness-to-pay and willingness-to-wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features., RESULTS: Choice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out-of-pocket costs and shorter wait times (all P < .05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188-389) to see a senior eye doctor, and $87 (95% CI 60-116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients., CONCLUSIONS AND RELEVANCE: Expertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out-of-pocket and concede longer waiting times to secure these preferences. Copyright © 2019 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Aged; Ambulatory Care/ec [Economics]; *Ambulatory Care/mt [Methods]; *Cost of Illness; *Disease Management; Female; *Glaucoma/di [Diagnosis]; Glaucoma/ec [Economics]; Humans; Male; Middle Aged; *Patient Preference; Surveys and Questionnaires

Cost-Utility Analysis of Glaucoma Medication Adherence. - Newman-Casey, Paula Anne; Salman, Mariam; Lee, Paul P; Gatwood, Justin D (Ophthalmology, 2020)
PURPOSE: The majority of patients with glaucoma do not take their medications as prescribed. Estimates of the cost-utility value of adherence to prescribed glaucoma medication are vital to implement potentially effective interventions., DESIGN: Cost-utility analysis using Monte Carlo microsimulations incorporating a series of Markov cycles (10 000 iterations per strategy)., PARTICIPANTS: Patients with glaucoma aged >=40 years with a full lifetime horizon (up to 60 years)., METHODS: The analysis estimated glaucomatous progression on the basis of data from the United Kingdom Glaucoma Treatment Study. Participants with glaucoma entered the model at age 40 years with a mean deviation in the better-seeing eye of -1.4+/--1.9 decibels (dB) and -4.3+/--3.4 dB in the worse-seeing eye. Participants whose glaucoma worsened each year accumulate -0.8 dB loss compared with -0.1 dB loss for those who remained stable. Data from the Glaucoma Laser Trial and the Tube versus Trabeculectomy Studies were used to assign probabilities of worsening disease among treated patients. Claims data estimating rates of glaucoma medication adherence over 4 years were used to assign probability of adherence. Those with poor adherence were modeled as having outcomes similar to the placebo arm of the clinical trials. As patients' mean deviation deteriorated, they transitioned between health states from mild (>=-6 dB), to moderate (<-6 to >=-12 dB), to severe glaucoma (<-12 to >=23 dB), to unilateral (<-20 dB) and bilateral blindness. At each health state, patients incurred the costs of treatment and established health utilities; ultimately, societal costs of low vision and blindness were included., MAIN OUTCOME MEASURES: Cost and quality-adjusted life year (QALY) of glaucoma medication adherence., RESULTS: Beginning at an initial glaucoma diagnosis at age 40 years, patients proceeded to single-eye blindness as early as 19 years among those who were nonadherent and 23 years for those remaining adherent. Total healthcare costs for adherent patients averaged $62 782 (standard deviation [SD], 34 107), and those for nonadherent patients averaged $52 722 (SD, 38 868). Nonadherent patients had a mean loss of 0.34 QALYs, resulting in a cost-effectiveness ratio of $29 600 per QALY gained., CONCLUSION: At a conservative willingness to pay of $50 000/QALY, there is room to expand services to improve patient adherence. Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Comment in (CIN)
Keywords: Adult; Aged; *Antihypertensive Agents/ec [Economics]; *Cost-Benefit Analysis/sn [Statistics & Numerical Data]; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; Health Care Costs; Humans; Male; Markov Chains; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Models, Theoretical; Monte Carlo Method; Quality of Life; *Quality-Adjusted Life Years; United Kingdom

The Association between Medication Adherence and Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study. - Newman-Casey, Paula Anne; Niziol, Leslie M; Gillespie, Brenda W; Janz, Nancy K; Lichter, Paul R; Musch, David C (Ophthalmology, 2020)
PURPOSE: To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS)., DESIGN: The CIGTS was a randomized, multicenter clinical trial comparing initial treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed glaucoma., PARTICIPANTS: Three hundred seven participants randomized to the medication arm of the CIGTS., METHODS: Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, "Did you happen to miss any dose of your medication yesterday?" The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported., MAIN OUTCOME MEASURE: Mean deviation over time., RESULTS: Three hundred seven subjects (306 with adherence data) were randomized to treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17-1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86-1.98; P < 0.0001); and subjects who reported missing medication doses at two thirds of visits showed a loss of 2.23 dB (95% CI, 1.19-3.26; P < 0.0001)., CONCLUSIONS: This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and glaucomatous vision loss. Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Disease Progression; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Retrospective Studies; Tonometry, Ocular; *Trabeculectomy; *Vision Disorders/di [Diagnosis]; Vision Disorders/pp [Physiopathology]; Visual Acuity/ph [Physiology]; Visual Field Tests; *Visual Fields/ph [Physiology]

Glaucoma Care of Prison Inmates at an Academic Hospital. - Kanu, Levi N; Jang, Inae; Oh, Daniel J; Tiwana, Manpreet S; Mehta, Amy A; Dikopf, Mark S; Vajaranant, Thasarat S; Aref, Ahmad A; Edward, Deepak P (JAMA ophthalmology, 2020)
Importance: Glaucoma care for prison inmates is underrepresented in the literature even though managing the treatment of such patients may provide unique challenges., Objectives: To evaluate the glaucoma profile of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics., Design, Setting, and Participants: This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017., Main Outcomes and Measures: Diagnosis, glaucoma severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared. Data analyses were conducted from January 2013 to December 2018., Results: In total, 82 patients (161 eyes) had 375 visits during the study period. All patients were male and ranged from 20 to 75 years of age (mean [SD] age, 50.8 [11.9] years). Most participants were black patients (65 [79.3%]). The most common diagnoses were primary open-angle glaucoma (POAG; 53 eyes [32.9%]) and POAG suspect (52 eyes [32.3%]). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70.0% of patients (95% CI, 57.7%-81.2%) reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24 [87.5%]) compared with others taking fewer medications (20 of 35 [57.1%]), for a difference of 30.4% (95% CI, 7.0%-53.6%; P = .02), and among those with advanced disease (22 of 26 [84.6%]) compared with glaucoma suspect (6 of 13 [46.2%]), for a difference of 38.4% (95% CI, 9.3%-67.5%; P = .02). Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant (11 procedures [64.7%]) and trabeculectomy (3 procedures [17.6%]). Only 26.6% of return office visits (95% CI, 21.3%-32.3%) occurred within the recommended follow-up time frame. Furthermore, 93 patients (34.8%; 95% CI, 28.2%-40.0%) were seen more than 1 month after the recommended follow-up., Conclusions and Relevance: Despite incarceration in prison, where medication administration and appointment attendance are theoretically controlled, the results of this study suggested that substantial medication and follow-up nonadherence exists among inmates.
Keywords: *Academic Medical Centers/sn [Statistics & Numerical Data]; Adult; Aged; Antihypertensive Agents/tu [Therapeutic Use]; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ep [Epidemiology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Illinois/ep [Epidemiology]; Intraocular Pressure/ph [Physiology]; Iridectomy; Laser Therapy; Male; Medication Adherence; Middle Aged; Ocular Hypertension/ep [Epidemiology]; Ocular Hypertension/th [Therapy]; *Prisoners/sn [Statistics & Numerical Data]; Prisons; Referral and Consultation; Retrospective Studies; Trabeculectomy; Young Adult

The Efficacy of the After-visit Summary in Medication Recall Among Glaucoma Patients. - Hirabayashi, Kyle J; Pomerantz, Madison; Radell, Jake E; Chadha, Nisha; Thomas, Stephanie; Serle, Janet B (Journal of glaucoma, 2020)
PReCIS:: To assess the after-visit summary (AVS) as a tool for glaucoma medication recall. Medication recall was associated with level of education and complexity of medication regimen. Receiving an AVS was not associated with better medication recall., PURPOSE: The purpose of this study was to determine whether patients given the AVS have better or worse glaucoma medication recall., MATERIALS AND METHODS: Observational clinical study. Adults on >=1 glaucoma medications examined between June 30, 2017 and August 2, 2017., DATA COLLECTION: in-person questionnaire and retrospective chart review. Self-reported glaucoma medications compared with prescribed glaucoma medication regimen verified by electronic medical record. Medication recall assessed using 3-point scoring: 1 point each for; (1) name or color of bottle or cap; (2) treatment eye(s); and (3) dosing regimen., DATA ANALYSIS: 2-sample Welch t test, 2-proportion z-test, analysis of variance, univariate, and multivariate regression., RESULTS: A total of 118 patients enrolled: age 69.7+/-12.9 years (mean+/-SD), 55.9% of patients had received an AVS at the previous visit. Of these, 33.3% reported receiving an AVS, 51.2% reported not receiving one (15.1% did not recall or respond). Patients who had received AVSs had lower medication recall scores than those who did not (2.4+/-1.0 vs. 2.7+/-0.6, P=0.04). Receipt of an AVS was associated with having Nisha Chadha as their provider (P=0.01), fewer days since prior visit (P=0.0001), and medication regimen change at prior visit (P<0.0001). Multivariate analysis revealed completion of associate's degree or higher and fewer prescribed medications to be independent predictors of higher recall score (P=0.0002 and 0.002)., CONCLUSIONS: AVSs were conceived to enhance patient care. This study indicates this goal is not achieved consistently. Less education and more complex medication regimens were identified as barriers to medication recall. Additional investigations should explore if modifying this document and enhanced explanation of its use will impact medication recall and health outcomes.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Drug Prescriptions; Electronic Health Records; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; *Mental Recall/ph [Physiology]; Middle Aged; *Office Visits; Patient Satisfaction; Retrospective Studies; Self Report; Surveys and Questionnaires

Contemporary management of refractory pediatric glaucoma. - Malik, Rizwan; AlDarrab, Abdulrahman; Edward, Deepak P (Current opinion in ophthalmology, 2020)
PURPOSE OF REVIEW: The management of pediatric glaucoma poses a unique challenge in terms of maintaining lifelong vision and combating an aggressive scarring response from surgery. Contemporary literature regarding the surgical management of children with pediatric glaucoma who fail, or are at a high risk of failure, from conventional surgery is limited. The aim of this review is to highlight recent developments in relation to the current opinion regarding the management of children with refractory pediatric glaucoma., RECENT FINDINGS: Some studies have reported impressive success rates with circumferential trabeculotomy, even in eyes with previous failed surgery. Early results of deep sclerectomy in populations which may not respond well to conventional angle surgery are encouraging but data is limited for the pediatric age group. In compliant patients in whom multiple postoperative examinations under anesthesia are possible, trabeculectomy remains an effective procedure. Multiple recent studies have demonstrated that glaucoma drainage device (GDD) surgery is associated with 5-year success rates of over 70% in primary childhood glaucomas., SUMMARY: Glaucoma drainage device surgery is likely to remain a mainstay of surgical management for refractory glaucoma in older children. More prospective data are needed on the success of circumferential trabeculotomy, deep sclerectomy and micropulse laser in pediatric eyes with previous failed surgery. VIDEO ABSTRACT: http://links.lww.com/COOP/A34.
Keywords: Child; *Glaucoma Drainage Implants; Humans; *Hydrophthalmos/su [Surgery]; Intraocular Pressure/ph [Physiology]; Prosthesis Implantation; *Trabeculectomy/mt [Methods]

Toward Improving the Mobility of Patients with Peripheral Visual Field Defects with Novel Digital Spectacles. - Sayed, Ahmed M; Kashem, Rashed; Abdel-Mottaleb, Mostafa; Roongpoovapatr, Vatookarn; Eleiwa, Taher K; Abdel-Mottaleb, Mohamed; Parrish, Richard K 2nd; Abou Shousha, Mohamed (American journal of ophthalmology, 2020)
PURPOSE: To assess the efficacy of novel Digital spectacles (DSpecs) to improve mobility of patients with peripheral visual field (VF) loss., DESIGN: Prospective case series., METHODS: Binocular VF defects were quantified with the DSpecs testing strategy. An algorithm was implemented that generated personalized visual augmentation profiles based on the measured VF. These profiles were achieved by relocating and resizing video signals to fit within the remaining VF in real time. Twenty patients with known binocular VF defects were tested using static test images, followed by dynamic walking simulations to determine if they could identify objects and avoid obstacles in an environment mimicking a real-life situation. The effect of the DSpecs were assessed for visual/hand coordination with object-grasping tests. Patients performed these tests with and without the DSpecs correction profile., RESULTS: The diagnostic binocular VF testing with the DSpecs was comparable to the integrated monocular standard automated perimetry based on point-by-point assessment with a mismatch error of 7.0%. Eighteen of 20 patients (90%) could identify peripheral objects in test images with the DSpecs that they could not previously. Visual/hand coordination was successful for 17 patients (85%) from the first trial. The object-grasping performance improved to 100% by the third trial. Patient performance, judged by finding and identifying objects in the periphery in a simulated walking environment, was significantly better with the DSpecs (P = 0.02, Wilcoxon rank sum test)., CONCLUSIONS: DSpecs may improve mobility by facilitating the ability of patients to better identify moving peripheral hazardous objects. Copyright © 2019 Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; *Eyeglasses; Female; *Glaucoma/co [Complications]; Humans; Male; Middle Aged; Prospective Studies; Scotoma/pp [Physiopathology]; *Scotoma/rh [Rehabilitation]; *Virtual Reality; *Visual Fields/ph [Physiology]; *Walking

Application of the Sight Outcomes Research Collaborative Ophthalmology Data Repository for Triaging Patients With Glaucoma and Clinic Appointments During Pandemics Such as COVID-19. - Bommakanti, Nikhil K; Zhou, Yunshu; Ehrlich, Joshua R; Elam, Angela R; John, Denise; Kamat, Shivani S; Kelstrom, Jared; Newman-Casey, Paula Anne; Shah, Manjool M; Weizer, Jennifer S; Wood, Sarah D; Zhang, Amy D; et al. (JAMA ophthalmology, 2020)
Importance: During the coronavirus disease 2019 (COVID-19) pandemic, eye care professionals caring for patients with sight-threatening diseases, such as glaucoma, have had to determine whether some patient appointments could safely get postponed, weighing the risk that the patient's glaucoma could worsen during the interim vs the morbidity risk of acquiring COVID-19 while seeking ophthalmic care. They also need to prioritize appointment rescheduling during the ramp-up phase (when pandemic-associated service reductions are eased)., Objective: To describe a flexible and scalable scoring algorithm for patients with glaucoma that considers glaucoma severity and progression risk vs the presence of high-risk features for morbidity from COVID-19, using information from a large data repository., Design, Setting, and Participants: In this cross-sectional study, patients with upcoming clinic appointments for glaucoma from March 16, 2020, to April 16, 2020, at an academic institution enrolled in the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Electronic Health Record Data Repository were identified. A risk stratification tool was developed that calculated a glaucoma severity and progression risk score and a COVID-19 morbidity risk score. These scores were summed to determine a total score for each patient., Main Outcomes and Measures: Total scores and percentages of clinic appointments recommended for rescheduling., Results: Among the 1034 patients with upcoming clinic appointments for glaucoma, the mean (SD) age was 66.7 (14.6) years. There were 575 women (55.6%), 733 White individuals (71%), and 160 Black individuals (15.5%). The mean (SD) glaucoma severity and progression risk score was 4.0 (14.4) points, the mean (SD) COVID-19 morbidity risk score was 27.2 (16.1) points, and the mean (SD) total score was 31.2 (21.4) points. During pandemic-associated reductions in services, using total score thresholds of 0, 25, and 50 points would identify 970 appointments (93.8%), 668 appointments (64.6%), and 275 appointments (26.6%), respectively, for postponement and rescheduling. The algorithm-generated total scores also helped prioritize appointment rescheduling during the ramp-up phase., Conclusions and Relevance: A tool that considers the risk of underlying ophthalmic disease progression from delayed care receipt and the morbidity risk from COVID-19 exposure was developed and implemented, facilitating the triage of upcoming ophthalmic appointments. Comparable approaches for other ophthalmic and nonophthalmic care during the COVID-19 pandemic and similar crises may be created using this methodology.
Keywords: Aged; Aged, 80 and over; Ambulatory Care Facilities; *Appointments and Schedules; *Betacoronavirus; COVID-19; *Coronavirus Infections/ep [Epidemiology]; Cross-Sectional Studies; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; Ophthalmology; *Outcome Assessment, Health Care; Pandemics; *Pneumonia, Viral/ep [Epidemiology]; SARS-CoV-2; *Triage

Ocular Inserts of Voriconazole-Loaded Proniosomal Gels: Formulation, Evaluation and Microbiological Studies. - El-Emam, Ghada Ahmed; Girgis, Germeen N S; El-Sokkary, Mohamed M Adel; El-Azeem Soliman, Osama Abd; Abd El Gawad, Abd El Gawad H (International journal of nanomedicine, 2020)
Background: Voriconazole (VRC) is a triazole broad spectrum antifungal drug, used in the management of versatile fungal infections, particularly fungal keratitis. The obligatory use of niosomal delivery of VRC may reduce the frequency of dosing intervals resulting from its short biological half time and consequently improve patient compliance., Methods: VRC loaded proniosomes (VRC-PNs) were set by the coacervation technique and completely characterized. The developed formula was comprehensively assessed concerning in- vitro release behavior, kinetic investigation, and its conflict against refrigerated and room temperature conditions. A selected noisomal formula was incorporated into ocusert (VRC-PNs Ocu) formulated by 1% w/w hydroxypropyl methyl cellulose HPMC and 0.1% w/w carbopol 940. Eventually, in vitro antifungal activity against Candida albicans and Aspergillus nidulans was assessed by the cup diffusion method., Results: The optimized VRC-PNs (Pluronic F127: cholesterol weight ratio 1:1 w/w) exhibited the highest entrapment efficiency (87.4+/-2.55%) with a spherical shape, proper size in nano range and a suitable Zeta potential of 209.7+/-8.13 nm and -33.5+/-1.85 mV, respectively. Assurance of drug encapsulation in nanovesicles was accomplished by several means such as attenuated total reflection Fourier-transform infrared spectroscopy, differential scanning calorimetry in addition to powder X-ray diffraction investigations. It displayed a biphasic in vitro release pattern and after 6 months of storage at a refrigerated temperature, the optimized formula preserved its stability. VRC-PNs Ocu proved a very highly significant antifungal activity matched with the free drug or nanosuspension which was extra assured by comparing its mean inhibition zone with that of 5% natamycin market eye drops., Conclusion: In conclusion, VRC-PNs Ocu could be considered as a promising stable sustained release topical ocular nanoparticulate system for the management of fungal infections. Copyright © 2020 El-Emam et al.
Keywords: Animals; *Antifungal Agents/ch [Chemistry]; *Antifungal Agents/pd [Pharmacology]; Antifungal Agents/tu [Therapeutic Use]; Candida albicans/de [Drug Effects]; Candida albicans/ph [Physiology]; *Drug Carriers/ch [Chemistry]; *Drug Compounding; *Eye/de [Drug Effects]; Eye/mi [Microbiology]; Eye Infections, Fungal/dt [Drug Therapy]; Gels; Humans; Particle Size; Surface-Active Agents/ch [Chemistry]; *Voriconazole/ch [Chemistry]; *Voriconazole/pd [Pharmacology]; Voriconazole/tu [Therapeutic Use]; Water/ch [Chemistry]

Low-Cost Eye Phantom for Stereophotogrammetry-Based Optic Nerve Head Topographical 3D Imaging. - Coghill, Ian; Black, Richard A; Livingstone, Iain A T; Giardini, Mario E (Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference, 2020)
Glaucoma is the second leading cause of blindness globally. Stereophotogrammetry-based optic nerve head topographical imaging systems could potentially allow for objective glaucoma assessment in settings where technologies such as optical coherence tomography and the Heidelberg Retinal Tomograph are prohibitively expensive. In the development of such systems, eye phantoms are invaluable tools for both system calibration and performance evaluation. Eye phantoms developed for this purpose need to replicate the optical configuration of the eye, the related causes of measurement artefacts, and give the possibility to present to the imaging system the targets required for system calibration. The phantoms in the literature that show promise of meeting these requirements rely on custom lenses to be fabricated, making them very costly. Here, we propose a low-cost eye phantom comprising a vacuum formed cornea and commercially available stock bi-convex lens, that is optically similar to a gold-standard reference wide-angle schematic eye model and meets all the compliance and configurability requirements for use with stereo-photogrammetry-based ONH topographical imaging systems. Moreover, its modular design, being fabricated largely from 3D-printed components, lends itself to modification for other applications. The use of the phantom is successfully demonstrated in an ONH imager.
Keywords: *Glaucoma; Humans; Imaging, Three-Dimensional; *Optic Disk; Phantoms, Imaging; Photogrammetry

Potential Therapeutic Usage of Nanomedicine for Glaucoma Treatment. - Kwon, Song; Kim, Sung Hyun; Khang, Dongwoo; Lee, Jong Yeon (International journal of nanomedicine, 2020)
Glaucoma is a group of diseases characterized by progressive degeneration of retinal ganglion cells, leading to irreversible blindness. Currently, intraocular pressure reduction is the only established treatment available for glaucoma. With this treatment, the progression of the disease can only be delayed and there is no recovery. In addition, the commercially available eye drops have the disadvantage of low compliance and short therapeutic time, while glaucoma surgery always has the risk of failure due to wound fibrosis. Nanotechnology can overcome the limitations of the current treatment through the encapsulation and conjugation of drugs used for lowering intraocular pressure and antifibrotic agents using biodegradable or biocompatible nanoparticles for the sustained release of the drugs to protect the damaged ocular cells. Furthermore, using nanotechnology, treatment can be administered in various forms, including eye drops, contact lens, and ocular inserts, according to the convenience of the patients. Despite the promising results of delaying the progression of glaucoma, the regeneration of damaged ocular cells, including trabecular meshwork and retinal ganglion cells, is another critical hurdle to overcome. Bone marrow-derived mesenchymal stem cells and Muller glia cells can secrete neurogenic factors that trigger the regeneration of associated cells, including trabecular meshwork and retinal ganglion cells. In conclusion, this review highlights the potential therapeutic applications of nanotechnology- and stem cell-based methods that can be employed for the protection and regeneration of ocular cells. Copyright © 2020 Kwon et al.
Keywords: Animals; Contact Lenses; Drug Delivery Systems; Glaucoma/et [Etiology]; *Glaucoma/th [Therapy]; Humans; *Nanomedicine; Nanotechnology; Trabecular Meshwork/pa [Pathology]

Ethnic variation in prevalence, self-reported barriers and outcome of cataract surgery in a rural population in southwestern China: the Yunnan minority eye study. - Shen, Wei; Cun, Qing; Zhong, Hua; Pan, Chen-Wei; Li, Jun; Chen, Qin (BMC public health, 2020)
BACKGROUND: As a part of the Yunnan Minority Eye Studies, the purpose of this study was to determine the prevalence, barriers and visual acuity outcomes of cataract surgery in a multiethnic adult population in rural areas of southwestern China., METHODS: A population-based cross-sectional survey was conducted with participants of Bai, Yi, and Han ethnicity aged >=50 years in Yunnan. A detailed eye examination was performed. Information on the date, setting, type, and complications of cataract surgery were recorded in the examination of cataract-operated eyes., RESULTS: Of 6546 subjects (2133 Bai ethnicity, 2208 Yi ethnicity and 2205 Han ethnicity), the prevalence of cataract surgery was 6.0%, with 4.6% in Bai, 7.0% in Yi, and 6.4% in Han ethnicity. Cataract Surgical coverage (CSC) among those with presenting visual acuity (PVA) < 20/200 in both eyes because of cataract was 53.3%, with 52.8% in Bai, 64.4% in Yi, and 45.3% in Han ethnicity. CSC was associated with Yi ethnicity, younger age, and higher education level, while unoperated cataract was associated with Han ethnicity, older age, and illiterate. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 525 cataract-operated eyes, PVA and best-corrected visual acuity (BCVA) of 20/63 or better was 44.5 and 67.2%, respectively, with 48.1 and 65.9% in Bai, 47.8 and 75.4% in Yi, 39.1 and 59.9% in Han ethnicity. Han ethnicity, aphakia, earlier year of surgery, lower-level surgical hospital and illiterate were associated with postoperative visual impairment defined by PVA, while Han ethnicity, aphakia, and illiterate were associated with that defined by BCVA. The principal causes of postoperative visual impairment were retinal disorders (26.8%), posterior capsule opacification (25.1%), refractive error(22.7%), and glaucoma (9.3%)., CONCLUSIONS: Han ethnicity had a lower CSC and relatively poor visual outcomes compared with ethnic minorities. Further effective effort to remove barriers and provide sight restoration is warranted.
Keywords: Aged; Aged, 80 and over; Cataract/ep [Epidemiology]; Cataract/eh [Ethnology]; *Cataract/th [Therapy]; Cataract Extraction/sn [Statistics & Numerical Data]; *Cataract Extraction; China/ep [Epidemiology]; Cross-Sectional Studies; Ethnic Groups/sn [Statistics & Numerical Data]; *Ethnic Groups; Eye Diseases/ep [Epidemiology]; Female; *Healthcare Disparities; Humans; Male; Middle Aged; Minority Groups/sn [Statistics & Numerical Data]; *Minority Groups; Postoperative Period; Prevalence; Refractive Errors/ep [Epidemiology]; Rural Population/sn [Statistics & Numerical Data]; *Rural Population; Self Report; Treatment Outcome; Vision Disorders/et [Etiology]; *Visual Acuity

The cost and quality of life impact of glaucoma in Tanzania: An observational study. - Murdoch, Ian; Smith, Andrew F; Baker, Helen; Shilio, Bernadetha; Dhalla, Kazim (PloS one, 2020)
AIMS: To determine the cost and quality of life impact imposed by glaucoma in Tanzania, East Africa., METHODS: An expert panel of eye health professionals was convened to agree current glaucoma practice in Tanzania. In addition a structured patient survey was developed and administered. Supplemental cost and quality of life information was collected using cost questionnaires and validated quality of life measures, including the EQ5D and VFQ-25., RESULTS: Key findings include following. Non-adherence is a major issue, especially in rural settings where over 50% of the patients may fail to return for review. Whilst medical therapy is overwhelmingly the first line treatment, the cost of maintaining this represents up to 25% of a patient's income. There is an impact of glaucoma on patients general well-being as determined by the EQ-5D and more tellingly on visual function with particular impact on role limitations as determined by the VF25. Despite our sample being taken in a private clinic and thus containing a much larger proportion of professionals than the general population, one third of the population earned Tanzanian Shillings (TZS) 170,000 per month which is below the minimum wage., CONCLUSION: These findings are of great importance for health care planners seeking to determine cost-effective, acceptable methods of both identifying and treating this major cause of preventable blindness.
Keywords: Adolescent; Adult; Aged; Cost-Benefit Analysis/mt [Methods]; Female; *Glaucoma/ec [Economics]; *Glaucoma/ep [Epidemiology]; *Glaucoma/pp [Physiopathology]; Humans; Male; Middle Aged; Quality of Life/px [Psychology]; Surveys and Questionnaires; Tanzania/ep [Epidemiology]; Vision, Ocular/ph [Physiology]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Diabetic Eye Disease: Advancements in Technology, Detection, and Access to Care. - Lyford, Trevor; Sheppard, John (The Senior care pharmacist, 2020)
OBJECTIVE: To educate pharmacists on advancements in, detection of, and access to care for diabetic eye disease (DED) by reviewing the etiologies, treatment options, and technological evolution in teleophthalmology for DED. DATA SYNTHESIS: The literature included review articles, original research articles, treatment information, and advancements in teleophthalmology for DED. CONCLUSION: DED encompasses a group of eye conditions that affect people with diabetes, which primarily includes diabetic retinopathy and diabetic macular edema but may also include cataracts, ocular surface disease, and glaucoma. Emerging technologies with retinal imaging tools and artificial intelligence have increased access to care for diabetic people with diabetes in many studies. Pharmacists familiar with diabetic screening advancements can work closely with primary care physicians and ophthalmologists to better educate patients on treatment regimens.
Keywords: Artificial Intelligence; *Diabetes Mellitus; *Diabetic Retinopathy; Health Services Accessibility; Humans; *Macular Edema; *Ophthalmology; *Telemedicine

[Long-term use of latanoprost in the treatment of glaucoma]. - Kurysheva, N I (Vestnik oftalmologii, 2020)
Glaucoma is the main cause of irreversible blindness in the world. Latanoprost - an ester prodrug of prostaglandin F2alpha (PGF2alpha) - was the first prostaglandin analogue used in the treatment of glaucoma. The present review shows that latanoprost is the most balanced prostaglandin analogue in terms of efficacy-safety. Its use improves the quality of life of glaucoma patients, provides reliable IOP reduction, has high patient compliance, and helps with the long-term preservation of visual functions. The review also reveals the possibility of long-term (more than five years) use of the drug, as well as effective combined treatment using latanoprost and beta-blockers, considers the pediatric use of latanoprost, and discusses its neuroprotective properties.
Keywords: Antihypertensive Agents; *Glaucoma; Humans; Intraocular Pressure; Latanoprost; Quality of Life

[Effectiveness of antihypertensive conservative-free therapy with fixed combination of bimatoprost and timolol (intermediate results)]. - Dorofeev, D A; Kryzhanovskaya, A V; Ciganov, A Z (Vestnik oftalmologii, 2020)
INTRODUCTION: The effects of antihypertensive therapy are often determined by patient compliance with the prescribed treatment plan. Acceptance of conservative-free forms of drugs leads to a decrease in the frequency and severity of side effects, reduces the need for the use of artificial tears, which lowers the cost of treatment for the patients., PURPOSE: to evaluate the hypotensive effectiveness of a fixed combination of bimatoprost (0.03%) and timolol (0.5%), and its effect on the ocular surface in patients with newly diagnosed advanced glaucoma., MATERIAL AND METHODS: The study was conducted during February-November 2018, and included 46 patients (76 eyes) with newly diagnosed POAG and healthy volunteers (control group). All patients underwent visometry, ICare rebound tonometry (Tiolat, Finland), elastometry with Maklakov tonometer (using 5 g, 10 g and 15 g loads), automated perimetry (AP) (Octopus-600, Haag-Streit diagnostics, Switzerland), optical coherence tomography (OCT) of the macular zone and optic nerve head, pachymetry (Spectralis OCT, Heidelberg Engineering, Germany). At the start of the study and one month after the start of treatment with the drug Ganfort (Allergan, USA), patients were examined to evaluate the state of their ocular surface: Norn's test, Schirmer's test, vital staining with lissamine green, and an OSDI questionnaire., RESULTS: At the start of treatment, administration of a fixed combination of bimatoprost and timolol led to a decrease in intraocular pressure by 7.9 (37.7%) mm Hg (V=271, p=5.496e-05) after 2 weeks of the use of Ganfort (Allergan, USA). During this period, the observation group did not exhibit statistically significant changes in the state of the ocular surface, which was comparable to the control group according to the data of the Norn's test, Schirmer's test, vital staining with lissamine green and the OSDI questionnaire (p>0.05)., CONCLUSION: The use of a fixed combination of bimatoprost and timolol, while effectively reducing IOP, did not result in statistically significant changes in the ocular surface. Some improvement of both objective and subjective indicators of the state of ocular surface associated with the use of the Ganfort drug was noted in patients of the observation group.
Keywords: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Combinations; Glaucoma, Open-Angle; Humans; Intraocular Pressure; *Ocular Hypertension; Timolol; Treatment Outcome

Societal and Economic Impact of Poor Glaucoma Medication Adherence. - Aptel, Florent; Toren, Andrew (Ophthalmology, 2020)
Comment on (CON)
Keywords: Antihypertensive Agents; Cost-Benefit Analysis; *Glaucoma; Humans; *Medication Adherence

Dynamic Scheimpflug Ocular Biomechanical Parameters in Untreated Primary Open Angle Glaucoma Eyes. - Miki, Atsuya; Yasukura, Yuichi; Weinreb, Robert N; Maeda, Naoyuki; Yamada, Tomomi; Koh, Shizuka; Asai, Tomoko; Ikuno, Yasushi; Nishida, Kohji (Investigative ophthalmology & visual science, 2020)
Purpose: To characterize the corneal biomechanical properties of glaucoma eyes by comparing the dynamic Scheimpflug biomechanical parameters between untreated glaucoma and control eyes., Methods: Cross-sectional observational data of dynamic Scheimpflug analyzer (Corvis ST) examinations were retrospectively collected from 35 eyes of 35 consecutive patients with untreated normal tension glaucoma and 35 eyes of 35 healthy patients matched on age and IOP. Ten biomechanical parameters were compared between the two groups using multivariable models adjusting for IOP, central corneal thickness, age, and axial length. The Benjamini-Hochberg method was used to correct for multiple comparison., Results: In multivariable models, glaucoma was associated with smaller applanation 1 time (P < 0.001, coefficient = -0.5865), applanation 2 time (P = 0.012, coefficient = -0.1702), radius (P = 0.006, coefficient = -0.5447), larger peak distance (P = 0.011, coefficient = 0.1023), deformation amplitude ratio at 1 mm (P < 0.001, coefficient = 0.072), and integrated radius (P < 0.001, coefficient = 1.094). These associations consistently indicate greater compliance of the cornea in glaucoma eyes., Conclusions: Untreated normal tension glaucoma eyes were more compliant than healthy eyes. The greater compliance (smaller stiffness) of normal tension glaucoma eyes may increase the risk of optic nerve damage. These results suggest the relevance of measuring biomechanical properties of glaucoma eyes.
Keywords: Adult; Aged; Aged, 80 and over; Axial Length, Eye; Biomechanical Phenomena; Case-Control Studies; Cornea/dg [Diagnostic Imaging]; *Cornea/ph [Physiology]; Cross-Sectional Studies; *Elasticity/ph [Physiology]; Female; Glaucoma, Open-Angle/dg [Diagnostic Imaging]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Retrospective Studies; Visual Fields/ph [Physiology]; Young Adult

Fixed-combination topical anti-hypertensive ophthalmic agents. - Machen, Lindsay; Razeghinejad, Reza; Myers, Jonathan S (Expert opinion on pharmacotherapy, 2020)
INTRODUCTION: Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of fixed-combination medications will help educate and inform providers for optimal patient care., AREAS COVERED: In this review, the authors describe the composition, mechanism of action, efficacy, side effects, and safety profile of fixed-combination agents for the treatment of ocular hypertension and glaucoma as well as comparisons between the most frequently prescribed medications., EXPERT OPINION: Fixed-combination therapeutics provide an effective and efficient means of lowering intraocular pressure with comparable side effects and outcomes to constituent parts with lower patient exposure to preservatives and improvement in compliance.
Keywords: Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; Humans; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/pd [Pharmacology]; *Ophthalmic Solutions/tu [Therapeutic Use]

Factors associated with depression and anxiety among glaucoma patients in a tertiary hospital South-East Nigeria. - Onwubiko, S N; Nwachukwu, N Z; Muomah, R C; Okoloagu, N M; Ngwegu, O M; Nwachukwu, D C (Nigerian journal of clinical practice, 2020)
Objective: To explore the factors associated with depression and anxiety among glaucoma patients., Subjects and Methods: This was a cross-sectional study involving adult glaucoma patients, who attended the eye clinic of Enugu State University Teaching Hospital, Parklane, Enugu, from April to September 2018. In total, 182 glaucoma patients with no other significant ophthalmic or medical conditions were recruited. Information on their socio-demographic and clinical characteristics was obtained using a close-ended, interviewer-administered questionnaire. Detailed ophthalmic evaluation to characterize the glaucoma was done. Depression and anxiety were assessed using the hospital anxiety and depression scale. Data were analyzed using SPSS version 21. Bivariate analysis was done to identify factors associated with depression and anxiety. The level of significance was at P < 0.05., Results: The participants were mainly females, 108 (59.3%), married, civil servants with tertiary education and mean age of 59.7 +/- 13.3 SD years. Majority of them had advanced stage of primary open angle glaucoma. Eighty (44%) of the participants had anxiety, while 76 (41.8%) had depression. Severe/blind stage of glaucoma and reduced visual acuity were significantly associated with anxiety and depression; occupation (trading) and intraocular pressure of <21 mmHg also significantly associated with depression., Conclusion: The prevalence of anxiety and depression among glaucoma patients in Enugu was high. Severe/blind stage of glaucoma and reduced visual acuity were the most important factors that associated with both anxiety and depression. Incorporating a psychological health approach to glaucoma care especially in patients with severe glaucoma and reduced visual acuity may promote effective communication between clinicians and patients and treatment adherence.
Keywords: Adult; African Continental Ancestry Group; Aged; Anxiety/di [Diagnosis]; *Anxiety/ep [Epidemiology]; Anxiety/px [Psychology]; Cross-Sectional Studies; Depression/di [Diagnosis]; *Depression/ep [Epidemiology]; Depression/px [Psychology]; Depressive Disorder/ep [Epidemiology]; Female; Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; Glaucoma/px [Psychology]; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Middle Aged; Nigeria/ep [Epidemiology]; Prevalence; *Quality of Life/px [Psychology]; Surveys and Questionnaires; Tertiary Care Centers; Tonometry, Ocular; Visual Acuity

Psychosocial Predictors of Glaucoma Medication Adherence Among the Support, Educate, Empower (SEE) Personalized Glaucoma Coaching Pilot Study Participants. - Salman, Mariam; Andrews, Chris; Heisler, Michele; Darnley-Fisch, Deborah; Newman-Casey, Paula Anne (American journal of ophthalmology, 2020)
PURPOSE: To evaluate the association between baseline psychosocial milieu and subsequent glaucoma medication adherence among participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program pilot study., DESIGN: Prospective cohort study., METHODS: Participants (University of Michigan glaucoma patients aged >=40 years, taking >=1 glaucoma medication, who self-reported poor adherence) completed a baseline survey that assessed the following: (1) demographics; (2) social network; (3) perceived stress; (4) consideration of future consequences; (5) glaucoma-related distress; and (6) social support. Medication adherence was then monitored electronically for 3 months and the percentage of prescribed doses taken was calculated. The relationship between baseline factors and medication adherence was assessed using univariate and multivariate analysis. Main outcome measure was median percent adherence over 3 months., RESULTS: Of the 95 study participants, 63% had graduated from college, 55% were white, 35% were African-American, and 97% had insurance. Median adherence over 3 months was 74% +/- 21% (+/-standard deviation, SD). Higher income and more education were significantly associated with better adherence (P < .0001, P = .03). Glaucoma-related distress (mean score 5.6, SD = 3.0) was inversely associated with medication adherence on univariate (P < .0001) and multivariate analysis (P = .0002). Every 1-point increase in glaucoma-related distress score predicted a 2.4-percentage-point decrease in medication adherence., CONCLUSIONS: Lower income, lower educational attainment, and a higher level of glaucoma-related distress all predicted lower adherence to glaucoma medications. Additional glaucoma self-management support resources should be directed toward patients with such risk factors for poor adherence. Copyright © 2020 Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/tu [Therapeutic Use]; Educational Status; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/px [Psychology]; Humans; Income; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/px [Psychology]; Mentoring; Middle Aged; Pilot Projects; Prospective Studies; *Stress, Psychological

Prospective evaluation of penetrating deep sclerectomy in advanced open-angle glaucoma: Filtration surgery adapted to resource scarcity in developing countries. - Kalala, A; Gillmann, K; Mermoud, A (Journal francais d'ophtalmologie, 2020)
PURPOSE: Two of the hurdles that are facing ophthalmologists in developing countries are scarcity of resources and patient follow-up. Deep sclerectomy (DS) has proven less costly and more effective than topical therapies and has a more favorable safety profile than trabeculectomy. The main factors preventing its use in developing countries are the need to perform laser goniopuncture in 40-80% of cases to maintain filtration and the risk of postoperative iris incarceration. The purpose of this study is to assess the efficacy and safety profile in advanced open-angle glaucoma of a relatively new surgical technique designed to overcome this limitation: penetrating DS., SETTING: This was an investigator-initiated, prospective, interventional study, conducted at a single ophthalmology center in Kinshasa, Congo. The study was conducted in full compliance with the Declaration of Helsinki., METHODS: Fifty-one eyes (34 patients) with uncontrolled advanced primary open-angle glaucoma (visual field mean deviation<-10 dBs) were enrolled between October 2012 and June 2016. Age, gender, comorbidities (hypertension/diabetes), best-corrected visual acuity, topical medications, medicated and unmedicated intraocular pressure (IOP) were recorded. All patients underwent penetrating DS, during which, following standard dissection of the scleral flaps, the anterior chamber was penetrated through the trabeculo-Descemet membrane and an iridectomy was performed. Patients attended postoperative appointments at months 1, 3, 6 and 12. Surgical success was defined as a 20% reduction of IOP from baseline in conjunction with a 12-month unmedicated IOP<=12mmHg., RESULTS: The mean age was 64.5+/-14.0 years (44.1% female, 100% African). Mean IOP decreased from 20.2+/-6.1 (medicated) and 30.7+/-9.8mmHg (unmedicated) preoperatively to 12.1+/-4.1 at 12 months. Concomitantly, the number of topical medications decreased from 1.5+/-0.7 to 0.0. Complete surgical success was achieved in 64.7%. Four eyes (7.8%) were considered surgical failures due to uncontrolled IOP. None of the eyes lost light perception or required additional surgery. A significant association between surgical failure and hypertension was observed (HR=1.49; P=0.008). There were no intraoperative complications. Postoperatively, 4 bleb encapsulations (7.8%) and 1 iris incarceration (2%) were observed., CONCLUSIONS: The present study demonstrates that penetrating DS achieved similar efficacy and safety results to traditional non-penetrating DS. In addition, it showed a lower potential for intraoperative complications, which might be associated with a more benign surgical learning curve. Finally, the rates of serious postoperative complications (iris incarceration, choroidal effusion and hypotony) were significantly lower than in DS and trabeculectomy, and this technique does not require subsequent Nd: YAG laser goniopuncture to maintain filtration, making frequent follow-up visits less critical. In view of these findings, perforating deep sclerectomy could offer a viable option for glaucoma management in developing countries as well as worldwide. Copyright © 2020 Elsevier Masson SAS. All rights reserved.
Keywords: Aged; Democratic Republic of the Congo; Developing Countries; Disease Progression; Female; Filtering Surgery/ec [Economics]; Filtering Surgery/mt [Methods]; Follow-Up Studies; Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/pa [Pathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; Male; Middle Aged; Postoperative Complications/et [Etiology]; Poverty/ec [Economics]; Sclera/pa [Pathology]; Sclera/su [Surgery]; Sclerostomy/ae [Adverse Effects]; Sclerostomy/ec [Economics]; *Sclerostomy/mt [Methods]; Trabeculectomy/ae [Adverse Effects]; Trabeculectomy/ec [Economics]; Trabeculectomy/mt [Methods]

Medication Adherence in Patients With Glaucoma After Cancer Diagnosis. - Hou, Chiun-Ho; Lin, Ken-Kuo; Lee, Jiahn-Shing; Pu, Christy (American journal of ophthalmology, 2020)
PURPOSE: To determine the association between cancer diagnosis and medication adherence in patients with glaucoma., DESIGN: Cohort study., METHODS: Setting: Population-based. StudyPopulation: All patients with confirmed glaucoma in one or both eyes. All patients were aged 20 years or older. Patients who developed cancer within 2 year of a confirmed glaucoma diagnosis or who were dead within 2 year after a confirmed cancer diagnosis were excluded. Intervention orObservationProcedure(s): Individuals without cancer but with a confirmed glaucoma diagnosis were followed until they received a confirmed cancer diagnosis. They were then matched with a group of patients with confirmed glaucoma who did not develop cancer during the study period. MainOutcomeMeasure(s): Secondary adherence measured using medication possession ratio (MPR) at 1-year, 2-year, and 2-year-average intervals., RESULTS: For both patients with cancer and their matches, MPR was the highest when measured at 1-year intervals. MPR was 0.379 (95% CI: 0.370-0.388) for the cancer group and 0.313 (95% CI: 0.308-0.319) for the cancer-free group. MPR measured using 1-year intervals decreased by 17.4% after cancer diagnosis (P < .001). MPR measured using 2-year and 2-year-average intervals decreased by 10.4% (P < .001) and 9.21% (P < .001), respectively., CONCLUSIONS: Cancer diagnosis leads to lower medication adherence in patients with glaucoma. To improve medication adherence in patients with glaucoma who also have cancer, policies should directly target the burden associated with having cancer that tends to create barriers for medication refills, rather than targeting risk factors that are also applicable to patients with glaucoma but without cancer. Copyright © 2020. Published by Elsevier Inc.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Drug Prescriptions/sn [Statistics & Numerical Data]; Female; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Services Accessibility; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; National Health Programs/sn [Statistics & Numerical Data]; *Neoplasms/di [Diagnosis]; Risk Factors; Taiwan

Nanotechnology for Medical and Surgical Glaucoma Therapy-A Review. - Occhiutto, Marcelo Luis; Maranhao, Raul C; Costa, Vital Paulino; Konstas, Anastasios G (Advances in therapy, 2020)
Glaucoma is the second leading cause of blindness worldwide. Even though significant advances have been made in its management, currently available antiglaucoma therapies suffer from considerable drawbacks. Typically, the success and efficacy of glaucoma medications are undermined by their limited bioavailability to target tissues and the inadequate adherence demonstrated by patients with glaucoma. The latter is due to a gradual decrease in tolerability of lifelong topical therapies and the significant burden to patients of prescribed stepwise antiglaucoma regimens with frequent dosing which impact quality of life. On the other hand, glaucoma surgery is restricted by the inability of antifibrotic agents to efficiently control the wound healing process without causing severe collateral damage and long-term complications. Evolution of the treatment paradigm for patients with glaucoma will ideally include prevention of retinal ganglion cell degeneration by the successful delivery of neurotrophic factors, anti-inflammatory drugs, and gene therapies. Nanotechnology-based treatments may surpass the limitations of currently available glaucoma therapies through optimized targeted drug delivery, increased bioavailability, and controlled release. This review addresses the recent advances in glaucoma treatment strategies employing nanotechnology, including medical and surgical management, neuroregeneration, and neuroprotection.
Keywords: Biological Availability; *Glaucoma/dt [Drug Therapy]; Glaucoma/th [Therapy]; Humans; *Nanomedicine/mt [Methods]; Nanomedicine/td [Trends]; *Nanoparticles/tu [Therapeutic Use]; *Nanotechnology/mt [Methods]; Quality of Life

Design, optimisation and evaluation of in situ gelling nanoemulsion formulations of brinzolamide. - Bhalerao, Hemant; Koteshwara, K B; Chandran, Sajeev (Drug delivery and translational research, 2020)
The present research work summarises the development of an in situ gelling ophthalmic nanoemulsion of brinzolamide providing sustained release and prolonged therapeutic effect for the treatment of glaucoma. Nanoemulsions were prepared using castor oil, polyoxyl 35 castor oil and polysorbate 80 and with gellan gum as the in situ gelling agent. Formulations were screened based on globule size, Zeta potential, in vitro drug release and stability towards phase separation and sol to gel conversion upon storage. Selected formulations exhibiting a low mean globule diameter (< 160 nm), narrow size distribution (polydispersity index < 0.3), quick in vitro gelling time (< 15 s) and stability for at least 6 months at 25 degreeC/40% RH and 40 degreeC/25% RH were evaluated for intraocular pressure (IOP)-lowering efficacy studies using glaucomatous rabbits. Tested nanoemulsion formulations were well tolerated and significantly decreased IOP relative to saline and placebo controls (p < 0.005). Furthermore, an appreciable increase in the area under change in IOP from baseline (DELTAIOP) vs. time curve and a longer mean residence time (MRT) was also observed for the test formulations compared with commercially available suspension of brinzolamide (Azopt, Alcon Laboratories, USA). Thus, nanoemulsion formulations containing in situ gelling polymer may serve as improved drug delivery system providing superior therapeutic efficacy and better patient compliance for the treatment of glaucoma. . Graphical abstract.
Keywords: Administration, Ophthalmic; Animals; *Castor Oil/ch [Chemistry]; Delayed-Action Preparations; Disease Models, Animal; Drug Compounding; Emulsions; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Nanoparticles; *Polysaccharides, Bacterial/ch [Chemistry]; *Polysorbates/ch [Chemistry]; Rabbits; *Sulfonamides/ad [Administration & Dosage]; Sulfonamides/ch [Chemistry]; Sulfonamides/pd [Pharmacology]; *Thiazines/ad [Administration & Dosage]; Thiazines/ch [Chemistry]; Thiazines/pd [Pharmacology]

[Keratoplasty in children : Indications and results]. - Lang, S J; Bohringer, D; Reinhard, T (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2020)
Penetrating keratoplasty in children is associated with very specific difficulties for the surgeon as well as for the patient and the parents. Special features are specific pediatric indications, which do not occur in adults, a more difficult examination and treatment adherence depending on the parents. Diseases with a favorable prognosis include keratoconus and herpetic keratitis. Especially sclerocornea and the Peters' anomaly often have a limited prognosis regarding vision and graft survival due to secondary malformations of the eye. In addition, younger age represents a risk factor. This is most likely due to the impaired examination during follow-up and reduced compliance. For successful penetrating keratoplasty in children the timing for the operation, in which the risk for the graft is weighed up against the risk for amblyopia, is crucial.
Keywords: Child; *Corneal Opacity; *Corneal Transplantation; Follow-Up Studies; Humans; Keratoplasty, Penetrating; Postoperative Complications; Retrospective Studies

Fixed combination netarsudil-latanoprost for the treatment of glaucoma and ocular hypertension. - Sinha, Sapna; Lee, Daniel; Kolomeyer, Natasha N; Myers, Jonathan S; Razeghinejad, Reza (Expert opinion on pharmacotherapy, 2020)
Introduction: Reduction of intraocular pressure (IOP) is the only known modifiable risk factor for prevention and treatment of glaucoma. Rho-kinase (ROCK) inhibitors are a new class of glaucoma medications introduced recently with novel mechanisms of action and favorable safety profiles. Latanoprost, a common first line drug used for treatment of glaucoma, does not adequately control pressures in all cases. Addition of more than one anti-glaucoma medication affects patient compliance and adherence. Fixed-combination eye drops are combinations of two or more active drugs in a single dosage form, thus simplify dosing. New to this group is the fixed combination netarsudil- latanoprost (FCNL). Area covered: This review focuses on FCNL, its pharmacodynamics and pharmacokinetics. It also details the efficacy and safety of individual drugs compared to FCNL. Expert opinion: The combination of latanoprost and netarsudil is a potent medication and modulates all known targets for IOP reduction in a single drop and has been shown to be more effective than either drug alone. FCNL is an alternative for those with inadequately controlled IOP on a prostaglandin analog alone, as well as those for whom a simplified regimen is desirable, or those who are not good candidates for other classes of glaucoma medications.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; *Benzoates/ad [Administration & Dosage]; Drug Combinations; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; *Latanoprost/ad [Administration & Dosage]; Male; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; beta-Alanine/ad [Administration & Dosage]; *beta-Alanine/aa [Analogs & Derivatives]

Cluster analysis of computerized visual field and optical coherence tomography-ganglion cell complex defects in high intraocular pressure patients or early stage glaucoma. - Perdicchi, Andrea; de Paula, Alessandro; Sordi, Edoardo; Scuderi, Gianluca (European journal of ophthalmology, 2020)
PURPOSE: The aim of the study is to evaluate the relationship between functional defects shown by cluster analysis of computerized visual field and anatomic defects from optical coherence tomography-ganglion cell complex examination in ocular hypertension or eyes affected by glaucoma., METHODS: 205 eyes affected by ocular hypertension (intraocular pressure > 22 mmHg) or early stage glaucoma were enrolled. The age of the patients ranged from 26 to 87 years (average: 61.83 +/- 1.54 years). Computerized 30degree visual field (Octopus G1x Dynamic strategy) and optical coherence tomography-ganglion cell complex (I-Vue Optovue) analyses were performed for each eye selected; 68 eyes were tested and retested from two to seven times for a total of 320 visual fields and 320 optical coherence tomography-ganglion cell complex examinations. The visual field was considered abnormal with a mean defect < -2 and loss variance > 6. The optical coherence tomography-ganglion cell complex was considered abnormal with a significant focal loss volume (p < 5%) and/or a significant thinning of total, superior, or inferior thickness (p < 5%). Four different groups of examinations were created according to the results of visual field and ganglion cell complex: normal visual field and normal ganglion cell complex (group 1), abnormal visual field and abnormal ganglion cell complex (group 2), normal visual field and abnormal ganglion cell complex (group 3), and abnormal visual field and normal ganglion cell complex (group 4). The cluster analysis of visual fields (EyeSuite software Interzeag CH) was performed only in the visual field of group 3, and the correlation between cluster values and topographical changes at optical coherence tomography-ganglion cell complex was analyzed., RESULTS: The results of the ganglion cell complex and visual field examinations matched 247 (77.19%) times. In 143 cases, the examinations belonged to group 1, in 104 to group 2, in 23 to group 3, and, finally, in 50 to group 4. The visual field cluster analysis performed on group 3 showed that the correlation between optical coherence tomography-ganglion cell complex and visual field cluster analysis defects was 100% (both the exams altered). In 72% of them, there was also a topographical correspondence between the visual field and optical coherence tomography-ganglion cell complex defects., CONCLUSION: In the early stages of glaucoma, the visual field cluster analysis seems to be useful to detect some focal defects that can be otherwise underestimated when globally considering the visual field. In group 3, where the conventional analysis of visual field was normal while the optical coherence tomography-ganglion cell complex exam was abnormal, the visual field cluster analysis showed a topographical correlation with optical coherence tomography-ganglion cell complex defects in more than 70% of the examinations performed. In addition, the patients with abnormal visual field and normal optical coherence tomography-ganglion cell complex were older than those with normal visual field and abnormal optical coherence tomography-ganglion cell complex (66.44 +/- 3.51 vs 57.04 +/- 5.96 years, p < 0.001 (0.0002)). These results confirm that the reliability of a visual field examination is subjective and decreases with age because of its difficulty and the personal compliance of the patient toward this examination.
Keywords: Adult; Aged; Aged, 80 and over; Cluster Analysis; Female; Glaucoma, Open-Angle/dg [Diagnostic Imaging]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Nerve Fibers/pa [Pathology]; Ocular Hypertension/dg [Diagnostic Imaging]; Ocular Hypertension/pp [Physiopathology]; Optic Disk/pp [Physiopathology]; *Retinal Ganglion Cells/pa [Pathology]; *Tomography, Optical Coherence; Tonometry, Ocular; Vision Disorders/di [Diagnosis]; *Vision Disorders/pp [Physiopathology]; Visual Field Tests; *Visual Fields/ph [Physiology]

Corneal biomechanics and biomechanically corrected intraocular pressure in primary open-angle glaucoma, ocular hypertension and controls. - Vinciguerra, Riccardo; Rehman, Salwah; Vallabh, Neeru A; Batterbury, Mark; Czanner, Gabriela; Choudhary, Anshoo; Cheeseman, Robert; Elsheikh, Ahmed; Willoughby, Colin E (The British journal of ophthalmology, 2020)
AIMS: To compare the biomechanically corrected intraocular pressure (IOP) estimate (bIOP) provided by the Corvis-ST with Goldmann applanation tonometry (GAT-IOP) in patients with high-tension and normal-tension primary open-angle glaucoma (POAG; HTG and NTG), ocular hypertension (OHT) and controls. Moreover, we compared dynamic corneal response parameters (DCRs) of the Corvis-ST in POAG, OHT and controls, evaluated the correlation between global visual field parameters mean deviation and pattern SD (MD and PSD) and DCRs in the POAG group., METHODS: 156 eyes of 156 patients were included in this prospective, single-centre, observational study, namely 41 HTG and 33 NTG, 45 OHT cases and 37 controls. Central corneal thickness (CCT), GAT-IOP and bIOP were measured, GAT-IOP was also adjusted for CCT (GATAdj). DCRs provided by Corvis-ST were evaluated, MD and PSD were recorded by 24-2 full-threshold visual field. To evaluate the difference in DCRs between OHT, HTG and NTG, a general linear model was used with sex, medications and group as fixed factors and bIOP and age as covariates., RESULTS: There was a significant difference between GAT-IOP, GATAdj and bIOP in NTG and HTG, OHT and controls. NTG corneas were significantly softer and more deformable compared with controls, OHT and HTG as demonstrated by significantly lower values of stiffness parameters A1 and highest concavity and higher values of inverse concave radius (all p<0.05). There was a significant correlation (p<0.05) between MD, PSD and many DCRs with POAG patients with softer or more compliant corneas more likely to show visual field defects., CONCLUSIONS: Corneal biomechanics might be a significant confounding factor for IOP measurement that should be considered in clinical decision-making. The abnormality of corneal biomechanics in NTG and the significant correlation with visual field parameters might suggest a new risk factor for the development or progression of NTG. Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Aged; Aged, 80 and over; Biomechanical Phenomena/ph [Physiology]; Case-Control Studies; Cornea/pa [Pathology]; *Cornea/pp [Physiopathology]; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pa [Pathology]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pa [Pathology]; *Ocular Hypertension/pp [Physiopathology]; Prospective Studies; Tonometry, Ocular/mt [Methods]; Visual Field Tests/mt [Methods]; Visual Fields/ph [Physiology]

Predictors of visual impairment in primary and secondary glaucoma in a tertiary institute in North India. - Raj, Srishti; Savla, Laxmi Prabhavathi; Thattaruthody, Faisal; Seth, Natasha Gautam; Kaushik, Sushmita; Pandav, Surinder Singh (European journal of ophthalmology, 2020)
AIM: To find out and compare various predictors of glaucoma-related visual impairments in primary and secondary glaucoma., METHODS: A prospective observational study of patients, who were above 30 years of age. They were diagnosed as primary/secondary glaucoma with visual acuity <20/200 Snellen's/visual field showing less than 20degree isopter in at least one eye, with a minimum follow-up of one year at a tertiary center. Patients were classified into advanced and end-stage glaucoma and outcome was assessed according to visual acuity and visual fields to see predictors of visual impairments., RESULTS: There were 169 (99 primary/70 secondary) glaucoma patients with mean age of 62.67 +/- 11.9 and 54.65 +/- 15.26 years, respectively. Trauma (21.4%), complicated cataract surgery (15.7%), and silicon oil tamponade (14.3%) were common causes of secondary glaucoma. There was significant delay in diagnosis in primary compared to secondary glaucoma (57.57% vs 32.85%) and non-compliance was significantly higher in primary glaucoma (34.3% vs 17.1%, p = 0.01). In univariate analysis, literacy, income status, locality, and delayed or missed diagnosis were found to be significant (p < 0.05) according to visual acuity criteria. Out of the 33 patients who had undergone glaucoma filtration surgery, 18 (54.5%) were in the end-stage group. While 105 (77.2%) of 136 patients who were not subjected to any glaucoma filtration surgery reached end-stage glaucoma as per visual fields criteria (p = 0.011)., CONCLUSION: Lack of awareness, delayed diagnosis, low literacy, and income were associated with poor visual outcome. Patients who underwent glaucoma filtration surgery had significantly better visual outcome in comparison to patients managed medically.
Keywords: Adult; Aged; Female; Filtering Surgery; *Glaucoma, Angle-Closure/di [Diagnosis]; Glaucoma, Angle-Closure/pp [Physiopathology]; Glaucoma, Angle-Closure/su [Surgery]; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; India; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Prospective Studies; Tertiary Care Centers; *Vision Disorders/di [Diagnosis]; Vision Disorders/pp [Physiopathology]; Vision Disorders/su [Surgery]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]; Visually Impaired Persons

Self-measurement with Icare HOME tonometer, patients' feasibility and acceptability. - Cvenkel, Barbara; Velkovska, Makedonka Atanasovska; Jordanova, Vesna Dimovska (European journal of ophthalmology, 2020)
PURPOSE: To evaluate and compare the accuracy of self-measurement of intraocular pressure using Icare Home rebound tonometer with Goldmann applanation tonometer and assess acceptability of self-tonometry in patients with glaucoma and ocular hypertension., METHODS: In the study, 117 subjects were trained to use Icare Home for self-measurement. Icare Home tonometer readings were compared with Goldmann applanation tonometer, including one eye per patient. Agreement between the two methods of measurement was evaluated by Bland and Altmann analysis. Questionnaire was used to evaluate patients' perception of self-tonometry., RESULTS: One hundred and three out of 117 patients (88%) were able to measure their own intraocular pressure and 96 (82%) fulfilled the requirements for certification. The mean (SD) difference Goldmann applanation tonometer minus Icare Home was 1.2 (2.4) mmHg (95% limits of agreement, -3.4 to 5.9 mmHg). The magnitude of bias between the two methods depended on central corneal thickness, with greater bias at central corneal thickness <500 microm. In 65 out of 96 subjects (67.7%), Icare Home results were within 2 mmHg of the Goldmann applanation tonometer. Seventy-three out of 93 (78.5%) felt that self-tonometry was easy to use and 75 patients (80.6%) responded that they would use the device at home., CONCLUSION: Icare Home tonometry tends to slightly underestimate intraocular pressure compared to Goldmann applanation tonometer. Most patients were able to perform self-tonometry and found it acceptable for home use. Measurements using rebound self-tonometry could improve the quality of intraocular pressure data and optimize treatment regimen.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Feasibility Studies; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ocular Hypertension/pp [Physiopathology]; Patient Acceptance of Health Care; Prospective Studies; Reproducibility of Results; *Self Care/mt [Methods]; Surveys and Questionnaires; *Tonometry, Ocular/mt [Methods]; Young Adult

Delay Along the Care Seeking Journey of Patients with Microbial Keratitis in Uganda. - Arunga, Simon; Kintoki, Guyguy M; Gichuhi, Stephen; Onyango, John; Newton, Rob; Leck, Astrid; Macleod, David; Hu, Victor H; Burton, Matthew J (Ophthalmic epidemiology, 2019)
Purpose: To describe the care seeking journey and causes of delay among patients with Microbial Keratitis in Uganda. Methods: A prospective cohort of patients presenting with microbial keratitis at the two main eye units in Southern Uganda (2016-2018). We collected information on demographics, home address, clinical history, and presentation pathway including, order of facilities where patients went to seek care, treatment advice, cost of care, and use of Traditional Eye Medicine. Presentation time was noted. We compared "direct" presenters versus "indirect" presenters and analysed predictors of delay. Results: About 313 patients were enrolled. All were self-referred. Only 19% of the patients presented directly to the eye hospital. Majority (52%) visited one facility before presenting, 19% visited two facilities, 9% visited three facilities, and 2% visited four facilities. The cost of care increased with increase in the number of facilities visited. People in a large household, further distance from the eye hospital and those who used Traditional Eye Medicine were less likely to come directly to the eye hospital. Visiting another facility prior to the eye hospital and use of Traditional Eye Medicine aOR 1.58 (95%CI 1.03-2.43), p = .038 were associated with delayed presentation to the eye hospital. Conclusion: This study provided information on patient journeys to seek care. Delay was largely attributable to having visited another health facility: a referral mechanism for microbial keratitis was non-existent. There is need to explore how these health system gaps can be strengthened.
Keywords: Adult; Eye Infections, Fungal/ec [Economics]; *Eye Infections, Fungal/th [Therapy]; Female; Health Care Costs; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Keratitis/ec [Economics]; *Keratitis/th [Therapy]; Male; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Prospective Studies; Referral and Consultation/st [Standards]; Regression Analysis; Uganda

Utilization of Secondary Eye Care Services in Western Kenya. - Rono MMed, Hillary K; Macleod, David; Bastawrous, Andrew; Wanjala, Emmanuel; Gichangi, Michael; Burton, Matthew J (International journal of environmental research and public health, 2019)
Background: Eye care provision is currently insufficient to meet the population's eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26-1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04-1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.
Keywords: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; *Eye Diseases/th [Therapy]; Female; Humans; Infant; Infant, Newborn; Kenya; Male; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Retrospective Studies; *Secondary Care/sn [Statistics & Numerical Data]; Sex Factors; Young Adult

Successful development and clinical translation of a novel anterior lamellar artificial cornea. - Rico-Sanchez, Laura; Garzon, Ingrid; Gonzalez-Andrades, Miguel; Ruiz-Garcia, Antonio; Punzano, Miriam; Lizana-Moreno, Antonio; Munoz-Avila, Jose Ignacio; Sanchez-Quevedo, Maria Del Carmen; Martinez-Atienza, Juliana; Lopez-Navas, Luis; Sanchez-Pernaute, Rosario; Oruezabal, Roke Inaki; et al. (Journal of tissue engineering and regenerative medicine, 2019)
Blindness due to corneal diseases is a common pathology affecting up to 23 million individuals worldwide. The tissue-engineered anterior human cornea, which is currently being tested in a Phase I/II clinical trial to treat severe corneal trophic ulcers with preliminary good feasibility and safety results. This bioartificial cornea is based on a nanostructured fibrin-agarose biomaterial containing human allogeneic stromal keratocytes and cornea epithelial cells, mimicking the human native anterior cornea in terms of optical, mechanical, and biological behavior. This product is manufactured as a clinical-grade tissue engineering product, fulfilling European requirements and regulations. The clinical translation process included several phases: an initial in vitro and in vivo preclinical research plan, including preclinical advice from the Spanish Medicines Agency followed by additional preclinical development, the adaptation of the biofabrication protocols to a good manufacturing practice manufacturing process, including all quality controls required, and the design of an advanced therapy clinical trial. The experimental development and successful translation of advanced therapy medicinal products for clinical application has to overcome many obstacles, especially when undertaken by academia or SMEs. We expect that our experience and research strategy may help future researchers to efficiently transfer their preclinical results into the clinical settings. Copyright © 2019 The Authors. Journal of Tissue Engineering and Regenerative Medicine published by John Wiley & Sons Ltd.
Keywords: Animals; *Biocompatible Materials/ch [Chemistry]; Corneal Diseases/me [Metabolism]; Corneal Diseases/pa [Pathology]; Corneal Diseases/th [Therapy]; *Corneal Diseases; Epithelium, Corneal/ch [Chemistry]; Epithelium, Corneal/me [Metabolism]; Epithelium, Corneal/pa [Pathology]; Epithelium, Corneal/tr [Transplantation]; *Epithelium, Corneal; Humans; Rabbits; *Tissue Engineering

Risk of aphakic glaucoma after pars plana-lensectomy with and without removal of the peripheral lens capsule. - Stech, M; Grundel, B; Daniel, M; Bohringer, D; Joachimsen, L; Gross, N; Wolf, C; Link, H; Gilles, U; Lagreze, W A (Eye (London, England), 2019)
BACKGROUND: The etiology of aphakic glaucoma is unclear. It has been suggested that remaining lens epithelium releases cytokines transducing trabecular meshwork cells. Therefore, we compared two cohorts of children undergoing lensectomy. In cohort 1, the entire lens including its capsule was removed, in cohort 2 the peripheral lens capsule was left intact, also to facilitate secondary intraocular lens implantation later on., METHODS: We included children with uni- or bilateral congenital cataract who underwent lensectomy during the first year of life with subsequent contact lenses fitting. Group 1 comprised 41 eyes, group 2 comprised 33 eyes. In group 1, the median age at surgery was 4.0 months in unilateral and 3.0 months in bilateral cases 1, in group 2, 8.1 months and 2.4 months, respectively. The mean follow-up was 12.8 years in group 1 and 9.3 years in group 2. All cases were analyzed for the prevalence of aphakic glaucoma, for visual acuity and for compliance in visual rehabilitation (contact lens/occlusion therapy)., RESULTS: We found no significant difference in glaucoma prevalence between group 1 and group 2 (p = 0.68). The overall glaucoma rate was 26% after the mean follow-up of 11 years in both groups. In unilateral cases, the median visual acuity was logMAR 0.7 in both groups. In bilateral cases it was logMAR 0.4 in group 1 and logMAR 0.2 in group 2 (p = 0.05)., CONCLUSIONS: Leaving the peripheral lens capsule intact had no negative effect on the incidence of glaucoma and on resulting visual acuity.
Keywords: Amblyopia/pp [Physiopathology]; *Aphakia, Postcataract/et [Etiology]; *Cataract/cn [Congenital]; *Cataract Extraction/ae [Adverse Effects]; Female; Follow-Up Studies; *Glaucoma/et [Etiology]; Humans; Infant; *Lens Capsule, Crystalline/su [Surgery]; Lens Implantation, Intraocular; *Lens, Crystalline/su [Surgery]; Male; Proportional Hazards Models; Risk Factors; Visual Acuity/ph [Physiology]

The cost-effectiveness of medication, laser trabeculoplasty, and trabeculectomy for treatment of open-angle glaucoma in South Korea. - Choi, Jin A; Song, Lina D; Choi, Seulggie; Park, Sang Min; Kwon, Jin Woo; Jee, Donghyun (Medicine, 2019)
OBJECTIVES: Open-angle glaucoma (OAG) imposes high disease burden in South Korea. Although various effective interventions are available to manage the progression of OAG, there is limited data on the cost-effectiveness of these treatment strategies in South Korea., METHODS: Using a Markov cohort model, we evaluated the cost-effectiveness of 3 major treatment strategies (medication, laser trabeculoplasty, and trabeculectomy) for South Korean patients with OAG. We projected a 25-year time horizon to study a hypothetical cohort of 10,000 patients of age 40 with mild OAG. The outcome measures were quality-adjusted life-years (QALYs) gained, cost from the societal perspective, and the incremental cost-effectiveness ratio (ICER) of medication, laser trabeculoplasty, and trabeculectomy. Interventions were evaluated at a willingness-to-pay (WTP) threshold of 30,000,000 KRW ($29,152) per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to address the model uncertainty., RESULTS: The mean costs for medication, laser trabeculoplasty, and trabeculectomy were 29,661,740 KRW, 17,34,1342 KRW, and 22,275,438 KRW, respectively. The mean QALYs gained were 15.7, 15.3, and 14.8 for medication, laser trabeculoplasty, and trabeculectomy, respectively. Surgery was strongly dominated because it generated fewer expected QALYs but incurred greater expected cost than laser. The ICER was 30,885,179 KRW per QALY for medication versus laser trabeculoplasty. Laser was cost-effective, however, at a lower WTP threshold of 21,000,000 KRW per QALY gained or below. The results were most sensitive to the progression rates from mild to moderate glaucoma under laser treatment., CONCLUSION: Under the WTP threshold of 30,000,000 KRW per QALY, medication was cost-effective compared with laser trabeculoplasty and trabeculectomy for treating mild OAG in South Korean population. Laser, however, can be a cost-effective alternative in more resource-limited settings.
Keywords: Adult; Cost-Benefit Analysis; *Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Laser Therapy/ec [Economics]; Laser Therapy/mt [Methods]; Markov Chains; Models, Theoretical; *Neuroprotective Agents/ec [Economics]; Neuroprotective Agents/tu [Therapeutic Use]; Patient Acceptance of Health Care; Quality-Adjusted Life Years; Republic of Korea; *Trabeculectomy/ec [Economics]; Trabeculectomy/mt [Methods]

21st century glaucoma care. - Quigley, Harry A (Eye (London, England), 2019)
Glaucoma care has evolved dramatically over the past generation, with changes that have incorporated new technology and improved understanding of the disease process. A major need is to construct a useful definition of glaucomatous optic neuropathy that can be used to compare data across clinical research studies. The treatment of glaucoma should now be based on achievement of a goal target for intraocular pressure, unique to each patient. Adherence with eye drop treatment is far from ideal and can be improved using reminder systems. Sustained delivery of glaucoma medication is on the horizon. New surgical approaches to glaucoma are being actively studied but have not as yet found their place in its care, with rigorous testing against present treatments needed.
Keywords: Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure/ph [Physiology]; Nerve Fibers/pa [Pathology]; Optic Nerve Diseases/pp [Physiopathology]; *Optic Nerve Diseases/th [Therapy]; Retinal Ganglion Cells/pa [Pathology]; Tonometry, Ocular

Trends in and Predictors of Depression Among Participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS). - Musch, David C; Niziol, Leslie M; Janz, Nancy K; Gillespie, Brenda W (American journal of ophthalmology, 2019)
PURPOSE: To characterize longitudinal trends and factors predictive of depressive symptoms following glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants., DESIGN: Cohort study using follow-up data from a clinical trial., METHODS: A total of 607 participants with newly diagnosed open-angle glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to treatment with medication or surgery, and followed every 6 months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score >= 7), and number of depressive symptoms endorsed., RESULTS: The average baseline CES-D score was 2.4 (SD = 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year posttreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR] = 2.41), female sex (OR = 1.42), younger age (OR per 10 years younger = 1.24), and less than high school education (OR = 2.93); other outcomes showed similar results., CONCLUSIONS: Depressive symptoms decreased considerably during the first year after treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce treatment adherence and thus increase the risk of glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary. Copyright © 2018 Elsevier Inc. All rights reserved.
Keywords: Adult; Age Factors; Aged; *Depressive Disorder/et [Etiology]; Female; *Glaucoma, Open-Angle/px [Psychology]; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Quality of Life; Risk Factors; Sex Factors

The most abundant cyst wall proteins of Acanthamoeba castellanii are lectins that bind cellulose and localize to distinct structures in developing and mature cyst walls. - Magistrado-Coxen, Pamela; Aqeel, Yousuf; Lopez, Angelo; Haserick, John R; Urbanowicz, Breeanna R; Costello, Catherine E; Samuelson, John (PLoS neglected tropical diseases, 2019)
BACKGROUND: Acanthamoeba castellanii, which causes keratitis and blindness in under-resourced countries, is an emerging pathogen worldwide, because of its association with contact lens use. The wall makes cysts resistant to sterilizing reagents in lens solutions and to antibiotics applied to the eye., METHODOLOGY/PRINCIPAL FINDINGS: Transmission electron microscopy and structured illumination microscopy (SIM) showed purified cyst walls of A. castellanii retained an outer ectocyst layer, an inner endocyst layer, and conical ostioles that connect them. Mass spectrometry showed candidate cyst wall proteins were dominated by three families of lectins (named here Jonah, Luke, and Leo), which bound well to cellulose and less well to chitin. An abundant Jonah lectin, which has one choice-of-anchor A (CAA) domain, was made early during encystation and localized to the ectocyst layer of cyst walls. An abundant Luke lectin, which has two carbohydrate-binding modules (CBM49), outlined small, flat ostioles in a single-layered primordial wall and localized to the endocyst layer and ostioles of mature walls. An abundant Leo lectin, which has two unique domains with eight Cys residues each (8-Cys), localized to the endocyst layer and ostioles. The Jonah lectin and glycopolymers, to which it binds, were accessible in the ectocyst layer. In contrast, Luke and Leo lectins and the glycopolymers, to which they bind, were mostly inaccessible in the endocyst layer and ostioles., CONCLUSIONS/SIGNIFICANCE: The most abundant A. castellanii cyst wall proteins are three sets of lectins, which have carbohydrate-binding modules that are conserved (CBM49s of Luke), newly characterized (CAA of Jonah), or unique to Acanthamoebae (8-Cys of Leo). Cyst wall formation is a tightly choreographed event, in which lectins and glycopolymers combine to form a mature wall with a protected endocyst layer. Because of its accessibility in the ectocyst layer, an abundant Jonah lectin is an excellent diagnostic target.
Keywords: Acanthamoeba castellanii/ch [Chemistry]; Acanthamoeba castellanii/ge [Genetics]; *Acanthamoeba castellanii/gd [Growth & Development]; *Acanthamoeba castellanii/me [Metabolism]; *Amebiasis/ps [Parasitology]; Amino Acid Sequence; *Cellulose/me [Metabolism]; Humans; Keratitis/ps [Parasitology]; Lectins/ch [Chemistry]; Lectins/ge [Genetics]; *Lectins/me [Metabolism]; Life Cycle Stages; Protein Binding; Protein Transport; Protozoan Proteins/ch [Chemistry]; Protozoan Proteins/ge [Genetics]; *Protozoan Proteins/me [Metabolism]; Sequence Alignment

A Highly Effective and Ultra-Long-Acting Anti-Glaucoma Drug, with a Novel Periorbital Delivery Method. - Woodward, David F; Wang, Jenny W; Coleman, Robert A; Woodrooffe, Amanda J; Clark, Kenneth L; Stamer, W Daniel; Tao, Guoxian; Fan, Shan; Toris, Carol B (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2019)
Purpose: Two features define the future of glaucoma therapeutics: (1) greatly improved ocular hypotensive efficacy and (2) a delivery method that improves patient convenience and compliance. A highly efficacious and extraordinarily long-acting ocular hypotensive agent PGN 9856-isopropyl ester represents a potential next-generation anti-glaucoma drug. A new periorbital drug delivery route was also investigated. Methods: PGN 9856-isopropyl ester pharmacology was determined by employing human cells, including prostanoid receptor transfectants, and FLIPr or cellular dielectric spectroscopy technology. Intraocular pressure (IOP) was measured in conscious cynomolgus monkeys trained to accept pneumatonometry when under gentle restraint. For periorbital application, the compound was applied radially using a roller-ball device connected to a cylindrical reservoir. Pharmacokinetic data were obtained using LC/MS/MS instrumentation. Results: Single doses of PGN 9856-isopropyl ester, administered over a 0.001%-0.01% dose range, produced profound decreases in monkey IOP that persisted for at least 5 days, which was long after the drug was detectable in ocular tissues. It was not uncommon for a single eye drop to reduce IOP to the level of 4-7 mm Hg. Drug application to the periorbital dermis of ocular normotensive monkeys produced a similarly profound reduction in IOP, which was well maintained. Conclusions: PGN 9856-isopropyl ester appears to possess efficacy and duration of action properties unmatched by currently prescribed anti-glaucoma agents and by those currently undergoing clinical evaluation. In addition, application to the periorbital skin using a roller-ball device offers a more convenient method of ophthalmic drug delivery than eye drops and is noninvasive, unlike other "dropless" technologies.
Keywords: Acetates/ad [Administration & Dosage]; Acetates/ch [Chemistry]; *Acetates/tu [Therapeutic Use]; Administration, Topical; Animals; Aqueous Humor/ch [Chemistry]; Biphenyl Compounds/ad [Administration & Dosage]; Biphenyl Compounds/ch [Chemistry]; *Biphenyl Compounds/tu [Therapeutic Use]; Cornea/ch [Chemistry]; *Drug Delivery Systems; Esters/ad [Administration & Dosage]; Esters/ch [Chemistry]; *Esters/tu [Therapeutic Use]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Macaca fascicularis; Male; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ch [Chemistry]; *Ophthalmic Solutions/tu [Therapeutic Use]; Optical Imaging; Time Factors

The Effect of a Reminder Short Message Service on the Uptake of Glaucoma Screening by First-Degree Relatives of Glaucoma Patients: A Randomized Controlled Trial. - Salihu, Dora K; Adenuga, Olukorede O; Wade, Patricia D (Middle East African journal of ophthalmology, 2019)
PURPOSE: The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening., MATERIALS AND METHODS: A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups., RESULTS: Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening., CONCLUSION: A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service. Copyright: © 2020 Middle East African Journal of Ophthalmology.
Keywords: Adult; Aged; Appointments and Schedules; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Male; *Mass Screening/sn [Statistics & Numerical Data]; Middle Aged; Nigeria; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Reminder Systems; *Text Messaging

[The effect of preservative-free treatment of primary open-angle glaucoma on the state of ocular surface in combination therapy (intermediate results)]. - Dorofeev, D A; Tur, E V; Vizgalova, L O; Tryapitsin, I D; Ciganov, A Z (Vestnik oftalmologii, 2019)
The goal of antihypertensive therapy is to reduce intraocular pressure (IOP). Sometimes it can only be achieved by using two or more drugs, which can lead to undesirable side effects on the ocular surface. The use of drugs that do not contain preservatives leads to fewer undesirable side effects, while also reducing the need for instillations of artificial tears, making it economically beneficial for patients., PURPOSE: To assess the state of ocular surface in patients with POAG when switching to preservative-free carbonic anhydrase inhibitor (ICA) containing 0.18% sodium hyaluronate in combination with prostaglandin analogues and beta-adrenergic blocking agents., MATERIAL AND METHODS: The study was conducted in 2019; according to selection criteria, it included 46 patients (80 eyes) with POAG and a control group of healthy persons. At the start of the study and one month later, after a change of treatment to uninterrupted ICA containing 0.18% sodium hyaluronate, the patients had state of their ocular surface examined: Norn's test (tear break-up time; TBUT), Schirmer's test, vital staining with lissamine green and an Ocular Surface Disease Index (OSDI) survey., RESULTS: Replacing the ICA with benzalkonium chloride in the combination therapy of glaucoma with a preservative-free ICA containing 0.18% sodium hyaluronate - Dorzolan Solo (Solopharm, Russia) - expectedly did not lead to additional decrease of IOP, but resulted in a decrease in the width of the confidence interval according to both Maklakov's and Icare tonometers, which may be associated with increased treatment adherence. At the same time, the state of ocular surface in the observation group was statistically significantly improved according to Norn's test - from 3.57+/-1.3; 3.0 (3.0; 5.0) to 4.9+/-2.5; 5.0 (3.0; 6.0) (V=16.5; p=0.0039)., CONCLUSION: According to Schirmer's test and vital staining with lissamine green, no statistically significant changes have occurred. OSDI survey did not reveal changes in the study patients during 4 weeks of the follow-up, while the control group exhibited improvement.
Keywords: Antihypertensive Agents; *Glaucoma, Open-Angle; Humans; Intraocular Pressure; *Ocular Hypertension; Ophthalmic Solutions; Preservatives, Pharmaceutical; Russia; Tears; Tonometry, Ocular

[Influence of treatment adherence on the progression of primary open-angle glaucoma in clinical setting]. - Neroev, V V; Zolotarev, A V; Karlova, E V; Kiseleva, O A; Shishkin, M M; Germanova, V N (Vestnik oftalmologii, 2019)
According to various studies, treatment adherence of patients with primary open-angle glaucoma ranges from 5% to 80% and significantly influences the effectiveness of the therapy. Some authors report higher levels of adherence in patients receiving preservative-free medications., PURPOSE: To study the influence of treatment adherence in patients receiving preservative-free and preserved medications on the progression of primary open-angle glaucoma (POAG)., MATERIAL AND METHODS: This prospective multicenter non-interventional study was conducted in clinical setting and included 504 patients with primary open-angle glaucoma receiving drug therapy; 51 ophthalmologist was involved in the management of patients' diaries., RESULTS: The percentage of patients who did not reach target IOP was three times lower in the group with high adherence, in comparison to patients with medium and low adherence (7% against 22%, respectively). Development of side effects was one of the factors influencing treatment adherence, their rates and expressiveness were much lower in the preservative-free group compared with the group receiving preserved medication (13.9% against 35.4%). The rate of patients who did not reach target IOP was two times lower in the group of preservative-free medication (10% against 21%)., CONCLUSION: The study confirms that preservative-free glaucoma medication promotes higher adherence to treatment in clinical setting predominantly due to the reduction of quantity and severity of side effects leading to treatment gaps, which results in increased effectiveness and better stabilization of glaucoma.
Keywords: Antihypertensive Agents; *Glaucoma, Open-Angle; Humans; *Intraocular Pressure; Preservatives, Pharmaceutical; Prospective Studies; Treatment Adherence and Compliance

Minimally Invasive Glaucoma Surgery: A Budget Impact Analysis and Evaluation of Patients' Experiences, Preferences, and Values. - Ontario Health (Quality) (Ontario health technology assessment series, 2019)
Background: Glaucoma is a condition that causes progressive damage to the optic nerve, which can lead to visual impairment and irreversible blindness. There is a spectrum of current treatments for glaucoma that aim to reduce intraocular pressure (IOP), including pharmacotherapy (eye drops), laser therapy, and the more invasive option of filtration surgery. A new class of treatments called minimally invasive glaucoma surgery (MIGS) may reduce IOP and offer a better safety profile than more invasive procedures. We conducted a budget impact analysis of MIGS for adults with glaucoma from the perspective of the Ontario Ministry of Health and Long-Term Care. We also conducted interviews with people with glaucoma and family members of people with glaucoma to determine patient preferences and values surrounding glaucoma and its treatment options, including MIGS. We completed this work to complement a health technology assessment conducted in collaboration with the Canadian Agency for Drugs and Technologies in Health (CADTH)., Methods: We analyzed the budget impact of publicly funding MIGS in adults with glaucoma in Ontario. We derived costs from the collaborative health technology assessment.1 We assumed MIGS may be used in three subgroups: (1) MIGS in combination with cataract surgery as a replacement for cataract surgery alone in people with mild to moderate glaucoma; (2) MIGS alone as a replacement for other glaucoma treatments in people with mild to moderate glaucoma; and (3) MIGS (alone or in combination with cataract surgery) to replace filtration surgery (alone or in combination with cataract surgery) in people with advanced to severe glaucoma. We estimated the budget impact over 5 years for two possible uptake scenarios: a slow rate of uptake and a fast rate of uptake. To contextualize the lived experience of glaucoma and treatments for glaucoma, we also interviewed people with glaucoma and family members of people with glaucoma, some of whom had experience with surgical procedures such as MIGS and some of whom did not., Results: Assuming a slow uptake scenario, the annual budget impact of publicly funding MIGS in Ontario over the next 5 years ranges from $1 million in year 1 to $18 million in year 5. Assuming a fast uptake scenario, the annual budget impact of publicly funding MIGS in Ontario over the next 5 years ranges from $6 million in year 1 to $70 million in year 5. The budget impact varies depending on the proportion of people in each of the three subgroups described above. Introducing a new MIGS billing code may reduce the overall expenditures. Interview participants felt that less invasive surgical procedures, such as MIGS, could control glaucoma progression with minimal side effects and recovery time needed., Conclusions: We estimate that publicly funding MIGS in Ontario would result in additional costs over the next 5 years; however, this may depend on the populations using MIGS and if uptake is restricted or controlled. For the people with glaucoma we spoke with, avoiding blindness was their paramount concern, and MIGS was perceived as an effective treatment option with minimal side effects and recovery time required. Copyright © Queen's Printer for Ontario, 2019.
Keywords: Budgets; Cost-Benefit Analysis; Filtering Surgery/ec [Economics]; *Financing, Government/ec [Economics]; Glaucoma/ec [Economics]; *Glaucoma/su [Surgery]; Humans; *Minimally Invasive Surgical Procedures/ec [Economics]; Minimally Invasive Surgical Procedures/mt [Methods]; Ophthalmologic Surgical Procedures/ec [Economics]; *Ophthalmologic Surgical Procedures/mt [Methods]; *Patient Preference; Quality of Life

Management of infective corneal ulcers in a high-income developing country. - AlMahmoud, Tahra; Elhanan, Mohamed; Elshamsy, Mohamed H; Alshamsi, Hanan N; Abu-Zidan, Fikri M (Medicine, 2019)
Microbial keratitis is a major risk for corneal blindness worldwide. We aimed to study the clinical presentation and outcome of hospitalized patients having infective corneal ulcers.All patients who were diagnosed as microbial keratitis and were admitted to Al-Ain Hospital during the period July 2011-Dec 2016 were retrospectively studied. Patients' demography, predisposing factors, symptoms and signs at presentation, time to presentation after onset of symptoms, microbial isolates, hospital stay, and visual acuity (VA) outcome were studied.74 patients with corneal ulcers were hospitalized. 79.7% were males. The median (range) age was 44 years (1-91). 36.5% had trauma as a risk factor. The main presenting symptoms were pain (90.5%), red eye (79.7%), and decreased vision (63.5%). All patients had stromal infiltrate while 39.2% had hypopyon at presentation. The average time from the start of the symptoms to hospital presentation was 11 (1-90) days. The mean (range) hospital stay was 10.6 (1-60) days. Forty eyes were culture positive. Bacteria were identified in 27 eyes and fungus in 16. Pseudomonas aeruginosa (9 eyes) and Staphylococcus epidermis (5 eyes) were the most common bacterial islolates. Aspergillus (6 eyes) was the most common fungus species. 95.2% of the bacterial isolates were susceptible to the quinolone antibiotics group. Twenty eight (51.9%) patients had a vision worse than 6/60 in the affected eye.Corneal ulcer poses a significant threat to the sight of an affected eye. Trauma was the most common risk factor for corneal ulcers. Usage of eyes personal protective equipment for high risk occupations and earlier accessibility to health care may reduce the impact of corneal ulcers in our community.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/ep [Epidemiology]; *Corneal Ulcer/th [Therapy]; Developing Countries; Female; Humans; Infant; Male; Middle Aged; Retrospective Studies; Risk Factors; United Arab Emirates/ep [Epidemiology]; Young Adult

Netarsudil and latanoprost ophthalmic solution for the reduction of intraocular pressure in open-angle glaucoma or ocular hypertension. - Aref, Ahmad A; Geyman, Lawrence S; Zakieh, Abdel-Rahman; Alotaibi, Humoud M (Expert review of clinical pharmacology, 2019)
Introduction: Netarsudil and latanoprost ophthalmic solution (0.02%/0.005%) is indicated for intraocular pressure (IOP) lowering in open-angle glaucoma (OAG) or ocular hypertension (OHTN). The once-daily agent combines the mechanism of action for each of the individual components and provides a new avenue for long-term intraocular pressure control. This review aims to cover the agent's current efficacy and safety data and opine as to its role in glaucoma management. Areas covered: This article will cover Phase II-III clinical efficacy and safety data as well as basic science literature pertaining to the agent's mechanism of action and pharmacodynamics. In selecting articles for inclusion in this review, a literature search using the PubMed database was carried out. Cross-referencing was carried out where applicable. We did not use any date or language restrictions in electronic searches. Expert opinion: Netarsudil and latanoprost ophthalmic solution plays a pivotal role in management of individuals with OAG and OHTN. The agent may be used as first-line therapy to provide substantial IOP-lowering or when additional lowering is indicated and prostaglandins have provided insufficient IOP lowering. The once-daily dosing regimen decreases the risk of inadequate treatment due to nonadherence.
Keywords: Animals; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; *Benzoates/ad [Administration & Dosage]; Benzoates/ae [Adverse Effects]; Drug Combinations; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure; *Latanoprost/ad [Administration & Dosage]; Latanoprost/ae [Adverse Effects]; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; beta-Alanine/ad [Administration & Dosage]; beta-Alanine/ae [Adverse Effects]; *beta-Alanine/aa [Analogs & Derivatives]

[Care delay the most common error in ophthalmic health care]. - Merkland, Dalia; Gjotterberg, Magnus (Lakartidningen, 2019)
This study reviewed 102 decisions on error reports in ophthalmic health care in Sweden between March 2017 and October 2018. The study included children, adults, women and men. We found that there was a clear association between long waiting times for ophthalmic health care and negative visual outcomes. As a result of care delay, 71 percent of the patients had moderate vision loss and 17 percent of the patients experienced severe vision loss. Patients with glaucoma and wet macular degeneration accounted for the majority of the patients with negative outcomes. Timely follow-up and prompt treatment are critical to patients' visual outcomes.
Keywords: Adult; Aged; Child; Female; Glaucoma/ep [Epidemiology]; Humans; Macular Degeneration/ep [Epidemiology]; Male; *Medical Errors/sn [Statistics & Numerical Data]; Middle Aged; *Ophthalmology/st [Standards]; Quality of Health Care/st [Standards]; Sweden/ep [Epidemiology]; *Time-to-Treatment; Treatment Outcome; Vision Disorders/ep [Epidemiology]; Waiting Lists

A Survey of Surgical Techniques in Pterygium, Thailand 2016. - Phathanthurarux, Saovapak; Chantaren, Patchima (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2019)
BACKGROUND: Pterygium causes a significant ocular disturbance which usually requires surgical removal; however, recurrence of pterygium after surgery frustrates both patients and surgeons. This survey aimed to determine the current surgical approaches in primary and recurrent pterygium, and the ideal surgical techniques among Thai ophthalmologists., METHODS: Questionnaires were sent to 1150 ophthalmologists who are members of Royal College of Ophthalmologists of Thailand (RCOPT). A survey was conducted between 21 September and December 21, 2016., RESULTS: 438 of 515 responded questionnaires were valid. The highest number of the respondents applied the bare sclera technique (BST) (37.4%) and conjunctival autograft transplantation (CAGT, 44.9%) in primary pterygium and recurrent pterygium, respectively. The recurrence was the most reported late postoperative complication. An ideal technique for primary pterygium surgery was CAGT (42.4%), whereas amniotic membrane transplant (AMT) with adjuvant therapy (27.4%) was most selected for recurrent pterygium. Around half of the respondents currently applied the ideal techniques in their practice. The inaccessible and unaffordable amniotic membranes or fibrin glues (58%) concerning about complications (26%), inexperience in surgical procedures (25%), large number of patients in the surgery waiting list, prolonged surgical time, and need for conjunctiva preservation in glaucoma patients were reported as the obstacles to the ideal techniques., CONCLUSIONS: BST and CAGT were the most selected surgical techniques for primary and recurrent pterygium, respectively. Better provision and distribution of amniotic membranes and fibrin glue along with training courses would promote the ideal surgical techniques.
Keywords: Amnion/tr [Transplantation]; *Conjunctiva/ab [Abnormalities]; Conjunctiva/su [Surgery]; Conjunctiva/tr [Transplantation]; Fibrin Tissue Adhesive/tu [Therapeutic Use]; Humans; *Ophthalmologic Surgical Procedures/mt [Methods]; *Pterygium/su [Surgery]; Recurrence; Thailand; Transplantation, Autologous

Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis. - Miraldi Utz, Virginia; Bulas, Sabrina; Lopper, Sarah; Fenchel, Matthew; Sa, Ting; Mehta, Mitul; Ash, Daniel; Lovell, Daniel J; Kaufman, Adam H (Pediatric rheumatology online journal, 2019)
BACKGROUND: Refractory non-infectious uveitis is a serious condition that leads to ocular complications and vision loss and requires effective systemic treatment to control disease. The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated., METHODS: Retrospective, single-center study between December 2002 and April 2016 of 27 children with refractory non-infectious uveitis [17 with juvenile idiopathic arthritis, JIA] treated with long-term IFX [9+ months]. Disease activity was assessed prior to and while on IFX using the Standardization of Uveitis Nomenclature [SUN]. Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2 years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Incomplete treatment adherence was assessed for each visit and defined as any deviance in corticosteroid use, prescribed infusion frequency, and/or follow-up examination frequency., RESULTS: Primary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention. Mean age at IFX initiation was 10.4 +/- 4.5 years; initial mean dose was 6.6 +/- 2.2 mg/kg [and given at weeks 0, 2, 4 and q4 weeks thereafter for 93%]. Median duration on IFX was 35 [range 9-128] months. Prior to IFX, 14/27 patients had failed adalimumab +/- methotrexate [MTX]; 21/27 failed MTX. IFX led to uveitis control in 89% and arthritis control in 76% (13/17). The odds ratio of having controlled disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (p = 0.007 right eye [OD], 0.003 left eye [OS] and p = 0.001 OD, p = 0.028 OS respectively). Incomplete adherence to treatment showed 10.3 times greater odds (7.1, 15.0) of having disease activity than full adherence., CONCLUSIONS: This study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.
Keywords: *Antirheumatic Agents/tu [Therapeutic Use]; Child; Child, Preschool; Female; Humans; *Infliximab/tu [Therapeutic Use]; Male; *Medication Adherence; Retrospective Studies; Treatment Outcome; *Uveitis/dt [Drug Therapy]

Role of Fibronectin in Primary Open Angle Glaucoma. - Faralli, Jennifer A; Filla, Mark S; Peters, Donna M (Cells, 2019)
Primary open angle glaucoma (POAG) is the most common form of glaucoma and the 2nd most common cause of irreversible vision loss in the United States. Nearly 67 million people have the disease worldwide including >3 million in the United States. A major risk factor for POAG is an elevation in intraocular pressure (IOP). The increase in IOP is believed to be caused by an increase in the deposition of extracellular matrix proteins, in particular fibronectin, in a region of the eye known as the trabecular meshwork (TM). How fibronectin contributes to the increase in IOP is not well understood. The increased density of fibronectin fibrils is thought to increase IOP by altering the compliance of the trabecular meshwork. Recent studies, however, also suggest that the composition and organization of fibronectin fibrils would affect IOP by changing the cell-matrix signaling events that control the functional properties of the cells in the trabecular meshwork. In this article, we will discuss how changes in the properties of fibronectin and fibronectin fibrils could contribute to the regulation of IOP.
Keywords: Animals; Biomarkers; *Disease Susceptibility; Extracellular Matrix; Fibronectins/ch [Chemistry]; Fibronectins/ge [Genetics]; *Fibronectins/me [Metabolism]; Gene Expression; *Glaucoma, Open-Angle/et [Etiology]; *Glaucoma, Open-Angle/me [Metabolism]; Glaucoma, Open-Angle/pa [Pathology]; Humans; Protein Aggregates; Protein Aggregation, Pathological; Trabecular Meshwork/me [Metabolism]; Trabecular Meshwork/pa [Pathology]

Feeling the pressure: a cross-sectional study exploring feasibility of a healthcare Pop-Up for intraocular pressure measurements in shopping centres in England. - Edwards, Laura A; Taylor, Deanna J; Campbell, Peter; Shah, Rakhee; Edgar, David F; Crabb, David P (BMJ open, 2019)
OBJECTIVES: To test the hypothesis that a shopping centre Pop-Up health check combining an intraocular pressure (IOP) check with a general health check (blood pressure (BP)) is more readily accepted by the general public than an IOP check only. We investigate public awareness of IOP compared with BP and the feasibility of measuring IOP in large numbers in a Pop-Up., DESIGN: A cross-sectional study using a tailor-made healthcare Pop-Up., SETTING: The 'Feeling the Pressure' Pop-Up was sited in eight regionally-different shopping centres in England., PARTICIPANTS: Adult members of the public in shopping centres., METHODS: On one day we measured IOP only and on another measured BP and IOP. IOP was measured by Icare IC100 tonometer (Helsinki, Finland). Potential participants were asked about their awareness of IOP and BP and when they last visited their optometrist., RESULTS: More people attended the combined BP + IOP days (461; 60%; 95% CI 56% to 64%) than IOP-only days (307; 40%, 95% CI 37% to 43%) over 16 days of testing. We recorded IOP in 652 participants (median (IQR) age and IOP of 54 (42 to 68) years and 13 (11 to 15) mm Hg, respectively). Fewer people reported awareness about IOP (19%, 95% CI 16% to 23%) compared with BP (71%, 95% CI 66% to 75%). Of 768 participants, 60 (8%) reported no previous optometric eye examination and 185 (24%) reported >2 years since their most recent examination., CONCLUSIONS: Measuring IOP in large numbers of the public via a shopping centre Pop-Up is feasible. Public engagement was greater when a BP check was offered alongside an IOP check, suggesting unfamiliar health checks can be promoted by aligning them with a more familiar check. Our findings hint at strategies for public health schemes that engage the public with their eye health. Copyright © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Adult; Aged; *Ambulatory Care; Blood Pressure Determination; Cross-Sectional Studies; England; Feasibility Studies; Female; *Glaucoma/di [Diagnosis]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; *Patient Acceptance of Health Care; *Tonometry, Ocular

Novel drug delivery methods for the treatment of keratitis: moving away from surgical intervention. - Garg, Prashant; Venuganti, Venkata Vamsi Krishna; Roy, Aravind; Roy, Girdhari (Expert opinion on drug delivery, 2019)
Introduction: Corneal ulceration is one of the leading causes of blindness especially in low- and mid-income countries (LMICs). Surgical treatment of microbial keratitis is associated with multiple challenges that include non-availability of donor corneal tissues, lack of trained corneal surgeons, and poor compliance to follow up care. As a result, the surgery fails in 70-90% cases. Therefore, improving outcome of medical treatment and thereby avoiding the need for the surgery is an unmet need in the care of corneal ulcer cases. Areas covered: In this review article, the authors have tried to compile information on the novel drug-delivery systems that have potential to enhance success of medical management. We have discussed the following systems: cyclodextrins, gel formulations, colloidal system, nanoformulations, drug-eluting contact lens, microneedle patch, and ocular inserts. Expert opinion: The goals of corneal ulcer treatment are as follows: rapid eradication of causative microorganisms, control of damage from induced inflammation and microbial toxins, and facilitation of repair. The ocular surface anatomy poses several challenges for drug delivery using standard topical therapy. The novel drug-delivery systems mentioned above aim to enhanced tear solubility; superior stability; improved bio-availability; reduced toxicity; besides facilitating targeted drug delivery and convenience of administration.
Keywords: Animals; *Drug Delivery Systems; Humans; *Keratitis/dt [Drug Therapy]

[Frequency and type of macular edema after cataract surgery in patients with glaucoma]. - Erichev, V P; Kozlova, I V; Kosova, J V (Vestnik oftalmologii, 2019)
Cataract is one of the common causes of reversible vision loss in people older than 50 years. Currently, the only way to treat it effectively is phacoemulsification with simultaneous implantation of an intraocular lens - a method that minimizes the amount of surgical trauma and the number of intra- and postoperative complications. Nevertheless, the problem of prevention and timely diagnosis of pathological changes in the retina, which may develop after extraction of cataracts, and in particular - macular edema, remains relevant. This problem becomes especially important when it comes to patients with concomitant cataract and glaucoma who use local antihypertensive drugs - in particular, prostaglandin analogues - for a long time. Having common properties with inflammatory mediators, in some cases they can cause vasodilation, increase vascular permeability and contribute to the development of exudative processes. Drugs of this group can cause impairment of the hematophthalmic and hematoretinal barriers provoking the development of cystoid macular edema, including in the early postoperative period after cataract extraction. As described by S. Irvine in 1953, macular edema is related to late postoperative complications and remains one of the main causes of visual impairment after lens removal. The review provides information about some studies concerning the effect of prostaglandin derivatives on the postoperative period after phacoemulsification. At this time, there is no consensus on this matter.
Keywords: *Cataract; *Cataract Extraction; *Glaucoma; Humans; Lens Implantation, Intraocular; *Macular Edema; *Phacoemulsification; Postoperative Complications

Applications of microneedles in delivering drugs for various ocular diseases. - Gupta, Pallavi; Yadav, Khushwant S (Life sciences, 2019)
Treatment of majority of eye diseases involve the use of eye drops or eye ointments, which have major drawbacks of needing frequent administration, lower bioavailability and inability to cross the various eye barriers. This necessitates the use of novel delivery systems. Microneedles (MNs) as an alternate novel delivery system facilitate drug delivery to various ocular diseases with promising approaches in healthcare. Advances in pharmaceutical technology have made MNs provide localized, effective, less invasive and targeted drug delivery in the eye. The purpose of this review is to provide an insight to efficacious therapeutic applications the MNs can bring in various ocular diseases. Out of which, glaucoma, age-related macular degeneration, uveitis, retinal vascular occlusion and retinitis pigmentosa are majorly discussed. Among the various types of MNs; solid coated, hollow and dissolving polymeric MNs are specifically focused for their applications in ocular diseases. In addition, MNs shows improvement in the visual acuity and decreases the progression of the different ocular diseases. Copyright © 2019 Elsevier Inc. All rights reserved.
Keywords: Administration, Ophthalmic; Animals; *Drug Delivery Systems; *Eye Diseases/dt [Drug Therapy]; Humans; *Microinjections/is [Instrumentation]; *Microinjections/mt [Methods]; Needles; *Pharmaceutical Preparations/ad [Administration & Dosage]

Demographic and socioeconomic barriers and treatment seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty. - Shah, Hem; Radhakrishnan, Naveen; Ramsewak, Shivaa; Chiu, Stephan; Joseph, Sanil; Rose-Nussbaumer, Jennifer; Prajna, N Venkatesh (Indian journal of ophthalmology, 2019)
Purpose: To understand demographic and socioeconomic barriers and treatment-seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty (TPK) in a developing country., Methods: This prospective non-comparative questionnaire- based study included all patients presenting to Aravind Eye Hospital, Madurai with infectious keratitis that eventuated to TPK between November 2015 and October 2016. A structured questionnaire was administered on post-operative day 3 to collect data on the demographic details, predisposing factors, prior treatment received, and treatment expenditures., Results: In total, 227 patients underwent TPK between November 2015 and October 2016 for infectious keratitis. The majority of patients were males (n = 132, 58.1%), illiterate (n = 129, 56.8%), and had a family monthly income of less than INR 6000 (n = 142, 62.5%). Most of the patients (n = 163, 71.8%) had prior treatment with an ophthalmologist before presenting to our hospital. The mean distance travelled to reach our centre was 269.2 +/- 298.5 km. The mean duration of disease before the presentation was 20.3 +/- 21.1 days. Corneal smear was positive for fungus in 163 (88.1%) and Aspergillus was the most commonly isolated fungi in 55 (41.3%) cultures. The mean total cost of treatment was INR 8752.87 +/- 7615.39 per patient. There was a positive correlation between the duration of the disease (rho 0.19, P = 0.0034) and the costs of treatment (rho 0.2, P = 0.0024) with the distance travelled by the patient., Conclusion: Patients who travelled a farther distance had a delayed onset of presentation and spent significantly more than their respective counterparts.
Keywords: *Acanthamoeba Keratitis/ep [Epidemiology]; Acanthamoeba Keratitis/ps [Parasitology]; Acanthamoeba Keratitis/su [Surgery]; Adult; *Corneal Ulcer/ep [Epidemiology]; Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/su [Surgery]; *Eye Infections, Bacterial/ep [Epidemiology]; Eye Infections, Bacterial/mi [Microbiology]; Eye Infections, Bacterial/su [Surgery]; *Eye Infections, Fungal/ep [Epidemiology]; Eye Infections, Fungal/mi [Microbiology]; Eye Infections, Fungal/su [Surgery]; Female; Graft Survival; Humans; *Keratoplasty, Penetrating; Male; Middle Aged; *Patient Acceptance of Health Care/px [Psychology]; Prospective Studies; *Socioeconomic Factors; Visual Acuity

Systematic review of the appropriateness of eye care delivery in eye care practice. - Ho, Kam Chun; Stapleton, Fiona; Wiles, Louise; Hibbert, Peter; Alkhawajah, Sally; White, Andrew; Jalbert, Isabelle (BMC health services research, 2019)
BACKGROUND: Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts' practice and to describe the methods used to measure appropriateness of eye care., METHODS: A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts' practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974., RESULTS: Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2-100% for glaucoma, 0-100% for diabetic retinopathy and 0-100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery., CONCLUSIONS: These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives.
Keywords: *Delivery of Health Care/st [Standards]; Delivery of Health Care/sn [Statistics & Numerical Data]; *Eye Diseases/th [Therapy]; Female; Humans; Male; Office Visits/sn [Statistics & Numerical Data]; Program Evaluation; *Quality of Health Care

Comparison of Prostaglandin Analog Treatment Patterns in Glaucoma and Ocular Hypertension. - Heo, Ji Haeng; Rascati, Karen L; Wilson, James P; Lawson, Kenneth A; Richards, Kristin M; Nair, Radhika (Journal of managed care & specialty pharmacy, 2019)
BACKGROUND: Prostaglandin analogs (PGAs) are considered an initial therapy to manage increased intraocular pressure (IOP) for patients with glaucoma. When the initial PGA treatment fails to lower IOP adequately, the patient may add or change medications or have surgery/laser treatment., OBJECTIVE: To compare medication adherence, duration of therapy, and treatment patterns among 3 PGAs-latanoprost, travoprost, and bimatoprost-as initial therapies for patients with glaucoma or ocular hypertension., METHODS: This was a retrospective cohort study using administrative claims data. The cohort consisted of patients newly diagnosed with glaucoma or ocular hypertension with at least 1 prescription claim for latanoprost, travoprost, or bimatoprost and enrolled in a Medicare Advantage plan between 2007 and 2012. The 24-month medication possession ratio (MPR) was used to measure medication adherence. Discontinuation of first-line PGA therapy was defined as nonpersistence (90-day gap allowance) of the index PGA or a change in therapy during the 24-month follow-up period. Types of second-line therapy (i.e., switch, addition, and surgery) were identified. The 1:1:1 propensity score matching was used., RESULTS: Patients who met the inclusion criteria were propensity score matched, resulting in 1,296 patients per PGA group. Latanoprost users showed higher adherence (50.1%) than travoprost (48.8%) and bimatoprost (43.0%) users. The latanoprost and travoprost groups had significantly higher MPRs than bimatoprost (P < 0.0001). The latanoprost group showed significantly longer duration of first-line therapy (372 days) than the bimatoprost group (343 days; P = 0.003) but not the travoprost group (361 days). After controlling for demographic and clinical characteristics, a Cox proportional hazards model showed that the travoprost and bimatoprost groups had a higher risk of discontinuation of first-line therapy than the latanoprost group (P < 0.0001). The percentage of patients continuing on the index PGA without treatment pattern change (i.e., switches, additions, and surgery) was higher for latanoprost users (52.9%) compared with travoprost (39.0%) or bimatoprost users (42.1%; P < 0.001)., CONCLUSIONS: Patients who used latanoprost as their initial therapy were more likely to adhere and persist to the index PGA compared with bimatoprost users. The latanoprost group demonstrated a lower risk of discontinuing first-line therapy than the travoprost and bimatoprost groups. The results may assist ophthalmologists in determining the optimal management of this patient population with respect to treatment patterns., DISCLOSURES: No outside funding supported this study. All authors except Heo and Nair are employed by The University of Texas at Austin College of Pharmacy. Heo was with the Health Outcomes Division, The University of Texas at Austin College of Pharmacy during a portion of this study and is employed by Genesis Research. Nair is employed by Humana. The authors have no financial relationships relevant to this article to disclose. This study was presented as a poster at the 2016 International Society for Pharmacoeconomics and Outcomes Research Annual Meeting, May 2016, Washington, DC.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medicare; Medication Adherence; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Retrospective Studies; United States

Characteristics of Infectious Keratitis in Bandage Contact Lens Wear Patients. - Zhu, Binbin; Liu, Yunfang; Lin, Lin; Huang, Xiaodan; Zhang, Yue; Zheng, Jiao; Jin, Xiuming (Eye & contact lens, 2019)
OBJECTIVE: The aim of this study was to determine the characteristics of infectious keratitis in patients wearing bandage contact lenses (BCLs)., METHODS: The BCL-related infectious keratitis cases were reviewed at the eye center of the Second Affiliated Hospital at the Zhejiang University School of Medicine from January 2015 to August 2018. Detailed information about the patients with infectious keratitis was collected, including the age, gender, clinical characteristics, culture results, and other measures. All the data analyses were performed using IBM SPSS Statistics for Windows version 24.0., RESULTS: From January 2015 until August 2018, 6,385 eyes of 6,188 patients, including 3,410 males and 2,778 females, received BCLs at our hospital. The mean age of these patients was 48.10+/-20.81 years (range=15-78 years). The mean BCL wearing time was 18.98+/-23.72 days (range=1-58 days). Eight patients (0.13%) with infectious keratitis were identified, and the mean age of these patients was 54.33+/-28.14 years (range=16-75 years). Seven of the infectious keratitis patients were older than 50 years, and one patient was 16 years old. The infectious keratitis incidence rate of the older patients (>=50 years) was significantly higher than that of the young patients (<50 years) (chi=9.647, P=0.002). There was a higher postkeratoplasty risk of BCL-related infectious keratitis than that in the corneal epithelial defect (chi=21.371, P=0.000) and pterygium surgery (chi=16.037, P=0.000) cases, but not in the corneal collagen cross-linking cases (chi=1.792, P=0.181). The mean onset time of BCL-related infectious keratitis was 22.63+/-18.72 days (range=3-58 days) after wearing the BCLs. Among these 8 infected patients, 3 were noncompliant with their eye drop use and 2 extended their BCL wearing time past 30 days., CONCLUSION: Bandage CL-related infectious keratitis is more likely to occur in older patients. The most common risk factor for BCL-related infectious keratitis was postkeratoplasty use. Overall, appropriate indications, good compliance, and close follow-up attention are required for BCL wearers.
Keywords: Administration, Ophthalmic; Adolescent; Adult; Aged; Anti-Bacterial Agents/ad [Administration & Dosage]; *Bandages/ae [Adverse Effects]; *Contact Lenses/ae [Adverse Effects]; *Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/et [Etiology]; *Eye Infections, Bacterial/di [Diagnosis]; Eye Infections, Bacterial/dt [Drug Therapy]; Eye Infections, Bacterial/et [Etiology]; *Eye Infections, Fungal/di [Diagnosis]; Eye Infections, Fungal/dt [Drug Therapy]; Eye Infections, Fungal/et [Etiology]; Female; Humans; Levofloxacin/ad [Administration & Dosage]; Male; Microscopy, Confocal; Middle Aged; Retrospective Studies; Young Adult

Lessons learned from the development and implementation of a patient-reported outcome and experience measure (POEM) in an Australian glaucoma practice. - Fraenkel, Alison; Lee, Graham A; Vincent, Stephen J; Vincent, Roslyn A; Bourne, Rupert R A; Shah, Peter (BMC ophthalmology, 2019)
BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life., METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised., RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean +/- standard deviation for subject age was 69 +/- 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye., CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.
Keywords: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Morbidity/td [Trends]; *Patient Reported Outcome Measures; Prospective Studies; *Quality of Health Care; Quality of Life; Queensland/ep [Epidemiology]; Surveys and Questionnaires; *Visual Acuity; *Visual Fields/ph [Physiology]; Young Adult

Multi-target-directed-ligands acting as enzyme inhibitors and receptor ligands. - Rodriguez-Soacha, Diego Alejandro; Scheiner, Matthias; Decker, Michael (European journal of medicinal chemistry, 2019)
In this review, we present the latest advances in the field of multi-target-directed ligand (MTDL) design for the treatment of various complex pathologies of multifactorial origin. In particular, latest findings in the field of MTDL design targeting both an enzyme and a receptor are presented for different diseases such as Alzheimer's disease (AD), depression, addiction, glaucoma, non-alcoholic steatohepatitis and pain and inflammation. The ethology of the diseases is briefly described, with special emphasis on how the MTDL can evolve into novel therapies that replace the classic pharmacological dogma "one target one disease". Considering the current needs for therapy adherence improvement, it is exposed as from the medicinal chemistry, different molecular scaffolds are studied. With the use of structure activity relationship studies and molecular optimization, new hybrid molecules are generated with improved biological properties acting at two biologically very distinct targets. Copyright © 2019 Elsevier Masson SAS. All rights reserved.
Keywords: Acetylcholinesterase/me [Metabolism]; Amyloid Precursor Protein Secretases/ai [Antagonists & Inhibitors]; Amyloid Precursor Protein Secretases/me [Metabolism]; Animals; Butyrylcholinesterase/me [Metabolism]; Drug Design; Enzyme Inhibitors/ch [Chemistry]; *Enzyme Inhibitors/pd [Pharmacology]; Humans; Ligands; Receptors, Cannabinoid/me [Metabolism]; Receptors, Histamine/me [Metabolism]

The Impact of R-801 Nanoparticles as a Long Acting Topical Glaucoma Therapy. - Ibrahim, Mohamed Moustafa; Jablonski, Monica M (Journal of biomedical nanotechnology, 2019)
Primary open angle glaucoma (POAG) is the most common glaucoma type worldwide. The most significant risk factor of this type of glaucoma is the increased intraocular pressure (IOP) that may result in optic nerve damage and gradual but complete loss of vision. Reduction of IOP is the most important measure that should be taken into consideration during selection of glaucoma therapy. Several IOP-lowering medications are available in the drug market. Unfortunately, most of them associated with severe local and/or systemic adverse effects, short duration of action and poor patient compliance. In the current research we strive to develop a long acting, once daily, nanoparticle (NP)-based, ocular formulation loaded with R-801 (a newly discovered drug). Our NPs were prepared from carefully selected bioadhesive and biocompatible materials using double emulsification solvent diffusion method. This method of preparation was selected to obtain the highest encapsulation efficiency for our water-soluble drug and the smallest particle size for our NPs. Also, the NPs were incorporated in biocompatible and bioadhesive vehicles to achieve the required safety, biocompatibility and prolonged corneal contact time. Our formulations were subjected to various in vitro and in vivo evaluations that demonstrated their safety and ability to sustain the drug release, prolong corneal contact time, lower IOP in different animal models, and maintain the IOP at almost constant low value through the day without any fluctuation upon long-term daily application.
Keywords: Animals; *Glaucoma; *Glaucoma, Open-Angle; Humans; Intraocular Pressure; *Nanoparticles; Particle Size

Novel therapies for glaucoma: a patent review (2013-2019). - Guglielmi, Paolo; Carradori, Simone; Campestre, Cristina; Poce, Giovanna (Expert opinion on therapeutic patents, 2019)
Introduction: Glaucoma is one of the main leading causes of irreversible blindness in the world. The treatment of this disease relies on the use of drugs able to reduce/control the intraocular pressure (IOP), one of the main risk factors for glaucoma. Current therapies are based on the use of compounds belonging to well-established categories (prostaglandin analogs, beta-adrenergic blockers, alpha-adrenergic agonists, carbonic anhydrase inhibitors, Rho kinase inhibitors, and cholinergic agonists). However, even if they are effective in reducing IOP, important side effects impair patient compliance, accounting for the necessity of novel therapy approaches. Therefore, new targets are emerging as alternative and more complete routes to fight glaucoma disease. Areas covered: This review provides a comprehensive update on the development state of innovative strategies against glaucoma describing results, administration routes, pharmaceutical compositions, structures, and SARs as well as the related shortcomings within the 2013-2019 range. Expert opinion: New innovative pharmacological targets have been explored in the last six years, allowing a broader therapeutic arsenal against glaucoma and IOP-related pathologies. The endocannabinoid system and FAAH inhibitors were the most investigated from a medicinal chemistry point of view.
Keywords: Animals; *Drug Development; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Medication Adherence; Patents as Topic; Risk Factors; Structure-Activity Relationship

Tear Film Osmolarity, Ocular Surface Disease and Glaucoma: A Review. - Fogagnolo, Paolo; Torregrossa, Giulia; Tranchina, Laura; Ferreras, Antonio; De Cilla, Stefano; Labbe, Antoine; Figus, Michele; Ottobelli, Laura; Rossetti, Luca (Current medicinal chemistry, 2019)
Glaucoma is the second leading cause of blindness in the world, affecting more than 60 million people globally. In order to reduce the progression of the disease, both medical and surgical treatments are used. Frequent side effects of both treatments include a range of modifications of the ocular surface grouped as the Ocular Surface Disease (OSD), which include Dry Eye Disease (DED). DED and other OSD negatively impact on the success of anti-glaucoma treatments and reduce the adherence to medical therapies. Tear film osmolarity (TFO) is a relatively novel test which has become a hallmark of DED. The aim of this paper was to review the association between OSD, DED and glaucoma in view of published TFO data, and to discuss future fields of research and treatments on the topic of glaucoma iatrogenic damage. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
Keywords: Animals; Antihypertensive Agents/ch [Chemistry]; *Antihypertensive Agents/pd [Pharmacology]; *Corneal Diseases/dt [Drug Therapy]; *Glaucoma/dt [Drug Therapy]; Humans; Osmolar Concentration; Preservatives, Pharmaceutical/ch [Chemistry]; *Preservatives, Pharmaceutical/pd [Pharmacology]; Surface Properties; *Tears/de [Drug Effects]

Toward Better Health Outcomes in Rural and Under-served Areas: L. V. Prasad Eye Institute's Diagonal Model of Glaucoma Care. - Choudhari, Nikhil S; Mundhe, Gajendra; Khanna, Rohit; Rathi, Varsha; Garudadri, Chandra Sekhar (Ophthalmic epidemiology, 2019)
Purpose: L. V. Prasad Eye Institute has adopted horizontal approach of eye care delivery for the past 22 years at one of its rural secondary centers. The recent implementation of a diagonal model for enhancing glaucoma care at this center and its outcomes are reported. Methods: This was a retrospective case-control study. We included newly and consecutively diagnosed adult glaucoma patients. A comprehensive ophthalmologist provided glaucoma care. During the study period, an experienced glaucoma specialist supported the care for 2 days every month in a structured format that consisted of triaging glaucoma patients for defined protocols of therapy along with hands-on and remote online guidance to the comprehensive ophthalmologist. The data from the worst or single eye were analyzed. Results: We have included 231 patients (151 study and 80 historical controls). Sixty (75%) control patients were managed at the study center and 20 (25%) were referred. The comprehensive ophthalmologist managed 70 (48.2%) study patients and co-managed 75 (51.7%) with the glaucoma specialist. The latter changed the diagnosis in 15 eyes and altered the treatment plan in 44 eyes. Six were excluded. Successful outcome was achieved in 52 (65%) eyes in the control group and 120 (84.5%) eyes in the study group (P < .01). Additionally, study group did better in terms of case detection rate, compliance to treatment and saving on expenses for patients. Conclusion: The new model has shown better clinical outcomes of glaucoma care in an under-served geographic area. The model has the potential for wider applicability.
Keywords: Adult; Aged; Aged, 80 and over; Case-Control Studies; *Delivery of Health Care/og [Organization & Administration]; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Ophthalmology/og [Organization & Administration]; Retrospective Studies; *Rural Health Services/og [Organization & Administration]

Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial. - Bilger, Marcel; Wong, Tina T; Lee, Jia Yi; Howard, Kaye L; Bundoc, Filipinas G; Lamoureux, Ecosse L; Finkelstein, Eric A (Applied health economics and health policy, 2019)
BACKGROUND: Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues., OBJECTIVE: The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence., METHODS: SIGMA is a 6-month randomized, controlled, open-label, single-center superiority trial with two parallel arms. A total of 100 non-adherent glaucoma patients from the Singapore National Eye Centre were randomized into intervention (adherence-contingent rebates) and usual care (no rebates) arms in a 1:1 ratio. The primary outcome was the mean change from baseline in percentage of adherent days at Month 6. The trial registration number is NCT02271269 and a detailed study protocol has been published elsewhere., FINDINGS: We found that participants who were offered adherence-contingent rebates were adherent to all their medications on 73.1% of the days after 6 months, which is 12.2 percentage points (p = 0.027) higher than in those not receiving the rebates after controlling for baseline differences. This better behavioral outcome was achieved by rebates averaging 8.07 Singapore dollars ($US5.94 as of 2 November 2017) per month during the intervention period., CONCLUSION: This study shows that simultaneously leveraging several insights from behavioral economics can significantly improve medication adherence rates. The relatively low cost of the rebates and significant health and cost implications of medication non-adherence suggest that this strategy has the potential to cost-effectively improve health outcomes for many conditions.
Keywords: Adult; Aged; Aged, 80 and over; *Chronic Disease/dt [Drug Therapy]; *Drug Therapy/ec [Economics]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; Middle Aged; *Reimbursement, Incentive; Young Adult

Medication Burden for Patients With Bacterial Keratitis. - Ballouz, Dena; Maganti, Nenita; Tuohy, Megan; Errickson, Josh; Woodward, Maria A (Cornea, 2019)
PURPOSE: To understand medication use and patient burden for treatment of bacterial keratitis (BK)., METHODS: A retrospective study was conducted examining medical records of adult patients with BK in an academic cornea practice. Data collected included medications used in the treatment of BK, dosing of medications, and the number and total duration of clinical encounters. Costs of medications were estimated using the average wholesale pharmacy price. Linear regression analysis was used to investigate associations of medication use with patient demographics and corneal culture results and reported with beta estimates (beta) and 95% confidence intervals (95% CIs)., RESULTS: Forty-eight patients with BK (56% female) were studied. Patients were treated for a median of 54 days with 10 visits, 5 unique medications, 587 drops, and 7 prescriptions. The estimated median medication cost was $933 (interquartile range: $457-$1422) US dollars. Positive bacterial growth was significantly associated with more visits (beta: 6.16, 95% CI: 1.75-10.6, P = 0.007), more days of treatment (beta: 86.8, 95% CI: 10.8-163, P = 0.026), more prescribed medications (beta: 2.86, 95% CI: 1.04-4.67, P = 0.003), and more doses of medications (beta: 796, 95% CI: 818-1412, P = 0.012) compared with patients who did not undergo corneal scraping. Patients were prescribed 132 more drops of medication for every 10 years of older age (beta: 132, 95% CI: 18.2-246, P = 0.024). Sex and income were not associated with medication burden or treatment length., CONCLUSIONS: Older patients and those with positive cultures incur the most medication burden in treatment of BK. Providers should be aware of medication usage and cost burden as it may affect compliance with treatment.
Keywords: Administration, Ophthalmic; *Anti-Bacterial Agents/ec [Economics]; *Anti-Bacterial Agents/tu [Therapeutic Use]; Bacteria/ip [Isolation & Purification]; *Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; *Costs and Cost Analysis; *Drug Costs; Drug Prescriptions/sn [Statistics & Numerical Data]; *Drug Utilization/sn [Statistics & Numerical Data]; *Eye Infections, Bacterial/dt [Drug Therapy]; Eye Infections, Bacterial/mi [Microbiology]; Female; Glucocorticoids/ec [Economics]; Glucocorticoids/tu [Therapeutic Use]; Humans; Male; Middle Aged; Mydriatics/ec [Economics]; Mydriatics/tu [Therapeutic Use]; Ophthalmic Solutions; Retrospective Studies

A Path Analysis of Effects of Patients' Underlying Conditions, Treatment Satisfaction, and Adherence on Quality of Life Among Korea Glaucoma Patients. - Kim, Chan Yun; Park, Ki Ho; Ahn, Jaehong; Ahn, Myung-Douk; Cha, Soon Cheol; Kim, Ho-Soong; Kim, Joon Mo; Kim, Moon Jung; Kim, Tae-Woo; Kim, Yong Yeon; Lee, Ji Woong; Park, Sang-Woo; et al. (Journal of glaucoma, 2019)
PReCIS:: This observed patient-specific features and treatment-driven conditions that were significantly associated with the impairment of health-related quality of life (HRQOL) among glaucoma patients. The results suggest that more systematic strategies should be implemented to improve an HRQOL., PURPOSE: To determine factors contributing to an HRQOL and assess total, direct and indirect, effects that may exist between the determinants using path analysis., MATERIALS AND METHODS: Data were derived from previous Korea glaucoma outcomes research. A total of 847 glaucoma outpatients with <=2 years of eye-drop use were included in the present study. Including factors and their hypothetical pathways to an HRQOL were based on the literature review and consultation with specialists. Age, sex, comorbidities, and education levels were included as underlying conditions and treatment patterns were defined by the number of daily instillations of prescribed eye-drops. Treatment satisfaction and adherence were estimated using a Treatment Satisfaction Questionnaire for Medication, which assessed side-effects, effectiveness, convenience, global satisfaction, and pill count. An HRQOL was assessed by EQ-5D and EQ-visual analogue scale (EQ-VAS)., RESULTS: In EQ-5D analysis, male individuals showed total effects (beta=0.102, P=0.0026), including both direct (beta=0.076, P=0.0095) and indirect effects (beta=0.0253, P=0.0020), which were mediated by treatment satisfaction in the side effects and global satisfaction categories. Higher education (beta=0.197, P=0.0020) and satisfaction in the side effect (beta=0.095, P=0.0076) and global satisfaction (beta=0.075, P=0.0414) categories were found to have direct effects on EQ-5D. For EQ-VAS, higher education levels had significant total effects (beta=0.153, P=0.0020) accounting for direct effects (beta=0.131, P=0.0030) and indirect effects (beta=0.0223, P=0.0531) through global satisfaction. In addition, male individuals had indirect effects (beta=0.274, P=0.0165), which was indirectly mediated by satisfaction in the global satisfaction category. Comorbidity (beta=-0.096, P=0.0090) and satisfaction in the effectiveness (beta=0.094, P=0.0302), convenience (beta=0.076, P=0.0390), and global satisfaction (beta =0.144, P=0.0020) categories showed indirect effect on EQ-VAS., CONCLUSION: Higher education and better treatment satisfaction had positive effects on HRQOL both in direct and indirect ways whereas comorbidities indirectly showed negative associations with HRQOL.
Keywords: Adult; Aged; Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; Health Status; Humans; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patient Satisfaction/sn [Statistics & Numerical Data]; *Quality of Life/px [Psychology]; Republic of Korea; Surveys and Questionnaires

The Association of an Upper Extremity Functional Survey and Glaucoma Medication Administration Success. - Hein, Aaron M; Rosdahl, Jullia A; Bosworth, Hayden B; Woolson, Sandra L; Olsen, Maren K; Kirshner, Miriam A; Muir, Kelly W (Current eye research, 2019)
Purpose/Aim: To determine if an upper extremity functional survey may identify which patients will have eye drop administration difficulty. Materials and Methods: Participants with glaucoma treated at a Veterans Affairs Eye Clinic who did not self-report 100% medication adherence were enrolled in a cross-sectional study. Participants were scored on their observed ability to place a drop into the eye (accuracy) and express no more than one drop from the bottle (efficiency). Successful execution of both of these conditions was defined as good drop technique. Participants also completed the QuickDASH, a validated upper extremity functional survey, with higher scores indicating worse disability. We hypothesized participants with lower QuickDASH scores would have an increased probability of observed success with drop administration measures. Diagnoses of upper extremity co-morbidities were abstracted from participants' medical records and clustered into diagnostic groups of either neurologic or musculoskeletal etiologies. Results: When observed, 80 of 94 participants displayed successful accuracy, 58 of 94 participants displayed successful efficiency, and 50 of 94 participants displayed good drop technique. Accuracy with eye drop performance was not related to QuickDASH scores (odds ratio (OR) [probability of successful administration per 10-point decrease in QuickDASH score]: 1.14, 95% CI: 0.89-1.45, p = .29). Success with drop administration efficiency was strongly associated with QuickDASH score (OR: 1.27, 95% CI: 1.04-1.54, p = .02), as was good drop technique (OR: 1.28, 95% CI: 1.05-1.56, p = .01), with lower (better) QuickDASH scores associated with better drop technique. There were no associations between upper extremity neurologic or musculoskeletal co-morbidities and observed good drop technique. The presence of either a neurologic or musculoskeletal upper extremity co-morbidity in a participant's medical record was associated with a higher QuickDASH score. Conclusions: The QuickDASH survey may identify patients with eye drop administration difficulties so this population receives focused drop technique education and management strategies. Abbreviations: CPRS: Computerized Patient Records System; MSK: musculoskeletal; UE: upper extremity; VA: Veterans Affairs.
Keywords: Administration, Ophthalmic; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Cross-Sectional Studies; Disability Evaluation; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; *Medication Adherence; *Musculoskeletal Diseases/di [Diagnosis]; Ophthalmic Solutions; *Psychomotor Performance/ph [Physiology]; Surveys and Questionnaires; *Upper Extremity/pp [Physiopathology]

The obstacle course to the inner retina: Hyaluronic acid-coated lipoplexes cross the vitreous but fail to overcome the inner limiting membrane. - Devoldere, Joke; Wels, Mike; Peynshaert, Karen; Dewitte, Heleen; De Smedt, Stefaan C; Remaut, Katrien (European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V, 2019)
Considerable research over the last few years has revealed dysregulation of growth factors in various retinal diseases, such as glaucoma, diabetic retinopathy and photoreceptor degenerations. The use of messengerRNA (mRNA) to transiently overexpress a specific factor could compensate for this imbalance. However, a critical challenge of this approach lies in the ability to efficiently deliver mRNA molecules to the retinal target cells. In this study we found that intravitreal (IVT) injection is an attractive approach to deliver mRNA to the retina, providing two critical barriers can be overcome: the vitreous and the inner limiting membrane (ILM). We demonstrated that the vitreous is indeed a major hurdle in the delivery of the cationic mRNA-complexes to retinal cells, both in terms of vitreal mobility and cellular uptake. To improve their intravitreal mobility and avoid unwanted extracellular interactions, we evaluated the use of hyaluronic acid (HA) as an electrostatic coating strategy. This HA-coating provided the complexes with a negative surface charge, markedly enhancing their mobility in the vitreous humor, without reducing their cellular internalization and transfection efficiency. However, although this coating strategy allows the mRNA-complexes to successfully overcome the vitreal barrier, the majority of the particles accumulated at the ILM. This study therefore underscores the crucial barrier function of the ILM toward non-viral retinal gene delivery and the need to smartly design mRNA-carriers able to surmount the vitreous as well as the ILM. Copyright © 2019 Elsevier B.V. All rights reserved.
Keywords: Animals; Cattle; Cell Line; Gene Transfer Techniques; Genetic Therapy/mt [Methods]; Humans; *Hyaluronic Acid/me [Metabolism]; Intravitreal Injections/mt [Methods]; RNA, Messenger/me [Metabolism]; *Retina/me [Metabolism]; Retinal Diseases/me [Metabolism]; Static Electricity; Transfection/mt [Methods]; Vitreous Body/me [Metabolism]

A computational framework to investigate retinal haemodynamics and tissue stress. - Rebhan, Joseph; Parker, Louis P; Kelsey, Lachlan J; Chen, Fred K; Doyle, Barry J (Biomechanics and modeling in mechanobiology, 2019)
The process of vision begins in the retina, yet the role of biomechanical forces in the retina is relatively unknown and only recently being explored. This contribution describes a computational framework involving 3D fluid-structure interaction simulations derived from fundus images that work towards creating unique data on retinal biomechanics. We developed methods to convert 2D fundus photographs into 3D geometries that follow the curvature of the retina. Retina arterioles are embedded into a six-layer representation of the retinal tissue with varying material properties throughout the retinal tissue. Using three different human retinas (healthy, glaucoma, diabetic retinopathy) and by varying our simulation approaches, we report the effects of transient versus steady flow, viscosity assumptions (Newtonian, non-Newtonian and Fahraeus-Lindqvist effect) and rigid versus compliant retinal tissue, on resulting wall shear stress (WSS) and von Mises stress. In the retinal arterioles, the choice of viscosity model is important and WSS obtained from models with the Fahraeus-Lindqvist effect is markedly different from Newtonian and non-Newtonian models. We found little difference in WSS between steady-state and pulsatile simulations (< 5%) and show that WSS varies by about 7% between rigid and deformable models. Comparing the three geometries, we found notably different WSS in the healthy (3.3 +/- 1.3 Pa), glaucoma (5.7 +/- 1.6 Pa) and diabetic retinopathy cases (4.3 +/- 1.1 Pa). Conversely, von Mises stress was similar in each case. We have reported a novel biomechanical framework to explore the stresses in the retina. Despite current limitations and lack of complete subject-specific physiological inputs, we believe our framework is the first of its kind and with further improvements could be useful to better understand the biomechanics of the retina.
Keywords: Arterioles/pp [Physiopathology]; Fundus Oculi; *Hemodynamics; Humans; *Models, Biological; *Retina/pp [Physiopathology]; Retinal Diseases/pp [Physiopathology]; Retinal Vessels/pp [Physiopathology]; *Stress, Mechanical; Viscosity

Biofilm characterization of Fusarium solani keratitis isolate: increased resistance to antifungals and UV light. - Cordova-Alcantara, Itzel Margarita; Venegas-Cortes, Diana Laura; Martinez-Rivera, Maria Angeles; Perez, Nestor Octavio; Rodriguez-Tovar, Aida Veronica (Journal of microbiology (Seoul, Korea), 2019)
Fusarium solani has drawn phytopathogenic, biotechnological, and medical interest. In humans, it is associated with localized infections, such as onychomycosis and keratomycosis, as well as invasive infections in immunocompromised patients. One pathogenicity factor of filamentous fungi is biofilm formation. There is still only scarce information about the in vitro mechanism of the formation and composition of F. solani biofilm. In this work, we describe the biofilm formed by a clinical keratomycosis isolate in terms of its development, composition and susceptibility to different antifungals and ultraviolet light (UV) at different biofilm formation stages. We found five biofilm formation stages using scanning electron microscopy: adherence, germination, hyphal development, maturation, and cell detachment. Using epifluorescence microscopy with specific fluorochromes, it was elucidated that the extracellular matrix consists of carbohydrates, proteins, and extracellular DNA. Specific inhibitors for these molecules showed significant biofilm reductions. The antifungal susceptibility against natamycin, voriconazole, caspofungin, and amphotericin B was evaluated by metabolic activity and crystal violet assay, with the F. solani biofilm preformation to 24 h increased in resistance to natamycin, voriconazole, and caspofungin, while the biofilm preformation to 48 h increased in resistance to amphotericin B. The preformed biofilm at 24 h protected and reduced UV light mortality. F. solani isolate could produce a highly structured extra biofilm; its cellular matrix consists of carbohydrate polymers, proteins, and eDNA. Biofilm confers antifungal resistance and decreases its susceptibility to UV light. The fungal biofilm functions as a survival strategy against antifungals and environmental factors.
Keywords: *Antifungal Agents/pd [Pharmacology]; *Biofilms/de [Drug Effects]; *Biofilms/gd [Growth & Development]; *Biofilms/re [Radiation Effects]; Drug Resistance, Fungal/de [Drug Effects]; Drug Resistance, Fungal/re [Radiation Effects]; *Eye Infections, Fungal/mi [Microbiology]; Fungi/de [Drug Effects]; Fungi/re [Radiation Effects]; *Fusarium/de [Drug Effects]; Fusarium/py [Pathogenicity]; *Fusarium/re [Radiation Effects]; Humans; Hyphae/de [Drug Effects]; Hyphae/re [Radiation Effects]; *Keratitis/mi [Microbiology]; Mexico; Microbial Sensitivity Tests; Microbial Viability/de [Drug Effects]; Microbial Viability/re [Radiation Effects]; Microscopy, Electron, Scanning

Awareness of ocular diagnosis, transportation means, and barriers to ophthalmology follow-up in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. - Hark, Lisa A; Radakrishnan, Anjithaa; Madhava, Malika; Anderson-Quinones, Catherine; Fudemberg, Scott; Robinson, Debra; Myers, Jonathan S; Zhan, Tingting; Adeghate, Jennifer; Hegarty, Sarah; Leite, Stela; Leiby, Benjamin E; et al. (Social work in health care, 2019)
Purpose: The purpose of this study was to assess factors affecting follow-up eye care in participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, such as awareness of ocular diagnosis, availability of transportation methods, and reasons for missing eye care appointments. Methods: The sample included 172 participants who were randomized to the intervention group and contacted by the social worker. Results: A total of 155 participants completed the assessment form, which was used as an instrument to assess factors affecting adherence to follow-up eye care. The main reasons for missing eye exam appointments were feeling ill (38.1%, n = 59) and forgetting the appointment (34.2%, n = 53). In addition, 45 (29.2%) participants were unaware of or did not comprehend the severity of their ocular diagnosis. Common methods of transportation included public transportation (31.6%, n = 49), driving (29.7%, n = 46), and being driven (27.7%, n = 43) to their appointment. Conclusion: These results suggest that individuals in need of eye care may benefit from additional assistance of a social worker regarding ongoing eye exam appointment reminders and in-depth explanation of their ocular diagnosis.
Keywords: Adult; *Aftercare/og [Organization & Administration]; Age Factors; Aged; Aged, 80 and over; Appointments and Schedules; Female; *Glaucoma/di [Diagnosis]; Health Services Accessibility/og [Organization & Administration]; Humans; Male; Middle Aged; *Ophthalmology/og [Organization & Administration]; Patient Compliance; Philadelphia; Risk Factors; Severity of Illness Index; Sex Factors; *Social Work/og [Organization & Administration]; Socioeconomic Factors; *Telemedicine/og [Organization & Administration]

Disease-specific Preference-based Measure of Glaucoma Health States: HUG-5 Psychometric Validation. - Kennedy, Kevin; Podbielski, Dominik; Nanji, Keean; Muratov, Sergei; Ahmed, Ike; Xie, Feng (Journal of glaucoma, 2019)
PURPOSE: Glaucoma is the second leading cause of irreversible blindness in the world, with 60 million people worldwide estimated to suffer from the condition. Health utility is an important outcome measure of treatment effect in economic outcomes. The available tools for the measurement of health utility in glaucoma patients do not support a preference-based algorithm required to estimate health utility. To resolve this gap in the literature, the HUG-5 (Health Utility for Glaucoma-5 dimensions) was developed. The objective of the present study was to validate the HUG-5 with accepted measures of health state and vision-specific quality of life., MATERIALS AND METHODS: The HUG-5 measures patient self-reported levels of visual discomfort, mobility, daily life activities, emotion, and social activities, as affected by the progression and management of glaucoma. To evaluate the psychometric properties, the HUG-5 was assessed for construct validity between similar and dissimilar dimensions of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and the EuroQol's 5 Dimensions. The HUG-5 was evaluated for test-retest reliability after a 2-week period. The HUG-5 composite distributions of mild/moderate and advanced glaucoma patients were tested for differences to measure sensitivity., RESULTS: A total of 124 patients with glaucoma were administered the NEI-VFQ-25, the HUG-5, and the EuroQol's 5 Dimensions. The HUG-5 demonstrated construct validity, with convergent and discriminant support for visual discomfort, mobility, daily life activities, emotional distress, and social activities. The HUG-5 concurrently measured health-related quality of life associated with best-eye visual field loss (r=0.63, P<0.001). The HUG-5 measured health state consistently with test-retest reliability (intraclass correlation=0.91, P<0.001). The HUG-5 was established to be sensitive in detecting differences between patients with mild/moderate glaucoma and those with advanced glaucoma with a rank-sum test with continuity correction (W=693.5, P<0.001)., CONCLUSIONS: This study demonstrates promising results for the HUG-5's response range and relationship with the NEI-VFQ-25 and best-eye visual field loss, highlighting the value of disease-specific preference-based scoring systems in measuring health state changes in glaucoma patients.
Keywords: Adult; Aged; Female; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Health Status; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Patient Preference; Patient Reported Outcome Measures; *Psychometrics/mt [Methods]; Quality of Life/px [Psychology]; *Quality of Life; Reproducibility of Results; *Surveys and Questionnaires; United States; Vision, Ocular/ph [Physiology]

Protective Action of Linear Polyethylenimine against Staphylococcus aureus Colonization and Exaggerated Inflammation in Vitro and in Vivo. - Mayandi, Venkatesh; Sridhar, Sreepathy; Fazil, Mobashar Hussain Urf Turabe; Goh, Eunice Tze Leng; Htoon, Hla Myint; Orive, Gorka; Choong, Yeu Khai; Saravanan, Rathi; Beuerman, Roger W; Barkham, Timothy Mark Sebastian; Yang, Liang; Baskaran, Mani; et al. (ACS infectious diseases, 2019)
Increased evolution of multidrug resistant pathogens necessitates the development of multifunctional antimicrobials. There is a perceived need for developing new antimicrobials that can interfere with acute inflammation after bacterial infections. Here, we investigated the therapeutic potential of linear polyethylenimine (LPEI) in vitro and in vivo. The minimum inhibitory concentration of LPEI ranged from 8 to 32 mug/mL and elicited rapid bactericidal activity against clinical isolates of meticillin-resistant Staphylococcus aureus (MRSA). The polymer was biocompatible for human cultured ocular and dermal cells. Prophylactic addition of LPEI inhibited the bacterial colonization of human primary dermal fibroblasts (hDFs). In a scratch wound cell migration assay, LPEI attenuated the migration inhibitory effects of bacterial secretions. The polymer neutralized the cytokine release by hDFs exposed to bacterial secretions, possibly by blocking their accessibility to host cell receptors. Topical instillation of LPEI (1 mg/mL) was noncytotoxic and did not affect the re-epithelialization of injured porcine cornea. In a prophylactic in vivo model of S. aureus keratitis, LPEI was superior to gatifloxacin in terms of reducing stimulation of cytokines, corneal edema, and overall severity of the infection. These observations demonstrate therapeutic potential of LPEI for antimicrobial prophylaxis.
Keywords: Animals; Cell Migration Assays; Cells, Cultured; *Cornea/de [Drug Effects]; Cornea/mi [Microbiology]; Cytokines/im [Immunology]; Dermis/cy [Cytology]; Drug Resistance, Multiple; Epithelium, Corneal/de [Drug Effects]; Female; *Fibroblasts/de [Drug Effects]; Fibroblasts/mi [Microbiology]; Humans; *Inflammation/dt [Drug Therapy]; Inflammation/mi [Microbiology]; Keratitis/mi [Microbiology]; Keratitis/pc [Prevention & Control]; *Methicillin-Resistant Staphylococcus aureus/de [Drug Effects]; Microbial Sensitivity Tests; Polyethyleneimine/ch [Chemistry]; *Polyethyleneimine/tu [Therapeutic Use]; Rabbits; *Staphylococcal Infections/dt [Drug Therapy]; Staphylococcal Infections/mi [Microbiology]; Swine; Wound Healing/de [Drug Effects]

Micro/Nanoparticle Delivery Systems for Ocular Diseases. - Halasz, Kathleen; Kelly, Shannon J; Iqbal, Muhammad Tajwar; Pathak, Yashwant; Sutariya, Vijaykumar (Assay and drug development technologies, 2019)
Micro- (MPs) and nanoparticles (NPs) have been recently studied for their application in ophthalmic drug delivery. These drug delivery systems are able to circumvent the ocular barriers that currently limit the efficacy of conventional treatments, as well as provide a more sustained release of drug, reducing the frequency of administration and increasing patient compliance. This review summarizes the recent trends in ophthalmic research from conventional treatment to the utilization of MPs and NPs as drug carriers.
Keywords: Animals; Drug Carriers/ch [Chemistry]; *Drug Delivery Systems; *Dry Eye Syndromes/dt [Drug Therapy]; *Glaucoma/dt [Drug Therapy]; Humans; *Nanoparticles/ch [Chemistry]

Reliability of the Evidence Addressing Treatment of Corneal Diseases: A Summary of Systematic Reviews. - Saldanha, Ian J; Lindsley, Kristina B; Lum, Flora; Dickersin, Kay; Li, Tianjing (JAMA ophthalmology, 2019)
Importance: Patient care should be informed by clinical practice guidelines, which in turn should be informed by evidence from reliable systematic reviews. The American Academy of Ophthalmology is updating its Preferred Practice Patterns (PPPs) for the management of the following 6 corneal diseases: bacterial keratitis, blepharitis, conjunctivitis, corneal ectasia, corneal edema and opacification, and dry eye syndrome., Objective: To summarize the reliability of the existing systematic reviews addressing interventions for corneal diseases., Data Source: The Cochrane Eyes and Vision US Satellite database., Study Selection: In this study of published systematic reviews from 1997 to 2017 (median, 2014), the Cochrane Eyes and Vision US Satellite database was searched for systematic reviews evaluating interventions for the management of any corneal disease, combining eyes and vision keywords and controlled vocabulary terms with a validated search filter., Data Extraction and Synthesis: The study classified systematic reviews as reliable when each of the following 5 criteria were met: the systematic review specified eligibility criteria for inclusion of studies, conducted a comprehensive literature search for studies, assessed risk of bias of the individual included studies, used appropriate methods for quantitative syntheses (meta-analysis) (only assessed if meta-analysis was performed), and had conclusions that were supported by the results of the systematic review. They were classified as unreliable if at least 1 criterion was not met., Main Outcomes and Measures: The proportion of systematic reviews that were reliable and the reasons for unreliability., Results: This study identified 98 systematic reviews that addressed interventions for 15 corneal diseases. Thirty-three of 98 systematic reviews (34%) were classified as unreliable. The most frequent reasons for unreliability were that the systematic review did not conduct a comprehensive literature search for studies (22 of 33 [67%]), did not assess risk of bias of the individual included studies (13 of 33 [39%]), and did not use appropriate methods for quantitative syntheses (meta-analysis) (12 of 17 systematic reviews that conducted a quantitative synthesis [71%]). Sixty-five of 98 systematic reviews (66%) were classified as reliable. Forty-two of the 65 reliable systematic reviews (65%) addressed corneal diseases relevant to the 2018 American Academy of Ophthalmology PPPs; 33 of these 42 systematic reviews (79%) are cited in the 2018 PPPs., Conclusions and Relevance: One in 3 systematic reviews addressing interventions for corneal diseases are unreliable and thus were not used to inform PPP recommendations. Careful adherence by systematic reviewers and journal editors to well-established best practices regarding systematic review conduct and reporting might help make future systematic reviews in eyes and vision more reliable.
Keywords: *Corneal Diseases/th [Therapy]; *Databases, Factual; Humans; Meta-Analysis as Topic; *Practice Guidelines as Topic/st [Standards]; Reproducibility of Results; *Systematic Reviews as Topic

A Novel Approach to Helping People with Glaucoma Use Their Drops Routinely. - McDonald, John E; Dickinson, Jane K (Optometry and vision science : official publication of the American Academy of Optometry, 2019)
Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.
Keywords: Administration, Ophthalmic; *Antihypertensive Agents/ad [Administration & Dosage]; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Health Communication; Humans; *Language; Medication Adherence; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Education as Topic/mt [Methods]; Patient-Centered Care; Physician-Patient Relations; Self Administration

Glaucoma Patient Preferences for Video Education on Eye Drop Technique. - Davis, Scott A; Carpenter, Delesha M; Blalock, Susan J; Budenz, Donald L; Lee, Charles; Muir, Kelly W; Robin, Alan L; Sleath, Betsy (Optometry and vision science : official publication of the American Academy of Optometry, 2019)
SIGNIFICANCE: Glaucoma patients express a strong need for practical instruction on instilling eye drops correctly. To maximize the benefit of a video intervention to improve eye drop technique, patients recommend that video education be provided both in the clinic setting and online., PURPOSE: The purposes of this study were to (1) describe glaucoma patients' perspectives on how to improve an online eye drop technique video and how to disseminate it to other glaucoma patients and (2) examine how these perspectives differ across demographics., METHODS: Glaucoma patients (N = 43) who viewed an online eye drop technique educational video as part of a randomized controlled trial were interviewed to assess their overall rating of the video on a 4-point scale, with whom they had watched the video, whether they would recommend the video to others, how the video helped them, how they would recommend improving the video, and how they would like the video to be disseminated to other glaucoma patients., RESULTS: Patients' mean (SD) rating of the video was 3.4 (0.8), with a higher mean rating of 3.8 among African Americans (P = .02). All 43 patients said that they would recommend that others watch the video. Patients most commonly said that the video helped them learn to block the tear duct correctly, put the cap down on its side, mix the medication correctly, and close the eye after instillation. Patients preferred viewing the video in the doctor's office examination room and a website., CONCLUSIONS: Eye drop technique videos should be disseminated in the doctor's office and online. Health systems that integrate educational videos into their everyday practice may be able to use technique videos to improve patient technique at low cost and little time burden to the provider.
Keywords: Administration, Ophthalmic; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Communication; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Education as Topic/mt [Methods]; *Patient Preference/sn [Statistics & Numerical Data]; Self Administration; *Videotape Recording/sn [Statistics & Numerical Data]; Young Adult

Real-world assessment of topical glaucoma medication persistence rates based on national pharmaceutical claim data in a defined population. - Zhu, Zhuoting; Jiang, Yu; Wang, Wei; Scheetz, Jane; Shang, Xianwen; Zhang, Lei; He, Mingguang (Clinical & experimental ophthalmology, 2019)
IMPORTANCE: The rate and determinants of persistence to topical glaucoma medications are important for identifying patients at high risk of discontinuing medications and designing targeted approaches to improve persistence., BACKGROUND: To evaluate the rate and determinants of persistence to topical glaucoma medications among middle-aged and older Australian adults., DESIGN: Population-based cohort study., PARTICIPANTS: Participants in need of persistent topical glaucoma medications in the 45 and Up Study., METHODS: The 45 and Up Study is a large-scale population-based cohort study. Participants were classified as needing persistent topical glaucoma medications if at least three claims with related prescriptions were recorded. Persistence was defined as topical glaucoma medications were filled within 90 days., MAIN OUTCOME MEASURES: The rates and determinants of medication persistence at 2-year follow-up., RESULTS: A total of 12 899 patients requiring persistent topical glaucoma medications were identified. Among them, 9019 (69.9%) had persisted with their glaucoma medications for at least 2 years. Multiple logistic regression analysis documented significant effects of patient-related factors (gender, socioeconomic status, language spoken at home, lifestyle and comorbidities) and drug-related factors (total number and drug class) on the persistence rate. Those most at risk groups of non-persistence were those patients living in remote areas (odds ratio, OR: 0.59, 95% confidence interval, CI: 0.37-0.92), having family income over 70 000 AUD/year (OR: 0.53, 95% CI: 0.45-0.62), speaking other languages at home (OR: 0.61, 95% CI: 0.53-0.68), and using cholinergic classes of medications (OR: 0.55, 95% CI: 0.38-0.79)., CONCLUSIONS AND RELEVANCE: Our data has shown a medium level of persistence to topical glaucoma medication among middle-aged and older Australian adults. However, efforts are still needed to improve the rate of persistence. Copyright © 2019 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Administration, Ophthalmic; Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; *Databases, Pharmaceutical/sn [Statistics & Numerical Data]; Drug Prescriptions/sn [Statistics & Numerical Data]; Educational Status; Female; *Glaucoma/dt [Drug Therapy]; Humans; Income/sn [Statistics & Numerical Data]; *Insurance Claim Review/sn [Statistics & Numerical Data]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; New South Wales; Odds Ratio; Ophthalmic Solutions; Retrospective Studies

The Choice of Drainage Device in Complicated Glaucomas: Comparing Ahmed and Baerveldt Implants. - Moschos, Marilita M; Nitoda, Eirini; Gouliopoulos, Nikolaos; Androudi, Sophia; Damaskos, Christos; Laios, Konstantinos; Bagkli, Eleni; Garmpis, Nikolaos; Kitsos, George (In vivo (Athens, Greece), 2019)
BACKGROUND/AIM: Glaucoma is a chronic and progressive optic neuropathy which leads to deterioration of visual function. It is estimated to be the second leading cause of severe vision loss and blindness worldwide. Failure of anti-glaucoma medication to sufficiently reduce intraocular pressure (IOP) and poor compliance with medication are indications for glaucoma surgery, for example using glaucoma drainage devices. Our aim was to compare the surgical outcomes following the implantation of Ahmed FP7 and Baerveldt 350 drainage devices., PATIENTS AND METHODS: Five hundred and fifty-two patients with primary or secondary glaucoma were enrolled in the study. All patients had a history of failed trabeculectomy or other intraocular surgery, and IOP >=18 mm Hg. The implantation of Ahmed (266 patients) or Baerveldt (286 patients) devices was randomly performed in the patients, who were subsequently examined for a period of 5 years. Follow-up visits were scheduled 1 day; 1 week; 1, 3 and 6 months; and 1, 1.5, 2, 3, 4 and 5 years postoperatively., RESULTS: Significant reduction of IOP was achieved in both groups. Ahmed valve (28.3+/-9.3, 13.4+/-6.9, 14.2+/-6 and 12.7+/-4.5 mmHg at baseline, 1, 3, and 5 years postoperatively, respectively) resulted in significantly greater IOP reduction compared to Baerveldt implant (29.6+/-10.1, 15.4+/-5.5, 14.5+/-5.5 and 14.7+/-4.4 mmHg at baseline, 1, 3, and 5 years postoperatively, respectively). A significantly lower number of medications was required in the Ahmed group in comparison to the Baerveldt one (Ahmed group: 1.5+/-1.4, 1.4+/-1.5 and 1.8+/-1.5; Baerveldt group: 1.9+/-1.3, 1.9+/-1.3 and 2.2+/-1.4, respectively). The incidence of treatment failure and the rate of glaucoma reoperation were significantly higher in the Baerveldt group (40%) compared to the Ahmed group (17%)., CONCLUSION: Ahmed drainage implantation seemed to outclass that using the Baerveldt device in our study, in terms of efficacy and success rate. Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
Erratum in (EIN)
Keywords: Clinical Decision-Making; Cross-Sectional Studies; Disease Management; *Drainage/is [Instrumentation]; *Drainage/mt [Methods]; Female; *Glaucoma/et [Etiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/su [Surgery]; *Glaucoma Drainage Implants/ae [Adverse Effects]; Humans; Intraocular Pressure; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications; Treatment Failure; Treatment Outcome

Colonization of therapeutic contact lens by dematiaceous fungi. - Radhakrishnan, Naveen; Panigrahi, Arun Kumar; Balasubramanium, Ashwin; Das, Manoranjan; Prajna, N Venkatesh (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2019)
PURPOSE: To report 2 patients with colonization of therapeutic contact lens with dematiaceous fungi., METHODS: Case report., RESULTS: The first patient had a retained soft contact lens on an opaque cornea for 4 years with brownish black multiple colonies on the soft contact lens and culture grew Bipolaris spp. The second patient was on therapeutic contact lens for pseudophakic bullous keratopathy for 4 months and developed a brownish colonization of contact lens with unidentified dematiaceous fungi. Both the patients had conjunctivitis but did not develop fungal keratitis., CONCLUSION: Judicious use of therapeutic contact lens is required in agrarian countries with adequate emphasis on strict adherence to the standard protocols and frequent replacement of the lens. Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Keywords: Administration, Ophthalmic; Aged; Antifungal Agents/tu [Therapeutic Use]; *Contact Lenses, Hydrophilic/mi [Microbiology]; Drug Therapy, Combination; Eye Infections, Fungal/di [Diagnosis]; Eye Infections, Fungal/dt [Drug Therapy]; *Eye Infections, Fungal/mi [Microbiology]; *Fungi/ip [Isolation & Purification]; Humans; Male; Middle Aged; Moxifloxacin/tu [Therapeutic Use]; Mycoses/di [Diagnosis]; Mycoses/dt [Drug Therapy]; *Mycoses/mi [Microbiology]; Natamycin/tu [Therapeutic Use]; Ophthalmic Solutions; Slit Lamp Microscopy

Referral to community care from school-based eye care programs in the United States. - Shakarchi, Ahmed F; Collins, Megan E (Survey of ophthalmology, 2019)
Approximately 25% of school-aged children in the United States have vision abnormalities, most commonly refractive error that can be corrected with spectacles. Limited follow-up adherence after failed school-based vision screening led to an increase in school-based eye care programs that provide screening, eye examinations, and spectacle prescription at the school. These programs address the access barrier and often provide the first point of contact between children and eye care. Nevertheless, several lower prevalence conditions, such as amblyopia, strabismus, and glaucoma, cannot be adequately treated in the school setting, and some require frequent and long-term follow-up, necessitating referral to eye care providers in the community. We conducted a literature review and identified 10 programs that provided school-based screening, examinations, and spectacle prescription and reviewed their referral rates, criteria, mechanisms, adherence, ocular findings at referral, and long-term care plans. Most programs referred 1% to 5% of screened children. Most communicated with parents or guardians through referral letters and used various strategies to incentivize adherence. Referral adherence was 20-50% in the four programs that reported these data. School-based eye care programs rarely referred children for long-term follow-up care needs, such as updating spectacle prescriptions annually. Copyright © 2019 Elsevier Inc. All rights reserved.
Keywords: *Community Health Services/og [Organization & Administration]; Humans; Mass Screening/og [Organization & Administration]; *Ophthalmology/og [Organization & Administration]; *Referral and Consultation/og [Organization & Administration]; *School Health Services/og [Organization & Administration]; United States; *Vision Disorders/di [Diagnosis]

Overuse and Underuse of Visual Field Testing Over 15 Years. - Ben-Artsi, Elad; Goldenfeld, Modi; Zehavi-Dorin, Tzukit; Cohen, Asaf; Porath, Avi; Levkovitch-Verbin, Hani (Journal of glaucoma, 2019)
PReCIS:: A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performance for nonglaucoma indications. Adherence to glaucoma management guidelines was suboptimal. Guidelines for referral to VF assessments should be established., PURPOSE: The purpose of this study was to identify trends in VF assessments over 15 years among patients with and without suspected or confirmed glaucoma, in a large healthcare maintenance organization., METHODS: This was a population-based retrospective cohort study, conducted by means of electronic medical database analyses., STUDY POPULATION: Maccabi Healthcare Services is an healthcare maintenance organization that insures 2 million members constituting 25% of the population. All members who underwent at least 1 VF test between January 2000 and December 2014 were included. In addition, all members with glaucoma or suspected glaucoma diagnosis or who were prescribed with antiglaucoma medications were evaluated., MAIN OUTCOME MEASURES: VF performance rates., RESULTS: A total of 93,617 Maccabi Healthcare Services members underwent 198,843 VF tests; of whom 47.9% involved patients without any glaucoma-related conditions. There was a growing trend over time toward more of those members to undergo VF tests and, by 2014, non-glaucoma-related members comprised 74.0% of new VF assessments. In contrast, 32.3% of glaucoma-related patients did not perform even 1 VF test throughout the entire study period. Although over 2 years (25.95+/-6.33 mo) passed between the first glaucoma-related diagnosis and first VF test, once a patient underwent the first VF test, an average once-a-year VF follow-up (0.95+/-0.37 annual tests) began., CONCLUSION: There is a growing trend for VF tests being apparently overused for indications other than glaucoma. Concurrently, adherence to glaucoma management guidelines on VF tests is suboptimal, leading to discernible underuse. Guidelines for VF assessments in nonglaucoma patients should be established. Adherence to existing glaucoma management guidelines should be improved.
Keywords: Aged; Aged, 80 and over; Cohort Studies; Electronic Health Records/sn [Statistics & Numerical Data]; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; *Glaucoma/ep [Epidemiology]; Health Maintenance Organizations; Humans; Intraocular Pressure; Israel/ep [Epidemiology]; Male; Middle Aged; Procedures and Techniques Utilization/st [Standards]; *Procedures and Techniques Utilization/sn [Statistics & Numerical Data]; Retrospective Studies; Visual Field Tests/st [Standards]; *Visual Field Tests/sn [Statistics & Numerical Data]; *Visual Fields/ph [Physiology]

Automated Framework for Screening of Glaucoma Through Cloud Computing. - Soorya, M; Issac, Ashish; Dutta, Malay Kishore (Journal of medical systems, 2019)
In recent times, the use of computer aided diagnosis for detection of Glaucoma from fundus images has been prevalent. In the proposed work, a cloud based system is proposed for automatic and real-time screening of Glaucoma with the use of automatic image processing techniques. The proposed system offers scalability to the developers and easy accessibility to the consumers. The proposed system is device and location independent. The input digital image is analyzed and a comprehensive diagnostic report is generated consisting of detailed analysis of indicative medical parameters like optic-cup-to-disc ratio, optic neuro-retinal rim, ISNT rules making the report informative and clinically significant. With recent advances in the field of communication technologies, the internet facilities are available that make the proposed system an efficient and economical method for initial screening and offer preventive and diagnostic steps in early disease intervention and management. The proposed system can perform an initial screening test in an average time of 6 s on high resolution fundus images. The proposed system has been tested on a fundus database and an average sensitivity of 93.7% has been achieved for Glaucoma cases. In places where there is scarcity of trained ophthalmologists and lack of awareness of such diseases, the cloud based system can be used as an effective diagnostic assistive tool.
Keywords: *Cloud Computing; Diagnosis, Computer-Assisted; Fundus Oculi; *Glaucoma/di [Diagnosis]; Glaucoma/pa [Pathology]; Humans; *Image Processing, Computer-Assisted/mt [Methods]; Mass Screening; Retinal Vessels/pa [Pathology]; *Telemedicine/mt [Methods]; Time Factors

Eye Movement Perimetry and Frequency Doubling Perimetry: clinical performance and patient preference during glaucoma screening. - Meethal, Najiya Sundus Kadavath; Pel, Johan J M; Mazumdar, Deepmala; Asokan, Rashima; Panday, Manish; van der Steen, Johannes; George, Ronnie (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2019)
PURPOSE: To evaluate the screening accuracy of an Eye Movement Perimetry (EMP) in comparison with Frequency Doubling Perimetry (FDP) and to investigate the patient preference and perception towards these visual field screening methods., METHODS: A total of 104 healthy subjects (mean age (SD) of 48 (14) years) and 73 glaucoma patients (mean age (SD) of 52 (13) years) were recruited. All the participants underwent a comprehensive ophthalmic evaluation including the 24-2 SITA standard protocol on the Humphrey Field Analyzer (HFA). This was followed by the 26-point protocol in EMP and the C-20-1 protocol in FDP. During EMP, all subjects were instructed to fixate a central target and to look at the detected peripheral target, followed by refixation of the central target and Saccadic Reaction Time (SRT) towards each of the "seen" stimuli was calculated. Next, a questionnaire was administered to evaluate the patient preference and perception towards the perimetry techniques. Mean SRTs and Robin scores were used to plot Receiver Operating Characteristics (ROC) curves to determine the screening accuracies. From the questionnaire survey, the frequency distributions of the responses were calculated., RESULTS: Robin score and SRT were significantly increased in glaucoma patients in comparison with the age-matched healthy subjects (p < 0.001). The ROC analysis revealed comparable Area Under the Curve (AUC) values (0.95, p = 0.81) with a specificity of 95.2% for FDP and 96.2% for EMP with a sensitivity of 87.7%. Thirty-seven percent of the older age group (>= 40 years) and 65% of severe glaucoma patients showed preference for EMP over FDP., CONCLUSIONS: This study results indicate that the customized protocol in EMP provides efficient and rapid means of screening visual field defects in glaucoma, which compared well with FDP. Elderly healthy participants and patients with moderate and severe glaucomatous defects preferred EMP as it permitted natural reflexive eye movements thereby resembling a real-life test setting.
Keywords: Adult; Cross-Sectional Studies; *Eye Movements; Female; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Humans; Male; Middle Aged; *Patient Preference; ROC Curve; Reproducibility of Results; *Vision Screening/mt [Methods]; *Visual Field Tests/mt [Methods]; *Visual Fields/ph [Physiology]; Young Adult

Exploring patients' expectations and preferences of glaucoma surgery outcomes to facilitate healthcare delivery and inform future glaucoma research. - Kulkarni, Bina Bhaskar; Leighton, Paul; King, Anthony J (The British journal of ophthalmology, 2019)
INTRODUCTION: Glaucoma is a lifelong condition often requiring surgical intervention. To allow us to inform patients' expectations of surgery effectively, it is important to understand patients' preferences and concerns regarding outcomes from glaucoma treatments including surgery., AIMS: To explore what clinical and social outcomes of glaucoma surgery are important to patients., METHODS: Forty-five glaucoma patients undergoing medical glaucoma treatments or surgery were recruited for focus group interviews to determine their opinions regarding the outcomes of glaucoma treatments. Thematic analysis was performed with NVivo software., RESULTS: Themes identified were understanding glaucoma, understanding surgery treatments and understanding treatment outcomes. The most important outcomes of the glaucoma surgery reported by the patients were social factors. Patients felt that being able to maintain their driving licence is a strong indicator of successful glaucoma treatment/surgery. Other important outcomes were independent living, ability to care for their family and having a good-quality social life. When considering novel surgical treatments, most patients felt that certainty of successful outcome and proven longevity of the effect are the primary motivators for choosing these treatments., CONCLUSIONS: Patients understood that clinical measures were surrogates for maintaining visual function, but ability to maintain independent living was the most important outcome from their treatment. For newer treatments patients wished to know more about long-term outcomes when considering this option. Copyright © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Aged; Aged, 80 and over; Biomedical Research; *Delivery of Health Care; Female; Focus Groups; Glaucoma/dt [Drug Therapy]; *Glaucoma/px [Psychology]; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Patient Preference/px [Psychology]; *Patient Reported Outcome Measures; Patient Satisfaction; Tonometry, Ocular; *Trabeculectomy; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Tuning of thermoresponsive pNIPAAm hydrogels for the topical retention of controlled release ocular therapeutics. - Bellotti, Elena; Fedorchak, Morgan V; Velankar, Sachin; Little, Steven R (Journal of materials chemistry. B, 2019)
Low patient compliance and poor bioavailability of ophthalmic medications are the main limitations of topical eye drops. A potential solution to these disadvantages could be provided by thermoresponsive hydrogels, which could be used as the basis for a gelling eye drop for long-term release of therapeutics. We previously reported such a system capable of being retained in the lower fornix of rabbits, continuously releasing an anti-glaucoma drug for one month. Here, we sought to improve the properties of the existing gels as most relevant to patient use without altering the drug release profile. Specifically, we optimized the sol-to-gel transition temperature and de-swelling kinetics of pNIPAAm gels to avoid risk of the gelled drop reverting to liquid during cold or windy weather, and ensure quick gelation upon administration. A reduction of the gel LCST, faster gelation kinetics, and suitable viscosity for the administration as an eye drop were successfully achieved through modification of the poly(ethylene glycol) content in the water phase and its molecular weight. Our data suggest that drug release is not affected by these changes, with representative drug concentration profiles of the previous and new formulations demonstrating comparable anti-glaucoma release kinetics.
Keywords: *Acrylic Resins/ch [Chemistry]; Administration, Topical; Cell Survival/de [Drug Effects]; Conjunctiva/cy [Cytology]; *Drug Carriers/ch [Chemistry]; Drug Liberation; Elastic Modulus; Epithelial Cells/cy [Cytology]; Epithelial Cells/de [Drug Effects]; Epithelial Cells/me [Metabolism]; *Hydrogels/ch [Chemistry]; Hydrogels/pd [Pharmacology]; Kinetics; Ophthalmic Solutions/ch [Chemistry]; Ophthalmic Solutions/me [Metabolism]; Transition Temperature; Viscosity

Patient Preference-Based Comparative Effectiveness and Cost-Utility Analysis of the Prostamides for Open-Angle Glaucoma. - Brown, Gary C; Brown, Melissa M (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2019)
PURPOSE: To perform patient preference-based comparative effectiveness and cost-utility (cost-effectiveness) analyses to evaluate topical bimatoprost 0.01%, latanoprost 0.005%, travoprost 0.004%, tafluprost 0.0015%, and timolol 0.5% for the treatment of open-angle glaucoma (OAG)., METHODS: Value-Based Medicine R, incremental cost-utility analysis, and average cost-utility analysis were performed using published systematic review and network meta-analyses with 3-month clinical data for a base case of OAG with an untreated intraocular pressure of 26 mm Hg. Visual acuity and visual field changes were converted to time tradeoff utility format. A 20-year model was undertaken; bilateral therapy was presumed; a national average Medicare Fee Schedule was used; and ophthalmic, third party insurer, and societal cost perspectives were utilized. Patient value outcomes (QALYs or quality-adjusted life-years) and costs were discounted at 3% annually., RESULTS: Bimatoprost conferred a mean 2.56 QALY gain (22.9% patient quality-of-life gain) for the average OAG patient, while latanoprost for the average OAG patient, while latanoprost conferred a 2.00 QALY gain (17.8% quality-of-life gain), tafluprost a 1.99 QALY gain (17.9% quality-of-life gain), travoprost a l.92 QALY gain (17.2% quality-of-life gain), and timolol a 1.42 QALY gain (12.8% quality-of-life gain). The ophthalmic cost-perspective, incremental cost-utility ratio of bimatoprost referent to travoprost was $6,034/QALY, to latanoprost was $27,973/QALY, and to timolol was $16,063/QALY. Bimatoprost dominated tafluprost, meaning that it conferred greater patient value for lesser cost than tafluprost., CONCLUSIONS: Topical bimatoprost delivers greater patient value than the other prostamides and topical timolol for the treatment of OAG. Bimatoprost is incrementally cost-effective referent to the other prostamides and timolol.
Keywords: Bimatoprost/ec [Economics]; *Bimatoprost/tu [Therapeutic Use]; Cost-Benefit Analysis; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Care Costs; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost/ec [Economics]; *Latanoprost/tu [Therapeutic Use]; Patient Preference; Prostaglandins F/ec [Economics]; *Prostaglandins F/tu [Therapeutic Use]; Timolol/ec [Economics]; *Timolol/tu [Therapeutic Use]; Travoprost/ec [Economics]; *Travoprost/tu [Therapeutic Use]; Visual Acuity/de [Drug Effects]

Causative glaucoma treatment: promising targets and delivery systems. - Mietzner, Raphael; Breunig, Miriam (Drug discovery today, 2019)
Glaucoma is one of the most common causes of blindness worldwide. Elevated intraocular pressure (IOP) is the major modifiable risk factor of the disease. Conventional therapy suffers from poor compliance, low bioavailability, and the lack of causative treatment options. To improve therapeutic success, it is crucial to identify major mediators of pathological changes associated with elevated IOP and to intervene at the molecular level. Here, we discuss relevant key functions of transforming growth factor-beta2 (TGF-beta2), connective tissue growth factor (CTGF), integrins, Rho-associated kinase (ROCK), and nitric oxide (NO) with regard to the onset of glaucoma, highlighting new drug delivery approaches for causative treatment. Copyright © 2019. Published by Elsevier Ltd.
Keywords: Animals; Drug Delivery Systems/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Humans; Nitric Oxide/me [Metabolism]; Signal Transduction/de [Drug Effects]; Transforming Growth Factor beta2/me [Metabolism]; rho-Associated Kinases/me [Metabolism]

Patient-Reported Nonadherence with Glaucoma Therapy. - Wolfram, Christian; Stahlberg, Erik; Pfeiffer, Norbert (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2019)
Purpose: Effective glaucoma therapy relies to a great extent on the patients' ability to regularly self-administer eye drops. This study aimed to assess self-reported nonadherence and to identify potential barriers to adherence in glaucoma patients. Methods: Participants completed a 16-item questionnaire, designed to examine nonadherence rate and assess the therapy experience. Inclusion criteria stipulated treatment duration of at least 1 year. Nonadherence was defined as missing >=5% of the prescribed pressure-lowering eye drops doses. Results: In total, 201 glaucoma patients aged 24-88 years were included. Mean treatment duration was 9.4 years. Nonadherence was reported by 30.3% of participants and 69.7% were reported to be adherent. Individuals who experienced side effects reported higher levels of nonadherence than those who did not (37.6% vs. 18.4%; P = 0.004). Eye drops with preservatives were used by 84.1% of participants, 11.9% were on combined preservative and preservative-free treatment, and 4.0% on preservative-free medication only. Self-reported nonadherence levels were 32.0%, 25.0%, and 12.5%, respectively, for each of these groups. Men reported higher rates of nonadherence than women (36.8% vs. 24.5%; P = 0.066). Age, social status, history of migration, severity of disease, and fear of blindness were not associated with significant differences in nonadherence levels. Conclusions: Nonadherence with glaucoma therapy is a significant barrier to therapeutic success for approximately one-third of patients. Nonadherence may be reduced if side effects are avoided. Preservative-free products may provide adherence benefits. The patient experience should be a key consideration when selecting appropriate treatments, to reduce nonadherence and optimize outcomes.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Germany; *Glaucoma/dt [Drug Therapy]; Humans; Injections, Intraocular; Male; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance; *Patient Reported Outcome Measures; Preservatives, Pharmaceutical/ad [Administration & Dosage]; *Preservatives, Pharmaceutical/tu [Therapeutic Use]; Surveys and Questionnaires; Young Adult

Glaucoma Patient Knowledge, Perceptions, and Predispositions for Telemedicine. - Rhodes, Lindsay A; Huisingh, Carrie E; McGwin, Gerald; Girkin, Christopher A; Owsley, Cynthia (Journal of glaucoma, 2019)
PURPOSE: The purpose was to identify factors associated with older glaucoma patients' knowledge of, perceptions of, and predispositions for telemedicine use., MATERIALS AND METHODS: Established patients age 60 years and above with a diagnosis of primary open-angle glaucoma, glaucoma suspect, or ocular hypertension followed by a glaucoma fellowship-trained ophthalmologist were enrolled in the study at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a Life Space Questionnaire (LSQ), scored 0 to 9, and Preferences for Telemedicine Questionnaire (PTQ), a Likert scale validated tool. chi testing analyzed PTQ responses by age, race, education, employment status, LSQ score, and distance traveled from home address to clinic. A Mann-Whitney U test was used to compare PTQ responses by visual field index and visual acuity for the better and worse eye., RESULTS: Of 110 patients enrolled, 71% of patients agreed or were neutral to receiving telediagnosis and 74% of patients agreed or were neutral to receiving teleintervention. Patients aged 60 to 69 years compared with those 70 and above had significantly greater knowledge about types of telemedicine: telediagnosis (53% vs. 31%, P=0.02), teleintervention (49% vs. 24%, P=0.006), teletriage (80% vs. 47%, P=0.0004), and telemonitoring (55% vs. 27%, P=0.003). Patients of European descent had significantly more knowledge about teletriage compared with those of non-European descent (72% vs. 53%, P=0.04). Patients with more education (>high school) compared with those with less education (<=high school) had more knowledge about telemedicine (39% vs. 16%, P=0.007) and all the uses of it: telediagnosis (61% vs. 45%, P<0.001), teleintervention (54% vs. 14%, P<0.001), teletriage (86% vs. 35%, P<0.001), and telemonitoring (59% vs. 18%, P=0.001). Patients with a LSQ score >=6, meaning they traveled a greater distance from home in the previous 3 days, displayed significantly more knowledge about telediagnosis (49% vs. 25%, P=0.02), teleintervention (43% vs. 19%, P=0.01), and telemonitoring (47% vs. 25%, P=0.03) than those with an LSQ<6. Responses to the PTQ were not significantly different by distance traveled., CONCLUSIONS: Knowledge of telemedicine was variable but between one third and one half of patients had favorable attitudes toward using telemedicine for glaucoma care.
Keywords: Aged; Aged, 80 and over; Ambulatory Care Facilities; Female; *Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/px [Psychology]; *Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Male; Middle Aged; Patient Preference/px [Psychology]; Patient Preference/sn [Statistics & Numerical Data]; *Patient Preference; *Perception; Surveys and Questionnaires; Telemedicine/mt [Methods]; Telemedicine/sn [Statistics & Numerical Data]; *Telemedicine; Visual Acuity

Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy: Consequences of Inadvertent Treatment Interruptions. - Wubben, Thomas J; Johnson, Mark W; Anti-VEGF Treatment Interruption Study Group (American journal of ophthalmology, 2019)
PURPOSE: To illustrate that patients with diabetic retinopathy who are treated exclusively with anti-vascular endothelial growth factor (VEGF) therapy and have an interruption in treatment may experience marked progression of disease with potentially devastating visual consequences., DESIGN: Retrospective, multicenter, case series., METHODS: Retrospective review of patients treated exclusively with anti-VEGF therapy for proliferative diabetic retinopathy (PDR) or nonproliferative diabetic retinopathy (NPDR), with or without diabetic macular edema (DME), and temporarily lost to follow-up. Baseline disease characteristics, cause and duration of the treatment interruption, and resulting disease progression, complications, and outcomes were assessed., RESULTS: Thirteen eyes of 12 patients with type 2 diabetes were identified. The mean age was 57 +/- 10 years, and 50% were women. Anti-VEGF therapy was indicated for PDR with DME in 7 (54%) eyes, PDR without DME in 3 (23%) eyes, and moderate to severe NPDR with DME in 3 (23%) eyes. Eight eyes had visual acuity (VA) of 20/80 or better before treatment interruption. The median duration of treatment hiatus was 12 months. Reasons for treatment interruption included intercurrent illness (31%), noncompliance (31%), and financial issues (15%). Complications upon follow-up included vitreous hemorrhage (9 eyes), neovascular glaucoma (5 eyes), and traction retinal detachment (4 eyes). Despite treatment of these complications, 77% of eyes lost >=3 lines of VA, with 46% of eyes having a final VA of hand motion or worse., CONCLUSIONS: Diabetic patients are subject to significant lapses in follow-up because of illness, financial hardship, or noncompliance. In patients with diabetic retinopathy, especially PDR, who are managed with anti-VEGF therapy alone, unintentional treatment interruptions can result in irreversible blindness. Copyright © 2019 Elsevier Inc. All rights reserved.
Keywords: Adult; Aged; Angiogenesis Inhibitors/ad [Administration & Dosage]; *Bevacizumab/ad [Administration & Dosage]; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/dt [Drug Therapy]; Disease Progression; Drug Administration Schedule; Female; Fluorescein Angiography/mt [Methods]; Follow-Up Studies; Fundus Oculi; Humans; Intravitreal Injections; Male; Middle Aged; *Retina/pa [Pathology]; Retrospective Studies; Tomography, Optical Coherence/mt [Methods]; Treatment Outcome; Vascular Endothelial Growth Factor A/ai [Antagonists & Inhibitors]; *Visual Acuity

Implantable drainage devices in glaucoma: Quo vadis?. - Yadav, Khushwant S; Sharma, Sushmita (European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences, 2019)
Glaucoma, a gradually progressive class of either chronic eye disease or disorder, occurs due to increasing intra-ocular pressure. To reduce glaucoma, it is essential to stop the progression of IOP in the eye which is achieved by medical treatment, laser treatment and surgery. Profuse conventional drugs and laser surgeries are the primary go-tos for decreasing IOP. However, presently available marketed formulations using anti-glaucoma drugs have issues of either difficulty in crossing the blood retinal barrier (BRB) or lower systemic bioavailability. Hence, the drugs having lower therapeutic index would need to be administered frequently. This repeated systemic administration of high doses of drugs eventually leads to side effects, damage to the eye as well as patient noncompliance. Implants are deemed to be the suitable treatment left when such side effects are to be avoided. An eye implant is one of the choices for restoring the volume of the eye socket following evisceration and enucleation. Implantable drainage devices (IDD) aka glaucoma drainage devices (GDDs) or aqueous shunts are small reconstructive surgery devices, either solid or made of a tube fixed to an endplate. The premonition behind implants is augmenting standard glaucoma surgery which successfully is attained by surgically creating a drainage opening and positioning the device properly on it. All implants are made with an objective of decreasing IOP by enhancing the fluid outflow from the eye. A critical comparison is made among different implants like Molteno: single-plate and Double-plate, Baerveldt drainage implant, Schocket implant, Ex-Press R50 implant, Ahmed glaucoma valve, Krypton implant to the latest one's including iStent, iStent inject, Hydrus, CyPass, XEN and InnFocus. Copyright © 2019 Elsevier B.V. All rights reserved.
Keywords: Animals; *Glaucoma/th [Therapy]; *Glaucoma Drainage Implants; Humans

Comparative analysis of intravitreal triamcinolone acetonide-moxifloxacin versus standard perioperative eyedrops in cataract surgery. - Nassiri, Saman; Hwang, Frank S; Kim, Jason; LeClair, Bronson; Yoon, Eden; Pham, Michael; Rauser, Michael E (Journal of cataract and refractive surgery, 2019)
PURPOSE: To compare the effectiveness of intravitreal injection of triamcinolone acetonide-moxifloxacin (Tri-Moxi) to a standard eyedrop regimen in controlling postoperative inflammation, corneal edema, and the rate of high intraocular pressure (IOP) among cataract patients., SETTING: Loma Linda University Eye Institute, California, USA., DESIGN: Retrospective longitudinal comparative study., METHODS: The electronic medical records of patients who underwent cataract surgery using triamcinolone acetonide-moxifloxacin injection along with a postoperative nonsteroidal antiinflammatory drug drop were reviewed (Group 1). Group 1 was compared with patients who received a standard eyedrop (Group 2) in terms of intraocular inflammation and corneal edema severity, and the rate of high IOP, postoperatively., RESULTS: A total of 1195 consecutive eyes (Group 1 [681 eyes], Group 2 [514 eyes]) of 919 patients were included in the study. The anterior chamber cell reaction severity decreased by 34.0% and 35.7% at 1 week and 1 month, respectively, after surgery following triamcinolone acetonide-moxifloxacin injection compared with standard eyedrop therapy (P = .001 and P = .02, respectively). Group 1 was associated with increased severity of corneal edema (odds ratio, 1.48; P = .001) on postoperative day 1, with no statistically significant difference at 1 week and 1 month postoperatively (P = .25 and P = .48, respectively). There was no statistically significant difference in the rate of high IOP between the two groups at different timepoints postoperatively., CONCLUSIONS: Triamcinolone acetonide-moxifloxacin injection is an effective method to control intraocular inflammation after cataract surgery. It is a promising substitute for standard eyedrop therapy, especially for patients who have poor compliance with eyedrop usage. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Ophthalmic; Adolescent; Adult; Aged; Aged, 80 and over; *Anti-Bacterial Agents/tu [Therapeutic Use]; Child; Child, Preschool; Corneal Edema/dt [Drug Therapy]; Drug Combinations; Female; *Glucocorticoids/tu [Therapeutic Use]; Humans; Inflammation/dt [Drug Therapy]; Intraocular Pressure/de [Drug Effects]; Intravitreal Injections; *Lens Implantation, Intraocular; Male; Middle Aged; *Moxifloxacin/tu [Therapeutic Use]; Ophthalmic Solutions; *Phacoemulsification; *Postoperative Complications/pc [Prevention & Control]; Retrospective Studies; *Triamcinolone Acetonide/tu [Therapeutic Use]

The Relationship of Self-Report and Medication Possession With Glaucoma Medication Administration Success. - Hein, Aaron M; Rosdahl, Jullia A; Bosworth, Hayden B; Woolson, Sandra L; Olsen, Maren K; Kirshner, Miriam A; Muir, Kelly W (Journal of glaucoma, 2019)
PURPOSE: Many glaucoma eye drop users cannot successfully self-administer drops, and observing patients' drop technique can be time-consuming. We sought to examine the association of patient self-reported efficacy of eye drop technique and medication possession data as potential surrogate measures for actual drop administration success., PATIENTS AND METHODS: In total, 137 adults with medically treated glaucoma were enrolled from a University eye clinic (n=54) or a Veteran Affairs (VA) eye clinic (n=83). All participants were asked, "How confident are you that you can get the medication into your eye?" Medication possession ratio (MPR), defined as the amount of eye drop available divided by the amount prescribed, was calculated for VA study site participants for 6 months. The main outcome was the correct eye drop technique, defined as the ability to get drops into the eye and to put only 1 drop into the eye at a time., RESULTS: Among 117 participants who were "very confident" they could administer eye drops correctly, 95 participants (81%) displayed the correct drop technique. Of those who reported being less than "very confident" (n=18), 11 participants (61%) displayed correct drop technique (the Fisher exact test, P=0.07). For the VA sample, 20 participants with MPR<1.2, 20 participants with MPR=1.2 to 1.8, and 23 participants with MPR>1.8 displayed correct eye drop technique (the Fisher exact test, P=0.18)., CONCLUSIONS: Self-reported administration success and MPR are not strongly associated with successful eye drop administration. Thus, direct observation of patients' drop instillation may be the most effective means of determining patient efficacy.
Keywords: Administration, Ophthalmic; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Self Report

Rapid assessment of avoidable blindness and diabetic retinopathy in individuals aged 50 years or older in Costa Rica. - Acevedo Castellon, Roger Ivan; Carranza Vargas, Esteban; Cortes Chavarria, Ritzi Elena; Rodriguez Vargas, Gabriel Andres (PloS one, 2019)
In the present study, we examined the causes and the prevalence of avoidable blindness and visual impairment, as well as the prevalence of diabetic retinopathy in individuals aged >=50 years in Costa Rica, in order to provide baseline data for the initial planning and monitoring of ongoing blindness intervention programs. The assessment was based on the standardized methodology of the Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy, a population-based survey for blindness and visual impairment. From 3,255 eligible subjects, 76.6% were examined. The adjusted prevalence of bilateral blindness [presenting visual acuity (VA) in the better eye of less than 3/60] was 1.7% (95% confidence interval, 1.2%-2.2%), with avoidable causes (treatable and preventable) accounting for 68.8% of cases. The main causes of blindness were cataract (52.1%), glaucoma (6.3%), and diabetic retinopathy (6.3%); these data were similar to those for other neighboring countries. Cataract surgical coverage (CSC) in the survey area was estimated as 88.9% for individuals with blindness (VA, <3/60), 76.6% for those with a VA of <6/60, and 60.3% for those with a VA of <6/18. The most common barriers against cataract surgery in individuals with a best-corrected VA of <=6/60 included "need not felt" (48.8%) and "fear" (14.6%). Among individuals with a past history of cataract surgery, only 57.1% showed a "good" or "very good" outcome (VA, >=6/18). Finally, 23.5% individuals with known or newly diagnosed diabetes showed retinopathy and/or maculopathy, with 6.2% exhibiting sight-threatening diabetic retinopathy (proliferative retinopathy, referable maculopathy, or both). Our findings indicate the need to overcome barriers against surgery for cataract, which is the main cause of avoidable blindness, to increase CSC, and to improve surgical outcomes. Moreover, improved methods for diabetic retinopathy screening can ensure prompt identification of patients with a risk of blindness. Glaucoma screening is also necessary for areas with a high prevalence.
Keywords: Age Factors; Aged; Aged, 80 and over; *Blindness/ep [Epidemiology]; Costa Rica/ep [Epidemiology]; *Diabetic Retinopathy/ep [Epidemiology]; Female; Humans; Male; Middle Aged; Prevalence; Risk Factors

Water Exposure and the Risk of Contact Lens-Related Disease. - Arshad, Memoona; Carnt, Nicole; Tan, Jacqueline; Ekkeshis, Irenie; Stapleton, Fiona (Cornea, 2019)
PURPOSE: To describe the association of water exposure with contact lens (CL)-related disease and explore the guidelines regarding water exposure to CL wearers, provided by CL manufacturing industry, global public health, and CL-related professional associations., METHODS: A review of the literature was conducted by searching PubMed, MEDLINE, and Web of Science databases up to September 2017 for articles published or translated in English using keywords: contact lens* AND tap water OR swimming OR showering OR water exposure AND microbial keratitis OR Acanthamoeba keratitis OR corneal infiltrate* OR ocular adverse event*. References in all relevant publications were also reviewed., RESULTS: Water exposure during CL wear is associated with complications ranging from sterile corneal infiltrative events to sight-threatening infections. Despite the documented risks due to water exposure, water-related habits are common among CL wearers. This suggests a lack of awareness and understanding regarding the risks among CL wearers and potentially CL practitioners. Discrepancies exist in guidelines for CL hygiene and compliance provided by the CL manufacturing industry, global public health, and CL-related professional associations. There is also widespread use of water imagery within CL marketing and packaging materials. These factors may give rise to confusion among wearers and may contribute toward risk-taking behaviors., CONCLUSIONS: Consensus among stakeholders about water and CL care is needed. Guidelines should unequivocally advocate for the avoidance of any water exposure including handling CLs with wet hands, rinsing CLs or storage cases in tap water, showering while wearing CLs and swimming with CLs without wearing goggles.
Keywords: *Contact Lenses; *Corneal Diseases/et [Etiology]; Corneal Diseases/mi [Microbiology]; *Eye Infections/et [Etiology]; Eye Infections/mi [Microbiology]; Humans; *Hygiene; Keratitis/et [Etiology]; Keratitis/mi [Microbiology]; *Water/ae [Adverse Effects]

Current management of glaucoma. - Lusthaus, Jed; Goldberg, Ivan (The Medical journal of Australia, 2019)
Glaucoma is an irreversible progressive optic neuropathy, for which the major proven treatment is to lower the intraocular pressure (IOP). Five groups of IOP-lowering eye drops have varying mechanisms of action. Some drops, such as beta-blockers and alpha-2 agonists, have potentially serious systemic side effects. Acetazolamide is the only available oral agent; it is effective at lowering IOP, but significant side effects relegate its use usually to refractory glaucoma. Two new eye drops, netarsudil and latanoprostene bunod, have recently been approved by the United States Food and Drug Administration. Both have novel IOP-lowering mechanisms and target the conventional aqueous outflow system. Selective laser trabeculoplasty is a gentle treatment that enhances conventional aqueous outflow. It may be used as an initial treatment, as a substitute for eye drops, or to delay glaucoma drainage surgery. Recent advancements in glaucoma surgery have seen an influx of minimally invasive glaucoma surgery devices, which are being used more frequently and earlier on in the treatment paradigm. As limited long term data are available, trabeculectomy remains the gold standard IOP-lowering procedure. Improvements in drug delivery are on the horizon. Drug-eluting devices and implants are able to deliver the drug closer to the receptors for an extended period of time. This will improve treatment adherence and efficacy, which are major limitations with current medical therapy. Copyright © 2019 AMPCo Pty Ltd.
Keywords: *Drug Delivery Systems/td [Trends]; *Glaucoma/th [Therapy]; Humans; *Laser Therapy/td [Trends]; *Ophthalmic Solutions/tu [Therapeutic Use]; *Trabeculectomy/td [Trends]

Visual Performance, Subjective Satisfaction and Quality of Life Effect of a New Refractive Intraocular Lens with Central Extended Depth of Focus. - Gillmann, Kevin; Mermoud, Andre (Klinische Monatsblatter fur Augenheilkunde, 2019)
PURPOSE: To assess the visual performance, clinical and quality of life outcomes, and subjective patient satisfaction after implantation of a new refractive/extended depth of focus (EDOF) hybrid intraocular lens (IOL)., METHODS: This is a monocentric, retrospective study of 29 patients (45 eyes), carried out in a tertiary care glaucoma research centre. All patients underwent implantation of a Lucidis (Swiss Advanced Vision, SAV-IOL SA, Neuchatel, Switzerland) IOL during cataract surgery. Near, intermediate, and distance best-corrected visual acuities and uncorrected visual acuities were collected at baseline and 3 months postoperatively. Adverse events, contrast sensitivity, optical aberrations, subjective satisfaction, and spectacle independence were also analysed at 3 months., RESULTS: At 3 months postoperatively, the mean photopic uncorrected monocular distance, and intermediate and near visual acuities were 0.2 logMAR (~ 20/32), 0.07 logMAR (~ 20/23), and 0.15 logMAR (~ 20/28), respectively. Mean best-corrected visual acuity was 0.05 logMAR (~ 20/23) for distance and 0.03 logMAR (~ 20/21) for near vision. Mean photopic contrast sensitivity was 1.5 log. The mean root mean square (RMS) was 0.119 +/- 0.05 microm. Subjectively, over the 3-month follow-up, 9% of patients (n = 4) complained of halos, and 2% (n = 1) of photophobia. No other adverse events were noted., CONCLUSIONS: The Lucidis IOL demonstrates a good safety profile, with an acceptably low complication rate. While the uncorrected visual performance of this new optical design is inferior to that of other EDOF IOLs for distance vision, it achieves better results in intermediate and near vision, with consistently near-normal contrast sensitivity. Interestingly, self-reported spectacle independence and subjective patient satisfaction were high for all distances. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Humans; *Lens Implantation, Intraocular; *Lenses, Intraocular; Patient Satisfaction; *Personal Satisfaction; *Phacoemulsification; Prospective Studies; Prosthesis Design; *Quality of Life; Retrospective Studies; Surveys and Questionnaires; Switzerland; Vision, Binocular

Glaucoma care in Nigeria: Is the current practice poised to tackle this emerging sight-threatening disease?. - Onwubiko, S N; Udeh, N N; Nkwegu, O; Ukwu, D O; Nwachukwu, N Z (International ophthalmology, 2019)
PURPOSE: To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria., METHODS: This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20., RESULTS: The participants are comprised of 46 (52.3%) males and 42 (47.7%) females, with a mean age of 42.2 +/- 8.7 SD years. They were 45 (51.1%) consultants, 31 (35.2%) residents and 12 (13.6%) diplomates. Their years of practice were 8.8 +/- 6.7 SD years. They worked mainly in government hospitals located at the southern part of Nigeria. The current practice was mainly comprehensive ophthalmology, 63 (71.6%). Only 2 (2.3%) had strict subspecialty practice. Others, 23 (26.1%), had combined practice. Eleven (12.5%) were glaucoma specialists and had combined practice. The majority of the participants, 57 (64.8%), were routinely diagnosed glaucoma properly. Sixty-three (71.6%) participants underwent trabeculectomy, 48 (54.5%) combined cataract surgery with trabeculectomy, 7 (8.0%) drainage implants, 5 (5.7%) laser trabeculoplasty, and 2 (2.3%) minimally invasive glaucoma surgery. Poor patients' acceptance and satisfaction, fear of complications, lengthy post-operative care and cost were the main deterrents to surgeries. Advocacy, public awareness, training of glaucoma specialists, provision of equipment and health insurance were the major recommendations on improving glaucoma care., CONCLUSION: Given the meagre number of specialists and lack of strict subspecialty practice, optimal glaucoma care in Nigeria is still far from reality.
Keywords: Adult; Cross-Sectional Studies; Delivery of Health Care/sn [Statistics & Numerical Data]; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; Nigeria; *Ophthalmology/st [Standards]; Ophthalmology/sn [Statistics & Numerical Data]; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Practice Patterns, Physicians'; Surveys and Questionnaires; Trabeculectomy/sn [Statistics & Numerical Data]

Simultaneous co-delivery of neuroprotective drugs from multi-loaded PLGA microspheres for the treatment of glaucoma. - Arranz-Romera, A; Davis, B M; Bravo-Osuna, I; Esteban-Perez, S; Molina-Martinez, I T; Shamsher, E; Ravindran, N; Guo, L; Cordeiro, M F; Herrero-Vanrell, R (Journal of controlled release : official journal of the Controlled Release Society, 2019)
Glaucoma is a multifactorial neurodegenerative disorder and one of the leading causes of irreversible blindness globally and for which intraocular pressure is the only modifiable risk factor. Although neuroprotective therapies have been suggested to have therapeutic potential, drug delivery for the treatment of ocular disorders such as glaucoma remains an unmet clinical need, further complicated by poor patient compliance with topically applied treatments. In the present study we describe the development of multi-loaded PLGA-microspheres (MSs) incorporating three recognised neuroprotective agents (dexamethasone (DX), melatonin (MEL) and coenzyme Q10 (CoQ10)) in a single formulation (DMQ-MSs) to create a novel sustained-release intraocular drug delivery system (IODDS) for the treatment of glaucoma. MSs were spherical, with a mean particle size of 29.04+/-1.89mum rendering them suitable for intravitreal injection using conventional 25G-32G needles. >62% incorporation efficiency was achieved for the three drug cargo and MSs were able to co-deliver the encapsulated active compounds in a sustained manner over 30-days with low burst release. In vitro studies showed DMQ-MSs to be neuroprotective in a glutamate-induced cytotoxicity model (IC50 10.00+/-0.94mM versus 6.89+/-0.82mM in absence of DMQ-MSs) in R28 cell line. In vivo efficacy studies were performed using a well-established rodent model of chronic ocular hypertension (OHT), comparing single intravitreal injections of microspheres of DMQ-MSs to their equivalent individual single-drug loaded MSs mixture (MSsmix), empty MSs, no-treatment OHT only and naive groups. Twenty one days after OHT induction, DMQ-MSs showed a significantly neuroprotective effect on RGCs compared to OHT only controls. No such protective effect was observed in empty MSs and single-drug MSs treated groups. This work suggests that multi-loaded PLGA MSs present a novel therapeutic approach in the management of retinal neurodegeneration conditions such as glaucoma. Copyright © 2019. Published by Elsevier B.V.
Keywords: Animals; Dexamethasone/ad [Administration & Dosage]; Dexamethasone/ch [Chemistry]; Disease Models, Animal; *Drug Carriers/ch [Chemistry]; Drug Compounding; Drug Liberation; Drug Therapy, Combination/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Humans; Injections, Intraocular; Male; Melatonin/ad [Administration & Dosage]; Melatonin/ch [Chemistry]; *Microspheres; Neuroprotective Agents/ad [Administration & Dosage]; *Neuroprotective Agents/ch [Chemistry]; *Polylactic Acid-Polyglycolic Acid Copolymer/ch [Chemistry]; Rats; Retina/de [Drug Effects]; Transcription Factor Brn-3B/me [Metabolism]; Treatment Outcome; Ubiquinone/ad [Administration & Dosage]; Ubiquinone/aa [Analogs & Derivatives]; Ubiquinone/ch [Chemistry]

Integrating Patient Education Into the Glaucoma Clinical Encounter: A Lean Analysis. - Newman-Casey, Paula A; Musser, John A; Niziol, Leslie M; Heisler, Michele M; Kamat, Shivani S; Shah, Manjool M; Patel, Nish; Cohn, Amy M (Journal of glaucoma, 2019)
PURPOSE: The main purpose of this study was to use Lean analysis to identify how often and when wait times occur during a glaucoma visit to identify opportunities for additional patient engagement., METHODS: This prospective observational time-motion study measured process and wait times for 77 patient visits from 12 ophthalmologists at an academic glaucoma clinic over a 3-month period. Value stream maps visually diagramed the process of a clinical visit from the patient's perspective. Descriptive statistics were calculated for process times, wait times, and the frequency of 10+ minute wait times during each part of the visit. Key stakeholders participated in a root cause analysis to identify reasons for long wait times. The main outcome measure was average times (hours: minutes: seconds) for process times and wait times., RESULTS: Twenty-nine new visit (NV) patients and 48 return visit (RV) patients were included. Total time in clinic was 187.1+/-44.5 (mean+/-SD) minutes for NV patients and 102.0+/-44.7 minutes for RV patients. Wait time for NV patients was 63.7+/-33.4 minutes (33.1% of total appointment time) and for RV patients was 52.6+/-31.6 minutes (49.4% of the total appointment time). All NV patients and 87.5% of RV patients had at least one 10+ minute wait time during their clinic visit and the majority (75.9% NV, 60.4% RV) had >1., CONCLUSIONS: Currently, sufficient wait time exists during the visit for key portions of glaucoma education such as teaching eye drop instillation.
Keywords: Adult; Aged; Aged, 80 and over; *Ambulatory Care/og [Organization & Administration]; Ambulatory Care/st [Standards]; Ambulatory Care Facilities; *Appointments and Schedules; Female; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; Patient Education as Topic/mt [Methods]; *Patient Education as Topic/og [Organization & Administration]; *Patient Participation/mt [Methods]; Prospective Studies; Time Factors; Waiting Lists

A Comparison of Resource Use and Costs of Caring for Patients With Exfoliation Syndrome Glaucoma Versus Primary Open-Angle Glaucoma. - Rathi, Siddarth; Andrews, Chris; Greenfield, David S; Stein, Joshua D (American journal of ophthalmology, 2019)
PURPOSE: To characterize differences in resource utilization and cost of managing enrollees with exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG)., DESIGN: Retrospective utilization and cost comparison using Medicare claims data., METHODS: We identified Medicare beneficiaries with XFG or POAG and >=5 years of continuous enrollment from January 2008 to December 2014. We distinguished newly diagnosed cases from those with preexisting disease. We compared ophthalmic resource utilization and costs over 2 years of follow-up for persons with newly diagnosed and preexisting XFG vs those with POAG. Main outcome measures were number of clinic visits, diagnostic procedures, medication fills, laser and incisional surgery, and mean eye care costs per beneficiary., RESULTS: Among 192 eligible enrollees (median age 77.6 years) with newly diagnosed XFG and 7339 enrollees (median age 77.3 years) with newly diagnosed POAG, those with XFG had more office visits (mean, 9.1 vs 7.9; P = .001), cataract surgery (34.9% vs 19.0%; P < .0001), and glaucoma surgery (28.7% vs 19.7%, P = .002). They also experienced 27% higher mean total eye care costs ($3260 vs $2562, P = .0001) over 2 years of follow-up. Among 2745 enrollees (median age 80.5 years) with preexisting XFG and 89 036 persons (median age 79.5) with preexisting POAG, persons with XFG had more office visits (mean 9.3 vs 7.3; P < .0001), perimetry (85.3% vs 79.8%; P < .0001), cataract surgery (23.4% vs 12.3%; P < .0001), laser trabeculoplasty (18.6% vs 9.6%; P < .0001), and trabeculectomy (8.1 vs 1.8%; P < .0001) and experienced 37% higher total mean eye care costs ($3764 vs $2739; P < .0001)., CONCLUSIONS: Healthcare resource utilization and costs are substantially higher for managing patients with XFG compared to POAG. Copyright © 2019 Elsevier Inc. All rights reserved.
Keywords: Aged; Aged, 80 and over; Cataract Extraction; Exfoliation Syndrome/di [Diagnosis]; *Exfoliation Syndrome/ec [Economics]; *Exfoliation Syndrome/su [Surgery]; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/su [Surgery]; *Health Care Costs/sn [Statistics & Numerical Data]; *Health Resources/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure/ph [Physiology]; Male; Medicare/sn [Statistics & Numerical Data]; Patient Acceptance of Health Care; Retrospective Studies; Trabeculectomy/mt [Methods]; United States; Visual Field Tests; Visual Fields/ph [Physiology]

Corticosteroids in Moderate-To-Severe Graves' Ophthalmopathy: Oral or Intravenous Therapy?. - Penta, Laura; Muzi, Giulia; Cofini, Marta; Leonardi, Alberto; Lanciotti, Lucia; Esposito, Susanna (International journal of environmental research and public health, 2019)
BACKGROUND: Ophthalmopathy is a rare extra-thyroid manifestation of Graves' disease, in paediatrics. Intravenous corticosteroids are the main treatment of moderate-to-severe Graves' orbitopathy. In this paper, we describe a moderate-to-severe active Graves' ophthalmopathy in a child and the response to oral therapy with prednisone., CASE PRESENTATION: A nine-year-old male child suffering for a few months, from palpitations, tremors, and paresthesia was hospitalized in our Pediatric Clinic. At admission, the thyroid function laboratory tests showed hyperthyroidism with elevated free thyroxine (FT4) and free triiodothyronine (FT3) levels and suppressed thyroid-stimulating hormone (TSH) levels. These findings, combined with the clinical conditions-an ophthalmologic evaluation (that showed the presence of exophthalmos without lagophthalmos and visual acuity deficiency), thyroid ultrasound, and TSH receptor antibody positivity-led to a diagnosis of Graves' disease. Therefore, methimazole was administered at a dose of 0.4 mg/kg/day. After 4 months, thyroid function was clearly improved, with normal FT3 and FT4 values and increasing TSH values, without adverse effects. Nevertheless, an eye examination showed ophthalmopathy with signs of activity, an increase in the exophthalmos of the right eye with palpebral retraction, soft tissue involvement (succulent and oedematous eyelids, caruncle and conjunctival hyperaemia and oedema) and keratopathy, resulting from exposure. We began steroid therapy with oral administration of prednisone (1 mg/kg/day) for four weeks, followed by gradual tapering. After one week of therapy with prednisone, an eye assessment showed reduced retraction of the upper eyelid of the right eye, improvement of right eye exophthalmometry and reduction of conjunctival hyperaemia. After four weeks of therapy with prednisone, an eye assessment showed reduction of the right palpebral retraction without conjunctival hyperaemia and no other signs of inflammation of the anterior segment; after twelve weeks, an eye assessment showed a notable decrease in the right palpebral retraction and the absence of keratitis, despite persisting moderate conjunctival hyperaemia. No adverse event associated with steroid use was observed during the treatment period and no problem in compliance was reported., CONCLUSION: Prednisone seems a better choice than intravenous corticosteroids, for treating moderate-to-severe and active Graves' ophthalmopathy, keeping in mind the importance of quality of life in pediatric patients.
Keywords: Administration, Intravenous; Administration, Oral; Child; *Glucocorticoids/ad [Administration & Dosage]; Graves Ophthalmopathy/di [Diagnosis]; *Graves Ophthalmopathy/dt [Drug Therapy]; Graves Ophthalmopathy/pa [Pathology]; Humans; Male; *Prednisone/ad [Administration & Dosage]; Quality of Life; Thyroid Function Tests; Treatment Outcome

Effect of vitamin-E integration on delivery of prostaglandin analogs from therapeutic lenses. - Sekar, Poorvajan; Chauhan, Anuj (Journal of colloid and interface science, 2019)
HYPOTHESIS: Glaucoma is effectively treated by prostaglandin analogs. Low corneal bioavailability (<5%) of daily-instilled prostaglandin drops complemented by frequent application results in low patient compliance (<50%). One alternative route is ocular delivery via commercial hydrogel contact lens. Commercial lenses, however, release prostaglandins rapidly in a few hours owing to their small molecular size, resulting in toxic side-effects. Here, the feasibility of sustained prostaglandin, namely bimatoprost and latanoprost delivery by vitamin-E integrated polymeric hydrogels is explored. Inclusion of these barriers is expected to augment transport resistance and influence delivery rates., EXPERIMENTS: Lens immersion in vitamin-E concentrated ethanol is done to enable formation of nano-barrier depots., FINDINGS: Pilot in vitro studies indicate that ACUVUE R OASYS R and ACUVUE R TruEye TM lenses loaded with ~0.2g of vitamin-E/g of hydrogel effectively prolong bimatoprost dynamics by 10-40-fold, delivering therapeutic dosages for >10days. Incorporation of vitamin-E into the lenses retains visible light transmission and other properties. Further, vitamin-E integration does not influence latanoprost transport. An in vivo model involving coupled mass transport in the lens and post-lens tear film (POLTF) domains predicts >50% corneal bioavailability of bimatoprost delivered via modified lenses. Copyright © 2018 Elsevier Inc. All rights reserved.
Keywords: *Contact Lenses; *Drug Delivery Systems; Humans; Particle Size; *Prostaglandins, Synthetic/ad [Administration & Dosage]; Prostaglandins, Synthetic/ch [Chemistry]; *Prostaglandins, Synthetic/tu [Therapeutic Use]; Vitamin E/ad [Administration & Dosage]; *Vitamin E/ch [Chemistry]

Conjunctival Goblet Cells, the Overlooked Cells in Glaucoma Treatment. - Tiedemann, Daniel; Mouhammad, Zaynab A; Utheim, Tor P; Dartt, Darlene A; Heegaard, Steffen; Petrovski, Goran; Kolko, Miriam (Journal of glaucoma, 2019)
Glaucoma is the leading cause of irreversible blindness worldwide. Although no definitive cure exists, lowering of the intraocular pressure decreases the rate of progression in the majority of patients with glaucoma. Antiglaucomatous treatment modalities consist predominantly of chronic use of eye drops. It has become increasingly evident that long-term exposure to eye drops has a significant impact on the ocular surface, and thereby on patient compliance and quality of life. Maintenance of the ocular surface is highly dependent on a stable tear film. Conjunctival goblet cells (GCs) of the ocular surface play an important role in providing the innermost mucin layer of the tear film and are essential for maintaining the ocular surface homeostasis. Recent studies have reported severe side effects of antiglaucomatous drops on GCs. In particular, a preservative containing antiglaucomatous drops have been shown to affect the viability and functions of the GCs. Furthermore, GC density has been suggested as a potential predictor of surgical outcome after filtration surgery. The present review provides an overview of the current literature on the impact of antiglaucomatous eye drops on GCs as well as the impact on the ocular surface. Moreover, the existing evidence of a possible association between GC density and glaucoma filtration surgery outcome is summarized. We conclude that prostaglandin analogs spare the conjunctival GCs more compared with other antiglaucomatous drops and that GCs may be a good predictor of surgical outcome after filtration surgery. Overall, given the multiple functions of GCs in the ocular surface homeostasis, dedicated strategies should be adopted to preserve this cell population during the course of glaucoma.
Keywords: Administration, Ophthalmic; *Antihypertensive Agents/tu [Therapeutic Use]; *Conjunctiva/de [Drug Effects]; Conjunctiva/pa [Pathology]; Dry Eye Syndromes/pp [Physiopathology]; *Glaucoma/dt [Drug Therapy]; *Goblet Cells/de [Drug Effects]; Goblet Cells/pa [Pathology]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/tu [Therapeutic Use]; *Preservatives, Pharmaceutical/tu [Therapeutic Use]; Quality of Life; Tears/ph [Physiology]; Tonometry, Ocular

Current opinion in ophthalmology: novel glaucoma devices in the pipeline. - Ittoop, Sabita M; Seibold, Leonard K; Kahook, Malik Y (Current opinion in ophthalmology, 2019)
PURPOSE OF REVIEW: Adherence to chronic use of topical intraocular pressure (IOP) lowering medications is a fundamental barrier to successful, long-term control in patients suffering from glaucoma. This has fueled innovation to create new vehicles for drug administration, new drug formulations with enhanced bioavailability, and minimally invasive glaucoma surgeries (MIGS) with improved risk-benefit profiles to enhance sustained IOP control. The present article is an overview of novel devices in the pipeline., RECENT FINDINGS: Several new devices that promise to deliver sustained drug therapy and reduce dependence on daily patient adherence are currently being vetted through clinical trials. In addition, the pipeline for new MIGS devices that target sustained IOP control continues to grow., SUMMARY: Alternative drug delivery approaches and novel MIGS devices broaden the treatment options for patients with glaucoma. This will allow the clinician to customize treatment by selecting specific approaches based on each patient's individual needs and coexisting ocular pathologies. Additional comprehensive, large-scale, clinical studies will help define the role that these options hold in a constantly evolving treatment paradigm.
Keywords: *Drug Delivery Systems; Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; *Glaucoma/th [Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; *Minimally Invasive Surgical Procedures; Ophthalmology; Pharmaceutical Preparations; Tonometry, Ocular

Influence of new treatment modalities on adherence in glaucoma. - Meier-Gibbons, Frances; Berlin, Michael S; Toteberg-Harms, Marc (Current opinion in ophthalmology, 2019)
PURPOSE OF REVIEW: It is well known that glaucoma patients are not adherent to their therapeutic regimens. The issue of nonadherence is multifactorial and includes inadequate communication between doctors and patients, resulting in significant costs associated with enhanced disease progression. Therapeutic regimens are risk factors which often influences adherence rates. Thus, alternative treatment modalities, especially those risk factors that do not rely on patients' cooperation, may enable improvements in long-term outcomes of glaucoma in patient., RECENT FINDINGS: The studies selected for this review were divided into new medications, especially advancements in pharmaceutical approaches to treat glaucoma and new ways of delivering the medication, new surgical methods, especially minimally invasive surgery methods for glaucoma, and new studies about adherence in glaucoma., SUMMARY: Surprisingly, a very few studies on glaucoma medication or surgery addressed the concept of adherence. However, adherence is discussed in studies which consider psychological aspects of patients or communication issues between doctors and patients. Although these studies were performed in clinical settings, the issue of adherence is not addressed; despite it has significant effect on long-term outpatient care. A combination of both aspects, adherence and miscommunication, should be considered in studies.
Keywords: Antihypertensive Agents/tu [Therapeutic Use]; Drug Delivery Systems; Glaucoma/di [Diagnosis]; *Glaucoma/th [Therapy]; Humans; Minimally Invasive Surgical Procedures; *Ophthalmologic Surgical Procedures; *Patient Compliance; *Pharmaceutical Preparations; *Treatment Adherence and Compliance

Impact of a Social Worker in a Glaucoma Eye Care Service: A Prospective Study. - Hark, Lisa A; Madhava, Malika; Radakrishnan, Anjithaa; Anderson-Quinones, Catherine; Robinson, Debra; Adeghate, Jennifer; Silva, Stephen; Zhan, Tingting; Adepoju, Tomilade; Dave, Yatee; Fudemberg, Scott J (Health & social work, 2019)
The purpose of this study was to evaluate the effects of a six-month social worker intervention for participants with a glaucoma-related diagnosis in an urban ophthalmic setting (N = 40). The social worker assessed common barriers to eye care, helping participants with transportation, access to low-vision resources, and supportive counseling. The Distress Thermometer, Patient Health Questionnaire-9, and a satisfaction survey were administered to determine the effect of the social worker intervention and participants' overall impressions of the social worker. The most common barrier to eye care was emotional distress (77.5 percent). There was a significant decrease in the number of participants with symptoms of major and moderate depression. Fourteen participants experienced a clinically relevant decrease in depression, 37 participants felt that the social worker's support addressed their issues, and 29 participants thought it helped them in managing their glaucoma. This study provides evidence that a social work intervention may improve care coordination and management of individuals afflicted with vision impairment due to glaucoma and other ocular diseases.
Keywords: *Counseling; Depression/px [Psychology]; Female; *Glaucoma/di [Diagnosis]; Health Services Accessibility; Humans; Male; Middle Aged; Prospective Studies; *Social Support; *Social Workers/px [Psychology]; Surveys and Questionnaires

Preliminary Steps to Address Glaucoma Medication Adherence: Beginning to Tackle the Elephant in the Room. - Newman-Casey, Paula Anne; Myers, Jonathan S (JAMA ophthalmology, 2019)
Comment on (CON)
Keywords: Antihypertensive Agents; Electronic Health Records; *Glaucoma; Humans; *Medication Adherence; Patient Satisfaction

Association of an Electronic Health Record-Linked Glaucoma Medical Reminder With Patient Satisfaction. - Varadaraj, Varshini; Friedman, David S; Boland, Michael V (JAMA ophthalmology, 2019)
Importance: While dosing reminders for glaucoma medications have been shown to increase drug adherence, an outstanding limitation preventing broad adoption is difficulty linking reminders to medication in each patient's electronic health record (EHR)., Objective: To examine the feasibility of implementing an EHR-linked, automated reminder system for glaucoma medications and assess patient satisfaction with it., Design, Setting, and Participants: In this prospective, cross-sectional study, patients receiving glaucoma medications were recruited from a university-based glaucoma clinic from April 2017 to January 2018. Analysis began in February 2018., Exposures: A web-based application was added to the EHR patient portal, allowing patients to configure telecommunication-based reminders for their glaucoma medications. For all potential participants, basic information was collected to determine risk of nonadherence with glaucoma medications. Those consenting to participate then answered questions on medication adherence, reminders, and their likelihood of using EHR-linked reminders. They then configured reminders using the EHR patient portal. After 3 months, they answered questions about their satisfaction with the system., Main Outcomes and Measures: Proportions of patients and high-risk patients willing to use the reminders, and patient satisfaction with the system., Results: Of 147 patients approached, 100 (68%) agreed to participate, of whom the majority were men (54 [54%]) and white (51 [51%]), with a mean (SD) age of 65 (12.4) years. There were no differences between those willing and unwilling to participate, except for a slightly lower self-reported medication adherence rate among those who participated (mean [SD], 91% [13.6%] vs 97% [6.0%]). Based on a previously validated risk assessment score, 9% (9 of 100) of participants were categorized as being at high risk for poor adherence (>=50% probability of nonadherence) compared with 11% (5 of 47) of nonparticipants. Of 100 participants, 94 ultimately configured reminders, of whom 89 (95%) completed follow-up. On follow-up, 74% (n = 66; 95% CI, 65-83) of participants found the reminders to be useful, 15% (n = 13) were neutral, and 11% (n = 10) found them not useful. Most participants (72 [81%]; 95% CI, 77-85) had help configuring reminders., Conclusions and Relevance: Electronic health records-linked reminders had good uptake and were well received among patients at a tertiary glaucoma clinic. These portals may represent a new and convenient method of allowing patients to link their glaucoma medications to automated reminders, although the generalizability of these results and the effect on glaucoma outcomes remains unknown.
Comment in (CIN)
Keywords: Adult; Aged; Cross-Sectional Studies; *Electronic Health Records; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Patient Satisfaction; Prospective Studies; *Reminder Systems/st [Standards]

Follow-up and adherence to glaucoma care by newly diagnosed glaucoma patients in enugu, nigeria. - Kizor-Akaraiwe, Nkiru N (Ophthalmic epidemiology, 2019)
PURPOSE: To determine uptake, adherence and influencing factors to follow-up care by newly diagnosed glaucoma patients from free eye screening exercise., METHODS: The study was a cross-sectional survey of newly diagnosed glaucoma patients during free eye screenings carried out in March and October, 2016 in Enugu, Nigeria. Data on participants were analyzed after a minimum of 6 months from the screening for uptake and adherence to follow-up care. Qualifying patients had questionnaires administered to them by phone interview. Information requested regards awareness, knowledge on diagnosis as well as reasons for non-uptake and non-adherence., RESULTS: 182 newly diagnosed glaucoma patients were included of which 121 (66.5%) were males, with median age of 50years.About 164 (90.1%) had at least a primary education. There were more self- employed persons 59 (32.4%) compared to other occupations. Uptake of follow up care was 17.6% (32/182). Adherence rate was 25% (8/32). Major reasons for non-uptake were lack of funds 54.9% (n = 50/91), distance 11% (n = 10/91) and receiving care from other facilities 11.0% (n = 10/91). Others include discourteous staff behavior and lack of information on diagnosis. Similarly, major reasons for non-adherence were lack of funds 44.4% (n = 8/18) and distance 22.2% (n = 4/18). Knowledge and prior awareness of glaucoma were found to be significantly associated with uptake of follow up care (p = 0.020)., CONCLUSION: Uptake and adherence to follow-up was found to be low in this study population mainly attributed to cost, distance and poor knowledge of glaucoma natural history. Reviewing cost/out of pocket expenditure, providing care closer to patients, adequate education of staff and patients may significantly improve uptake of care after initial diagnosis.
Keywords: Adult; *Aftercare/sn [Statistics & Numerical Data]; Aged; Cross-Sectional Studies; Female; *Glaucoma/th [Therapy]; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Nigeria; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]

Engineering and Development of Chitosan-Based Nanocoatings for Ocular Contact Lenses. - Mehta, Prina; Al-Kinani, Ali A; Arshad, Muhammad Sohail; Singh, Neenu; van der Merwe, Susanna M; Chang, Ming-Wei; Alany, Raid G; Ahmad, Zeeshan (Journal of pharmaceutical sciences, 2019)
This article reports on electrohydrodynamic atomization to engineer on-demand novel coatings for ocular contact lenses. A formulation approach was adopted to modulate the release of timolol maleate (TM) using chitosan and borneol. Polymers polyvinylpyrrolidone and poly (N-isopropylacrylamide) were utilized to encapsulate TM and were electrically atomized to produce optimized, stationary contact lens coatings. The particle and fiber diameter, thermal stability, material compatibility of the formed coatings, their in vitro release-modulating effect, and ocular tolerability were investigated. Results demonstrated highly stable nanomatrices with advantageous morphology and size. All formulations yielded coatings with high TM encapsulation (>88%) and excellent ocular biocompatibility. Coatings yielded biphasic and triphasic release, depending on composition. Kinetic modeling revealed a noticeable effect of chitosan; the higher the concentration, the more the release of TM because of chitosan swelling, with the mechanism changing from Fickian diffusion (1% w/v; n = 0.5) to non-Fickian (5% w/v, 0.45 <n < 0.89). The use of electrohydrodynamic atomization has not yet been explored in depth within the ocular research remit, engineering on-demand lens coatings capable of sustaining TM release. This is likely to offer an alternative dosage form for management of glaucoma with particular emphasis on improving poor patient compliance. Copyright © 2019 American Pharmacists Association R. Published by Elsevier Inc. All rights reserved.
Keywords: Administration, Ophthalmic; Animals; *Antihypertensive Agents/ad [Administration & Dosage]; Cattle; Chemical Engineering; Chemistry, Pharmaceutical; Chitosan/ch [Chemistry]; *Contact Lenses; Cornea/de [Drug Effects]; *Drug Compounding/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Humans; Nanoparticles/ch [Chemistry]; Particle Size; *Timolol/ad [Administration & Dosage]

Hand hygiene is linked to microbial keratitis and corneal inflammatory events. - Fonn, Desmond; Jones, Lyndon (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2019)
Lack of or inadequate hand washing is a risk factor in the development of contact lens related microbial keratitis and corneal inflammatory events. In the public health domain there is compelling evidence that proper hand washing with soap can save lives. The purpose of this review is to draw attention to some of the public health literature in support of hand washing and how education can influence patients' hand hygiene behavior. Contact lens wearers are also guilty of poor hand washing behavior but there is scant evidence that education of hand washing procedures of lens wearers alters patient non-compliance. It is well known that pathogenic microbial contamination of contact lenses, lens cases, care solutions and anterior ocular components have been found with contact lens wear. However while the originating source may be hands or water, it is most likely both of these. Besides proper hand washing this paper will include mitigating strategies for avoiding microbial contamination. Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Keywords: *Contact Lenses; Equipment Contamination; *Eye Infections, Bacterial/mi [Microbiology]; *Hand Hygiene; Humans; Inflammation/mi [Microbiology]; *Keratitis/mi [Microbiology]; Patient Compliance; Risk Factors

Novel Dexamethasone Sodium Phosphate Treatment (DSP-Visulex) for Noninfectious Anterior Uveitis: A Randomized Phase I/II Clinical Trial. - Papangkorn, Kongnara; Truett, Kim R; Vitale, Albert T; Jhaveri, Chirag; Scales, David K; Foster, C Stephen; Montieth, Alyssa; Higuchi, John W; Brar, Balbir; Higuchi, William I (Current eye research, 2019)
PURPOSE: Frequent steroid drops represent a challenge in patient compliance. This study evaluated the safety and efficacy of 5 minute topical dexamethasone sodium phosphate-Visulex (DSP-Visulex) treatment regimen (two applications on the first week then weekly after) compared to daily prednisolone acetate 1% (PA) for noninfectious anterior uveitis., MATERIALS AND METHODS: Forty-four patients were randomized to 8% DSP-Visulex with placebo eye drops (8% group, n = 14), 15% DSP-Visulex with placebo eye drops (15% group, n = 15), or Vehicle-Visulex with PA eye drops (PA group, n = 15). Patients received daily eye drops and Visulex treatments on days 1, 3, 8, and 15 with an optional treatment on day 22. Efficacy measures were change in anterior chamber cell (ACC) count from baseline and proportion of patients with zero ACC count at days 8, 15, and 29. Safety measures were adverse events (AEs), visual acuity, ocular symptoms, and intraocular pressure (IOP)., RESULTS: ACC resolution over time was similar among the three groups. The percentage of patients with clear ACC was 18%, 22%, and 15% on day 8; 27%, 56%, and 54% on day 15; and 90%, 88%, and 77% on day 29 for the 8%, 15%, and PA groups, respectively. The numbers of reported AEs were 10, 36, and 12 for the 8%, 15%, and PA groups, respectively. Ten patients among all groups experienced treatment-related AEs, which included headache, eye pain, corneal abrasion, conjunctival/corneal staining, conjunctivitis, visual acuity reduction, and keratitis all of which were resolved during the timeframe of patients' participation in the study. IOP elevation was noted in the PA group throughout the study, whereas IOP elevation in the DSP-Visulex groups was observed at day 3 but not thereafter., CONCLUSIONS: The efficacy of the DSP-Visulex applications was comparable to the daily PA drops in the treatment of noninfectious anterior uveitis. Both 8% and 15% DSP-Visulex treatments were safe and well tolerated.
Keywords: Administration, Topical; Adult; Aged; *Anterior Chamber/pa [Pathology]; Cell Count; Dexamethasone/ad [Administration & Dosage]; *Dexamethasone/aa [Analogs & Derivatives]; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Glucocorticoids/ad [Administration & Dosage]; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Slit Lamp Microscopy; Treatment Outcome; Uveitis, Anterior/di [Diagnosis]; *Uveitis, Anterior/dt [Drug Therapy]; Uveitis, Anterior/pp [Physiopathology]; *Visual Acuity; Young Adult

Ocular Antihypertensive Medication Use After iStent Implantation Concurrent With Cataract Surgery vs Cataract Surgery Alone in a Large US Health Care Claims Database. - Wang, Sophia Y; Singh, Kuldev; Stein, Joshua D; Chang, Robert T (JAMA ophthalmology, 2019)
Importance: The iStent Trabecular Micro-Bypass (Glaukos Corporation) is a minimally invasive glaucoma implant used in conjunction with cataract surgery to lower intraocular pressure., Objective: To determine whether implantation of the iStent concurrent with cataract surgery is associated with reduced use of ocular antihypertensive medications in a US health care claims database., Design, Setting, and Participants: Retrospective, observational longitudinal cohort study of individuals enrolled in a US managed care network who underwent iStent implantation with cataract surgery (iStent/CEIOL) from 2012 to 2016 (n = 1509 bilateral and n = 1462 unilateral surgery). A control group of individuals who underwent bilateral cataract surgery only (CEIOL) were matched 1:1 to patients undergoing bilateral iStent/CEIOL on baseline demographic and clinical factors. Data were analyzed between November 1, 2017, and January 31, 2018., Main Outcomes and Measures: The number of topical ocular antihypertensive agents used postoperatively by patients undergoing iStent/CEIOL compared with baseline and with matched CEIOL control individuals, and hazard ratios with 95% confidence intervals for sustained reduced use of at least 1 topical ocular antihypertensive agent postoperatively., Results: Of the 2971 eligible enrollees, mean age at first surgery was 74.3 years, and 1659 (55.8%) were women. Patients undergoing iStent/CEIOL had diagnoses that included primary open-angle glaucoma (n = 2329; 78.4%), narrow angles (n = 381; 12.8%), and secondary glaucomas (n = 261; 8.8%). At baseline, 1223 (41.2%) were receiving no topical glaucoma agents; 876 (29.5%), 437 (14.7%), and 435 (14.6%) were receiving 1, 2, or at least 3 agents, respectively. Although only 678 persons (22.8%) completed at least 2 years of postoperative follow-up, the proportion of patients receiving no drops increased postoperatively (64.7%, 20-24 months, P < .001, chi2). Patients receiving at least 1 topical agent at baseline had mean reduction of 1.01 and 0.61 medications used at 20 to 24 months with bilateral or unilateral surgery, respectively (both P < .001, paired t). Sustained reduction in glaucoma medication use was more likely in patients receiving at least 3 vs 1 medication at baseline (hazard ratio, 1.68; 95% CI, 1.36-2.09). Compared with matched control individuals undergoing CEIOL, patients undergoing bilateral iStent/CEIOL had a greater mean reduction in drops used (0.99 vs 0.49; postoperative month 20-24; P < .001; paired t) and a higher proportion receiving no drops postoperatively (73.5% vs 55.3%, postoperative month 20-24; P < .001; chi2)., Conclusions and Relevance: Implantation of the iStent trabecular micro-bypass stent concurrent with cataract surgery was associated with moderately reduced use of topical ocular antihypertensive medication. Reduction in the use of glaucoma medications may lessen the burden of medication adverse effects and promote better adherence.
Erratum in (EIN)
Keywords: Administration, Ophthalmic; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; *Cataract Extraction/mt [Methods]; Databases, Factual; Female; Follow-Up Studies; *Glaucoma Drainage Implants; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; Insurance, Health/sn [Statistics & Numerical Data]; Intraocular Pressure/ph [Physiology]; Lens Implantation, Intraocular; Male; Ophthalmic Solutions; *Prosthesis Implantation/mt [Methods]; Retrospective Studies; *Stents; Tonometry, Ocular; United States; Visual Acuity/ph [Physiology]

Lymphatic vessels of the eye - old questions - new insights. - Gruntzig, Johannes; Hollmann, Frank (Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft, 2019)
Due to its accessible position and tissue heterogeneity, the eye is ideally suited for studying the lymphatic system. As early as the 19th century, questions about the origin and function of this system were discussed. For example, whether Schlemm's canal, which is of particular importance in the pathogenesis of glaucoma, is a lymphatic vessel, or does this vascular system begin with finger-shaped protuberances? Despite the discovery of lymphatic endothelial molecules and the use of molecular imaging technologies, these questions are still discussed controversially today. Leber demonstrated in 1873 with a solution consisting of two dyes of different particle size that only the smaller particles from the anterior chamber of the eye filled the episcleral and conjunctival veins around the corneal margin. He believed to have proven - to be read in the historical review of our article - that the Canalis Schlemmii in humans is a venous circular vessel and not a lymphatic vessel. In our own investigations, we reduced the rather contradictory and complex question of whether there are lymphatic vessels in the eye to the question of whether there are drainage connections between the different sections of the eye and the lymphatic system or not. With different radioactive tracers and combined with unilateral ligation of cervical lymph vessels, we observed outflow from the subconjunctival and retrobulbar space, from the anterior chamber and the vitreous body. The rate of discharge of the radioactive tracer was determined by the radiopharmaceutical and injection site. In analogy to the lymphatic drainage of the head we found a segmental drainage of lymphatic substances on the eye. Vitreous humour and retrobulbar space were drained by lymphatic vessels, predominantly to the deep cervical lymph nodes, while anterior chamber and subconjunctival space drains predominated over the superficial cervical lymph nodes. Eyeball tattoos - as loved by some fan communities - should therefore cause a coloured staining of the superficial cervical lymph nodes. The boundary of the drained segments would be in the area of the eyeball's equator. According to the textbooks, the lymph is actively removed from finger-shaped initial segments via pre-collectors and collectors with properly functioning intraluminal valves and smooth muscle cells in the vessels' media. In patients with spontaneous conjunctival bleeding, however, we observed phenomena in the conjunctival lymph vessels, which ca not be explained with old familiar ideas. At nozzle-shaped vessel constrictions separation of blood components occurred. The erythrocytes formed partially a so-called fluidic "resting bulk layer". Parallel vessel parts caused a retrograde filling of already emptied segments. These observations led our experimental investigations. In the literature, there are different scanning electron microscopy (SEM) images of lymphatic endothelial surfaces; nevertheless they are unassigned to a particular vessel segment. In the conjunctiva, we studied the question whether there is a dependence between vessel diameter and the surface characteristics of endothelial cells (after unfolding by lymphography). A constantly applied photo-mathematical procedure for all specimens allowed determining the size of the cross sections. The specimens were randomized into seven groups with diameters of 0.1-1.0mm and above and examined by SEM. In the smallest vessels (diameter=0.11mm), the impressions of the occasionally occurring nuclei in the lumen were clearly impressive. With increasing diameter, these impressions were lost and the individual endothelial nuclei could no longer be identified. Rather, one recognized only wall-like structures. In vessels of intermediate diameter (0.3-0.4mm), structures could be seen on the surface similar to reticular fibres. With increasing diameters, their prominent character weakened. In the group with diameters above 0.5mm, wavy surface structures were shown. Finally, in vessels of diameters over 1.0mm, a uniform, flat surface was observed. Regardless of the collection site of the specimens, we found certain surface characteristics related to the vessels' calibre. In further investigations by means of interstitial dye lymphography, we were able to demonstrate in the conjunctiva that under increasing injection pressure, additional vessels stained from finger-shaped processes. At least in the conjunctiva, the existence of so-called "blind-ending initial segments" seems doubtful (despite the fact that initial segments or "initial lymphatics" would begin in periphery, not end). Rather, these are likely to be temporary filling states. SEM investigations were carried out on the internal structure of these dome-shaped vessel parts by means of a specially developed preparation technique. Despite numerous variants in the lymphographic design of the blind bags - in the form of finger, balloon, dome, piston, pyramidal, double-humped and spearhead-like endings - slot-shaped, lip-shaped and saw blade-like structures were repeatedly found, similar to a zipper. These findings suggest preformed connections to the next segment and may control lymphatic flow. To clarify the retrograde fluid movements, we examined the lymph vessels' valves or those structures that were previously interpreted as valves. The different structures found could be subdivided into three groups. The lack of common bicuspid structures provides an explanation for retrograde fluid movement. That nevertheless a directional flow is possible, is explained by the flow model developed by Gerhart Liebau. Conjunctival lymphatics show intraluminal structures by double contrast injection, which we divided into four groups due to anatomical differences: An accurate statement about the occurrence of certain intraluminal vascular structures in certain vascular calibres was possible only conditionally. However, complex and extended structures (group d) were found almost exclusively in larger vessel calibres (diameter>0.9mm). The structures are reminiscent of published findings in the "collector channel orifices of Schlemm's canal". They should play an important role in the regulation of the intraocular pressure, or the balance between production and outflow of the aqueous humour. The influence of such structures on the function of the lymphatic vessels is not yet known. As an approach models could be used, which for instance are applied in the water industry for the drainage, the degradation of introduced substances, or the detention pond. The latter serves for the retention and purification of drainage water (storage, treatment and reuse of drainage water). Dead zones, barriers, short-circuit currents and swirling are further hydraulic terms. Can intraluminal vascular structures, for example, affect the lymphatic flow and thus the mechano-sensitivity of lymphatic endothelial cells? Whatever interpretation model we use, the warning of the Swiss anatomist His from 1862 is still true today that all theories about the formation and movement of lymph should be based on precise anatomical basics. This review article therefore tries to make a contribution therefore. Despite knowing of lymphatic endothelial molecules, despite the discovery of the role of lymphangiogenic growth factors in diseases and the use of molecular imaging technologies, we still know too little about the anatomy and function of the lymphatic system. Copyright © 2018. Published by Elsevier GmbH.
Keywords: Anatomy/hi [History]; Eye/ah [Anatomy & Histology]; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Lymphatic Vessels/ah [Anatomy & Histology]; *Ophthalmology/hi [History]

Psychometric Properties of the Reduced Version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT). - Barker, Gordon T; Mansberger, Steven L (Ophthalmic epidemiology, 2019)
PURPOSE: To measure the psychometric properties of a reduced, 27-statement version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT)., METHODS: We administered the GTCAT to 183 participants who were using a single bottle of an ocular hypotensive agent, and objectively measured adherence with Medication Event Monitoring System devices over 60 days. Adherence was the number of days with correctly timed bottle openings divided by the total number of study days. Using the 47-statement GTCAT, we created a reduced GTCAT by removing statements that: (1) did not load using Principal Components Analysis (PCA); (2) did not have a univariable association with adherence; or (3) were highly correlated (.75 or higher) with another statement. We assessed the construct validity of the remaining statements using PCA and assessed the predictive validity using multiple logistic regression analysis., RESULTS: We removed 20 statements because they did not appear in the PCA analysis; were not predictive of adherence; and/or had high correlation. PCA of the reduced GTCAT (27 statements) extracted 5 components of the Health Belief Model (knowledge, susceptibility, cues-to-action, self-efficacy, and barriers). Multiple regression showed that the 27 statements predicted adherence (Rsq = .11, p = .03)., CONCLUSIONS: The reduced version of the GTCAT is associated with adherence, which suggests that after external validation, future glaucoma medication adherence studies could use the reduced version to efficiently measure health behaviors and determine the benefit of the GTCAT to develop personalized interventions in glaucoma adherence.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; *Attitude to Health; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence; Ophthalmic Solutions/ad [Administration & Dosage]; *Psychometrics/mt [Methods]; *Surveys and Questionnaires

Ocular Surface Disease and Glaucoma Medications: A Clinical Approach. - Zhang, Xuemin; Vadoothker, Saujanya; Munir, Wuqaas M; Saeedi, Osamah (Eye & contact lens, 2019)
OBJECTIVES: Ocular surface disease frequently coexists with glaucoma and may be initiated or exacerbated by topical glaucoma medications. We performed a review of current literature to assess the prevalence, causes, and treatment of ocular surface disease in glaucoma patients, specifically those on topical therapy., METHODS: A Pubmed database search was conducted. A total of 720 articles published from 1972 to 2018 were found in relation with ocular surface disease, glaucoma, and glaucoma medications. Of these, 102 articles were included in this analysis. We included primary and empirical studies for patients on topical glaucoma medications. Exclusion criteria included case reports, non-English studies, and articles unrelated to the primary subject of this review., RESULTS: Ocular surface disease among normal and glaucomatous eyes was evaluated based on diagnostic testing including clinical examination and questionnaires to determine visual function and quality of life. Glaucoma medications can be associated with toxicities to the ocular surface, most often due to the nature of the preservative included in the medication; however, the incidence of toxicity can be mitigated by the use of preservative free medications, decreased preservative medications, or treatment of dry eye disease. Treatment of glaucoma with laser trabeculoplasty or minimally invasive glaucoma surgeries that spare the conjunctiva and the cornea may avoid or decrease reliance on topical glaucoma medications, potentially avoiding the initiation or progression of ocular surface disease., CONCLUSIONS: Recognition and treatment of ocular surface disease in glaucoma patients may improve patient quality of life and medication adherence. This may ultimately improve glaucoma treatment outcomes.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ae [Adverse Effects]; Conjunctiva/pa [Pathology]; Cornea/pa [Pathology]; *Dry Eye Syndromes/ci [Chemically Induced]; Dry Eye Syndromes/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions

Significant hyperopic shift in a patient with extreme myopia following severe hypotonia caused by glaucoma filtering surgery. - Costa, Joao C; Alio, Jorge (European journal of ophthalmology, 2019)
INTRODUCTION:: To report the case of a high hyperopic refractive shift associated with significant shortening of the ocular axial length following glaucoma filtering surgery., METHODS:: Case report. Patient's records were consulted retrospectively., RESULTS:: A 57-year-old woman, highly myopic, with a history of bilateral intraocular refractive surgery in 1998 (phakic lens ZB5M) and bilensectomy in 2011 (phakic intraocular lens extraction plus cataract surgery with pseudophakic intraocular lens implantation), presented with consistently high intraocular pressure. Despite the treatment with different topical antiglaucomatous medications and good compliance, her intraocular pressure values remained consistently above 20 mmHg. In 2016, the patient was submitted for glaucoma filtering surgery and the mini shunt Ex-Press was implanted in both the eyes (3 months between surgeries). On the first postoperative day, the eyes were hypotonic (intraocular pressure of 5 mmHg) and bilateral macular edema was observed. Three days later, the intraocular pressure in both the eyes reached values higher than 6 mmHg (between 6 and 14 mmHg). Five months after the surgery the macular edema resolved and a significant shortening of the axial length and an important hyperopic refractive shift was observed. When comparing the preoperative and postoperative (18 months) measurements, the variation of the axial length was 2.49 mm in the right eye and 2.19 mm in the left eye; the patient refraction (spherical equivalent) shifted 2.50 diopters in the right eye and 1.75 diopters in the left eye., CONCLUSION:: To the best of our knowledge, we report herein the first documented case of an axial length change of this magnitude after glaucoma filtering surgery.
Keywords: *Axial Length, Eye/pp [Physiopathology]; Female; *Filtering Surgery/ae [Adverse Effects]; *Glaucoma/su [Surgery]; Humans; *Hyperopia/et [Etiology]; Hyperopia/pp [Physiopathology]; Intraocular Pressure/ph [Physiology]; Middle Aged; *Myopia, Degenerative/co [Complications]; *Ocular Hypotension/et [Etiology]; Ocular Hypotension/pp [Physiopathology]; Pseudophakia/et [Etiology]; Retrospective Studies; Tonometry, Ocular; Visual Acuity/ph [Physiology]

Knowledge of medications among patients with glaucoma in Taiwan. - Ko, Mei Lan; Wei, Kai Lin; Ho, Yi-Jung; Peng, Pai Huei; Lu, Henry Horng Shing (Journal of the Formosan Medical Association = Taiwan yi zhi, 2019)
BACKGROUND/PURPOSE: To investigate the knowledge and learning ability of glaucoma patients regarding their anti-glaucoma topical medications., METHODS: Patients on regular follow-up at the Glaucoma Clinic at Hsin-Chu General Hospital were recruited. After detailed ocular examinations, the participants were asked to recall and identify their glaucoma eye drops. The same test was repeated 3 months later. The results of both tests, the learning ability of patients regarding their glaucoma drugs, and the relationship between learning ability and demographic variables were evaluated., RESULTS: Two hundred eighty-seven glaucoma patients participated in this study. Of the study population, 25.8% and 57.1% could recall their topical mediation at the first and second tests, whereas 72.1% and 88.5% could identify their prescribed eye drops at the first and second tests, respectively. Approximately 34% of the participants showed improved knowledge at the repeat test, whereas 40% of the participants showed no improvement. Participants with a better learning ability were more likely to be younger, with a higher level of education, and with less visual field impairment., CONCLUSION: The knowledge of glaucoma patients regarding their prescribed medication was deficient in Taiwan. Physician effort could improve knowledge on the prescribed drugs. Patient-centered education should be considered, targeting elderly individuals, illiterate individuals, and those with loss of visual function to increase compliance with glaucoma medication. Copyright © 2018. Published by Elsevier B.V.
Keywords: Adult; Aged; Drug Monitoring; Female; *Glaucoma/dt [Drug Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Logistic Models; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; Surveys and Questionnaires; Taiwan

Uncontrolled Hypertension Is Common in Glaucoma Clinics. - Varadaraj, Varshini; Vardhan, Ashok; Mudie, Lucy I; LaBarre, Sophie; Ong, Yuhan; Wang, Bingsong; Sherrod, Cheryl; Friedman, David S (American journal of hypertension, 2019)
BACKGROUND: To determine the magnitude of uncontrolled hypertension and smoking among patients visiting an eye clinic, and ascertain if referral to care providers is effective., METHODS: Information on smoking status and blood pressure (BP) was collected among patients >=18 years visiting an eye clinic. Those with high BP (systolic: >=140 mm Hg and/or diastolic: >=90 mm Hg) received a pamphlet on harms of hypertension on vision and were referred to a primary care physician. Smokers received a pamphlet on negative effects of smoking on vision and were offered referral to a tobacco quitline. Patients were followed up for referral outcome within 10 weeks from screening., RESULTS: Screening: A total of participants screened included 140 (29.5%) with high BP and 31 (6.6%) current smokers. In the high BP group, 92 (66%) subjects were previously diagnosed with hypertension. Follow-up: Of the 140 participants with elevated BP, 84 (60%) responded to follow-up. Among these 84 participants, 57 (67.9%) had consulted primary care, of whom 5 (8.8%) reported being newly diagnosed with hypertension, and 11 (19.3%) reported a change in their antihypertensive prescription. Among the 31 smokers, 24 (77.4%) were willing for quitline referral. Sixteen (66.7%) of these patients responded to follow-up, 8 (50%) of whom reported participation in a smoking-cessation program with 1 patient (6.3%) successfully quitting smoking., CONCLUSIONS: Nearly one-third of patients attending an eye clinic had elevated BP, and a smaller, but substantial, number of patients were current smokers. Eye clinics may serve as point for identification and referral of these patients with unmet needs.
Comment in (CIN)
Keywords: Aged; *Ambulatory Care Facilities; Antihypertensive Agents/tu [Therapeutic Use]; Baltimore/ep [Epidemiology]; Blood Pressure/de [Drug Effects]; *Blood Pressure; Female; Glaucoma/di [Diagnosis]; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; Hypertension/di [Diagnosis]; Hypertension/dt [Drug Therapy]; *Hypertension/ep [Epidemiology]; Hypertension/pp [Physiopathology]; Male; Middle Aged; Patient Acceptance of Health Care; Patient Education as Topic; Primary Health Care; Referral and Consultation; Risk Factors; *Smoking/ae [Adverse Effects]; Smoking/ep [Epidemiology]; Smoking/pp [Physiopathology]; Smoking Cessation

The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland. - Sii, Samantha; Nasser, Ahmad; Loo, Cheng Yi; Croghan, Catherine; Rotchford, Alan; Agarwal, Pankaj Kumar (The British journal of ophthalmology, 2019)
BACKGROUND: Since the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs)., AIM: To assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists., METHODOLOGY: A retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October-November 2014 (group 1) and September-October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines., RESULTS: Three hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. ( p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%)., CONCLUSION: Patients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria. Copyright © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Aged; *Community Health Workers/st [Standards]; False Positive Reactions; Female; *Glaucoma/di [Diagnosis]; Gonioscopy; Guideline Adherence; Humans; Intraocular Pressure/ph [Physiology]; Male; Middle Aged; *Optometrists/st [Standards]; Patient Discharge; *Practice Guidelines as Topic/st [Standards]; Predictive Value of Tests; *Referral and Consultation/st [Standards]; Referral and Consultation/sn [Statistics & Numerical Data]; Retrospective Studies; Scotland; Tonometry, Ocular; Visual Field Tests

Adherence to topical glaucoma medications and associated factors in Gondar University Hospital Tertiary Eye Care Center, northwest Ethiopia. - Anbesse, Dereje Hayilu; Yibekal, Betelhem Temesgen; Assefa, Natnael Lakachew (European journal of ophthalmology, 2019)
PURPOSE:: The purpose of the study was to determine proportion of adherence to topical glaucoma medications and associated factors among glaucoma patients in Gondar University Hospital Tertiary Eye Care and Training Center, northwest Ethiopia., METHODS:: This cross-sectional design study was conducted on 360 participants from April-May 2017. Structured questionnaire was completed and adherence was assessed by patients' self-report survey. The data were analyzed by SPSS version 20. Multivariate logistic regression was used to identify the determinant factors. The significance was considered at p value less than 0.05., RESULT:: More than half, 221 (61.4%) (95% confidence interval: 56.1-66.7), of the study participants were found to adhere well to glaucoma medications. Male sex (adjusted odds ratio = 1.86 (95% confidence interval: 1.13-3.06)), urban residence (adjusted odds ratio = 2.33 (95% confidence interval: 1.46-3.72)), normal visual acuity (adjusted odds ratio = 2.23 (95% confidence interval: 1.13-4.42)), low visual acuity (adjusted odds ratio = 1.74 (95% confidence interval: 1.05-2.88)), and self-sponsor for medications (adjusted odds ratio = 0.21 (95% confidence interval: 0.12-0.38)) were significantly associated with good adherence., CONCLUSION:: The level of medication adherence to topical glaucoma medications is not good enough as compared to other studies done in Ethiopia. Male sex, urban residence, normal, and low visual acuity were positive predictors, whereas self-sponsored for medications was negative predictors for good adherence to glaucoma medications.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Ethiopia/ep [Epidemiology]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; *Hospitals, University; Humans; Incidence; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Odds Ratio; Surveys and Questionnaires; *Tertiary Care Centers; Young Adult

A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan. - Tsumura, Toyoaki; Kashiwagi, Kenji; Suzuki, Yasuyuki; Yoshikawa, Keiji; Suzumura, Hirotaka; Maeda, Toshine; Takeda, Ryuji; Saito, Hitomi; Araie, Makoto (International ophthalmology, 2019)
INTRODUCTION: Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors., METHODS: A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops., RESULTS: A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740-0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma., CONCLUSION: Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects' reports and ophthalmologists' responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma were associated with adherence among Japanese glaucoma subjects.
Keywords: Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; Humans; Incidence; *Intraocular Pressure/de [Drug Effects]; Japan/ep [Epidemiology]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/ep [Epidemiology]; Ocular Hypertension/pp [Physiopathology]; Ophthalmic Solutions; *Population Surveillance/mt [Methods]; Prospective Studies; Tonometry, Ocular

Factors associated with participation by African Americans in a study of the genetics of glaucoma. - Parikh, Rupin; O'Keefe, Laura; Salowe, Rebecca; Mccoskey, Makayla; Pan, Wei; Sankar, Prithvi; Miller-Ellis, Eydie; Addis, Victoria; Lehman, Amanda; Maguire, Maureen; O'Brien, Joan (Ethnicity & health, 2019)
Objective: African Americans have been historically underrepresented in research studies. Our aim was to evaluate factors influencing enrollment in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Design: Patients approached to enroll in the POAAGG study were asked to complete a 15-item survey addressing demographic characteristics, knowledge of genetics and glaucoma, and opinions on human research. Survey responses were compared between subjects who enrolled (Enrollers) and did not enroll (Decliners) in the POAAGG study. Results: Enrollers (N = 190) were 3.7 years younger (P = 0.007) and had similar gender, education, and income level to Decliners (N = 117). Knowledge about genetics and glaucoma was similar between groups. Enrollers were more comfortable providing DNA for research studies (93.1% vs 54.1%; P < 0.001) and more likely to have participated in prior studies (P = 0.003) and consider participating in future studies (P < 0.001). Among Decliners, lack of time was the primary reason given for not enrolling. Conclusion: To increase participation of African Americans in genetic research studies, efforts should be made to raise comfort with DNA donation.
Keywords: African Americans/px [Psychology]; *African Americans; Aged; *Biomedical Research; DNA Mutational Analysis; Female; Genetic Testing; *Glaucoma, Open-Angle/ge [Genetics]; *Health Knowledge, Attitudes, Practice/eh [Ethnology]; Humans; Male; Middle Aged; *Patient Participation; Patient Selection; Surveys and Questionnaires; Time Factors

RE-INTERVENTION IN DE NOVO VITREOUS OPACITIES AFTER PARS PLANA VITRECTOMY IN FAMILIAL AMYLOIDOTIC POLYNEUROPATHY TTR VAL30METPORTUGUESE PATIENTS. - Ferreira, Natalia Novais; Cunha Dias, David Afonso; Afonso Carvalho, Rui Pedro; Pardal Monteiro Coelho, Maria Teresa (Retinal cases & brief reports, 2019)
PURPOSE: To report management of de novo vitreous amyloid opacities after previous pars plana vitrectomy in familial amyloidotic polyneuropathy transthyretin Val30Met., METHODS: This work is a retrospective observational consecutive case series of five eyes of four patients. Demographic data, transthyretin mutation involved, age at the beginning of disease, duration of disease, treatment (liver transplant or tafamidis), time between vitrectomy and re-intervention, and ophthalmologic changes were evaluated. Surgical re-intervention included phacoemulsification with intraocular lens implantation in phakic eyes, re-vitrectomy as complete as possible with posterior capsulectomy, and internal limiting membrane peeling if wrinkling of internal retinal surface was present., RESULTS: All patients had transthyretin Val30Met mutation, and three were women. Mean age of onset of the disease was 52 +/- 11.0 years, and average evolution time of the disease was 8 years. Three patients had been submitted to liver transplant 4, 9, and 15 years before. Time between first vitrectomy and surgical re-intervention was longer than 2 years in all cases. Two eyes had amyloid deposits on anterior lens surface and pupillary border with scalloped pupil. Two eyes were phakic. Glaucoma was present in two eyes; one of them had previous trabeculectomy. All cases had vitreous opacities behind posterior lens capsule and at vitreous base area. After re-intervention, no further recurrence was observed (average follow-up of 10 months)., CONCLUSION: De novo vitreous amyloid opacities may occur several years after pars plana vitrectomy. Amyloid deposition in vitreous cavity was observed only in strong vitreous adherence locations (behind posterior lens capsule and at vitreous base area). The authors expect that this procedure, an extensive re-vitrectomy associated with posterior capsulectomy, will prevent de novo vitreous amyloid opacities.
Keywords: Aged; *Amyloid Neuropathies, Familial/co [Complications]; *Eye Diseases/su [Surgery]; Female; Humans; Male; Middle Aged; *Plaque, Amyloid/su [Surgery]; Prealbumin/ge [Genetics]; Reoperation; Retrospective Studies; *Vitrectomy/mt [Methods]; *Vitreous Body/pa [Pathology]

Adherence to topical treatment of glaucoma, risk and protective factors: A review. - Velez-Gomez, M C; Vasquez-Trespalacios, E M (Archivos de la Sociedad Espanola de Oftalmologia, 2018)
INTRODUCTION: Glaucoma is a chronic asymptomatic disease, progressing to loss of vision. Elevated intraocular pressure is the only modifiable factor. Adherence to glaucoma treatment varies from 2-80%., OBJECTIVE: To evaluate factors associated with adherence to topical glaucoma treatment reported in the literature, and to identify protective factors and risk factors, as well as modifiable and non-modifiable factors, in order to take them into account to perform interventions in adherence., MATERIALS AND METHODS: A bibliographic search of articles published in the last 8 years in databases such as Clinical Key, Cochrane (OVID), EBSCO, Lilacs, PubMed and Science Direct, of different observational studies that performed a measurement of the treatment of glaucoma and to identify associated factors., RESULTS: A total of 7 studies were selected that directly and indirectly measured adherence to glaucoma treatment. Different risk and protective factors for adherence to treatment were found. These showed that African-American race, poor education, low personal income, and high treatment costs, are strongly related to poor adherence to treatment. It was also found that educational interventions and a good patient- physician relationship impacted positively on adherence., CONCLUSION: The results found are a guide for risk and protective factors for adherence to treatment of glaucoma. It is cost effective to educate patients to positively impact adherence. By identifying such factors, attention can be focused on poor adherence patients. Copyright © 2017 Sociedad Espanola de Oftalmologia. Publicado por Elsevier Espana, S.L.U. All rights reserved.
Keywords: Administration, Topical; *Glaucoma/dt [Drug Therapy]; Humans; *Medication Adherence; Risk Factors

The Role of Axon Transport in Neuroprotection and Regeneration. - Shah, Sahil H; Goldberg, Jeffrey L (Developmental neurobiology, 2018)
Retinal ganglion cells and other central nervous system neurons fail to regenerate after injury. Understanding the obstacles to survival and regeneration, and overcoming them, is key to preserving and restoring function. While comparisons in the cellular changes seen in these non-regenerative cells with those that do have intrinsic regenerative ability has yielded many candidate genes for regenerative therapies, complete visual recovery has not yet been achieved. Insights gained from neurodegenerative diseases, like glaucoma, underscore the importance of axonal transport of organelles, mRNA, and effector proteins in injury and disease. Targeting molecular motor networks, and their cargoes, may be necessary for realizing complete axonal regeneration and vision restoration. Copyright © 2018 Wiley Periodicals, Inc.
Keywords: Animals; *Axonal Transport/ph [Physiology]; *Glaucoma/me [Metabolism]; Humans; *Nerve Regeneration/ph [Physiology]; *Neurodegenerative Diseases/me [Metabolism]; *Neuroprotection/ph [Physiology]; Retinal Ganglion Cells/me [Metabolism]; *Retinal Ganglion Cells/ph [Physiology]

Patterns of care for glaucoma patients in Korea from 2002 to 2013 using the national health insurance service claims data. - Choi, Seulggie; Choi, Jin A; Kwon, Jin Woo; Park, Sang Min; Jee, Donghyun (Medicine, 2018)
Due to the rapidly increasing life-expectancy, the prevalence of glaucoma has increased steadily in recent years. We aimed to evaluate the patterns of care and primary treatment strategy patterns in Korea according to glaucoma subtypes to assess the quality of care for glaucoma patients. In this serial cross-sectional survey, the claims data from the Korean National Health Insurance Service was used to identify and group glaucoma patients into primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), other types of glaucoma, and ocular hypertension from 2002 to 2013. Records for outpatient visits, hospitalizations, drug prescriptions, admissions, and surgical interventions were used to determine the patterns of care and identify primary treatment strategies. Both the prevalence (0.11% in 2002 to 0.43% in 2013) and incidence rates (0.06% in 2003 to 0.11% in 2013) for glaucoma increased over time. The mean number of outpatient visits increased (4.9-6.0 visits per year), while the proportion of hospitalized patients (2.3-1.0% of patients) and duration of hospital stay (4.5-3.4 days among hospitalized patients) decreased between 2002 and 2013 for patients with POAG. The proportion of patients not being managed by medication or surgery decreased, with POAG and PACG patients receiving medications increasing from 70.9% and 59.2% in 2002 to 88.4% and 63.3% in 2013, respectively. Finally, while the proportion of trabeculectomy decreased (22.2% to 10.0% of surgical procedures in 2002 and 2013, respectively), more patients with PACG have received iridectomy (59.3% to 86.0% of surgical procedures in 2002 and 2013, respectively). Between 2002 and 2013, the pattern of care for both patients with POAG and PACG has shifted toward management by outpatient visits and intervention with anti-glaucoma medications in Korea.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Female; *Glaucoma, Angle-Closure/ep [Epidemiology]; Glaucoma, Angle-Closure/th [Therapy]; *Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/th [Therapy]; *Hospitalization/td [Trends]; Humans; Incidence; Infant; Infant, Newborn; Insurance, Health/sn [Statistics & Numerical Data]; Male; Middle Aged; National Health Programs/sn [Statistics & Numerical Data]; *Office Visits/td [Trends]; Prevalence; Republic of Korea/ep [Epidemiology]; *Trabeculectomy/td [Trends]; Young Adult

Access to and Experiences with, e-Health Technology Among Glaucoma Patients and Their Relationship with Medication Adherence. - Newman-Casey, Paula Anne; Killeen, Olivia J; Renner, Morgan; Robin, Alan L; Lee, Paul; Heisler, Michele (Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2018)
Background: As online health information becomes common, it is important to assess patients' access to and experiences with online resources. Introduction: We examined whether glaucoma patients' technology usage differs by medication adherence and whether adherence is associated with online education experiences. Materials and Methods: We included 164 adults with glaucoma taking >=1 glaucoma medication. Participants completed a survey including demographic and health information, the Morisky Adherence Scale, and questions about online glaucoma resource usage. Differences in technology access, adherence, and age were compared with chi-squared, Fisher exact, and two-sample t-tests. Results: Mean age was 66 years. Twenty-six percent reported poor adherence. Eighty percent had good technology access. Seventy-three percent of subjects with greater technology access wanted online glaucoma information and yet only 14% of patients had been directed to online resources by physicians. There was no relationship between technological connectivity and adherence (p = 0.51). Nonadherent patients were younger (mean age 58 years vs. 66 years for adherent patients, p = 0.002). Nonadherence was associated with negative feelings about online searches (68% vs. 42%, p = 0.06). Discussion: Younger, poorly adherent patients navigate online glaucoma resources without physician input. These online searches are often unsatisfying. Technology should be leveraged to create high quality, online glaucoma resources that physicians can recommend to provide guidance for disease self-management.
Keywords: Age Factors; Aged; Aged, 80 and over; Female; *Glaucoma/dt [Drug Therapy]; Health Status; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Patient Education as Topic/mt [Methods]; Prospective Studies; Severity of Illness Index; Socioeconomic Factors; *Telemedicine/mt [Methods]

Effectiveness of multiple therapeutic strategies in neovascular glaucoma patients: A PRISMA-compliant network meta-analysis. - Dong, Zixian; Gong, Jianyang; Liao, Rongfeng; Xu, Shaojun (Medicine, 2018)
PURPOSE: Neovascular glaucoma (NVG) is a severe secondary glaucoma with uncontrolled intraocular pressure that leads to serious eye pain and vision loss. Presently, the therapeutic strategies for NVG are diverse, but the therapeutic effects are still not ideal. We performed a network analysis to assess the effect of multiple therapeutic strategies on the treatment of NVG patients., METHODS: We searched public electronic databases through April 2017 using the following keywords "neovascular glaucoma," "iris neovascularization," "hemorrhagic glaucoma," and "random" without language restrictions. The outcome considered in the present analysis was treatment success rate. A network meta-analysis and multilevel mixed-effects logistic regression were used to compare regimens., RESULTS: We included 27 articles assessing a total of 1884 NVG patients in our analysis. According to the network analysis, interferon and mitomycin plus trabeculectomy (94.9%), glaucoma valve implantation (86.9%), and iris photocoagulation plus trabeculectomy (81.9%) were the most likely to improve treatment success rate in NVG patients. The multilevel logistic regression analysis showed that glaucoma valve, bevacizumab, interferon, cyclophotocoagulation, trabeculectomy, iris photocoagulation, ranibizumab, and mitomycin had advantages in terms of improving treatment success rate in NVG patients. However, the application of retinal photocoagulation and vitrectomy reduced patient treatment success rate., CONCLUSION: The regimen including mitomycin, interferon, and trabeculectomy was the most likely to improve the treatment success rate in NVG patients. The application of glaucoma valve and bevacizumab were more beneficial for improving patient treatment success rate as a surgery and as an agent, respectively.
Keywords: *Angiogenesis Inhibitors/tu [Therapeutic Use]; *Anti-Infective Agents/tu [Therapeutic Use]; Bevacizumab/tu [Therapeutic Use]; Combined Modality Therapy/mt [Methods]; *Glaucoma, Neovascular/th [Therapy]; Humans; Interferons/tu [Therapeutic Use]; Iris/su [Surgery]; Light Coagulation/mt [Methods]; Mitomycin/tu [Therapeutic Use]; Network Meta-Analysis; *Ophthalmologic Surgical Procedures/mt [Methods]; Ranibizumab/tu [Therapeutic Use]; Retina/su [Surgery]; *Trabeculectomy/mt [Methods]; Treatment Outcome; Vitrectomy/mt [Methods]

Patient attitudes toward novel glaucoma drug delivery approaches. - Wang, Benjamin B; Lin, Michael M; Nguyen, Thuan; Turalba, Angela V (Digital journal of ophthalmology : DJO, 2018)
Purpose: Understanding patients' attitudes toward novel therapeutic options can help guide providers in personalizing treatment regimens for glaucoma patients. This study aimed to determine factors associated with acceptance of new drug delivery options among glaucoma patients., Methods: A total of 199 patient volunteers participated in an interviewer-administered survey from June to August 2016 at the Glaucoma Service of Massachusetts Eye and Ear. The questionnaire was designed to determine acceptance of 6 drug delivery approaches: (1) triple combination eye drop, (2) microdose eye spray, (3) drug-eluting contact lens, (4) drug-eluting periocular ring insert, (5) injectable subconjunctival drug insert, and (6) injectable anterior chamber implant. Other factors analyzed included self-reported demographics, disease severity, and prior ocular history., Results: The average respondent age was 63.2 +/- 15.1 years; 48% were female. For approaches 1-6 listed above, overall acceptance rates were, respectively, 85%, 54%, 31%, 43%, 32%, and 30%. Patients with greater disease severity and prior incisional glaucoma surgery were more likely to pursue alternatives to traditional eye drops., Conclusions: There is limited acceptance of alternatives to traditional eye drop medications among glaucoma patients. Understanding motivating factors and potential barriers to patient acceptance of novel drug delivery approaches is important in how providers will incorporate these glaucoma treatment options into practice.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Attitude; Contact Lenses; *Drug Delivery Systems/mt [Methods]; Drug Implants; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Patient Acceptance of Health Care; Young Adult

Glaucoma management in primary care: barriers perceived by optometrists in Scotland. - Bruce, Gillian; Tatham, Andrew J (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2018)
PURPOSE: Over the next 10 years, the prevalence of glaucoma in the United Kingdom (UK) is predicted to rise by 22%,(The Way Forward: Glaucoma, The Royal College of Ophthalmologists, London, 2017) posing a considerable challenge to already overstretched hospital eye services. To help address this problem, services traditionally offered in hospital such as managing stable glaucoma patients, could be transferred to community optometrists. The aim of this study was to identify whether optometrists in Scotland have an interest in managing primary open angle glaucoma (POAG) in primary care and to assess perceived barriers., METHODS: All optometrists on the NHS Education Scotland (NES) database were invited to participate in an online survey over a 7-week period. Optometrists were asked if they had an interest in being accredited to manage POAG in the community and a free text question was used to elicit perceived barriers. Responders with an interest in managing POAG were invited to take part in two further rounds of electronic surveying, using a modified Delphi approach, with the aim of reaching a consensus on perceived barriers., RESULTS: Two hundred and ninety-nine of 1566 optometrists (19%) responded to the survey. 229 (79%) expressed an interest in managing patients with POAG in primary care. The most commonly perceived barriers after two rounds of Delphi surveying were remuneration (29%), communication with secondary care (18%), perceived ophthalmology resistance (13%), training (11%) and capacity (10%). Multivariate regression revealed fewer years in practice and comfort using and interpreting results of pachymetry were associated with higher odds of interest in managing glaucoma in the community., CONCLUSIONS: Among survey responders, there was significant interest from community optometrists to being accredited to manage POAG in primary care. A collaborative approach between primary and secondary care will be required to address the concerns of community optometrists in any future expansion of their role in glaucoma management. Copyright © 2018 The Authors Ophthalmic & Physiological Optics © 2018 The College of Optometrists.
Keywords: *Attitude of Health Personnel; *Disease Management; Female; *Glaucoma/th [Therapy]; Humans; Male; *Optometrists/st [Standards]; *Optometry/mt [Methods]; Pilot Projects; *Primary Health Care/mt [Methods]; Retrospective Studies; Scotland; *Surveys and Questionnaires

The Current Status of Glaucoma and Glaucoma Care in Sub-Saharan Africa. - Kyari, Fatima; Adekoya, Bola; Abdull, Mohammed Mahdi; Mohammed, Abdullahi Sadiq; Garba, Farouk (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2018)
Glaucoma is a serious and irreversibly blinding eye condition of public health importance in Africa. The absence of distinct early symptoms makes the condition hard to recognize by patients. The gradual vision deterioration that occurs is worse in one eye, thereby making it difficult for those affected to be aware of the vision loss until the advanced stages of the disease. We discuss the epidemiology of glaucoma in sub-Saharan Africa, highlighting the risk factors for the disease as well as risk factors for blindness in glaucoma patients. Available evidence suggests that treatment options of medical, surgical, and laser therapies for glaucoma are limited by availability of medicines and equipment, lack of adequate surgical and diagnostic skills, and high costs of treatment. We propose 3 complementary strategies in developing models of glaucoma care: strengthening clinical services for glaucoma; earlier detection of glaucoma in the clinics and communities; and strengthening health systems governance. Further research to define a suitable cost-beneficial treatment modality and mechanisms for financing eye care is required. Copyright 2018 Asia-Pacific Academy of Ophthalmology.
Keywords: Africa South of the Sahara/ep [Epidemiology]; Blindness/pc [Prevention & Control]; *Delivery of Health Care/og [Organization & Administration]; *Glaucoma/ep [Epidemiology]; *Glaucoma/th [Therapy]; *Health Services Accessibility/og [Organization & Administration]; Humans; Ophthalmologic Surgical Procedures; Risk Factors

Can Artificial Intelligence Make Screening Faster, More Accurate, and More Accessible?. - Li, Zhixi; Keel, Stuart; Liu, Chi; He, Mingguang (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2018)
Diabetic retinopathy, glaucoma, and age-related macular degeneration are leading causes of vision loss and blindness worldwide. They tend to be asymptomatic in the early phase of disease and therefore require active screening programs to identify the patients requiring referral and treatment. Deep learning-based artificial intelligence technology has recently become a major topic in the field of ophthalmology. This paper aimed to provide a general view of the major findings on the application of deep learning for the classification of eye diseases from common imaging modalities. In the future, it is expected that these technologies will be applied in real-world screening programs to improve their efficiency and affordability. Copyright 2018 Asia-Pacific Academy of Ophthalmology.
Keywords: *Artificial Intelligence; *Diabetic Retinopathy/di [Diagnosis]; *Glaucoma/di [Diagnosis]; Health Services Accessibility; Humans; *Macular Degeneration/di [Diagnosis]; Reproducibility of Results; Vision Disorders/pc [Prevention & Control]

Glaucoma - Next Generation Therapeutics: Impossible to Possible. - Adams, Christopher M; Stacy, Rebecca; Rangaswamy, Nalini; Bigelow, Chad; Grosskreutz, Cynthia L; Prasanna, Ganesh (Pharmaceutical research, 2018)
The future of next generation therapeutics for glaucoma is strong. The recent approval of two novel intraocular pressure (IOP)-lowering drugs with distinct mechanisms of action is the first in over 20 years. However, these are still being administered as topical drops. Efforts are underway to increase patient compliance and greater therapeutic benefits with the development of sustained delivery technologies. Furthermore, innovations from biologics- and gene therapy-based therapeutics are being developed in the context of disease modification, which are expected to lead to more permanent therapies for patients. Neuroprotection, including the preservation of retinal ganglion cells (RGCs) and optic nerve is another area that is actively being explored for therapeutic options. With improvements in imaging technologies and determination of new surrogate clinical endpoints, the therapeutic potential for translation of neuroprotectants is coming close to clinical realization. This review summarizes the aforementioned topics and other related aspects.
Keywords: Animals; *Antihypertensive Agents/ad [Administration & Dosage]; Delayed-Action Preparations; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Ocular Hypertension/dt [Drug Therapy]

[A model of ophthalmological network care including primary care centers and a tertiary care hospital]. - Jones, Alex; Gallegos, Manuel; Diaz, Ignacio; Donoso, Rodrigo (Revista medica de Chile, 2018)
BACKGROUND: Primary care units of ophtalmology (UAPO) were incorporated in 2003 into the healthcare system of the Ministry of Health, in response to the high demand for hospital care. Three of these primary care units were incorporated to provide a network care with the ophthalmology service of a tertiary care hospital., AIM: To report the public health impact of networking., MATERIAL AND METHODS: A descriptive-prospective study was carried out analyzing all the healthcare attentions carried out between June and August 2016. An epidemiological characterization of the sample was made. We recorded: clinical diagnoses, decisions, resolution of the clinical problem at the primary care or referral to the hospital., RESULTS: A total of 2,096 ophthalmologic attentions were carried out in the three UAPOs during the study period. The main diseases attended were disorders of refraction, cataracts, glaucoma and diabetic retinopathy. The resolution index was 84% of attentions. Only 16% of attentions required referral and consisted mainly of cataracts (covered by a special health care system), diabetic retinopathy, capsulotomies, iridotomies, uveitis, pterygium and lacrimal duct obstruction., CONCLUSIONS: This model of care allowed an efficient management of the high demand for hospital referral. This is expressed in the high-resolution index and low derivation, resulting in a decrease in waiting lists at the tertiary level. This system should be implemented by other tertiary centers of our country.
Keywords: *Health Services Accessibility/og [Organization & Administration]; Health Services Needs and Demand; Humans; Ophthalmology; *Primary Health Care/og [Organization & Administration]; Prospective Studies; Public Health; *Referral and Consultation/og [Organization & Administration]; *Tertiary Care Centers/og [Organization & Administration]

The Rationale for Selective Laser Trabeculoplasty in Africa. - Realini, Tony; Olawoye, Olusola; Kizor-Akaraiwe, Nkiru; Manji, Selina; Sit, Arthur (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2018)
Glaucoma is the leading cause of irreversible blindness in Africa. The condition is treatable but not curable. There are numerous obstacles to glaucoma care in Africa, including availability, accessibility and affordability of treatments, as well as medication nonadherence among patients. Medical therapy is costly relative to the average income in Africa and it requires daily self-dosing by patients. Surgery is of limited availability in many regions in Africa, and a high proportion of patients refuse surgery because it is expensive. Selective laser trabeculoplasty (SLT) proves to be a favorable alternative to medical or surgical care, as it is highly effective and safe in people of African descent, more cost-effective than medical therapy, quick and easy to perform, and portable. The procedure also requires no postoperative care, thus obviates the issue of nonadherence. In uncontrolled studies, SLT has a high response rate and it lowers intraocular pressure by 30% to 40%, which exceeds the goal in international guidelines for initial therapies. The African Glaucoma Consortium (AGC), a member-driven stakeholder collective, has been formed in part to develop the infrastructure for continent-wide improvements in glaucoma care. It embraces SLT as a potential key tool in their development plans. The mission of AGC includes improving clinical care by educating existing and new health care professionals to expand the provider network, by conducting trials to identify optimal care strategies for glaucoma in Africa, and by facilitating the development of an integrated network of Centers of Excellence to bring SLT and other crucial glaucoma therapies to communities throughout Africa. Copyright 2018 Asia-Pacific Academy of Ophthalmology.
Keywords: Africa; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Laser Therapy/mt [Methods]; Tonometry, Ocular; *Trabecular Meshwork/su [Surgery]; *Trabeculectomy/mt [Methods]

[Evaluation of intravitreal injection practice patterns in Cotonou]. - Agbahoungba, L; Alamou, S; Abouki, C; Djossou-Doutetien, A; Lawani, R; Tchabi, S (Journal francais d'ophtalmologie, 2018)
INTRODUCTION: Intravitreal injections of medication are designed to obtain a high concentration in the posterior segment. We conducted a retrospective study of our practice of intravitreal injections to assess safety of the technique and short- and medium-term tolerability, and to analyze indications and the complications., PATIENTS AND METHODS: This analytic retrospective study focused on consecutive patients treated with intravitreal injections for the period of January 2015 to June 2016 in the "Lumiere" ohthalmology clinic in Cotonou, with incidents or accidents during the injection procedure as a measure of safety. Included were all patients undergoing one or more intravitreal injections regardless of the type of product injected, who had undergone a complete ophthalmologic work-up prior to injection and who had been followed at one week (W1) and 1 month (M1) after treatment., RESULTS: During the study period, we safely performed 124 intravitreal injections on 49 patients. The indications were diabetic macular edema in 53.06% and macular edema due to vein occlusions in 26.53%. The main complication observed was ocular hypertension in 60%, mainly related to triamcinolone injection. In 51.02%, the drug used was Ranibizumab, followed by Bevacizumab in 28.54% and Triamcinolone in 20.40%., DISCUSSION: The main goal of intravitreal injection is to achieve instantly effective concentrations in the center of the globe. Intravitreal injection is a safe, feasible practice in our context. The male predominance observed in our series is explained by the low socio-economic status of women in our context as well as the economically difficult accessibility of important drugs such as anti-VEGF. Significant improvements in D7 and D30 visual acuity in our patients highlights the beneficial effects of the presence of the active molecule in the vitreous cavity for these indications., CONCLUSION: Intravitreal injection is a common practice in our context, which is being performed safely. The indications are many, and ocular hypertension is a significant complication. The difficulties in terms of supply and preservation of the main drugs used (anti-VEGF) remains to be resolved. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
Keywords: Adult; Aged; Angiogenesis Inhibitors/ad [Administration & Dosage]; Angiogenesis Inhibitors/ae [Adverse Effects]; Antibodies, Monoclonal, Humanized/ad [Administration & Dosage]; Antibodies, Monoclonal, Humanized/ae [Adverse Effects]; Benin/ep [Epidemiology]; *Diabetic Retinopathy/dt [Drug Therapy]; Diabetic Retinopathy/ep [Epidemiology]; Female; Glucocorticoids/ad [Administration & Dosage]; Glucocorticoids/ae [Adverse Effects]; Humans; *Intravitreal Injections/ae [Adverse Effects]; *Intravitreal Injections/sn [Statistics & Numerical Data]; *Macular Edema/dt [Drug Therapy]; Macular Edema/ep [Epidemiology]; Male; Middle Aged; Ocular Hypertension/ep [Epidemiology]; Ocular Hypertension/et [Etiology]; Postoperative Complications/ep [Epidemiology]; Practice Patterns, Physicians'/st [Standards]; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Retinal Vein Occlusion/co [Complications]; Retinal Vein Occlusion/dt [Drug Therapy]; Retinal Vein Occlusion/ep [Epidemiology]; Retrospective Studies; Young Adult

Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Ocular Findings at Two Health Centers. - Hark, Lisa; Acito, Megan; Adeghate, Jennifer; Henderer, Jeffrey; Okudolo, Joseph; Malik, Kunal; Molineaux, Jeanne; Eburuoh, Rita; Zhan, Tingting; Katz, L Jay (Journal of health care for the poor and underserved, 2018)
Blindness from glaucoma can be prevented by early detection and treatment. Telemedicine improves access to treatment in high-risk populations that face barriers to receiving adequate ophthalmic care. We used a practice-based telemedicine screening model at two health centers. Telemedicine imaging of the fundus and optic nerve, followed by a complete eye exam at the same location for participants with abnormal findings, unreadable images, or ocular hypertension (OHTN), was performed. A total of 182 participants were screened, of whom 108 qualified for a complete eye exam. Of these, 62 (34.1%) had abnormal images, 12 (6.6%) had OHTN, and 34 (18.7%) had unreadable images. Eighty-nine of the 108 (82%) returned for the complete eye exam. Predominantly, participants were African American with glaucoma suspect and cataract. Screening location was an important factor for follow-up. Assessment of the fundus and optic disc using telemedicine resulted in early detection of glaucoma and other ocular pathology.
Keywords: Adult; Aged; Aged, 80 and over; *Cataract/di [Diagnosis]; Cataract/eh [Ethnology]; Continental Population Groups; Diabetes Mellitus/eh [Ethnology]; *Diagnostic Techniques, Ophthalmological; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Glaucoma/eh [Ethnology]; Humans; Hypertension/eh [Ethnology]; Male; *Mass Screening/og [Organization & Administration]; Middle Aged; Ocular Hypertension/di [Diagnosis]; Patient Satisfaction; Philadelphia; Primary Health Care/og [Organization & Administration]; Prospective Studies; Socioeconomic Factors; *Telemedicine/og [Organization & Administration]

The determinants of therapeutic observance in open-angle glaucoma. - Amara, Fatma; Ben Amor, Hager; Kaibi, Imene; Taktak, Mariem; Taktak, Jalel (La Tunisie medicale, 2018)
Adherence to medical treatment in primary open angle glaucoma is key to the success of the treatment. Most of the work show that glaucoma patients are poor observant. Poor adherence is multifactorial. The analysis of these factors is crucial. That is why the author wanted to expose, through a literature review, the main determinants of adherence in glaucoma.
Keywords: *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Medication Adherence; Risk Factors; Treatment Outcome