Endothelial keratoplasty in the management of irido-corneal endothelial syndrome. - Chaurasia, S; Ramappa, M; Garg, P; Murthy, S I; Senthil, S; Sangwan, V S (Eye (London, England), 2013)
PURPOSE: To describe the results of endothelial keratoplasty (EK) in the management of irido-corneal endothelial (ICE) syndrome., DESIGN: Retrospective, consecutive, interventional case series., METHODS: Eight eyes of seven patients underwent EK for corneal edema owing to ICE syndrome. Simultaneous cataract surgery was performed in five eyes. The charts were reviewed for demographics, clinical findings, and outcomes after EK., RESULTS: Mean age was 50.4 years (range 35-59 years). Mean follow-up was 12.5 months (range 6-24 months). Corneal clarity was restored in all eyes and was maintained till the last follow-up. Four patients had acute rise in the intraocular pressure in the post-operative period, which was well controlled on medical treatment. One patient who was non-compliant with medications and regular follow-up advice had progression of glaucomatous disc changes and visual field loss. The best-corrected visual acuity ranged from 20/50-20/30., CONCLUSIONS: EK is a viable option in ICE syndrome. Adequate control of glaucoma is the paramount factor in maintaining good visual acuity in these eyes.
Keywords: Adult; *Corneal Diseases/su [Surgery]; Corneal Edema/et [Etiology]; Corneal Edema/su [Surgery]; Endothelium, Corneal/su [Surgery]; Female; Humans; *Iris Diseases/su [Surgery]; *Keratoplasty, Penetrating; Male; Middle Aged; Retrospective Studies; Syndrome

Challenges of glaucoma care -- high volume, high quality, low cost. - Tuulonen, Anja (Acta ophthalmologica, 2013)
Comment on (CON), Comment on (CON)
Keywords: *Glaucoma; *Glaucoma, Open-Angle/th [Therapy]; *Health Care Surveys/sn [Statistics & Numerical Data]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; *Ophthalmology/sn [Statistics & Numerical Data]

3. Ocular surface health with contact lens wear. - Shovlin, Joseph P; Argueso, Pablo; Carnt, Nicole; Chalmers, Robin L; Efron, Nathan; Fleiszig, Suzanne M J; Nichols, Jason J; Polse, Kenneth A; Stapleton, Fiona; Wiley, Lee; Willcox, Mark; Bright, Frank V; et al. (Contact lens & anterior eye : the journal of the British Contact Lens Association, 2013)
Eye care practitioners (ECPs) would tend to agree that wearing contact lenses increases the risk for infection, but millions of patients are still fitted with lenses every year because ECPs feel that the risk is manageable and that their patients' eye health can be protected. The Fusarium and Acanthamoeba keratitis outbreaks of years past were a wake-up call to manufacturers, ECPs, and regulatory agencies that risk cannot be managed without diligence, and that the complex relationship between contact lens materials, contact lens solutions, and compliance needs to be better understood in order to optimize the efficacy of contact lens care and improve care guidelines. Copyright © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Keywords: *Contact Lenses/ae [Adverse Effects]; *Contact Lenses/mi [Microbiology]; *Equipment Contamination/pc [Prevention & Control]; *Eye Infections, Bacterial/et [Etiology]; *Eye Infections, Bacterial/pc [Prevention & Control]; Humans

[Combination therapy in the medical treatment of glaucoma]. - Hommer, A (Klinische Monatsblatter fur Augenheilkunde, 2013)
A combination of antiglaucoma medications is indicated if monotherapy is not sufficient to achieve the predefined target pressure and/or in case of a progression of glaucomatous damage or conversion from ocular hypertension to glaucomatous optic neuropathy. Most recently many fixed combinations with two active compounds have become available for the medical treatment of glaucoma. Compared to non-fixed combinations, these drugs offer a much easier use for the patients. Fixed combinations have to be applied less frequently which may improve adherence. Furthermore, they most likely contain a lower amount of toxic preservatives compared to non-fixed combinations. And finally, fixed combinations may eliminate the risk of a "washout" of the first medication by using the second product of a non-fixed combination too soon after the first drop has been installed. This review aims to examine the most important aspects of IOP-lowering fixed and non-fixed combinations in glaucoma management with a clear focus on the results obtained with fixed combinations. In Germany, fixed combinations with the compositions dorzolamide/timolol (FCDT), brinzolamide/timolol (FCBRINT), latanoprost/timolol (FCLT), travoprost/timolol (FCTT), bimatoprost/timolol (FCBIMT), brimonidine/timolol (FCBT), pilocarpine/timolol (FCPT) and metipranolol/timolol (FCMT) are approved for the medical management of glaucoma and ocular hypertension. The results of clinical studies comparing fixed combinations with their active ingredients and with the corresponding non-fixed combinations will be discussed. Furthermore - if available - the results of direct comparisons of the efficacy and safety of different IOP-lowering fixed combinations are summarised. Copyright Georg Thieme Verlag KG Stuttgart . New York.
Keywords: Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/pk [Pharmacokinetics]; *Antihypertensive Agents/tu [Therapeutic Use]; Biological Availability; Clinical Trials as Topic; Disease Progression; Dose-Response Relationship, Drug; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions; Treatment Outcome

Patterns of adherence behaviour for patients with glaucoma. - Cate, H; Bhattacharya, D; Clark, A; Holland, R; Broadway, D C (Eye (London, England), 2013)
AIMS AND PURPOSE: Adherence to long-term treatment regimens for primary open-angle glaucoma holds a challenge for both clinicians and patients. The study aims were to (i) establish the magnitude of travoprost non-adherence using an Electronic Adherence Monitor (EAM), (ii) compare electronic with patient self-reported adherence, and (iii) explore the application of a previously reported method of graphically presenting adherence data to a larger cohort over a longer monitoring period., METHODS: A cohort study of patients using travoprost for glaucoma or ocular hypertension was conducted. All participants used an EAM and adherence data were collected prospectively for 2 months. Self-reported adherence was obtained using the Morisky Medication Adherence Scale (MMAS); patients also reported frequency of missed doses. Potential predictors of adherence were collected via a structured interview. EAM-recorded interdose intervals were plotted graphically., RESULTS: Of 100 patients invited to participate, 98 consented and EAM data were collected successfully from 88 participants. The median EAM adherence score for the cohort was 88.9% (interquartile range: 71.2, 92.2). When dichotomised (>=80%: adherent; <80%: non-adherent), EAM identified 36.7% as non-adherent and MMAS 12.2%. EAM data were used to classify five types of adherence behaviour including a category representing levels of >=97% maintained by 21% of participants., CONCLUSION: EAM revealed good adherence to glaucoma monotherapy but poor agreement with patient self-reported adherence. An adherence category of persistent and exceptionally high adherence to travoprost over a 2-month period was identified.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/tu [Therapeutic Use]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; Cohort Studies; Female; *Glaucoma/dt [Drug Therapy]; Humans; Logistic Models; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Self Report; Travoprost

Ophthalmological disorders in rural areas of Crete: a geospatial analysis. - Pistolla, Georgia; Tsilimparis, Miltiadis K; Prastacos, Poulicos; Sifaki-Pistolla, Dimitra; Philalithis, Anastas; Pallikaris, Ioannis G (Rural and remote health, 2013)
INTRODUCTION: Estimation of the prevalence of vision impairment in a population can be performed using epidemiological research. The purpose of this study was to measure, using spatial statistics, the prevalence of ophthalmologic disease identified at visits of the Mobile Ophthalmologic Unit (MOU) of the Vardinogiannion Eye Institute of Crete (VEIC) to villages in Crete. The study also aimed to estimate increased 'risk' of ophthalmological disease according to demographic and location factors and, thus, use the present findings as a basis for planning future services., METHODS: Estimation of risks for cataract, glaucoma, and refractive errors were assessed by multiple logistic regression models in order to measure the effect of demographic (age, sex) and location (province, distance from nearest ophthalmologist) parameters. Spatial analysis was applied in order to produce a density and probability density map of ophthalmologic disorders using kriging interpolation methods., RESULTS: Newly diagnosed cataracts and refractive errors were found more frequently in locations greater than 70 km from the nearest ophthalmologist (respectively, OR = 6.0 [95% CI = 1.637-9.482]; OR = 27.4 [20.038-39.028] p-value = 0.004). Those aged >60 years had higher risk for all eye abnormalities: cataracts (OR = 0.7; 95% CI = 0.238-0.938), glaucoma (OR = 1.6; 95% CI = 1.227-2.037), and refractive errors (OR = 0.5; 95% CI = 0.183-0.829)., CONCLUSION: The present study supports the use of local policies and preventive measures in rural areas of Crete in order to improve rural health standards. Some insights concerning the effectiveness of future visits of MOUs are provided, guided by spatial analysis.
Keywords: Adult; Aged; Data Interpretation, Statistical; Diagnostic Techniques, Ophthalmological; Eye Diseases/di [Diagnosis]; *Eye Diseases/ep [Epidemiology]; Eye Diseases/th [Therapy]; Female; Greece/ep [Epidemiology]; Health Services Accessibility/st [Standards]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; International Classification of Diseases; Interviews as Topic; Logistic Models; Male; Middle Aged; Rural Population/sn [Statistics & Numerical Data]; *Rural Population; Socioeconomic Factors; Spatial Analysis; Travel/sn [Statistics & Numerical Data]; Vision Disorders/di [Diagnosis]; *Vision Disorders/ep [Epidemiology]; Vision Disorders/th [Therapy]

Nanotechnology and glaucoma: little particles for a big disease. - Pita-Thomas, Daniel W; Goldberg, Jeffrey L (Current opinion in ophthalmology, 2013)
PURPOSE OF REVIEW: Current medical treatments designed to halt the progressive loss of retinal ganglion cells (RGCs) in glaucoma are limited by low bioavailability to target tissues and lack of patient adherence to frequent dosing regimens. For a certain percentage of patients with glaucoma, reducing intraocular pressure (IOP) does not stop disease progression, motivating the search for new therapeutic targets and delivery systems., RECENT FINDINGS: The emerging science of nanoparticles has the potential to address the current limitations of glaucoma therapy by improving drug bioavailability, exploiting IOP-independent targets such as RGC neuroprotection, and optimizing gene therapy as a more permanent treatment for glaucoma., SUMMARY: We review the recent advances in nanoparticle-based glaucoma therapy with a focus on drug delivery to the eye, as well as novel applications including gene therapy.
Keywords: Animals; *Antihypertensive Agents/ch [Chemistry]; *Drug Carriers; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure; *Nanoparticles/ch [Chemistry]; *Nanotechnology/mt [Methods]

The effects of silicone hydrogel lens wear on the corneal epithelium and risk for microbial keratitis. - Robertson, Danielle M (Eye & contact lens, 2013)
Previous studies using animal models and human clinical trials have demonstrated that the use of low-oxygen-transmissible contact lens materials produce corneal epithelial surface damage resulting in increased Pseudomonas aeruginosa (PA) adhesion and raft-mediated internalization into surface corneal epithelial cells. These findings led to the testable clinical predictions that (1) microbial keratitis (MK) risk is expected to be the greatest during the first 6 months of wear; (2) there is no difference between 6 and 30 night extended wear; and (3) that wear of hyperoxygen-transmissible lenses would reduce the reported incidence of infection. Subsequent epidemiologic studies have confirmed the first two predictions; however, increased oxygen transmissibility with silicone hydrogel (SiHy) lens wear has not altered the overall incidence of MK. In this review, more recent clinical and basic studies that investigate epithelial alterations and bacterial adhesion to corneal epithelial cells after the wear of SiHy lenses with and without concomitant exposure to chemically preserved multipurpose solutions (MPS) will be examined. The collective results of these studies demonstrate that even in the absence of lens-related hypoxia, MPS induce ocular surface changes during SiHy lens wear that are associated with a pathophysiologic increase in PA adherence and internalization in the corneal epithelium, and therefore, predict a greater risk for PA-MK. In addition, new data supporting an interactive role for inflammation in facilitating PA adherence and internalization in the corneal epithelium will also be discussed.
Keywords: Bacterial Adhesion; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Epithelium, Corneal/mi [Microbiology]; Epithelium, Corneal/pa [Pathology]; Humans; *Hydrogels; Hypoxia; *Keratitis/et [Etiology]; Keratitis/mi [Microbiology]; *Pseudomonas Infections/et [Etiology]; Pseudomonas aeruginosa/ph [Physiology]; Risk Factors; *Silicones

Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. - de Nie, Karlijn F; Crama, N; Tilanus, Maurits A D; Klevering, B Jeroen; Boon, Camiel J F (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2013)
BACKGROUND: Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities., METHODS: We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8%) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2%) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4-136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire., RESULTS: A retinal detachment occurred in 10.9% of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5% of the eyes, a retinal detachment developed within the first 3 months, and 6.4% occurred later in the postoperative period. Cystoid macular edema occurred in 5.5%, and an epiretinal membrane was seen postoperatively in 3.6% of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9% of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3% of patients were less troubled by vitreous floaters. Ten patients (9.3%) were dissatisfied, and six of these patients (5.6%) had a serious complication that resulted in permanent visual loss., CONCLUSIONS: Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate.
Keywords: Adult; Aged; Aged, 80 and over; *Eye Diseases/su [Surgery]; Female; Follow-Up Studies; Humans; Intraoperative Complications; Male; Microsurgery/mt [Methods]; Middle Aged; *Patient Satisfaction/sn [Statistics & Numerical Data]; Postoperative Complications; Refraction, Ocular/ph [Physiology]; Sickness Impact Profile; Treatment Outcome; Visual Acuity/ph [Physiology]; *Vitrectomy; *Vitreous Body/su [Surgery]

Hybrid dendrimer hydrogel/poly(lactic-co-glycolic acid) nanoparticle platform: an advanced vehicle for topical delivery of antiglaucoma drugs and a likely solution to improving compliance and adherence in glaucoma management. - Yang, Hu; Leffler, Christopher T (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2013)
Glaucoma therapy typically begins with topical medications, of which there are 4 major classes in common use in the United States: beta-adrenergic antagonists, alpha-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. Unfortunately, all 4 classes require at least daily dosing, and 3 of the 4 classes are approved to be administered 2 or 3 times daily. This need for frequent dosing with multiple medications makes compliance difficult. Longer-acting formulations and combinations that require less frequent administration might improve compliance and therefore medication effectiveness. Recently, we developed an ocular drug delivery system, a hybrid dendrimer hydrogel/poly(lactic-co-glycolic acid) nanoparticle platform for delivering glaucoma therapeutics topically. This platform is designed to deliver glaucoma drugs to the eye efficiently and release the drug in a slow fashion. Furthermore, this delivery platform is designed to be compatible with many of the glaucoma drugs that are currently approved for use. In this article, we review this new delivery system with in-depth discussion of its structural features, properties, and preclinical application in glaucoma treatment. In addition, future directions and translational efforts for marketing this technology are elaborated.
Keywords: Administration, Ophthalmic; Animals; *Dendrimers/ad [Administration & Dosage]; Dendrimers/ch [Chemistry]; Dendrimers/me [Metabolism]; *Drug Delivery Systems/mt [Methods]; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Humans; *Hydrogel, Polyethylene Glycol Dimethacrylate/ad [Administration & Dosage]; Hydrogel, Polyethylene Glycol Dimethacrylate/ch [Chemistry]; Hydrogel, Polyethylene Glycol Dimethacrylate/me [Metabolism]; *Lactic Acid/ad [Administration & Dosage]; Lactic Acid/ch [Chemistry]; Lactic Acid/me [Metabolism]; *Medication Adherence; *Polyglycolic Acid/ad [Administration & Dosage]; Polyglycolic Acid/ch [Chemistry]; Polyglycolic Acid/me [Metabolism]; Polylactic Acid-Polyglycolic Acid Copolymer

Conjunctival modifications induced by medical and surgical therapies in patients with glaucoma. - Mastropasqua, Leonardo; Agnifili, Luca; Mastropasqua, Rodolfo; Fasanella, Vincenzo (Current opinion in pharmacology, 2013)
Lowering intra-ocular pressure, either medically or surgically, is the proven strategy to control glaucoma, though profound changes to the ocular surface and conjunctiva are caused. Toxicity and allergy initiated by medical therapy induce modifications, which progressively worsen with the length of treatment and number of drugs. Conjunctival changes lead to symptoms of ocular surface disease, reduced quality of life, reduced therapeutic compliance and increased risk of surgical failure. Surgery modifies conjunctiva by inducing bleb formation in fistulizing techniques, and by activating secondary aqueous humour outflow pathways, such as trans-scleral routes, in both filtration and bleb-less approaches. The use of unpreserved medications, limitation of intra-operative conjunctival damage and development of bleb-less surgery are advisable. Copyright © 2012 Elsevier Ltd. All rights reserved.
Keywords: Animals; *Conjunctival Diseases/et [Etiology]; Conjunctival Diseases/pa [Pathology]; Drug-Related Side Effects and Adverse Reactions; *Glaucoma/dt [Drug Therapy]; Glaucoma/pa [Pathology]; *Glaucoma/su [Surgery]; Humans; Preservatives, Pharmaceutical/ae [Adverse Effects]

Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China. - Huang, Wenyong; Ye, Ronghua; Liu, Bin; Chen, Qianyun; Huang, Guofu; Liu, Yizhi; Friedman, David S; Congdon, Nathan G; Ling, Jin; He, Mingguang (Clinical & experimental ophthalmology, 2013)
BACKGROUND: To assess the outcomes of cataract surgery performed by novice surgeons during training in a rural programme. DESIGN : Retrospective study., PARTICIPANTS: Three hundred thirty-four patients operated by two trainees under supervision at rural Chinese county hospitals., METHODS: Two trainees performed surgeries under supervision. Visual acuity, refraction and examinations were carried out 3 months postoperatively., MAIN OUTCOME MEASURES: Postoperative uncorrected visual acuity, pinhole visual acuity, causes of visual impairment (postoperative uncorrected visual acuity < 6/18) RESULTS: Among 518 operated patients, 426 (82.2%) could be contacted and 334 (64.4% of operated patients) completed the examinations. The mean age was 74.1 +/- 8.8 years and 62.9% were women. Postoperative uncorrected visual acuity was available in 372 eyes. Among them, uncorrected visual acuity was >=6/18 in 278 eyes (74.7%) and <6/60 in 60 eyes (16.1%), and 323 eyes (86.8%) had pinhole visual acuity >= 6/18 and 38 eyes (10.2%) had pinhole visual acuity < 6/60. Main causes of visual impairment were uncorrected refractive error (63.9%) and comorbid eye disease (24.5%). Comorbid eye diseases associated with pinhole visual acuity < 6/60 (n = 23, 6.2%) included glaucoma, other optic nerve atrophy, vitreous haemorrhage and retinal detachment., CONCLUSIONS: The findings suggest that hands-on training remains safe and effective even when not implemented in centralized training centres. Further refinement of the training protocol, providing postoperative refractive services and more accurate preoperative intraocular lens calculations, can help optimize outcomes. Copyright © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Aged; Aged, 80 and over; China; *Clinical Competence/st [Standards]; *Education, Medical, Graduate; Educational Measurement; Female; Hospitals, County; Hospitals, Rural; Humans; Intraoperative Complications; Male; Middle Aged; *Ophthalmology/ed [Education]; Patient Satisfaction; *Phacoemulsification/ed [Education]; Postoperative Complications; Refraction, Ocular/ph [Physiology]; Retrospective Studies; Rural Population; Treatment Outcome; *Visual Acuity/ph [Physiology]

Noncompliance with glaucoma medication in Korean patients: a multicenter qualitative study. - Park, Myoung Hee; Kang, Kyu-Dong; Moon, Jungil; Korean Glaucoma Compliance Study Group (Japanese journal of ophthalmology, 2013)
PURPOSE: To investigate the common side effects of topical antiglaucoma medication, factors affecting compliance, and the utilization of herbal medicine for glaucoma treatment in South Korea., PATIENTS AND METHODS: A cross-sectional multicenter hospital-based study. In-depth interviews using a structured questionnaire were conducted with 581 individuals diagnosed with glaucoma. Additional eligibility requirements were: all participants were diagnosed with glaucoma in one or both eyes and prescribed eye drops at least one month before the start of the study, and were in a suitable condition for an interview. The frequency of response for each category in the interview questionnaire was analyzed., RESULTS: Conjunctival injection, a stinging sensation, and blurred vision were the most frequently reported side effects, among which blurred vision was the most unbearable. Patient knowledge of glaucoma was the only factor associated with the patient's self-evaluation of compliance. Forgetfulness was the most common reason for nonadherence. Only 2.9 % of patients were taking herbal medicine., CONCLUSIONS: Physicians should address a patient's complaint of blurred vision resulting from medication. Complete initial explanation of the consequences of nonadherence and of the potential vision loss from glaucoma are critical elements in improving patient adherence in Asian populations.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/tu [Therapeutic Use]; Cross-Sectional Studies; Female; Follow-Up Studies; Glaucoma/di [Diagnosis]; *Glaucoma/dt [Drug Therapy]; Glaucoma/ep [Epidemiology]; Humans; Incidence; Intraocular Pressure; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance/sn [Statistics & Numerical Data]; Prognosis; Republic of Korea/ep [Epidemiology]; Surveys and Questionnaires

Adherence improvement in Dutch glaucoma patients: a randomized controlled trial. - Beckers, Henny J M; Webers, Carroll A B; Busch, Michiel J W M; Brink, Hendrik M A; Colen, Thomas P; Schouten, Jan S A G; Dutch Adherence Study Group (Acta ophthalmologica, 2013)
PURPOSE: To study the effect of patient education and the TravAlert( R) -Eyot( R) drop guider on intraocular pressure (IOP) and adherence in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT) monitored with the TravAlert( R) dosing aid., METHODS: Multicentre, randomized, controlled clinical trial among 18 Dutch hospitals. Patients were randomized to one of the four study arms: (1) use of the dosing aid, (2) use of the dosing aid with the drop guider, (3) use of the dosing aid together with patient education or (4) use of the dosing aid and drop guider together with patient education. IOP was recorded at baseline and after 3 and 6 months. Data on adherence generated by the dosing aid were collected and studied at the end of the study., RESULTS: Mean IOP dropped from 20.3 +/- 5.7 mmHg at baseline to 16.3 +/- 4.0 mmHg (right eye) after 6 months and from 20.2 +/- 5.9 mmHg to 16.4 +/- 4.1 mmHg (left eye). The mean adherence rate was 0.91 +/- 0.1. IOP and adherence rate were not statistically different between the study arms. Patients with 'drug holidays' had a significantly higher mean IOP after 6 months. Patients who used the drop guider were less adherent. A lower adherence level was also associated with new patients with glaucoma and patients with a lower level of knowledge on glaucoma., CONCLUSION: Patient education is especially useful for new patients with glaucoma. The use of a drop guider does not improve adherence. Especially patients with 'drug holidays' are at risk for developing uncontrolled IOP levels. Copyright © 2012 Acta Ophthalmologica Scandinavica Foundation.
Keywords: Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/aa [Analogs & Derivatives]; Drug Combinations; *Drug Monitoring/is [Instrumentation]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Netherlands; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Patient Compliance/sn [Statistics & Numerical Data]; *Patient Education as Topic; Surveys and Questionnaires; Timolol; Tonometry, Ocular; Travoprost

The United Kingdom Glaucoma Treatment Study: a multicenter, randomized, placebo-controlled clinical trial: design and methodology. - Garway-Heath, David F; Lascaratos, Gerassimos; Bunce, Catey; Crabb, David P; Russell, Richard A; Shah, Ameet; United Kingdom Glaucoma Treatment Study Investigators (Ophthalmology, 2013)
OBJECTIVE: Elevated intraocular pressure (IOP) is a major risk factor for the deterioration of open-angle glaucoma (OAG); medical IOP reduction is the standard treatment, yet no randomized placebo-controlled study of medical IOP reduction has been undertaken previously. The United Kingdom Glaucoma Treatment Study (UKGTS) tests the hypothesis that treatment with a topical prostaglandin analog, compared with placebo, reduces the frequency of visual field (VF) deterioration events in OAG patients by 50% over a 2-year period., DESIGN: The UKGTS is a randomized, double-masked, placebo-controlled, multicenter treatment trial for OAG., PARTICIPANTS: Five hundred sixteen newly diagnosed (previously untreated) patients with OAG were recruited prospectively at 10 centers between 2007 and 2010., METHODS: Patients were assigned by concealed telephone allocation to treatment with a prostaglandin analog (latanoprost 0.005%) or placebo. The observation period was 2 years, with subjects monitored by VF testing, quantitative imaging, optic disc photography, and tonometry at 11 visits. Data were acquired according to novel protocols optimized for the analysis of deterioration velocity. The sample size was determined for a 2-sided error of alpha=0.05 to detect the difference between 24% and 11% in incident deterioration over a 24-month follow-up at 90% power and assuming a 25% attrition rate., MAIN OUTCOME MEASURES: The primary outcome was time to VF deterioration within 24 months. Secondary outcomes included the deterioration velocity of VF and quantitative imaging measures and the relationship between these velocities and risk factors for deterioration., RESULTS: The study design enabled a short trial with a 2-year observation period and provided data that can be used to assess the feasibility of further shortening trial duration with the progression velocity of VF and structural imaging measurements as outcomes., CONCLUSIONS: The UKGTS is the first randomized, placebo-controlled trial to evaluate the efficacy of medical treatment in reducing VF deterioration in OAG. The measurement of deterioration velocity and inclusion of quantitative imaging has the potential to reduce the number of patients and duration required for subsequent clinical trials. This trial also will quantify risk factors for deterioration, enabling more precise risk profiling of patients and the development of patient management protocols., FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Blood Pressure; Double-Blind Method; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Latanoprost; Medication Adherence; Middle Aged; Ophthalmoscopy; Prospective Studies; *Prostaglandins F, Synthetic/tu [Therapeutic Use]; Quality Assurance, Health Care; *Research Design; Risk Factors; Scanning Laser Polarimetry; Tomography, Optical Coherence; Treatment Outcome; United Kingdom; Vision Disorders/pc [Prevention & Control]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Design and development of a novel pH triggered nanoemulsified in-situ ophthalmic gel of fluconazole: ex-vivo transcorneal permeation, corneal toxicity and irritation testing. - Pathak, Mukesh K; Chhabra, Gulshan; Pathak, Kamla (Drug development and industrial pharmacy, 2013)
The objective of the present research was to develop a novel pH triggered nanoemulsified in-situ gel (NE-ISG) for ophthalmic delivery of fluconazole (FLZ) to enhance the permeation and residence time of the formulation, by overcoming the limitations associated with protective ocular barriers. Pseudoternary phase diagrams were constructed using capmul MCM (oil phase), tween 80 (surfactant) and transcutol P (cosurfactant) to identify the NE region. Nanoemulsions (NE1-NE6) of FLZ were prepared by spontaneous emulsification method and evaluated for various pharmacotechnical characteristics. NE4 was selected as optimized NE and was dispersed in carbopol 934 solution to form nanoemulsified sols (NE-ISG1 to NE-ISG5) that were expected to convert in to in-situ gels at corneal pH (7.4). The optimized NE-ISG was selected on the basis of gelation ability with a residence time up to or more than 6 h. Ex-vivo transcorneal permeation study displayed significantly higher (p < 0.05) permeation of FLZ from NE-ISG5 (337.67 microg/cm(2)) and NE4 (419.30 microg/cm(2)) than the commercial eye drops (112.92 microg/cm(2)). Hen's egg test-Chorioallantoic membrane (HET-CAM) test with zero score indicated the non-irritant property of developed NE-ISG5. Corneal toxicity study revealed no visual signs of tissue damage. Hence it can be concluded that NE-ISG5 may offer a more intensive treatment of ocular fungal infections due to higher permeation, prolonged precorneal residence time and sustained drug release along with higher in-vitro efficacy, safety and greater patient compliance.
Keywords: Acrylates/ch [Chemistry]; Administration, Ophthalmic; Animals; *Antifungal Agents/ch [Chemistry]; Antifungal Agents/pk [Pharmacokinetics]; Antifungal Agents/to [Toxicity]; *Cornea/me [Metabolism]; Corneal Diseases/pc [Prevention & Control]; Delayed-Action Preparations; Drug Design; *Fluconazole/ch [Chemistry]; Fluconazole/pk [Pharmacokinetics]; Fluconazole/to [Toxicity]; *Gels; Goats; Humans; Hydrogen-Ion Concentration; Nanoparticles; Ophthalmic Solutions

Patient satisfaction with topical ocular hypotensives. - Kerr, Nathan M; Patel, Hussain Y; Chew, Shenton Sl; Ali, Noor Q; Eady, Elizabeth K; Danesh-Meyer, Helen V (Clinical & experimental ophthalmology, 2013)
BACKGROUND: The aim of this study is to assess patient satisfaction, convenience of use, ease of administration, side effects and treatment burden of topical ocular hypotensives., DESIGN: Prospective, observational cohort., PARTICIPANTS: Two thousand five hundred and forty-one patients with glaucoma or ocular hypertension., METHODS: The Treatment Impact Patient Satisfaction Scale (TIPSS) was administered by mail to all patients with glaucoma or ocular hypertension registered with Glaucoma New Zealand during a 3-month study period. The questionnaire assessed patient demographics; topical ocular hypotensive use including number of medications, frequency of administration, ease of use, class of medication, and presence/severity of side effects; impact on quality of life; and patient satisfaction. Univariate and multivariate analyses were performed to identify determinants of patient satisfaction., MAIN OUTCOME MEASURES: Patient satisfaction., RESULTS: Almost 80% of respondents were either 'very satisfied' or 'satisfied' with topical ocular hypotensives. Factors that were predictive of patient satisfaction included satisfaction with frequency of eye drop use {odds ratio (OR) 2.4 (95% confidence interval [CI] 1.8-3.1); P < 0.001}, subjective convenience (OR 2.6 [95% CI 2.0-3.4]; P < 0.001) and ease of administration (OR 2.5 [95% CI 2.0-3.3]; P < 0.001). Male gender was associated with lower satisfaction (OR 0.6 [95% CI 0.5-0.9]; P = 0.01). Factors that were not predictive of patient satisfaction included age, duration of eye drop use, class of medication and the presence of side effects., CONCLUSIONS: Patients with glaucoma and ocular hypotension are satisfied with topical ocular hypotensives. Efforts to improve patient satisfaction should focus on convenience and ease of administration. Copyright © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.
Comment in (CIN)
Keywords: Administration, Topical; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Prospective Studies; Quality of Life; Surveys and Questionnaires

Sociodemographic factors and utilization of eye care services: is there an association with patients presenting to a tertiary referral hospital in acute angle-closure?. - Sandhu, Suneet; Van Wijngaarden, Peter; Nguyen, Dan Q; O'Hare, Fleur; Sandhu, Navneet; Wang, Jie Jin; Crowston, Jonathan G (Clinical & experimental ophthalmology, 2013)
BACKGROUND: The aim of this study is to examine the relationship between sociodemographic factors and utilization of eye care services in patients presenting in acute angle-closure (AAC)., DESIGN: A hospital-based retrospective, case-control study., PARTICIPANTS: Fifty-five patients consecutively presenting to the emergency department of the Royal Victorian Eye and Ear Hospital with AAC (cases), and 43 patients consecutively referred to the outpatient department for prophylactic laser peripheral iridotomy (controls) over a 3-year period., METHODS: Standardized telephone questionnaires., MAIN OUTCOME MEASURES: Comparisons were made for sociodemographic factors, utilization of eye care services and provision of information on glaucoma and premonitory symptoms of AAC., RESULTS: No significant differences across a range of socioeconomic and demographic factors were found. Fewer cases reported having attended an eye care professional ever (P = 0.02), or in the 12 months preceding their acute hospital attendance (P = 0.002), and had less awareness of angle closure glaucoma (P = 0.001). Logistic regression modelling demonstrated premonitory symptoms of AAC (odds ratio 3.96, [95% confidence interval 1.52-10.32], P < 0.001) and a period of greater than 12 months since the last eye examination (odds ratio 3.89, [95% confidence interval 1.64-9.21]) were significantly associated with the risk of AAC., CONCLUSIONS: No significant differences in socioeconomic or demographic parameters between cases and controls were identified. Control subjects had a history of more frequent and recent access to eye care services than cases. The finding that more than one-third of patients presenting with AAC had consulted an eye care provider in the preceding year suggests that a significant proportion of individuals at risk of AAC remain undetected. Copyright © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: Acute Disease; Case-Control Studies; Female; *Glaucoma, Angle-Closure/su [Surgery]; Gonioscopy; *Health Services/sn [Statistics & Numerical Data]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Services Research; Humans; Intraocular Pressure; Iridectomy; *Iris/su [Surgery]; Laser Therapy; Male; Middle Aged; *Ophthalmology/sn [Statistics & Numerical Data]; Retrospective Studies; *Socioeconomic Factors; Surveys and Questionnaires; *Tertiary Care Centers/sn [Statistics & Numerical Data]; Tonometry, Ocular; Victoria/ep [Epidemiology]

Adherence to glaucoma medication: the effect of interventions and association with personality type. - Lim, Michele C; Watnik, Mitchell R; Imson, Katrina R; Porter, Scott M; Granier, Alison M (Journal of glaucoma, 2013)
PURPOSE: To determine whether multiple interventions influence adherence to glaucoma medication and to study the relationship between personality type and adherence., METHODS: Eighty patients with glaucoma using prostaglandin monotherapy were prospectively randomized to an intervention or a nonintervention group. Over a 5-month period, the intervention group received monthly automated telephone calls reminding them to take their glaucoma medications. At month 3, the intervention group had an office visit with their physician and received education regarding their disease and treatment. The nonintervention group returned at the end of the study period. Adherence was directly measured with an electronic monitoring cap. Outcome measures were adherence rate and therapeutic coverage. Patients completed the Minnesota Multiphasic Personality Inventory-2., RESULTS: Thirty-eight patients were randomized to the intervention group and 42 were randomized to the nonintervention group. Mean adherence rate for the intervention group over 5 months was 76% and for the nonintervention group, 81%. For the intervention group, adherence did not change significantly after the midstudy visit (P=0.233). No difference existed between the intervention and nonintervention groups before (P=0.456) or after (P=0.134) the midstudy intervention visit. The Minnesota Multiphasic Personality Inventory-2 personality scales for depression (P=0.01) and hypochondriasis (P>0.0001) were significantly associated with poorer adherence., CONCLUSIONS: Monthly automated telephone reminders, a 1-time educational session, and increased contact with a physician did not improve adherence rate with glaucoma medications. Depression and hypochondriasis personality types were related to poor adherence and highlight the role of psychosocial factors in medication adherence.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Female; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Glaucoma/px [Psychology]; Humans; Intraocular Pressure; Male; *Medication Adherence/px [Psychology]; Middle Aged; *Patient Compliance/px [Psychology]; Patient Education as Topic/mt [Methods]; *Personality; Prospective Studies; Treatment Outcome

Comparison of the utility of Pascal dynamic contour tonometry with Goldmann applanation tonometry in routine clinical practice. - Anderson, Matthew Frederick; Agius-Fernandez, Adriana; Kaye, Stephen B (Journal of glaucoma, 2013)
PURPOSE: To compare the utility of Pascal dynamic contour tonometry with Goldmann applanation tonometry in routine practice, METHODS: In a prospective study, 10 clinicians recruited 97 patients attending outpatient ophthalmology appointments. Intraocular pressure was measured with both Pascal and Goldmann tonometry in a randomized order. The time taken with each instrument, the number of measurements required to obtain a satisfactory Pascal reading (Q1 to Q3) and the quality value of this reading were recorded. Both the difficulty experienced by the clinician and patient experience for each instrument were assessed., RESULTS: Satisfactory Pascal measurements were obtained for 181 of 194 eyes (93%). For these eyes there was no significant difference in mean measured intraocular pressure between Pascal (15.95+/-3.20) and Goldmann (16.37+/-3.51) (mean difference 0.43 mm Hg, P=0.26) tonometry. The median number of attempts required to obtain a satisfactory Pascal measurement was 2 (range, 1 to 10). The time taken to obtain bilateral satisfactory Pascal readings was 2.76+/-1.53 minutes (range, 0.5 to 7 min), compared with 0.82+/-0.43 minutes (range, 0.5 to 3 min) for Goldmann tonometry (P<0.001). For these patients, clinicians scored the difficulty of tonometry as 3.24+/-1.97 for Pascal (1=very easy, 10=very difficult) and 1.28+/-0.85 for Goldmann (P<0.0001). The mean score (1=no discomfort, 10=extremely unpleasant) given by patients was 1.31+/-0.64 for Goldmann and 2.11+/-1.83 for Pascal tonometry (P<0.0001)., CONCLUSIONS: Clinicians found Pascal tonometry significantly more time consuming and difficult than Goldmann tonometry in routine practice. Most eyes required repeated Pascal measurements, and for some an acceptable result was not obtained. Both types of tonometry were well tolerated by patients.
Keywords: Adult; Aged; Aged, 80 and over; Female; Glaucoma/di [Diagnosis]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Ophthalmology; Patient Satisfaction; Practice Patterns, Physicians'; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Time Factors; *Tonometry, Ocular/is [Instrumentation]

Patient acceptance and attitude toward an alternative method of subconjunctival injection for the medical treatment of glaucoma. - Chong, Rachel S; Su, Daniel H W; Tsai, Andrew; Jiang, Yuzhen; Htoon, Hla Myint; Lamoureux, Ecosse L; Aung, Tin; Wong, Tina T (Journal of glaucoma, 2013)
PURPOSE: Nonadherence to glaucoma medications may be a major cause of treatment failure. We examined the acceptance of glaucoma patients toward a possible new route of administering glaucoma medication by subconjunctival injection., PATIENTS AND METHODS: Patients were recruited from specialist glaucoma clinics on a voluntary basis. Trained interviewers administered a 30-item questionnaire and an information sheet with details of an alternative subconjunctival injection route involving injections at 3-month intervals. Outcome measures regarding acceptance of the new procedure, social situational factors, disease factors, and treatment factors were assessed., RESULTS: A total of 151 patients participated in this study. Of the 151 patients 112 (74.2%) were willing to have their glaucoma medication given by the new method of subconjunctival injection, 101 of 112 (90.2%) were willing to accept it at the same cost as their present medication, and 87 of 101 (86.1%) were willing to accept it even at a higher cost. These patients tended to be on a greater number of medications (P=0.006), and medicating more frequently in a day (P=0.003). Nine of 10 (90%) patients who were admitted to nonadherence were willing to accept subconjunctival injections at 3-month intervals in place of their topical medication., CONCLUSIONS: Our study found that 74% of glaucoma patients were willing to accept an alternative form of glaucoma treatment through 3-monthly subconjunctival injections. A large proportion of patients who were admitted to nonadherence to topical medication were willing to consider this alternative method of medication. Our findings are helpful when developing patient-acceptable drug-delivery regimes, which may alleviate the need for daily medication.
Keywords: Administration, Topical; Aged; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/tu [Therapeutic Use]; *Attitude to Health; *Conjunctiva/de [Drug Effects]; Cross-Sectional Studies; Drug Administration Routes; Female; *Glaucoma, Angle-Closure/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Injections; Intraocular Pressure/de [Drug Effects]; Male; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Patient Compliance; Surveys and Questionnaires

Glaucoma management in Sweden -- results from a nationwide survey. - Linden, Christina; Bengtsson, Boel; Alm, Albert; Calissendorff, Berit; Eckerlund, Ingemar; Heijl, Anders (Acta ophthalmologica, 2013)
PURPOSE: To report the results from a nationwide survey on glaucoma management in Sweden, performed as a part of an Open Angle Glaucoma project conducted by the Swedish Council on Health Technology Assessment 2004-2008., METHODS: In 2005, a survey was distributed to all providers of glaucoma care in Sweden: public eye departments, public outpatient departments and private practices. The questionnaire included questions on number of examined patients, types of examinations during one defined week, internal organization and access to diagnostic equipment. The questionnaire was endorsed by the Swedish Ophthalmological Society. Reminders were sent out to nonresponders., RESULTS: Response rate was high; 97% (33/34) of eye departments, 85% (39/46) of outpatient departments and 55% (69/125) of private practices. Out of 29 282 visits in ophthalmic care during the study week, 7737 (26%) were related to glaucoma. Diagnostic equipment was generally available; all public eye facilities and 92% of private practices had at least one computerized perimeter, while equipment for fundus photography/imaging was available at 100% of eye departments, 82% of outpatient departments and 62% of private practices. The number of visual field tests and fundus images was rather low. Survey results indicate that patients on the average underwent bilateral field testing every 2nd year and fundus imaging every 8th year., CONCLUSION: Glaucoma care generated about a quarter of all patient visits in Swedish ophthalmic care. Access to diagnostic facilities was good. To meet modern standards of glaucoma care, glaucoma damage must be measured and followed more closely than at the time of the survey. Copyright © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.
Comment in (CIN)
Keywords: Benchmarking; Diagnostic Techniques, Ophthalmological/is [Instrumentation]; *Glaucoma, Open-Angle/th [Therapy]; *Health Care Surveys/sn [Statistics & Numerical Data]; *Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Intraocular Pressure; *Ophthalmology/sn [Statistics & Numerical Data]; Surveys and Questionnaires; Sweden/ep [Epidemiology]; Visual Field Tests; Visual Fields/ph [Physiology]

Morning dosing of once-daily glaucoma medication is more convenient and may lead to greater adherence than evening dosing. - Ford, Bryce A; Gooi, Malcolm; Carlsson, Anthony; Crichton, Andrew C (Journal of glaucoma, 2013)
PURPOSE: To determine if adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening., DESIGN: Prospective, randomized crossover treatment trial., PATIENTS AND METHODS: Thirty patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for 1 month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid., MAIN OUTCOME MEASURES: Adherence was compared between morning versus evening dosing and first versus second month dosing. Demographic characteristics were obtained, treatment effect was measured, and patients completed a post-study questionnaire regarding the convenience of the 2 dosing regimens., RESULTS: Patient adherence overall was good (89.3%). There was no statistically significant difference (P=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%). Adherence in the first month (91.7%) was superior to the second month (86.5%). There was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing., CONCLUSIONS: Early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.
Keywords: Administration, Topical; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cross-Over Studies; *Drug Chronotherapy; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Prospective Studies; Surveys and Questionnaires; Travoprost

Effect of beclomethasone nasal spray on intraocular pressure in ocular hypertension or controlled glaucoma. - Yuen, Darana; Buys, Yvonne M; Jin, Ya-Ping; Alasbali, Tariq; Trope, Graham E (Journal of glaucoma, 2013)
PURPOSE: To evaluate the effect of 6 weeks administration of beclomethasone nasal spray on intraocular pressure (IOP) in patients with ocular hypertension or controlled primary open-angle glaucoma., PATIENTS AND METHODS: Randomized double-masked controlled trial. Patients were randomized to twice daily beclomethasone versus placebo saline nasal spray. There were a total of 4 study visits: baseline and weeks 2, 4, 6 after starting the spray. Each study visit was at the same time within a 1-hour time window. Primary outcome measure was IOP. Secondary measures included visual acuity, anterior segment changes, patient reported side effects, and compliance. Study endpoint was 6 weeks from the start of treatment or an IOP increase of >20% from baseline. A sample size calculation suggested that 8 patients in each arm would be sufficient to detect a difference of 3.2 mm Hg with a power of 80%., RESULTS: Nineteen consecutive consenting patients completed the study-9 in the steroid arm and 10 in the placebo arm. There were no statistically significant differences between groups in baseline characteristics, IOP at each study visit, or change in IOP from baseline at any time point. At 6 weeks, the change in mean IOP from baseline was +0.50+/-1.52 versus +0.70+/-1.44 mm Hg in the steroid and saline nasal spray groups, respectively (P=0.77)., CONCLUSIONS: Patients with ocular hypertension and primary open-angle glaucoma showed no evidence of IOP elevation after 6 weeks use of beclomethasone nasal spray.
Keywords: *Beclomethasone/ad [Administration & Dosage]; Double-Blind Method; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; *Glucocorticoids/ad [Administration & Dosage]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Nasal Sprays; Ocular Hypertension/dt [Drug Therapy]; Prospective Studies; Tonometry, Ocular; Visual Acuity/ph [Physiology]

Challenges in the management of glaucoma in developing countries. - Butt, Nadeem Hafeez; Ayub, Muhammad Hammad; Ali, Muhammad Hassaan (Taiwan journal of ophthalmology, 2016)
Glaucoma is the most common optic neuropathy characterized by normal to raised intraocular pressure (IOP), visual field defects, loss of retinal nerve fiber layer, thinning of the neuroretinal rim, and cupping of the optic disc. IOP reduction by medical, laser, or surgical therapies remains the only clinically proven treatment of glaucoma. The challenges in glaucoma management are diverse. They include early detection and diagnosis, setting of appropriate target IOP, choice of treatment, monitoring of quality of life and sight, and compliance with the treatment. Early diagnosis can be made by assessing optic nerve structure using imaging devices and optic nerve function through perimetry. Reducing IOP and controlling its fluctuations are considered to be the most important factors in limiting progression of glaucoma. Selection of the best suitable therapy out of medical, surgical, or laser treatment options is yet another management challenge. Patients suffering from glaucoma experience poor quality of life owing to the diagnosis itself, functional visual loss, inconvenience and cost of treatment, and side effects of treatment. All these factors lead to poor compliance, adherence, and persistence to treatment, and further progression of the disease. It is, therefore, important that ophthalmologists keep all the aforementioned factors in mind when managing patients with glaucoma.

So let me find my way, whatever it will cost me, rather than leaving myself in darkness: experiences of glaucoma in Nigeria. - Kyari, Fatima; Chandler, Clare I; Martin, Martha; Gilbert, Clare E (Global health action, 2016)
BACKGROUND: Blindness from glaucoma is associated with socio-economic deprivation, presumed to reflect poor access to care and poor adherence to treatment., OBJECTIVES: To determine why people with glaucoma are presenting late for treatment and to understand access to glaucoma care. Additionally, we sought to identify what patients and the community know, do and think about the condition and why the poor are the most affected with glaucoma blindness., DESIGN: Study participants were from four communities and two hospitals in Abuja-FCT and Kaduna State, Nigeria. A total of 120 participants were involved, including 8 focus group discussions, 7 in-depth interviews with blind/visually impaired glaucoma patients, 5 rapid direct observation visits with these patients and 13 exit interviews of glaucoma patients in the hospital. The data were analysed using content analysis, interpreting participant experiences in terms of three key steps conceptualised as important in the care pathway: what it takes to know glaucoma, to reach a diagnosis and to access continued care., RESULTS: This article presents multiple narratives of accessing and maintaining glaucoma care and how people manage and cope with the disease. People may be presenting late due to structural barriers, which include lack of knowledge and awareness about glaucoma and not finding an appropriately equipped health care facility. What keeps glaucoma patients within the care pathway are a good hospital experience; a support structure involving family, counselling and shared patients' experiences; and an informed choice of treatment, as well as agency. The high cost of purchasing care is a major factor for patients dropping out of treatment., CONCLUSION: The findings suggest the need to address economic and social structural drivers as glaucoma presents another case study to demonstrate that poverty is a strong driver for blindness. There is also a need for clear glaucoma care pathways with early case finding in the community, two-way referral/feedback systems, well-equipped glaucoma care hospitals and better eye health care financing.

Blebs, Barriers, and Bagpipes: Why is It so Hard?. - Coote, Michael (Journal of current glaucoma practice, 2016)
Doug Johnson was a clinician-scientist who made great contributions to the understanding of outflow from the eye. This lecture is in honour of Doug and explores the author's understanding of outflow in the surgical context., HOW TO CITE THIS ARTICLE: Coote M. Blebs, Barriers, and Bagpipes: Why is It so Hard? J Curr Glaucoma Pract 2016; 10(3):79-84.

Efficacy and tolerability of benzalkonium chloride-free travoprost in glaucoma patients switched from benzalkonium chloride-preserved latanoprost or bimatoprost. - Garcia-Feijoo, Julian; Munoz-Negrete, Francisco J; Hubatsch, Douglas A; Rossi, Gemma C (Clinical ophthalmology (Auckland, N.Z.), 2016)
INTRODUCTION: The preservative benzalkonium chloride (BAK) is used to preserve several topical, intraocular pressure (IOP)-lowering glaucoma medications but can cause tolerability concerns that may lead to decreased adherence to treatment and ultimately diminish the effectiveness of IOP control. The study aimed to determine the efficacy and tolerability of BAK-free travoprost preserved with polyquaternium-1 in glaucoma patients switched from BAK-preserved latanoprost or bimatoprost., METHODS: This 12-week, open-label study was conducted in Europe between December 2011 and February 2013. We enrolled adult patients with open-angle glaucoma or ocular hypertension who were receiving BAK-preserved latanoprost 0.005% or bimatoprost 0.01% and, in the opinion of the investigator, would benefit from transition to BAK-free travoprost 0.004% preserved with polyquaternium-1 because of tolerability concerns. Assessments included IOP, proportion of patients with IOP <=18 mmHg, ocular surface status, hyperemia, patient treatment preference, and adherence. Adverse events were recorded throughout the study., RESULTS: Of the 202 patients screened, 187 patients were included in the intent-to-treat population (mean age, 66.6 years; range, 19-90 years). The mean IOP significantly reduced from baseline (17.0 mmHg) to week 6 (mean change, -1.17 mmHg; P<0.001) and week 12 (-1.16 mmHg; P<0.001). At week 12, more patients achieved IOP <=18 mmHg (81.2% versus 73.3% at baseline), and ocular surface disease severity improved from baseline to week 12. Most patients preferred BAK-free travoprost (74.9%) versus their previous medication and were very confident in their adherence (84.1%). Reduced visual acuity and eye pruritus were the most common adverse events (2.5% each)., CONCLUSION: BAK-free travoprost 0.004% preserved with polyquaternium-1 was efficacious and well tolerated and may be an advantageous prostaglandin analog option for patients with open-angle glaucoma or ocular hypertension who are intolerant to BAK-preserved latanoprost or bimatoprost.

Adherence to treatment in patients with open-angle glaucoma and its related factors. - Movahedinejad, Tayebeh; Adib-Hajbaghery, Mohsen (Electronic physician, 2016)
INTRODUCTION: Lack of adherence to medical treatments typically lead to burdensome consequences such as progressive visual impairment, blindness, and disabilities. This study aimed to determine the adherence to medication in patients with open-angle glaucoma and related factors in patients referred to the Matini Ophthalmology Hospital in Kashan, Iran., METHODS: A cross-sectional study was conducted from 23 July 2015 to 20 January 2016 on all patients with open-angle glaucoma referred to the Matini Ophthalmology Hospital in Kashan, Iran. A questionnaire was used to gather data about patients' demographics and factors affecting adherence to medical treatments. The Morisky Medication Adherence Scale was used to evaluate the adherence to glaucoma medication. Results were analyzed using SPSS version 13. Descriptive statistics, chi-square, and logistic regression analysis were used., RESULTS: In total, 130 patients with a mean age of 55.36 +/- 15.54 were studied. Only 34.6% of patients completely adhered to glaucoma medications. The chi-square test showed that age (p=0.007), education (p=0.01), life entourage (p=0.04), place of residence (p=0.06), average monthly income (p=0.005), the interval between medical visits (p=0.007), problem in scheduling the medical visits (p<0.001), number of medications (p<0.001), lifelong using and side-effects of medications (p<0.001), answers of the physician to the patient's questions (p<0.001), financial and traveling problems (p<0.001), lack of skill in using eye drops (p<0.001), lack of awareness of glaucoma complications and symptoms (p<0.001), forgetting, fatigue, impatience, believing in uselessness of medications, and lack of support from family (p<0.001) were associated with patients' adherence. Logistic regression showed that 89% of variance of patients' adherence to glaucoma medications can be predicted by seven factors: problems in traveling and scheduling medical visits, the large number and side effects of medications, impatience, forgetting, and lack of skill in using eye drops., CONCLUSION: About two-thirds of patients with open-angle glaucoma did not adhere to their own medications. Appropriate patient education and planning a patient follow-up strategy might positively affect the patients' adherence to glaucoma medications.

Validation of a glaucoma knowledge assessment in glaucoma patients. - Rao, Veena S; Peralta, Esteban A; Rosdahl, Jullia A (Clinical ophthalmology (Auckland, N.Z.), 2016)
SUMMARY: To develop metrics to identify knowledge deficits and barriers to learning in glaucoma patients, this study seeks to validate a glaucoma knowledge assessment to use in the evaluation of knowledge in glaucoma patients., PURPOSE: Glaucoma treatment adherence appears to improve when patients demonstrate a greater knowledge of the disease and its treatment. This study seeks to validate a glaucoma knowledge assessment in a glaucoma patient population to assist in patient educational assessments and interventions., PATIENTS AND METHODS: The National Eye Health Education Program's (NEHEP) glaucoma knowledge assessment has previously been suggested as a useful measure to assess glaucoma patient's knowledge. This questionnaire was administered in glaucoma patients along with a more comprehensive 49-question examination. Demographic data and health literacy were assessed. Statistical analyses were performed to assess the validity of the assessments., RESULTS: A total of 12 glaucoma patients completed the knowledge assessments. The mean +/- standard deviation age of the patients was 69+/-14 years, and the duration of glaucoma was 14+/-13 years. The participants' mean score on the NEHEP assessment was 7.3+/-0.8 (of 10, 73% correct) vs 29.3+/-7.3 (of 49, 60% correct) on the comprehensive assessment. The value of coefficient alpha was 0.592 for NEHEP and 0.872 for the cumulative assessment. The P-value (proportion of examinees answering correctly) ranged from 0 to 1 for individual questions. Item point-biserial correlation values for each question ranged from -0.402 to 0.813., DISCUSSION: The NEHEP quiz may be a good starting point for the development of a reliable knowledge assessment tool to measure and monitor glaucoma knowledge, due to its concise nature and reasonable level of difficulty. This study suggests that questions included in the currently available questionnaires vary widely in difficulty and ability to differentiate knowledge level, which may ultimately compromise reliability and utility of existing examinations. Further examination of individual questions and teaching points included in the current assessments may help to construct increasingly reliable and useful knowledge assessments in the future.

A Combination of Intrastromal and Intracameral Injections of Amphotericin B in the Treatment of Severe Fungal Keratitis. - Hu, Jianzhang; Zhang, Jingjin; Li, Yanling; Han, Xiaoli; Zheng, Weidong; Yang, Juan; Xu, Guoxing (Journal of ophthalmology, 2016)
Purpose. To evaluate the efficacy of a combination of intrastromal and intracameral injections of amphotericin B in the treatment of severe recalcitrant fungal keratitis. Methods. Patients with severe fungal keratitis who were resistant to conventional antifungal medical treatments and needed potential surgical intervention were recruited at the First Affiliated Hospital of Fujian Medical University between January 2012 and July 2013. The patients were treated with a combination of intrastromal and intracameral injections of amphotericin B (25 mug/mL and 50 mug/mL, resp.). Selectively repeated injections were performed as necessary. The efficacy, complications, and outcome were evaluated. Results. Nine patients (9 eyes) were involved in this study. All 9 cases responded favorably, and the clinical appearance of serious corneal damage and intraocular extension was resolved after the treatment. Four eyes required only 1 injection, and 5 eyes required repeated injections. Seven corneal ulcers healed with leucoma, and 2 healed with adherent leucoma. All of our cases had a marked increase in the anterior chamber reaction and pain immediately after the injection. There was no obvious clinical evidence of corneal or lenticular toxicity in any patient. Conclusions. A combination of intrastromal and intracameral injections of amphotericin B may be safe and effective for the treatment of severe fungal keratitis that is resistant to conventional therapy.

Preservative-free bimatoprost 0.03%/timolol 0.5% fixed combination in patients with glaucoma in clinical practice. - Pfennigsdorf, Stefan; Eschstruth, Peter; Hasemeyer, Stefan; Feuerhake, Cord; Brief, Gerrett; Grobeiu, Ioana; Shirlaw, Andrew (Clinical ophthalmology (Auckland, N.Z.), 2016)
PURPOSE: The aim of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF), fixed-combination (FC) bimatoprost 0.03%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension in a clinical practice setting., PATIENTS AND METHODS: This open-label study observed patients switched to PF FC bimatoprost 0.03%/timolol 0.5% due to insufficient intraocular pressure (IOP) control on previous therapies. IOP was measured at baseline and at ~12 weeks. Tolerability and continuation of therapy were also assessed., RESULTS: A total of 1,553 patients were included in the study, and the per-protocol population comprised 1,391 patients. There were some minor deviations from protocol: some patients with no prior therapy and some who switched for reasons other than insufficient IOP control were included in the analysis. The mean IOP was reduced by 27.4%, from 22.2 mmHg to 16.1 mmHg. In subgroup analyses, the mean IOP was significantly reduced from baseline, irrespective of whether previous treatment was monotherapy or combination therapy, and preserved or PF therapy. Physicians mostly (88.1%) reported the IOP-lowering efficacy of PF FC bimatoprost 0.03%/timolol 0.5% to be as expected or better than expected. Switching to PF FC bimatoprost 0.03%/timolol 0.5% resulted in reductions from baseline in the number of patients reporting ocular symptoms. Adverse events were reported by 6.2% of patients, the most common being eye irritation (1.6%) and eye pruritus (1.0%). Physicians reported treatment compliance as better or unchanged compared with prior treatment in almost all patients (93.9%). Most patients were expected to continue PF FC bimatoprost 0.03%/timolol 0.5% after the end of the study., CONCLUSION: Switching to PF FC bimatoprost 0.03%/timolol 0.5% was associated with significant IOP reductions from baseline over 12 weeks. Adverse events were uncommon, and compliance was high compared with previous therapy. PF FC bimatoprost 0.03%/timolol 0.5% may be a suitable treatment for patients with inadequately controlled IOP or who are sensitive to preservatives.

Preservative-free bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension in clinical practice. - Pillunat, Lutz E; Eschstruth, Peter; Hasemeyer, Stefan; Thelen, Ulrich; Foja, Christian; Leaback, Richard; Pfennigsdorf, Stefan (Clinical ophthalmology (Auckland, N.Z.), 2016)
BACKGROUND: Intraocular pressure (IOP)-lowering medications for primary open-angle glaucoma and ocular hypertension commonly contain preservatives that can cause ocular surface damage in many patients. The purpose of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF) bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension (IOP >=18 mmHg) in a clinical practice setting., METHODS: This open-label study observed patients who were switched to PF bimatoprost 0.03% for medical reasons. IOP was measured at baseline and ~12 weeks later at the final visit, and the change in IOP was calculated. Tolerability and continuation of therapy were assessed at two follow-up visits., RESULTS: A total of 1,830 patients were included in the study, and complete IOP data were available for 1,543 patients. Mean IOP was reduced by 23% from 21.64 mmHg to 16.59 mmHg (P<0.0001). In subgroup analyses, the mean IOP was significantly reduced compared with baseline, regardless of prior therapy, including those previously treated with PF monotherapy. A total of 85.7% of physicians reported the IOP-lowering efficacy of PF bimatoprost 0.03% to be as expected or better than expected. Adverse events (AEs) were experienced by 5.7% of patients, and there were no serious AEs reported. The most common AEs were eye irritation (1.7%) and hyperemia (1.4%). Physician-reported treatment compliance was reported as better than (48.7%) or equal to (43.6%) prior treatment in most patients. Most patients (82%) were expected to continue PF bimatoprost 0.03% after the end of the study., CONCLUSION: This observational study showed that, in clinical practice, switching to PF bimatoprost 0.03% was associated with a significant IOP reduction from baseline. There was a low AE rate. PF bimatoprost 0.03% may, therefore, be an effective treatment option for patients who are intolerant of preservatives or have an inadequate response to prior IOP-lowering treatments.

A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence. - Hark, Lisa A; Johnson, Deiana M; Berardi, Giuliana; Patel, Neal S; Zeng, Lichuan; Dai, Yang; Mayro, Eileen L; Waisbourd, Michael; Katz, L Jay (Patient preference and adherence, 2016)
PURPOSE: Patients with glaucoma who do not keep their follow-up eye care appointments are at risk for developing more severe ocular disease. The primary aim of the current study was to evaluate whether the use of a patient navigator altered adherence to follow-up eye care appointments in community-versus office-based settings., PATIENTS AND METHODS: Patients diagnosed with a glaucoma-related condition following a comprehensive eye examination at 43 community sites in Philadelphia, PA, USA, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community-based setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; and Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05., RESULTS: A total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (+/-standard deviation) was 71.2 (+/-10.0) years. Patients were predominantly female (65.8%, n=102/155) and African-American (71.6%, n=111/155). The mean (+/-standard deviation) number of follow-up visits during the 1-year study period was 1.3 (+/-1.3) for G1, 1.6 (+/-1.3) for G2, and 1.3 (+/-1.1) for G3 (P=0.48). Appointment adherence, defined as attendance of >=1 follow-up visit, was 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=33/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended >=2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11)., CONCLUSION: Help from a patient navigator did not increase the likelihood of keeping >=1 follow-up appointment in an office-based setting. Adherence rates for follow-up appointments reached close to 70% or above in a self-selected patient population.

Adherence to Glaucoma Medications Over 12 Months in Two US Community Pharmacy Chains. - Feehan, Michael; Munger, Mark A; Cooper, Daniel K; Hess, Kyle T; Durante, Richard; Jones, Gregory J; Montuoro, Jaime; Morrison, Margaux A; Clegg, Daniel; Crandall, Alan S; DeAngelis, Margaret M (Journal of clinical medicine, 2016)
UNLABELLED: This study determined the degree of adherence to medications for glaucoma among patients refilling prescriptions in community pharmacies., METHODS: Data abstracted from the dispensing records for 3615 adult patients (18 years or older, predominantly over 45) receiving glaucoma medications from two retail pharmacy chains (64 stores in total) were analyzed. From a 24-month historic data capture period, the 12-month levels of adherence were determined using standard metrics, the proportion of days covered (PDC) and the medication possession ratio (MPR). The overall 12-month mean PDC was only 57%, and the mean MPR was 71%. Using a criterion by which 80% coverage was considered satisfactory adherence, only 30% had satisfactory overall 12-month PDC coverage, and only 37% had satisfactory overall 12-month MPR coverage. Refill adherence increased with age and was highest in the 65-and-older age group (p < 0.001). Differential adherence was found across medication classes, with the highest satisfactory coverage seen for those taking alpha2-adrenergic agonists (PDC = 36.0%; MPR = 47.6%) down to those taking direct cholinergic agonists (PDC = 25.0%; MPR = 31.2%) and combination products (PDC = 22.7%; MPR = 31.0%). Adherence to glaucoma medications in the community setting, as measured by pharmacy refill data, is very poor and represents a critical target for intervention. Community pharmacists are well positioned to monitor and reinforce adherence in this population.

Differences in Neuroticism Between Patients with Glaucoma Who Have Discontinued Visits to Ophthalmologists and Those Who Make Regular Visits: Implications for Adherence to Topical Glaucoma Medications. - Nakano, Tadashi; Kodaka, Fumitoshi; Tsuneoka, Hiroshi (Ophthalmology and therapy, 2016)
INTRODUCTION: Neuroticism is a personality trait often described in individuals with glaucoma (GLC), but is not necessarily representative of the total population of patients. There is a population of patients with GLC who are invisible to clinical ophthalmologists; in other words, those who once have been diagnosed with GLC, but spontaneously stop visiting an ophthalmologist. Little is known about their neuroticism personality trait. In the present study, the authors compared the level of neuroticism between patients no longer visiting an ophthalmologist and those who continue visit them regularly., METHODS: Patients were assigned to two groups according to the duration of their last visit to an ophthalmologist: the Discontinued group included those patients who had not visited an ophthalmologist for the last 6 months, and the Regular Visitor group included those patients who continued to make regular visits to an ophthalmologist. The Japanese version of Ten Items Personality Inventory (TIPI-J), a questionnaire specifically used to assess the Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), was completed by patients through a dedicated website., RESULTS: Three-hundred and seventy-three patients with GLC were recruited. The neuroticism score from the TIPI-J in the Discontinued group was significantly lower than that in the Regular Visitor group (7.63 +/- 2.23 vs. 8.23 +/- 2.21, respectively; P = 0.01). No significant difference was found in the other TIPI-J sub-item scores between the Discontinued and the Regular Visitor groups., CONCLUSION: In this study, the authors showed that neuroticism trait in patients with GLC who have discontinued visiting their ophthalmologists was lower than that in patients who regularly visited them, on the basis of the Big Five personality traits as measured by the TIPT-J., FUNDING: Santen Pharmaceutical Co., Ltd.

Evaluation of Physical Properties of Generic and Branded Travoprost Formulations. - Wadhwani, Meenakshi; Mishra, Sanjay K; Angmo, Dewang; Velpandian, Thirumurthy; Sihota, Ramanjit; Kotnala, Ankita; Bhartiya, Shibal; Dada, Tanuj (Journal of current glaucoma practice, 2016)
PURPOSE: Comparative evaluation of pharmaceutical characteristics of three marketed generic vs branded travoprost formulations., MATERIALS AND METHODS: Three generic travoprost formulations and one branded (Travatan without benzalkonium chloride) formulation (10 vials each), obtained from authorized agents from the respective companies and having the same batch number, were used. These formulations were coded and labels were removed. At a standardized room temperature of 25degreeC, the drop size, pH, relative viscosity, and total drops per vial were determined for Travatan (Alcon, Fort Worth, TX, USA) and all the generic formulations. Travoprost concentration in all four brands was estimated by using liquid chromatography-coupled tandem mass spectrometry LCMS., RESULTS: Out of the four formulations, two drugs (TP 1 and TP 4) were found to follow the United States Pharmacopoeia (USP) limits for ophthalmic formulation regarding drug concentration, while the remaining two drugs failed due to the limits being either above 110% (TP 2) or below 90% (TP 3). Two of them (TP 1 and TP 2) had osmolality of 313 and 262 mOsm respectively, which did not comply with the osmolality limits within 300 mOsm (+ 10%). The pH of all the formulations ranged between 4.7 and 5.9, and the mean drop size was 30.23 +/- 6.03 uL. The total amount of drug volume in the bottles varied from 2.58 +/- 0.15 to 3.38 +/- 0.06 mL/bottle., CONCLUSION: There are wide variations in the physical properties of generic formulations available in India. Although some generic drugs are compliant with the pharmacopeia standards, this study underscores the need for a better quality control in the production of generic travoprost formulations. How to cite this article: Wadhwani M, Mishra SK, Angmo D, Velpandian T, Sihota R, Kotnala A, Bhartiya S, Dada T. Evaluation of Physical Properties of Generic and Branded Travoprost Formulations. J Curr Glaucoma Pract. 2016;10(2):49-55.

Indications and Visual Outcome of Penetrating Keratoplasty in Tertiary Eye Care Institute in Uttarakhand. - Raj, Anuradha; Gupta, Neeti; Dhasmana, Renu; Nagpal, Ramesh Chander; Bahadur, Harsh; Maitreya, Amit (Journal of clinical and diagnostic research : JCDR, 2016)
INTRODUCTION: Corneal blindness forms significant proportion of visual blindness in developing countries and penetrating keratoplasty (PK) can restore vision for this. The prognosis of PK is dependent on the corneal diseases responsible for corneal blindness., AIM: To evaluate the indications and visual outcome of PK in tertiary eye care institute in Uttarakhand., MATERIALS AND METHODS: Data was reviewed from the medical records of 145 PK done in Department of Ophthalmology, Himalayan Institute of Medical Sciences from January 2012 to October 2014. Analysis of data was done for evaluation of the indications and visual outcome by Paired student's t-test for hypothesis testing of grouped values of preoperative and last follow-up best corrected visual acuity in cases of optical and therapeutic grafts. A p-value < 0.05 was considered statistically significant., RESULTS: In this study data of 145 eyes of 138 patients was reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma 48 (33.10%). Therapeutic keratoplasty was done for 33 cases with maximum 30(20.68%) cases of infectious keratitis. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (p=.0001) in best corrected visual acuity improvement from 1.39 logMAR+ 0.022(SD) preoperatively to 0.367 logMAR+0.44(SD) postoperatively and 1.4 logMAR+.000(SD) preoperatively to 0.16 logMAR+0.57(SD) postoperatively for optical and therapeutic grafts respectively., CONCLUSION: Infective keratitis either active or healed was the major indication for keratoplasty. Poor prognosis indications were most common in this part of the country. The visual outcome following corneal transplantation was encouraging particularly in cases of optical keratoplasty.

Prospective Observational Post-marketing Study of Tafluprost 0.0015%/Timolol 0.5% Combination Ophthalmic Solution for Glaucoma and Ocular Hypertension: Short-Term Efficacy and Safety. - Takagi, Yasutaka; Osaki, Hirotaka; Yamashita, Tomohiro; Kai, Yasuhiko (Ophthalmology and therapy, 2016)
INTRODUCTION: The intraocular pressure (IOP)-lowering effect and safety of tafluprost 0.0015%/timolol maleate 0.5% combination ophthalmic solution (Taf-TFC) were investigated in a real-world clinical setting., METHODS: A prospective up to 2-year (more than 1 year) observational study has been initiated to collect data on the IOP, conjunctival hyperemia score, corneal staining score, and adverse events suffered by patients with glaucoma or ocular hypertension treated at 3 months, and up to 2 years (more than 1 year) after initiating treatment with Taf-TFC. The 3-month findings are reported here., RESULTS: Among 439 patients enrolled at 100 institutions in Japan, most had normal tension glaucoma (45.3%) or primary open angle glaucoma (36.0%). Adverse drug reaction (ADR) occurred in 5.01%. The important ADRs were conjunctival hyperemia (five patients), blepharitis (four patients), and punctate keratitis (two patients). Serious adverse reactions occurred in two patients (three events). In 410 patients with data both before and after treatment, baseline mean IOP was 17.5 +/- 5.0 mmHg, and it was significantly decreased after 1, 2, and 3 months (all P < 0.05, paired-t test). IOP was significantly reduced in patients switched to Taf-TFC from either prostaglandin or beta-blocker monotherapy. IOP also decreased significantly in patients switched from a prostaglandin/timolol fixed combination, but not in patients switched from concomitant use of a prostaglandin analog and a beta-blocker. The use of Taf-TFC did not worsen the adherence in most patients., CONCLUSION: Taf-TFC significantly reduced the IOP in patients with glaucoma or ocular hypertension treated in daily clinical practice with controllable or recoverable ADRs in short period. Taf-TFC was effective regardless of treatment patterns, and particularly, Taf-TFC significantly reduced IOP in cases in which requiring the second line therapy as insufficient of monotherapy., FUNDING: Santen Pharmaceutical Co., Ltd., Osaka, Japan.

Advanced drug delivery and targeting technologies for the ocular diseases. - Barar, Jaleh; Aghanejad, Ayuob; Fathi, Marziyeh; Omidi, Yadollah (BioImpacts : BI, 2016)
INTRODUCTION: Ocular targeted therapy has enormously been advanced by implementation of new methods of drug delivery and targeting using implantable drug delivery systems (DDSs) or devices (DDDs), stimuli-responsive advanced biomaterials, multimodal nanomedicines, cell therapy modalities and medical bioMEMs. These technologies tackle several ocular diseases such as inflammation-based diseases (e.g., scleritis, keratitis, uveitis, iritis, conjunctivitis, chorioretinitis, choroiditis, retinitis, retinochoroiditis), ocular hypertension and neuropathy, age-related macular degeneration and mucopolysaccharidosis (MPS) due to accumulation of glycosaminoglycans (GAGs). Such therapies appear to provide ultimate treatments, even though much more effective, yet biocompatible, noninvasive therapies are needed to control some disabling ocular diseases/disorders., METHODS: In the current study, we have reviewed and discussed recent advancements on ocular targeted therapies., RESULTS: On the ground that the pharmacokinetic and pharmacodynamic analyses of ophthalmic drugs need special techniques, most of ocular DDSs/devices developments have been designed to localized therapy within the eye. Application of advanced DDSs such as Subconjunctival insert/implants (e.g., latanoprost implant, Gamunex-C), episcleral implant (e.g., LX201), cationic emulsions (e.g., Cationorm TM, Vekacia TM, Cyclokat TM), intac/punctal plug DDSs (latanoprost punctal plug delivery system, L-PPDS), and intravitreal implants (I-vitaion TM, NT-501, NT- 503, MicroPump, Thethadur, IB-20089 Verisome TM, Cortiject, DE-102, Retisert TM, Iluvein TM and Ozurdex TM) have significantly improved the treatment of ocular diseases. However, most of these DDSs/devices are applied invasively and even need surgical procedures. Of these, use of de novo technologies such as advanced stimuli-responsive nanomaterials, multimodal nanosystems (NSs)/nanoconjugates (NCs), biomacromolecualr scaffolds, and bioengineered cell therapies need to be further advanced to get better compliance and higher clinical impacts., CONCLUSION: Despite mankind successful battle on ocular diseases, our challenge will continue to battle the ocular disease that happen with aging. Yet, we need to understand the molecular aspects of eye diseases in a holistic way and develop ultimate treatment protocols preferably as non-invasive systems.

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY): impact of an eye health education program on patient knowledge about glaucoma and attitudes about eye care. - Rhodes, Lindsay A; Huisingh, Carrie E; McGwin, Gerald Jr; Mennemeyer, Stephen T; Bregantini, Mary; Patel, Nita; Saaddine, Jinan; Crews, John E; Girkin, Christopher A; Owsley, Cynthia (Patient related outcome measures, 2016)
PURPOSE: To assess the impact of the education program of the Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) telemedicine program on at-risk patients' knowledge about glaucoma and attitudes about eye care as well as to assess patient satisfaction with EQUALITY., PATIENTS AND METHODS: New or existing patients presenting for a comprehensive eye exam (CEE) at one of two retail-based primary eye clinics were enrolled based on >=1 of the following at-risk criteria for glaucoma: African Americans >=40 years of age, Whites >=50 years of age, diabetes, family history of glaucoma, and/or preexisting diagnosis of glaucoma. A total of 651 patients were enrolled. A questionnaire was administered prior to the patients' CEE and prior to the patients receiving any of the evidence-based eye health education program; a follow-up questionnaire was administered 2-4 weeks later by phone. Baseline and follow-up patient responses regarding knowledge about glaucoma and attitudes about eye care were compared using McNemar's test. Logistic regression models were used to assess the association of patient-level characteristics with improvement in knowledge and attitudes. Overall patient satisfaction was summarized., RESULTS: At follow-up, all patient responses in the knowledge and attitude domains significantly improved from baseline (P<=0.01 for all questions). Those who were unemployed (odds ratio =0.63, 95% confidence interval =0.42-0.95, P=0.026) or had lower education (odds ratio =0.55, 95% confidence interval =0.29-1.02, P=0.058) were less likely to improve their knowledge after adjusting for age, sex, race, and prior glaucoma diagnosis. This association was attenuated after further adjustment for other patient-level characteristics. Ninety-eight percent (n=501) of patients reported being likely to have a CEE within the next 2 years, whereas 63% (n=326) had a CEE in the previous 2 years. Patient satisfaction with EQUALITY was high (99%)., CONCLUSION: Improved knowledge about glaucoma and a high intent to pursue eye care may lead to improved detection of early disease, thus lowering the risk of blindness.

Feasibility study of sustained-release travoprost punctum plug for intraocular pressure reduction in an Asian population. - Perera, Shamira A; Ting, Daniel Sw; Nongpiur, Monisha E; Chew, Paul T; Aquino, Maria Cecilia D; Sng, Chelvin Ca; Ho, Sue-Wei; Aung, Tin (Clinical ophthalmology (Auckland, N.Z.), 2016)
PURPOSE: To investigate the efficacy and safety of a punctum plug-based sustained drug release system for a prostaglandin analog, travoprost (OTX-TP), for intraocular pressure (IOP) reduction in an Asian population., METHODS: This is an initial feasibility, prospective, single-arm study involving 26 eyes and a bioresorbable punctum plug containing OTX-TP. An OTX-TP was placed in the vertical portion of the superior or inferior canaliculus of patients with primary open-angle glaucoma or ocular hypertension. The main outcome measure was the IOP-lowering efficacy of OTX-TP at 3 (8 am) and 10, 20, and 30 days (8 am, 10 am, and 4 pm), compared to baseline., RESULTS: A total of 26 OTX-TP were inserted for 17 subjects. The mean (standard deviation) age was 57.2 (13.8) years. At 10 days, all plugs were still present, and the IOP reduction from baseline was 6.2 (23%), 5.4 (21%), and 7.5 mmHg (28%) at 8 am, 10 am, and 4 pm, respectively. At 10 days, the mean IOP (standard error of mean) was 21.2 (1.2), 20.4 (0.8), and 19.7 (1.0) at 8 am, 10 am, and 4 pm, respectively, showing no discernible IOP trend during the course of the day. At 30 days, plug retention had declined to 42%, and the overall IOP reduction had decreased to 16%., CONCLUSION: The sustained-release OTX-TP is able to reduce IOP by 24% (day 10) and 15.6% (day 30), respectively. It is a potentially well-tolerable ocular hypotensive for glaucoma patients with a history of poor compliance.

Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence: an update in 2015. - Newman-Casey, Paula Anne; Dayno, Megan; Robin, Alan L (Expert review of ophthalmology, 2016)
PURPOSE: To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence., METHODS: A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015., RESULTS: Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size.., CONCLUSION: The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma.

A combined analysis of four observational studies evaluating the intraocular pressure-lowering ability and tolerability of bimatoprost 0.01% in patients with primary open-angle glaucoma or ocular hypertension. - Stevens, Annemie; Iliev, Milko E; de Jong, Leo; Grobeiu, Ioana; Hommer, Anton (Clinical ophthalmology (Auckland, N.Z.), 2016)
OBJECTIVE: Combine and evaluate data from four clinical practice studies investigating the intraocular pressure (IOP)-lowering ability, tolerability of and patient adherence to bimatoprost 0.01% therapy in patients with primary open-angle glaucoma or ocular hypertension., METHODS: Data were combined from four multicenter, prospective, observational studies. Patients (n=2,593) were recruited from 328 sites in Austria, Belgium, Switzerland, and the Netherlands. Assessments were at study entry (baseline) and after 10-14 weeks., RESULTS: Bimatoprost 0.01% lowered mean IOP by 5.0 mmHg from baseline to final visit (P<0.0001). Individual IOP goals were achieved in 75.5% of patients. Results were similar in right and left eyes; right-eye data are presented here for brevity. The greatest mean IOP reduction was 6.7+/-4.7 mmHg (28.8% reduction from baseline to final visit, P<0.0001) in treatment-naive patients. Switching to bimatoprost 0.01% monotherapy from previous monotherapy reduced mean IOP by a further 3.2+/-3.6 mmHg (17.2%, P<0.0001). Switching to bimatoprost 0.01% from previous prostaglandin monotherapy reduced mean IOP by 2.9+/-3.5 mmHg (15.5%), including by 3.1+/-3.4 mmHg (15.8%) and 3.3+/-4.1 mmHg (16.9%) for previous latanoprost and travoprost treatment, respectively (all P<0.0001). IOP reduction in patients previously treated with a fixed combination was 2.7+/-4.0 mmHg (14.2%, P<0.0001). The most commonly reported adverse events were conjunctival hyperemia (5.2%) and eye irritation (4.7%). Tolerability was rated as "very good" or "good" by 90.1% of patients. Adherence was rated by physicians as "better than" or "equal to" previous treatment in 97.2% of patients., CONCLUSION: The combined studies demonstrated in a clinical practice setting, bimatoprost 0.01% lowered IOP effectively in treatment-naive and previously treated ocular hypertension and primary open-angle glaucoma patients, and was associated with good tolerability and patient adherence over 12 weeks.

Omega-3 fatty acid supplementation improves dry eye symptoms in patients with glaucoma: results of a prospective multicenter study. - Tellez-Vazquez, Jesus (Clinical ophthalmology (Auckland, N.Z.), 2016)
PURPOSE: The purpose of this study is to assess the effectiveness and tolerability of a dietary supplement with a combination of omega-3 fatty acids and antioxidants on dry eye symptoms caused by chronic instillation of antihypertensive eye drops in patients with glaucoma., PATIENTS AND METHODS: A total of 1,255 patients with glaucoma and dry eye symptoms related to antiglaucoma topical medication participated in an open-label, uncontrolled, prospective, and multicenter study and were instructed to take three capsules a day of the nutraceutical formulation (Brudypio( R) 1.5 g) for 12 weeks. Dry eye symptoms (graded as 0-3 [none to severe, respectively]), conjunctival hyperemia, tear breakup time, Schirmer I test, Oxford grading scheme, and intraocular pressure were assessed., RESULTS: After 12 weeks of administration of the dietary supplement, all dry eye symptoms improved significantly (P<0.001) (mean 1.3 vs 0.6 for scratching, 1.4 vs 0.7 for stinging sensation, 1.6 vs 0.7 for grittiness, 1.0 vs 0.4 for tired eyes, 1.1 vs 0.5 for grating sensation, and 0.8 vs 0.3 for blurry vision). The Schirmer test scores and the tear breakup time also increased significantly. There was an increase in the percentage of patients grading 0-I in the Oxford scale and a decrease in those grading IV-V. Compliance was recorded in 62.5% of patients. In compliant patients, the mean differences at 12 weeks vs baseline of dry eye symptoms were statistically significant as compared to noncompliant patients., CONCLUSION: Dietary supplementation with Brudypio( R) may be a clinically valuable additional option for the treatment of dry eye syndrome in patients with glaucoma using antiglaucoma eye drops. These results require confirmation with an appropriately designed randomized controlled study.

Teleophthalmology: improving patient outcomes?. - Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu (Clinical ophthalmology (Auckland, N.Z.), 2016)
Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes.

Electronic medical record and glaucoma medications: connecting the medication reconciliation with adherence. - Bacon, Thomas S; Fan, Kenneth C; Desai, Manishi A (Clinical ophthalmology (Auckland, N.Z.), 2016)
PURPOSE: To evaluate consistency in documentation of glaucoma medications in the electronic medical record and identify which regimen patients adhere to when inconsistencies exist. Factors contributing to medication nonadherence are also explored., METHODS: Retrospective chart review of medication adherence encompassing 200 patients from three glaucoma physicians at a tertiary referral center over a 1-month period. Adherence was determined by the consistency between a patients stated medication regimen and either the active medication list in the electronic medical record, or the physicians planned medication regimen in the preceding clinic visit. Patient charts were also reviewed for patient sex, age, primary language, race, and total number of medications., RESULTS: A total of 160 charts showed consistency in documentation between the physician note and electronic medication reconciliation. Of those patients, 83.1% reported adherence with their glaucoma medication schedule. When there was a discrepancy in documentation (40 charts), 72.5% patients followed the physician-stated regimen vs 20% who followed neither vs 7.5% who followed the medical record (P<0.01). No difference in adherence was observed based on sex (P=0.912) or total number of medications taken (P=0.242). Language, both English- (P=0.075) and Haitian (P=0.10) -speaking populations, as well as race, Caucasian (P=0.31), African-American (P=0.54), and Hispanic (P=0.58), had no impact on medication adherence. Patients over 80 years of age were more nonadherent as compared to other decades (P=0.04)., CONCLUSION: Inconsistent documentation between the electronic medical record physician note and medication regimen may contribute to patient medication nonadherence. Patients over 80 years of age were associated with higher rates of nonadherence, while sex, total number of medications, race, and language had no interaction with medication adherence.

Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic. - Fudemberg, Scott J; Lee, Brian; Waisbourd, Michael; Murphy, Rachel A; Dai, Yang; Leiby, Benjamin E; Hark, Lisa A (Patient preference and adherence, 2016)
PURPOSE: To determine the rate of adherence to follow-up appointment recommendations in a resident glaucoma clinic with no mechanism for reminders, compared to a resident cataract and primary eye care (CPEC) clinic in which telephone reminders were used, and to identify factors that contribute to adherence in each patient group., METHODS: This retrospective cohort study included subjects in the CPEC clinic who received telephone reminders and those in the glaucoma clinic who did not. Each sample was selected to have a similar proportion of follow-up recommendations for 1, 3, and 6 months. Subjects were considered adherent if they returned within a specified timeframe., RESULTS: A total of 144 subjects from the glaucoma clinic and 151 subjects from the CPEC clinic were included. There was no significant difference between follow-up adherence rates of patients who received telephone reminders and those who did not (odds ratio [OR] =1.35, 95% confidence interval [CI] 0.79-2.32, P=0.28). Patients who were on more than two ocular medications were more likely to return for follow-up (OR=3.11, 95% CI 1.53-6.35, P=0.0018). Subjects between the ages 50 and 80 years were more likely to be adherent compared to their younger and older peers (P=0.02)., CONCLUSION: The follow-up adherence of patients in a CPEC clinic who received telephone reminders was similar to patients in a glaucoma clinic who did not receive any intervention to increase their adherence. Younger (50 years old) and elderly (80 years old) subjects, as well as patients using less than two glaucoma medications, were less likely to adhere to their follow-up appointments.

Diagnostic accuracy of the iCare rebound tonometer compared to the Perkins applanation tonometer in assessing intraocular pressure in rural patients. - Li, Yifan; Carpenter, Christopher R; Nicholson, Kathryn; Milne, William Ken (Diagnosis (Berlin, Germany), 2015)
BACKGROUND: Vision health is recognized as a critical unmet need in North America. The ocular morbidity associated with glaucoma results from increased intraocular pressure (IOP) and early detection is crucial for the management of glaucoma. Our objective was to find a diagnostically accurate screening tool for intraocular hypertension that can be used in rural communities. We sought to validate the diagnostic accuracy of the iCare rebound tonometer against the gold standard Perkins applanation tonometer (PAT) in measuring IOP., METHODS: Patients from two rural communities in Ontario, Canada visiting their optometrists for routine appointments had their IOP measured by a non-contact tonometer (NCT), an iCare rebound tonometer, and a Perkins applanation tonometer (PAT). Values of sensitivity, specificity, and likelihood ratios for a positive and negative result were calculated for the iCare and the NCT., RESULTS: Complete data was collected from 209 patients. Overall, the iCare tonometer had high levels of validity, as compared to the gold standard PAT. The iCare tonometer displayed excellent sensitivity of 98.3% (90-99%, 95% CI) and excellent negative likelihood ratio of 0.024 (0.0088-0.066, 95% CI) which is useful for ruling out intraocular hypertension., CONCLUSIONS: The iCare tonometer is a reasonably valid tool for detecting elevated IOP. Its ease of use, simplicity, and accessibility makes it a good screening tool to improve eye health in rural areas.

National centers of excellence in glaucoma. - Cornel, Stefan; Mihaela, Timaru Cristina; Adriana, Iliescu Daniela; Speranta, Schmitzer; Algerino, De Simone; Mehdi, Batras; Jalaladin, Hosseini-Ramhormozi (Romanian journal of ophthalmology, 2015)
Glaucoma refers to a group of related eye disorders that have in common an optic neuropathy associated with visual function loss. It is the second leading cause of blindness in developed countries and Romania and the first cause of irreversible blindness worldwide. In Europe, 2% of the population over 40 and 7% of the population over 80 have glaucoma. In Romania, there are no official statistics concerning glaucoma disease, but it was estimated that over 160000 Romanians suffer from this disease and only 50% of them are undergoing treatment. The silent evolution of the disease, the deficient sanitary education, the lack of well structured national programs for screening and follow-up and the lack of adherence to treatment and check-ups, are the causes of late diagnosis and irreversible visual function loss. The article emphasizes the need for national centers specialized in managing patients with glaucoma, from prevention, screening, early diagnosis to treatment and monitoring.

Long-term visual outcome of congenital cataract at a Tertiary Referral Center from 2004 to 2014. - Rajavi, Zhale; Mokhtari, Sara; Sabbaghi, Hamideh; Yaseri, Mehdi (Journal of current ophthalmology, 2015)
PURPOSE: To assess the long-term visual acuity (VA) outcome after congenital cataract surgery at Imam Hossein Medical Center (Tertiary Referral Center) (2004-2014)., METHODS: In this descriptive study, records of 120 patients with a history of congenital cataract surgery were studied. Those with traumatic, metabolic cataract, aged <5 years at the last visit who were not able to respond VA testing accurately and follow-up < 6 months were excluded. Cases with incomplete files were recalled and reexamined. Finally, the records of 42 patients (71 eyes) were included., RESULTS: In this study, 20 males and 22 females with a mean age of 11.80 +/- 6 years at their last visit were studied. Bilateral and unilateral cataract was seen in 69% and 31% of cases, respectively. Posterior and anterior subcapsular opacity was the most common (53.70%) and rarest (1.90%) type of congenital cataract, respectively. The mean age at the time of operation and surgical interval was 65 +/- 66.6 (range: 1-200) and 12.9 +/- 23.5 (range: 0-96) months, respectively. The most common method of refractive error correction was pseudophakia plus glasses (56.3%) with the mean best corrected visual acuity (BCVA) of 0.29 +/- 0.28 LogMAR., The mean BCVA was 0.7 +/- 0.53 LogMAR for aphakic patients correcting by glasses. In our study, amblyopia (56%), glaucoma (23.90%), and posterior capsular opacity (16.40%) were observed during their follow-ups on an average of 76 +/- 65 months (median: 60, range: 6-240). Unilateral cataract, aphakia, nystagmus, female gender, and strabismus were risk factors of VA loss., CONCLUSION: Based on our results, 56% of cases showed amblyopia. It could be due to late operation (especially in unilateral cases), longer surgical interval between two eyes, and no compliance of amblyopia therapy. Early detection through screening may reduce the rate of amblyopia. Refractive errors, visual acuity, amblyopia, glaucoma, posterior capsular opacity, and compliance of amblyopia therapy should be checked regularly at follow-up visits.

How 'Drug Aware' are our Glaucoma Patients?. - Mohindroo, Chirayu; Ichhpujani, Parul; Kumar, Suresh (Journal of current glaucoma practice, 2015)
BACKGROUND: Poor knowledge, attitude and self-care practices (KAP) as regards medication compliance is a major concern in the management of glaucoma. This study aims to evaluate the knowledge, attitude regarding eyedrop instillation and self-care practices pertaining to eyedrops in diagnosed glaucoma patients., METHODS: In this cross-sectional, open-ended questionnaire-based study, 101 consecutive glaucoma patients on medication were recruited from an urban tertiary care hospital of North India. A self-designed 10-point KAP questionnaire that addressed patient-, medication-, environment- and physicians related factors was used. For each desirable answer, the participant gives a score of 1 was given and for each undesirable answer a score of '0' was given for each question. The total scores for each domain were calculated separately along with the total score. The association between the individual domain scores, the total score and various sociodemographic parameters were compared using unpaired t-test. Analysis of variance (ANOVA) test was used to compare the means, where the exposure variable had more than two categories., RESULTS: Out of 101 participants, 98% knew the reason why they were instilling the medicine. Only 61.4% subjects knew that the eyedrops should be stored in cool and dry place. Nearly 30% participants believed that two eyedrops could be instilled back to back. Half of the participants (55.4%) did not consider missing a dose of medicine to be significant. Majority (89.1%) of the participants asked the doctor about the drug dosage and timings and 71.3% of them did not use the eyedrops beyond 40 days after opening the vial. 37.6% participants believed that the medicine could be discontinued without asking the doctor, once the symptoms are relieved. Eighty percent patients checked the vial for correct drug name and expiry date before buying. 57.4% of the participants washed their hands before instilling the eyedrops. Only 23.8% patients asked their doctor for alternate medication name, in case they do not get the primary medication. There were no statistically significant differences in the mean domain and total scores between males and females and between urban and rural patients. There were no statistically significant differences in knowledge (p = 0.059) and attitude (p = 0.809) scores in people with different educational qualification. But education had a statistically significant relation with the practice scores (p = 0.004) and total scores (p = 0.047)., CONCLUSION(S): There exists marked variation in the reported practices, even in the very basic prerequisites of instilling eye-drops like washing of hands, checking the expiry date before the usage of eyedrops. The findings in our study suggest a need to better educate our patients by providing them detailed information about eyedrop and its administration. This would help to reduce patients' frustration, improve compliance and increase the efficacy of anti-glaucoma therapy. How to cite this article: Mohindroo C, Ichhpujani P, Kumar S. How 'Drug Aware' are our Glaucoma Patients? J Curr Glaucoma Pract 2015;9(2):33-37.

Strategies to Improve Glaucoma Compliance Based on Cross-Sectional Response-Based Data in a Tertiary Healthcare Center: The Glauco-Jung Study. - Gupta, Vishnu S; Sethi, Harindersingh; Naik, Mayuresh (Journal of current glaucoma practice, 2015)
PURPOSE: To elucidate compliance rates among glaucoma patients in a tertiary healthcare center, reasons for noncompliance and response-based-solutions to improve compl iance in the same cohort., MATERIALS AND METHODS: In the Glauco-Jung study, a cross-sectional descriptive epidemiological one, information was obtained from 500 patients from 1st January, 2014 to 30th June, 2014. Patients were intercepted at entry point where they get their intraocular pressure (IOP) checked, wherein they were asked to fill an exhaustive questionnaire. At the same setting, they were also asked to demonstrate how they (or their relatives or helpers) instill eyedrops, following which any irregularities were brought to notice and corrected. Finally, they were also asked any suggestions to improve compliance to medications. Noncompliance rates were determined based on the number of patients who did not instill anti-glaucoma medications as per prescribed dosage or frequency schedule. Noncompliance rates were then evaluated by the Chi-square test for any association with distributions based on various parameters., RESULTS: In case of a positive association, correlation coefficient was further calculated to know the strength of this association. No association was observed in distributions based on diet, associated co-morbidities, daily dosage frequency and side-effects experienced by patients. Positive association was noted in distributions based on age, sex, duration of treatment, social structure and number of medications (p < 0.05); but correlation coefficients were very weak (c < 0.3). Cost of medications not only had positive association but also had a very strong correlation coefficient (c = 0.9188), proving that cost of medications had a modest bearing on compliance rates., CONCLUSION: The Glauco-Jung study concluded that besides availability of medications at reasonable cost, simplification of treatment regimen and interactive health education appear to be the most important factors for improving compliance so that patients do not feel guilty or inadequate because they have problems while administering their eyedrops. How to cite this article: Gupta VS, Sethi H, Naik M. Strategies to Improve Glaucoma Compliance Based on Cross-Sectional Response-Based Data in a Tertiary Healthcare Center: The Glauco-Jung Study. J Curr Glaucoma Pract 2015;9(2):38-46.

Primary Open-Angle Glaucoma in Individuals of African Descent: A Review of Risk Factors. - Salowe, Rebecca; Salinas, Julia; Farbman, Neil H; Mohammed, Aishat; Warren, Joshua Z; Rhodes, Allison; Brucker, Alexander; Regina, Meredith; Miller-Ellis, Eydie; Sankar, Prithvi S; Lehman, Amanda; O'Brien, Joan M (Journal of clinical & experimental ophthalmology, 2015)
OBJECTIVE: To identify the major risk factors for primary open-angle glaucoma (POAG) in individuals of African descent., METHODS: We searched PubMed for relevant articles, with results spanning April 1947 to present. All abstracts were reviewed and, where relevant to POAG and race, articles were catalogued and analyzed. Additional sources were identified through citations in articles returned by our search., RESULTS: Numerous potential POAG risk factors were identified and organized into categories by demographics (age, sex, and skin color), lifestyle choices (smoking, alcohol), comorbidities (hypertension, diabetes, and obesity), ophthalmic findings (eye structure, central corneal thickness, corneal hysteresis, elevated intraocular pressure, myopia, cataract, and vascular abnormalities), family history, socioeconomic status, and adherence. Older age, male sex, lower central corneal thickness, decreased corneal hysteresis, elevated intraocular pressure, myopia, vascular abnormalities, and positive family history were definitively associated with increased risk of POAG., CONCLUSIONS: Individuals at greatest risk for POAG should be screened by an ophthalmologist to allow earlier detection and to slow disease progression. Further studies on the genetics of the disease will provide more insight into underlying pathologic mechanisms and could lead to improved therapeutic interventions. Continued research in urban areas with large populations of blacks is especially needed.

Brinzolamide 1%/timolol versus dorzolamide 2%/timolol in the treatment of open-angle glaucoma or ocular hypertension: prospective randomized patient-preference study. - Altafini, Romeo; Scherzer, Maria-Luise; Hubatsch, Douglas A; Frezzotti, Paolo (Clinical ophthalmology (Auckland, N.Z.), 2015)
PURPOSE: The objective of this study was to assess preference for fixed-combination brinzolamide 1%/timolol 0.5% (BTFC) versus fixed-combination dorzolamide 2%/timolol 0.5% (DTFC) in patients with open-angle glaucoma or ocular hypertension., METHODS: In this prospective, single-masked crossover study, patients were randomized 1:1 to BTFC-DTFC or DTFC-BTFC treatment sequences. Patients self-administered each medication for 7 days, with a 48-hour washout period between treatments, and rated ocular discomfort after each treatment period. Medication preferences based on ocular comfort (primary endpoint) and anticipated adherence were assessed. Safety outcomes included adverse events and intraocular pressure. Between-group differences in treatment preference and ocular discomfort scores were analyzed using chi-square and Wilcoxon-Mann-Whitney tests, respectively. Adherence, intraocular pressure, and adverse events were summarized descriptively., RESULTS: In total, 112 patients were enrolled (mean +/- SD age, 66+/-11 years), and 109 patients completed the study. Numerically, more patients in the intent-to-treat dataset preferred BTFC versus DTFC (59.3% versus 40.7%); however, this result was not statistically significant (treatment difference, 18.6%; P=0.0670). Mean ocular discomfort scores (range, 0-9) were statistically significantly lower with BTFC versus DTFC (2.6 versus 3.7; P=0.0002, Wilcoxon- Mann-Whitney test). More patients who preferred BTFC over DTFC were confident that they would adhere to their preferred medication. Treatment-related adverse events included blurred vision with BTFC and eye irritation or eye pain with DTFC., CONCLUSION: BTFC and DTFC were preferred by approximately 60% and 40% of patients, respectively, and BTFC was associated with less patient-reported ocular discomfort. Greater ocular comfort of glaucoma medications may improve treatment adherence.

Pediatric glaucoma medical therapy: who more accurately reports medication adherence, the caregiver or the child?. - Moore, Daniel B; Neustein, Rebecca F; Jones, Sarah K; Robin, Alan L; Muir, Kelly W (Clinical ophthalmology (Auckland, N.Z.), 2015)
As they grow older, most children with glaucoma must eventually face the transition to self-administering medications. We previously reported factors associated with better or worse medication adherence in children with glaucoma, using an objective, electronic monitor. Utilizing the same data set, the purpose of the current study was to determine whose report (the caregiver's or the child's) corresponded better with electronically monitored adherence. Of the 46 participants (22 girls), the mean age of children primarily responsible, and caregiver primarily responsible for medication administration was 15+/-2 and 10+/-2 years, respectively. For the children whose caregiver regularly administered the eyedrops, the caregiver's assessment of drop adherence was associated with measured adherence (P=0.012), but the child's was not (P=0.476). For the children who self-administered eyedrops, neither the child's (P=0.218) nor the caregiver's (P=0.395) assessment was associated with measured percent adherence. This study highlights potential errors when relying on self-reporting of compliance in patients and caregivers with pediatric glaucoma, particularly when the child is responsible for administering their own eyedrops. Frank discussions about the importance of medication adherence and how to improve compliance may help both the child and caregiver better communicate with the treating provider.

Clinical effectiveness of brinzolamide 1%-brimonidine 0.2% fixed combination for primary open-angle glaucoma and ocular hypertension. - Sharma, Sourabh; Trikha, Sameer; Perera, Shamira A; Aung, Tin (Clinical ophthalmology (Auckland, N.Z.), 2015)
The main first-line treatment strategy for glaucoma is to reduce intraocular pressure (IOP) by topical ocular hypotensive medications, but many patients require multiple medications for adequate IOP control. Fixed-combination therapies provide several benefits, including simplified treatment regimens, theoretical improved treatment adherence, elimination of the potential for washout of the first drug by the second, and the reduction in ocular exposure to preservatives. beta-Adrenoceptor antagonists (particularly 0.5% timolol) are the most commonly used agents in combination with other classes of drugs as fixed-combination eyedrops, but they are contraindicated in many patients, owing to local allergy or systemic side effects. A fixed-combination preparation without a beta-blocker is therefore warranted. This paper reviews the clinical effectiveness of brinzolamide 1% and brimonidine 0.2% fixed combination (BBFC) for use in patients with primary open-angle glaucoma and ocular hypertension. We searched PubMed and the ClinicalTrials.gov registry, and identified three randomized controlled trials comparing BBFC vs its constituents (brimonidine vs brinzolamide), and one comparing BBFC with unfixed brimonidine and brinzolamide. All of the studies demonstrated mean diurnal IOP to be statistically significantly lower in the BBFC group compared with constituent groups and noninferior to that with the concomitant group using two separate bottles. The safety profile of BBFC was consistent with that of its individual components, the most common ocular adverse events being ocular hyperemia, visual disturbances, and ocular allergic reactions. Common systemic adverse effects included altered taste sensation, oral dryness, fatigue, somnolence, and decreased alertness. BBFC seems to be a promising new fixed combination for use in glaucoma patients. However, long-term effects of BBFC on IOP, treatment adherence, and safety need to be determined.

Health coaching for glaucoma care: a pilot study using mixed methods. - Vin, Anita; Schneider, Suzanne; Muir, Kelly W; Rosdahl, Jullia A (Clinical ophthalmology (Auckland, N.Z.), 2015)
INTRODUCTION: Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care., METHODS: A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study., RESULTS: Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects' qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members., CONCLUSION: Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health.

Implementation of a vision-screening program in rural northeastern United States. - Tsui, Edmund; Siedlecki, Andrew N; Deng, Jie; Pollard, Margaret C; Cha, Sandolsam; Pepin, Susan M; Salcone, Erin M (Clinical ophthalmology (Auckland, N.Z.), 2015)
BACKGROUND: Rural populations comprise almost 20% of the US population and face unique barriers in receiving health care. We describe the implementation of a medical student-run free vision-screening clinic as a strategy to overcome barriers in accessing eye care in New Hampshire and Vermont., METHODS: Medical students were trained by an ophthalmologist to administer screening eye examinations. Patients from New Hampshire and Vermont were enrolled through a free community clinic. Screening included a questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, level of education, and diagnoses were recorded and analyzed., RESULTS: Of 103 patients (mean age of 45.5+/-12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmologic examination findings were observed in 58/66 (88%) patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal diseases (8%), amblyopia (8%), cataract (6%), others (6%), and normal examination (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancellation of appointment, work conflicts, or forgetfulness. Patients traveled a mean distance of 16.6 miles (range: 0-50 miles) to attend screening examinations. Mean time for patients' last effort to seek eye care was 7.1 years (range: 1-54 years)., CONCLUSION: This study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, it demonstrates that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting.

Specifying active components of educational interventions to promote adherence to treatment in glaucoma patients: application of a taxonomy of behavior change techniques. - Berzins, Kathryn M; Gray, Trish A; Waterman, Heather; Francis, Jill J (Psychology research and behavior management, 2015)
PURPOSE: In response to recent calls for clearer specification of behavior change interventions, the purpose of this study was to apply a system of taxonomy for behavior change techniques (BCTs) to two educational interventions to improve adherence to glaucoma eye drops. Clarification of constituent BCTs will promote easy and reliable application of the interventions in clinical settings and research., METHODS: A published taxonomy of BCTs was used to code two interventions (group and individual) to increase adherence to eye drops. Intervention materials were coded by assigning a BCT label to each text unit. We noted the frequency with which each BCT occurred, compared the interventions in terms of the BCTs that were delivered, and identified whether the taxonomy was sufficient to describe the intervention components., RESULTS: The individual intervention consisted of 94 text units. Fifty-seven were identified as targeting behavior change and coded using 18 BCTs, many coded more than once. In the group intervention, 165 units of text were identified, and 125 were coded using 22 BCTs. The most frequently coded BCT was "provide information about behavior-health link" in the group intervention and "prompt barrier identification" in the individual intervention. The interventions included similar BCTs. All text units targeting behavior change were codable into BCTs., CONCLUSION: The similarity of the two interventions may have implications for the cost-effectiveness of the interventions. The taxonomy was found sufficient to describe both interventions. This level of specification can be used to ensure that precisely the same intervention that has been pilot tested is reproducible in the clinical setting and in any further research.

Natural Bioadhesive Biodegradable Nanoparticle-Based Topical Ophthalmic Formulations for Management of Glaucoma. - Ibrahim, Mohammed Mostafa; Abd-Elgawad, Abd-Elgawad Helmy; Soliman, Osama Abd-Elazeem; Jablonski, Monica M (Translational vision science & technology, 2015)
PURPOSE: We prepared and characterized topical ophthalmic formulations containing brimonidine-loaded bioadhesive cationic chitosan or anionic alginate nanoparticles (NPs) for sustained release of brimonidine as once daily regimen for management of glaucoma., METHODS: Nanoparticles were prepared using a spontaneous emulsification solvent diffusion method. Different concentrations of polymers, emulsifiers, and NPs stabilizers were used for formulation optimization. Nanoparticles were characterized regarding particle size, zeta potential, morphology, and drug content. Brimonidine-loaded NPs were incorporated into eye drops, a temperature-triggered in situ gelling system, and a preformed gel. They then were characterized regarding their pH, viscosity, uniformity of drug content, in vitro release characteristics, in vitro cytotoxicity, and in vivo intraocular pressure (IOP) lowering effects., RESULTS: Characteristics of optimized brimonidine-loaded chitosan and alginate NPs, respectively, are: particle size, 115.67 +/- 3.58 and 157.67 +/- 5.53 nm; zeta potential, +35.27 +/- 3.39 and -37.8 +/- 3.77 mV; encapsulation efficiency, 74.34% +/- 2.05% and 70.40% +/- 2.77%; drug loading, 11.81% +/- 0.67% and 13.14% +/- 0.90%; and yield, 87.91% +/- 5.92% and 76.53% +/- 3.32%. Transmission electron microscope (TEM) analyses revealed that NPs have spherical shapes with a dense core and distinct coat. Formulations possessed uniform drug content. Furthermore, pH and viscosity were compatible with the eye. Formulations showed a sustained release without any burst effect with a Higuchi non-Fickian diffusion mechanism. Cytotoxicity studies revealed that all formulations are biocompatible. Importantly, all formulations possessed a sustained IOP lowering effect compared to the marketed brimonidine tartrate eye drops., CONCLUSIONS: These formulations provide a great improvement in topical ocular brimonidine delivery. The application of a single drop is sufficient to provide extended IOP reduction, which should improve patient compliance., TRANSLATIONAL RELEVANCE: We have developed a novel biocompatible topical delivery system for brimonidine, a first line glaucoma medication. Once daily application should have positive effects on patient compliance and, therefore, preservation of vision.

Analysis of Factors Affecting Patients' Compliance to Topical Antiglaucoma Medications in Egypt as a Developing Country Model. - Abu Hussein, Nahla B; Eissa, Iman M; Abdel-Kader, Ahmed A (Journal of ophthalmology, 2015)
Purpose . To study factors affecting patients' compliance to antiglaucoma medications in Egypt where there are unique factors as a developing country. Patients and Methods. A cross-sectional descriptive study on 440 Egyptian patients with open angle glaucoma (OAG) recruited for over two years. The patients were thoroughly interviewed about their age, education level, duration of glaucoma, difficulty in instilling the drops, medication regimens, a family history of glaucoma, knowledge of the disease, and the presence of medical insurance. Results . 236 (53.6%) were noncompliant compared to 204 (46.4%) who were compliant. Females had a tendency for higher compliance (p=0.061). Patient age above 50 years and low level of education and negative family history of glaucoma were factors significantly associated with poor compliance (p < 0.0001). Polytherapy and lack of medical insurance could be contributing factors. Conclusion . Egyptian patients have a high rate of noncompliance compared to the average in literature. Great effort is needed in educating patients about the importance of medications and the risk and the prognosis of this disease. Economic factors must also be taken into consideration in developing countries with large number of poor patients. We recommend simplifying drug regimens, incorporating electronic dose monitors, and creating reminders for follow-up visits of glaucoma patients.

Cost Analysis of Commonly used Combination of Drugs in Primary Open Angle Glaucoma. - Kumbar, Shivaprasad Kalakappa; Mirje, Mrutyunjay; Moharir, Gurudatta; Bharatha, Ambadasu (Journal of clinical and diagnostic research : JCDR, 2015)
BACKGROUND: Glaucoma is second cause of blindness in the world. The financial burden on the patient during long-term treatment is immense and affects the compliance to medications, thus visual morbidity., OBJECTIVE: To analyse economic impact of three commonly used drug combinations (Dorzolamide + Timolol = DT; Brimonidine + Timolol = BT; Latanoprost+Timolol = LT) in primary open angle glaucoma., MATERIALS AND METHODS: This observational, prospective study was undertaken at M & J Institute of Ophthalmology, Civil Hospital, Ahmedabad, a western regional institute of Ophthalmology. A total of 257 patients were included in the study. Only101 patients could complete the 6 month follow-up, of which 35, 34 and 32 patients belonged to DT, BT and LT group respectively. Cost of drug, details of the transportation were noted at every visit. Total cost incurred per patient/eye was calculated. Cost effectiveness was calculated by cost per mm Hg IOP (Intra-Ocular Pressure) reduction., RESULTS: Treatment with DT, BT & LT group consumed 8.6%, 4.6% and 7.7% of the per annum income of the family, respectively. Cost of medications per annum (in INR)/eye for DT, BT & LT group were 2562 +/- 15.74, 1544 +/- 32.06, 3876 +/- 73.68 (Mean+/-SEM) respectively. Additional cost of travelling was different for patients coming from Ahmedabad (Locals) and outsiders (patients coming outside Ahmedabad, India). Outsiders has to bear the brunt of higher transport charges, where they spent an average of Rs. 914, 856 & 933 per annum (5 follow-ups), whereas, Locals spent an average of Rs. 104, 112, 100 for DT, BT & LT group respectively., CONCLUSION: Treatment with BT was found to be most cost-effective among three groups. Drug therapy takes substantial amount from per annum income of family and was an important compliance factor in the treatment of POAG.

Trends in Glaucoma Medication Expenditures under Universal Health Coverage: A National Population-Based Longitudinal Survey in Taiwan. - Chiu, Shin-Lin; Chu, Chiao-Lee; Muo, Chih-Hsin; Chen, Chiu-Liang; Lan, Shou-Jen (Journal of ophthalmology, 2015)
Medical care in Taiwan is well known for its low cost, high efficiency, high quality, excellent medical accessibility, and high equity. We investigate the trends in medication expenditures for glaucoma from 1997 to 2010. The results show that higher medical expenditures were incurred by patients who were aged >=40 years, male patients, and patients in the highest salary population whereas lower medical expenditures were incurred by blue-collar workers. The medications with the most significant increases in expenditure were prostaglandin analogs (PGAs), alpha-agonists, and fixed combinations, whereas the medications with the most significant decreases in expenditure were beta-blockers and cholinergic agonists. The number of trabeculectomies shows two downward break points in 1999 and 2000 when PGAs were listed and were reimbursed. These results suggest socioeconomic disparities in glaucoma care, as well as understanding of the changes in the expenditure of glaucoma medications under such universal health insurance coverage system.

The eye drop chart: a pilot study for improving administration of and compliance with topical treatments in glaucoma patients. - McVeigh, Katherine Anne; Vakros, Georgios (Clinical ophthalmology (Auckland, N.Z.), 2015)
AIM: In order to improve patient education, compliance, and administration of eye drops prescribed for patients suffering with glaucoma within a UK ophthalmology department, an eye drop chart (EDC) was designed, developed, and piloted with patients attending the glaucoma clinic over 1 month., METHODS: A cross-sectional prospective pilot study of 25 patients using an administration aid and a self-reported questionnaire. Chi-square tests were used to compare responses pre- and postintervention., RESULTS: Results demonstrated an impressive improvement in nine of eleven categories assessed regarding drop administration and compliance. Patients stating that they always wash their hands increased significantly from 64% (13 participants) to 92% (23 participants) (P=0.029), and those who always shake the bottle improved from 40% (10) to 84% (21) (P=0.001). Punctal occlusion techniques improved from 44% (11) to 72% (18) (P=0.015). Finally, patients who always discarded the bottle after 28 days of use rose from 68% to 92%, though the difference was not significant (P=0.09). Only the number of drops being administered to the eye and the length of time left between the application of drops remained relatively unchanged. Sixty-four percent reported finding EDC helpful or useful, 52% had positive responses when asked if they would continue using EDC, and 88% would recommend it to a friend., CONCLUSION: Although there are limitations to the data as they are subjective, descriptive, and limited to sample size of 25, the results of this pilot study have shown promise. The EDC appears to be a cost-effective way at improving patients' use of topical ocular medications.

Patient satisfaction with glaucoma therapy: reality or myth?. - Lemij, Hans G; Hoevenaars, Juliette Gmm; van der Windt, Cees; Baudouin, Christophe (Clinical ophthalmology (Auckland, N.Z.), 2015)
While safe and effective treatments for glaucoma exist, their effectiveness is compromised by poor compliance. Patients who have problems with their topical glaucoma medication are acknowledged to be at higher risk for poor compliance, frequent medication switching, and surgery. Patient satisfaction with therapy and its associated benefits have until recently taken second place to efficacy. The present study is a transverse cross-sectional epidemiological survey among glaucoma patients receiving therapy with prostaglandin analogs. The primary objective was to determine and characterize patient satisfaction with glaucoma therapy, and the secondary objective was to identify factors that may contribute to poor patient satisfaction. Ophthalmologists in the Netherlands included 199 patients and 164 were analyzed. Patients were predominantly elderly with early, primary, open angle glaucoma. Eighty-nine percent of them stated they were satisfied or very satisfied with their treatment. However, signs of ocular surface disorder on ophthalmological examination were evident in 44% of patients, corneal fluorescein staining was positive in 28% of patients, and 38% of patients were using tear substitutes. The prevalence of blepharitis/meibomian gland dysfunction and dry eye was more than twice as high after the commencement of therapy compared with before therapy. Univariate analysis revealed that patient dissatisfaction with their glaucoma therapy was statistically significantly (P<0.001) associated with the presence of ocular surface disease, hyperemia, ocular signs, symptoms upon and between instillation, and the use of tear substitutes. Apparently, patients in the present study are satisfied with their treatment; 89% expressed satisfaction compared with only 11% who professed dissatisfaction. The results suggest that even if local adverse events and ocular surface disease, in particular, contribute to glaucoma patient dissatisfaction, only a minority of patients expressed such dissatisfaction. At the time of the study, most (94%) of the patients included were receiving preserved preparations. Further studies should evaluate the influence of preservative on patient satisfaction.

Safety and efficacy of switching from dorzolamide 1.0%/timolol maleate 0.5% eye drops to brinzolamide 1.0%/timolol maleate 0.5% eye drops. - Inoue, Kenji; Shiokawa, Minako; Ishida, Kyoko; Tomita, Goji (Clinical ophthalmology (Auckland, N.Z.), 2015)
PURPOSE: To evaluate the safety and efficacy of switching from dorzolamide 1.0%/timolol maleate 0.5% fixed-combination (DTFC) eye drops to brinzolamide 1.0%/timolol maleate 0.5% fixed-combination (BTFC) eye drops in patients with primary open-angle glaucoma or ocular hypertension., METHODS: A total of 35 eyes of 35 patients with primary open-angle glaucoma or ocular hypertension using DTFC eye drops were included. Participants discontinued DTFC drops and immediately began using BTFC drops. All other eye drops currently being used were continued. Intraocular pressure (IOP) 1 and 3 months after switching medications was compared with baseline IOP. One month after switching medications, participant preference and adherence were evaluated. Adverse reactions were monitored at each study visit., RESULTS: The IOP was 17.9+/-2.6 mmHg at baseline and 18.3+/-4.1 mmHg and 17.8+/-3.4 mmHg 1 month and 3 months after switching medications, respectively (P=0.633). The frequency of missing a dose was not different before (6.1%) and after (6.1%) switching to BTFC. Significantly fewer participants reported stinging after switching to BTFC (15.2%) than while using DTFC (51.5%, P,0.01). Blurred vision was reported with the same frequency before (39.4%) and after (42.4%) switching to BTFC. A total of 33.3% and 27.3% of patients preferred DTFC and BTFC, respectively. Several patients withdrew from the study because of discomfort (n=2, 5.7%), discharge (n=1, 2.9%), dizziness (n=1, 2.9%), or increased IOP (n=2, 5.7%)., CONCLUSION: Switching from DTFC to BTFC was well tolerated and did not result in IOP changes or a decreased patient adherence. When glaucoma patients complain of stinging with DTFC administration, switching to BTFC is an acceptable treatment option.

Assessing the adherence behavior of glaucoma patients to topical eye drops. - Welge-Lussen, Ulrich; Weise, Stefanie; Yu, Alice L (Patient preference and adherence, 2015)
PURPOSE: The goal of this study was to determine the adherence of glaucoma patients to their topical glaucoma medication. Furthermore, the relationships between the adherence behavior and the patients' demographic data, clinical characteristics, and their knowledge about glaucoma were evaluated., METHODS: This was a prospective study of 123 patients with primary open-angle glaucoma who were given two standardized questionnaires. The first questionnaire at time point T1 comprised a knowledge assessment and the self-reported adherence measures Adherence to Refills and Medication Scale 2 (ARMS2), visual analogue scale for adherence (VAS-AD), and missed doses in the past 14 days. Two months later at time point T2, a second questionnaire reevaluated the adherence measures ARMS2, VAS-AD, and missed doses in the past 14 days., RESULTS: There was a good correlation among all the three adherence measures at T1 and T2. The mean values of ARMS2 were in the lower range, with 3.38 at T1 and 2.8 at T2. The VAS-AD detected that 18.5% of patients always took their eye drops correctly, and 77.9% of patients reported not to have missed a single dose in the past 14 days. There was no significant correlation between the patients' demographic data or knowledge about glaucoma and the adherence measures ARMS2 or VAS-AD. Among the clinical characteristics, only single-eye blindness showed a significant correlation with VAS-AD., CONCLUSION: In this study, no general relationships were found between medication adherence and the patients' demographic data, clinical characteristics, or knowledge about glaucoma. It may be assumed that more individualized strategies are required to optimize adherence behavior.

Adherence, Predicting Factors and Satisfaction of Patients on Glaucoma Therapy: Findings From a Cross-Sectional Study in Korea. - Park, K H; Cha, J H (Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2014)

Medication Adherence and Discontinuation Predicted by Disease Duration in Glaucoma Patients: Findings From A Cross-Sectional Study in Korea. - Park, K H; Cha, J H (Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2014)

Screening First Degree Relatives of Persons with Primary Open Angle Glaucoma in India. - Rajendrababu, Sharmila; Gupta, Nidhi; Vijayakumar, B; Kumaragurupari, R; Krishnadas, S R (Journal of current glaucoma practice, 2014)
PURPOSE: To report the results of screening first degree relatives of persons identified with primary open angle glaucoma in a tertiary eye hospital glaucoma services., DESIGN: A cross-sectional study of first degree relatives of persons with primary open angle glaucoma., MATERIALS AND METHODS: First degree relatives of patients identified with primary open angle glaucoma were invited to participate in a screening evaluation in the base hospital to detect glaucoma. All participating individuals had comprehensive eye examination including vision screening, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, frequency doubling peri-metry and dilated fundus examination. Persons with definite and suspected glaucoma were subject to full threshold automated perimetry., RESULTS: A 514 first degree relatives of 346 persons with primary open angle glaucoma, of 4972 individuals who were invited to participate attended the screening examination (Response Rate 7%). Fifty-five percent of those who attended were males and mean age of participants was 56.8 years. Sixty-eight relatives (13.3% of those screened) were detected to have definite glaucoma. Sixty percent of those detected with definite glaucoma were siblings. Fifteen percent of siblings, 4% of off-springs and 20% of parents who attended the screening examination had definite open angle glaucoma., CONCLUSION: Prevalence of open angle glaucoma amongst first degree relatives of persons with glaucoma is higher than in the general population as reported in previous studies. Significant barriers, however, exist in the uptake of eye care services among relatives of persons known to have primary open angle glaucoma. How to cite this article: Rajendrababu S, Gupta N, Vijayakumar B, Kumaragurupari R, Krishnadas SR. Screening First Degree Relatives of Persons with Primary Open Angle Glaucoma in India. J Curr Glaucoma Pract 2014;8(3):107-112.

Wound Healing Modulation in Glaucoma Filtration Surgery-Conventional Practices and New Perspectives: The Role of Antifibrotic Agents (Part I). - Fan Gaskin, Jennifer C; Nguyen, Dan Q; Soon Ang, Ghee; O'Connor, Jeremy; Crowston, Jonathan G (Journal of current glaucoma practice, 2014)
Glaucoma filtration surgery is regularly performed for the treatment of glaucoma and trabeculectomy is often regarded as the 'gold standard' glaucoma operation. The biggest risk of failure of the operation is bleb scarring. The advent of anti-fibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5FU) has vastly prolonged the longevity of the bleb, but concerns remain regarding the potential increase in postoperative complications. More selective therapeutic targets have therefore been explored. One of these is vascular endothelial growth factor (VEGF) inhibition. Vascular endothelial growth factor inhi bition has a role not only in sub conjunctival angiogenesis inhi bition but also it has direct anti-fibrotic properties. Newer phar macological compounds and materials have also been developed in recent years in attempt to modulate the wound healing in different ways after glaucoma surgery. These include physical barriers to scarring and vehicles for sustained release of pharmacological agents, and early promising results have been demonstrated. This two-part review will provide a discussion of the application of anti-fibrotic agents in glaucoma filtration surgery and evaluate the newer agents that have been developed. How to cite this article: Fan Gaskin JC, Nguyen DQ, Ang GS, O'Connor J, Crowston JG. Wound Healing Modulation in Glaucoma Filtration Surgery-Conventional Practices and New Pers pectives: The Role of Antifibrotic Agents (Part I). J Curr Glaucoma Pract 2014;8(2):37-45.

Wound Healing Modulation in Glaucoma Filtration Surgery- Conventional Practices and New Perspectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II). - Fan Gaskin, Jennifer C; Nguyen, Dan Q; Soon Ang, Ghee; O'Connor, Jeremy; Crowston, Jonathan G (Journal of current glaucoma practice, 2014)
Glaucoma filtration surgery is regularly performed for the treatment of glaucoma and trabeculectomy is often regarded as the 'gold standard' glaucoma operation. The biggest risk of failure of the operation is bleb scarring. The advent of antifibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5FU) has vastly prolonged the longevity of the bleb, but concerns remain regarding the potential increase in postoperative complications. More selective therapeutic targets have therefore been explored. One of these is vascular endothelial growth factor (VEGF) inhibition. VEGF inhibition has a role not only in subconjunctival angiogenesis inhibition but also it has direct anti-fibrotic properties. Newer pharmacological compounds and materials have also been developed in recent years in attempt to modulate the wound healing in different ways after glaucoma surgery. These include physical barriers to scarring and vehicles for sustained release of pharmacological agents, and early promising results have been demonstrated. This two-part review will provide a discussion of the application of anti-fibrotic agents in glaucoma filtration surgery and evaluate the newer agents that have been developed. How to cite this article: Fan Gaskin JC, Nguyen DQ, Ang GS, O'Connor J, Crowston JG. Wound Healing Modulation in Glau coma Filtration Surgery-Conventional Practices and New Pers pectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II). J Curr Glaucoma Pract 2014;8(2):46-53.

Nanomedicine for glaucoma: sustained release latanoprost offers a new therapeutic option with substantial benefits over eyedrops. - Wong, Tina T; Novack, Gary D; Natarajan, Jayaganesh V; Ho, Ching Lin; Htoon, Hla M; Venkatraman, Subbu S (Drug delivery and translational research, 2014)
Glaucoma is a chronic progressive optic neuropathy that is characterized by optic nerve changes and visual field loss. Elevated intraocular pressure (IOP) is the main modifiable risk factor. Chronic instillation of daily eyedrops to lower IOP is the primary treatment of choice, although it requires patient adherence and correct performance. We have developed a nanoliposome drug delivery system for the longer term delivery of latanoprost. In the present open-label, pilot study, the safety and efficacy of a single subconjunctival injection of liposomal latanoprost was evaluated in six subjects with a diagnosis of either ocular hypertension (OHT) or primary open-angle glaucoma (POAG). Subconjunctival injection of liposomal latanoprost was well tolerated by all six subjects. From a baseline IOP of 27.55 +/- 3.25 mmHg, the mean IOP decreased within 1 h to 14.52 +/- 3.31 mmHg (range 10-18 mmHg). This represented a mean decrease of 13.03 +/- 2.88 mmHg (range 9-17 mmHg), or 47.43 +/- 10.05 % (range 37-63 %). A clinically and statistically significant IOP reduction (>=20 % IOP reduction, P = 0.001 to 0.049) was observed through 3 months after injection. The nanomedicine reported here is the first nanocarrier formulation that has an extended duration of action in humans, beyond a couple of weeks. The findings in this study open up a new treatment modality, which will greatly enhance patient compliance and improve treatment outcomes. The current study provides the evidence and support for further clinical studies of liposomal latanoprost in the treatment of glaucoma.

Novel therapies for open-angle glaucoma. - Wentz, Scott M; Kim, Nathaniel J; Wang, Jenny; Amireskandari, Annahita; Siesky, Brent; Harris, Alon (F1000prime reports, 2014)
Open-angle glaucoma is a multifactorial optic neuropathy characterized by progressive loss of retinal ganglion cells and their axons. It is an irreversible disease with no established cure. The only currently approved treatment is aimed at lowering intraocular pressure, the most significant risk factor known to date. However, it is now clear that there are other risk factors involved in glaucoma's pathophysiology. To achieve future improvements in glaucoma management, new approaches to therapies and novel targets must be developed. Such therapies may include new tissue targets for lowering intraocular pressure, molecules influencing ocular hemodynamics, and treatments providing neuroprotection of retinal ganglion cells. Furthermore, novel drug delivery systems are in development that may improve patient compliance, increase bioavailability, and decrease adverse side effects.

[Clinical Findings in Family with Aniridia due the PAX6 Mutation]. - Godavova, L; Godava, M; Sabova, J; Kolarova, G; Mohlerova, S (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 2014)
BACKGROUND: inborn isolated aniridia is rare bilateral impairment of several eye structures manifesting mainly by absence of iris, photophobia and decreased visual acuity. There are also others ocular symptoms associated with aniridia such as nystagmus, strabismus, eyelid ptosis, amblyopia, serious refractive errors, anisometropia, corneal changes, impairment of the lens, chamber angle dysgenesis, optic nerve and macular hypoplasia and congenital or secondary glaucoma. The most frequent aetiology of this eye dysgenesis is mutation in PAX6. Aim of this report is to describe ocular findings in the family with familial aniridia (MIM #106210), to debate their severity, prognosis and therapy options., MATERIAL AND METHODS: assessment of previous medical history and actual ophthalmological findings in 4 persons of 3 generation family with aniridia. According to the compliance, the patients underwent these tests: assessment of the visual acuity, intraocular pressure, refraction test, slit-lamp examination and biomicroscopy, pachymetry test and OCT examination. The genetic counselling was performed with subsequent PAX6 mutation analysis., RESULTS: all of the examined aniridia family members showed severe symptoms of the disease, the aniridia and photophobia were present. Positive age related correlation showed progressive visual acuity decrease to the practical blindness due to aniridia-associated keratopathy, secondary glaucoma and cataract. DNA analysis revealed presence of p.Gln180X PAX6 mutation in all of the affected persons. The mutation leads to shortened and therefore non-functional protein., CONCLUSIONS: PAX6 mutations leading to premature termination of protein translation are frequently associated with severe symptoms of aniridia and small intrafamilial variability of ocular impairment. This fact is also well demonstrated in members of family described by this report, the symptoms are severe and progressing with age. Therapy is difficult and often with partial success, such in case of secondary glaucoma in young girl from this family. Any eye surgery must be individually judged due to risk of several post-operative complications. And more, the poor vision in aniridia patients is progressively worsening in time to practical blindness.Key words: aniridia, PAX6, macular hypoplasia, glaucoma.

Latanoprost in the treatment of glaucoma. - Alm, Albert (Clinical ophthalmology (Auckland, N.Z.), 2014)
Prostaglandins are approved by the European Glaucoma Society guidelines as first-line treatment for glaucoma. This review focuses on latanoprost, an ester prodrug of prostaglandin (PG) F2alpha, which was the first of the currently available topical PGF2alpha analogs to be launched for glaucoma or ocular hypertension and which still accounts for the majority of prescriptions. It is better absorbed than the parent compound through the cornea, and peak concentration of the active drug is in the aqueous humor 1-2 hours after topical dosing (15-30 ng/mL). Metabolism occurs mainly in the liver. Latanoprost (0.005%) has been very well studied in clinical trials and meta-analyses that show it to be generally as effective as the other PG analogs (bimatoprost, travoprost, and tafluprost) and more effective than timolol, dorzolamide, and brimonidine. Latanoprost has good short- and long-term safety and tolerability profiles. In common with other prostaglandins, it lacks systemic effects, but can cause ocular adverse events such as conjunctival hyperemia, pigmentation of the iris, periocular skin or eyelashes, hypertrichosis, and ocular surface effects or irritation. Latanoprost is significantly better tolerated than either bimatoprost or travoprost. Patients treated with latanoprost have better compliance and persist with therapy longer than those that are given other drugs. An improved formulation of latanoprost without the preservative benzalkonium chloride has recently been developed. It is as effective as conventional latanoprost, has a lower incidence of hyperemia, and can be stored at room temperature. In conclusion, latanoprost has the best efficacy-tolerability ratio of the PG analogs available for glaucoma treatment, and has good compliance and persistence. These factors should be improved further by the recent development of preservative-free latanoprost.

Efficacy and safety of benzalkonium chloride-free fixed-dose combination of latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. - Bhagat, Purvi; Sodimalla, Kalyani; Paul, Chandrima; Pandav, Surinder S; Raman, Ganesh V; Ramakrishnan, Rengappa; Joshi, Abhijeet; Raut, Atul (Clinical ophthalmology (Auckland, N.Z.), 2014)
BACKGROUND: Benzalkonium chloride (BAK) is a common preservative in topical ocular preparations; however, prolonged use may lead to deleterious effects on the ocular surface, affecting quality of life and reducing adherence to treatment and overall outcomes. This study compared the intraocular pressure (IOP)-lowering efficacy and safety of a novel once-daily, BAK-free, fixed-dose combination of latanoprost plus timolol with latanoprost or timolol administered as monotherapy or concomitantly., METHODS: This was a 6-week, randomized, open-label, parallel-group, active-controlled study in patients aged >=18 years with open-angle glaucoma or ocular hypertension. A total of 227 patients were randomized to either a once-daily, BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% ophthalmic solution or concomitant administration of once-daily latanoprost 0.005% plus twice-daily timolol 0.5% or once-daily latanoprost 0.005% monotherapy, or twice-daily timolol 0.5% monotherapy. Efficacy end points were assessed at three time points on visits at weeks 1, 2, 4, and 6 versus baseline., RESULTS: The IOP-lowering efficacy of the fixed-dose combination of latanoprost/timolol was similar to that of latanoprost plus timolol administered concomitantly at all time points (mean IOP difference and 95% confidence interval within +/-1.5 mmHg; P=0.4223 to P=0.9981). The fixed-dose combination of latanoprost/timolol demonstrated significantly better IOP-lowering efficacy than timolol monotherapy at all time points (P=0.001 to P<0.0001) and significantly better IOP-lowering efficacy than latanoprost monotherapy at all time points. Responder rates on at least one time point and on at least two time points with fixed-dose combination latanoprost/timolol were similar to those with concomitant latanoprost plus timolol (85.5% versus 82.1%, P=0.6360; 78.2% versus 75%, P=0.6923), but significantly better than either latanoprost or timolol monotherapy (68.5%, P=0.0355; 55.4%, P=0.0005; 57.4%, P=0.0202; and 46.4%, P=0.0006, respectively). No significant differences in ocular and nonocular treatment-emergent adverse events were found between the treatment groups., CONCLUSION: A BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% was as effective and well tolerated as concomitant latanoprost and timolol for treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension.

Intensity of side effects of topical glaucoma medication and its influence on adherence behavior in patients with glaucoma. - Yu, Alice L; Weise, Stefanie; Welge-Lussen, Ulrich (Clinical ophthalmology (Auckland, N.Z.), 2014)
BACKGROUND: The aim of this study was to investigate the intensity of side effects that patients attribute to their topical glaucoma medication and their relationship to adherence behavior., METHODS: This was a questionnaire-based study of 123 glaucoma patients at a university eye clinic in Erlangen, Germany. An initial questionnaire asked about patient demographic data, the treatment plan, and intensity of side effects, and included Adherence to Refills and Medication Scale 2 (ARMS2) and visual analog scale (VAS-AD) scores. In a follow-up questionnaire, the treatment plan, intensity of side effects, ARMS2, and VAS-AD were reanalyzed., RESULTS: Most patients reported having few side effects, although only 20% said that they had no symptoms suggestive of side effects at all. The patients showed good adherence behavior on both the ARMS2 and VAS-AD scores, which were stable over time. The intensity of side effects experienced in the previous 7 days did not correlate with adherence scores and had no predictive value for adherence., CONCLUSION: This study could not detect any significant influence of the subjectively experienced intensity of side effects on patients' adherence behavior. However, we believe that a simple and clear treatment plan with few side effects is still preferred by most patients.

Combination of brinzolamide and brimonidine for glaucoma and ocular hypertension: critical appraisal and patient focus. - Nguyen, Quang H (Patient preference and adherence, 2014)
Glaucoma is one of the leading causes of blindness and is characterized by optic nerve damage that results in visual field loss. Elevated intraocular pressure (IOP) has been associated with glaucoma progression; thus, IOP-lowering medications are the standard of care for glaucoma. Guidelines suggest monotherapy with IOP-lowering agents such as beta-blockers (eg, timolol), prostaglandin analogs, carbonic anhydrase inhibitors (eg, brinzolamide), and alpha2-receptor agonists (eg, brimonidine). However, monotherapy may provide insufficient IOP reduction in some patients, thereby necessitating the use of multiple IOP-lowering medications. Multidrug regimens may be complex, may increase the risk of preservative-related ocular symptoms, and may potentially reduce overall drug exposure as a consequence of drug washout during closely timed sequential administrations; these difficulties may reduce overall drug efficacy and decrease patient persistence and adherence with multidrug treatment regimens. Fixed-combination medications that provide two IOP-lowering therapies within a single solution are available and may overcome some of these challenges. However, all currently available fixed combinations combine timolol with another IOP-lowering agent, indicating that additional fixed-combination alternatives would be beneficial. To meet this demand, a novel fixed combination of brinzolamide 1% and brimonidine 0.2% (BBFC) has recently been developed. In two randomized, double-masked, multinational clinical trials, BBFC had greater IOP-lowering efficacy than brinzolamide or brimonidine monotherapy after 3 months of treatment in patients with open-angle glaucoma or ocular hypertension. In both studies, the overall safety profile of BBFC was consistent with that of brinzolamide and brimonidine. Comparative studies with BBFC versus other IOP-lowering monotherapy and fixed-combination medications are not available, but the IOP reductions observed with BBFC are similar to or greater than those reported in the literature for other glaucoma treatments; thus, BBFC provides an additional fixed-combination therapeutic option for patients who require further efficacious IOP reduction and improved convenience and tolerability versus concomitant administration of two separate medications.

Adjunctive therapy patterns in glaucoma patients using prostaglandin analogs. - Schmier, Jordana K; Hulme-Lowe, Carolyn K; Covert, David W (Clinical ophthalmology (Auckland, N.Z.), 2014)
PURPOSE: To analyze patterns of use of adjunctive therapies among new initiators of topical prostaglandin analogs (PGAs) in a managed care population., METHODS: The study cohort included patients in a claims database who initiated PGA therapy between June 2007 and April 2011. Patients who had one or more adjunctive therapy prescriptions during 24 months of follow-up were included. Patterns of adjunctive therapy use were identified and compared between patients who had one or two fills of the initial adjunctive therapy and those who had three or more., RESULTS: There were 16,486 eligible beneficiaries. Of these, 5,933 (36%) had one or more adjunctive therapies within 24 months from the start of the PGA, 82% of whom started adjunctive therapy within 12 months. About 28% of patients started adjunctive therapy with a fixed-combination product; 45% of these patients started within the first 30 days. Overall, a large number of patients (42%) required adjunctive therapy within 30 days. Twenty-five percent of patients had only one or two prescriptions of their initial adjunctive therapy; of these patients, 74% discontinued adjunctive therapy altogether., CONCLUSION: Approximately 30% of patients starting glaucoma therapy will require adjunctive therapy within 1 year, and many receive a fixed-combination product as initial adjunctive therapy shortly after starting glaucoma therapy. This suggests a prescribing trend toward earlier, more aggressive drug therapy to control pressure and minimize disease progression. We found that compliance with adjunctive therapy continues to be a problem for patients, which could be attributed to a number of treatment burden and economic factors.

Patient adherence and persistence with topical ocular hypotensive therapy in real-world practice: a comparison of bimatoprost 0.01% and travoprost Z 0.004% ophthalmic solutions. - Campbell, Joanna H; Schwartz, Gail F; LaBounty, Britni; Kowalski, Jonathan W; Patel, Vaishali D (Clinical ophthalmology (Auckland, N.Z.), 2014)
BACKGROUND: Effective control of intraocular pressure is predicated upon patient compliance with pharmacotherapy. We compared patient adherence and persistence with two new ocular hypotensive formulations, using real-world utilization data., METHODS: This observational cohort study employed pharmacy claims data from the Source( R) Lx (Wolters Kluwer Pharma Solutions) database. Patients with an initial (index) prescription for topical bimatoprost 0.01% or travoprost Z (April to June 2011) and no claim for ophthalmic prostaglandin or prostamide analogs within the previous 18 months were identified. Treatment adherence was expressed as proportion of days covered with study medication during the first 365 days after the index prescription. Treatment persistence with study medication was assessed over the first 12 months using Kaplan-Meier survival analyses, allowing a maximum 30-day gap for prescription refill. Treatment status was determined monthly over this period., RESULTS: A total of 12,985 patients were assessed for treatment adherence, and 10,470 for treatment persistence. Adherence was better with bimatoprost 0.01% than with travoprost Z (mean proportion of days covered 0.540 versus [vs] 0.486, P<0.001), and more patients showed high adherence (proportion of days covered >0.80) with bimatoprost 0.01% than travoprost Z (29.1% vs 22.3%, P<0.001). Continuous 12-month persistence was higher with bimatoprost 0.01% than with travoprost Z (29.5% vs 24.2%, P<0.001). At month 12, more patients were on treatment with bimatoprost 0.01% than travoprost Z (48.8% vs 45.7%, P<0.01). Similar findings were demonstrated in cohorts of ocular hypotensive treatment-naive patients, branded latanoprost switchers, and older patients (age >=65 years), and after inclusion of patient characteristics as covariates., CONCLUSION: For patients with glaucoma or ocular hypertension, bimatoprost 0.01% offers compliance advantages over travoprost Z.

Prospective unmasked randomized evaluation of the iStent inject ( R) versus two ocular hypotensive agents in patients with primary open-angle glaucoma. - Fea, Antonio M; Belda, Jose I; Rekas, Marek; Junemann, Anselm; Chang, Lydia; Pablo, Luis; Voskanyan, Lilit; Katz, L Jay (Clinical ophthalmology (Auckland, N.Z.), 2014)
PURPOSE: The purpose of this study was to compare outcomes of subjects with open-angle glaucoma (OAG) not controlled on one medication who underwent either implantation of two iStent inject ( R) trabecular micro-bypass devices or received medical therapy consisting of a fixed combination of latanoprost/timolol., PATIENTS AND METHODS: Of 192 subjects who qualified for the study and were enrolled, 94 were randomized to surgery with implantation of two iStent inject( R) devices in the treated eye and 98 to receive medical therapy., RESULTS: At the month 12 visit, 94.7% of eyes (89/94) in the stent group reported an unmedicated intraocular pressure (IOP) reduction of >=20% versus baseline unmedicated IOP, and 91.8% of eyes (88/98) in the medical therapy group reported an IOP reduction >=20% versus baseline unmedicated IOP. A 17.5% between-group treatment difference in favor of the iStent inject group was statistically significant (P=0.02) at the >=50% level of IOP reduction. An IOP <=18 mmHg was reported in 92.6% of eyes (87/94) in the iStent inject group and 89.8% of eyes (88/98) in the medical therapy group. Mean (standard deviation) IOP decreases from screening of 8.1 (2.6) mmHg and 7.3 (2.2) mmHg were reported in the iStent inject and medical therapy groups, respectively. A high safety profile was also noted in this study in both the iStent inject and medical therapy groups, as measured by stable best corrected visual acuity, cup-to-disc ratio, and adverse events., CONCLUSION: These data show that the use of iStent inject is at least as effective as two medications, with the clinical benefit of reducing medication burden and assuring continuous treatment with full compliance to implant therapy as well as having a highly favorable safety profile.

Impact of Eighteen-Year Varied Compliance to Onchocerciasis Treatment with Ivermectin in Sentinel Savannah Agrarian Communities in Kaduna State of Nigeria. - Osue, Hudu O; Inabo, Helen I; Yakubu, Sabo E; Audu, Patrick A; Galadima, Musa; Odama, Lillian E; Musa, Danjuma; Ado, Saleh A; Mamman, Mohammed (ISRN parasitology, 2013)
Baseline and impact assessment data were generated in 1994 (n = 532) and 2011 (n = 593) from 6 sentinel villages with generalized onchocerciasis. Only volunteers and a cohort (n = 445, 75%) were screened at both visits. Each village had received 11 (64.7%) annual treatments and 92.6%, range 88.7-100%, treatment compliance. Overall mean number of treatment was 2.9 +/- 1.6 with a range 2.0 +/- 1.2-3.3 +/- 0.6. Significant decreases in skin microfilaria prevalence from 201 (38%) to 0 (0%), palpable nodule from 77 (15%) to 4 (0.7%), dermal changes from 51 (9.6%) to 2 (0.04%), optic nerve disease from 24 (4.5%) to 4 (2.0%), and onchocercal inducible ocular lesions from 31 (5.8%) to 12 (2.0%) were recorded, P < 0.05, (t-test of unpaired data). Cases of glaucoma, 8 (1.4%), and blindness, 6 (1.05%), remained unchanged. Visual acuity >=6/24 in one or both eyes, 198 (33.45%); cataract, 169 (28.5%); pterygium 157 (26.5%); and acute senilis, 165 (27.9%), were significantly increased and positively correlated with increase in age (R (2) = 0.898 - 0.949). Dissected parous Simulium damnosum caught (n = 222) were without infective third stage larva. Active onchocerciasis transmission seems halted despite varied compliance to long-term ivermectin treatment. We recommend continued surveillance and targeted treatment of controlled and hypoendemic areas.

Adherence and Persistence: The Challenges for Glaucoma Medical Therapy. - Skalicky, Simon E; Goldberg, Ivan (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2013)
Suboptimal adherence and persistence to therapy are major challenges for patients treated with ocular hypotensive medications. The problem affects 5% to 80% of glaucoma patients from all nations, ethnicities, socioeconomic backgrounds, and education levels. Although health care providers are generally poor at detecting suboptimal or poor adherence in the clinical setting, several strategies to systematically assess adherence and persistence rates are available. One strategy involves electronic monitoring of patient dosing, which provides useful insights into specific patterns of adherence behavior among glaucoma patients. Adherence behavior is complex with multiple interrelated determinants; these can be broadly grouped into provider factors, environmental factors, medication factors, and patient factors. Targeted patient education strategies, counseling, electronic monitors, alarms, and reminders have all been used in efforts to improve adherence. These interventions probably work best in combination. Identifying tangible barriers to adherence and simple strategies to overcome these through an open, discursive relationship between clinician and patient is key to optimizing adherence.

Medication Adherence in Glaucoma Patients. - Lai, Jimmy S M; Tham, Clement C Y (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2013)

Preservative toxicity in glaucoma medication: clinical evaluation of benzalkonium chloride-free 0.5% timolol eye drops. - Rosin, Lauren M; Bell, Nicholas P (Clinical ophthalmology (Auckland, N.Z.), 2013)
Timolol (generic name) is a frequently used medication for the control of glaucoma. Benzalkonium chloride (BAK) is a commonly used preservative in ophthalmic solutions with a broad range of antimicrobial activity; however, this nonspecificity can result in toxicity. Adverse effects attributed to BAK, including conjunctival inflammation and fibrosis, tear film instability, corneal cytotoxicity, anterior chamber inflammation, trabecular meshwork cell apoptosis, cataract development, macular edema, and even systemic effects, have been well documented. These effects can lead to ocular discomfort, poor intraocular pressure control, glaucoma surgery failure, and decreased patient compliance. BAK use in topical medications has decreased recently as newer and less toxic preservatives have become available. Yet these preservatives still exert some toxic effects, especially in patients with chronic eye disease who use multiple drops over extended periods of time. Thus, attempts to reduce overall preservative loads for patients are important, whether it be decreasing the amount of preservative, decreasing the total number of drops patients use, or eliminating preservatives entirely. A preservative-free formulation of timolol, TIMOPTIC R in OCUDOSE R, is available in unit-dose vials. Preservative-free unit-dose vials minimize toxic adverse effects and are a good option for patients with ocular surface disease, on long-term multidrop therapy, or who simply do not tolerate the effects of preservatives due to discomfort.

A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients. - Richardson, Cliff; Brunton, Lisa; Olleveant, Nicola; Henson, David B; Pilling, Mark; Mottershead, Jane; Fenerty, Cecilia H; Spencer, Anne Fiona; Waterman, Heather (Patient preference and adherence, 2013)
BACKGROUND: Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops., METHODS: People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12). Adherence was also measured objectively using a Medical Events Monitoring System device., RESULTS: Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero., CONCLUSION: All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops. A multicenter, randomized, controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step.

Critical assessment of implantable drug delivery devices in glaucoma management. - Manickavasagam, Dharani; Oyewumi, Moses O (Journal of drug delivery, 2013)
Glaucoma is a group of heterogeneous disorders involving progressive optic neuropathy that can culminate into visual impairment and irreversible blindness. Effective therapeutic interventions must address underlying vulnerability of retinal ganglion cells (RGCs) to degeneration in conjunction with correcting other associated risk factors (such as elevated intraocular pressure). However, realization of therapeutic outcomes is heavily dependent on suitable delivery system that can overcome myriads of anatomical and physiological barriers to intraocular drug delivery. Development of clinically viable sustained release systems in glaucoma is a widely recognized unmet need. In this regard, implantable delivery systems may relieve the burden of chronic drug administration while potentially ensuring high intraocular drug bioavailability. Presently there are no FDA-approved implantable drug delivery devices for glaucoma even though there are several ongoing clinical studies. The paper critically assessed the prospects of polymeric implantable delivery systems in glaucoma while identifying factors that can dictate (a) patient tolerability and acceptance, (b) drug stability and drug release profiles, (c) therapeutic efficacy, and (d) toxicity and biocompatibility. The information gathered could be useful in future research and development efforts on implantable delivery systems in glaucoma.

Noncompliance with Ocular Hypertensive Treatment in Patients with Primary Open Angle Glaucoma among the Arab Population in Israel: A Cross-Sectional Descriptive Study. - Masoud, Muhannad; Sharabi-Nov, Adi; Pikkel, Joseph (Journal of ophthalmology, 2013)
Objective . To evaluate the noncompliance treatment rates among primary open angle glaucoma (POAG) Arab patients in Israel and to verify the associated factors for noncompliance. Patients and Methods. A cross-sectional study took place using a questionnaire. Patients were initially interviewed and requested to answer a questionnaire. The questionnaire was developed based on a pilot test. Items included information about age, gender, number of prescribed drugs, and multiple reasons for noncompliance with drug therapy. Setting . Ophthalmologic HMO clinics, located in 3 Arab cities in the center of Israel. Participants . 400 Arab participants (197 men, 203 women) undergoing routine clinical care were recruited. Results . General rate of noncompliance, for both genders, was found to be 50%. Factors associated with nonadherence included inadequate knowledge (32%), underestimation of the disease severity (25.5%), and denial 15.5%. Compliance rates were unaffected by gender or number of prescribed drugs. Compliance was significantly higher in younger patients (age < 50) and in older patients (age > 80), 63% and 77%, respectively, (P < 0.05). Conclusion (s). Noncompliance was found to be common among an Arab population in Israel, particularly between the ages of 50 and 80. Educational programs, improving patient-physician relationship, and personalizing treatment could provide means for improved adherence.

A combined analysis of five observational studies evaluating the efficacy and tolerability of bimatoprost/timolol fixed combination in patients with primary open-angle glaucoma or ocular hypertension. - Pfennigsdorf, Stefan; de Jong, Leo; Makk, Stefan; Fournichot, Yvette; Bron, Alain; Morgan-Warren, Robert J; Maltman, John (Clinical ophthalmology (Auckland, N.Z.), 2013)
OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of a fixed combination of bimatoprost 0.03% and timolol (BTFC) in a clinical setting, in a large sample of patients with primary open-angle glaucoma or ocular hypertension and insufficient intraocular pressure (IOP) lowering on prior therapy., METHODS: Patient data were combined (n = 5556) from five multicenter, observational, non-controlled, open-label studies throughout Europe. Patients were identified from 830 sites in Austria, France, Germany, The Netherlands, and Switzerland. Assessments were made at baseline, 6 weeks (in Austrian, German and Swiss centers), and 12 weeks in all centers., RESULTS: BTFC lowered mean IOP from baseline by 5.4 mmHg over the 12-week duration of the studies (P < 0.0001). At study entry, 92.9% of patients were receiving another ocular hypotensive medication. In patients with no previous treatment (n = 311), BTFC reduced IOP by -9.1 mmHg, corresponding to a reduction from baseline of 36.4% (P < 0.0001). In patients receiving prior therapy of a prostaglandin analog, a beta-blocker, or a fixed combination, BTFC reduced IOP by a further 24.5%, 25.9%, and 21.4%, respectively. The majority of patients (90.3%) reported no adverse events. The most common adverse events were conjunctival hyperemia (3.2%) and eye irritation (2.8%). BTFC was rated as "good" or "very good" by 92.5% of physicians and 88.0% of patients. Most patients (96.3%) were equally or more compliant with BTFC than with their previous treatment., CONCLUSION: In routine clinical practice, BTFC achieved consistent IOP lowering in both previously treated and untreated patients with primary open-angle glaucoma or ocular hypertension. BTFC was associated with significant IOP reductions, good tolerability, and good compliance.

The primary vascular dysregulation syndrome: implications for eye diseases. - Flammer, Josef; Konieczka, Katarzyna; Flammer, Andreas J (The EPMA journal, 2013)
Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood-brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit. - Azfar, Mohammad Feroz; Khan, Muhammad Faisal; Alzeer, Abdulaziz H (Saudi journal of anaesthesia, 2013)
BACKGROUND: Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients., OBJECTIVE: This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients., METHODS: This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2., RESULTS: In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each., CONCLUSION: Protocolized eye care can reduce the risk of corneal complications in ventilated patients.

Adherence to ocular hypotensive therapy: patient health education needs and views on group education. - Waterman, Heather; Brunton, Lisa; Fenerty, Cecilia; Mottershead, Jane; Richardson, Cliff; Spencer, Fiona (Patient preference and adherence, 2013)
BACKGROUND: In this study the authors sought both to understand the health education needs of patients with glaucoma, with particular regard to adherence to glaucoma treatment, and to examine these patients' views of group education., METHODS: Using a health promotion approach to health education, 27 qualitative interviews with new and established patients receiving glaucoma treatment were conducted. Health promotion is defined as a way of strengthening people's capacities to control and optimize their own health. The interviews were transcribed and were then analyzed thematically, RESULTS: NINE CATEGORIES OF HEALTH EDUCATION NEEDS WERE IDENTIFIED FROM THE TRANSCRIPTS: (1) to understand glaucoma; (2) to understand their diagnosis or understand the difficulties in giving a diagnosis; (3) to understand the implications of eye drops, their side effects, and how to renew the eye drops; (4) to feel confident to put in eye drops; (5) to put the condition into perspective - to know how to manage their risk; (6) to be able to ask questions of clinicians; (7) to be able to navigate the health care system; (8) to understand and be able to manage own adherence behavior; and (9) to know where to access other sources of information. The majority of patients had something positive to say about group education, and about half of the patients said they would attend group education if they were offered the opportunity., CONCLUSION: A health promotion approach identified a wide range of patient-centered health education needs regarding adherence to glaucoma treatment. Group education will be attractive to some patients. Clinicians could use the health education needs identified in this study to guide the development of either individual or group-based educational intervention to improve adherence to glaucoma treatment. However, clinicians need to be aware that when developing a group intervention, attention will need to be given to making the education relevant to the circumstances of each patient.

Tafluprost once daily for treatment of elevated intraocular pressure in patients with open-angle glaucoma. - Liu, Yang; Mao, Weiming (Clinical ophthalmology (Auckland, N.Z.), 2013)
Glaucoma is a leading cause of visual loss worldwide. Current antiglaucoma therapy focuses on lowering intraocular pressure to a safe level. In recent years, prostaglandin analogs have become the first-line agents for treating open angle glaucoma. Tafluprost, which was first reported in 2003, is a novel prostaglandin analog, and has been shown to be a potent ocular hypotensive agent in a number of preclinical and clinical studies. Also, its unique preservative-free formulation helps to decrease preservative-associated ocular disorders and improve patient compliance. In this review, studies from 2003 to 2012 focusing on the structure, metabolism, efficacy, and safety of tafluprost are summarized. These studies suggested that application of tafluprost once daily is a safe and effective treatment for patients with open angle glaucoma.

Surveillance for ocular hypertension: an evidence synthesis and economic evaluation. - Burr, J M; Botello-Pinzon, P; Takwoingi, Y; Hernandez, R; Vazquez-Montes, M; Elders, A; Asaoka, R; Banister, K; van der Schoot, J; Fraser, C; King, A; Lemij, H; et al. (Health technology assessment (Winchester, England), 2012)
OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways., DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model., SETTING: Primary and secondary care., PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences)., INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a >= 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community., MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs)., RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than 30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > 30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence., LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates., CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment., FUNDING: The National Institute for Health Research Health Technology Assessment Programme.
Keywords: Administration, Ophthalmic; Age Factors; Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ec [Economics]; *Antihypertensive Agents/tu [Therapeutic Use]; Cohort Studies; Cost-Benefit Analysis; *Glaucoma, Open-Angle/pc [Prevention & Control]; Humans; Intraocular Pressure; Mass Screening; Models, Theoretical; *Ocular Hypertension/dt [Drug Therapy]; *Ocular Hypertension/ec [Economics]; Ocular Hypertension/ep [Epidemiology]; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Risk Assessment

Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. - Zhang, Xinzhi; Cotch, Mary Frances; Ryskulova, Asel; Primo, Susan A; Nair, Parvathy; Chou, Chiu-Fang; Geiss, Linda S; Barker, Lawrence E; Elliott, Amanda F; Crews, John E; Saaddine, Jinan B (American journal of ophthalmology, 2012)
PURPOSE: To assess vision health disparities in the United States by race/ethnicity, education, and economic status., DESIGN: Cross-sectional, nationally representative samples., METHODS: We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (ie, age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (ie, eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US Census population. Linear trends in the estimates were assessed by weighted least squares regression., RESULTS: Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < .001 in NHANES 2005-2008). From 1999 to 2008, individuals with less education (ie, high school) and lower income (poverty income ratio [PIR] <1.00 vs >= 4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < .05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = .004 and P = .007; respectively), those with high school education (trend P = .036), and those with PIR 1.00-1.99 (trend P < .001)., CONCLUSIONS: Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups. Copyright Published by Elsevier Inc.
Keywords: Adult; Cataract/eh [Ethnology]; *Continental Population Groups; Cross-Sectional Studies; Databases, Factual; Diabetic Retinopathy/eh [Ethnology]; *Educational Status; *Ethnic Groups; *Eye Diseases/eh [Ethnology]; Glaucoma/eh [Ethnology]; *Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility; *Healthcare Disparities/eh [Ethnology]; Healthcare Disparities/sn [Statistics & Numerical Data]; Humans; Macular Degeneration/eh [Ethnology]; Nutrition Surveys; *Socioeconomic Factors; United States/ep [Epidemiology]

Closing the quality gap: revisiting the state of the science (vol. 4: medication adherence interventions: comparative effectiveness). - Viswanathan, Meera; Golin, Carol E; Jones, Christine D; Ashok, Mahima; Blalock, Susan; Wines, Roberta C M; Coker-Schwimmer, Emmanuel J L; Grodensky, Catherine A; Rosen, David L; Yuen, Andrea; Sista, Priyanka; Lohr, Kathleen N (Evidence report/technology assessment, 2012)
OBJECTIVES: To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events., DATA SOURCES: MEDLINE R, the Cochrane Library. Additional studies were identified from reference lists and technical experts., REVIEW METHODS: Two people independently selected, extracted data from, and rated the risk of bias of relevant trials and systematic reviews. We synthesized the evidence for effectiveness separately for each clinical condition, and within each condition, by type of intervention. We also evaluated the prevalence of intervention components across clinical conditions and the effectiveness of interventions for a range of vulnerable populations. Two reviewers graded the strength of evidence using established criteria., RESULTS: We found a total of 62 eligible studies (58 trials and 4 observational studies) from our review of 3,979 abstracts. These studies included patients with diabetes, hyperlipidemia, hypertension, heart failure, myocardial infarction, asthma, depression, glaucoma, multiple sclerosis, musculoskeletal diseases, and multiple chronic conditions. Fifty-seven trials of patient, provider, or systems interventions (KQ 1) evaluated 20 different types of interventions; 4 observational studies and one trial of policy interventions (KQ 2) evaluated the effect of reduced out-of-pocket expenses or improved prescription drug coverage. We found the most consistent evidence of improvement in medication adherence for interventions to reduce out-of-pocket expenses or improve prescription drug coverage, case management, and educational interventions across clinical conditions. Within clinical conditions, we found the strongest support for self-management of medications for short-term improvement in adherence for asthma patients; collaborative care or case management programs for short-term improvement of adherence and to improve symptoms for patients taking depression medications; and pharmacist-led approaches for hypertensive patients to improve systolic blood pressure., CONCLUSIONS: Diverse interventions offer promising approaches to improving medication adherence for chronic conditions, particularly for the short term. Evidence on whether these approaches have broad applicability for clinical conditions and populations is limited, as is evidence regarding long-term medication adherence or health outcomes.
Keywords: *Case Management/sn [Statistics & Numerical Data]; Humans; *Medication Adherence/sn [Statistics & Numerical Data]; *Motivation; *Patient Education as Topic/mt [Methods]; *Patient Education as Topic/st [Standards]; *Quality Improvement/sn [Statistics & Numerical Data]; *Self Administration/sn [Statistics & Numerical Data]; United States/ep [Epidemiology]

Racial disparities in the use of ancillary testing to evaluate individuals with open-angle glaucoma. - Stein, Joshua D; Talwar, Nidhi; Laverne, Alejandra M; Nan, Bin; Lichter, Paul R (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE: To determine whether racial disparities exist in the use of ancillary testing to evaluate individuals with open-angle glaucoma., METHODS: We identified all enrollees aged 40 years and older in a large US managed care network with retinal or optic nerve conditions that could warrant the use of ancillary testing. Among persons with open-angle glaucoma or glaucoma suspects, we performed repeated-measures multivariable logistic regression to determine the odds and probabilities each year of undergoing visual field testing, fundus photography, and other ocular imaging for black, white, Hispanic, and Asian American men and women and compared the groups., RESULTS: Among the 797 879 eligible enrollees, 149 018 individuals had open-angle glaucoma. The odds of undergoing visual field testing decreased for all groups from 2001 through 2009, decreasing most for Hispanic men and women (63% and 57%, respectively) (adjusted odds ratio [AOR], 0.37; 95% CI, 0.31-0.43 and AOR, 0.43; 95% CI, 0.37-0.50, respectively) and least (36%) for Asian American men (AOR, 0.64; 95% CI, 0.51-0.80). By comparison, the odds of undergoing other ocular imaging increased for all groups from 2001 through 2009, increasing most (173%) for black men and women (AOR, 2.73; 95% CI, 2.34-3.18 for men and AOR, 2.73; 95% CI, 2.40-3.09 for women) and least (77%) for Hispanic women (AOR, 1.77; 95% CI, 1.49-2.09)., CONCLUSION: Hispanic men and women had considerably reduced odds of undergoing visual field testing and other ocular imaging compared with other groups during the decade. Although increases in glaucoma testing have been noted in recent years among Hispanic men and women for some types of ancillary tests, efforts should be made to better understand and overcome some of the persistent barriers to monitoring for glaucoma in this group.
Comment in (CIN)
Keywords: Aged; *Diagnostic Techniques, Ophthalmological/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/di [Diagnosis]; *Healthcare Disparities/eh [Ethnology]; Humans; Male; *Mass Screening/td [Trends]; Middle Aged; *Population Surveillance; Scanning Laser Polarimetry; Tomography, Optical Coherence; United States

Acceptance, attitudes, and beliefs of Singaporean Chinese toward an ocular implant for glaucoma drug delivery. - Foo, Reuben Chao Ming; Lamoureux, Ecosse L; Wong, Ryan C K; Ho, Sue-Wei; Chiang, Peggy P C; Rees, Gwyneth; Aung, Tin; Wong, Tina T (Investigative ophthalmology & visual science, 2012)
PURPOSE: We investigated patients' attitudes and perceptions toward a subconjunctival implant as a novel ocular drug delivery method for glaucoma., METHODS: We recruited 344 Chinese patients with primary open angle or angle closure glaucoma currently on topical antiglaucoma medication for a minimum of six months from specialist glaucoma clinics. Sociodemographic data, and information about patients' general and ocular health were collected. Beliefs about medicines, glaucoma, eye drops, and self-reported adherence were assessed by trained interviewers using validated questionnaires. A description about the implant was provided and patients subsequently were assessed on their understanding and acceptance., RESULTS: Of the 344 Chinese patients enrolled, 216 (62.8%) would accept the implant as a replacement for their current eye drops. Of those who accepted the implant, 99 (45.8%) were willing to accept it at similar costs, while 40 (18.5%) and 20 (9.3%) patients were willing to pay 1.5 and 2 times the cost of their present medication, respectively. Patients who accepted the implant had more severe glaucoma (P = 0.015) and felt that the implant was more helpful than eye drops (P < 0.001). Beliefs toward medicines, glaucoma, eye drops, self-reported adherence, and sociodemographic factors did not have a significant impact on the patients' decisions., CONCLUSIONS: An ocular drug implant would be an acceptable alternative to topical eye drops for subgroups of glaucoma patients.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ad [Administration & Dosage]; *Asian Continental Ancestry Group/eh [Ethnology]; *Attitude to Health/eh [Ethnology]; Cross-Sectional Studies; *Drug Delivery Systems; *Drug Implants; Female; Glaucoma, Angle-Closure/dt [Drug Therapy]; *Glaucoma, Angle-Closure/eh [Ethnology]; Glaucoma, Angle-Closure/px [Psychology]; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/eh [Ethnology]; Glaucoma, Open-Angle/px [Psychology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; Middle Aged; *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; Singapore/ep [Epidemiology]; Surveys and Questionnaires

[Preservative-containing eye drops and adherence in ophthalmological practice]. - Lanzl, I; Kaercher, T (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2012)
Chronic eye diseases, such as glaucoma or dry eye syndrome, require long-term drug application to the eyes. Good adherence is required to achieve the therapeutic goal and patient needs and requirements have to be taken into account. This distinguishes adherence to drug therapy from the former compliance which implies only following medical instructions. Adherence is influenced by socioeconomic, health system-related, disease-related, treatment-related and patient-related factors. It can be measured by tedious procedures, such as electronic monitoring, self-assessment, drop counting and laboratory findings of systemic drug levels. Non-adherence is a growing medical problem worldwide. An increase in adherence means an increased degree of therapeutic safety for the patient and long-term cost savings for the individual as well as society. Non-adherence in chronic diseases, such as glaucoma and dry eye syndrome is increased by eye drops that cause side effects. Often these side effects are caused by agents such as the preservative benzalkonium chloride. To achieve a good adherence preservative-free eye drops are advised.
Keywords: Guideline Adherence; Humans; *Ophthalmic Solutions/ae [Adverse Effects]; *Ophthalmic Solutions/tu [Therapeutic Use]; *Ophthalmology/st [Standards]; Patient Compliance; *Practice Guidelines as Topic; *Preservatives, Pharmaceutical/ae [Adverse Effects]; *Preservatives, Pharmaceutical/tu [Therapeutic Use]

Protocol for a randomised controlled trial to estimate the effects and costs of a patient centred educational intervention in glaucoma management. - Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Fordham, Richard; Notley, Caitlin; Broadway, David C (BMC ophthalmology, 2012)
BACKGROUND: Poor glaucoma education is thought to be a causative factor of non-adherence to glaucoma therapy. However, the multi-factorial nature of non-adherent behaviour may explain the failure of purely educational interventions to achieve significant improvement in adherence. Behaviour Change Counselling (BCC) allows both the imparting of information and assessment of patient ambivalence to medication use and may elicit behaviour change in order to achieve better adherence. The chronic and complex nature of glaucoma means that patient non-adherence to glaucoma therapy does not easily correlate with measureable objective clinical endpoints. However, electronic medication monitoring offers an objective method of measuring adherence without reliance on clinical endpoints., METHODS/DESIGN: The study is a randomised controlled trial (RCT) with glaucoma (open angle) or ocular hypertension patients attending a glaucoma clinic and prescribed travoprost. The study will determine whether additional glaucoma education using BCC is beneficial and cost effective in improving adherence with glaucoma therapy. An 8-month follow-up period, using an electronic adherence monitoring device (Travalert dosing aid, TDA), will indicate if the intervention is likely to be sustained in the longer term. Additionally, a cost-effectiveness framework will be used to estimate the cost benefit of improving adherence. The development of a novel intervention to deliver glaucoma education using BCC required practitioner training and fidelity testing. Five practitioners were successfully trained to become Glaucoma Support Assistants able to deliver the BCC intervention. The research group had prior clinical and investigative experience in this setting, and used multiple strategies to design a method to address the study objectives., DISCUSSION: This RCT, using BCC to improve adherence to ocular hypotensive therapy, to our knowledge is the first within this disease area. Using a variety of adherence measures allows examination of the known inaccuracies of patient self-report with respect to glaucoma medication. The novel BCC component has undergone fidelity testing using BECCI and the BCC template will ensure conformity to a standardised intervention., TRIAL REGISTRATION: Current Controlled Trials: ISRCTN89683704.
Keywords: Antihypertensive Agents/ec [Economics]; Antihypertensive Agents/tu [Therapeutic Use]; *Clinical Protocols; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/tu [Therapeutic Use]; *Cognitive Behavioral Therapy/ec [Economics]; Cost-Benefit Analysis; Follow-Up Studies; Glaucoma, Open-Angle/ec [Economics]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Medication Adherence; Ocular Hypertension/ec [Economics]; *Ocular Hypertension/th [Therapy]; Patient Education as Topic/ec [Economics]; *Patient Education as Topic/mt [Methods]; Travoprost

The use of the iCare tonometer reduced the need for anesthesia to measure intraocular pressure in children. - Grigorian, Florin; Grigorian, A Paula; Olitsky, Scott E (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 2012)
PURPOSE: To determine whether the introduction of iCare rebound tonometry in a pediatric ophthalmology clinic resulted in fewer examinations under anesthesia to evaluate children with glaucoma., METHODS: The medical records of consecutive glaucoma patients were retrospectively reviewed. The numbers of examinations under anesthesia (EUAs) and office visits that included measurement of intraocular pressure (IOP) were compared for three periods relative to introduction of the Icare (Icare Finland Oy, Helsinki, Finland) rebound tonometer into our clinical practice: before device introduction, learning/transition period, and routine use., RESULTS: A total of 87 subjects were included: 48 subjects met inclusion criteria for the first period; 58 patients met inclusion criteria for the third period (some subjects straddled all three periods). The average patient age for the first period was 4.2 years and 4.9 years (P = 0.3) for the third period. The number of EUAs performed before the introduction of the Icare was 55 and after the introduction of the Icare was 18 (P < 0.001). The number of office visits at which IOP was measured increased from 34 to 151 (P < 0.001). Data from the transition period suggest a trend and a short learning period., CONCLUSIONS: The use of Icare tonometry decreased the need for EUAs to evaluate children with glaucoma and significantly increased successful IOP measurement in clinic. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
Keywords: *Anesthesia, Local/sn [Statistics & Numerical Data]; Child, Preschool; *Drug Utilization/sn [Statistics & Numerical Data]; Glaucoma/di [Diagnosis]; Humans; *Intraocular Pressure/ph [Physiology]; Office Visits/sn [Statistics & Numerical Data]; Physical Examination; *Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Retrospective Studies; *Tonometry, Ocular/is [Instrumentation]

Pneumotrabeculoplasty as treatment for primary open angle glaucoma: critical review of the literature. - Librando, A; Migliorini, R; Pacella, F; Turchetti, P; Cerutti, F; Mazzeo, G; Mazzeo, F (La Clinica terapeutica, 2012)
PURPOSE: To evaluate with criticism the available evidence shown in the literature about the efficacy of pneumotrabeculoplasty (PNT) as a treatment for primary open angle glaucoma., MATERIALS AND METHODS: PNT is a recent non-surgical and noninvasive technique to safely reduce the intraocular pressure (IOP) in eyes suffering from ocular hypertension or primary open angle glaucoma. The technique consists in the application on the ocular surface of a disposable suction ring that induces a temporary trabecular meshwork stretching, increasing outflow of aqueous humor in the Schlemm's canal. In our study, we compared the results on the efficacy and safety of this treatment published to date in the literature., RESULTS: During follow-up, Authors have observed significant reductions in IOP in about 70% of treated eyes. The first treatment consists in 3 applications at day 0, 7 and 90, repeatable every 90 days. Immediately after suction ring application there is a significant elevation of IOP, however, of short duration and without demonstrable visual field worsening. Side effects observed are of little clinical significance and spontaneously resolving in a short time., CONCLUSIONS: The PNT is a safe and effective technique to reduce IOP in patients with ocular hypertension or open-angle glaucoma. It is repeatable, but can not replace drug treatment in patients already receiving topical therapy for glaucoma; however, it has proven effectiveness in maintaining an IOP target over time if accompanied with only a single topical drug, favoring a reduction of antiglaucoma drugs in polytherapy and increasing the compliance with treatment.
Keywords: Glaucoma, Open-Angle/pp [Physiopathology]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Trabeculectomy/mt [Methods]

Antiglaucoma pharmacotherapy. - Tataru, C P; Purcarea, V L (Journal of medicine and life, 2012)
This review presents the pharmacotherapeutic approaches available in the treatment of glaucomatous optic neuropathy. Although its etiology is multi-factorial, currently, the main therapy is to decrease intraocular pressure. New therapies are being developed; the current trend is a retinal ganglion cell neuroprotection. Neuroprotection is achieved by combining antihypertensive agents with drugs that directly protect the optic nerve by promoting cell survival and inhibition of neuronal signals that initiate apoptosis. The treatment should also preserve the ocular hemodynamics, ensure proper patient compliance and be free of side effects.
Keywords: Antihypertensive Agents/pd [Pharmacology]; *Antihypertensive Agents/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Neuroprotective Agents/pd [Pharmacology]; *Neuroprotective Agents/tu [Therapeutic Use]

Comparative study of in vitro ocular surface cytotoxicity of a fixed combination of 0.5% timolol/1% dorzolamide eyedrop and its components with 0.005% benzalkonium chloride. - Ayaki, Masahiko; Iwasawa, Atsuo; Niwano, Yoshimi (Biocontrol science, 2012)
We evaluated the cytotoxicity of antiglaucoma ophthalmic solutions preserved with the same concentration of benzalkonium chloride (BAK) in four cultured corneal and conjunctival cell lines. The viability of cell cultures was determined following the exposure of cells to timolol maleate, dorzolamide, and their fixed combination, Kosoputo( R) (MSD, a Japanese formulation of Cosopt( R) (Merck)), and two commercially available eyedrop solutions, 0.5% Timpotol( R) (containing 0.5% timolol maleate, MSD) and 1% Trusopt( R) (containing 1% dorzolamide, MSD) for varying exposure times and at various dilutions using the MTT and neutral red assays. All the three commercially available eyedrop solutions tested in this study were preserved with 0.005% BAK. The toxicity of each solution was compared using the % cell viability score (CVS) . Cell viability was also subjected to statistical analysis using ANOVA, Dunnett's multiple comparison tests and a chi-square test. %CVS50/%CVS40/80s for the tested solutions were 53/-13 for 0.5% Timoptol( R), 100/88 for preservative-free 0.5% timolol maleate, 50/ -10 for 1% Trusopt( R), 72/100 for preservative-free 1% dorzolamide, and 44/-17 for Kosoputo( R). The results of statistical analysis were consistent to them. In conclusion, Kosoputo( R) had greater cytotoxicity than each component; however, in actual use it may have the advantages of reduced toxicity (side effect) due to reduced instillation frequency, and better patient adherence to the treatment regimen as well as a comparable pressure reduction effect.
Keywords: Animals; *Benzalkonium Compounds/to [Toxicity]; Cattle; Cell Line; Cell Survival/de [Drug Effects]; Conjunctiva/cy [Cytology]; *Conjunctiva/de [Drug Effects]; Cornea/cy [Cytology]; *Cornea/de [Drug Effects]; Drug Combinations; *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions/an [Analysis]; *Ophthalmic Solutions/tu [Therapeutic Use]; *Preservatives, Pharmaceutical/to [Toxicity]; Rabbits; Sulfonamides/an [Analysis]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/an [Analysis]; *Thiophenes/tu [Therapeutic Use]; Timolol/an [Analysis]; *Timolol/tu [Therapeutic Use]

Three-month evaluation of dorzolamide hydrochloride/timolol maleate fixed-combination eye drops versus the separate use of both drugs. - Inoue, Kenji; Shiokawa, Minako; Sugahara, Michitaka; Wakakura, Masato; Soeda, Shoichi; Tomita, Goji (Japanese journal of ophthalmology, 2012)
PURPOSE: To investigate the ocular hypotensive effect and safety of dorzolamide hydrochloride 1 %/timolol maleate 0.5 % fixed-combination eye drops., METHODS: The study cohort comprised 34 patients with either primary open-angle glaucoma or ocular hypertension who were being concomitantly treated with dorzolamide hydrochloride 1 % eye drops and timolol maleate 0.5 % eye drops. The dorzolamide hydrochloride 1 % and timolol maleate 0.5 % eye drops were replaced with dorzolamide hydrochloride 1 %/timolol maleate 0.5 % fixed-combination eye drops without any washout period. The intraocular pressure (IOP) was evaluated both before and 1 and 3 months after the treatment change. The patients were asked to complete a questionnaire on adherence to the treatment protocol 1 month after the change in treatment., RESULTS: The IOP was 15.5 +/- 2.7 mmHg at the time of treatment change, 15.2 +/- 2.7 mmHg at 1 month post-change, and 15.5 +/- 2.9 mmHg at 3 months post-change, which is consistent with that before the treatment change (p = 0.286). Based on the completed questionnaire, following the treatment change, 50 % of patients felt a stinging sensation following administration of the eye drops and 11.8 % experienced blurred vision. In no case were the eye drops discontinued due to adverse reactions or insufficient IOP decrease., CONCLUSION: The replacement of concomitant treatment with dorzolamide hydrochloride 1 % and timolol maleate 0.5 % eye drops with dorzolamide hydrochloride 1 %/timolol maleate 0.5 % fixed-combination eye drops improved protocol adherence and preserved the IOP.
Keywords: Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Intraocular Pressure/ph [Physiology]; Male; Medication Adherence; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/pp [Physiopathology]; Ophthalmic Solutions; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Surveys and Questionnaires; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]; Tonometry, Ocular

Inhibitory effect of extracellular polysaccharide EPS-II from Pseudoalteromonas on Candida adhesion to cornea in vitro. - Chen, Hao; Zheng, Zhou; Chen, Peng; Wu, Xiang Gen; Zhao, Ge (Biomedical and environmental sciences : BES, 2012)
OBJECTIVE: Fungal keratitis (FK) is a vision-threatening infection, whose treatment requires more effective and safer anti-fungal agent exploitation urgently. With this aim, we focused on the effect of an extracellular polysaccharide on fungal adhesion to human corneal epithelial cells., METHODS: We performed the cytotoxicity assays of the extracellular polysaccharide EPS-II from an antarctic bacterium Pseudoaltermonas and evaluated its inhibitory effect on Candida albicans cells' adherence to human corneal epithelial cells (HCECs)., RESULTS: EPS-II, which displayed minor cytotoxicity but also promoted proliferation of HCECs, could inhibit the adherence of yeast cells to HCECs in a dose-dependent manner. EPS-II could also suppress the subsequent PI3K/AKT signaling pathway, and thereby decrease the expression of early inflammatory cytokines., CONCLUSIONS: Extracellular polysaccharide EPS-II was suggested as a new natural agent for attenuating FK.
Keywords: Blotting, Western; *Candida/de [Drug Effects]; Candida/ph [Physiology]; *Cell Adhesion/de [Drug Effects]; *Cornea/mi [Microbiology]; Humans; Phosphorylation; *Polysaccharides, Bacterial/pd [Pharmacology]; Proto-Oncogene Proteins c-akt/me [Metabolism]; *Pseudoalteromonas/me [Metabolism]

Does training clinic nurses to test pinhole visual acuity as a screen for glaucoma increase glaucoma referrals to eye care professionals? A pilot study in Malawi. - Dean, William H; Courtright, Paul; Cook, Colin (Ophthalmic epidemiology, 2012)
PURPOSE: To test whether general nurses, trained in screening for glaucoma, can increase the number of glaucoma cases seen by eye-care professionals in a rural setting in Africa., METHODS: In two districts in Malawi, 87 clinic nurses and two ophthalmic clinical officers were trained in case detection and referral of patients with suspect glaucoma. Data were collected on the number of patients screened and referred over a 12-month period. The clinic nurses and ophthalmic clinical officers received supportive supervision four times during the period and interviews were used to elicit their perspectives on the training and referral procedures., RESULTS: The 87 nurses screened 294 people (mean 3.4 per nurse) and referred 147 (50%) of them. Of the 147 referred, 56 (38%) were seen by the ophthalmic clinical officers who referred 15 (27%) to the ophthalmologist. Only two people were seen by the ophthalmologist. Testing visual acuity in people over 40 years of age was not seen as a priority by primary level clinic nurses. Nurses reported that cost and distance were barriers precluding attendance by patients at the next level. Women were two times less likely to be referred. About one quarter of patients who were offered surgery refused. Fewer than half the patients who had surgery attend for follow-up., CONCLUSIONS: Training general nurses to screen for and refer suspect glaucoma cases did not lead to increased glaucoma service delivery. Other strategies to identify high risk patients need to be tested.
Keywords: Adult; Aged; Aged, 80 and over; Delivery of Health Care/sn [Statistics & Numerical Data]; *Education, Nursing/sn [Statistics & Numerical Data]; Female; *Glaucoma/di [Diagnosis]; Humans; *Inservice Training/sn [Statistics & Numerical Data]; Malawi/ep [Epidemiology]; Male; Middle Aged; Ophthalmology/sn [Statistics & Numerical Data]; Pilot Projects; *Referral and Consultation/sn [Statistics & Numerical Data]; Rural Population/sn [Statistics & Numerical Data]; Vision Screening/is [Instrumentation]; *Vision Screening/mt [Methods]; *Visual Acuity/ph [Physiology]

The use of teleglaucoma at the University of Alberta. - Kassam, Faazil; Amin, Samreen; Sogbesan, Enitan; Damji, Karim F (Journal of telemedicine and telecare, 2012)
The aim of the teleglaucoma service at the University of Alberta is to improve access for people in northern Alberta who have early-stage glaucoma or who are at risk for glaucoma. Two types of teleglaucoma service are offered: remote and in-house. A standardized approach is used to capture patient information (structured histories, examinations and fundus photographs) which is then sent to a tertiary care centre for grading and recommendations. Only one grader reads and makes management recommendations for each case. Reports are sent electronically. A total of 195 cases have been graded through the remote service since 2008. A total of 62 cases have been graded through the in-house service since 2011. The average reporting time for consultations in the in-house service was 7 days, and it was also 7 days for the remote service. We believe that the use of teleglaucoma can improve the way that patients are diagnosed and managed, both in industrialized and developing countries. Teleglaucoma is currently being used as a screening tool at the Aga Khan University Hospital in Nairobi with mobile units equipped with a fundus camera and a visual field machine.
Keywords: Africa/ep [Epidemiology]; Alberta/ep [Epidemiology]; Blindness/di [Diagnosis]; Blindness/et [Etiology]; Canada/ep [Epidemiology]; Glaucoma/co [Complications]; *Glaucoma/di [Diagnosis]; Health Services Accessibility; Humans; *Ophthalmology/mt [Methods]; Remote Consultation/mt [Methods]; Rural Population; *Telemedicine/sn [Statistics & Numerical Data]

Glaucoma in developing countries. - Thomas, Ravi (Indian journal of ophthalmology, 2012)
OBJECTIVE: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries., MATERIALS AND METHODS: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations., RESULTS: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available., CONCLUSIONS: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.
Keywords: Blindness/ep [Epidemiology]; Blindness/et [Etiology]; *Developing Countries; Glaucoma/co [Complications]; *Glaucoma/ep [Epidemiology]; Humans; Morbidity/td [Trends]

[Management of juvenile ocular hypertension]. - Sun, Xing-huai ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 2012)
Ocular hypertensions (OHTs) in juvenile are characterized by occurrence in teenage with intraocular pressure (IOP) frequently fluctuated and increased over 30 mm Hg (1 mm Hg = 0.133 kPa) without any ocular symptoms and disturbance of visual acuity. IOPs are normalized in the majorities of juvenile over adolescence stage with long-term follow up. The medical terminology of 'adolescence IOP fluctuation' or 'adolescence ocular hypertension' is therefore used. The diagnosis and management of juvenile OHT remain difficult clinical challenges. OHTs in juvenile sometimes are incorrectly diagnosed due to inappropriate IOP measurement and thicker central cornea as younger children are non-compliant and resisting the examination. In this paper, we reviewed OHT in juvenile in the light of significant studies in the past and based on our experience of clinical practice in order to provide a better understanding and management of OHTs in juvenile.
Keywords: Adolescent; Child; Humans; *Ocular Hypertension/di [Diagnosis]; *Ocular Hypertension/th [Therapy]

Patterns of adherence to NICE glaucoma guidance in two different service delivery models. - Chawla, A; Patel, I; Yuen, C; Fenerty, C (Eye (London, England), 2012)
PURPOSE: To assess adherence patterns to the UK National Institute of Health and Clinical Excellence (NICE) guidelines on glaucoma management (2009) in a tertiary referral centre shared care setting and in a district general hospital (DGH) setting., METHOD: We performed a retrospective case note analysis of 200 patients from two centres between January and June 2010. The two centres involved were a consultant-guided teaching hospital optometry-led shared care setting (setting 1) and a consultant-led DGH clinic setting (setting 2). The main outcome measures were compliance with eight of the main NICE guidelines on glaucoma diagnosis and management (2009)., RESULTS: Both centres showed good adherence to the guidelines regarding the choice of initial treatment (96% vs 100%, settings 1 and 2, respectively) and arranging appropriate monitoring intervals (92% vs 86%). However, significant differences were seen when assessing whether an optic disc image was obtained at the initial visit (74% vs 10%), whether an appropriate initial assessment was performed (96% vs 58%), whether patients' review interval complied with the NICE guidance regardless of hospital cancellations (92% vs 66%), and whether concordance with medication was checked (88% vs 24%) (settings 1 and 2, respectively, P<0.01-Fisher's exact test)., CONCLUSION: Our study provides evidence to suggest that a hospital-based shared care service with trained optometrists using assessment sheets compares favourably to non-specialist glaucoma care delivered by ophthalmologists.
Keywords: Aged; Delivery of Health Care/st [Standards]; Female; *Glaucoma/di [Diagnosis]; Gonioscopy; *Guideline Adherence/st [Standards]; Hospitals, District/st [Standards]; Hospitals, Teaching/st [Standards]; Humans; *Intraocular Pressure; Male; Middle Aged; National Health Programs/st [Standards]; *Ophthalmology/st [Standards]; *Optometry/st [Standards]; *Patient Care Team/st [Standards]; *Practice Guidelines as Topic/st [Standards]; Retrospective Studies; Tonometry, Ocular; United Kingdom; Visual Field Tests; Visual Fields

Effectiveness of a short message reminder in increasing compliance with pediatric cataract treatment: a randomized trial. - Lin, Haotian; Chen, Weirong; Luo, Lixia; Congdon, Nathan; Zhang, Xinyu; Zhong, Xiaojian; Liu, Zhaochuan; Chen, Wan; Wu, Changrui; Zheng, Danying; Deng, Daming; Ye, Shaobi; et al. (Ophthalmology, 2012)
OBJECTIVE: Regular follow-up is essential to successful management of childhood cataract. We sought to assess whether a mobile phone short message service (SMS) for parents of children with cataract could improve follow-up adherence and the proportion of procedures performed in timely fashion., DESIGN: Randomized, controlled trial. This trial is registered with ClinicalTrials.gov, NCT01417819., PARTICIPANTS: We included 258 parent-child pairs involved in the Childhood Cataract Program of the Chinese Ministry of Health., METHODS: Participants were randomized (1:1) to a mobile phone SMS intervention or standard follow-up appointments. All participants were scheduled to attend >= 4 follow-up appointments according to the protocol. Parents in the intervention group received SMS automated reminders before scheduled appointments. The control group parents did not receive SMSs or any alternative reminder of scheduled appointments. Regular ocular examinations and analyses were performed by investigators masked to group allocation; however, study participants and the manager in charge of randomization and sending SMSs were not masked., MAIN OUTCOME MEASURES: Number of follow-up appointments attended, additional surgeries, laser treatments, changes in eyeglasses prescription, and occurrence of secondary ocular hypertension., RESULTS: Among parent-child participants, 135 were randomly assigned to the SMS intervention and 123 to standard appointments. Attendance rates for the SMS group (first visit, 97.8%; second, 91.9%; third, 92.6%; fourth, 83%) were significantly higher than those for the control group (first visit, 87.8%; second, 69.9%; third, 56.9%; fourth, 33.3%). The increase in attendance rate for total number of follow-up visits with SMS reminders was 47.2% (relative risk [RR] for attendance, 1.47; 95% confidence interval [CI], 1.16-1.78; P = 0.003). The number needed to remind (NNR) to gain 1 additional visit by 1 child was 3 (95% CI, 1.8-4.2). A total of 247 clinical interventions were carried out in the SMS group and 134 in the control group (RR, 1.68; 95% CI, 1.37-1.99; P = 0.007). The NNR to result in 1 additional clinical intervention was 5 (95% CI, 3.5-6.5)., CONCLUSIONS: The SMS reminders significantly improved follow-up adherence in pediatric cataract treatment. Using readily available mobile phone resources may be an effective and economic strategy to improve management of childhood cataract in China., FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Keywords: Adolescent; *Appointments and Schedules; Capsule Opacification/su [Surgery]; *Cataract/th [Therapy]; Cataract Extraction; *Cell Phone/sn [Statistics & Numerical Data]; *Delivery of Health Care/mt [Methods]; Double-Blind Method; Eyeglasses/sn [Statistics & Numerical Data]; Female; Humans; Laser Therapy/sn [Statistics & Numerical Data]; Male; Ocular Hypertension/th [Therapy]; *Patient Compliance/sn [Statistics & Numerical Data]; *Reminder Systems; *Text Messaging

The role of type III secretion system and lens material on adhesion of Pseudomonas aeruginosa to contact lenses. - Shen, Elizabeth P; Tsay, Ruey-Yug; Chia, Jean-San; Wu, Semon; Lee, Jing-Wen; Hu, Fung-Rong (Investigative ophthalmology & visual science, 2012)
PURPOSE: To determine the distribution of invasive and cytotoxic genotypes among ocular isolates of P. aeruginosa and investigate the influence of the type III secretion system (T3SS) on adhesion to conventional, cosmetic, and silicone hydrogel contact lenses (CL)., METHODS: Clinical isolates from 2001 to 2010 were analyzed by multiplex PCR for exoS, exoU, and exoT genes. Bacterial adhesion to etafilcon, nelfilcon (gray colored), balafilcon, and galyfilcon CL with or without artificial tear fluid (ATF) incubation were compared. Surface characteristics were determined with scanning electron microscopy (SEM)., RESULTS: Among 87 total isolates, 64 strains were from microbial keratitis cases. CL-related microbial keratitis (CLMK) isolates were mostly of the cytotoxic genotype (expressing exoU) (P = 0.002). No significant differences were found in bacterial adhesion to all types of CL between the genotypes under T3SS-inducing conditions. A trend for least bacterial adhesion of galyfilcon compared to the other CL was noted for both genotypes. Needle complex pscC mutants adhered less to all materials than the wild type (P < 0.05), indicating a role of the T3SS in contact lens adhesion. ATF-incubated CL had significantly more bacterial adhesion (P < 0.05). SEM showed most of the bacteria adhering on CL surfaces., CONCLUSIONS: CLMK isolates were mostly of cytotoxic genotype. Different genotypes did not significantly differ in its adhesion to various CL. T3SS and other adhesins are involved in bacteria-contact lens adhesion through complex interactions. Contact lens materials may also play an important role in the adherence of both genotypes of P. aeruginosa.
Keywords: ADP Ribose Transferases/ge [Genetics]; ADP Ribose Transferases/me [Metabolism]; Bacterial Adhesion/ge [Genetics]; Bacterial Adhesion/ph [Physiology]; Bacterial Proteins/ge [Genetics]; Bacterial Proteins/me [Metabolism]; Bacterial Toxins/ge [Genetics]; *Contact Lenses, Hydrophilic/mi [Microbiology]; GTPase-Activating Proteins/ge [Genetics]; GTPase-Activating Proteins/me [Metabolism]; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Hydrogels; Keratitis/me [Metabolism]; *Keratitis/mi [Microbiology]; Methacrylates; Mutagenesis/ph [Physiology]; Ophthalmic Solutions; Pseudomonas Infections/me [Metabolism]; *Pseudomonas Infections/mi [Microbiology]; *Pseudomonas aeruginosa/ge [Genetics]; *Pseudomonas aeruginosa/me [Metabolism]; Pseudomonas aeruginosa/py [Pathogenicity]; Secretory Pathway/ge [Genetics]; *Secretory Pathway/ph [Physiology]; Silicones; Virulence/ge [Genetics]

Phase-sensitive optical coherence tomography characterization of pulse-induced trabecular meshwork displacement in ex vivo nonhuman primate eyes. - Li, Peng; Reif, Roberto; Zhi, Zhongwei; Martin, Elizabeth; Shen, Tueng T; Johnstone, Murray; Wang, Ruikang K (Journal of biomedical optics, 2012)
Glaucoma is a blinding disease for which intraocular pressure (IOP) is the only treatable risk factor. The mean IOP is regulated through the aqueous outflow system, which contains the trabecular meshwork (TM). Considerable evidence indicates that trabecular tissue movement regulates the aqueous outflow and becomes abnormal during glaucoma; however, such motion has thus far escaped detection. The purpose of this study is to describe anovel use of a phase-sensitive optical coherence tomography (PhS-OCT) method to assess pulse-dependent TM movement. For this study, we used enucleated monkey eyes, each mounted in an anterior segment holder. A perfusion system was used to control the mean IOP as well as to provide IOP sinusoidal transients (amplitude 3 mmHg, frequency 1 pulse/second) in all experiments. Measurements were carried out at seven graded mean IOPs (5, 8, 10, 20, 30, 40, and 50 mm Hg). We demonstrate that PhS-OCT is sensitive enough to image/visualize TM movement synchronous with the pulse-induced IOP transients, providing quantitative measurements of dynamic parameters such as velocity, displacement, and strain rate that are important for assessing the biomechanical compliance of the TM. We find that the largest TM displacement is in the area closest to Schlemm's canal (SC) endothelium. While maintaining constant ocular pulse amplitude, an increase of mean IOP results in a decrease of TM displacement and mean size of the SC. These results demonstrate that the PhS-OCT is a useful imaging technique capable of assessing functional properties necessary to maintain IOP in a healthy range, offering a new diagnostic alternative for glaucoma.
Keywords: Animals; Humans; *Intraocular Pressure/ph [Physiology]; *Microscopy, Phase-Contrast/mt [Methods]; Motion; Movement/ph [Physiology]; Pilot Projects; Primates; *Pulsatile Flow/ph [Physiology]; *Tomography, Optical Coherence/mt [Methods]; *Trabecular Meshwork/cy [Cytology]; *Trabecular Meshwork/ph [Physiology]

The clinical performance of lenses disposed of daily can vary considerably. - Diec, Jennie; Lazon de la Jara, Percy; Willcox, Mark; Holden, Brien A (Eye & contact lens, 2012)
OBJECTIVES: To evaluate clinical performance of three lens types disposed of on a daily disposable (DD) basis., METHOD: A total of 120 participants were randomized into one of three lens types (etafilcon A, narafilcon A, and senofilcon A), all worn bilaterally on a DD regime. Participants were observed at baseline, 2-week, and 1- and 3-month visits where ocular physiology and lens performance variables were collected on a 0 to 4 grading scale in 0.1 increments. Subjective comfort and vision ratings were collected on a 1 to 100 rating scale and in the form of symptom severity., RESULTS: Forty participants wore each lens type with no differences in age or gender between groups (P>0.05). Etafilcon A exhibited more limbal redness compared with either of the other lens types (P<0.01). More superior corneal staining was noted with narafilcon A lenses compared with senofilcon A (P<0.01), and more superior conjunctival indentation was noted for narafilcon A compared with etafilcon A (P=0.001). No differences were found between lenses in the 1 to 100 rating scale (P>0.05). Narafilcon A showed more moderate to severe dryness symptoms and symptoms of blurred vision at lens wearing visits (P<0.05). One bilateral contact lens papillary conjunctivitis, one unilateral superior epithelial arcuate lesion, and one infiltrative keratitis were associated with narafilcon A only. Of the seven discontinuations, six were from the narafilcon A group., CONCLUSION: Different contact lens materials and designs, worn on the same DD modality, elicit different ocular and patient responses. Narafilcon A did not perform clinically as well as etafilcon A and senofilcon A worn on a DD modality.
Keywords: Adult; Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Contact Lenses, Hydrophilic/st [Standards]; Cornea/ph [Physiology]; *Disposable Equipment; Female; Humans; Logistic Models; Male; Myopia/pp [Physiopathology]; *Myopia/rh [Rehabilitation]; Patient Satisfaction; Prospective Studies; Severity of Illness Index; Vision, Ocular/ph [Physiology]

Moving from PROMs to POEMs for glaucoma care: a qualitative scoping exercise. - Somner, John E A; Sii, Freda; Bourne, Rupert R; Cross, Vinette; Burr, Jennifer M; Shah, Peter (Investigative ophthalmology & visual science, 2012)
PURPOSE: Patient-reported outcome measures (PROMs) are accepted widely as important outcomes in comparative effectiveness research. Over 30 PROMs have been described for use in glaucoma research, but their role in routine care is undefined. Our study explores the views of patients with glaucoma and their carers on the feasibility and content of a glaucoma PROM for use in day-to-day clinical practice., METHODS: Focus groups were held with 71 participants facilitated by 23 staff working in the field of ophthalmology. Comparisons were made among themes derived from this exercise using simple thematic analysis and currently available health-related quality of life (HRQoL) instruments., RESULTS: Participants were supportive of reporting their outcomes if the instrument was short, practical, and useful. Potential barriers to the use of PROMs, including bureaucratic overload and accessibility issues, were identified. Measuring health outcome and patient experience was important to participants. No freely available instrument covers all the domains identified, particularly knowledge and understanding. A novel instrument, a glaucoma patient-reported outcome and experience measure (POEM) is proposed. This addresses three aspects of outcome (fear of blindness, acceptability of treatment/side effects, and impact on daily life), and three aspects of experience (safety, respect, and understanding)., CONCLUSIONS: Using PROMs routinely in the management of glaucoma presents significant challenges. Although current instruments (questionnaires) cover many of the participants' key domains, no single instrument covered them all. Further research is required to determine the feasibility (resources required), and validity and reliability of the proposed glaucoma POEM in clinical care.
Keywords: Activities of Daily Living; Adolescent; Adult; Aged; Aged, 80 and over; Child; Comparative Effectiveness Research/mt [Methods]; Female; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Health Status; Humans; Male; Middle Aged; *Outcome Assessment, Health Care; Psychometrics; *Quality of Life; Reproducibility of Results; *Sickness Impact Profile; Surveys and Questionnaires; Young Adult

Challenges in neuroprotective nanomedicine development: progress towards noninvasive gene therapy of glaucoma. - Alqawlaq, Samih; Huzil, J Torin; Ivanova, Marina V; Foldvari, Marianna (Nanomedicine (London, England), 2012)
Over the past decade the application of gene therapy of retinal diseases such as glaucoma has produced promising results. However, optic nerve regeneration and restoration of vision in patients with glaucoma is still far from reality. Neuroprotective approaches in the form of gene therapy may provide significant advantages, but are still limited by many factors both at the organ and cellular levels. In general, gene delivery systems for eye diseases range from simple eye drops and ointments to more advanced bio- and nanotechnology-based systems such as muco-adhesive systems, polymers, liposomes and ocular inserts. Most of these technologies were developed for front-of-the-eye ophthalmic therapies and are not applicable as back-of-the-eye delivery systems. Currently, only the invasive intravitreal injections are capable of successfully delivering genes to the retina. Here we review the challenges and possible strategies for the noninvasive gene therapy of glaucoma including the barriers in the eye and in neural cells, and present a cross-sectional view of gene delivery as it pertains to the prevention and treatment of glaucoma.
Keywords: Animals; Drug Delivery Systems/mt [Methods]; Eye/me [Metabolism]; Eye/pa [Pathology]; *Gene Transfer Techniques; *Genetic Therapy/mt [Methods]; *Glaucoma/ge [Genetics]; Glaucoma/pa [Pathology]; *Glaucoma/th [Therapy]; Humans

[Evaluation of the self-tonometer Icare ONE in comparison to Goldmann applanation tonometry]. - Witte, V; Glass, A; Beck, R; Guthoff, R (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2012)
OBJECTIVE: The aim of this clinical study was to demonstrate the practicability of self-measured intraocular pressure and to evaluate the reliability by comparing the data with those obtained by Goldmann applanation tonometry (GAT)., METHODS: A total of 40 patients aged between 44 and 82 years with glaucoma were introduced to the handling of the tonometer. The self-measurements were done for 1-3 days following the medical measurement by GAT. The data were saved as "correct" or in the case of wrong handling as "false". The impressions of the patients were obtained by a questionnaire., RESULTS: A total number of 191 single measurements were registered by the Icare ONE and of these there were 97 (50.8%) signed "false". Of the patients 45% reached a maximum difference of +/-5 mmHg between GAT and self-measurement in every single measurement. In the subgroup of under 60-year-old patients 70% reached this result. There were no indications of a systematic error. Of the probands 60% considered the handling of the Icare ONE as difficult. Nevertheless, 80% could imagine using the self-tonometer at home., CONCLUSIONS: The differences between the self-measurements and the GAT were highly fluctuating in some cases. In the group of patients younger than 60 years the agreement was better, so problems with the handling of the Icare ONE may be an important factor. However, the acceptance in the patients tested was high and continuous pressure measurements at home could be reasonable. Advancements in the handling and reliability are needed to improve clinical application of the measured values.
Keywords: Adult; Aged, 80 and over; Animals; Equipment Design; Female; *Glaucoma/di [Diagnosis]; *Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; *Manometry/is [Instrumentation]; Manometry/mt [Methods]; Middle Aged; Patient Satisfaction; *Self Care; Sensitivity and Specificity; Surveys and Questionnaires

Attitudes of physicians, patients, and village health workers toward glaucoma and diabetic retinopathy in rural China: a focus group study. - Yan, Xixi; Liu, Tianyu; Gruber, Layla; He, Mingguang; Congdon, Nathan (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE To understand the knowledge and attitudes of rural Chinese physicians, patients, and village health workers (VHWs) toward diabetic eye disease and glaucoma. METHODS Focus groups for each of the 3 stakeholders were conducted in 3 counties (9 groups). The focus groups were recorded, transcribed, and coded using specialized software. Responses to questions about barriers to compliance and interventions to remove these barriers were also ranked and scored. RESULTS Among 22 physicians, 23 patients, and 25 VHWs, knowledge about diabetic eye disease was generally good, but physicians and patients understood glaucoma only as an acutely symptomatic disease of relatively low prevalence. Physicians did not favor routine pupillary dilation to detect asymptomatic disease, expressing concerns about workflow and danger and inconvenience to patients. Providers believed that cost was the main barrier to patient compliance, whereas patients ranked poorly trained physicians as more important. All 3 stakeholder groups ranked financial interventions to improve compliance (eg, direct payment, lotteries, and contracts) low and preferred patient education and telephone contact by nurses. All the groups somewhat doubted the ability of VHWs to screen for eye disease accurately, but patients were generally willing to pay for VHW screening. The VHWs were uncertain about the value of eye care training but might accept it if accompanied by equipment. They did not rank payment for screening services as important. CONCLUSIONS Misconceptions about glaucoma's asymptomatic nature and an unwillingness to routinely examine asymptomatic patients must be addressed in training programs. Home contact by nurses and patient education may be the most appropriate interventions to improve compliance.
Keywords: Adult; Aged; Attitude of Health Personnel; China/ep [Epidemiology]; *Community Health Workers/px [Psychology]; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/px [Psychology]; Diabetic Retinopathy/th [Therapy]; Female; Focus Groups; Glaucoma/di [Diagnosis]; *Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Patient Compliance; *Patients/px [Psychology]; *Physicians/px [Psychology]; *Rural Population/sn [Statistics & Numerical Data]

Fixed topical combinations in glaucomatous patients and ocular discomfort. - Nebbioso, Marcella; Evangelista, Mariasilvia; Librando, Aloisa; Di Blasio, Dario; Pescosolido, Nicola (Expert opinion on pharmacotherapy, 2012)
OBJECTIVE: The purpose of this study was to verify the ocular comfort of a fixed topical combination of brinzolamide 1% plus timolol 0.5% suspension vs. dorzolamide 2% plus timolol 0.5% solution, both preserved with benzalkonium chloride (BAK), in patients with primary open-angle glaucoma (POAG) through subjective and objective methods. BAK is the most commonly used preservative in topical glaucoma medications., METHODS: 62 subjects were examined and included in the analysis. Each patient was asked to complete a questionnaire on symptoms (Ocular Surface Disease Index) and then underwent a series of examinations. The Ocular Protection Index evaluated the risk of damage to the ocular surface, and was expressed as the ratio between fluorescein breakup time and blinking interval. These and other analyses were repeated 30 days after instillation of the new eye drop treatment., RESULTS: The results demonstrated that patients enrolled with the preserved fixed combination of dorzolamide or brinzolamide represented a subgroup of patients in which the discomfort symptoms were supposedly justified by the presence of BAK used chronically in antihypertensive drops. Ocular discomfort scores were significantly higher with dorzolamide/timolol than brinzolamide/timolol (p < 0.0001)., CONCLUSIONS: This work shows the better tolerability of brinzolamide 1% plus timolol 0.5% suspension, compared with dorzolamide 2% plus timolol 0.5% solution. Fortunately, some of the adverse reactions induced by preserved eye drop glaucoma medication are reversible after removing the preservatives. Both the potential for added benefit and patient compliance should be considered when selecting ocular hypotensive therapy.
Keywords: Administration, Ophthalmic; Aged; Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Antihypertensive Agents/tu [Therapeutic Use]; Benzalkonium Compounds/ae [Adverse Effects]; Benzalkonium Compounds/ch [Chemistry]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ae [Adverse Effects]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Preservatives, Pharmaceutical/ae [Adverse Effects]; Preservatives, Pharmaceutical/ch [Chemistry]; Prospective Studies; Single-Blind Method; Sulfonamides/ad [Administration & Dosage]; *Sulfonamides/ae [Adverse Effects]; Sulfonamides/tu [Therapeutic Use]; Suspensions; Thiazines/ad [Administration & Dosage]; *Thiazines/ae [Adverse Effects]; Thiazines/tu [Therapeutic Use]; Thiophenes/ad [Administration & Dosage]; *Thiophenes/ae [Adverse Effects]; Thiophenes/tu [Therapeutic Use]; Time Factors; Timolol/ad [Administration & Dosage]; *Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Is low dose of estrogen beneficial for prevention of glaucoma?. - Wei, Xin; Cai, Su-Ping; Zhang, Xiulan; Li, Xiaohong; Chen, Xiaoming; Liu, Xuyang (Medical hypotheses, 2012)
Glaucoma, as characterized by accelerated retinal ganglion cell (RGC) death and cupping of optic nerve head (ONH), is one of the leading causes of blindness worldwide. Elevated intraocular pressure (IOP) is generally considered as a major risk factor in the pathogenesis of glaucoma. Previous studies showed that glaucoma caused decrease in collagen and elastin density in several ocular tissues, such as lamina cribrosa, peripapillary sclera and cornea, and resulted in reduced elasticity and compliance of these tissues. It is known that estrogen has protective effects against glaucoma, yet the underlying mechanism still remains obscure. Prior researches have provided evidences showing that the estrogen receptors (ERs) express in a variety of the ocular tissues. Estrogen activates the synthesis of collagen fiber and improves the compliance of these tissues. This leads to a reasonable postulation that increased estrogen may result in a higher content of the collagen fibers and enhanced flexibility of the whole eye, which would therefore decrease IOP. Particularly, the increase in the amounts of collagen fibers at lamina cribrosa improves its compliance, which in turn relieves its compression on RGC axons. Therefore, even at the same IOP level, the softening of cribriform foramina yields a more flexible environment for the RGCs to survive. We therefore hypothesize that estrogen at proper dosage can be considered as a potential therapy for glaucoma since it is able to prevent the eye from glaucomatous damage and lower IOP, especially for those menopausal women with glaucoma. Copyright © 2012 Elsevier Ltd. All rights reserved.
Keywords: Collagen/me [Metabolism]; Dose-Response Relationship, Drug; Estrogens/ad [Administration & Dosage]; *Estrogens/tu [Therapeutic Use]; Glaucoma/me [Metabolism]; *Glaucoma/pc [Prevention & Control]; Humans; Receptors, Estrogen/me [Metabolism]

Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System. - Mateen, Farrah J; Carone, Marco; Al-Saedy, Huda; Nyce, Sayre; Ghosn, Jad; Mutuerandu, Timothy; Black, Robert E (Bulletin of the World Health Organization, 2012)
OBJECTIVE: To determine the range and burden of health services utilization among Iraqi refugees receiving health assistance in Jordan, a country of first asylum., METHODS: Medical conditions, diagnosed in accordance with the tenth revision of the International classification of diseases, were actively monitored from 1 January to 31 December 2010 using a pilot centralized database in Jordan called the Refugee Assistance Information System., FINDINGS: There were 27 166 medical visits by 7642 Iraqi refugees (mean age: 37.4 years; 49% male; 70% from Baghdad; 6% disabled; 3% with a history of torture). Chronic diseases were common, including essential hypertension (22% of refugees), visual disturbances (12%), joint disorders (11%) and type II diabetes mellitus (11%). The most common reasons for seeking acute care were upper respiratory tract infection (11%), supervision of normal pregnancy (4%) and urinary disorders (3%). The conditions requiring the highest number of visits per refugee were cerebrovascular disease (1.46 visits), senile cataract (1.46) and glaucoma (1.44). Sponsored care included 31 747 referrals or consultations to a specialty service, 18 432 drug dispensations, 2307 laboratory studies and 1090 X-rays. The specialties most commonly required were ophthalmology, dentistry, gynaecology and orthopaedic surgery., CONCLUSION: Iraqi refugees in countries of first asylum and resettlement require targeted health services, health education and sustainable prevention and control strategies for predominantly chronic diseases.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chronic Disease; *Emigrants and Immigrants/sn [Statistics & Numerical Data]; Female; Health Services Accessibility/ec [Economics]; Health Services Accessibility/sn [Statistics & Numerical Data]; Health Services Needs and Demand/ec [Economics]; Health Services Needs and Demand/sn [Statistics & Numerical Data]; *Health Status; Humans; Infant; Infant, Newborn; Internationality; Iraq/eh [Ethnology]; Jordan; Male; Middle Aged; Population Surveillance/mt [Methods]; *Public Health/ec [Economics]; Public Health/sn [Statistics & Numerical Data]; *Refugees/sn [Statistics & Numerical Data]; Social Work/ec [Economics]; Social Work/sn [Statistics & Numerical Data]; United Nations; Young Adult

Impact of a health communication intervention to improve glaucoma treatment adherence. Results of the interactive study to increase glaucoma adherence to treatment trial. - Glanz, Karen; Beck, Allen D; Bundy, Lucja; Primo, Susan; Lynn, Michael J; Cleveland, Julia; Wold, Jessica A; Echt, Katharina V (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE: To determine the efficacy of an automated, interactive, telephone-based health communication intervention for improving glaucoma treatment adherence among patients in 2 hospital-based eye clinics., METHOD: A total of 312 patients with glaucoma (18-80 years of age) were enrolled in a randomized controlled trial at 2 eye clinics located in hospitals in the southeastern United States. These patients were considered nonadherent because they did not take their medication, refill their medication, and/or keep their appointments. The treatment group received an automated, interactive, tailored, telephone-based health communication intervention and tailored print materials. The control group received usual care., MAIN OUTCOME MEASURES: Adherence with medication taking, prescription refills, and appointment keeping measured by interviews, medical charts, appointment records, and pharmacy data., RESULTS: A statistically significant increase was found for all adherence measures in both the intervention and control groups. Interactive telephone calls and tailored print materials did not significantly improve adherence measures compared with controls., CONCLUSIONS: During the study period, patient adherence to glaucoma treatment and appointment keeping improved in both study arms. Participation in the study and interviews may have contributed. Strategies that address individuals' barriers and facilitators may increase the impact of telephone calls, especially for appointment keeping and prescription refills., APPLICATION TO CLINICAL PRACTICE: Glaucoma patient care should include reminders about consistent use of medication and the importance of keeping appointments. More frequent, and personalized, telephone contact may be helpful to patients who are known to be nonadherent., TRIAL REGISTRATION: clinicaltrials.gov Identifier:NCT00794170.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Appointments and Schedules; Drug Prescriptions/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; Health Behavior; *Health Communication/mt [Methods]; *Health Promotion/mt [Methods]; Humans; Male; *Medication Adherence; Middle Aged; Ophthalmic Solutions; Patient Acceptance of Health Care/sn [Statistics & Numerical Data]; *Patient Education as Topic; Teaching Materials; Telephone/sn [Statistics & Numerical Data]; Young Adult

Combination therapy as initial treatment in glaucoma and suspected glaucoma. - Mikelberg, Frederick S; Etminan, Mahyar (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2012)
OBJECTIVE: We hypothesize that there may be an inappropriate overuse of initial combination therapy in patients with glaucoma and in those who are glaucoma suspects. To test this hypothesis, we examined the British Columbia Population DataBase to determine the frequency of prescription of combination eye drops as initial therapy in glaucoma patients or glaucoma suspects., DESIGN: Cohort study., PARTICIPANTS: The study cohort included all those who visited an ophthalmologist's office between 2004 and 2007. Within the cohort we identified all those who were newly prescribed any ocular hypotensive eye drop. Specifically, we identified those who had been newly prescribed any ocular hypotensive eye drop within 60 days of receiving diagnoses of glaucoma, as defined by having received an international classification for disease code ICD-9 for glaucoma 365., METHODS: We used the Population Data British Columbia (POP Data BC) as the main data source for this study. POP Data BC is a provincially linkable database that captures the physician visits (including inpatient procedures); hospital admissions; demographics; and prescription drug use of 4.5 million residents of British Columbia., RESULTS: Between 2004 and 2007, the percentage of combination therapy as the first ocular hypotensive prescription rose from 12.29% to 18.63%., CONCLUSIONS: The high percentage of combination therapy as initial therapy suggests that ophthalmologists either require additional education in principles of pharmacologic therapy or are unduly influenced by their interaction with the pharmaceutical industry. Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: Adrenergic Agonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; *Antihypertensive Agents/ad [Administration & Dosage]; British Columbia; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Cholinergic Agonists/ad [Administration & Dosage]; Cohort Studies; Databases, Factual; *Drug Therapy, Combination; *Drug Utilization/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Humans; *Inappropriate Prescribing/sn [Statistics & Numerical Data]; *Intraocular Pressure/de [Drug Effects]; Medication Adherence; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Ophthalmology/sn [Statistics & Numerical Data]; Practice Patterns, Physicians'; Prostaglandins/ad [Administration & Dosage]

Intraocular pressure-lowering combination therapies with prostaglandin analogues. - Aptel, Florent; Chiquet, Christophe; Romanet, Jean-Paul (Drugs, 2012)
Intraocular pressure (IOP) reduction is currently the only therapeutic approach demonstrated to preserve visual function in patients with glaucoma. The first line of glaucoma treatment consists of topical IOP-lowering medications, usually initiated as monotherapy. A significant proportion of patients require more than one medication to reach a target IOP at which optic nerve damage will not progress. As prostaglandin analogues (PGAs) are the most effective class for reducing IOP, one of the other commonly used classes (beta-adrenoceptor antagonist [beta-blocker], carbonic anhydrase inhibitor or alpha(2)-adrenoceptor agonist) is frequently combined with a PGA. In the last decade, the use of fixed combinations containing two medications in a single bottle has steadily increased. Fixed combinations have the potential to simplify the dosing regimen, increase patient adherence, avoid the washout effect of the second drop on the first medication instilled, decrease exposure to preservatives and, sometimes, reduce the cost of treatment. Clinical trials have evaluated PGA-based fixed combinations versus unfixed combinations (individual components administered concomitantly) or versus individual monotherapies; however, any advantage that the fixed combinations may have in terms of IOP-lowering efficacy is still debated. For these reasons, the PGA-based fixed combinations are not approved by regulatory authorities in some countries, such as the US. We review the published studies evaluating the efficacy and tolerability of the IOP-lowering unfixed and fixed combination therapies with PGAs. Regarding unfixed combinations, the review shows that alpha(2)-adrenergic agonists-PGA and carbonic anhydrase inhibitor-PGA combinations seem to be at least as effective at reducing IOP as the beta-blocker-PGA combinations. As for the fixed combinations, the review shows that the three PGA-timolol fixed combinations are more effective than their component medications used separately as monotherapy and are better tolerated than the three respective prostaglandins. The three PGA-timolol fixed combinations are less effective at reducing IOP than the unfixed combinations but are better tolerated. The advantage of the fixed combinations in terms of patient adherence and persistence is supported by a very small number of studies and remains to be more accurately determined. Most studies, but not all, seem to show that PGA-timolol fixed combinations are more effective than other available beta-blocker fixed combinations (dorzolamide-timolol fixed combinations) at reducing IOP and are similarly tolerated.
Keywords: Adrenergic alpha-2 Receptor Agonists/ad [Administration & Dosage]; Adrenergic alpha-2 Receptor Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; *Glaucoma/dt [Drug Therapy]; Glaucoma/me [Metabolism]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Prostaglandins/ad [Administration & Dosage]; *Prostaglandins/tu [Therapeutic Use]; Treatment Outcome

Glaucoma medications. How to improve compliance and adherence. - Cakiner-Egilmez, Tulay; Lara-Smalling, Agueda (Insight (American Society of Ophthalmic Registered Nurses), 2012)
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Medication Adherence; *Patient Compliance

Review of the publications of the Nigeria national blindness survey: methodology, prevalence, causes of blindness and visual impairment and outcome of cataract surgery. - Rabiu, M Mansur; Kyari, Fatima; Ezelum, Christian; Elhassan, Elizabeth; Sanda, Safiya; Murthy, Gudlavalleti V S; Sivasubramaniam, Selvaraj; Glibert, Clare; Abdull, M M; Abiose, A; Bankole, O; Entekume, G; et al. (Annals of African medicine, 2012)
This is a review of the major publications from the Nigeria national blindness survey in order to highlight major findings and challenges of eye care in Nigeria. The review summarizes methodology and key findings. Survey publications on methodology, prevalence and causes of visual impairment and outcome of cataract surgery were retrieved, reviewed and relevant data extracted, reported and discussed. The study was the largest and more detailed eye survey in Nigeria (15,375 people 40 years and older recruited). Participants had detailed eye examination including visual acuity, autorefractokeratometry, A- scan biometry, visual field and basic eye examination. Cause(s) of visual impairment in each eye using WHO algorithm was determined among participants with vision < 6/12. Some of the participants also had qualitative questions on barriers to uptake of services, quality of life and visual function. Major highlights of the results as contained in the publications include a high prevalence of blindness with 4.2% (95% CI: 3.8-4.6%;),of the study population having blindness (using presenting vision (PVA)) even with best correction the prevalence was 3.4% (95% CI: 3.0-3.8%. The prevalence of SVI using PVA was 1.5% (95% CI: 1.3-1.7%). and with best correction 0.8% (95% CI: 0.7-1.0%). Blindness varied by age groups, sex, literacy level and geopolitical zone. Furthermore, 84% of blindness was due to avoidable causes with cataract responsible for 43% of blindness, glaucoma 16.7%, uncorrected aphakia 8.4% and corneal opacity 7.9%. Of the total 538 eyes that had cataract surgery procedures, 42.7% had couching and the remaining had cataract surgery, but only 41.4% of cataract operated eyes had IOL surgery. Outcome of cataract surgery was good at presentation for only 30.8% of eyes (84 eyes) which improved to 56.8% with correction. The possible remedy for the high burden of needless blindness and harmful eye health practices in Nigeria are discussed.
Keywords: Adult; Age Distribution; Aged; Aged, 80 and over; Blindness/di [Diagnosis]; Blindness/ep [Epidemiology]; Blindness/et [Etiology]; *Blindness; Cataract/ep [Epidemiology]; *Cataract Extraction/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Female; Health Surveys; Humans; Male; Middle Aged; Nigeria/ep [Epidemiology]; Prevalence; Sex Distribution; Treatment Outcome; Vision, Low/di [Diagnosis]; Vision, Low/ep [Epidemiology]; Vision, Low/et [Etiology]; *Vision, Low; Visual Acuity

Shared care for chronic eye diseases: perspectives of ophthalmologists, optometrists and patients. - O'Connor, Patricia M; Harper, C Alex; Brunton, Cathy L; Clews, Sandra J; Haymes, Sharon A; Keeffe, Jill E (The Medical journal of Australia, 2012)
OBJECTIVE: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases., DESIGN, SETTING AND PARTICIPANTS: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007-2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model., RESULTS: Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists' expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust., CONCLUSIONS: Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.
Comment in (CIN)
Keywords: Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; *Attitude to Health; Chronic Disease; Diabetic Retinopathy/di [Diagnosis]; Diabetic Retinopathy/th [Therapy]; Eye Diseases/di [Diagnosis]; Eye Diseases/th [Therapy]; *Eye Diseases; Female; Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; Health Care Surveys; Humans; Interprofessional Relations; Macular Degeneration/di [Diagnosis]; Macular Degeneration/th [Therapy]; Male; Middle Aged; *Ophthalmology; *Optometry; *Patient Care Team; Patient Satisfaction; Qualitative Research; Referral and Consultation; Waiting Lists

Effects of multipurpose contact lens care solutions on the adhesion of Acanthamoeba to silicone hydrogel contact lenses. - Uno, Toshihiko; Ohashi, Yuichi; Nomachi, Miya; Imayasu, Masaki (Cornea, 2012)
PURPOSE: To evaluate the effect of 7 multipurpose contact lens care solutions (MPSs) on the adhesion of Acanthamoeba (AC) to 5 silicone hydrogel contact lenses (SHCLs)., METHODS: Acanthamoeba castellanii (ATCC50370) trophozoites were inoculated onto disks trimmed from SHCLs, Asmofilcon A, Galyfilcon A, Senofilcon A, Lotrafilcon B, and Balafilcon A. After 4-hour incubation, the number of adherent AC trophozoites on SHCL was counted under phase contrast microscopy. AC trophozoites mixed with 7 MPSs were inoculated onto Balafilcon A and incubated for 24 hours followed by direct counting, phase contrast microscopy, and scanning electron microscopy. AC cysts were also inoculated onto Balafilcon A followed by counting using phase contrast microscopy., RESULTS: Adhesion of AC trophozoites to Lotrafilcon B and Balafilcon A was 10 times higher in comparison with the other 3 SHCLs. Twenty four-hour treatment of AC trophozoites with Epica Cold, Epica Cold Aquamore, ReNu MultiPlus, OptiFree Plus, and Complete DoubleMoist reduced the numbers of adherent AC to less than 25% of control, whereas the numbers of AC treated with Complete AminoMoist and C3 SoftOne Moist was about 50% and 75% of control, respectively. Normal AC trophozoites without any treatments showed 25 times higher adhesion rates compared with normal AC cysts., CONCLUSIONS: The adhesion rates of AC trophozoites to SHCL varied depending on the type of MPSs used. Appropriate uses of MPS could reduce adhesion rates of AC to SHCL and potentially decrease clinical rates of Acanthamoeba keratitis.
Keywords: Acanthamoeba/de [Drug Effects]; *Acanthamoeba/ph [Physiology]; Animals; Cell Adhesion/de [Drug Effects]; *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses, Hydrophilic/ps [Parasitology]; Humans; *Hydrogels; Microscopy, Phase-Contrast; *Silicones

Antimicrobial efficacy tests of multipurpose contact lens care solutions simulating poor contact lens hygiene behaviors. - Uno, Toshihiko; Ohashi, Yuichi; Imayasu, Masaki (Eye & contact lens, 2012)
PURPOSE: The aim of this study was to simulate the biofilm formation in contact lens (CL) case under poor hygiene behaviors; antimicrobial efficacies of multipurpose solutions (MPSs) against biofilm on the lens case were evaluated., METHODS: Five MPSs (Epica Cold, Complete 10 min, ReNu MultiPlus, SoftOne Mois, and OPTI-FREE Plus) were tested. Lens cases containing ACUVUE2 were inoculated with 1x10, 10, or 10 colony-forming units (CFUs) of Staphylococcus epidermidis (SE). Each lens case was treated with 1 MPS for 4 hrs followed by the estimation of the number of SE by the CFU method. Disinfection efficacies of MPSs against SE biofilm were evaluated by biomicroscopy with safranin staining and scanning electron microscopy., RESULTS: Lens cases, inoculated with 1x10 CFU, were disinfected by all MPSs. Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE showed almost a 2-log reduction of the CFU, whereas SoftOne Mois effect was almost a 1 log reduction, significantly lower than other MPSs (P<0.05). No biofilm formations were observed in Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE Plus-treated groups unlike significant biofilm formation in the SoftOne Mois-treated group (P<0.01)., CONCLUSIONS: Greater efforts to educate patients regarding compliant lens care behavior are needed to reduce the incidence of CL-associated microbial keratitis.
Keywords: Analysis of Variance; Biofilms/de [Drug Effects]; Colony Count, Microbial/sn [Statistics & Numerical Data]; *Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses/mi [Microbiology]; Disinfectants/pd [Pharmacology]; *Equipment Contamination/pc [Prevention & Control]; Hygiene; Microscopy, Electron, Scanning; *Staphylococcus/de [Drug Effects]; Staphylococcus/ip [Isolation & Purification]

Disparities in adult vision health in the United States. - Zambelli-Weiner, April; Crews, John E; Friedman, David S (American journal of ophthalmology, 2012)
PURPOSE: To review the existing knowledge on vision health disparities in major adult vision health outcomes (age-related macular degeneration, diabetic retinopathy, glaucoma, cataract, refractive errors) and visual impairment and to identify knowledge gaps as related to the development of enhanced vision health surveillance in the United States., DESIGN: Literature review., METHODS: Analysis of relevant publications in the peer-reviewed literature., RESULTS: Prevalence data on vision health outcomes is limited to findings from a few key population-based studies. Study populations are not representative of all persons living in the United States. Vision loss and visual impairment are more common with age, and there is racial variation in the specific causes of vision loss (underlying health conditions). Women are at greater risk of vision loss than men (even after adjusting for age). Vision-related disability and disparities in visual outcomes are monitored poorly at present., CONCLUSIONS: Data to assess and monitor trends in vision health disparities in the United States are not collected presently in a systematic fashion. This lack of data limits public health efforts to overcome barriers to eye care use and to improve vision outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.
Keywords: Adult; Cataract/ep [Epidemiology]; Diabetic Retinopathy/ep [Epidemiology]; *Eye Diseases/ep [Epidemiology]; Female; Glaucoma/ep [Epidemiology]; *Health Services Accessibility/td [Trends]; Health Surveys; *Healthcare Disparities/sn [Statistics & Numerical Data]; Humans; Macular Degeneration/ep [Epidemiology]; Male; *Ophthalmology/td [Trends]; Population Surveillance; Refractive Errors/ep [Epidemiology]; United States/ep [Epidemiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Therapeutic applications of ultrasound in ophthalmology. - Aptel, Florent; Lafon, Cyril (International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group, 2012)
Therapeutic ultrasound, although less well known than ultrasound for diagnostic imaging, has become a topic of growing interest in ophthalmology. High intensity focused ultrasound (HIFU) for the treatment of glaucoma and ultrasonic drug delivery are the two main areas of research and potential clinical applications. For the treatment of glaucoma, the specific advantage of HIFU, particularly when compared to the laser, is that the energy can be focused through optically opaque media, especially through the sclera which is a strongly light-scattering medium. HIFU is therefore a possible method for partial coagulation of the ciliary body (an anatomical structure responsible for the production of the liquid filling the eye) and, hence, reducing intraocular pressure and the risk of glaucoma. Ocular drug bioavailability also remains a challenge, being limited by multiple barriers to drug entry and lacrimal drainage, and making it difficult to achieve a sufficient drug concentration for numerous diseases of the front and back of the eye. As the front wall of the eye (cornea and anterior sclera) is a pathway for topically applied drugs, locally applied ultrasound has been proposed as a way of enhancing the delivery and activity of drugs and genes. Despite the fact that experimental studies seem to confirm the potential benefit of ultrasound ocular drug delivery, there is still a lack of clinical evidence. The aim of this contribution is to provide an update on recent advances in the field of therapeutic ultrasound in ophthalmology.
Keywords: Animals; *Drug Delivery Systems/mt [Methods]; Eye/me [Metabolism]; Eye Diseases/me [Metabolism]; *Eye Diseases/th [Therapy]; Humans; Ophthalmology/mt [Methods]; Sound; *Ultrasonic Therapy

[Contact lenses and keratitis]. - Bischoff, G; Brocks, U (Klinische Monatsblatter fur Augenheilkunde, 2012)
Keratitis is a rare but important and possibly sight threatening complication of Contact Lens wearing. Despite of the number of only about 1.7 keratitis cases per ophthalmolgist per year, this serious side effect needs knowledge and special diagnosis and treatment. Global changes of infectious agents and increase of previously unsuspicious pathogens in combination with a high degress of non-compliance indicate that Contact Lens wearing must be accompanied careful ophthalmologist's medical care and after-care. Copyright © Georg Thieme Verlag KG Stuttgart . New York.
Keywords: *Contact Lenses/ae [Adverse Effects]; Humans; Keratitis/di [Diagnosis]; *Keratitis/et [Etiology]; *Keratitis/pc [Prevention & Control]

Expressions of equity: imbalances in the patient-clinician interaction. - Mocherla, Shobha; Raman, Usha; Holden, Brien (Indian journal of medical ethics, 2012)
This paper reports patient perceptions of inequities in the doctor-patient interaction. A mixed method study was conducted in a tertiary eye care centre in southern India to gain an insight into patient understanding and satisfaction from clinician communication. Non-participant observations enabled us to map the sequence of communication opportunities in the clinical interaction, and in-depth interviews were used to identify patient perceptions of the content and clarity of clinician communication in a clinic for patients of glaucoma, a chronic eye disease. A 60-item instrument was administered to 550 participants in the quantitative phase to explore associations between patient expectations, experience and ratings of clinician communication and satisfaction with it. The qualitative results helped map the clinical interaction, highlighting the consequences of poor clinician communication. The quantitative phase showed that patients expected explanations about the disease, the opportunity to ask questions, receiving supportive signals, and being treated as equals. Most patients stated their information source on disease was their doctor, leading us to conclude that clinicians must utilise communication opportunities optimally to ensure every patient has an equal chance to correctly understand their disease and role in treatment. By consciously improving their communication and using it strategically, clinicians can help ensure effective treatment outcomes.
Keywords: Adult; Aged; Female; *Glaucoma/th [Therapy]; *Healthcare Disparities; Humans; India; Male; Middle Aged; *Patient Satisfaction; *Physician-Patient Relations; Socioeconomic Factors

Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. - Kur, Joanna; Newman, Eric A; Chan-Ling, Tailoi (Progress in retinal and eye research, 2012)
We review the cellular and physiological mechanisms responsible for the regulation of blood flow in the retina and choroid in health and disease. Due to the intrinsic light sensitivity of the retina and the direct visual accessibility of fundus blood vessels, the eye offers unique opportunities for the non-invasive investigation of mechanisms of blood flow regulation. The ability of the retinal vasculature to regulate its blood flow is contrasted with the far more restricted ability of the choroidal circulation to regulate its blood flow by virtue of the absence of glial cells, the markedly reduced pericyte ensheathment of the choroidal vasculature, and the lack of intermediate filaments in choroidal pericytes. We review the cellular and molecular components of the neurovascular unit in the retina and choroid, techniques for monitoring retinal and choroidal blood flow, responses of the retinal and choroidal circulation to light stimulation, the role of capillaries, astrocytes and pericytes in regulating blood flow, putative signaling mechanisms mediating neurovascular coupling in the retina, and changes that occur in the retinal and choroidal circulation during diabetic retinopathy, age-related macular degeneration, glaucoma, and Alzheimer's disease. We close by discussing issues that remain to be explored. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
Keywords: Animals; Calcium/me [Metabolism]; *Choroid/bs [Blood Supply]; Choroid/ir [Innervation]; Choroid/re [Radiation Effects]; *Eye Diseases/pp [Physiopathology]; Humans; Light; Medical Illustration; Oculomotor Muscles/me [Metabolism]; Potassium/me [Metabolism]; Regional Blood Flow/ph [Physiology]; Regional Blood Flow/re [Radiation Effects]; *Retina/ph [Physiology]; Retina/re [Radiation Effects]; *Retinal Vessels/ph [Physiology]; Retinal Vessels/pp [Physiopathology]; Signal Transduction/ph [Physiology]; Visual Fields/ph [Physiology]

[Toward a high quality glaucoma care]. - Kashiwagi, Kenji (Nippon Ganka Gakkai zasshi, 2012)
The following studies were performed to solve current problems in glaucoma care and to pursue quality glaucoma care. Using a scanning peripheral anterior chamber depth analyzer that we developed, we: 1) conducted cross-sectional screening for eyes with angle closure; 2) examined longitudinal changes in anterior chamber depth and occurrence rates of primary angle closure in local senior residents; 3) investigated the significance of the anterior chamber and the angle of eyes with open angle glaucoma; and 4) looked into possible applications of anterior chamber depth and the angle in routine examinations. We investigated the effects of retinal glial cells and optic nerve astrocytes on retinal ganglion cell (RGC) survival and neurite growth using a culture system. We also identified candidate genies of retinal glial cells and optic nerve astrocytes affecting RGC survival and neurite growth using microarray and siRNA systems. SRC, a membrane-associated 60-kDa tyrosine kinase, is reported to be involved in neuron death and neurite growth. We developed two types of gene-targeted mice in which we modified the status of SRC phosphorylation. We compared RGC survival and neurite growth by conducting in vivo and in vitro experiments. Adherence is currently a very important issue in the field of glaucoma. We developed a nm thick and composed of 21.5 chitosan-sodium alginate pairs. IOP reduction and its duration, as well as adverse effects, were investigated. In addition, we established and evaluated a support system for glaucoma care in an effort to promote participation of glaucoma patients in glaucoma care using information and communication technology. This system improved the literacy of glaucoma patients as well as glaucoma medical therapy. At the same time, in order to ably provide glaucoma care given the increase in the number of glaucoma patients and the shortage of glaucoma specialists, a tele-medicine system for ophthalmology was developed, in which ophthalmologists are able to operate a slit-lamp system from remote areas. We compared the accuracy of diagnosis of ocular surface diseases using this tele-medicine system with that of a conventional slit-lamp system. We anticipate that the combination of Internet-based glaucoma support system with the tele-medicine system for ophthalmology will form a new framework for glaucoma care for both chronic and acute stage patients.
Keywords: Animals; Glaucoma/di [Diagnosis]; Glaucoma/pa [Pathology]; *Glaucoma/th [Therapy]; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/th [Therapy]; Humans; Mice; Nanotechnology; Optic Nerve/pa [Pathology]; Patient Participation; Retina/pa [Pathology]; Telemedicine

[Bilateral recurrent blurred vision associated with halos around sources of light and headache]. - Volcker, D; Reinhard, T; Ness, T (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2012)
A 21-year-old male presented with headache and blurred vision associated with halos around sources of light. The visual acuity was slightly reduced and the intraocular pressure in the left eye was elevated to 44 mmHg and in the right eye to 49 mmHg. Slit lamp examination of the anterior segment revealed bilateral cells and a Tyndall phenomenon 2 +, several cell clumps adherent to the corneal endothelium, known as mutton-fat keratic precipitates and a circumscribed inflammatory infiltration of the right iris. The posterior segment of both eyes was normal. The cause of the presumed clinical diagnosis secondary open angle glaucoma due to anterior granulomatous uveitis was sarcoidosis, confirmed by elevated serological markers of angiotensin-converting enzyme (ACE), soluble interleukin-2 receptor (sIL-2R) and by pulmonary hilar lymphadenopathy. The local and systemic corticosteroid therapy was successful and also normalized the intraocular pressure.
Keywords: *Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/et [Etiology]; Glaucoma, Open-Angle/th [Therapy]; Humans; Male; *Sarcoidosis/co [Complications]; *Sarcoidosis/di [Diagnosis]; Sarcoidosis/pc [Prevention & Control]; Secondary Prevention; Treatment Outcome; *Uveitis/co [Complications]; *Uveitis/di [Diagnosis]; Uveitis/pc [Prevention & Control]; Vision Disorders/di [Diagnosis]; *Vision Disorders/et [Etiology]; Vision Disorders/th [Therapy]; Young Adult

Corneal ulceration in a LASIK patient due to vitamin a deficiency after bariatric surgery. - Donaldson, Kendall E; Fishler, Jane (Cornea, 2012)
PURPOSE: To review the case of a 41-year-old woman who underwent bariatric surgery in 2000. She subsequently underwent laser in situ keratomileusis (LASIK) surgery in 2008 and complained of dry eye since the LASIK surgery. In November 2010, she was diagnosed with a corneal melt and was treated with aggressive lubrication, followed by eventual amniotic membrane placement and a tarsorrhaphy. She then presented for consultation at the Bascom Palmer Eye Institute when she developed a corneal infiltrate. She was diagnosed with fungal keratitis with corneal xerosis. At that time, vitamin A levels were measured and were less than 2 mu/dL. The patient admitted noncompliance with nutritional supplements., METHODS: Case report., RESULTS: The patient was treated with aggressive lubrication and natamycin. Vitamin supplements were restarted, and the patient experienced dramatic improvement in symptoms with resolution of the infection. A central corneal scar with corneal thinning remains. The patient underwent a penetrating keratoplasty for visual rehabilitation., CONCLUSIONS: Patient education with emphasis on compliance with nutritional supplements is essential after bariatric surgery. Consider vitamin A deficiency in the differential diagnosis of dry eye after LASIK surgery.
Keywords: Adult; Antifungal Agents/tu [Therapeutic Use]; *Ascomycota/ip [Isolation & Purification]; *Bariatric Surgery/ae [Adverse Effects]; Corneal Ulcer/di [Diagnosis]; *Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/th [Therapy]; Eye Infections, Fungal/di [Diagnosis]; *Eye Infections, Fungal/mi [Microbiology]; Eye Infections, Fungal/th [Therapy]; Female; Humans; Keratoconjunctivitis Sicca/et [Etiology]; Keratoconjunctivitis Sicca/su [Surgery]; *Keratomileusis, Laser In Situ; Keratoplasty, Penetrating; Mycoses/di [Diagnosis]; *Mycoses/mi [Microbiology]; Mycoses/th [Therapy]; Visual Acuity; Vitamin A/bl [Blood]; Vitamin A/tu [Therapeutic Use]; *Vitamin A Deficiency/et [Etiology]

Avoidable sight loss from glaucoma: is it unavoidable?. - Kotecha, Aachal; Fernandes, Sofia; Bunce, Catey; Franks, Wendy A (The British journal of ophthalmology, 2012)
AIMS: To review the characteristics of patients attending a tertiary ophthalmic referral centre certified as sight impaired (SI) or severely sight impaired (SSI) from glaucoma., METHODS: One hundred consecutive patients certified SI/SSI from the Glaucoma Service at Moorfields Eye Hospital, London, from January 2007 were identified from the England and Wales certification of visual impairment database. Clinical and demographic data were collected from hospital case records., RESULTS: The median (IQR) age of patients at presentation was 66.3 (55.6 to 75.3) years; median (IQR) interval to certification was 62.2 (22.5 to 129.3) months. Fifty-seven patients presented with bilateral SSI (median (IQR) age 70.4 (59.0 to 76.9) years); interval to certification was 35.4 (5.6 to 78.1) months. Seventeen patients presented with a bilateral SI (median (IQR) age 62.1 (58.7 to 68.4) years; median (IQR) interval to certification: 137.4 (64.4 to 190.4) months). Twenty-eight patients showed disease progression while under National Health Service hospital eye service care, five of whom had no certifiable visual impairment in either eye at presentation. This was attributed to inadequate intraocular pressure control; five of these patients (18%) were deemed poorly compliant to topical hypotensive medication., CONCLUSIONS: Over 80% patients on the certification of visual impairment register from Moorfields Eye Hospital with glaucoma as the primary cause had a significant visual disability at presentation, with almost two-thirds of patients presenting bilaterally 'blind'. There appear to be delays to certification. Despite being under the hospital eye service, a number of glaucoma patients still progress to certifiable visual impairment.
Keywords: Aged; Blindness/di [Diagnosis]; *Blindness/ep [Epidemiology]; *Certification/sn [Statistics & Numerical Data]; Databases, Factual; Disability Evaluation; Female; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/ep [Epidemiology]; Humans; Male; Middle Aged; *Registries/sn [Statistics & Numerical Data]; Retrospective Studies; State Medicine; United Kingdom/ep [Epidemiology]; Vision, Low/di [Diagnosis]; *Vision, Low/ep [Epidemiology]; Visual Acuity/ph [Physiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Review of endophthalmitis following Boston keratoprosthesis type 1. - Robert, Marie-Claude; Moussally, Krystel; Harissi-Dagher, Mona (The British journal of ophthalmology, 2012)
Endophthalmitis remains one of the most damaging and challenging complications following Boston keratoprosthesis type 1 (KPro) surgery. The authors reviewed the literature from 2001 onward to identify cases of endophthalmitis following KPro surgery and present an additional case of endophthalmitis in a patient with Stevens Johnson syndrome. The prevalence of endophthalmitis between 2001 and 2011 was 5.4%. Gram-positive bacteria are the most common agents responsible for endophthalmitis in this patient population while gram-negative bacteria and fungi are emerging pathogens. Risk factors for endophthalmitis include preoperative diagnosis of cicatricial disease and postoperative infectious keratitis, glaucoma drainage device erosion and non-compliance with antibiotic prophylaxis. Additional studies on the prevention and treatment of endophthalmitis are required to improve the overall prognosis of these patients.
Keywords: *Artificial Organs; *Cornea; Endophthalmitis/ep [Epidemiology]; *Endophthalmitis/mi [Microbiology]; Eye Infections, Bacterial/ep [Epidemiology]; *Eye Infections, Bacterial/mi [Microbiology]; Humans; Male; Middle Aged; Mycoses/ep [Epidemiology]; *Mycoses/mi [Microbiology]; *Postoperative Complications; Prostheses and Implants; Risk Factors; Stevens-Johnson Syndrome/co [Complications]

Radiofrequency thermocoagulation for trigeminal neuralgia without intra-operative patient waking. - Hart, Michael G; Nowell, Mark; Coakham, Hugh B (British journal of neurosurgery, 2012)
OBJECTIVE: It is proposed that radiofrequency thermocoagulation (RFT) under general anaesthesia without waking the patient intra-operatively, which is usually performed to confirm lesion location, will reduce the peri-operative discomfort and anxiety suffered by patients., METHODS: A retrospective review of all procedures, identified through standard hospital audit codes and performed by a single surgeon from 2000 to 2007. Postal questionnaires were sent to all eligible patients. Outcome criteria included pain relief, adverse events and patients' views on satisfaction, timing and outcomes. A Kaplan-Meier plot was used to determine actuarial rates of pain relief., RESULTS: Follow-up was available for 84% (37/44) of patients. Complete post-operative pain relief was 96% (42/44). The actuarial rates of complete pain relief at 6, 12, 24 and 36 months were 89%, 79%, 66% and 43%. No patients reported an outcome that did not meet their expectations while 71% (20/28) had an outcome that was better than their expectation. Serious complications included corneal numbness affecting 12% (5/41), but no cases of keratitis and a single case of anaesthesia dolorosa., CONCLUSIONS: Not waking a patient intra-operatively when performing a RFT is a viable treatment option that results in excellent early pain relief, comparable to results in the literature and without an increase in complications. Patient reported outcomes indicate a high rate of satisfaction and are a novel addition to our understanding of the procedure; there is no comparable data in the literature documenting patient satisfaction outcomes when the procedure is performed with patient waking.
Comment in (CIN)
Keywords: Aged; Aged, 80 and over; Anesthesia, General; *Electrocoagulation/mt [Methods]; Female; Humans; Intraoperative Care/mt [Methods]; Male; Middle Aged; Pain Measurement; Pain, Postoperative/pc [Prevention & Control]; Patient Satisfaction; Quality of Life; *Radiosurgery/mt [Methods]; Recurrence; Surveys and Questionnaires; Treatment Outcome; *Trigeminal Neuralgia/su [Surgery]; Wakefulness

Short-term outcome of Boston Type 1 keratoprosthesis for bilateral limbal stem cell deficiency. - Basu, Sayan; Taneja, Mukesh; Narayanan, Raja; Senthil, Sirisha; Sangwan, Virender S (Indian journal of ophthalmology, 2012)
This study reports the short-term functional and anatomical outcome of Boston Type 1 keratoprosthesis (Boston Kpro) implantation for bilateral limbal stem cell deficiency (LCSD). Retrospective analysis was done on eight eyes of eight patients who underwent Boston Kpro implantation between July 2009 and October 2009. The best corrected visual acuity (BCVA) and slit-lamp biomicroscopy findings were assessed at 1, 3 and 6 months postoperatively. All eight eyes retained the prosthesis. BCVA of 20/40 or better was achieved in 8, 6, and 5 eyes at 1, 3, and 6 months, respectively, postoperatively. One patient each developed epithelial defect, sterile stromal melt and fungal keratitis in the late postoperative period associated with antecedent loss of the soft contact lens from the eye. Boston Kpro has good short-term visual and anatomical outcome in patients with bilateral LSCD, provided compliance with postoperative care can be ensured.
Keywords: Adolescent; Adult; Blindness/et [Etiology]; *Blindness/su [Surgery]; Corneal Diseases/co [Complications]; Corneal Diseases/pa [Pathology]; *Corneal Diseases/su [Surgery]; Follow-Up Studies; Humans; *Limbus Corneae/pa [Pathology]; Middle Aged; *Prostheses and Implants; Retrospective Studies; *Stem Cells/pa [Pathology]; Treatment Outcome; Young Adult

Influence of parental health literacy and dosing responsibility on pediatric glaucoma medication adherence. - Freedman, Rebecca B; Jones, Sarah K; Lin, Alice; Robin, Alan L; Muir, Kelly W (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE: To assess glaucoma medication adherence in children, hypothesizing that poor parental health literacy and eye drop instillation by the child are associated with worse adherence., METHODS: This prospective, observational study enrolled pediatric patients with glaucoma who were prescribed eye drops. Parent(s) reported who was responsible for eye drop instillation (parent vs child), took the Rapid Estimate of Adult Literacy in Medicine, and were instructed on the use and purpose of the Medication Event Monitoring System. Calculations included average adherence (proportion of prescribed doses taken), dosing errors (number of overdosing or underdosing events in 24 hours), and proportion of doses taken on schedule (doses taken within 2 hours of prescribed dosing interval). Results are reported as mean (SD) or median., RESULTS: The study included 46 of the 50 enrolled children who used the Medication Event Monitoring System for 30 days or more. Adherence ranged from 43% to 107% (93% [12%]) and was not associated with age (slope, 0.09 [0.52]; P = .86) but decreased with the parent's lower health literacy (slope, 0.62 [0.24]; P = .01). The mean number of dosing errors for medications prescribed daily vs twice daily was similar (3.3 vs 2.9; P = .66). The proportion of doses taken on schedule (within 2 hours of prescribed dosing interval) ranged from 3% to 97% (median, 34%; mean, 41% [24%]) and was better when the parent vs the child instilled eye drops (46% [26%] vs 23% [19%]; P < .001)., CONCLUSIONS: Time-dependent glaucoma medication adherence was better when the parent was responsible for eye drop instillation. Overall decreased adherence was associated with decreased parental health literacy. Children of parents with poor health literacy are vulnerable to poor medication adherence; efforts to address poor health literacy may improve outcomes.
Keywords: Adolescent; Adult; Child; Child, Preschool; Drug Monitoring/sn [Statistics & Numerical Data]; Female; *Glaucoma/dt [Drug Therapy]; *Health Literacy/sn [Statistics & Numerical Data]; Health Surveys; Humans; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Medication Errors/pc [Prevention & Control]; Medication Errors/sn [Statistics & Numerical Data]; *Ophthalmic Solutions/ad [Administration & Dosage]; *Parents/ed [Education]; Prospective Studies

The modified Cincinnati procedure: combined conjunctival limbal autografts and keratolimbal allografts for severe unilateral ocular surface failure. - Chan, Clara C; Biber, Joseph M; Holland, Edward J (Cornea, 2012)
PURPOSE: To describe the technique and present the outcomes of combined conjunctival limbal autografts (CLAU) and keratolimbal allografts (KLAL) for the treatment of unilateral severe ocular surface failure., METHODS: Interventional case series. Eleven eyes of 11 patients who sustained chemical burns (4 alkali and 2 acid) and combined chemical/thermal burns (5 eyes) from firework explosions had combined CLAU/KLAL surgery. Keratoplasty was performed subsequently for residual corneal stromal scarring limiting visual acuity. Inclusion criteria included eyes with severe unilateral total ocular surface failure, controlled glaucoma, and reasonable eyelid apposition with no exposure. Exclusion criteria included patients with any ocular surface abnormality in the fellow eye and those with contraindications to systemic immunosuppression (SI). Outcome measures included Snellen best-corrected visual acuity (BCVA), ocular surface stability, SI exposure, and complications., RESULTS: Preoperative BCVA was 20/400 or worse in all eyes. At the final follow-up (mean, 35.8 months; range, 12.1-105.9 months), 73% (8 of 11) eyes had BCVA of 20/80 or better (range, 20/25 to counting fingers), and ocular surface was stable in 82% (9 of 11). Ninety-one percent (10 of 11) had additional penetrating keratoplasty (PK) with a 60% (6 of 10 eyes) success rate. Three cases had subsequent Boston type 1 keratoprosthesis implantation after PK failure, and the fourth patient, at the time of his last follow-up visit, did not want further intervention for his edematous PK, which was a result of noncompliance-related corneal rejection. In eyes with more than 2 years of follow-up, SI was tapered at a mean of 16 months (range, 8-28 months). There were no intraoperative complications. No secondary tumors, cardiac events, or deaths occurred while patients were on SI. One patient developed secondary glaucoma refractory to medical management after subsequent PK, requiring cyclodiode laser., CONCLUSIONS: Combined CLAU/KLAL and staged keratoplasty is effective in improving vision and maintaining long-term ocular surface stability in patients with severe unilateral ocular surface disease and conjunctival deficiency.
Keywords: Adolescent; Adult; Aged; Blast Injuries/pp [Physiopathology]; *Blast Injuries/su [Surgery]; Burns, Chemical/pp [Physiopathology]; *Burns, Chemical/su [Surgery]; Combined Modality Therapy; *Conjunctiva/tr [Transplantation]; Corneal Diseases/pp [Physiopathology]; *Corneal Diseases/su [Surgery]; Drug Combinations; Epithelium, Corneal/cy [Cytology]; *Eye Burns/ci [Chemically Induced]; Female; Glucocorticoids/ad [Administration & Dosage]; Humans; Immunosuppressive Agents/ad [Administration & Dosage]; Keratoplasty, Penetrating; *Limbus Corneae/cy [Cytology]; Male; Middle Aged; Prosthesis Implantation; *Stem Cell Transplantation; Sulfamethizole/ad [Administration & Dosage]; Tissue Donors; Transplantation, Autologous; Transplantation, Homologous; Trimethoprim/ad [Administration & Dosage]; Visual Acuity/ph [Physiology]; Young Adult

The effect of appointment rescheduling on monitoring interval and patient attendance in the glaucoma outpatient clinic. - Tatham, A; Murdoch, I (Eye (London, England), 2012)
AIM: To assess the effect of appointment rescheduling on monitoring intervals and patient attendance in the glaucoma clinic., METHODS: A retrospective review of 100 consecutive patients was conducted. Patients were categorised into groups based on risk of progressive visual loss. The monitoring interval requested by the clinician was compared with the interval recommended by national guidelines. One hundred consecutive patients who had had their appointment rescheduled were also examined to assess the effect of appointment rescheduling on the actual monitoring interval. Patient non-attendance rates and attendances at the emergency department were also examined., RESULTS: After excluding patients with secondary glaucoma, glaucoma suspects, and those with short-term factors affecting monitoring interval, 54 patients with chronic open-angle glaucoma (COAG) were included. Forty-eight (89%) of patients had a monitoring interval requested in accordance with national guidelines (2 had longer intervals by 1-2 months and 4 had shorter time intervals). The monitoring interval was not influenced by disease severity (Kruskal-Wallis test, P=0.16), but was significantly shorter if the intraocular pressure was above target (P<0.0001) or the patient showed structural or functional progression (P<0.0001). Hospital-initiated appointment rescheduling led to significant lengthening of monitoring interval. The mean difference between intended and actual monitoring interval was 5.6 months. Eight percent (8/100) of patients with rescheduled appointments did not attend compared with 15% (39/265) without rescheduled appointments., CONCLUSION: Clinical staff are selecting appropriate monitoring intervals for patients with COAG; however, hospital-initiated rescheduling of appointments is a major challenge to appropriate follow-up.
Keywords: *Appointments and Schedules; Chronic Disease; *Continuity of Patient Care/sn [Statistics & Numerical Data]; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Monitoring, Physiologic; *Outpatient Clinics, Hospital; *Patient Compliance/sn [Statistics & Numerical Data]; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Time Factors

Coverage of hospital-based cataract surgery and barriers to the uptake of surgery among cataract blind persons in nigeria: the Nigeria National Blindness and Visual Impairment Survey. - Abubakar, Tafida; Gudlavalleti, Murthy V S; Sivasubramaniam, Selvaraj; Gilbert, Clare E; Abdull, Mohammed M; Imam, Abdullahi U (Ophthalmic epidemiology, 2012)
PURPOSE: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria., METHODS: Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery., RESULTS: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4-1.8), significantly higher among those aged >=70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%)., CONCLUSIONS: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery.
Keywords: Adult; Aged; *Blindness/ep [Epidemiology]; *Cataract/ep [Epidemiology]; *Cataract Extraction/sn [Statistics & Numerical Data]; Cross-Sectional Studies; Female; *Health Services Accessibility/sn [Statistics & Numerical Data]; Health Surveys; Humans; Male; Middle Aged; Nigeria/ep [Epidemiology]; Prevalence; Rural Population/sn [Statistics & Numerical Data]; Urban Population/sn [Statistics & Numerical Data]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]; *Visually Impaired Persons/sn [Statistics & Numerical Data]

Cost-effectiveness of medications compared with laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma. - Stein, Joshua D; Kim, David D; Peck, Will W; Giannetti, Steven M; Hutton, David W (Archives of ophthalmology (Chicago, Ill. : 1960), 2012)
OBJECTIVE: To determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP)., METHODS: Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only., RESULTS: The incremental cost-effectiveness of LTP over no treatment is $16,824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14,179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value., CONCLUSIONS: Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.
Keywords: Antihypertensive Agents/ad [Administration & Dosage]; *Antihypertensive Agents/ec [Economics]; Cloprostenol/ad [Administration & Dosage]; *Cloprostenol/aa [Analogs & Derivatives]; Cloprostenol/ec [Economics]; Cost-Benefit Analysis; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/th [Therapy]; Health Status; Humans; *Laser Therapy/ec [Economics]; Markov Chains; Medication Adherence; Middle Aged; Quality of Life; Quality-Adjusted Life Years; *Trabeculectomy/ec [Economics]; Travoprost

Losing sight under pressure. - Bastawrous, Andrew; Southward, Suzanne; Horner, Michael; Noonan, Carmel (Age and ageing, 2012)
A non-communicative patient with vascular dementia who was admitted to hospital with non-specific symptoms. Ophthalmic emergencies are rare, however they should be considered as part of a systemic work-up in unexplained non-specific presentations, particularly in patients who are not able to communicate as in the case we present here.
Keywords: *Communication; *Dementia, Vascular/co [Complications]; Dementia, Vascular/px [Psychology]; Diagnostic Techniques, Ophthalmological; Female; Glaucoma, Angle-Closure/co [Complications]; *Glaucoma, Angle-Closure/di [Diagnosis]; Glaucoma, Angle-Closure/pp [Physiopathology]; Glaucoma, Angle-Closure/px [Psychology]; Glaucoma, Angle-Closure/th [Therapy]; Humans; *Intraocular Pressure; Ophthalmologic Surgical Procedures; *Patient Compliance; Physician-Patient Relations; Predictive Value of Tests; Treatment Outcome; *Vision Disorders/di [Diagnosis]; Vision Disorders/et [Etiology]; Vision Disorders/pp [Physiopathology]; Vision Disorders/px [Psychology]; Vision Disorders/th [Therapy]; Visual Acuity

[Post-operative rehabilitation of functional amblyopia in primary infantile glaucoma: 11 year-follow-up]. - Boulze-Pankert, M; Zanin, E; Matonti, F; Benso, C; Toesca, E; Denis, D (Journal francais d'ophtalmologie, 2012)
PURPOSE: To evaluate the efficacy of functional amblyopia treatment in children having undergone surgery for primary infantile glaucoma., PATIENTS AND METHOD: Parameters studied included: age at surgery, current age, visual acuity (VA) (initial and most recent acuity), refraction, alignment, adherence to amblyopia treatment, condition of the cornea (Haab striae, stromal scarring, pachymetry, cell count), condition of the optic disc (cupping, RNFL OCT) and intraocular pressure. Pearson's p-value was fixed at 5%., RESULTS: Retrospective study of 29 eyes; average age at surgery was four months, mean follow-up was 11.2 years. Initial VA averaged 4.5 over 10, most recent VA 7 over 10, i.e. a gain of 2.3 over 10. Refraction revealed 37.9% myopia, 10.3% emmetropia, 48.2% hyperopia and an average astigmatism of 2.14 D. A negative correlation was found between astigmatism and most recent VA (rho=-0.7; P<0.001). A positive correlation was found between the quality of the occlusion therapy and the recovery of VA with a gain of 3.2 over 10 (P=0.001). A strong positive correlation was found between the cylinder power and the number of Haab striae [rho 0.702, P<0.0001]; final VA is best when the striae show no organized scar formation (P=0.04)., CONCLUSION: This study underlines the necessity of prolonged treatment of functional amblyopia in primary infantile glaucoma for the best possible visual rehabilitation. Copyright A© 2012 Elsevier Masson SAS. All rights reserved.
Keywords: Age of Onset; Amblyopia/ep [Epidemiology]; Amblyopia/et [Etiology]; Amblyopia/pp [Physiopathology]; *Amblyopia/rh [Rehabilitation]; Child; Child, Preschool; Female; Follow-Up Studies; Glaucoma/ep [Epidemiology]; Glaucoma/pp [Physiopathology]; Glaucoma/rh [Rehabilitation]; *Glaucoma/su [Surgery]; Humans; Infant; Male; *Ophthalmologic Surgical Procedures/rh [Rehabilitation]; Postoperative Period; Recovery of Function/ph [Physiology]; Retrospective Studies; Time Factors; Visual Acuity/ph [Physiology]

Ocular telehealth screenings in an urban community. - Shahid, Khadija; Kolomeyer, Anton M; Nayak, Natasha V; Salameh, Nura; Pelaez, Gina; Khouri, Albert S; Eck, Thomas T; Szirth, Ben (Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2012)
The current U.S. economic recession has resulted in a loss of income, housing, and healthcare coverage. Our major goal in this socioeconomic setting was to provide ophthalmic remote health screenings for urban soup kitchen and homeless populations in order to identify and refer undetected vision-threatening disease (VTD). We assessed visual acuity, blood pressure, pulse/oxygen saturation, body mass index, and intraocular pressure for 341 participants at soup kitchens as part of the homeless outreach program in Newark, NJ. History of diabetes, hypertension, and smoking, last ocular examination, and ocular history were noted. Imaging was performed with an 8.2 megapixel non-mydriatic retinal camera with high-speed Internet ready for off-site second opinion image evaluation. Positive VTD findings were identified in 105 participants (31%) (mean age, 53.6 years), of whom 78% were African American, 73% males, and 62% smokers. We detected glaucoma in 34 participants (32%), significant cataract in 22 (21%), diabetic retinopathy in 5 (5%), optic atrophy in 1 (1%), age-related macular degeneration in 1 (1%), and other retinal findings in 43 (41%). The incidence of VTDs was higher among this cohort than among study groups in previous screenings (31% vs. 12%). This finding shows an increase in ocular morbidity in a younger, at-risk population with elevated rates of hypertension, diabetes, and smoking. Functional visual impairment was 2.5 times higher than the national average (16% vs. 6.4%). Comprehensive, community-based screenings can provide more sensitive detection of VTDs in high-risk groups with low access to ophthalmic care and can be an integral part of recession solutions for improving healthcare.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Eye Diseases/di [Diagnosis]; Female; Health Services Accessibility; *Health Services Needs and Demand; Humans; Male; Mass Screening/ec [Economics]; *Mass Screening/mt [Methods]; Middle Aged; Ophthalmology/ec [Economics]; *Ophthalmology/mt [Methods]; Poverty; Socioeconomic Factors; Telemedicine/ec [Economics]; *Telemedicine/mt [Methods]; United States; *Urban Population/sn [Statistics & Numerical Data]; Young Adult

Glaucoma screening during regular optician visits: the feasibility and specificity of screening in real life. - de Vries, Margriet M; Stoutenbeek, Remco; Muskens, Rogier P H M; Jansonius, Nomdo M (Acta ophthalmologica, 2012)
PURPOSE: To determine the feasibility and specificity of glaucoma screening during regular optician visits., METHODS: In four optician shops, glaucoma screening was offered to 400 consecutive visitors aged 45 years or above. If the visitor agreed to participate, an intraocular pressure measurement and - in those with a pressure below 25 mmHg - a frequency-doubling perimeter (FDT) C20-1 visual field screening test were performed. Those with an elevated pressure or at least one reproducibly abnormal test location on FDT were referred to our hospital., RESULTS: Three-hundred and fifty-two of 400 consecutive visitors (88%) were screened. Fifteen of the unscreened visitors were not screened because they were already regularly checked by an ophthalmologist related to glaucoma. Forty-two of 352 screened participants (12%) were referred. Of these 42 referrals, seven were diagnosed with glaucoma, 10 were diagnosed with ocular hypertension (OHT), 12 did not have any eye disease, seven had an eye disease other than glaucoma or OHT that was diagnosed previously and six were newly diagnosed with an eye disease other than glaucoma or OHT. The specificity of the screening protocol was 91% (95% confidence interval 88-94%)., CONCLUSIONS: Glaucoma screening at the optician shop was feasible, but the specificity of the screening protocol was rather low. With more stringent cut-off points (30 mmHg; at least two reproducibly abnormal test locations), the specificity could be improved to 96% (94-98%), apparently without a significant loss of sensitivity. This suggests that screening during regular optician visits might be a viable approach. Copyright © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.
Keywords: Aged; Aged, 80 and over; Feasibility Studies; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; *Office Visits; Optometry; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; Surveys and Questionnaires; Tonometry, Ocular; *Vision Screening/mt [Methods]; Vision Screening/st [Standards]; Visual Field Tests

The role of the expected value of individualized care in cost-effectiveness analyses and decision making. - van Gestel, Aukje; Grutters, Janneke; Schouten, Jan; Webers, Carroll; Beckers, Henny; Joore, Manuela; Severens, Johan (Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2012)
OBJECTIVE: To explore the feasibility and potential role of the expected value of individualized care (EVIC) framework., METHODS: The EVIC quantifies how much benefits are forgone when a treatment decision is based on the best-expected outcomes in the population rather than in the individual patient. We have reviewed which types of patient-level attributes contribute to the EVIC and how they affect the interpretation of the outcomes. In addition, we have applied the EVIC framework to the outcomes of a microsimulation-based cost-effectiveness analysis for glaucoma treatment., RESULTS: For EVIC outcomes to inform decisions about clinical practice, we need to calculate the parameter-specific EVIC of known or knowable patient-level attributes and compare it with the real costs of implementing individualized care. In the case study, the total EVIC was 580 per patient, but patient-level attributes known at treatment decision had minimal impact. A subgroup policy based on individual disease progression could be worthwhile if a predictive test for glaucoma progression could be developed and implemented for less than 130 per patient., CONCLUSIONS: The EVIC framework is feasible in cost-effectiveness analyses and can be informative for decision making. The EVIC outcomes are particularly informative when they are (close to) zero. When the EVIC has a high value, implications depend on the type of patient-level attribute. EVIC can be a useful tool to identify opportunities to improve efficiency in health care by individualization of care and to quantify the maximal investment opportunities for implementing subgroup policy. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Keywords: Cost-Benefit Analysis; Data Interpretation, Statistical; *Decision Making; Disease Progression; *Glaucoma/ec [Economics]; Glaucoma/pp [Physiopathology]; *Glaucoma/th [Therapy]; Humans; *Models, Economic; Patient Preference; *Research Design

Clinical trials for glaucoma neuroprotection are not impossible. - Quigley, Harry A (Current opinion in ophthalmology, 2012)
PURPOSE OF REVIEW: To discuss issues that affect development of new glaucoma treatments known as neuroprotection., RECENT FINDINGS: There are barriers to neuroprotection trials for glaucoma., SUMMARY: With design features discussed in the review, neuroprotection trials can be effectively carried out.
Keywords: Animals; Clinical Trials as Topic; Disease Models, Animal; *Glaucoma/pc [Prevention & Control]; Humans; *Nerve Fibers/de [Drug Effects]; *Neuroprotective Agents/tu [Therapeutic Use]; *Optic Nerve Diseases/pc [Prevention & Control]; *Retinal Ganglion Cells/de [Drug Effects]

Shared care of patients with ocular hypertension in the Community and Hospital Allied Network Glaucoma Evaluation Scheme (CHANGES). - Mandalos, A; Bourne, R; French, K; Newsom, W; Chang, L (Eye (London, England), 2012)
AIMS: The Community and Hospital Allied Network Glaucoma Evaluation Scheme (CHANGES) used accredited community-based optometrists with a special interest (OSIs) in glaucoma to monitor ocular hypertensive (OHT) patients under virtual supervision of the Hospital Glaucoma Service (HGS). The purpose of this paper was to report the outcomes of the first completed community-based visit., METHODS: Eligible patients underwent a glaucoma consultant-led clinical examination before transfer to CHANGES. Individualised intraocular pressure (IOP) and follow-up time interval targets were set for each patient. OSIs used applanation tonometry, slit-lamp biomicroscopy, automated visual field testing and digital optic disc photography. The hospital-based glaucoma team evaluated the data virtually. Patients were referred back to the HGS according to specific criteria., RESULTS: One hundred and sixty eight OHT patients were invited to attend their first OSI appointment. Of these, 144 attended their appointment (attendance rate 85.7%). Outcomes of 130 patients with complete data sets are reported. Sixteen patients (12.3%) were referred back to the HGS due to IOP above target, new visual field defects and/or optic nerve changes. The glaucoma consultant retained eight patients (6.1%) within the HGS on the basis of definite or probable glaucomatous conversion., CONCLUSIONS: CHANGES freed up capacity within a busy HGS. However, improvements need to be made regarding non-attendance rates in the community. The relatively high one-year definite or probable conversion rate emphasises the importance of the comprehensive review of OHT patients and of hospital-led virtual supervision to maintain patient safety.
Keywords: Aged; *Community Health Services/og [Organization & Administration]; Female; *Hospitals, Special; Humans; Male; Middle Aged; Ocular Hypertension/di [Diagnosis]; *Ocular Hypertension/th [Therapy]; *Ophthalmology; Referral and Consultation/sn [Statistics & Numerical Data]

A gelatin-g-poly(N-isopropylacrylamide) biodegradable in situ gelling delivery system for the intracameral administration of pilocarpine. - Lai, Jui-Yang; Hsieh, Ai-Ching (Biomaterials, 2012)
In this study, the aminated gelatin was grafted with carboxylic end-capped poly(N-isopropylacrylamide) (PN) via a carbodiimide-mediated coupling reaction to fabricate biodegradable in situ forming delivery systems for intracameral administration of antiglaucoma medications. The chemical structure of the graft copolymers (GN) was confirmed by Fourier transform infrared (FTIR) spectroscopy. When the feed molar ratio of NH(2)/COOH was 0.36, the grafting ratio, efficiency and degree of grafting, and weight ratio of PN to aminated gelatin was 25.6, 18.6%, 52.6%, and 1.9, respectively. As compared to PN, the GN samples possessed better thermal gelation ability and adherence, indicating remarkable phase transition properties. Under gelatinase degradation, the remaining weight of GN was significantly lower than those of PN at each time point from 8 h to 4 weeks. Cytocompatibility studies showed that the culture of anterior segment cells with both in situ forming gels does not affect proliferation and has little effect on inflammation. Higher encapsulation efficiency (~62%) and cumulative release (~95%) were achieved for GN vehicles, which was attributed to initial fast temperature triggered capture of pilocarpine and subsequent progressive degradation of gelatin network. In a rabbit glaucoma model, the performance of delivery carriers was evaluated by biomicroscopy, intraocular pressure (IOP), and pupil size change. Intracameral administration of pilocarpine using GN was found to be more effective than other methods such as instillation of eye drop and injection of free drug or PN containing drug in improving ocular bioavailability and extending the pharmacological responses (i.e., miosis and IOP lowering effect and preservation of corneal endothelial cell density). Copyright © 2011 Elsevier Ltd. All rights reserved.
Keywords: Acrylamides/cs [Chemical Synthesis]; Acrylamides/ch [Chemistry]; Acrylamides/me [Metabolism]; *Acrylamides; Acrylic Resins; Animals; Biocompatible Materials/cs [Chemical Synthesis]; Biocompatible Materials/ch [Chemistry]; Biocompatible Materials/me [Metabolism]; Drug Carriers/cs [Chemical Synthesis]; Drug Carriers/ch [Chemistry]; Drug Carriers/me [Metabolism]; *Drug Carriers; *Drug Delivery Systems/mt [Methods]; Gelatin/cs [Chemical Synthesis]; Gelatin/ch [Chemistry]; Gelatin/me [Metabolism]; *Gelatin; Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Materials Testing; *Miotics/ad [Administration & Dosage]; Miotics/pk [Pharmacokinetics]; Miotics/pd [Pharmacology]; Miotics/tu [Therapeutic Use]; Molecular Structure; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/tu [Therapeutic Use]; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/pk [Pharmacokinetics]; Pilocarpine/pd [Pharmacology]; Pilocarpine/tu [Therapeutic Use]; Polymers/cs [Chemical Synthesis]; Polymers/ch [Chemistry]; Polymers/me [Metabolism]; *Polymers; Rabbits; Spectroscopy, Fourier Transform Infrared

Boston type 1 keratoprosthesis: the New York Eye and Ear experience. - Patel, A P; Wu, E I; Ritterband, D C; Seedor, J A (Eye (London, England), 2012)
PURPOSE: The Boston keratoprosthesis has had variable success rates in the past. However, significant modifications to design and management have recently led to successful outcomes. This study was undertaken to evaluate the outcomes of the Boston type 1 keratoprosthesis at our institution., METHODS: A retrospective chart review was performed of all Boston type 1 keratoprosthesis procedures conducted at a single practice at the New York Eye and Ear Infirmary from December 2006 to August 2010. Outcome measures included visual acuity, retention rates, and complications., RESULTS: In all, 58 eyes of 51 patients who received a Boston type 1 keratoprosthesis were included. The most common indication for the keratoprosthesis was failed penetrating keratoplasty (PK) (81.0%; mean 2.4+/-1.3 PKs per eye). Glaucoma was the most common comorbidity (75.9%). Pre-operative best corrected visual acuity (BCVA) was <20/400 in 87.9% of eyes. At last follow-up, 43.1% of eyes had a BCVA of 20/200. Retention rate was 87.9% over an average follow-up of 21.5+/-11.4 months (median 22 months, range 3-47 months). Complications increased with time, with 65.5% of eyes experiencing at least one event by 6 months and 75.9% by 1 year. The most common post-operative complication was retroprosthetic membrane formation (50.0%)., CONCLUSIONS: The Boston type 1 keratoprosthesis provides visual recovery for eyes with multiple PK failures or with poor prognosis for primary PK, showing excellent retention rates. However, there is a trend towards a decline in visual acuity with time and the development of late complications, highlighting a need for longer-term studies.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Cornea/su [Surgery]; Corneal Diseases/pp [Physiopathology]; *Corneal Diseases/su [Surgery]; Female; Humans; Keratoplasty, Penetrating/ae [Adverse Effects]; Male; Middle Aged; Patient Acceptance of Health Care; Postoperative Complications; *Prostheses and Implants; Retrospective Studies; Treatment Failure; Visual Acuity/ph [Physiology]; Young Adult

Timogel R vs timolol 0.5% ophthalmic solution: efficacy, safety, and acceptance. - Rolle, Teresa; Curto, Daniela; Alovisi, Camilla; Franzone, Mauro; Brogliatti, Beatrice; Grignolo, Federico M (European journal of ophthalmology, 2012)
PURPOSE: To evaluate the efficacy, safety, and tolerability of Timogel R preservative-free once daily compared to timolol 0.5% ophthalmic solution bid in patients with ocular hypertension (OHT) and patients with primary open-angle glaucoma (POAG)., METHODS: A total of 75 patients with OHT and patients with POAG treated with timolol 0.5% bid with intraocular pressure (IOP) <= 21 mmHg were enrolled. They underwent complete ophthalmologic examination, IOP measurements (at trough and daytime curve), evaluation of side effects, Schirmer test, break-up time [BUT], blood pressure, heart rate, ocular diastolic perfusion pressure measurements, and acceptance (Comparison of Ophthalmic Medications for Tolerability). Patients switched to Timogel R and were re-evaluated 3 months later. The analysis of variance and the Pearson Chi2 tests were used to test differences between the treatments., RESULTS: Intraocular pressure reduction at trough was 23.6% with timolol 0.5% and 22.3% with Timogel R. No statistical differences were observed in IOP values at trough and in the daytime curve between the 2 treatments. Local and systemic side effects were less frequent with Timogel R (hazard ratio: p<0.05). Patients demonstrated a significant improvement of Schirmer test and BUT (p<0.05) and a reduction of dryness and foreign body sensation (42.6% vs 15.4%; p<0.01) after switching to Timogel R. Mild and short-lasting blurred vision after Timogel R instillation occurred in about 18.5% of patients. A total of 82% of patients were satisfied or very satisfied with Timogel R vs 61% with previous treatment (p<0.01)., CONCLUSIONS: Timogel R preservative-free dosed once every morning has a 24-hour hypotensive effect with a better safety profile than timolol 0.5% bid and it is well-accepted by patients. The once-daily dosing improved acceptance and compliance.
Keywords: *Antihypertensive Agents/ad [Administration & Dosage]; Antihypertensive Agents/ae [Adverse Effects]; Blood Pressure; Gels; *Glaucoma, Open-Angle/dt [Drug Therapy]; Heart Rate; Humans; *Intraocular Pressure/de [Drug Effects]; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Ophthalmic Solutions/ae [Adverse Effects]; Patient Compliance; Patient Satisfaction; Preservatives, Pharmaceutical; Prospective Studies; Surveys and Questionnaires; Tears/me [Metabolism]; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]; Tonometry, Ocular; Treatment Outcome

Contact lens complications in an urgent-care population: the University of California, Los Angeles, contact lens study. - Lee, Sharon Y; Kim, Yoon Hee; Johnson, Duncan; Mondino, Bartly J; Weissman, Barry A (Eye & contact lens, 2012)
OBJECTIVES: This is a prospective study in an urgent-care ophthalmic setting to investigate contact lens (CL) complications and their association with extended wear (EW)., METHODS: Data on CL designs, care system(s), and ocular complications were collected over a 6-month period., RESULTS: One thousand three hundred and sixty-nine patients presented to the Jules Stein Eye Institute urgent care with symptoms of eye problems. Of these, 56 were identified with diagnoses etiologically associated with CL wear, and 49 were studied. The five most common ocular diagnoses found in our study were in the following order: epithelial staining or abrasion/epithelial defect, conjunctival injection, papillae, corneal neovascularization, and presumed microbial keratitis (PMK). Fifteen of 49 patients were diagnosed with PMK. The mean number of complications was 3.43 per eye. Most of the patients (65%) reported some form of EW. Analysis of the patients with PMK showed an association with EW. There seemed to be no statistical difference in the number of complications per symptomatic eye with hydrogel and silicone hydrogel lenses although 13 of the 15 patients with PMK were silicone hydrogel wearers., CONCLUSIONS: We studied various aspects of care and compliance in an urgent-care population and found that most of our urgent-care patients slept with CLs on their eyes. Symptomatic CL wear-related complications, and specifically MK, strongly correlate with EW with less relation to lens design, material, and wear modality. We therefore conclude that CL EW is a risk factor leading to urgent-care visits.
Keywords: Adolescent; Adult; Aged; Contact Lens Solutions/st [Standards]; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Cross-Sectional Studies; Emergency Medical Services; *Eye Diseases/et [Etiology]; Female; Humans; Los Angeles; Male; Middle Aged; Patient Compliance; Prospective Studies; Prosthesis Design; Risk Factors; Surveys and Questionnaires; Young Adult

The impact of cellular debris on Pseudomonas aeruginosa adherence to silicone hydrogel contact lenses and contact lens storage cases. - Burnham, Geoffrey W; Cavanagh, H Dwight; Robertson, Danielle M (Eye & contact lens, 2012)
OBJECTIVES: To evaluate neutrophil-enhanced Pseudomonas aeruginosa (PA) biofilm formation on silicone hydrogel contact lenses and to determine the effect of epithelial biodebris on PA adherence in contact lens storage cases., METHODS: A fully invasive PA corneal isolate stably conjugated to green fluorescent protein was used. Unworn lotrafilcon A contact lenses were incubated at various ratios of PA to polymorphonuclear neutrophil (PMN) for 24 hours at 37degreeC. Lens-associated PA was evaluated using laser scanning confocal microscopy and nonviable PA were visualized using propidium iodide. Viable bacteria were enumerated by colony-forming unit (CFU) analysis. For acute epithelial cell studies, PA viability was determined after coincubation with freeze-thaw epithelial cell lysates in 96-well polystyrene plates. Levels of residual cellular debris and bacterial viability were further assessed in used contact lens storage cases., RESULTS: Laser scanning confocal microscopy demonstrated that cotreatment with PMA-stimulated neutrophils increased PA adherence over 24 hours to lens surfaces with a striking alteration of PA architecture. Propidium iodide staining showed that the adherent bacteria consisted of a mixture of viable and nonviable PA; a PMN-associated increase in viable PA was confirmed by CFU (PA:PMN 0.1:1, P = 0.025; PA:PMN 1:1, P = 0.005). Acute epithelial cell debris studies revealed a significant increase in viable PA in 96-well plates in the presence of epithelial freeze-thaw lysates (PA:debris 1:1, P = 0.002; PA:debris 100:1, P = 0.002). Crystal violet staining of used lens storage cases revealed residual cellular debris at all time points, which was independent of microbial contamination; all lens cases used for periods of 9 months or more were uniformly associated with high levels of viable microorganisms., CONCLUSION: These results demonstrate that prolonged corneal inflammation with the presence of PMNs when confronted with simultaneous PA challenge in extended contact lens wear has the potential to stimulate biofilm formation on silicone hydrogel contact lenses. These findings further suggest that a persistent buildup of extracellular debris in lens storage cases may contribute to the heavy biofilms reported on these surfaces.
Keywords: *Bacterial Adhesion/ph [Physiology]; Biofilms/gd [Growth & Development]; Cell Survival; Colony Count, Microbial; *Contact Lenses, Hydrophilic/mi [Microbiology]; Disposable Equipment/mi [Microbiology]; Epithelial Cells/ph [Physiology]; Equipment Contamination; Humans; Hydrogels; Neutrophils/ph [Physiology]; *Pseudomonas aeruginosa/ph [Physiology]; Silicones

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial. - Gray, T A; Fenerty, C; Harper, R; Spencer, A F; Campbell, M; Henson, D B; Waterman, H (Eye (London, England), 2012)
PURPOSE: To evaluate the impact of individualised patient care, as an adjunct to standard care, on adherence to ocular hypotensive therapy., METHODS: A two-arm, single-masked exploratory randomised controlled trial recruited patients newly prescribed ocular hypotensive therapy. The intervention involved an individual assessment of health-care needs and beliefs and a 1-year follow-up period according to need. The primary outcome was refill adherence, measured by collating prescription and dispensing data for 12 months. Secondary outcomes included self-reported adherence, glaucoma knowledge, beliefs about illness and medicines, quality of care, intraocular pressure (IOP) fluctuation, and changes in clinical management assessed at 12 months. The strength of the intervention was measured following withdrawal by reviewing clinical outcomes for a further 12 months., RESULTS: In all, 127 patients were recruited (91% response rate). Intervention-arm patients collected significantly more prescriptions than control-arm patients. Self-report adherence was significantly better in the intervention-arm for patients who forgot drops and those who intentionally missed drops. The intervention group demonstrated significantly more glaucoma knowledge, expressed a significantly stronger belief in the necessity of eye drops and believed that they had more personal control over managing their condition. Control-arm patients had more IOP fluctuation and changes in clinical management. However, this finding only reached significance at 24 months., CONCLUSION: Modelling patient care according to health-care needs and beliefs about illness and medicines can have a significant impact on improving adherence to therapy for this patient group, with the potential benefit of improving clinical outcomes.
Keywords: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; *Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure/ph [Physiology]; Male; *Medication Adherence/px [Psychology]; Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; *Ocular Hypotension/dt [Drug Therapy]; Ocular Hypotension/pp [Physiopathology]; *Ocular Hypotension/px [Psychology]; *Patient Care Planning; Precision Medicine; Quality of Health Care/st [Standards]

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment. - Leighton, P; Lonsdale, A J; Tildsley, J; King, A J (Eye (London, England), 2012)
AIM: The aim of this study is to examine the attitudes of patients, who presented with advanced glaucoma in at least one eye, to participation in a randomised prospective trial comparing primary medical treatment with primary surgical treatment for advanced glaucoma., METHODS: Patients who had presented with advanced glaucoma (>15 dB loss mean deviation on Humphrey visual field testing) in at least one eye were asked to participate. Five focus groups comprising of 4-8 patients and consisting of 29 patients in total were undertaken. The group interviews were conducted by two experienced qualitative researchers, an ophthalmic clinician was present to clarify technical issues. The focus group discussions were taped and transcribed in full, and analysed through a process of familiarisation, open (inductive) coding, theme generation, theme refinement, and thematic mapping., RESULTS: Three overarching themes were identified: (1) the extent of patients' knowledge, (2) anxieties about surgery, and (3) concerns about compromised care due to trial involvement; these themes were further classified into eight sub-themes., CONCLUSIONS: Patients' willingness to participate in randomised clinical studies is significantly connected to their level of comprehension and insight about the medical condition, its treatment, and the research process; misunderstandings about any of these aspects may act as a significant barrier to trial recruitment. Recruitment rates for future randomised trials may be enhanced by ensuring that patients have full and accurate information about the treatment alternatives, and that uncertainty exists for best patient outcomes between treatment options, and reassuring potential participants that the research process, in particular randomisation, will not compromise clinical care.
Keywords: Anxiety/px [Psychology]; *Attitude to Health; Fear; Female; Focus Groups; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; *Health Knowledge, Attitudes, Practice; Humans; Male; Ophthalmologic Surgical Procedures/px [Psychology]; *Patient Participation/px [Psychology]; Qualitative Research; Randomized Controlled Trials as Topic

The influence of health literacy level on an educational intervention to improve glaucoma medication adherence. - Muir, Kelly W; Ventura, Alice; Stinnett, Sandra S; Enfiedjian, Abraham; Allingham, R Rand; Lee, Paul P (Patient education and counseling, 2012)
OBJECTIVE: To test an educational intervention targeted to health literacy level with the goal of improving glaucoma medication adherence., METHODS: One hundred and twenty-seven veterans with glaucoma were randomized to glaucoma education or standard care. The intervention included a video scripted at a 4th, 7th, or 10th grade level, depending on the subject's literacy level. After six months, the number of days without glaucoma medicine (DWM) according to pharmacy records for the intervention and control groups was compared., RESULTS: The number of DWM in the six months following enrollment was similar for control and intervention groups (intervention, n=67, DWM=63 +/- 198; standard care, n=60, DWM=65 +/- 198; p=0.708). For each subgroup of literacy (adequate, marginal, inadequate), subjects in the intervention group experienced less mean DWM than subjects in the control group and the effect size (ES) increased as literacy decreased: adequate literacy, ES 0.069; marginal, ES 0.183, inadequate, ES 0.363. Decreasing health literacy skills were associated with decreasing self-reported satisfaction with care (slope=0.017, SE=0.005, p=0.002)., CONCLUSIONS: Patients with decreased health literacy skills may benefit from educational efforts tailored to address their health literacy level and learning style., PRACTICE IMPLICATIONS: Providers should consider health literacy skills when engaging in glaucoma education. Copyright Published by Elsevier Ireland Ltd.
Keywords: Adult; Aged; Aged, 80 and over; *Educational Status; Female; *Glaucoma/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; *Health Literacy; Health Surveys; Humans; Male; *Medication Adherence; Middle Aged; North Carolina; *Patient Education as Topic/mt [Methods]; Patient Satisfaction; *Pharmaceutical Preparations/ad [Administration & Dosage]; Surveys and Questionnaires; Tape Recording; Veterans

Twenty-four hour efficacy with the dorzolamide/timolol-fixed combination compared with the brimonidine/timolol-fixed combination in primary open-angle glaucoma. - Konstas, A G P; Quaranta, L; Yan, D B; Mikropoulos, D G; Riva, I; Gill, N K; Barton, K; Haidich, A-B (Eye (London, England), 2012)
AIM: The aim of this study is to compare the 24-hour efficacy of dorzolamide/timolol-fixed combination (DTFC) and brimonidine/timolol-fixed combination (BTFC) in primary open-angle glaucoma (POAG)., METHODS: One eye each of 77 POAG patients was included in this prospective, observer-masked, crossover comparison. Following a 2-month timolol run-in period, patients had three intraocular pressure (IOP) measurements at 1000, 1200 and 1400 h while on timolol treatment. Patients showing at least a 20% IOP reduction on timolol were randomised to 3 months of therapy with DTFC or BTFC, and then were crossed over to the opposite therapy., RESULTS: Sixty POAG patients completed the study. The mean 24-hour IOP was significantly reduced with both the fixed combinations compared with the timolol-treated diurnal IOP (P < 0.001). When the two fixed combinations were compared directly, DTFC demonstrated a lower mean 24-hour IOP level as compared with BTFC (mean difference: -0.7 mm Hg, 95% confidence interval (CI): (-1.0, -0.3), P < 0.001). At two individual time points, DTFC significantly reduced IOP more than BTFC: at 1800 h (-1.0 mm Hg, 95% CI (-1.6,-0.5), P = 0.001) and at 0200 (-0.9 mm Hg, 95% CI: (-1.4,-0.5), P = 0.001). No significant difference existed for the other time points., CONCLUSION: Both the fixed combinations significantly reduce 24-hour IOP in POAG. DTFC provided significantly better 24-hour efficacy.
Keywords: Aged; *Antihypertensive Agents/tu [Therapeutic Use]; Brimonidine Tartrate; Cross-Over Studies; Drug Combinations; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; Prospective Studies; *Quinoxalines/tu [Therapeutic Use]; *Sulfonamides/tu [Therapeutic Use]; *Thiophenes/tu [Therapeutic Use]; Time Factors; *Timolol/tu [Therapeutic Use]; Treatment Outcome

Elevation of intraocular pressure in glaucoma patients after automated visual field testing. - Ni, Nina; Tsai, James C; Shields, M Bruce; Loewen, Nils A (Journal of glaucoma, 2012)
PURPOSE: To examine whether automated visual field (VF) testing may exert a short-term influence on subsequent intraocular pressure (IOP) measurement during the same visit., METHODS: We reviewed patients with primary open-angle glaucoma whose most recent visit occurred at a major academic institution from July to December 2009 and who had 3 visits without intervening changes in glaucoma management within the previous 5 years. Exclusion criteria were patient admittance of nonadherence with medical therapy and documented difficulty of IOP measurement. One hundred nine right eyes from 109 patients were included. IOP obtained within 30 minutes after VF testing was compared with IOP from the previous and next visits without VF testing. Subgroup analyses included the role of reliability of VF test performance, surgical versus medical IOP control, and different topical medications., RESULTS: The average IOP measured after VF testing was 14.9 +/- 4.7 mm Hg, higher than both the previous (13.7 +/- 4.4 mm Hg, P < 0.001) and next visits without VF examination (13.8 +/- 4.4 mm Hg, P < 0.001). A total of 22.9% of patients experienced a more than 20% increase of IOP. Eyes with surgical control had less IOP elevation than eyes with medical control (3.1% +/- 15.9% vs. 11.7% +/- 17.4%, P = 0.009). Users of beta-blockers or alpha-2-agonists had less IOP elevation than eyes controlled with prostaglandins or carbonic anhydrase inhibitors (0.9% +/- 15.1% vs. 9.0% +/- 12.3%, P = 0.030)., CONCLUSIONS: This retrospective study suggests that patients with primary open-angle glaucoma experience a small and transient increase in IOP after VF testing and that this effect may be lower after surgical pressure control.
Keywords: Adrenergic alpha-2 Receptor Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Retrospective Studies; Tonometry, Ocular; Trabeculectomy; *Vision Disorders/pp [Physiopathology]; *Visual Field Tests; *Visual Fields/ph [Physiology]

Determinants of medication adherence to topical glaucoma therapy. - Dreer, Laura E; Girkin, Christopher; Mansberger, Steven L (Journal of glaucoma, 2012)
INTRODUCTION/PURPOSE: To determine the associations between medical, demographic, socioeconomic, and ocular factors and adherence to topical glaucoma ocular hypotensive therapy., METHODS: One hundred sixteen patients with ocular hypertension or open-angle glaucoma from 2 tertiary glaucoma services participated in this prospective study. Adherence to ocular hypotensive therapy was measured using an electronic dose monitor (Travatan Dosing Aid, Alcon Laboratories Inc., Fort Worth, TX) and collected data at 3 months after enrollment. We used 3 different definitions of adherence: 1) Definition 1: the proportion of days taking the prescribed number of drops within 3 hours of the prescribed dosing time; 2) Definition 2: the proportion of days taking any drops within 3 hours of the prescribed dosing time; and 3) Definition 3: the proportion of days taking any drops within 6 hours of the prescribed dosing time. Univariate and multivariate models were used to determine the association between the 3 adherence definitions, medical, demographic, socioeconomic, and ocular factors at 3-month follow-up. The main outcome measures for this study were risk factors for poor objective medication adherence., RESULTS: Adherence, using Definition 1, Definition 2, and Definition 3, was 64%, 75%, and 80%, respectively. Age, total number of other eye diseases, and race were significantly associated with full treatment adherence (Definition 1), with race alone significantly predicting 11% of full treatment adherence. For Definition 2, age, income, level of education, and total number of eye diseases were significantly associated with partial adherence (3 h), again race alone significantly predicted 15% of partial adherence (any drops within 3 h). For Definition 3, race, income, level of education, and total number of other eye diseases significantly predicted partial adherence (any drops within 6 h), both race and income predicted 19% of partial treatment adherence. Significant differences for adherence rates between patients of European descent and those of African descent were found for all 3 definitions with those who were less adherent more likely to be of African descent., CONCLUSIONS: Electronic dose monitors provide important information regarding adherence to topical ocular hypotensive medications in glaucoma patients. Electronic dose monitors show low adherence in a significant number of participants. Future studies are needed to determine the reasons for these differences in health behaviors related to glaucoma treatment, which should guide treatment of poor adherence with glaucoma therapy.
Keywords: Administration, Topical; Age Factors; *Antihypertensive Agents/ad [Administration & Dosage]; Continental Population Groups; Drug Monitoring/is [Instrumentation]; Drug Prescriptions/sn [Statistics & Numerical Data]; Educational Status; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Knowledge, Attitudes, Practice; Humans; Income; Intraocular Pressure; Male; *Medication Adherence/sn [Statistics & Numerical Data]; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions/ad [Administration & Dosage]; Prospective Studies; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Tonometry, Ocular

Validation of a short version of the glaucoma medication self-efficacy questionnaire. - Sleath, Betsy; Blalock, Susan J; Stone, Jennifer L; Skinner, Asheley Cockrell; Covert, David; Muir, Kelly; Robin, Alan L (The British journal of ophthalmology, 2012)
AIMS: The aims of this study were: (1) to examine whether the original glaucoma medication adherence and eye drop technique self-efficacy scales could be shortened for easier use in practice settings; and (2) to validate these scales against objective medication adherence measures., METHODS: Prospective study conducted at a single private practice site. We measured subjects' adherence to glaucoma medications through Medication Event Monitoring System (MEMS) devices and assessed eye drop instillation technique by video-recording. Principal components factor analysis and logistic and linear regression were used to analyse the data., RESULTS: Our results yielded a 10-item Glaucoma Medication Adherence Self-Efficacy Scale that was strongly associated with subject adherence measured using MEMS (beta coefficient 8.52, 95% CI 1.94 to 15.1). In addition, the six-item Eye Drop Technique Self-Efficacy Scale was strongly associated with video-recorded subject eye drop installation technique (OR 10.47, 95% CI 1.78 to 61.63)., CONCLUSIONS: Eye care providers and researchers could use these shorter scales to identify subjects with either poor glaucoma medication adherence and/or eye drop instillation technique. This could help to identify those who may benefit most from education and training on both adherence and eye drop instillation.
Keywords: Adult; Aged; Aged, 80 and over; *Antihypertensive Agents/ad [Administration & Dosage]; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Medication Adherence; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Principal Component Analysis; Prospective Studies; *Self Efficacy; *Surveys and Questionnaires; Video Recording

A 2-hour information session and patient recall has minimal impact on glaucoma-treatment persistence in a mature practice. - Blondeau, Pierre; Carbonneau, Marjorie; Esper, Philip; Turcotte, Pierre-Christophe (Journal of glaucoma, 2012)
PURPOSE: To study the impact of a 2-hour information session and 3 patients' phone calls on patient persistence with glaucoma medication., PATIENTS AND METHODS: All patients with glaucoma treatment, part of a 27-year old solo glaucoma practice, were invited to attend the information session. Patients who attended the session (n=342) were contacted by phone 1, 4, 10 months later and regular use of drops was stressed. Patients were unaware of the study. We compared the persistence of the patients before and after attending the session, and their persistence to that of patients who did not attend (n=1187). Persistence with glaucoma medication was assessed by examination of data (2002 to 2007) from a provincial medical and drug insurance database., RESULTS: Patients attending the session had glaucoma for 10 years. They had a better persistence than those who did not attend (P<0.05). Their persistence remained the same 1 year after attending the session but tended to be improved in the first 180 days (P<0.076). During the study period, there was a 4% increase in overall persistence (P<0.05). This could be due to an increase in prostaglandins prescriptions and changes in beta-blockers formulation., CONCLUSIONS: The information session and patient's recalls had a limited impact on patient persistence. This could be due to the selection of a population already persistent (78.9%). The results could have been different in less persistent patients and new patients. It could be different in another practice setting.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Databases, Factual; Drug Prescriptions/sn [Statistics & Numerical Data]; *Drug Utilization/sn [Statistics & Numerical Data]; *Glaucoma/dt [Drug Therapy]; Humans; *Mental Recall; *Patient Compliance; *Patient Education as Topic; Prostaglandins F, Synthetic/ad [Administration & Dosage]; Time Factors

Prevalence of cognitive impairment, depression, and anxiety symptoms among older adults with glaucoma. - Yochim, Brian P; Mueller, Anne E; Kane, Katherine D; Kahook, Malik Y (Journal of glaucoma, 2012)
PURPOSE: Two factors which may disrupt the ability to adhere to the treatment for glaucoma are cognitive impairment and mental health complications. Poor adherence to treatment may lead to preventable vision loss. Past research in this area has been limited by little focus on older patients with glaucoma, and the use of brief measures of cognition that may not detect subtle deficits related to Alzheimer disease., PATIENTS AND METHODS: This study examined the prevalence of cognitive impairment, depression, and anxiety in a sample of 41 glaucoma patients at a tertiary care glaucoma clinic. They had a mean age of 70.0 years (SD=9.2 y; range: 51 to 86 y) and 70% (n=30) were female. Two cognitive measures commonly used in detecting dementia were used to measure cognitive functioning., RESULTS: Controlling for age, memory impairment was found in approximately 20% of the sample, and impaired executive functioning was found in approximately 22% of the sample. Forty-four percent of the sample scored in the impaired range on one or more measures. Mild-to-moderate depressive symptoms were found in 12.2% of participants, and 1 person reported clinically significant anxiety., CONCLUSIONS: The results from this study indicate that cognitive impairment may be common in older patients with glaucoma. This has implications for treatment adherence, as difficulties in remembering information may significantly impede the ability to follow instructions from a physician. It is imperative that physicians and caregivers are aware of the prevalence of such conditions, as they are among the first to interact with such individuals. Given the high prevalence of cognitive impairment and depressive symptoms, future research should examine the impact of such factors on glaucoma treatment adherence.
Keywords: Aged; Aged, 80 and over; Anxiety Disorders/di [Diagnosis]; *Anxiety Disorders/ep [Epidemiology]; Cognition Disorders/di [Diagnosis]; *Cognition Disorders/ep [Epidemiology]; Depressive Disorder/di [Diagnosis]; *Depressive Disorder/ep [Epidemiology]; Female; Geriatric Assessment; *Glaucoma/ep [Epidemiology]; Humans; Male; Manifest Anxiety Scale; Memory Disorders/di [Diagnosis]; Middle Aged; Neuropsychological Tests; Pilot Projects; Prevalence; Prospective Studies

Evaluating eye drop instillation technique in glaucoma patients. - Gupta, Raghav; Patil, Bharat; Shah, Bhavin M; Bali, Shveta Jindal; Mishra, Sanjay K; Dada, Tanuj (Journal of glaucoma, 2012)
AIM: To evaluate the technique of eye drop instillation in glaucoma patients., METHODS: Seventy patients with primary open-angle glaucoma or primary angle-closure glaucoma, self-administering topical antiglaucoma medications for at least 6 months were evaluated. All patients instilled a tear substitute in 1 eye using the same technique they used for instilling antiglaucoma medications at home. The parameters that were recorded included time taken to instill the first drop, number of eye drops instilled, drop contact location, any contact with the tip of the bottle, and closure of the eyelids or tear duct after drop instillation., RESULTS: The mean age of the patients was 54.1+/-10.0 years. The mean time taken to instill the first drop was 14.8+/-3.7 seconds (range, 8.7 to 23.5 s). The mean number of drops squeezed from the bottle per instillation was 1.8+/-1.2 drops (range, 1 to 8 drops). In 22 patients (31.43%), the eye drops fell on the eyelids or cheek. Fifty-three patients (75.7%) touched the tip of the bottle to the globe or periocular tissue. Twenty patients (28.57%) closed eyes after instilling drops and 4 patients (5.7%) occluded the punctum. Only 6 patients (8.57%) were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact)., CONCLUSIONS: Nearly, 9 of 10 glaucoma patients were unable to instill eye drops correctly. This may be an important cause of unintentional noncompliance in glaucoma medical therapy.
Keywords: Administration, Topical; Adrenergic alpha-Agonists/ad [Administration & Dosage]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; Adult; Aged; *Antihypertensive Agents/ad [Administration & Dosage]; Carbonic Anhydrase Inhibitors/ad [Administration & Dosage]; Cross-Sectional Studies; Drug Packaging; Female; *Glaucoma, Angle-Closure/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Medication Adherence; Middle Aged; Miotics/ad [Administration & Dosage]; Ophthalmic Solutions/ad [Administration & Dosage]; Prostaglandins, Synthetic/ad [Administration & Dosage]; Visual Acuity/ph [Physiology]

Selective Laser Trabeculoplasty: An Overview. - Jha, Bhaskar; Bhartiya, Shibal; Sharma, Reetika; Arora, Tarun; Dada, Tanuj (Journal of current glaucoma practice, 2012)
Given the obvious quality of life concerns with medical and surgical lowering of intraocular pressure (IOP), lasers have received considerable attention as a therapeutic modality for glaucoma. Selective laser trabeculoplasty (SLT) is increasingly being used in clinical practice as both the primary procedure and as an adjunct to medical and surgical therapy. Preliminary published evidence suggests that SLT is an effective, compliance-free, repeatable and safe therapeutic modality having only minor, transient, self-limiting or easily controlled side effects with no sequelae. This review attempts a broad overview of the current knowledge of its mechanism, efficacy, indications and limitations, point out the knowledge lacunae that still exist with respect to this highly promising technology which has captured the attention of glaucoma surgeons all over the world., HOW TO CITE THIS ARTICLE: Jha B, Bhartiya S, Sharma R, Arora T, Dada T. Selective Laser Trabeculoplasty: An Overview. J Current Glau Prac 2012;6(2):79-90.

Initial Treatment: Prostaglandin Analog or Selective Laser Trabeculoplasty. - Clement, Colin I (Journal of current glaucoma practice, 2012)
Prostaglandin analogs (PGA) have been the initial treatment of choice in many patients with glaucoma. However, there is an increasing awareness that non adherence and disruption of the ocular surface may limit PGA utility and tolerability respectively in some patients. In an eye with an open iridocorneal angle, these issues can potentially be addressed with the use of laser trabeculoplasty (LT). This therapy can achieve long-term intraocular pressure reduction following 1 to 2 treatment sessions without the ongoing need to apply medication (and preservatives) to the ocular surface. Whether PGAs or LT should be used in a given individual will also be influenced by other important factors including efficacy, response rate, tolerability, complications, cost and accessibility. This review examines these issues in relation to the initiation of primary therapy. How to cite this article: Clement CI. Initial Treatment: Prostaglandin Analog of Selective Laser Trabeculoplasty. J Current Glau Prac 2012;6(3):99-103.

One Year of Glaucoma Research in Review: 2011 to 2012. - Kim, Charles; Radcliffe, Nathan M (Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), 2012)
PURPOSE: To provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published over the past 12 months., METHODS: The authors conducted a one year (July 1, 2011 to June 30, 2012) English language glaucoma literature search on Pubmed using the following terms: automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, medical therapy and compliance in glaucoma, glaucoma laser treatment, cataract extraction and intraocular pressure, secondary glaucoma, glaucoma surgery, pediatric glaucoma, molecular biology in glaucoma, and miscellaneous topics in glaucoma., DESIGN: Literature review., RESULTS: This review includes original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts., CONCLUSIONS: This review is not meant to be all-inclusive-rather, it highlights literature that is most applicable to ophthalmologists in practice.

Recent Patents on Emerging Therapeutics for the Treatment of Glaucoma, Age Related Macular Degeneration and Uveitis. - Vadlapudi, Aswani Dutt; Patel, Ashaben; Cholkar, Kishore; Mitra, Ashim K (Recent patents on biomedical engineering, 2012)
Advancements in the field and rising interest among pharmaceutical researchers have led to the development of new molecules with enhanced therapeutic activity. Design of new drugs which can target a particular pathway and/or explore novel targets is of immense interest to ocular pharmacologists worldwide. Delivery of suitable pharmacologically active agents at proper dose (within the therapeutic window) to the target tissues without any toxicity to the healthy ocular tissues still remain an elusive task. Moreover, the presence of static and dynamic barriers to drug absorption including the corneal epithelium (lipophilic), corneal and scleral stroma (hydrophilic), conjunctival lymphatics, choroidal vasculature and the blood-ocular barriers also pose a significant challenge for achieving therapeutic drug concentrations at the target site. Although many agents are currently available, new compounds are being introduced for treating various ocular diseases. Deeper understanding of the etiology and complex mechanisms associated with the disease condition would aid in the development of potential therapeutic candidates. Novel small molecules as well as complex biotechnology derived macromolecules with superior efficacy, safety and tolerability are being developed. Therefore, this review article provides an overview of existing drugs, treatment options, advances in emerging therapeutics and related recent patents for the treatment of ocular disorders such as glaucoma, age related macular degeneration (AMD) and uveitis.

Sustained release ocular inserts of brimonidine tartrate for better treatment in open-angle glaucoma. - Bhagav, Prakash; Trivedi, Vaibhav; Shah, Darshan; Chandran, Sajeev (Drug delivery and translational research, 2011)
Pathology of eye, especially in the case of glaucoma, requires optimal therapeutically effective concentration of the drug in the ocular tissues for prolonged period of time with decreased dosing frequency and improved patient compliance. In the present study, brimonidine tartrate (BRT) ocular inserts were designed based on hydrophilic and/or inert/zwitterionic polymer matrix to design mucoadhesive and extended release ocular inserts. Designed inserts were evaluated for their physicochemical properties such as crushing strength/hardness, friability, drug content and mucoadhesion, and erosion and in vitro drug release characteristics. The selected optimised formulations were compared with marketed preparation for in vivo ocular irritation in healthy rabbits and for in vivo pharmacodynamic efficacy on alpha-chymotrypsin-induced glaucomatous rabbits. The developed formulations showed good physicochemical properties and mucoadhesive strength, and a good correlation was seen between rate of erosion or swelling with drug release rate in case of formulations with higher proportion of polyethylene oxide (PEO). Modulation of drug release was achieved by incorporating Eudragit in PEO matrix. Addition of Eudragit resulted in shifting of drug release mechanism from erosion-controlled to diffusion-controlled mechanism. In vivo ocular irritation studies confirmed the absence of any irritation upon administration in rabbits. Intraocular pressure (IOP) measurement studies showed an improved IOP-lowering ability of ocular insert of BRT in comparison to eye drops.

Management of posteriorly dislocated endothelial keratoplasty donor lenticule. - Barakat, Mark R; Sachdeva, Reecha; Sepulveda, Ricardo N; Schoenfield, Lynn; Dupps, William J Jr; Sears, Jonathan E (Retinal cases & brief reports, 2011)
PURPOSE: The purpose of this study was to describe the management of a keratoplasty lenticule adhering to the retina after intraoperative dislocation., METHODS: We describe the posterior dislocation of the donor lenticule during endothelial keratoplasty in a 72-year-old woman with a transscleraly sutured intraocular lens, previous pars plana vitrectomy, and a posteriorly positioned Ahmed glaucoma tube shunt. The lenticule was retrieved through a pars plana approach 2 weeks later, at which time it was tightly adherent to the extramacular retina. Concurrent keratoplasty was performed., RESULTS: Six months after retrieval of the dislocated lenticule with repeat keratoplasty, the retinal examination is stable and the new graft remains attached., CONCLUSION: An iris defect, the absence of capsular support, and a history of previous vitrectomy are all potential risk factors for the intraoperative migration of a keratoplasty lenticule. The surgical view 2 weeks after dislocation was not a limiting factor in the retrieval of the lenticule. However, the tight adherence of the lenticule to the retina required extensive peeling. To avoid a more difficult surgical repair and the potential for scar formation, earlier surgical repair would be preferable, especially if dealing with a macular location.

Diagnosing vision impairment before the onset of adverse effects. - Sander, Ruth (Nursing older people, 2008)
As we age we experience natural changes in the structure of our eyes with drooping lids, changes in colour perception and difficulty adjusting to light. The prevalence of ocular diseases such as glaucoma, cataracts, wounds retinopathy and macular degeneration also increase with age. Despite its inevitable and common occurrence, vision impairment is often undiagnosed and untreated. This could lead to adverse effects such as falls, medication non-compliance and general accidents.

12-week study comparing the fixed combination of brimonidine and timolol with concomitant use of the individual components in patients with glaucoma and ocular hypertension. - Goni, F J (European journal of ophthalmology, 2005)
PURPOSE: To evaluate the efficacy and safety of fixed-combination brimonidine tartrate 0.2%/timolol 0.5% ophthalmic solution dosed BID and demonstrate non-inferiority to concomitant use of brimonidine tartrate 0.2% BID and timolol 0.5% BID in glaucoma and ocular hypertension patients with intraocular pressure (IOP) uncontrolled on monotherapy., METHODS: Randomized, multicenter, double-masked, parallel-group study involving 371 patients with inadequate IOP control (IOP from 22 to 34 mmHg) after >=3 weeks of run-in on any monotherapy. Patients were treated with fixed-combination brimonidine/timolol BID (fixed-combination group, n=188) or concomitant brimonidine BID and timolol BID (concomitant group, n=183). IOP was assessed pre-dose and 2 hours after morning dosing at weeks 2, 6, and 12., RESULTS: A total of 355 patients (96%) completed the study. Patient demographics, run-in monotherapy, and baseline mean IOP on monotherapy were comparable between treatment groups. During follow-up, the mean reduction from baseline IOP was significant (p<0.001) at all time points and ranged from 4.4 to 5.3 mmHg in each group. Brimonidine/timolol fixed combination was as effective as concomitant therapy with respect to mean IOP and mean change from baseline IOP at all time points and visits. Between-group differences were <=0.35 mmHg for mean IOP and <=0.30 mmHg for mean change from baseline IOP; none were significant. No unexpected side effects were associated with the fixed combination. Both treatments were well tolerated with no difference in adverse events between groups., CONCLUSIONS: Brimonidine/timolol fixed-combination therapy is as safe and effective as concomitant treatment with the individual components. Its simplified dosing regimen has the potential to improve compliance. (Eur J Ophthalmol 2005; 15: 581-90).

Patient race, reported problems in using glaucoma medications, and adherence. - Sleath, Betsy; Blalock, Susan J; Covert, David; Skinner, Asheley Cockrell; Muir, Kelly W; Robin, Alan L (ISRN ophthalmology, 2012)
Objective . The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results . Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions . Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.

Ophthalmic drug delivery in glaucoma-a review. - Januleviciene, Ingrida; Siaudvytyte, Lina; Barsauskaite, Ruta (Pharmaceutics, 2012)
Glaucoma is a progressive optic neuropathy and medical therapy is the initial option for the treatment of this potentially blinding condition. Topical instillation of eye drops from the bottle is the most common glaucoma drug delivery form. Due to limited permeability of anterior ocular surface, natural clearance and drainage, eye drops contain large amounts of inactive ingredients. Effective penetration enhancers are known as irritants causing ocular discomfort. Although drug efficacy is determined by active ingredients, inactive agents can affect tolerance and can result in conjunctival irritation and hyperemia and influence patients' adherence and quality of life.

Ocular drug delivery for glaucoma management. - Gooch, Nathan; Molokhia, Sarah A; Condie, Russell; Burr, Randon Michael; Archer, Bonnie; Ambati, Balamurali K; Wirostko, Barbara (Pharmaceutics, 2012)
Current glaucoma management modalities are hindered by low patient compliance and adherence. This can be due to highly complex treatment strategies or poor patient understanding. Treatments focus on the management or reduction of intraocular pressure. This is most commonly done through the use of daily topical eye drops. Unfortunately, despite effective therapies, glaucoma continues to progress, possibly due to patients not adhering to their treatments. In order to mitigate these patient compliance issues, many sustained release treatments are being researched and are entering the clinic. Conjunctival, subconjunctival, and intravitreal inserts, punctal plugs, and drug depots are currently in clinical development. Each delivery system has hurdles, yet shows promise and could potentially mitigate the current problems associated with poor patient compliance.

Acute Herpetic Keratitis: What is the Role for Ganciclovir Ophthalmic Gel?. - Sahin, Afsun; Hamrah, Pedram (Ophthalmology and eye diseases, 2012)
Herpes simplex keratitis (HSK) is a major cause of corneal blindness in the world. Following the primary infection, the virus enters into a latent phase. Recurrent infectious or immune keratitis cause structural damage to the cornea, scarring, and may lead to blindness. Several commercially available topical and oral antiviral drugs for HSK are currently available. However, toxicity and low patient compliance hamper their use in HSK. Further, oral antiviral drugs alone are not always effective in HSK. Thus, there had been a need for safe and effective topical antiviral agents against HSK. Systemic ganciclovir has been in use for the treatment of cytomegalovirus infections. Recently, topical ganciclovir has become available for use in patients with HSK. Ganciclovir 0.15% ophthalmic gel has been shown to be both safe and effective against viruses of the herpes family. Topical ganciclovir ophthalmic gel is well tolerated and does not cause significant toxic effects on the ocular surface. Several multicenter studies have revealed the potential role of ganciclovir ophthalmic gel in the treatment and prophylaxis of epithelial HSK. In this paper, we have reviewed the pharmacology, efficacy, side effects, and the role of ganciclovir ophthalmic gel 0.15% in the treatment of acute herpetic keratitis.

Patient perspectives when switching from Cosopt( R) (dorzolamide-timolol) to Azarga TM (brinzolamide-timolol) for glaucoma requiring multiple drug therapy. - Auger, Graham Anthony; Raynor, Mathew; Longstaff, Simon (Clinical ophthalmology (Auckland, N.Z.), 2012)
BACKGROUND: This study aimed to determine the impact of switching patients requiring multiple drug treatment from the dorzolamide-timolol fixed combination to the brinzolamide-timolol fixed combination and potential effects on tolerability and compliance., METHODS: Patients were switched from dorzolamide-timolol to brinzolamide-timolol and questioned within a period of 4-26 weeks. Questions were asked to confirm if a specific side effect had been experienced, and then a numerical comparison between the two types of eye drop was made., RESULTS: Thirty-one consecutive patients (12 males and 19 females aged 41-89 years) successfully completed the questionnaire. Comparison of the severity and chronicity of the side effects of the two types of fixed-combination eye drops showed that brinzolamide-timolol caused significantly less stinging for a shorter amount of time than dorzolamide-timolol; it also produced less eye redness for a significantly shorter amount of time. Brinzolamide-timolol produced more blurring, although the length of time this was present was similar to that for dorzolamide-timolol. No differences between the two eye drops were found for taste, overall impression, and likelihood of compliance., CONCLUSION: Our study confirms the findings of other researchers pertaining to the side effect profile of brinzolamide-timolol after switching from dorzolamide-timolol, which is a reduction in stinging but an increase in blurred vision. The advantage of one eye drop over the other then becomes patient-specific, depending on which side effect they find most tolerable. We suggest that both eye drops are acceptable choices in treating patients with glaucoma, and are interchangeable if compliance becomes an issue because of a specific side effect of one eye drop or the other.

Economic burden of glaucoma in Rivers State, Nigeria. - Adio, Adedayo O; Onua, Alfred A (Clinical ophthalmology (Auckland, N.Z.), 2012)
BACKGROUND: Primary open angle glaucoma is reported to blind 150,000 people in the Nigerian population and over 7000 in Rivers State, and requires constant follow-up. Compliance is a challenge, given that most inhabitants live below the poverty line. This study was performed to determine how Nigerian patients are affected economically by the disease., METHODS: Consecutive adult patients attending the eye clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria, with a diagnosis of primary open angle glaucoma and on outpatient antiglaucoma treatment in the first 6 months of 2006, were recruited for the study. The lowest paid government worker was on USD50 (N7500.00) per month and the gross domestic product per capita was USD1150 for the period under review., RESULTS: We enrolled 120 consecutive patients of mean age 52.7 +/- 10.4 years, with a male to female ratio of 2:3. The most common occupations were in the civil service (n = 56, 46.7%). All participants were on topical antiglaucoma treatment. The average cost of medical antiglaucoma medication was N6000 (USD40) per month. Computed to include indirect costs, including medical laboratory tests, transportation, and care by patient escorts, an average sum of USD105.4 (N15,810) was spent by each patient per month. Most of the patients (73.3%) were responsible for their own treatment costs. No patient accepted the cheaper option of surgery (USD275.4, N41,310). Eighty of the patients (66.7%) visited our eye clinic monthly. Direct and indirect loss to the economy was USD3,064587 per annum from those already blind. This was in addition to the USD 4.1 million being spent yearly on medical treatment by those who were visually impaired by glaucoma., CONCLUSION: Middle-income earners spent over 50% of their monthly income and low-income earners spend all their monthly earnings on treatment for glaucoma. This situation often resulted in noncompliance with treatment and hospital follow-up visits. To reduce the economic burden of glaucoma, trabeculectomy performed by experienced surgeons should be offered as first-line treatment for glaucoma in this country, rather than medical therapy.

The privileged immunity of immune privileged organs: the case of the eye. - Benhar, Inbal; London, Anat; Schwartz, Michal (Frontiers in immunology, 2012)
Understanding of ocular diseases and the search for their cure have been based on the common assumption that the eye is an immune privileged site, and the consequent conclusion that entry of immune cells to this organ is forbidden. Accordingly, it was assumed that when immune cell entry does occur, this reflects an undesired outcome of breached barriers. However, studies spanning more than a decade have demonstrated that acute insults to the retina, or chronic conditions resulting in retinal ganglion cell loss, such as in glaucoma, result in an inferior outcome in immunocompromised mice; likewise, steroidal treatment was found to be detrimental under these conditions. Moreover, even conditions that are associated with inflammation, such as age-related macular degeneration, are not currently believed to require immune suppression for treatment, but rather, are thought to benefit from immune modulation. Here, we propose that the immune privilege of the eye is its ability to enable, upon need, the entry of selected immune cells for its repair and healing, rather than to altogether prevent immune cell entry. The implications for acute and chronic degenerative diseases, as well as for infection and inflammatory diseases, are discussed.

Differential activity and clinical utility of latanoprost in glaucoma and ocular hypertension. - Pacella, Fernanda; Turchetti, Paolo; Santamaria, Valentina; Impallara, David; Smaldone, Gianpaolo; Brillante, Chiara; Librando, Aloisa; Damiano, Angela; Pecori-Giraldi, Jose; Pacella, Elena (Clinical ophthalmology (Auckland, N.Z.), 2012)
BACKGROUND: The purpose of this study was to demonstrate the hypotensive efficacy and tolerability of latanoprost when used as monotherapy and as polytherapy associated with antiglaucomatous medication proven to be ineffective in keeping intraocular pressure under control., METHODS: Three hundred and thirty-seven patients (672 eyes) affected by primary open-angle glaucoma and intraocular hypertension were recruited over a period of 10 years from the Glaucoma Centre, Department of Ophthalmological Sciences, University of Rome "Sapienza", and treated, subject to informed consent, with latanoprost 0.005% alone or in combination with other ocular hypotensive drugs. The patients were followed during this period at regular intervals, with determination of visual field, fundus oculi, visual acuity, and eventual onset of local and systemic side effects., RESULTS: Latanoprost used as monotherapy and as polytherapy renders possible optimal and durable control of intraocular pressure in the form of one antiglaucomatous drug because it can substitute for one or more drugs and obtain the same hypotensive effect., CONCLUSION: Latanoprost can be described as the ideal hypotensive drug, not only because of its ideal compliance profile (only one daily dose in the evening), excellent hypotensive effect, and, above all, few systemic side effects.

Multicenter, prospective, open-label, observational study of bimatoprost 0.01% in patients with primary open-angle glaucoma or ocular hypertension. - Pfennigsdorf, Stefan; Ramez, Osman; von Kistowski, Gerrit; Mader, Birgit; Eschstruth, Peter; Frobose, Michael; Thelen, Ulrich; Spraul, Christoph; Schnober, Dietmar; Cooper, Hazel; Laube, Thomas (Clinical ophthalmology (Auckland, N.Z.), 2012)
BACKGROUND: Bimatoprost 0.01% was developed for improved tolerability over bimatoprost 0.03%, while maintaining efficacy in lowering intraocular pressure (IOP). This multicenter, prospective, open-label, observational study was designed to investigate the efficacy and tolerability of bimatoprost 0.01% in routine clinical practice., METHODS: Data were collected from 10,337 patients with primary open-angle glaucoma or ocular hypertension attending 1334 centers in Germany. The primary efficacy outcome was mean change in IOP in each eye from baseline to 10-14 weeks after initiation of bimatoprost 0.01%. Target IOP, prior therapies, additional treatments, and adverse events were also assessed. All treatment decisions were at the physicians' discretion., RESULTS: Bimatoprost 0.01% significantly lowered mean IOP from baseline by -4.1 mmHg (P < 0.0001) in all patients after a mean of 10.45 weeks. In patients without previous treatment, bimatoprost 0.01% reduced mean IOP from baseline by -6.5 mmHg (P < 0.0001). Bimatoprost 0.01% also significantly reduced IOP in patients previously treated with monotherapy of beta-blockers, prostaglandin analogs, carbonic anhydrase inhibitors or bimatoprost 0.03%. No adverse events were reported by 93.9% of patients during treatment with bimatoprost 0.01%; the most commonly reported adverse events were eye irritation (2.0%), ocular hyperemia (1.4%), and conjunctival hyperemia (1.2%). Physicians and patients rated tolerability and adherence as high, and most patients said they would continue with bimatoprost 0.01% treatment., CONCLUSION: Bimatoprost 0.01% can produce additional IOP-lowering effects when used in routine clinical practice in patients who have received prior therapy, in addition to lowering IOP in previously untreated patients. A high rate of continuation of therapy with bimatoprost 0.01% was observed in patients who switched from a variety of different medications. The results suggest that bimatoprost 0.01% is a suitable first-choice therapy in patients with primary open-angle glaucoma or ocular hypertension.

Differential pharmacology and clinical utility of preservative-free tafluprost in the treatment of ocular hypertension and glaucoma. - Ermis, Sitki Samet (Clinical ophthalmology (Auckland, N.Z.), 2012)
Glaucoma is a chronic disease requiring lifelong treatment. Discomfort due to medications may affect patients' quality of life and may cause poor compliance, which leads to poor intraocular pressure control. To minimize the side effects of long-term treatment, preparations with lower benzalkonium chloride concentrations, preservative-free preparations and alternative preservatives have been developed and reported to have a lower rate of side effects. Tafluprost, launched on the ophthalmic market in 2008, is a new 16-phenoxy analogue of prostaglandin F(2alpha), clinically used as an ocular hypotensive agent for the treatment of glaucoma and ocular hypertension. The safety and intraocular pressure-lowering efficacy of tafluprost has been demonstrated in various preclinical and clinical studies.

Comparing the efficacy of the monocular trial treatment paradigm with multiple measurements of intraocular pressure before and after treatment initiation in primary open-angle glaucoma. - Krishna, Rohit; Debry, Peter W; Waldman, Corey W; Koulen, Peter (Clinical ophthalmology (Auckland, N.Z.), 2012)
The monocular trial has been proposed as a test to help control for diurnal fluctuations in eye pressure when assessing medication effectiveness. We undertook a prospective study to determine the sensitivity and specificity of the monocular trial as a test for determining the effectiveness of a glaucoma medication. The efficacy of the monocular trial was compared to the diagnostic paradigm of repeated pre- and post-treatment measurements in determining whether an intraocular pressure (IOP)-lowering drug is effective. Forty-two patients with newly diagnosed open-angle glaucoma completed five visits: visit 1 for determining eligibility, obtaining consent, and measuring IOP, visit 2 for a second pressure measurement, and visit 3 for a third pressure reading. The new medication was then started in one eye. IOP measurements were made at weeks 4 and 6. The gold standard IOP change was defined as the difference in mean between the pre- and post-medication visits. A medication was deemed effective if this difference was at least 15%. The monocular trial pressure change was defined as the IOP change in the treated eye between the visit immediately before and immediately after the medication addition, corrected by subtracting the pressure change in the untreated eye. All 42 patients completed the full protocol with good compliance. Twenty-five of 42 (60%) medication additions were considered effective by the gold standard method, and 25/42 (60%) by the monocular trial method. However, the two methods agreed in only 26 patients (17 Yes/Yes, 9 No/No). The calculated sensitivity was low (0.68), with a specificity of 0.53. The monocular trial can give useful clues as to whether a medication is effective, but should not be the only information used in making this determination. To obtain the most valid results, multiple pressure checks should be done before and after starting a new medication.

Ocular hypotensive effect and safety of travoprost 0.004%/timolol maleate 0.5% fixed combination after change of treatment regimen from beta-blockers and prostaglandin analogs. - Inoue, Kenji; Setogawa, Akira; Higa, Risako; Moriyama, Ryo; Wakakura, Masato; Tomita, Goji (Clinical ophthalmology (Auckland, N.Z.), 2012)
INTRODUCTION: Travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops are available in Japan. We prospectively investigated the intraocular pressure (IOP)-decreasing effect of travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops and the adherence of patients to the administration protocol., MATERIALS AND METHODS: We studied 43 eyes from 43 patients diagnosed with primary open- angle glaucoma, who were using prostaglandin analogs and beta-blockers. The prostaglandin analogs and beta-blockers were discontinued, and the treatment regimen was changed to travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops without any washout period. IOP before and at 1 month, 3 months, and 6 months after the treatment change was evaluated and compared. A questionnaire about protocol adherence was administered 1 month after the treatment change., RESULTS: IOP was 15.7 +/- 2.9 mmHg before the change, 15.5 +/- 2.7 mmHg at 1 month after the change, 15.3 +/- 3.6 mmHg at 3 months after the change, and 15.8 +/- 3.2 mmHg at 6 months after the change, and none of the differences were significant (P = 0.191). The responses to the questionnaire showed that cases where eye drop administration was forgotten decreased after the treatment change. Moreover, because of changes in eye drops, 19.0% of patients had irritation. More than half (54.8%) of the patients preferred travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops. Seven patients (16.3%) discontinued eye drop use because of adverse reactions within 6 months after the change., CONCLUSION: When the treatment regimen was changed from prostaglandin analogs and beta-blockers to travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops, administration protocol adherence increased and IOP was preserved; however, adverse reactions appeared in about 16% of the cases.

Assessing the knowledge and skills in clinical ophthalmology of medical interns: survey results from enugu, South-eastern Nigeria. - Eze, Boniface I; Oguego, Ngozi C; Uche, Judith N; Shiwoebi, Jude O; Mba, Chibuike N (Middle East African journal of ophthalmology, 2012)
PURPOSE: To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu, Nigeria, to the recommendations of the International Council of Ophthalmology (ICO)., MATERIALS AND METHODS: A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, from April 2010 to June 2010. Data on cohort demographics, undergraduate ophthalmology exposure, clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P < 0.05., RESULTS: The cohort comprised 81 males and 48 females (sex ratio = 1.7 : 1), aged 21-35 years (mean: 26.8 +/- 2.4 years). The gender difference was significant (P < 0.05). The response rate was 88.7%. The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3%), lens/cataract (95.3%) and glaucoma (92.2%); but not in vitreo-retinal disease (47.3%), neuro-ophthalmology (45.7%) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7%) and visual field examination (93.0%). There was lower competency at anterior chamber assessment (49.6%) and slit-lamp examination (39.5%). The majority could confidently diagnose conjunctivitis (96.1%) and cataract (90.7%), but not strabismus (42.6%) or macular degeneration (20.2%)., CONCLUSIONS: Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure, clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum, provision of training resources and compliance with ICO guidelines could address the deficiencies.

A new manner of reporting pressure results after glaucoma surgery. - Bordeianu, Constantin-Dan; Ticu, Cristina-Eugenia (Clinical ophthalmology (Auckland, N.Z.), 2012)
PURPOSE: To evaluate to what extent contemporary glaucoma abstracts offer complete information and to suggest a new manner of pressure results reporting., MATERIALS, METHODS, AND RESULTS: Most of the 36 relevant surgical glaucoma abstracts found in one issue of International Glaucoma Review contain insufficient data-supported statements. Such abstracts cannot offer a clear picture of the study essence if economic, linguistic, or political barriers prevent access to the full text. In order to enrich abstract content and to avoid typographic space waste, a formula is suggested to provide, in one single line of symbols and figures, all the necessary data for statistical interpretation at two evolution moments: the first significative control (6 months) and the final one., CONCLUSION: The current manner of results reporting in surgical glaucoma abstracts is subject to too little standardization, allowing insufficiently data-supported statements. Abstracts, especially those printed in small-circulation language journals, should be conceived and standardized in such a manner that any abstract review reader is capable of grasping the essence of the study at first glance. The suggested manner of reporting results would bring satisfaction to all areas of the process. Publishers would save typographic space, readers would find all the necessary data for statistical analysis and comparison with other studies, and authors would be convinced that the essence of their work would penetrate in spite of any economic, linguistic, or political barriers.

Gene therapy strategies in glaucoma and application for steroid-induced hypertension. - Borras, Teresa (Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society, 2011)
Gene therapy of the eye has a high potential of becoming the preferred treatment of a number of eye diseases. Because of its easy accessibility, all the tissues of the eye can be reached and genetically manipulated with nowadays standard gene delivery technologies. Gene therapy offers the possibility to do both, correct a genetic defect by replacing the mutated or missing gene and that of using genes as drugs. Gene drugs would be more specific and would have a longer duration of action and less toxicity than conventional drugs. Examples of both applications are beginning to emerge. Using gene replacement, vision has been restored in several patients of Leber congenital amaurosis (Maguire et al., 2009). Some gene drugs, such as siRNA, are currently in clinical trials to silence angiogenic factors in macular degeneration (Campa and Harding, 2011). In this manuscript we first give a short overview of the basics of gene therapy in the eye and then review the ongoing preclinical studies in our laboratory for the gene-drug treatment of steroid-induced ocular hypertension.

Unusual presentation of phacolytic glaucoma: simulating microbial keratitis. - Sahu, Srikant Kumar; Keswarwani, Siddharth; Mittal, Ruchi (Case reports in ophthalmological medicine, 2011)
The differential diagnoses for phacolytic glaucoma are acute angle closure glaucoma, open angle glaucoma with uveitis, neovascular glaucoma, and glaucoma secondary to trauma. We report an unusual case where the dislocated cataractous lens firmly adherent to the corneal endothelium evoked a cellular reaction similar to phacolytic glaucoma but clinically appeared like a deep corneal abscess. The 73-year-old lady presented with severe photophobia, pain, and redness in the left eye for two months despite being on antibiotics and antifungals. Anterior chamber wash revealed a cataractous lens buried within the infiltrate, which was removed and sent for histopathological examination. Postoperatively she was treated with topical ofloxacin, homatropine, dorzolamide, timolol, and tapering dose of steroids. Histological confirmation of inflammation, histiocytic response, and giant cells around the lens material confirmed the ongoing phacolytic process. Photophobia, pain, and redness subsided following removal of the lens and surrounding cellular reaction. At her last visit, four months after surgery, she was comfortable.

Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review. - Reardon, Gregory; Kotak, Sameer; Schwartz, Gail F (Patient preference and adherence, 2011)
PURPOSE: This study summarizes findings from objective assessments of compliance (or adherence) and persistence with ocular hypotensive agents in patients with glaucoma and ocular hypertension., DESIGN: Systematic literature review., METHODS: A PubMed and reference list search was conducted across publication years 1970-2010, using these terms and variants: "compliance," the equivalent term "adherence," and "persistence" in patients with these conditions and therapies. Summaries of selected studies were stratified by measurement method (electronic monitor, prescription fills review, medical chart review). Measures of central tendency across studies were calculated for commonly-reported compliance or persistence measures., RESULTS: Fifty-eight articles met all inclusion/exclusion criteria: measurement of compliance-electronic monitoring (seven studies reported in 14 articles), measurement of compliance/ persistence-prescription records (36 studies in 38 articles), and measurement of persistence- medical chart review (six studies in six articles). From electronic monitoring, most therapy-experienced patients took medication consistently, but >=20% met criteria for poor compliance. From prescription records, only 56% (range 37%-92%) of the days in the first therapy year could be dosed with the medication supply dispensed over this period. At 12 months from therapy start, only 31% (range 10%-68%) of new therapy users had not discontinued, and 40% (range 14%-67%) had not discontinued or changed the initial therapy. From medical chart review, only 67% (range 62%-78%) of patients remained persistent 12 months after starting therapy., CONCLUSIONS: Evidence provided by this review suggests that poor compliance and persistence has been and remains a common problem for many glaucoma patients, and is especially problematic for patients new to therapy. The direction of empirical research should shift toward a greater emphasis on understanding of root causes and identification and testing of solutions for this problem.

Update and optimal use of a brinzolamide-timolol fixed combination in open-angle glaucoma and ocular hypertension. - Syed, Misha F; Loucks, Emma Kr (Clinical ophthalmology (Auckland, N.Z.), 2011)
Glaucoma encompasses a wide clinical spectrum of disease, with the common pathophysiology of progressive optic neuropathy leading to visual field loss. Elevated intraocular pressure (IOP) is a key risk factor in disease progression. Treatment is aimed at reduction of IOP to minimize continued optic nerve head damage. Pharmacologic treatment with various classes of IOP-lowering medications is generally employed before more aggressive surgical interventions. Monotherapy is generally accepted as initial therapy for glaucoma, but at least half of patients may require more than one IOP-lowering medication. One option is the fixed combination of brinzolamide 1% and timolol maleate 0.5%, which is commercially available in some countries as Azarga( R) for treatment of glaucoma not adequately responsive to monotherapy. These agents may also be used in an unfixed fashion, but fixed combination therapy is generally more convenient for patients, which may result in improved compliance, a reduction of the "washout effect" from instilling multiple drops, and a potential reduction in the side effects related to multiple doses of preservatives.

Perceived satisfaction of ophthalmology residents with the current Iranian ophthalmology curriculum. - Mostafaei, Ali; Hajebrahimi, Sakineh (Clinical ophthalmology (Auckland, N.Z.), 2011)
OBJECTIVE: To assess the level of perceived satisfaction with the current Iranian ophthalmology curriculum in ensuring that residents acquire required competencies in various ophthalmology fields., METHODS: A closed-ended questionnaire was circulated to 100 residents or recently graduated ophthalmologists in Iran to measure their level of satisfaction about clinical conferences, journal clubs, scientific lectures, wet lab, simulation, evidence-based practice, and outpatient clinic and operating room training. They also cited the main barriers to a successful board exam., RESULTS: Ninety-nine questionnaires were completed and returned. Mean age of the responders was 31 +/- 4.56 years. A total of 36 (36.4%) responders expressed an overall satisfaction about the residency program, and 49 (49.5%) did not feel happy about the state of teaching evidence-based decision making. They identified cataract surgery and eyeglass prescription as the most common regularly functioning modalities in their centers. The majority of the participants stated they have received appropriate training in cataract surgery (71%), but only 9% were satisfied with the provided training in glaucoma or vitreous and retinal surgery. Nevertheless, their overall satisfaction with their outpatient skills was good., CONCLUSION: The ophthalmologists felt quite confident in management of uncomplicated cases, especially cataract surgery at the level of general ophthalmology, but future studies can assess the effect of new practice-based teaching methods on the residents' clinical training and eventually on patient care.

Blindness in iraq: leading causes, target patients, and barriers to treatment. - Al-Shakarchi, Faiz I (Middle East African journal of ophthalmology, 2011)
PURPOSE: To define the main causes of blindness, demographic characteristics and barriers to care of blind patients attending a teaching eye hospital in Iraq., MATERIAL AND METHOD: Successive new patients, 6 years of age and older, who attended three outpatients clinics at Ibn Al-Haetham Teaching Eye Hospital (IAHTEH), Baghdad, Iraq, from September 1 to November 30, 2007, were included in this study. Inclusion criterion was fulfillment of the World Health Organization's definition of blindness. The cause of blindness was identified and subjects were interviewed for collection of data on demographic characteristics and barriers to treatment., RESULTS: Of 18612 consecutive patients who attended the outpatient clinics, 497 (2.7%) patients were blind. Cataract (76.1%), diabetic retinopathy (12.9%), and glaucoma (5%) were the leading causes of blindness. The majority of blind patients had low socioeconomic status and poor educational level. In cases of cataract, the most important barrier to treatment was the waiting list at the hospital (53.7%). A lack of awareness was the most important barrier to treatment for patients with diabetic retinopathy (54.7%) and glaucoma (56%)., CONCLUSIONS: The preliminary data from our study will aid in the development of blindness prevention programs in Iraq. Priorities include decreasing waiting lists for cataract surgeries at governmental hospitals. Active health promotion programs for early detection and treatment of diabetic retinopathy and glaucoma are also warranted.

Self-induced Elizabethkingia meningoseptica endophthalmitis: a case report. - Connell, Paul P; Wickremasinghe, Sanj; Devi, Uma; Waters, Mary Jo; Allen, Penelope J (Journal of medical case reports, 2011)
INTRODUCTION: Endophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces. It is classified as either endogenous or exogenous depending on the route of infection. Exogenous endophthalmitis results from direct inoculation as a complication of intra-ocular surgery, penetrating ocular trauma, intra-ocular foreign bodies, corneal ulceration and following a breach of ocular barriers from a periocular infection. We report a rare case of exogenous endophthalmitis with both unusual etiology and microbiology., CASE PRESENTATION: A 41-year-old Caucasian man with a history of depressive illness presented to our eye department with painful acute visual loss on a background history of chronic uveitis. Ocular examination revealed a dense fibrinous panuveitis with a suspicion of a focal lesion in the posterior segment. Microbiological sampling from his anterior chamber and posterior segment revealed a culture of Elizabethkingia meningoseptica. On closer questioning, he volunteered the occurrence of multiple episodes of deliberate needle ocular penetration. Following vitrectomy for associated retinal detachment, a final Snellen visual acuity of 6/60 was obtained., CONCLUSIONS: Elizabethkingia meningoseptica endophthalmitis is a rare condition, and visual results to date are poor.