Tolerability and effectiveness of preservativefree dorzolamide-timolol (preservative-free COSOPT®) in patients with open-angle glaucoma or ocular hypertension - Hutnik, C.; Neima, D.; Ibrahim, F.; Scott, R.; Vaillancourt, J.; Haine, D.; Sampalis, J.S.; Bastien, N.; Foucart, S. (Clinical Ophthalmology, 2010)
Purpose: To assess the effect of preservative-free dorzolamide-timolol on nonvisual symptoms and intraocular pressure (IOP) in newly diagnosed and untreated patients with open-angle glaucoma or ocular hypertension. Methods: This was a prospective, 8-week, open-label, Canadian multicenter study. All patients were treated with preservative-free dorzolamide-timolol formulation. The primary outcome was the change in the nonvisual symptom score of the Glaucoma Symptom Scale (GSS-SYMP-6) from baseline to 8 weeks. Secondary effectiveness outcome measures were absolute and percent changes in IOP from baseline to 4 and 8 weeks. Results: One hundred and seventy-eight patients were enrolled. Mean (SD) age was 65.6 (12.1) years and 90 (50.6%) were females. There were 92 patients diagnosed with open-angle glaucoma, 62 with ocular hypertension, and 23 with both diseases (diagnosis was missing for one patient). The mean (SD) GSS-SYMP-6 score increased from 73.6 (21.8) at baseline to 76.1 (20.7) at 8 weeks (P = 0.097). Mean (SD) IOP significantly decreased by 11.7 (5.1) mmHg at 4 weeks (P< 0.001) and by 11.5 (5.3) mmHg at 8 weeks (P< 0.001), representing reductions of-38.5% (P< 0.001) and-38.0% (P< 0.001), respectively. Conclusion: Preservative-free dorzolamide-timolol does not increase eye discomfort while significantly reducing IOP in patients with open-angle glaucoma or ocular-hypertension. © 2010 Hutnik et al.
Keywords: dorzolamide plus timolol; adult; article; bradycardia; clinical assessment tool; clinical trial; disease severity; drug efficacy; drug safety; drug tolerability; drug withdrawal; female; Glaucoma Symptom Scale 6; human; intraocular hypertension; major clinical study; male; multicenter study; nausea; open angle glaucoma; outcome assessment; patient compliance; scoring system; treatment response; cosopt

A Canadian population-based study of vision problems: Assessing the significance of socioeconomic status - Perruccio, A.V.; Badley, E.M.; Trope, G.E. (Canadian Journal of Ophthalmology, 2010)
Objective: To examine the relationship between age, gender, socioeconomic status, and 3 chronic conditions (glaucoma, cataracts, and diabetes) and corrected and uncorrected vision problems, and to document the prevalence of visual problems in Canada across the adult age range. Design: Cross-sectional, representative, population-based study. Participants: Health survey respondents (n = 113 212, aged ≥20 years). Methods: Data are from a 2000-2001 Canadian health survey. Self-reported data included sociodemographic/economic characteristics, vision problems, eye care professional consultations, and medical conditions. Prevalence estimates were calculated; multinomial logistic regression examined the relationship between indicated variables and vision problems, generally and by type. Results: Fifty-seven percent of adults reported some form of vision problem, the majority corrected by lenses. Blindness was reported by 0.09% of adults. Increasing age, being female, and having a low income and lower educational attainment were significantly associated with reported vision problems. However, age and gender were not significant determinants of the type of vision problem. Cataracts, diabetes, and glaucoma in particular, were significantly associated with reported vision problems. Conclusions: Socioeconomic characteristics may underscore the socioeconomic burden of visual impairments in the population and highlight obstacles to eye service utilization among subgroups. This information is essential to establishing the need for treatment and management services, developing targeted screening programmes, and identifying priority areas of research.
Keywords: adult; aged; article; blindness; Canada; cataract; consultation; cross-sectional study; diabetes mellitus; disease association; educational status; eye care; female; gender; glaucoma; health care utilization; health survey; human; lowest income group; major clinical study; male; optical instrumentation; population research; self report; social status; visual disorder

Preliminary survey of educational support for patients prescribed ocular hypotensive therapy - Gray, T.A.; Fenerty, C.; Harper, R.; Lee, A.; Spencer, A.F.; Campbell, M.; Henson, D.B.; Waterman, H. (Eye, 2010)
Purpose: To establish the impact of educational support on patients' knowledge of glaucoma and adherence, in preparation for an intervention study. Methods: Structured observation encapsulated the educational support provided during clinical consultations and patient interviews captured the depth of glaucoma knowledge, problems associated with glaucoma therapy, and adherence issues. Results: One hundred and thirty-eight patients completed the study. Education was didactic in nature, limited for many patients and inconsistent across clinics. Patients showed generally poor knowledge of glaucoma with a median score of 6 (range 0-16). A significant association was found between educational support and knowledge for newly prescribed patients (Kendall's tau = 0.30, P = 0.003), but no association was found for follow-up patients (Kendall's tau = 0.11, P = 0.174). Only five (6%) patients admitted to a doctor that they did not adhere to their drop regimen, yet 75 (94%) reported at interview that they missed drops. Conclusions: Although important, knowledge alone may not sufficiently improve adherence: a patient-centred approach based on ongoing support according to need may provide a more effective solution for this patient group. © 2010 Macmillan Publishers Limited All rights reserved.
Keywords: adult; aged; clinical assessment; correlation analysis; drug instillation; female; glaucoma; health; health education; health survey; human; interview; major clinical study; male; medical education; observation; patient attitude; patient compliance; review; self care; self report

Electronic compliance monitoring of topical treatment after ophthalmic surgery - Hermann, M.M.; Stündag, C.U.; Diestelhorst, M. (International Ophthalmology, 2010)
The success of many medical treatments is built on compliance. Electronic monitoring is the most accurate tool to quantify compliance by measuring adherence. In order to assess the efficiency of a recently introduced miniature monitoring device for eye drop application, we evaluated adherence in ophthalmic patients undergoing post-operative shortterm topical treatment. This pilot study enrolled 30 outpatients (mean age 61.8 ± 18.5 years) after cataract (n = 24) and glaucoma filtration surgery (n = 6) applying fixed-combination eye drops containing prednisolone and gentamicin five times daily for 2 weeks. Patients received eye drops in conventional bottles each equipped with a miniature monitoring device recording events of application. Two patients failed to bring back the monitoring device; therefore data collected from only 28 patients could be examined. Data showed highly variable results with a mean dose compliance of 50.2%. Dose compliance was below 25% in approximately one out of five patients. Four cataract patients, but no glaucoma patient, discontinued therapy prematurely. The observed mean dosage interval was calculated for each patient and ranged 4.6-19.7 h. Thirty percent of analysed dosage intervals exceeded 12.0 h. Different patterns of compliance behaviour-like early nonpersistence, drug holiday and low treatment frequency could be identified and illustrated using electronic data. Age or gender did not significantly influence compliance rates. Our pilot study demonstrates successful electronic compliance monitoring using a technology capable of continuous data recording over weeks of treatment. The low compliance rate for a relevant part of the patients demonstrates the necessity to study and improve compliance in ophthalmology. In future, new application methods and electronic application devices may improve treatment response in eye care. © Springer Science+Business Media B.V. 2010.
Keywords: eye drops; gentamicin; inflanegent; prednisolone; unclassified drug; adolescent; adult; aged; article; cataract; cataract extraction; clinical article; devices; drug withdrawal; electronics; eye care; eye surgery; female; filtering operation; glaucoma; human; information processing; information technology; male; outpatient; patient compliance; patient monitoring; pilot study; postoperative care; topical treatment; treatment duration; treatment response; inflanegent

Penetrating keratoplasty in active acanthamoeba keratitis - Nguyen, T.H.; Weisenthal, R.W.; Florakis, G.J.; Reidy, J.J.; Gaster, R.N.; Tom, D. (Cornea, 2010)
Purpose: To report the results of penetrating keratoplasty (PK) in active Acanthamoeba keratitis (AK). Methods: Nine patients with deep stromal infiltrates because of AK were treated with intensive antiamoebic medical therapy followed by PK during the acute infectious phase because of poor clinical response or poor compliance. Antiamoebic therapy was tapered after PK. Results: Visual acuity ranged from 20/15 to 20/50 after an average of 17 months after PK with no signs of recurrences. Patients had rapid resolution of symptoms. Conclusion: PK is a viable option for active AK not responding to maximum medical treatment. © 2010 by Lippincott Williams & Wilkins.
Keywords: chlorhexidine; clotrimazole; fluconazole; itraconazole; ketoconazole; neomycin; poly(hexamethylenebiguanide); propamidine; Acanthamoeba keratitis; adolescent; adult; article; clinical article; drug dose reduction; female; human; male; patient compliance; penetrating keratoplasty; priority journal; treatment response; visual acuity

Scalp psoriasis: European consensus on grading and treatment algorithm - Ortonne, J.P.; Chimenti, S.; Luger, T.; Puig, L.; Reid, F.; Trüeb, R.M. (Journal of the European Academy of Dermatology and Venereology, 2009)
The scalp is a common site of involvement of psoriasis and, for many patients, is a challenging aspect of their disease. This can be attributed not only to the scaling, itching and cosmetic embarrassment that go with scalp psoriasis, but also to the fact that the scalp skin is relatively inaccessible, making topical therapies difficult to apply. The proximity of sensitive facial skin can also limit the use of potentially irritating topical treatments. Nevertheless, the specific challenges of scalp psoriasis are often neglected by treatment guidelines. This paper summarizes the discussions that took place at an international conference of experts convened in Geneva, Switzerland, in March 2008. The objective of the meeting was to review the available treatments for scalp psoriasis in terms of efficacy, safety, convenience, and the implications for patient compliance with treatment. In addition, definitions of mild, moderate and severe scalp psoriasis were agreed. This paper presents a treatment algorithm that includes recommendations for patients in all three categories. It considers the role of potent topical corticosteroids, vitamin D3 derivatives, salicylic acid preparations, and photo- and radiotherapy, as well as systemic therapies, including newer biological agents, for patients with widespread psoriasis with scalp involvement. Data from clinical trials indicate that a potent topical corticosteroid in a short-contact formulation is the most appropriate treatment for most patients with scalp psoriasis. © 2009 European Academy of Dermatology and Venereology.
Keywords: alefacept; betamethasone dipropionate; betamethasone valerate; calcipotriol; clobetasol propionate; coal tar; colecalciferol; corticosteroid; cyclosporine; efalizumab; infliximab; ketoconazole; methotrexate; placebo; psoralen; retinoid; salicylic acid; selenium sulfide; algorithm; allergic reaction; clinical trial; conference paper; Cushing syndrome; disease severity; drug efficacy; drug hypersensitivity; drug safety; dry skin; dyspnea; erythema; excimer laser; gel; glaucoma; hair color; hair discoloration; hair loss; hair texture; human; hypercalcemia; lotion; ointment; patient compliance; phototherapy; phototoxicity; priority journal; pruritus; psoriasis; pustule; rash; scalp; scalp psoriasis; side effect; skin abrasion; skin atrophy; skin discoloration; skin irritation; telangiectasia

Compliance and ignorance in glaucoma in Romanian patients - Dumitrica, D.M.; Stefan, C. (Oftalmologia (Bucharest, Romania : 1990), 2009)
The compliance to treatment of glaucoma patient has a big importance on the long term vision preservation, as well as on the quality of life of our patients. Unknowing and misunderstanding of disease real implications and the importance of the treatment are present in out every day practice in our patients. We want to identify and analyze these aspects in a glaucoma group of Romanian patients, knowing the implications of socio-economic aspects.
Keywords: antihypertensive agent; aged; article; attitude to health; doctor patient relationship; drug effect; female; glaucoma; health survey; human; intraocular pressure; male; open angle glaucoma; patient compliance; quality of life; questionnaire; reproducibility; Romania; statistics

Pharmacotherapy of intraocular pressure: Part I. Parasympathomimetic, sympathomimetic - Costagliola, C.; Dell'Omo, R.; Romano, M.R.; Rinaldi, M.; Zeppa, L.; Parmeggiani, F. (Expert Opinion on Pharmacotherapy, 2009)
Elevated intraocular pressure (IOP) has been recognized as the major risk factor for the development of glaucoma and a wide range of options are now available to reduce it: medical treatment, laser, filtering, or cyclodestructive surgery (alone or in combination). All these modalities act by decreasing eye pressure and, thereby, protecting the optic nerve head from a mechanic direct and/or vascular indirect insult. Topical medical therapy represents the first-choice treatment and, in most cases, it effectively controls IOP, avoiding the occurrence of further optic nerve damage. All medications lower IOP in two main ways: decreasing the production of aqueous humour or by increasing its outflow from the eye. Consequently, antiglaucoma drugs either suppress aqueous humour formation (β-adrenergic antagonists, carbonic anhydrase inhibitors, and alpha-2-adrenergic agonists) or raise aqueous humour outflow throughout the conventional (e.g., pilocarpine) or uveoscleral (prostaglandin FP receptor agonists, and prostamides) route. In addition, fixed and unfixed combinations of antiglaucoma compounds have also been available for patients requiring more than one type of medication. This review, which is part one of two (please see Expert Opinion on Pharmacotherapy 10 (17)) briefly considers the characteristics of sympathomimetic, sympatholytics and parasympathomimetic commonly employed in the medical treatment of glaucoma, mainly the primary open-angle form, focusing the discussion on the clinical evidence supporting the use of these three classes of compound. © 2009 Informa UK Ltd.
Keywords: acetylcholine; epinephrine; adrenergic receptor blocking agent; adrenergic receptor stimulating agent; apraclonidine; atenolol; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brimonidine plus timolol; carbachol; carteolol; cholinergic receptor stimulating agent; clonidine; dapiprazole; dipivefrine; latanoprost; levobunolol; metipranolol; noradrenalin; pilocarpine; placebo; timolol; timolol maleate; abnormal sensation; absence of side effects; accommodation; acetylcholine release; allergic conjunctivitis; aqueous humor flow; aqueous humor formation; asthma; blepharoconjunctivitis; blepharoconjunctivitis; blood pressure; bronchospasm; burning sensation; chemical structure; chemosis; cholesterol blood level; ciliary muscle spasm; ciliary muscle spasm; ciliary vasoconstriction; clinical trial; closed angle glaucoma; conjunctiva disease; conjunctiva toxicity; conjunctiva toxicity; conjunctival blanching; conjunctival blanching; conjunctival deposit; conjunctivitis; cornea epithelium; cornea sensibility; dermatitis; diarrhea; diastolic blood pressure; drug absorption; drug blood level; drug contraindication; drug dosage form comparison; drug half life; drug induced headache; drug mechanism; drug potentiation; drug tolerability; dry nose; dyslipidemia; dyspnea; epiphora; eye burning; eye inflammation; eye irritation; eye pain; eye redness; eye redness; eye stinging; eye stinging; eye synechia; eye toxicity; eyelid disease; eyelid edema; fatigue; foreign body reaction; gastrointestinal cramp; gastrointestinal cramp; gastrointestinal symptom; glaucoma; headache; heart arrhythmia; heart palpitation; heart rate; human; hydrolysis; hyperemia; hyperhidrosis; hypotension; intraocular hypertension; intraocular pressure

Pharmacotherapy of intraocular pressure part II. Carbonic anhydrase inhibitors, prostaglandin analogues and prostamides - Costagliola, C.; Dell'Omo, R.; Romano, M.R.; Rinaldi, M.; Zeppa, L.; Parmeggiani, F. (Expert Opinion on Pharmacotherapy, 2009)
The second part of this two part review (please see Expert Opinion on Pharmacotherapy 10(16)) reports the characteristics of other antiglaucoma medications: systemic (acetazomide) and topical (dorzolamide and brinzolamide) carbonic anhydrase inhibitors, which suppress aqueous humour formation; and prostaglandin analogues (latanoprost and travoprost) and prostamides (bimatoprost), which raise aqueous humour outflow. The pharmacologic properties of each compound and its efficacy in the medical treatment of glaucoma, mainly the primary open-angle form, are discussed briefly, focusing on the clinical evidence supporting their use. © 2009 Informa UK Ltd.
Keywords: aceclidine; acetazolamide; acetylcholine; acetylsalicylic acid; epinephrine; apraclonidine; betaxolol; bimatoprost; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; clonidine; dorzolamide; latanoprost; levobunolol; pilocarpine; propranolol derivative; prostaglandin derivative; prostamide derivative; prostanoid; sulfonamide; timolol; travoprost; unclassified drug; aplastic anemia; aqueous humor formation; aqueous humor outflow; asthenia; bitter taste; blood analysis; blood pressure; blurred vision; bone marrow suppression; burning sensation; clinical trial; conjunctival hyperemia; conjunctivitis; cyst; drug efficacy; drug mechanism; drug megadose; drug withdrawal; dry eye; epiphora; evening dosage; eyelash; eyelid inflammation; eyelid inflammation; fatigue; foreign body reaction; glaucoma; headache; heart rate; hirsutism; human; inflammation; insect sting; intraocular hypotension; intraocular pressure; iris cyst; iris cyst; iris disease; iris pigmentation; iris pigmentation; keratitis; leukopenia; liver function test; malaise; metabolic acidosis; morning dosage; nausea; nausea and vomiting; nephrolithiasis; nonhuman; pancytopenia; paresthesia; patient compliance; pigmentation; pruritus; rash; recommended drug dose; macular edema; review; side effect; skin manifestation; skin pigmentation; thrombocytopenia; transamination; urinalysis; urolithiasis; uveitis; aspirin; diamox

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

A mobile eye unit for screening of diabetic retinopathy and follow-up of glaucoma in remote locations in northern Finland - Hautala, N.; Hyytinen, P.; Saarela, V.; Hägg, P.; Kurikka, A.; Runtti, M.; Tuulonen, A. (Acta Ophthalmologica, 2009)
Keywords: cost effectiveness analysis; diabetic retinopathy; eye examination; Finland; follow up; glaucoma; health care access; health service; human; letter; non insulin dependent diabetes mellitus; preventive health service; priority journal; screening

Readability of prescription labels and medication recall in a population of tertiary referral glaucoma patients - O'Hare, F.; Jeganathan, V.S.E.; Rokahr, C.G.; Rogers, S.L.; Crowston, J.G. (Clinical and Experimental Ophthalmology, 2009)
Purpose: To evaluate readability of eye drop labels and accurate recall of prescription instructions in a glaucoma population. Methods: A hospital-based, cross-sectional study. A trained, interviewer examined patient ability to read standard and larger font medication labels. A questionnaire was administered to ascertain accurate recall of prescribed eye drops. Clinical information was obtained through independent chart review. Glaucoma severity was classified according to a glaucoma staging system. The setting for the study was the glaucoma outpatient clinic, Royal Victorian Eye and Ear Hospital (Melbourne, Australia), a major tertiary referral centre. A total of 200 glaucoma patients (96.2% response), aged 45-90 years, on eye drops took part in the study. Non-English-speaking patients were excluded. The main outcome measure was the ability to read prescribed medication labels and accurately recall treatment regime was compared with glaucoma severity and the number of eye drops. Results: Of the glaucoma patients, 12% were unable to read standard pharmacy labels. Only 5.5% were unable to read the larger font labels. Of the patients, 32% were not able to accurately recall the type of drops or prescribed frequency of instillation. An inability to read standard labels was associated with a threefold reduction in the likelihood of accurate medication recall (95% confidence intervals, 1.40-7.66, P < 0.05). Patients with three or more types of eye drops were five times less likely to recall their medications (95% confidence interval, 0.07-0.57, P < 0.05). Conclusions: Inability to read or recall prescribed eye drops was associated with glaucoma severity and the number of prescribed eye drops. These factors may impact significantly on patients' adherence to glaucoma medications. © 2009 The Authors. Journal compilation © 2009 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: eye drops; latanoprost plus timolol; prostaglandin derivative; aged; article; disease severity; drug information; drug labeling; female; glaucoma; human; intraocular hypertension; intraocular pressure; major clinical study; male; medication error; patient compliance; prescription; recall; tertiary health care; visual acuity; xalacom

General considerations in designing a drug-eluting contact lens - Ciolino, J.B.; Kohane, D.S. (Expert Review of Ophthalmology, 2009)
Keywords: agents acting on the eye; eye drops; anterior eye segment; biocompatibility; chronic disease; contact lens; cost effectiveness analysis; device therapy; drug blood level; drug delivery system; drug design; drug penetration; drug release; drug storage; drug transport; editorial; equipment design; glaucoma; human; hydrogel; patient compliance; patient safety; sustained release preparation; unspecified side effect

The ocular surface in glaucoma - Baudouin, C. (Cornea, 2009)
Purpose: To review the effects of preservatives on the ocular surface and assess how preserved eyedrops can affect clinical outcome in patients with glaucoma. Rationale: Dry eye and other symptoms of ocular surface disease are frequently encountered in patients with glaucoma and ocular hypertension and associated with the use of preserved topical antiglaucoma medications. The most commonly used preservative in ophthalmic solutions is benzalkonium chloride, which has adverse effects on the production and quality of tears and can cause damage to the corneal surface and conjunctival epithelia. Findings: Evidence from in vitro human cell culture and animal and clinical studies suggests that benzalkonium chloride is toxic to ocular tissues, even at very low concentrations. Use of benzalkonium chloride can result in clinical symptoms that disrupt treatment and reduce patients' quality of life. Conclusions: Switching patients to preservative-free antiglaucoma treatments greatly improves tolerability, reducing the incidence of adverse events such as burning, stinging, and dry eye. Preservative-free antiglaucoma formulations therefore offer clinical benefits to patients in terms of improved safety and increased likelihood of adherence to treatment. © 2009 by Lippincott Williams & Wilkins.
Keywords: antiglaucoma agent; benzalkonium chloride; drug preservative; eye drops; timolol; blurred vision; burning sensation; cataract; conference paper; conjunctiva epithelium; cornea epithelium; drug formulation; drug hypersensitivity; drug safety; dry eye; epiphora; filtering operation; glaucoma; glaucoma drainage implant; human; human cell; immunohistochemistry; inflammation; intraocular hypertension; intraocular pressure; nonhuman; patient compliance; priority journal; quality of life; macular edema; treatment failure; treatment outcome

Hydroxypropyl cellulose ophthalmic inserts (Lacrisert) reduce the signs and symptoms of dry eye syndrome and improve patient quality of life - McDonald, M.; D'Aversa, G.; Perry, H.D.; Wittpenn, J.R.; Donnenfeld, E.D.; Nelinson, D.S. (Transactions of the American Ophthalmological Society, 2009)
Purpose: A multicenter, 2-visit, open-label, 4-week study was conducted to determine the acceptability of hydroxypropyl cellulose ophthalmic inserts in adult patients with a history of dry eye syndrome (DES). Methods: At visit 1, patients (N = 520) were evaluated, screened by slit-lamp biomicroscopy, and completed the Ocular Surface Disease Index (OSDI), a validated measure of quality of life. Patients were trained in the proper placement and use of hydroxypropyl cellulose ophthalmic inserts and were contacted by telephone on day 3 of the study. At week 4, patients were given a clinical evaluation and completed a second questionnaire. Answers determined changes in symptoms and quality of life. Adverse events were monitored throughout the study. Results: Four hundred eighteen patients completed the study and reported significant improvements in discomfort, burning, dryness, grittiness, stinging, and light sensitivity (P = .05) after 4 weeks use of hydroxypropyl cellulose ophthalmic inserts. Significant improvements in clinical signs (keratitis, conjunctival staining, and tear volume) were reported. Contact lens wearers reported significant improvements similar to nonwearers, with a strong trend toward improvement in light sensitivity. Mean OSDI total scores, measuring quality of life, significantly improved by 21.3% (from 41.8 ± 22.38 to 32.9 ± 21.97, P ≤ .0215). The most commonly reported adverse event leading to discontinuation was blurred vision, observed in 8.7% of patients (n = 45). Compliance during the study was good; 41.5% of subjects were fully compliant. Of the 58.5% of subjects who missed doses, the majority (69.4%) missed only one to five. Conclusions: Hydroxypropyl cellulose ophthalmic inserts significantly reduced symptoms and clinical signs of moderate to severe DES. They also significantly improved DES in patients wearing contact lenses. Patients experienced a statistically significant improvement in quality of life, as measured by the OSDI, of 21.3%.
Keywords: hydroxypropylcellulose; adult; article; blurred vision; clinical evaluation; clinical trial; drug packaging; drug withdrawal; dry eye; eye discomfort; eye examination; eye infection; eye irritation; eye pain; eyelash; human; intraocular foreign body; keratomileusis; major clinical study; multicenter study; patient compliance; priority journal; quality of life; questionnaire; side effect; slit lamp; treatment outcome; visual acuity; visual analog scale; lacrisert

Peer discussion - Tsai, J.C.; Flach, A.J.; Ing, M.R.; Stamper, R.L.; Kaufman, P.L.; Alvarado, J.A. (Transactions of the American Ophthalmological Society, 2009)
Keywords: epinephrine; bimatoprost; brimonidine; brinzolamide; chemoattractant; green fluorescent protein; latanoprost; protein ZO1; timolol; timolol maleate; travoprost; aqueous humor; aqueous humor outflow; argon laser; cell communication; cell junction; cell membrane permeability; cell motion; clinical trial; concentration response; confocal laser scanning microscopy; confocal microscopy; culture medium; drug effect; drug mechanism; endothelium cell; filopodium; fluorophotometry; follow up; genetic transfection; glaucoma; histology; homeostasis; human; in vitro study; in vivo study; intraocular hypotension; intraocular pressure; laser; monocyte; neodymium laser; note; open angle glaucoma; patient compliance; physics; plasmid; prediction; priority journal; prognosis; Schlemm canal; sclera; selective laser trabeculoplasty; trabecular meshwork; trabeculoplasty; treatment outcome; uvea; lumigan; travatan; xalatan

Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for diabetic macular oedema - Parravano, M.; Menchini, F.; Virgili, G. (Cochrane Database of Systematic Reviews, 2009)
Background: Diabetic macular oedema (DMO) is a common complication of diabetic retinopathy. The retina at the macula thickens and this can cause gradual loss of central vision. Although grid or focal laser photocoagulation has been shown to reduce the risk of visual loss in DMO or clinically significant macular oedema (CSMO), vision is rarely improved. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) modalities has recently been proposed for improving vision in people with DMO. Anti-VEGF drugs are delivered by an injection in the vitreous cavity of the eye. Objectives: This review aims to assess the effectiveness of anti-VEGF therapy for preserving or improving vision in people with DMO. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and Caribbean Literature on Health Sciences (LILACS). There were no language or date restrictions in the search for trials.The electronic databases were last searched on 16 April 2009. Selection criteria: We included randomised controlled trials (RCTs) comparing any antiangiogenic drugs with an anti-VEGF mechanism of action compared to another treatment, sham treatment, or no treatment. Data collection and analysis: Two authors independently extracted the data. The risk ratio (RR) of visual loss and visual gain of 3 or more lines was estimated at least six months after treatment. Main results: We found four small studies that collected only short-termoutcomes (24 to 36 weeks); three of which hadmore than two randomisation groups generating five types of comparisons overall. Only one comparison included more than one trial in the analysis. The shortterm outcome was the mean change in LogMAR visual acuity. One study on 172 patients compared three doses of pegaptanib versus sham (about 5 injections on average) and another compared bevacizumab or bevacizumab plus triamcinolone with sham (multiple bevacizumab injections and a single triamcinolone injection in 101 patients, 115 eyes overall) in patients with CSMOthat was refractory to photocoagulation. Bevacizumab or bevacizumab plus triamcinolone were also compared to photocoagulation in 129 patients with untreated CSMO(150 eyes,multiple injections needed in 24 patients). Although comparisons tended to favour antiangiogenic therapy, estimates did not reach statistical significance or, if they did, they were not robust to sensitivity analysis regarding missing data and potential bias related to single trial estimates. No difference could be demonstrated in one study on 26 patients comparing bevacizumab to triamcinolone (both administered with a single injection) and between bevacizumab and bevacizumab plus triamcinolone in two studies on 182 patients. All the studies in this review, except for the study on pegaptanib, were at risk of bias based on the assessment of six methodological quality items. There were no serious adverse effects in these short-term studies, except for one case of severe anterior uveitis in one eye treated with bevacizumab. No included study examined long-term adverse effects of antiangiogenic therapy. Authors' conclusions: There is not sufficient high quality evidence from large RCTs supporting the use of either single or multiple anti-VEGF intravitreal injections to treat DMO. Results from ongoing studies on several compounds should assess not only treatment efficacy but also, if a benefit is found, the number of injections needed for maintenance and long-term safety. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Keywords: bevacizumab; pegaptanib; triamcinolone acetonide; vasculotropin; anterior eye chamber disease; antiangiogenic therapy; biomicroscopy; cataract; clinical trial; diabetic macular edema; diabetic retinopathy; drug efficacy; drug mechanism; drug safety; endophthalmitis; human; intermethod comparison; intraocular hypertension; laser coagulation; optical coherence tomography; patient compliance; review; risk benefit analysis; stereoscopic vision; systematic review; treatment duration; treatment outcome; uveitis; vision; visual acuity; visual impairment

Management of chronic open-angle glaucoma in the aging US population - Lin, A.P.; Orengo-Nania, S.; Braun, U.K. (Geriatrics, 2009)
Chronic open-angle glaucoma is a leading cause of blindness and visual impairment in older adults. Optic nerve damage and the associated peripheral and subsequent central vision loss are irreversible, but early diagnosis and treatment will give patients the best chance to maintain functional vision and quality of life. Primary care physicians can assist with the diagnosis of glaucoma by making appropriate referrals for routine ophthalmic examinations, especially in patients with risk factors for glaucoma. Medication adherence and persistence may also be enhanced by discussing strategies to improve medication use and efficacy in the primary care setting. Recognition of adverse reactions from glaucoma medications and surgeries will allow proper management of these potentially serious conditions. Patients with advanced visual deficits can still benefit from treatment as well as low-vision and supportive care and should be referred for an ophthalmic evaluation. With an understanding of comprehensive glaucoma management, primary care physicians play an invaluable role in assisting their patients with effective and timely therapy that will result in improved outcomes.
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brimonidine plus timolol; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; eye drops; latanoprost; levobunolol; prostaglandin derivative; timolol; travoprost; abnormal sensation; application site reaction; bedtime dosage; bitter taste; blindness; bradycardia; bronchospasm; central scotoma; clinical feature; conjunctival hyperemia; conjunctivitis; depression; disease course; drowsiness; drug absorption; drug efficacy; drug hypersensitivity; early diagnosis; evening dosage; eye color; eye disease; eye edema; eye irritation; eye toxicity; eyelid edema; eyelid erythema; fatigue; foreign body sensation; foreign body sensation; hair growth; human; hypokalemia; impotence; intraocular pressure; morning dosage; open angle glaucoma; optic nerve lesion; patient compliance; primary medical care; quality of life; review; risk factor; sedation; side effect; skin allergy; stinging sensation; stinging sensation; thrombocytopenia; United States; visual disorder; visual field; visual impairment; xerostomia; combigan; cosopt

Doctor-Patient Communication in Glaucoma Care. Analysis of Videotaped Encounters in Community-Based Office Practice - Friedman, D.S.; Hahn, S.R.; Quigley, H.A.; Kotak, S.; Kim, E.; Onofrey, M.; Eagan, C.; Mardekian, J. (Ophthalmology, 2009)
Purpose: To assess doctor-patient communication in patients with glaucoma. Design: Observational cohort study. Participants: Twenty-three ophthalmologists and 50 patients with glaucoma. Methods: Doctor-patient encounters were audio- and videotaped and analyzed using validated sociolinguistic approaches. After the visit, the doctor and the patient completed questionnaires, and patients were interviewed using a semistructured, patient-centered protocol. Main Outcome Measures: Summary statistics about doctor-patient encounters, assessment of alignment of attitudes between patients and doctors, and patient admission to missing doses. Results: Physicians spent an average of 8.0 (standard deviation [SD], 3.1; median, 7.8) minutes in the room with the patient and an average of 5.8 (SD, 2.4; median, 7.5) minutes talking with the patient, delivering 70% of all spoken words and asking two thirds of all questions. Glaucoma-related discussion occupied 50% of talk time and was focused primarily on examinations and treatment (25%). One third of discussions addressed ocular issues other than glaucoma. Virtually all physician questions (94%) were closed ended. Most patient questions were about intraocular pressure (20% of visits), details of the medication regimen (20%), disease status (14%), and testing (12%). Although physicians and patients were aligned in believing that the physician should control the visit agenda, physicians tended to support greater physician control of decision making than did patients. Physicians failed to identify most patients who admitted to missing doses, a surrogate for nonadherence, stating that 10 of 13 in this category were taking drops "all" or "most" of the time. Physician interviews detected 3 of the 11 patients whose postvisit questionnaire indicated missing a dose in the last week compared with 11 of the 11 detected by the postvisit research interview. Patients who stated they had missed doses recently reported being less satisfied with the doctor-patient encounter than those who did not. Conclusions: Doctor-patient dialogue was universally physician centered; physicians spoke 70% of the words and asked closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses. A minority of physicians ever asked patients if they had questions. In contrast with the patient-centered research interview, doctors' physician-centered communication failed to identify most patients who had missed doses. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2009 American Academy of Ophthalmology.
Keywords: antiglaucoma agent; adult; aged; article; clinical article; clinical practice; cohort analysis; doctor patient relationship; female; glaucoma; human; male; normal human; observational study; patient compliance; priority journal; treatment refusal

Interventions Improve Poor Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients - Okeke, C.O.; Quigley, H.A.; Jampel, H.D.; Ying, G.-s.; Plyler, R.J.; Jiang, Y.; Friedman, D.S. (Ophthalmology, 2009)
Purpose: To investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma. Design: Randomized controlled clinical trial. Participants: Sixty-six patients with glaucoma being treated with a prostaglandin analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007. Methods: In an observational study, participants who took 75% or fewer doses (as measured using the travoprost Dosing Aid [DA]) during an initial 3-month period were randomized into 2 groups. The intervention group watched an educational video, reviewed current barriers to drop-taking and possible solutions with a study coordinator, received regular phone call reminders, and had audible and visible reminders activated on their DA devices. The control group was told to take drops as prescribed and received no additional intervention. Main Outcome Measures: Change in drop use adherence as determined by the DA device. Results: In the 3-month observation period before randomization, intervention group patients had used a mean of 54±17% of scheduled doses, and this increased to 73±22% during the following 3-month period (P<0.001, n = 35). The control mean adherence rate of 46±23% at baseline was statistically unchanged during the follow-up observation period (51±30%, P = 0.16, n = 31). In a multivariate analysis, intervention, baseline compliance rate of <50%, and white ethnicity were predictors of improved adherence during the 3 months of intervention. The intraocular pressure (IOP) of the intervention and control groups did not change between months 3 and 6 after intervention (P = 0.96, 0.34, respectively), and there was no correlation of IOP change with adherence rate change between both groups (Pearson correlation r = 0.06, P = 0.51). Conclusions: A multifaceted intervention significantly increased adherence with glaucoma medications. Those with improved adherence were in the intervention group, had very low adherence rates at baseline, and were white. IOP did not correlate with adherence. Further research is needed to determine which components of this intervention were most effective. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2009 American Academy of Ophthalmology.
Keywords: travoprost; adult; aged; article; clinical trial; controlled clinical trial; controlled study; drug monitoring; electronics; European American; female; glaucoma; human; intraocular pressure; major clinical study; male; patient compliance; patient monitoring; predictor variable; priority journal; randomized controlled trial; treatment refusal; Dosing Aid

Chronic obstructive pulmonary disease: An update on diagnosis and management issues in older adults - Nazir, S.A.; Erbland, M.L. (Drugs and Aging, 2009)
Chronic obstructive pulmonary disease (COPD) is a debilitating disease of the elderly that causes significant morbidity and mortality. Despite being a treatable and preventable disease, the prevalence continues to rise because of the worldwide epidemic of smoking. COPD is associated with enormous healthcare costs. It has systemic effects, and common co-morbid conditions such as cardiovascular disease, muscle wasting and osteoporosis may all be linked through a common systemic inflammatory cascade. Depression, anxiety and malnutrition are also common in elderly COPD patients. These factors not only affect quality of life (QOL) but also compliance with therapy. Malnutrition is an independent predictor of mortality and poor outcome. Spirometry is essential for the diagnosis of COPD, but the criteria defining airflow limitation are not clear cut for elderly patients and could result in over-diagnosis. However, older patients perceive their symptoms differently, and COPD could also be under-diagnosed in this population. Acute exacerbations result in worsening symptoms that necessitate additional treatment, and may cause a more rapid decline in lung function and QOL. The management of elderly patients with COPD should encompass a multidisciplinary approach. An evaluation of patients nutritional status and mental health should be undertaken, in addition to assessing their lung function and functional impairment. Significant underlying co-morbidities should be evaluated and treated to derive the maximal benefit of therapy. Specific therapy for COPD should start with cessation of exposure to the most important risk factor, tobacco smoke. Smoking cessation rates in the elderly have not declined, and this may reflect an underlying reluctance by physicians to counsel and offer smoking cessation therapies to the elderly. Unlike oxygen therapy in hypoxaemic patients, bronchodilators and corticosteroids do not decrease mortality in COPD patients and they are primarily directed towards symptom relief. However, they do have a positive effect on QOL and exacerbation rates. The choice of delivery devices for inhaled medications is important in the elderly, and patients inhaler technique and manual dexterity should be frequently assessed. Pulmonary rehabilitation and nutritional supplementation are other important components of care. End-of-life issues should be adequately addressed in the elderly with COPD, and an approach integrating curative and palliative interventions is recommended. © 2009 Adis Data Information BV. All rights reserved.
Keywords: antidepressant agent; antiinfective agent; arformoterol; beta adrenergic receptor stimulating agent; cholinergic receptor blocking agent; corticosteroid; erythromycin; fenoterol; formoterol; indacaterol; influenza vaccine; ipratropium bromide; levalbuterol; macrolide; nitrogen dioxide; orciprenaline; ozone; phosphodiesterase IV inhibitor; pirbuterol; placebo; Pneumococcus vaccine; prednisone; salbutamol; salmeterol; sulfur dioxide; terbutaline; theophylline; tiotropium bromide; air pollution; antibiotic therapy; anxiety; assisted ventilation; bone density; cardiovascular disease; case management; cataract; chronic obstructive lung disease; clinical feature; closed angle glaucoma; comorbidity; corticosteroid therapy; depression; disease classification; disease exacerbation; disease severity; elderly care; forced expiratory volume; glaucoma; glucose intolerance; health care cost; heart arrhythmia; hip fracture; human; hypokalemia; immunization; inflammation; influenza vaccination; lung function; malnutrition; mental health; metered dose inhaler; mortality; muscle atrophy; myopathy; nausea; nebulizer; nutritional status; nutritional support; osteoporosis; oxygen therapy; palliative therapy; patient compliance; pneumonia; powder inhaler; prevalence; priority journal; pulmonary rehabilitation; quality of life; restlessness; review; risk benefit analysis; risk factor; seizure; side effect; smoking cessation; tachycardia; terminal care; thrush; tremor; urine retention; spine fracture; vital capacity; vomiting; xerostomia

Pharmacotherapy of asthma: Regular treatment or on demand? - Montuschi, P.; Pagliari, G.; Fuso, L. (Therapeutic Advances in Respiratory Disease, 2009)
Some studies have raised the question of the need for chronic controller therapy in mild persistent asthma as suggested by international guidelines. Although the Improving Asthma Control (IMPACT) and Beclomethasone plus Salbutamol (BEST) studies suggest that on-demand therapy in some patients with mild persistent asthma achieves a similar degree of asthma control based on symptoms and functional outcomes, the IMPACT study indicates that regular and on-demand therapy is not equivalent for controlling airway inflammation. Persistent airway inflammation might lead to airway remodelling with onset or worsening of symptoms, deterioration in lung function, and reduced response to pharmacological therapy. However, the relationships between chronic airway inflammation and airway remodelling need to be clarified. Choosing the 'right' pharmacological strategy (regular versus on-demand treatment) for asthma control is currently difficult due to the fact that (1) inflammatory outcome measures were not generally incorporated into asthma clinical trials; (2) the relationships between chronic airway inflammation and airway remodelling are largely unknown; (3) current clinical asthma trials that are generally based on symptomatic and functional outcome measures are too short to assess the impact of regular anti-inflammatory therapy on natural history of asthma; (4) asthma is an heterogeneous disease and different phenotypes of asthma patients likely requiring a different therapeutic approach can be identified, even in the same class of asthma severity. Guidelines for asthma management are valuable tools, although they are necessarily based on a strategy directed to the best outcome in a group of patients. Asthma phenotyping is becoming central for asthma management. The issue of regular versus on-demand treatment of intermittent and mild persistent asthma would be better addressed if considered within an individualized approach to asthma management and assessment. Identification of clinical, functional, morphological and biochemical phenotypes of patients with asthma and its clinical implications is likely to lead to a tailored, individualized, pharmacological therapy and asthma management.
Keywords: beclomethasone dipropionate; beclometasone dipropionate plus salbutamol; beta 2 adrenergic receptor; beta adrenergic receptor stimulating agent; brain derived neurotrophic factor; budesonide; budesonide plus formoterol; cholinergic receptor blocking agent; chromone derivative; corticosteroid derivative; cromoglycate disodium; fluticasone; formoterol; immunoglobulin E antibody; leukotriene receptor blocking agent; long acting drug; montelukast; muscarinic receptor blocking agent; nedocromil; omalizumab; placebo; prednisone; salbutamol; salmeterol; short acting drug; terbutaline; theophylline derivative; unindexed drug; zafirlukast; zileuton; add on therapy; adrenal suppression; allergic asthma; antiinflammatory activity; asthma; bone demineralization; bronchospasm; candidiasis; cataract; childhood disease; chronic disease; clinical trial; combination chemotherapy; cost utility analysis; disease classification; disease control; disease exacerbation; disease severity; dosage schedule comparison; dose response; drug absorption; drug activity; drug antagonism; drug cost; drug dose comparison; drug dose increase; drug dose reduction; drug excretion; drug fatality; drug intermittent therapy; drug mechanism; drug megadose; drug metabolism; drug potentiation; drug safety; drug withdrawal; forced expiratory volume; growth inhibition; growth retardation; heart palpitation; hoarseness; human; intraocular hypertension; larynx disorder; low drug dose; lung function; monotherapy; nonhuman; outcome assessment; patient compliance; peak expiratory flow; pharynx disease; priority journal; receptor down regulation; review; side effect; sore throat; tachycardia; toxic hepatitis; treatment duration; treatment planning; treatment response; tremor; unspecified side effect

Optimizing topical therapy for psoriasis - Busse, K.L.; Alikhan, A.; Feldman, S.R. (Expert Review of Dermatology, 2009)
There are a wide variety of topical treatment options for psoriasis. Despite their effectiveness in clinical trials, control of psoriasis in clinical practice remains a challenge. A multitude of factors limits patients' use of medication, including frustration with poor efficacy, inconvenience, fear of side effects, financial restraints, vague application instructions, complicated regimens and unpleasant treatment characteristics. The first step to optimize topical therapy is to develop a physician-patient relationship that contributes to realistic expectations and proper use of medication. Patients should be involved in the choice of medications and vehicles. Topical corticosteroids form the foundation of treatment and topical vitamin D analogs and other noncorticosteroid agents can be used as complements to optimize long-term results. © 2009 Expert Reviews Ltd.
Keywords: 2 hydroxyacid; 22 oxacalcitriol; allantoin; becocalcidiol; betamethasone; betamethasone dipropionate; betamethasone valerate; calcineurin inhibitor; calcipotriol; calcitriol; clobetasol; clobetasol propionate; coal tar; colecalciferol derivative; corticosteroid; dithranol; fluocinonide; hydrocortisone; lactic acid; mometasone furoate; pimecrolimus; placebo; salicylic acid; steroid; tacalcitol; tacrolimus; tazarotene; ulobetasol propionate; unclassified drug; unindexed drug; calcitriol; vitamin D derivative; acne; acute toxicity; application site burning; application site reaction; atopic dermatitis; bone necrosis; caregiver support; cataract; clinical feature; clinical trial; combination chemotherapy; Cushing syndrome; dermatitis; disease exacerbation; doctor patient relationship; drug absorption; drug antagonism; drug contraindication; drug cost; drug dose sequence; drug efficacy; drug eruption; drug excretion; drug formulation; drug indication; drug mechanism; drug potency; drug potentiation; drug protein binding; drug safety; drug use; drug withdrawal; dry skin; edema; erythema; erythroderma; fatigue; folliculitis; gastrointestinal symptom; glaucoma; headache; hirsutism; hormone deficiency; human; hypercalcemia; hypercalciuria; hyperpigmentation; hypoglycemia; hypopigmentation; keratoacanthoma; mycosis; nausea and vomiting; oral mucosal disease; patient compliance; patient education; patient participation; patient satisfaction; perioral dermatitis; photosensitivity; photosensitization; pigment disorder; priority journal; pruritus; psoriasis; purpura; recommended drug dose; review; rosacea

Understanding the Importance of IOP Variables in Glaucoma: A Systematic Review - Sultan, M.B.; Mansberger, S.L.; Lee, P.P. (Survey of Ophthalmology, 2009)
Glaucoma is one of the leading causes of visual impairment and blindness. Lowering intraocular pressure (IOP) is the only proven means to slow or halt disease progression among those at higher risk of developing glaucoma and those with early to moderate or more advanced glaucoma. Recent publications have highlighted the potential for increased rates or likelihood of worsening glaucoma among those with larger IOP swings within defined time periods. The purpose of this systematic, comprehensive review and analysis of the literature was to assess the state of knowledge in the area of IOP changes over time and the potential impact of such changes on treatment. Current literature indicates that a random IOP measurement is a poor surrogate for IOP levels throughout the day and across visits. We address several key questions: 1) What is the best way to measure IOP? 2) Should multiple IOP measurements be performed in a day in the office (short-term IOP fluctuation)? 3) Is measurement at night required? 4) Should clinicians begin to assess long-term IOP fluctuation in patients under stable treatment (across days or visits)? and 5) Should therapy choices be influenced by properties of different treatment options relative to short- or long-term IOP fluctuation? © 2009 Elsevier Inc. All rights reserved.
Keywords: alpha adrenergic receptor blocking agent; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; latanoprost; prostaglandin derivative; timolol; travoprost; water; ambulatory care; circadian rhythm; clinical trial; cornea thickness; diagnostic accuracy; diagnostic value; disease classification; drug efficacy; evening dosage; glaucoma; home care; human; hysteresis; intermethod comparison; intraocular pressure; literature; long term care; monotherapy; morning dosage; outcome assessment; patient care; patient positioning; priority journal; provocation test; review; risk reduction; self care; sleep waking cycle; standardization; surgical technique; systematic review; test retest reliability; tonometry; trabeculoplasty; treatment duration; treatment indication; validation process

A comprehensive perspective on patient adherence to topical glaucoma therapy. - Tsai, J.C. (Ophthalmology, 2009)
TOPIC: Risk factors for poor adherence or nonadherence to topical glaucoma medication regimens. CLINICAL RELEVANCE: Poor adherence to glaucoma medication regimens may be associated with subsequent visual loss and irreversible optic nerve damage. METHODS: A literature search was performed using the words "glaucoma AND adherence AND risk" and "glaucoma AND compliance AND risk," limited to those studies in English and focused on care in the United States. Publications from well-regarded journals in this field were reviewed, and a focused summary of the literature is presented. RESULTS: There are a myriad of adherence barriers inherent to the glaucoma patient population. Although most of these obstacles are common in the elderly (e.g., reduced cognition, musculoskeletal problems, and transportation difficulties), older age has not been shown to be a consistent risk factor for poor adherence to glaucoma medication regimens. Other expected barriers, such as medication cost, limited health insurance, disease severity, and role of complicated dosing regimens, have varied effects based on the patient population studied and the definition of adherence. Poor medication adherence also is associated with decreased adherence to follow-up medical visit schedules. A systematic taxonomy of adherence barriers has been formulated. In addition, subanalyses from the Glaucoma Adherence and Persistency Study identified 8 variables that affect adherence to glaucoma medication regimens as well as several characteristics that support the importance of and associations between doctor-patient communications. CONCLUSIONS: Recent studies have provided valuable insights into the many factors that increase the risk(s) for poor adherence in patients prescribed glaucoma medications. Four major types of barriers to effective patient adherence (medication regimen, patient factors, provider factors, and situational or environmental factors) have been identified. Addressing these specific barriers will require a tailored, patient-centered approach. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: antihypertensive agent; eye drops; attitude to health; blindness; drug administration; drug cost; economics; educational status; glaucoma; health care delivery; health education; human; patient compliance; review; risk factor; statistics; topical drug administration

Patient-centered communication to assess and enhance patient adherence to glaucoma medication. - Hahn, S.R. (Ophthalmology, 2009)
TOPIC: Using an understanding of a patient's difficulty in revealing nonadherence and patient-centered communication skills to identify and address barriers to adherence to glaucoma medication regimens. CLINICAL RELEVANCE: In addition to cost and logistical difficulties with obtaining and administering medicine, a patient's adherence to medication is influenced by the balance between the perceived need for medication and concerns about taking medication. METHODS: This article is based on both the author's clinical experience and peer-reviewed research on effective doctor-patient communication and assessment and management of nonadherence. RESULTS: Three strategies have been identified that help physicians to detect and address problems with adherence: (1) a 4-step adherence assessment interview designed to detect nonadherence that decreases patient resistance to revealing nonadherence by applying a shared decision-making process and mitigating social undesirability; (2) asking open-ended questions in ask-tell-ask sequences; and (3) tailoring interventions to the patient's stage of readiness for change. CONCLUSIONS: Patients conceal nonadherence because they want to be thought of by their physicians as good patients. They are driven to nonadherence by an imbalance between their perceived need for medication and their concerns about taking it. Patient-centered communication techniques can engage the patient in shared decision making about medication, thereby redefining the good patient as someone who works with his or her health care provider to address adherence barriers. Those barriers can be explored with open-ended questions designed to elicit the patient's understanding and concerns, to provide information, and to assess change in the patient's understanding and attitudes. Communication will be more effective if it is based on the patient's stage of readiness to adopt adherent self-management practices. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: antihypertensive agent; eye drops; doctor patient relationship; glaucoma; health behavior; human; interpersonal communication; motivation; patient care; patient compliance; patient education; psychological aspect; review

A clinician's guide to the assessment and management of nonadherence in glaucoma. - Budenz, D.L. (Ophthalmology, 2009)
PURPOSE: To apply lessons learned in the treatment of systemic hypertension to the problem of nonadherence in glaucoma medical therapy. CLINICAL RELEVANCE: Although physicians recognize that nonadherence with glaucoma medication is a problem, most lack the skill set to identify nonadherent patients, to identify the causes of nonadherence, and to provide solutions to address nonadherence. METHODS: A PubMed search was conducted using the terms "adherence" OR "compliance" AND "hypertension," with the following limitations: title, English language, humans, from 2000 through 2009. Other studies identified outside of the PubMed search were included if relevant. RESULTS: Studies from the systemic hypertension literature suggest that simplifying medication regimens, lowering costs, and patient education about the disease and the importance of taking medications are successful strategies for improving adherence. In addition, good family or social support, frequent physician visits, and pairing medication administration with specific activities (such as meals or brushing one's teeth) can help improve adherence. CONCLUSIONS: The body of literature on adherence interventions in chronic diseases such as systemic hypertension shows that although many interventions have been tested and evaluated, only some are successful. Paradigms derived from behavioral medicine and nursing offer valuable lessons on how to motivate patients to change behavior, but these activities require skill sets not traditionally taught in medical school. Just as there are myriad causes of nonadherence, the interventions most likely will need to be multifaceted and tailored to the individual patient. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Keywords: antihypertensive agent; eye drops; blindness; doctor patient relationship; glaucoma; health behavior; human; motivation; paramedical personnel; patient compliance; patient education; practice guideline; psychological aspect; review

The role of patient inexperience in medication discontinuation: A retrospective analysis of medication nonpersistence in seven chronic illnesses - Vanelli, M.; Pedan, A.; Liu, N.; Hoar, J.; Messier, D.; Kiarsis, K. (Clinical Therapeutics, 2009)
Background: Previous studies have reported that patients who are medication naive in some medication classes have a higher risk of medication discontinuation during the first 30 days of treatment and shorter median times to discontinuation than do medication-experienced patients. Objectives: This study compared the risk of discontinuation during the first 30 days after the index fill and the median time to discontinuation for medication-naive and medication-experienced patients who were prescribed drugs for asthma, diabetes mellitus, high cholesterol, cardiovascular disease, breast cancer, glaucoma, or osteoporosis. Methods: Deidentified outpatient pharmacy records from 4 large US retail chains were searched for patients who had obtained a prescription for one of the index medications between January 1, 2007, and January 31, 2007. Included medication classes were asthma inhalers, asthma pills, oral breast-cancer agents, cardiovascular medications, oral antidiabetic medications, insulin, glaucoma drops, osteoporosis medications, and statins. Patients were divided into 2 groups: those for whom an in-class medication was not dispensed in the previous 180 days were identified as medication naive, and those for whom an in-class medication was dispensed during this period were identified as medication experienced. Discontinuation was defined as being >30 days late for a scheduled refill. Time to discontinuation was measured using Kaplan-Meier analysis during a 360-day follow-up period. Results: Data for 2.17 million patients who received prescriptions from 3821 pharmacies were analyzed. During the first 30 days of therapy, rates of discontinuation for medication-naive patients were 17.4% to 42.6% higher than for medication-experienced patients, and their median times to discontinuation were 14.2% to 28.9% as long. The difference in persistence between medication-naive and medication-experienced patients emerged during the first 30 days of medication use, after which rates of discontinuation were relatively consistent. Patients prescribed nonoral medications for diabetes mellitus (insulin), asthma (inhalers), and glaucoma (drops) had an especially high risk of discontinuation during the first month of treatment. Conclusion: This study found that medicationnaive patients had a higher risk of discontinuation during the first 30 days of therapy than did medicationexperienced patients, regardless of the medication class prescribed, leading to shorter median times to discontinuation. © 2009 Excerpta Medica Inc. All rights reserved.
Keywords: 2,4 thiazolidinedione derivative; alpha adrenergic receptor stimulating agent; angiotensin receptor antagonist; antiestrogen; aromatase inhibitor; beta adrenergic receptor blocking agent; beta adrenergic receptor stimulating agent; biguanide derivative; bisphosphonic acid derivative; calcitonin; calcium channel blocking agent; carbonate dehydratase inhibitor; cholesterol; corticosteroid; dipeptidyl carboxypeptidase inhibitor; diuretic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; leukotriene receptor blocking agent; meglitinide; parathyroid hormone; prostaglandin receptor stimulating agent; selective estrogen receptor modulator; sulfonylurea derivative; adult; aged; article; asthma; breast cancer; cardiovascular disease; controlled study; diabetes mellitus; drug utilization; drug withdrawal; female; financial management; glaucoma; human; hypercholesterolemia; income; Kaplan Meier method; major clinical study; male; osteoporosis; patient compliance; personal experience; pharmacy (shop); prescription; risk assessment; treatment duration

N-acetylcarnosine lubricant eyedrops possess all-in-one universal antioxidant protective effects of L-carnosine in aqueous and lipid membrane environments, aldehyde scavenging, and transglycation activities inherent to cataracts: A clinical study of the new vision-saving drug n-acetylcarnosine eyedrop therapy in a database population of over 50,500 patients - Babizhayev, M.A.; Micans, P.; Guiotto, A.; Kasus-Jacobi, A. (American Journal of Therapeutics, 2009)
The antioxidant activity of L-carnosine (β-alanyl-L-histidine, bioactivated in ocular tissues) versus N-acetylcarnosine (N-acetyl-β- alanyl-L-histidine, ocular-targeted small dipeptide molecules) was studied in aqueous solution and in a lipid environment, employing liposomes as a model of lipid membranes. Reactive oxygen species (ROS) were generated by an iron/ascorbate promoter system for induction of lipid peroxidation (LPO). L-carnosine, which is stabilized from enzymatic hydrolysis, operates as a universal aldehyde and ROS scavenger in both aqueous and lipid environments and is effective at preventing ROS-induced damage to biomolecules. Second-generation carnosine analogs bearing the histidyl-hydrazide moiety were synthesized and tested versus L-carnosine for their ability to reverse the glycation process, also known as the Maillard reaction, and reverse the stable intermolecular cross-links, monitored in the glucose-ethylamine Schiff base model, ultimately resulting in the formation of the advanced glycation end products (AGEs) from nonenzymatic glycation, accumulating in numerous body tissues and fluids. The obtained data demonstrate the transglycation properties of the ophthalmically stabilized L-carnosine and L-carnosine histidyl-hydrazide derivatives tested and can be used to decrease or predict the occurrence of long-term complications of AGE formation and improve therapeutically the quality of vision and length of life for diabetes mellitus patients and survivors with early aging. Scientists at Innovative Vision Products, Inc. (IVP), developed lubricant eyedrops designed as a sustained-release 1% N-acetylcarnosine prodrug of L-carnosine. The eyedrops contain a mucoadhesive cellulose-based compound combined with corneal absorption promoters and glycerine in a drug-delivery system. Anti-aging therapeutics with the ophthalmic drug eyedrop formula including N-acetylcarnosine showed efficacy in the nonsurgical treatment of age-related cataracts for enrolled participants in the prospective, randomized, double-masked, placebo-controlled crossover clinical trial after controlling for age, gender, and daily activities. In a cohort in excess of 50,500 various patients seeking cutting-edge medical care, the N-acetylcarnosine topical eyedrops target therapy was demonstrated to have significant efficacy, safety, and good tolerability for the prevention and treatment of visual impairment in this older population with relatively stable patterns of causes for blindness and visual impairment. Overall, accumulated study data demonstrate that the IVP-designed new vision-saving drugs, including N-acetylcarnosine eyedrops, promote health vision and prevent vision disability from senile cataracts, primary open-angle glaucoma, age-related macular degeneration, diabetic retinopathy, and aging. N-acetylcarnosine eyedrop therapy is the crown jewel of the anti-aging medical movement and revolutionizes early detection, treatment, and rejuvenation of aging-related eye-disabling disorders. N-acetylcarnosine, as an innovative medical science tool and component of the home medicine and alternative medicine approaches, has the potential to alleviate visual impairment and its associated social, economic, and political woes for an aging population.new landscapes but in having new eyes.-Marcel Proust. © 2009 Lippincott Williams & Wilkins.
Keywords: advanced glycation end product; aldehyde; ascorbic acid; benzyl alcohol; carboxymethylcellulose; carnosine; ethylamine; eye drops; glucose; glycerol; iron; lubricating agent; malonaldehyde; n acetylcarnosine; penetration enhancing agent; placebo; potassium bicarbonate; potassium borate; reactive oxygen metabolite; Schiff base; unclassified drug; adult; aged; aging; antioxidant activity; aqueous solution; article; blindness; cataract; chemical model; clinical trial; controlled clinical trial; controlled study; cross linking; diabetes mellitus; disability; double blind procedure; drug efficacy; drug safety; drug stability; drug synthesis; female; glycation; health care cost; human; lipid membrane; lipid peroxidation; major clinical study; male; mucoadhesion; patient compliance; priority journal; randomized controlled trial; survivor; sustained release formulation; vision; visual acuity; visual impairment

Comparing adherence and persistence across 6 chronic medication classes - Yeaw, J.; Benner, J.S.; Walt, J.G.; Sian, S.; Smith, D.B. (Journal of Managed Care Pharmacy, 2009)
BACKGROUND: The National Quality Forum recently endorsed the proportion of days covered (PDC) - a measure of medication adherence - as an indicator of quality in drug therapy management. OBJECTIVE: To inform initial efforts to improve the quality of drug therapy management, we compared PDC and persistence among new users of 6 commonly used chronic medication categories. METHODS: A retrospective analysis of pharmacy claims in a database of more than 64 million members enrolled in 100 health plans assessed persistence and adherence to drug therapy in 6 chronic conditions. Patients were included in the analysis if they initiated a prescription drug of interest in any of 6 drug classes - prostaglandin analogs, statins, bisphosphonates, oral antidiabetics, angiotensin II receptor blockers (ARBs), and overactive bladder (OAB) medications - between January 1 and December 31, 2005. The first claim for a drug of interest during this period was considered a patient's index date. Patients were required to have a minimum of 12 months of continuous enrollment both preceding and following their index date. New users of a treatment were identified by excluding patients who filled a prescription for any drug in the same class during the previous 12 months and were followed for a minimum of 12 months. Nonpersistence was defined as discontinuation of the therapy class following an allowed gap between refills - 30-, 60-, and 90-day refill gaps were used. Adherence was defined as a continuous measure of the proportion of days covered (PDC) during the 12-month post-index period. Logistic regression analyses predicted (a) nonpersistence during the 12-month post-index period and (b) adherence (PDC) of at least 80%, with drug class as the predictor variable of interest, controlling for demographic variables, insurance and plan type, history of hospitalization, Charlson comorbidity score, copayment for index medication, and number of medications at index. RESULTS: A total of 167,907 patients were identified across 6 cohorts. Using the 60-day gap, 6-month persistence rates were prostaglandin analogs 47%, statins 56%, bisphosphonates 56%, oral antidiabetics 66%, ARBs 63%, and OAB medications 28%. After the first 90 days of therapy, relative persistence was stable across cohorts, and rates declined consistently from 6 months post-index to study end. Logistic regression models showed that oral antidiabetic users had a 59%, 36%, 37%, and 79% decreased risk of nonpersistence in a 12-month follow-up period compared with patients taking prostaglandin analogs, statins, bisphosphonates, or OAB medications, respectively. Risk of nonpersistence decreased with increasing age. Mean (SD) 12-month adherence rates were: prostaglandin analogs 37% (26%), statins 61% (33%), bisphosphonates 60% (34%), oral antidiabetics 72% (32%), ARBs 66% (32%), and OAB medications 35% (32%). Logistic regression indicated that oral antidiabetic use was a significant predictor of adherence (PDC) of at least 80% compared with other therapy classes. Adjusted odds ratios for oral antidiabetics were 17.60 (95% confidence interval [CI] = 15.38-20.14) versus prostaglandin analogs, 2.06 (95% CI = 1.99-2.12) versus statins, 1.92 (95% CI = 1.83-2.02) versus bisphosphonates, 1.29 (95% CI = 1.24-1.34) versus ARBs, and 5.77 (95% CI = 5.38-6.19) versus OAB medications. CONCLUSION: This analysis of adherence (PDC) and persistence across a sample of 6 chronic therapies found variable but uniformly suboptimal medication use. Adherence to prostaglandin eye drops and OAB medications was lower than to cardiovascular, oral antidiabetic, and oral osteoporosis therapies. These findings provide useful baseline information for the development of initiatives to improve the quality of drug therapy management. Copyright © 2009, Academy of Managed Care Pharmacy. All rights reserved.
Keywords: angiotensin receptor antagonist; bisphosphonic acid derivative; hydroxymethylglutaryl coenzyme A reductase inhibitor; muscarinic receptor blocking agent; oral antidiabetic agent; prostaglandin derivative; adolescent; adult; aged; article; child; cohort analysis; data base; demography; female; follow up; glaucoma; health care planning; health insurance; hospitalization; human; hyperlipidemia; hypertension; infant; major clinical study; male; non insulin dependent diabetes mellitus; osteoporosis; overactive bladder; patient compliance; pharmacy (shop); prediction; preschool child; prescription; qualitative analysis; retrospective study; risk assessment; school child; scoring system

Allergic respiratory diseases in the elderly - Todo Bom, A.; Mota Pinto, A. (Respiratory Medicine, 2009)
In industrialized countries there has been a significant increase in life expectancy, but chronic diseases are still important causes of death and disability in the elderly. Individuals over 65 years of age have a decrease in organic functions and lungs can lose more than 40% of their capacity. Although asthma and allergic rhinitis are more common in young people their prevalence in the elderly is increasing and the mortality reported in these patients is high. Asthmatic airways show an accumulation of activated eosinophils and lymphocytes determining structural changes of the bronchi. Local allergic inflammation, changes in T cell phenotypes and in apoptosis contribute to systemic inflammation. An increased risk of respiratory infections and neoplasic diseases has been recognized. These patients have increased susceptibility to atherosclerosis and cardiovascular diseases. Metabolic diseases are associated with an impairment of lung function and with systemic inflammation. Summing up older asthmatic patients have an increased risk to premature disability and death. A proper therapeutic approach to asthma can minimize this evolution. To identify the triggers is an important goal that allows reducing medication needs. Corticosteroids dampen allergic inflammation; therefore, they are the first choice in the treatment of patients with persistent asthma and rhinitis. Second-generation H1 receptor antagonists have reduced side effects and can be used if necessary. The elderly may have difficult access to health care. They should be educated about their disease and receive a written treatment plan. This information improves the quality of life, socialization and disease outcome in older people. © 2009 Elsevier Ltd. All rights reserved.
Keywords: beta 2 adrenergic receptor stimulating agent; calcium; cetirizine; corticosteroid; cytokine receptor antagonist; desloratadine; fexofenadine; histamine H1 receptor antagonist; influenza vaccine; ipratropium bromide; leukotriene receptor blocking agent; loratadine; theophylline; thromboxane A2 receptor blocking agent; vitamin D; aged; aging; allergic rhinitis; anxiety; apoptosis; asthma; atherosclerosis; balance disorder; cardiovascular disease; cataract; comorbidity; confusion; constipation; disease course; disease predisposition; drug activity; drug excretion; drug megadose; drug metabolism; dry powder; eosinophil; fracture; geriatric disorder; glaucoma; health care access; heart arrhythmia; heart palpitation; hoarseness; human; hypokalemia; immunotherapy; infection risk; low drug dose; lymphocyte; metabolic disorder; metered dose inhaler; mortality; oropharynx candidiasis; orthostatic hypotension; osteoporosis; priority journal; quality of life; respiratory tract allergy; respiratory tract infection; review; sedation; side effect; socialization; T lymphocyte; tachycardia; tremor; unspecified side effect; urine retention

Iatrogenic glaucoma therapy failure: The adverse effects of topical antiglaucoma medication treatment outcome - Mirza, S.K.; Higginbotham, E.J. (Expert Review of Clinical Pharmacology, 2009)
Glaucoma, a group of eye diseases that share a characteristic pattern of deterioration of the optic nerve, is a leading cause of blindness internationally. The treatment options for this optic neuropathy continue to remain limited considering that patients may become refractory to either medical therapy or surgical intervention. The initial treatment of choice for most ophthalmologists is topical medical therapy. The goal of medical therapy is to reduce the intraocular pressures in an effort to either halt or slow the progressive deterioration of the optic nerve. However, topical therapy causes a spectrum of cellular responses that may lead to chronic conjunctivitis after the use of multimedication and/or long-term therapy. This chronic conjunctivitis may not only lead to intolerance to therapy, but is also attributed to a significant proportion of trabeculectomy failures due to scarring of the bleb. Since incisional surgery is a primary option for long-term management of glaucoma, particularly those patients with end-stage disease, it is important to investigate the presence of topical drug-mediated inflammation and its effects on further surgical failure. © 2009 Expert Reviews Ltd.
Keywords: antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; drug preservative; latanoprost; levobunolol; placebo; platelet derived growth factor alpha receptor; prostaglandin derivative; tafluprost; timolol; travoprost; tumor necrosis factor; conjunctivitis; drug induced headache; drug response; lack of drug effect; glaucoma; histopathology; human; hyperemia; intraocular pressure; optic nerve disease; patient compliance; review; rhinopharyngitis; trabeculectomy; trabeculoplasty; treatment outcome; upper respiratory tract infection

Interventions for improving adherence to ocular hypotensive therapy - Gray, T.A.; Orton, L.C.; Henson, D.; Harper, R.; Waterman, H. (Cochrane Database of Systematic Reviews, 2009)
Background: Poor adherence to therapy is a significant healthcare issue, particularly in patients with chronic disease such as open angle glaucoma. Treatment failure may necessitate unwarranted changes of medications, increased healthcare expenditure and risk to the patient if surgical intervention is required. Simplifying eye drop regimes, providing adequate information and ongoing support according to patient need, may have a positive effect on improving adherence. Objectives: To summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma. Search strategy: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ZETOC and OpenSIGLE. In addition, we searched research registers of ongoing studies. We contacted pharmaceutical manufacturers to request unpublished data and searched conference proceedings for the Association for Research in Vision andOphthalmology (ARVO), and the Annual Congress for the Royal College of Ophthalmologists (RCO). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 15 January 2009. Selection criteria: We included randomised controlled trials (RCTs) and quasi RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma. Data collection and analysis: At least two authors independently assessed the search results for eligibility and extracted data for included trials onto specifically designed forms. We calculated the mean difference for continuous data and relative risks for dichotomous data. Where appropriate, we pooled data using a fixed-effect model. Main results: Eight trials met the inclusion criteria. There was considerable heterogeneity of interventions and reported outcome measures and therefore, meta-analysis was limited to two studies. Overall, studies were not of high quality due to small sample sizes, missing data and short term follow-up. Three of five drug comparison studies provided evidence that reducing the frequency of drops can improve adherence. However, the study that compared the least frequent regime with one of the most complicated, showed no difference in reported adherence. A small study of thirteen patients found a reminder device beneficial to adherence levels yet only one of two studies involving education and individualised care planning was found to be successful. Authors' conclusions: Interventions involving simplified dosing regimes, reminder devices, education and individualised care planning, did showimprovements in adherence rates. However, due to inadequate methodological quality and heterogeneity of study design we are unable to advocate any particular interventions at this time. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Keywords: antihypertensive agent; dorzolamide; dorzolamide plus timolol; latanoprost; pilocarpine; timolol; Cinahl; clinical trial; closed angle glaucoma; Cochrane Library; data extraction; Embase; eye examination; follow up; glaucoma; health education; health status; human; intraocular hypertension; intraocular pressure; medical record; medical society; Medline; meta analysis; oculoplethysmography; outcome assessment; patient care planning; patient compliance; patient monitoring; PsycINFO; register; research; review; systematic review; visual acuity; visual field defect

The promise of nanomedicine for ocular disease - Thomson, H.; Lotery, A. (Nanomedicine, 2009)
In summary, the eye is a very suitable and important organ for developing novel nano-medicines. Recent advances in the treatment of macular degeneration and inherited retinal dystrophies have demonstrated that new medical technologies can be rapidly and successfully translated into clinically relevant treatments in the eye. Nanoscientists should therefore focus their efforts on nano-ophthalmology. Early studies suggest they could make a significant impact in treating common causes of blindness such as macular degeneration and glaucoma. © 2009 Future Medicine Ltd.
Keywords: antisense oligonucleotide; aptamer; carbonate dehydratase II; cerium; cerium oxide; eye drops; nanoparticle; pigment epithelium derived factor; polyglactin; polylactide; small interfering RNA; vasculotropin; virus vector; absence of side effects; blindness; cell adhesion; cell migration; cell proliferation; clinical trial; degradation; detoxification; drug bioavailability; editorial; eye disease; gene expression; gene targeting; gene therapy; glaucoma; human; intraocular pressure; nanodevice; nanomedicine; nonhuman; open angle glaucoma; patient compliance; photoreceptor; pigment epithelium; priority journal; retina degeneration; age related macular degeneration; subretinal neovascularization; upregulation; vitamin supplementation

Medical glaucoma therapy - Neuburger, M.; Dietlein, T.S.; Jordan, J.F. (Gynakologische Praxis, 2009)
Glaucoma is a multifactorial disease resulting blindness due to optic nerve atrophy if not treated properly. Large clinical trials have identified intraocular pressure as the main risk factor for disease progression. Intraocular pressure is also the only risk factor that can be treated by application of local therapy. The aim of modern medical glaucoma therapy is to reach reliably the patient's individual target pressure, furthermore to avoid significant diurnal fluctuations. Current medications from betablockers, prostaglandin-analogues, alpha-agonists, parasympathomimetics (miotics), carboanhydrase-inhibitors, hyperosmotics, as well as medications improving ocular blood flow, are listed and discussed.
Keywords: acetazolamide; adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; benzalkonium chloride; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; clonidine; dorzolamide; dorzolamide plus timolol; glycerol; latanoprost; latanoprost plus timolol; levobunolol; metipranolol; prostaglandin derivative; tafluprost; timolol; timolol plus travoprost; travoprost; unindexed drug; allergic conjunctivitis; argon laser; arthralgia; blepharitis; blindness; blurred vision; capsulotomy; cataract; circadian rhythm; conjunctival hyperemia; conjunctivitis; conservative treatment; cornea injury; dermatitis; disease course; drug contraindication; drug effect; drug hypersensitivity; drug induced headache; dyspnea; eye blood flow; eyelid erythema; glaucoma; glaucoma surgery; Grippale syndrome; Grippale syndrome; heart arrhythmia; human; hyperemia; intraocular hypertension; intraocular pressure; iridotomy; keratitis; laser surgery; mastalgia; monotherapy; muscle hypertonia; myalgia; neodymium laser; ocular pruritus; optic nerve atrophy; patient compliance; photophobia; retina macula cystoid edema; review; side effect; Sjoegren syndrome; syndrome; taste; trabeculoplasty; urolithiasis; urticaria; xerostomia; alphagan; arteoptic; azopt; betamann; betoptima; cosopt; diamox; duotrav; ganfort; glaupax; iopidine; isoglaucon; lumigan; taflotan; travatan; trusopt; vistagan

Brinzolamide/timolol fixed combination for open-angle glaucoma and ocular hypertension - Holló, G. (Expert Review of Ophthalmology, 2009)
The brinzolamide/timolol fixed combination contains brinzolamide 1% and timolol maleate 0.5% in ophthalmic suspension produced for twice-daily application to reduce elevated intraocular pressure in open-angle glaucoma and ocular hypertension. This fixed combination was recently approved by the European Medicines Agency, in December 2008. The brimzolamide/timolol fixed combination provides an approximately 30-33% intraocular pressure reduction from the untreated baseline of 25-27 mmHg, thus is more potent than any of its ingredients alone and is similarly effective but better tolerated than the dorzolamide/timolol fixed combination, which consists of molecules from the same drug classes. The fixed combination of brinzolamide and timolol can be used as a separate therapy, but due to the additivity of its ingredients to drugs belonging to other classes, it may also be administered in combination with other intraocular pressure-lowering molecules, most importantly topical prostaglandin analogues. © 2009 Expert Reviews Ltd.
Keywords: antiglaucoma agent; brinzolamide plus timolol; brinzolamide; brinzolamide plus timolol; carbomer; dorzolamide; dorzolamide plus timolol; latanoprost plus timolol; polymer; prostaglandin derivative; timolol maleate; timolol plus travoprost; travoprost; unclassified drug; adjuvant therapy; article; blood pressure; blurred vision; bradycardia; bronchospasm; chronic obstructive lung disease; clinical effectiveness; clinical trial; conjunctival hyperemia; drug absorption; drug approval; drug efficacy; drug mechanism; drug metabolism; drug potency; drug potentiation; drug response; drug safety; drug structure; drug substitution; drug tolerability; drug withdrawal; Europe; eye discomfort; eye irritation; falling; heart failure; human; intraocular hypertension; ocular pruritus; open angle glaucoma; patient compliance; physical chemistry; punctate keratitis; side effect; structure activity relation; faintness; azarga; cosopt

Glaucoma medication persistence with a fixed combination versus multiple bottles - Higginbotham, E.J.; Hansen, J.; Davis, E.J.; Walt, J.G.; Guckian, A. (Current Medical Research and Opinion, 2009)
Objective: To determine if prescribing combination therapy versus two or three separate bottles results in greater persistence among patients with glaucoma. Methods: Using a retail pharmacy claims database, three glaucoma patient cohorts were defined and followed for 12 months (January 2004 through December 2004). Patients in cohort 1 had a prescription for a single fixed-combination therapy during the month of January 2004. Cohort 2 consisted of patients with prescriptions for a β-blocker and one other glaucoma product in the same month. Cohort 3 comprised patients with prescriptions filled for three different glaucoma therapies during the first month. A fixed-combination formulation may have been included in cohorts 2 and 3 as well, but was counted as a single bottle. Persistence rate, defined as the percentage of patients who did not discontinue their medication over the 12-month period, was calculated. Results: Cohort 1 (one bottle; n=14 742) was more persistent than cohort 2 (two bottles; n=18 411), with 35.3% vs. 27.2% of patients remaining on therapy at the end of the study period (p<0.0001). Cohort 3 (n=4826), with three separate bottles per patient, had the lowest percentage remaining on therapy (23.9%; p<0.0001). Conclusion: Analyses of pharmacy database data are limited by the possibilities of misidentifying newly treated patients or misclassifying added versus switched medications. As the number of separate products used for glaucoma therapy increases, patient persistence decreases. A management regimen requiring as few products as possible may enhance glaucoma patient persistence. © 2009 Informa UK Ltd. All rights reserved.
Keywords: brimonidine; dorzolamide plus timolol; latanoprost; timolol; adolescent; adult; aged; article; child; cohort analysis; female; glaucoma; human; major clinical study; male; patient compliance; pharmacy (shop); preschool child; prescription; school child; treatment duration

Mycotic keratitis due to Aspergillus nomius - Manikandan, P.; Varga, J.; Kocsubé, S.; Samson, R.A.; Anita, R.; Revathi, R.; Dóczi, I.; Németh, T.M.; Narendran, V.; Vágvölgyi, C.; Manoharan, C.; Kredics, L. (Journal of Clinical Microbiology, 2009)
We report the first known case of fungal keratitis caused by Aspergillus nomius. Ocular injury was known as a predisposing factor. The patient was treated with natamycin and econazole eye drops, itraconazole eye ointment, and oral ketoconazole. A therapeutic penetrating keratoplasty was performed 16 days after presentation. A sequence-based approach was used to assign the isolate to a species. Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Keywords: amphotericin B; antifungal agent; doxycycline; econazole; homatropine; itraconazole; ketoconazole; natamycin; nonsteroid antiinflammatory agent; adult; analgesia; anamnesis; antifungal susceptibility; article; Aspergillus; Aspergillus nomius; case report; cornea perforation; disease predisposition; eye injury; female; follow up; fungal structures; fungus identification; Gram staining; hospital admission; human; hypopyon; keratomycosis; microscopy; mycology; patient compliance; penetrating keratoplasty; priority journal; scleritis; slit lamp; visual acuity

The Saudi initiative for asthma - Al-Moamary, M.; Al-Hajjaj, M.; Idrees, M.; Zeitouni, M.; Alanezi, M.; Al-Jahdal, H.; Al Dabbagh, M. (Annals of Thoracic Medicine, 2009)
The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.
Keywords: acetylsalicylic acid; allergen; antihistaminic agent; beclometasone; beta 2 adrenergic receptor stimulating agent; budesonide; budesonide plus formoterol; cholinergic receptor blocking agent; ciclesonide; corticosteroid; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol; glucocorticoid; hydrocortisone; ipratropium bromide; leukotriene receptor blocking agent; long acting drug; magnesium sulfate; methylprednisolone; montelukast; nonsteroid antiinflammatory agent; omalizumab; prednisolone; prednisone; salbutamol; salmeterol; short acting drug; theophylline; unindexed drug; add on therapy; adrenal insufficiency; desensitization; allergic asthma; allergic reaction; anaphylaxis; asthma; bitter taste; cataract; clinical feature; clinical protocol; continuous infusion; diabetes mellitus; disease control; disease exacerbation; doctor patient relationship; drug dose reduction; drug dose regimen; drug efficacy; drug fatality; drug hypersensitivity; drug indication; drug safety; drug tolerability; dysphonia; evidence based practice; exercise induced asthma; fetus disease; gastrointestinal symptom; glaucoma; headache; health care organization; health care personnel; health care utilization; heart arrhythmia; human; hypertension; hypokalemia; immunotherapy; influenza vaccination; injection site contusion; injection site pain; low drug dose; medical literature; muscle cramp; muscle weakness; nausea; obesity; oropharynx candidiasis; osteoporosis; pathophysiology; patient education; practice guideline; review; risk factor; risk reduction; Saudi Arabia; Saudi Initiative for Asthma; seizure; self care; side effect; single drug dose; skin disease; skin thinning; skin thinning; tachycardia; thrush; treatment outcome; tremor; unspecified side effect

Back to being barber surgeons - Hodge, W.G. (Evidence-Based Ophthalmology, 2009)
Keywords: cefuroxime; cataract extraction; clinical trial; cost effectiveness analysis; editorial; endophthalmitis; glaucoma; human; outcome assessment; patient compliance; priority journal; surgical technique

Intravitreal bevacizumab for neovascular glaucoma - Vasudev, D.; Blair, M.P.; Galasso, J.; Kapur, R.; Vajaranant, T. (Journal of Ocular Pharmacology and Therapeutics, 2009)
Purpose: To report 6-month and 1 year outcomes of eyes treated for neovascular glaucoma (NVG) with intravitreal bevacizumab injection and panretinal laser (PRP) compared to those receiving PRP alone. Design: retrospective, consecutive case series. Methods: Charts of patients with NVG from retinal ischemia and at least 6 months of follow-up were reviewed. Patients were treated with one injection of 1.25 mg intravitreal bevacizumab followed by PRP or with PRP alone. The primary outcome was the long-term angle anatomy. Secondary measures included intraocular pressure (IOP), visual acuity, patient compliance, and control of systemic diseases. Results: Fourteen eyes of 12 patients treated with bevacizumab and PRP and 15 eyes of 11 patients treated with PRP alone were included in the study. Mean sectors of open angle at baseline was 1.31 in the bevacizumab group and 1.47 in the retinal ablation group (P = 0.73). Mean sectors of open angle was 2.14 and 1.18 in the bevacizumab and retinal ablation groups, respectively (P < 0.05) at 6-month follow-up, and 2.27 and 1.18, respectively (P < 0.05) at 1-year follow-up. Mean baseline IOP was 32.3 mmHg (±14.8) in the bevacizumab group and 31.8 mmHg (±13) in the PRP group (P = 0.75). At 6-month follow-up, the mean IOP was 18.28 mmHg (±10) in the bevacizumab group and 23.33 mmHg (±14.6) in the PRP group (P = 0.05), and 19.12 mmHg (±6.8) and 26.2 mmHg (±18) (P = 0.1), respectively at 1-year follow-up. Nineteen patients were judged to be noncompliant, 10 had uncontrolled diabetes and 7 had uncontrolled hypertension. Conclusions: This study documents better long-term preservation of open angle and IOP control in eyes receiving bevacizumab along with PRP. We stress that NVG is still associated with poor visual acuity outcomes. © © Mary Ann Liebert, Inc. 2009.
Keywords: bevacizumab; brimonidine; bunazosin; dipivefrine; dorzolamide; latanoprost; pilocarpine; timolol maleate; unclassified drug; adult; article; clinical article; controlled study; diabetes mellitus; follow up; human; hypertension; intraocular pressure; laser; neovascular glaucoma; panretinal laser; patient attitude; patient compliance; retina detachment; retina ischemia; treatment outcome; visual acuity; alphagan; detantol; pivalephrine; sanpilo; timoptol; trusopt; xalatan

Interventional procedures in glaucoma: resources and costs in five european countries - Lafuma, A.; Verboven, Y.; Darba, J.; Brüeggenjuergen, B.; Gylee, E.; Berto, P. (Value in Health, 2009)
OBJECTIVES: Despite increasing medical management of glaucoma, interventional procedures remain a substantial part. This study in 5 countries (France, Germany, Spain, Italy and England) aimed to estimate the annual number and costs of glaucoma operating procedures (surgery and laser). METHODS: Analysis of the available Diagnosis Related Groups (DRG) national health care databases was performed. Both inpatient stays and ambulatory care in hospitals were selected on the basis of specific DRG and diagnosis codes. Standard costs were applied. RESULTS: There are large variations in the number of glaucoma-related hospitalizations reported. Germany and France had the highest numbers at 46,191 and 19,784 respectively. England, Italy and Spain had 7,741, 4,135 and 2,210 stays annually in that order. Databases for Italy and Spain, however, were not nationally exhaustive. Of these figures, 26,827 procedures included combined cataract-glaucoma coding in Germany and 6,656 in France. These figures on in-hospital were over the last 3 year stable in Italy, France and England, Spain whereas there is an upward trend in Germany. Outpatient treatments were only reported in England, an additional 3,340 procedures. Severe or more complex procedures involving surgery account for an estimated 46%, 93%, 67%, 23%, 89% in Germany, France, England, Italy, and Spain respectively. The corresponding average costs are a1972, a1469, a2246, a1946, and a2683. Of these. Day-Hospitalization in Italy account for 37% at a cost of 1085a while stays of less than 2 days in France account for 49% of all severe cases at a cost of 1009a. Total cost estimates are estimated at 65 million a in Germany, 28 million a in France and 6 million £ in England. CONCLUSIONS: Available national health care databases have different coding.. Cost among severe interventions are comparable across countries. Short length of stay DRGs have a lower cost. Further studies including outpatient settings are needed.
Keywords: glaucoma; France; United Kingdom; Germany; Italy; Spain; data base; surgery; public health service; outpatient; hospital; hospitalization; diagnosis related group; hospital patient; ambulatory care; length of stay; laser; diagnosis; disease management; cataract

Effect of epigallocatechin-gallate on inner retinal function in ocular hypertension and glaucoma: A short-term study by pattern electroretinogram - Falsini, B.; Marangoni, D.; Salgarello, T.; Stifano, G.; Montrone, L.; Landro, S.; Guccione, L.; Balestrazzi, E.; Colotto, A. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2009)
Background: Epigallocatechin-gallate (EGCG) is a powerful antioxidant with suggested neuroprotective action. The aim of this study was to evaluate the effect of short-term supplementation of EGCG on inner retinal function in ocular hypertension (OHT) and open-angle glaucoma (OAG). Methods: Eighteen OHT and 18 OAG patients (perimetric mean deviation: >-10 dB) were randomly assigned to assume oral placebo or EGCG over a 3-month period in a randomized, placebo-controlled, double-blind, cross-over design clinical trial (clinicaltrials.gov identifier: NCT00476138). Pattern-evoked electroretinograms (PERGs) to 1.6 cycles/ degree square-wave gratings, counterphased at 16 reversals/second, and standard automated perimetry (Humphrey 30-2) were assessed at the study entry (baseline), and after 3 months of placebo or EGCG. Results: After EGCG, PERGs of OAG, but not OHT patients were increased in amplitude, compared either to baseline values (mean amplitude change: 0.06 log μV, p<0.05) or to PERG amplitude values found in the same patients after placebo administration (mean change: -0.02 log μV, p not significant; difference between EGCG and placebo: 0.08 log μV, p<0.05). In both OHT and OAG patients, standard automated perimetry did not show significant changes after either EGCG or placebo. In individual OAG patients, the magnitude of PERG amplitude increment after EGCG was inversely related (r=-0.8, plt;0.01) to corresponding baseline amplitudes. Conclusions: Although this study cannot provide evidence for long-term benefit of EGCG supplementation in OAG, and the observed effect is small, the results suggest that EGCG might favourably influence inner retinal function in eyes with early to moderately advanced glaucomatous damage. © Springer-Verlag 2009.
Keywords: NCT00476138; betaxolol; epigallocatechin gallate; latanoprost plus timolol; placebo; timolol maleate; absence of side effects; action potential; adult; aged; article; cell function; clinical article; clinical trial; controlled clinical trial; controlled study; crossover procedure; double blind procedure; drug effect; drug efficacy; electroretinogram; electroretinography; female; human; intraocular hypertension; intraocular pressure; male; open angle glaucoma; optical coherence tomography; patient compliance; pattern evoked electroretinogram; perimetry; priority journal; randomized controlled trial; retina ganglion cell; short course therapy; visual field; visual system examination; visual system function; vitamin supplementation; waveform

Different concepts of drug delivery in disease entities - Serafin, A.; Stańczak, A. (Mini-Reviews in Medicinal Chemistry, 2009)
This is a review of classical and novel concepts of drug delivery in particular diseases such as central nervous system disease, ophthalmic disease, cardiovascular disease, cancer and others. Nowadays, scientists are trying to propose efficient and selective drugs for the site of action, with best acceptance of patients, that can be metabolized to non-toxic derivatives. Prodrugs, soft drugs, codrugs are designed to maximize the amount of active drugs that reaches the site of action, through changing the physicochemical, biopharmaceutical or pharmacokinetic properties of the parent drugs. For last years different concepts of drug delivery have been developed to achieve the best patients' tolerance of a drug that has no undesirable properties. It is established that future studies will ameliorate drug properties so as to achieve the best drug delivery system. © 2009 Bentham Science Publishers Ltd.
Keywords: fosamprenavir; bimatoprost; carbamazepine; clopidogrel; dexanabinol; docarpamine; entacapone; fosopamine; fosphenytoin sodium; fospropofol; gabapentin; gabapentin enacarbil; gamma glutamyldopa; gw 433908a; gw 433908g; ibopamine; latanoprost; levodopa; lisdexamfetamine; loteprednol etabonate; n acetylglutamic acid 5 [n2 (5 butyl 2 pyridyl)hydrazide]; parecoxib; phenytoin; pilocarpine; prodrug; propofol; ticlopidine; tilisolol; travoprost; unclassified drug; unindexed drug; valproic acid; ximelagatran; add on therapy; adjuvant therapy; anxiety disorder; attention deficit disorder; blood brain barrier; blood retina barrier; cardiovascular disease; clinical trial; cognitive defect; controlled release formulation; drug absorption; drug bioavailability; drug blood level; drug delivery system; drug diffusion; drug distribution; drug efficacy; drug elimination; drug metabolism; drug structure; drug tolerability; epilepsy; essential hypertension; eye irritation; focal epilepsy; gastrointestinal irritation; glaucoma; half life time; human; Human immunodeficiency virus infection; intraocular hypertension; kidney failure; liver necrosis; neuropathic pain; nonhuman; Parkinson disease; patient compliance; postherpetic neuralgia; postoperative pain; restless legs syndrome; review; sedation; side effect; teratogenicity; tonic clonic seizure; aquavan; cerebyx; cgp 22979; comtan; comtess; gw 433908a; gw 433908g; lotemax; lumigan; sim 2055; ta 870; travatan; vyvanse; xalatan; xp 13512

Notable role of glaucoma club on patients' knowledge of glaucoma - Chen, X.; Chen, Y.; Sun, X. (Clinical and Experimental Ophthalmology, 2009)
Purpose: To assess how general glaucoma patients understand their disease compared with patients from the Shanghai Glaucoma Club and various influencing factors as well. Shanghai Glaucoma Club was further evaluated to determine its efficacy on its members' understanding and knowledge of glaucoma. Methods: A total of 301 glaucoma patients in Shanghai Glaucoma Club and 314 general glaucoma patients were investigated by a questionnaire, composed of three parts and consisting of 20 questions. The first part asked questions about 'level of cognition about glaucoma', the second part was about 'compliance of medication and follow-up', and the third part was about 'life style and habit'. Answers were graded on each question and scores were summed up separately for each part and as a total. Differences of scores and influencing effects were analysed using multivariate linear regression (stepwise) between the two groups. Results: The average total scores of the general glaucoma patients and the glaucoma club members were 19.6 ± 5.4 and 23.8 ± 4.0 (t = -11.14 P < 0.01), respectively. After multivariate linear regression adjustment for the effects of age, diagnosis and educational level glaucoma club members still had 3.73 points edge over the general patients (t = 8.14, P < 0.01). The club was shown to be the strongest positive factor influencing patients' cognition. Patients in Shanghai Glaucoma Club understood the nature and course of glaucoma significantly better than the general glaucoma patients (t = 10.97, P < 0.01) and also lived healthier lives (t = 7.55, P < 0.01). The level of background education was found to be a positive influencing factor although age was negatively correlated with total score. Primary glaucoma patients demonstrated better cognition of their diseases compared with secondary glaucoma patients, and those patients unaware of their type of glaucoma produced lower scores. Conclusions: This study demonstrated significant differences regarding the basic understanding of glaucoma between two groups: general glaucoma patients and members of the Shanghai Glaucoma Club. Club members presented with better cognition of glaucoma and self-management compared with general glaucoma patients. Therefore, the Shanghai Glaucoma Club is an effective medium to improve patients' knowledge of disease and compliance for medication. © 2009 The Authors Journal compilation © 2009 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: adult; age; aged; article; attitude to health; China; cognition; educational status; female; glaucoma; habit; health education; human; lifestyle; major clinical study; male; patient compliance; primary glaucoma; questionnaire; scoring system; secondary glaucoma; support group

Glaucoma club: A successful model to educate glaucoma patients - Kong, X.; Chen, X.; Sun, X.; Xiao, M.; Zuo, L.; Guo, W. (Clinical and Experimental Ophthalmology, 2009)
Keywords: doctor patient relationship; glaucoma; health education; health program; letter; patient compliance; patient education; support group; symposium

Fungal keratitis with intracameral extension following penetrating keratoplasty - Gupta, G.; Feder, R.S.; Lyon, A.T. (Cornea, 2009)
PURPOSE: To report the clinical findings and management of a case of fungal keratitis with extension into the anterior chamber following penetrating keratoplasty. METHODS: Interventional case report. RESULTS: A 45-year-old man developed a white, cottonball-like mass in the anterior chamber 3 months after penetrating keraplasty for keratoconus. Cytology evaluation was performed following excisional biopsy of the intracameral portion of the lesion. The presence of filamentous fungus was confirmed. The patient was treated with oral, topical, and intracameral voriconazole with complete resolution of the infection 9 months after initial presentation. CONCLUSION: This case illustrates the unusual presentation of fungal keratitis with intracameral extension and demonstrates effective management with preservation of the corneal graft and restoration of visual function. © 2009 Lippincott Williams & Wilkins, Inc.
Keywords: cyclosporine; gatifloxacin; prednisolone; vancomycin; voriconazole; adult; anterior eye chamber; article; Aspergillus; case report; cornea stroma; cornea transplantation; corneal biopsy; cytology; debridement; fungal detection; graft rejection; human; human tissue; keratoconus; keratomycosis; male; patient compliance; penetrating keratoplasty; postoperative period; priority journal; treatment outcome; visual acuity

Infectious keratitis caused by Aspergillus tubingensis - Kredics, L.; Varga, J.; Kocsubé, S.; Rajaraman, R.; Raghavan, A.; Dóczi, I.; Bhaskar, M.; Németh, T.M.; Antal, Z.; Venkatapathy, N.; Vágvölgyi, C.; Samson, R.A.; et al. (Cornea, 2009)
PURPOSE: To report 2 cases of keratomycosis caused by Aspergillus tubingensis. METHODS: The therapeutic courses were recorded for 2 male patients, 52 and 78 years old, with fungal keratitis caused by black Aspergillus strains. Morphological examination of the isolates was carried out on malt extract agar plates. A segment of the β-tubulin gene was used for molecular identification. Antifungal susceptibilities were determined by the E test method for molds and the broth microdilution technique National Committee for Clinical Laboratory Standards M38-A. RESULTS: A 52-year-old man presented with complaints of pain and redness in the right eye. The patient was successfully treated with natamycin and econazole eyedrops, itraconazole eye ointment, and oral ketoconazole. A 78-year-old man presented with total corneal necrosis in the right eye. A therapeutic keratoplasty was performed, and topical natamycin and econazole were applied. At the postoperative visit after 3 weeks, almost the full corneal graft was clear with formed anterior chamber. Black Aspergillus strains were isolated from the corneal scrapings of both cases and initially identified as Aspergillus niger based on culture characteristics. Sequence analysis of a segment of the β-tubulin gene revealed that the isolates are representatives of A. tubingensis. CONCLUSIONS: Aspergillus tubingensis is closely related with A. niger, the differentiation of these 2 species is difficult by classical morphological criteria. To our knowledge, the presented cases of fungal keratitis are the first reports on ocular infection caused by A. tubingensis. © 2009 Lippincott Williams & Wilkins, Inc.
Keywords: agar; amphotericin B; atropine; auroclot; aurozole; beta tubulin; caspofungin; cotrimoxazole; econazole; eye drops; homide; itraconazole; ketoconazole; natamet; natamycin; ofloxacin; unclassified drug; voriconazole; adult; aged; antifungal susceptibility; article; Aspergillus; Aspergillus tubingensis; broth dilution; case report; cornea necrosis; cornea transplantation; drug dose reduction; epsilometer test; eye pain; fungal gene; fungal structures; fungus identification; fungus isolation; gene sequence; human; keratomycosis; keratoplasty; male; nonhuman; nucleotide sequence; patient compliance; priority journal; slit lamp; visual acuity; auroclot; aurozole; natamet

Bilateral ocular hypertension with rapidly progressive optic neuropathy in a teen - Hua, L.V.; Byrne, E.; Yudcovitch, L. (Optometry and Vision Science, 2009)
Purpose.: We report a rare case of bilateral juvenile open-angle glaucoma (JOAG), with discussion of current understanding of its pathogenesis, differential diagnosis, genetics, and management. The importance of tonometry and dilated fundus examination as essential parts of a complete ocular examination, regardless of patient age, is emphasized. CASE REPORT.: A Hispanic female teenager presented for an updated eye examination as a requirement before joining military boot camp. Chief concern was blurry vision at distance, with no other reported ocular or systemic problems. She manifested simple myopia in both eyes and was correctable to 20/20 in each eye with glasses. However, intraocular pressure (IOP) in each eye was measured above 40 mm Hg. Subsequent automated perimetry showed significant visual field defects, and laser polarimetry analysis of the optic nerve fibers corresponded with the visual field loss pattern. Maximal medical therapy was administered to lower the IOP, with minimal success. Subsequent incisional trabeculectomy with topical antimetabolite were performed in both eyes to achieve adequate control of her IOPs. CONCLUSIONS.: Juvenile-onset Open Angle Glaucoma (JOAG) has been proposed to be a small subset of Primary Open Angle Glaucoma (POAG) and on a continual spectrum of Primary Open Angle Glaucoma. Because most patients with JOAG are asymptomatic, tonometry and optic nerve analysis are crucial in early detection and, thus, must be performed on all patients, young and old. JOAG has a variable onset, with rapidly progressive neuropathy that does not respond well to medical therapy alone, and surgical intervention is often the eventual treatment of choice. Mutations in the myocillin gene have been strongly linked to the disease. JOAG follows an autosomal dominant inheritance with relatively high penetrance. As such, close monitoring, genetics screening, and/or early medical management to prevent irreversible optic neuropathy and blindness should be considered as well for presymptomatic family members. Copyright © 2009 American Academy of Optometry.
Keywords: apraclonidine; brimonidine; brimonidine plus timolol; brinzolamide; eye drops; fluorouracil; iodipine; prednisolone acetate; tetryzoline; travoprost; travoprost; unclassified drug; adolescent; article; blurred vision; case report; disease course; drug dose increase; eye examination; eye irritation; female; human; intraocular hypertension; juvenile open angle glaucoma; myopia; open angle glaucoma; optic nerve fiber; patient compliance; perimetry; polarimetry; priority journal; tonometry; trabeculectomy; visual acuity; visual field defect; alphagan; azopt; combigan; iodipine; pred forte; travatan z

Glaucoma and home medicines reviews - Gowan, J.; Roller, L. (Australian Journal of Pharmacy, 2009)
Keywords: adrenergic receptor stimulating agent; alpha 2 adrenergic receptor; antihistaminic agent; benzodiazepine derivative; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine plus timolol; carbonate dehydratase inhibitor; central stimulant agent; cholinergic receptor blocking agent; corticosteroid; dorzolamide plus timolol; eye drops; ipratropium bromide; latanoprost; latanoprost plus timolol; levobunolol; miotic agent; monoamine oxidase inhibitor; phenothiazine derivative; prostaglandin derivative; serotonin uptake inhibitor; tetracycline derivative; theophylline derivative; timolol maleate; travoprost; tricyclic antidepressant agent; unindexed drug; vasodilator agent; African American; aging; allergy; blindness; blurred vision; bradycardia; bronchodilatation; bronchospasm; cataract; closed angle glaucoma; confusion; congenital rubella syndrome; conjunctivitis; depression; diabetes mellitus; diabetic retinopathy; diagnostic procedure; differential diagnosis; disease association; Down syndrome; drug use; eye color; eye disease; eye examination; eye fundus; eye pain; eyelash growth; eyelash growth; family history; fatigue; gastrointestinal symptom; glaucoma; Hallermann Streiff syndrome; headache; Herpes simplex virus; human; hyperemia; hyperhomocysteinemia; hypertension; hypoglycemia; hypokalemia; hypotension; idiopathic infantile hypoglycemia; impotence; intraocular pressure; iridotomy; keratitis; local irritation; local irritation; Lowe syndrome; malaise; Marfan syndrome; melanoma; metabolic acidosis; migraine; miosis; myopia; nephrolithiasis; neurofibromatosis; night vision; nightmare; open angle glaucoma; optic disk; optic nerve; optic neuritis; paresthesia; patient compliance; periorbital pigment; periorbital pigment; pharmacist

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

Smoothing the Intraocular Pressure Roller Coaster: A New Goal? - Jay Katz, L.; Myers, J.S. (American Journal of Ophthalmology, 2009)
Keywords: antiglaucoma agent; latanoprost; timolol; clinical trial; contact lens; disease course; drug effect; drug efficacy; editorial; glaucoma; hemodynamics; human; intraocular pressure; monitor; open angle glaucoma; optic nerve injury; patient compliance; patient monitoring; pressure measurement; priority journal; risk factor; telemetry; tonometry; treatment response; visual field defect

Increasing the efficiency of ophthalmic care for all patients during Ramadan - Khan, R.; Al-Maskari, A.; Khan, K. (British Journal of Ophthalmology, 2009)
Keywords: latanoprost; diabetic retinopathy; disease severity; doctor patient relationship; evening dosage; follow up; glaucoma; human; letter; medical practice; patient care; patient compliance; patient education; priority journal; religion

Pharmacological Management of Neuropathic Pain in Older Adults: An Update on Peripherally and Centrally Acting Agents - McGeeney, B.E. (Journal of Pain and Symptom Management, 2009)
The burden of neuropathic pain in older adults is great and the practitioner is challenged to reduce symptoms and improve quality of life. Many common neuropathic pain syndromes are more prevalent in the older population, and older adults also carry greater sensitivity to certain side effects. The health care professional should have a thorough familiarity with all medications available to treat this difficult group of disorders. © 2009 U.S. Cancer Pain Relief Committee.
Keywords: agents acting on the peripheral nervous and neuromuscular systems; anticonvulsive agent; antidepressant agent; calcium channel affecting agent; cannabinoid; capsaicin; carbamazepine; central nervous system agents; etiracetam; gabapentin; lamotrigine; lidocaine; n methyl dextro aspartic acid receptor blocking agent; naproxen; nonsteroid antiinflammatory agent; opiate; oxcarbazepine; oxymorphone; phenobarbital; phenytoin; pregabalin; serotonin noradrenalin reuptake inhibitor; topiramate; tramadol; tricyclic antidepressant agent; unindexed drug; valproic acid; varicella zoster vaccine; venlafaxine; zonisamide; albumin blood level; alcohol abuse; allodynia; application site burning; application site reaction; article; bedtime dosage; bladder disease; blood flow; blurred vision; body burden; body fat; cardiovascular disease; carpal tunnel syndrome; chickenpox; chronic pain; clinical trial; closed angle glaucoma; Cochrane Library; cognition; cognitive defect; constipation; depression; diabetic neuropathy; dizziness; drug clearance; drug cost; drug distribution; drug efficacy; drug safety; drug tolerability; electroneurography; erectile dysfunction; falling; Food and Drug Administration; gait disorder; gastrointestinal motility; health care personnel; heart muscle conduction disturbance; herpes zoster; hip osteoarthritis; hip pain; human; hyperalgesia; hypogonadism; immune response; insomnia; kidney disease; kidney function; knee osteoarthritis; knee pain; lean body weight; liver disease; liver function; low back pain; lung disease; migraine; nausea; neoplasm; neuropathic pain; neurotoxicity; nociception; off label drug use; orthostatic hypotension; osteoarthritis; pain assessment; pain threshold; patient compliance; peripheral edema; polyneuropathy

Chronic Pain Management in Older Adults: Special Considerations - Fine, P.G. (Journal of Pain and Symptom Management, 2009)
The rising prevalence of neuropathic pain and the multifaceted sequelae of pain particularly within older adults are part of the increasing challenges in providing good geriatric pain management. Aging can lead to a higher sensitivity to pain within older adults, whereas physiological changes modify the absorption, bioavailability, and transit time of pharmaceutical agents. Ultimately, these differences within older adults require clinicians treating them to provide individually tailored analgesic approaches. Progressive age increases the variance in physiology among people; thus, the management approach should reflect an individual's unique requirements and limitations based on findings at the time of assessment. © 2009 U.S. Cancer Pain Relief Committee.
Keywords: amitriptyline; analgesic agent; anticonvulsive agent; buprenorphine; cannabinoid derivative; capsaicin; carbamazepine; clonidine; duloxetine; fentanyl; gabapentin; hydrocodone; hydromorphone; ketamine; lamotrigine; lidocaine; memantine; mexiletine; mirtazapine; nortriptyline; opiate; pregabalin; serotonin noradrenalin reuptake inhibitor; tapentadol; tizanidine; tramadol; tricyclic antidepressant agent; unindexed drug; valproic acid; venlafaxine; age distribution; allodynia; anxiety; application site reaction; article; Australia; caudate nucleus; central nervous system; chronic kidney failure; chronic pain; Cochrane Library; cognitive defect; consensus; constipation; coping behavior; daily life activity; degenerative disease; delayed diagnosis; delirium; dementia; depression; diagnostic error; dizziness; drowsiness; drug absorption; drug accumulation; drug bioavailability; drug formulation; drug indication; drug withdrawal; fracture; functional assessment; gastrointestinal tract; geriatric care; glaucoma; glomerulus filtration rate; heart infarction; human; hyperalgesia; hypertension; hypesthesia; inflammation; intestine absorption; intestine blood flow; intestine motility; intestinal secretion; intestine transit time; renal clearance; kidney function; length of stay; liver blood flow; liver function; medical education; nausea; neuropathic pain; nociception; nursing home; pain assessment; pain threshold; patient compliance; perceptive threshold; peripheral neuropathy; personality; physical examination; polypharmacy; postherpetic neuralgia; practice guideline; prescription; putamen; quality of life

Response to D. Eisenbergs Comments - Denis, P.; Cucherat, M.; Aptel, F. (Journal of Glaucoma, 2009)
Keywords: bimatoprost; latanoprost; latanoprost plus timolol; prostaglandin derivative; analytical error; clinical evaluation; clinical practice; clinical trial; conjunctival hyperemia; disease course; drug effect; drug efficacy; drug substitution; drug tolerability; glaucoma; human; intraocular hypertension; intraocular pressure; letter; open angle glaucoma; patient compliance; priority journal; risk factor; trabeculoplasty; treatment outcome; visual field

In-office diagnostic equipment rental. (Optometry (St. Louis, Mo.), 2009)
Keywords: ambulatory care; article; economics; devices; glaucoma; human; devices; leasing; optometry; organization and management

Noncompliance with drug therapy of glaucoma: A review about intervening factors - De Castro, A.N.B.V.; Mesquita, W.A. (Revista Brasileira de Ciencias Farmaceuticas/Brazilian Journal of Pharmaceutical Sciences, 2009)
Glaucoma is defined as an optic neuropathy, characterized for loss of visual field and injury of the optic nerve, being considered as the second cause of blindness in the world, which could be prevented by the use of antiglaucoma eyedrops. The lack of adhesion of the patient to the drug treatment can culminate with loss of the vision. The objective was to revise possible literature data regarding intervening factors for noncompliance and explain estimated rates of noncompliance. A systematic review about the subject was carried out in the period of January to June of 2006. Articles had been searched in two data bases, in the National Library of Medicine (PUBMED) and in the Literature Latin American and Caribbean Health Sciences (LILACS) using the following keywords: glaucoma, compliance of the patient, noncompliance of the patient, treatment and eyedrops. In PUBMED, 199 articles were collected, written in English and French languages. No article was found in LILACS. Considering the inclusion and exclusion criteria, 27 articles were selected, with 25 originals and two reviews. Twelve possible intervening factors for noncompliance were raised, as well as estimates for rates of noncompliance. The noncompliance rates varied from 4.6% up to 59%. Two factors, forgetfulness and inadequate between-doses interval, had been associated to noncompliance of the drug therapy. The factors race, adverse effects, treatment cost, number of instilled doses, coexisting illnesses and number of eyedrops used, had resulted contradictory, being impossible to affirm that they have contributed for noncompliance. Age, sex, educational level and loss of visual field, had not been associated with noncompliance. The glaucoma patients tended to disregard the drug treatment. The wide variation in noncompliance rates could be an influence from the authors' difficulty to define the noncompliance and the variety of methodologies used to estimate it. More studies are necessary for a better evaluation of these 12 raised factors.
Keywords: pilocarpine; timolol maleate; ankle edema; dyspnea; educational status; ethnicity; evening dosage; glaucoma; health care cost; human; Medline; methodology; migraine; patient compliance; review; systematic review; visual field defect

Crack Eye - Miller, A.D.; Sherman, S.C. (Journal of Emergency Medicine, 2009)
Keywords: cefazolin; cocaine; eye drops; gentamicin; adult; anterior eye chamber; article; blurred vision; case report; cocaine dependence; cornea ulcer; crack eye syndrome; eye pain; female; human; patient compliance; priority journal; slit lamp; symptomatology

Will improvement of knowledge lead to improvement of compliance with glaucoma medication? Authors' reply - Hoevenaars, J.G.M.M.; Schouten, J.S.A.G.; Van Den Borne, B.; Beckers, H.J.M.; Webers, C.A.B. (Acta Ophthalmologica, 2009)
Keywords: antiglaucoma agent; glaucoma; human; letter; Netherlands; patient compliance; patient education; priority journal; treatment refusal; unspecified side effect

Will improvement of knowledge lead to improvement of compliance with glaucoma medication? - Mansouri, K.; Shaarawy, T. (Acta Ophthalmologica, 2009)
Keywords: antiglaucoma agent; glaucoma; human; letter; patient compliance; patient education; priority journal; risk reduction; treatment refusal

The relationship of mean deviation scores and resource utilization among patients with glaucoma: A retrospective United States and European chart review analysis - Berenson, K.; Kymes, S.; Walt, J.G.; Siegartel, L.R. (Journal of Glaucoma, 2009)
Purpose: To determine the relationship between mean deviation (MD) scores and resource utilization among glaucoma patients in the United States and Europe. Methods: A retrospective analysis of patient in the United States (June 1990 to January 2003, N = 151) and Europe (June 1994 to July 2003, N = 194) was conducted. Office visits, pressure-lowering medications, visual field examinations, and glaucoma surgeries were recorded with age, intraocular pressure (IOP), and MD. Patients with missing MD and IOP were excluded; final sample sizes were 130 in the United States and 161 in Europe. Fixed effects and logistic regression models assessed the associations between MD and visits, medication, examinations, and surgery. Results: Number of office visits and visual field examinations significantly increased but the number of glaucoma medications decreased as MD worsened and IOP increased. Odds of trabeculoplasty within 2 years decreased by 8.1% in the United States and 9.9% in Europe with every 1.0 dB improvement in MD. Odds of trabeculectomy within 2 years increased by 13.9% in the United States and by 18.6% in Europe with every 1 mm Hg increase in IOP. In the United States, odds of trabeculectomy within 5 years increased by 12.2% with each 1.0 dB worsening in MD. Conclusions: MD is associated with resource utilization in glaucoma patients. Evidence supporting use of MD to predict surgery is less conclusive, possibly due to the relative low frequency of surgeries. Therapies aimed at stabilizing visual field deterioration may reduce resource use and costs associated with glaucoma; however, more research is necessary to establish whether such treatments meet common standards of cost-effectiveness. Copyright © 2009 by Lippincott Williams & Wilkins.
Keywords: adult; age distribution; aged; ambulatory care; article; Europe; female; glaucoma; glaucoma surgery; health care utilization; human; intraocular pressure; logistic regression analysis; major clinical study; male; mean deviation; medical record review; priority journal; retrospective study; sample size; scoring system; trabeculectomy; trabeculoplasty; United States; visual field

Allergic rhinitis - Kemp, A.S. (Paediatric Respiratory Reviews, 2009)
Childhood rhinitis may be classified into non-allergic and allergic. Allergic rhinitis is further divided into seasonal and perennial. Seasonal rhinitis is a disease particularly of teenagers and young adults and appears to be less common in primary and pre school age children. In seasonal rhinitis, with relevant grass pollen sensitization, the link between the allergen exposure and rhinitis is clear cut. However, in other situations such as perennial rhinitis and house dust mite allergen sensitization, the link between symptoms and allergen exposure is less certain. Avoidance of allergens often proves to be difficult in practice. Intranasal steroids are the treatment of choice for persistent moderate-severe allergic rhinitis and are more effective than antihistamines for relief of nasal obstruction. Antihistamines are effective for control of histamine related symptoms such as itching, rhinorrhoea and sneezing. The use and benefits of sublingual or injectable immunotherapy in children are controversial. © 2009 Elsevier Ltd. All rights reserved.
Keywords: allergen; azelastine; beclometasone; budesonide; cetirizine; fexofenadine; fluticasone; fluticasone propionate; histamine; house dust allergen; ketotifen; leukotriene receptor blocking agent; levocabastine; loratadine; mometasone furoate; montelukast; placebo; pollen antigen; probiotic agent; steroid; triamcinolone; adrenal suppression; allergic rhinitis; allergy test; avoidance behavior; bone density; cataract; child; clinical trial; Dermatophagoides; desensitization; disease severity; domestic animal; drug bioavailability; drug efficacy; drug intermittent therapy; drug safety; lack of drug effect; dry nose; environmental sanitation; epistaxis; glaucoma; grass pollen; growth retardation; human; immunotherapy; nasal pruritus; nose disease; nose irritation; nose obstruction; osteoporosis; patient compliance; prick test; priority journal; review; rhinorrhea; sedation; sensitization; side effect; sneezing; spring; summer; wheezing

Risk Factors for Poor Adherence to Eyedrops in Electronically Monitored Patients with Glaucoma - Friedman, D.S.; Okeke, C.O.; Jampel, H.D.; Ying, G.-s.; Plyler, R.J.; Jiang, Y.; Quigley, H.A. (Ophthalmology, 2009)
Purpose: To identify risk factors for poor adherence to topical once daily therapy for glaucoma. Design: Prospective, observational cohort study. Participants: A total of 196 patients with glaucoma who were being treated with a prostaglandin analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007. Methods: Demographics, ocular history, and responses to interview questions about glaucoma knowledge, health beliefs, and drop-taking behaviors were obtained from each patient. All patients used the Travatan Dosing Aid (DA; Alcon Laboratories Inc., Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months, and the data of drop use were downloaded using software provided with the DA. Patients taking ≤75% doses during the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit were compared with those taking >75% of doses. Main Outcome Measures: Risk factors for poor adherence. Results: Eighty-seven patients (44.4% of the 196 subjects with evaluable data at 3 months) used the DA on 75% or less of the monitored days. In univariate analysis, poorer adherers were more likely to be <50 or ≥80 years of age, to be African American, to report less than excellent health, to report higher amounts of depression, to have lower income, and to be treated at the Scheie Eye Institute. Multivariate analysis (adjusting for education and income) found that age, race/ethnicity, and less than excellent health were associated with poor adherence. Conclusions: Those who failed to take more than 75% of eyedrop doses were more likely to be African American and to report poor health. Those in the youngest and oldest age groups were less adherent, although this finding was not always statistically significant. Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2009 American Academy of Ophthalmology.
Keywords: travoprost; adult; African American; aged; article; software; controlled study; depression; dosing aid; electronics; female; follow up; glaucoma; health belief; human; lowest income group; major clinical study; male; patient compliance; priority journal

Non-compliance in glaucoma treatment: A Hong Kong perspective - Pong, J.; Lai, J. (Acta Ophthalmologica, 2009)
Keywords: eye drops; follow up; glaucoma; Hong Kong; human; letter; long term care; patient compliance; priority journal; questionnaire

Efficacy and safety of mometasone furoate nasal spray in allergic rhinitis, acute rhinosinusitis and nasal polyposis - Small, C.B.; Teper, A. (Therapy, 2009)
Seasonal and perennial allergic rhinitis, acute rhinosinusitis and nasal polyposis are common inflammatory conditions of the airway that markedly impair patient health and quality of life. Treatment guidelines for each of these conditions recommend intranasal corticosteroids, which help to alleviate symptoms by reducing inflammation. One of the most extensively studied intranasal corticosteroids for these conditions is mometasone furoate nasal spray (MFNS). In more than 20 clinical trials, MFNS has been shown to reduce both objective and subjective signs of inflammation and promotes rapid resolution of nasal, sinus and ocular symptoms in adults, adolescents and children. MFNS is well-tolerated and local adverse events are generally mild and self-limiting, usually resolving without discontinuation of therapy. The low systemic bioavailability (<0.1%) and high first-pass metabolism of MFNS also reduce its risk for systemic adverse events. © 2009 Future Medicine Ltd.
Keywords: amoxicillin; amoxicillin plus clavulanic acid; antibiotic agent; beclomethasone dipropionate; budesonide; corticosteroid; flunisolide; fluticasone furoate; fluticasone propionate; mometasone furoate; placebo; triamcinolone acetonide; adjuvant therapy; allergic rhinitis; antiinflammatory activity; article; bacterial infection; clinical feature; clinical trial; cost benefit analysis; dosage schedule comparison; drug absorption; drug bioavailability; drug blood level; drug dose comparison; drug efficacy; drug induced headache; drug metabolism; drug safety; drug structure; drug tolerability; endoscopic surgery; epistaxis; evidence based medicine; eye disease; first pass effect; glaucoma; pollen allergy; health care cost; human; nose atrophy; nose atrophy; nose disease; nose obstruction; nose polyp; organoleptic property; patient compliance; perennial rhinitis; practice guideline; quality of life; rhinosinusitis; single drug dose; subcapsular cataract; systemic disease; treatment duration

Correlation between diurnal variation of intraocular pressure, ocular pulse amplitude and corneal structural properties. - Villas-Bôas, F.S.; Doi, L.M.; Sousa, A.K.; Melo Jr., L.A. (Arquivos brasileiros de oftalmologia, 2009)
PURPOSE: The purpose of this study was to evaluate the fluctuation of intraocular pressure measurements obtained by Goldmann applanation tonometry, dynamic contour tonometry, and corneal compensated non-contact tonometry during office hours in glaucoma and healthy participants. This study also aims at correlating the intraocular pressure fluctuations with fluctuations of corneal hysteresis, central corneal thickness, mean central corneal curvature and ocular pulse amplitude. METHODS: A total of 12 controls (24 eyes) and 21 patients (38 eyes) with open-angle glaucoma were recruited. Intraocular pressure measured by Goldmann applanation tonometry, dynamic contour tonometry and corneal compensated non-contact tonometry, ocular pulse amplitude, central corneal curvature and thickness, corneal hysteresis, and resistance factor were obtained at intervals of 2 hours, between 9 AM and 5 PM. RESULTS: Intraocular pressure fluctuated significantly throughout the day in controls and glaucoma individuals with all tonometers (P<0.001). There was no statistically significant variation in mean corneal curvature (P=0.048 in controls; P=0.04 in glaucomatous) or hysteresis over time (P=0.12 in controls; P=0.36 in glaucomatous). The ocular pulse amplitude showed a significant diurnal fluctuation in both groups (P<0.001). There was a significant correlation between the intraocular pressure measured by dynamic contour tonometry and ocular pulse amplitude (P<0.001). CONCLUSION: There was significant intraocular pressure fluctuation over office hours on measurements performed by Goldmann applanation tonometry, dynamic contour tonometry, and corneal compensated non-contact tonometry in normal and glaucoma individuals. Intraocular pressure varied independently of corneal hysteresis, central corneal thickness, and central curvature variation. However, there was significant correlation between ocular pulse amplitude and intraocular pressure measurements performed by dynamic contour tonometry.
Keywords: adult; aged; ambulatory monitoring; article; case control study; circadian rhythm; cornea; histology; human; intraocular pressure; methodology; oculoplethysmography; open angle glaucoma; pathophysiology; physiology; statistical model

The safety and efficacy of glaucoma medication in the pediatric population - Coppens, G.; Stalmans, I.; Zeyen, T.; Casteels, I. (Journal of Pediatric Ophthalmology and Strabismus, 2009)
Topical glaucoma medications are widely used for childhood glaucoma, although little is known concerning the use of the newer glaucoma medications in this population. The majority of the references cited were extracted from PubMed. A literature review of all English language reports related to glaucoma medication in the pediatric population since 1980 was performed. Medical therapy of pediatric glaucoma contains four groups of drugs: β-blockers (timolol and betaxolol), carbonic anhydrase inhibitors (dorzolamide), α2-agonists (brimonidine), and prostaglandin analogs (latanoprost). Timolol is the first choice in pediatric glaucoma. In cases with insufficient reduction of the intraocular pressure (IOP), the combination of timolol once a day and dorzolamide twice a day brings about a good control of the IOP. Both medications are effective and well tolerated. The α2-agonists have more and potentially serious adverse effects in children and are contraindicated for children younger than 2 years of age. Latanoprost tends to be less effective in lowering IOP in children than in adults. However, no studies are reported where latanoprost is used in monotherapy. Additional study may further delineate this drug's role in treating pediatric glaucoma. The safety profile of latanoprost in children appears excellent.
Keywords: acetazolamide; acetylsalicylic acid; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bicarbonate; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; chloride; clonidine; creatinine; dorzolamide; electrolyte; latanoprost; metipranolol; nitrogen; prostaglandin derivative; timolol; travoprost; urea; adjuvant therapy; angioneurotic edema; apnea; asthenia; asthma; bicarbonate blood level; bitter taste; blepharitis; blurred vision; bradycardia; bronchospasm; burning sensation; chloride blood level; choroid disease; clinical trial; coma; conjunctiva disease; conjunctivitis; cornea disease; cornea edema; creatinine blood level; depression; dizziness; drowsiness; drug absorption; drug blood level; drug choice; drug contraindication; drug distribution; drug dosage form comparison; drug effect; drug efficacy; drug eruption; drug half life; drug hypersensitivity; drug induced headache; drug megadose; drug metabolism; drug response; drug safety; drug tolerability; drug withdrawal; dry eye; dyspnea; epistaxis; erythema; eye inflammation; eye irritation; eye toxicity; fatigue; glaucoma; glaucoma surgery; growth retardation; heart rate; human; hyperemia; allergic reaction; hypoglycemia; hypotension; intraocular hypertension; intraocular pressure; iris disease; iritis; lacrimation; low level laser therapy; metabolic acidosis; monotherapy; muscle hypotonia; myopia; nausea; neurotoxicity; open angle glaucoma; pain; paresthesia; patient compliance; pruritus

Cost of illness of glaucoma: A critical and systematic review - Fiscella, R.G.; Lee, J.; Davis, E.J.H.; Walt, J. (PharmacoEconomics, 2009)
Cost-of-illness studies determine the total financial burden of a disease by considering direct and indirect costs, including medication, diagnostics and surgery. Studies of resource use and costs associated with primary open-angle glaucoma have used varying methodologies. Most have focused on consumption of healthcare resources at various stages of disease to anticipate costs. The direct costs associated with the disease often continue to increase as glaucoma progresses from the earliest to most advanced stages. Determinations of the costs associated with glaucoma progression and prevention should also incorporate the chance of patient non-compliance with treatment. Since glaucoma severity most often correlates with increased costs, minimizing or halting visual field loss and increasing patient treatment compliance may all contribute to a reduction in the overall economic burden of glaucoma. © 2009 Adis Data Information BV. All rights reserved.
Keywords: Canada; cost of illness; diagnostic procedure; disease course; disease severity; drug cost; economic aspect; Europe; glaucoma surgery; human; open angle glaucoma; patient compliance; priority journal; prophylaxis; review; treatment refusal; United States; visual field; visual impairment

Glaucoma treatment-Glaucoma: Many affected; high estimated number of unreported cases (Deutsche Apotheker Zeitung, 2009)
Keywords: betaxolol; bimatoprost; brimonidine; brinzolamide; carbachol; carteolol; clonid ophtal; clonidine; dorzolamide; glauco stulln; latanoprost; metipranolol; pilocarpine; pilocarpine; pindolol; tafluprost; timo ophtal; timolol; travoprost; unclassified drug; blindness; glaucoma; human; intraocular pressure; low level laser therapy; pathogenesis; patient compliance; risk factor; short survey; visual field; alphagan; arteoptic; azopt; betamann; betoptima; clonid ophtal; glauco stulln; isopto carbachol; lumigan; pilomann; taflotan; timo ophtal; travatan; trusopt; xalatan

Intraocular pressure control and fluctuation: The effect of treatment with selective laser trabeculoplasty - Nagar, M.; Luhishi, E.; Shah, N. (British Journal of Ophthalmology, 2009)
Aims: To evaluate the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) control and diurnal tension curves of patients with open-angle glaucoma (OAG) and ocular hypertension (OHT), and to compare this effect with that of latanoprost. Methods: Forty patients were randomised to receive either SLT or latanoprost. IOP control was evaluated by comparing pretreatment values with post-treatment measurements on day 3, week 1, month 1 and 4-6 months; success was defined as 20% decrease in IOP. Tension curves were plotted prior to treatment and 4-6 months afterwards; success was 50% reduction in fluctuation. Results: SLT decreased pressure by 4.7 mm Hg on average (95% CI 3.6 to 5.7 mm Hg; p. 0.01). The reduction was similar for latanoprost at all follow-ups except month 1; 75% of SLT patients and 73% of latanoprost patients achieved success in IOP control (p = 0.4). SLT significantly reduced IOP fluctuation, but latanoprost was more effective (3.6 mm Hg, 95% CI 3.2 to 3.9 mm Hg vs 2.5 mm Hg, 95% CI 2.2 to 2.9 mm Hg for SLT; p = 0.04). Success in fluctuation reduction was 50% for SLT and 83% for latanoprost (p = 0.045). Conclusions: Both SLT and latanoprost had a significant impact on IOP control and fluctuation. While latanoprost may be more likely to reduce IOP fluctuation, SLT has the benefit of being a one-time intervention not requiring ongoing patient compliance.
Keywords: latanoprost; adult; aged; article; clinical article; female; human; intermethod comparison; intracranial pressure monitoring; intraocular hypertension; intraocular pressure; laser surgery; male; open angle glaucoma; patient compliance; priority journal; trabeculoplasty

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients - Sleath, B.; Ballinger, R.; Covert, D.; Robin, A.L.; Byrd, J.E.; Tudor, G. (American Journal Geriatric Pharmacotherapy, 2009)
Objective: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients. Methods: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week. Results: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37-93 years]; black race, 45.4%; white race, 44.0%; "other" or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported ≥1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were "drops fall on cheek" (29.1%), "too many drops come out" (20.6%), and "hard to read print" (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05). Conclusion: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite. © 2009 Excerpta Medica Inc. All rights reserved.
Keywords: antiglaucoma agent; eye drops; adult; African American; aged; article; Caucasian; drug self administration; female; glaucoma; health survey; human; major clinical study; male; outpatient; outpatient care; patient attitude; patient compliance; priority journal; race difference; self report; veteran

Efficacy, tolerability and safety of the fixed combination of bimatoprost 0.03% and timolol 0.5% in a broad patient population: Multicenter, open-label observational study - Feuerhake, C.; Buchholz, P.; Kimmich, F. (Current Medical Research and Opinion, 2009)
Objective: To evaluate intraocular pressure (IOP)-lowering efficacy, tolerability, and safety of the fixed combination of bimatoprost 0.03% and timolol 0.5% (Ganforty) among German patients. Methods: Multicenter, observational, open-label study of patients with primary open angle glaucoma or ocular hypertension (n = 606). As determined by participating physicians, patients had insufficient IOP control and required a medication change. They were switched to once-daily fixed-combination bimatoprost/timolol with no wash-out period. IOP was recorded at treated baseline, 4-6 weeks and 12 weeks after switching. Tolerability was measured using a 4-step scale (excellent, good, moderate, poor) and all adverse events were recorded. Results: A total of 405 patients switched from monotherapy, 97 switched from other fixed combinations, and 104 switched from non-fixed combinations. Among all patients, 32.5% had used prostaglandin analog (PGA) monotherapy, 8.7% had been using a fixed combination that included a PGA, and 6.9% had been using an adjunctive combination of a PGA and a β-blocker. Mean treated baseline IOP (±SD) for all patients was 20.7 ± 3.5 mmHg. Overall, changing medication to fixed-combination bimatoprost/timolol lowered IOP to 16.6 ± 2.7 mmHg (p<0.001 vs. baseline) after 4-6 weeks and to 16.1 ± 2.6 mmHg (p<0.001) after 12 weeks; reductions of 19.8% and 22.2%, respectively. Combined bimatoprost/timolol provided an additional IOP reduction versus baseline in most subgroups based on prior treatment. At week 12, patients who had previously used a β-blocker achieved an additional 25.8% decrease from baseline and IOP was reduced by 22.6% in former PGA monotherapy patients. At week 12, 84.6% of all eyes reached a target pressure less than or equal to 18 mmHg. Tolerability of bimatoprost/timolol was rated excellent or good by the physicians for 98.7% of patients and by 96.7% of the patients themselves. Few adverse events occurred during the treatment period. Conclusions: Although this study was limited by its observational design, our results show that the fixed combination of bimatoprost 0.03%/timolol 0.5% was effective, well tolerated, and safe in a broad patient population. © 2009 Informa UK Ltd. All rights reserved.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; brimonidine plus timolol; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost plus timolol; miotic agent; prostaglandin derivative; timolol; timolol plus travoprost; adolescent; adult; aged; clinical trial; conference paper; conjunctival hyperemia; drug efficacy; drug mechanism; drug safety; drug substitution; drug tolerability; drug withdrawal; dry eye; eye irritation; eyelid disease; female; Germany; human; intraocular pressure; major clinical study; male; multicenter study; observational study; open angle glaucoma; open study; optic disk anomaly; patient compliance; rating scale; risk factor; visual field defect; ganfort

Personality traits, depression, and objectively measured adherence to once-daily prostaglandin analog medication in glaucoma - Holló, G.; Kóthy, P.; Géczy, A.; Vargha, P. (Journal of Glaucoma, 2009)
PURPOSE: To investigate the influence of personality traits, depression, and training on objectively measured adherence to once-daily prostaglandin analog medication. METHODS: Adherence was measured with the Travalert Dosing Aid on 58 consecutive, regularly followed-up glaucoma patients already on self-administered travoprost. Before the 3-month data-collection period all patients received training on use of the device. Psychologic characteristics were measured using the State-Trait Anxiety Inventory, Eysenck Personality Questionnaire, and Beck Hopeless Scale and Depression Inventory. An adherent day was defined as travoprost instillation at 9 PM ±2 hours. RESULTS: Adherence was 77% for the total period. Social desirability was higher than normal (U test, P<0.0001). Seven patients (12.1%) showed mild-to-moderate depression, which was not significantly associated with decreased adherence (Kruskal-Wallis test, P=0.071). Severity of glaucoma, number of ocular and systemic medications, satisfaction with the recording device, and socio-economic characteristics had no influence on adherence. CONCLUSIONS: Objectively measured adherence to once-daily prostaglandin analog medication was good, and not influenced by treatment characteristics or patient factors including mild-to-moderate depression. The elevated social desirability suggests that self-reported adherence is not a reliable measure of adherence in glaucoma. © 2009 Lippincott Williams & Wilkins, Inc.
Keywords: travoprost; anxiety; article; Beck Hopelessness Scale; controlled study; depression; depression inventory; devices; disease severity; drug instillation; drug self administration; evening dosage; Eysenck Personality Questionnaire; female; follow up; glaucoma; human; major clinical study; male; patient attitude; patient compliance; patient education; patient participation; patient satisfaction; personality; priority journal; social status; socioeconomics; State Trait Anxiety Inventory; travert dosing aid; treatment duration; travatan

The safety and efficacy of brinzolamide 1%/timolol 0.5% fixed combination versus dorzolamide 2%/timolol 0.5% in patients with open-angle glaucoma or ocular hypertension - Manni, G.; Denis, P.; Chew, P.; Sharpe, E.D.; Orengo-Nania, S.; Coote, M.A.; Laganovska, G.; Volksone, L.; Zeyen, T.; Filatori, I.; James, J.; Aung, T. (Journal of Glaucoma, 2009)
PURPOSE: This study compared the intraocular pressure (IOP)-lowering efficacy of 2 fixed combination products, brinzolamide 1%/timolol 0.5% suspension (Azarga, Brinz/Tim) and dorzolamide 2%/timolol 0.5% solution (Dorz/Tim), in patients with open-angle glaucoma or ocular hypertension who required a change in therapy due to elevated IOP while receiving IOP-lowering medication. METHODS: This was a one-year, multicenter, randomized, double-masked, active-controlled, parallel-group trial of Brinz/Tim and Dorz/Tim. IOP assessments were taken at 8 and 10 AM at week 2 and months 3 and 9, and at 8 AM, 10 AM, and 4 PM at months 6 and 12. Primary efficacy was a noninferiority comparison of mean IOP at the three month 6 time points. RESULTS: Of the 437 patients enrolled, 220 dosed Brinz/Tim whereas 217 dosed Dorz/Tim twice daily. Brinz/Tim produced IOP-lowering efficacy comparable to Dorz/Tim, with the upper 95% confidence limits for the differences between groups within +1.5 mm Hg at all assessment times, including the month 6 primary efficacy time points, establishing noninferiority. Differences in means numerically favored Brinz/Tim at 9 of 12 study visits and times. The IOP reductions ranged from 7.2 to 9.2 mm Hg for Brinz/Tim and from 7.4 to 8.9 mm Hg for Dorz/Tim. Although a similar overall safety profile was observed between the 2 treatment groups, Brinz/Tim showed significantly less ocular irritation (2.7% vs. 10.6%; P=0.0009) than Dorz/Tim. CONCLUSIONS: Brinz/Tim suspension provides statistically significant and clinically relevant IOP-lowering efficacy that is noninferior to Dorz/Tim. Additionally, Brinz/Tim affords an ocular comfort advantage compared with Dorz/Tim. © 2009 Lippincott Williams & Wilkins, Inc.
Keywords: antiglaucoma agent; brinzolamide plus timolol; brinzolamide plus timolol; dorzolamide plus timolol; unclassified drug; abnormal sensation; adult; aged; article; blurred vision; clinical trial; conjunctival hyperemia; controlled clinical trial; controlled study; double blind procedure; drug efficacy; drug safety; drug withdrawal; dysgeusia; eye irritation; eye pain; female; foreign body sensation; foreign body sensation; human; intraocular hypertension; intraocular pressure; major clinical study; male; multicenter study; ocular hyperemia; ocular hyperemia; open angle glaucoma; patient compliance; priority journal; randomized controlled trial; treatment response; azarga

The impact of ocular adverse effects in patients treated with topical prostaglandin analogs: Changes in prescription patterns and patient persistence - Zimmerman, T.J.; Hahn, S.R.; Gelb, L.; Tan, H.; Kim, E.E. (Journal of Ocular Pharmacology and Therapeutics, 2009)
Purpose: To document patient/physician perceptions of adverse effects and their relationship to medication changes among patients prescribed prostaglandin analogs. Methods: Medical/pharmacy claims (private U.S. health network) identified patients filling initial topical ocular hypotensive prescriptions from 2001 to 2004; 300 open-angle glaucoma patients prescribed a prostaglandin analog and 103 ophthalmologists were selected by algorithm for telephone interviews. Medical charts for 225/300 interviewed and 75 non-interviewed patients were abstracted. Medication patterns were assessed in pharmacy claims data. Frequency of adverse effects noted by physicians and associations with medication change decisions were examined in charted data. Patients' experiences with adverse effects were compiled from surveys. Results: In patients treated with latanoprost (N = 4,071), bimatoprost (N = 1,199), or travoprost (N = 1,001), continuous refill of medication through 1 year was seen in 11%, 9%, and 5% of patients, respectively (P = 0.0001; retrospective pharmacy claims). Adverse effects were the second most common reasons noted by physicians for switching medications after lack of efficacy (19% vs. 43%, respectively). Adverse effects were noted in 65% of patient charts. Hyperemia was the most common adverse effect occurring with at least one other adverse effect in 48% of patients with the condition. Conclusions: Ocular adverse effects, particularly hyperemia, negatively affect patient continuation with therapy and switching. © Mary Ann Liebert, Inc. 2009.
Keywords: bimatoprost; latanoprost; travoprost; adult; article; billing and claims; controlled study; drug efficacy; drug substitution; drug utilization; drug withdrawal; eye burning; eye color; eye discomfort; eye disease; eye pain; eyelid disease; frequency analysis; health survey; human; hyperemia; interview; major clinical study; medical decision making; medical record review; monotherapy; ocular pruritus; open angle glaucoma; patient compliance; personal experience; pharmacy (shop); prescription; side effect; telephone; topical treatment; utilization review

Patient-reported barriers to glaucoma medication access, use, and adherence in southern India - Sleath, B.L.; Krishnadas, R.; Cho, M.; Robin, A.L.; Mehta, R.; Covert, D.; Tudor, G. (Indian Journal of Ophthalmology, 2009)
The objectives of the study were to (a) describe the different types of problems that patients in southern India reported having when taking their glaucoma medications and (b) examine the relationship between patient reported-problems in taking their glaucoma medications and the self-reported patient adherence. A survey was conducted by clinical staff on 243 glaucoma patients who were on at least one glaucoma medication in an eye clinic in southern India. We found that 42% of patients reported one or more problems in using their glaucoma medications. Approximately 6% of patients reported being less than 100% adherent in the past week. Unmarried patients and patients who reported difficulty squeezing the bottle and difficulty opening the bottle were significantly more likely to report nonadherence.
Keywords: antihypertensive agent; article; attitude to health; drug utilization; female; glaucoma; health care delivery; health services research; human; India; male; medication error; patient compliance; questionnaire; statistics; urban population

The Logic Behind Target Intraocular Pressure - Coleman, A.L.; Caprioli, J. (American Journal of Ophthalmology, 2009)
Keywords: antihypertensive therapy; blood pressure measurement; clinical practice; disease course; editorial; Europe; glaucoma; hypertension; intraocular hypertension; intraocular pressure; medical society; medical specialist; medicare; open angle glaucoma; patient compliance; practice guideline; priority journal; smoking cessation; United States; vision

Reply: Routine reduction of glaucoma medication following phacoemulsification - Shingleton, B.J. (Journal of Cataract and Refractive Surgery, 2009)
Keywords: acetazolamide; cost of illness; disease control; drug use; follow up; glaucoma; human; intraocular pressure; lens implant; letter; major clinical study; open angle glaucoma; optic nerve lesion; patient compliance; phacoemulsification; postoperative care; preoperative evaluation; priority journal

Seizure Disorders - Schachter, S.C. (Medical Clinics of North America, 2009)
The diagnosis and management of patients with epilepsy is often undertaken by pediatricians, internists, and geriatricians (primary care physicians [PCPs]). Although referral to a neurologist may be necessary if the diagnosis of epilepsy is unclear or if the patient does not respond to initial therapy with antiepileptic drugs, PCPs may subsequently follow-up with patients to implement the recommendations of the neurologist. To maximize the likelihood of treatment success, PCPs should supplement antiepileptic drug therapy with patient education and referrals for psychosocial and vocational support when needed. Special considerations are warranted for women of childbearing potential and elderly patients. © 2009 Elsevier Inc. All rights reserved.
Keywords: alpha fetoprotein; anticonvulsive agent; carbamazepine; ethosuximide; etiracetam; folic acid; gabapentin; lamotrigine; oxcarbazepine; phenobarbital; phenytoin; pregabalin; topiramate; valproic acid; absence; agranulocytosis; alcohol abuse; Alzheimer disease; amniocentesis; anorexia; aplastic anemia; asthenia; ataxia; congenital malformation; blurred vision; brain tumor; capillary resistance; cerebrovascular disease; cleft lip; cleft palate; cognitive defect; complex partial seizure; computer assisted tomography; concentration loss; confusion; congenital heart malformation; depression; dermatitis; diarrhea; differential diagnosis; diplopia; dizziness; DRESS syndrome; drowsiness; drug abuse; drug blood level; drug clearance; drug eruption; drug excretion; drug fatality; drug half life; drug metabolism; drug protein binding; dyslexia; electroencephalogram; epilepsy; fatigue; fetus echography; fetus malformation; fluid retention; focal epilepsy; follow up; geriatric patient; gingiva hypertrophy; glaucoma; tonic clonic seizure; hair loss; head injury; headache; hirsutism; human; hyperactivity; hyponatremia; irritability; laboratory test; lethargy; liver dysfunction; liver failure; lymphadenopathy; metabolic acidosis; microcephaly; nausea; nephrolithiasis; nervousness; neural tube defect; neuropathy; nuclear magnetic resonance imaging; pancreatitis; paresthesia; pathogenesis; patient assessment; patient compliance; patient education; patient referral; pregnancy outcome; prenatal drug exposure; primary medical care; priority journal; pruritus; psychosocial care

Best practice contact lens care: A review of the Asia Pacific Contact Lens Care Summit - Sweeney, D.; Holden, B.; Evans, K.; Ng, V.; Cho, P. (Clinical and Experimental Optometry, 2009)
Contact lens hygiene has long been recognised as key to the prevention of contact-lens associated infection and inflammation. Microbial keratitis (MK) is the only serious and potentially sight-threatening contact lens adverse event. International studies including recent research in Asia Pacific show that MK is rare but, as the consequences can be severe, it is important to minimise the risk factors. Studies continue to show that one of the key risk factors is lens and lens case hygiene. Therefore, it is also useful to review the behaviour of our patients, to see how closely they follow the recommended hygiene practices. Recent studies in various regions have shown that patients' lens care habits do not meet a required standard. Patients can become complacent and thus non-compliant with lens care instructions. Furthermore, they do not understand the high risk of some behaviour and they are not hearing the practitioner when instructions and reminders are given. Further education is important to improve patient compliance and safety. The Asia Pacific Contact Lens Care Summit held in Singapore urged the industry and practitioners to restore the emphasis of proper lens care, including the 'rub and rinse' technique, and developed a new set of guidelines to help eye-care professionals educate their patients on the importance of proper contact lens care to avoid eye infections. The summit also presented the latest research on how to avoid corneal staining, another important element of contact lens care. This review provides a summary of the summit presentations and the science behind these guidelines. © 2008 Optometrists Association Australia.
Keywords: contact lens solution; article; contact lens; eye infection; human; hygiene; keratitis; patient compliance; patient education; practice guideline

Graft rejection episodes after Descemet stripping with endothelial keratoplasty: Part one: Clinical signs and symptoms - Jordan, C.S.; Price, M.O.; Trespalacios, R.; Price Jr., F.W. (British Journal of Ophthalmology, 2009)
Aim: To investigate characteristics of initial immunological graft rejection after Descemet stripping with endothelial keratoplasty (DSEK). Methods: The incidence, symptoms and clinical characteristics of initial immunological graft rejection episodes were analysed retrospectively in 598 eyes treated with primary DSEK at a single tertiary referral centre. Results: Graft rejection episodes occurred in 54 eyes of 48 patients. Thirty-five per cent of the eyes were asymptomatic and were diagnosed during routine examination. Signs of immunological rejection at the initial diagnosis included keratic precipitates (69%), diffuse corneal oedema (11%) or both (20%); no endothelial rejection lines were observed. In contrast to standard full-thickness grafts, there were no epithelial immunological reactions because the epithelium and anterior stroma are not transplanted in DSEK. Most grafts cleared; four (7%) progressed to graft failure and were successfully regrafted with DSEK. Conclusions: Immunological graft rejection is an important postoperative complication after DSEK. The range of clinical findings indicative of corneal graft rejection differs in some respects between DSEK and standard penetrating keratoplasty.
Keywords: corticosteroid; dexamethasone plus tobramycin; fluorometholone; loteprednol etabonate; methylprednisolone sodium succinate; prednisolone acetate; aged; article; clinical article; cornea edema; Descemet membrane; Descemet stripping endothelial keratoplasty; drug dose reduction; drug substitution; drug withdrawal; endothelium cell; eye edema; eye examination; eye irritation; eye pain; female; graft failure; graft rejection; human; immunoreactivity; immunosuppressive treatment; intraocular hypertension; keratitis; keratoplasty; low drug dose; male; patient compliance; postoperative complication; priority journal; reoperation; retrospective study; stroma; surgical technique; treatment duration; treatment outcome; visual acuity; visual impairment; lotemax; pred forte; tobradex

Improving the prediction of medication compliance: The example of bisphosphonates for osteoporosis - Curtis, J.R.; Xi, J.; Westfall, A.O.; Cheng, H.; Lyles, K.; Saag, K.G.; Delzell, E. (Medical Care, 2009)
Introduction: Administrative claims data have a limited ability to identify persons with high compliance to oral bisphosphonates. We tested whether adding information on compliance with other drugs used to treat chronic, asymptomatic conditions would improve the predictive ability of administrative data to identify adherent individuals. Methods: Using data from a large, US healthcare organization, we identified new bisphosphonate users and their 1-year compliance to oral bisphosphonates, quantified by the Medication Possession Ratio (MPR). Multivariable logistic regression models evaluated the relationship between high bisphosphonate compliance (MPR ≥80%) and patient demographics, comorbidities, and health services utilization. To these logistic regression models, we evaluated the incremental change in the area under the receiver operator curve (AUC) after adding information regarding compliance with other drug classes. These included antihyperlipidemics (statins), antihypertensives, antidepressants, oral diabetes agents, and glaucoma medications. Results from the logistic regression models were evaluated in parallel using recursive partitioning trees with 10-fold cross-validation. Results: Among 101,038 new bisphosphonate users, administrative data identified numerous nonmedication factors (eg, age, gender, use of preventive services) significantly associated with high bisphosphonate compliance at 1 year. However, all these factors in aggregate had low discriminant ability to identify persons highly adherent with bisphosphonates (AUC = 0.62). For persons who were new users of ≥1 of the other asymptomatic condition drugs, MPR data on the other drugs substantially improved the prediction of high bisphosphonate compliance. The impact on prediction was largest for concomitant statin users (AUC = 0.70). Conclusions: Information on compliance with drugs used to treat chronic asymptomatic conditions improves the prediction of compliance with oral bisphosphonates. This information may help identify persons who should receive targeted interventions to promote compliance to osteoporosis medications. Copyright © 2009 by Lippincott Williams & Wilkins.
Keywords: alendronic acid; angiotensin receptor antagonist; antidepressant agent; antidiabetic agent; antiglaucoma agent; antihypertensive agent; beta adrenergic receptor blocking agent; bisphosphonic acid derivative; calcitonin; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; estrogen; glucocorticoid; hydroxymethylglutaryl coenzyme A reductase inhibitor; ibandronic acid; raloxifene; risedronic acid; serotonin uptake inhibitor; thiazide diuretic agent; adult; aged; article; colonoscopy; comorbidity; controlled study; demography; depression; diabetes mellitus; female; gender; glaucoma; health care utilization; hip fracture; human; hypertension; hyperthyroidism; long term care; major clinical study; male; mammography; occult blood; osteoporosis; patient compliance; prediction; rheumatoid arthritis; sigmoidoscopy; smoking; spine fracture

The monocular trial controversy: A critical review - Bhorade, A.M. (Current Opinion in Ophthalmology, 2009)
Purpose of review The utility of the monocular trial to determine the response to topical ocular hypotensive medications has been recently debated. This review provides a critical evaluation of recent studies and discusses factors that affect the accurate determination of medication response. Recent findings Recent concerns about the validity of the monocular trial arise from studies reporting a low-to-moderate correlation of intraocular pressure (IOP) response between the first and second eyes to the same topical ocular hypotensive medication. Few studies, however, have addressed the classic monocular trial that adjusts IOP in the trial eye based on IOP change in the fellow eye. Conflicting results from prior studies are due to differences in study question, study design, and method of analysis. Factors such as variability of IOP, diurnal variation, and regression to the mean further complicate the understanding of whether monocular trials or binocular simultaneous trials (i.e. testing each eye separately) are better for determining medication effect. Summary The issue of whether or not to use the monocular trial remains controversial. A more clear understanding of factors such as nontherapeutic variability of IOP within the same eye and between eyes may elucidate the answer to this question. Further studies of monocular and binocular trials are needed to clarify which method better estimates medication response. © 2009 Wolters Kluwer Health|Lippincott Williams & Wilkins.
Keywords: adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; latanoprost; prostaglandin derivative; accuracy; circadian rhythm; clinical trial; glaucoma; human; intraocular hypertension; intraocular pressure; open angle glaucoma; patient compliance; priority journal; review; treatment response

Switching within glaucoma medication class - Law, S.K. (Current Opinion in Ophthalmology, 2009)
Purpose of review In the current medical care environment, switching within class is often demanded by cost consideration, medical insurance coverage, or formulary restriction. With many choices of drugs available within a glaucoma medication class, questions exist whether switching within class is beneficial. The purpose of this article is to provide a clinical update on the feasibility of switching among the frequently used drugs within glaucoma medication class. Recent findings Although efficacies of medications within a therapeutic class are similar and significant differences are generally not observed in clinical trials, response to medication often varies among individual patients in a clinical practice. Such variation may be secondary to differences in drug-receptor interactions, patient's compliance and tolerability to medical treatment, or bioavailability of the medication in individual ocular condition. In addition, switching within class is often necessary to minimize the systemic or local adverse reactions from the active or inactive ingredients of the medication. Summary In addition to keeping up-to-date with the efficacy and safety profiles of drugs within each glaucoma medication class, clinicians should familiarize themselves with the different formulations available, preservative systems used, generics availability and compatibility, and the local insurance formulary restriction to deliver an effective glaucoma management. © 2009 Wolters Kluwer Health|Lippincott Williams & Wilkins.
Keywords: acetazolamide; epinephrine; alpha adrenergic receptor stimulating agent; brimonidine; apraclonidine; benzalkonium chloride; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; dipivefrine; dorzolamide; ecothiopate iodide; latanoprost; levobunolol; methazolamide; metipranolol; pilocarpine; prostaglandin derivative; timolol; timolol gfs; timolol maleate; travoprost; unclassified drug; unoprostone isopropyl ester; bedtime dosage; blurred vision; bronchospasm; cardiovascular disease; conjunctival hyperemia; drug efficacy; drug formulary; drug hypersensitivity; drug indication; drug safety; drug substitution; drug tolerability; drug withdrawal; epiphora; eye color; eye toxicity; eyelash; feasibility study; glaucoma; heart arrhythmia; human; hypertension; intraocular pressure; open angle glaucoma; patient compliance; priority journal; review; sedation; side effect; tachycardia; treatment response; unspecified side effect; alphagan p; istalol; ocusert; timolol gfs; timoptic xe

Relationship with the glaucomatous patient: how to announce glaucoma to the patient? - Ginies, P. (Journal Francais d'Ophtalmologie, 2009)
Announcement of a chronic disease, always, is a difficult task in the physician professional activity. For glaucoma, its possible impact on their vision and quality of life are a source of anxiety for most patients. The message should be simple and comprehensible, but accurate, to ensure long term compliance to follow-up and treatment. Announcement should be tailored to the patient personality and psychological profile. The clinician should know his own personality, but his patient's personality also, to guarantee successful information and communication and a good quality patient-clinician relationship. Simple rules to be applied are described. © 2009 Elsevier Masson SAS. All rights reserved.
Keywords: adaptive behavior; doctor patient relationship; glaucoma; human; interpersonal communication; ophthalmology; psychological aspect; short survey

Pathophysiology of glaucoma and continuous measurements of intraocular pressure. - Sit, A.J.; Liu, J.H. (Molecular & cellular biomechanics : MCB, 2009)
Glaucoma is a leading cause of visual impairment and blindness worldwide. The main risk factor for glaucoma is an elevated intraocular pressure (IOP), which is also the only currently treatable risk factor. Despite its importance, our understanding of IOP is incomplete and our ability to measure IOP is limited. IOP is known to undergo both random fluctuations as well as variations following a circadian pattern. In humans, IOP is highest at night and lower during the daytime, largely due to changes in body position, although other factors appear to contribute. In rabbits, IOP is also highest at night and lower during the day, likely due to circadian variations in sympathetic nervous system activity. Random and circadian IOP variations may be important to glaucoma pathogenesis, independent of the diurnal IOP level. However, due to limitations with current IOP measurement technology, clinical practice typically involves only a few IOP measurements per year. As well, current technology does not allow 24-hour monitoring of pressure without the use of sleep laboratories or hospital admission. Two strategies for automating IOP measurement are temporary (non-invasive) monitoring and permanent (implantable) monitoring. Efforts at developing devices to allow continuous IOP monitoring have occurred for over 40 years without producing a clinical device. Current technological progress would seem to suggest that such devices are possible at this time, and a review of previous attempts provides guidelines for their development.
Keywords: ambulatory monitoring; animal; animal model; blood pressure; body position; circadian rhythm; eye; glaucoma; histology; human; devices; intraocular pressure; methodology; oculoplethysmography; optic nerve; pathology; pathophysiology; physiology; Leporidae; review; risk factor

Determinants of adherence to glaucoma medical therapy in a long-term patient population - Djafari, F.; Lesk, M.R.; Harasymowycz, P.J.; Desjardins, D.; Lachaine, J. (Journal of Glaucoma, 2009)
PURPOSE: Estimate patient adherence to glaucoma medications and identify potential determinants of nonadherence. DESIGN: Descriptive study. METHODS: Two hundred patients with open angle glaucoma, ocular hypertension, or glaucoma suspects were interviewed regarding their glaucoma and its treatment and their charts were reviewed. Their ophthalmologist completed a brief assessment form. Drug utilization data were extracted from the provincial drug program database. Patients were defined as adherent if they filled at least 75% of the prescribed medication necessary for their treatment. RESULTS: Data were available for 181 patients. About 62.9% were female and the mean age (±SD) was 75.1±8.8 years. The mean number of years of glaucoma treatment was 10.7±9.3. Self-reported treatment adherence was 88.3%. On the basis of the drug database, the proportion of patients who were adherent to treatment was 71.8%. According to physicians, 74.6% of patients were adherent. Among patients considered by physicians as nonadherent, 71.1% (32/45) were adherent and among patients predicted as adherent, 72.1% (98/136) were adherent. There was no significant difference in adherence according to age, sex, education, and income. However, patients using fewer agents (P=0.041), who were widowed (P=0.041), or who lived alone (P=0.042) were more adherent. Patients using prostaglandins analogs or β-blockers were more adherent than those using carbonic anhydrase inhibitors (P<0.05). CONCLUSIONS: Fewer medications, use of prostaglandin analogs or β-blockers, living alone, and being widowed were significantly associated with adherence. Physicians were unable to significantly predict which patients are adherent. © 2009 Lippincott Williams & Wilkins, Inc.
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; miotic agent; prostaglandin derivative; aged; article; controlled study; female; glaucoma; human; intraocular hypertension; long term care; major clinical study; male; open angle glaucoma; patient compliance; patient education; priority journal; self report

Pharmacotherapy compliance in patients with ocular hypertension or primary open-angle glaucoma - Traverso, C.E.; Walt, J.G.; Stern, L.S.; Dolgitser, M. (Journal of Ocular Pharmacology and Therapeutics, 2009)
Purpose: The aim of this study was to compare rates of pharmacotherapy coverage in patients with ocular hypertension (OH) and patients with primary open-angle glaucoma (POAG). Methods: Retrospective cohort study analysis of a nationally representative, multimanaged health plan database (PharMetrics; 1998-2005) which included 4818 medicated OH patients and 52,985 medicated POAG patients with at least 1 year of continuous enrollment and at least one prescription for IOP-lowering medication during the first year of follow-up. Patients selected for the current study were nested within the cohort of OH patients (n = 36,767) and POAG patients (n =72,412) previously reported. Of the previously reported OH cohort, only 13.1% of patients filled at least one prescription, as compared to 73.2% of the previously reported POAG cohort. Medication coverage was defined as the percent of days during which a patient was in possession of IOP-lowering therapy over the first year of follow-up (medication coverage = number of covered days/365). Compliant patients were defined as those with ≥ 75th percentile medication coverage. Results: POAG patients had slightly longer mean length of enrollment in the database (2.5 years, SD = 1.2) than did OH patients (2.4 years, SD = 1.1; P < 0.0001). The mean medication coverage was 50% for the POAG cohort (SD = 0.26) and 40% for the OH cohort (SD = 0.25; P < 0.0001). In multivariate models controlling for key covariates of interest, POAG patients were 1.9 (95% CI: 1.7 to 2.0) times more likely to be compliant with their pharmacotherapy than OH patients. Conclusion: In general, pharmacotherapy coverage was poor. Patients with POAG, a more severe condition, were significantly more covered with pharmacotherapies than patients with OH. It is important to implement strategies to help improve patient coverage prior to occurrence of more severe disease. © Mary Ann Liebert, Inc. 2009.
Keywords: adolescent; adult; aged; article; cohort analysis; comorbidity; controlled study; female; human; intraocular hypertension; intraocular pressure; major clinical study; male; open angle glaucoma; patient care; patient compliance

Blueberry eye: Acquired total anterior staphyloma after a fungal corneal ulcer - Grieser, E.J.; Tuli, S.S.; Chabi, A.; Schultz, S.; Downer, D. (Cornea, 2009)
PURPOSES: The purposes of this study were to report the presentation and management of an acquired total anterior staphyloma that resulted from a fungal corneal ulcer and to discuss its pathogenesis. METHODS: Observational case report. Clinical observation and surgical intervention of a patient who developed a total anterior staphyloma after a partially treated fungal corneal ulcer. RESULTS: The patient presented with a large traumatic fungal ulcer but was poorly compliant with follow-up and medications. He subsequently presented with a large total anterior staphyloma that resulted from perforation of the ulcer with plugging of the defect with iris and formation of a pseudocornea over the iris. The anterior staphyloma measured 15 × 16 mm and progressed to a stage where the patient was unable to close his eyelids and required a sclerokeratoplasty. Currently, vision is poor from amblyopia and a cloudy graft; however, the eye is intact and comfortable. CONCLUSIONS: Anterior staphylomas usually result from untreated fungal ulcers in developing nations. Poor compliance with medications and follow-up was the cause of our patient's anterior staphyloma. Sclerokeratoplasty can restore the globe structurally but has poor visual prognosis. © 2009 by Lippincott Williams & Wilkins.
Keywords: antifungal agent; timolol; adult; amblyopia; anamnesis; article; case report; clinical assessment; clinical feature; cornea neovascularization; cornea ulcer; eye examination; follow up; fungus culture; histopathology; human; human tissue; intraocular pressure abnormality; keratomycosis; keratoplasty; male; pathogenesis; patient compliance; priority journal; sclerokeratoplasty; slit lamp; staphyloma; surgical technique; uvea disease; vision; visual acuity

Factors affecting compliance with eye drop therapy for glaucoma in a multicultural outpatient setting. - Curtis, C.; Lo, E.; Ooi, L.; Bennett, L.; Long, J. (Contemporary nurse : a journal for the Australian nursing profession, 2009)
Ophthalmic nurses at Sydney Hospital Sydney Eye Hospital aimed to assess and evaluate the knowledge and resulting behaviours of patients using eye drop therapy for glaucoma and the effect that using interpreters or English speaking family members had on patients' understanding and compliance. Non-compliance is known to lead to progression of the disease with resulting loss of vision. The study showed that patients undergoing long-term therapy for glaucoma have areas of non-compliance that may not be apparent to staff who see them in a clinic setting. It also showed that ineffectual use or missed doses of eye drops occur in both male and female groups, young and older groups and those from non-English and English speaking backgrounds. This is in spite of the same patients' assurances that they have received clear instructions. It has been shown that the use of interpreters or English speaking family members has not affected compliance. This study has shown that even patients who have been on therapy for over 12 months are likely to benefit from continuing education and reinforcement of good technique. Poor understanding of glaucoma in the over 65 age group was not associated with a higher rate of non-compliance.
Keywords: eye drops; adolescent; adult; aged; ambulatory care; article; Australia; cultural anthropology; female; glaucoma; human; male; middle aged; patient compliance; questionnaire

Adherence with Topical Glaucoma Medication Monitored Electronically. The Travatan Dosing Aid Study - Okeke, C.O.; Quigley, H.A.; Jampel, H.D.; Ying, G.-s.; Plyler, R.J.; Jiang, Y.; Friedman, D.S. (Ophthalmology, 2009)
Purpose: To assess patient adherence and behaviors with topical once-daily therapy for glaucoma. Design: Prospective, observational cohort study. Participants: One hundred ninety-six patients with glaucoma who were being treated with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007. Methods: Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit. Main Outcome Measures: Assessment of adherence and patterns of drop usage as indicated by the DA. Results: A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (±standard deviation) adherence rate was 0.71 (±0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19). Conclusions: Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2009 American Academy of Ophthalmology.
Keywords: travoprost; adult; aged; anamnesis; article; clinical assessment; clinical trial; cohort analysis; software; controlled clinical trial; controlled study; dosing aid; drug monitoring; drug use; electronics; female; glaucoma; health behavior; human; major clinical study; male; medical record; observational study; patient attitude; patient compliance; patient monitoring; physician; priority journal; prospective study; randomized controlled trial; self report; single blind procedure; technical aid; treatment outcome; unspecified side effect; travatan; Travatan dosing aid

Cultural adaptation and validation into Spanish of the Glaucoma Symptom Scale (GSS) - Ruiz, M.A.; Pardo, A.; Martínez de la Casa, J.M.; Polo, V.; Esquirol, J.; Soto, J. (Medicina Clinica, 2009)
Background and objective: To describe the process of the cultural and psychometric adaptation (validation) into Spanish of the Glaucoma Symptom Scale (GSS) in order to measure the impact of glaucoma symptoms, and inform about the psychometric properties. Material and method: The study was supervised by a 6-member expert panel. After forward and backward translations in duplicate, a Spanish version was obtained which was administered to three samples: a 16-patient sample to check comprehenssion and face validity, a 100-patient sample to check structural validity (factor analysis and reliability) and, finally, a 387-patient sample for assessing construct and discrimination validity. Results: The questionnaire yielded 2 dimensions, which are not exactly the same as the ones in the original study. Reliability was high (alpha=0.82), and correlation between even-odd items was high too (r=0.92). The scale discriminated between lower and upper quartile groups (p<0.001). The average on non visual symptoms was higher than on visual ones (p=0.001), showing more inconvenience of the former. There were differences between compliant and non-compliant patients (p=0.004), but a lack of agreement between self-reported measures was also found. We found differences between patients with one or 2 drops treatments (p=0.0014). Conclusions: The results showed acceptable psychometric properties and they make available to health professionals a new instrument to assess glaucoma symptoms, taking into account the patient perspective. © 2008 Elsevier España, S.L. All rights reserved.
Keywords: article; comprehension; construct validity; correlation analysis; cultural factor; discriminant validity; face validity; factor analysis; glaucoma; Glaucoma Symptom Scale; human; instrument validation; language; language processing; major clinical study; patient compliance; patient participation; psychometry; questionnaire; rating scale; reliability; sample (statistics); self report; Spain; symptom; validation process

Prevalence and determinants of non-adherence to topical hypotensive treatment in Dutch glaucoma patients - Olthoff, C.M.G.; Hoevenaars, J.G.M.M.; van den Borne, B.W.; Webers, C.A.B.; Schouten, J.S.A.G. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2009)
Background: To assess the prevalence and determinants of non-adherence to topical hypotensive treatment in glaucoma patients in order to support interventions targeting enhancement of patient adherence. Methods: One-hundred and sixty-six glaucoma patients, recruited by nationwide multi-stage sampling, filled in an extensive and carefully developed questionnaire covering various theoretically relevant determinants of patient adherence which were categorized as psychosocial aspects, barriers and skills. Results: Prevalence of self-reported non-adherence was 27.3%. Younger patients (<55 years of age) had a higher risk of being non-adherent. Forgetfulness, unavailability of eye drops and difficulties with holding the bottle above the eye when applying the eye drops were the most cited reasons for non-adherence. Fifty percent of the patients indicated that they required more information on the correct administration of eye drops. There was no association between non-adherence and sex, level of education, type of insurance, duration of disease or family history of glaucoma. Conclusions: Non-adherence to topical glaucoma medication is fairly common. Aids that minimize forgetfulness and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence before advancing to other therapies with additional risks and costs. © The Author(s) 2008.
Keywords: aceclidine; agents acting on the eye; antiglaucoma agent; befunolol; betaxolol; brimonidine; brinzolamide; carteolol; dipivefrine; dorzolamide; dorzolamide plus timolol; epinephrine plus guanethidine; eye drops; latanoprost; levobunolol; metipranolol; metoprolol plus pilocarpine; timolol; unclassified drug; adult; article; disease duration; educational status; family history; female; health insurance; health survey; high risk population; human; major clinical study; male; open angle glaucoma; patient attitude; patient compliance; patient education; priority journal; self report; sex difference; social psychology

Sustained delivery of timolol maleate from poly(lactic-co-glycolic acid)/ poly(lactic acid) microspheres for over 3 months - Bertram, J.P.; Saluja, S.S.; McKain, J.; Lavik, E.B. (Journal of Microencapsulation, 2009)
It is estimated that 2.2 million people have glaucoma in the US and 67 million people worldwide. The majority of cases are associated with elevated intraocular pressure (IOP) and decreasing IOP eliminates or greatly reduces degeneration in most cases, including cases in which the IOP is in the normal range but optic neuropathy occurs. Timolol maleate has the longest record of safety and efficacy to lower IOP and is administered via eye drops one or more times per day. Unfortunately, compliance is poor across patient populations leading to degeneration. Patients typically see their ophthalmologist once every 3-4 months. If one could administer a long-acting treatment while in the doctor's office, one might overcome the compliance issue and effectively preserve sight. The critical step is to develop a formulation for timolol maleate that leads to sustained delivery for greater than 90 days and would permit a different treatment paradigm, namely subconjunctival administration once every 3-4 months. By using a 50 : 50 blend of PLGA 502H and PLA, this study was able to fabricate microspheres that delivered timolol maleate continually over 107 days, well within the time frame needed to make subconjunctival administration feasible and permit a new approach to treating glaucoma and diseases of the eye more broadly.
Keywords: eye drops; microsphere; polyglactin; polylactic acid; timolol maleate; article; controlled study; drug delivery system; drug efficacy; drug safety; encapsulation; glaucoma; human; intraocular pressure; particle size; patient compliance; scanning electron microscopy; sustained drug release; sustained release formulation

Exploring glaucoma awareness and the utilization of primary eye care services: Community perceived barriers among elderly African Caribbeans in Chapeltown, Leeds - Awobem, J.F.; Cassels-Brown, A.; Buchan, J.C.; Hughes, K.A. (Eye, 2009)
Keywords: African Caribbean; clinical study; eye care; glaucoma; health care utilization; health service; human; letter; patient attitude; primary medical care; socioeconomics; United Kingdom

Effect of travoprost on intraocular pressure during 12 months of treatment for normal-tension glaucoma - Suh, M.H.; Park, K.H.; Kim, D.M. (Japanese Journal of Ophthalmology, 2009)
Purpose: To evaluate the intraocular pressure (IOP)-lowering effect of travoprost in normal-tension glaucoma (NTG) over a 12-month follow-up. Methods: Forty-five eyes of 45 patients with unilateral NTG were treated with travoprost (0.004%) once a day for 12 months. Mean IOP and the IOP reduction from baseline were assessed at 0.5, 1, 3, 6, 9, and 12 months after the initiation of the treatment. Adverse ocular event frequency and the frequency of discontinuation of treatment due to adverse events were evaluated. Results: Mean IOP during 12 months of travoprost treatment ranged from 11.17 to 11.82 mmHg, and the mean IOP reduction in relation to baseline IOP from -2.71 to -3.71 mmHg (-18.3% to -25.1%). Mean IOP and IOP changes in the travoprost-treated and control groups were significantly different at every follow-up (P < 0.05 in each case). Both the magnitude (r = 0.6992) and percentage (r = 0.5464) of IOP reductions correlated positively with baseline IOP values. Ocular adverse events were usually mild to moderate and resolved without treatment. Conclusions: Travoprost was well tolerated and significantly reduced IOP in NTG patients. In addition, initial IOP reductions were maintained throughout follow-up. Travoprost was found to be more effective in patients with greater baseline IOP. © 2009 Japanese Ophthalmological Society (JOS).
Keywords: travoprost; adult; article; clinical article; conjunctival hyperemia; controlled study; drug withdrawal; evening dosage; eye disease; eye refraction; female; follow up; foreign body sensation; foreign body sensation; glaucoma; gonioscopy; human; hypertrichosis; intraocular pressure; iris pigmentation; male; ocular pruritus; optic disk; patient compliance; periocular hyperpigmentation; periocular hyperpigmentation; priority journal; side effect; stinging sensation; stinging sensation; superior sulcus deepening; superior sulcus deepening; visual acuity

Knowledge about glaucoma and barriers to follow-up care in a community glaucoma screening program - Altangerel, U.; Nallamshetty, H.S.; Uhler, T.; Fontanarosa, J.; Steinmann, W.C.; Almodin, J.M.; Chen, B.H.; Henderer, J.D. (Canadian Journal of Ophthalmology, 2009)
Objective: To assess perceived barriers to glaucoma follow-up care, including the lack of glaucoma knowledge and the lack of health care access, among participants in a community glaucoma screening program. Design: Community survey. Participants: Two hundred forty-three consecutive participants in a series of free glaucoma screenings between November 2002 and August 2003. Methods: The survey consisted of 20 questions designed to elicit knowledge of glaucoma and perception of potential barriers to follow-up care. Our aim was to find correlations between patient demographics and knowledge of glaucoma as well as perceived potential barriers to follow-up care. The data were analyzed using SPSS, v. 10.1. Results: The average age of the respondents was 70 years, and females predominated (66%). About half of the respondents knew of an eye doctor in their neighborhood, and 60% had had an eye examination in the past year. Two hundred twenty-two (91%) indicated they could get to an eye doctor if the screening examination indicated they needed a follow-up examination. Two hundred twenty (90.5%) had medical insurance. One hundred seventy-eight (73%) of the participants had heard of glaucoma; 71 (29%) identified an accurate definition of glaucoma. The level of education and the language spoken at home were correlated with both glaucoma awareness (p < 0.001; p < 0.001) and knowledge of an accurate definition of glaucoma (p < 0.001; p < 0.025). Conclusions: In this population, a lack of adequate education about glaucoma may be more significantly associated with poor follow-up rates than a lack of access to care in those identified as glaucoma suspects.
Keywords: aged; article; community program; controlled study; eye examination; female; follow up; glaucoma; health survey; human; major clinical study; male; patient care; patient education; screening test

Comparison of topical fixed-combination fortified vancomycin-amikacin (VA solution) to conventional separate therapy in the treatment of bacterial corneal ulcer - Chiang, C.-C.; Lin, J.-M.; Chen, W.-L.; Chiu, Y.-T.; Tsai, Y.-Y. (Eye, 2009)
Purpose: In an in vitrostudy, fixed-combination fortified vancomycin and amikacin ophthalmic solutions (VA solution) had the same potency and stable physical properties as the separate components. In this retrospective clinical study, we evaluated the efficacy of the topical VA solution in the treatment of bacterial corneal ulcer and comparison with separate topical fortified vancomycin and amikacin. Methods: Separate topical fortified eye drops was used prior to January 2004 and switched to the VA solution afterwards in the treatment of bacterial corneal ulcer. The medical records of 223 patients diagnosed with bacterial corneal ulcers between January 2002 and December 2005 were reviewed retrospectively. There were 122 patients in the VA group and 101 in the separate group. Cure was defined as complete healing of the ulcer accompanied by a nonprogressive stromal infiltrate on two consecutive visits. Results: No significant difference was found between the VA and separate therapy group. The mean treatment duration was 15.4 days in the VA group and 16.1 days in the separate therapy group. The average hospital stay was 5.4 days (VA) and 7.2 days (separate antibiotics). Stromal infiltration regressed significantly without further expansion in both groups. All corneal ulcers completely re-epithelialized without complications related to drugs. Conclusion: VA solution provided similar efficacy to the conventional separate therapy in the treatment of bacterial corneal ulcers; however, it is more convenient and tolerable, promotes patient's compliance, avoids the washout effect, and reduces nurse utilization. Hence, VA solution is a good alternative to separate therapy. © 2009 Macmillan Publishers Limited All rights reserved.
Keywords: amikacin; amikacin plus vancomycin; unclassified drug; vancomycin; adolescent; adult; aged; article; bacterial infection; child; comparative study; controlled study; cornea ulcer; drug efficacy; drug potency; epithelization; female; healing; health care utilization; hospitalization; human; major clinical study; male; medical record; medical record review; monotherapy; patient compliance; retrospective study; school child; time series analysis; amikin; vancocin cp

Shining a spotlight on glaucoma - The Lancet, (The Lancet, 2009)
Keywords: antiglaucoma agent; antihypertensive agent; Africa; aging; Asia; awareness; blindness; disease course; early diagnosis; editorial; eye examination; follow up; genetic predisposition; glaucoma; glaucoma surgery; health care access; health care cost; health education; health promotion; high risk population; intraocular pressure abnormality; optic nerve disease; patient compliance; preventive medicine; primary prevention; priority journal; risk factor; visual impairment; World Health Organization

Barriers to adherence with glaucoma medications: A qualitative research study - Lacey, J.; Cate, H.; Broadway, D.C. (Eye, 2009)
Purpose Glaucoma is initially asymptomatic, but untreated can result in progressive visual field loss and eventual blindness. With adequate therapy progression can be halted, but poor adherence with medical therapy is a significant issue requiring further research. The aim of the present study was to gain a better understanding of the obstacles to, and the motivations for, adherence with glaucoma medication and explore potential methods to improve adherence.MethodsParticipants had moderate/severe glaucoma diagnosed for >1 year, had seen ≥2 NHS ophthalmologists, and were prescribed ≥2 topical medications. Qualitative methodology was utilized to investigate aspects of adherence. Recruited patients either attended a focus group or had a home-based semi-structured interview. The transcripts were member-checked and the resulting data were analysed using 'Framework' analysis. The analysis was verified by a co-investigator and NVIVO Software was used to check data reliability. ResultsMultiple obstacles to adherence were identified, including poor education, lack of motivation, forgetfulness, drop application, and other practical issues, together with specific individual and age differences. Motivation for adherence was determined by fear of blindness and a faith in drop efficacy.ConclusionsSpecific obstacles to adherence with anti-glaucomatous therapy should be identified as early as possible after diagnosis. A tailored approach to patient care with initial education about the consequences of non-adherence and longer-term feedback about drop efficacy may improve patients' motivations for adherence. Future research should focus on investigating methods by which initial education about glaucoma and its management should best be delivered to patients. © 2009 Macmillan Publishers Limited All rights reserved.
Keywords: adult; article; clinical article; controlled study; disease severity; drug efficacy; drug safety; female; glaucoma; human; male; patient care; patient compliance; patient education; patient satisfaction; semi structured interview

Intraocular pressure reduction in the untreated fellow eye after selective laser trabeculoplasty - Rhodes, K.M.; Weinstein, R.; Saltzmann, R.M.; Aggarwal, N.; Kooner, K.S.; Petroll, W.M.; Whitson, J.T. (Current Medical Research and Opinion, 2009)
Objective: To investigate the effect of selective laser trabeculoplasty (SLT) on the intraocular pressure (IOP) of untreated fellow eyes in patients with open-angle glaucoma. Study design: Retrospective chart review. Patients and methods: Charts of all patients who underwent SLT at the University of Texas Southwestern Medical Center at Dallas between September 2003 and May 2006 were reviewed. Each patient had IOP measurements by Goldmann applanation tonometry in both eyes preoperatively, and at 1 hour, 2 weeks, 3 months, and 6 months postoperatively. Patient age, gender, diagnosis, central corneal thickness (CCT), previous intraocular surgeries, and degrees of laser treatment were tabulated for each patient. Patients with a history of previous glaucoma surgery in either eye were excluded as were those who underwent any change in glaucoma medications or further laser or surgical intervention in either eye within 6 months of SLT. Data were analyzed using a paired two-tailed t-test, an unpaired two-tailed t-test, ANOVA, and linear regression. Results: A total of 43 patients were included through 6 months of follow-up. Mean reduction in IOP in the treated eye was 3.9 ± 0.6 mmHg or 18.8% (p < 0.001) at final exam. Mean IOP reduction in the fellow untreated eye was 2.1 ± 0.5 mmHg or 11.2% (p < 0.01). Patients with higher preoperative IOPs had a greater reduction in IOP in both eyes (p < 0.001 for treated eyes, and p = 0.02 for untreated eyes). Patients who were on a larger number of glaucoma medications preoperatively had a greater response in both eyes (treated eye p = 0.002, untreated eye p = 0.008). There was no significant difference in IOP response in either eye based on age, gender, CCT, degrees of treatment, or phakic status. Conclusions: SLT produces a sustained and statistically significant IOP reduction in the fellow untreated eyes of patients with open-angle glaucoma. The results of our study support a biological mechanism of action for SLT. Limitations of this study include its retrospective design, relatively small sample size, a possible effect of increased compliance with medical therapy following SLT, and an inherent bias of excluding patients who underwent a change in medications or further laser or surgical therapy during the period under review. © 2009 Informa UK Ltd. All rights reserved.
Keywords: adult; age distribution; aged; analysis of variance; article; cornea thickness; female; follow up; glaucoma surgery; human; intraocular pressure abnormality; laser surgery; linear regression analysis; low tension glaucoma; major clinical study; male; medical record review; oculoplethysmography; open angle glaucoma; patient compliance; phakic intraocular lens; postoperative period; preoperative period; retrospective study; sample size; sex difference; trabeculoplasty; two tailed test

Rates of glaucoma medication utilization among persons with primary open-angle glaucoma, 1992 to 2002 - Fellman, R.L. (Evidence-Based Ophthalmology, 2008)
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; miotic agent; prostaglandin derivative; cost effectiveness analysis; doctor patient relationship; ethnicity; glaucoma surgery; health care utilization; human; medicaid; medical society; medicare; note; open angle glaucoma; priority journal

Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future directions - Aggarwal, S.K.; Carter, G.T.; Sullivan, M.D.; ZumBrunnen, C.; Morrill, R.; Mayer, J.D. (Journal of Opioid Management, 2009)
Cannabis (marijuana) has been used for medicinal purposes for millennia, said to be first noted by the Chinese in c. 2737 BCE. Medicinal cannabis arrived in the United States much later, burdened with a remarkably checkered, yet colorful, history. Despite early robust use, after the advent of opioids and aspirin, medicinal cannabis use faded. Cannabis was criminalized in the United States in 1937, against the advice of the American Medical Association submitted on record to Congress. The past few decades have seen renewed interest in medicinal cannabis, with the National Institutes of Health, the Institute of Medicine, and the American College of Physicians, all issuing statements of support for further research and development. The recently discovered endocannabinoid system has greatly increased our understanding of the actions of exogenous cannabis. Endocannabinoids appear to control pain, muscle tone, mood state, appetite, and inflammation, among other effects. Cannabis contains more than 100 different cannabinoids and has the capacity for analgesia through neuromodulation in ascending and descending pain pathways, neuroprotection, and anti-inflammatory mechanisms. This article reviews the current and emerging research on the physiological mechanisms of cannabinoids and their applications in managing chronic pain, muscle spasticity, cachexia, and other debilitating problems.
Keywords: acetylsalicylic acid; ajumelic acid; alizapride; cannabinoid derivative; cannabis; domperidone; dronabinol; endocannabinoid; levonantradol; nabilone; nabiximol; opiate; placebo; prochlorperazine; unclassified drug; anorexia; antiemetic activity; antiinflammatory activity; antioxidant activity; cachexia; cancer pain; chronic pain; clinical trial; depersonalization; disease association; drowsiness; drug industry; drug overdose; dysphoria; dyspnea; epilepsy; Food and Drug Administration; Gilles de la Tourette syndrome; glaucoma; health care access; health care delivery; health care personnel; human; intractable pain; intraocular pressure abnormality; medical information; medical practice; medical society; migraine; multiple sclerosis; myofascial pain; nausea; neuropathic pain; neuroprotection; pain; pain threshold; panic; patient counseling; psychosis; review; spasticity; spinal cord injury; tachycardia; tranquilizing activity; United States; vomiting; aspirin

Postherpetic neuralgia in the elderly - Johnson, R.W.; McElhaney, J. (International Journal of Clinical Practice, 2009)
Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ) or 'shingles' and affects a significant proportion of HZ patients with the disease, with the elderly being most frequently and seriously affected. Characterised by various types of pain (constant, intermittent and stimulus evoked) that persist between 3 months and many years after the resolution of the HZ rash, PHN can have a severe impact on the patient's quality of life and functional ability. PHN remains highly resistant to current treatments. In this review, we discuss the epidemiology, clinical features and management of PHN in the elderly and the potential of vaccination against varicella zoster virus as a means to prevent HZ, and thus decrease the incidence and severity of PHN. © 2009 The Authors.
Keywords: 5 (2 bromovinyl) 2' deoxyuridine; aciclovir; amitriptyline; capsaicin; carbamazepine; corticosteroid; desipramine; dextromethorphan; lidocaine plus prilocaine; famciclovir; gabapentin; ketamine; lamotrigine; levorphanol; lidocaine; maprotiline; methylprednisolone; morphine; nortriptyline; opiate; oxycodone; placebo; pregabalin; tramadol; tricyclic antidepressant agent; valaciclovir; varicella zoster vaccine; allodynia; analgesia; anxiety disorder; appetite; ataxia; blurred vision; burning sensation; chronic fatigue syndrome; cognitive defect; concentration loss; confusion; constipation; delirium; depression; disease duration; disease severity; dizziness; drowsiness; drug dependence; fatigue; functional disease; functional status; gel; geriatric patient; glaucoma; headache; herpes zoster; human; incidence; infection; injection site irritation; injection site pain; injection site reaction; mood; nausea; pain; patient compliance; peripheral edema; postherpetic neuralgia; priority journal; pruritus; psychosis; quality of life; rash; relaxation training; respiration depression; review; sedation; side effect; skin discomfort; sleep disorder; social isolation; somnolence; sympathetic blocking; transcutaneous electrical nerve stimulation; unspecified side effect; urine retention; vaccination; vomiting; body weight loss; xerostomia; EMLA; zostavax

An assessment of readiness for behaviour change in patients prescribed ocular hypotensive therapy - Schwartz, G.F.; Plake, K.S.; Mychaskiw, M.A. (Eye, 2009)
Objectives: To compare responses in two patient populations with a questionnaire developed to identify those prescribed ocular hypotensive medication whose adherence may need improvement and who may be ready to change. Methods: The content/face validity of a 62-item, self-administered questionnaire was confirmed by nine glaucoma specialists. Questions concerned demographics, health and medications, use of/problems with medications, and visual function. The questionnaire was administered anonymously to 102 consecutive patients in a glaucoma referral practice ('glaucoma practice') and 100 from a multispecialty ophthalmology practice ('multispecialty practice'). All participants were prescribed ≥1 ocular hypotensive medication and had no previous trabeculectomy. Results: Patients in the glaucoma practice were more likely to be younger, African-American, and better educated (P<0.05 for each). In both, >80% had glaucoma with >60% diagnosed ≥3 years previously. Most (glaucoma, multispecialty: 87, 93%) reported administering drops every day, but more in the multispecialty practice reported administering drops at the same time every day (79, 92%; P<0.05). Number of adherence problems (mean, 1/patient) and adherence scores (mean, 24; possible scale range, 0-25) were similar. Common adherence barriers were falling asleep and forgetting when the regular schedule changed or when travelling. In the glaucoma practice, the number of adherence problems was correlated with adherence score (r=-0.611; P<0.0001) and number of side effects (r=0.349; P<0.0001). Conclusions: Similarities between patient populations limited our ability to compare responses between groups or to propose adherence counselling tailored to specific demographics. Until such recommendations are possible, physicians should incorporate adherence counselling broadly into their practices. © 2009 Macmillan Publishers Limited All rights reserved.
Keywords: antiglaucoma agent; adult; aged; article; behavior change; blurred vision; eye disease; face validity; female; glaucoma; human; intraocular hypotension; major clinical study; male; patient attitude; patient compliance; prescription; questionnaire; scoring system

Introduction: new insights on enhancing adherence to topical glaucoma medications. - Friedman, D.S. (Ophthalmology, 2009)
Keywords: antihypertensive agent; eye drops; blindness; editorial; glaucoma; human; patient compliance; topical drug administration

A 12-week study evaluating the efficacy of bimatoprost 0.03% in patients with pseudoexfoliative and open-angle glaucoma - Ciancaglini, M.; Carpineto, P.; Agnifili, L.; Nubile, M.; Toto, L.; Mastropasqua, L. (European Journal of Ophthalmology, 2009)
Purpose. To evaluate the control of diurnal intraocular pressure (IOP) and the safety profile of bimatoprost in pseudoexfoliative glaucoma (PXG) compared to primary open angle glaucoma (POAG). Methods. A prospective, observer-masked, nonrandomized study was performed. Seventy consecutive patients with either POAG (35 eyes) or PXG (35 eyes) drug-naive for glaucoma were assigned to receive bimatoprost 0.03% once daily for 12 weeks. Diurnal IOP was measured at baseline and after 12 weeks at three time points (8 AM, noon, and 4 PM). Main outcomes were diurnal IOP control and achievement of target IOP (CIGTS criteria). Mean diurnal IOP, hour-by-hour IOP measurements, and safety, including serious adverse events, were also evaluated. Results. A significant IOP reduction from baseline was found in both groups (p<0.001). Mean and hour-by-hour IOP differences between groups were not statistically significant (NS). The observed IOP values and percentages of IOP reduction were 17.0 mmHg (31.5%) and 16.4 mmHg (31.9%) in PXG and POAG eyes, respectively; the differences were not statistically significant. Six eyes (1 POAG and 5 PXG, respectively) responded with a <20% IOP reduction (NS). Twenty-seven POAG (77.1%) and 23 PXG (65.7%) eyes achieved target IOP. Consequently, 20 eyes (8 POAG and 12 PXG, respectively) were classified as unable to achieve the IOP target values (NS). Conclusions. Bimatoprost was effective and safe in lowering IOP both in open angle and pseudoexfoliative glaucoma, achieving target pressure in most patients. However, long-term efficacy in PXG must be evaluated. © Wichtig Editore, 2009.
Keywords: bimatoprost; adult; aged; article; blurred vision; clinical trial; controlled clinical trial; controlled study; dermatitis; drug efficacy; drug induced headache; drug response; drug safety; eye color; eye pain; female; glaucoma; human; intraocular foreign body; intraocular pressure; lid dermatitis; major clinical study; male; ocular pruritus; open angle glaucoma; patient compliance; pigmentation; priority journal; pseudoexfoliative glaucoma; side effect; treatment duration

Novel 3D computer-automated threshold Amsler grid visual field testing of scotomas in patients with glaucoma - Nguyen, D.T.; Fahimi, A.; Fink, W.; Nazemi, P.P.; Kim, J.K.; Sadun, A.A. (European Journal of Ophthalmology, 2009)
Purpose. Three-dimensional (3D) computer-automated threshold Amsler grid testing was used to identify and characterize scotomas typical of glaucoma. Methods. The 3D test exhibits a grid on a computer screen at a preselected grayscale and angular resolution, and allows patients to trace those areas on the grid that are missing in their visual field using a touch screen. Eleven eyes in patients with an established diagnosis of glaucoma were examined according to the above protocol. A total of 23 eyes from normal subjects were used as controls. The 5-minute test required that patients repeatedly outline scotomas on a touch screen with varied displays of contrast while maintaining their gaze on a central fixation marker. A 3D depiction of the visual field defects was then obtained that was further characterized by the location, shape, extent, depth, and slope of the scotomas. Results. In this pilot study, the 3D depiction of visual field loss demonstrated paracentral, superior and inferior altitudinal, and nasal step defects consistent with glaucomatous damage. The 3D depiction showed a shape, extent, depth, and slope that are consistent with the severity of damage. Conclusions. The 3D test identified and characterized scotomas typical of glaucoma. The test provides several advantages over conventional perimetry including additional information through 3D depiction of scotomas with the addition of contrast sensitivity and a higher angular/ spatial resolution. Improved patient compliance and reliability through shorter testing time and potential interactive accessibility and distribution over the Internet further characterize the test. © Wichtig Editore, 2009.
Keywords: adult; aged; article; clinical article; clinical protocol; computer aided design; controlled study; disease association; disease classification; disease severity; female; gaze; human; Internet; male; open angle glaucoma; patient compliance; perimetry; pilot study; priority journal; reliability; scotoma; sensitivity analysis; three-dimensional imaging; visual field; visual field defect; Amsler grid

Benefits of early awareness in age-related macular degeneration - Woo, J.H.; Sanjay, S.; Au Eong, K.G. (Eye, 2009)
Keywords: cataract; diet supplementation; glaucoma; health service; human; letter; patient compliance; patient counseling; patient education; age related macular degeneration

Xal-Ease®: Impact of an ocular hypotensive delivery device on ease of eyedrop administration, patient compliance, and satisfaction - Nordmann, J.-P.; Baudouin, C.; Bron, A.; Denis, P.; Rouland, J.-F.; Sellem, E.; Renard, J.-P. (European Journal of Ophthalmology, 2009)
PURPOSE: To measure the impact of the Xal-Ease® delivery device on ease of eyedrop administration and on treatment compliance and satisfaction. METHODS: This prospective, multicenter, randomized, comparative, crossover study was conducted at 43 sites in France. Eligible subjects were >18 years of age, were diagnosed with primary open-angle glaucoma or ocular hypertension, had been treated with latanoprost or fixed-combination latanoprost/ timolol for ≥3 months prior to enrollment, and did not require a therapy change. Subjects used either Xal-Ease or the dropper bottle for 4 weeks and then switched to the alternate delivery method for the next 4 weeks. Subjects completed questionnaires after 1 and 4 weeks in each treatment period. RESULTS: In all, 211 subjects were enrolled, 107 to the Xal-Ease/dropper bottle group and 104 to the dropper bottle/Xal-Ease group. Baseline demographic and ocular characteristics were similar. Use of Xal-Ease made it significantly less likely that the subject would need someone to help with drop instillation (6.9% vs 18.1%, respectively; p<0.001) and reduced the problem of the tip of the bottle touching the eye (3.2% vs 35.6%, respectively; p<0.001). Reported compliance rates were very high and similar across groups during both treatment periods. After 1 month of use during both treatment periods, more than 70% of subjects reported global satisfaction with Xal-Ease to their physicians. No adverse events associated with the use of Xal-Ease were noted. CONCLUSIONS: Xal-Ease generally makes administration of latanoprost or fixed-combination latanoprost/ timolol easier compared with the dropper bottle. © Wichtig Editore, 2009.
Keywords: latanoprost; latanoprost plus timolol; adult; aged; article; clinical trial; controlled clinical trial; controlled study; crossover procedure; drug administration route; drug delivery system; female; human; intermethod comparison; intraocular hypertension; major clinical study; male; multicenter study; open angle glaucoma; patient attitude; patient compliance; patient satisfaction; priority journal; prospective study; questionnaire; randomized controlled trial; treatment duration

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

Detrimental effect of preservatives in eyedrops: Implications for the treatment of glaucoma - Baudouin, C. (Acta Ophthalmologica, 2008)
Antiglaucoma medications are often associated with ocular adverse reactions such as dry eye, and burning or stinging sensations. These undesirable effects may lead to treatment discontinuation and reduced quality of life in patients with glaucoma. Antiglaucoma medications usually contain benzalkonium chloride (BAK) as a preservative. Animal studies, in vitro studies and in vivo experiments have demonstrated various adverse effects of BAK. Clinical studies have also shown an increased incidence of adverse events with BAK and have demonstrated that the withdrawal of preservatives reduces these effects. Collectively, these data suggest that preservative-free antiglaucoma treatments have clinically relevant benefits for patients. © 2008 The Authors Journal compilation © 2008 Acta Ophthalmol.
Keywords: adrenergic receptor stimulating agent; antiglaucoma agent; artificial tear; befunolol; benzalkonium chloride; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; dipivefrine; drug preservative; eye drops; latanoprost; miotic agent; pilocarpine; placebo; purite; refresh tears; tafluprost; timolol; timolol maleate; travoprost; unclassified drug; blurred vision; cataract; cataract extraction; clinical feature; clinical study; clinical trial; conjunctiva disease; conjunctiva epithelium; conjunctival hyperemia; conjunctivitis; cornea cell; cornea disease; cornea injury; cost effectiveness analysis; disease model; drug bioavailability; drug dosage form comparison; drug dose increase; drug efficacy; drug hypersensitivity; drug induced disease; drug mechanism; drug response; drug safety; drug substitution; drug tolerability; drug toxicity; drug withdrawal; dry eye; eye burning; eye discomfort; eye disease; eye pain; filtering operation; glaucoma; goblet cell; human; human cell culture; in vitro study; in vivo study; incidence; intraocular foreign body; intraocular pressure; keratinization; lacrimation; lens epithelium; long term care; morbidity; nonhuman; ocular fibrosis; ocular pruritus; patient compliance; patient satisfaction; priority journal; quality of life; retina macula cystoid edema; review; side effect; squamous cell metaplasia; surgical risk; tear film; topical treatment; trabecular meshwork; trabeculectomy; treatment duration; treatment failure; treatment response; lumigan; purite; refresh tears; timabak; timoptol; travatan; xalatan

Anti-vascular endothelial growth factor for macular edema secondary to central retinal vein occlusion - Smith, T.S.T.; Nanji, A.A.; Greenberg, P.B. (Cochrane Database of Systematic Reviews, 2008)
Keywords: placebo; vasculotropin antibody; cataract; central retina vein occlusion; Cinahl; clinical trial; Cochrane Library; conjunctival hemorrhage; conjunctival hyperemia; cost benefit analysis; drug efficacy; drug safety; Embase; endophthalmitis; eye inflammation; fluorescence angiography; human; information retrieval; intraocular hypertension; Medline; patient compliance; quality of life; randomized controlled trial; retina detachment; macular edema; retina tear; review; stereophotogrammetry; systematic review; thromboembolism; treatment duration; treatment outcome; visual acuity

Views of glaucoma patients on provision of follow-up care; An assessment of patient preferences by conjoint analysis - Bhargava, J.S.; Bhan-Bhargava, A.; Foss, A.J.E.; King, A.J. (British Journal of Ophthalmology, 2008)
Aims: To determine patients' preferences for provision of glaucoma follow-up services examining preferences for location, access and personnel for delivery of this care. Methods: 100 patient patients attending the glaucoma outpatient clinic for follow-up review underwent an interview-based assessment during which they completed the visual function questionnaire 25 and ranking of scenario options for provision of follow-up care for their glaucoma. Percentage preferences for aspects of care offered in the conjoint analysis scenario packages and generation of utility values for each of the factor levels included in the scenario design were calculated. Results: Travel time and training of health professional were the most important factors for patients (accounting for over 60%) of their preference. Utility scores were generated for each factor, with shorter travel time and examination by a doctor being the most important features to the patients. Patients who lived furthest from the hospital and had severe visual disability considered the number of visits to complete an episode to be an important feature. Conclusion: Patients ideally would like to travel a short distance and be seen by a doctor when being followed up for their glaucoma.
Keywords: adult; aged; article; female; follow up; glaucoma; health care access; health care delivery; health care personnel; hospital; human; independent variable; internal validity; interview; linear regression analysis; male; medical education; multivariate analysis; outpatient department; patient assessment; priority journal; questionnaire; trabeculectomy; travel; vision; visual acuity

Will improvement of knowledge lead to improvement of compliance with glaucoma medication? - Hoevenaars, J.G.M.M.; Schouten, J.S.A.G.; Van Den Borne, B.; Beckers, H.J.M.; Webers, C.A.B. (Acta Ophthalmologica, 2008)
Purpose: To identify specific items on knowledge and need for information that could be used to improve compliance with glaucoma medication. Methods: Forty-four randomly selected ophthalmologists assigned 166 consecutive glaucoma patients to complete a questionnaire. The questionnaire was developed systematically based on focus group interviews, consultation of experts and a pilot test. Items included knowledge about glaucoma and its treatment, need for information and compliance with therapy. Results: No statistically significant correlation was found between the total level of knowledge and compliance. Concerning knowledge of glaucoma, one out of 19 items had a statistically significant negative correlation with compliance. Concerning knowledge of glaucoma treatment, one out of 18 items had a statistically significant positive correlation with compliance. Regarding total need for information, no statistically significant correlation with compliance was found. Three out of 22 items had a statistically significant positive correlation with compliance. Conclusion: Given the number of related items, their direction and limited strength of correlation and the difficulty of hypothesizing a causal relation for some items, it is unlikely that further improving knowledge will greatly improve compliance with glaucoma medication. Interventions focused on attitude and discipline may be of more benefit in improving compliance with therapy. © 2008 The Authors.
Keywords: antiglaucoma agent; article; controlled study; glaucoma; health behavior; health survey; human; major clinical study; medical information; patient attitude; patient compliance; priority journal; questionnaire

The impact of co-payment increases on dispensings of government-subsidised medicines in Australia - Hynd, A.; Roughead, E.E.; Preen, D.B.; Glover, J.; Bulsara, M.; Semmens, J. (Pharmacoepidemiology and Drug Safety, 2008)
Purpose: Patient co-payments for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) increased by 24% in January 2005. We investigated whether this increase and two related co-payment changes were associated with changes in dispensings of selected subsidised medicines in Australia. Method: We analysed national aggregate monthly prescription dispensings for 17 medicine categories, selected to represent a range of treatments (e.g. for diabetes, cardiovascular diseases, gout). Trends in medication dispensings from January 2000 to December 2004 were compared with those from January 2005 to September 2007 using segmented regression analysis. Results: Following the January 2005 increase in PBS co-payments, significant decrease in dispensing volumes were observed in 12 of the 17 medicine categories (range: 3.2-10.9%), namely anti-epileptics, anti-Parkinson's treatments, combination asthma medicines, eye-drops, glaucoma treatments, HmgCoA reductase inhibitors, insulin, muscle relaxants, non-aspirin antiplatelets, osteoporosis treatments, proton-pump inhibitors (PPIs) and thyroxine. The largest decrease was observed for medicines used in treating asymptomatic conditions or those with over-the-counter (OTC) substitutes. Decrease in dispensings to social security beneficiaries was consistently greater than for general beneficiaries following the copayment changes (range: 1.8-9.4% greater, p=0.028). Conclusions: The study findings suggest that recent increase in Australian PBS co-payments have had a significant effect on dispensings of prescription medicines. The results suggest large increase in co-payments impact on patients' ability to afford essential medicines. Of major concern is that, despite special subsidies for social security beneficiaries in the Australian system, the recent co-payment increase has particularly impacted on utilisation for this group. Copyright © 2008 John Wiley & Sons, Ltd.
Keywords: antiasthmatic agent; anticonvulsive agent; antiglaucoma agent; antigout agent; antiparkinson agent; antithrombocytic agent; anxiolytic agent; beta adrenergic receptor blocking agent; eye drops; hydroxymethylglutaryl coenzyme A reductase inhibitor; hypnotic agent; insulin; muscle relaxant agent; non prescription drug; proton pump inhibitor; thyroxine; article; Australia; drug cost; drug utilization; government regulation; health care access; health care availability; health care cost; health insurance; prescription; priority journal; regression analysis; social security; time series analysis; trend study

Safety and efficacy of inhaled corticosteroids (ICS) in children with asthma - Petrisko, M.A.; Skoner, J.D.; Skoner, D.P. (Journal of Asthma, 2008)
Inhaled corticosteroids (ICS) are the guideline-preferred preventative therapy for persistent asthma of all severity levels and for all ages, including children. While these drugs are unquestionably efficacious, concerns of adverse systemic effects limit patient compliance with treatment regimens and thus the attainable benefits. Suppression of bone growth, bone density, and HPA axis function, in addition to cataract formation and elevated intraocular pressure/glaucoma, have been associated with ICS use. This review will focus on recent developments in the safety and efficacy of ICS as compared to oral CS corticosteroids and the achievement of a balance between risk and benefit in optimizing ICS therapy. Copyright © 2008 Informa Healthcare USA, Inc.
Keywords: beclomethasone dipropionate; budesonide; chlorofluorocarbon; ciclesonide; corticosteroid derivative; cromoglycate disodium; fluorinated hydrocarbon; fluticasone propionate; mometasone furoate; montelukast; nedocromil; placebo; prednisolone; salbutamol; salmeterol; theophylline; triamcinolone acetonide; adrenal suppression; age distribution; asthma; bone density suppression; bone density suppression; bone disease; bone growth suppression; bone growth suppression; cataract; childhood disease; clinical trial; controlled clinical trial; Cushing syndrome; dermal thinning; dermal thinning; diabetes mellitus; disease severity; dose response; drug absorption; drug bioavailability; drug dose comparison; drug dose reduction; drug efficacy; drug elimination; drug formulation; drug megadose; drug metabolism; drug protein binding; drug safety; endocrine disease; environmental factor; glaucoma; growth retardation; heredity; human; hypothalamo pituitary adrenal function suppression; hypothalamo pituitary adrenal function suppression; hypothalamus hypophysis adrenal system; inhaler; intraocular hypertension; low drug dose; muscle weakness; patient compliance; prophylaxis; randomized controlled trial; review; sex difference; skin disease; subcapsular cataract; treatment duration; treatment response

Diabetic retinopathy and blindness in Spain: Epidemiology and prevention - Vila, L.; Viguera, J.; Alemán, R. (Endocrinologia y Nutricion, 2008)
Diabetic retinopathy (DR) remains an important cause of blindness in Spain. The prevalence of blindness in diabetic persons ranges from 4% to 11% and is higher than that in other countries (between 1 and 5%). The prevalence of DR in Spain varies in the distinct studies but is approximately 40%, while that of proliferative DR is between 4% and 6% and that of macular edema is between 1.4 % and 7.9%. Routine screening is effective in reducing the incidence of visual loss and blindness. Screening compliance is about 50% in primary care and is over 70% in specialized care. Although there is some evidence that the incidence of DR is decreasing in Europe and the USA, only a few studies have reported the same trend in Spain. Screening of DR with nonmydriatic camera has been supported by several guidelines, since this procedure shows the best cost-effectiveness ratio and is easy to use.
Keywords: calcium antagonist; corticosteroid; hemoglobin A1c; lipid; alcohol consumption; arterial pressure; blindness; body mass; cataract; cigarette smoking; diabetic macular edema; diabetic nephropathy; diabetic retinopathy; disease course; disease duration; dyslipidemia; glaucoma; heredity; human; insulin dependent diabetes mellitus; metabolic regulation; morbidity; non insulin dependent diabetes mellitus; ophthalmoscopy; patient compliance; prevalence; primary medical care; macular edema; review; risk factor; screening test; Spain; United States

Eye health care getting clearer and clearer - Rybovic, A. (Pharmacy Times, 2008)
Keywords: article; cataract; conjunctivitis; eye care; eye disease; glaucoma; health care access; health care cost; health care delivery; health care organization; health care quality; health care system; health survey; optometry; periodic medical examination; macular degeneration; United States

Safety, tolerability and risk benefit analysis of tiotropium in COPD - Oba, Y.; Zaza, T.; Thameem, D.M. (International Journal of COPD, 2008)
COPD is a chronic disease and, like many other chronic diseases, there is no treatment to reverse the severity of the disease except for lung transplant. To date, no inhaled medications have been shown to improve survival. Tiotropium bromide is a long-acting inhaled anticholinergic drug for the treatment of COPD that can improve lung function, reduce symptoms and exacerbations, and improve quality of life with once-daily dosing. It was initially approved and marketed in several countries in Europe in 2002 and then approved in the US in 2004. Tiotropium is generally well tolerated with dry mouth being the main adverse effect. Other adverse effects include constipation, tachycardia, blurred vision, urinary retention and increased intraocular pressure. Despite the recently raised concerns about an excess risk of cardiovascular adverse events with inhaled anticholinergic agents, the risk/benefit ratio of tiotropium appears still favorable given the favorable safety profile demonstrated in the UPLIFT study. However, caution should be advised in patients at high risk for cardiovascular disease given the paucity of data in such patients. © 2008 Dove Medical Press Limited. All rights reserved.
Keywords: beta adrenergic receptor stimulating agent; budesonide plus formoterol; cholinergic receptor blocking agent; corticosteroid; fluticasone; fluticasone propionate plus salmeterol; formoterol; formoterol fumarate; ipratropium bromide; long acting drug; salbutamol; salmeterol; short acting drug; tiotropium bromide; angina pectoris; angioneurotic edema; anticholinergic effect; blurred vision; bronchodilatation; bronchospasm; candidiasis; cardiovascular disease; cataract; cerebrovascular accident; chronic obstructive lung disease; clinical trial; closed angle glaucoma; constipation; cost effectiveness analysis; disease severity; drug absorption; drug eruption; drug fatality; drug hypersensitivity; drug mechanism; drug safety; drug tolerability; drug withdrawal; dyspepsia; edema; epistaxis; glaucoma; heart arrhythmia; heart death; heart disease; heart infarction; heart palpitation; human; intraocular pressure; lung function; myalgia; paralytic ileus; patient compliance; patient satisfaction; pharyngitis; pneumonia; quality of life; review; risk benefit analysis; side effect; sinusitis; smooth muscle relaxation; tachycardia; tachyphylaxis; thorax pain; throat irritation; tremor; urinary tract infection; urine retention; vomiting; xerostomia; foradil

Compliance in glaucoma - Stefan, C.; Dumitricǎ, D.M. (Oftalmologia (Bucharest, Romania : 1990), 2008)
Keywords: antihypertensive agent; eye drops; drug effect; glaucoma; human; intraocular pressure; pathophysiology; patient compliance; patient education; practice guideline; quality of life; review

Obstacles to medication compliance for patients with glaucoma - Kowal, M.; Choragiewicz, T.; Mietlicka, K.; Wyszyńska, A.; Zarnowski, T. (Klinika oczna, 2008)
PURPOSE: Aim of the study was to identify obstacles to medication adherence (compliance) for patients with glaucoma. MATERIAL AND METHODS: A prospective case series of structured interviews were conducted in 150 patients with glaucoma. (75 patients treated in the glaucoma out-patient clinic of the Department of Ophthalmology, Medical University, Lublin, Poland and 75 patients treated in regional out-patient clinics). Questionnaire of an anonymous survey, formulated on the basis of the publication: Tsai J.C. et al. "Compliance barriers in glaucoma: a systematic classification", J. Glaucoma. 2003, 12, 393-398. RESULTS: The results of the survey showed omissions of particular doses of medications in 62.7% of patients from regional outpatient clinics and in 35.3% of patients treated at the Department of Ophthalmology. It was shown that 32.7% of respondents from regional outpatient clinics and 8.7% from the Department of Ophthalmology Glaucoma Clinic declared remaining without antiglaucoma drops for more than one day. As reasons for omissions of single doses of the medications: forgetfulness (54.7%), too many doses of medications (10%) and little knowledge about the disease (10%) were usually pointed. According to the respondents: little knowledge (32%) and financial factors (22%) are the main causes of medications withdrawal for longer time. CONCLUSIONS: The most common obstacles to medication compliance for patients with glaucoma include: forgetfulness, low level of knowledge about the disease, financial factors and too many doses of the medications. Fewer doses and the presence of a supporting person have a positive influence on compliance.
Keywords: antihypertensive agent; aged; article; attitude to health; female; follow up; glaucoma; health behavior; human; male; middle aged; patient compliance; Poland; questionnaire; statistics; treatment refusal

Physician beliefs and behaviors related to glaucoma treatment adherence: The glaucoma adherence and persistency study - Gelb, L.; Friedman, D.S.; Quigley, H.A.; Lyon, D.W.; Tan, J.; Kim, E.E.; Zimmerman, T.J.; Hahn, S.R. (Journal of Glaucoma, 2008)
PURPOSE: Patient adherence with topical glaucoma therapy is recognized as suboptimal. Though some studies have associated physician/patient interaction with adherence, little systematic research has explored the ophthalmologist's perspective of this interaction. Telephone interviews with physicians treating glaucoma were conducted to ascertain the extent to which multivariate analysis of physician demographics, beliefs, and behaviors could reveal differences potentially relevant to future adherence with topical glaucoma therapy for primary open-angle glaucoma, in conjunction with other phases of the Glaucoma Adherence and Persistency Study (GAPS). METHODS: Structured interviews were conducted with 103 ophthalmologists treating significant numbers of primary open-angle glaucoma patients in a national managed care network. To the maximum extent possible, eligible patients of physicians interviewed were included in the other GAPS phases (claims analysis, patient surveys, and medical chart reviews). RESULTS: Physicians reported a wide range of beliefs and behaviors regarding patients' medication adherence, but beliefs and behaviors were linked. The segmentation analysis yielded 3 clusters of physicians, which we have described on the basis of their predominant beliefs as "reactives," "skeptics," and "idealists." The "idealists," though the smallest group, more often reported beliefs and behaviors that may be more positively associated with patient adherence, especially in the context of other GAPS findings. CONCLUSIONS: Physician vigilance for opportunities to detect and address nonadherence is suggested, as is interventional research on the basis of the constructs identified. Copyright © 2008 by Lippincott Williams & Wilkins.
Keywords: alertness; article; demography; glaucoma; health behavior; health belief; managed care; medical record review; medical research; open angle glaucoma; ophthalmology; patient compliance; physician; priority journal; structured interview; telephone; topical treatment

Influence of acupuncture on intraocular pressure and compliance of patients with ocular hypertension or primary wide-angle glaucoma: First results of a controlled prospective follow-up study - Ewert, H.; Schwanitz, R. (Revista Internacional de Acupuntura, 2008)
Background and aims: Primary wide-angle glaucoma (the most common form of glaucoma) is a multi-factorial disease of the optic nerve marked by the preceding loss of retinal ganglion cells, eventually leading to the atrophy of the optic nerve. Intraocular pressure (IOP) makes up the most important and most treatable risk factor. Methods: The study examined the eff ect of acupuncture therapy on eye pressure and the compliance in patients suff eringfrom primary wide-angle glaucoma (n = 21) and ocular hypertension (n = 13) against a group of test subjects not suff eringfrom any eye complaint (n = 16). Before commencing therapy, corneal thickness was determined by 4 Optics-Pachymeter. Before and after acupuncture treatment, an ophthalmologic determination of visual acuity according to DIN 58220 and a computer-aided visual field analysis were done. The IOP wasmeasured before and immediately after acupuncture as well as30 minutes after therapy. Changes in compliance were documented with a standardized questionnaire completed by eachpatient having received this treatment. Results: It was shown that for patients with primary wide angle glaucoma and ocular hypertension, acupuncture is able to significantly lower intraocular pressure. According to the questionnaire analysis, a subjective improvement of quality of life and better compliance of using anti-glaucomatous medication was achieved. Conclusions: Acupuncture is an appropriate method to treat patients with primary wide-angle glaucoma in addition tolowering eye pressure by anti-glaucomatous pharmacologicaltherapy. In patients suff ering from ocular hypertension, acupuncture can significantly lower intraocular pressure and therefore reduce the rate of conversion into a manifest glaucoma. Therefore this treatment can be suggested for ocular hypertension patients with contraindications against localanti-glaucomatous medicine (e. g. beta-blocker). However, it is absolutely necessary in this treatment that patients are continuously monitored regarding visual field, retinal nerve fibre thickness and micromorphological alterations of the disc in order to detect tissue damage of the optic nerve and functional loss caused by the onset of glaucoma.
Keywords: beta adrenergic receptor blocking agent; acupuncture; adult; article; clinical article; controlled study; cornea thickness; follow up; human; intraocular hypertension; intraocular pressure; open angle glaucoma; patient compliance; quality of life; questionnaire; risk factor; therapy effect; visual acuity; visual field

Primary open angle glaucoma: an overview on medical therapy - Vetrugno, M.; Cantatore, F.; Ruggeri, G.; Ferreri, P.; Montepara, A.; Quinto, A.; Sborgia, C. (Progress in Brain Research, 2008)
The purpose of this review is to discuss the topics relevant to the use of intraocular pressure-lowering strategies, which remains the first line in the management of glaucoma. Estimates of blindness from glaucoma and identification of risk factors remain of interest for all ophthalmologists. New functional tests offer promise for better detection and more accurate diagnosis of glaucoma. We finally discuss the impact of various glaucoma therapies, the principles of monotherapy and fixed combinations, which offer benefits of convenience, cost, and safety. © 2008 Elsevier B.V. All rights reserved.
Keywords: aceclidine; acetylcholine; epinephrine; alpha adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; clonidine; dipivefrine; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; levobunolol; miotic agent; pilocarpine; pindolol; prostaglandin derivative; timolol; timolol maleate; timolol plus travoprost; travoprost; African American; age distribution; agranulocytosis; allergic conjunctivitis; allergy; amnesia; blindness; bronchospasm; burning sensation; cataract; clinical trial; conjunctiva disease; conjunctival hyperemia; conjunctivitis; cost benefit analysis; depression; diagnostic accuracy; diagnostic value; drowsiness; drug absorption; drug contraindication; drug efficacy; drug safety; drug tolerability; enteropathy; erythema; exercise tolerance; eye discomfort; eye disease; fatigue; flu like syndrome; function test; gastrointestinal symptom; genetic association; hallucination; headache; heart disease; human; hypertrichosis; hypotension; impotence; intraocular pressure; intraocular pressure abnormality; iris disease; lacrimation; libido; malaise; mood change; musculoskeletal pain; nephrolithiasis; open angle glaucoma; optic nerve; paresthesia; pathophysiology; patient compliance; prevalence; priority journal; pruritus; respiration depression; respiratory tract disease; retina detachment; retina macula cystoid edema; macular edema; review; risk factor; side effect; skin pigmentation; thrombocytopenia; tonometry; upper respiratory tract infection; visual acuity

The treatment of normal-tension glaucoma - Desai, P.V.; Caprioli, J. (Progress in Brain Research, 2008)
Normal-tension glaucoma (NTG) is generally defined as visual field loss and optic nerve defects consistent with glaucoma and an intraocular pressure (IOP) that does not exceed 21 mmHg (Allingham, R.R., Damji, K., Freedman, S., Moroi, S., Shafranov, G., Shields, M.B. (2005). In: Pine J. and Murphy J. (Eds.), Shields' Textbook of Glaucoma, 5th edn., Lippincott Williams & Wilkins, Philadelphia, PA, pp. 197-207, Chapter 11). If a patient has an atypical presentation (unilateral disease, decreased central visual acuity or visual field loss not consistent with optic disk appearance) then the clinician should rule out medical or neurologic etiologies. IOP-dependent and IOP-independent mechanisms play a role in NTG nerve damage. The exact mechanisms of IOP-independent damage are not currently known. Research has shown that vascular etiologies, such as vascular insufficiency and vasospasm, may be possible mechanisms for IOP-independent damage. The mainstay of glaucoma treatment remains robust IOP reduction. The chief goal of ongoing glaucoma research is to more clearly identify IOP-independent mechanisms of damage and to find neuroprotective treatment strategies to prevent retinal ganglion cell death and consequent visual loss. © 2008 Elsevier B.V. All rights reserved.
Keywords: calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; memantine; nifedipine; nimodipine; verapamil; cell death; clinical feature; differential diagnosis; disease course; genetic association; glaucoma; glaucoma surgery; high tension glaucoma; human; intraocular pressure; nerve injury; neuroprotection; low tension glaucoma; open angle glaucoma; optic nerve; optic nerve disease; orthostatic hypotension; patient compliance; prevalence; priority journal; retina ganglion cell; review; risk factor; trabeculoplasty; visual impairment

German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye - Erb, C.; Gast, U.; Schremmer, D. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2008)
Background: The purpose of this register was to determine the links between glaucoma, age, concomitant disease, medication, and dry eye in a large group of glaucoma patients. Methods: A total of 20,506 patients from 900 centers across Germany were included. The first 30 consecutive glaucoma patients at each center were recruited. Epidemiological data as well as information on glaucoma, medication, concomitant diseases, dry eye, and local symptoms were elicited by means of a questionnaire. We analyzed primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigmentary glaucoma (PDG). Results: According to the register data, more women develop dry eye and glaucoma than men (56.9 vs. 45.7%). The most frequent concomitant systemic diseases were hypertension (48.1%), diabetes mellitus (22.5%), and dry mouth, nose, and skin (11.3%). As expected, the highest incidence of dry eye was found in those patients with dry mouth, nose, and skin. Dry eye occurred with dissimilar frequencies in association with the various glaucoma types: PEX>POAG>PDG. The incidence of dry eye increases with age. The gender difference in the occurrence of dry eye becomes apparent from the age of 50. Dry eye occurred more frequently when three or more antiglaucoma drugs were used and increased with the duration of glaucoma disease. Conclusions: We publish the first results from the German Glaucoma and Dry Eye Register. We found that the occurrence of dry eye is linked to several factors. Thus, the type of glaucoma has an impact on the risk of dry eye. The quantity of eye drops applied also plays a role in the development of the dry eye syndrome if more than three medications are used. While POAG is usually treated with one drug, PEX and PDG tend to be treated with multiple drugs. The gender difference in the occurrence of dry eye becomes apparent from the age 50 years. Because of the vicious circle of dry eye, antiglaucoma eye drops containing benzalkonium chloride compromises patient compliance. The results of the register are therefore of key relevance for the care of glaucoma patients. © Springer-Verlag 2008.
Keywords: antiglaucoma agent; benzalkonium chloride; adult; aged; aging; arthritis; article; blurred vision; comorbidity; controlled study; depression; diabetes mellitus; disease classification; disease course; disease duration; dry eye; dry nose; dry skin; eye pain; female; Germany; glaucoma; human; hypertension; hypotension; incidence; intraocular foreign body; lipid metabolism; major clinical study; male; migraine; neoplasm; obesity; open angle glaucoma; patient compliance; photosensitivity; pigment glaucoma; priority journal; pruritus; pseudoexfoliation; questionnaire; register; risk factor; sex difference; skin disease; slit lamp; smoking; thyroid disease; tinnitus; xerostomia

Adherence and Persistence with Glaucoma Therapy - Schwartz, G.F.; Quigley, H.A. (Survey of Ophthalmology, 2008)
Adherence and persistence with chronic therapies is crucial to prevent disease progression, such as in glaucoma. Patients report high rates of adherence, which are not supported by pharmacy claims analysis. This article reviews the literature regarding methods to assess adherence and persistence and the patient behaviors that pose challenges to proper treatment. Rates for persistence are generally below 50% at 1 year. Differentiating efficacy of eyedrops from lack of adherence presently confounds ophthalmic treatment. Additionally, as intraocular pressure (IOP) can appear controlled by short-term adherence, the physician can be fooled into believing the patient's glaucoma is well-controlled. Likewise, when progressive worsening is noted despite good IOP control, it can be problematic whether the patient's target pressure needs to be lowered or adherence needs to be improved. White-coat adherence is common, in which patient adherence rises sharply 1 week before the appointment with the physician, then declines rapidly following the appointment. White-coat adherence may make it difficult to assess IOP control over the longer term; cycling behavior with medication use is well-documented. Adherence and persistence rates differ by class of drug, with higher rates associated with prostaglandin use. We review findings from The Glaucoma Adherence and Persistency Study that identified behaviors associated with poor adherence. Greater physician awareness of adherence and persistence issues is necessary in order to help the patient become more adherent. © 2008 Elsevier Inc. All rights reserved.
Keywords: alpha adrenergic receptor blocking agent; alpha adrenergic receptor stimulating agent; antihypertensive agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; latanoprost; prostaglandin derivative; article; clinical trial; disease course; drug efficacy; follow up; glaucoma; human; intraocular pressure; patient compliance; patient participation; priority journal; questionnaire; risk assessment; self report; survival rate; treatment outcome; unspecified side effect

Prostanoids for the management of glaucoma - Arranz-Marquez, E.; Teus, M.A. (Expert Opinion on Drug Safety, 2008)
Background: Prostanoids are the newest pharmacologic group of ocular hypotensive drugs for clinical management of glaucoma. The group includes four chemical compounds structurally derived from naturally-occurring prostaglandin (PG) F2α. Prostanoids have been divided into PG analogues (unoprostone, latanoprost and travoprost) and prostamides (bimatoprost) because of differences in molecular structures. The drugs share a novel mechanism of action that produces a potent ocular hypotensive effect and a novel local adverse effect of increased iridial pigmentation. Objective: To summarise the pharmacologic and clinical data regarding the effectiveness and safety of prostanoids in clinical glaucoma management. Methods: The review was supported by a literature search of peer-reviewed publications, based on medical information available in databases such as PubMed. Results/conclusion: The prostanoids began a treatment revolution not only because of their novel mechanism of action but also as a result of a new local side effect. © 2008 Informa UK Ltd.
Keywords: benzalkonium chloride; bimatoprost; collagen type 1; collagen type 3; collagen type 4; collagen type 6; fibronectin; gelatinase A; gelatinase B; hyaluronic acid; interstitial collagenase; laminin; latanoprost; prostaglandin receptor; stromelysin; timolol; travoprost; unoprostone isopropyl ester; angina pectoris; aqueous humor flow; article; asthma; bronchospasm; ciliary muscle; conjunctival hyperemia; cornea erosion; dizziness; dosage schedule comparison; drug absorption; drug blood level; drug efficacy; drug elimination; drug half life; drug mechanism; drug metabolism; drug safety; drug structure; evening dosage; extracellular matrix; glaucoma; herpes simplex keratitis; human; intraocular pressure; iris disease; medical information; medical literature; Medline; muscle relaxation; patient compliance; peer review; receptor upregulation

Unilateral granulomatous post-streptococcal uveitis with elevated tension - Besada, E.; Frauens, B.J. (Optometry and Vision Science, 2008)
PURPOSE.: We document a presumptive case of unilateral post-streptococcal uveitis. The affected eye manifested a granulomatous anterior uveitis with elevated intra-ocular pressure (IOP) compared with the contra-lateral eye. This presentation was preceded by a recent streptococcal pharyngitis. CASE REPORT.: An asymptomatic, otherwise healthy 13-year-old black female presented with anterior chamber cells, mutton fat resembling keratic precipitates, and elevated IOP in the left eye relative to the right eye. The patient had been diagnosed with streptococcal pharyngitis approximately 1 week before her eye examination. A blood chemistry analysis, rheumatoid profile panel and antistreptolysin antibody titer were requested. The patient was prescribed predinisolone acetate 1% ophthalmic suspension in the left eye. RESULTS.: Anti-streptolysin antibody titers were significantly elevated (291 IU/ml). The patient responded favorably to topical ophthalmic steroid treatment with a reduction of IOP and inflammation. CONCLUSIONS.: Unilateral, granulomatous anterior uveitis may be a variant manifestation of post-streptococcal uveitis. The IOP elevation in these cases may result secondary to concurrent trabeculitis. © 2008 American Academy of Optometry.
Keywords: amoxicillin; prednisolone acetate; rheumatoid factor; steroid; adolescent; anterior eye chamber; antibody titer; article; blood analysis; case report; clinical feature; diagnostic imaging; disease association; disease duration; eye; eye examination; eye inflammation; female; human; intraocular hypertension; iridocyclitis; keratitis; patient compliance; photophobia; priority journal; slit lamp; streptococcal pharyngitis; Streptococcus; streptolysin titer; symptom; tonometry; treatment duration; treatment outcome; unilateral granulomatous anterior uveitis; uveitis; visual acuity

Learning disability: Challenging behaviour - Pilling, R. (British Journal of Ophthalmology, 2008)
Keywords: cataract extraction; decision making; eye examination; glaucoma; health care access; human; law; learning disorder; letter; patient assessment; patient attitude; patient information; physician attitude; priority journal; visual disorder

Predictors of and barriers associated with poor follow-up in patients with glaucoma in South India - Lee, B.W.; Sathyan, P.; John, R.K.; Singh, K.; Robin, A.L. (Archives of Ophthalmology, 2008)
Objectives: To determine predictors of and reasons for poor longitudinal glaucoma follow-up in South India. Methods: This 1-to-1, matched, case-control study enrolled 300 patients with established glaucoma. We defined cases (poor follow-up) and controls (good follow-up) based on number of and maximum interval between glaucoma follow-up visits attended in the preceding year. We collected data by oral questionnaire and used step-wise multivariate logistic regression to calculate odds ratios (ORs) for poor follow-up. Results: Adjusting for age and sex, independent predictors of poor follow-up included lack of formal education (adjusted OR, 4.13; 95% confidence interval [CI], 1.44-11.90), no use of prescribed glaucoma medications (adjusted OR, 2.17; 95% CI, 1.06-4.43), and belief that follow-up is less important if one uses glaucoma medications and has no noticeable visual changes (adjusted OR, 10.59; 95% CI, 3.74-29.97). Age, sex, and disease severity were not significant predictors. The most prevalent barriers to follow-up were belief that there was no problem with one's eyes (44.4%) and lack of escort (19.7%). Conclusions: Knowing predictors of poor follow-up can help identify patients who need individualized strategies to improve follow-up. Because believing one's eyes are problem-free and lacking escorts are significant barriers to follow-up, novel strategies in patient education (eg, intensive counseling, audiovisual aides, and patient support groups) and escort provision may improve longitudinal glaucoma follow-up and disease management. ©2008 American Medical Association. All rights reserved.
Keywords: adult; aged; article; controlled study; educational status; female; follow up; general aspects of disease; glaucoma; human; major clinical study; male; priority journal; questionnaire; vision

Visual cues to health - Offord, L. (Australian Journal of Pharmacy, 2008)
Keywords: antihistaminic agent; antiinflammatory agent; antioxidant; beta adrenergic receptor blocking agent; contraceptive agent; omega 3 fatty acid; ranibizumab; tricyclic antidepressant agent; zinc; article; blindness; clinical feature; clinical trial; diabetes mellitus; diet supplementation; drug marketing; dry eye; eye care; eye disease; glaucoma; health care access; health promotion; human; human relation; menopause; optometry; patient counseling; patient education; pharmacist; pharmacy (shop); macular degeneration; smoking cessation; visual impairment; lucentis

Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US - Cantor, L.B.; Katz, L.J.; Cheng, J.W.; Chen, E.; Tong, K.B.; Peabody, J.W. (Current Medical Research and Opinion, 2008)
Objective: Despite the significant clinical and economic burden associated with glaucoma, studies evaluating the long-term costs of existing treatments are limited. This study compared the 5-year costs of three treatment strategies: medication, laser trabeculoplasty, and filtering surgeries in managing patients with primary open-angle glaucoma whose intra-ocular pressures were not adequately controlled by two medications. Research design and methods: A Markov model was developed to simulate the transition of treatment progression over a 5-year period to evaluate the total treatment costs associated with each strategy. In the medication arm, medications were the only available treatment, whereas in the laser trabeculoplasty and surgery arms, patients would receive concomitant medications both at the time of the procedure and in subsequent years. Treatment states were determined by the rate of success in controlling patients' intra-ocular pressure in each year. The distribution of treatment states and the transition probabilities between these states were derived from published literature, adjusted or supplemented by the authors' own treatment experiences. Costs assessed in the model included treatment, complications associated with each treatment, and physician office visits obtained from published literature and standardized fees and schedules. Results: The 5-year cumulative costs were approximately $6571, $4838 and $6363 for patients in the medication, laser trabeculoplasty, and filtering surgery arms, respectively. Costs of third-line medication, first-line medication following laser trabeculoplasty, and post-surgery complications had the greatest impact on the model results in the medication, laser trabeculoplasty, and filtering surgery arms, respectively. Probabilistic sensitivity suggested the results were statistically significant (p<0.001), favoring the use of laser trabeculoplasty. Conclusions: Over 5 years laser trabeculoplasty was associated with the lowest total costs compared to treatment by medication alone or by filtering surgery for patients who were not adequately controlled by two medications. Future development of glaucoma treatment should focus on reducing the need for post-procedure medical therapy as well as lowering the rate of post-procedure complications. Limited by the availability of the transition probabilities in published literature, the model results need to be validated by prospective or retrospective observational studies. © 2008 Informa UK Ltd.
Keywords: alpha adrenergic receptor stimulating agent; brimonidine; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; carteolol; dorzolamide; latanoprost; levobunolol; metipranolol; prostaglandin; prostaglandin derivative; timolol; timolol maleate; travoprost; travoprost; unclassified drug; ambulatory care; article; drug cost; economic evaluation; filtering operation; health care cost; hidden Markov model; human; intraocular pressure; open angle glaucoma; patient care; postoperative complication; probability; simulation; statistical significance; trabeculoplasty; United States; alphagan p; azopt; istalol; lumigan; timoptic; travatan z; travatan; trusopt; xalatan

Glaucoma: Good health competence is positive for the course of the disease - Bitzer, M. (Gesundheitsokonomie und Qualitatsmanagement, 2008)
Keywords: competence; disease course; glaucoma; health status; human; note; patient compliance

Subconjunctival bevacizumab for corneal neovascularization - Doctor, P.P.; Bhat, P.V.; Foster, C.S. (Cornea, 2008)
Purpose: To describe whether subconjunctival bevacizumab decreases corneal neovascularization in patients with ocular surface inflammatory diseases. Methods: The study is a retrospective case series that includes 8 eyes of 7 patients with corneal neovascularization. Patients received 1-3 injections of 2.5 mg subconjunctival bevacizumab. Morphologic changes were assessed clinically by the same investigator at each visit. Results: Subconjunctival bevacizumab was well-tolerated without obvious corneal side effects. All 8 eyes of the 7 patients showed a reduction in the neovascularized area. Conclusions: Subconjunctival bevacizumab may provide an additional strategy in improving vision or improving success of corneal grafts in these patients. © 2008 by Lippincott Williams & Wilkins.
Keywords: aciclovir; amoxicillin plus clavulanic acid; antibiotic agent; azathioprine; bevacizumab; corticosteroid; cyclosporine; dapsone; lubricating agent; methotrexate; prednisolone; prednisone; retinoic acid; rituximab; steroid; triamcinolone; adolescent; adult; aged; article; astigmatism; case study; clinical article; conjunctival biopsy; cornea disease; cornea neovascularization; cornea transplantation; corticosteroid therapy; drug dose reduction; drug efficacy; drug tolerability; drug withdrawal; female; hemolytic anemia; herpes simplex keratitis; human; human tissue; local therapy; male; microscopic polyangiitis; mucous membrane pemphigoid; patient compliance; penetrating keratoplasty; priority journal; pseudopterygium; pterygium; age related macular degeneration; retrospective study; steroid therapy; Stevens Johnson syndrome; symblepharon; systemic therapy; treatment outcome; trichiasis; unspecified side effect; uveitis; vision; avastin

Epidemiology of glaucoma in central Ethiopia - Alemu, A.M.; Nelson, L.A.; Kruft, B.; Stewart, J.A.; Stewart, W.C. (International Journal of Ophthalmology, 2008)
• Aim: To evaluate the prevalence of glaucoma, treatment patterns and patient attitudes in Ethiopia. • Methods: A survey was administered to glaucoma patients in hospitals in Addis Ababa, Ethiopia. • Results: Of the 415 qualified patients, exfoliative glaucoma (17%) was most commonly found in the Gurage population (33%), whereas chronic angle-closure glaucoma (5%) was found in the Amhara/Tigre (6%) population (P = 0.006). Patients were treated with an average of 1.4 ± 0.8 medications: 52% admitted recent noncompliance and 36% had undergone filtering surgery. Patients believed their physician was trying to help them (93%). God wanted them to receive treatment (89%) and their spouse was sympathetic to their disease (82%). Patients noted their community was unaware of their condition (87%) with Muslims [most common in the Gurage population (31%, P < 0.0001)] reporting this the most (25%, P = 0.01). Amhara/Tigre patients strongly believed their doctors were concerned about them (94%, P = 0.04). • Conclusion: The prevalence of glaucoma type varies among ethnic groups in Ethiopia with exfoliation more common in the Gurage population and chronic angle-closure glaucoma more frequent in the Amhara/Tigre population.
Keywords: antiglaucoma agent; adult; article; attitude to illness; closed angle glaucoma; controlled study; disease classification; Ethiopia; ethnic difference; female; filtering operation; glaucoma; health survey; human; major clinical study; male; Muslim; patient attitude; patient compliance; prevalence; religion

Anti-VEGF therapy: Riding the wave of change - Hunyor, A.P. (Clinical and Experimental Ophthalmology, 2008)
Keywords: bevacizumab; ranibizumab; vasculotropin inhibitor; clinical decision making; diabetic retinopathy; drug absorption; drug cost; drug efficacy; drug indication; drug response; drug safety; editorial; fluorescence angiography; health care access; health care availability; health care delivery; human; medical education; medical specialist; neovascular glaucoma; off label drug use; optical coherence tomography; photodynamic therapy; retina detachment; age related macular degeneration; retina neovascularization; vitrectomy; avastin; lucentis

Corneal ulcer due to Neocosmospora vasinfecta in an immunocompetent patient - Manikandan, P.; Vismer, H.F.; Kredics, L.; Doczi, I.; Marasas, W.F.O.; Bhaskar, M.; Anita, R.; Revathi, R.; Narendran, V. (Medical Mycology, 2008)
We report a case of Neocosmospora vasinfecta keratitis in a 55-year-old man. While the patient did not recall any specific trauma or eye injury, he might have sustained a trivial wound during the course of his duties as a farmer. Direct examination of corneal scrapings revealed fungal filaments. As topical treatment with natamycin and econazole and subsequent systemic ketoconazole therapy failed, a full thickness therapeutic keratoplasty was performed. Post-operative treatment with amphotericin B and clotrimazole combined with cyclosporine resulted in a complete cure. The residual corneal infiltration in the recipient cornea became clear in a week. The fungal isolate was initially identified as a Fusarium species, but later reidentified through the use of morphological characteristics and sequence analysis of the internal transcribed spacer region as N. vasinfecta. The latters is a Hypocrealean fungus not hitherto reported as a causative agent of keratomycosis.
Keywords: acetazolamide; amphotericin B; clotrimazole; cyclosporine; econazole; eye drops; homatropine; internal transcribed spacer; ketoconazole; natamycin; adult; article; Ascomycetes; case report; cornea ulcer; lack of drug effect; fungus isolation; Fusarium; human; immunocompetence; keratoplasty; male; mycosis; Neocosmospora vasinfecta; nucleotide sequence; patient compliance; postoperative care

Current Status of Hepatic Transplantation - Broering, D.C.; Walter, J.; Braun, F.; Rogiers, X. (Current Problems in Surgery, 2008)
Keywords: alemtuzumab; azathioprine; basiliximab; calcineurin inhibitor; corticosteroid; cyclosporine; daclizumab; everolimus; lymphocyte antibody; mammalian target of rapamycin inhibitor; methylprednisolone; mycophenolate mofetil; OKT 3; peginterferon; prednisolone; prednisone; rapamycin; ribavirin; tacrolimus; thymocyte antibody; acne; alopecia; anatomical variation; article; biliary tract disease; bone marrow suppression; cardiovascular disease; chemoembolization; clinical trial; Cushing syndrome; drug substitution; drug withdrawal; gastrointestinal symptom; gingiva hyperplasia; glaucoma; hepatitis C; human; hyperglycemia; hyperlipidemia; immunosuppressive treatment; liver cancer; liver cell carcinoma; liver cirrhosis; liver disease; liver failure; liver graft; liver toxicity; liver transplantation; living donor; medical ethics; mouth ulcer; nephrotoxicity; nonhuman; osteopenia; patient compliance; patient selection; pediatrics; postoperative care; postoperative complication; radiofrequency ablation; recipient; side effect; stem cell transplantation; surgical anatomy; surgical technique; treatment contraindication; treatment indication; vascular disease; virus replication; OKT 3

Satisfaction and compliance of ocular hypertensive and glaucoma patients topically treated with a combination therapy - Bron, A.; Baudouin, C.; Denis, P.; Nordmann, J.-P.; Renard, J.-P.; Rouland, J.-F.; Sellem, E. (Journal Francais d'Ophtalmologie, 2008)
Objectives: To evaluate satisfaction and compliance in glaucoma and ocular hypertensive patients receiving a fixed combination treatment. Materials and methods: After instilling a fixed combination, patients were asked to fill out a questionnaire about their satisfaction and compliance at baseline and 15 days after the onset of new therapy. Results: 1693 glaucoma patients (G) and 621 ocular hypertensive (OHT) patients were included. Mean age was 65.6±11.7 years. Onset of disease was 7.2±6.6 years and 5.2±4.9 years for G and OHT patients, respectively. Insufficient efficacy of the previous topical treatment (monotherapy in 55 % of cases) was the main cause for shifting to a fixed combination in 70 % of cases. Satisfaction was increased in 15 % of the patients and compliance was increased in 25 % of the patients. Discussion: Fixed combination provides an easier regimen and therefore encourages better compliance, a key issue in a chronic disease such as glaucoma. © 2008. Elsevier Masson SAS.
Keywords: beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; prostaglandin; aged; article; clinical trial; comparative study; drug combination; female; human; intraocular hypertension; male; middle aged; multicenter study; open angle glaucoma; patient compliance; patient satisfaction; prospective study; treatment outcome

Inflammatory bowel disease in older people - Grimpen, F.; Pavli, P. (Journal of Pharmacy Practice and Research, 2008)
Inflammatory bowel disease (IBD) can affect patients of all ages. The majority of patients are diagnosed in the second or third decade of life, but a minority develop the disease at an advanced age. Diagnosis can be delayed due to the preconception that IBD mainly affects young people, and the broader spectrum of differential diagnoses in the elderly. Management and treatment options are similar to those in younger patients but adverse reactions and drug interactions may be of greater significance in the elderly. Precluding treatment with anti-tumour necrosis factor drugs on grounds of previous infection with tuberculosis or viral hepatitis, comorbidities or previous malignancy - factors often found with advanced age - can make treatment challenging. The increased risk of bowel cancer in IBD warrants regular screening, specially in the elderly as their absolute risk of cancer is higher.
Keywords: 6 mercaptopurine derivative; adalimumab; allopurinol; azathioprine; balsalazide; bisphosphonic acid derivative; budesonide; calcium; certolizumab; corticosteroid; digoxin; folic acid; hydrocortisone; immunosuppressive agent; infliximab; influenza vaccine; lipoprotein; mercaptopurine; mesalazine; methotrexate; methylprednisolone; olsalazine; oral antidiabetic agent; placebo; prednisolone; salazosulfapyridine; tumor necrosis factor antibody; unclassified drug; unindexed drug; vitamin D; warfarin; aging; agitation; agranulocytosis; article; bone marrow suppression; calcium deficiency; cancer risk; cardiovascular disease; cataract; clinical feature; clinical trial; colitis; colon diverticulosis; colon surgery; colorectal cancer; comorbidity; corticosteroid induced osteoporosis; Crohn disease; diet therapy; differential diagnosis; disease severity; drug antagonism; drug blood level; drug choice; drug dose reduction; drug efficacy; drug eruption; drug fever; drug induced headache; drug megadose; drug metabolism; drug safety; drug tolerability; drug withdrawal; enteritis; flu like syndrome; fragility fracture; glaucoma; hepatitis; high risk patient; human; hyperglycemia; influenza; insomnia; intestine infection; intestine ischemia; leukopenia; lipoprotein blood level; low drug dose; malaise; mood disorder; myalgia; myopathy; nausea; opportunistic infection; optimal drug dose; pancreatitis; patient assessment; patient compliance; patient monitoring; photosensitivity; psychosis; side effect; thromboembolism; treatment duration; tuberculosis; ulcerative colitis; unspecified side effect; virus hepatitis

24-hour control of intraocular pressure with 2% dorzolamide/0.5% timolol fixed-combination ophthalmic solution in open-angle glaucoma - Feldman, R.M.; Stewart, R.H.; Stewart, W.C.; Jia, G.; Smugar, S.S.; Galet, V.A. (Current Medical Research and Opinion, 2008)
Objective: To evaluate the 24-hour efficacy and tolerability of 2% dorzolamide/0.5% timolol fixed combination (DTFC) solution in open-angle glaucoma and ocular hypertension. Research design and methods: Randomized, parallel, double-masked, multicenter study. Patients with insufficiently controlled intraocular pressure (IOP ≥ 22 mmHg) were randomized to DTFC (N=117) or timolol (N=115). IOP was measured at baseline, 6 weeks, and 8 weeks, with measurements taken at 6 p.m., 8 p.m., 10 p.m., 2 a.m., 6 a.m., 8 a.m., 10 a.m., and 2 p.m. ClinicalTrials.gov identifier: NCT00108017 Main outcome measures: Statistically significant change in IOP from untreated baseline for DTFC at all hours at week 8. Secondary outcome measures included: IOP-lowering at week 6 at all individual time points, change from baseline to 8 weeks in mean daytime IOP (average of 8 a.m., 10 a.m., 2 p.m., 6 p.m., and 8 p.m. IOPs) and night-time IOP (10 p.m., 2 a.m., 6 a.m.), and comparison of DTFC with timolol after 8 weeks. Results: Patients receiving DTFC had a statistically significant and clinically relevant reduction in IOP at week 8 compared with baseline at all eight time points (p<0.001). Significant IOP reductions were also seen at all time points at week 6 (p<0.001). DTFC significantly lowered mean daytime IOP and night-time IOP (p<0.001 for both). Timolol alone also significantly reduced IOP from baseline at 8 weeks for all diurnal time points, and mean daytime and night-time IOP (p<0.001 for all). Compared with timolol alone, there were significantly greater reductions with DTFC at 10 a.m. (p=0.003) and 2 p.m. (p=0.016), and for mean daytime IOP (p=0.025) at 8 weeks. Significant between-treatment differences were not observed at other time points. Both treatments were well-tolerated, with no differences observed in the safety profiles between the treatment groups. Conclusions: Both DTFC and timolol provided significant IOP reduction over the entire 24-hour measurement period. Although this study was not designed or powered to compare DTFC and timolol, DTFC exhibited greater IOP-lowering than timolol during the daytime, but not at night. © 2008 Informa UK Ltd. All rights reserved.
Keywords: NCT00108017; dorzolamide plus timolol; timolol maleate; adult; aged; blurred vision; cholelithiasis; circadian rhythm; clinical trial; consciousness disorder; controlled study; diabetic neuropathy; dose time effect relation; double blind procedure; drug efficacy; drug induced disease; drug safety; drug tolerability; drug withdrawal; dry eye; evening dosage; eye disease; eye irritation; eye pain; female; human; intraocular hypertension; intraocular pressure; major clinical study; male; morning dosage; multicenter study; open angle glaucoma; papilledema; patient compliance; patient monitoring; pressure measurement; randomized controlled trial; retina exudate; review; urinary tract infection; vitreous floaters; timoptic

Safety of inhaled corticosteroids. Why the variation in systemic adverse effects? - Anthracopoulos, M.B.; Priftis, K.N.; Russell, G. (Current Pediatric Reviews, 2008)
Inhaled corticosteroids (ICS) are currently the mainstay of therapy in persistent childhood asthma. However, systemic adverse effects of various available agents - particularly on growth, bone metabolism, and the hypothalamic-pituitary-adrenal (HPA) axis - continue to concern the families of asthmatic children, and are debated within the medical community. Although there is short- and medium-term suppressive effect of usual doses of ICS on linear growth, the findings of long term studies are reassuring, suggesting attainment of the full potential of adult height. ICS do not appear to exert significant untoward effects on bone mineral density. Measurable systemic effect of ICS by sensitive measurements of function of the HPA axis does not necessarily translate into clinically significant side effects. However, use of higher than recommended doses of ICS may on occasion lead to symptomatic adrenal insufficiency and should be of concern; there may be important differences among available compounds regarding such potential. Variation in adverse effects of ICS is explained by differences in their pharmacokinetic and pharmacodynamic properties, formulation and delivery devices, and patient factors such as degree of airway obstruction, suppressive effect of airway inflammation per se on the HPA axis, genetic factors, patient training in the use of delivery devices, and compliance. © 2008 Bentham Science Publishers Ltd.
Keywords: beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; betamethasone valerate; budesonide; ciclesonide; corticosteroid; corticotropin; corticotropin releasing factor; cortisone; cortisone acetate; dexamethasone; flunisolide; fluticasone propionate; glucocorticoid; insulin; leukotriene receptor blocking agent; metyrapone; mometasone furoate; nedocromil; omalizumab; placebo; prednisolone; salmeterol; tetracosactide; theophylline; triamcinolone acetonide; adrenal cortex insufficiency; adrenal suppression; asthma; bone density; bone metabolism; bone mineral; bronchospasm; calcium deficiency; child growth; clinical trial; corticosteroid induced osteoporosis; coughing; Cushing syndrome; volume of distribution; drug bioavailability; drug clearance; drug dose comparison; drug dose reduction; drug efficacy; drug intermittent therapy; drug mechanism; drug megadose; drug protein binding; drug receptor binding; drug safety; dysphonia; endocrine function test; forced expiratory volume; fracture; glaucoma; growth disorder; growth rate; growth retardation; half life time; human; hypothalamus hypophysis adrenal system; long term care; low drug dose; mean residence time; metered dose inhaler; mild persistent asthma; oropharynx candidiasis; particle size; patient compliance; patient education; pharmacodynamics; powder inhaler; priority journal; recommended drug dose; respiratory tract inflammation; review; rheumatoid arthritis; secondary hyperparathyroidism; side effect; single drug dose; skin contusion; sore throat; subcapsular cataract; systemic disease; treatment duration; Diskhaler; Turbuhaler

Intraocular pressure response to medication in a clinical setting: The marshfield clinic personalized medicine research project - McCarty, C.A.; Mukesh, B.N.; Kitchner, T.E.; Hubbard, W.C.; Wilke, R.A.; Burmester, J.K.; Patchett, R.B. (Journal of Glaucoma, 2008)
PURPOSE: To estimate glaucoma and ocular hypertension prevalence and to describe temporal trends in prescribing patterns and intraocular pressure (IOP) response to topical medications used in glaucoma and ocular hypertension. MATERIALS AND METHODS: The medical records of adult subjects enrolled in the population-based Marshfield Clinic Personalized Medicine Research Project were searched to identify participants who had been diagnosed with ocular hypertension or glaucoma and prescribed agent(s) to lower IOP. All IOPs before and after prescription of the IOP agents were recorded. RESULTS: As of December 31, 2005, 18,773 adults were enrolled in the Personalized Medicine Research Project, 57.1% were female, and their mean age was 50.3 years (range, 18 to 101y). The overall rate of definite glaucoma in subjects aged 50 years and above was 2.1% (95% confidence interval=1.2, 2.4) and the rate of treated ocular hypertension was 1.4% (95% confidence interval=1.2, 1.7). Topical β-blockers were the agents prescribed for the majority of subjects until the year 2000, when prostaglandins, first used in 1995, became the primary agent prescribed. In 2005, 75% of subjects used prostaglandin analogs and 46% used topical β-blockers. The largest relative reduction in IOP in the first 3 months after prescription was observed for prostaglandin analogs (21.4% mean relative reduction), followed by β-blockers (20.9% mean relative reduction). There has been a significant decrease over time in mean IOP before initiating medical therapy (linear regression β coefficient=-0.30, P<0.0001, r=0.09). CONCLUSIONS: In this clinic-based setting, we found that treatment of glaucoma has changed over the past 20 years, with ophthalmologists more likely to begin treatment at lower baseline levels of IOP, and prostaglandin analogs the most commonly prescribed and agent to lower IOP. © 2008 by Lippincott Williams & Wilkins.
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin derivative; adult; aged; article; combination chemotherapy; confidence interval; controlled study; drug competition; drug efficacy; female; human; intraocular hypertension; intraocular pressure; major clinical study; male; medical record review; monotherapy; open angle glaucoma; patient compliance; prescription; prevalence; priority journal; statistical significance; trabeculectomy; trabeculoplasty; treatment response

Doctor-Patient Communication, Health-Related Beliefs, and Adherence in Glaucoma. Results from the Glaucoma Adherence and Persistency Study - Friedman, D.S.; Hahn, S.R.; Gelb, L.; Tan, J.; Shah, S.N.; Kim, E.E.; Zimmerman, T.J.; Quigley, H.A. (Ophthalmology, 2008)
Objective: To use multiple data sources to determine drivers of patient adherence to topical ocular hypotensive therapy. Design: Retrospective database and chart reviews in combination with prospective patient surveys. Diverse medical environments where insured patients in the research database seek care. Participants: Three hundred patients with a new claim diagnosis for open-angle glaucoma who initially were prescribed one of three prostaglandins and 103 physicians participating in the same medical plans. Methods: A structured interview addressing self-reported adherence, experiences with medication, communication with the physician, and health-related beliefs associated with adherence behavior was administered to surveyed patients. Phone interviews were conducted with participating ophthalmologists. Main Outcome Measure: Of adherence, medication possession ratio. Results: Eight variables were associated independently with a lower medication possession ratio: (1) hearing all of what you know about glaucoma from your doctor (compared with some or nothing); (2) not believing that reduced vision is a risk of not taking medication as recommended; (3) having a problem paying for medications; (4) difficulty while traveling or away from home; (5) not acknowledging stinging and burning; (6) being nonwhite; (7) receiving samples; and (8) not receiving a phone call visit reminder. The multivariate model explained 21% of the variance. Conclusions: These findings indicate that doctor-patient communications and health-related beliefs of patients contribute to patient adherence. Patient learning styles that are associated with less concern about the future effects of glaucoma and the risks of not taking medications are associated with lower adherence. Specifically, knowledge about potential vision loss from glaucoma is a critical element that tends to be missed by more passive doctor-dependent patients who tend to be poorly adherent. These findings suggest that educational efforts in the office may improve patient adherence to medical therapies. © 2008 American Academy of Ophthalmology.
Keywords: prostaglandin; timolol; adult; article; burn; comparative study; controlled study; data base; doctor patient relationship; education; environment; female; health behavior; home; human; hyperemia; interpersonal communication; knowledge; learning style; major clinical study; male; medical record review; medical research; multivariate analysis; open angle glaucoma; ophthalmology; patient compliance; physician; planning; prescription; priority journal; prospective study; retrospective study; risk; sample; structured interview; travel; vision; visual impairment

A case of fungal keratitis: A clinical and in vivo confocal microscopy assessment - Miller, W.L.; Giannoni, A.G.; Perrigin, J. (Contact Lens and Anterior Eye, 2008)
A presumed case of fungal keratitis is presented. Confocal images highlight the advantage of using such technology to follow therapeutic progress, particularly when standard laboratory testing is inconclusive. This case also demonstrates the importance of continued patient education regarding overall compliance and lens care. © 2008 British Contact Lens Association.
Keywords: artificial tear; bacitracin; hydrocodone bitartrate plus paracetamol; moxifloxacin; natamycin; scopolamine; tobramycin; adult; article; biomicroscopy; blepharitis; case report; clinical assessment; confocal microscopy; conjunctival hyperemia; contact lens; cornea edema; cornea ulcer; drug dose reduction; drug eruption; drug withdrawal; dry eye; evening dosage; eye care; eye irritation; eye pain; follow up; fungus growth; fungus hyphae; Fusarium; human; keratomycosis; male; nonhuman; pain; patient compliance; patient education; priority journal; scar; visual acuity; vicodin; vigamox

Management of narcolepsy - Bhat, A.; El Solh, A.A. (Expert Opinion on Pharmacotherapy, 2008)
Background: Narcolepsy is a rare chronic sleep disorder classically characterized by excessive daytime sleepiness. Other symptoms of the disease, including cataplexy, sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep, may follow later. The disease can be incapacitating and frequently results in impaired psychosocial interaction. In the absence of a cure for narcolepsy, medical therapy is directed at symptom control. Objectives: The aim of this study was to review the current approach to the treatment of narcolepsy. Methods: A search of three bibliographic databases (MEDLINE/PubMed, EMBASE and the Cochrane Library Database) was conducted from 1966 to January 2008 using the National Library of Medicine MeSH search terms narcolepsy and cataplexy. Relevant studies, case reports, review articles, editorials, short communications and chapters from selected textbooks were then extracted and manually cross-referenced. Results/conclusions: Traditionally, stimulants have been used to improve the symptoms of excessive daytime sleepiness. However, the treatment of narcolepsy has evolved recently with the widespread use of newer drugs, including modafinil for daytime sleepiness, newer antidepressants for cataplexy and γ-hydroxybutyrate (sodium oxybate) for both excessive daytime sleepiness and cataplexy. © 2008 Informa UK Ltd.
Keywords: amphetamine; amphetamine derivative; antidepressant agent; armodafinil; central stimulant agent; clomipramine; desipramine; dexamphetamine; diazepam; ethinylestradiol; fluoxetine; imipramine; mazindol; methamphetamine; methylphenidate; modafinil; oxybate sodium; pemoline; pethidine; phenytoin; placebo; propranolol; protriptyline; reboxetine; selegiline; serotonin uptake inhibitor; tricyclic antidepressant agent; unindexed drug; venlafaxine; viloxazine; aggression; agitation; anorexia; anxiety; bedtime dosage; blood pressure; body temperature; catalepsy; cataplexy; clinical trial; Cochrane Library; combination chemotherapy; confusion; constipation; coping behavior; daytime somnolence; depression; diaphoresis; diarrhea; dizziness; dosage schedule comparison; dose response; drug bioavailability; drug blood level; drug choice; drug dose escalation; drug dose increase; drug effect; drug efficacy; drug elimination; drug half life; drug induced headache; drug mechanism; drug megadose; drug metabolism; drug potentiation; drug safety; drug substitution; drug tolerability; drug withdrawal; ejaculation disorder; Embase; erectile dysfunction; exercise; gait disorder; glaucoma; hallucination; heart arrhythmia; heart palpitation; human; hyperreflexia; hypotension; impotence; insomnia; irritability; libido disorder; liver toxicity; low drug dose; Medline; mental health; monotherapy; mood change; morning dosage; muscle rigidity; myoclonus; narcolepsy; nausea; nervousness; neuroleptic malignant syndrome; night sleep

Nonseasonal allergic conjunctivitis in the tropics: Experience in a tertiary care institution - Choi, H.; Lee, S.B. (Ocular Immunology and Inflammation, 2008)
Purpose: To understand the epidemiology, severity, types of pathology, clinical features, precipitating factors, and treatment outcomes of patients with allergic conjunctivitis in a tropical climate receiving corneal subspecialist intervention. A total of 33 patients with severe allergic conjunctivitis under corneal subspecialist care in National University Hospital, Singapore were studied. Design: A retrospective, noncomparative case series. Main outcome measures: epidemiological data, clinical features, complete ophthalmological examination, and treatment types. Methods: Both eyes of 33 patients seen at the cornea subspecialist clinic between May 2005 and July 2006 were examined at baseline, and followed up. Clinical features, treatment given, and outcome variables through case sheet review were analyzed. Results: Twenty-five patients (75.8%) were male, and 8 (24.2%) were female. Seventeen patients (51.5%) had concomitant allergic rhinitis, 16 patients (48.5%) had asthma, and 17 (51.5%) had associated dermatitis. Only 9 patients (27.3%) had documented precipitating factors. None of the 33 patients said that their symptoms were seasonal; 22 (66.7%) said their symptoms were perennial. Twenty-nine patients (87.9%) had punctate epithelial erosions, and 12 patients eventually progressed to have a corneal epithelial defect or shield ulcer (36.4%). Eleven out of the 33 patients (33.3%) received topical cyclosporine 0.5%. Of these, only 1 (9.1%) had documented complaints of intolerable side effects. Conclusion: Allergic conjunctivitis in a non-temperate, non-seasonal climate has different clinical presentations, and varied precipitating factors. The disease in such conditions may respond differently to the usual anti-allergy drug options used in temperate countries. Copyright © Informa Healthcare USA, Inc.
Keywords: antiallergic agent; antihistaminic agent; cetirizine; corticosteroid; cromoglycate disodium; cyclosporine; dexamethasone; fluorometholone; glutamic acid derivative; hydroxyzine; ketotifen; lodoxamide; loratadine; loteprednol etabonate; n aspartylacetylglutamic acid; naphazoline; olopatadine; pheniramine; prednisolone; promethazine; triamcinolone; unclassified drug; adolescent; adult; allergic conjunctivitis; allergic rhinitis; article; asthma; burning sensation; child; clinical article; clinical feature; contact lens; controlled study; cornea disease; cornea epithelium; cornea erosion; cornea ulcer; dermatitis; disease severity; drug withdrawal; eczema; epidemiological data; eye examination; eye surgery; female; follow up; glaucoma; homeopathy; human; intraocular pressure; male; medical specialist; outcome assessment; outcome variable; patient compliance; retrospective study; side effect; Singapore; skin defect; symptom; tertiary health care; tropic climate; tropics; university hospital; unspecified side effect

Azathioprine in the management of autoimmune uveitis - Pacheco, P.A.; Taylor, S.R.J.; Cuchacovich, M.T.; Diaz, G.V. (Ocular Immunology and Inflammation, 2008)
Purpose: To evaluate the role of azathioprine as an immunosuppressive for steroid-resistant autoimmune uveitis (AIU). Methods: Patients using oral prednisolone for active AIU without clinical response were recruited. A standard protocol of oral prednisolone and azathioprine was used. Results: Twenty-seven patients participated in the study: 3 with anterior uveitis, 1 pars planitis, 4 idiopatic panuveitis, 8 Vogt-Koyonagi-Harada syndrome, 3 Behcet disease, and 8 choroidoretinopathies. Complete response was observed in 92%. Eleven patients had well-tolerated minor side effects. Conclusion: Azathioprine is safe and effective in controlling steroid-resistant AIU. Copyright © Informa Healthcare USA, Inc.
Keywords: aciclovir; antibiotic agent; azathioprine; immunosuppressive agent; prednisolone; adult; aged; aminotransferase blood level; article; autoimmune disease; Behcet disease; cataract; Caucasian; central serous retinopathy; clinical article; controlled study; drug dose reduction; drug dose titration; drug tolerability; epiretinal membrane; female; gastrointestinal symptom; herpes zoster; human; intermediate uveitis; intraocular hypertension; iridocyclitis; leukopenia; maintenance drug dose; male; migraine; optic neuritis; patient care; patient compliance; retina aneurysm; retina detachment; retina disease; retina macula cystoid edema; side effect; treatment outcome; treatment response; urinary tract infection; uveitis; Vogt Koyanagi syndrome

Manpower issues in pediatric ophthalmology - Simon, J.; Koller, H.P. (Journal of Pediatric Ophthalmology and Strabismus, 2008)
Keywords: article; cataract extraction; child health care; clinical practice; congenital cataract; continuing education; economic aspect; eye surgery; glaucoma; health care access; health care need; health insurance; managed care; manpower planning; medical practice; medical society; patient care; reimbursement; residency education; strabismus surgery; training; United States; urban area

Large variations in the cost of eye medications for uninsured patients in the United States - Wu, Z.; Sadda, S. (Journal of Pharmaceutical Finance, Economics and Policy, 2008)
To understand the cost of prescription eye medications for uninsured patients, a telephone survey of store pharmacies and their online counterparts was conducted in one community within the United States. The retail prices of some common brand name and generic eye medications were recorded. Store pharmacies were found to be about 10% more expensive than their online counterparts, but some medicines were not available online. Overall, pharmacies of national retailers were cheaper than chain pharmacies. Generic medicines were more affordable and had greater price variability than brand name products. The unit cost of glaucoma medications was lower when bought as 3-month supplies. Prescription eye medication prices can vary significantly from one pharmacy to another. To increase patient compliance and to provide cost-effective care, physicians should research their local pharmacies to gain greater understanding of the economic impact of prescription drugs. © 2008 by Informa Healthcare USA, Inc. All rights reserved.
Keywords: agents acting on the eye; azelastine; betaxolol; bimatoprost; brimonidine; brinzolamide; bromfenac; cyclosporine; dexamethasone; dexamethasone plus tobramycin; diclofenac; dorzolamide; dorzolamide plus timolol; epinastine; gatifloxacin; ketorolac trometamol; ketotifen fumarate; latanoprost; levofloxacin; loteprednol etabonate; dexamethasone plus neomycin plus polymyxin B; moxifloxacin; neomycin; ofloxacin; olopatadine; polymyxin; prednisolone acetate; timolol; timolol maleate; travoprost; article; community; cost effectiveness analysis; drug cost; glaucoma; health insurance; health survey; human; online analysis; patient compliance; pharmacy (shop); physician; prescription; priority journal; prospective pricing; telephone; United States; acular; alphagan; alrex; azopt; betoptic; cosopt; econopred; elestat; lotemax; lumigan; maxitrol; ocuflox; optivar; patanol; quixin; restasis; timoptic xe; tobradex; travatan; trusopt; vigamox; voltaren; xalatan; xibrom; zaditor; zymar

Pharmacological management of atypical antipsychotic-induced weight gain - Baptista, T.; ElFakih, Y.; Uzcátegui, E.; Sandia, I.; Tálamo, E.; Araujo De Baptista, E.; Beaulieu, S. (CNS Drugs, 2008)
Excessive bodyweight gain was reported during the 1950s as an adverse effect of typical antipsychotic drug treatment, but the magnitude of bodyweight gain was found to be higher with the atypical antipsychotic drugs that were introduced after 1990. Clozapine and olanzapine produce the greatest bodyweight gain, ziprasidone and aripiprazole have a neutral influence, and quetiapine and risperidone cause an intermediate effect. In the CATIE study, the percentage of patients with bodyweight gain of >7% compared with baseline differed significantly between the antipsychotic drugs, i.e. 30%, 16%, 14%, 12% and 7% for olanzapine, quetiapine, risperidone, perphenazine (a typical antipsychotic) and ziprasidone, respectively (p < 0.001). Appetite stimulation is probably a key cause of bodyweight gain, but genetic polymorphisms modify the bodyweight response during treatment with atypical antipsychotics. In addition to nutritional advice, programmed physical activity, cognitive-behavioural training and atypical antipsychotic switching, pharmacological adjunctive treatments have been assessed to counteract excessive bodyweight gain. In some clinical trials, nizatidine, amantadine, reboxetine, topiramate, sibutramine and metformin proved effective in preventing or reversing atypical antipsychotic-induced bodyweight gain; however, the results are inconclusive since few randomized, placebo-controlled clinical trials have been conducted. Indeed, most studies were short-term trials without adequate statistical power and, in the case of metformin, nizatidine and sibutramine, the results are contradictory. The tolerability profile of these agents is adequate. More studies are needed before formal recommendations on the use of these drugs can be made. Meanwhile, clinicians are advised to use any of these adjunctive treatments according to their individual pharmacological and tolerability profiles, and the patient's personal and family history of bodyweight gain and metabolic dysfunction. © 2008 Adis Data Information BV. All rights reserved.
Keywords: amantadine; amisulpride; aripiprazole; atypical antipsychotic agent; betahistine; chlorpromazine; clozapine; famotidine; fluoxetine; fluphenazine; fluvoxamine; haloperidol; mesoridazine; metformin; molindone; nizatidine; olanzapine; perphenazine; quetiapine; ranitidine; reboxetine; risperidone; sertindole; sibutramine; tetrahydrolipstatin; thioridazine; topiramate; unindexed drug; ziprasidone; zotepine; abdominal discomfort; agitation; anorgasmia; anxiety disorder; appetite; arthralgia; blurred vision; clinical trial; closed angle glaucoma; cognitive therapy; constipation; defecation; diarrhea; dizziness; drug efficacy; drug tolerability; drug withdrawal; dysmenorrhea; dysphoria; dyspnea; edema; ejaculation disorder; family history; fatigue; feces incontinence; flatulence; gastrointestinal hemorrhage; gastrointestinal pain; gastrointestinal symptom; genetic polymorphism; headache; heart arrhythmia; heart rate; hematuria; hot flush; human; hypertension; hypotension; insomnia; jaundice; lactic acidosis; leukopenia; livedo reticularis; liver toxicity; loose feces; memory disorder; mental concentration; mental disease; metabolic acidosis; metabolic disorder; mood change; myalgia; myopia; nausea; nephrolithiasis; nutrition; obesity; paresthesia; patient compliance; physical activity; priority journal; psychomotor disorder; pulmonary hypertension; rash; review; schizophrenia; sedation; seizure; serotonin syndrome; sexual dysfunction

Intravitreal triamcinolone versus laser photocoagulation for persistent diabetic macular oedema - Ockrim, Z.K.; Sivaprasad, S.; Falk, S.; Roghani, S.; Bunce, C.; Gregor, Z.; Hykin, P. (British Journal of Ophthalmology, 2008)
Aim: To determine if repeated intravitreal triamcinolone improves best corrected visual acuity at 1 year compared with conventional laser therapy for persistent diabetic macular oedema. Methods: 88 eyes with persistent clinically significant macular oedema, after at least one prior laser photocoagulation, were included in this prospective randomised controlled trial. 43 patients were randomised to 4 mg of intravitreal triamcinolone (TA) and 45 to laser photocoagulation. The primary endpoint was the proportion of patients who improved by 15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters at 12 months in TA versus laser groups. Secondary endpoints were the change in mean best corrected visual acuity, difference in macular thickness and macular volume and adverse event reporting in particular elevated intraocular pressure at 12 months. Results: Improvement in ≥15 ETDRS letters occurred in two of 42 patients in the TA group (4.8%) and in five of 41 (12.2%) patients in the laser group (p = 0.265). At baseline, the mean ETDRS scores at baseline were 54.4 letters in the TA group and 53.0 letters in the laser group. At 12 months, these were 54.5 and 54.6, respectively. Optical coherence tomography showed a reduction in central macular thickness of 82.0 μm with TA and 62.3 μm with laser at 12 months. There was one case of sterile endophthalmitis. 22 out of 43 patients in the triamcinolone group required ocular antihypertensives. Conclusion: This study did not show a benefit from intravitreal triamcinolone over conventional laser therapy for patients with chronic diabetic macular oedema.
Keywords: antihypertensive agent; triamcinolone acetonide; adult; article; cataract; chronic disease; clinical trial; controlled clinical trial; controlled study; corticosteroid therapy; diabetic macular edema; drug safety; endophthalmitis; female; human; intermethod comparison; intraocular hypertension; intraocular pressure; laser coagulation; major clinical study; male; optical coherence tomography; patient compliance; priority journal; randomized controlled trial; retina macula lutea; side effect; treatment outcome; visual acuity; kenalog

Late-stage, primary open-angle glaucoma in Europe: Social and health care maintenance costs and quality of life of patients from 4 countries - Thygesen, J.; Aagren, M.; Arnavielle, S.; Bron, A.; Fröhlich, S.J.; Baggesen, K.; Azuara-Blanco, A.; Buchholz, P.; Walt, J.G. (Current Medical Research and Opinion, 2008)
Objective: The purpose of this study was to estimate costs and quality of life (QoL) of late-stage glaucoma patients in 4 European countries. Methods: Retrospective review of medical charts of patients with POAG who were followed in a low-vision or vision rehabilitation center in one of 4 countries for at least 1 year was used to determine patient characteristics, health status, and health care resource use. Visual impairment was measured by best-corrected visual acuity (Snellen score). Patients were also interviewed over the telephone in order to assess their health-related QoL (using EuroQol EQ-5D) and use of resources including: the number of visits to rehabilitation centers, visits to hospital and non-hospital specialists, the use of low-vision devices, medication, tests, and the use of hired home help. The costs associated with resource use were calculated from the perspective of a third-party payer of health and social care based on resource usage and unit costs in each country. Results: Patients undergoing visual rehabilitation in France (n=21), Denmark (n=59), Germany (n=60), and the United Kingdom (n=22) were identified, interviewed and had their medical charts reviewed. Annual maintenance costs of late-stage glaucoma amounted to €830 (±445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (±0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also positively correlated to health care costs, but negatively correlated to costs of home help. Conclusions: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential savings from a better preventive treatment are to be found for social care payers rather than health care payers. © 2008 Informa UK Ltd All rights reserved.
Keywords: adult; aged; conference paper; controlled study; cost benefit analysis; Denmark; disease severity; female; France; Germany; health care; health care cost; health care utilization; health status; human; major clinical study; male; open angle glaucoma; quality of life; rehabilitation center; scoring system; social care; telephone; United Kingdom; visual acuity; visual impairment

Topical Therapy in Pediatric Atopic Dermatitis - Krakowski, A.C.; Dohil, M.A. (Seminars in Cutaneous Medicine and Surgery, 2008)
With a prevalence of 10% to 20% in the first decade of life, atopic dermatitis (AD) is one of the most common skin disorders in young children. It is a chronic illness with limited therapeutic options. Topical anti-inflammatory agents remain at the core of medical management; however, their efficacy must be balanced with safety concerns, especially as they relate to the pediatric population. This article discusses the principles of topical AD therapy with a detailed review of the differences between topical corticosteroids and topical calcineurin inhibitors. It also includes specialized topical treatment strategies for AD, such as wet wraps and diluted bleach baths, and highlights the most common challenges to patient compliance in atopic dermatitis. © 2008 Elsevier Inc. All rights reserved.
Keywords: alclometasone dipropionate; antibiotic agent; bleaching agent; calcineurin inhibitor; ceramide; clobetasol propionate; corticosteroid; desonide; fluocinolone acetonide; fluocinonide; fluticasone propionate; hydrocortisone; mometasone furoate; pimecrolimus; prednicarbate; tacrolimus; triamcinolone acetonide; acne; application site reaction; application site stinging; application site stinging; article; atopic dermatitis; balneotherapy; bone density; cataract; clinical feature; cost effectiveness analysis; delayed hypersensitivity; disease control; disease exacerbation; drug mechanism; drug potency; drug safety; drug tolerability; glaucoma; growth retardation; health education; human; hypopigmentation; hypothalamus hypophysis adrenal system; monotherapy; occlusive dressing; patient compliance; perioral dermatitis; prevalence; rosacea; side effect; skin atrophy; skin care; skin maceration; Staphylococcus aureus; stria; tachyphylaxis; telangiectasia; xerosis

Success rates for switching to dorzolamide/timolol fixed combination in timolol responders who are insufficiently controlled by latanoprost monotherapy - Sonty, S.; Henry, J.C.; Sharpe, E.D.; Weiss, M.J.; Stewart, J.A.; Nelson, L.A.; Stewart, W.C. (Acta Ophthalmologica, 2008)
Purpose: We aimed to investigate the safety and efficacy of dorzolamide/ timolol fixed combination (DTFC) in timolol responders with ocular hypertension or open-angle glaucoma who switched to DTFC because of insufficient control on latanoprost. Methods: We carried out a prospective, open-label cohort study with an active-historical control in which qualifying patients must have been treated with latanoprost monotherapy for at least 4weeks, must have demonstrated insufficiently controlled intraocular pressure (IOP) (≥ 19 mmHg at 08.00 hours), and must have shown a decrease in IOP at 2 hours after timolol instillation of ≥ 3 mmHg or ≥ 15%. Patients then began DTFC dosed at 08.00 hours and 20.00 hours and discontinued latanoprost. Patients were evaluated again after 4 and 12 weeks. Results: In 57 patients IOP was further reduced by 2.4 ± 3.3 mmHg at 08.00 hours (p < 0.0001) and by 3.5 ± 3.3 mmHg at 10.00 hours (p < 0.0001) after switching to DTFC. Responses to the Comparison of Ophthalmic Medications for Tolerability (COMTol) questionnaire showed no difference between DTFC and latanoprost for in terms of overall preference, typical daily activities, limitation of activities, compliance, satisfaction or quality of life (p > 0.05). However, greater frequency in burning and/or stinging (p < 0.0001) and bitter taste (p < 0.0001) were observed with DTFC, whereas unusual taste (p = 0.02) and itchy eyes (p = 0.05) were associated with latanoprost. Conclusions: This study suggests that patients who are insufficiently controlled on latanoprost monotherapy, and who are timolol responders, can generally achieve further IOP reduction and similar tolerance levels when changed to DTFC. © 2007 The Authors Journal compilation © 2007 Acta Ophthalmol.
Keywords: dorzolamide plus timolol; latanoprost; timolol; adult; aged; article; bitter taste; blurred vision; clinical trial; cohort analysis; conjunctival hyperemia; controlled clinical trial; controlled study; daily life activity; drug efficacy; drug preference; drug response; drug safety; drug substitution; drug tolerability; drug withdrawal; dry eye; eye burning; female; human; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; ocular pruritus; open angle glaucoma; open study; patient compliance; patient satisfaction; priority journal; prospective study; quality of life; questionnaire; side effect; statistical significance; systemic disease; taste disorder; cosopt; xalatan

The role of vitreo-retinal surgery in children with uveitis - Arevalo, J.F.; Garcia-Amaris, R.A. (International Ophthalmology Clinics, 2008)
Uveitis in children has been reported at a much lower incidence than in adults, although with worse prognosis because at the time of diagnosis a substantial number of patients have complications that represent an important cause of ocular morbidity and visual loss. Children may be at special risk of complications, because inflammation is frequently chronic, and diagnosis is often delayed because of lack of symptoms or failure to report changes in vision. In addition, children are more difficult to examine and to treat. The evaluation and management of children with uveitis require special considerations. Medical and surgical management can be challenging owing to the unique features of clinical presentation. Therefore, early and aggressive anti-inflammatory therapy is the best means to improved long-term outcomes in children. Surgical intervention for diagnostic or therapeutic reasons may be necessary, and generally is required to address complications that are unresponsive to or not amenable to medical therapy. In addition, surgical procedures must be appropriately planned keeping in mind the risks and benefits and always under an appropriate and strict immunosuppressive (preoperative, intraoperative, and postoperative) therapy. Surgical treatment should be considered only when uveitis is controlled medically. Multistage surgery may be necessary to address each complication of uveitis using diverse strategies. Finally, a close relation should be fostered among pediatricians, pediatric rheumatologist, and ophthalmologist to more effectively diagnose and manage children with uveitis. © 2008, Lippincott Williams & Wilkins.SRSR.
Keywords: azathioprine; chlorambucil; corticosteroid; cyclophosphamide; cyclosporine; cyclosporine; dexamethasone; fluocinolone acetonide; fluorocarbon; methotrexate; nonsteroid antiinflammatory agent; steroid; triamcinolone acetonide; amblyopia; cataract; cataract extraction; childhood disease; clinical trial; cryotherapy; disease exacerbation; drug delivery system; epiretinal membrane; eye surgery; follow up; glaucoma; human; immunosuppressive treatment; intermediate uveitis; intraocular hypotension; iridocyclitis; keratopathy; laser coagulation; laser surgery; lens implantation; lensectomy; patient compliance; polymerase chain reaction; priority journal; retina; retina detachment; retina injury; review; sarcoidosis; strabismus; surgical technique; toxocariasis; treatment indication; uveitis; vitrectomy; vitreoretinopathy; vitreous biopsy; posurdex; retisert

Improving eye drop treatment for glaucoma through better adherence - Quigley, H.A. (Optometry and Vision Science, 2008)
Keywords: eye drops; article; cognition; comorbidity; drug use; drug withdrawal; educational status; family relation; glaucoma; health belief; health care access; health care cost; human; intraocular pressure; patient compliance; priority journal; social status; treatment withdrawal

Intracameral SF6 injection and anterior segment OCT-based documentation for acute hydrops management in pellucid marginal corneal degeneration - Vanathi, M.; Behera, G.; Vengayil, S.; Panda, A.; Khokhar, S. (Contact Lens and Anterior Eye, 2008)
Purpose: To report a case of acute hydrops in pellucid marginal corneal degeneration (PMCD) documented with anterior segment optical segment tomography and successfully treated with sulphur hexafluoride (SF6) intracameral injection. Methods: A 47-year-old female patient presented with spontaneous onset of pain, redness and decreased vision in her left eye. Clinical evaluation revealed bilateral PMCD with evidence of acute hydrops in the left eye. Anterior segment Slit lamp Adapted Optical Coherence Tomography (SL-OCT) examination revealed intrastromal clefts with Descemet's membrane detachment in the left eye. She was managed with descemetopexy with 0.2 ml injection of iso-expansile SF6 (18%) intracameral. Results: The patient showed excellent early resolution of the stromal edema with reattachment of the Descemet's membrane. Conclusion: Prompt intervention in acute hydrops in PMCD cases helps in achieving early good visual results and prevents potentially serious complications such as perforation. Newer imaging modalities like SL-OCT helps in better visualisation and also in monitoring the response to treatment. © 2008 British Contact Lens Association.
Keywords: antibiotic agent; steroid; sulfur hexafluoride; acute disease; adult; anterior eye segment; article; case report; cornea disease; cornea dystrophy; cornea edema; cornea perforation; cornea stroma; Descemet membrane; disease duration; eye pain; eye refraction; female; human; edema; intraocular hypertension; optical coherence tomography; patient compliance; pellucid marginal cornea dystrophy; photophobia; priority journal; slit lamp; supine position; visual acuity; visual impairment

Introduction to special issue - Wagoner, M.D. (International Ophthalmology, 2008)
Keywords: antiglaucoma agent; aging; amblyopia; anisometropia; astigmatism; blindness; contact lens; cornea transplantation; cryopreservation; editorial; glaucoma; graft failure; graft rejection; graft survival; human; keratoplasty; lens implant; limbal stem cell transplantation; medical literature; medical specialist; microsurgery; ophthalmology; patient compliance; postoperative care; prognosis; refraction error; shelf life; surgical technique; treatment outcome

Long-term use of topical tacrolimus (FK506) in high-risk penetrating keratoplasty - Dhaliwal, J.S.; Mason, B.F.; Kaufman, S.C. (Cornea, 2008)
PURPOSE: To evaluate the long-term efficacy and side effects of off-label topical tacrolimus 0.03% ointment (Protopic; Fujisawa Health, Deerfield, IL) as a sole second-line immunosuppressive agent in the management of high-risk corneal grafts. METHODS: Four consecutive patients underwent high-risk penetrating keratoplasty (4 grafts) with a prior diagnosis of corneal scar secondary to herpetic keratitis, keratoconus, acanthamoeba keratitis, and Fuchs endothelial dystrophy, respectively. All 4 patients developed steroid-induced glaucoma and failed traditional immunosuppressant therapy. Patients were started on topical tacrolimus ointment 0.03%, twice daily, which was tapered to the lowest possible therapeutic dose that maintained its antirejection efficacy. Patients were monitored for adverse treatment effects. The mean follow-up was 33 months (range, 26-48 months), and the mean treatment duration was 22.6 months (range, 13-32 months). RESULTS: All 4 high-risk corneal transplant patients experienced episodes of acute rejection that was successfully reversed with topical tacrolimus treatment. During tacrolimus treatment, there were no further episodes of graft rejection and no incidents of herpes simplex virus infection or reactivation, with the longest follow-up being 4 years. Two patients have been successfully tapered off tacrolimus, and 2 patients are currently on once-daily dosing. No adverse effects were observed. CONCLUSIONS: Topical tacrolimus 0.03% ointment seems to be a promising second-line immunosuppressant in management of high-risk grafts. © 2008 Lippincott Williams & Wilkins, Inc.
Keywords: bacquacil; brimonidine; cyclosporine; gramicidin; loteprednol etabonate; neomycin; neosporin; poly(hexamethylenebiguanide); polymyxin B; prednisolone acetate; prednisone; tacrolimus; timolol; trifluridine; valaciclovir; absence of side effects; Acanthamoeba keratitis; acute graft rejection; adult; article; case report; cataract; chronic drug administration; hereditary corneal dystrophy; cornea transplantation; cornea ulcer; drug dose increase; drug dose reduction; drug efficacy; drug substitution; drug withdrawal; eye epithelium toxicity; eye epithelium toxicity; eye toxicity; female; follow up; glaucoma; herpes simplex keratitis; Herpes simplex virus; high risk patient; human; immunosuppressive treatment; intraocular pressure; keratoconus; male; monotherapy; patient compliance; penetrating keratoplasty; priority journal; treatment duration; virus reactivation; alphagan; bacquacil; fk 506; lotemax; neosporin; pred forte; protopic; restasis; valtrex

Functional health literacy in patients with glaucoma in urban settings - Juzych, M.S.; Randhawa, S.; Shukairy, A.; Kaushal, P.; Gupta, A.; Shalauta, N. (Archives of Ophthalmology, 2008)
Objective: To assess the relationship between health literacy and compliance, disease awareness, and disease progression in patients with glaucoma. Methods: A cross-sectional observational study of 204 English-speaking patients treated for glaucoma for at least 1 year at Kresge Eye Institute was conducted. Health literacy was assessed using the standardized Test of Functional Health Literacy in Adults (TOFHLA). An oral questionnaire assessed patients' demographic information and glaucoma understanding. A retrospective medical record review was conducted to record parameters indicating glaucoma severity. Results: One hundred two participants (50%) were categorized as having poor functional health literacy (mean [SD] TOFHLA score, 18.4 [7.5]) and 102 participants (50%) had adequate health literacy (mean [SD] TOFHLA score, 42.8 [5.1]). The poor health literacy group showed significant differences in income, education, medication compliance, glaucoma understanding, and missed appointments compared with the adequate health literacy group (P < .001). Patients with poor health literacy showed a greater visual field loss on initial presentation (mean deviation [SD], -10.58 [9.3] dB) compared with the adequate health literacy group (mean deviation [SD], -7.79 [6.9] dB; P = .02) and significantly worse visual field parameters when comparing pattern SDs on the recent and the initial visual fields (pattern SD change [SD], 0.19 [2.5] dB in the poor health literacy group vs -0.7 [2.2] dB in the adequate health literacy group; P = .02). Conclusions: Patients with poor health literacy had poorer compliance, worse disease understanding, and greater disease progression compared with the adequate health literacy group, highlighting the need to promote health literacy in patients with glaucoma. ©2008 American Medical Association. All rights reserved.
Keywords: adult; aged; article; awareness; controlled study; disease course; disease severity; female; glaucoma; health education; human; income; major clinical study; male; medical record review; patient compliance; patient education; priority journal; questionnaire; urban area; visual field

Treatment of glaucoma patients with insufficient intraocular pressure control: A survey of German ophthalmologists in private practice - Vorwerk, C.; Thelen, U.; Buchholz, P.; Kimmich, F. (Current Medical Research and Opinion, 2008)
Objective: To assess the degree to which glaucoma treatment guidelines have been incorporated into daily practices and to describe the therapeutic practices chosen for patients with insufficient intraocular pressure (IOP) control. Methods: Ophthalmologists in private practice in Germany were surveyed to obtain information about patients who exhibited unsatisfactory progress with IOP-lowering pharmacotherapy. Using a questionnaire, physicians provided data concerning treatment difficulty, target IOP, number and type of medications used, two most recent IOP readings, and optic nerve head and visual field observations. Results: Of the 853 patients analyzed, primary open-angle glaucoma was the diagnosis for 67.1%, and other diagnoses included ocular hypertension, normal tension glaucoma, and Pseudoexfoliation glaucoma. Target IOP levels had been determined for 95.5% of patients, and not achieving the target pressure was identified as a treatment difficulty for 81.0% of patients. Of patients on monotherapy, β-blockers were prescribed most often (42.3%). Of all patients, 53.3% were treated with two or more agents as either fixed or non-fixed combinations. The non-fixed combination of a prostaglandin and carbonic anhydrase inhibitor was the most frequently prescribed dual therapy (19.2%). Non-fixed prostaglandin plus β-blocker was used by 18.0% of dual therapy patients, whereas the available fixed combination was used by 10.5%. Non-compliance was identified as a cause of unsatisfactory IOP-lowering in 26.8% of all patients. This study is limited by its descriptive, non-interventional design. Conclusions: Treatment alterations are necessary to achieve sufficient IOP control in some patients. If these patients were to take advantage of more aggressive therapies as outlined by treatment guidelines, including newer formulations and fixed combination preparations, both efficacy and compliance may be improved. © 2008 Informa UK Ltd. All rights reserved.
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; dorzolamide; latanoprost; metipranolol; miotic agent; pilocarpine; prostaglandin; timolol; aged; article; drug efficacy; female; glaucoma; human; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; open angle glaucoma; optic nerve; patient compliance; practice guideline; prescription; private practice; pseudoexfoliation; questionnaire; visual field

Ocular novel drug delivery: Impacts of membranes and barriers - Barar, J.; Javadzadeh, A.R.; Omidi, Y. (Expert Opinion on Drug Delivery, 2008)
Background: Ocular drug delivery is an extremely challenging area due to its restrictive barrier functionalities. Objective: Drug transport via corneal/non-corneal routes involves several intricate biological processes such as drug penetration across the ocular barriers and transfer to the anterior or posterior chambers, thus the influence of these processes on the pharmacotherapy of the eye should be fully addressed. Methods: To pursue the impacts of such impediments in novel drug therapy, recent publications were reviewed regarding advanced strategies such as nanomedicines. Conclusion: The ocular barriers are highly specialized and selectively control the inward/outward traverse of compounds, hence a better understanding of these biological obstacles would provide a platform to advance ophthalmic drug therapy towards specified delivery/targeting with minimal adverse consequences. © 2008 Informa UK Ltd.
Keywords: acetazolamide; adenovirus vector; agents acting on the eye; albumin; bevacizumab; chitosan; clathrin; eudragit; eye drops; fluocinolone acetonide; foscarnet sodium; ganciclovir; gentamicin; ABC transporter subfamily B; lentivirus vector; liposome; macrogol; methylprednisolone acetate; mifepristone; nucleic acid; pegaptanib; pilocarpine; piloplex; piroxicam; polyglactin; polylactic acid; prostaglandin F2 alpha; ranibizumab; timolol maleate; unindexed drug; verteporfin; aqueous humor flow; astigmatism; blood eye barrier; blood retina barrier; cataract; cell membrane transport; ciliary body; clinical trial; conjunctiva epithelium; cornea endothelium; cornea epithelium; drug absorption; drug activity; drug bioavailability; drug delivery system; drug implantation; drug penetration; drug targeting; drug transport; endocytosis; endophthalmitis; eye disease; gene therapy; glaucoma; human; intraocular pressure abnormality; lacrimal fluid; liposomal gene delivery system; long term care; nanomedicine; nonhuman; nonviral gene therapy; patient compliance; permeability barrier; photodynamic therapy; retina degeneration; macular degeneration; retinitis; review; subretinal neovascularization; sustained drug release; tear film; uveitis; viral gene delivery system; vitreous body; vitreous hemorrhage; avastin; lucentis; macugen; ocusert; piloplex; retisert; timoptol; visudyne; vitrasert

Ranibizumab and pegaptanib for the treatment of age-related macular degeneration: A systematic review and economic evaluation - Colquitt, J.L.; Jones, J.; Tan, S.C.; Takeda, A.; Clegg, A.J.; Price, A. (Health Technology Assessment, 2008)
Objectives: To assess the clinical effectiveness and cost-effectiveness of ranibizumab and pegaptanib for subfoveal choroidal neovascularisation (CNV) associated with wet age-related macular degeneration (AMD). Data sources: Electronic databases were searched from inception to September 2006. Experts in the field were consulted and manufacturers' submissions were examined. Review methods: The quality of included studies was assessed using standard methods and the clinical effectiveness data were synthesised through a narrative review with full tabulation of results. A model was developed to estimate the cost-effectiveness of ranibizumab and of pegaptanib (separately), compared with current practice or best supportive care, from the perspective of the NHS and Personal Social Services. Two time horizons were adopted for each model. The first adopted time horizons determined by the available trial data. The second analysis extrapolated effects of treatment beyond the clinical trials, adopting a time horizon of 10 years. Results: The combined analysis of two randomised controlled trials (RCTs) of pegaptanib [0.3 mg (licensed dose), 1.0 mg and 3.0 mg] versus sham injection in patients with all lesion types was reported by three publications (the VISION study). Three published RCTs of ranibizumab were identified (MARINA, ANCHOR, FOCUS), and an additional unpublished RCT was provided by the manufacturer (PIER). Significantly more patients lost less than 15 letters of visual acuity at 12 months when taking pegaptanib (0.3 mg: 70% of patients; 1.0 mg: 71% of patients; 3.0 mg: 65% of patients) or ranibizumab (0.3 mg: 94.3-94.5%; 0.5 mg: 94.6-96.4%) than sham injection patients (55% versus pegaptanib and 62.2% versus ranibizumab) or, in the case of ranibizumab, photodynamic therapy (PDT) (64.3%). The proportion of patients gaining 15 letters or more (a clinically important outcome having a significant impact on quality of life) was statistically significantly greater in the pegaptanib group for doses of 0.3 and 1.0 mg but not for 3.0 mg, and for all ranibizumab groups compared to the sham injection groups or PDT. This was also statistically significant for patients receiving 0.5 mg ranibizumab plus PDT compared with PDT plus sham injection. Pegaptanib patients lost statistically significantly fewer letters after 12 months of treatment than the sham group [mean letters lost: 7.5 (0.3 mg), 6.5 (1.0 mg) or 10 (3.0 mg) vs 14.5 (sham)]. In the MARINA and ANCHOR trials, ranibizumab patients gained letters of visual acuity at 12 months whereas patients with sham injection or PDT lost about 10 letters (p < 0.001) and in the PIER study, ranibizumab patients lost significantly fewer than the sham injection group. Significantly fewer patients receiving pegaptanib or ranibizumab deteriorated to legal blindness compared with the control groups. Adverse events were common for both pegaptanib and ranibizumab but most were mild to moderate. Drug costs for 1 year of treatment were estimated as £4626 for pegaptanib and £9134 for ranibizumab. Non-drug costs accounted for an additional £2614 for pegaptanib and £3120 for ranibizumab. Further costs are associated with the management of injection-related adverse events, from £1200 to £2100. For pegaptanib compared with usual care, the incremental cost-effectiveness ratio (ICER) ranged from £163,603 for the 2-year model to £30,986 for the 10-year model. Similarly, the ICERs for ranibizumab for patients with minimally classic and occult no classic lesions, compared with usual care, ranged from £152,464 for the 2-year model to £25,098 for the 10-year model. Conclusions: Patients with AMD of any lesion type benefit from treatment with pegaptanib or ranibizumab on measures of visual acuity when compared with sham injection and/or PDT. Patients who continued treatment with either drug appeared to maintain benefits after 2 years of follow-up. When comparing pegaptanib and ranibizumab, the evidence was less clear due to the lack of direct comparison through head-to-head trials and the lack of opportunity for indirect statistical comparison due to heterogeneity. The cost-effectiveness analysis showed that the two drugs offered additional benefit over the comparators of usual care and PDT but at increased cost. Future research should encompass trials to compare pegaptanib with ranibizumab and bevacizumab, and to investigate the role of verteporfin PDT in combination with these drugs. Studies are also needed to assess adverse events outside the proposed RCTs, to consider the optimal dosing regimes of these drugs and the benefits of re-treatment after initial treatment, and to review costing in more detail. Health state utilities and their relationship with visual acuity and contrast sensitivity, the relationship between duration of vision loss and the quality of life and functional impact of vision loss, behavioural studies of those genetically at risk are other topics requiring further research. © Queen's Printer and Controller of HMSO 2008. All rights reserved.
Keywords: antibiotic agent; pegaptanib; ranibizumab; steroid; verteporfin; bleeding; blepharitis; blindness; blurred vision; brain infarction; cataract; choroid hemorrhage; clinical trial; combination chemotherapy; conjunctival hemorrhage; controlled clinical trial; cornea edema; cost benefit analysis; cost control; cost effectiveness analysis; cryotherapy; deterioration; digestive system perforation; dose response; drug cost; drug dose comparison; drug dose reduction; drug efficacy; drug fatality; drug hypersensitivity; drug safety; drug tolerability; drug withdrawal; economic evaluation; endophthalmitis; eye discharge; eye disease; eye inflammation; eye irritation; eye pain; eye surgery; follow up; health care cost; health economics; heart infarction; human; hypertension; information retrieval; injection site reaction; intraocular foreign body; intraocular hypertension; iridocyclitis; iritis; lacrimation; laser coagulation; lens disease; low level laser therapy; monotherapy; national health service; ocular fibrosis; patient compliance; photodynamic therapy; punctate keratitis; quality adjusted life year; quality of life; randomized controlled trial; retina detachment; retina hemorrhage; age related macular degeneration; macular degeneration; retina tear; review; side effect; statistical significance; cerebrovascular accident; subretinal neovascularization; systematic review; thromboembolism; treatment duration; treatment outcome; unspecified side effect; uveitis; visual acuity; visual disorder; vitrectomy; vitreous body detachment; vitreous floaters; vitreous hemorrhage; vitreous opacity; lucentis; lucentis; macugen

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years - Main, C.; Shepherd, J.; Anderson, R.; Rogers, G.; Thompson-Coon, J.; Liu, Z.; Hartwell, D.; Loveman, E.; Green, C.; Pitt, M.; Stein, K.; Harris, P.; et al. (Health Technology Assessment, 2008)
Objectives: To assess the clinical and cost-effectiveness of inhaled corticosteroids (ICS) alone and ICS used in combination with a long-acting beta2 agonist (LABA) in the treatment of chronic asthma in children aged under 12 years. Data sources: Major electronic bibliographic databases, e.g. MEDLINE and EMBASE, were searched up to February/March 2006 (and updated again in October 2006). Review methods: A systematic review of clinical and cost-effectiveness studies and economic analyses were carried out. A flexible framework was used to allow different types of economic analyses as appropriate, with either a cost comparison or cost-consequence comparison conducted. Results: Of 5175 records identified through systematic literature searching, 34 records describing 25 studies were included (16 were fully published randomised controlled trials, six were systematic reviews, and three were post-2004 conference abstracts). The most frequently reported relevant outcomes in the 16 RCTs were peak expiratory flow rate (13 trials), FEV1 (13 trials), symptoms (13 trials), adverse events or exacerbations (13 trials), use of rescue medication (12 trials), markers of adrenal function (e.g. blood or urine cortisol concentrations) (13 trials), height and/or growth rate (seven trials) and markers of bone metabolism (two trials). In the trials that compared low-dose ICS versus ICS and high-dose ICS versus ICS, no consistent significant differences or patterns in differential treatment effect among the outcomes were evident. Where differences were statistically significant at high doses, such as for lung function and growth, they favoured formoterol fumarate (FF), but this was generally in studies that did not compare the ICS at the accepted clinically equivalent doses. Differences between the drugs in impact on adrenal suppression were only significant in two studies. At doses of 200, 400 and 800 μg/ day, beclometasone dipropionate (BDP) appears to be the current cheapest ICS product both with the inclusion and exclusion of chlorofluorocarbon (CFC)-propelled products. In the trials comparing ICS at a higher dose with ICS and LABA in combination, most outcomes favoured the combined inhaler. Only the combination inhaler, Seretide Evohaler, is slightly cheaper than the weighted mean cost of all types of ICS at increased dose except BDP 400 μg/day (including CFC-propelled products). Both the combination inhalers, Seretide Accuhaler and Symbicort Turbohaler, are more expensive than the weighted mean cost for all types of ICS at a two-fold increased dose. Compared with the lowest cost preparation for each ICS drug, all the combination inhalers are always more expensive than the ICS products at increased dose. Conclusions: The limited evidence available indicates that there are no consistent significant differences in effectiveness between the three ICS licensed for use in children at either low or high dose. BDP CFC-propelled products are often the cheapest ICS currently available at both low and high dose, and may remain so even when CFC-propelled products are excluded. Exclusion of CFC-propelled products increases the mean annual cost of all budesonide (BUD) and BDP, while the overall cost differences between the comparators diminish. There is very limited evidence available for the efficacy and safety of ICS and LABAs in children. From this limited evidence, there appear to be no significant clinical differences in effects between the use of a combination inhaler versus the same drugs in separate inhalers. There is a lack of evidence comparing ICS at a higher dose with ICS and LABA in combination and comparing the combination products with each other. In the absence of any evidence concerning the effectiveness of ICS at higher dose with ICS and LABA, a cost-consequence analysis gives mixed results. There are potential cost savings with the use of combination inhalers compared to separate inhalers. At present prices, the BUD/FF combination is more expensive than those containing FP/SAL, but it is not known whether there are clinically significant differences between them. A scoping review is required to assess the requirements for additional primary research on the clinical effectiveness of treatment for asthma in children under 5 years old. Such a review could also usefully include all treatment options, pharmacological and nonpharmacological, for asthma. A direct head-to-head trial that compares the two combination therapies of FP/SAL and BUD/FF is warranted, and it is important to assess whether the addition of a LABA to a lower dose of ICS could potentially be as effective as an increased dose of ICS alone, but also be steroid sparing. There is also a need for the long-term adverse events associated with ICS use to be assessed systematically. Future trials of treatment for chronic asthma in children should aim to standardise further the way in which outcome measures are defined. There should be a greater focus on patient-centred outcomes to provide a more meaningful estimation of the impact of treatment on asthma control. Methods of reporting also require standardisation. © Queen's Printer and Controller of HMSO 2008. All rights reserved.
Keywords: beclomethasone dipropionate; antihistaminic agent; asmabec; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; budesonide; budesonide plus formoterol; ciclesonide; corticosteroid; cromoglycate disodium; beclomethasone dipropionate; filair forte; flunisolide; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol; formoterol fumarate; ketotifen; leukotriene receptor blocking agent; mometasone furoate; nedocromil; placebo; prednisone; pulvinal bdp; salbutamol; salmeterol; salmeterol xinafoate; terbutaline; theophylline; triamcinolone acetonide; unclassified drug; add on therapy; adrenal function; adrenal suppression; antiinflammatory activity; asthma; body height; bone density; bone metabolism; bronchitis; bronchodilatation; bronchospasm; candidiasis; child; clinical trial; corticosteroid induced osteoporosis; cost control; cost effectiveness analysis; cost of illness; coughing; disease control; disease exacerbation; disease severity; drug bioavailability; drug cost; drug dose comparison; drug dose increase; drug efficacy; drug induced headache; drug mechanism; drug megadose; drug receptor binding; drug safety; drug withdrawal; dry powder; dysphonia; Embase; endocrine disease; forced expiratory volume; glaucoma; growth inhibition; growth rate; growth retardation; health care utilization; heart palpitation; hospitalization cost; human; hydrocortisone blood level; hydrocortisone urine level; hyperglycemia; hypertension; hypokalemia; hypothalamus hypophysis adrenal system depression; hypothalamus hypophysis adrenal system depression; hypothalamus hypophysis adrenal system suppression; hypothalamus hypophysis adrenal system suppression; intraocular hypertension; low drug dose; Medline; metered dose inhaler; mild intermittent asthma; monotherapy; mortality; open angle glaucoma; oropharynx candidiasis; patient compliance; pharmacodynamics; pharyngitis; prevalence; prognosis

Multicenter phase II trial of gefitinib first-line therapy followed by chemotherapy in advanced non-small-cell lung cancer (NSCLC): SAKK protocol 19/03 - D'Addario, G.; Rauch, D.; Stupp, R.; Pless, M.; Stahel, R.; Mach, N.; Jost, L.; Widmer, L.; Tapia, C.; Bihl, M.; Mayer, M.; Ribi, K.; et al. (Annals of Oncology, 2008)
Background: Gefitinib is active in patients with pretreated non-small-cell lung cancer (NSCLC). We evaluated the activity and toxicity of gefitinib first-line treatment in advanced NSCLC followed by chemotherapy at disease progression. Patients and methods: In all, 63 patients with chemotherapy-naive stage IIIB/IV NSCLC received gefitinib 250 mg/day. At disease progression, gefitinib was replaced by cisplatin 80 mg/m2 on day 1 and gemcitabine 1250 mg/m2 on days 1, 8 for up to six 3-week cycles. Primary end point was the disease stabilization rate (DSR) after 12 weeks of gefitinib. Results: After 12 weeks of gefitinib, the DSR was 24% and the response rate (RR) was 8%. Median time to progression (TtP) was 2.5 months and median overall survival (OS) 11.5 months. Never smokers (n = 9) had a DSR of 56% and a median OS of 20.2 months; patients with epidermal growth factor receptor (EGFR) mutation (n = 4) had a DSR of 75% and the median OS was not reached after the follow-up of 21.6 months. In all, 41 patients received chemotherapy with an overall RR of 34%, DSR of 71% and median TtP of 6.7 months. Conclusions: First-line gefitinib monotherapy led to a DSR of 24% at 12 weeks in an unselected patients population. Never smokers and patients with EGFR mutations tend to have a better outcome; hence, further trials in selected patients are warranted. © The Author 2007. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Keywords: carboplatin; cisplatin; epidermal growth factor receptor; erythropoietin; gefitinib; gemcitabine; granulocyte colony stimulating factor; serotonin antagonist; steroid; abdominal pain; adult; advanced cancer; aged; anemia; anorexia; appendix perforation; article; cancer chemotherapy; cancer growth; cancer staging; cardiotoxicity; clinical trial; combination chemotherapy; confusion; creatinine clearance; deep vein thrombosis; dehydration; diarrhea; drug efficacy; drug safety; drug substitution; drug tolerability; drug withdrawal; dry skin; fatigue; febrile neutropenia; female; fluorescence in situ hybridization; gene mutation; glaucoma; hearing impairment; human; hyperbilirubinemia; hypoalbuminemia; hyponatremia; inappropriate vasopressin secretion; infection; interstitial lung disease; lung embolism; non small cell lung cancer; major clinical study; male; metastasis; monotherapy; mucosa inflammation; multicenter study; multiple cycle treatment; musculoskeletal pain; nausea; nephrotoxicity; neurologic disease; neutropenia; overall survival; patient compliance; phase 2 clinical trial; priority journal; pruritus; quality of life; side effect; skin toxicity; treatment outcome; vomiting; weakness

Effectiveness and safety of dorzolamide-timolol alone or combined with latanoprost in open-angle glaucoma or ocular hypertension - Lesk, M.R.; Koulis, T.; Sampalis, F.; Sampalis, J.S.; Bastien, N.R. (Annals of Pharmacotherapy, 2008)
BACKGROUND: Treatment of glaucoma is aimed at reducing intraocular pressure (IOP) to prevent further damage to the optic nerve. For patients who do not respond to monotherapy, combination treatment may be effective in achieving therapeutic reduction or target IOP. OBJECTIVE: To evaluate the effectiveness and safety of dorzolamide 2% with timolol 0.5% alone or combined with latanoprost in reducing IOP in a real-world setting. METHODS: A prospective, open-label, multicenter, nonrandomized interventional study was designed. Three hundred fifty patients with primary open-angle glaucoma or ocular hypertension and uncontrolled IOP after latanoprost monotherapy for 4 or more weeks were treated with combination dorzolamide-timolol twice daily added to their existing latanoprost therapy (D/T-Add-On; n = 280) or dorzolamide-timolol twice daily monotherapy (D/T-Switch; p = 70). The primary effectiveness outcome measure was the change in IOP after 6 and 12 weeks of treatment. RESULTS: Of the total population, 313 patients completed this trial (248 D/T-Add-On; 65 D/T-Switch). After 12 weeks, the mean ± SD IOP decrease was -6.3 ± 3.6 mm Hg (-28.1%) and -58 ± 4.9 mm Hg (-23.5%) in the D/T-Add-On and D/T-Switch groups, respectively (both p < 0.001). Therapeutic response rates (defined as IOP reduction >20%) after 12 weeks of treatment for the D/T-Add-On and the D/T-Switch groups were 66.4% (186/280) and 52.9% (37/70), respectively. There were 116 predominantly mild, nonserious adverse events attributed to the study drugs, reported by 86 (24.6%) patients. The most frequent adverse events were eye irritation (n = 42; 12.0%) and taste perversion (n = 15; 4.3%). No serious adverse events related to the study medications were reported. CONCLUSIONS: In patients with primary open-angle glaucoma or ocular hypertension and elevated IOP while on monotherapy with latanoprost, switching to dorzolamide-timolol or combining dorzolamide-timolol with latanoprost are effective and safe treatment options for reducing IOP and achieving therapeutic response.
Keywords: dorzolamide plus timolol; latanoprost; add on therapy; aged; article; bedtime dosage; clinical trial; combination chemotherapy; controlled clinical trial; controlled study; diarrhea; drug efficacy; drug safety; drug substitution; drug withdrawal; eye irritation; female; gout; headache; human; intervention study; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; morning dosage; multicenter study; nausea; open angle glaucoma; open study; patient compliance; priority journal; prospective study; taste disorder; treatment duration; treatment outcome; treatment response; unspecified side effect

Who should manage contact lens related microbial keratitis in Australia and New Zealand? - Sutton, G. (Clinical and Experimental Ophthalmology, 2008)
Keywords: aminoglycoside; cefalotin; cephalosporin; quinoline derived antiinfective agent; steroid; anterior eye chamber; antibiotic resistance; antibiotic therapy; Australia and New Zealand; contact lens; disease association; disease severity; drug choice; drug contraindication; drug efficacy; drug response; drug safety; early diagnosis; editorial; eye pain; health care access; health care cost; health care system; hospital care; human; keratitis; microbial identification; monotherapy; morbidity; outpatient care; patient care; patient referral; primary medical care; prosthesis infection; public health; resource allocation; slit lamp; therapy delay

Travoprost/timolol fixed combination - Herceg, M.; Noecker, R. (Expert Opinion on Pharmacotherapy, 2008)
Background: Travoprost and timolol are topical ocular hypotensive medications that have been used in the treatment of glaucoma. The fixed combination eye drop, Duotrav (travoprost 0.004% and timolol maleate 0.5%), has recently been introduced into the market. Objective: In this paper, the results of clinical trials and existing data on the performance of travoprost/timolol are discussed and analyzed. Methods: Appropriate studies for review were identified using PubMed. Studies selected for review compared efficacy and side-effect profile of fixed combination travoprost/timolol with travoprost and timolol used concomitantly, latanoprost and timolol used concomitantly, fixed combination latanoprost/timolol, travoprost alone and timolol alone. Results/conclusion: Fixed combination eye drops such as travoprost/ timolol offer the potential benefits of increased patient adherence, reduced exposure to preservatives, and reduced cost. © 2008 Informa UK Ltd.
Keywords: benzalkonium chloride; beta adrenergic receptor blocking agent; latanoprost; latanoprost plus timolol; placebo; prostaglandin derivative; timolol; timolol plus travoprost; travoprost; bradycardia; bronchospasm; clinical trial; combination chemotherapy; conjunctival hyperemia; cost effectiveness analysis; depression; dizziness; dosage schedule comparison; dose kidney function relation; drug absorption; drug cost; drug efficacy; drug elimination; drug half life; drug mechanism; drug metabolism; drug safety; drug withdrawal; dyspnea; evening dosage; eye burning; eye irritation; fatigue; headache; heart arrhythmia; human; hypercholesterolemia; hypertrichosis; hypesthesia; hypoglycemia; hypotension; intraocular hypertension; intraocular pressure; iridocyclitis; monotherapy; morning dosage; ocular pruritus; open angle glaucoma; patient compliance; retina macula cystoid edema; retina tear; review; side effect; skin pigmentation; somnolence; duotrav

The role of patient compliance in the management of glaucoma - Suić, S.P.; Cerovski, B.; Jukić, T. (Acta Medica Croatica, 2008)
Aim: The aim of the study was to evaluate patient cooperation in glaucoma treatment. Methods: We evaluated data collected by an anonymous questionnare from 98 glaucoma patients who answered 6 questions regarding their compliance and persistence in glaucoma treatment. Results: Study results revealed 50% of patients to fail taking their antiglaucoma therapy regularly. Patients on monotherapy showed better compliance and higher level of satisfaction with treatment than those on combination antiglaucoma therapy consisting of 2 or 3 eyedrops. Discontinuation of persistence was recorded in 31% of patients, whereas 51% of patients did not present for control visits every six months as suggested by their ophthalmologist. Conclusion: Patients are more compliant and persistent with antiglaucoma monotherapy than with combined therapy. Greater compliance and persistence with ocular hypotensive therapy may improve the outcomes in glaucoma.
Keywords: antiglaucoma agent; eye drops; article; glaucoma; human; major clinical study; monotherapy; patient compliance; patient satisfaction; questionnaire

Preliminary evidence of the efficacy of probiotic eye-drop treatment in patients with vernal keratoconjunctivitis - Iovieno, A.; Lambiase, A.; Sacchetti, M.; Stampachiacchiere, B.; Micera, A.; Bonini, S. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2008)
Background: Probiotics have been shown to improve allergic inflammation. The aim of this study was to evaluate the efficacy of Lactobacillus Acidophilus eye-drops in controlling signs and symptoms of vernal keratoconjunctivitis (VKC). Methods: Seven patients (mean age 11.8±4.3; five M, two F) with mild to moderate VKC were included in the study. Lactobacillus Acidophilus diluted in saline solution (2±108 CFU/ml) was administrated as eye-drops four times daily for 4 weeks in both eyes. Clinical signs (conjunctival hyperemia, chemosis, secretion, Trantas dots, superficial punctuate keratitis) and symptoms (itching, photophobia, burning, tearing) were evaluated and scored from 0 to 3 at baseline, after 2 and 4 weeks of treatment. Total sign (TSS) and symptom (TSyS) scores were calculated. Conjunctival impression cytology was performed in three patients at baseline and after 4 weeks of treatment, in order to evaluate the expression of ICAM-1 and TLR-4. Results: In the six out of seven patients who completed the study, symptoms were significantly improved after both 2 weeks (TSyS: baseline 6.7±0.9 vs 4.1±1.2; p=0.017) and 4 weeks (TSyS: baseline 6.7±0.9 vs 3.6±1.2, p=0.011) of treatment. A significant improvement of clinical signs was observed after 4 weeks of treatment (TSS: baseline 7.5±1.6 vs 3.9±1.7, p=0.034) but not after 2 weeks of treatment (TSS: baseline 7.5±1.6 vs 5.3±1.5; NS). In particular, photophobia was significantly reduced (2±0.6 vs 1±0.3; p=0.023) at 2 weeks, while at 4 weeks the scores for itching (1.8±0.3 vs 1±0.3), tearing (1.6±0.4 vs 0.8±0.2), conjunctival hyperemia (2.3±0.2 vs 1.4±0.5) and chemosis (1.2±0.4 vs 0.4±0.4) were significantly lower compared to baseline. A down-regulation of ICAM-1 and TLR-4 was observed in two patients showing clinical improvement after 4 weeks of treatment. Conclusion: Our open pilot study showed that 1-month treatment with probiotic eye-drops improves signs and symptoms in patients with VKC. Additional double-blind controlled clinical trials with a larger sample of patients are needed to confirm the effects of topical Lactobacilli on VKC patients. © Springer-Verlag 2007.
Keywords: intercellular adhesion molecule 1; lacteol forte; probiotic agent; toll like receptor 4; unclassified drug; absence of side effects; adolescent; article; chemosis; child; clinical article; clinical feature; conjunctival hyperemia; controlled study; down regulation; drug efficacy; drug tolerability; lack of drug effect; drug withdrawal; eye burning; female; human; lacrimation; Lactobacillus acidophilus; male; nucleotide sequence; ocular pruritus; open study; patient compliance; photophobia; pilot study; priority journal; protein expression; punctate keratitis; slit lamp; tear flow; vernal conjunctivitis; lacteol forte

Managed care and the impact of glaucoma - Reeder, C.E.; Franklin, M.; Bramley, T.J. (American Journal of Managed Care, 2008)
Changes in the healthcare system, population demographics, and treatment alternatives have contributed to an emerging awareness of glaucoma among managed care organizations. Early diagnosis and treatment are essential to thwarting the personal and economic consequences of end-stage glaucoma. Despite recognition of the need for early intervention and therapy, the literature suggests a great need still exists for improvements in lowering intraocular pressure, managing appropriate follow-up, and improving adherence to current glaucoma medication regimens. As the elderly population continues to increase, these issues will intensify and present further problems for the healthcare system. The purpose of this introductory manuscript is to highlight the literature on the clinical and economic impact of glaucoma and its importance to the managed care community. The remainder of the supplement will focus on the current management of glaucoma and the potential role of neuroprotection in this patient population.
Keywords: bimatoprost; dorzolamide plus timolol; latanoprost; timolol; drug cost; follow up; glaucoma; health care system; human; intraocular pressure; managed care organization; medical care; neuroprotection; prevalence; priority journal; review; trabeculoplasty

Barriers to glaucoma drug delivery - Ghate, D.; Edelhauser, H.F. (Journal of Glaucoma, 2008)
Topical medications remain the mainstay of glaucoma treatment. This review will aim to cover the pharmacokinetics of topically applied drops, the ocular barriers to drug delivery, and the role of ophthalmic drug formulation in enhancing drug delivery to the target tissue while minimizing side effects and increasing patient compliance. Recent advances in surgical techniques, therapeutic approaches, and material sciences have produced exciting new therapies for ocular diseases. The development of new vehicles and drug formulations that require less patient compliance is also discussed, as are the routes of drug delivery for neuroprotection. © 2008 Lippincott Williams & Wilkins, Inc.
Keywords: acetazolamide; aciclovir; antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brinzolamide; carbonate dehydratase inhibitor; cefazolin; chitosan; ciprofloxacin; cyclodextrin; cyclosporine; dipivefrine; dorzolamide; drug vehicle; gentamicin; hydrocortisone; hydroxypropylmethylcellulose; inulin; latanoprost; ofloxacin; phenylephrine; pilocarpine; polyvinyl alcohol; timolol; timolol maleate; trifluoromethazolamide; unindexed drug; asthma; blurred vision; cornea epithelium; dosage schedule comparison; drug absorption; drug binding; drug bioavailability; drug blood level; drug delivery system; drug formulation; drug metabolism; drug penetration; drug solubility; edema; eye disease; glaucoma; human; nonhuman; patient compliance; priority journal; review

Brinzolamide - Iester, M. (Expert Opinion on Pharmacotherapy, 2008)
Primary open-angle glaucoma is a multifactorial optic neuropathy characterized by the progressive loss of retinal ganglion cells and their axons. However, the primary risk factor is elevated intraocular pressure (IOP), which can damage the optic nerve head (ONH) and until now was the only treatable risk factor. Brinzolamide ophthalmic suspension 1% is a topical carbonic anhydrase inhibitor that is prescribed to lower IOP up to 18% from baseline and can improve retinal blood flow. No significant change was found in corneal thickness and corneal endothelium cell density after 18 months of brinzolamide 1% treatment. In clinical trials, brinzolamide 1% has been shown to be able to reduce IOP when administered as monotherapy, adjunctive therapy or after cataract surgery. Adverse events related to brinzolamide treatment, occurring at the time of instillation, tended to be mild and nonserious. The most common non-ocular adverse event was taste perversion. In the revised studies, there were no clinically significant differences from baseline in heart rate and blood pressure, and laboratory values for haematology, blood chemistry and urinalysis variables did not show any changes. © 2008 Informa UK Ltd.
Keywords: acetazolamide; alpha adrenergic receptor stimulating agent; betaxolol; brimonidine; brinzolamide; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide; latanoprost; latanoprost plus timolol; placebo; prostaglandin; timolol; travoprost; adjuvant therapy; article; bedtime dosage; blepharitis; blurred vision; clinical trial; combination chemotherapy; conjunctiva disease; conjunctival hyperemia; conjunctivitis; dose response; drug absorption; drug blood level; drug cost; drug dose comparison; drug formulation; drug half life; drug substitution; drug tolerability; drug withdrawal; dry eye; eye discharge; eye discomfort; eye irritation; eye pain; glaucoma; human; intraocular pressure; keratitis; lacrimation; laser surgery; metabolic acidosis; monotherapy; nonhuman; ocular pruritus; open angle glaucoma; optic nerve; optic nerve disease; pathophysiology; patient compliance; postoperative period; primary glaucoma; quality of life; side effect; taste disorder; trabeculoplasty; azopt

Mast cell stabilizers in the treatment of allergic rhinitis - Can, I.H.; Samim, E.E. (Anti-Inflammatory and Anti-Allergy Agents in Medicinal Chemistry, 2008)
Allergic rhinitis (AR) is caused by an immediate type hypersensitivity reaction in sensitized subjects after exposure to airborn allergens. The interaction of the allergen with a specific IgE antibody attached to the nasal mast cells leads to the local release of vasoactive and inflammatory mediators such as histamine, leukotriene C4 and prostaglandin D2. These mediators cause the nasal allergic symptoms complex of rhinorrhea, nasal obstruction, nasal itching and sneezing, which improve spontaneously or with treatment. Cromolyn sodium and nedocromil sodium are often termed anti-allergic drugs', which are defined here as drugs capable of inhibiting both the early-phase response to challenge and chronic allergic inflammation. They act at the cell membrane levels. Intranasal and ocular formulations of cromones, such as cromoglycate, are available without medical prescription in many countries. Sodium, cromoglycate or nedocromil have a good safety profile They reduce the symptoms of AR, and should be used profilactically but limited efficacy and the need for frequent dosing are disadvantages. © 2008 Bentham Science Publishers Ltd.
Keywords: antihistaminic agent; azelastine; cholinergic receptor blocking agent; chymase; corticosteroid; cromoglycate disodium; decongestive agent; glucocorticoid; granulocyte colony stimulating factor; histamine; interleukin 3; interleukin 4; interleukin 5; kallikrein; leukotriene C4; leukotriene D4; leukotriene E4; nedocromil; prostaglandin; prostaglandin D2; thrombocyte activating factor; tryptase; tumor necrosis factor; agitation; airborne particle; allergic conjunctivitis; allergic reaction; allergic rhinitis; antibody production; article; asthma; bedtime dosage; bitter taste; bronchospasm; burning sensation; chemical structure; clinical trial; conjunctivitis; drug mechanism; drug safety; food allergy; genetic predisposition; glaucoma; growth retardation; headache; heart palpitation; human; allergic reaction; hypertension; immunotherapy; insomnia; mast cell degranulation; mastocytosis; mediator release; mucosal dryness; nose allergy; nose irritation; pathogenesis; pathophysiology; patient compliance; patient education; restlessness; rhinitis; rhinorrhea; sedation; sensitization; side effect; sneezing; thyrotoxicosis; tremor; urine retention; intal; nasalcrom; opticrom

The one-eye trial and fellow eye response to prostaglandin analogues - Dayanir, V.; Cakmak, H.; Berkit, I. (Clinical and Experimental Ophthalmology, 2008)
Background: To determine if the intraocular pressure (IOP) reduction in one-eye trial correlates with the IOP reduction in the fellow eye when IOP variability during office hours is taken into account. Methods: This retrospective observational case series includes 50 high tension (primary open-angle glaucoma, exfoliative glaucoma and ocular hypertension; Group 1) and 21 normal tension (Group 2) glaucoma patients. Charts of bilateral open-angle glaucoma patients at Glaucoma Unit, School of Medicine, Adnan Menderes University who had pretreatment baseline office IOP measurements at 9:30, 11:30 and 15:30; were put on a one-eye trial with prostaglandin analogues, and then subsequently received the same medication in the fellow eye were reviewed. Pretreatment baseline office IOP measurements and reductions in the first and second eyes were compared to determine variability and correlation, respectively. Results: Both groups showed significant variability in pretreatment baseline office IOP measurements. Peak IOP level was before noon in at least 70% of eyes in Group 1, 50% in Group 2. IOP dropped a mean of 8.8±4.8 mmHg (34%, P=<0.0001) in Group 1 and 4.9±2.4 mmHg (30%, P=<0.0001) in Group 2 during the one-eye trial. Following bilateral use of the medication a mean drop of 7.5±4.0 mmHg (31%, P=<0.0001) in Group 1 and 2.9±1.9 mmHg (18%, P=<0.0001) in Group 2 were obtained. The IOP reduction between fellow-eye pairs were significantly correlated in Group 1 (r=0.541, P=<0.0001) but not Group 2 (r=-0.310, P=0.171). Conclusions: One-eye trial is a feasible method to determine the effectiveness of prostaglandin analogues and to predict the amount of IOP reduction in the fellow eye in patients with high tension glaucoma. © Journal compilation © 2008 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: bimatoprost; latanoprost; prostaglandin derivative; travoprost; adult; aged; ambulatory care; article; case study; controlled study; correlation analysis; drug efficacy; drug response; pseudoexfoliation; feasibility study; female; glaucoma; human; intraocular hypertension; intraocular pressure; major clinical study; male; observational study; open angle glaucoma; prediction; pressure measurement; retrospective study; lumigan; travatan; xalatan

Safety and efficacy of PRK and LASIK in pediatric patients - Qian, Y.; Pineda, R. (International Ophthalmology Clinics, 2008)
Keywords: anesthetic agent; antibiotic agent; betazole; diazepam; eye drops; fentanyl; fluorometholone; inhalation anesthetic agent; intravenous anesthetic agent; ketamine; lidocaine; midazolam; midazolam maleate; pilocarpine; propofol; proxymetacaine; steroid; accommodation paralysis; anisometropia; astigmatism; Brazil; Canada; contact lens; cornea disease; cornea opacity; Czech Republic; drug dose reduction; drug withdrawal; Egypt; free tissue graft; general anesthesia; herpes simplex keratitis; high myopia; human; hypermetropia; India; intermethod comparison; intraocular hypertension; Ireland; Italy; keratitis; keratometry; keratomileusis; myopia; outcome assessment; patient compliance; patient selection; pediatric anesthesia; photorefractive keratectomy; postoperative complication; postoperative infection; preoperative evaluation; priority journal; review; Russian Federation; Saudi Arabia; strabismus; surgical equipment; surgical risk; topical anesthesia; topography; treatment outcome; United States; visual acuity; visual system

Noncompliance with drug therapy for glaucoma - Castro, A.N.; Mesquita, W.A. (Arquivos brasileiros de oftalmologia, 2008)
INTRODUCTION: The treatment of glaucoma is made initially with the use of eyedrops, with the purpose to decrease intraocular pressure and to minimize the damages to the optic nerve. The lack of compliance with drug therapy can be influenced by factors related to patients, doctors and medicines. PURPOSES: To estimate the rate of noncompliance with the treatment with antiglaucoma eyedrops and to verify the intervenience of possible factors for noncompliance. METHODS: A study of the transversal type was carried out, in the Ophthalmologic Clinic of the Hospital Governador Israel Pinheiro, in Belo Horizonte, Minas Gerais. Questionnaires were applied to 102 glaucoma patients to collect information about the level of noncompliance and the intervenience of possible factors for noncompliance with drug therapy. RESULTS: The rate of noncompliance was 21.5%. The factors: not using the eyedrops due to money shortage (p=0.035) and accomplishment of corrective surgery (p=0.049), significantly contributed to noncompliance. CONCLUSION: More than one fifth of the glaucoma patients does not follow the drug treatment in an adequate way. Donation of eyedrops to all the glaucoma patients without favorable economic conditions, governmental actions for the reduction of the prices of the eyedrops, information on the continuity of the use of the eyedrops after the accomplishment of corrective surgeries would help to decrease the rates of noncompliance.
Keywords: eye drops; timolol; adult; aged; article; cross-sectional study; female; glaucoma; human; male; middle aged; patient compliance; psychological aspect; questionnaire; risk factor; socioeconomics; statistics

Challenges and solutions in topical ocular drug-delivery systems - Ali, M.; Byrne, M.E. (Expert Review of Clinical Pharmacology, 2008)
Vision significantly affects quality of life and the treatment of ocular disease poses a number of unique challenges. This review presents the major challenges faced during topical ocular drug administration and highlights strategies used to overcome the natural transport barriers of the eye. The circulation of tear fluid and aqueous humor decrease the residence time of topically delivered drugs, while ocular barriers in the corneal and conjuctival epithelia and the retinal pigment epithelium limit transport. Successful treatment strategies increase the residence time of drugs in the eye and/or enhance the ability of the drug to penetrate the ocular barriers and reach the target tissue. In this review, we discuss several drug-delivery strategies that have achieved clinical success or demonstrate high potential. We also draw attention to a number of excellent reviews that explore various ocular drug-delivery techniques in depth. Finally, we highlight cutting-edge drug-delivery technologies that improve the efficacy of current drug-delivery methods or use proven techniques to deliver novel therapeutics. © 2008 Future Drugs Ltd.
Keywords: agents acting on the eye; antibiotic agent; carbomer; chitosan; ciprofloxacin; cisplatin; cyclodextrin; cyclosporine; dexamethasone; eye drops; fluocinolone acetonide; ganciclovir; gellan; gentamicin; glucocorticoid; hydroxypropylcellulose; ketotifen fumarate; liposome; fluocinolone acetonide; nanoparticle; ofloxacin; pegaptanib; pilocarpine; poloxamer; polyglactin; ranibizumab; tacrolimus; timolol; timolol maleate; unclassified drug; unindexed drug; vancomycin; aqueous humor; blood eye barrier; cataract; clinical trial; conjunctiva epithelium; contact lens; controlled release formulation; cornea epithelium; diabetic macular edema; drug absorption; drug bioavailability; drug delivery system; drug efficacy; drug formulation; drug penetration; drug solubility; drug transport; dry eye; esterification; eye disease; glaucoma; human; hydrogel; hydrophilicity; intraocular hypertension; iontophoresis; lacrimal fluid; lipophilicity; microemulsion; nonhuman; particle size; patient compliance; pigment epithelium; age related macular degeneration; retinitis; review; unspecified side effect; uveitis; lacrisert; medidur; ocusert; retisert; vitrasert

Acute bacterial conjunctivitis - Høvding, G. (Acta Ophthalmologica, 2008)
Acute bacterial conjunctivitis is the eye disease most commonly seen by general practitioners, and is estimated to represent approximately 1% of all consultations in primary care. This article gives a review of the epidemiology, aetiology, clinical picture, complications, differential diagnoses, in vitro examinations and therapy of acute bacterial conjunctivitis. Until now, topical antibacterial therapy has generally been preferred by both physicians and patients because this will usually shorten the course of the disease slightly and allow the early readmittance of children to their kindergarten or school. Recently, several reports from primary care have confirmed the well-known clinical experience that the disorder has an excellent prognosis with a high frequency of spontaneous remission. In accordance, an expectant attitude or delayed prescription policy are now frequently strongly recommended. However, these reports also emphasize the difficulty in making a correct clinical distinction between bacterial and viral conjunctivitis. The effect of a general non-prescription attitude on transmission rates of pathogens also remains to be clarified. This must be born in mind when deciding how these patients should be handled. The socioeconomic and medical pros and cons of different treatment policies are discussed, and a highly personal view on the optimal handling strategy for these patients is also presented. © 2007 The Author Journal compilation 2007 Acta Ophthalmol Scand.
Keywords: antibiotic agent; bacitracin; cefixime; chloramphenicol; ciprofloxacin; fusidic acid; gatifloxacin; gentamicin; immunosuppressive agent; levofloxacin; neomycin; netilmicin; norfloxacin; ofloxacin; placebo; polymyxin B; polytrim; prednisolone; quinoline derived antiinfective agent; rifampicin; tetracycline; tobramycin; Adenoviridae; allergic conjunctivitis; antibiotic resistance; antibiotic sensitivity; aplastic anemia; bacterial colonization; bacterial transmission; bacterium culture; blood dyscrasia; blood toxicity; blurred vision; bone marrow disease; burning sensation; Chlamydia trachomatis; clinical feature; clinical trial; conjunctival hyperemia; conjunctivitis; cytopenia; differential diagnosis; disease course; drug choice; drug efficacy; drug formulation; evening dosage; folliculitis; glaucoma; Haemophilus influenzae; Herpes simplex virus; human; impetigo; infection rate; iridocyclitis; keratitis; leg ulcer; monotherapy; Moraxella; morning dosage; Neisseria gonorrhoeae; nonhuman; osteomyelitis; patient compliance; polymerase chain reaction; primary medical care; priority journal; prognosis; Pseudomonas aeruginosa; remission; review; risk benefit analysis; skin infection; slit lamp; socioeconomics; Staphylococcus aureus; Staphylococcus infection; Streptococcus pneumoniae; therapy delay; unspecified side effect; viral conjunctivitis; fucithalmic

Clinical efficacy and safety of the combination of ipratropium bromide and fenoterol inhaled via the Respimat® Soft Mist™ inhaler for relief of airflow obstruction - Vincken, W. (Expert Review of Respiratory Medicine, 2008)
Bronchodilators are key drugs in symptomatic as well as maintenance treatment of obstructive lung diseases such as chronic obstructive pulmonary disease and asthma. The short-acting anticholinergic ipratropium bromide and the short-acting β2-adrenergic receptor agonist fenoterol hydrobromide have been available for combined use both as a pressurized metereddose inhaler and as a solution for nebulization. Their combination at half the dose in the novel device, the Respimate® Soft Mist™ inhaler (RMT), has been shown to provide therapeutic equivalence to their combination into a conventional pressurized metered-dose inhaler, both in terms of efficacy and safety in patients with chronic obstructive pulmonary disease or asthma, both adults and children. Dose reduction with the RMT has been made possible due to the physical characteristics of the aerosol cloud emitted from the RMT, facilitating correct inhalation and ensuring higher pulmonary deposition of thq aerosolized bronchodilators. Post-marketing studies using validated questionnaires confirm a high level of satisfaction with the performance and convenience of the RMT device, a large majority of patients preferring the RMT to other inhaler systems. © 2008 Future Drugs Ltd.
Keywords: beta 2 adrenergic receptor stimulating agent; bronchodilating agent; cholinergic receptor blocking agent; corticosteroid; fenoterol; fenoterol plus ipratropium bromide; formoterol; ipratropium bromide; ipratropium bromide plus salbutamol; methylxanthine derivative; oxitropium bromide; placebo; salbutamol; salmeterol; terbutaline; theophylline; tiotropium bromide; airway obstruction; allergic reaction; angina pectoris; angioneurotic edema; article; asthma; bronchodilatation; bronchospasm; chronic obstructive lung disease; clinical trial; closed angle glaucoma; combination chemotherapy; constipation; coughing; diarrhea; diastolic blood pressure; dizziness; drug absorption; drug administration route; drug contraindication; drug delivery system; drug dose comparison; drug efficacy; drug induced headache; drug marketing; drug mechanism; drug megadose; drug metabolism; drug safety; eye disease; eye pain; eye toxicity; face edema; flushing; gastrointestinal disease; gastrointestinal motility disorder; glaucoma; glossitis; heart arrhythmia; heart disease; heart palpitation; hoarseness; hot flush; human; allergic reaction; hypertension; hypokalemia; immunopathology; intraocular hypertension; kidney disease; lactation; lip disease; low drug dose; lung gas exchange; mediastinum disease; mental disease; metered dose inhaler; monotherapy; mucociliary clearance; mucus secretion; muscle cramp; muscle weakness; myalgia; mydriasis; nausea; nebulization; nervousness; neurologic disease; nonhuman; patient compliance; patient safety; patient satisfaction; pharmacodynamics; pharyngitis; pharynx disease; powder inhaler; pregnancy; pulse pressure; rash; recommended drug dose; respiratory tract disease; side effect; skin disease

Hypertension: So many treatments, yet so undermanaged - Beyzarov, E. (Drug Topics, 2008)
Keywords: aldosterone antagonist; aliskiren; amlodipine; angiotensin receptor antagonist; antihypertensive agent; atenolol; hydrochlorothiazide plus irbesartan; beta adrenergic receptor blocking agent; bisoprolol; nebivolol; calcium channel blocking agent; carvedilol; dipeptidyl carboxypeptidase inhibitor; diuretic agent; hydrochlorothiazide plus irbesartan; losartan; metoprolol; nebivolol; perindopril; placebo; thiazide diuretic agent; unclassified drug; valsartan; angina pectoris; atherosclerosis; blood pressure regulation; child care; clinical practice; clinical trial; combination chemotherapy; congestive heart failure; coronary artery disease; diabetes mellitus; disease severity; drug approval; drug dose titration; drug efficacy; drug mechanism; Food and Drug Administration; glaucoma; health survey; atrial fibrillation; heart left ventricle failure; heart muscle ischemia; human; hypertension; hypotension; ischemic heart disease; lifestyle modification; medical society; meta analysis; metabolic syndrome X; monotherapy; morbidity; mortality; patient compliance; practice guideline; prevalence; recurrent disease; renin angiotensin aldosterone system; risk assessment; short survey; staging; cerebrovascular accident; systematic review; systolic blood pressure; treatment indication; avalide; bystolic; diovan; tekturna

Poverty and blindness in Pakistan: Results from the Pakistan national blindness and visual impairment survey - Gilbert, C.E.; Shah, S.P.; Jadoon, M.Z.; Bourne, R.; Dineen, B.; Khan, M.A.; Johnson, G.J.; Khan, M.D. (BMJ, 2008)
Objective: To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan. Design: Cross sectional population based survey. Setting: 221 rural and urban clusters selected randomly throughout Pakistan. Participants: Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate). Main outcome measures: Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services. Results: 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001). Conclusion: Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.
Keywords: adult; article; blindness; cataract; cataract extraction; cluster analysis; cornea opacity; disease association; eye care; eye examination; female; glaucoma; health care access; health center; health survey; human; lens implant; light; major clinical study; male; Pakistan; population research; poverty; prevalence; priority journal; rural area; spectacles; statistical significance; urban area; visual impairment

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings - Johnson, B.A. (Biochemical Pharmacology, 2008)
The past decade has seen an expansion of research and knowledge on pharmacotherapy for the treatment of alcohol dependence. The Food and Drug Administration (FDA)-approved medications naltrexone and acamprosate have shown mixed results in clinical trials. Oral naltrexone and naltrexone depot formulations have generally demonstrated efficacy at treating alcohol dependence, but their treatment effect size is small, and more research is needed to compare the effects of different doses on drinking outcome. Acamprosate has demonstrated efficacy for treating alcohol dependence in European trials, but with a small effect size. In U.S. trials, acamprosate has not proved to be efficacious. Research continues to explore which types of alcohol-dependent individual would benefit the most from treatment with naltrexone or acamprosate. The combination of the two medications demonstrated efficacy for treating alcohol dependence in one European study but not in a multi-site U.S. study. Another FDA-approved medication, disulfiram, is an aversive agent that does not diminish craving for alcohol. Disulfiram is most effective when given to those who are highly compliant or who are receiving their medication under supervision. Of the non-approved medications, topiramate is among the most promising, with a medium effect size in clinical trials. Another promising medication, baclofen, has shown efficacy in small trials. Serotonergic agents such as selective serotonin reuptake inhibitors and the serotonin-3 receptor antagonist, ondansetron, appear to be efficacious only among certain genetic subtypes of alcoholic. As neuroscientific research progresses, other promising medications, as well as medication combinations, for treating alcohol dependence continue to be explored. © 2007 Elsevier Inc. All rights reserved.
Keywords: 4 aminobutyric acid B receptor stimulating agent; acamprosate; alpha amino 3 hydroxy 5 methyl 4 isoxazolepropionic acid; aripiprazole; asparagine; baclofen; buspirone; cannabinoid 1 receptor antagonist; depotrex; disulfiram; dopamine receptor blocking agent; dopamine receptor stimulating agent; fluoxetine; kainic acid receptor antagonist; memantine; mu opiate receptor antagonist; n methyl dextro aspartic acid receptor blocking agent; naloxone; naltrexone; neramexane; ondansetron; placebo; quetiapine; ritanserin; serotonin 1 agonist; serotonin 2 antagonist; serotonin 3 antagonist; serotonin uptake inhibitor; tiagabine; topiramate; unclassified drug; unindexed drug; abdominal pain; alcoholism; anorexia; arcuate nucleus; backache; blurred vision; clinical trial; closed angle glaucoma; cognitive therapy; conjunctival hyperemia; controlled clinical trial; controlled drug release; depression; diarrhea; dopamine release; drug blood level; drug dose titration; drug effect; drug efficacy; drug excretion; drug formulation; drug inhibition; drug mechanism; drug megadose; drug potentiation; drug safety; drug tolerability; drug withdrawal; erythema; eye pain; fatigue; flatulence; gamma glutamyl transferase blood level; gastrointestinal pain; genetic variability; headache; heart arrhythmia; hepatitis; human; hypothalamus hypophysis adrenal system; injection site discomfort; injection site mass; injection site pain; injection site reaction; interstitial pneumonia; intraocular hypertension; irritability; lethargy; liver toxicity; Loeffler pneumonia; low drug dose; memory disorder; mental concentration; myopia; nausea; nausea and vomiting; nervousness; neurotransmission; nonhuman; paresthesia; patient compliance; priority journal; psychosis; QT prolongation; quality of life; randomized controlled trial; relapse; review

The mystery of sudden death: Mechanisms for risks - Lathers, C.M.; Schraeder, P.L.; Bungo, M.W. (Epilepsy and Behavior, 2008)
This review addresses the possible overlapping mechanisms that may apply to the risk of sudden unexpected death occurring in epilepsy and in cardiac disease. It explores the interaction between the central and peripheral autonomic nervous systems and the cardiopulmonary systems. Included is a discussion of the potential interactive role of genetically determined subtle cardiac risk factors for arrhythmias with a predisposition for seizure-related cardiac arrhythmias. We address the possible mechanisms that are operant in producing both epileptogenic and cardiogenic arrhythmias. Finally, we speculate about potential preventive measures to minimize the risk of both sudden unexpected death in epilepsy and sudden cardiac death. © 2007 Elsevier Inc. All rights reserved.
Keywords: aldosterone antagonist; amiodarone; antiarrhythmic agent; anticonvulsive agent; beta adrenergic receptor blocking agent; carbamazepine; chlorpromazine; clonidine; diazepam; digoxin; dipeptidyl carboxypeptidase inhibitor; fluoxetine; gabapentin; hydroxymethylglutaryl coenzyme A reductase inhibitor; lamotrigine; lorazepam; neuroleptic agent; phenobarbital; phenytoin; procainamide; propranolol; psychotropic agent; quinidine; rofecoxib; thioridazine; tiagabine; timolol; topiramate; unindexed drug; zonisamide; 4 aminobutyric acid release; amygdala; antiarrhythmic activity; anticonvulsant activity; anxiety; arrhythmogenesis; autonomic nervous system; Brugada syndrome; cardiopulmonary hemodynamics; cardiovascular disease; cognitive defect; convulsion; depression; diabetes mellitus; drug dose increase; drug mechanism; drug potentiation; dyslipidemia; epilepsy; epileptic discharge; epileptogenesis; gene mutation; generalized epilepsy; genetic predisposition; genetic risk; glaucoma; heart arrhythmia; heart disease; heart infarction; heart muscle ischemia; heart rate variability; heart right ventricle dysplasia; human; hypothalamus; ischemic heart disease; lethargy; long QT syndrome; lung edema; nonhuman; orthostatic hypotension; pathophysiology; patient compliance; radiofrequency ablation; review; risk factor; sedation; seizure; side effect; physiological stress; sudden death; sudden infant death syndrome; sympathetic innervation; tachycardia; tonic clonic seizure; body weight gain

Current treatment of inflammatory bowel disease in children - Markowitz, J. (Digestive and Liver Disease, 2008)
Children with inflammatory bowel disease present formidable therapeutic challenges. As both Crohn's disease and ulcerative colitis remain medically incurable conditions associated with potentially significant morbidity, the focus of treatment must be to reduce or eliminate symptoms, optimize nutritional status, promote normal growth and development, prevent complications and minimize the potential psychological effects of these chronic illnesses. This review focuses on the evidence supporting the treatments currently used in children with inflammatory bowel disease, and suggests potential treatment algorithms for particular clinical circumstances. © 2007 Editrice Gastroenterologica Italiana S.r.l.
Keywords: azathioprine; balsalazide; budesonide; contraceptive agent; corticosteroid; cyclosporine; immunomodulating agent; infliximab; mercaptopurine; mesalazine; methotrexate; methylprednisolone; olsalazine; placebo; prednisone; salazosulfapyridine; tacrolimus; tioguanine; acne; adrenal insufficiency; allergic pneumonitis; avascular necrosis; bone marrow suppression; caloric intake; cancer risk; cataract; clinical trial; colon cancer; colon resection; corticosteroid induced osteoporosis; Crohn disease; Cushing syndrome; demyelinating disease; dietary intake; disease control; disease severity; drug efficacy; drug fatality; drug hypersensitivity; drug indication; drug mechanism; drug metabolism; drug safety; drug tolerability; enteritis; first pass effect; glaucoma; glucose intolerance; growth retardation; heart failure; human; hypertension; infection; leukopenia; liver function test; liver toxicity; lung toxicity; lupus like syndrome; lymphoma; maintenance therapy; mood disorder; nausea; nephrotoxicity; neurotoxicity; nutritional deficiency; nutritional status; pancreatitis; patient compliance; recurrent disease; remission; risk reduction; serum sickness; short survey; side effect; stomatitis; T cell lymphoma; teratogenicity; tuberculosis; ulcerative colitis; unspecified side effect

Efficacy and safety of bimatoprost/timolol fixed combination in the treatment of glaucoma or ocular hypertension - Martinez, A.; Sanchez, M. (Expert Opinion on Pharmacotherapy, 2008)
When a single medication does not adequately control intraocular pressure, additional intraocular hypotensive agents are often added to the therapeutic regime. However, regimen complexity has been associated with reduced patient compliance. Treatment with a fixed combination may, therefore, increase compliance as a result of simplifying the dosage regimen. Bimatoprost/timolol fixed combination (BTFC) combines two clinically effective agents that decrease elevated intraocular pressure by independent mechanisms. In two clinical studies, BTFC was more effective than its individual components. Furthermore, in a non-inferiority study BTFC has been shown to be as effective as the association of its individual components. BTFC was clinically effective and generally well tolerated, with no unexpected adverse reactions reported for the BTFC compared with those reported for bimatoprost or timolol monotherapies. © 2008 Informa UK Ltd.
Keywords: antiglaucoma agent; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; latanoprost; latanoprost plus timolol; prostaglandin derivative; prostamide derivative; timolol; unclassified drug; aqueous humor flow; article; clinical effectiveness; clinical examination; clinical trial; combination chemotherapy; conjunctival hyperemia; dizziness; drug absorption; drug contraindication; drug distribution; drug efficacy; drug elimination; drug excretion; drug half life; drug induced headache; drug mechanism; drug metabolism; drug penetration; drug response; drug safety; drug tissue level; drug tolerability; evening dosage; eye burning; eye pain; eye toxicity; eyelid edema; follow up; glaucoma; human; intraocular foreign body; intraocular hypertension; maximum plasma concentration; monotherapy; morning dosage; outcome assessment; patient compliance; pruritus; time to maximum plasma concentration; treatment duration; visual disorder

World Glaucoma Day, 6 March 2008: Tackling glaucoma internationally - Buys, Y.; Goldberg, I.; Lambrou, G.N.; Ritch, R. (Clinical and Experimental Ophthalmology, 2008)
Keywords: age; blindness; diagnostic imaging; disease predisposition; early diagnosis; editorial; family history; follow up; glaucoma; health care cost; high myopia; human; hypotension; incidence; intraocular pressure abnormality; laser surgery; medical information; Black person; optic nerve lesion; patient compliance; prevalence; prognosis; public health; quality of life; risk factor; vasospasm; visual field defect; visual impairment

Can adherence to topical glaucoma medication be improved by using an audible alarm? A pilot study - Holló, G.; Kóthy, P. (Pharmaceutical Medicine, 2008)
Background: Adherence to long-term intraocular pressure (IOP) lowering medication is poor in patients with glaucoma, which is a significant factor in disease progression. Aim: To investigate whether objectively monitored adherence to 0.004% travoprost (Travatan®), an IOP-lowering prostaglandin-analogue eye drop, improves if the audible alarm function of the monitoring device is activated. Methods: Thirty-nine consecutive patients already on self-administered once-daily (evening) travoprost medication for glaucoma received an electronic monitoring device on loan and detailed training on its use. An adherent day was defined as a day with instillation of travoprost (from the monitoring device) at 9:00 pm ± 2 hours. In the first 3-month phase of the investigation, the audible alarm function of the device was disabled, but in the second 3-month period it was activated and set for 9:00 pm. The participants continued using their other eye drops in both phases of the study. Results: Thirty-four participants completed both periods. Non-adherence (mean ± SD) was 18.4 ± 18.9% in the first period and 14.7 ± 18.9% during the second (Wilcoxon signed rank test, p = 0.059). Thus, adherence was 81.6% with the alarm function disabled, and 85.3% when the signal was activated. A significant positive correlation was found between the number of daily eye drop instillations and change of non-adherence (Spearman's correlation, p = 0.014), showing that when more instillations were used, less marked adherence-improvement was achieved. Conclusion: Though adherence to once-daily topical travoprost medication was satisfactorily high even without the audible alarm function being activated, a nonsignificant tendency for a further improvement of adherence was found when the audible signal was present. For patients who instilled eye drops more frequently, this improvement was significantly less. Our results suggest that using an audible alarm signal set for the time of instillation may have a role in improving adherence in patients with glaucoma who already have relatively good adherence to their medication regimen; however, further studies are required to test this hypothesis. © 2008 Adis Data Information BV. All rights reserved.
Keywords: travoprost; adult; aged; alarm monitor; article; clinical article; devices; drug self administration; evening dosage; eye disease; female; glaucoma; human; intraocular pressure; male; patient compliance; pilot study; priority journal; self monitoring; treatment outcome; travatan; Travalert Dosing Aid

Influence of acupuncture on intraocular pressure and compliance of patients with ocular hypertension or primary wide-angle glaucoma: First results of a controlled prospective follow-up study - Ewert, H.; Schwanitz, R. (Deutsche Zeitschrift fur Akupunktur, 2008)
Background and Aims: Primary wide-angle glaucoma (the most common form of glaucoma) is a multi-factorial disease of the optic nerve marked by the preceding loss of retinal ganglion cells, eventually leading to the atrophy of the optic nerve. Intraocular pressure (IOP) makes up the most important and most treatable risk factor. Methods: The study examined the effect of acupuncture therapy on eye pressure and the compliance in patients suffering from primary wide-angle glaucoma (n = 21) and ocular hypertension (n = 13) against a group of test subjects not suffering from any eye complaint (n = 16). Before commencing therapy, corneal thickness was determined by 4Optics-Pachymeter. Before and after acupuncture treatment, an ophthalmologic determination of visual acuity according to DIN 58220 and a computer-aided visual field analysis were done. The IOP was measured before and immediately after acupuncture as well as 30 minutes after therapy. Changes in compliance were documented with a standardized questionnaire completed by each patient having received this treatment. Results: It was shown that for patients with primary wide-angle glaucoma and ocular hypertension, acupuncture is able to significantly lower intraocular pressure. According to the questionnaire analysis, a subjective improvement of quality of life and better compliance of using anti-glaucomatous medication was achieved. Conclusions: Acupuncture is an appropriate method to treat patients with primary wide-angle glaucoma in addition to lowering eye pressure by anti-glaucomatous pharmacological therapy. In patients suffering from ocular hypertension, acupuncture can significantly lower intraocular pressure and therefore reduce the rate of conversion into a manifest glaucoma. Therefore this treatment can be suggested for ocular hypertension patients with contraindications against local anti-glaucomatous medicine (e. g. beta-blocker). However, it is absolutely necessary in this treatment that patients are continuously monitored regarding visual field, retinal nerve fibre thickness and micro-morphological alterations of the disc in order to detect tissue damage of the optic nerve and functional loss caused by the onset of glaucoma.
Keywords: antiglaucoma agent; beta adrenergic receptor blocking agent; acupuncture; article; clinical article; cornea; devices; drug contraindication; follow up; human; intraocular hypertension; intraocular pressure; open angle glaucoma; optic nerve lesion; patient compliance; prospective study; questionnaire; retina nerve cell; risk factor; thickness; tissue injury; treatment indication; treatment outcome; visual acuity; visual field; 4Optics

Multicenter study of compliance and drop administration in glaucoma - Kholdebarin, R.; Campbell, R.J.; Jin, Y.-P.; Buys, Y.M.; Beiko, G.; Birt, C.; Damji, K.; Feldman, F.; Lajaoie, C.; Kulkarni, S.; Martow, J.; Sakamoto, T.; et al. (Canadian Journal of Ophthalmology, 2008)
Background: Poor compliance with medication is a major concern in the management of glaucoma. Improper administration technique can lead to contamination and inaccurate dosing. This study estimates the prevalence and predictors of noncompliance and improper administration technique among Canadian glaucoma patients. Methods: Data were collected using a standardized questionnaire. Noncompliance was defined as missing at least 1 drop of medication per week and (or) the inability to accurately describe the medication regimen. Patients were asked to indicate the most common reason for missing medication. Study personnel assessed drop administration technique as patients were applying eye drops. Physicians provided information, including measures of disease stability, regarding the patient's glaucoma. Predictors were assessed using odds ratios from a logistic regression model. Results: 500 patients from 10 centers across Canada participated in the study. Of these, 25.6% reported missing at least 1 drop of medication per week, and 4.2% were unable to accurately describe their medication regimen. The overall proportion of noncompliance was 27.9%. With regard to drop administration, 6.8% missed their eye and 28.8% contaminated the bottle tip; overall, 33.8% demonstrated improper technique. The most common reasons given for missing eye drops were "forgetfulness" and "being away from drops." Formal education limited to elementary school and treatment duration of <5 years increased patient-reported noncompliance. Factors associated with improper administration technique were age 60 years and older and formal education limited to elementary school. Interpretation: Over 50% of the patients surveyed were either noncompliant or demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and instructed on proper drop administration.
Keywords: antiglaucoma agent; eye drops; topical agent; accuracy; adult; aged; article; Canada; clinical protocol; clinical trial; education; female; glaucoma; human; major clinical study; male; multicenter study; patient attitude; patient compliance; prediction; prevalence; questionnaire

Blindness in the elderly - The Lancet, (The Lancet, 2008)
Keywords: bevacizumab; eye drops; pegaptanib; ranibizumab; aging; blindness; cataract; cataract extraction; cost effectiveness analysis; developed country; diabetic retinopathy; drug efficacy; drug safety; editorial; elderly care; eye care; gene; genetic susceptibility; genetic variability; geographic distribution; glaucoma; health care access; health care system; human; pathogenesis; priority journal; prophylaxis; refraction error; age related macular degeneration; serping1 gene; smoking cessation; spectacles; stigma; vision test; visual impairment

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over - Shepherd, J.; Rogers, G.; Anderson, R.; Main, C.; Thompson-Coon, J.; Hartwell, D.; Liu, Z.; Loveman, E.; Green, C.; Pitt, M.; Stein, K.; Harris, P.; et al. (Health Technology Assessment, 2008)
Objectives: To assess the clinical and cost-effectiveness of inhaled corticosteroids (ICS) alone and ICS used in combination with a long-acting beta2 agonist (LABA) in the treatment of chronic asthma in adults and children aged over 12 years. Data sources: Major electronic bibliographic databases, e.g. MEDLINE and EMBASE, were searched up to February/March 2006 (and updated again in October 2006). Review methods: A systematic review of clinical and cost-effectiveness studies was conducted. Cost comparison and cost-consequence analyses were performed where appropriate. Results: The assessment of clinical effectiveness was based on the 67 randomised controlled trials selected from the 5175 reports identified through the systematic literature search. The most frequently reported relevant outcomes were lung function, symptoms, use of rescue medication and adverse events. The trials varied considerably. In the trials that compared low-dose ICS versus ICS and high-dose ICS versus ICS, there were few significant differences in clinical effectiveness, although a few of the trials had assessed non-inferiority between the comparators rather than superiority. At doses of 400, 800 and 'high-level' doses of 1500 or 1600 μg/day, beclometasone dipropionate (BDP) appears to be the current cheapest ICS product both with the inclusion and exclusion of chlorofluorocarbon (CFC)-propelled products. A significant treatment benefit for combination ICS/LABA therapy across a range of outcomes compared with ICS alone was identified [when the ICS was double the accepted clinically equivalent dose of the ICS in the combination inhaler, and dry powder inhalers (DPIS) were used to deliver the drugs]. When a formoterol fumarate (FF)/salmeterol (SAL) combination inhaler and a budesonide (BUD)/FF combination inhaler were each compared with their constituent drugs delivered in separate inhalers, there were very few statistically significant differences between the treatments across the various efficacy outcomes and the rate of adverse events. Combination inhalers were more often cheaper than doubling the dose of ICS alone. However, the costs were highly variable and dependent on both the dose required and the preparation used in the trials. The estimated mean annual cost of FP/SAL combination varied from being £94 cheaper to £109 more expensive than the alternative of BUD at a higher dose. The BUD/FF combination varied from being £163 cheaper to £66 more expensive than the higher dose of either BUD or FP. When the combination inhalers were compared to each other, the results were mixed, with the FP/SAL combination significantly superior on some outcomes and the BUD/ FF combination superior on others; however, meta-analysis showed that there were no significant differences between the two treatments in the rate of adverse events. Taking an ICS with a LABA as either of the two currently available combination products, FP/ SAL and BUD/FF, is usually cheaper than taking the relevant constituent drugs in separate inhalers. At very high doses of BUD (1600 μg/day), however, the BUD/FF combination inhaler can be up to £156 more expensive than having the same drugs in separate inhalers. In terms of the relative costs associated with taking one of the combination inhalers, at low dose (400 μg BUD or 200 μg FP/day) the cheapest combination inhaler is FP/SAL as a pressurised metered dose inhaler (pMDI) (Seretide Evohaler). However, this is only slightly cheaper than using BUD/FF as a DPI (Symbicort Turbohaler). At higher dose levels (800 μg BUD or 500 μg FP/day) FP/ SAL as either pMDI aerosol (Seretide Evohaler) or a DPI (Seretide Accuhaler) is the cheapest combination product available, but again only slightly cheaper than the DPI BUD/FF combination (Symbicort Turbohaler). It should be highlighted, however, that the three head-to-head trials that compared the effects of FP/SAL with BUD/FF used the FP/SAL DPI combination inhaler, Seretide Accuhaler. Conclusions: The evidence indicates that there are few consistent significant differences in effects between the five ICS licensed for use in adults and adolescents over the age of 12 years, at either low or high dose. On average, BDP products currently tend to be the cheapest ICS available and tend to remain so as the daily ICS dose required increases. There is evidence that the addition of a LABA to an ICS is potentially more clinically effective than doubling the dose of ICS alone, although consistent significant differences between the two treatment strategies are not observed for all outcome measures. The cost differences between combination therapy compared with ICS monotherapy are highly variable and dependent on the dose required and the particular preparations used. For the combination therapies of ICS/LABA there are potential cost savings with the use of combination inhalers compared with separate inhalers, with few differences between the two treatment strategies in terms of effects. The only exception to this cost saving is with BUD/FF at doses higher than 1200 μg/day, where separate inhaler devices can become equivalent to or cheaper than combination inhalers. Neither of the two combination inhalers (FP/SAI or BUD/FF) is consistently superior in terms of treatment effect. A comparison of the costs associated with each combination therapy indicates that at low dose FP/SAL delivered via a pMDI is currently the cheapest combination inhaler but only marginally cheaper than BUD/FF delivered as a DPI. At higher doses, both the FP/SAL combination inhalers (PMDI and DPI) are marginally cheaper than BUD/FF (DPI). Future trials of treatment for chronic asthma should standardise the way in which outcome measures are defined and measured, with a greater focus on patient-centred outcomes. For informing future cost-utility and cost-effectiveness analyses from a UK NHS perspective, there is a need for longitudinal studies that comprehensively track the care pathways followed when people experience asthma exacerbations of different severity. Further research synthesis, quantifying the adverse effects of the different ICS, is required for treatment choices by patients and clinicians to be fully informed. © Queen's Printer and Controller of HMSO 2008. All rights reserved.
Keywords: beclomethasone dipropionate; aerobec forte; altimos modulite; bdp cyclocaps; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; bud cyclocaps; budesonide; budesonide plus formoterol; chlorofluorocarbon; ciclesonide; clenil modulite; corticosteroid derivative; beclomethasone dipropionate; filair forte; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol fumarate; long acting drug; mometasone furoate; dry powder inhaler; placebo; pulvinal; pulvinal bdp; salbutamol; salmeterol; salmeterol xinafoate; unclassified drug; adrenal cortex insufficiency; antiinflammatory activity; asthma; bronchospasm; cardiopulmonary insufficiency; clinical trial; controlled clinical trial; cost benefit analysis; cost control; cost effectiveness analysis; coughing; drug absorption; drug binding site; drug bioavailability; drug cost; drug delivery system; drug dose comparison; drug dose reduction; drug efficacy; drug fatality; drug megadose; drug potentiation; drug withdrawal; dry powder; dysphonia; economic evaluation; Embase; fracture; health care cost; health care utilization; human; hyperglycemia; hypokalemia; intraocular hypertension; low drug dose; Medline; metered dose inhaler; monotherapy; mortality; national health service; open angle glaucoma; osteoporosis; powder inhaler; prevalence; prognosis; QT interval; quality of life; randomized controlled trial; resource allocation; review; side effect; skin contusion; skin disease; subcapsular cataract; systematic review; tachycardia; throat irritation; thrush; treatment outcome; tremor; United Kingdom; unspecified side effect; aerobec; aerobec forte; altimos modulite; alvesco; bdp cyclocaps; beclate; becloforte; becotide; becotide; bud cyclocaps

Recent advances in pharmacotherapy of glaucoma - Gupta, S.; Galpalli, N.; Agrawal, S.; Srivastava, S.; Saxena, R. (Indian Journal of Pharmacology, 2008)
Glaucoma is a slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to irreversible blindness if left undiagnosed and untreated. Although increased intraocular pressure is a major risk factor of glaucoma, other factors include increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species. Glaucoma is the second leading cause of blindness globally, accounting for 12.3% of the total blindness. Glaucoma has been broadly classified as primary or secondary open-angle or angle-closure glaucoma. The primary goal in management of glaucoma is to prevent the risk factor, especially elevated intraocular pressure (IOP), using medications, laser therapy or conventional surgery. The first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective blocker or a prostaglandin analog. Second-line drugs of choice include alpha-agonists and topical carbonic anhydrase inhibitors. Cholinergic agonists are considered third-line treatment options. When a single therapy is not sufficient to lower the IOP, a combination therapy is indicated. To enhance the patient compliance, drug delivery systems like electronic devices, ocular inserts, tansdermal and mechanical drug delivery systems have been developed. Use of viscoelastic agents in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) enhance patience compliance and ocular drug delivery in patients in long-term glaucoma therapy. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are recommended. Several nutrients and botanicals hold promise for the treatment of glaucoma, but most studies are preliminary, and larger, controlled studies are required. Future directions for the development of a novel therapy glaucoma may target glutamate inhibition, NMDA receptor blockade, exogenously applied neurotrophins, open channel blockers, antioxidants, protease inhibitors and gene therapy.
Keywords: acetazolamide; epinephrine; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; ascorbic acid; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; cannabinoid derivative; carteolol; clonidine; dipivefrine; dorzolamide; flavonoid; forskolin; Ginkgo biloba extract; latanoprost; levobunolol; methazolamide; metipranolol; miotic agent; pilocarpine; thioctic acid; timolol; travoprost; unindexed drug; unoprostone isopropyl ester; accommodation; add on therapy; agranulocytosis; allergic blepharitis; allergic conjunctivitis; anxiety; aplastic anemia; aqueous humor outflow; argon laser; bedtime dosage; blindness; blurred vision; bradycardia; bronchospasm; cardiovascular disease; central nervous system disease; clinical trial; closed angle glaucoma; combination chemotherapy; conjunctival hyperemia; conjunctivitis; cornea edema; depression; diplopia; dizziness; drowsiness; drug absorption; drug delivery system; drug effect; drug formulation; drug half life; drug hypersensitivity; drug induced headache; drug mechanism; drug penetration; drug potentiation; drug safety; drug selectivity; drug tolerability; dry eye; enzyme inhibition; epiphora; evening dosage; eye burning; eye discomfort; eye irritation; eye pain; fatigue; gastrointestinal symptom; gene therapy; glaucoma; glaucoma surgery; heart palpitation; human; hypertension; hypotension; intraocular hypertension; intraocular pressure; intraocular pressure abnormality; iritis; low level laser therapy; micturition; miosis; molecular dynamics; monotherapy; morning dosage; neodymium laser; nephrolithiasis; neuroprotection; nonhuman

Use of fixed-dose combination drugs for the treatment of glaucoma - Khouri, A.S.; Realini, T.; Fechtner, R.D. (Drugs and Aging, 2007)
Glaucoma is a leading cause of irreversible visual loss. This potentially blinding disease is a progressive optic neuropathy associated with elevated intraocular pressure (IOP). Initial therapy for glaucoma typically consists of topical medications or laser treatment to lower IOP. Frequently, more than one medication is required to achieve adequate control of IOP. However, more medications means more bottles and greater complexity for the patient. There are several potential benefits of fixed combination medications compared with using the individual components separately. These include a reduction in the total number of drops and preservative instilled per day, cost savings, improved tolerability and compliance and avoiding the washout effect resulting from rapid-sequence instillation of multiple drops. Attempts to develop effective fixed combinations of glaucoma medications date back several decades. In recent years, fixed combinations of commonly paired drugs have been approved by various regulatory bodies in different countries and have gained wide acceptance. Current commercially available, fixed combination drugs include the topical β-adrenoceptor antagonist timolol 0.5% combined with a prostaglandin, a topical carbonic anhydrase inhibitor or an α-adrenoceptor agonist. Although there is no uniformity among registration trial designs, most published literature compares the efficacy of the fixed combination to the individual components and to concomitant use of both components. Various factors inherent to study design such as medication run-in, washout periods and peak and trough effects have to be taken into consideration when analysing the demonstrated efficacy of fixed combinations. Fixed combination treatments offer effective IOP control while reducing the washout effect and exposure to preservatives. They are also convenient. However, fixed combinations also remove the possibility of titrating the individual components both in terms of concentration and timing of administration. In addition, fixed combinations might not always provide the same efficacy as proper use of the individual components. The clinician must make individualised assessments when weighing the convenience of these medications against their limitations for specific patients. © 2007 Adis Data Information BV. All rights reserved.
Keywords: epinephrine; antiglaucoma agent; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; brimonidine plus timolol; dorzolamide; dorzolamide plus timolol; timolol plus travoprost; timolol plus travoprost; eye drops; bimatoprost plus timolol; latanoprost; latanoprost plus timolol; latanoprost plus timolol; pilocarpine; timolol; timolol plus travoprost; travoprost; unclassified drug; clinical trial; disease exacerbation; drug efficacy; drug safety; drug tolerability; glaucoma; human; intraocular pressure; monotherapy; patient compliance; priority journal; review; treatment outcome; United States; unspecified side effect; vision; visual impairment; combigan; cosopt; duotrav; extravan; ganfort; xalacom

Migraine prevention - Dodick, D.W.; Silberstein, S.D. (Practical Neurology, 2007)
Preventive medications reduce migraine frequency and severity, and improve migraine-specific quality of life. Recent evidence also suggests that these same medications enhance the patient's response to acute migraine therapies, and may also reduce the likelihood of developing chronic daily headache. However, many patients who should receive or be offered preventive treatment are not. Most patients can be successfully managed when patient and physician expectations are realistic and aligned, the selection of preventive medications is individualised, and the initiation and titration strategy is appropriate and carefully followed. Rational combinations of preventive medications may also be useful. This review provides an evidence and experience-based approach to the preventive treatment of migraine.
Keywords: alpha adrenergic receptor stimulating agent; amitriptyline; analgesic agent; anticoagulant agent; anticonvulsive agent; antidepressant agent; antihistaminic agent; antimigraine agent; atenolol; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; ibuprofen; liver enzyme; methysergide; metoprolol; nadolol; naproxen; nonsteroid antiinflammatory agent; Petasites hybridus extract; propranolol; serotonin antagonist; timolol; topiramate; tricyclic antidepressant agent; ubiquinone; unindexed drug; valproate semisodium; valproic acid; warfarin; abdominal pain; acupuncture; acute disease; agitation; agranulocytosis; allergic reaction; alopecia; analgesic activity; appetite disorder; asthenia; behavior therapy; bloating; blurred vision; bronchospasm; chronic disease; clinical effectiveness; clinical trial; closed angle glaucoma; comorbidity; constipation; depression; diarrhea; disease severity; dizziness; dose response; drug choice; drug contraindication; drug dose reduction; drug dose titration; drug indication; drug megadose; drug potentiation; drug safety; drug tolerability; drug tolerance; lack of drug effect; dysgeusia; dyspepsia; encephalomyopathy; evidence based medicine; fatigue; flatulence; headache; heart arrhythmia; heartburn; hormonal therapy; human; hyperammonemia; allergic reaction; hyperthermia; insomnia; irritability; low drug dose; manipulative medicine; memory disorder; menstruation; metabolic acidosis; migraine; migraine with aura; migraine without aura; morbidity; myopia; nausea; nausea and vomiting; nephrolithiasis; nonhuman; optimal drug dose; orthostatic hypotension; pancreatitis; pancytopenia

Patient and physician factors contributing to poor outcomes in patients with asthma and COPD - Gillissen, A.; Wirtz, H.; Juergens, U. (Disease Management and Health Outcomes, 2007)
Poor adherence with medical regimens by patients with asthma and chronic obstructive pulmonary disease (COPD) is a major problem facing medical practitioners, with patients typically taking approximately half the prescribed doses of self-administered medications. Poor adherence with medication regimens results in inadequate disease control and is assumed to be associated with poor long-term outcomes and high medical and social costs. Efforts to assist patients with treatment adherence are thought to improve the benefits of prescribed medications; however, even the most effective interventions do not necessarily lead to significant improvements in adherence and treatment outcomes. Simple interventions (such as re-calling patients who miss appointments, making every effort to keep patients in care, and simplifying treatment regimens) and complex strategies (including combinations of more thorough patient instructions and counseling, reminders, close follow-up, supervised self-monitoring, family therapy, crisis intervention, and telephone follow-up) may improve adherence and treatment outcomes for both short- and long-term treatments. All these measures are highly dependent on a good physician-patient relationship, and the willingness and ability of caregivers to closely follow guidelines and recommendations. The diversity and complexity of interventions, and uncertainty about their effects, make it difficult to assess which interventions are effective and which are not. The literature regarding interventions remains surprisingly limited. There is little evidence to show that medication adherence can be improved consistently, or that interventions will inevitably lead to improvements in treatment outcomes, especially considering the resources usually available in outpatient settings. Most studies assessing successful complex interventions have not assessed the effect on clinical endpoints. Studies in COPD are sparse compared with those in asthma, leaving room for further research efforts. As all self-administered treatments are affected by low adherence, and as the number of efficacious, self-administered treatments continues to grow, detailed knowledge about this complex issue may help to ensure better management in patients with obstructive pulmonary diseases. © 2007 Adis Data Information BV. All rights reserved.
Keywords: beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; bronchodilating agent; cholinergic receptor blocking agent; corticosteroid; cromoglycate disodium; fluticasone; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol; ipratropium bromide; montelukast; nedocromil; salbutamol; salmeterol; theophylline; tiotropium bromide; asthma; attitude to health; cataract; chronic obstructive lung disease; clinical feature; combination chemotherapy; coughing; doctor patient relationship; dose response; drug dose increase; dysphonia; follow up; glaucoma; high risk behavior; human; monotherapy; outcome assessment; patient attitude; patient compliance; patient counseling; prescription; review; thrush