Newly Diagnosed Primary Open-Angle Glaucoma Randomized to 2 Trabecular Bypass Stents or Prostaglandin: Outcomes Through 36 Months - Vold, S.D.; Voskanyan, L.; Tetz, M.; Auffarth, G.; Masood, I.; Au, L.; Ahmed, I.I.K.; Saheb, H. (Ophthalmology and Therapy, 2016)
Purpose: To examine outcomes through 36 months in phakic eyes with newly diagnosed primary open-angle glaucoma (POAG) naïve to therapy randomized to treatment with two trabecular micro-bypass stents or topical prostaglandin. Methods: Subjects with POAG naïve to therapy, with intraocular pressure (IOP) ≥21 and ≤40 mmHg, were randomized to implantation of two stents or travoprost. Additional medication was to be prescribed post-treatment for elevated IOP or glaucomatous optic nerve findings. Of 101 randomized subjects, 100 subjects were followed for 24 months and 73 subjects were followed for 36 months. Follow-up on all subjects is ongoing. Results: In this randomized cohort of 101 POAG subjects, 54 subjects underwent 2-stent surgery and 47 received topical travoprost. Mean pre-treatment IOP was 25.5 ± 2.5 mmHg in stent-treated eyes and 25.1 ± 4.6 mmHg in medication-treated eyes. By 3 years, mean IOP was 14.6 mmHg in stent eyes (with medication added in 6 eyes) and 15.3 mmHg in travoprost eyes (with a second medication added in 11 eyes). In the subset of eyes that did not require additional medical therapy, mean IOP was 14.5 mmHg and 15.7 mmHg in the respective groups. Ninety-one percent of stent eyes had 3-year IOP ≤18 mmHg without additional therapy (62% ≤ 15 mmHg) and 79% of travoprost eyes had 3-year IOP ≤18 mmHg (21% ≤ 15 mmHg). Safety was favorable in both groups. Conclusions: In this prospective, randomized comparison of subjects with newly diagnosed POAG naïve to therapy, substantial IOP reduction with a favorable low complication rate was shown through 3 years after either 2 trabecular stents implanted as the sole procedure or topical travoprost therapy. These data suggest 2-stent implantation may be a viable initial treatment option comparable to topical prostaglandin in newly diagnosed POAG patients. Trial registration: ClinicalTrials.gov identifier, NCT01443988. Funding: Glaukos Corporation, Laguna Hills, CA.
Keywords: NCT01443988; prostaglandin; travoprost; adult; article; cornea thickness; female; follow up; human; intraocular hypertension; intraocular pressure; male; open angle glaucoma; patient compliance; priority journal; prospective study; screening test; vascular disease; Alcon; travatan

Frequency of unplanned interventions in patients attending for a presumed routine glaucoma follow-up appointment - Calafati, J.; Pradhan, Z.S.; Birt, C.M. (Canadian Journal of Ophthalmology, 2016)
Objective To determine the frequency of patient visits in which an unplanned treatment modification was required in chronic patients attending a glaucoma clinic for routine follow-up and to identify the treatment interventions most commonly employed. Design Prospective, cross-sectional study. Participants A total of 630 previously stable patients attending a glaucoma clinic for routine follow-up. Methods This was a single-centre survey of all eligible patients returning to an academic glaucoma clinic. Data regarding whether patients’ visit remained routine or required intervention, which clinical parameter had changed, and any alterations in treatment regimens were studied. Results The percentage of patients found to require a change in management was 20.79% (131 of 630 patients); 16.9% were found to have a cause for change because of glaucoma, and the remaining 4% required intervention because of a nonglaucomatous condition. The most common parameter that changed treatment was intraocular pressure (43.87%), followed by visual fields (21.29%). The frequency of abnormal parameters varied within each subtype of glaucoma. The frequency of treatment changes among those with primary open-angle glaucoma was 22.58% compared with 16.5% of glaucoma suspects, 14% of ocular hypertensives, 32% of pseudoexfoliative glaucoma, and 50% of normal tension glaucoma patients. The most common intervention (32.84%) was a change in antiglaucoma medications. The next most frequent interventions were laser procedures (21.90%) and surgery (16.06%). Conclusions This study suggests that a significant minority of patients attending a glaucoma clinic for a routine appointment require treatment modification.
Keywords: antiglaucoma agent; article; capsulotomy; cataract extraction; comparative study; controlled study; cross-sectional study; eye examination; follow up; glaucoma; glaucoma surgery; health care utilization; human; intraocular hypertension; intraocular pressure; lens implantation; low level laser therapy; low tension glaucoma; major clinical study; observational study; open angle glaucoma; ophthalmic neodymium YAG laser; patient referral; pharmaceutical care; prospective study; pseudoexfoliation; trabeculectomy; treatment planning; visual acuity; visual field

Improvement of the visual field index in clinical glaucoma care - Cohen, S.L.; Rosen, A.I.; Tan, X.; Kingdom, F.A.A. (Canadian Journal of Ophthalmology, 2016)
Objective This article investigates the prevalence and attributes of patients with open-angle glaucoma who exhibit improvement of visual field loss in a clinical setting. Design We conducted a retrospective chart review of patients in a clinical glaucoma practice. Participants We identified 719 glaucoma patients with at least 5 SITA strategy visual field tests and a minimum continuous follow-up period of 5 years. Methods The change in the slope of the visual field index (VFI) over time was illustrated using histogram analysis for the study eye with the worst VFI at baseline. Multiple variables were analyzed to determine their impact on rates of visual field progression, including sex, age, disease staging, intraocular pressure (IOP), and incisional surgeries. Eyes with severe nonophthalmic and ophthalmic comorbidities were excluded. Results Considering 582 eligible eyes, 232 (39.9%) showed significantly positive slopes of the VFI as a function of time, 76 (13.1%) showed nonsignificant slopes, and 276 (47.4%) showed significantly negative slopes. In all, 10 eyes (1.7%) demonstrated VFI slope improvement of ≥2% per year, whereas 21 (3.6%) demonstrated VFI slope reduction ≥2% per year. More advanced disease stage was significantly associated with a negative VFI slope (p < 0.0001). Trabeculectomy and poor compliance were not associated with a negative VFI slope, whereas cataract surgery correlated with higher odds of a negative VFI slope (p = 0.048). Conclusions In a clinical setting, a significant VFI improvement over time was observed over an interval of greater than 5 years.
Keywords: eye drops; age; aged; article; cataract extraction; comorbidity; disease classification; follow up; histogram; human; incision; intraocular pressure; laser surgery; major clinical study; measurement; medical record review; open angle glaucoma; patient compliance; perimetry; plots and curves; sex; staging; time; trabeculectomy; trabeculoplasty; visual field; visual field defect; visual field index

Right services to right patients at right time in right setting in Tays Eye Centre - Tuulonen, A.; Kataja, M.; Syvänen, U.; Miettunen, S.; Uusitalo, H. (Acta Ophthalmologica, 2016)
Purpose: The report describes the concepts behind procedures implemented in Tays Eye Centre to enable improved access to care and improved productivity. Methods: The strategy was developed in 2009 after hospital district decided to construct a new eye hospital which was opened in 2012. The following principles were implemented: (i) identification of high-volume patient groups: the ‘big four’ eye diseases accounting for 70% of patient visits and costs: age-related macular degeneration (AMD), glaucoma, retinal diseases and cataract; (ii) stratification and prioritization of patient care based on risk of permanent visual disability; (iii) standardization of services for low-risk patients; (iv) maximization of productivity; and (v) shared care. The impact of the new strategy on access to care and productivity is reported for years 2011–2015. Results: In 2011–2015, the total number of services provided increased 46% while the work contribution increased 15%. The number of referrals increased 76% and the number of outpatient appointments increased 2.5-fold. Simultaneously, the number of delayed follow-up visits decreased to zero. Age-related macular degeneration (AMD) injections increased 1.8-fold. However, after 50% yearly increase in Age-related macular degeneration (AMD) injections, a plateau was reached in 2014 with a 3% decline in 2014–2015 with no changes in treatment indications. In the beginning of 2016, the number of injections has started to increase again (+9% compared to 2015). The total number of surgical procedures increased 98%. The annual number of cataract surgeries increased 64% and bilateral surgeries from 11% to 39%. Conclusion: Revised operational concepts and new facilities together with a 15% increase in work contribution led to a 46% increase in overall productivity, improved access to care and the clearance of delayed services. Efforts continue to further refine cost-effective care and to define the appropriate levels of services.
Keywords: age related macular degeneration; article; cataract; cataract extraction; eye disease; glaucoma; health care access; health care cost; health care planning; human; low risk patient; patient care; priority journal; retina disease; standardization; surgical technique; treatment indication; visual impairment

Prevalence of diagnosed ocular disease in veterans with serious mental illness - Saeedi, O.; Ashraf, H.; Malouf, M.; Slade, E.P.; Medoff, D.R.; Li, L.; Kreyenbuhl, J. (General Hospital Psychiatry, 2016)
Objective To compare the prevalence of diagnosed ocular disease and eye disease treatment between Veteran's Administration (VA) patients with and without serious mental illness (SMI). Methods Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year 2011 in the VA Capitol Health Care System (VISN 5). Results We identified 6462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P<.001). Those with SMI had a higher prevalence of glaucoma (10.2% vs. 7.1%, P<.0001), cataract (12.6% vs. 9.2%, P<.0001) and dry eye (4.0% vs. 2.7%, P<.0001). Less than half (34.3%) of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P<.0001). Conclusion VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with SMI do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated.
Keywords: adult; article; bipolar disorder; cataract; comparative study; controlled study; disease severity; dry eye; eye disease; eye examination; female; glaucoma; health care system; health care utilization; human; major clinical study; male; mental disease; ophthalmology; optometry; prevalence; psychosis; retrospective study; risk factor; schizoaffective psychosis; schizophrenia; veteran

Impossibility to eliminate observer effect in the assessment of adherence in clinical trials - Myers, J.S.; Fudemberg, S.J.; Fintelmann, R.E.; Hark, L.A.; Khanna, N.; Leiby, B.E.; Waisbourd, M. (Patient Preference and Adherence, 2016)
Purpose: To utilize the Travoprost Dosing Aid (DA) in the assessment of patient medication adherence, while also determining whether or not altering the functionality of the DA in three randomized subject groups can reduce observer effect. Methods: Forty-five subjects were randomized into three groups: two with monitored DAs and one without monitoring. One group of subjects was given a DA that both monitored drop usage and had visual and audible alarms, while the other monitored group included subjects given a DA that had no alarms but continued to monitor drop usage. The third group was given a DA that had no alarm reminders or dose usage monitoring. Subjects were informed that some monitors would not be functional, in an attempt to reduce observer effect, or the effect of being monitored on subject behavior and adherence. A six-item questionnaire was also utilized to assess how the subjects felt about their adherence and DA use. Results: The overall adherence rates were found to be 78% in the fully functional group (95% confidence interval: 70-88) and 76% in the no alarms group (95% confidence interval: 65-89). No association was seen between questionnaire response and medication adherence. The patients in the DA group without alarms had a significantly higher odds ratio of medication adherence if they reported on the questionnaire that using the DA did affect how much they used their drops. Conclusion: Though the use of DA was expected to reveal different rates of adherence depending on the functionality of the DA between groups, patients with a nonfunctioning DA did not have a significant difference in medication adherence compared to those given a fully functional DA. This supports that an observer effect was not reduced despite these interventions, and that the subjects adhered to taking their medications as if they had a functioning DA and were being monitored.
Keywords: eye drops; placebo; prostaglandin derivative; travoprost; adult; aged; alarm monitor; alarm monitoring; article; clinical article; controlled study; female; glaucoma; high risk patient; human; male; observer bias; patient attitude; patient compliance; patient monitoring; questionnaire; randomized controlled trial; risk assessment

Validation of a glaucoma knowledge assessment in glaucoma patients - Rao, V.S.; Peralta, E.A.; Rosdahl, J.A. (Clinical Ophthalmology, 2016)
To develop metrics to identify knowledge deficits and barriers to learning in glaucoma patients, this study seeks to validate a glaucoma knowledge assessment to use in the evaluation of knowledge in glaucoma patients. Purpose: Glaucoma treatment adherence appears to improve when patients demonstrate a greater knowledge of the disease and its treatment. This study seeks to validate a glaucoma knowledge assessment in a glaucoma patient population to assist in patient educational assessments and interventions. Patients and methods: The National Eye Health Education Program’s (NEHEP) glaucoma knowledge assessment has previously been suggested as a useful measure to assess glaucoma patient’s knowledge. This questionnaire was administered in glaucoma patients along with a more comprehensive 49-question examination. Demographic data and health literacy were assessed. Statistical analyses were performed to assess the validity of the assessments. Results: A total of 12 glaucoma patients completed the knowledge assessments. The mean ± standard deviation age of the patients was 69±14 years, and the duration of glaucoma was 14±13 years. The participants’ mean score on the NEHEP assessment was 7.3±0.8 (of 10, 73% correct) vs 29.3±7.3 (of 49, 60% correct) on the comprehensive assessment. The value of coefficient α was 0.592 for NEHEP and 0.872 for the cumulative assessment. The P-value (proportion of examinees answering correctly) ranged from 0 to 1 for individual questions. Item point–biserial correlation values for each question ranged from -0.402 to 0.813. Discussion: The NEHEP quiz may be a good starting point for the development of a reliable knowledge assessment tool to measure and monitor glaucoma knowledge, due to its concise nature and reasonable level of difficulty. This study suggests that questions included in the currently available questionnaires vary widely in difficulty and ability to differentiate knowledge level, which may ultimately compromise reliability and utility of existing examinations. Further examination of individual questions and teaching points included in the current assessments may help to construct increasingly reliable and useful knowledge assessments in the future.
Keywords: antiglaucoma agent; adult; aged; article; clinical article; descriptive research; disease duration; educational status; female; glaucoma; health literacy; human; knowledge management; male; medical information; patient compliance; patient education; prospective study; statistical analysis; validation study

Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016 - Saeki, H.; Nakahara, T.; Tanaka, A.; Kabashima, K.; Sugaya, M.; Murota, H.; Ebihara, T.; Kataoka, Y.; Aihara, M.; Etoh, T.; Katoh, N. (Journal of Dermatology, 2016)
Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.
Keywords: allergen; antihistaminic agent; antiinflammatory agent; corticosteroid; cyclosporine; emollient agent; immunoglobulin E; lactate dehydrogenase; tacrolimus; allergy; article; atopic dermatitis; bacterial infection; burning sensation; cancer risk; carcinogenesis; cataract; Chinese medicine; clinical decision making; clinical practice; counseling; differential diagnosis; disease exacerbation; disease predisposition; disease severity; disease severity assessment; drug efficacy; drug therapy; eczema; environmental factor; eosinophil count; erythema; evidence based medicine; food; glaucoma; herbal medicine; hospital care; human; immunoglobulin blood level; lactate dehydrogenase blood level; mycosis; pathogenesis; patient compliance; patient education; practice guideline; pregnancy; proactive therapy; prognosis; pruritus; psychosomatic disorder; quality of life; relapse; skin barrier; skin care; skin function; sweat; treatment outcome; ultraviolet phototherapy; virus infection

Early adherence to anti-glaucoma therapy: An observational study - Belhassen, M.; Laforest, L.; Licaj, I.; Van Ganse, É. (Therapie, 2016)
Objectives Glaucoma is a major cause of blindness, preventable by a regular therapy. Thus, a good knowledge of patients’ adherence to preventive therapy is critical to improve disease management. Early persistence to first-line glaucoma therapy is poorly documented in France. We verified to what extent first-line glaucoma therapy was interrupted within the 12 months following initiation and how this interruption varied with patients’ characteristics and drug classes. Methods Patients newly-treated with chronic glaucoma therapy (prostaglandins, beta-blockers alone or combined with another therapy, and topical carbonic anhydrase inhibitors) between 2005 and 2008 were identified in the French National Claims data (1/97th random sample). Twelve-month persistence was defined by the presence of the first-line drug class (≥ 1 dispensation) between the 12th and 24th months following initiation. Twelve-month persistence was compared between patients according to the first-line drug classes and baseline characteristics. Proportion of days covered (12 months) and number of quarters with initiated drug class (24 months) were also studied. Results Among 5331 patients initiated with chronic glaucoma therapy in monotherapy (63% aged ≥ 60 years old, 57% females), initiated therapy mainly consisted of prostaglandins (43%) and beta-blockers alone (32%). Only 45% of the patients were persistent to first-line therapy 12 months after initiation. Salient differences in persistence rates appeared between drug classes (P < 0.0001): from 59% with prostaglandins to 26% for topical carbonic anhydrase inhibitors. Better results also appeared for prostaglandins with other dimensions of adherence. Non-persistent patients were more likely younger than 40, or conversely aged ≥ 80 (P < 0.0001). They were also more likely to necessitate social assistance for therapy (P = 0.0007). No salient difference appeared as to gender. Conclusions Our findings confirm the low early persistence of first-line therapy, despite better results for prostaglandins. Education of patients and identification of barriers to adherence could contribute to improve quality of care.
Keywords: antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin; adult; aged; article; female; glaucoma; human; major clinical study; male; medication compliance; middle aged; monotherapy; observational study; patient compliance; priority journal; time to treatment; topical treatment; treatment interruption; very elderly

Guide to treatments used for atopic dermatitis in adults - Chaplin, S. (Prescriber, 2016)
Atopic dermatitis, or eczema, usually begins in childhood but adults can also be affected due to either persistence of symptoms or late-onset disease. This article provides a guide to the topical and systemic treatments used for atopic dermatitis in adults, including administration, adherence and primary care prescribing data.
Keywords: antibiotic agent; antihistaminic agent; azathioprine; calcineurin inhibitor; crisaborole; cyclosporine; dupilumab; emollient agent; methotrexate; mycophenolic acid; steroid; adult; application site burning; application site irritation; application site pruritus; application site reaction; atopic dermatitis; drug cost; flushing; human; hypertension; infection; intraocular hypertension; leg ulcer; medication compliance; nephrotoxicity; patient compliance; patient education; patient referral; phototherapy; prescription; primary medical care; pruritus; recurrent disease; relapse; review; scalp; side effect; skin atrophy; skin cancer; skin infection; sleep disorder

Healthcare use among young Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy - Eloranta, S.; Smedby, K.E.; Ekberg, S.; Chang, E.; Neovius, M.; Glimelius, I. (Haematologica, 2016)
Purpose. With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study provides a global assessment of late effects for working-age HL survivors treated with contemporary protocols (intensive chemotherapy and lim-ited radiotherapy). Patients and Methods. From Swedish nationwide registers we identified 1017 HL survivors diagnosed in 2000-2009, aged 18-60 years (median 32) and surviving at least one year post-diagnosis, and 4031 age-, sex- and calendar-year-matched population comparators. Incidence rate ratios (IRR) and 95% confidence intervals (95%CI) for hospital outpatient visits and hospital bed-days after the first year and up to 2013 (maximum 14 years post-diagnosis) were estimated across treatment subgroups, considering relapse-free time and using negative binomial regression. Scheduled outpatient visits for HL were excluded but inpatient visits for HL were included in analysis of bed-days. Results. The rate of outpatient visits among relapse-free survivors was nearly double (IRR=1.8, 95%CI: 1.6-2.0) and the rate of bed-days was more than triple that among comparators (IRR=3.6, 95%CI: 2.7-4.7). The higher rates of outpatient visits persisted up to 10 years and bed-days up to four years post-diagnosis. However, absolute numbers of extra visits were low (mean=2 outpatient visits and 2 bed-days, respectively, during follow-up). Patients requiring 6-8 chemotherapy courses had higher rates of outpatient visits (IRR=1.4, 95%CI: 1.1-1.7) and bed-days (IRR=4.7, 95%CI: 2.9-7.8) than patients treated with 2-4 courses+radiotherapy. Established late effects including heart disease and second malignancies accounted for a minority of outpatient visits. Previously unstudied reasons for excess healthcare use included diabetes mellitus, keratitis, chest pain, and asthma (Figure 1). Conclusions. Chemotherapy, but not radiotherapy, appears to drive the slight excess healthcare use among contemporarily treated HL survivors. The diagnoses of healthcare visits reflected a broad panorama of disorders, indicating the need of comprehensive care in addition to specific screening programs.(Figure Presented).
Keywords: adult; asthma; chemotherapy; confidence interval; controlled study; diabetes mellitus; diagnosis; follow up; health care utilization; heart disease; Hodgkin disease; hospital bed; hospital patient; human; incidence; keratitis; major clinical study; outpatient; radiotherapy; relapse; remission; screening; second cancer; survivor; thorax pain; young adult

Possibilities and limitations of eye drops for glaucoma therapy - Lanzl, I.M.; Poimenidou, M.; Spaeth, G.L. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2016)
Keywords: delayed release formulation; eye drops; administration and dosage; delayed release formulation; dose response; evidence based medicine; Germany; open angle glaucoma; human; intraocular drug administration; patient compliance; treatment outcome

Preservative-free bimatoprost 0.03%/timolol 0.5% fixed combination in patients with glaucoma in clinical practice - Pfennigsdorf, S.; Eschstruth, P.; Häsemeyer, S.; Feuerhake, C.; Brief, G.; Grobeiu, I.; Shirlaw, A. (Clinical Ophthalmology, 2016)
Purpose: The aim of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF), fixed-combination (FC) bimatoprost 0.03%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension in a clinical practice setting. Patients and methods: This open-label study observed patients switched to PF FC bimatoprost 0.03%/timolol 0.5% due to insufficient intraocular pressure (IOP) control on previous therapies. IOP was measured at baseline and at ~12 weeks. Tolerability and continuation of therapy were also assessed. Results: A total of 1,553 patients were included in the study, and the per-protocol population comprised 1,391 patients. There were some minor deviations from protocol: some patients with no prior therapy and some who switched for reasons other than insufficient IOP control were included in the analysis. The mean IOP was reduced by 27.4%, from 22.2 mmHg to 16.1 mmHg. In subgroup analyses, the mean IOP was significantly reduced from baseline, irrespective of whether previous treatment was monotherapy or combination therapy, and preserved or PF therapy. Physicians mostly (88.1%) reported the IOP-lowering efficacy of PF FC bimatoprost 0.03%/timolol 0.5% to be as expected or better than expected. Switching to PF FC bimatoprost 0.03%/timolol 0.5% resulted in reductions from baseline in the number of patients reporting ocular symptoms. Adverse events were reported by 6.2% of patients, the most common being eye irritation (1.6%) and eye pruritus (1.0%). Physicians reported treatment compliance as better or unchanged compared with prior treatment in almost all patients (93.9%). Most patients were expected to continue PF FC bimatoprost 0.03%/timolol 0.5% after the end of the study. Conclusion: Switching to PF FC bimatoprost 0.03%/timolol 0.5% was associated with significant IOP reductions from baseline over 12 weeks. Adverse events were uncommon, and compliance was high compared with previous therapy. PF FC bimatoprost 0.03%/timolol 0.5% may be a suitable treatment for patients with inadequately controlled IOP or who are sensitive to preservatives.
Keywords: NCT01999348; bimatoprost plus timolol; preservative; aged; article; conjunctival hyperemia; controlled study; drug efficacy; drug hypersensitivity; drug safety; drug tolerability; dry eye; eye irritation; eye pain; eyelid erythema; female; foreign body sensation; foreign body sensation; human; informed consent; intraocular foreign body; intraocular hypertension; intraocular pressure; lacrimation; major clinical study; male; observational study; ocular pruritus; open angle glaucoma; open study; patient compliance; population research; prospective study; punctate keratitis; randomized controlled trial; side effect; treatment duration; ganfort

Preservative-free bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension in clinical practice - Pillunat, L.E.; Eschstruth, P.; Häsemeyer, S.; Thelen, U.; Foja, C.; Leaback, R.; Pfennigsdorf, S. (Clinical Ophthalmology, 2016)
Background: Intraocular pressure (IOP)-lowering medications for primary open-angle glaucoma and ocular hypertension commonly contain preservatives that can cause ocular surface damage in many patients. The purpose of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF) bimatoprost 0.03% in patients with primary openangle glaucoma or ocular hypertension (IOP ≥18 mmHg) in a clinical practice setting. Methods: This open-label study observed patients who were switched to PF bimatoprost 0.03% for medical reasons. IOP was measured at baseline and ~12 weeks later at the final visit, and the change in IOP was calculated. Tolerability and continuation of therapy were assessed at two follow-up visits. Results: A total of 1,830 patients were included in the study, and complete IOP data were available for 1,543 patients. Mean IOP was reduced by 23% from 21.64 mmHg to 16.59 mmHg (P<0.0001). In subgroup analyses, the mean IOP was significantly reduced compared with baseline, regardless of prior therapy, including those previously treated with PF monotherapy. A total of 85.7% of physicians reported the IOP-lowering efficacy of PF bimatoprost 0.03% to be as expected or better than expected. Adverse events (AEs) were experienced by 5.7% of patients, and there were no serious AEs reported. The most common AEs were eye irritation (1.7%) and hyperemia (1.4%). Physician-reported treatment compliance was reported as better than (48.7%) or equal to (43.6%) prior treatment in most patients. Most patients (82%) were expected to continue PF bimatoprost 0.03% after the end of the study. Conclusion: This observational study showed that, in clinical practice, switching to PF bimatoprost 0.03% was associated with a significant IOP reduction from baseline. There was a low AE rate. PF bimatoprost 0.03% may, therefore, be an effective treatment option for patients who are intolerant of preservatives or have an inadequate response to prior IOP-lowering treatments.
Keywords: NCT01853085; bimatoprost; preservative; absence of side effects; adult; aged; article; controlled clinical trial; controlled study; coronary artery disease; drug efficacy; drug safety; drug tolerability; eye irritation; female; follow up; human; hyperemia; hypertension; intraocular hypertension; intraocular pressure; major clinical study; male; observational study; open angle glaucoma; open study; patient compliance; prospective study; treatment outcome; lumigan

A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence - Hark, L.A.; Johnson, D.M.; Berardi, G.; Patel, N.S.; Zeng, L.; Dai, Y.; Mayro, E.L.; Waisbourd, M.; Jay Katz, L. (Patient Preference and Adherence, 2016)
Purpose: Patients with glaucoma who do not keep their follow-up eye care appointments are at risk for developing more severe ocular disease. The primary aim of the current study was to evaluate whether the use of a patient navigator altered adherence to follow-up eye care appointments in community-versus office-based settings. Patients and methods: Patients diagnosed with a glaucoma-related condition following a comprehensive eye examination at 43 community sites in Philadelphia, PA, USA, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community-based setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; and Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05. Results: A total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±standard deviation) was 71.2 (±10.0) years. Patients were predominantly female (65.8%, n=102/155) and African-American (71.6%, n=111/155). The mean (±standard deviation) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Appointment adherence, defined as attendance of ≥1 follow-up visit, was 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=33/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended ≥2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11). Conclusion: Help from a patient navigator did not increase the likelihood of keeping ≥1 follow-up appointment in an office-based setting. Adherence rates for follow-up appointments reached close to 70% or above in a self-selected patient population.
Keywords: African American; age; aged; article; controlled study; disease severity; eye examination; female; follow up; glaucoma; health care access; health care management; health care personnel; human; major clinical study; male; multicenter study; National Eye Institute Visual Function Questionnaire; patient attendance; patient education; patient navigator; Pennsylvania; program effectiveness; prospective study; randomized controlled trial; urban area

Identifying Consistent High-cost Users in a Health Plan: Comparison of Alternative Prediction Models - Chang, H.-Y.; Boyd, C.M.; Leff, B.; Lemke, K.W.; Bodycombe, D.P.; Weiner, J.P. (Medical Care, 2016)
Background: High-cost users in a period may not incur high-cost utilization in the next period. Consistent high-cost users (CHUs) may be better targets for cost-saving interventions. Objectives: To compare the characteristics of CHUs (patients with plan-specific top 20% medical costs in all 4 half-year periods across 2008 and 2009) and point high-cost users (PHUs) (top users in 2008 alone), and to build claims-based models to identify CHUs. Research Design: This is a retrospective cohort study. Logistic regression was used to predict being CHUs. Independent variables were derived from 2007 claims; 5 models with different sets of independent variables (prior costs, medications, diagnoses, medications and diagnoses, medications and diagnoses and prior costs) were constructed. Subjects: Three-year continuous enrollees aged from 18 to 62 years old from a large administrative database with $100 or more yearly costs (N=1,721,992). Measures: Correlation, overlap, and characteristics of top risk scorers derived from 5 CHUs models were presented. C-statistics, sensitivity, and positive predictive value were calculated. Results: CHUs were characterized by having increasing total and pharmacy costs over 2007-2009, and more baseline chronic and psychosocial conditions than PHUs. Individuals' risk scores derived from CHUs models were moderately correlated (∼0.6). The medication-only model performed better than the diagnosis-only model and the prior-cost model. Conclusions: Five models identified different individuals as potential CHUs. The recurrent medication utilization and a high prevalence of chronic and psychosocial conditions are important in differentiating CHUs from PHUs. For cost-saving interventions with long-term impacts or focusing on medication, CHUs may be better targets.
Keywords: prescription drug; addiction; adult; age related macular degeneration; anxiety disorder; article; asthma; attention deficit disorder; billing and claims; bipolar depression; bipolar disorder; chronic disease; chronic obstructive lung disease; cohort analysis; congestive heart failure; controlled study; diabetes mellitus; disorders of lipid metabolism; drug cost; female; glaucoma; health care cost; health care utilization; health insurance; human; Human immunodeficiency virus infection; hypertension; hypothyroidism; ischemic heart disease; kidney failure; logistic regression analysis; low back pain; major clinical study; male; malignant neoplasm; middle aged; osteoporosis; Parkinson disease; personality disorder; prediction; predictive value; prescription; prevalence; priority journal; problem behavior; psychosocial disorder; retrospective study; rheumatoid arthritis; schizophrenia; seizure; sensitivity and specificity; social problem; substance use; tobacco consumption

Comparison of Self-Reported and Objective Adherence to Antiglaucoma Medications - Zarnowski, T.; Wyszynska, A.; Rekas, M. (Journal of Ocular Pharmacology and Therapeutics, 2016)
Keywords: timolol plus travoprost; travoprost; aged; comparative study; controlled study; drug instillation; electronic device; female; glaucoma; Glaucoma Quality of Life 15 questionnaire; Glaucoma Symptom Scale; human; letter; major clinical study; male; medication compliance; outcome assessment; patient compliance; quality of life; questionnaire; rating scale; self report; duotrav; travatan; Travalert DA

Adherence to glaucoma medications over 12 months in two US community pharmacy chains - Feehan, M.; Munger, M.A.; Cooper, D.K.; Hess, K.T.; Durante, R.; Jones, G.J.; Montuoro, J.; Morrison, M.A.; Clegg, D.; Crandall, A.S.; DeAngelis, M.M. (Journal of Clinical Medicine, 2016)
This study determined the degree of adherence to medications for glaucoma among patients refilling prescriptions in community pharmacies. Methods: Data abstracted from the dispensing records for 3615 adult patients (18 years or older, predominantly over 45) receiving glaucoma medications from two retail pharmacy chains (64 stores in total) were analyzed. From a 24-month historic data capture period, the 12-month levels of adherence were determined using standard metrics, the proportion of days covered (PDC) and the medication possession ratio (MPR). The overall 12-month mean PDC was only 57%, and the mean MPR was 71%. Using a criterion by which 80% coverage was considered satisfactory adherence, only 30% had satisfactory overall 12-month PDC coverage, and only 37% had satisfactory overall 12-month MPR coverage. Refill adherence increased with age and was highest in the 65-and-older age group (p < 0.001). Differential adherence was found across medication classes, with the highest satisfactory coverage seen for those taking alpha2-adrenergic agonists (PDC = 36.0%; MPR = 47.6%) down to those taking direct cholinergic agonists (PDC = 25.0%; MPR = 31.2%) and combination products (PDC = 22.7%; MPR = 31.0%). Adherence to glaucoma medications in the community setting, as measured by pharmacy refill data, is very poor and represents a critical target for intervention. Community pharmacists are well positioned to monitor and reinforce adherence in this population.
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin derivative; adult; age distribution; aged; article; female; glaucoma; human; major clinical study; male; medical record; patient compliance; patient satisfaction; pharmacy (shop); prescription; United States

Evidence of circadian biological rhythm alterations in glaucoma patients - Vidal, K.S.M.; Duque-Chica, G.L.; Nagy, B.V.; Martinez-Madrid, M.J.; Hidalgo, P.A.; Moura, A.L.L.A.; Paranhos, A.; Rol, M.A.; Madrid, J.A.; Ventura, D.F. (Investigative Ophthalmology and Visual Science, 2016)
Purpose: To evaluate the circadian rhythms of temperature, activity and body position of patients with glaucoma compared to controls. Methods: Twenty patients diagnosed with primary open glaucoma (70.6 yrs ± 6.70) were subjected to ambulatory monitoring of wrist temperature, activity and body position using an actimeter (Hobo® Pendant G Acceleration Data Logger) and a temperature sensor (Thermochron® iButton DS1921 H, Dallas, Maxim) for one week. The rhythm assessment was based on Interdaily Stability (IS), Intradaily Variability (IV), Relative Amplitude (RA) and Circadian Function Index (CFI) parameters. T-test analyses were used to compare these parameters in glaucoma patients and 19 healthy subjects (71.7 yrs ± 1.4) obtained from Tudela et al. (2014) study. Results: The IV (0.13 ± 0.01) and CFI (0.46 ± 0.01) from the wrist temperature of glaucoma patients were lower compared to controls (IV: 0,20 ± 0.01; CFI: 0.55 ± 0.01, respectively, ps<0.01). In activity, IS (0.33 ± 0.03) and CFI (0.55 ± 0.01) were smaller than controls (IS: 0,45 ± 0.01; CFI: 0.62 ± 0.01, respectively, ps<0.01). Also, for body position, RA from glaucoma and control group was significantly different (0.20 ± 0.01 and 0.47 ± 0,03, respectively p<0,01). Finally, CFI for glaucoma patients (0.35 ± 0.01) was significantly lower than in controls (0.61 ± 0.01 p<0,01). Other comparisons were not significant (p>0.05). Conclusions: These preliminary results suggest that temperature, body position and activity circadian rhythms are globally affected in glaucoma. Although, previous studies showed that the intrinsically photosensitive ganglion cells (ipRGCs) are also damaged in glaucoma disease, there are few studies evaluating their clinical repercussions in the biological circadian rhythm in glaucoma patients. Furthermore, multiple-rhythm assessment using actigraphy and temperature sensor could be a relevant tool for understand the pathophysiology of glaucoma.
Keywords: acceleration; actimetry; ambulatory monitoring; biological rhythm; body position; circadian rhythm; clinical article; control group; controlled study; diagnosis; female; glaucoma; human; information processing device; male; nerve cell; sensor; Student t test; wrist

Compliance and barriers for follow-up care in community eye screening: The stop glaucoma study - Zhao, D.; Guallar, E.; Swenor, B.K.; Gajwani, P.; Mude, L.; Friedman, D.S. (Investigative Ophthalmology and Visual Science, 2016)
Purpose : To identify barriers to follow-up eye care in individuals aged 50 years and older with abnormal findings in a community-based glaucoma screening. Methods : Individuals screened at community sites in Baltimore, MD with abnormal findings were referred at no cost for a definitive exam at the Wilmer Eye Institute. Those who failed to show for their scheduled visit were called a minimum of 3 times and o ered other appointments. Those who did not schedule or did not show after 5 reschedule attempts were classified as “lost to follow-up”; participants yet to come in for visits were classified as having “incomplete” visits. Multivariable logistic regression models were used to assess the association between demographic, behavioral, and ocular risk factors and loss to follow-up. Results : Among 419 individuals referred for an eye exam, 202 (48.2%) completed their visits and 106 (25.3%) were lost to follow-up (Table 1) The odds ratio (OR [95% CI]) for loss to follow-up was 5.82 (2.66, 12.76) comparing those referred for refraction only vs those referred for eye abnormalities, 0.54 (0.29, 0.98) for those with high school vs <high school education, 0.47 (0.24, 0.92) for those with presenting visual acuity (PVA) 20/50-20/200 vs 20/40 in the better eye, 3.50 (1.75, 7.00) for participants with ungradable/untestable vs gradable/testable results on autorefraction or fundus imaging, and 2.04 (1.03, 4.05) for screening sites of 1-<3 vs <1 mile from the hospital (Table 2). Insurance status and self-reported dificulty in walking were not significantly associated with loss to follow-up. A negative association between older age and loss to follow-up was observed in model 1 but was attenuated and no longer significant in the fully adjusted model (Model 3, Table 2). Conclusions : Identified risk factors for not following-up after eye screening were: low education, poor PVA, longer distance from screening sites to hospital, referral for refraction only, untestable/ungradable autorefraction or fundus photos, and younger age. Many with poor vision requiring refraction who were o ered free glasses did not attend the definitive exam. While this program removes some costassociated barriers, transportation and other opportunity costs may still play a role. E orts are being made to improve follow-up rates using various strategies.
Keywords: controlled study; eye malformation; female; follow up; glaucoma; high school; hospital; human; imaging; insurance; logistic regression analysis; low vision; major clinical study; male; Maryland; odds ratio; patient referral; population model; risk factor; screening; spectacles; stomach fundus; visual acuity; walking

Understanding the reasons and factors for loss to follow-up in glaucoma patients at a tertiary-referral teaching hospital in Seoul, Korea - Kim, Y.K.; Jeoung, J.W.; Park, K.H. (Investigative Ophthalmology and Visual Science, 2016)
Purpose : To assess the reasons and factors for loss to follow-up (LTFU) among patients treated at the glaucoma clinic of a tertiary-referral teaching hospital in Seoul, Korea. Methods : We identified all adult patients (≤ 65 years) with primary open-angle glaucoma (POAG) who had visited the glaucoma clinic between April 2011 and March 2014 and had missed an appointment by at least 18 months. POAG patients who had been LTFU were traced via cellular phone, and their true status and reasons for discontinuation of follow-up were documented. Results : A total of 10,134 POAG patients were considered: 5,608 (55.3%) men and 4,526 (44.7%) women. Among them, 207 (2.04%) had missed a scheduled appointment by 18 months or more, 193 (93.2%) of whom were successfully traced, three of whom (1.6%) had died. Of the 190 patients still alive, 98 (51.6%) had had discontinued their medication, 87 (45.8%) had self-transferred to another glaucoma clinic, and five (2.6%) had been treated with alternative medicine. The reasons cited for LTFU involving treatment interruptions were: lack of understanding regarding the necessity of follow-up (45.9%), unawareness of appointment schedule (30.6%), weakness or illness (13.3%), side effects of glaucoma medication (5.1%), dissatisfaction with clinic or hospital (2.0%), lack of money (2.0%), and others. In both univariate and stepwise multivariate linear regression analyses, older age (P = 0.001), male gender (P = 0.013), and shorter elapsed duration of glaucoma treatment (P = 0.038) were independently associated with follow-up loss involving treatment interruptions. Conclusions : Approximately half of the patients who had been LTFU had had treatment interruptions. This study's results emphasize the need for ongoing educational support and improved appointment notification, especially for the elderly, men, and those who have started treatment in recent years.
Keywords: adult; adverse drug reaction; aged; alternative medicine; clinical trial; doctor patient relationship; drug withdrawal; female; follow up; gender; human; linear regression analysis; major clinical study; male; mobile phone; money; open angle glaucoma; patient referral; side effect; South Korea; teaching hospital; treatment interruption; weakness

Factors influencing patient satisfaction in a glaucoma population - Muhire, R.S.M.; Myers, J.S.; Waisbourd, M.; Dai, Y.; Myers, S.R.; Hark, L.A. (Investigative Ophthalmology and Visual Science, 2016)
Purpose : Patient satisfaction surveys have been utilized to characterize and understand the patient experience in various healthcare settings. Little has been published on satisfaction surveys specifically with regard to outpatient ophthalmic care. Within the field of glaucoma, patient satisfaction survey research has focused on specific treatments - both medical and surgical. The purpose of this study was to investigate possible interactions between patient demographics, clinical factors, and other variables, and satisfaction survey responses. Methods : A 37-question satisfaction survey was administered to patients with glaucoma prior to their appointment in a Glaucoma Department at Wills Eye Hospital. Demographic data, glaucoma diagnosis, disease severity, and prior and current treatments were collected for each participant. Timing of appointment and care, visual acuity (VA) and visual field (VF) data, distance to patient's home, and outside weather were documented. Correlation coeficients were calculated between patient satisfaction scores and patient specific variables. ANOVA test was used to compare satisfaction score differences between categorical variables. Results : A total of 69 patients were enrolled in the study. The mean (±SD) age was 67.9 (±14.0) years, and patients were predominantly female (59.4%, n=41/69). The most common type of glaucoma was open-angle glaucoma (81%, n=56/69). On a scale of 1 to 10, the mean (±SD) satisfaction score of the patients regarding their glaucoma specialist was 9.7 (±0.8). Nearly all (97.1%, n=67/69) would recommend the glaucoma specialist's office to a family member or a friend. Satisfaction scores did not differ among gender or race groups (P=0.588 and P=0.164, respectively). There was no significant correlation between the mean satisfaction score and age (P=0.93), VA in the better eye (P=0.64), VF mean deviation in the better eye (P=0.12), cup-to-disc ratio (P=0.19), distance to patient's home (P=0.46), office wait time (P=0.33), number of glaucoma medications (P=0.11), and outside weather (P=0.20). Conclusions : Glaucoma patients were highly satisfied with the eye care they received from their glaucoma specialists. There were no significant correlations between the investigated outcome measures and satisfaction levels, possibly due to the uniformly high satisfaction scores. Further analysis of patient satisfaction with non-medical doctor aspects of office visits will be presented.
Keywords: aged; ambulatory care; analysis of variance; demography; diagnosis; eye care; family study; female; friend; gender; hospital; human; jurisprudence; major clinical study; male; open angle glaucoma; patient satisfaction; race; visual acuity; visual field; weather

Glaucoma prevalence in brazil demonstrated in ten years - Graciano, A.R.R.; De Carvalho, T.H.T.; Pereira, F.Z.; Fonseca, P.A.A.A.; Vaz, M.A.F.; Silva, L.M.N.; Póvoa, C.A. (Investigative Ophthalmology and Visual Science, 2016)
Purpose : There are few epidemiological studies in Brazil about glaucoma, a neuropathy which causes irreversible damage and is the second major cause of blindness in the world. It was used a brazilian health system database (DATASUS) to map the distribution of general frequency of glaucoma in Brazil by age and sex. The information was also obtained from Brazilian Institute of Geography and Statistics (IBGE) to perform a cross sectional study. Methods : The glaucoma cases reported by DATASUS were analyzed in Brazil over 10 years (2004-2014). Patients aged between 0 and 85 years old with glaucoma who had ambulatory care were included in the study. The total number of glaucoma cases varied between 566.895 and 2.004.975 into a population with 182.060.108 to 202.768.562 inhabitants. The data were analyzed using descriptive statistics in SPSS (Statistical Package for the Social Sciences) version 20.0 and Excel program. Results : The data analysis showed prevalence rate of 0.8% over the corresponding years, with values between 0.6% and 1%. The estimated proportion of glaucoma cases in women was equivalent to 1.04%, while for man it was 1.15 %. In 2008, there was a lower proportion for both female and male and the relative risk ( RR ) was 0.97 for women related to men ( 95% CI: 0.97 to 0.98 ). The year 2014 showed the highest value corresponding to RR = 1.1 ( 95% CI: 1:10 to 1:11 ) . Regarding the age group, the group with the highest prevalence rate corresponded to the age between 70 and 79 years ( 6.2%), and the least affected group was aged between 10 and 19 years (0.12 %). Conclusions : According to DATASUS, the prevalence of glaucoma in Brazil ranged from 0.6 % to 1% between 2004-2009. The distribution of the disease by age group showed higher incidence in the age group between 70 and 79 years. The data analysis showed lower rate than another few studies and this can be explained by underreporting in the brazilian database. Due to the dificulties of conducting epidemiological studies of glaucoma, the DATASUS information system is still relevant in the determination of health policies and must be improved.
Keywords: adolescent; adult; aged; ambulatory care; Brazil; child; clinical study; data analysis software; data base; female; glaucoma; health care policy; human; information system; male; prevalence; risk factor; sociology; statistics; very elderly

Comparison of burden of care and visual field progression between newly diagnosed glaucoma patients managed on topical monotherapy and those who switch or add on therapies - Fong, D.S.; Batech, M.; Hudson, S.M.; Luong, T.; Jimenez, J.; Chandwani, H. (Investigative Ophthalmology and Visual Science, 2016)
Purpose : To compare healthcare utilization and visual field progression of glaucoma patients who add or switch topical therapies vs. patients managed on topical monotherapy. Methods : This was a retrospective analysis of Kaiser Permanente Southern California electronic health records between 2001 and 2011, with supplemental chart review. Records of newly-diagnosed glaucoma (ICD-9 365.xx) patients aged 18 years or older and prescribed a glaucoma agent within 90 days of diagnosis were included. Two cohorts were defined: patients treated with topical monotherapy for the study duration, and patients who switched or added drugs at any time during follow-up. Outcomes of interest included health care utilization measured by office visits, visual field testing, laser procedures, and surgery. The risk of visual field progression was assessed using multivariable Cox regression. Results : 6,014 newly diagnosed glaucoma patients were included for analyses; 1,783 remained on monotherapy and 4,231 switched/added medications. Mean follow-up was 8.2 years (SD=2.4). At baseline, 46.9% took beta-blockers, 35.0% prostaglandins, 16.2% adrenergic agents, and 1.4% carbonic anhydrase inhibitors. At 5 years, a greater proportion of patients who added or switched therapy had progressed compared to patients continuing on monotherapy (48.3% vs. 32.8%, p<0.001). Patients who switched/added therapy also had more office visits (20.4 vs. 15.8), more visual field tests (4.9 vs. 4.6) and higher prevalence of trabeculectomies (2.9% vs. 0%) (p<0.001 for all). In multivariable hazard models, predictors of progression from baseline included older age, Black or Hispanic vs. White race/ethnicity, and diabetes; switching or adding therapy was not a statistically significant predictor of progression (HR with 95% CI: 1.10 (1.00, 1.22)). Conclusions : Patients who switched or added medications had a larger healthcare burden. They had more office visits and procedures at 5 years from diagnosis, including a significantly higher number of procedures and visual field tests. Thus, this analysis supports the use of the most effective therapeutic option early. Using factors evaluated in the multivariable model, identifying glaucoma patients at higher risk of progression may be possible.
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; endogenous compound; prostaglandin; adult; ambulatory care; animal model; California; Caucasian; controlled study; diabetes mellitus; diagnosis; disease course; electronic health record; ethnicity; female; follow up; glaucoma; health care utilization; Hispanic; human; ICD-9; laser; major clinical study; male; medical record review; monotherapy; perimetry; prevalence; proportional hazards model; retrospective study; surgery; topical drug administration; trabeculectomy; young adult

A randomized, controlled trial to test the effectiveness of patient navigation in a community versus office-based setting to improve follow-up appointment adherence in patients with glaucoma - Zeng, L.; Waisbourd, M.; Dai, Y.; Johnson, D.M.; Patel, N.; Molineaux, J.; Divers, M.; Burns, C.; Spaeth, G.L.; Jay Katz, L. (Investigative Ophthalmology and Visual Science, 2016)
Purpose: Patients with glaucoma who are non-adherent to follow-up appointment recommendations receive sub-optimal eye care and are at risk for developing more severe ocular disease. The primary goal of this study was to evaluate the use of a patient navigator to increase adherence to follow-up recommendations in community versus office-based settings. Methods: Patients diagnosed with a glaucoma-related condition following a comprehensive eye exam at community sites in Philadelphia, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05. Results: A total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±SD) was 71.2 (±10.0) years. Patients were predominantly female (65.8%. n=102/155) and African-American (71.6%, n=111/155). The mean (±SD) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Adherence rates, defined as attendance of at least 1 or more follow-up visit, were 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=32/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended >2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11). Conclusions: Adherence rates to follow-up recommendations were similar between community- and office-based settings. Considering that most patients diagnosed with glaucoma or glaucoma suspect were older African Americans, overall adherence rates were relatively high among this high-risk population.
Keywords: African American; clinical trial; comparative effectiveness; controlled clinical trial; controlled study; diagnosis; eye care; female; follow up; glaucoma; high risk population; human; major clinical study; Pennsylvania; randomized controlled trial

Predictors, Resource Utilization, and Short-term Costs of Laser Trabeculoplasty Versus Medication Management in Open-Angle Glaucoma - Schultz, N.M.; Wong, W.B.; Coleman, A.L.; Malone, D.C. (American Journal of Ophthalmology, 2016)
Purpose Adjunctive laser trabeculoplasty (LT) is an alternative to topical medications for open-angle glaucoma (OAG). The purpose was to: (1) identify predictors of LT vs glaucoma medication treatment; and (2) estimate the resource utilization and short-term costs associated with LT vs medication management. Design Retrospective administrative claims analysis. Methods Medical and pharmacy claims data between 2007 and 2012 were analyzed to identify prostaglandin analogue monotherapy OAG patients with an index date LT claim or second medication class claim. Patients were followed for 12 months pre-index and 24 months post-index. Predictive LT attributes included age, sex, employment status, medication adherence, comorbidity status, and geographic region. Short-term costs included glaucoma-specific and comprehensive healthcare encounters. Cohort comparisons were analyzed using χ2 and Student t tests, logistic regression (predictive), and generalized linear models (cost). Results The study included 4743 LT and 16 484 medication patients. Baseline demographics were similar but significant differences were identified for comorbidities, adherence, and geography. Younger age (odds ratio [OR]: 1.21; P <.001), low adherence (OR: 1.18; P =.001), high comorbidities (OR: 1.12; P =.006), and region (OR: 1.50; P <.001) significantly predicted LT receipt. Within LT patients, 60% did not have a pharmacy claim 45 days post-index; by 2 years, this reduced to 20%. LT attributed significantly higher medical ($2684 vs $1980; P <.0001), lower pharmacy ($807 vs $1467; P <.0001), and greater overall costs ($3441 vs $3408; P =.325). Conclusions Poor adherence, younger age, and more comorbidities were predictors of receiving LT. Despite the potential for LT to address adherence, most patients had a medication claim within 2 years. Overall, LT does not provide glaucoma-specific cost savings.
Keywords: prostaglandin derivative; adult; age; aged; article; cohort analysis; comorbidity; cost control; female; health care cost; health care utilization; human; major clinical study; male; monotherapy; open angle glaucoma; patient compliance; pharmacy (shop); priority journal; retrospective study; trabeculoplasty; treatment outcome

Comparison of Latanoprostene Bunod 0.024% and Timolol Maleate 0.5% in Open-Angle Glaucoma or Ocular Hypertension: The LUNAR Study - Medeiros, F.A.; Martin, K.R.; Peace, J.; Scassellati Sforzolini, B.; Vittitow, J.L.; Weinreb, R.N. (American Journal of Ophthalmology, 2016)
Purpose To compare the intraocular pressure (IOP)-lowering effect of latanoprostene bunod (LBN) 0.024% with timolol maleate 0.5% in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). Design Prospective, randomized, double-masked, parallel-group, noninferiority clinical trial. Methods Adults with OAG or OHT from 46 clinical sites (United States and European Union) were randomized 2:1 to LBN instilled once daily (QD) in the evening and vehicle in the morning or timolol instilled twice a day (BID) for 3 months. IOP was measured at week 2, week 6, and month 3 (8 AM, 12 PM, and 4 PM each visit). Results A total of 387 subjects (LBN, n = 259; timolol, n = 128) completed the study. Analysis of covariance showed that mean IOP reduction with LBN was not only noninferior to timolol but significantly greater (P ≤ .025) than timolol at all but the first time point in this study (week 2, 8 AM). Of LBN- and timolol-treated subjects, respectively, 31.0% and 18.5% (P = .007) had their IOP reduced ≥25% from baseline, and 17.7% and 11.1% (P = .084) had their IOP reduced to ≤18 mm Hg over all time points/visits in this study. Ocular treatment-emergent adverse events, while uncommon, appeared more frequently in the LBN group (all mild-moderate except 1 case of severe hyperemia). Conclusions LBN 0.024% QD in the evening was noninferior to timolol 0.5% BID over 3 months of treatment, with significantly greater IOP lowering in subjects with OAG or OHT at all but the earliest time point evaluated, and demonstrated a good safety profile.
Keywords: NCT01749930; latanoprostene bunod; timolol maleate; abnormal sensation; adult; aged; analysis of covariance; application site pain; article; asthenopia; blurred vision; conjunctival hyperemia; controlled study; dizziness; double blind procedure; drug effect; drug efficacy; drug withdrawal; dry eye; dysgeusia; dyspnea; European Union; evening dosage; eye irritation; eye pain; female; foreign body sensation; foreign body sensation; hair disease; headache; human; insomnia; instillation site pain; instillation site pain; intraocular hypertension; intraocular pressure; madarosis; madarosis; major clinical study; male; morning dosage; multicenter study; ocular pruritus; open angle glaucoma; outcome assessment; parallel design; patient compliance; periocular rash; periocular rash; phase 3 clinical trial; priority journal; prospective study; punctate keratitis; randomized controlled trial; rash; respiratory tract disease; somnolence; thorax pain; treatment duration; United States

Effect of Vitamin D replacement on indexes of insulin resistance in overweight elderly individuals: A randomized controlled trial - Fuleihan, G.E.-H.; Baddoura, R.; Habib, R.H.; Halaby, G.; Arabi, A.; Rahme, M.; Singh, R.J.; Kassem, M.; Mahfoud, Z.; Hoteit, M.; Daher, R.T.; Kassir, M.-F. (American Journal of Clinical Nutrition, 2016)
It is unclear whether and at what dose vitamin D supplementation affects insulin resistance (IR). Objective: We sought to investigate whether vitamin D at doses higher than currently recommended decreases indexes of IR in an ambulatory population of overweight elderly subjects. Design: This double-blind, randomized, controlled multicenter trial enrolled 257 elderly overweight individuals aged ≥ 65 y with baseline 25-hydroxyvitamin D [25(OH)D] concentrations between 10 and 30 ng/mL. All subjects received 1000 mg calcium citrate/d, with vitamin D administered weekly at an equivalent dose of 600 or 3750 IU/d. The homeostasis model assessment (HOMA) of IR index at 1 y was the primary outcome.We also assessed the McAuley index. Results: In total, 222 subjects (55% women) with a mean ± SD age and body mass index (BMI; in kg/m2) of 71 ± 4 y and 30 ± 4, respectively, completed the study. Subjects' baseline characteristics, including IR indexes, were similar across groups: 69% had prediabetes, 54% had hypertension (47% were taking antihypertensive medications), and 60% had hyperlipidemia, nearly half of whom were receiving lipidlowering drugs. At 1 y, mean ± SD serum 25(OH)D increased from 20 ± 7 to 26 ± 7 ng/mL in the low-dose arm (P <0.0001) and from 21 ± 8 to 36 ± 10 ng/mL in the high-dose arm (P > 0.001). Median HOMA-IR indexes did not change compared with baseline concentrations and were similar in the high-[2.2 (IQR: 1.5, 2.9)] and low-dose [2.3 (IQR: 1.6, 3.3] treatment groups. Adjusted analyses showed that HOMA-IR was predicted by the baseline HOMA index and BMI but not by vitamin D dose, baseline serum 25(OH)D, or change in 25(OH)D. Conclusion: Vitamin D3 at 3750 IU/d did not improve HOMA-IR compared with the Institute of Medicine Recommended Dietary Allowance of 600 IU/d in elderly overweight individuals.
Keywords: NCT01315366; 25 hydroxyvitamin D; antihypertensive agent; antilipemic agent; C peptide; calcium; cholesterol; citrate calcium; colecalciferol; creatinine; glucose; hemoglobin A1c; high density lipoprotein; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; low density lipoprotein; placebo; triacylglycerol; aged; antihypertensive therapy; article; body mass; calcium blood level; cerebrovascular accident; cholesterol blood level; comparative effectiveness; controlled study; creatinine blood level; diet restriction; dietary reference intake; dose response; double blind procedure; drug dose comparison; drug efficacy; drug megadose; drug safety; drug withdrawal; female; glaucoma; heart infarction; hemorrhoid; homeostasis; homeostasis model assessment of insulin resistance index; human; hypercholesterolemia; hyperlipidemia; hypertension; impaired glucose tolerance; insulin blood level; insulin resistance; kidney colic; low drug dose; major clinical study; male; mcauley index; medication compliance; metabolic parameters; mobilization; multicenter study; obesity; outcome assessment; patient compliance; randomized controlled trial; retina detachment; side effect; sudden cardiac death; thrombophlebitis; treatment response; triacylglycerol blood level; very elderly; vitamin blood level; vitamin supplementation; citracal d; euro d

Glaucoma treatment adherence at a United Kingdom general practice - Tse, A.P.; Shah, M.; Jamal, N.; Shaikh, A. (Eye (Basingstoke), 2016)
Purpose To estimate patient adherence with glaucoma therapy and identify factors associated with adherence using computerised patient prescribing records.MethodsIdentification of patients diagnosed with glaucoma, ocular hypertension or suspect glaucoma and/or prescribed topical glaucoma medications registered at a United Kingdom general practice with 13 422 patients. Adherence was defined as the average difference in the actual number of prescriptions collected annually compared to twelve prescriptions required annually (one bottle per month) over the duration of treatment.ResultsOverall, 278 patients were identified of which 139 (50%) were male. The average age was 72 years (range: 22-100). A total of 206 patients (74%) were prescribed glaucoma treatment. Adherence varied significantly between age groups with younger patients demonstrating poorest adherence (P=0.0347). There was no statistical difference when comparing medication class, diagnosis, co-morbidities, or the number of drops being taken.ConclusionsGlaucoma treatment adherence improves with increasing age. Older patients require more prescriptions and may be experiencing drop wastage. Younger patients should be targeted with educational interventions to improve their understanding of glaucoma, and older patients for drop technique review. General practices are well placed to provide such interventions.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; prescription drug; prostaglandin derivative; adult; age distribution; aged; article; comorbidity; controlled study; female; general practice; glaucoma; human; intraocular hypertension; major clinical study; male; medication compliance; patient compliance; practice guideline; prescription; Read code; topical treatment; treatment duration; United Kingdom; very elderly

The impact of formulary drug exclusion policies on patients and healthcare costs - Chambers, J.D.; Rane, P.B.; Neumann, P.J. (American Journal of Managed Care, 2016)
OBJECTIVES: In an attempt to increase the efficiency of their drug benefit policies, insurers are increasingly excluding drugs from their formularies that they deem to be of low value. Our objective was to identify and review empirical evaluations of drug exclusion policies and examine how they affected patients and healthcare costs. STUDY DESIGN: Literature review. METHODS: We performed a literature search to identify empirical studies that evaluated drug exclusion policies. We reviewed each study to determine how the policy impacted patients (ie, if disease control or frequency, or severity of symptoms, were affected) and if healthcare costs (eg, drug expenditures and costs associated with physician office visits, hospitalizations, laboratory tests) changed. RESULTS: We included 26 studies pertaining to 27 drug exclusion policies. Twenty studies reported the impact of 21 drug exclusion policies on patients: 6 (28.6%) policies were reported to have had a positive impact, 6 (28.6%) to have had a negative impact, and 9 (42.8%) to not have impacted patients. Eighteen studies reported the impact of 19 drug exclusion policies on overall healthcare costs: 14 (73.7%) policies were reported to have reduced costs, 1 (5.3%) to have had a neutral impact on costs, and 4 (21.1%) to have increased costs. CONCLUSIONS: Although there were important exceptions, most studies found that drug exclusion policies reduced costs and did not negatively impact patients.
Keywords: antiglaucoma agent; antihypertensive agent; prescription drug; proton pump inhibitor; rabeprazole; allergic rhinitis; ambulatory care; diabetes mellitus; disease control; disease severity; drug cost; drug formulary; drug legislation; gastroesophageal reflux; glaucoma; health care cost; health service; hospitalization cost; human; hyperlipidemia; hypertension; laboratory test; medical service; priority journal; psychosis; review

Traditional Therapies for Severe Asthma - Wang, E.; Hoyte, F.C.L. (Immunology and Allergy Clinics of North America, 2016)
Severe asthma is a complex and heterogeneous disease. The European Respiratory Society and American Thoracic Society guidelines define severe asthma for patients 6 years or older as “asthma which requires treatment with high-dose inhaled corticosteroids…plus a second controller or systemic corticosteroids to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite this therapy.” This article reviews available traditional therapies, data behind their uses in severe asthma, and varying recommendations. As various asthma endotypes and phenotypes are better understood and characterized, targeted therapies should help improve disease outcomes, efficacy, and cost-effectiveness.
Keywords: allergen; beclometasone; beta adrenergic receptor stimulating agent; budesonide; budesonide plus formoterol; cholinergic receptor blocking agent; ciclesonide; corticosteroid; flunisolide; fluticasone furoate; fluticasone furoate plus vilanterol; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol fumarate plus mometasone furoate; leukotriene receptor blocking agent; levalbuterol; macrolide; mometasone furoate; montelukast; muscarinic receptor blocking agent; omalizumab; salbutamol; theophylline; zafirlukast; zileuton; adrenal suppression; aggression; agitation; anxiety disorder; asthma; avascular necrosis; bone density; bronchial thermoplasty; cataract; cerebrovascular disease; comorbidity; cost effectiveness analysis; Cushingoid syndrome; depression; disease exacerbation; disease severity; drug efficacy; ecchymosis; elevated blood pressure; ethnicity; glaucoma; heart infarction; human; hyperglycemia; immunotherapy; infection risk; insomnia; lactation; mania; mental instability; moon face; multicenter study (topic); myopathy; nonhuman; obesity; patient compliance; pediatrics; peptic ulcer; phenotype; practice guideline; pregnancy; priority journal; psychosis; race; randomized controlled trial (topic); review; side effect; stria; systemic therapy; treatment outcome; wound healing impairment; accolate; singulair; zyflo

Overcoming Barriers to Eye Care: Patient Response to a Medical Social Worker in a Glaucoma Service - Fudemberg, S.J.; Amarasekera, D.C.; Silverstein, M.H.; Linder, K.M.; Heffner, P.; Hark, L.A.; Waisbourd, M. (Journal of community health, 2016)
This paper investigates the patient response to a medical social worker in a glaucoma clinic. The literature suggests that medical social workers are effective in a variety of health care settings, yet the efficacy of a medical social worker in an adult ophthalmic setting has not been studied. We present the results of a retrospective chart review of 50 patients with glaucoma referred to a medical social worker between January 5, 2015 and June 31, 2015 in an outpatient clinic of an urban eye hospital. Clinical and demographic data, as well as the data from a quality of care questionnaire, were collected for each patient. Patients rated their interaction with the medical social worker as highly positive (mean = 4.75, 5-point Likert scale), and nearly 90 % of patients expressed interest in future contact with the social worker. Additionally, most patients reported that the social worker resolved the issues they were facing (61.1 %), supported them in seeing their ophthalmologist (70.6 %), and helped them to manage their glaucoma (69.7 %). Reported barriers to glaucoma care were emotional distress; cost of office visits and medications; lack of medical insurance; transportation; poor medication adherence; impairment of daily activities; follow-up adherence; and language. As vision loss from glaucoma is irreversible, it is important to detect and treat patients at early stages of the disease. Therefore, it is imperative for patients to regularly visit their eye care providers and adhere to treatment and follow-up recommendations. This study suggests that a medical social worker could play a pivotal role in helping patients with glaucoma overcome barriers to treatment and facilitate disease management.
Keywords: aged; female; glaucoma; health care delivery; human; male; middle aged; ophthalmology; patient attitude; social worker; statistics and numerical data; very elderly

Patching for corneal abrasion - Lim, C.H.L.; Turner, A.; Lim, B.X. (Cochrane Database of Systematic Reviews, 2016)
Background: Published audits have demonstrated that corneal abrasions are a common presenting eye complaint. Eye patches are often recommended for treating corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye patch when used to treat corneal abrasions. Objectives: The objective of this review was to assess the effects of patching for corneal abrasion on healing and pain relief. Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2016), System for Information on Grey Literature in Europe (OpenGrey) (January 1995 to May 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 9 May 2016. We also searched the reference lists of included studies, unpublished 'grey' literature and conference proceedings and contacted pharmaceutical companies for details of unpublished trials. Selection criteria: We included randomised and quasi-randomised controlled trials that compared patching the eye with no patching to treat simple corneal abrasions. Data collection and analysis: Two authors independently assessed the risk of bias and extracted data. Investigators were contacted for further information regarding the quality of trials. The primary outcome was healing at 24, 48 and 72 hours while secondary outcomes included measures of pain, quality of life and adverse effects. We graded the certainty of the evidence using GRADE. Main results: We included 12 trials which randomised a total of 1080 participants in the review. Four trials were conducted in the United Kingdom, another four in the United States of America, two in Canada, one in Brazil and one in Switzerland. Seven trials were at high risk of bias in one or more domains and one trial was judged to be low risk of bias in all domains. The rest were a combination of low risk or unclear. People receiving a patch may be less likely to have a healed corneal abrasion after 24 hours compared to those not receiving a patch (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.79 to 1.00, 7 trials, 531 participants, low certainty evidence). Similar numbers of people in the patch and no-patch groups were healed by 48 hours (RR 0.97, 95% CI 0.91 to 1.02, 6 trials, 497 participants, moderate certainty evidence) and 72 hours (RR 1.01, 95% CI 0.97 to 1.05, 4 trials, 430 participants, moderate certainty evidence). Participants receiving a patch took slightly longer to heal but the difference was small and probably unimportant (mean difference (MD) 0.14 days longer, 95% CI 0 to 0.27 days longer, 6 trials, 642 participants, moderate certainty evidence). Ten trials reported pain scores. Most studies reported pain on a visual analogue scale (VAS). It was not possible to pool the data because it was skewed. In general, similar pain ratings were seen between patch and no-patch groups. Data from two trials reporting presence or absence of pain at 24 hours was inconclusive. There was a higher risk of reported pain in the patch group but wide confidence intervals compatible with higher or lower risk of pain (RR 1.51, 95% CI 0.86 to 2.65, 2 trials, 193 participants, low certainty evidence). Five trials compared analgesic use between the patch and no-patch groups. Data from three of these trials could be combined and suggested similar analgesic use in the patch and no-patch groups but with some uncertainty (RR 0.95, 95% CI 0.69 to 1.32, 256 participants, low certainty evidence). Frequently reported symptoms included photophobia, lacrimation, foreign body sensation and blurred vision but there was little evidence to suggest any difference in these symptoms in people with or without a patch. Activities of daily living (ADL) were assessed in one study involving children. There was little difference in ADL with the exception of walking which was reported to be more difficult with a patch on: VAS 1.7 cm (SD 2.1) versus 0.3 cm (SD 0.7). Complication rates were low across studies and there is uncertainty about the relative effects of patching or not patching with respect to these (RR 3.24, 95% CI 0.87 to 12.05, 8 trials, 660 participants, low certainty evidence). Three trials reporting rates of compliance to treatment found that 22% of participants did not have their eye patches during follow-up. No-patch groups generally received more adjuvant treatment with antibiotics or cycloplegics, or both, than the patch group. There were limited data on the effect of patching on abrasions greater than 10mm2 in size. Authors' conclusions: Trials included in this review suggest that treating simple corneal abrasions with a patch may not improve healing or reduce pain. It must be noted that, in these trials, participants who did not receive a patch were more likely to receive additional treatment, for example with antibiotics. Overall we judged the certainty of evidence to be moderate to low. Further research should focus on designing and implementing better quality trials and examining the effectiveness of patching for large abrasions.
Keywords: eye patch; ophthalmological therapeutic device; analgesic agent; antibiotic agent; cycloplegic agent; eye drops; mydriatic agent; abrasion; analgesia; bath; blurred vision; Brazil; Canada; conjunctivitis; consultation; contact lens; cornea erosion; cornea injury; cornea ulcer; corneal abrasion; daily life activity; epiphora; eye irritation; eye pain; eye patch; eye redness; follow up; foreign body; healing; hospital admission; human; hypopyon; insomnia; lacrimation disorder; medical leave; ophthalmological therapeutic device; outcome assessment; patient compliance; photophobia; play; priority journal; quality of life; quasi randomization; randomization; randomized controlled trial (topic); rest; review; running; sensitivity analysis; sleep; slit lamp; Switzerland; United Kingdom; visual acuity; visual acuity chart; visual analog scale; walking

Study on Incentives for Glaucoma Medication Adherence (SIGMA): Study protocol for a randomized controlled trial to increase glaucoma medication adherence using value pricing - Bilger, M.; Wong, T.T.; Howard, K.L.; Lee, J.Y.; Toh, A.N.; John, G.; Lamoureux, E.L.; Finkelstein, E.A. (Trials, 2016)
Background: Many glaucoma patients do not adhere to their medication regimens because they fail to internalize the (health) costs of non-adherence, which may not occur until years or decades later. Behavioural economic theory suggests that adherence rates can be improved by offering patients a near-term benefit. Our proposed strategy is to offer adherence-contingent rebates on medication and check-up costs. This form of value pricing (VP) ensures that rebates are granted only to those most likely to benefit. Moreover, by leveraging loss aversion, rebates are expected to generate a stronger behavioural response than equivalent financial rewards. Methods/Design: The main objective of the Study on Incentives for Glaucoma Medication Adherence (SIGMA) is to test the VP approach relative to usual care (UC) in improving medication adherence. SIGMA is a randomized, controlled, open-label, single-centre superiority trial with two parallel arms. A total of 100 non-adherent (Morisky Medication Adherence Scale ≤6) glaucoma patients from the Singapore National Eye Centre are block-randomized (blocking factor: single versus multiple medications users) into the VP and UC arms in a 1:1 ratio. The treatment received by VP patients will be strictly identical to that received by UC patients, with the only exception being that VP patients can earn either a 50 % or 25 % rebate on their glaucoma-related healthcare costs conditional on being adherent on at least 90 % or 75 % of days as measured by a medication event monitoring system. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome is the mean change from baseline in percentage of adherent days at month 6. A day will be counted as adherent when the patients take all their medication(s) within the appropriate dosing windows. Discussion: This trial will provide evidence on whether adherence-contingent rebates can improve medication adherence among non-adherent glaucoma patients, and more generally whether this approach represents a promising strategy to cost-effectively improve chronic disease management. Trial registration:NCT02271269. Registered on 19 October 2014.
Keywords: NCT02271269; antiglaucoma agent; article; controlled study; cost effectiveness analysis; glaucoma; health care cost; human; medication compliance; money; open study; parallel design; patient compliance; randomized controlled trial (topic); randomized controlled trial; reward; Singapore; value pricing

Eye Care Disparities and Health-Related Consequences in Elderly Patients with Age-Related Eye Disease - Umfress, A.C.; Brantley, M.A. (Seminars in Ophthalmology, 2016)
The elderly population in the United States (age 65 and older) is growing rapidly, estimated by the U.S. Census Department to reach 83.7 million by 2050.1 Visual impairment increases with age among all racial and ethnic groups.2 In the elderly, the most common culprits for vision loss are cataract, glaucoma, and age-related macular degeneration (AMD).2 In the developed world, vision loss from cataract has been dramatically reduced by increased access to cataract surgery. However, AMD and glaucoma lead to irreversible vision loss without early diagnosis and intervention. In the U.S., cases of AMD are expected to double by 2050, reaching 17.8 million among patients age 50 or older.3 Similarly, cases of glaucoma are expected to reach 5.5 million by 2050, an increase of over 90% from 2014.3 The visually impaired elderly face disparities in access to eye care, and subsequent general medical and psychosocial complications.
Keywords: age related macular degeneration; aged; cataract; cataract extraction; comorbidity; disability; eye care; eye disease; glaucoma; health care access; health care disparity; human; mortality; priority journal; review; social psychology; visual impairment

Challenges in the pharmacological treatment of geriatric asthma - Agusta, F.; Battaglia, S.; Benfante, A.; Spatafora, M.; Scichilone, N. (Expert Review of Clinical Pharmacology, 2016)
Asthma in older populations is characterized by frequent comorbid conditions, which increase the risk of side effects and of detrimental interactions between respiratory and non-respiratory drugs. These observations lead to the need to manage asthma in older populations by applying a multidimensional assessment and a multidisciplinary treatment; therefore, we favor the use of the ‘geriatric’ term to define asthma in the elderly. Geriatric asthma is a complex disease, which may not necessarily imply that it is also complicated, although the two conditions may often coexist. On this basis, the switch from an organ-driven management to the holistic approach may be the key factor to attain optimal control of the disease in this age range. The current review discusses the age-related factors affecting asthma treatment in the oldest individuals, such as the comorbid conditions, and age-related changes of metabolism and excretion that can impair the efficacy and safety of drugs.
Keywords: allergen; antiasthmatic agent; beta 2 adrenergic receptor stimulating agent; bronchodilating agent; calcium channel blocking agent; cholinergic receptor blocking agent; clarithromycin; corticosteroid; creatinine; cytochrome P450; immunoglobulin E; itraconazole; Staphylococcus enterotoxin; theophylline; aged; aging; airway obstruction; anosmia; asthma; cataract; chronic obstructive lung disease; chronic rhinosinusitis; closed angle glaucoma; cognitive defect; comorbidity; creatinine blood level; diabetes mellitus; disease control; drug efficacy; drug safety; dry powder inhaler; electrolyte disturbance; fracture; gastroesophageal reflux; geriatric asthma; geriatric disorder; glaucoma; headache; heart arrhythmia; heart failure; human; hyperglycemia; hypokalemia; inhalation; inhaler; kidney failure; liver disease; lung tuberculosis; medication compliance; metered dose inhaler; mydriasis; nausea and vomiting; nose allergy; nose polyp; obesity; osteoporosis; patient compliance; peak inspiratory flow; physical inactivity; pneumonia; QT prolongation; review; sensitization; skin contusion; smoking; stomach acid secretion; stomach disease; supraventricular tachycardia; tachycardia; thrush; tremor; xerostomia

A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy - Mokhles, P.; Schouten, J.S.A.G.; Beckers, H.J.M.; Azuara-Blanco, A.; Tuulonen, A.; Webers, C.A.B. (Journal of Glaucoma, 2016)
Purpose: Glaucoma patients are still at risk of becoming blind. It is of clinical significance to determine the risk of blindness and its causes to prevent its occurrence. This systematic review estimates the number of treated glaucoma patients with end-of-life visual impairment (VI) and blindness and the factors that are associated with this. Methods: A systematic literature search in relevant databases was conducted in August 2014 on end-of-life VI. A total of 2574 articles were identified, of which 5 on end-of-life VI. Several data items were extracted from the reports and presented in tables. Results: All studies had a retrospective design. A considerable number of glaucoma patients were found to be blind at the end of their life; with up to 24% unilateral and 10% bilateral blindness. The following factors were associated with blindness: (1) baseline severity of visual field loss: advanced stage of glaucoma or substantial visual field loss at the initial visit; (2) factors influencing progression: fluctuation of intraocular pressure (IOP) during treatment, presence of pseudoexfoliation, poor patient compliance, higher IOP; (3) longer time period: longer duration of disease and older age at death because of a longer life expectancy; and (4) coexistence of other ocular pathology. Conclusions: Further prevention of blindness in glaucoma patients is needed. To reach this goal, it is important to address the risk factors for blindness identified in this review, especially those that can be modified, such as advanced disease at diagnosis, high and fluctuating IOP, and poor compliance.
Keywords: adverse outcome; age; age related macular degeneration; blindness; cataract; comorbidity; disease course; disease duration; follow up; human; intraocular hypertension; intraocular pressure; life expectancy; open angle glaucoma; patient compliance; priority journal; pseudoexfoliation; review; systematic review; unilateral blindness; visual field defect; visual impairment

Big data and ophthalmic research - Clark, A.; Ng, J.Q.; Morlet, N.; Semmens, J.B. (Survey of Ophthalmology, 2016)
Large population-based health administrative databases, clinical registries, and data linkage systems are a rapidly expanding resource for health research. Ophthalmic research has benefited from the use of these databases in expanding the breadth of knowledge in areas such as disease surveillance, disease etiology, health services utilization, and health outcomes. Furthermore, the quantity of data available for research has increased exponentially in recent times, particularly as e-health initiatives come online in health systems across the globe. We review some big data concepts, the databases and data linkage systems used in eye research—including their advantages and limitations, the types of studies previously undertaken, and the future direction for big data in eye research.
Keywords: amantadine; antiglaucoma agent; bevacizumab; hydroxymethylglutaryl coenzyme A reductase inhibitor; phosphodiesterase inhibitor; quinoline derived antiinfective agent; ranibizumab; abducens nerve paralysis; age related macular degeneration; anterior ischemic optic neuropathy; blindness; cataract; cataract extraction; closed angle glaucoma; cornea edema; data base; diabetic retinopathy; disease surveillance; dry eye; endophthalmitis; eye disease; eye injury; glaucoma; government; health care planning; health care utilization; health economics; health services research; heart infarction; human; ischemic optic neuropathy; medical record; medical research; medicare; online system; open angle glaucoma; ophthalmic epidemiology; ophthalmoscopy; optic nerve disease; pharmacoepidemiology; postmarketing surveillance; priority journal; register; retina detachment; retina vein occlusion; retrolental fibroplasia; review; strabismus; visual impairment

Use of atypical antipsychotics and risks of cataract development in patients with schizophrenia: A population-based, nested case-control study - Chou, P.-H.; Chu, C.-S.; Lin, C.-H.; Cheng, C.; Chen, Y.-H.; Lan, T.-H.; Huang, M.-W. (Schizophrenia Research, 2016)
Objective: Previous research has suggested a link between typical antipsychotic use and the development of cataracts, but the association between atypical antipsychotics and cataracts remains unclear in schizophrenia (SZ). Methods: A retrospective nested case-control study was conducted using data from the National Health Insurance Database of Taiwan between the year of 2000 and 2011. A total of 2144 SZ patients with cataracts and 2222 controls matched for age, sex, and index date were included. Antipsychotic exposure was categorized by type and duration, and the association between antipsychotic exposure and cataract development was assessed using a conditional logistic regression analysis. Results: We found that the severity of physical comorbidities, concurrent antidepressant use, and comorbidity with glaucoma or other retinal disorders were associated with an increased risk for cataract development. Alternatively, we did not find significant associations between continuous use of clozapine, risperidone, paliperidone, ziprasidone, olanzapine, quetiapine, amisulpride, zotepine or aripiprazole and risk of cataract development in SZ patients. Conclusions: We did not detect any association between atypical antipsychotic use and risk of cataract development in SZ patients. Future studies with longitudinal ocular evaluations in patients using atypical antipsychotics are warranted to confirm our findings.
Keywords: amisulpride; aripiprazole; atypical antipsychotic agent; clozapine; olanzapine; paliperidone; quetiapine; risperidone; steroid; ziprasidone; zotepine; adult; article; case control study; cataract; comorbidity; controlled study; disease severity; drug efficacy; drug response; drug use; female; glaucoma; health care utilization; human; major clinical study; male; population research; priority journal; retina disease; risk assessment; risk factor; schizophrenia; Taiwan

Preservative-free tafluprost in the treatment of open-angle glaucoma or ocular hypertension in India: a phase III clinical trial - Chabi, A.; Baranak, C.; Lupinacci, R.; Herring, W.J. (International Journal of Clinical Practice, 2016)
Aim: The aim of this study was to evaluate the efficacy and safety of preservative-free (PF) tafluprost compared with PF timolol in Indian subjects with open-angle glaucoma (OAG) or ocular hypertension. Methods: This was a randomised, multicentre, double-masked, phase III trial. Subjects aged 18–80 years, following washout of current medication, with intraocular pressure (IOP) ≥ 24 and ≤ 36 mmHg in at least one eye were randomised in a 1:1 ratio to 0.0015% PF tafluprost or 0.5% PF timolol for 4 weeks. IOP was measured at 08:00, 10:00 and 16:00 hours at baseline and at weeks 2 and 4. The primary efficacy end-point was the mean diurnal IOP change from baseline at week 4, and PF tafluprost was considered non-inferior to PF timolol if the upper bound of the 95% confidence interval (CI) for between-treatment differences was ≤ 1.5 mmHg. The secondary end-point was the proportion of subjects with ≥ 25% reduction in IOP from baseline at week 4. Results: In total, 190 subjects were randomised, 95 each, to PF tafluprost and PF timolol treatment. PF tafluprost was non-inferior to PF timolol with respect to diurnal IOP changes from baseline over 4 weeks. The mean PF tafluprost-PF timolol difference in the diurnal IOP change was −1.7 (95% CI −2.6 to −0.7), suggestive of superiority for PF tafluprost. The secondary end-point was achieved in a higher proportion of PF tafluprost group subjects. Both PF tafluprost and PF timolol were well-tolerated with similar incidences of adverse events. Conclusions: PF tafluprost was safe and efficacious in reducing IOP in Indian subjects.
Keywords: NCT01254604; drug preservative; tafluprost; timolol; adult; aged; article; circadian rhythm; conjunctival hyperemia; controlled study; double blind procedure; drug efficacy; drug safety; drug withdrawal; eye irritation; eye pain; female; human; India; intraocular hypertension; intraocular pressure; major clinical study; male; ocular pruritus; open angle glaucoma; patient compliance; phase 3 clinical trial; priority journal; randomized controlled trial

Why Patients with Glaucoma Lose Vision: The Patient Perspective - Newman-Casey, P.A.; Shtein, R.M.; Coleman, A.L.; Herndon, L.; Lee, P.P. (Journal of Glaucoma, 2016)
Purpose: To explore why glaucoma patients believe that glaucoma continues to cause vision loss despite the availability of effective treatment. Methods: Nine focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 56 participants, 31 with poor vision and 25 with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme. Results: A total of 474 relevant comments were made in the 9 focus groups. Focus groups elicited 305 comments about barriers to glaucoma management including issues with adherence (30%), the doctor-patient relationship (21%), knowledge about glaucoma (19%), personal support systems (19%), and barriers to health care delivery such as cost and insurance (11%). A total of 101 comments were made regarding feelings about glaucoma and 58 comments were made regarding beliefs about disease and treatment. Conclusions: These focus groups brought up many issues surrounding barriers to glaucoma treatment, perceived susceptibility to glaucoma, perceived benefits to treatment, and the emotional response to living with glaucoma. There is a need to create a more comprehensive chronic disease management approach for patients with glaucoma to address both the concrete and emotional issues identified in these focus group discussions.
Keywords: antiglaucoma agent; adult; aged; article; attitude to illness; blindness; content analysis; doctor patient relationship; emotion; female; glaucoma; health belief; health care cost; health care delivery; health insurance; human; independence; information processing; major clinical study; male; medication compliance; patient compliance; priority journal; social support; United States; unspecified side effect; visual impairment

Quantifying glaucoma medication adherence: The relationship between self-report, electronic monitoring, and pharmacy refill - Kumar, J.B.; Bosworth, H.B.; Sleath, B.; Woolson, S.; Olsen, M.; Danus, S.; Muir, K.W. (Journal of Ocular Pharmacology and Therapeutics, 2016)
Purpose: Glaucoma medications reduce the risk of progressive visual field loss, but adherence to these medications is often poor. A better understanding of the appropriate metrics for quantifying glaucoma medication adherence is needed. We describe and compare different means of quantifying glaucoma medication adherence. Methods: Adults with glaucoma were enrolled in a prospective 2-site study. Participants completed a selfreport instrument and received electronic medication monitors to use for ∗3 months. Pharmacy records were queried regarding requested refills over the monitoring period; medication possession ratio (MPR) was calculated. Results: Of the 137 total participants, those who answered "Very confident" to the question, "How confident are you that you always remember to use your glaucoma medications?" and "No" to the question, "In the past 4 weeks, did you ever forget to take your medicine?" were more likely [odds ratio (OR) 2.78, 95% confidence interval (CI) 1.19-6.52] to take ≥80% of the prescribed doses according to electronic medication monitors. Mean MPR was 1.49, standard deviation (SD) 0.82, range 0.1-5.31. The proportion of participants taking greater than or equal to 80% of the prescribed doses according to the electronic monitors was 59% for participants with MPR <1.2 (n = 27), 63% for participants with MPR 1.2-1.8 (n = 27), and 88% for MPR >1.8 (n = 25). Conclusions: Asking about confidence may be a good method of screening for poor adherence for glaucoma medication. MPR may be an inadequate representation of glaucoma medication adherence.
Keywords: antiglaucoma agent; eye drops; timolol; adult; aged; article; drug monitoring; drug use; female; glaucoma; health literacy; human; interpersonal communication; major clinical study; male; medication compliance; medication possession ratio; patient compliance; pharmaceutical care; pharmacy (shop); prescription; prospective study; self concept; self report; treatment refusal; visual analog scale

A randomized, placebo-controlled pilot trial of armodafinil for fatigue in patients with gliomas undergoing radiotherapy - Lee, E.Q.; Muzikansky, A.; Drappatz, J.; Kesari, S.; Wong, E.T.; Fadul, C.E.; Reardon, D.A.; Norden, A.D.; Nayak, L.; Rinne, M.L.; Alexander, B.M.; Arvold, N.D.; et al. (Neuro-Oncology, 2016)
Background Fatigue is common among glioma patients undergoing radiotherapy (RT) and impacts quality of life (QOL). We evaluated whether armodafinil, a wakefulness-promoting medication, improves fatigue in glioma patients undergoing RT. Methods Eligibility criteria included age ≥18 years, Karnofsky performance status ≥60, and grade 2-4 glioma undergoing RT to a total dose of 50-60 Gy. Patients were randomized 1:1 to armodafinil or placebo for 8 weeks beginning within 10 days of starting RT. Fatigue and QOL were assessed at baseline, day 22, day 43, and day 56 with the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F), the Functional Assessment of Cancer Therapy - General (FACT-G), the Brief Fatigue Inventory (BFI), and the Cancer Fatigue Scale (CFS). The primary aim was to detect a difference in the 42-day change in FACIT-F fatigue subscale between the 2 groups using a 2-sample Wilcoxon statistic. Results We enrolled 81 patients total (42 armodafinil and 39 placebo). Armodafinil did not significantly improve fatigue or QOL based on the 42-day change in FACIT-F fatigue subscale, FACT-G, CFS, or BFI. Further analysis suggests no difference between the arms even after accounting for the potential bias of missing data. Treatment was well tolerated with few grade 3 or 4 toxicities. Conclusions While treatment was well-tolerated, an 8-week course of armodafinil did not improve fatigue or QOL in glioma patients undergoing RT in this pilot study. Further studies are needed to determine whether pharmacologic treatment improves fatigue in glioma patients undergoing RT.
Keywords: NCT00766467; armodafinil; bevacizumab; placebo; temozolomide; abdominal pain; adult; aged; agitation; article; Brief Fatigue Inventory; Cancer Fatigue Scale; cancer radiotherapy; colon obstruction; confusion; controlled study; dehydration; diarrhea; drug effect; drug tolerability; drug withdrawal; fatigue; female; Functional Assessment of Cancer Therapy General; Functional Assessment of Chronic Illness Therapy Fatigue Scale; glaucoma; glioma; human; hyperkalemia; hypokalemia; hypomagnesemia; ileus; insomnia; major clinical study; male; multicenter study; patient compliance; pilot study; quality of life; radiation dose; randomized controlled trial; rash; scoring system; seizure; side effect; speech disorder; thrombocytopenia; treatment duration; unspecified side effect

Survey of compliance in patients with topical glaucoma therapy in Wuhan - Sun, Z.; Zhao, M. (International Eye Science, 2016)
AIM: To investigate the compliance in patients with topical glaucoma therapy, and identify the most frequent barriers to adherence. METHODS: One-on-one interview and questionnaire were taken to investigate the compliance with hypotensive eye drops in 366 patients who had been diagnosed as glaucoma and received the therapy for at least 6mo in Wuhan and suburban district from July 2014 to June 2015 in Wuhan Aier Eye Hospital. RESULTS: The proportion of compliance was 44.3% (162/366). Factors significantly influencing compliance included severity of the better eye, the severity of symptom when attacked, duration of medication and whether to ad ministrate on the same time daily (OR=5.700, 0.554, 0.336, 0.558, P<0.05). Age, gender, marital status, education level, economic status, domicile, knowledge of the disease, suffering from other diseases with medication, type of glaucoma, type of eye drop, frequency were not associated with a higher rate of non-compliance. CONCLUSION: Compliance in patients with topical glaucoma therapy in Wuhan is poor. Regularly carrying out relevant health education and interventions is very important.
Keywords: antiglaucoma agent; eye drops; article; China; disease severity; educational status; glaucoma; health education; health survey; human; interview; knowledge; major clinical study; marriage; patient compliance; questionnaire; social status; suburban area; treatment duration; treatment indication

Trans-scleral diode laser cyclophotocoagulation for refractory glaucoma after high-risk penetrating keratoplasty - Rodríguez-García, A.; González-González, L.A.; Carlos Alvarez-Guzmán, J. (International Ophthalmology, 2016)
To analyze the intraocular pressure reduction, number of anti-glaucoma medications needed, and post-operative complications of trans-scleral diode laser cyclophotocoagulation (DCPC) in patients with high-risk penetrating keratoplasty (PKP) and secondary refractory glaucoma. Prospective interventional, longitudinal, non-comparative series of cases, including 16 eyes of 15 patient’s post-PKP on maximal anti-glaucoma medical therapy with intraocular pressures above 22 mmHg. All patients received 18 shots, 360° peri-limbal (avoiding the long posterior ciliary nerves and arteries at 3 and 9 o’clock positions) of trans-scleral DCPC (2000 mW, time: 2.0 s/shot). There was a 55.5 % reduction (total of 14.0 mmHg) of the mean pre-operative IOP (31.5 mmHg) after the first diode laser application (p = 0.0020). Re-treatment was required in 31.2 % of eyes over a mean period of 10.7 months. In these five eyes, the mean pre-operative IOP was 40.4 mmHg, which decreased to 15.0 mmHg post-therapy, and a mean IOP reduction of 25.4 mmHg (p = 0.0218). There was a 51.0 % reduction in the mean number of medications used after the first, and a 57.1 % reduction after a second laser application. The incidence of failure (IOP ≥ 22 mmHg or need of additional medical therapy) from initial intervention to loss of follow-up was 1.3 % per person-month. DCPC effectively reduces the intraocular pressure and the number of anti-glaucoma medications with few complications in patients after high-risk PKP and secondary glaucoma. Only, one-third of the eyes needed a second intervention to control the intraocular pressure. Post-DCPC complications were limited to phthisis bulbi and endothelial dysfunction, one eye each. Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct.
Keywords: antiglaucoma agent; adolescent; adult; aged; article; child; clinical article; clinical effectiveness; clinical trial; drug use; endothelial dysfunction; eye disease; female; follow up; glaucoma; glaucoma surgery; graft rejection; human; incidence; intraocular pressure; longitudinal study; male; medical history; middle aged; ophthalmic diode laser; patient compliance; penetrating keratoplasty; phthisis bulbi; postoperative period; preoperative period; prospective study; refractory glaucoma; retreatment; school child; time to treatment; trans scleral cyclophotocoagulation; treatment failure; visual acuity; IRIS Medical IQ 810

Quality of Life in Glaucoma: A Review of the Literature - Quaranta, L.; Riva, I.; Gerardi, C.; Oddone, F.; Floriano, I.; Konstas, A.G.P. (Advances in Therapy, 2016)
The ultimate goal of glaucoma management is the preservation of patients’ visual function and quality of life (QoL). The disease itself as well as the medical or surgical treatment can have an enormous impact on a patient’s QoL. Even the mere diagnosis of a chronic, irreversible, potentially blinding disorder can adversely affect the patient’s sense of well-being and QoL by eliciting significant anxiety. Patients with primary open-angle glaucoma rarely present with visual symptoms, at least early in the course of the disease. A better understanding of patient-reported QoL can improve patient–physician interaction and enhance treatment adherence by customizing treatment options based on individual patient profile, thus optimizing long-term prognosis. These aspects are summarized and critically appraised in this article.
Keywords: antiglaucoma agent; anxiety disorder; binocular visual field loss; daily life activity; doctor patient relationship; glaucoma; human; intraocular hypertension; mental health; monocular visual field loss; ocular surface disease; open angle glaucoma; patient compliance; patient satisfaction; quality of life; questionnaire; review; Short Form 36; social interaction; systematic review; visual impairment

Adverse Effects of Nonsystemic Steroids (Inhaled, Intranasal, and Cutaneous): a Review of the Literature and Suggested Monitoring Tool - Gupta, R.; Fonacier, L.S. (Current Allergy and Asthma Reports, 2016)
Inhaled, intranasal, and cutaneous steroids are prescribed by physicians for a plethora of disease processes including asthma and rhinitis. While the high efficacy of this class of medication is well known, the wide range of adverse effects, both local and systemic, is not well elucidated. It is imperative to monitor total steroid burden in its varied forms as well as tracking for possible side effects that may be caused by a high cumulative dose of steroids. This review article highlights the adverse effects of different steroid modalities as well as suggests a monitoring tool to determine steroid totality and side effects.
Keywords: beclomethasone dipropionate; budesonide; ciclesonide; fluticasone; fluticasone furoate; fluticasone propionate; hydrocortisone; mometasone furoate; nedocromil; placebo; steroid; triamcinolone acetonide; acne; adrenal cortex insufficiency; allergic rhinitis; antiinflammatory activity; antiproliferative activity; asthma; atopic dermatitis; binding affinity; bone density; burning sensation; candidiasis; cataract; chronic obstructive lung disease; chronic rhinitis; contact allergy; contact sensitivity; coughing; Cushing syndrome; drug absorption; drug bioavailability; drug dose comparison; drug efficacy; drug exposure; drug half life; drug indication; drug induced disease; drug metabolism; drug monitoring; drug penetration; drug potency; drug receptor binding; drug safety; dry nose; dysphonia; epistaxis; growth disorder; growth inhibition; histone acetylation; hoarseness; human; hydrocortisone blood level; hyperglycemia; hyperpigmentation; hypertrichosis; hypopigmentation; hypothalamus hypophysis adrenal system; infection; intraocular hypertension; lung disease; mild persistent asthma; mood change; moon face; myopathy; nasal mucosal atrophy; nasal mucosal atrophy; nonhuman; nose disease; nose polyp; nose septum perforation; nose ulcer; oropharynx candidiasis; outcome assessment; patient compliance; patient satisfaction; perioral dermatitis; pharyngitis; pyoderma; randomized controlled trial (topic); review; rosacea; side effect; skin atrophy; skin contusion; sleep disorder; stinging; stinging; systematic review (topic); telangiectasia; throat irritation; tinea; tinea incognito; tinea incognito; treatment duration; vocal cord disorder; body weight gain

Is there a need for a therapeutic education with patients suffering with open-angle glaucoma? Preliminary inquiry regarding knowledge and patient adherence - Dugast, P.; Thiboust, P.; Blumen-Ohana, E.; Nordmann, J.-P. (Journal francais d'ophtalmologie, 2016)
Keywords: eye drops; adult; aged; blindness; disease course; female; open angle glaucoma; human; knowledge; male; middle aged; needs assessment; patient compliance; patient education; perception; questionnaire; standards; very elderly

Systemic treatment for blepharokeratoconjunctivitis in children - O'Gallagher, M.; Banteka, M.; Bunce, C.; Larkin, F.; Tuft, S.; Dahlmann-Noor, A. (Cochrane Database of Systematic Reviews, 2016)
Background: Blepharokeratoconjunctivitis (BKC) is a type of inflammation of the surface of the eye and eyelids which can affect children and adults. BKC involves changes of the eyelids, dysfunction of the meibomian glands, and inflammation of the conjunctiva and cornea. Chronic inflammation of the cornea can lead to scarring, vascularisation and opacity. BKC in children can cause significant symptoms which include irritation, watering, photophobia and loss of vision. Loss of vision in children with BKC may be due to corneal opacity, refractive error or amblyopia. BKC treatment is directed towards the obstruction of meibomian gland openings, the bacterial flora of lid margin and conjunctiva, and ocular surface inflammation. Dietary modifications that involve increased intake in essential fatty acids (EFAs) may also be beneficial. Both topical and systemic treatments are used; this Cochrane review focuses on systemic treatments. Objectives: To assess and compare data on the efficacy and safety of systemic treatments (including antibiotics, nutritional supplements and immunosuppressants), alone or in combination, for BKC in children aged between zero to 16 years. Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 3), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2016), EMBASE (January 1980 to April 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 21 April 2016. Selection criteria: We searched for randomised controlled trials that involved systemic treatments in children aged between zero to 16 years with a clinical diagnosis of BKC. We planned to include studies that evaluated a single systemic medication versus placebo, and studies that compared two or multiple active treatments. We planned to include studies in which participants receive additional treatments, such as topical antibiotics, anti-inflammatories and lubricants, warm lid compresses and lid margin cleaning. Data collection and analysis: Two review authors independently screened the literature search results (titles and abstracts) to identify studies that possibly met the inclusion criteria of the review. We divided studies into 'definitely include', 'definitely exclude' and 'possibly include' categories. We made a final judgement as to the inclusion or exclusion of studies in the 'possibly include' category after we obtained the full text of each article. Main results: No report or trial met the inclusion criteria of this Cochrane review; no randomised controlled trials have been carried out on this topic. There is a lack of standardised outcome measures. Authors' conclusions: There is currently no evidence from clinical trials regarding the safety and efficacy of systemic treatments for BKC. Trials are required to test efficacy and safety of current and future treatments. Outcome measures need to be developed which can capture both objective clinical and patient-reported aspects of the condition and treatments.
Keywords: antibiotic agent; antiinflammatory agent; artificial tear; azathioprine; beta lactam antibiotic; essential fatty acid; macrolide; mycophenolate mofetil; placebo; prednisolone; tetracycline derivative; abdominal pain; adolescent; adrenal insufficiency; antibiotic therapy; arthralgia; bibliographic database; blepharoconjunctivitis; blepharokeratoconjunctivitis; bone marrow suppression; cataract; central database; child; child nutrition; compression therapy; conjunctiva; cost effectiveness analysis; cost utility analysis; Cushing syndrome; cytomegalovirus infection; diabetes mellitus; diarrhea; dietary supplement; drug efficacy; drug safety; Embase; eosinophilia; esophagus disease; esophagus irritation; esophagus irritation; eye care; fever; gastrointestinal symptom; heat treatment; human; hypertension; immunosuppressive treatment; infant; infection; keratoconjunctivitis; loose feces; lymphoma; Medline; meibomian gland dysfunction; mental disease; mucosa inflammation; nausea; newborn; obstructive jaundice; osteoporosis; patient compliance; phototoxicity; priority journal; randomized controlled trial (topic); rash; review; steroid therapy; stomach ulcer; systemic therapy; topical treatment; treatment outcome; vomiting; warm lid compress; World Health Organization

Special considerations for glaucoma management in the elderly - Niyadurupola, N.; Broadway, D.C. (Expert Review of Ophthalmology, 2016)
ABSTRACT: Introduction: Glaucoma is principally a disease that affects the elderly population. Although the same treatments are available for the elderly as the young, there are special considerations that have to be made for older patients. Areas covered: This review will discuss the current management options for glaucoma highlighting the factors that particularly apply to the elderly population. The published literature on treatments for glaucoma with the terms ‘age’, ‘aging’, ‘older’ and ‘elderly’ were searched using PubMed. Expert commentary: Topical medication may not be appropriate for all elderly patients due to particular side-effects and other intraocular pressure lowering treatments, including cataract surgery should be considered for these patients. Low target intraocular pressures are not always required in this age group and over-treatment of elderly patients should be avoided.
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; bimatoprost plus timolol; brimonidine plus brinzolamide; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost plus timolol; miotic agent; osmotic diuretic agent; pilocarpine; pilocarpine plus timolol; prostaglandin derivative; tafluprost plus timolol; timolol; timolol plus travoprost; unclassified drug; aged; aging; aqueous humor flow; bradycardia; bronchospasm; cataract extraction; cell death; depression; drug response; fatigue; glaucoma; glaucoma drainage implant; glaucoma surgery; heart failure; human; intraocular pressure; iridotomy; laser coagulation; laser surgery; non-penetrating filtration surgery; optic nerve; patient compliance; retina ganglion cell; review; side effect; trabeculectomy; trabeculoplasty; treatment indication; ultrasound therapy

Ocular pharmacology - Novack, G.D.; Robin, A.L. (Journal of Clinical Pharmacology, 2016)
Ophthalmic diseases include both those analogous to systemic diseases (eg, inflammation, infection, neuronal degeneration) and not analogous (eg, cataract, myopia). Many anterior segment diseases are treated pharmacologically through eye drops, which have an implied therapeutic index of local therapy. Unlike oral dosage forms administered for systemic diseases, eyedrops require patients not only to adhere to treatment, but to be able to accurately perform - ie, instill drops correctly. Anatomical and physiological barriers make topical delivery to the anterior chamber challenging - in some cases more challenging than absorption through the skin, nasal passages, or gut. Treatment of the posterior segment (eg, vitreous, retina, choroid, and optic nerve) is more challenging due to additional barriers. Recently, intravitreal injections have become a standard of care with biologics for the treatment of macular degeneration and other diseases. Although the eye has esterases, hydroxylases, and transporters, it has relatively little CYP450 enzymes. Because it is challenging to obtain drug concentrations at the target site, ocular clinical pharmacokinetics, and thus pharmacokinetic-pharmacodynamic interactions, are rarely available. Ophthalmic pharmaceuticals require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Although applied locally, ocular medications may be absorbed systemically, which results in morbidity and mortality (eg, systemic hypotension, bronchospasm, and bradycardia).
Keywords: agents acting on the eye; aminoglycoside; antibiotic agent; apraclonidine; bimatoprost; brimonidine; brinzolamide; chloramphenicol; cidofovir; cyclosporine; cytochrome P450; dorzolamide; esterase; excipient; eye drops; fomivirsen; ganciclovir; idoxuridine; macrolide; natamycin; oxygenase; pilocarpine; propamidine isethionate; rebamipide; timolol; travoprost; trichloroethylene; unindexed drug; valganciclovir; vasoactive agent; allergic conjunctivitis; antibiotic prophylaxis; antibiotic therapy; autonomic innervation; bacterial conjunctivitis; blepharitis; blepharospasm; cornea ulcer; Cytomegalovirus retinitis; disease course; drug absorption; drug delivery system; drug formulation; drug solubility; drug stability; drug sterility; endophthalmitis; eye care; eye disease; glaucoma; glaucoma surgery; health care quality; herpes simplex keratitis; human; intraocular pressure; keratitis; keratoconjunctivitis sicca; local therapy; macular degeneration; mycosis; ocular surface disease; ophthalmology; osmolarity; patient compliance; pH; pharmaceutical care; pharmacogenomics; refraction error; retina degeneration; review; skin absorption; strabismus; systemic therapy; therapeutic index; trabeculectomy

The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis - Foot, H.; La Caze, A.; Gujral, G.; Cottrell, N. (Patient Education and Counseling, 2016)
Objective: This meta-analysis investigated whether beliefs in the necessity and concerns of medicine and the necessity-concerns differential are correlated with medication adherence on a population level and in different conditions. Methods: An electronic search of Web of Science, EMBASE, PubMed and CINAHL was conducted for manuscripts utilising the Beliefs about Medicines Questionnaire and comparing it to any measure of medication adherence. Studies were pooled using the random-effects model to produce a mean overall effect size correlation. Studies were stratified for condition, adherence measure, power and study design. Results: Ninety-four papers were included in the meta-analysis. The overall effect size(r) for necessity, concerns, and necessity-concerns differential was 0.17, -0.18 and 0.24 respectively and these were all significant (p < 0.0001). Effect size for necessity was stronger in asthma and weaker in the cardiovascular group compared to the overall effect size. Conclusion: Necessity and concerns beliefs and the necessity-concerns differential were correlated with medication adherence on a population level and across the majority of included conditions. The effect sizes were mostly small with a magnitude comparable to other predictors of adherence. Practice implications: This meta-analysis suggests that necessity and concern beliefs about medicines are one important factor to consider when understanding reasons for non-adherence.
Keywords: asthma; breast cancer; cardiovascular disease; chronic disease; conceptual framework; correlation analysis; diabetes mellitus; effect size; epilepsy; glaucoma; health belief; health care system; health care utilization; hemophilia; human; Marfan syndrome; medical record; medication compliance; mental disease; patient education; prediction; priority journal; questionnaire; review; rheumatoid arthritis; systematic review

Reasons for intraocular pressure to resist hypotensive therapy in glaucoma patients - Onishchenko, A.L.; Kolbasko, A.V.; Safronova, M.A.; Isakov, I.N. (Vestnik oftalmologii, 2016)
Keywords: antihypertensive agent; aged; drug effect; drug resistance; female; glaucoma; human; intraocular pressure; male; middle aged; oculoplethysmography; pathophysiology; patient compliance; procedures; psychology; statistics and numerical data; treatment outcome

Feasibility study of sustained-release travoprost punctum plug for intraocular pressure reduction in an Asian population - Perera, S.A.; Ting, D.S.W.; Nongpiur, M.E.; Chew, P.T.; Aquino, M.C.D.; Sng, C.C.A.; Ho, S.-W.; Aung, T. (Clinical Ophthalmology, 2016)
Purpose: To investigate the efficacy and safety of a punctum plug-based sustained drug release system for a prostaglandin analog, travoprost (OTX-TP), for intraocular pressure (IOP) reduction in an Asian population. Methods: This is an initial feasibility, prospective, single-arm study involving 26 eyes and a bioresorbable punctum plug containing OTX-TP. An OTX-TP was placed in the vertical portion of the superior or inferior canaliculus of patients with primary open-angle glaucoma or ocular hypertension. The main outcome measure was the IOP-lowering efficacy of OTX-TP at 3 (8 am) and 10, 20, and 30 days (8 am, 10 am, and 4 pm), compared to baseline. Results: A total of 26 OTX-TP were inserted for 17 subjects. The mean (standard deviation) age was 57.2 (13.8) years. At 10 days, all plugs were still present, and the IOP reduction from baseline was 6.2 (23%), 5.4 (21%), and 7.5 mmHg (28%) at 8 am, 10 am, and 4 pm, respectively. At 10 days, the mean IOP (standard error of mean) was 21.2 (1.2), 20.4 (0.8), and 19.7 (1.0) at 8 am, 10 am, and 4 pm, respectively, showing no discernible IOP trend during the course of the day. At 30 days, plug retention had declined to 42%, and the overall IOP reduction had decreased to 16%. Conclusion: The sustained-release OTX-TP is able to reduce IOP by 24% (day 10) and 15.6% (day 30), respectively. It is a potentially well-tolerable ocular hypotensive for glaucoma patients with a history of poor compliance.
Keywords: travoprost; adult; aged; article; Asian; clinical article; controlled clinical trial; controlled study; drug efficacy; drug safety; drug tolerability; drug withdrawal; epiphora; evening dosage; eye pain; feasibility study; female; foreign body reaction; human; intraocular hypertension; intraocular pressure; male; medication compliance; morning dosage; multicenter study; ocular pruritus; open angle glaucoma; patient compliance; prospective study; pruritus; punctal plug; sustained release formulation

Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria - Abdull, M.M.; Chandler, C.; Gilbert, C. (BMC ophthalmology, 2016)
METHOD: Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management. RESULTS: Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up. CONCLUSION: Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial. BACKGROUND: In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment.
Keywords: antihypertensive agent; attitude to health; female; filtering operation; glaucoma; health behavior; health care delivery; human; intraocular pressure; male; Nigeria; patient; patient attitude; patient compliance; psychology; rural population; visual acuity

A combined analysis of four observational studies evaluating the intraocular pressure-lowering ability and tolerability of bimatoprost 0.01% in patients with primary open-angle glaucoma or ocular hypertension - Stevens, A.; Iliev, M.E.; de Jong, L.; Grobeiu, I.; Hommer, A. (Clinical Ophthalmology, 2016)
Objective: Combine and evaluate data from four clinical practice studies investigating the intraocular pressure (IOP)-lowering ability, tolerability of and patient adherence to bimatoprost 0.01% therapy in patients with primary open-angle glaucoma or ocular hypertension. Methods: Data were combined from four multicenter, prospective, observational studies. Patients (n=2,593) were recruited from 328 sites in Austria, Belgium, Switzerland, and the Netherlands. Assessments were at study entry (baseline) and after 10–14 weeks. Results: Bimatoprost 0.01% lowered mean IOP by 5.0 mmHg from baseline to final visit (P<0.0001). Individual IOP goals were achieved in 75.5% of patients. Results were similar in right and left eyes; right-eye data are presented here for brevity. The greatest mean IOP reduction was 6.7±4.7 mmHg (28.8% reduction from baseline to final visit, P<0.0001) in treatment-naïve patients. Switching to bimatoprost 0.01% monotherapy from previous monotherapy reduced mean IOP by a further 3.2±3.6 mmHg (17.2%, P<0.0001). Switching to bimatoprost 0.01% from previous prostaglandin monotherapy reduced mean IOP by 2.9±3.5 mmHg (15.5%), including by 3.1±3.4 mmHg (15.8%) and 3.3±4.1 mmHg (16.9%) for previous latanoprost and travoprost treatment, respectively (all P<0.0001). IOP reduction in patients previously treated with a fixed combination was 2.7±4.0 mmHg (14.2%, P<0.0001). The most commonly reported adverse events were conjunctival hyperemia (5.2%) and eye irritation (4.7%). Tolerability was rated as “very good” or “good” by 90.1% of patients. Adherence was rated by physicians as “better than” or “equal to” previous treatment in 97.2% of patients. Conclusion: The combined studies demonstrated in a clinical practice setting, bimatoprost 0.01% lowered IOP effectively in treatment-naïve and previously treated ocular hypertension and primary open-angle glaucoma patients, and was associated with good tolerability and patient adherence over 12 weeks.
Keywords: beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; latanoprost; prostaglandin; travoprost; aged; article; Austria; Belgium; blepharal pigmentation; blepharal pigmentation; clinical practice; combination chemotherapy; conjunctival hyperemia; drug safety; drug tolerability; dry eye; eye disease; eye irritation; eye pain; female; headache; human; intraocular hypertension; intraocular pressure; major clinical study; male; medication compliance; monotherapy; multicenter study (topic); Netherlands; observational study; ocular pruritus; open angle glaucoma; outcome assessment; patient compliance; pigment disorder; prospective study; Switzerland

Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care - Pizzi, L.T.; Tran, J.; Shafa, A.; Waisbourd, M.; Hark, L.; Murchison, A.P.; Dai, Y.; Mayro, E.L.; Haller, J.A. (Applied Health Economics and Health Policy, 2016)
Background: Glaucoma is the leading cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. Objectives: The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. Methods: This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. Results: Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04–1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08–1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. Conclusions: A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
Keywords: aged; article; controlled study; cost benefit analysis; cost effectiveness analysis; disease severity; female; follow up; health insurance; human; major clinical study; male; medication compliance; open angle glaucoma; outcome assessment; prospective study; randomized controlled trial; sample size

Uncovering some of the hidden costs and burdens of glaucoma - Stein, J.D. (JAMA Ophthalmology, 2016)
Keywords: ambulatory care; caregiver support; comorbidity; daily life activity; depression; disease association; disease course; driving ability; emergency care; eye disease; eye examination; falling; fatality; fracture; functional status; glaucoma; health; health care cost; health care utilization; health service; home care; hospitalization; human; incidence; mental health; mobilization; note; patient care; peripheral vision; priority journal; reading; self care; self report; traffic accident; vision; visual impairment; walking difficulty

Self-reported function, health resource use, and total health care costs among medicare beneficiaries with glaucoma - Prager, A.J.; Liebmann, J.M.; Cioffi, G.A.; Blumberg, D.M. (JAMA Ophthalmology, 2016)
Importance The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. OBJECTIVE To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. DESIGN, SETTING, AND PARTICIPANTS Longitudinal observational study of 72 587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. MAIN OUTCOMES AND MEASURES Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. RESULTS Participants were 72 587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68 146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2%were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95%CI, 1.17-1.39; P <.001) and home health aide visits (OR, 1.27; 95%CI, 1.13-1.43; P <.001) compared with Medicare beneficiaries without glaucoma. Furthermore, patients with glaucoma with self-reported visual disability were more likely to report depression (OR, 1.47; 95%CI, 1.26-1.71; P <.001), falls (OR, 1.34; 95%CI, 1.09-1.66; P =.006), and difficulty walking (OR, 1.22; 95%CI, 1.02-1.45; P =.03) compared with those without self-reported visual disability. In the risk-adjusted model, Medicare beneficiaries with glaucoma incurred an additional $2903 (95%CI, $2247-$3558; P <.001) annual total health care costs and $2599 (95%CI, $1985-$3212; P <.001) higher costs for nonoutpatient services compared with Medicare beneficiaries without glaucoma. CONCLUSIONS AND RELEVANCE Glaucoma is associated with greater use of inpatient and home health aide services and with higher annual total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.
Keywords: aged; article; controlled study; depression; female; glaucoma; health care cost; health care utilization; hip fracture; human; insurance; longitudinal study; major clinical study; male; medicare; observational study; outcome assessment; prescription; priority journal; risk assessment; self report; socioeconomics; very elderly; walking difficulty

Barriers to Receiving Follow-Up Eye Care and Detection of Non-Glaucomatous Ocular Pathology in the Philadelphia Glaucoma Detection and Treatment Project - Zheng, C.X.; Hu, W.D.; Tran, J.; Siam, L.; Berardi, G.G.; Sembhi, H.; Hark, L.A.; Katz, L.J.; Waisbourd, M. (Journal of community health, 2016)
This cross-sectional study aimed to evaluate adherence rates and identify barriers to receiving follow-up eye care in participants diagnosed with significant non-glaucomatous eye pathology in the Philadelphia Glaucoma Detection and Treatment Project. This community-based project aimed to improve detection, management, treatment, and follow-up eye care of individuals at high risk for glaucoma in community-based settings. Participants throughout Philadelphia, Pennsylvania, USA were enrolled. After a comprehensive eye examination, follow-up recommendations were given to each participant. A telephone survey was administered to individuals diagnosed with non-glaucomatous ocular pathology 3 months after initial eye examination to assess rates of follow-up and to evaluate potential barriers to follow-up. Of the 1649 participants enrolled in this project, 249 (15 %) were diagnosed with significant non-glaucomatous ocular pathology requiring follow-up care. There were 143 (57 %) who responded to the telephone survey. Respondents had a median age of 72 years, and were predominately female (69 %) and African-American (64 %). Of the respondents, 36 (25 %) attended a follow-up appointment. Participants who did not remember the results of their examinations, did not remember their recommendations, and had not seen an eye doctor within the past year were less likely to make a follow-up appointment (P = 0.04, 0.001 and 0.005, respectively). The Philadelphia Glaucoma Detection and Treatment Program was able to detect a significant amount of non-glaucomatous ocular pathology requiring follow-up care. Actual follow-up rates were sub-optimal. Further research is needed to determine interventions to overcome barriers and increase adherence with follow-up recommendations.
Keywords: adult; aftercare; aged; cross-sectional study; eye disease; female; health care delivery; health care survey; human; male; middle aged; Pennsylvania; utilization; very elderly

Efficacy and tolerability of brinzolamide/brimonidine suspension and prostaglandin analogs in patients previously treated with dorzolamide/timolol solution and prostaglandin analogs - Lo, J.S.; Pang, P.M.; Lo, S.C. (Clinical Ophthalmology, 2016)
Objective: Fixed combination glaucoma medication is increasingly used in glaucoma treatment. There is a lack of comparative study in the literature of non-beta blocker combination agents used adjunctively with a glaucoma agent in a different class. The objective of this study is to evaluate the effect of intraocular pressure (IOP) control and tolerability of non-beta blocker combination suspension with prostaglandin analogs (PGA) in patients with open angle glaucoma who were previously treated with beta blocker combination solution with PGA. Design: Open-label retrospective review of patient records. Patients and methods: This study looked at patients with open angle glaucoma taking dorzolamide/timolol solution with PGA that were switched to brinzolamide/brimonidine combination suspension with PGA. This study reviewed the charts of all patients who were at least 21 years old with a clinical diagnosis of open-angle glaucoma or ocular hypertension in at least one eye. Patients needed to have been treated with concomitant use of PGA and dorzolamide/timolol solution for at least one month. Patients using dorzolamide/timolol solution plus PGA with medication related ocular irritation were switched to brinzolamide/brimonidine suspension with the same PGA. Best-corrected visual acuity, ocular hyperemia grading, slit lamp biomicroscopy and Goldmann applanation tonometry measurements, and patient medication preferences were assessed at baseline, 1 month and 3 months. Results: Forty eyes with open angle glaucoma. The mean age of the patients was 68 and 60% were females. The IOP before the switch was 17.2 and 16.5 (P=0.70) following the switch at 3 months. We found a decreasing trend of ocular hyperemia (P=0.064) and strong preference (P=0.011) for non-beta blocker combination suspension but no difference of visual acuity and slit lamp findings. Conclusion: Brinzolamide/brimonidine combination suspension when used adjunctively with PGA is equally effective. Patients in this study reported greatly reduced ocular redness and shorter duration of stinging with non-beta blocker combination suspension. Their preference of it over dorzolamide/timolol combination solution makes it a viable treatment option, particularly for the aging glaucoma patient with comorbidities that restrict the beta blocker use.
Keywords: brimonidine plus brinzolamide; dorzolamide plus timolol; prostaglandin derivative; aged; allergic conjunctivitis; article; best corrected visual acuity; biomicroscopy; clinical article; controlled study; drug efficacy; drug substitution; drug tolerability; drug withdrawal; eye disease; female; human; intraocular pressure; male; medical record review; ocular hyperemia; ocular hyperemia; open angle glaucoma; outcome assessment; patient compliance; patient preference; suspension; tonometry; trend study; visual acuity

Improving access to eye care among persons at high-risk of glaucoma in Philadelphia - design and methodology: The Philadelphia glaucoma detection and treatment project - Hark, L.; Waisbourd, M.; Myers, J.S.; Henderer, J.; Crews, J.E.; Saaddine, J.B.; Molineaux, J.; Johnson, D.; Sembhi, H.; Stratford, S.; Suleiman, A.; Pizzi, L.; et al. (Ophthalmic Epidemiology, 2016)
Purpose: The Wills Eye Glaucoma Research Center initiated a 2-year demonstration project to develop and implement a community-based intervention to improve detection and management of glaucoma in Philadelphia.Methods: The glaucoma detection examination consisted of: ocular, medical, and family history; visual acuity testing; corneal pachymetry; biomicroscopy of the anterior segment; intraocular pressure (IOP) measurement; gonioscopy; funduscopy; automated visual field testing; and fundus-color photography. Treatment included laser surgery and/or IOP-lowering medication. A cost analysis was conducted to understand resource requirements. Outcome measures included; prevalence of glaucoma-related pathology and other eye diseases among high-risk populations; the impact of educational workshops on level of knowledge about glaucoma (assessed by pre- and post-test evaluation); and patient satisfaction of the glaucoma detection examinations in the community (assessed by satisfaction survey). Treatment outcome measures were change in IOP at 4-6 weeks and 4-6 months following selective laser trabeculoplasty treatment, deepening of the anterior chamber angle following laser-peripheral iridotomy treatment, and rate of adherence to recommended follow-up examinations. Cost outcomes included total program costs, cost per case of glaucoma detected, and cost per case of ocular disease detected.Results: This project enrolled 1649 participants (African Americans aged 50+ years, adults 60+ years and individuals with a family history of glaucoma). A total of 1074 individuals attended a glaucoma educational workshop and 1508 scheduled glaucoma detection examination appointments in the community setting.Conclusions: The Philadelphia Glaucoma Detection and Treatment Project aimed to improve access and use of eye care and to provide a model for a targeted community-based glaucoma program.
Keywords: adult; African American; anterior eye segment; article; biomicroscopy; corneal pachymetry; cost benefit analysis; eye disease; eye examination; eye photography; family history; follow up; fundus color photography; glaucoma; gonioscopy; high risk patient; human; intraocular pressure; iridotomy; laser surgery; major clinical study; measurement; ophthalmoscopy; outcome assessment; patient satisfaction; priority journal; trabeculoplasty; United States; visual acuity; visual field

Complications related to sutures following penetrating and deep anterior lamellar keratoplasty - Crawford, A.Z.; Meyer, J.J.; Patel, D.V.; Ormonde, S.E.; Mcghee, C.N. (Clinical and Experimental Ophthalmology, 2016)
Keywords: ophthalmic suture; age distribution; controlled study; cornea dystrophy; cornea injury; cornea transplantation; cornea ulcer; device safety; endophthalmitis; graft failure; health care access; human; keratoconus; keratopathy; keratoplasty; letter; major clinical study; medical device complication; ophthalmic suture; postoperative complication; private hospital; public hospital; sex difference; social status; surgical wound; suture abscess; suture erosion; suture loosening; suture removal; treatment duration; treatment indication; virus keratitis; wound dehiscence; wound leak

Association of socioeconomic status with eye health among women with and without diabetes - Norris, K.L.; Beckles, G.L.; Chou, C.-F.; Zhang, X.; Saaddine, J. (Journal of Women's Health, 2016)
Objective: To investigate the association between socioeconomic position (SEP) and poor eye health among women. Materials and Methods: We included the 7,708 women aged ≥40 years who participated in the 2008 National Health Interview Survey. We defined poor eye health as self-reported age-related eye diseases (AREDs; cataract, glaucoma, macular degeneration, or diabetic retinopathy) or visual impairment (VI). We identified diagnosed diabetes by self-report. We measured SEP by education attained and annual household income. We conducted logistic regression analyses while controlling for demographic, clinical, behavioral, and healthcare access variables. Results: The age-standardized prevalence of VI and ARED was significantly higher among women with diagnosed diabetes than among those without diagnosed diabetes, 29.8% versus 14.4% and 34.1% versus 20.8%, respectively (p < 0.05 for both). The prevalence of VI and ARED increased with decreasing SEP, but the trends were only significant among women without diabetes. After multivariable adjustment, education and income were significantly associated with VI but not with ARED. We found no interaction with diagnosed diabetes. Conclusions: SEP was inversely associated with VI but not with ARED. We found no interaction with diagnosed diabetes.
Keywords: adult; article; cataract; demography; diabetes mellitus; diabetic retinopathy; educational status; eye; eye disease; female; glaucoma; health care access; health survey; human; income; logistic regression analysis; macular degeneration; major clinical study; prevalence; priority journal; self report; social status; visual impairment

Complexities of Medical Glaucoma Therapy - The Elderly Patient in Focus - Dietlein, T.S.; Rosentreter, A.; Lappas, A. (Klinische Monatsblatter fur Augenheilkunde, 2016)
In order to treat glaucoma with medication successfully, the patient needs to participate actively in the process. Adherence, formerly compliance, describes the willingness and capacity to follow the prescribed regimen every day. It is not trivial to measure adherence and persistence, as this quite often relies on self reports by the patient or speculations by the physician. Hence, the overall reported adherence may vary from 5 to 95%. In general, the following categories have been defined for reduced adherence: Medication-related factors, patient-related factors, environmental factors and social factors. Age has been found to intensify or modify many of these factors. Older adults often face various challenges, due to motor disabilities, reduced visual acuity or impaired cognitive capabilities. In patients with movement disorders or tactile limitations, the target area can be reached more successfully with standard eye drop bottles than with single-use dose units. This should be considered if antiglaucoma eye drops are prescribed in the elderly. Frequency of application is a main factor influencing adherence. Monotherapy - as provided with prostaglandins - Or drops with a fixed combination have proven to support adherence significantly. A significant boost for self-monitoring activities is initiated by the growing market of electronic devices, like smartphones. For instance, they can provide acoustic alarms as reminders to apply the eye drops. It is evident that any external support or disease-related information by family members, the medical practitioners, support groups or even electronic devices may improve adherence and persistence, even in patients with severe impairments.
Keywords: antiglaucoma agent; age; aged; article; environmental factor; geriatric patient; glaucoma; human; medication compliance; monotherapy; motor dysfunction; patient compliance; self monitoring; self report; smartphone; visual acuity

Applicability of smartphone-based screening programs - Garg, S.J. (JAMA Ophthalmology, 2016)
Keywords: anterior eye segment; blindness; crowdsourcing; device maintenance; diabetic retinopathy; direct ophthalmoscope; eye examination; eye photography; fundus camera; glaucoma; health care access; health care delivery; human; image analysis; image quality; intraocular pressure; macular degeneration; note; ophthalmoscopy; optic disk; optic nerve disease; optical coherence tomography; posterior eye segment; postgraduate education; priority journal; residency education; retina; sensitivity and specificity; slit lamp; smartphone; visual impairment

Impact of socioeconomic status on the diagnosis of primary open-angle glaucoma and primary angle closure glaucoma: A nationwide population-based study in Taiwan - Ko, Y.-C.; Hwang, D.-K.; Chen, W.-T.; Lee, C.-C.; Liu, C.J. (PLoS ONE, 2016)
Purpose: To understand the impact of socioeconomic status (SES) on the diagnosis of primary openangle glaucoma (POAG) and primary angle closure glaucoma (PACG) in Taiwan. Methods: Subjects with glaucoma were identified from the National Health Insurance Research Database of year 2006, which included one million randomly selected insurants. Individuals who had ≥4 ambulatory visits within one year which had the diagnosis code of POAG (ICD-9-CM 365.11 or 365.12) or PACG (365.23) and concurrent prescription of anti-glaucoma medication or surgery were selected. Individual SES was represented by monthly income calculated from the insurance premium. Neighborhood SES was defined based on neighborhood household income averages. Urbanization level of habitation was categorized into 3 levels. The odds ratio of having POAG or PACG in subjects with different SES was evaluated by using multiple logistic regression analysis. Results: In total, 752 and 561 subjects with POAG and PACG, respectively, who were treated on a regular basis, were identified. The diagnosis of glaucoma was affected by age, gender, frequency of healthcare utilization, individual SES, and urbanization level of habitation. With the adjustment of age, gender, healthcare utilization, neighborhood SES and level ofurbanization, subjects with lower income were more likely to be diagnosed as PACG, but less likely as POAG. Conclusions: Subjects with more frequent healthcare utilization were more likely to be diagnosed with glaucoma. Subjects with low SES were more susceptible to PACG, but subjects with high SES were more likely to be diagnosed as POAG. This information is useful for the design and target participant setting in glaucoma education and screening campaign to maximize the efficacy of limited resources in preventing glaucoma blindness.
Keywords: adult; age; aged; article; closed angle glaucoma; controlled study; female; health care utilization; human; ICD-9-CM; income; major clinical study; male; open angle glaucoma; prescription; prevalence; sex difference; social interaction; social status; Taiwan; urban area; urbanization

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

Strategies to estimate the characteristics of 24-hour IOP curves of treated glaucoma patients during office hours - Colombo, L.; Fogagnolo, P.; Montesano, G.; De Cillà, S.; Orzalesi, N.; Rossetti, L. (BMC ophthalmology, 2016)
BACKGROUND: It is known that office-hour measurements might not adequately estimate IOP mean, peaks and fluctuations in healthy subjects. The purpose of the present study is to verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP) in treated POAG patients. METHODS: The 24-hour IOP curves of 70 eyes of 70 caucasian patients with treated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine (TonoPen XL) and sitting (Goldmann tonometer) positions. The ability of five strategies to estimate IOP mean, peak and fluctuation was evaluated. Each method was analyzed both with regression of the estimate error on the real value and with "hit or miss" analysis. RESULTS: The least biased estimate of the Peak IOP was obtained using measurements from both supine and sitting positions, also yielding the highest rate of correct predictions (which was significantly different from 3 of the remaining 4 strategies proposed, p < 0.05). Strategies obtained from the combination of supine, sitting and peak measurements resulted to be least biased for the Mean IOP and the IOP Fluctuation estimate, but all strategies were not found significantly different in terms of correct prediction rate (the only significant difference being between the two strategies based on sitting or supine measurements only, with the former being the one with the highest correct prediction rate). CONCLUSIONS: The results of this study remark the concept that IOP is a dynamic parameter and that intensive measurement is helpful in determining its characteristics. All office-hour strategies showed a very poor performance of in correctly predicting the considered parameters within the thresholds used in this paper, all scoring a correct prediction rate below 52%.
Keywords: antihypertensive agent; brimonidine; drug combination; latanoprost; prostaglandin F; timolol; aged; ambulatory care; body position; circadian rhythm; drug combination; drug effect; female; open angle glaucoma; health care facility; human; intraocular pressure; male; middle aged; oculoplethysmography; pathophysiology; physiology; very elderly

Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic - Fudemberg, S.J.; Lee, B.; Waisbourd, M.; Murphy, R.A.; Dai, Y.; Leiby, B.E.; Hark, L.A. (Patient Preference and Adherence, 2016)
Purpose: To determine the rate of adherence to follow-up appointment recommendations in a resident glaucoma clinic with no mechanism for reminders, compared to a resident cataract and primary eye care (CPEC) clinic in which telephone reminders were used, and to identify factors that contribute to adherence in each patient group. Methods: This retrospective cohort study included subjects in the CPEC clinic who received telephone reminders and those in the glaucoma clinic who did not. Each sample was selected to have a similar proportion of follow-up recommendations for 1, 3, and 6 months. Subjects were considered adherent if they returned within a specified timeframe. Results: A total of 144 subjects from the glaucoma clinic and 151 subjects from the CPEC clinic were included. There was no significant difference between follow-up adherence rates of patients who received telephone reminders and those who did not (odds ratio [OR] =1.35, 95% confidence interval [CI] 0.79–2.32, P=0.28). Patients who were on more than two ocular medications were more likely to return for follow-up (OR=3.11, 95% CI 1.53–6.35, P=0.0018). Subjects between the ages 50 and 80 years were more likely to be adherent compared to their younger and older peers (P=0.02). Conclusion: The follow-up adherence of patients in a CPEC clinic who received telephone reminders was similar to patients in a glaucoma clinic who did not receive any intervention to increase their adherence. Younger (<50 years old) and elderly (>80 years old) subjects, as well as patients using less than two glaucoma medications, were less likely to adhere to their follow-up appointments.
Keywords: antiglaucoma agent; adult; age distribution; aged; article; cataract and primary eye care clinic; controlled study; drug use; female; follow up; glaucoma; glaucoma surgery; hospital; human; insurance; intraocular pressure; major clinical study; male; optic disk; optic disk cup; patient attitude; resident glaucoma clinic; retrospective study; telephone; urban area; very elderly; visual acuity; visual field

Feasibility, Patient Acceptability, and Preliminary Efficacy of a Culturally Informed, Health Promotion Program to Improve Glaucoma Medication Adherence among African Americans: " G laucoma Management O ptimism for A frican Americans L iving with Glaucoma" (GOAL) - Dreer, L.E.; Owsley, C.; Campbell, L.; Gao, L.; Wood, A.; Girkin, C.A. (Current Eye Research, 2016)
Purpose/Aims: To examine the feasibility, patient acceptability, and preliminary effectiveness of a culturally informed, health promotion program designed to improve glaucoma medication adherence among African Americans (AAs) with glaucoma.Materials/Methods: A sample of 11 AA glaucoma patients (mean age 61 years; 73% women and 27% men) completed a culturally informed and individually tailored, health promotion program developed for AAs titled, "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL). The aim of the brief 4-week program is to enhance glaucoma medication adherence through a combination of education, motivational interviewing (MI), and problem-solving training (PST). Feasibility was assessed on the basis of patient satisfaction with the program, number of sessions completed, and length of sessions. Preliminary efficacy was evaluated using a pre-post design to determine whether the program improved objective glaucoma medication adherence via an electronic Travalert dosing aid as well as satisfaction with aspects of glaucoma treatment, health beliefs about medications, glaucoma symptoms, emotional well-being, and intraocular pressure.Results: Overall patient satisfaction and acceptability was high for the program, interactions with the health educator, program materials, and the length of sessions. Feasibility was also supported given the need for the program, success in recruitment/retention, and ease of implementing the program with AA glaucoma patients in clinic and/or over the telephone. In terms of preliminary efficacy, patients showed significant pre-post improvements in objective medication adherence rates by 15% (p = 0.03), self-efficacy for glaucoma management (p = 0.02), ease of use in administering eye drops (p = 0.03), glaucoma treatment satisfaction (p = 0.05), beliefs about the necessity of taking glaucoma medications (p = 0.05), and functional visual ocular symptoms (p = 0.03).Conclusions: (GOAL) holds great promise toward improving glaucoma medication adherence and beliefs among AAs with glaucoma.
Keywords: antiglaucoma agent; eye drops; adult; African American; article; clinical article; clinical effectiveness; female; glaucoma; health belief; health education; health promotion; human; intraocular pressure; male; medication compliance; motivational interviewing; patient compliance; patient satisfaction; priority journal; program acceptability; program feasibility

Persistence of glaucoma therapy and visual field progression - De Leon, J.M.S.; Quek, D.T.; Htoon, H.M.; Tun, T.A.; Perera, S.A.; Lamoureux, E.L.; Aung, T. (Journal of Glaucoma, 2016)
Purpose: To determine the association of visual field (VF) progression with medication persistence in a cohort on glaucoma therapy. Patients and Methods: Pharmacy records were examined over 3 years for patients started on glaucoma monotherapy. A patient was persistent if a prescription was refilled for the same medication <90 days after the previous prescription had lapsed; otherwise was nonpersistent. Only patients with >5 reliable VFs within 1-year pretherapy and 6-year posttherapy were included. Progression was analyzed with pointwise linear regression and defined using 2 criteria: (A) Z2 adjacent progressing points (slope P<0.01) in 1 hemifield; and (B) Z3 progressing points (slope P<0.01). The mean number and mean slope of progressing points and the mean global slopes were determined. Results: Of 1206 patient eyes (131 persistent, 1075 nonpersistent), 941 were excluded leaving 175 (47 persistent and 128 nonpersistent) for analysis. The mean follow-up durations were 59.3±10.9 and 58.2±9.7 months (P=0.07) for persistent and nonpersistent eyes, respectively. Overall, 2/47 (4.3%) and 10/128 (7.8%) eyes progressed among persistent and nonpersistent patients, respectively (P=0.52) using criterion A and 1/47 (2.1%) and 12/128 (9.4%; P=0.19) eyes using criterion B. Mean number of progressing points (0.3±0.9 vs. 0.7±1.8; P=0.17), mean slope of progressing points (-2.2±1.1 vs.-2.8±1.3 dB/y; P=0.27), and mean global slope (0.7±0.5 vs.-0.1±0.8 dB/y; P=0.07) were similar for persistent and nonpersistent patients, respectively. Conclusion: There were small but appreciable differences in VF progression rates between persistent and nonpersistent patient eyes on glaucoma drops, but differences were not significant.
Keywords: antiglaucoma agent; adult; article; closed angle glaucoma; cohort analysis; disease association; disease course; female; follow up; glaucoma; human; intraocular hypertension; juvenile open angle glaucoma; juvenile open angle glaucoma; low tension glaucoma; major clinical study; male; middle aged; monotherapy; open angle glaucoma; patient compliance; prescription; priority journal; pseudoexfoliative glaucoma; pseudoexfoliative glaucoma; retrospective study; secondary glaucoma; treatment outcome; visual field

Glaucoma and cataract surgery: Two roads merging into one - Shah, M.; Law, G.; Ahmed, I.K. (Current Opinion in Ophthalmology, 2016)
Purpose of review To discuss the increasing utilization of cataract extraction in the management of glaucoma and to highlight advances in surgical care that can promote synergistic treatment of these comorbid conditions. Recent findings Recent years have demonstrated significant advances in the management of glaucoma through the use of novel microinvasive glaucoma devices. Furthermore, an increased understanding of the role of cataract surgery in the treatment of various glaucomas warrants review. Nevertheless, cataract surgery in the glaucoma patient warrants specific preoperative, intraoperative, and postoperative planning to optimize visual function and quality of life while mitigating potential risk factors for adverse events. Summary Although the challenges of performing cataract extraction on glaucoma patients exist, the potential benefit to these patients is substantial. With attention to pre-And perioperative surgical planning and intraoperative technique, as well as with awareness and potential utilization of novel devices and treatment strategies, cataract extraction offers a unique platform for anatomical and functional improvement in this increasingly common cohort of patients.
Keywords: cataract extraction; filtering operation; glaucoma; glaucoma surgery; health care utilization; human; intraoperative period; lens implant; postoperative complication; priority journal; quality of life; review; visual field

Comparison of the intraocular pressure-lowering effect and safety of brimonidine/timolol fixed combination and 0.5 % timolol in normal-tension glaucoma patients - Kim, J.M.; Kim, T.-W.; Kim, C.Y.; Kim, H.K.; Park, K.H. (Japanese Journal of Ophthalmology, 2016)
Purpose: To compare the therapeutic efficacy and safety of brimonidine/timolol fixed-combination (BTFC) and 0.5 % timolol ophthalmic solution in normal-tension glaucoma (NTG) patients. Methods: This was a multi-institution, randomized, active-controlled, open-label, parallel-group study. After a full ophthalmic and glaucoma examination, a total of 110 NTG patients—55 undergoing therapy with BTFC and 55 0.5 %, with timolol—participated in this study. Among them, 1 failed to meet the inclusion/exclusion criteria, 10 revoked their consent to participate in the study, 3 had adverse reactions, and 1 had a drug adherence rate of less than 70 %. Ultimately, a total of 95 patients—48 in the BTFC group and 47 in the 0.5 % timolol group—completed the study. The study visits took place at baseline and at 4 and 12 weeks. Diurnal IOP was measured at 9 a.m., 11 a.m., and 5 p.m. during the baseline visit and the visit at 12 weeks after eye-drop instillation. At each follow-up visit, compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the investigators. Results: The average difference in IOP change measured at 11 a.m. 12 weeks after administration between the two groups was 2.10 ± 2.59 mmHg. The BTFC group had a better IOP-lowering effect at all time points than did the 0.5 % timolol group. The ratio of patients whose average IOP had decreased by >20 % after 4 and 12 weeks was 50 and 56 % in the BTFC group, respectively, whereas it was 29.41 and 23.53 % in the 0.5 % timolol group, respectively (p = 0.034, <0.001). Conclusions: BTFC has a superior IOP-lowering effect than 0.5 % timolol in NTG patients.
Keywords: brimonidine plus timolol; eye drops; latanoprost; timolol; travoprost; adult; adverse outcome; allergic reaction; article; asthma; clinical assessment; clinical effectiveness; cold sensation; comparative study; controlled study; dizziness; drug effect; drug safety; lack of drug effect; dry eye; eye examination; eye irritation; female; follow up; headache; human; hyperemia; intraocular pressure; low tension glaucoma; major clinical study; male; medication compliance; middle aged; multicenter study; open study; outcome assessment; priority journal; randomized controlled trial; side effect; therapy effect; xerostomia

Age-related eye disease and gender - Zetterberg, M. (Maturitas, 2016)
Worldwide, the prevalence of moderate to severe visual impairment and blindness is 285 millions, with 65% of visually impaired and 82% of all blind people being 50 years and older. Meta-analyses have shown that two out of three blind people are women, a gender discrepancy that holds true for both developed and developing countries. Cataract accounts for more than half of all blindness globally and gender inequity in access to cataract surgery is the major cause of the higher prevalence of blindness in women. In addition to gender differences in cataract surgical coverage, population-based studies on the prevalence of lens opacities indicate that women have a higher risk of developing cataract. Laboratory as well as epidemiologic studies suggest that estrogen may confer antioxidative protection against cataractogenesis, but the withdrawal effect of estrogen in menopause leads to increased risk of cataract in women. For the other major age-related eye diseases; glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy, data are inconclusive. Due to anatomic factors, angle closure glaucoma is more common in women, whereas the dominating glaucoma type; primary open-angle glaucoma (POAG), is more prevalent in men. Diabetic retinopathy also has a male predominance and vascular/circulatory factors have been implied both in diabetic retinopathy and in POAG. For AMD, data on gender differences are conflicting although some studies indicate increased prevalence of drusen and neovascular AMD in women. To conclude, both biologic and socioeconomic factors must be considered when investigating causes of gender differences in the prevalence of age-related eye disease.
Keywords: estradiol; estrogen; glutathione peroxidase; manganese superoxide dismutase; nitric oxide; reactive oxygen metabolite; vasculotropin antibody; age related macular degeneration; blindness; cataract; closed angle glaucoma; diabetic retinopathy; drusen; eye disease; female; geriatric disorder; glaucoma; health care access; hormone substitution; human; open angle glaucoma; pseudoexfoliation; review; senile cataract; sex difference; visual impairment

Characterization of glaucoma medication adherence in kaiser permanente Southern California - Jones, J.P.; Fong, D.S.; Fang, E.N.; Mesirov, C.A.; Patel, V. (Journal of Glaucoma, 2016)
Purpose: To describe adherence to glaucoma medications. Patients and Methods: Medication adherence was investigated using the computerized records of Kaiser Permanente Southern California, a group model health maintenance organization that provides care to 3.4 million residents of Southern California. Eligible glaucoma patients were diagnosed between 2005 and 2009 and had medical and prescription drug coverage between 2005 and 2009. Utilization and adherence parameters were calculated for each of the 5 years from the incident date. Results: A total of 17,943 newly diagnosed glaucoma patients were identified between the years 2005 and 2009. Of patients diagnosed with glaucoma in 2005, 71% were continuously eligible for 5 years. Medication adherence was calculated using a medication possession ratio. Adherence was bimodal and not normal in distribution. Overall, the mean age of the entire group was 66 years, with 56% being 65 years of age or older. The high adherence group tended to be older, more likely to be female, and more likely to be white. The low adherent group (younger) tended to have more and worse diabetes, renal disease, myocardial infarction, and stroke. Conclusions: The shape of the adherence distribution appears bimodal, so analysis based on parametric measures may not be appropriate. Investigations of adherence should probably be performed separately for the low, mid, and high groups.
Keywords: antiglaucoma agent; antilipemic agent; prescription drug; acquired immune deficiency syndrome; adult; age; aged; American Indian; article; Asian; Black person; Caucasian; cerebrovascular accident; comorbidity; dementia; diabetes mellitus; disease severity; education; emergency ward; female; follow up; gender; glaucoma; health care utilization; health insurance; health maintenance organization; heart failure; heart infarction; Hispanic; human; Human immunodeficiency virus infection; hypertension; income; kidney disease; liver disease; major clinical study; male; medication compliance; paralysis; patient compliance; peptic ulcer; peripheral vascular disease; priority journal; race; rheumatic disease; United States

Compliance of glaucoma patients to ocular hypotensive medications among the saudi population - Osman, E.A.; Alqarni, B.A.M.; Alhasani, S.S.H.; Al Harbi, S.S.S.; Gikandi, P.W.; Mousa, A. (Journal of Ocular Pharmacology and Therapeutics, 2016)
Purpose: To evaluate the compliance of glaucoma patients to medical treatment and its impact on the intraocular pressure (IOP) and to verify the associated risk factors for noncompliance. Methods: All recruited patients were examined at the ophthalmology clinics of King Abdulaziz University Hospital, Riyadh, Saudi Arabia between May and August 2012. Patients were interviewed and subjected to answer a questionnaire that was developed based on a pilot test. Collected data included age, gender, number of prescribed drugs, and different reasons for noncompliance to the prescribed drugs. Results: Noncompliance was detected in 18 (19.4%) of the recruited patients. Factors associated with noncompliance demonstrated a trend toward older patients, males, patients with lower IOP at presentation, higher cup to disc ratio, and drug self-administering patients. However, the only statistically significant characteristic was being under lifelong medications (P = 0.005). Conclusion: Noncompliance was detected in around one-fifth of our glaucoma patients, particularly, the older group. Awareness programs, maintaining good patient-physician relationship, and personalizing treatment can lead to better adherence to treatment.
Keywords: antiglaucoma agent; adult; aged; article; closed angle glaucoma; female; glaucoma; glaucoma surgery; human; intraocular pressure; iridectomy; laser coagulation; major clinical study; male; open angle glaucoma; patient compliance; risk factor; Saudi; Saudi Arabia; sclerectomy; self report; trabeculectomy

The maccabi glaucoma study: Treatment patterns and persistence with glaucoma therapy in a large israeli health maintenance organization - Goldshtein, I.; Shalev, V.; Zigman, N.; Chodick, G.; Levkovitch-Verbin, H. (Journal of Glaucoma, 2016)
Purpose: To describe treatment patterns, adherence, and persistence with initial therapy among glaucoma patients in the community. Materials and Methods: A population-based historical prospective cohort study, using the electronic medical databases of Maccabi Healthcare Services, a 2 million member health maintenance organization in Israel. Newly diagnosed glaucoma patients between 2003 and 2010, who purchased at least 1 antiglaucoma medication, were followed up to December 31, 2012. Outcome measures included medication adherence analyzed by proportion of days covered by drugs during follow-up time, and persistence with initial therapy measured by time until switch or discontinuation of firstline therapy. Results: A total of 5934 incident definite glaucoma patients were identified, 13% of whom were nonadherent with therapy (covered <20% of the follow-up time), and only 25% exhibited high adherence (covered at least 80% of the follow-up period). Adherence was positively associated with female sex, age, socioeconomic status, frequent follow-up visits, and higher baseline intraocular pressure. Lower median adherence (P<0.01) was observed among patients of normal tension glaucoma (52%) and angle closure (59%) as compared with open angle (65%) and exfoliation glaucoma (68%). Patients treated by glaucoma specialists had similar adherence to those treated by general ophthalmologists (proportion of days covered=65% vs. 63%, P=0.42). Persistence with initial line of therapy varied by type of medication, with prostaglandin initiators exhibiting the highest persistence (13% reduced likelihood of switch or discontinuation as compared with b-blockers, P<0.01) and a-agonists the lowest persistence (39% increased likelihood of switch or discontinuation as compared with b-blockers, P<0.01). Conclusions: This large-scale analysis of real-world use of glaucoma medications reveals that adherence to glaucoma therapy is associated with medication type, patient's sex, age, socioeconomic status, type of glaucoma, follow-up visits, and baseline intraocular pressure.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin; age; article; closed angle glaucoma; cohort analysis; controlled study; female; follow up; gender; health maintenance organization; human; hypertension; intraocular pressure; Israeli; low tension glaucoma; major clinical study; male; malignant neoplasm; medical specialist; medication compliance; open angle glaucoma; ophthalmologist; outcome assessment; patient compliance; priority journal; prospective study; pseudoexfoliation; sensitivity analysis; social status; telephone interview

Adverse drug reactions associated with anti-hypertensive drugs and its management - Sudhakar, R.; George, M.K.; Yasaswini, B.; Sundararajan, N.; Ahamada Safna Mariyam, M. (International Journal of Pharmaceutical Sciences and Research, 2016)
Adverse Drug Reactions associated with drugs are common and impose a serious health related problem, which can limit the treatment options, compliance and even leads to discontinuation of therapy. Hypertension is a chronic disease condition which is considered to be one of the major cardiovascular risk factor. For the treatment of hypertension a wide range of anti-hypertensive agents are available as single or combination therapy to achieve a target blood pressure in individual patient, whereas the combination therapy increases the risk of developing Adverse Drug Reaction. Hypertensive patients often have concomitant disease condition such as hyperlipidemia, impaired glucose metabolism and renal impairment, leading to an increased rate of Cardio Vascular morbidity and mortality. Therefore, a comprehensive management of both hypertension as well as concomitant Cardio Vascular Disease risk factors is critical when treating hypertensive patients. Beta-blockers provoked psoriasis, calcium channel blockers induced gingival hyperplasia, peripheral oedema, Angiotensin Converting Enzyme inhibitors produced ankle oedema and thiazide diuretics produced hyponatremia, hyperglycemia are some of the rare and serious Adverse Drug Reaction occurred in patients treated with these drugs. More often hypertension is asymptomatic and requires a lifelong treatment with antihypertensive agents, predisposing to Adverse Drug Events. Monitoring of adverse drug reactions by healthcare professionals is necessary in the patients taking antihypertensive drugs, in order to improve the treatment outcomes and to reduce the morbidity and mortality related to adverse drug reactions.
Keywords: epinephrine; amlodipine; antihypertensive agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; corticosteroid; diltiazem; dipeptidyl carboxypeptidase inhibitor; lacidipine; lercanidipine; nifedipine; oral antidiabetic agent; thiazide diuretic agent; adverse drug reaction; angina pectoris; angioneurotic edema; ankle edema; anxiety disorder; bradycardia; bronchospasm; constipation; disease exacerbation; dizziness; drug dose titration; drug safety; drug substitution; drug tolerability; drug withdrawal; flushing; gingiva hyperplasia; glaucoma; gout; headache; heart arrhythmia; heart block; heart failure; heart palpitation; human; hyperglycemia; hypertension; hyperthyroidism; hyperuricemia; hypoglycemia; hypokalemia; hyponatremia; hypotension; intermittent claudication; ischemic heart disease; kidney dysfunction; low drug dose; non insulin dependent diabetes mellitus; patient compliance; peripheral edema; psoriasis; Raynaud phenomenon; review; side effect; xerostomia

Glucocorticoids and Rheumatoid Arthritis - Ferreira, J.F.; Ahmed Mohamed, A.A.; Emery, P. (Rheumatic Disease Clinics of North America, 2016)
Glucocorticoids (GCs) were discovered in the 1940s and were administered for the first time to patients with rheumatoid arthritis in 1948. However, side effects were subsequently reported. In the last 7 decades, the mechanisms of action for both therapeutic properties and side effects have been elucidated. Mechanisms for minimizing side effects were also developed. GCs are the most frequently used class of drugs in the treatment of rheumatoid arthritis because of their efficacy in relieving symptoms and their low cost. A review of clinical applications, side effects, and drug interactions is presented.
Keywords: betamethasone; calcium; carbamazepine; clarithromycin; deflazacort; dexamethasone; efavirenz; fosphenytoin sodium; gamma interferon; glucocorticoid; interleukin 17; interleukin 1beta; interleukin 2; interleukin 3; interleukin 6; isoniazid; itraconazole; methylprednisolone; oxcarbazepine; parathyroid hormone[1-34]; pentobarbital; phenobarbital; phenytoin; placebo; prednisolone; prednisone; triamcinolone; tumor necrosis factor; unindexed drug; vitamin D; acne; adrenal insufficiency; analgesia; antiinflammatory activity; anxiety; atherosclerosis; bone necrosis; corticosteroid induced osteoporosis; Cushing syndrome; depression; disease course; drug absorption; drug bioavailability; drug blood level; drug cost; drug efficacy; drug half life; drug mechanism; drug protein binding; drug pulse therapy; drug solubility; ecchymosis; fatigue; fatty liver; gastritis; glaucoma; hair loss; hirsutism; human; hyperglycemia; hypertension; hypokalemia; increased appetite; infection; insomnia; intraocular pressure abnormality; kidney dysfunction; memory disorder; meta analysis (topic); metabolic alkalosis; morning stiffness; myopathy; pancreatitis; patient compliance; patient education; patient monitoring; priority journal; psychosis; randomized controlled trial (topic); restlessness; review; rheumatoid arthritis; side effect; skin atrophy; skin contusion; sleep disorder; stomach hemorrhage; stomach ulcer; stria; subcapsular cataract; Th1 cell; body weight gain; wound healing impairment

Squeeze me if you can: Variability in force requirements to extract a drop from common glaucoma bottles - Moore, D.B.; Hammer, J.D.; Akhtari, R.; Beck, J.; Sanders, S.; Kryscio, R.J. (Journal of Glaucoma, 2016)
Purpose: To determine the force requirements to dispense a single drop from commonly prescribed brand and generic topical glaucoma medications and correlate these findings with pinch strength in a representative patient population. Patients and Methods: Four bottles of each medication were tested: 2 in the vertical and 2 in the horizontal orientation. Bottles were housed in a customized force gauge apparatus designed to mimic ballpoint fingertip contact with a bottle tip. For all bottles, each of the first 10 dispensed drops was tested and then tests were performed in increments of 10 until the bottle was empty. For each tested drop, the maximum force and displacement were electronically measured. Concurrently, maximum pinch strength was measured on consecutive glaucoma patients. Results: A total of 84 bottles from 21 bottle designs were tested. There was significant variability across the designs, with roughly a 7-fold (0.67 to 4.49 kgf) and 4-fold (0.81 to 3.00 kgf) difference in force requirements in the vertical and horizontal positions, respectively. Of 53 enrolled patients in the glaucoma clinic, the mean pinch strength was 5.05 (range, 1.23 to 10.4 kgf) and 4.82 (range, 1.47 to 10.67 kgf) kgf for the right and left hands, respectively. Conclusions: There is statistically significant variability in the force required to squeeze a drop from common glaucoma medications, and a representative sampling of clinic patients suggests that many likely struggle with the force requirements of several bottle designs. These data further support standardization of topical glaucoma drug delivery and design.
Keywords: antiglaucoma agent; bimatoprost; brimonidine; brimonidine plus brinzolamide; brimonidine plus timolol; brinzolamide; dorzolamide; dorzolamide plus timolol; dorzolamide plus timolol maleate; eye drops; generic drug; latanoprost; prescription drug; timolol maleate; travoprost; adult; article; closed angle glaucoma; correlational study; drug cost; female; force gauge; glaucoma; grip strength; human; left handedness; low tension glaucoma; major clinical study; male; medication compliance; middle aged; open angle glaucoma; patient compliance; pinch strength; plastic bottle; prescription; priority journal; right handedness; topical treatment; alphagan p; azopt; combigan; cosopt; lumigan; simbrinza; timoptic; travatan z; trusopt; xalatan

The Wills eye glaucoma app: Interest of patients and their caregivers in a smartphone-based and tablet-based glaucoma application - Waisbourd, M.; Dhami, H.; Zhou, C.; Hsieh, M.; Abichandani, P.; Pro, M.J.; Moster, M.R.; Katz, L.J.; Hark, L.A.; Myers, J.S. (Journal of Glaucoma, 2016)
Purpose: To evaluate the interest of glaucoma patients and their caregivers in a smartphone-based and tablet-based glaucoma application (App), developed by the Wills Eye Glaucoma Research Center in collaboration with Drexel University. Materials and Methods: Cross-sectional survey of patients with glaucoma and their caregivers. Main outcome measures are answers to survey questions regarding how receptive participants are to using the Glaucoma App. Results: Fifty subjects completed the survey. The mean age (SD) was 59.5 (±17.3) years. A total of 88.6% of the participants lived in a household with access to a smartphone or tablet. The majority (72.3%) of participants would consider downloading the Glaucoma App, and younger participants (<65 y) were more likely to do so compared with their older (Z65 y) counterparts, P=0.025. Participants were more likely to download the App if it was free of charge, compared with a version that costs $3, P=0.018. Although only about one third (37.8%) of participants used eye drop reminders, nearly 3 of 4 (72.9%) participants were receptive to using the automated reminder feature of the Glaucoma App. Conclusions: Glaucoma patients and their caregivers were very interested in using a Glaucoma App; however, many were not willing to spend $3 for an App they seem to value. The free Wills Eye Glaucoma App currently available on the Apple store, includes educational videos, eye drop and appointment reminders, medical and ocular data storage, visual field tutorial, and intraocular pressure tracker. These features aim to increase patients' level of knowledge about glaucoma and improve their adherence to medication and follow-up appointment recommendations.
Keywords: antiglaucoma agent; eye drops; adult; African American; aged; article; caregiver; Caucasian; clinical article; cross-sectional study; female; follow up; glaucoma; glaucoma surgery; health care cost; human; low level laser therapy; male; medication compliance; mobile application; outcome assessment; patient compliance; patient education; perimetry; priority journal; smartphone

Outcomes of pediatric cataract surgery in the Copperbelt Province of Zambia - Mboni, C.; Gogate, P.M.; Phiri, A.; Seneadza, A.; Ramson, P.; Manolakos-Tsehisi, H.; Musonda, L.; Benjamin, L.; Øverland, L. (Journal of Pediatric Ophthalmology and Strabismus, 2016)
Purpose: To study the outcomes of pediatric cataract surgeries in children operated on in the Copperbelt Province of Zambia and the barriers to accessing surgery. Methods: All children who had congenital, developmental, and traumatic cataracts operated on by lens aspiration, primary posterior capsulotomy, and anterior vitrectomy with posterior chamber intraocular lens implantation from 2012 to 2013 and followed up beyond 6 months were studied. Each child underwent a comprehensive preoperative evaluation. An active, assisted follow-up was done and parents were asked about reasons for delay between presentation and surgery. Results: One hundred two eyes of 70 children met the inclusion criteria of the study. Preoperatively, 76 of 77 (98.7%) eyes in the congenital and developmental cataract group had presenting visual acuity of worse than 6/60. This improved postoperatively, with 19 (29.7%) eyes having best corrected visual acuity (BCVA) of better than 6/18, 23 (35.9%) having BCVA of 6/24 to 6/60, and 22 (34.4%) having BCVA of worse than 6/60. Older age (P = .005), better preoperative vision (P = .045) at presentation, unilaterality (P = .012), and delay between presentation and surgery (P = .004) were predictors of a better postoperative outcome. On multivariate analysis, only age was significant (P = .025). Distance and cost of travel and surgery were the causes of delay in presentation. In the patients with traumatic cataracts, 17 of 25 (68%) had BCVA of better than 6/18, 6 (24%) had BCVA between 6/24 and 6/60, and 2 (8%) had BCVA of worse than 6/60 at the 6-month follow-up. The most common causes of injury were being struck by sticks and stones (10 children, 25%). Conclusions: Visual outcomes after pediatric cataract surgery in Zambia were comparable and satisfactory. Cost of treatment was a barrier, but delay did not adversely affect outcome. Copyright
Keywords: age distribution; article; best corrected visual acuity; capsulorhexis; capsulotomy; cataract extraction; child; clinical outcome; congenital cataract; controlled study; developmental disorder; female; follow up; health care access; health care barrier; health care cost; health care system; human; intraocular hypertension; lens implant; lens implantation; major clinical study; male; pediatric surgery; postoperative complication; preoperative evaluation; therapy delay; time to treatment; traumatic cataract; travel; visual acuity; vitrectomy; Zambia

Harrowing Blindness and Ocular Morbidity in a Himalayan Village - Pokharel, A.; Kandel, H.; Shrestha, R. (Nepal Journal of Epidemiology, 2016)
Keywords: amblyopia; blindness; cataract; disease severity; eye care; eye examination; glaucoma; health care access; health care delivery; human; hypermetropia; letter; myopia; Nepal; prevalence; refraction error; visual acuity

Nanotherapeutics: Future medicine for infectious diseases - Prabhu, P.S.; Patravale, V.B.; Andrabi, K.I.; Shiekh, F.A. (Frontiers in Drug Design and Discovery, 2016)
Infectious diseases are increasingly becoming a major health concern annually afflicting millions of humans worldwide. Presently, the greatest challenge to any successful effective treatment of a particular pathogen is the emergence of drug-resistance, less bioavailability and non-specificity of potent antibiotics at the target sites, requiring large doses of medicine over a longer period of time, resulting in maximum toxicity to patients. However, drug delivery is a powerful concept in nanomedicine which is constantly growing at a burgeoning pace, could provide an efficient alternative to target any pathogens at any site in the body using advanced combined nanoparticle platforms or nanocarriers with fewer side effects. Significantly, nanotherapeutics could be administered through various specific routes such as oral, parenteral, and topical for effective treatment. In summary, this chapter would highlight the role of targeted antibiotics as an advancement of future nanomedicine over conventional therapeutics against virulent infectious diseases.
Keywords: amphotericin B; amphotericin B deoxycholate; amphotericin B lipid complex; antibiotic agent; atovaquone; bismuth nanoparticle; chitosan nanoparticle; clofazimine; copper oxide nanoparticle; dendrimer; efavirenz; gentamicin; gold nanoparticle; liposome; metal nanoparticle; moxifloxacin; nanocapsule; nanocarrier; nanocomposite; nanomaterial; nanoparticle; nevirapine; polymeric micelles; polymer nanoparticle; rifampicin; silver nanoparticle; solid lipid nanoparticle; tetracycline; titanium dioxide nanoparticle; unclassified drug; unindexed drug; vancomycin; zinc oxide nanoparticle; antibacterial activity; antibiotic resistance; antifungal activity; antimicrobial activity; antiviral activity; bacterial infection; biofilm; drug bioavailability; drug concentration; drug cost; drug delivery system; drug specificity; drug tissue level; drug toxicity; herpes labialis; herpes simplex keratitis; hospital infection; human; Human immunodeficiency virus infection; infectious disease medicine; intrapulmonary drug administration; keratomycosis; malaria; microemulsion; mononuclear phagocyte; mycosis; nanomedicine; nonhuman; parasitosis; patient compliance; periodontitis; phage therapy; photodynamic antimicrobial chemotherapy; photodynamic therapy; photothermal therapy; pneumonia; priority journal; Pseudomonas infection; Staphylococcus infection; surgical infection; treatment duration; tuberculosis; vagina candidiasis; virus infection; visceral leishmaniasis; ambisome; fungizone

Considerations and complications after Bells' palsy - Nemet, A.Y.; Vinker, S. (Journal of Clinical Neuroscience, 2015)
We present a retrospective, observational study of all patients diagnosed with Bells' palsy (BP) at the Central District of Clalit Health Services from 2003 through to 2012. BP is associated with several complications. We evaluated clinical characteristics including the number of patient visits to general physicians (GP), otolaryngologists, ophthalmologists and neurologists, medications prescribed in the acute phase of BP (steroids and antiviral agents), and the ophthalmic diagnoses. A total of 4463 patients with the diagnosis of BP were included. The incidence per 100,000/year was 87.0, and it increased with age. Patients had significantly more visits to all specialists at 6 months after the BP event. Steroid treatment was prescribed to 50.4% of the patients and antiviral agents to 65.5%. Both treatments were associated with older patient age and female sex. The rate of post BP lagophthalmos and keratitis was 3.45% and 0.63% at 1-3 months, respectively, and both were more likely to develop in older patients. Steroid and/or antiviral treatments were not associated with a decrease in ophthalmic complications. BP may cause ophthalmic complications at a low rate, which are associated with older age. Steroids and antiviral agents appeared to have no effect on ophthalmic complications.
Keywords: antivirus agent; steroid; adolescent; adult; age distribution; aged; article; Bell palsy; child; cohort analysis; controlled study; female; health care utilization; human; incidence; infant; keratitis; lagophthalmos; major clinical study; male; middle aged; newborn; observational study; preschool child; priority journal; retrospective study; sex difference; very elderly; young adult

A comparison of measures used to describe adherence to glaucoma medication in a randomised controlled trial - Cate, H.; Bhattacharya, D.; Clark, A.; Holland, R.; Broadway, D.C. (Clinical Trials, 2015)
Background: Understanding the magnitude of non-adherence in pre-marketing clinical trials and clinical practice is essential. However, accurately measuring non-adherence to medication is problematic, and the variety of adherence measures and/or calculation methods has led to highly variable results. Purpose: To compare commonly used methods for measuring adherence to eye drop therapy in order to assess which methods achieve the most complete datasets over an 8-month monitoring period, to quantify the magnitude of variance in adherence estimations and to review the different methods used to calculate or interpret adherence data. Methods: Adherence was measured electronically for 8 months by participants administering eye drops using a Travalert® dosing aid. The mean number of Travalert dosing aid recorded doses administered over the monitoring period was used to calculate a percentage adherence score. In addition, the value of graphically presenting Travalert dosing aid data to classify patterns of adherence behaviour was explored. The validated Morisky Measure of Adherence Scale and questions requesting participants to report the Frequency of Missed Doses were two measures of self-reported adherence calculated for each participant. Finally, medication possession ratio was calculated from expected repeat prescription orders compared with actual repeat prescription orders. Results: For the 208 recruited participants, self-reported adherence was the most reliable method of collecting complete datasets over the 8-month period; 16% of self-reported adherence data were missing compared with 45% of Travalert dosing aid data missing at 8 months. The mean adherence measured over the monitoring period by the Travalert dosing aid was 77%. When adherence measures were dichotomised into adherent and non-adherent groups, the Travalert dosing aid found 54% of participants were adherent, compared to 60% Morisky Measure of Adherence Scale and 57% Frequency of Missed Dose self-report measures. However, there was poor agreement between the Travalert dosing aid measured adherence and self-report measures. Medication possession ratio was not a reliable measure of persistence with medication. Graphical Travalert dosing aid data presentation provided additional information about participant behaviour by indicating that most non-adherence was due to participants taking drug holidays rather than missing occasional doses. Conclusion: The analysis provided evidence about the inconsistencies between different monitoring strategies and adherence measures. Furthermore, the analysis highlighted the difficulties in collecting complete data for studies investigating chronic, slowly progressive conditions that require long-term follow-up. Future adherence studies could use multiple methods for quantifying and classifying adherence in parallel, both to maximise precision of adherence estimates and to facilitate comparison between studies. However, the authors are cautious of the effect of using multiple adherence measures on participant behaviour and their potential reactivity effects is an area for future research.
Keywords: antiglaucoma agent; eye drops; aged; article; clinical practice; controlled study; female; glaucoma; human; intermethod comparison; major clinical study; male; monitoring; national health service; patient compliance; prescription; priority journal; questionnaire; rating scale; reliability; scoring system; self report; teaching hospital; United Kingdom; visual field; travalert

Brinzolamide 1%/timolol versus dorzolamide 2%/timolol in the treatment of open-angle glaucoma or ocular hypertension: Prospective randomized patient-preference study - Altafini, R.; Scherzer, M.-L.; Hubatsch, D.A.; Frezzotti, P. (Clinical Ophthalmology, 2015)
Purpose: The objective of this study was to assess preference for fixed-combination brinzolamide 1%/timolol 0.5% (BTFC) versus fixed-combination dorzolamide 2%/timolol 0.5% (DTFC) in patients with open-angle glaucoma or ocular hypertension. Methods: In this prospective, single-masked crossover study, patients were randomized 1:1 to BTFC-DTFC or DTFC-BTFC treatment sequences. Patients self-administered each medication for 7 days, with a 48-hour washout period between treatments, and rated ocular discomfort after each treatment period. Medication preferences based on ocular comfort (primary endpoint) and anticipated adherence were assessed. Safety outcomes included adverse events and intraocular pressure. Between-group differences in treatment preference and ocular discomfort scores were analyzed using chi-square and Wilcoxon–Mann–Whitney tests, respectively. Adherence, intraocular pressure, and adverse events were summarized descriptively. Results: In total, 112 patients were enrolled (mean ± SD age, 66±11 years), and 109 patients completed the study. Numerically, more patients in the intent-to-treat dataset preferred BTFC versus DTFC (59.3% versus 40.7%); however, this result was not statistically significant (treatment difference, 18.6%; P=0.0670). Mean ocular discomfort scores (range, 0–9) were statistically significantly lower with BTFC versus DTFC (2.6 versus 3.7; P=0.0002, Wilcoxon–Mann–Whitney test). More patients who preferred BTFC over DTFC were confident that they would adhere to their preferred medication. Treatment-related adverse events included blurred vision with BTFC and eye irritation or eye pain with DTFC. Conclusion: BTFC and DTFC were preferred by approximately 60% and 40% of patients, respectively, and BTFC was associated with less patient-reported ocular discomfort. Greater ocular comfort of glaucoma medications may improve treatment adherence.
Keywords: NCT01340014; brinzolamide plus timolol; dorzolamide plus timolol; abnormal sensation; adult; aged; article; blurred vision; controlled study; crossover procedure; dizziness; drug efficacy; drug preference; drug safety; drug withdrawal; eye discomfort; eye irritation; eye pain; fatigue; female; human; intention to treat analysis; intraocular foreign body; intraocular hypertension; major clinical study; male; open angle glaucoma; patient compliance; patient preference; phase 4 clinical trial; pruritus; randomized controlled trial; rhinopharyngitis; side effect; single blind procedure; tachycardia; taste disorder; very elderly

Do March-In Rights Ensure Access to Medical Products Arising from Federally Funded Research? A Qualitative Study - Treasure, C.L.; Avorn, J.; Kesselheim, A.S. (Milbank Quarterly, 2015)
Policy Points: The Bayh-Dole Act of 1980 formalized the ability of institutions receiving federal research funding to commercialize discoveries by issuing exclusive licenses for patents that emerge. This legislation also contained a march-in rights provision, allowing the US government to cancel the exclusive license if the product was not available to the American public on reasonable terms. Since 1980, there have been 5 march-in rights petitions for 4 different health care-related products, most recently in cases of drugs discovered with federal funding made available only at exorbitant prices. The National Institutes of Health (NIH) has rejected each petition. In our qualitative analysis of experts and participants involved in these march-in rights petitions, we found little prospect NIH will ever invoke march-in rights in such cases. Context The high cost of new prescription drugs and other medical products is a growing health policy issue. Many of the most transformative drugs and vaccines had their origins in public-sector funding to nonprofit research institutions. Although the Bayh-Dole Act of 1980 provides for "march-in rights" through which the government can invoke some degree of control over the patents protecting products developed from public funding to ensure public access to these medications, the applicability of this provision to current policy options is not clear. Methods We conducted a primary-source document review of the Bayh-Dole Act's legislative history as well as of hearings of past march-in rights petitions to the National Institutes of Health (NIH). We then conducted semistructured interviews of 12 key experts in the march-in rights of the Bayh-Dole Act to identify the sources of the disputes and the main themes in the statute's implementation. We analyzed the interview transcripts using standard qualitative techniques. Findings Since 1980, the NIH has fully reviewed only 5 petitions to invoke governmental march-in rights for 4 health-related technologies or medical products developed from federally funded research. Three of these requests related to reducing the high prices of brand-name drugs, one related to relieving a drug shortage, and one related to a potentially patent-infringing medical device. In each of these cases, the NIH rejected the requests. Interviewees were split on the implications of these experiences, finding the NIH's reluctance to implement its march-in rights to be evidence of either a system working as intended or of a flawed system needing reform. Conclusions The Bayh-Dole Act's march-in rights continue to be invoked by policymakers and health advocates, most recently in the context of new, high-cost products originally discovered with federally funded research. We found that the existence of march-in rights may select for government research licensees more likely to commercialize the results and that they can be used to extract minor concessions from licensees. But as currently specified in the statute, such march-in rights are unlikely to serve as a counterweight to lower the prices of medical products arising from federally funded research.
Keywords: agalsidase alfa; agalsidase beta; latanoprost; lopinavir plus ritonavir; prescription drug; ritonavir; zidovudine; article; drug approval; drug cost; drug efficacy; Fabry disease; funding; glaucoma; government; health care access; health care policy; highly active antiretroviral therapy; human; Human immunodeficiency virus infection; law; legal aspect; licence; march in rights; medical device; national health organization; patent; priority journal; qualitative analysis; qualitative research; semi structured interview; United States; fabrazyme; kaletra; replagal; retrovir; xalatan

A Circadian and Cardiac Intraocular Pressure Sensor for Smart Implantable Lens - Donida, A.; Di Dato, G.; Cunzolo, P.; Sala, M.; Piffaretti, F.; Orsatti, P.; Barrettino, D. (IEEE transactions on biomedical circuits and systems, 2015)
This paper presents a new system to measure the Intraocular Pressure (IOP) with very high accuracy (0.036 mbar) used for monitoring glaucoma. The system not only monitors the daily variation of the IOP (circadian IOP), but also allows to perform an spectral analysis of the pressure signal generated by the heartbeat (cardiac IOP). The system comprises a piezoresistive pressure sensor, an application-specific integrated circuit (ASIC) to read out the sensor data and an external reader installed on customized glasses. The ASIC readout electronics combines chopping modulation with correlated double sampling (CDS) in order to eliminate both the amplifier offset and the chopper ripple at the sampling frequency. In addition, programmable current sources are used to compensate for the atmospheric pressure ( 800-1200 mbar ) and the circadian component (± 7 mbar) thus allowing to read out the very weak cardiac signals (± 1.6 mbar) with a maximum accuracy of 0.036 mbar.
Keywords: ambulatory monitoring; circadian rhythm; devices; genetic procedures; glaucoma; human; intraocular pressure; lens implant; mobile application; oculoplethysmography; physiology; procedures; remote sensing

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design - Owsley, C.; Rhodes, L.A.; McGwin, G.; Mennemeyer, S.T.; Bregantini, M.; Patel, N.; Wiley, D.M.; LaRussa, F.; Box, D.; Saaddine, J.; Crews, J.E.; Girkin, C.A. (International Journal for Equity in Health, 2015)
Background: Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans. Methods/Design: We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist's diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients' knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY's impact on Walmart pharmacy prescription rates. Discussion: As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.
Keywords: antiglaucoma agent; adult; article; cost effectiveness analysis; diagnostic test; drug cost; eye care; female; glaucoma; health care access; health care cost; health care delivery; health care quality; health education; health program; high risk population; human; major clinical study; male; observational study; ophthalmologist; optometrist; paramedical personnel; patient attitude; patient care; patient compliance; patient satisfaction; prescription; priority journal; prospective study; questionnaire; telemedicine; United States; visual system examination

Health Service Use and Mortality of the Elderly Blind - Crewe, J.M.; Spilsbury, K.; Morlet, N.; Morgan, W.H.; Mukhtar, A.; Clark, A.; Semmens, J.B. (Ophthalmology, 2015)
Purpose To determine whether blindness in older people is associated with increased health service use and mortality. Design Retrospective matched cohort study from July 1, 1999, through June 30, 2010. Participants A blind cohort 65 years of age and older from a volunteer blind register and a cohort of age- and gender-matched controls selected randomly from the Western Australian electoral roll. Methods Person-level linked hospital, emergency department (ED), mental health, and death records for the blind and control cohorts were used. Generalized estimating equations assuming a negative binomial distribution were used to estimate relative rates of hospital admissions, lengths of stay, and mortality after adjusting for sociodemographic variables and comorbidity. Emergency department and mental health service visits also were quantified. Main Outcome Measures Relative rates of hospital admissions, lengths of stay, and mortality, as well as crude proportions of ED and mental health service visits. Results The blind cohort comprised 1726 individuals alongside 1726 matched controls; 39% were men, and the mean age was 83 years. Combined, the cohorts accumulated a total of 34 130 hospital admissions amounting to 201 867 bed-days. After adjusting for the principal reason for hospital admission and comorbidity, the blind cohort was admitted to the hospital 11% (95% confidence interval [CI], 6%-17%) more often than the control cohort. The blind cohort also stayed in the hospital longer than the controls, but this effect varied by age. Blind participants 65 to 69 years of age spent 88% more days (95% CI, 27%-178%) in the hospital compared with age-matched controls, whereas there was no difference in length of stay between the cohorts by 80 years of age (rate ratio, 1.10; 95% CI, 0.97-1.25). A larger proportion of the blind cohort visited a hospital ED and accessed mental health services compared with the control cohort. Conclusions Health service use is increased for the elderly blind compared with age-matched controls after accounting for comorbidity. The elderly blind have more hospital admissions, ED visits, and mental health-related visits. The younger elderly blind stay longer in hospital. However, there was no evidence of worse mortality outcomes after adjusting for comorbidity.
Keywords: age related macular degeneration; aged; article; binomial distribution; blindness; cataract; cohort analysis; comorbidity; controlled study; cornea disease; diabetic retinopathy; emergency ward; female; geriatric patient; glaucoma; groups by age; health care access; health care utilization; hospital admission; human; length of stay; lens disease; major clinical study; male; mental health service; mortality; optic nerve disease; priority journal; retina dystrophy; retina vein occlusion; retrospective study; social status

Implementation of a vision-screening program in rural northeastern United States - Tsui, E.; Siedlecki, A.N.; Deng, J.; Pollard, M.C.; Cha, S.; Pepin, S.M.; Salcone, E.M. (Clinical Ophthalmology, 2015)
Background: Rural populations comprise almost 20% of the US population and face unique barriers in receiving health care. We describe the implementation of a medical student-run free vision-screening clinic as a strategy to overcome barriers in accessing eye care in New Hampshire and Vermont. Methods: Medical students were trained by an ophthalmologist to administer screening eye examinations. Patients from New Hampshire and Vermont were enrolled through a free community clinic. Screening included a questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, level of education, and diagnoses were recorded and analyzed. Results: Of 103 patients (mean age of 45.5±12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmologic examination findings were observed in 58/66 (88%) patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal diseases (8%), amblyopia (8%), cataract (6%), others (6%), and normal examination (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancellation of appointment, work conflicts, or forgetfulness. Patients traveled a mean distance of 16.6 miles (range: 0–50 miles) to attend screening examinations. Mean time for patients’ last effort to seek eye care was 7.1 years (range: 1–54 years). Conclusion: This study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, it demonstrates that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting.
Keywords: adolescent; adult; age related macular degeneration; aged; amblyopia; article; cataract; demography; diabetic retinopathy; education; eye care; eye examination; eye movement; female; glaucoma; health care access; health program; human; keratoconus; major clinical study; male; medical student; night blindness; ophthalmologist; optic nerve disease; patient referral; pterygium; questionnaire; refraction error; retina disease; rural area; United States; vision screening program; vision test; visual acuity; visual field

Effect of Topical Tacrolimus in the Treatment of Thygeson's Superficial Punctate Keratitis - Marquezan, M.C.; Nascimento, H.; Vieira, L.A.; Serapião, M.; Ghanem, R.C.; Belfort, R.; Freitas, D. (American Journal of Ophthalmology, 2015)
Purpose To evaluate topical tacrolimus ointment for treating Thygeson's superficial punctate keratitis (Thygeson SPK). Design Retrospective interventional case series. Methods setting: Institutional practice. patient population: The medical records of 14 patients (9 women; age range, 9-65 years) with Thygeson SPK were reviewed retrospectively. Diagnosis was based on the history and clinical examination. intervention: Patients were treated with tacrolimus 0.03% eye ointment instilled into the lower fornix twice daily for the first 2 weeks, followed by nocturnal application. The clinical signs and symptoms were assessed after 1 month of treatment. The drug was tapered with disease improvement. main outcome measure(s): Treatment efficacy and side effects. Results All patients had bilateral disease (average duration, 6 years). All patients, except 2 who used the medication irregularly, had improved visual acuity (VA), symptoms, and signs as long as the medication was applied. Before treatment 28.57% of patients had VA between 20/30 and 20/50, with improvement after treatment to 20/25 or 20/20. Attempts to withdraw the medication resulted in recurrent disease, and, therefore, treatment was not curative during the study period. No significant local medication side effects were reported. Conclusion Tacrolimus eye ointment 0.03% was effective for controlling Thygeson SPK for a long period with good patient tolerance and no noticeable local or systemic side effects. During the average 6-year follow-up, treatment was not curative. Randomized studies are difficult to conduct because of the disease rarity.
Keywords: eye ointment; tacrolimus; adolescent; adult; aged; article; bedtime dosage; blurred vision; burning sensation; case study; child; clinical article; clinical examination; drug dose reduction; drug effect; drug efficacy; drug tolerance; evaluation study; eye cancer; female; follow up; foreign body; herpes simplex keratitis; human; hyperemia; intervention study; male; medical history; medical record review; medication compliance; patient compliance; priority journal; punctate keratitis; recurrent disease; retrospective study; topical treatment; treatment duration; treatment response; visual acuity

Healthcare resource use and costs associated with side effects of high oral corticosteroid use in asthma: A claims-based analysis - Luskin, A.; Antonova, E.; Broder, M.; Chang, E.; Ledford, D. (Journal of Managed Care and Specialty Pharmacy, 2015)
BACKGROUND: Oral corticosteroids (OCS) are used in the management of asthma exacerbations and severe asthma. Patients using OCS bear the risk of side effects (SEs) associated with OCS exposure; the economic burden of such SEs is unknown. This analysis estimated the prevalence of OCS-related PSEs and associated healthcare resource use (HRCU) and costs. OBJECTIVE: To estimate all-cause healthcare resource use (HCRU) and healthcare costs that could be attributed to SEs of high-OCS use in patients with asthma. METHODS: This cross-sectional, matched-cohort, retrospective study included adult patients in a 2008 and 2009 commercial administrative claims database using diagnosis codes for asthma and evidence of asthma medication use. We formed two groups: (a) high-OCS (≥ 30 OCS days annually) and (b) non-OCS users (matched [1:1] exactly on age, sex, geographic region and chronic obstructive pulmonary disease [COPD] status). We further divided high-OCS users into two groups: (a) those with diagnoses indicating possible OCS side effects (PSEs) or (b) those without such diagnoses. PSE diagnoses included: bonerelated conditions, pneumonia, opportunistic infections, diabetes mellitus, hypertension, lipid disorders, glaucoma, obesity, cataracts, and ulcer disease. In high-OCS patients, we compared HCRU and healthcare cost using t-test in ordinary linear regression models, or Wald Chi-square test in negative binomial regression models, adjusting for age, sex, geographic region, Charlson Comorbidity Index, and COPD status. RESULTS: The matched groups included 3,604 high-OCS and 3,604 non-OCS asthma patients (mean age: 54.4 years; 68.1% female; 44.9% with COPD). High-OCS users had significantly higher rates of any PSE (83.5% vs. 78.1%; P < 0.001) and mean healthcare costs ($24,627 vs. $12,479 P < 0.001) than non-OCS group. After adjustment, high-OCS users with PSEs were more likely to have office visits (23.0 vs. 19.6; P < 0.001) and hospitalizations (0.44 vs. 0.22; P < 0.001) than those without PSE. ED visit rates were not statistically significant between the groups. Among high-OCS users with PSEs vs. without PSEs, adjusted total annual mean healthcare cost totaled $25,168 vs. $21,882 (P = 0.009). CONCLUSIONS: High OCS use was associated with significantly higher costs than non-OCS use. Furthermore, among the high-OCS group, patients with PSEs were more likely to use healthcare services, than those without PSEs. Although OCS may help with asthma control and the management of exacerbations, they are associated with a high rate of SEs and additional HCRU and costs, highlighting the need for OCS-sparing asthma therapies in asthma patients.
Keywords: corticosteroid; adult; adverse drug reaction; ambulatory care; asthma; cataract; Charlson Comorbidity Index; chi square test; chronic obstructive lung disease; cohort analysis; conference abstract; controlled study; diabetes mellitus; diagnosis; disease exacerbation; disorders of lipid metabolism; drug therapy; female; glaucoma; health care cost; hospitalization; human; hypertension; linear regression analysis; major clinical study; male; middle aged; obesity; opportunistic infection; pneumonia; prevalence; remission; retrospective study; side effect; ulcer

Outcome Measures in Glaucoma: A Systematic Review of Cochrane Reviews and Protocols - Ismail, R.; Azuara-Blanco, A.; Ramsay, C.R. (Journal of Glaucoma, 2015)
Purpose: In clinical trials, the selection of appropriate outcomes is crucial for the assessment of whether one intervention is better than another. Selection of inappropriate outcomes can compromise the utility of a trial. However, the process of selecting the most suitable outcomes to include can be complex. Ideally, glaucoma trials aim to evaluate important outcomes for clinicians and patients. A high variability in the selection of outcomes suggests that there is no consensus on how best to evaluate the effect of glaucoma interventions. Further, it makes evidence synthesis difficult. The purpose of this review is to determine the extent of clinical outcome measures used in published glaucoma Cochrane Reviews and Protocols. Methods: A systematic review was conducted (up to February 2012) of all Cochrane Reviews and Protocols related to glaucoma interventions and published in English language. All clinical, patient-reported, as well as economic outcomes were included. Results: In the Cochrane Library there were 12 Reviews and 9 Protocols on glaucoma. A total of 118 clinical outcomes were reported. Intraocular pressure was the most commonly used clinical outcome (n=40), and it was used in 11 Reviews and 5 Protocols. Intraocular pressure was evaluated in many different ways; the most common one was a composite definition of success. Safety outcomes were also frequently reported. Visual field progression or change was reported in 6 reviews and 3 protocols, but in 13 different ways. Patient-reported quality-of-life measures were chosen as main outcome measure in 1 Review. Conclusions: There is a large variability in outcomes selected in glaucoma Cochrane Reviews and Protocols. This heterogeneity in outcome selection impairs the ability for evidence synthesis. There is an urgent need for standardization of outcomes used in glaucoma trials.
Keywords: anterior eye chamber angle; aqueous humor flow; article; clinical protocol; Cochrane Library; glaucoma; hemodynamics; human; intraocular pressure; optic nerve; outcome assessment; patient compliance; phase 1 clinical trial (topic); priority journal; quality of life; retinal nerve fiber layer thickness; standardization; systematic review; visual acuity; visual field

A Survey on the Preference of Sustained Glaucoma Drug Delivery Systems by Singaporean Chinese Patients: A Comparison between Subconjunctival, Intracameral, and Punctal Plug Routes - Chan, H.H.; Wong, T.T.; Lamoureux, E.; Perera, S. (Journal of Glaucoma, 2015)
Purpose: To investigate the acceptance and preferences rates of 3 sustained drug delivery systems in glaucoma patients. Materials and Methods: A cross-sectional study involving 250 Chinese patients recruited from outpatient glaucoma clinics in Singapore using an interviewer-administered survey. Beliefs toward medicines, eye drops, illness perception, medication adherence, and health literacy were assessed using validated questionnaires. After receiving standard information on the 3 sustained drug delivery systems, that is, subconjunctival, intracameral, and punctal routes; each route's acceptance and attitudes were determined. Results: The subconjunctival (acceptance: 61.6%, n=154), intracameral (acceptance: 57.2%, n=143), and punctal (acceptance: 63.2%, n=158) routes were willing to be accepted by the majority of the interviewed patients. Among those, 78.6%, 79.1%, and 78.5% were willing to pay an equal or higher cost compared with their current eye drops for the subconjunctival, intracameral, and punctal plug routes, respectively. Independent factors associated with the acceptance for subconjunctival, intracameral, and punctal plug routes included: male sex (P=0.007, 0.014, 0.046, respectively), patients not on health care subsidies (P=0.022, 0.002, 0.016, respectively), and bilateral glaucoma disease (P=0.003, 0.013, 0.004, respectively). A total of 120 (48.0%) patients ranked punctal plug placement as the preferred route for sustained drug delivery followed by subconjunctival (n=76, 30.4%) and intracameral (n=54, 21.6%) routes. Conclusions: Sustained drug delivery for the medical treatment of glaucoma is an acceptable alternative to daily eye drop administration by most Singaporean Chinese individuals in this study. Male patients, nonsubsidized patients, and those with bilateral glaucoma were independently associated with preference of these 3 alternative routes of administration to traditional glaucoma drops.
Keywords: antiglaucoma agent; adult; aged; article; attitude to health; Chinese; clinical effectiveness; closed angle glaucoma; comorbidity; comparative study; controlled study; cross-sectional study; disease duration; disease severity; drug cost; educational status; female; follow up; glaucoma; health literacy; health survey; human; major clinical study; male; medication compliance; open angle glaucoma; patient attitude; patient compliance; patient preference; priority journal; punctal plug; questionnaire; self report; sex difference; treatment duration; treatment response

The cost-effectiveness analysis of teleglaucoma screening device - Thomas, S.; Hodge, W.; Malvankar-Mehta, M. (PLoS ONE, 2015)
Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients atrisk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist- referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of- $27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective than current inperson examination and can improve the quality of life in glaucoma patients.
Keywords: ophthalmological diagnostic device; adult; article; blindness; Canada; cost effectiveness analysis; diabetes mellitus; eye care; family history; glaucoma; health care access; health care cost; hidden Markov model; human; hypertension; ophthalmological diagnostic device; patient referral; quality adjusted life year; risk factor; rural area; teleglaucoma; telemedicine; visual system examination

Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment - Tafida, A.; Kyari, F.; Abdull, M.M.; Sivasubramaniam, S.; Murthy, G.V.S.; Kana, I.; Gilbert, C.E.; Abiose, A.; Bankole Olufunmilayo, O.; Ezelum, C.; Elhassan, E.; Entekume, G.; et al. (Ophthalmic Epidemiology, 2015)
Purpose: Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria. Methods: Participants ≥40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA <6/12 in either eye. Causes of vision loss were determined using World Health Organization guidelines. Households were categorized into three levels of poverty based on literacy and occupation at household level. Results: A total of 569/13,591 participants were blind (PVA <3/60, better eye; prevalence 4.2%, 95% confidence interval [CI] 3.8-4.6%). Prevalences of blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%). Conclusion: In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.
Keywords: adult; aphakia; article; blindness; cataract; cornea opacity; demography; educational status; eye examination; female; glaucoma; health care access; health literacy; health survey; human; major clinical study; male; Nigeria; ophthalmologist; poverty; practice guideline; prevalence; priority journal; sex difference; socioeconomics; visual acuity; World Health Organization

A two-year follow-up of oral antioxidant supplementation in primary open-angle glaucoma: An open-label, randomized, controlled trial - Garcia-Medina, J.J.; Garcia-Medina, M.; Garrido-Fernandez, P.; Galvan-Espinosa, J.; Garcia-Maturana, C.; Zanon-Moreno, V.; Pinazo-Duran, M.D. (Acta Ophthalmologica, 2015)
Purpose To evaluate the effect of oral antioxidant supplementation (OAS) on primary open-angle glaucoma (POAG) over a 2-year follow-up period. Patients and methods In this open-label, randomized controlled trial, 117 eyes of 117 patients with mild or moderate POAG and intraocular pressure under control with topical antiglaucoma medications were recruited and randomly divided into three groups according to supplementation: (1) OAS with (ICAPS R® - Alcon Laboratories, n = 26); (2) OAS without ω-3 fatty acids (OFTAN MACULA® - Laboratorios Esteve, n = 28); and (3) a control group without OAS (n = 63). They all underwent visual field (VF) tests (Humphrey 24-2) and scans using a Fourier-domain optical coherence tomography (FD-OCT) device (RTVue-100) at the beginning of the study and 2 years later. Mean deviation (MD), standard pattern deviation (PSD), peripapillary retinal nerve fibre layer (RNFL) and macular ganglion cell complex (GCC) parameters were considered for the analysis. Patients were also classified according to MD deterioration (fast deterioration vs. slow deterioration). Results Visual field global indices, peripapillary RNFL thickness and macular GCC thickness showed no differences among the groups at the beginning and end of the follow-up. Besides all the comparisons among groups for differences before and after the follow-up of the MD, PSD, RNFL and GCC parameters were also non-significant. The proportions of patients according to MD deterioration were similar among the groups and subgroups (p > 0.05 for all the comparisons). Conclusion Oral antioxidant supplementation with or without ω-3 fatty acids does not appear useful as an adjuvant treatment of mild/moderate POAG in the short term.
Keywords: antiglaucoma agent; antioxidant; icaps r; oftan macula; omega 3 fatty acid; unclassified drug; adult; conference paper; controlled study; disease severity; female; follow up; Fourier domain optical coherence tomography device; human; Humphrey perimeter; intraocular pressure; macular ganglion cell complex; major clinical study; male; middle aged; multicenter study; open angle glaucoma; open study; optical coherence tomography device; outcome assessment; patient compliance; priority journal; prospective study; randomized controlled trial; retinal nerve fiber layer thickness; unspecified side effect; visual system parameters; icaps r; oftan macula

Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment - Abdull, M.M.; Gilbert, C.C.; Evans, J. (BMC ophthalmology, 2015)
BACKGROUND: To determine the stage of primary open angle glaucoma at presentation at a tertiary eye unit, to assess patient's knowledge of glaucoma and acceptance and subsequent adherence to treatment. METHOD: Information collected prospectively on new glaucoma patients aged 30 or more years included distance from residence and what they knew about glaucoma and its treatment. Treatment offered took account of disease severity and socioeconomic factors. Reasons for not accepting surgery were recorded. At follow up intraocular pressure (IOP) was measured and adherence to medication assessed verbally. Four categories of severity were defined based on visual acuity and visual fields defects in the worse eye. RESULTS: 131 patients were recruited (mean age 52.8 years; 62% male). Most attended because of symptoms (70%). Mean IOP in affected eyes was 31.9+/-SD 12.4 and mean vertical cup:disc ratio was 0.8. 99 eyes (47%) had a visual acuity of light perception or worse. Risk factors for advanced/end-stage disease were age >50 years, living >10 km from the hospital, some awareness of glaucoma, not being literate, being unemployed and presenting with symptoms. In multivariable analysis older age and poor knowledge of glaucoma remained independent risk factors. 75 were offered trabeculectomy: five agreed but only one underwent surgery. Reasons for rejecting surgery were fear (37%), preferred medical treatment (27 %) and cost (15 %). 32/85 (24 %) participants started on topical medication attended follow up. 72% reported excellent compliance but only 56% of glaucomatous eyes had IOPs less than 21 mmHg. CONCLUSIONS: To prevent glaucoma blindness strategies are required which promote earlier detection, with counselling to promote acceptance of and adherence to treatment.
Keywords: adult; aged; attitude to health; female; open angle glaucoma; human; intraocular pressure; male; middle aged; Nigeria; patient attitude; patient compliance; perimetry; physiology; prospective study; risk factor; statistics and numerical data; trabeculectomy; very elderly; visual acuity; visual field

Parent/caregiver health literacy among children with special health care needs: A systematic review of the literature - Keim-Malpass, J.; Letzkus, L.C.; Kennedy, C. (BMC Pediatrics, 2015)
Background: Children with special health care needs (CSHCN) are children with medical or behavioral diagnoses that require services beyond those generally needed by pediatric populations. They account for a significant portion of pediatric health care expenditures and often have complicated treatment regiments. Health literacy has recently been recognized as a key indicator of quality chronic disease self-management and parental/caregiver health literacy of CSHCN is an understudied area. The purpose of this systematic review was to assess the available evidence of studies investigating parent/caregiver health literacy of CSHCN. Methods: Databases were searched to retrieve relevant articles for inclusion (dating from 1998 to 2014). Only studies that assessed the relationship between parent/caregiver health literacy on outcomes pertinent to CSHCN were included. Because of the limited number of studies, there were no restrictions placed on type of outcome. Results: Thirteen studies were included in the final review with a range of health literacy assessments and outcome ascertainment. The majority of studies; (1) focused on the relationship between parental/caregiver health literacy and asthma outcomes, (2) were cross-sectional study designs, and (3) included samples recruited from pediatric clinics in academic medical settings. Conclusions: There were several gaps in the literature where future research is needed including; (1) direct assessment of child/adolescent health literacy, (2) inclusion of children with co-morbid conditions, (3) further assessment of the relationship between health literacy and health care utilization and cost, and (4) assessment of parental/caregiver health literacy in the inpatient care setting.
Keywords: article; asthma; attention deficit disorder; caregiver; child; chronic disease; cross-sectional study; glaucoma; health care need; health care utilization; health literacy; human; knowledge; outcome assessment; parent; practice guideline; systematic review

Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma - Siegel, M.J.; Boling, W.S.; Faridi, O.S.; Gupta, C.K.; Kim, C.; Boling, R.C.; Citron, M.E.; Siegel, M.J.; Siegel, L.I. (Clinical and Experimental Ophthalmology, 2015)
Background: To evaluate the long-term effects of combined endoscopic cyclophotocoagulation and phacoemulsification (phaco) versus phacoemulsification alone on intraocular pressure control and medication reliance in the treatment of mild to moderate glaucoma. Design: Retrospective chart review in private practice setting by glaucoma fellowship trained surgeons. Participants: A total of 261 eyes in the combined phaco-endoscopic cyclophotocoagulation group with 52 eyes in the phaco-alone group. Methods: Comparison of phaco-endoscopic cyclophotocoagulation with phaco alone over 36 months. Main Outcome Measures: Full and qualified success cumulative survival, intraocular pressure and medication reliance 6-36 months compared with baseline. Full success was defined as minimum 20% intraocular pressure reduction with a decrease of at least one ocular hypertensive medication. Qualified success was defined as intraocular pressure no higher than baseline with a decrease of at least one ocular hypertensive medication. Results: At 36 months, mean intraocular pressure in the combined phaco-endoscopic cyclophotocoagulation group was 14.6mmHg, whereas the phaco-alone group was 15.5mmHg (P=0.34). Mean medication reliance in the combined phaco-endoscopic cyclophotocoagulation group was 0.2 medications, whereas the phaco-alone group was 1.2 (P<0.001). Full success in the phaco-endoscopic cyclophotocoagulation group was 61.4%; the phaco-alone group was 23.3% (P<0.001). Qualified success survival was 72.6% in the phaco-endoscopic cyclophotocoagulation group and 23.3% in the phaco-alone group (P<0.001). Conclusions: Combined phaco-endoscopic cyclophotocoagulation effectively lowers or maintains intraocular pressure and results in ocular hypertensive medication reduction up to 36 months when compared with phaco alone. Therefore, phaco-endoscopic cyclophotocoagulation may help to increase medication compliance and reduce glaucoma progression in mild to moderate glaucoma.
Keywords: antiglaucoma agent; hyaluronic acid; ketorolac; prednisolone acetate; quinoline derived antiinfective agent; aged; article; closed angle glaucoma; controlled study; diode laser; endoscope; endoscopic cyclophotocoagulation; female; human; intermethod comparison; intraocular pressure; laser coagulation; lens implantation; low tension glaucoma; major clinical study; male; medical record review; open angle glaucoma; ophthalmic viscosurgical device; patient compliance; phacoemulsification; postoperative infection; postoperative inflammation; postoperative pain; private practice; surgeon; surgical technique; survival rate; treatment outcome; OcuLight

Long-term visual outcomes of secondary intraocular lens implantation in children with congenital cataracts - Rong, X.; Ji, Y.; Fang, Y.; Jiang, Y.; Lu, Y. (PLoS ONE, 2015)
Aim: The aim of this study was to evaluate the long-term visual outcomes and factors affecting visual results in children undergoing secondary intraocular lens (IOL) implantation following primary congenital cataract extraction. Methods: Children with congenital cataracts who underwent secondary IOL implantation for aphakia at the Eye and ENT Hospital of Fudan University between January 1, 2001, and December 31, 2007, were retrospectively reviewed. One eye was randomly selected in children with bilateral cataracts. Laterality, type of cataract (total or partial opacity), sex, age at primary and secondary surgeries, visual axis opacity (VAO), compliance with amblyopia therapy, postoperative ocular complications, refractive error, ocular alignment, and best corrected visual acuity (BCVA) at last follow-up were recorded; potential factors that might have affected the visual results were evaluated. Results: Seventy-six bilateral and 34 unilateral congenital cataract cases were analyzed; the mean ages of the children were 12.70±5.06 and 12.50±2.71 years at final follow-up, the mean follow-up periods from IOL implantation were 94.93±24.22 and 109.09±18.89 months, and the mean BCVA (Log MAR) values were 0.51±0.37 and 1.05±0.46, respectively. Final BCVA after secondary IOL implantation was significantly associated with laterality, type of cataract, age at primary cataract extraction, compliance with amblyopia therapy, and refractive correction after surgery. No significant associations were found between BCVA and sex, age at secondary IOL implantation, VAO, or other ocular complications. The most common ocular complications were VAO and elevated intraocular pressure after surgery. There were no other complications, with the exception of one eye with IOL dislocation. Conclusions: The results indicate that the important determinants of long-term visual outcomes in children with congenital cataracts undergoing secondary IOL implantation are laterality, cataract type, age at initial cataract extraction, compliance with amblyopia therapy, and refractive error.
Keywords: adolescent; adult; age; amblyopia; aphakia; article; cataract extraction; child; China; congenital cataract; female; follow up; human; intraocular hypertension; lens implantation; lens luxation; major clinical study; male; nystagmus; patient compliance; postoperative complication; refraction error; retrospective study; strabismus; university hospital; visual acuity; visual axis opacity

Noninvasive intraocular pressure monitoring: Current insights - De Smedt, S. (Clinical Ophthalmology, 2015)
Glaucoma is the second leading cause of blindness worldwide and intraocular pressure (IOP) is currently its only modifiable risk factor. Peak IOP has for a long time been considered as a major contributor to glaucoma progression, but its effects may depend not only on its magnitude, but also on its time course. The IOP is nowadays considered to be a dynamic parameter with a circadian rhythm and spontaneous changes. The current practice of punctual measuring the IOP during office hours is therefore a suboptimal approach, which does not take into account the natural fluctuation of IOP. Because of its static nature a single IOP measurement in sitting position fails to document the true range of an individual’s IOP, peak IOP, or variation throughout the day. Phasing means monitoring a patient’s IOP during the daytime or over a 24-hour period. This can provide additional information in the management of glaucoma patients. This review focuses on the current insight of non-invasive IOP monitoring as a method of obtaining more complete IOP profiles. Invasive techniques using an implantable sensor are beyond the scope of this review.
Keywords: biosensor; contact lens; contact lens sensor; arterial pressure; biosensor; blurred vision; circadian rhythm; clinical effectiveness; conjunctival hyperemia; contact lens; contact lens sensor; device safety; diagnostic test accuracy study; disease course; eye pressure monitor; eye structural assessment equipment; false positive result; Goldmann applanation tonometer; human; intraocular pressure; intraocular pressure monitoring; low tension glaucoma; non invasive measurement; nonhuman; oculoplethysmography; patient compliance; pressure measurement; punctate keratitis; reproducibility; review; self tonometry; time to treatment; Proview; SENSIMED Triggerfish; Tiolat iCare tonometer; Tono-pen

Factors associated with awareness, attitudes and practices regarding common eye diseases in the general population in a rural district in Bangladesh: The Bangladesh population-based diabetes and eye study (BPDES) - Islam, F.M.A.; Chakrabarti, R.; Islam, S.Z.; Finger, R.P.; Critchley, C. (PLoS ONE, 2015)
Background To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Methods Data were collected using a multilevel cluster random sampling technique from 3104 adults aged 30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Results Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p<0.001). Overall 51% of people had heard of at least six (67%) out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30-35 years (p<0.001). Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks. Conclusions In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.
Keywords: adult; age; age related macular degeneration; aged; article; Bangladeshi; blurred vision; cataract; diabetic retinopathy; educational status; eye disease; eye examination; female; glaucoma; health care utilization; health literacy; help seeking behavior; human; male; pterygium; random sample; rural population; socioeconomics; trachoma; visual impairment

Dexamethasone intravitreal implant in the treatment of diabetic macular edema - Dugel, P.U.; Bandello, F.; Loewenstein, A. (Clinical Ophthalmology, 2015)
Diabetic macular edema (DME) resembles a chronic, low-grade inflammatory reaction, and is characterized by blood–retinal barrier (BRB) breakdown and retinal capillary leakage. Corticosteroids are of therapeutic benefit because of their anti-inflammatory, antiangiogenic, and BRB-stabilizing properties. Delivery modes include periocular and intravitreal (via pars plana) injection. To offset the short intravitreal half-life of corticosteroid solutions (~3 hours) and the need for frequent intravitreal injections, sustained-release intravitreal corticosteroid implants have been developed. Dexamethasone intravitreal implant provides retinal drug delivery for 36 months and recently has been approved for use in the treatment of DME. Pooled findings (n=1,048) from two large-scale, randomized Phase III trials indicated that dexamethasone intravitreal implant (0.35 mg and 0.7 mg) administered at £6-month intervals produced sustained improvements in best-corrected visual acuity (BCVA) and macular edema. Significantly more patients showed a 315-letter gain in BCVA at 3 years with dexamethasone intravitreal implant 0.35 mg and 0.7 mg than with sham injection (18.4% and 22.2% vs 12.0%). Anatomical assessments showed rapid and sustained reductions in macular edema and slowing of retinopathy progression. Phase II study findings suggest that dexamethasone intravitreal implant is effective in focal, cystoid, and diffuse DME, in vitrectomized eyes, and in combination with laser therapy. Ocular complications of dexamethasone intravitreal implant in Phase III trials included cataract-related events (66.0% in phakic patients), intraocular pressure elevation 325 mmHg (29.7%), conjunctival hemorrhage (23.5%), vitreous hemorrhage (10.0%), macular fibrosis (8.3%), conjunctival hyperemia (7.2%), eye pain (6.1%), vitreous detachment (5.8%), and dry eye (5.8%); injection-related complications (eg, retinal tear/detachment, vitreous loss, endophthalmitis) were infrequent (<2%). Dexamethasone intravitreal implant offers a viable treatment option for DME, especially in cases that are persistent or treatment (anti-vascular endothelial growth factor/laser) refractory.
Keywords: NCT01309451; NCT01492400; NCT01571232; NCT01613716; NCT01788475; NCT01790685; NCT01951066; drug implant; corticosteroid; dexamethasone; fluocinolone acetonide; triamcinolone acetonide; best corrected visual acuity; cataract; chemosis; conjunctival hemorrhage; conjunctival hyperemia; conjunctivitis; device safety; diabetic macular edema; drug effect; drug efficacy; drug implant; drug mechanism; drug safety; drug tolerability; dry eye; endophthalmitis; human; implant fracture; intraocular hypertension; low level laser therapy; macular fibrosis; macular fibrosis; medical device complication; multicenter study (topic); nonhuman; patient compliance; phase 2 clinical trial (topic); phase 3 clinical trial (topic); randomized controlled trial (topic); retina detachment; retina hemorrhage; retina macula cystoid edema; retina maculopathy; retina tear; retinopathy; review; sustained drug release; visual acuity; vitreous body detachment; vitreous hemorrhage; ozurdex; Iluvien; Kenalog; Ozurdex; Retisert; Triesence; Trivaris

The prevalence and incidence of glaucoma in Denmark in a fifteen year period: A nationwide study - Kolko, M.; Horwitz, A.; Thygesen, J.; Jeppesen, J.; Torp-Pedersen, C. (PLoS ONE, 2015)
Purpose: The purpose of the present study was to describe the prevalence, incidence and geographic variation of glaucoma in Denmark in the period from 1996 to 2011. Moreover, the aim was to identify the treatment patterns of glaucoma within the studied period. Methods: All Danish citizens were included throughout the study period. The National Prescription Registry was used to identify all claimed prescriptions for glaucoma medication. Results: A total of 116,592 incident glaucoma patients were identified. Average age at onset was 66 years (range: 0-105 years), 55% were women. The prevalence of glaucoma increased from 0.79% to 1.72% during the investigated period. In 2011 glaucoma affected 3.76% of the population above 50 years and 10% in patients above 80 years. The age-specific incidence rate of glaucoma seemed to be constant and the increasing prevalence was primarily attributed to an aging population. We found the highest prevalence of glaucoma in the capital region of Denmark. Within the studied period the use of prostaglandin analogs and combination drugs increased, whereas the use of β-blockers, carbon anhydrase inhibitors and parasympathomimetic drugs decreased (p<0.001). Finally, the use of α2-adrenergic agonists remained unchanged. A total of 75% of the patients were treated with two or more glaucoma medications. Conclusions: Over all, the present study is the first to assess the frequency and the development of glaucoma in Denmark over a 15-year period. We find that glaucoma affects a little less than 2% of the total population and increases with age to reach a prevalence of more than 10% amongst people above 80 years. Generally, the present study is the largest nation-wide study ever made and must be a close-to-real-life-picture of the utilization of glaucoma medication on a national scale. Our findings confirm other recent estimations on an increasing burden of glaucoma globally. Copyright:
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin derivative; adult; aged; aging; article; controlled study; Denmark; female; glaucoma; health care utilization; human; incidence; male; onset age; population research; prevalence

Pharmacotherapy and Adherence Issues in Treating Elderly Patients with Glaucoma - Broadway, D.C.; Cate, H. (Drugs and Aging, 2015)
Glaucoma is a leading cause of visual morbidity throughout the world and is an age-related condition, the prevalence of which rises significantly with increasing age. Glaucoma, a condition affecting the optic nerve, has a variety of subtypes with multiple aetiological factors, the most important of which are intraocular pressure (IOP) and increasing age. Treatment by lowering of IOP is the only current method, for which there is evidence, by which the rate of progressive visual deterioration can be slowed or halted. Although there are surgical and laser treatments that are efficacious in lowering IOP, the most common manner in which patients with glaucoma control their IOP is with administration of daily topical ocular hypotensive drugs (eye drops). The variety of topical drugs utilised in the management of glaucoma all have the potential to have adverse effects and/or interactions with concomitant medications, many of which may be used for other age-related conditions. Adherence with appropriate medicines has a major effect on the outcome of medical conditions and this aspect applies to the management of glaucoma. There are certain specific issues that relate to the administration of topical agents, with respect to both adverse effects and adherence. Although many suspect poor adherence in elderly patients with glaucoma, relative to younger patients, adequate evidence for this is lacking. Furthermore, the manner by which adherence issues could be improved remains inadequately understood and poorly addressed. The aims of this article were to review, from a clinical perspective, the medical therapies currently used for glaucoma and discuss adherence issues with respect to the population of patients with glaucoma, who tend to be relatively elderly.
Keywords: acetazolamide; alpha adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; dorzolamide; glycerol; latanoprost; levobunolol; mannitol; miotic agent; osmotic diuretic agent; pilocarpine; prostaglandin derivative; tafluprost; timolol; travoprost; unoprostone; aqueous humor; bradycardia; bronchospasm; central nervous system disease; circadian rhythm; comorbidity; dehydration; drug hypersensitivity; elderly care; glaucoma; heart disease; human; hyperemia; intraocular pressure; life expectancy; miosis; myopia; open angle glaucoma; patient compliance; prescription; priority journal; quality of life; review; tachyphylaxis; taste disorder; xerostomia

Risk factors for predicting visual field progression in Chinese patients with primary open-angle glaucoma: A retrospective study - Hung, K.-H.; Cheng, C.-Y.; Liu, C.J.-L. (Journal of the Chinese Medical Association, 2015)
Background: Glaucoma is a leading cause of irreversible blindness worldwide. It is characterized by progressive deterioration of the visual field (VF) that results in a complete loss of vision. This study aimed to determine the risk factors associated with VF progression in Chinese patients with primary open-angle glaucoma (POAG). Methods: We reviewed the charts of POAG patients who visited our clinic between July 2009 and June 2010. We included patients with five or more reliable VF tests using the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA, USA) during a period of at least 2 years. The scoring system of the Collaborative Initial Glaucoma Treatment Study (CIGTS) was used to code the VF. Progression was defined as an increasing score ≥3, compared to the averaged baseline data. Univariate and multivariate logistic regression analyses were performed to identify the risk factors of VF progression. Results: There were 92 patients (representing 92 eyes) with an average of 8.9 reliable VFs over a mean follow up of 5.4 years. Multivariate logistic regression showed that eyes with more VF tests [odds ratio (OR) = 1.500, p < 0.010] and either increased peak intraocular pressure (IOP) (OR = 1.235, p = 0.044) or a wide IOP range (OR = 1.165, p = 0.041) favored VF progression. High myopia (less than -6.0 D) was not a risk factor (OR = 1.289, p = 0.698) for VF progression in this study. Conclusion: In addition to a greater number of VF tests, Chinese patients with treated POAG who experienced a high peak IOP or a wide range of IOP during follow up were more likely to have VF deterioration.
Keywords: adult; ambulatory care; article; Chinese; disease association; disease course; false negative result; family history; female; follow up; high myopia; human; intraocular pressure; major clinical study; male; medical record review; middle aged; open angle glaucoma; ophthalmological diagnostic device; quality of life; retina hemorrhage; retrospective study; risk factor; scoring system; visual acuity; visual field; Humphrey Field Analyzer

The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey - Newman-Casey, P.A.; Robin, A.L.; Blachley, T.; Farris, K.; Heisler, M.; Resnicow, K.; Lee, P.P. (Ophthalmology, 2015)
Purpose To evaluate the frequency of 11 commonly cited barriers to optimal glaucoma medication adherence among glaucoma patients and to identify barriers contributing to poor adherence. Design Prospective, cross-sectional survey. Participants One hundred ninety adults with glaucoma taking 1 or more glaucoma medication who received care in glaucoma clinics in Ann Arbor, Michigan, and Baltimore, Maryland. Methods Participants completed a survey on demographic and disease characteristics, barriers to optimal glaucoma medication adherence, interest in an eye drop aid, and self-reported adherence (measured by the Morisky Adherence Scale). Descriptive statistics and logistic regression analyses were performed. Main Outcome Measures Frequency and number of barriers to adherence among both adherent and nonadherent patients. Odds ratios (ORs) with 95% confidence intervals (CIs) identifying barriers associated with poor adherence. Results Twenty-seven percent of the sample reported poor adherence. Sixty-one percent of all participants cited multiple barriers and 10% cited a single barrier as impediments to optimal adherence. Twenty-nine percent of subjects cited no barriers, although only 13% of patients who cited no barriers were nonadherent. Among nonadherent patients, 31% or more cited each of the 11 barriers as important. Logistic regression analysis, adjusted for age, revealed that the following barriers were associated with higher odds of nonadherence: decreased self-efficacy (OR, 4.7; 95% CI, 2.2-9.7; P ≤ 0.0001), difficulty instilling drops (OR, 2.3; 95% CI, 1.1-4.9; P = 0.03), forgetfulness (OR, 5.6; 95% CI, 2.6-12.1; P ≤ 0.0001), and difficulties with the medication schedule (OR, 2.9; 95% CI, 1.4-6.0; P = 0.006). For each additional barrier cited as important, there was a 10% increased odds of being nonadherent (OR, 1.1; 95% CI, 1.0-1.2; P = 0.01). Conclusions Each of the 11 barriers was important to at least 30% of surveyed patients with poor adherence, with most identifying multiple barriers to adherence. Low self-efficacy, forgetfulness, and difficulty with drop administration and the medication schedule were barriers associated with poor adherence. Interventions to improve medication adherence must address each patient's unique set of barriers.
Keywords: eye drops; adult; article; confidence interval; controlled study; cross-sectional study; female; glaucoma; human; logistic regression analysis; major clinical study; male; medication compliance; patient compliance; priority journal; prospective study; self concept; self report; visual analog scale

Collaborative care: The way of the future - White, A.J.; Green, C.M. (Clinical and Experimental Ophthalmology, 2015)
Keywords: Australia; clinical decision making; editorial; glaucoma; health care cost; health care need; health care personnel; health care quality; health care utilization; high risk patient; human; integrated health care system; low risk patient; medical specialist; New Zealand; ophthalmologist; optometrist; outcome assessment; patient referral; practice guideline

Evolution of Corneal Transplantation in the Province of Quebec from 2000 to 2011 - Robert, M.-C.; Choronzey, M.-E.; Lapointe, J.; Gauvin Meunier, L.-P.; Harissi-Dagher, M.; Germain, M.; Mabon, M.; Brunette, I. (Cornea, 2015)
Purpose: The goal of this study was to determine the changes in surgical techniques and leading indications for corneal transplantations performed in the last decade. The impact of administrative changes of corneal banking in Quebec was also evaluated. Methods: The records of all corneal transplantations performed between January 2000 and December 2011 in the territory subserved by the Quebec Eye Bank and Héma-Québec (Quebec, Canada) were retrospectively reviewed. Results: A total of 3459 corneal transplantations were performed between 2000 and 2011. The rate of corneal transplantation more than doubled from 234 grafts per year in 2000 to 592 grafts per year in 2011. Imported tissue represented 40% of grafted corneas. Increases in tissue importation were seen in 2003 and 2009 to address local tissue shortage and peaks in wait time. The average wait time decreased from 434 ± 456 days (2000-2008) to 418 ± 551 days (2009-2011) (P 0.01). The leading surgical indications were Fuchs endothelial corneal dystrophy (27%), pseudophakic corneal edema (26%), keratoconus (13%), and viral keratitis (8%). Regrafts represented 25% of procedures. Descemet stripping automated endothelial keratoplasty became the preferred technique for endothelial diseases, surpassing penetrating keratoplasty in 2011. Conclusions: The surgical indications and techniques used for corneal transplantation in Quebec reflected those of the literature. However, long wait times and corneal tissue shortages mandated significant changes in the organization of the Quebec Eye Bank. Partnering with a larger agency responsible for tissue and blood donation coordination (Héma-Québec) had a positive impact on yearly transplantation rates and wait times.
Keywords: adolescent; adult; aged; article; Canada; cell count; comparative study; hereditary corneal dystrophy; controlled study; cornea donor; cornea edema; cornea transplantation; deep lamellar endothelial keratoplasty; Descemet stripping endothelial keratoplasty; endothelium cell; eye bank; female; health care access; hospital admission; human; infant; keratoconus; major clinical study; male; organ donor; penetrating keratoplasty; priority journal; pseudophakic corneal edema; retrospective study; selection bias; surgical technique; treatment indication; virus keratitis

Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis - Angeles-Han, S.T.; McCracken, C.; Yeh, S.; Jenkins, K.; Stryker, D.; Rouster-Stevens, K.; Vogler, L.B.; Lambert, S.R.; Drews-Botsch, C.; Prahalad, S. (Pediatric Rheumatology, 2015)
Background: Juvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to poor visual outcomes and impact a child's quality of life (QOL) and function. Our aim is to identify risk markers of JIA-U and examine differences in the QOL of children with JIA and JIA-U. Methods: Rheumatology and ophthalmology record reviews and questionnaires were completed every 4-6 months on 287 children with JIA. We collected arthritis, uveitis, and QOL data. We examined data through last study visit. Results: There were 52/287 (18 %) children with JIA-U who were younger at arthritis diagnosis, had oligoarticular persistent JIA, and ANA positive. Confirmed uveitis predictors were age at JIA diagnosis (OR=0.86) and oligoarticular subtype (OR=5.92). They had worse vision specific QOL and function, but similar general QOL. Blindness occurred in 17.5 % of children but was more common in African American children compared to non-Hispanic Caucasian children ((5/7 (71 %) vs. 2/29 (7 %), p <0.001) despite a similar uveitis prevalence (22 % vs. 16 %). Both races had similar complications, although band keratopathy was more frequent in African Americans (75 % vs. 15.6 %, p=0.003). Conclusions: We confirm young age at JIA diagnosis and the oligoarticular JIA subtype as predictors of uveitis development. Although we were unable to identify predictors of ocular complications or blindness, AA children appeared to have a more severe disease course manifested by increased ocular complications, vision loss and blindness. Potential causes that warrant additional study include underlying disease severity, access to medical care and referral bias. Further investigation of the risk factors for vision-compromising uveitis and its' long-term effects should be conducted in a large racially diverse population.
Keywords: abatacept; adalimumab; antinuclear antibody; cyclic citrullinated peptide antibody; etanercept; eye drops; infliximab; methotrexate; nonsteroid antiinflammatory agent; rheumatoid factor; steroid; adolescent; adult; African American; age; article; blindness; cataract; cataract extraction; Caucasian; child; childhood disease; cohort analysis; controlled study; disease association; disease duration; disease severity; eye disease; female; follow up; glaucoma; health care access; human; juvenile idiopathic arthritis associated uveitis; juvenile rheumatoid arthritis; keratopathy; major clinical study; male; oligoarticular juvenile rheumatoid arthritis; patient referral; preschool child; prevalence; priority journal; quality of life; race difference; retina macula cystoid edema; risk assessment; school child; synechiae; systemic juvenile idiopathic arthritis; uveitis; visual impairment; young adult

Fluticasone-formoterol: A systematic review of its potential role in the treatment of asthma - Prosser, T.R.; Bollmeier, S.G. (Therapeutics and Clinical Risk Management, 2015)
Background: The purpose of this systematic review is to summarize and evaluate the available published data regarding the efficacy and safety of a combination product containing fluticasone propionate/formoterol (FP-F) in order to establish its potential role compared with other inhaled combination corticosteroid/long-acting beta2 receptor agonists for the maintenance treatment of asthma. Methods: A PubMed and EMBASE search was conducted using the terms “fluticasone propionate”, “formoterol fumarate”, “Flutiform®”, and “asthma” in July 2014 to identify trials using this combination specifically for the treatment of asthma. Additional information was gathered from references cited in the identified publications, the package insert, and the ClinicalTrials.gov registry. All randomized controlled clinical trials for humans in asthma were evaluated for inclusion. Data from animal trials, clinical trials for chronic obstructive pulmonary disease, and non-English sources were excluded. Results: Seven short-term safety and efficacy trials of FP-F compared with its individual components and two comparison trials of FP-F versus other combination products were identified. Generally, the incidence of drug-related adverse events was low and consistent with previously reported drug class-related adverse events (ie, pharyngitis, dysphonia, and headache). The combination of FP-F was shown to be noninferior to fluticasone propionate/salmeterol for improving predose forced expiratory volume at one second (FEV1) and 2 hours post dose FEV1. FP-F was also noninferior to budesonide/formoterol in improving predose FEV1. Other clinical endpoints, including various symptom scores, asthma control, quality of life, and subjects’ assessment of the medications were not significantly different. Conclusion: Poor asthma control is common. The data from short-term studies indicate that this inhaled corticosteroid and long-acting beta2 receptor agonist combination product is noninferior to similar combination products available. As FP-F is available in different strengths, the corticosteroid dose can be titrated without changing devices. A potential advantage is that those with good technique, the same type of device could be used for both their controller and rapid relief inhaler medicines. The choice of this combination versus other similar products may be based primarily on cost.
Keywords: beclometasone; beclomethasone dipropionate; beta 2 adrenergic receptor; beta 2 adrenergic receptor stimulating agent; budesonide; budesonide plus formoterol; ciclesonide; corticosteroid; flunisolide; fluticasone furoate plus vilanterol; fluticasone propionate; fluticasone propionate plus formoterol fumarate; fluticasone propionate plus salmeterol; fluticasone propionate plus salmeterol xinafoate; formoterol fumarate; formoterol fumarate plus mometasone furoate; mometasone furoate; placebo; salbutamol; salmeterol; triamcinolone acetonide; antiinflammatory activity; article; asthma; bronchodilatation; cataract; drug binding site; drug efficacy; drug receptor binding; drug safety; drug tolerability; drug withdrawal; dysphonia; forced expiratory volume; glaucoma; headache; human; incidence; infection; influenza; monotherapy; patient assessment; patient compliance; pharyngitis; practice guideline; quality of life; randomized controlled trial (topic); rhinitis; rhinopharyngitis; scoring system; sinus congestion; systematic review (topic); throat irritation; thrush; upper respiratory tract infection; advair; breo; dulera; flutiform; seretide; symbicort

Glaucoma Medications Update: How to Improve Compliance and Adherence - Cakiner-Egilmez, T. (Insight (American Society of Ophthalmic Registered Nurses), 2015)
Keywords: antihypertensive agent; glaucoma; human; intraocular pressure; medication compliance; patient compliance

Prevalence of visual impairment and vision-threatening eye diseases in an underserved population - Guo, W.; Blachley, T.; Lee, P.P.; Newman-Casey, P.A. (Investigative Ophthalmology and Visual Science, 2015)
Purpose To assess the prevalence of vision threatening eye diseases and visual impairment among patients referred for ophthalmologic consultation from a local free clinic (Hope Clinic, Ypsilanti, Michigan) through a collaborative program with the University of Michigan before and after the implementation of the Affordable Care Act (ACA). Free clinic patients are seen after hours at the university eye clinic by volunteer physicians and staff to facilitate access to specialty equipment not available at the Hope Clinic. Methods We conducted a retrospective cohort study to determine the prevalence of visual impairment and vision-threatening eye disease in this underserved population and compared the prevalence of visual impairment between those who did and did not obtain health insurance after the initiation of the ACA. We used logistic regression analysis to evaluate potential socio-economic and demographic risk factors for visual impairment. Results 335 subjects were included between 9/2012-3/2014, and their average age was 55. 22% presented with visual impairment as defined by a best-corrected visual acuity <20/40 in the better-seeing eye, compared to 2.9% of the general US population >age 40. Significant causes of visual impairment were cataract, glaucoma, and refractive error (p=0.002). 21% of those who presented with visual impairment had a primary diagnosis of refractive error compared to 5.3% of the general US population. 23% of subjects obtained insurance after the launch of the ACA and Medicaid expansion, and subjects with visual impairment were not more likely to have obtained insurance through the ACA than those without visual impairment (p=0.6). Those who were employed had a 74% reduced odds of visual impairment compared to those who were unemployed (OR=0.26, 95% CI 0.10, 0.67, p=0.002). Conclusions Despite improvements in healthcare access with the ACA and through community free clinics such as Hope, specialty eye care and spectacle correction continue to be in high need, given that they are not covered through private insurance. However, new spectacles for adults over the age of 21 every 24 months are now covered by Medicaid expansion. Thus, as visual impairment due to refractive error continues to pose a needless burden on uninsured populations in the US, it will be important to consider extending vision benefits as in Medicaid into the qualified health plans initiated through the ACA.
Keywords: adult; best corrected visual acuity; cataract; cohort analysis; controlled study; diagnosis; eye care; female; glaucoma; health care access; human; logistic regression analysis; major clinical study; male; medicaid; medically uninsured; middle aged; prevalence; refraction error; risk factor; spectacles; unemployment; visual impairment; young adult

Estimating the cost of visual impairment: Initial results - Marques, A.P.; Macedo, A.F.; Rocha-Sousa, A.A.; Baptista, A.M.G.; Rubin, G.S.; Monteiro, J.; Moreno, L.H.; Cima, J.; Santana, R. (Investigative Ophthalmology and Visual Science, 2015)
Purpose: Vision loss can have a substantial human and economic impact on individuals and society that include disability, loss of productivity and reduction in quality of life. The purpose of this study was to estimate economic burden of visual impairment in Portugal. Methods: A prevalence-based cost of illness approach was adopted to estimate costs of vision impairment. We estimated direct medical costs and indirect economic costs. Direct medical hospital costs were determined using a bottom up approach. For those meeting the inclusion criteria (visual acuity of 20/40 or 0.5decimal or worse in the better eye and/or visual field of less than 20deg) we estimated direct costs by collecting information from administrative records that included: physician's office visits, emergency and outpatient visits. We developed a survey based in parts of the annotated cost questionnaire-HERU Discussion Paper N.03/01 (UK Working Party on Patient Costs) and the Service Receipt Inventory- European Version. Using the questionnaire that we developed, in face-to-face interviews, we collect direct medical expenditures supported by patients that included: costs with medical prescriptions, low vision aids and devices. With the same questionnaire we collected information for indirect costs calculations. Indirect costs were calculated by estimating the value of productivity losses including employment participation, absenteeism and caregiver costs. Results: Results presented here correspond to 442 patients that met the inclusion criteria. The four main causes of visual impairment in this sample were Diabetic Retinopathy, Cataract, Glaucoma and Age-related macular degeneration. Direct medical hospital costs were accountable for 12% of total costs calculated. Patient expenditures represented 25% of expenses with visual impairment and indirect costs corresponded to 63% of the total. From this data we estimated that the average annual direct cost per patient with VI was 958 euro and average annual indirect cost was 1655 euro. Conclusions: With the instruments and methodology that was adopted we were able quantify direct medical hospital costs as well as indirect costs of visual impairment. Results of this study show that more than half of the costs with VI are indirect. This highlights that particular attention should be given to costs that arise for individuals with vision loss.
Keywords: absenteeism; age related macular degeneration; ambulatory care; attention; blindness; calculation; caregiver; cataract; cost of illness; diabetic retinopathy; doctor patient relationship; emergency; employment; female; glaucoma; hospital cost; human; human tissue; information processing; interview; low vision; major clinical study; male; outpatient; Portugal; prescription; prevalence; productivity; quantitative study; questionnaire; visual acuity; visual aid; visual field

SLT as an essential tool for management of glaucoma in the African eye - Coleman, K.; Visser, L.; Goosen, E.; Sponsel, W.E.; Dalmar, A.; Galley, J. (Investigative Ophthalmology and Visual Science, 2015)
Purpose: Sub-Saharan Africa has fewer than 1 Ophthalmologist per million population. Sight preserving support services, including optometry and access to glaucoma medications, are absent in all but a few urban populations. Our experience in Africa since 2006, working in partnership with African eye surgeons, has revealed a remarkably high incidence of untreated early and advanced glaucoma. This study reports initial experience using SLT in adult glaucoma patients in Durban, South Africa. Methods: Lumenis Selecta SLT was performed on either or both eyes of consecutive glaucoma patients. After recording pre-treatment IOP by applanation,1800 treatment with ∼50 spots was performed, titrating from 0.5 mJ, in +.1 mJ increments until bubbles arose from ∼1 in every 3 spots placed. Repeat tonometry was scheduled at 1 and 6 months post-SLT. Significance of change in IOP from baseline was assessed by 2-tailed paired t-test. Results: Among 90 treated patients (65 black, 22 Indian, 3 white; 48M, 42F; mean age 59 ±[sem]1.3yrs ), 63 (70%) returned for at least one of the two scheduled follow-up visits. 20 patients (31.7%) had a prior history of glaucoma filtration surgery in at least one eye. At 1 mo, treated right eyes (n=35) showed reduction of -4.6mmHg (-25.3%) from the associated pre-treatment IOP, from 19.1 to 14.5mmHg. Among left eyes the corresponding findings were n=38; Δ-7.6 (-36.0%) from 21.2 to 13.6mmHg. The 6 mo values were OD n=33; Δ-4.7 (-24.9%) from 18.9 to 14.2mmHg, and OS n=32; Δ-5.9 (-30%). All results had P < 0.0001. No evidence for any systematic bias influencing follow-up attrition was evident from the available clinical data. Conclusions: SLT appears to be a very effective choice of treatment to reduce intraocular pressure among glaucomatous eyes of South African adults, with or without a history of medical and surgical glaucoma therapy. Mean reductions of IOP of 25-30% were sustained for 6 months without supplementary therapy. If such findings can be confirmed among other populations on the continent, the potential for SLT to help prevent visual loss in Africa would be inestimable. Further investigation is needed to identify duration of effect, utility of supplementary therapy, and to improve follow-up compliance. The impact of these findings may be highly significant where glaucoma medications and general services are essentially unavailable.
Keywords: adult; blindness; clinical trial; drug dose titration; female; filtering operation; follow up; glaucoma; human; intraocular pressure; major clinical study; male; middle aged; prevention; South Africa; South African; statistical bias; Student t test; tonometry

Effectiveness of glaucoma counseling on patient follow-up rates and glaucoma knowledge in a South Indian population - Do, A.; Singh, K.; Pilai, M.; Balakrishnan, V.; Chang, R.; Lee, B. (Investigative Ophthalmology and Visual Science, 2015)
Purpose: This study aims to compare the impact of traditional counseling versus patient-centered counseling including recorded audio reinforcement on clinical follow-up rates and patient retention of basic glaucoma knowledge. Methods: This prospective randomized controlled trial compared three types of glaucoma counseling: (1) traditional counseling which consisted of one-way information sharing, (2) patient-centered counseling which focused on filling in gaps in patient knowledge and empowering patients to understand their disease, and (3) patient-centered counseling with recorded audio information reinforcement. 399 consecutive patients newly diagnosed with glaucomatous disease at the Aravind Eye Hospital glaucoma clinic in South India were enrolled and randomized to receive the either the standard glaucoma counseling or one of the two new methods of patientcentered counseling. All subjects completed an 8-point glaucoma knowledge questionnaire before and after counseling sessions at diagnosis and 1-month follow-up. Patients were advised to return to clinic for routine follow-up and repeat counseling at 1, 3, 6, 9, and 12 months after enrollment. Multivariate logistic regression model was used to determine factors associated with appropriate followup, defined as at least 3 follow-up visits. Main outcome measures included Glaucoma Knowledge Assessment Score (GKAS) and the proportion of subjects with adequate follow-up. Results: Overall, only 13.5% of the 399 subjects completed the three-visit requirement for appropriate follow-up. There was no significant difference in follow-up rate among the three groups (12.8% with traditional counseling, 11.3% with patient-centered counseling, and 16.5% with patient-centered counseling and audio reinforcement). The mean GKAS improved an average of 77.6% with counseling and did not differ amongst the three groups (p<0.0001). While the GKAS gradually decreased with time and increased with repeat counseling, no difference in this parameter was found between groups at any time point. Conclusions: While initial and repeat patient-centered counseling significantly improved patient knowledge regarding glaucomatous disease and the importance of appropriate follow-up, the majority of newly diagnosed glaucoma patients did not return for care, suggesting that factors other than disease information likely impact adherence to appropriate follow-up schedules.
Keywords: controlled clinical trial; controlled study; counseling; diagnosis; doctor patient relationship; female; follow up; glaucoma; human; India; logistic regression analysis; major clinical study; male; model; questionnaire; randomized controlled trial; reinforcement (psychology)

Adherence to Follow-Up Appointments in a Resident Glaucoma Clinic vs. Primary Eye Care Clinic: A Retrospective Analysis - Lee, B.; Fudemberg, S.; Murphy, R.; Hark, L.A.; Waisbourd, M.; Dai, Y.; Leiby, B. (Investigative Ophthalmology and Visual Science, 2015)
Purpose: Glaucoma is a slow, progressive disease that is among the leading causes of blindness worldwide. However, patient adherence to treatment is exceedingly low. We performed a retrospective study to determine the role of telephone reminders in increasing adherence. Methods: This retrospective, case-controlled study included randomly selected subjects from a cataract and primary eye care clinic (CPEC) and a specialty glaucoma clinic. Subjects in the CPEC clinic received telephone reminders while those in the glaucoma clinic did not. Each sample was selected to have similar proportions of follow-up recommendations of 1 month, 3 months, and 6 months, and subjects were considered adherent if they returned within the specified timeframe. Chisquare tests were conducted to compare adherence rates between different clinics, age groups, genders, races, insurance statuses, glaucoma diagnoses, number of ocular medications, and follow-up recommendations. A logistic regression model was used to determine the odds ratios for each factor. Results: A total of 144 subjects from the glaucoma clinic and 151 subjects from the CPEC clinic were included. There was no significant di erence in follow-up rates between the glaucoma clinic (68.1%) and the CPEC clinic (65.6%) (P=0.65). We found that patients who were on more than two ocular medications were more likely to return for follow-up (OR=3.99 95%CI 1.92-8.30). Subjects ages 50 to 80 (71.4%) were more likely to follow-up than their younger (57.9%) and older (54.9%) peers. Conclusions: The follow-up adherence of patients in a primary eye care clinic who receive telephone reminders is similar to patients in a glaucoma clinic who do not. Young and elderly subjects are less likely to follow-up.
Keywords: adult; aged; cataract; controlled clinical trial; controlled study; diagnosis; eye care; female; follow up; gender; glaucoma; hospital; human; insurance; logistic regression analysis; major clinical study; male; model; odds ratio; population based case control study; race; randomized controlled trial; resident; retrospective study; telephone

Compliance with follow-up after trabeculectomy surgery in rural Southern China - Yang, K.; Jin, L.; Li, L.; Dan, A.; Chen, T.; Congdon, N.G. (Investigative Ophthalmology and Visual Science, 2015)
Purpose Glaucoma is the second-leading cause of blindness in China and globally. In rural areas, surgery is the primary treatment, and patient post-operative follow-up is a crucial determinant of surgical success. We sought to evaluate follow-up rates and their determinants in rural southern China. Methods Data on follow up at one week, two weeks, and one month after surgery were obtained from medical records. Patients completed questionnaires providing demographic and socioeconomic information, their transportation status, and knowledge and attitudes about glaucoma, glaucoma surgery and importance of follow-up. Linear regression models were used to assess potential predictors of follow-up. Results Among 212 patients enrolled and completing questionnaires at 14 rural county-level hospitals in Guangdong and Guangxi Provinces (mean age 60.2 +/-15.2 years, 54.3% women), the post-operative follow-up rates were 60.8% (129/212),75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month respectively. Predictors of poor follow-up (treated as a cumulative score, 10 points at 1 week, 7 points at 2 weeks, 5 points at one month) in multiple regression models included having received no formal education (Beta=-3.04, 95% CI-5.56,-0.52, p=0.022), believing follow-up is less important (Beta=-2.64, 95% CI-4.67,-0.61, P=0.015) and lack of an accompanying friend or family member (Beta=-4.94, 95 CI-5.67,-4.21, P<0.001). Age, sex, employment, transportation, and travel distance, time and costs were not significantly associated with follow-up. Conclusions Only a quarter of rural patients returned a month after glaucoma surgery, at a time when important post-operative interventions affecting outcome (removal of sutures, adjustment of medications, ocular massage) would still be done. Interventions targeting less-educated patients, providing support for return visits and explaining the importance of follow-up are needed.
Keywords: adult; doctor patient relationship; education; employment; family; female; follow up; friend; glaucoma surgery; Guangxi; human; linear regression analysis; major clinical study; male; massage; medical record; middle aged; model; multiple regression; questionnaire; surgery; suture; trabeculectomy; travel

A pilot study of the effectiveness of motivational interviewing to improve adherence to glaucoma treatment in patients of African descent - Altaras, I.; Bigatti, S.; Sirk, E.; Hosty, E.; Payton, C.; Grow, S.; Sutton, B.; Torbit, J.; Idowu, E.; Racette, L. (Investigative Ophthalmology and Visual Science, 2015)
Purpose: The first line of treatment for open-angle glaucoma is the use of daily hypotensive eye drops to control intra-ocular pressure. Adherence to this treatment is known to be challenging for patients, and has been reported to be worse in patients of African descent (AD), a segment of the population that is disproportionately affected by the disease. Motivational interviewing (MI) can improve adherence and has been shown to be more effective in minority populations. The purpose of this prospective, longitudinal and interventional pilot study was to determine whether MI might improve adherence in glaucoma patients of AD. Methods: Thirteen patients of African descent (AD) who received a clinical diagnosis of open-angle glaucoma within the past five years were included in this study. All patients used once-daily prostaglandin analog eye drops and administered their medication. Adherence was measured using Medical Event Monitoring System (MEMS) bottles. The cap of these bottles electronically records the date and time at which the bottle is opened. At visit 1, patients were instructed to place their eye drop bottle in the MEMS bottle and to otherwise use their eye drops as usual. At the 4-weeks visit, baseline adherence was assessed. Patients with adherence levels below 75% (n=9) received an approximately 20-minutes MI intervention and those with adherence levels over 75% served as controls (n=4). At the 12-weeks visit, patients returned and the final adherence was assessed. The difference between baseline and final adherence was compared between the groups using one-tailed paired t-tests. Results: In the group who received MI, final adherence (67.9% ± 7.68) was significantly higher than baseline adherence (55.95% ± 22.16) (p=0.03). Adherence improved in all but one of these patients (the adherence of one patient decreased by 0.2%). In controls, no significant difference between baseline adherence (81.38% ± 5.52) and final adherence (82% ± 17.33) (p=0.46) was observed. In this group, adherence improved in two patients (by 11.3% and 10.7%) and decreased in two patients (by 3.6% and 15.9%). Conclusions: These preliminary results obtained in a small sample suggest that MI may be effective in improving adherence in glaucoma in patients of African descent.
Keywords: antihypertensive agent; eye drops; prostaglandin derivative; clinical article; clinical trial; controlled study; diagnosis; drug therapy; female; human; human tissue; information processing; male; monitoring; motivational interviewing; open angle glaucoma; pilot study; Student t test

Fixed-combination treatments for intraocular hypertension in Chinese patients – Focus on bimatoprost-timolol - Fang, Y.; Ling, Z.; Sun, X. (Drug Design, Development and Therapy, 2015)
Glaucoma is a common eye disease that can lead to irreversible vision loss if left untreated. The early diagnosis and treatment of primary open-angle glaucoma is challenging, and visual impairment in Chinese glaucoma patients is a serious concern. Most of these patients need more than one topical antiglaucoma agent to control their intraocular pressures (IOPs). In the People’s Republic of China, the daily cost of different glaucoma medication varies greatly, and the treatment habits differ throughout the country. Prostaglandin analogs (PGAs) are recommended as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Fixed-combination drops, particularly PGA-based fixed combinations, have recently been developed and used in patients with progression or who have failed to achieve their target IOPs. Here, we reviewed the current literature on the use of bimatoprost-timolol fixed combination (BTFC) in the People’s Republic of China. BTFC has achieved good efficacy and tolerability in Chinese clinical trials. In addition, BTFC is more cost effective compared with other fixed combinations available in the People’s Republic of China. Fixed-combination drops may offer benefits, such as keeping the ocular surface healthy, convenience of administration, and improvement in long-term adherence and quality of life. Therefore, BTFC has great potential for the treatment of Chinese glaucoma patients. However, the long-term efficacy of BTFC, comparisons of BTFC with other fixed-combination drugs, and treatment adherence and persistence with treatment in Chinese patients are unknown and will require further study.
Keywords: benzalkonium chloride; bimatoprost; bimatoprost plus timolol; eye drops; latanoprost; latanoprost plus timolol; prostaglandin derivative; timolol; timolol plus travoprost; travoprost; Chinese; conjunctival hyperemia; cost effectiveness analysis; deepening of the upper eyelid sulcus; deepening of the upper eyelid sulcus; drug cost; drug efficacy; drug safety; drug tolerability; evening dosage; eye disease; eye pain; eyelash bristling; eyelash bristling; eyelash lengthening; eyelash lengthening; eyelid pigmentation; eyelid pigmentation; glaucoma; human; intraocular hypertension; intraocular pressure; iris pigmentation; iris pigmentation; low tension glaucoma; medication compliance; open angle glaucoma; patient compliance; quality of life; review; unspecified side effect; ganfort; lumigan; travatan; xalacom; xalatan

Selective laser trabeculoplasty: Current perspectives - Leahy, K.E.; White, A.J. (Clinical Ophthalmology, 2015)
Selective laser trabeculoplasty (SLT) has been used in the treatment of glaucoma for just over a decade. Here, we review the current literature in terms of suggested mechanism, efficacy, method of treatment, predictors of success, adverse events, repeatability, and cost of SLT. The exact mechanism by which SLT lowers intraocular pressure (IOP) remains unknown although circumstantial evidence has come in many forms in relation to structural alteration; oxidative stress and inflammatory responses; tight junction integrity; proliferative responses; and microbubble formation. SLT is as effective as argon laser trabeculoplasty and medications in reducing IOP in glaucoma and ocular hypertension. The treatment is not uniformly effective in all eyes, and its IOP-lowering effect decreases over time. High pretreatment IOP is the strongest predictor of success; however, significant pressure reduction has also been shown in normal-tension glaucoma and in patients already taking multiple antiglaucoma drops. Mild, transient adverse effects are common. Transient IOP spikes usually resolve quickly with or without antiglaucoma treatment but may be problematic in pigmented angles. The limited available evidence suggests SLT is repeatable and cost-effective for the treatment of glaucoma and ocular hypertension.
Keywords: antiglaucoma agent; protein ZO1; triamcinolone; argon laser; argon laser trabeculoplasty; cell proliferation; clinical effectiveness; corneal stromal edema; cost; cost effectiveness analysis; diabetic macular edema; eye discomfort; eye disease; eye pain; eye redness; glaucoma; human; inflammation; intraocular hypertension; intraocular pressure; laser surgery; low tension glaucoma; microbubble; oxidative stress; patient compliance; peripheral anterior synechiae; photophobia; pigmentary glaucoma; pseudoexfoliation; repeat procedure; retina macula cystoid edema; review; selective laser trabeculoplasty; tight junction; trabecular meshwork; trabeculoplasty

Comparing total and disease specific healthcare costs for glaucoma patients before and after their index diagnosis: A retrospective claims database analysis - Yep, T.; Patel, V.; Slejko, J.F.; Devine, B. (Value in Health, 2015)
OBJECTIVES: Describing the cost of care for glaucoma patients will lead to a better understanding of the disease impact on the healthcare system. Few studies have determined healthcare costs associated with glaucoma patients, and even fewer examined a commercially insured population. This study sought to characterize and compare the glaucoma specific costs and overall healthcare costs before and after diagnosis. METHODS: We analyzed a large US commercial claims database to identify patients 18 years and older with an initial diagnosis of open-angle glaucoma occurring in 2011. Patients with two separate occurrences of open-angle glaucoma codes (ICD-9 365.10 or 365.11) were included. Patients were excluded for presence of a glaucoma code in the 12 months before their initial diagnosis, other types of glaucoma (i.e. angle-closure glaucoma), or other possible causes of vision loss (i.e.: cataracts). Outcomes of interest were glaucoma specific and overall healthcare costs for the 12-months before (baseline) and 12-months after (follow-up) initial diagnosis. Costs consisted of inpatient stays, emergency department visits, general and vision related office visits, glaucoma diagnostic tests, glaucoma surgeries, and medications. Paired t-tests were used to compare baseline and follow-up costs. RESULTS: 8,575 patients were identified as having newly diagnosed glaucoma in 2011. Mean glaucoma specific baseline costs were $107 (95% CI: $102, $112) and follow-up costs were $487 (95% CI: $475, $498); resulting in a 4.6-fold increase from baseline (p ≤ 0.001). 41% of follow-up glaucoma costs were due to glaucoma medications. Mean overall healthcare costs at baseline were $5,405 (95% CI: $5,122, $5,688) and at follow-up were $7,106 (95% CI: $6,677, $7,534); resulting in a 1.3-fold increase from baseline (p ≤ 0.001). 23.2% of follow-up total healthcare costs were due to medications. CONCLUSIONS: Glaucoma specific and overall healthcare costs significantly increase after glaucoma diagnosis for patients who are commercially insured.
Keywords: health care cost; glaucoma; patient; human; diagnosis; data base; follow up; drug therapy; open angle glaucoma; Student t test; diagnostic test; ICD-9; emergency ward; hospital patient; population; cataract; visual impairment; ambulatory care; glaucoma surgery; closed angle glaucoma; health care system

Safety and efficacy of switching from dorzolamide 1.0%/timolol maleate 0.5% eye drops to brinzolamide 1.0%/timolol maleate 0.5% eye drops - Inoue, K.; Shiokawa, M.; Ishida, K.; Tomita, G. (Clinical Ophthalmology, 2015)
Purpose: To evaluate the safety and efficacy of switching from dorzolamide 1.0%/timolol maleate 0.5% fixed-combination (DTFC) eye drops to brinzolamide 1.0%/timolol maleate 0.5% fixed-combination (BTFC) eye drops in patients with primary open-angle glaucoma or ocular hypertension. Methods: A total of 35 eyes of 35 patients with primary open-angle glaucoma or ocular hypertension using DTFC eye drops were included. Participants discontinued DTFC drops and immediately began using BTFC drops. All other eye drops currently being used were continued. Intraocular pressure (IOP) 1 and 3 months after switching medications was compared with baseline IOP. One month after switching medications, participant preference and adherence were evaluated. Adverse reactions were monitored at each study visit. Results: The IOP was 17.9±2.6 mmHg at baseline and 18.3±4.1 mmHg and 17.8±3.4 mmHg 1 month and 3 months after switching medications, respectively (P=0.633). The frequency of missing a dose was not different before (6.1%) and after (6.1%) switching to BTFC. Significantly fewer participants reported stinging after switching to BTFC (15.2%) than while using DTFC (51.5%, P,0.01). Blurred vision was reported with the same frequency before (39.4%) and after (42.4%) switching to BTFC. A total of 33.3% and 27.3% of patients preferred DTFC and BTFC, respectively. Several patients withdrew from the study because of discomfort (n=2, 5.7%), discharge (n=1, 2.9%), dizziness (n=1, 2.9%), or increased IOP (n=2, 5.7%). Conclusion: Switching from DTFC to BTFC was well tolerated and did not result in IOP changes or a decreased patient adherence. When glaucoma patients complain of stinging with DTFC administration, switching to BTFC is an acceptable treatment option.
Keywords: brinzolamide plus timolol; dorzolamide plus timolol maleate; eye drops; adult; aged; article; blurred vision; clinical article; clinical trial; dizziness; drug efficacy; drug preference; drug safety; drug substitution; drug withdrawal; evening dosage; eye discharge; eye discomfort; female; human; intraocular hypertension; intraocular pressure; male; medication compliance; morning dosage; open angle glaucoma; pain; patient comfort; patient compliance; patient preference; stinging; stinging; azarga; cosopt

Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter? - Calderón-Larrañaga, A.; Abad-Díez, J.M.; Gimeno-Feliu, L.A.; Marta-Moreno, J.; González-Rubio, F.; Clerencia-Sierra, M.; Poblador-Plou, B.; Poncel-Falcó, A.; Prados-Torres, A. (European Journal of Internal Medicine, 2015)
To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. Methods Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n = 65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. Results Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). Conclusion In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.
Keywords: acquired immune deficiency syndrome; acute heart infarction; acute leukemia; adult; affective psychosis; anxiety disorder; aortic aneurysm; aphakia; aplastic anemia; arthropathy; article; asthma; atherosclerosis; attention deficit disorder; autoimmune disease; behavior disorder; bladder cancer; blindness; blood clotting disorder; breast cancer; cardiomyopathy; cardiovascular disease; cataract; cerebral palsy; cerebrovascular disease; chromosome aberration; chronic kidney failure; chronic liver disease; chronic obstructive lung disease; chronic pancreatitis; cleft lip; clinical assessment; colorectal cancer; comorbidity; congenital heart disease; congenital hip dislocation; congenital malformation; congestive heart failure; connective tissue disease; cystic fibrosis; deep vein thrombosis; delirium; dementia; depression; dermatitis; developmental disorder; diabetic patient; diabetic retinopathy; disorders of lipid metabolism; diverticulosis; eczema; emergency ward; emphysema; endocrine disease; endometriosis; esophagus cancer; female; gallstone formation; gastroesophageal reflux; glaucoma; gout; hair disease; health care utilization; hearing impairment; heart arrhythmia; hematologic disease; hemolytic anemia; hemophilia; hospital service; human; Human immunodeficiency virus infection; hypertension; hypospadias; hypothyroidism; immunopathology; iron deficiency anemia; irritable colon; ischemic heart disease; kidney disease; kyphoscoliosis; lactose intolerance; leg varicosis; length of stay; longitudinal study; low back pain; lung embolism; lymphoma; major clinical study; male; malignant neoplasm; medical specialist; metabolic disorder; multiple sclerosis; muscular dystrophy; nephritis; neuritis; neurologic disease; neurosis; non insulin dependent diabetes mellitus; obesity

Safety and tolerability of the tafluprost/timolol fixed combination for the treatment of glaucoma - Holló, G.; Katsanos, A. (Expert Opinion on Drug Safety, 2015)
Introduction: The preservative-free (PF) fixed combination (FC) of tafluprost 0.0015%/timolol 0.5% is the newest member of the prostaglandin analogue/timolol FC class.Areas covered: In this review, we summarize data on safety and tolerability of this FC.Expert opinion: The intraocular pressure-lowering effect of the tafluprost/timolol FC is approximately 30-35%, which is similar to that of the other members of the class. However, in contrast to most similar eye drops the tafluprost/timolol FC is manufactured in a PF, unit-dose pipette formulation. The PF nature eliminates preservative-related ocular surface changes, and improves tolerability. In clinical studies, the tafluprost/timolol FC was well tolerated. The side effects represented the typical side effects of the topical prostaglandin analogue class. The most common side effect, conjunctival hyperemia was mild, and occurred in only 6.4-8% of patients during 6 months of treatment. The figures for ocular irritation were also low (7.0-12.7%). The other side effects occurred only in very few patients. The frequency and severity of conjunctival hyperemia was lower than those published for most prostaglandin/timolol FCs. Thus, the main clinical advantage of this PF FC is improved tolerability, which may support treatment adherence of glaucoma patients.
Keywords: antiglaucoma agent; drug preservative; prostaglandin derivative; tafluprost; tafluprost plus timolol; timolol; unclassified drug; article; asthma; blepharitis; bradycardia; clinical feature; clinical trial (topic); comparative effectiveness; conjunctival hyperemia; disease severity; dizziness; drug efficacy; drug formulation; drug induced headache; drug manufacture; drug safety; drug tolerability; eye injury; eye irritation; eye pain; faintness; falling; glaucoma; heart block; heart failure; herpes simplex keratitis; human; intraocular hypertension; intraocular pressure; medication compliance; monotherapy; multicenter study (topic); ocular pruritus; ocular surface disease; orthostatic hypotension; patient compliance; phase 3 clinical trial (topic); randomized controlled trial (topic); retina macula cystoid edema; sexual dysfunction; side effect; topical treatment; weakness

Determinants of glaucoma patients who overreport medication adherence via self-report on a visual analog scale - Sayner, R.; Blalock, S.; Carpenter, D.; Robin, A.; Muir, K.; Hartnett, M.; Giangiacomo, A.; Tudor, G.; Sleath, B. (Journal of the American Pharmacists Association, 2015)
Objective: The objectives of this study were to: (1) compare patient-reported glaucoma medication adherence on the visual analog scale (VAS) with adherence data collected from Medication Event Monitoring Systems (MEMS) electronic monitors and (2) identify which patient characteristics were associated with overreporting adherence on the VAS. Methods: A cohort study was conducted at six ophthalmology practices. English-speaking adults with glaucoma were recruited. Patients were interviewed after their medical visits and were given MEMS bottles. The MEMSmeasured percent adherence assessed the percentage of prescribed number of doses taken and the MEMS-measured timing adherence assessed the percent of doses taken on time for 60 days following the initial visit. Patients reported adherence on the VAS approximately 60 days after their initial visit. The VAS has been validated against prescription medication refills. Bivariate analyses were used to analyze the data. Results: Compared with MEMSmeasured percent adherence, 31% (n = 75) overestimated their adherence on the VAS while 58% (n = 140) underestimated. Compared with MEMS-measured timing adherence, 74% (n = 177) overestimated on the VAS while 24% (n = 58) underestimated. Compared with the MEMS-measured percent adherence, patients who were newly prescribed glaucoma medications were significantly more likely to overreport adherence on the VAS (Pearson χ2 = 15.2; P <0.001). Compared with the MEMS timing adherence, being male (Pearson χ2 = 6.78; P = 0.009) and being prescribed glaucoma medications dosed multiple times daily (Pearson χ2 = 4.02; P = 0.045) were significantly associated with patients overreporting adherence on the VAS. Conclusion: Patient's perceptions of their own adherence differ significantly from measured adherence, especially with regard to timing. Providers should rely on multiple methods for assessing medication adherence. Pharmacists should take a role in helping glaucoma patients by answering any glaucoma medication questions and encouraging patients to report any glaucoma medication problems to their provider. Additionally, pharmacists could reinforce the importance of medication adherence to patients who do not pick up their medications on time.
Keywords: human; medication compliance; visual analog scale; self report; patient; glaucoma; drug therapy; microelectromechanical system; pharmacist; speech; cohort analysis; monitor; ophthalmology; bivariate analysis; monitoring; prescription; adult; male

APhA2015 (Journal of the American Pharmacists Association, 2015)
The proceedings contain 411 papers. The topics discussed include: assessment of workflow modifications of the medication synchronization program in a community pharmacy; classifying medication adherence behavior based on beliefs about medicines and illness perceptions: results from a cluster analysis; community pharmacists' interventions: effects on patients' adherence to medicare star rating medications; comparison of medication adherence rates between an appointment-based medication synchronization program and an automatic medication refill process; determinants of glaucoma patients who over-report medication adherence via self-report on a visual analog scale; developing a scoring algorithm for the medication adherence reasons scale; development and implementation of an adherence pharmacy model in community practice; and effects of community pharmacist telephone follow-up on adherence and readmission rates in the heart failure population: a multicenter study.
Keywords: human; medication compliance; drug therapy; pharmacy (shop); multicenter study (topic); pharmacist; patient; cluster analysis; visual analog scale; self report; glaucoma; population; medicare; heart failure; hospital readmission; algorithm; follow up; telephone; community; model; diseases; multicenter study; workflow

Oral steroid therapy as an adjuvant treatment for severe epidemic keratoconjunctivitis in patients younger than 3 years - Kim, S.Y.; Chung, Y.K.; Lee, Y.-C.; Kim, S.-Y. (Cornea, 2015)
Purpose: To evaluate the therapeutic effect of oral steroids given to patients younger than 3 years with epidemic keratoconjunctivitis (EKC) accompanied by severe eyelid edema and inflammatory ptosis, in whom eye drops were not feasible. Methods: This study included 9 patients treated for EKC in local clinics whose condition failed to improve due to severe eyelid swelling together with difficulties in application of eye drops and pseudomembrane removal. We analyzed the extent of eyelid swelling, corneal damage, follicles, chemosis, and pseudomembrane formation in these patients before and after oral corticosteroid therapy in collaboration with the pediatrics department. Results: After a mean of 1.8 ± 0.7 days of oral steroid treatment, eyelid edema, corneal damage, conjunctival injection, follicles, and chemosis improved in all patients. Conclusions: Oral steroids are an effective adjuvant treatment for EKC in patients younger than 3 years in whom eye drops could not be administered frequently due to severe eyelid edema.
Keywords: eye drops; fluorometholone; ofloxacin; prednisolone; proxymetacaine; tobramycin sulfate; antibiotic therapy; article; boy; bronchiolitis; chemosis; child; clinical article; conjunctivitis; cornea injury; cornea ulcer; corticosteroid therapy; disease severity; drug dose increase; epidemic; epidemic keratoconjunctivitis; eye discomfort; eye pain; eyelid edema; female; follow up; gastrointestinal symptom; girl; herpes simplex keratitis; human; keratoconjunctivitis; male; medical history; medical record review; medication compliance; otitis media; patient compliance; physical examination; portable equipment; priority journal; retrospective study; secondary infection; short course therapy; skin defect; slit lamp; topical anesthesia; topical treatment; treatment duration; upper respiratory tract infection; ocuflox; ocumetholone; solondo; tobra

Providing prescheduled appointments as a strategy for improving follow-up compliance after community-based glaucoma screening: results from an urban underserved population - van Zyl, T.; Su, Z.; Zhou, E.; Wong, R.K.; Mohsenin, A.; Rogers, S.; Tsai, J.C.; Forster, S.H. (Journal of community health, 2015)
To determine if receiving a prescheduled appointment is associated with an increased likelihood of complying with follow-up eye care among individuals identified as at risk for glaucoma during community-based glaucoma screening in an urban underserved population. This study sampled 362 individuals aged ≥30 years without known glaucoma from low-income, predominantly black/Hispanic neighborhoods in New Haven, Connecticut presenting to one of twelve community-based glaucoma screening events from May 2010 to October 2012. A quasi-experimental design systematically assigned 63 individuals identified as at risk for glaucoma into either intervention or control group with a 1:2 ratio. Individuals in the control group (n = 41) received counseling on glaucoma and a recommendation for obtaining a follow-up appointment at the eye department of a local community health center, which offers affordable health services with income-adjusted fee discounts to uninsured, low-income patients. Those in the intervention group (n = 22) received the same counseling and a prescheduled appointment at the community health center. The overall rate of follow-up compliance within 3 months of screening was 30 % (41 % in the intervention group; 24 % in the control group). Multivariate logistic regression analysis adjusting for sex, age, ethnicity, health insurance status, car access, living situation, and smoking status found that follow-up compliance was significantly associated with intervention (adjusted odds ratio 4.8; 95 % confidence interval 1.1-20.9). Providing prescheduled appointments can improve follow-up compliance after community-based glaucoma screening. This finding may be potentially applicable to community-based health screening for other preventable diseases.
Keywords: adult; African American; counseling; epidemiology; ethnology; female; glaucoma; health care delivery; health center; Hispanic; hospital management; human; male; middle aged; organization and management; patient compliance; risk factor; United States; vision test; vulnerable population

The Barrie Jones lecture - Eye care for the neglected population: Challenges and solutions - Rao, G.N. (Eye (Basingstoke), 2015)
Globally, pockets of 'neglected populations' do not have access to basic health-care services and carry a much greater risk of blindness and visual impairment. While large-scale public health approaches to control blindness due to vitamin A deficiency, onchocerciasis, and trachoma are successful, other causes of blindness still take a heavy toll in the population. High-quality comprehensive eye care that is equitable is the approach that needs wide-scale application to alleviate this inequity. L V Prasad Eye Institute of India developed a multi-tier pyramidal model of eye care delivery that encompasses all levels from primary to advanced tertiary (quaternary). This has demonstrated the feasibility of 'Universal Eye Health Coverage' covering promotive, preventive, corrective, and rehabilitative aspects of eye care. Using human resources with competency-based training, effective and cost-effective care could be provided to many disadvantaged people.
Keywords: amblyopia; article; blindness; cataract; cornea disease; cornea opacity; cost effectiveness analysis; diabetes mellitus; electronic medical record; eye care; eye malformation; glaucoma; health care access; health care quality; health care system; health promotion; human; onchocerciasis; optic nerve atrophy; primary health care; refraction error; rehabilitation center; retinol deficiency; screening; telemedicine; trachoma; visual impairment

Impact on intraocular pressure after 20-MG decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy - Barteselli, G.; Amini, P.; Ezon, I.C.; Nezgoda, J.T.; Cheng, L.; Freeman, W.R. (Retina, 2015)
Purpose: To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy. Method: Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed. Results: In cases of consistent compliance with IOP-lowering drugs (79.2%), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8%), IOP increased by 7 mmHg at 1 month (P < 0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46% greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45% greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome. Conclusion: Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.
Keywords: brimonidine; dorzolamide plus timolol; triamcinolone acetonide; adult; aged; article; drug effect; drug megadose; female; glaucoma; glaucoma surgery; human; intraocular pressure; macular edema; major clinical study; male; patient compliance; prophylaxis; vitrectomy; kenalog

An adult blind man presenting severe impairment of the right finger, ecchymosis in the thorax region, and haemorrhagic blisters on the oral mucosa - Chaves, F.N.; Fonteles, C.S.R.; Carvalho, F.S.R.; Ribeiro, T.R.; Pereira, K.M.A.; Costa, F.W.G. (Journal of the European Academy of Dermatology and Venereology, 2015)
Keywords: prednisone; adult; blindness; case report; corticosteroid therapy; dental procedure; disease course; disease severity; ecchymosis; follow up; gingiva bleeding; glaucoma; human; hypertension; idiopathic thrombocytopenic purpura; letter; lowest income group; male; medication compliance; middle aged; mouth discomfort; mouth lesion; oral blister; patient compliance; patient referral; petechia; physical examination; priority journal; platelet count; thrombocytopenia; treatment outcome; treatment response

Double-masked, randomized, dose-response study of AR-13324 versus latanoprost in patients with elevated intraocular pressure - Bacharach, J.; Dubiner, H.B.; Levy, B.; Kopczynski, C.C.; Novack, G.D. (Ophthalmology, 2015)
Objective AR-13324 is a small-molecule inhibitor of Rho kinase and a norepinephrine transporter. The objective of this 28-day study was to evaluate the ocular hypotensive efficacy and safety of AR-13324 ophthalmic solution compared with a positive control, latanoprost ophthalmic solution, in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). Design Double-masked, randomized study in 22 private practice ophthalmology clinics. Participants Participants were required to be adults with a diagnosis of OAG or OHT with unmedicated intraocular pressure (IOP) in the range of 22 to 36 mmHg. Methods Patients were randomized to receive AR-13324 ophthalmic solution 0.01%, daily (pm), AR-13324 ophthalmic solution 0.02% daily (pm), or latanoprost 0.005% daily (pm) for 28 days. Main Outcome Measures The primary efficacy endpoint was the mean diurnal IOP across subjects within the treatment group at day 28. Results Randomized and treated were 224 patients, 213 (95.1%) of whom completed the study. On day 28, mean diurnal IOP was 20.1, 20.0, and 18.7 mmHg in the AR-13324 0.01%, 0.02%, and latanoprost groups, respectively, representing a decrease from unmedicated baseline of 5.5, 5.7, and 6.8 mmHg (P<0.001). The 5.7-mmHg reduction in IOP by AR-13324 0.02% did not meet the criterion for noninferiority to latanoprost. The most frequently reported adverse event was conjunctival/ocular hyperemia, with a combined incidence of 52%, 57%, and 16%, respectively. On day 28 at 08:00 hours, the incidence of mild to moderate hyperemia by biomicroscopy was 18%, 24%, and 11%, respectively. Conclusions AR-13324 0.02% was less effective than latanoprost by approximately 1 mmHg in patients with unmedicated IOPs of 22 to 35 mmHg. The major safety finding was ocular hyperemia, which was more common for both concentrations of AR-13324 than for latanoprost.
Keywords: NCT01528787; NCT01731002; netarsudil; eye drops; latanoprost; latanoprost; Rho kinase inhibitor; unclassified drug; abnormal sensation; adult; aged; article; biomicroscopy; clinical article; conjunctival hemorrhage; conjunctival hyperemia; controlled study; disease severity; dose response; double blind procedure; drug efficacy; drug safety; drug withdrawal; female; foreign body sensation; foreign body sensation; human; incidence; intraocular hypertension; intraocular pressure; lacrimation disorder; male; open angle glaucoma; patient compliance; priority journal; randomized controlled trial; ar 13324

Potential Limitations of E-mail and Text Messaging in Improving Adherence in Glaucoma and Ocular Hypertension - Saeedi, O.J.; Luzuriaga, C.; Ellish, N.; Robin, A. (Journal of Glaucoma, 2015)
Purpose: To determine how receptive patients are to the use of e-mail and text message reminders for appointments and medications. Methods: We conducted a consecutive cross-sectional survey of eligible patients with glaucoma or ocular hypertension at a private glaucoma subspecialty practice with 3 locations from February 2011 to January 2012. Main outcome measures were answers to survey questions regarding how receptive patients are to e-mail and text messaging reminders for appointments and medications. Results: Of 989 patients, 404 (40.8%) patients reported that e-mail reminders would help remember appointments and 185 (18.7%) reported that they would help for medications. Among those with access to text messaging, 280 (68.9%) reported text messaging would help them remember appointments and 193 (47.5%) reported it would help with medications. Patients who reported e-mail would help them remember medications were more likely to live in an urban location [P = 0.05, odds ratio (OR) = 1.84], check the internet at least daily (P ≤ 0.001, OR = 1.04), check e-mail when not at home or the office (P = 0.02, OR = 1.62), and know how to open attachments (P = 0.03, OR = 1.87). Patients who reported that text messaging would help them remember their medications were more likely to be 40 or less (P ≤ 0.001, OR = 8.54) and African American (P < 0.001, OR = 2.59). Conclusions: E-mail and text messaging reminders currently may have a limited utility in improving adherence in the general glaucoma population but may be useful in younger patients with glaucoma.
Keywords: adult; African American; age; aged; article; cross-sectional study; e-mail; female; follow up; glaucoma; health care survey; human; Internet; intraocular hypertension; knowledge; major clinical study; male; medication therapy management; outcome assessment; patient compliance; priority journal; reminder system; text messaging; urban area

Assessing the adherence behavior of glaucoma patients to topical eye drops - Welge-Lussen, U.; Weise, S.; Lyu, A. (Patient Preference and Adherence, 2015)
Results: There was a good correlation among all the three adherence measures at T1 and T2. The mean values of ARMS2 were in the lower range, with 3.38 at T1 and 2.8 at T2. The VAS-AD detected that 18.5% of patients always took their eye drops correctly, and 77.9% of patients reported not to have missed a single dose in the past 14 days. There was no significant correlation between the patients’ demographic data or knowledge about glaucoma and the adherence measures ARMS2 or VAS-AD. Among the clinical characteristics, only single-eye blindness showed a significant correlation with VAS-AD. Conclusion: In this study, no general relationships were found between medication adherence and the patients’ demographic data, clinical characteristics, or knowledge about glaucoma. It may be assumed that more individualized strategies are required to optimize adherence behavior. Purpose: The goal of this study was to determine the adherence of glaucoma patients to their topical glaucoma medication. Furthermore, the relationships between the adherence behavior and the patients’ demographic data, clinical characteristics, and their knowledge about glaucoma were evaluated. Methods: This was a prospective study of 123 patients with primary open-angle glaucoma who were given two standardized questionnaires. The first questionnaire at time point T1 comprised a knowledge assessment and the self-reported adherence measures Adherence to Refills and Medication Scale 2 (ARMS2), visual analogue scale for adherence (VAS-AD), and missed doses in the past 14 days. Two months later at time point T2, a second questionnaire reevaluated the adherence measures ARMS2, VAS-AD, and missed doses in the past 14 days.
Keywords: eye drops; Adherence to Refills and Medication Scale 2; adult; aged; article; assessment of humans; attitude to health; clinical feature; female; follow up; human; intraocular pressure; major clinical study; male; medication compliance; open angle glaucoma; patient assessment; patient compliance; patient decision making; questionnaire; scoring system; self report; treatment outcome; visual acuity; visual analog scale; visual field defect

Improving patient access to prevent sight loss: Ophthalmic electronic referrals and communication (Scotland) - Khan, A.A.; Mustafa, M.Z.; Sanders, R. (Public Health, 2015)
Introduction: With the number of people with sight loss predicted to double to four million people in the UK by the year 2050, preventable visual loss is a significant public health issue. Sight loss is associated with an increased risk of falls, accidents and depression and evidence suggests that 50% of sight loss can be avoided. Timely diagnosis is central to the prevention of sight loss. Access to care can be a limiting factor in preventable cases. By improving referrals and access to hospital eye services it is possible to treat and minimise the number of patients with preventable sight loss and the impact this has on wider society. Clinical pilot study: In 2005, NHS Fife took part in a flagship pilot funded by the Scottish government e-health department to evaluate the feasibility, safety, clinical effectiveness, and cost of electronic referral with images of patients directly from community optometrists to Hospital Eye Service (HES). The pilot study showed that electronic referral was feasible, fast, safe, and obviated the need for outpatient appointments in 128 (37%) patients with a high patient satisfaction. Centralised ophthalmic electronic referral unit: The results of the pilot study were presented and in May 2007, the electronic referral system was rolled out regionally in southeast Scotland. Referrals were accepted at a single site with vetting by a trained team and appointments were allocated within 48hours. Following the implementation of electronic referral, waiting times were reduced from a median of 14 to 4 weeks. Significantly fewer new patients were seen (7462 vs 8714 [. p<0.001]). There were also fewer casualties (1984 vs 2671 [. p<0.001]) and 'did not arrive' (DNA) new patients (503 vs 635 [. p<0.001]). Eye care integration project (Scotland): In 2010 the Scottish Government Health Department committed £6.6 million to community and hospital ophthalmic services forming the Eyecare Integration Project in 2011. The main aim of this project was to create electronic communication between community optometry practices and hospital eye departments. Five electronic forms were specifically designed for cataract, glaucoma, macula, paediatric and general ophthalmic disease. A Virtual Private Network was created which enabled optometrists to connect to the Scottish clinical information gateway system and send referrals to hospital and receive referral status feedback. Numerous hurdles have been encountered and overcome in order to deliver this project.
Keywords: article; clinical effectiveness; controlled study; electronic communication system; electronic referral system; eye care; feasibility study; health care access; health care planning; health care system; hospital department; hospital service; human; major clinical study; medical information system; optometry; outpatient; patient satisfaction; pilot study; public health service; social welfare; United Kingdom; visual impairment

Community practice patterns for bacterial corneal ulcer evaluation and treatment - Park, J.; Lee, K.M.; Zhou, H.; Rabin, M.; Jwo, K.; Burton, W.B.; Gritz, D.C. (Eye and Contact Lens, 2015)
Objective: To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists. Methods: A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics. Results: One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001). Conclusions: Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.
Keywords: antibiotic agent; besifloxacin; cefazolin; ciprofloxacin; fortified broad spectrum antibiotic agent; gatifloxacin; gentamicin; levofloxacin; moxifloxacin; ofloxacin; quinolone derivative; quinolone derivative; tobramycin; unclassified drug; vancomycin; anterior eye chamber; antibiotic resistance; antibiotic therapy; article; bacterial keratitis; bacterium culture; community care; comparative effectiveness; cornea ulcer; disease severity; drug efficacy; e-mail; Gram staining; health care access; health care survey; human; major clinical study; medical specialist; nonhuman; ophthalmologist; physician attitude; practice guideline; priority journal; program evaluation; protocol compliance; public health service; questionnaire; treatment outcome; United States

Adherence to topical glaucoma medications in Ethiopian patients - Tamrat, L.; Gessesse, G.W.; Gelaw, Y. (Middle East African Journal of Ophthalmology, 2015)
Purpose: Successful outcomes of medical treatment for glaucoma require proper and daily use of medication to prevent disease progression. The aim of this study was to determine the adherence to anti-glaucoma medications and factors associated with non-adherence among patients with ocular hypertension (OHT) or glaucoma at Jimma University Specialized Hospital, Ethiopia. Materials and Methods: A hospital based cross sectional study was conducted on 200 consecutive patients from July to November 2010 at Jimma University Hospital in Southwest Ethiopia. Patients with OHT or glaucoma who were taking topical anti-glaucoma medications for more than six months were included. The study subjects were interviewed and their medical records were reviewed. Non-adherence to glaucoma therapy (NAGT) was defined as self-reported on missed medications or missed appointments, or a physician noting poor adherence. A P < 0.05 was statistically significant. Result: Overall, 135 (67.5%) patients were non adherent to glaucoma therapy. Non adherence was associated with older age (P = 0.04), advanced stage of glaucoma (P = 0.01), longer frequency of follow up (P = 0.00) and financial problem (P = 0.000). Sex (P = 0.53), level of education (P = 0.09), and marital status (P = 0.77) were not statistically significantly associated with non-adherence to anti-glaucoma drug treatment. Conclusion: A relatively high proportion of patients were not adhering to the medications regimen for glaucoma. Older age, advanced glaucoma, lengthier frequency of follow-up and financial hardship were associated with non-adherence. Eye care providers should be aware of the problem of non-adherence to topical medications.
Keywords: antiglaucoma agent; adult; aged; article; clinical practice; controlled study; cross-sectional study; disease severity; educational status; Ethiopian; ethnicity; eye care; female; follow up; human; intraocular hypertension; major clinical study; male; marriage; medical record review; medication compliance; middle aged; patient compliance; self report; tertiary care center; treatment refusal; very elderly; young adult

Performing accurate CO2 laser-assisted sclerectomy surgery - Ton, Y.; Assia, E.I.; Geffen, N. (Expert Review of Ophthalmology, 2015)
Most glaucoma surgeries achieve intraocular pressure (IOP) reduction by penetrating the sclerotrabecular wall. Deep sclerectomy surgery aims to enhance aqueous drainage without penetrating the globe and also aims to avoid some of the severe complications associated with violating ocular integrity; however, this procedure is difficult to perform manually in a safe and effective way. CO2 laser has been suggested as a tool to facilitate deep, effective ablation over the ocular drainage system to reduce IOP without penetrating the eyeball in a procedure called CO2 laser-assisted sclerectomy surgery. In this study, the authors report the rationale of choosing this type of laser, the development of the laser delivery and control systems (IOPtiMate; IOPtima, Tel Aviv, Israel) and the experimental and clinical experience to date.
Keywords: antiglaucoma agent; antihypertensive agent; mitomycin; moxifloxacin; prednisolone acetate; allergy; article; carbon dioxide laser; carbon dioxide laser assisted sclerectomy surgery; dry eye; eye inflammation; filtering operation; glaucoma; human; intraocular hypertension; intraocular pressure; laser surgery; micromanipulator; non invasive procedure; nonhuman; nonpenetrating trabecular surgery; open angle glaucoma; patient compliance; postoperative complication; pseudoexfoliative glaucoma; sclerectomy; surgical microscope; trabeculectomy; unspecified side effect; pred forte; vigamox; IOPtiMate

Current medical and surgical therapeutic approaches to cystoid macular edema in uveitis - Schaal, S.; Reddy, S.V.; Kaplan, H.J. (Expert Review of Ophthalmology, 2015)
Cystoid macular edema (CME), a frequent complication of uveitis, is defined as central retinal thickening caused by accumulation of intra-retinal fluid in the outer plexiform and inner nuclear layers of the retina. Chronic retinal edema can lead to vision loss secondary to photoreceptor impairment and retinal pigment epithelium dysfunction. Patients suffering from CME often complain of decrease in visual acuity, contrast sensitivity and difficulty performing near tasks such as reading. The pathophysiology of CME revolves around disruption of the blood-retinal barrier due to release of pro-inflammatory mediators and/or Muller-cell dysfunction. Imaging modalities have advanced in recent years allowing earlier detection and better management of uveitic CME. Though often managed medically, when CME is refractory to anti-inflammatory therapy such as corticosteroids and/or immunomodulators, underlying mechanical causes such as vitreo-macular traction and internal limiting membrane gliosis must be considered as causes of CME formation. In such cases, Pars-plana vitrectomy with internal limiting membrane peel may be undertaken. New intraoperative imaging modalities, such as intraoperative optical coherence tomography, carry the promise of better and more accurate surgical manipulations.
Keywords: adalimumab; azathioprine; corticosteroid; cyclophosphamide; cyclosporine; dexamethasone; difluprednate; fluocinolone acetonide; immunosuppressive agent; infliximab; methotrexate; methylprednisolone; mycophenolate mofetil; prednisolone acetate; prednisone; prostaglandin; tacrolimus; triamcinolone acetonide; B scan; blood retina barrier; bone necrosis; cataract; central retinal thickness; contrast sensitivity; demyelinating disease; drug implant; drug withdrawal; endophthalmitis; enhanced depth imaging optical coherence tomography; gliosis; human; hypertension; immunosuppressive treatment; infection; internal limiting membrane peeling; intraocular hypertension; intraocular hypotension; kidney failure; lupus like syndrome; Mueller cell; optical coherence tomography; optical coherence tomography device; pars plana vitrectomy; pathophysiology; patient compliance; periocular drug administration; preoperative evaluation; ptosis (eyelid); retina detachment; retina fluorescein angiography; retina macula cystoid edema; retina surgery; review; spectral domain optical coherence tomography; subcapsular cataract; sustained drug release; swept source optical coherence tomography; systemic lupus erythematosus; tuberculosis; unspecified side effect; uveitis; visual acuity; vitrectomy; vitreous body detachment; cellcept; durezol; humira; ozurdex; predforte; remicade; retisert; triasence; trivaris; Spectralis; Stratus

Trends in bacterial and fungal keratitis in South India, 2002-2012 - Lalitha, P.; Prajna, N.V.; Manoharan, G.; Srinivasan, M.; Mascarenhas, J.; Das, M.; D'Silva, S.S.; Porco, T.C.; Keenan, J.D. (British Journal of Ophthalmology, 2015)
Objective: To assess the trends in microbiological organisms identified from corneal scrapings from patients with infectious keratitis at a tertiary care medical centre in South India. Methods: We reviewed the records of the microbiology laboratory at Aravind Eye Hospital in Madurai, India, from 2002 until 2012. We identified the microbiological causes of all corneal ulcers from the culture and smear results, and assessed for trends in bacterial and fungal keratitis over time. Results: Of 23 897 corneal patients with ulcer with a corneal smear from 2002 to 2012 a fungal organism was identified in 34.3%, a bacterial organism in 24.7% and no organism in 38.3%. During this period, the annual number of keratitis cases due to bacteria decreased from 677 to 412, and the annual number due to fungus increased from 609 to 863. In analyses accounting for the total number of outpatients seen each year, the decline in number of smears positive for bacteria was statistically significant (p<0.001) but the increase in the number positive for fungus was not (p=0.73). The relative frequency of individual bacterial or fungal organisms remained relatively stable over this time. Conclusions: At a tertiary eye care centre in South India, there has been a reduction in the numbers of smear-positive bacterial keratitis over the past 11 years. This decline likely reflects economic development in India and increased access to antibiotics.
Keywords: antibiotic agent; article; Aspergillus; bacterial keratitis; bacterium identification; cornea smear; cornea ulcer; cross-sectional study; economic development; fungus identification; Fusarium; health care access; human; India; keratomycosis; major clinical study; medical record review; morbidity; Nocardia; nonhuman; outpatient; Pseudomonas aeruginosa; retrospective study; smear; Staphylococcus aureus; Streptococcus pneumoniae; tertiary care center; trend study

How effective is health coaching in reducing health services expenditures? - Jonk, Y.; Lawson, K.; O'Connor, H.; Riise, K.S.; Eisenberg, D.; Dowd, B.; Kreitzer, M.J. (Medical Care, 2015)
Health coaching interventions aim to identify high-risk enrollees and encourage them to play a more proactive role in improving their health, improve their ability to navigate the health care system, and reduce costs. OBJECTIVES:: Evaluate the effect of health coaching on inpatient, emergency room, outpatient, and prescription drug expenditures. RESEARCH DESIGN:: Quasiexperimental pre-post design. Health coaching participants were identified over the 2-year time period 2009-2010. Propensity scores facilitated matching eligible participants and nonparticipating controls on a one-to-one basis using nearest kernel techniques. Difference in differences logistic and generalized linear models addressed the impact of health coaching on the probability of incurring costs and levels of inpatient, emergency room, outpatient, and prescription drug expenditures, respectively. MEASURES:: Administrative claims data were used to analyze health services expenditures preparticipation and post health coaching participation time periods. RESULTS:: Of the 6940 health coaching participants, 1161 participated for at least 4 weeks and had a minimum of 6 months of claims data preparticipation and postparticipation. Although the probability of incurring costs and expenditure levels for emergency room services were not affected, the probability of incurring inpatient expenditures and levels of outpatient and total costs for health coaching participants fell significantly from preparticipation to postparticipation relative to controls. Estimated outpatient and total cost savings were $286 and $412 per person per month, respectively. CONCLUSIONS:: Health coaching led to significant reductions in outpatient and total expenditures for high-risk plan enrollees. Future studies analyzing both health outcomes and claims data are needed to assess the cost-effectiveness of health coaching in specific populations.
Keywords: prescription drug; adult; age related macular degeneration; aged; article; asthma; bipolar disorder; chronic disease; chronic obstructive lung disease; congestive heart failure; controlled study; cost control; diabetes mellitus; drug cost; emergency ward; female; glaucoma; health behavior; health care cost; health care utilization; health coaching; health education; health service; health status; hospital patient; human; Human immunodeficiency virus infection; hyperlipidemia; hypertension; hypothyroidism; ischemic heart disease; low back pain; major clinical study; male; middle aged; osteoporosis; outpatient care; Parkinson disease; prescription; priority journal; private health insurance; program effectiveness; public health insurance; quasi experimental study; rheumatoid arthritis; rural area; schizophrenia; seizure

Incremental Healthcare Service Utilization for Open-angle Glaucoma: A Population-Based Study - Chung, S.-D.; Ho, J.-D.; Lin, H.-C.; Kao, L.-T.; Tsai, M.-C. (Journal of Glaucoma, 2015)
Purpose: To investigate differences in the utilization of healthcare services between subjects with open-angle glaucoma (OAG) and comparison subjects without OAG using Taiwan's National Health Insurance population-based database. Patients and Methods: The study comprised 2204 subjects with OAG and 2204 sex-matched and age-matched subjects without OAG. We individually followed each subject for a 1-year period to evaluate their healthcare resource utilization. Outcome variables of the healthcare resource utilization were as follows: numbers of outpatient visits and inpatient days and the mean costs of outpatient and inpatient treatment. In addition, we divided healthcare resource utilization into ophthalmologic and nonophthalmologic services. Results: As for the utilization of ophthalmologic services, OAG subjects had significantly more outpatient visits (7.4 vs. 1.3, P < 0.001) and significantly higher outpatient costs (US$272 vs. US$39, P < 0.001) than comparison subjects. For nonophthalmologic services, OAG subjects also had significantly more outpatient visits (29.4 vs. 21.8, P < 0.001) and significantly higher outpatient costs (US$1263 vs. US$847, P < 0.001) than comparison subjects. Furthermore, OAG subjects incurred significantly higher inpatient costs compared with comparison subjects (US$434 vs. US$234, P < 0.001). For all healthcare services, OAG subjects had significantly more outpatient visits (36.8 vs. 23.1, P < 0.001) and significantly higher outpatient (US$1535 vs. US$887, P < 0.001) and total (US$2245 vs. US$1122, P < 0.001) costs than comparison subjects. In other words, the total cost was about 2-fold greater for OAG subjects than comparison subjects. Conclusions: We concluded that subjects with OAG had significantly higher utilization of all healthcare services than comparison subjects.
Keywords: adult; aged; ambulatory care; article; controlled study; cross-sectional study; essential hypertension; female; follow up; health care cost; health care utilization; health service; hospitalization; human; income; major clinical study; male; middle aged; national health insurance; non insulin dependent diabetes mellitus; open angle glaucoma; outpatient care; population research; priority journal; senile cataract; Taiwan; upper respiratory tract infection; urbanization; very elderly

Geriatric Patients With Fractures Below the Hip are Medically Similar to Geriatric Patients With Hip Fracture - Della Rocca, G.J.; Uppal, H.S.; Copeland, M.E.; Crist, B.D.; Volgas, D.A. (Geriatric Orthopaedic Surgery and Rehabilitation, 2015)
The objective of this study was to compare a cohort of geriatric patients with operatively managed isolated fractures below the hip to a cohort of geriatric patients with operatively managed isolated hip fractures. All patients greater than 59 years of age admitted to our institution for surgical care of an isolated lower extremity fracture during a 3-year period were included. Patients were divided into 2 cohorts: BTH (fracture below the subtrochanteric region of the femur) and HIP (proximal femoral fracture at subtrochanteric region or proximal). We identified 141 patients included in cohort BTH and 205 patients included in cohort HIP. HIP patients were older (P <.01) and less obese (P <.01) but were otherwise very similar. An extensive comorbidity review revealed that the 2 cohorts were similar, with the exception of an increased incidence of dementia (P =.012) or glaucoma (P =.04) in HIP patients and of peripheral neuropathy (P =.014) in BTH patients. HIP patients were more likely to be under active antiosteoporotic medication management and were more likely to be receiving pharmacological anticoagulation at the time of admission. HIP patients and BTH patients were similar with regard to necessity of assistance with ambulation preinjury, but HIP patients were less likely to reside independently at home than were BTH patients (P <.001). HIP patients were also less likely to be discharged directly home from the hospital (P <.001). Geriatric patients with fractures below the hip are medically similar to geriatric patients with hip fracture. Medical comanagement protocols have been extensively published that improve care of geriatric patients with hip fracture; consideration should be given to similar protocol-driven medical comanagement programs for geriatric patients with fractures below the hip.
Keywords: adult; aged; ambulatory care; ankle fracture; article; below the hip fracture; Charlson Comorbidity Index; female; femur intertrochanteric fracture; femoral neck fracture; femoral shaft; femur shaft fracture; femur subtrochanteric fracture; foot fracture; geriatric patient; hip fracture; human; incidence; major clinical study; male; osteoporosis; patella fracture; priority journal; tibia fracture

Therapeutic potential of cannabinoids in counteracting chemotherapy-induced adverse effects: An exploratory review - Ostadhadi, S.; Rahmatollahi, M.; Dehpour, A.-R.; Rahimian, R. (Phytotherapy Research, 2015)
Cannabinoids (the active constituents of Cannabis sativa) and their derivatives have got intense attention during recent years because of their extensive pharmacological properties. Cannabinoids first developed as successful agents for alleviating chemotherapy associated nausea and vomiting. Recent investigations revealed that cannabinoids have a wide range of therapeutic effects such as appetite stimulation, inhibition of nausea and emesis, suppression of chemotherapy or radiotherapy-associated bone loss, chemotherapy-induced nephrotoxicity and cardiotoxicity, pain relief, mood amelioration, and last but not the least relief from insomnia. In this exploratory review, we scrutinize the potential of cannabinoids to counteract chemotherapy-induced side effects. Moreover, some novel and yet important pharmacological aspects of cannabinoids such as antitumoral effects will be discussed.
Keywords: 2,3 dihydro 5 methyl 3 (morpholinomethyl) 6 (1 naphthoyl)pyrrolo[1,2,3 de][1,4]benzoxazine; analgesic agent; antiemetic agent; antineoplastic agent; bleomycin; cannabidiol; cannabinoid; caryophyllene; cisplatin; delta8 tetrahydrocannabinol; docetaxel; dopamine 2 receptor blocking agent; doxorubicin; dronabinol; levonantradol; nabilone; nabiximols; narcotic analgesic agent; neurokinin 1 receptor antagonist; nonabine; nonsteroid antiinflammatory agent; ondansetron; placebo; platinum complex; prochlorperazine; serotonin 3 antagonist; taxane derivative; tetrahydrocannabinol; unclassified drug; unindexed drug; Vinca alkaloid; add on therapy; adjuvant therapy; analgesic activity; antiemetic activity; antineoplastic activity; breast cancer; cancer pain; cancer palliative therapy; cardiotoxicity; chemoprophylaxis; chemotherapy induced nausea and vomiting; combination chemotherapy; diabetic cardiomyopathy; distal paresthesia; dose response; drug effect; drug efficacy; drug mechanism; drug megadose; drug potentiation; drug receptor binding; drug safety; drug selectivity; drug targeting; drug tolerability; drug withdrawal; exploratory research; eye toxicity; hemorrhagic cystitis; human; intraocular hypertension; limb pain; low drug dose; lung toxicity; monotherapy; nephrotoxicity; neuropathic pain; nonhuman; patient compliance; peripheral neuropathy; review; sensory neuropathy; skin fibrosis; unspecified side effect; sativex; win 55212 2

Twenty-four-hour intraocular pressure patterns in patients with thyroid eye disease - Parekh, A.S.; Mansouri, K.; Weinreb, R.N.; Tafreshi, A.; Korn, B.S.; Kikkawa, D.O. (Clinical and Experimental Ophthalmology, 2015)
To prospectively investigate the safety, tolerability and 24-h intraocular pressure (IOP) patterns in patients with thyroid eye disease (TED) using a contact lens sensor (CLS). Design: Prospective study. Participants: Ten patients with established TED. Methods: Ten eyes of 10 patients were prospectively evaluated in an ambulatory 24-h IOP monitoring session using the CLS (Sensimed AG, Lausanne, Switzerland). Patients pursued daily activities, and sleep behaviour was uncontrolled. Main Outcome Measures: Incidence of adverse events (AEs) and tolerability (scale of 0-10, increasing intolerance) were assessed. IOP patterns were evaluated using a cosinor rhythmometry model, and linear regression slopes were constructed for the transition from wake/sitting (W/S) to sleep/supine (S/S) and vice versa. Results: Mean age was 61.8±21.6 years, and 90% of patients were female. Main AEs were blurred vision (50%), conjunctival hyperaemia (100%) and superficial punctate keratitis (20%). Tolerability of the lens was found to be 1.5±0.7. Positive linear slopes of the CLS signal from wake to sleep were detected (18.0±43.8arbitrary units [a.u.]; P=0.254), whereas at the transition from S/S to W/S a significant decrease (-62.9±56.8a.u.; P=0.010) was found. Five patients (50%) had a significant nocturnal/sleep acrophase with the peak occurring at 6:30 a.m. The mean amplitude of the 24-h curves was 102.2±52.6a.u. Conclusions: In patients with TED, the CLS provides a safe and well-tolerated approach to 24-h IOP monitoring. After modelling the 24-h IOP curves, TED patients were found to have a morning acrophase.
Keywords: adult; aged; ambulatory monitoring; article; blurred vision; clinical article; conjunctival hyperemia; contact lens; daily life activity; endocrine ophthalmopathy; eye discomfort; female; human; incidence; intraocular pressure; lens; male; optical biosensor; parasomnia; prospective study; punctate keratitis; rating scale; safety; supine position; very elderly; wakefulness

Ambulatory 24-h intraocular pressure monitoring in the management of glaucoma - Mansouri, K.; Weinreb, R.N. (Current Opinion in Ophthalmology, 2015)
Purpose of review To review current status and future of ambulatory 24-h intraocular pressure monitoring. Despite important advances in the diagnosis and management of glaucoma during the last decade, the fundamental understanding of intraocular pressure, its only modifiable risk factor, remains elusive. The current practice of single intraocular pressure measurements during a clinic visit does not adequately reflect the variability of intraocular pressure throughout the 24-h day. Recent findings There has been considerable progress recently with the prototype and commercial introduction of continuous 24-h intraocular pressure monitoring devices. Implantable intraocular pressure sensors have the advantage to directly measure intraocular pressure over many months and years, whereas temporary (contact lens based) approaches provide a noninvasive alternative for repeated 24-h periods. This review provides an overview of implantable devices as well as a critical assessment of a 24-h contact lens sensor. Summary Recent advances in microelectromechanical systems and nanoelectromechanical systems have enabled the development of 24-h intraocular pressure monitoring devices. Once these technologies have shown their safety and efficacy, larger questions as to the data interpretation and handling will arise. It is likely that the use of 24-h intraocular pressure monitoring will herald fundamental changes in our understanding and management of glaucoma.
Keywords: ambulatory monitoring; contact lens; glaucoma; human; intraocular pressure; microelectromechanical system; monitoring; nanoelectromechanical system; pressure measurement; priority journal; review

Ambulatory surgery center utilization by vitreoretinal surgeons: 1999-2011 - Vaziri, K.; Moshfeghi, D.M.; Hernandez-Boussard, T.; Callaway, N.F.; Moshfeghi, A.A. (Ophthalmic Surgery Lasers and Imaging Retina, 2015)
BACKGROUND AND OBJECTIVE: To evaluate the utilization rates of ambulatory surgery centers (ASCs) in the state of Florida for vitreoretinal, cataract, and glaucoma surgical procedures over a 13-year period from 1999 through 2011. PATIENTS AND METHODS: Retrospective analysis utilizing the State Ambulatory Surgery Databases (SASD) for Florida from 1999 through 2011. ICD-9 codes for vitreoretinal, cataract, and glaucoma procedures were queried. Joinpoint regression was used to calculate average annual percent change (APC) in ASC utilization by these procedures over the 13-year study period and also separately for the years 2007 to 2011. RESULTS: From 1999 through 2011, APC in ambulatory surgery center utilization was +26.4% (P = .0039) for vitreoretinal, +21.3% (P = .012) for cataract, and +20.9% (P = .0063) for glaucoma surgery. The APC from 2007 through 2011 was -1.2% for vitreoretinal (P = .47), -9.2% for cataract (P = .0039), and -17.3% for glaucoma surgery (P = .008). CONCLUSION: A significant overall increase in ASC utilization by vitreoretinal, cataract, and glaucoma surgeons over the study period was seen; however, the most recent 5-year data show that these trends may have begun to reverse.
Keywords: adult; ambulatory surgery; article; cataract; cataract extraction; cohort analysis; glaucoma; glaucoma surgery; health care utilization; human; ICD-9; major clinical study; outcome assessment; priority journal; retrospective study; surgeon; treatment indication; United States; vitreoretinal surgery; vitreoretinopathy

One year results of a phase 1 study of the safety and tolerability of combination therapy using sustained release intravitreal triamcinolone acetonide and ranibizumab for subfoveal neovascular AMD - Lim, J.I.; Niec, M.; Wong, V. (British Journal of Ophthalmology, 2015)
Purpose: To investigate safety and evidence of efficacy of IBI-20089, an intravitreal, liquid, sustained drug delivery system formulated with triamcinolone acetonide (TA) in combination with ranibizumab (Lucentis) for neovascular age related macular degeneration. Methods: Patients received a single intravitreal injection of IBI-20089 containing either 6.9 mg (25 μL) TA or 13.8 mg (50 μL) TA followed a week later by intravitreal injection of 0.5 mg ranibizumab. Patients were followed monthly and underwent best corrected visual acuity testing, slit lamp biomicroscopy, dilated ophthalmoscopy, fundus photos and optical coherence tomography. Patients received pro re nata dosing of ranibizumab. Results: Patients ranged in age from 59 years to 81 years (mean 73.4 years) and all completed 1 year follow-up. No serious related adverse events occurred. Ocular adverse events included mild, transient, elevated intraocular pressure in eight patients and cataract progression in three of the five phakic patients. At 1 year, 30 of a total 120 (25%) possible pro re nata re-Rx's had been given. Combination therapy resulted in a median number of 3.5 re-treatments at and including month 12. Conclusions: Combination therapy IBI-20089 and ranibizumab was well-tolerated and resulted in fewer ranibizumab retreatments. Transient intraocular pressure elevation and cataract progression occurred. Trial registration number: NCT01175395.
Keywords: NCT01175395; ranibizumab; triamcinolone acetonide; adult; age related macular degeneration; aged; article; cataract; clinical article; combination chemotherapy; conjunctival hemorrhage; drug administration route; drug efficacy; drug mixture; drug potentiation; drug safety; drug tolerability; female; human; injection site bleeding; intraocular hypertension; male; middle aged; outcome assessment; patient compliance; phase 1 clinical trial; priority journal; retreatment; single drug dose; subfoveal neovascular age related macular degeneration; sustained release formulation; treatment duration; very elderly; ibi 20089; lucentis

Prospective Evaluation of Acupuncture as Treatment for Glaucoma - Law, S.K.; Lowe, S.; Law, S.M.; Giaconi, J.A.; Coleman, A.L.; Caprioli, J. (American Journal of Ophthalmology, 2015)
Purpose To evaluate acupuncture as treatment for glaucoma. Design Prospective double-masked randomized crossover study. Methods setting: Clinical practice. population: One eye per patient with primary open-angle glaucoma and stable intraocular pressure (IOP). intervention: Patients were randomized to receive 1 acupuncture series (12 sessions with either eye-related [eye-points] or non-eye-related [non-eye-points] acupoints) and then crossed over to receive the other series. outcome measures: IOP, blood pressure (BP), heart rate (HR), best-corrected visual acuity (BCVA), visual field (VF), optic disc and peripapillary retinal nerve fiber layer (RNFL) measurements, compliance, and adverse reactions. Probability to detect 3 mm Hg IOP difference between series was 90%. Results Twenty-two patients volunteered and 11 (50.0%) completed the study; 8 (36.4%) did not complete treatment owing to changes of health, moving away, lack of transportation, or family crisis; and 3(13.6%) were withdrawn owing to needle sensitivity or IOP elevation (8 mm Hg) in the contralateral eye. After an acupuncture session, mean IOP increased slightly with both eye-points (from 12.9 ± 1.8 mm Hg to 13.6 ± 2.0 mm Hg, P =.019) and non-eye-points (from 13.0 ± 1.5 mm Hg to 13.5 ± 1.7 mm Hg, P =.073) series. HR, diurnal IOP, and BCVA showed no statistically significant changes after 12 sessions of either series. Systolic and diastolic BP were reduced after 12 sessions of non-eye-points series (P =.040, P =.002, respectively). Optic disc, RNFL, and VF showed no statistically significant changes. Conclusions Acupuncture has no overall effect on diurnal IOP or BCVA but may temporally increase the IOP immediately after a treatment session. BP is lowered by acupuncture with non-eye-points, but not with eye-points. Compliance and adverse event rates were low.
Keywords: acupuncture needle; disposable equipment; stainless steel; acupuncture; acupuncture needle; adult; aged; article; best corrected visual acuity; clinical article; clinical evaluation; clinical practice; controlled study; crossover procedure; diastolic blood pressure; disposable equipment; double blind procedure; family stress; female; heart rate; human; intraocular hypertension; intraocular pressure; male; medical device complication; open angle glaucoma; optic disk; patient compliance; priority journal; prospective study; randomized controlled trial; retinal nerve fiber layer thickness; spectral domain optical coherence tomography; systolic blood pressure; visual acuity; visual acuity chart; visual field; vital sign

OUTCOMES of an inner-city vision outreach program: Give Kids Sight Day - Dotan, G.; Truong, B.; Snitzer, M.; McCauley, C.; Martinez-Helfman, S.; Maria, K.S.; Levin, A.V. (JAMA Ophthalmology, 2015)
IMPORTANCE: Low-socioeconomic urban children often do not have access to ophthalmic care. OBJECTIVE: To characterize the demographic characteristics and ophthalmic conditions in children attending Give Kids Sight Day (GKSD), an outreach ophthalmic care program held annually in Philadelphia, Pennsylvania, providing vision screening and immediate treatment when needed. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case-series study of children attending GKSD in 2012 (GKSD 2012) at an ophthalmology center in Philadelphia. Registration forms and records of all children attending GKSD 2012 were reviewed. MAINOUTCOMESANDMEASURES: Demographic characteristics, insurance status, spoken languages, reasons for attending, prior failure of vision screening, and attendance pattern of previous events were analyzed. The ophthalmological findings of these children were examined, including refractive errors, need for optical correction, and diagnoses for which continuous ophthalmic care was necessary. For children who needed ophthalmic follow-up, the rate of return to clinic and barriers for continuous care were analyzed. RESULTS: We studied 924 children (mean age, 9 years; age range, 0-18 years; 51% female; 25% speaking a non-English language) coming from 584 families who attended GKSD 2012, of whom 27% were uninsured and 10% were not aware of their insurance status. Forty-two percent of participants had public insurance, which covered vision care and glasses, but 35% did not know their benefits and did not realize vision care was covered. Forty-nine percent of children attended because they failed community vision screening. Provision of free glasses and failure of previous vision screening were the most common reasons families elected to attend GKSD (64% and 49%, respectively). Eighty-five percent of children attended GKSD 2012 for the first time, whereas 15% attended prior events. Glasses were provided to 61% of attendees. Ten percent of the attendees needed continuous ophthalmic care, most commonly for amblyopia. Ten children needed ocular surgery for cataract, strabismus, nystagmus, ptosis, or nasolacrimal duct obstruction. With the assistance of a social worker, 59% of children requiring continuous treatment returned to the clinic, compared with 2% in prior years before social worker intervention. CONCLUSIONS AND RELEVANCE: Programs suchas GKSD can bridge the gap between successful vision screening and ophthalmic treatment, a gap that often occurs in low-socioeconomic urban populations. Those with public insurance coverage for vision services may not realize these services are covered. Social worker intervention is useful in overcoming common barriers to follow-up care.
Keywords: adolescent; amblyopia; article; cataract; child; child care; congenital cataract; eye disease; eye surgery; female; glaucoma; health care access; health insurance; health program; human; lacrimal duct occlusion; major clinical study; male; neurofibromatosis type 1; nystagmus; optic nerve atrophy; preschool child; priority journal; ptosis (eyelid); refraction error; school child; social worker; spectacles; strabismus; United States; vision test; visual impairment

Comparing the efficacy and safety of salmeterol/fluticasone pMDI versus its mono-components, other LABA/ICS pMDIs and salmeterol/fluticasone Diskus in patients with asthma - Mehta, N.; Aggarwal, B.; Gogtay, J.; Abdool-Gaffar, S. (Expert Opinion on Drug Delivery, 2015)
Introduction: Pressurized metered dose inhalers (pMDIs) are evolving to be a very effective drug delivery option in patients with airway diseases. They offer comparable lung deposition and reduced oropharyngeal deposition similar with the dry powder inhalers. As recommended by the Global Initiative for Asthma guidelines, the ideal maintenance treatment for asthma is a combination of long acting β2-Agonists (LABAs) and inhaled corticosteroids (ICSs). One of the available LABA/ICS combinations is the salmeterol/fluticasone propionate combination (SFC) and a plethora of evidence supports its clinical efficacy and safety.Areas covered: This article focuses on the SFC hydrofluroalkane pMDI and compares the efficacy and tolerability with salmeterol and fluticasone given individually, and with other fixed-dose combinations namely formoterol/fluticasone, formoterol/beclometasone and formoterol/mometasone furoate, all delivered via pMDI. Also discussed is the efficacy and tolerability of the SFC delivered via a pMDI, as compared to the SFC via Diskus.Expert opinion: pMDIs play an important role in inhalation therapy given the low price, low maintenance and convenience of use. LABA/ICS combinations are the preferred choice of medication for asthma treatment and will remain the mainstay for the decades to come. In our opinion, pMDI should be the choice of device to administer LABA/ICS maintenance therapy, as it is already being used by the patients for reliever therapy, which may eventually improve patient adherence and compliance.
Keywords: NCT00369993; beclometasone dipropionate plus formoterol fumarate; budesonide plus formoterol; fluticasone propionate plus salmeterol; fluticasone propionate plus salmeterol xinafoate; formoterol fumarate plus mometasone furoate; glucose; salbutamol; salmeterol; adrenal suppression; asthma; cataract; corticosteroid therapy; coughing; diabetes mellitus; drug efficacy; drug induced headache; drug safety; drug tolerability; dry powder inhaler; dysphonia; forced expiratory volume; forced vital capacity; glaucoma; human; lung function; maintenance therapy; maximal expiratory flow; medication compliance; metered dose inhaler; oropharynx candidiasis; patient compliance; patient satisfaction; peak expiratory flow; quality of life; review; throat irritation; upper respiratory tract infection; seretide evohaler

Subsequent Receipt of Interventions for Glaucoma among a Nationwide Sample of Patients Who Underwent Laser Peripheral Iridotomy - Bansal, S.; Balakrishnan, S.A.; Blachley, T.; Weizer, J.S.; Lee, P.P.; Stein, J.D. (American Journal of Ophthalmology, 2015)
Purpose To evaluate use of medical, laser, or incisional surgical interventions for glaucoma after laser peripheral iridotomy (LPI). Design Retrospective longitudinal cohort study. Methods All enrollees aged ≥21 years in a US managed-care network who underwent bilateral LPIs in 2001-2011 were identified. The mean numbers of pre- and post-LPI glaucoma medication classes prescribed and the proportion of enrollees requiring cataract or glaucoma surgery within 2 years after the LPIs were determined. Multivariable logistic regression assessed factors associated with enrollees' prescription of ≥1 glaucoma medication class after bilateral LPIs. Results Of the 1660 patients undergoing bilateral LPIs, 1280 (77.1%) had no pre- or post-LPI prescriptions for any glaucoma medication class. Of the remaining patients, 251 (66.1%) required more glaucoma medication classes after than before the procedures, whereas 44 (11.6%) used fewer after the procedures; 85 (22.4%) were prescribed the same number before and after the LPIs. A total of 167 patients (10.1%) underwent cataract surgery and 79 (4.8%) received glaucoma surgery over the 2-year follow-up. Black patients had a 130% increased odds for glaucoma medication-class prescriptions after bilateral LPIs, compared with white patients (P =.02). The odds of post-LPI glaucoma medication use increased by 21% for every additional 5 years of age (P <.0001). Conclusion Most patients undergoing bilateral LPIs received no pre- or post-LPI glaucoma medication-class prescriptions and had no cataract or additional glaucoma surgery within 2 years after LPIs. Clinicians should alert black or older patients and those already taking glaucoma medications before the procedure of their higher odds of requiring medications afterward.
Keywords: acetazolamide; adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brimonidine plus timolol; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; dipivefrine; dorzolamide; dorzolamide plus timolol; ecothiopate iodide; latanoprost; levobunolol; methazolamide; metipranolol; miotic agent; pilocarpine; propranolol; prostaglandin derivative; timolol; timolol maleate; travoprost; unoprostone isopropyl ester; adult; article; Black person; cataract; cataract extraction; Caucasian; cohort analysis; female; follow up; glaucoma; glaucoma surgery; health care utilization; human; iridotomy; laser peripheral iridotomy; laser surgery; longitudinal study; major clinical study; male; postoperative care; preoperative treatment; prescription; priority journal; retrospective study; alphagan; alphagan p; azopt; betagan; betimol; betoptic; betoptic s; combigan; cosopt; diamox; diamox sequels; epifrin; iopidine; isopto carbachol; isopto carpine; istalol; lumigan; neptazane; ocupress; ocusert pilo 20; ocusert pilo 40; optipranolol; phospholine iodide; pilocar; pilopine hs; piloptic 1; piloptic 2; piloptic 4; piloptic 6; propine; rescula; timoptic; timoptic xe; travatan; travatan z; trusopt; xalatan

The critical role of pharmacists in management and adherence of glaucoma therapy - Rickards, J.; Fritsch, M.A. (Pharmacy Times, 2015)
Keywords: antiglaucoma agent; eye drops; drug efficacy; drug mechanism; drug safety; glaucoma; human; medication compliance; note; paramedical education; patient compliance; pharmacist; professional knowledge; risk factor

The utility of cap color and bottle characteristics for topical glaucoma therapy - Marando, C.M.; Seibold, L.K.; Soohoo, J.R.; Pantcheva, M.B.; Ramulu, P.Y.; Kahook, M.Y. (Ophthalmology, 2015)
Keywords: adult; aged; color; drug packaging; female; glaucoma; human; intraocular pressure; major clinical study; male; packaging material; patient compliance; patient satisfaction; priority journal; short survey; topical treatment; very elderly

Current considerations in the treatment of glaucoma - DeSimone, E.M.; Pietig, B.A. (U.S. Pharmacist, 2015)
Glaucoma is a disorder of the eyes that can lead to blindness. Its incidence increases with age. While there is no cure, numerous topical medications are used to reduce the elevated intraocular pressure seen in patients. Topical prostaglandin analogues and beta-blockers are the most commonly used medications. Pharmacists can be effective partners in the treatment of glaucoma by monitoring adherence, counseling patients on the proper use of eyedrops, and recommending preservative-free or combination products when problems arise.
Keywords: acetazolamide; adrenergic receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; brimonidine; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; cholinesterase inhibitor; dipivefrine; dorzolamide; eye drops; methazolamide; prostaglandin derivative; timolol; African American; age; article; blindness; clinical feature; closed angle glaucoma; glaucoma; goniolens; gonioscopy; human; intraocular pressure; laser surgery; open angle glaucoma; optic nerve lesion; patient compliance; patient counseling; perimetry; pharmacist; prevalence; tonometry; trabeculectomy; trabeculoplasty; visual field; visual field defect

Clinical course of unilateral Acanthamoeba keratitis in a cosmetic contact lens wearer - Gupta, R.; Gorski, M.; Henderson, T.; Lazzaro, D.; Haseeb, M.A. (Annals of Clinical and Laboratory Science, 2015)
Purpose. To report the features and clinical course of Acanthamoeba keratitis in a cosmetic contact lens wearer. Case Report. A 29-year-old man sought medical attention for severe ocular pain, blurry vision, photophobia, and a foreign body sensation in the left eye for the past 3-4 days. He had been wearing a single sapphire cosmetic soft contact lens for 1-2 months. The left upper eyelid was edematous and the conjunctiva was hyperemic; the best corrected distance visual acuity was 20/400. A slit lamp examination revealed circular and perineural linear stromal opacities and diffuse keratic precipitates. A clinical diagnosis of herpes simplex keratitis was made and the patient was started on antiviral therapy. After initial improvement, the patient returned with worsening pain and vision; the corneal lesions had exacerbated. Unresponsiveness to antiviral therapy prompted examination of corneal scrapings, which revealed Acanthamoeba developmental forms. Antimicrobial therapy was prescribed resulting in relief of symptoms despite corneal opacities and poor vision. Conclusion. This case illustrates the importance of considering Acanthamoeba keratitis in contact lens wearers at presentation, particularly in those with symptomatic keratitis unresponsive to antiviral and antifungal therapy.
Keywords: soft contact lens; aciclovir; chlorhexidine; cyclopentolate; hexamidine isetionate; itraconazole; ofloxacin; poly(hexamethylenebiguanide); prednisolone acetate; Acanthamoeba keratitis; adult; antimicrobial therapy; antiviral therapy; article; blurred vision; case report; conjunctival hyperemia; cornea edema; cornea endothelium; cornea epithelium; cornea lesion; cornea opacity; cyst (resting stage); debridement; disease course; disease exacerbation; lack of drug effect; drug withdrawal; eye pain; foreign body; herpes simplex keratitis; human; hypopyon; male; medical device complication; medication compliance; microscopy; patient compliance; photophobia; priority journal; scar formation; slit lamp; soft contact lens; treatment response; treatment withdrawal; trophozoite; upper eyelid; visual acuity; visual disorder; cyclogyl; pred forte; Rainbowlens

Practical selection of antiemetics in the ambulatory setting - Flake, Z.A.; Linn, B.S.; Hornecker, J.R. (American Family Physician, 2015)
Nausea and vomiting are mediated primarily by three neurotransmitter pathways: visceral stimulation releases dopamine and serotonin; vestibular and central nervous system activation release histamine and acetylcholine; and chemoreceptor trigger zone activation releases dopamine and serotonin. Clinicians can improve the effectiveness and cost-effectiveness of treatments by targeting the appropriate pathways. Antihistamines and anticholinergics are most effective in patients with vestibular-mediated nausea secondary to vertigo. Serotonin antagonists block serotonin in the intestines and chemoreceptor trigger zone, and are most effective for treating gastroenteritis. Dopamine antagonists block dopamine in the intestines and chemoreceptor trigger zone; indications for these agents are similar to those for serotonin antagonists. For treatment of mild pregnancy-induced nausea, pyridoxine with or without doxylamine is recommended, and ginger may also be effective. In patients with migraine headache–associated nausea, metoclopramide improves response to oral anti-migraine agents. Ondansetron reduces nausea and vomiting in children with acute gastroenteritis and in women with hyperemesis gravidarum.
Keywords: antiemetic agent; antihistaminic agent; cholinergic receptor blocking agent; corticosteroid; dexamethasone; diphenhydramine; dopamine receptor blocking agent; doxylamine plus pyridoxine; ginger extract; meclozine; methylprednisolone acetate; metoclopramide; ondansetron; prochlorperazine; promethazine; pyridoxine; scopolamine; serotonin antagonist; allergic reaction; ambulatory monitoring; article; blurred vision; clinical effectiveness; closed angle glaucoma; constipation; cost effectiveness analysis; diarrhea; extrapyramidal symptom; fatigue; gastroenteritis; headache; human; hyperemesis gravidarum; hyperglycemia; hypertension; hypotension; mental disease; migraine; nausea and vomiting; pregnancy; QT prolongation; sedation; tardive dyskinesia; urine retention; xerostomia; antivert; benadryl; depo medrol; diclegis; reglan; transderm scop; zofran

An Analysis of the Fixed-Dose Combinations Authorized by the European Union, 2009-2014: A Focus on Benefit-Risk and Clinical Development Conditions - Sawicki-Wrzask, D.; Thomsen, M.; Bjerrum, O.J. (Therapeutic Innovation and Regulatory Science, 2015)
Background: Apparent issues with the treatment and management of complex, chronic, and multifactorial diseases with monotherapies are becoming more prevalent, with a potential solution being fixed-dose combinations (FDCs). There is a certain stigma associated with FDCs, namely after the bans in the mid- to late 20th century; however, FDCs have proven useful in improving efficacy, reducing adverse effects, prolonging marketability, and producing new therapeutic entities. In addition to this, FDCs may be advantageous in increasing patient compliance and reducing off-label use. Methods: FDCs authorized by the European Union in the past 5 years were analyzed according to benefit-risk and clinical trial design. Results: An overall stable authorization of FDCs from 2009 to 2014 was observed, with most being developed to treat cardiac- and immune-related disorders.The aforementioned bans have led to stricter guidelines and regulations on FDCs; however, the examples presented demonstrate that the clinical guidelines from the European Medicines Agency are flexible within limits and may be altered given proper justification. Conclusion: With off-label use, profitability, and reimbursement threatening the development of FDCs, it is the patients who end up suffering the most. The industry, regulatory bodies, and patients need to unite for the successful development of new FDCs.
Keywords: article; clinical trial (topic); diabetes mellitus; disease course; drug combination; dyslipidemia; European Medicines Agency; European Union; fixed dose combination; glaucoma; heart disease; hematologic disease; human; lung disease; neoplasm; neurologic disease; off label drug use; osteoporosis; patient compliance; practice guideline; priority journal; study design

Occurrence of adverse events in patients with JIA receiving biologic agents: Long-term follow-up in a real-life setting - Tarkiainen, M.; Tynjälä, P.; Vähäsalo, P.; Lahdenne, P. (Rheumatology (United Kingdom), 2015)
Objective. The aim of this study was to carry out a safety evaluation of biologic agents in patients with JIA and associated uveitis. Methods. In three tertiary centres in Finland, all adverse events (AEs) in 348 consecutive patients were collected. AEs were classified according to the Common Terminology Criteria for AEs. Results. A total of 1516 patient-years (py) were included: 710 on etanercept, 591 on infliximab, 188 on adalimumab, 8 on rituximab, 5 on anakinra, 6 on tocilizumab, 6 on abatacept and 1 on golimumab. The median follow-up of an individual patient was 51 months (range 1-155). The most common of the 2902 AEs (191/100 py) observed were mild infections, infusion or injection site reactions and alanine aminotransferase elevations. At least one AE occurred in 319 (92%) patients and 121 (35%) had at least one serious AE (SAE). The rate of SAEs was 11.4/100 py on etanercept, 11.8 on infliximab, 10.1 on adalimumab, 15.7 on abatacept, 31.2 on tocilizumab and 87.5 on rituximab, higher than with most anti-TNF agents (P = 0.005). No cases of malignant neoplasms or tuberculosis were detected. New-onset uveitis occurred in 9 patients, psoriasis or psoriasiform lesions in 13 and IBD in 6. Conclusion. Mild and moderate AEs in patients with JIA treated with biologics were more frequent than previously reported. SAEs were observed in one-third of the patients, but SAEs seldom led to drug discontinuation.
Keywords: abatacept; adalimumab; alanine aminotransferase; biological product; corticosteroid; double stranded DNA antibody; etanercept; glucocorticoid; golimumab; infliximab; methotrexate; anakinra; rituximab; tocilizumab; tumor necrosis factor inhibitor; adolescent; adrenal cortex insufficiency; adult; adverse drug reaction; alanine aminotransferase blood level; alopecia; anemia; appendicitis; article; atypical mycobacteriosis; autoimmune disease; bacterial pneumonia; biological therapy; bone marrow hypoplasia; bone necrosis; brain cyst; breast cyst; bronchitis; cataract; chickenpox; child; conjunctivitis; corticosteroid therapy; coughing; Crohn disease; depression; disease exacerbation; drug fatality; drug hypersensitivity; drug induced cancer; drug induced headache; drug safety; drug withdrawal; eczema; encephalitis; epidermoid cyst; fatigue; female; Finland; follow up; furunculosis; gastroenteritis; glaucoma; herpes zoster; human; influenza; infusion related reaction; injection site reaction; insulin dependent diabetes mellitus; juvenile rheumatoid arthritis; leukopenia; lichen planus; macrophage activation syndrome; major clinical study; male; medical terminology; medication compliance; mental disease; migraine; muscle disease; myalgia; mycobacterium avium pneumonia; mycobacterium avium pneumonia; nausea; obesity; observational study; opportunistic infection; osteopenia; osteoporosis; otitis media; patient compliance; patient safety; Pneumocystis pneumonia; pneumonia; priority journal; psoriasis; pyelonephritis; pyrexia idiopathica; retrospective study; school child; septicemia; side effect; sinusitis; skin infection; spleen cyst

Demand for Tertiary Eye Care Services in Developing Countries - Subburaman, G.-B.B.; Hariharan, L.; Ravilla, T.D.; Ravilla, R.D.; Kempen, J.H. (American Journal of Ophthalmology, 2015)
Purpose To analyze the experience of a large developing country tertiary ophthalmology system to identify generalizable information relevant for those planning similar centers elsewhere. Design Retrospective utilization analysis. Methods A historical review of the development of the Aravind Eye Care system was undertaken to evaluate the services provided by various tertiary services of the system. Demand for services is inferred based on the utilization statistics described below and distance traveled by patients to obtain services. Results Utilization of subspecialty services increased logarithmically for 17 years in all specialties. At all centers except one historically focused on glaucoma, retina services had the highest demand among subspecialty surgical services. The proportion of tertiary care patients among all new outpatients (39% in 2009 and 45% in 2013) and the proportion of specialty surgical and treatment procedures among all procedures (30% in 1997 and 49% 2013) increased over time. More patients traveled long distances (>100 kilometers) to receive specialty services than to receive cataract services (30% vs 23%). Conclusions These observations suggest that in regions where tertiary services are not widely available, (1) patients demand (travel further for) tertiary care more than general ophthalmology services; (2) demand for services can expand rapidly for many years; (3) tertiary care services tend to grow over time as a proportion of all services provided; and (4) retina services are the most highly demanded subspecialty surgical services. In such settings, it is likely that considerable latent demand exists; planned tertiary eye centers should anticipate sustained growth of tertiary services.
Keywords: cataract; cataract extraction; clinical assessment; clinical evaluation; consultation; cornea surgery; developing country; eye care; follow up; glaucoma; glaucoma surgery; health care access; health care need; health care utilization; health service; hospital management; human; medical information; ophthalmology; outpatient care; personal experience; priority journal; retina; retina surgery; retrospective study; review; surgical technique; tertiary health care; time to treatment; treatment planning

Patterns of glaucoma medication adherence over four years of follow-up - Newman-Casey, P.A.; Blachley, T.; Lee, P.P.; Heisler, M.; Farris, K.B.; Stein, J.D. (Ophthalmology, 2015)
Purpose To assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up. Design Retrospective, longitudinal cohort analysis. Participants Beneficiaries aged 40 years who were enrolled in a United States (US)-managed care plan for 7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma. Methods For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses. Main Outcome Measures Patterns of glaucoma medication adherence. Results Of the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (β = -0.06/dollar, P = 0.03). Conclusions For most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; miotic agent; prostaglandin derivative; adult; article; Black person; cohort analysis; drug cost; eye care; female; follow up; glaucoma; group based trajectory modeling; health care cost; human; income; longitudinal study; major clinical study; male; managed care; medication compliance; model; open angle glaucoma; patient attitude; patient compliance; prescription; priority journal; quantitative analysis; United States

Bandage Soft Contact Lenses for Ocular Graft-versus-Host Disease - Inamoto, Y.; Sun, Y.-C.; Flowers, M.E.D.; Carpenter, P.A.; Martin, P.J.; Li, P.; Wang, R.; Chai, X.; Storer, B.E.; Shen, T.T.; Lee, S.J. (Biology of Blood and Marrow Transplantation, 2015)
To examine safety and efficacy of bandage soft contact lenses (BSCLs) for ocular chronic graft-versus host disease (GVHD), we conducted a phase II clinical trial. Extended-wear BSCLs were applied under daily topical antibiotic prophylaxis. Patients completed standardized symptom questionnaires at enrollment and at 2 weeks, 4 weeks, and 3 months afterward. Ophthalmologic assessment was performed at enrollment, at 2 weeks, and afterward as medically needed. Assessments at follow-up were compared with baseline by paired t-test. Nineteen patients with ocular GVHD who remained symptomatic despite conventional treatments were studied. The mean Lee eye subscale score was 75.4 at enrollment and improved significantly to 63.2 at 2 weeks (P = .01), to 61.8 at 4 weeks (P = .005), and to 56.3 at 3 months (P = .02). The ocular surface disease index score and 11-point eye symptom ratings also improved significantly. According to the Lee eye subscale, clinically meaningful improvement was observed in 9 patients (47%) at 2 weeks, in 11 patients (58%) at 4 weeks, and in 9 patients (47%) at 3 months. Visual acuity improved significantly at 2 weeks compared with enrollment values. Based on slit lamp exam at 2 weeks, punctate epithelial erosions improved in 58% of the patients, showed stability in 16%, and worsened in 5%. No corneal ulceration or ocular infection occurred. BSCLs are a widely available, safe, and effective treatment option that improves manifestations of ocular GVHD in approximately 50% of patients. This study was registered at www.clinicaltrials.gov as NCT01616056.
Keywords: NCT01616056; bandage contact lens; soft contact lens; aciclovir; azathioprine; cevimeline; cyclosporine; methotrexate; moxifloxacin; mycophenolate mofetil; ofloxacin; prednisone; rapamycin; steroid; tacrolimus; trifluridine; adult; aged; article; bandage contact lens; cauterization; clinical article; device safety; epiphora; eyelid edema; female; foreign body reaction; graft versus host reaction; human; male; ocular graft versus host disease; ocular surface disease; patient compliance; punctal plug; questionnaire; rating scale; slit lamp; soft contact lens; virus infection; visual acuity; 'purevision'; 'softlens'

Chronic pain, its management and psychological issues: A review - Jena, M.; Mishra, S.; Pradhan, S.; Jena, S.; Mishra, S.S. (Asian Journal of Pharmaceutical and Clinical Research, 2015)
Chronic pain is one of the most prevalent, disabling conditions both in clinical and psychological aspects and yet often remains inadequately treated due to cost reasons. Moreover, chronic pain commonly occurs in conjunction with depression, anxiety and somatoform disorders. Chronic and recurrent pain not associated with a disease is very common in childhood and adolescence, but there are very less studies and analysis has been done on chronic pain epidemiology and management. As pain is the important factor influencing quality of life and also the reason for which a person seek the advice of physician even require hospitalization that is why this systematic review highlights the different types of chronic pain, epidemiology, pathophysiology, and management of chronic pain along with psychological issues associated with it.
Keywords: acetylsalicylic acid; aminotransferase; amitriptyline; antidepressant agent; carbamazepine; citalopram; clomipramine; clonidine; cyclooxygenase 2 inhibitor; desipramine; dextropropoxyphene; fluoxetine; imipramine; lidocaine; monoamine oxidase inhibitor; nortriptyline; opiate; paracetamol; paroxetine; pimozide; serotonin uptake inhibitor; tramadol; tricyclic antidepressant agent; acupuncture; alcohol consumption; amenorrhea; analgesia; anxiety disorder; arachnoiditis; arthritis; arthropathy; cancer pain; cause of death; chronic disease; chronic pain; closed angle glaucoma; cognitive defect; cognitive therapy; complex regional pain syndrome type I; constipation; depression; diabetic neuropathy; disease association; distress syndrome; dizziness; drowsiness; drug cost; drug efficacy; drug safety; erectile dysfunction; face pain; fear; fetus risk; fibromyalgia; fluoroscopy; health care utilization; heart arrhythmia; helplessness; hospitalization; human; hyperalgesia; hypogonadism; kidney disease; leg pain; liver cirrhosis; low back pain; migraine; nausea; neoplasm; neuropathic pain; nociception; orthostatic hypotension; osteoarthritis; pathophysiology; physical disability; postherpetic neuralgia; pregnancy; prevalence; prospective study; prostate hypertrophy; quality of life; randomized controlled trial (topic); recurrent disease; respiration depression; review; risk factor; sedation; seizure; self concept; self esteem; somatoform disorder; spinal cord dorsal horn; spinal cord injury; suicidal behavior; tardive dyskinesia; tension headache; traditional medicine; transcranial direct current stimulation; transcranial magnetic stimulation; trend study

Barriers to follow-up and strategies to improve adherence to appointments for care of chronic eye diseases - Thompson, A.C.; Thompson, M.O.; Young, D.L.; Lin, R.C.; Sanislo, S.R.; Moshfeghi, D.M.; Singh, K. (Investigative Ophthalmology and Visual Science, 2015)
PURPOSE. To understand factors associated with poor attendance of follow-up appointments for care of glaucoma (GL), AMD, and diabetic retinopathy (DR) in a tertiary referral center, and to identify strategies to improve adherence. METHODS. Cross-sectional study of 240 adults attending follow-up appointments for GL, AMD, or DR. Cases (N = 102) were patients with poor follow-up who missed and failed to reschedule an appointment within 1 month of the recommended follow-up date during the preceding year. Controls (N = 138) were patients who completed the assigned follow-up. Data regarding the factors impacting adherence to appointments were collected via an orally administered questionnaire. Multivariate logistic regression was performed to determine factors associated with poor follow-up. RESULTS. In a multivariate logistic regression model, independent factors significantly associated with poor follow-up included incorrectly answering more than 50% of questions about eye disease (adjusted odds ratio [OR] = 3.24, P = 0.001), legal blindness (adjusted OR 2.64, P = 0.013), the presence of glaucomatous versus retinal disease (adjusted OR 2.06, P = 0.013), and difficulty for the study subject and/or escort taking time away from work for the appointments (adjusted OR 1.80, P = 0.049). Subjects identified the following strategies to improve follow-up: contact with others having the same eye condition (41.3%), greater education regarding eye disease (40.8%), and improved transportation services to the clinic (44.6%). CONCLUSIONS. Low disease knowledge scores, legal blindness, and difficulty getting time away from work for appointments adversely impacted follow-up independent of eye disease diagnosis. Improvements in patient education, transportation services, and clinic efficiency may increase adherence to recommended appointment intervals.
Keywords: age related macular degeneration; aged; anthropometry; article; awareness; cross-sectional study; diabetic retinopathy; disease severity; eye care; eye disease; female; follow up; glaucoma; health care cost; human; interview; knowledge; major clinical study; male; medical information; multivariate logistic regression analysis; patient assessment; patient transport; priority journal; protocol compliance; questionnaire; visual acuity

Pediatric cataract surgery: Challenges - Johnson, W.J.; Wilson, M.E.; Trivedi, R.H. (Expert Review of Ophthalmology, 2015)
This review examines pediatric cataract surgery via the challenges and complications that must be considered by the treating physician. The following is structured to examine challenges in clinically relevant categories, each with a brief background, philosophy, incidence and/or outcomes when available, and an overview of interventions and treatment modalities. The latter part of each segment contains a summary of data and/or comments published from the infant aphakia treatment study, a prospective, randomized controlled trial that compared primary intraocular lens implantation to aphakia corrected with a contact lens when operating for unilateral cataract from 1 to 7 months of age. The infant aphakia treatment study authors have published clinical data out to 5 years of age in their study cohort.
Keywords: amblyopia; aphakia; capsule opacification; cataract; cataract extraction; central corneal thickness; contact lens; cornea edema; corneal endothelial cell loss; endophthalmitis; glaucoma; health care access; human; incidence; intraocular hypotension; intraocular pressure; intraoperative floppy iris syndrome; lens implantation; outcome assessment; pediatric surgery; postoperative period; refraction error; retina detachment; retina hemorrhage; retinopathy; review; strabismus; surgical risk; visual acuity; vitreous hemorrhage; wound dehiscence

Cost-Related medication nonadherence and cost-saving behaviors among patients with glaucoma before and after the implementation of medicare part D - Blumberg, D.M.; Prager, A.J.; Liebmann, J.M.; Cioffi, G.A.; De Moraes, C.G. (JAMA Ophthalmology, 2015)
Importance Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. ObjectiveS To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. Design, Setting, and ParticipantsSerial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. Intervention Effect of the implementation of the Medicare Part D drug benefit. Main Outcomes and Measures The change in cost-related nonadherence and the change in cost-reduction strategies. Results Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4%and 8.2%to 2.7%(P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4%in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0%to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<30 000), self-reported visual disability, and a smaller Lawton index. Conclusions and Relevance After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.
Keywords: prescription drug; adult; article; cost control; cross-sectional study; drug cost; eye care; female; glaucoma; health care planning; human; major clinical study; male; medicaid; medicare; medication compliance; patient compliance; prescription; priority journal; self report

Failure of Glaucoma Follow-up Compliance - Ung, C.; Spaeth, G.L.; Lin, S.C.; Singh, K. (American Journal of Ophthalmology, 2015)
Keywords: disease course; disease severity; disease surveillance; editorial; follow up; glaucoma; human; medication compliance; patient education; priority journal; treatment refusal; visual impairment

Effects of switching from timolol to brimonidine in prostaglandin analog and timolol combination therapy - Aihara, M.; Adachi, M.; Hamada, N.; Honda, N.; Koseki, N.; Matsuo, H.; Miyata, K.; Otani, S.-I.; Unoki, K. (Journal of Ocular Pharmacology and Therapeutics, 2015)
Purpose: To assess the efficacy and safety of switching from timolol 0.5% to brimonidine 0.1% in patients with glaucoma treated with a prostaglandin analog (PGA) and timolol combination. Methods: This prospective, open-label multicenter study enrolled patients with open-angle glaucoma or ocular hypertension who were being treated with a PGA and timolol. After baseline measurements, timolol was switched to brimonidine 0.1%, and patients were followed for 12 weeks. Patients visited at 4 and 12 weeks after switching. The main outcome measure was the change in intraocular pressure (IOP). For safety evaluations, hyperemia, formation of conjunctival follicles, superficial punctate keratopathy as a local side effect, blood pressure (BP), and heart rate (HR) were evaluated. Results: One hundred seven patients participated in this study. Among them, 103 patients completed the study. The IOP values at baseline, 4 weeks, and 12 weeks after the transition were 15.7±2.7, 14.3±2.8, and 14.0±2.8mmHg, respectively. IOP was significantly reduced at 4 and 12 weeks compared with baseline (p<0.001). There were no significant changes in hyperemia or follicle formation. The superficial punctate keratopathy score was significantly reduced at 12 weeks compared with baseline (p<0.05). Systolic and diastolic BP values were significantly reduced and HR significantly increased after switching (p<0.05). Conclusion: Switching from timolol 0.5% to brimonidine 0.1% may not change IOP in the combination use of timolol 0.5% and a PGA and was well tolerated by patients without severe ocular or systemic side effects.
Keywords: brimonidine; eye drops; prostaglandin derivative; timolol; aged; article; blood pressure; conjunctival hyperemia; drug efficacy; drug safety; drug substitution; female; glaucoma; Goldmann applanation tonometer; heart rate; human; hyperemia; intraocular hypertension; intraocular pressure; Japanese (people); keratopathy; major clinical study; male; multicenter study; open angle glaucoma; open study; patient compliance; prospective study; punctate keratitis

Health coaching for glaucoma care: A pilot study using mixed methods - Vin, A.; Schneider, S.; Muir, K.W.; Rosdahl, J.A. (Clinical Ophthalmology, 2015)
Introduction: Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care. Methods: A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study. Results: Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects’ qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members. Conclusion: Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health.
Keywords: NCT02090777; antiglaucoma agent; aged; article; case report; controlled clinical trial; controlled study; demography; drug surveillance program; feasibility study; female; glaucoma; glaucoma surgery; health coaching; human; interview; laser surgery; male; medical information; medication compliance; patient compliance; patient counseling; pilot study; prospective study; questionnaire; self care; telephone; unspecified side effect; visual analog scale

Patient question-asking about glaucoma and glaucoma medications during videotaped medical visits - Sleath, B.; Sayner, R.; Blalock, S.J.; Carpenter, D.M.; Muir, K.W.; Hartnett, M.E.; Tudor, G.; Lawrence, S.; Giangiacomo, A.L.; Robin, A.L. (Health communication, 2015)
We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.
Keywords: adult; aged; ambulatory care; doctor patient relationship; female; glaucoma; human; interpersonal communication; male; middle aged; patient; physician; psychology; statistics and numerical data; very elderly; videorecording; young adult

Socioeconomics of long-term glaucoma therapy in India - Nayak, B.; Gupta, S.; Kumar, G.; Dada, T.; Gupta, V.; Sihota, R. (Indian journal of ophthalmology, 2015)
PURPOSE: To determine the socioeconomic impact of long-term glaucoma therapy. MATERIALS AND METHODS: One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side-effects was administered. RESULTS: The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/- (range: Rs. 500/- to Rs. 50,000/-) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti-glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6-96 h/month). About 2.7% experienced systemic side-effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment. CONCLUSIONS: Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.
Keywords: antihypertensive agent; adult; aged; economics; follow up; glaucoma; health care cost; human; incidence; income; India; middle aged; patient compliance; physiology; poverty; prognosis; questionnaire; socioeconomics; statistics and numerical data; time factor; trends; very elderly; visual acuity; young adult

A multi-center, cross-sectional study on the burden of infectious keratitis in China - Song, X.; Xie, L.; Tan, X.; Wang, Z.; Yang, Y.; Yuan, Y.; Deng, Y.; Fu, S.; Xu, J.; Sun, X.; Sheng, X.; Wang, Q. (PLoS ONE, 2014)
Objective: To understand the prevalence and demographic characteristics of infectious keratitis and infectious corneal blindness. Methods: A multi-center, population-based cross-sectional study was conducted from January 1 to August 31, 2010. A total of 191,242 individuals of all age groups from 10 geographically representative provinces were sampled using stratified, multi-stage, random and systematic sampling procedures. A majority, 168,673 (88.2%), of those sampled participated in the study. The examination protocol included a structured interview, visual acuity testing, an external eye examination, and an anterior segment examination using a slit lamp. The causes and sequelae of corneal disease were identified using uniform customized protocols. Blindness in one eye caused by infectious keratitis was defined as infectious corneal blindness. Results: The prevalence of past and active infectious keratitis was 0.192% (95% confidence interval [CI], 0.171-0.213%), and the prevalence of viral, bacterial, and fungal keratitis was 0.11%, 0.075%, and 0.007%, respectively. There were 138 cases of infectious corneal blindness in at least one eye in the study population (prevalence of 0.082% [95%CI, 0.068%-0.095%]). Statistical analysis suggested that ocular trauma, alcoholic consumption, low socioeconomic levels, advanced age, and poor education were risk factors for infectious corneal blindness. Conclusions: Infectious keratitis is the leading cause of corneal blindness in China. Eye care strategies should focus on the prevention and rehabilitation of infectious corneal blindness.
Keywords: adolescent; adult; age; alcohol consumption; anterior eye segment; article; bacterial keratitis; blindness; child; China; cornea disease; cornea opacity; cross-sectional study; demography; educational status; epidemiological data; eye examination; eye injury; female; geographic distribution; health care access; human; infectious corneal blindness; keratitis; keratomycosis; low vision; male; prevalence; pterygium; rural area; slit lamp; smoking; social status; structured interview; urban area; virus keratitis; visual acuity

Exciting directions in glaucoma - Rasmussen, C.A.; Kaufman, P.L. (Canadian Journal of Ophthalmology, 2014)
Glaucoma is a complex, life-long disease that requires an individualized, multifaceted approach to treatment. Most patients will be started on topical ocular hypotensive eyedrop therapy, and over time multiple classes of drugs will be needed to control their intraocular pressure. The search for drugs with novel mechanisms of action, to treat those who do not achieve adequate intraocular pressure control with, or become refractory to, current therapeutics, is ongoing, as is the search for more efficient, targeted drug delivery methods. Gene-transfer and stem-cell applications for glaucoma therapeutics are moving forward. Advances in imaging technologies improve our understanding of glaucoma pathophysiology and enable more refined patient evaluation and monitoring, improving patient outcomes.
Keywords: antihypertensive agent; benzalkonium chloride; drug delivery system; gene transfer; glaucoma; human; intraocular pressure; pathophysiology; patient compliance; review; stem cell; trabecular meshwork

Medical cannabis: US researchers battle for access to the plant - Frisch, S. (BMJ (Online), 2014)
Keywords: cannabis derivative; dronabinol; medical cannabis; nabilone; acquired immune deficiency syndrome; amyotrophic lateral sclerosis; article; cachexia; cancer pain; cannabis use; chronic pain; drug classification; drug control; drug delivery system; drug efficacy; drug research; drug safety; funding; glaucoma; government regulation; health care access; Human immunodeficiency virus infection; migraine; multiple sclerosis; Parkinson disease; seizure; sickle cell anemia; sickle cell crisis; spasticity

Twenty-four-hour intraocular pressure patterns in a symptomatic patient after ab interno trabeculotomy surgery - Mansouri, K.; Medeiros, F.A.; Weinreb, R.N. (Clinical Ophthalmology, 2014)
We report the results of repeated ambulatory continuous 24-hour intraocular pressure (IOP) monitoring with a contact lens sensor (CLS) in a glaucoma patient with ocular pain after ab interno trabeculotomy (Trabectome™) surgery. Our findings show that a combined prostaglandin–pilocarpine treatment reduced nighttime IOP peaks and relieved the patient’s symptoms.
Keywords: bimatoprost; pilocarpine; ab interno trabeculotomy; adult; ambulatory monitoring; article; case report; contact lens sensor; eye pain; female; Goldmann applanation tonometry; human; intraocular pressure; middle aged; open angle glaucoma; postoperative period; pressure measurement; selective laser trabeculoplasty; sensor; tonometry; trabeculoplasty; trabeculotomy; water loading (test)

Compliance to glaucoma medication and its effect on treatment regime - Bodle, L.; Craig, J.; Little, J.-A. (Clinical and Experimental Ophthalmology, 2014)
Purpose: Long-term treatment compliance to a chronic asymptomatic condition is a demanding task for many patients. Treating progressive glaucoma can also be confounding for physicians, particularly when management relies on assumption of compliance. This study aims to investigate the relationship between self-reported compliance and frequency of medication changes due to glaucoma progression. Methods: 128 participants with primary open angle glaucoma were recruited from glaucoma clinics in Flinders Eye Centre, South Australia and completed confidential questionnaires. Information was obtained regarding beliefs about glaucoma and their treatment. Compliance was assessed using Morisky Medication Adherence Scale (MARS). Medical records were analyzed for the number of medication changes, due to glaucoma progression. Results: Compliance to topical glaucoma medication was found in 41.4% (MARS = 0). Data were analyzed for behaviors affecting compliance, history of compliance and reasons for changing compliance. Qualitative data and detailed responses were collated from all participants. There was no significant relationship between compliance and changes in medication regime (Chi-squared test for independence), however a significantly lower compliance was detected if participants had difficulties with their drop regime (p = 0.001) and participants who had help with drop insertion at home. (p = 0.015). Conclusion: Using a questionnaire and sympathetic questioning, confidential from their treating physician, higher non-compliance was revealed than in previous studies. Qualitative data indicated availability of ongoing glaucoma education and counselling would be a valuable adjunctive resource alongside medical treatment. Development of a simple validated questionnaire is also needed for assessing glaucoma medication compliance, so an individual tailored approach to non-compliance can be developed.
Keywords: drug therapy; human; Australian; New Zealand; college; ophthalmologist; glaucoma; questionnaire; medication compliance; physician; astronomy; hospital; open angle glaucoma; patient compliance; independence; medical record; patient; asymptomatic disease; Australia; eye; education; counseling; therapy; long term care

Latanoprost in the treatment of glaucoma - Alm, A. (Clinical Ophthalmology, 2014)
Prostaglandins are approved by the European Glaucoma Society guidelines as first-line treatment for glaucoma. This review focuses on latanoprost, an ester prodrug of prostaglandin (PG) F2α, which was the first of the currently available topical PGF2α analogs to be launched for glaucoma or ocular hypertension and which still accounts for the majority of prescriptions. It is better absorbed than the parent compound through the cornea, and peak concentration of the active drug is in the aqueous humor 1–2 hours after topical dosing (15–30 ng/mL). Metabolism occurs mainly in the liver. Latanoprost (0.005%) has been very well studied in clinical trials and meta-analyses that show it to be generally as effective as the other PG analogs (bimatoprost, travoprost, and tafluprost) and more effective than timolol, dorzolamide, and brimonidine. Latanoprost has good short- and long-term safety and tolerability profiles. In common with other prostaglandins, it lacks systemic effects, but can cause ocular adverse events such as conjunctival hyperemia, pigmentation of the iris, periocular skin or eyelashes, hypertrichosis, and ocular surface effects or irritation. Latanoprost is significantly better tolerated than either bimatoprost or travoprost. Patients treated with latanoprost have better compliance and persist with therapy longer than those that are given other drugs. An improved formulation of latanoprost without the preservative benzalkonium chloride has recently been developed. It is as effective as conventional latanoprost, has a lower incidence of hyperemia, and can be stored at room temperature. In conclusion, latanoprost has the best efficacy–tolerability ratio of the PG analogs available for glaucoma treatment, and has good compliance and persistence. These factors should be improved further by the recent development of preservative-free latanoprost.
Keywords: bimatoprost; brimonidine; brinzolamide; dorzolamide; latanoprost; tafluprost; timolol; travoprost; comparative effectiveness; conjunctival hyperemia; dose response; drug absorption; drug effect; drug efficacy; drug half life; drug indication; drug mechanism; drug metabolism; drug safety; drug tolerability; eye irritation; eyelash; glaucoma; human; hypertrichosis; intraocular pressure; iris disease; iris pigmentation; iris pigmentation; meta analysis (topic); multicenter study (topic); outcome assessment; patient compliance; phase 2 clinical trial (topic); phase 3 clinical trial (topic); randomized controlled trial (topic); review; side effect; treatment duration; monoprost; protriaxin

The medical marijuana movement reflects an indifference to public health - Madras, B.K. (Journal of Global Drug Policy and Practice, 2014)
In 1996, the stringent procedures that regulate drug safety and the practice of medicine were imperiled in the United States. The California ballot initiative Prop. 215 (and its successor SB420), was passed by voters following an intense and heavily funded campaign to shape their views: a “yes” vote was deemed a vote of compassion, a vote to enable physicians to “recommend” smoking marijuana to end the suffering of debilitating and life-threatening ailments. Smoked marijuana was approved by voters as a valid treatment for serious medical conditions - “AIDS, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, persistent muscle spasms, seizures, epilepsy, severe nausea, and any other chronic or persistent medical symptom that substantially limits the ability of the person to conduct major life activities.” Energized by the California decision and empowered by the success of their compassionate care strategy, itinerant, strategic, wealthy ballot backers invested millions of dollars in other states, and succeeded in legitimizing smoked marijuana as a medicine in more than 20 states and the District of Columbia. There are grave implications to a drug approval process by the ballot box or by politicians; neither party is accountable to patients.
Keywords: cannabinoid; medical cannabis; acquired immune deficiency syndrome; article; bronchitis; cancer pain; cannabis addiction; cognitive defect; daily life activity; dose response; drug approval; drug delivery system; drug efficacy; drug manufacture; drug safety; elevated blood pressure; evidence based medicine; health care access; health promotion; human; increased appetite; lung cancer; medical practice; multiple sclerosis; nausea and vomiting; neuropathic pain; psychosis; public health; schizophrenia; shelf life; smoking; spasticity; treatment indication; treatment refusal; United States; xerostomia

Congenital conditions and corneal hydrops in keratoconus - Case reports - Herceg, A.; Stabuc Silih, M. (Acta Clinica Croatica, Supplement, 2014)
Purpose: Report of three cases of acute, unilateral hydrops in patients with bilateral keratoconus and congenital conditions. Setting/Venue: Keratoconus is a bilateral, non-inflammatory and progressive corneal ectasia with an incidence of 1 per 2000. It is diagnosed more often in people with Down's syndrome. Acute hydrops is an influx of aqueous into the cornea as a result of a break in Descemet's membrane. It can cause sudden decrease in vision, pain, photophobia and profuse tearing. It occurs in 3% of patients with keratoconus and generally resolves without intervention over 2-4 months. Treatment regimens can be divided into conservative, medical, and surgical options. Materials and methods: A 22-year-old woman with congenital deformation of lacrimal canaliculus, a 39-year-old woman with Down syndrome and a 32-year-old man with mental retardation, all presented with a sudden decrease of visual acuity, redness, pain, burning sensation and increased tearing. Slit-lamp examination revealed conjunctival hyperemia, very extensive corneal edema, and in two cases large fluid-filled intrastromal clefts. Results: With conservative and medical therapy, corneal edema in all cases took a few months to resolve and left a smaller or bigger residual scar. In the last 10 years, intracameral injection of air or expansile gas has been advocated, but further studies are required to validate the area and depth of the tear, beyond which intracameral gas injection is unhelpful. Owing to issues of patient compliance, reinjection of gas, possible pupil block glaucoma and lack of benefit in terms of final visual acuity or reduction in need of transplantation surgery, we did not decide to treat our patients with intracameral gas injections. Conclusions: Larger studies are required to further refine the possible prevention and treatment options. Accurate and prompt clinical diagnosis of hydrops with close observation allows for early detection and treatment of complications such as perforation and infection. Acute hydrops is not an indication for emergency corneal transplantation, except for rare cases of corneal perforation, which may be first treated with tissue adhesives and bandage contact lenses.
Keywords: tissue adhesive; edema; keratoconus; human; case report; contact lens; congenital disorder; gas; intracameral drug administration; patient; injection; cornea edema; visual acuity; pain; female; Down syndrome; lacrimal duct; slit lamp; photophobia; emergency; perforation; cornea transplantation; conjunctival hyperemia; cornea perforation; prevention; transplantation; glaucoma; burning sensation; mental deficiency; cornea; lacrimal fluid; patient compliance; male; scar; therapy; diagnosis; bandage contact lens; infection; liquid; Descemet membrane

Effect of dorzolamide/timolol combination on the visual field in glaucoma - Takeda, S.; Mimura, T.; Matsubara, M. (Clinical Ophthalmology, 2014)
Purpose: To evaluate the effect of treatment for 3 years with a dorzolamide/timolol (1%/0.5%) fixed combination (DTFC) on visual field progression in patients with open-angle glaucoma. Participants: A total of 14 consecutive patients were enrolled who had been previously treated with monotherapy or any combination of a beta blocker, carbonic anhydrase inhibitor, and/or prostaglandin analog for primary open-angle glaucoma (POAG; n=4) or normal-tension glaucoma (NTG; n=10). Methods: Patients were switched to DTFC from their prior glaucoma therapy. The IOP was measured at intervals of 4-6 weeks, and the visual fields were examined at least twice a year for 3 years. The annual change of mean deviation (MD slope) was used to quantify visual field loss. Results: The mean MD value was -5.9±5.0 dB at baseline; it was -5.6±4.8 dB at 12 months, -5.9±5.0 dB at 24 months, and -5.6±5.1 dB at 36 months after switching. The mean MD slope was -0.2±0.8 dB/year before switching and 0.3±1.3 dB/year from baseline to 1 year, -0.3±1.1 dB/year from 1-2 years, and 0.3±0.9 dB/year from 2-3 years after switching. The mean MD slope from baseline to 36 months was correlated with the IOP reduction rate at 36 months after switching. Visual field progression was associated with the IOP reduction rate at 12 months after switching. Conclusion: Switching to DTFC from prior glaucoma therapy improved the MD slope for at least 3 years. Reduction of the IOP after switching to DTFC was effective for delaying visual field progression. Although our study was not nonrandomized and was small in scale, the findings suggest that DTFC might have a beneficial effect on the visual fields in patients with open-angle glaucoma. © 2014 Takeda et al.
Keywords: beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; dorzolamide plus timolol; prostaglandin derivative; absence of side effects; adult; aged; article; case study; clinical article; clinical trial; combination chemotherapy; disease course; drug effect; drug substitution; drug tolerability; drug withdrawal; female; follow up; foveal sensitivity; human; intraocular pressure; longitudinal study; low tension glaucoma; male; medication compliance; monotherapy; open angle glaucoma; outcome assessment; patient compliance; prospective study; treatment duration; very elderly; visual field; visual field defect; visual field loss; visual field loss; visual system parameters; cosopt; cosopt

Increase in examinations for cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration : Comparative cross-sectional study between 2010 and 1997 in ophthalmological practices - Bertram, B.; Gante, C.; Hilgers, R.-D. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2014)
Keywords: adult; aged; ambulatory care; cataract; clinical practice; comorbidity; comparative study; cross-sectional study; diabetic retinopathy; female; Germany; glaucoma; health care survey; human; macular degeneration; male; middle aged; ophthalmology; prevalence; statistics and numerical data; trends; utilization; utilization review; very elderly; visual system examination

Intensity of side effects of topical glaucoma medication and its influence on adherence behavior in patients with glaucoma - Yu, A.L.; Weise, S.; Welge-Lussen, U. (Clinical Ophthalmology, 2014)
Background: The aim of this study was to investigate the intensity of side effects that patients attribute to their topical glaucoma medication and their relationship to adherence behavior. Methods: This was a questionnaire-based study of 123 glaucoma patients at a university eye clinic in Erlangen, Germany. An initial questionnaire asked about patient demographic data, the treatment plan, and intensity of side effects, and included Adherence to Refills and Medication Scale 2 (ARMS2) and visual analog scale (VAS-AD) scores. In a follow-up questionnaire, the treatment plan, intensity of side effects, ARMS2, and VAS-AD were reanalyzed. Results: Most patients reported having few side effects, although only 20% said that they had no symptoms suggestive of side effects at all. The patients showed good adherence behavior on both the ARMS2 and VAS-AD scores, which were stable over time. The intensity of side effects experienced in the previous 7 days did not correlate with adherence scores and had no predictive value for adherence. Conclusion: This study could not detect any significant influence of the subjectively experienced intensity of side effects on patients' adherence behavior. However, we believe that a simple and clear treatment plan with few side effects is still preferred by most patients. © 2014 Yu et al.
Keywords: antiglaucoma agent; adult; aged; article; disease severity; dizziness; drug safety; eye inflammation; eye pain; eye redness; female; follow up; foreign body; Germany; headache; human; major clinical study; male; open angle glaucoma; patient attitude; patient compliance; predictive value; pruritus; side effect; treatment planning; unspecified side effect; very elderly; visual analog scale; visual disorder; visual impairment; xerostomia

Differential pharmacology and clinical utility of emerging combination treatments in the management of COPD - Role of umeclidinium/vilanterol - Malerba, M.; Morjaria, J.B.; Radaeli, A. (International Journal of COPD, 2014)
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. Bronchodilator therapy is the cornerstone in COPD treatment. Bronchodilation in COPD is mainly achieved via administration of long-and ultralong-acting β2-agonists and with long-acting muscarinic antagonists. New combinations of bronchodilators with dual-acting muscarinic antagonist and β2-agonist properties have been licensed, and others are currently being developed with the aim of achieving once-daily dosing, and therefore may improve the likelihood of treatment compliance. These combination bronchodilators include glycopyrronium bromide/indacaterol maleate, umeclidinium (UMEC) bromide/vilanterol trifenatate (VI), aclidinium bromide/formoterol and tiotropium bromide/olodaterol (Boehringer Ingelheim, Germany). This review will focus mainly on studies and clinical trials involving the novel fixed-dose combination of UMEC/VI at doses of 125/25 μg and 62.5/25 μg in patients with COPD. Data from large clinical trials involving more than 4,500 COPD patients indicate that UMEC/VI is an effective once-daily treatment in COPD with improved pulmonary function. Future studies assessing the impact of this combination on exacerbations, delay in disease progression, and health status in patients with COPD are warranted. © 2014 Malerba et al.
Keywords: formoterol; indacaterol; moxifloxacin; muscarinic M3 receptor; placebo; soft mist inhaler; salbutamol; salmeterol; tiotropium bromide; umeclidinium; umeclidinium plus vilanterol; unclassified drug; verapamil; vilanterol; airway obstruction; anxiety disorder; blurred vision; bronchospasm; chronic obstructive lung disease; closed angle glaucoma; constipation; disease course; disease exacerbation; disease severity; drug absorption; drug efficacy; drug elimination; drug excretion; drug mechanism; drug potentiation; drug tolerability; dyspepsia; forced expiratory volume; gastroesophageal reflux; glaucoma; glycogenolysis; headache; health status; heart arrhythmia; heart palpitation; heart rate variability; human; hyperglycemia; hypokalemia; kidney disease; liver disease; lung function; monotherapy; nervousness; papilledema; patient compliance; phase 2 clinical trial; phase 3 clinical trial; powder inhaler; quality of life; review; rhinopharyngitis; single drug dose; supraventricular tachycardia; tremor; urinary tract disease; urine retention; xerostomia; anoro; respimat; Ellipta

Combination of brinzolamide and brimonidine for glaucoma and ocular hypertension: Critical appraisal and patient focus - Nguyen, Q.H. (Patient Preference and Adherence, 2014)
Glaucoma is one of the leading causes of blindness and is characterized by optic nerve damage that results in visual field loss. Elevated intraocular pressure (IOP) has been associated with glaucoma progression; thus, IOP-lowering medications are the standard of care for glaucoma. Guidelines suggest monotherapy with IOP-lowering agents such as β-blockers (eg, timolol), prostaglandin analogs, carbonic anhydrase inhibitors (eg, brinzolamide), and α2-receptor agonists (eg, brimonidine). However, monotherapy may provide insufficient IOP reduction in some patients, thereby necessitating the use of multiple IOP-lowering medications. Multidrug regimens may be complex, may increase the risk of preservative-related ocular symptoms, and may potentially reduce overall drug exposure as a consequence of drug washout during closely timed sequential administrations; these difficulties may reduce overall drug efficacy and decrease patient persistence and adherence with multidrug treatment regimens. Fixed-combination medications that provide two IOP-lowering therapies within a single solution are available and may overcome some of these challenges. However, all currently available fixed combinations combine timolol with another IOP-lowering agent, indicating that additional fixed-combination alternatives would be beneficial. To meet this demand, a novel fixed combination of brinzolamide 1% and brimonidine 0.2% (BBFC) has recently been developed. In two randomized, double-masked, multinational clinical trials, BBFC had greater IOP-lowering efficacy than brinzolamide or brimonidine monotherapy after 3 months of treatment in patients with open-angle glaucoma or ocular hypertension. In both studies, the overall safety profile of BBFC was consistent with that of brinzolamide and brimonidine. Comparative studies with BBFC versus other IOP-lowering monotherapy and fixed-combination medications are not available, but the IOP reductions observed with BBFC are similar to or greater than those reported in the literature for other glaucoma treatments; thus, BBFC provides an additional fixed-combination therapeutic option for patients who require further efficacious IOP reduction and improved convenience and tolerability versus concomitant administration of two separate medications. © 2014 Nguyen.
Keywords: bimatoprost plus timolol; brimonidine; brimonidine plus brinzolamide; brimonidine plus timolol; brinzolamide; brinzolamide plus timolol; dorzolamide plus timolol; latanoprost plus timolol; allergic conjunctivitis; blurred vision; comparative effectiveness; conjunctival follicle; conjunctival follicle; conjunctival hyperemia; conjunctivitis; drug efficacy; drug safety; drug tolerability; dry eye; dysgeusia; eye allergy; eye irritation; eye pain; fatigue; glaucoma; human; hyperemia; intraocular hypertension; intraocular pressure; lacrimation disorder; medication compliance; monotherapy; ocular pruritus; patient comfort; patient compliance; patient preference; phase 3 clinical trial (topic); punctate keratitis; randomized controlled trial (topic); review; treatment duration; xerostomia; simbrinza

Adjunctive therapy patterns in glaucoma patients using prostaglandin analogs - Schmier, J.K.; Hulme-Lowe, C.K.; Covert, D.W. (Clinical Ophthalmology, 2014)
Purpose: To analyze patterns of use of adjunctive therapies among new initiators of topical prostaglandin analogs (PGAs) in a managed care population. Methods: The study cohort included patients in a claims database who initiated PGA therapy between June 2007 and April 2011. Patients who had one or more adjunctive therapy prescriptions during 24 months of follow-up were included. Patterns of adjunctive therapy use were identified and compared between patients who had one or two fills of the initial adjunctive therapy and those who had three or more. Results: There were 16,486 eligible beneficiaries. Of these, 5,933 (36%) had one or more adjunctive therapies within 24 months from the start of the PGA, 82% of whom started adjunctive therapy within 12 months. About 28% of patients started adjunctive therapy with a fixed-combination product; 45% of these patients started within the first 30 days. Overall, a large number of patients (42%) required adjunctive therapy within 30 days. Twenty-five percent of patients had only one or two prescriptions of their initial adjunctive therapy; of these patients, 74% discontinued adjunctive therapy altogether. Conclusion: Approximately 30% of patients starting glaucoma therapy will require adjunctive therapy within 1 year, and many receive a fixed-combination product as initial adjunctive therapy shortly after starting glaucoma therapy. This suggests a prescribing trend toward earlier, more aggressive drug therapy to control pressure and minimize disease progression. We found that compliance with adjunctive therapy continues to be a problem for patients, which could be attributed to a number of treatment burden and economic factors. © 2014 Schmier et al. This work is published by Dove Medical Press Limited.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; latanoprost; travoprost; aged; article; cohort analysis; controlled study; disease course; female; follow up; human; major clinical study; male; monotherapy; open angle glaucoma; patient compliance; patient selection; prescription; retrospective study

Symptom based diagnosis of infant under one year in outpatient clinic - Han, S.; Kim, U.S. (Korean journal of ophthalmology : KJO, 2014)
PURPOSE: We investigated chief complaints and ocular disorders in infants under one year of age and analyzed the association between complaints and disorders. METHODS: The medical records of 815 infants were reviewed. Chief complaints were grouped into the following 11 categories: eyelid drooping, epiphora (tearing), ocular discharge, lid swelling, eyelashes touching the eyeball, abnormalities of the anterior segment, abnormal eyeball movement (e.g., squint or nystagmus), red eye, trauma, poor eye contact, and miscellaneous. We performed ophthalmologic examinations at the doctors' discretion and analyzed the relationship between chief complaint and final diagnosis. RESULTS: Mean age of visiting the outpatient clinic was 6.09 ± 3.07 months. The most common complaint was ocular discharge, followed by abnormal eyeball movement, epiphora, and eye redness. Among infants with ocular discharge, most were attributed to congenital nasolacrimal duct obstruction (155 infants) and conjunctivitis (75 infants). A total of 160 guardians complained of abnormal eyeball movement and 86 of 160 infants (51.9%) suffered from pseudoesotropia. Additionally, exodeviation and esodeviation was found in 17.9% and 16.4% of infants, respectively. Eight guardian complained of poor eye contact in their infants and these infants were diagnosed with retinal disorders (3), congenital optic nerve disorders (2), cataract (1), glaucoma (1), and high hyperopia (1). CONCLUSIONS: The most common ocular symptoms in infants under one year of age included ocular discharge, epiphora, and eye redness. However, infants with poor eye contact or suspected abnormal eye movement should undergo a full ophthalmologic examination.
Keywords: eye disease; female; follow up; human; infant; male; outpatient department; patient compliance; retrospective study

Patient adherence and persistence with topical ocular hypotensive therapy in real-world practice: A comparison of bimatoprost 0.01% and travoprost Z 0.004% ophthalmic solutions - Campbell, J.H.; Schwartz, G.F.; Labounty, B.; Kowalski, J.W.; Patel, V.D. (Clinical Ophthalmology, 2014)
Background: Effective control of intraocular pressure is predicated upon patient compliance with pharmacotherapy. We compared patient adherence and persistence with two new ocular hypotensive formulations, using real-world utilization data. Methods: This observational cohort study employed pharmacy claims data from the Source® Lx (Wolters Kluwer Pharma Solutions) database. Patients with an initial (index) prescription for topical bimatoprost 0.01% or travoprost Z (April to June 2011) and no claim for ophthalmic prostaglandin or prostamide analogs within the previous 18 months were identified. Treatment adherence was expressed as proportion of days covered with study medication during the first 365 days after the index prescription. Treatment persistence with study medication was assessed over the first 12 months using Kaplan-Meier survival analyses, allowing a maximum 30-day gap for prescription refill. Treatment status was determined monthly over this period.Results: A total of 12,985 patients were assessed for treatment adherence, and 10,470 for tstrokereatment persistence. Adherence was better with bimatoprost 0.01% than with travoprost Z (mean proportion of days covered 0.540 versus [vs] 0.486, P,0.001), and more patients showed high adherence (proportion of days covered.0.80) with bimatoprost 0.01% than travoprost Z (29.1% vs 22.3%, P,0.001). Continuous 12-month persistence was higher with bimatoprost 0.01% than with travoprost Z (29.5% vs 24.2%, P,0.001). At month 12, more patients were on treatment with bimatoprost 0.01% than travoprost Z (48.8% vs 45.7%, P,0.01). Similar findings were demonstrated in cohorts of ocular hypotensive treatment-naïve patients, branded latanoprost switchers, and older patients (age $65 years), and after inclusion of patient characteristics as covariates. Conclusion: For patients with glaucoma or ocular hypertension, bimatoprost 0.01% offers compliance advantages over travoprost Z. © 2014 Campbell et al.
Keywords: bimatoprost; latanoprost; travoprost; travoprost Z; unclassified drug; adolescent; adult; aged; article; child; cross-sectional study; drug substitution; drug utilization; drug withdrawal; female; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; major clinical study; male; medical procedures; observational study; patient attitude; patient compliance; prescription; school child; topical ocular hypotensive therapy; treatment duration; very elderly; lumigan; travatan z

Managing adverse effects of glaucoma medications - Inoue, K. (Clinical Ophthalmology, 2014)
Glaucoma is a chronic, progressive disease in which retinal ganglion cells -disappear and subsequent, gradual reductions in the visual field ensues. Glaucoma eye drops have hypotensive effects and like all other medications are associated with adverse effects. Adverse reactions may either result from the main agent or from preservatives used in the drug vehicle. The preservative benzalkonium chloride, is one such compound that causes frequent adverse reactions such as superficial punctate keratitis, corneal erosion, conjunctival allergy, and conjunctival injection. Adverse reactions related to main hypotensive agents have been divided into those affecting the eye and those affecting the entire body. In particular, β-blockers frequently cause systematic adverse reactions, including bradycardia, decrease in blood pressure, irregular pulse and asthma attacks. Prostaglandin analogs have distinctive local adverse reactions, including eyelash bristling/lengthening, eyelid pigmentation, iris pigmentation, and upper eyelid deepening. No systemic adverse reactions have been linked to prostaglandin analog eye drop usage. These adverse reactions may be minimized when they are detected early and prevented by reducing the number of different eye drops used (via fixed combination eye drops, reducing the number of times eye drops are administered, using benzalkonium chloride-free eye drops, using lower concentration eye drops, and providing proper drop instillation training. Additionally, a one-time topical medication can be given to patients to allow observation of any adverse reactions, thereafter the preparation of a topical medication with the fewest known adverse reactions can be prescribed. This does require precise patient monitoring and inquiries about patient symptoms following medication use. © 2014 Inoue.
Keywords: adrenergic receptor stimulating agent; alpha 1 adrenergic receptor blocking agent; antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; eye drops; prostaglandin derivative; adverse drug reaction; allergic conjunctivitis; anemia; anorexia; anxiety disorder; asthma; blepharitis; body weight disorder; bradycardia; bronchitis; cataract; chronic obstructive lung disease; confusion; conjunctiva disease; conjunctival hyperemia; cornea disease; cornea erosion; coughing; depression; diarrhea; disease exacerbation; dizziness; drowsiness; drug contraindication; drug dose reduction; drug efficacy; drug induced headache; drug instillation; drug mechanism; drug safety; drug tolerability; drug use; dysarthria; dysesthesia; dyspnea; eye allergy; eye disease; eye irritation; eyelid disease; gastrointestinal disease; glaucoma; hallucination; headache; human; hypertension; hypotension; insomnia; intraocular foreign body; iris disease; lassitude; lethargy; metabolic acidosis; miosis; nausea; neurotoxicity; patient compliance; patient education; pemphigoid; pigment disorder; pollakisuria; punctate keratitis; retina detachment; retina maculopathy; review; somnolence; Stevens Johnson syndrome; stomach pain; sweat gland disease; tachycardia; taste disorder; toxic epidermal necrolysis; tremor; urolithiasis; visual field defect; visual impairment; vomiting; xerostomia

Current approaches to the management of new-onset ulcerative colitis - Marchioni Beery, R.; Kane, S. (Clinical and Experimental Gastroenterology, 2014)
Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following Review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to-moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future directions in related inflammatory bowel disease care. © 2014 Marchioni Beery and Kane.
Keywords: 6 mercaptopurine derivative; adalimumab; aminosalicylic acid; azathioprine; balsalazide; corticosteroid; cyclosporine; golimumab; infliximab; mesalazine; methylprednisolone; olsalazine; placebo; prednisolone; salazosulfapyridine; steroid; tacrolimus; tofacitinib; vedolizumab; abdominal pain; acne; acute kidney failure; adrenal insufficiency; arthralgia; avascular necrosis; bone marrow suppression; cataract; colon resection; colonoscopy; connective tissue disease; convulsion; cost of illness; Cushingoid syndrome; diabetes mellitus; diagnostic imaging; diarrhea; differential diagnosis; disease activity; disease association; disease severity; dose response; drug contraindication; drug dose comparison; drug dose reduction; drug dose titration; drug efficacy; drug hypersensitivity; drug megadose; drug safety; drug tolerability; lack of drug effect; drug withdrawal; ecchymosis; economic evaluation; evidence based medicine; fever; glaucoma; headache; hemolytic anemia; hepatitis; hepatosplenic T cell lymphoma; hepatosplenic T cell lymphoma; hirsutism; hospitalization; hot flush; human; hyperglycemia; hyperkalemia; hypernatremia; hypertension; hypokalemia; image analysis; incidence; indigestion; infection; influenza; insomnia; interstitial nephritis; intestine endoscopy; leukopenia; liver toxicity; long term care; medical history; megaloblastic anemia; mental disease; metabolic alkalosis; molecular pathology; mood disorder; myopathy; nausea; nonhodgkin lymphoma; opportunistic infection; osteopenia; osteoporosis; outcome assessment; pancreatitis; paresthesia; patient assessment; patient attitude; patient compliance

A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SDOCT in African American communities - Blumberg, D.M.; Vaswani, R.; Nong, E.; Al-Aswad, L.; Cioffi, G.A. (Investigative Ophthalmology and Visual Science, 2014)
Purpose. To assess the impact on visual function of community glaucoma screening in an African American population using spectral-domain optical coherence tomography (SD-OCT). Methods. Using a Monte Carlo microsimulation model with a 10-year time horizon, we analyzed the efficacy of SD-OCT screening on visual field outcomes in a population of African Americans who are not otherwise seeking office-based care. Outcomes included classification of visual field severity, quality-adjusted life years, and direct health care costs. Results. Assuming a 60% follow-up rate, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%, and decreased the prevalence of severe visual field loss in patients with glaucoma from 29.1% to 23.9%. Conversely, screening increased the prevalence of mild visual field loss in patients with glaucoma from 9.2% to 18.7%. From initial screening through confirmatory eye examination, the screening program ("screen only") cost $98 per screened individual, and $2561 per new diagnosis of glaucoma. When considering the costs of initial screening though the resultant treatment, the screening program ("screen and treat") had an average annual cost of $79 and $2138, respectively, over a 10-year time period. The cost of one quality-adjusted life year (QALY) gained by screening, including management and treatment, in comparison with opportunistic case finding, ranged from $46,416 to $67,813. Conclusions. Our findings suggest that community SD-OCT screening in an African American population will minimize glaucoma-related visual morbidity. Ideally, strategies to maximize treatment efficacy through improved medication adherence and improved compliance with follow-up should be identified and implemented before instituting a screening program. © 2014 The Association for Research in Vision and Ophthalmology, Inc.
Keywords: adult; aged; article; cost benefit analysis; eye examination; follow up; glaucoma; health care cost; human; major clinical study; medication compliance; optical coherence tomography; outcome assessment; prevalence; priority journal; quality adjusted life year; retinal nerve fiber layer thickness; screening; sensitivity and specificity; spectral domain optical coherence tomography; very elderly; visual field; visual system function

Examining patient provider communication regarding cost in the glaucoma patient population - Slota, C.; Blalock, S.; Carpenter, D.; Robin, A.; Muir, K.; Sleath, B. (Value in Health, 2014)
Objectives: Adherence to medications is a significant problem in glaucoma patients. Costs of medications have frequently been cited as barriers to adherence. This study aims to identify the extent of physician-patient communication concerning medication cost during glaucoma medical visits. The study also aims to examine ophthalmologist and patient characteristics that influence whether the ophthalmologist discusses medication costs with the patient during glaucoma medical visits. Methods: English-speaking adults with glaucoma and their ophthalmologists at six geographically diverse ophthalmology practices were recruited for the study. All visits were videotape recorded and transcribed verbatim. Patients were interviewed following their office visit. A research assistant reviewed the patient's medical records noting comorbidities, glaucoma medication use, and glaucoma severity. Ophthalmologists completed a demographic survey. Transcripts were coded to identify whether the ophthalmologist discussed medication cost with the patient during the office visit. Bivariate analyses were performed to examine whether ophthalmologist and patient characteristics were associated with discussion of medication cost. Results: Fifteen ophthalmologists and 279 of their glaucoma patients participated in the study. Ophthalmologists discussed medication costs during only 67 (24%) of glaucoma medical visits. Ophthalmologists with more years of experience practicing were significantly more likely to discuss medication cost (p< 0.03). Also, ophthalmologists were significantly more likely to discuss medication cost with patients who had higher levels of formal education, were new to using glaucoma medications, and were taking more glaucoma medications (p< 0.05). Conclusions: Ophthalmologists do not routinely discuss medication cost during glaucoma patient office visits. Future research is needed to investigate the impact of physician-patient communication concerning medication cost on adherence in the glaucoma patient population.
Keywords: human; patient; population; glaucoma; interpersonal communication; drug therapy; ophthalmologist; ambulatory care; physician; bivariate analysis; speech; medical record; scientist; videotape; ophthalmology; adult; education

Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: Study protocol for a randomized controlled trial - Abdull, M.M.; Gilbert, C.; McCambridge, J.; Evans, J. (Trials, 2014)
Background: Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa.Methods: This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being " standard care" ) compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale.Discussion: Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa.Trial registration: ISRCTN79330571 (Controlled-Trials.com). © 2014 Abdull et al.; licensee BioMed Central Ltd.
Keywords: eye drops; adaptation; adolescent; adult; article; blindness; clinical article; controlled study; cost effectiveness analysis; glaucoma; glaucoma surgery; health care quality; human; informed consent; intraocular pressure; lifestyle modification; low level laser therapy; motivational interviewing; Nigeria; ophthalmologist; outcome assessment; patient compliance; personnel; pilot study; program cost effectiveness; randomized controlled trial

Nanotechnology and glaucoma: A review of the potential implications of glaucoma nanomedicine - Kim, N.J.; Harris, A.; Gerber, A.; Tobe, L.A.; Amireskandari, A.; Huck, A.; Siesky, B. (British Journal of Ophthalmology, 2014)
The purpose of this review is to discuss the evolution of nanotechnology and its potential diagnostic and therapeutic applications in the field of ophthalmology, particularly as it pertains to glaucoma. We reviewed literature using MEDLINE and PubMed databases with the following search terms: glaucoma, nanotechnology, nanomedicine, nanoparticles, ophthalmology and liposomes. We also reviewed pertinent references from articles found in this search. A brief history of nanotechnology and nanomedicine will be covered, followed by a discussion of the advantages and concerns of using this technology in the field of glaucoma. We will look at various studies concerning the development of nanomedicine, its potential applications in ocular drug delivery, diagnostic and imaging modalities and, surgical techniques. In particular, the challenges of assuring safety and efficacy of nanomedicine will be examined. We conclude that nanotechnology offers a novel approach to expanding diagnostic, imaging and surgical modalities in glaucoma and may contribute to the knowledge of disease pathogenesis at a molecular level. However, more research is needed to better elucidate the mechanism of cellular entry, the potential for nanoparticle cytotoxicity and the assurance of clinical efficacy.
Keywords: 6 o lauryl levo ascorbic acid; acetazolamide; antiglaucoma agent; brimonidine; brinzolamide; carbomer; carteolol; dendrimer; drug carrier; eudragit; glucosamine; glyceryltriacrylate nanoparticle; hydroxylethylmethacrylate; iobrim; latanoprost; liposome; macrogol; mitomycin; nanomaterial; nanoparticle; phosphatidylcholine; pilocarpine; polyamidoamine; polyglactin; polymer; quantum dot; small interfering RNA; timolol; timolol maleate; tropicamide; unclassified drug; aqueous humor flow; artificial nanodrainage implant; biosensor; bleaching; bleb leak; carboxy terminal sequence; contact lens; cornea thickness; cytotoxicity; drug absorption; drug bioavailability; drug delivery system; drug efficacy; drug formulation; drug penetration; drug release; drug stability; drug storage; drug targeting; drug tissue level; endophthalmitis; fluorescence imaging; glaucoma; glaucoma drainage implant; glaucoma surgery; Goldmann applanation tonometer; human; hydrogel; intraocular hypertension; intraocular pressure measuring device; iridotomy; laser surgery; lymphatic drainage; nanodevice; nanofabrication; nanomedicine; nanotechnology; nerve fiber regeneration; nonhuman; optic nerve injury; patient compliance; patient monitoring; patient safety; postoperative complication; priority journal; regenerative medicine; review; scar; subconjunctival scar; subconjunctival scar; trabecular meshwork; trabeculectomy; azopt; iobrim

Tell us where you live and we will tell you something about your glaucoma - Crabb, D.P.; Russell, R.A.; Ceccon, S. (Investigative Ophthalmology and Visual Science, 2014)
Purpose We use modern geodemographic tools to interrogate large volumes of patient data to examine factors that are associated with late presentation of disease and poor adherence to follow-up in glaucoma. Methods Over 500,000 Humphrey visual fields (VFs) recorded in four regionally different glaucoma clinics/services in England (Cheltenham, Huddersfield, London and Portsmouth) in the last decade were retrospectively investigated. Surrogate measures for late presentation of glaucoma and adherence to treatment were estimated by a patient s VF damage (mean deviation [MD] at first visit) and frequency of VF tests respectively. Socioeconomic status and consumer/community segmentation data was defined by patients postcodes (ZIP codes) using the IMD (Index of Multiple Deprivation) and ACORN (A Classification Of Residential Neighbourhoods) geodemographic tools. Results Data from 57090 patients were analysed. There were strong links between geodemographic measures of socioeconomic status and later presentation of disease. There was significant correlation between MD at presentation and IMD score (Spearman s rho = -0.20; p < 0.0001; partial correlation corrected for age); geodemographic maps highlight this relationship (see figure). Patients from the least deprived areas, on average, are predicted to present with significantly less MD damage (MD = -5 dB; 95% confidence interval [CI] = -4 to -6 dB) than patients from the most deprived regions (MD = -9 dB; 95% CI = -8 to -10 dB). Other associations between socioeconomic status and a surrogate measure for adherence to treatment were indicated. Other geodemographic maps reveal relationships between late detection of disease and proximity to primary health care providers (optometrists). Conclusions Big data from glaucoma clinics can be used to reveal associations between socioeconomic status, late presentation of disease and adherence to follow-up care. Interactive geodemographic mapping tools can help illuminate public health requirements for glaucoma.
Keywords: biostatistics; confidence interval; consumer; economics; England; female; follow up; glaucoma; human; major clinical study; male; workforce; neighborhood; optometrist; patient coding; perimetry; primary health care; public health; social status

The effectiveness of a tailored intervention to increase follow-up adherence in patients with glaucoma - Tran, J.; Waisbourd, M.; Weiss, D.; Murchison, A.P.; Katz, L.J.; Spaeth, G.L.; Haller, J.A.; Hark, L.A. (Investigative Ophthalmology and Visual Science, 2014)
Purpose This randomized, prospective study evaluated the effectiveness of an intervention that utilized personalized reminder letters and telephone calls to increase follow-up adherence in patients with glaucoma in an urban, tertiary eye care clinic. Methods Patients previously Diagnosed with glaucoma and scheduled for a 1-month, 3-month, or 6-month follow-up appointment between September 1, 2013 and November 30, 2013 were randomized into the usual care group or the intervention group. Patients in the usual care group Did not receive a reminder call or letter prior to their appointment and Did not receive phone calls to reschedule if they Did not attend their appointment. Patients in the intervention group received a personalized reminder letter 2 weeks before their scheduled appointment and a reminder phone call 1-2 days before their appointment. If the patient in the intervention group Did not attend their appointment, they were called up to 2 times to reschedule. If these intervention patients failed to reschedule their appointment, a personalized letter was sent to their home. Follow-up adherence was recorded using electronic health records. Demographic data were also documented. Results The final sample size included 250 patients. Male and females patients were equally represented. The majority of patients were African-American (56%), with an average age of 69 years. Preliminary results with 177 patients demonstrate that 83% of patients in the intervention group were adherent to their recommended follow-up appointment, compared to 71% in the usual care group (p = 0.078). However, this Difference is only approaching statistical significance. Patients over the age of 60 were significantly more likely to adhere to their follow-up appointment regardless of intervention group (p = 0.01). Conclusions Tailored phone calls and letters may increase follow-up adherence among patients with glaucoma in an urban tertiary eye care clinic. While the effectiveness of the intervention Did not increase with patient age, patients over age 60 were more likely to adhere to their follow-up appointment. Therefore, future interventions to increase adherence in glaucoma patients should target younger patients.
Keywords: adult; African American; aged; controlled study; demography; electronic health record; eye care; female; follow up; glaucoma; hospital; human; human tissue; major clinical study; male; middle aged; sample size; statistical significance; treatment failure