Systemic circulatory parameters: Comparison between patients with normal tension glaucoma and normal subjects using ambulatory monitoring - Kashiwagi, K.; Hosaka, O.; Kashiwagi, F.; Taguchi, K.; Mochizuki, J.; Ishii, H.; Ijiri, H.; Tamura, K.; Tsukahara, S. (Japanese Journal of Ophthalmology, 2001)
Purpose: To compare circadian changes of systemic circulation in patients with normal tension glaucoma (NTG) and normal subjects. Methods: Forty-three patients with NTG and 226 normal subjects were enrolled in this study. Circulatory parameters, including blood pressure (BP) and pulse rate (PR), were measured in all subjects for 49 hours using an ambulatory monitoring system. In addition to a comparison between NTG patients and normal controls, the same parameters were compared between NTG patients who had progressive field defects and NTG patients who had stable field defects. Results: The BP in NTG patients was significantly higher than in normal subjects. The nocturnal dip of BP in NTG patients was similar to the dip in normal subjects. However, the BP dip in NTG patients showing progressive visual field defects was significantly smaller than in patients with NTG showing stable visual field defects. Blood pressure fluctuation in sleep in the 'progressive' patients was significantly greater than in the 'stable' patients. Patients with NTG whose random BP was in a normal range showed a higher BP than normal subjects. The dip in PR in NTG patients was significantly lower than in normal subjects. Conclusions: An insufficient physiological nocturnal BP dip or a greater nocturnal fluctuation in BP may disturb the microcirculation of, and/or may directly damage, the optic nerve, resulting in increasing field loss in NTG. Copyright © 2001 Japanese Ophthalmological Society.
Keywords: adult; aged; ambulatory monitoring; article; circadian rhythm; controlled study; female; glaucoma; human; major clinical study; male; priority journal; pulse rate; sleep; systemic circulation; visual field defect; wakefulness

Glaucoma and pitfalls in therapy in the elderly with multiple morbidity from the viewpoint of the geriatrician - Weber, P.; Svacinová, J. (Casopís lékarů ceských, 2001)
Glaucoma in multi-morbid patients is frequently treated by specialists non-ophthalmologists. The growing number of elderly patients with glaucoma and comparatively small knowledge on this disease among the medical workers brought us to review recent findings on the aetiology, pathogenesis, risks of development and namely the problems of glaucoma treatment, possible drug interactions and their side effects. Considering the growing incidence of glaucoma with age, general practitioners, internists, geriatrists and other specialists will face the problems of drug interactions and global or ophthalmological side effects during the polypharmacological treatment of their multi-morbid seniors. The article gives basic information on the problems of using antiglaucoma drugs and their effects on the organism and eyes. Effects of some foodstuff and medicaments used in therapy of other diseases on the intraocular pressure and glaucoma are also summarise.
Keywords: aged; aging; article; chronic disease; drug interaction; glaucoma; human; metabolism; patient compliance; pharmacokinetics

Doctors must learn to let others treat them and their families [1] - Bass, D. (British Medical Journal, 2001)
Keywords: aged; case report; female; glaucoma; health care access; human; letter; male; physician attitude; priority journal; social isolation

Therapeutic potential of prostaglandin analogues in glaucoma - Lindén, C. (Expert Opinion on Investigational Drugs, 2001)
One of the most recent contributions to the therapeutic arsenal available for the treatment of glaucoma is the prostaglandin (PG) analogues. They represent a new class of ocular hypotensive drugs, targeting the uveoscleral outflow of ocular aqueous humour. Two drugs, latanoprost and unoprostone, are presently commercially available. In terms of intraocular pressure (IOP) reduction, latanoprost is the most powerful drug in clinical use today. The once daily dosing promotes compliance. Additional effect is achieved in combination with other hypotensive drugs, including those that increase trabecular outflow facility. The most frequent side effect is increased iris pigmentation that seems to be irreversible. A low frequency of cystoid macular oedema has been reported, predominantly in patients whose blood-retinal barrier (BRB) is compromised. Systemic side effects are rare. The experience with unoprostone is still much less than that with latanoprost. The ocular hypotensive mechanism of action of unoprostone is not well documented but an increase in uveoscleral outflow may be at least a part of its mode of action. Systemic side effects are rare and the ocular side effects seem to be mild. The ocular hypotensive effect is less than that of latanoprost and may not be suitable for monotherapy. It is widely accepted that the IOP alone is not responsible for the development of glaucomatous visual defects. It remains to be seen if this class of drugs will preserve vision in glaucoma patients better than other classes. More PG analogues are under development for potential clinical use.
Keywords: acetazolamide; adrenergic receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; arachidonic acid; autacoid; benzalkonium chloride; beta adrenergic receptor blocking agent; brimonidine; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; diamox depot; diclofenac; dipivefrine; dorzolamide; fluorometholone; latanoprost; physostigmine; pilocarpine; placebo; prodrug; prostaglandin derivative; prostaglandin F2 alpha; prostaglandin F2 alpha isopropyl ester; timolol; travopost; uf 201; unclassified drug; unoprostone isopropyl ester; allergy; aqueous humor outflow; blood eye barrier; blood retina barrier; cardiovascular disease; clinical trial; conjunctivitis; controlled clinical trial; controlled study; cornea erosion; dose response; double blind procedure; drug effect; drug mechanism; drug metabolism; drug potentiation; drug selectivity; drug synthesis; headache; herpes simplex keratitis; human; hyperemia; intraocular pressure; keratopathy; monotherapy; open angle glaucoma; pain; patient compliance; pigmentation; preservation; randomized controlled trial; respiratory tract disease; retina macula cystoid edema; review; sclera; systemic disease; uvea; uveitis; vision; diamox depot; rescula; uf 201; xalatan

Twenty-four hour intraocular pressure reduction with latanoprost compared with pilocarpine as third-line therapy in exfoliation glaucoma - Konstas, A.G.P.; Lake, S.; Maltezos, A.C.; Holmes, K.T.; Stewart, W.C. (Eye, 2001)
Purpose: To compare the 24 hour efficacy of latanoprost 0.005% given every evening with that of pilocarpine 4% given four times daily as third-line therapy in patients with exfoliation glaucoma receiving timolol 0.5% and dorzolamide 2% each given twice daily. Method: We enrolled 30 patients with exfoliation glaucoma not adequately controlled on timolol maleate 0.5% and dorzolamide 2%. Each patient underwent a baseline 24 hour intraocular pressure curve testing at 06:00, 10:00, 14:00, 18:00, 22:00 and 02:00 hours. Patients were randomised to receive either latanoprost 0.005% or pilocarpine 4% for a minimum of 8 weeks and were then crossed over to the opposite therapy. Diurnal curve testing was repeated at the end of each treatment. Results: There was a significant decrease from baseline in intraocular pressure at each timepoint for both study medicines (p<0.016). Latanoprost provided better intraocular pressure control than pilocarpine at daytime measurements (17.4 vs 19.7 mmHg at 06:00 hours, p<0.001; 17.8 vs 19.1 mmHg at 10:00 hours, p=0.04). However, pilocarpine reduced the pressure more than latanoprost at 22:00 hours (18.4 vs 19.5 mmHg, p=0.016). Overall, the diurnal intraocular pressure was reduced from a baseline of 21.5 ± 3.7 mmHg to 18.8 ± 3.1 mmHg on pilocarpine and to 18.0 ± 3.0 mmHg on latanoprost (p=0.06). In addition, mean peak pressure was similar between pilocarpine (21.0 ± 2.9 mmHg) and latanoprost (20.5 ± 3.8 mmHg) (p=0.20). Side-effects were similar with the exception of blurred vision, which was only found with pilocarpine (10%). Compliance was more difficult with pilocarpine. Conclusion: In exfoliation glaucoma, as a thirdline adjunctive therapy added to timolol and dorzolamide, latanoprost and pilocarpine have similar diurnal efficacy. However, latanoprost provides a greater morning pressure reduction.
Keywords: dorzolamide; latanoprost; pilocarpine; timolol maleate; adult; aged; allergy; article; circadian rhythm; clinical article; clinical trial; controlled clinical trial; controlled study; crossover procedure; drug efficacy; pseudoexfoliation; female; headache; human; intraocular pressure; male; patient compliance; randomized controlled trial; vertigo; visual impairment

Evaluation of the work time used in outpatient ophthalmology techniques - Arias López, M.C.; Lanuza García, A.; García García, N.; Ramos Martí, F. (Archivos de la Sociedad Española de Oftalmología, 2001)
PURPOSE: To determine the work time used for out-patients seen in the ophthalmology out-patient clinic according to treatment for each diagnosis and examination guidelines. Another objective was to discover the diagnostic related outpatient demand as well as the time spent on each technique. METHOD: We have designed a computer database system that includes examinations, treatments and medical services. Their duration was measured in a random sample of 127 ophthalmology outpatients in the General Hospital of Castellon. Sixty five of the patients had come to their first visit and 62 to the follow-up visits. RESULTS: A new patient spends a mean of 42 minutes and a follow-up patient spends a mean of 27 minutes. The most frequent diagnoses are retinal diseases (30%), cataract (18.6%), glaucoma (11.8%) and ocular motility disorders (11.8%). We present the mean times used by the physician in the ophthalmic techniques used in outpatients. CONCLUSIONS: We have modified the standard times of 30 minutes for the first visit and 15 minutes for the follow-up visit. Data on the work time used for all the ophthalmics techniques in our outpatient clinic are presented. This ophthalmology survey can be used for health care managers to establish the <<Outpatient Visit Groups>> and health care plan administration to adapt the resources to the demand.
Keywords: ambulatory care; article; eye disease; human; ophthalmology; outpatient department; statistics; time

Health utility attributes for chronic conditions - Mittmann, N.; Chan, D.; Trakas, K.; Risebrough, N. (Disease Management and Health Outcomes, 2001)
Objective: To determine the importance of specific health utility attributes that comprise overall utility scores for a number of chronic health state conditions. Study design: Cross-sectional study using data from a prospective national survey of the health of community-dwelling Canadians. Study population: 47 534 individuals who answered both health questions and utility questions (51.8% male). Methods: The attributes making up the Health Utilities Index (HUI-Mark III) scores (i.e. vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain) for 21 chronic conditions were examined from the National Population Health Survey (NPHS) 1996 to 1997. Conditions included Alzheimer's disease, arthritis/rheumatism, asthma, back problems excluding arthritis, bowel disorder, chronic bronchitis or emphysema, cancer, cataracts, diabetes, epilepsy, food allergies, glaucoma, heart disease, hypertension, migraine headaches, other allergies, sinusitis, stroke, stomach/intestinal ulcers, thyroid conditions and urinary incontinence. HUI-Mark III scores for patients without an NPHS-defined chronic condition were also collected. All conditions were mutually exclusive. Results: The mean HUI-Mark III score for patients without a chronic health state was 0.953 ± 0.060. Individuals with Alzheimer's disease (0.846 ± 0.168), stroke (0.869 ± 0.163) and arthritis/rheumatism (0.883 ± 0.132) had the lowest overall HUI-Mark III scores. Individuals with Alzheimer's disease (28.6%), epilepsy (23.1%) and urinary incontinence (19.8%) reported higher scores on the emotional impairment attribute. Individuals with arthritis/rheumatism (24.7%) and back problems (20.6%) had high levels of pain/discomfort. Patients with stroke (16.4%) had low mobility scores. Conclusion: By determining which attributes are important to chronic health conditions, this study provides health economists, researchers and policy makers with a reference of health state attributes for various chronic conditions.
Keywords: adolescent; adult; Alzheimer disease; arthritis; article; Canada; chronic disease; community care; disease severity; emotion; epilepsy; health care policy; health care utilization; health survey; human; major clinical study; pain; questionnaire; rheumatic disease; cerebrovascular accident; urine incontinence

A comparison of dorzolamide-timolol combination versus the concomitant drugs - Choudhri, S.; Wand, M.; Shields, M.B. (American Journal of Ophthalmology, 2000)
PURPOSE: To compare the intraocular pressure (IOP) lowering effect of fixed combination dorzolamide 2% and timolol 0.5% therapy to that of concomitant administration of a topical beta-blocker and dorzolamide. METHODS: Seventy-four consecutive glaucoma patients were changed from a regimen including a topical beta-blocker and dorzolamide to the fixed combination dorzolamide-timolol in 1 eye, with the other eye used as the control. The average IOP readings before and 1 month after the change were compared. RESULTS: The mean baseline IOP in the entire study population was 19.4 ± 4.2 mm Hg in the study eyes and 16.9 ± 4.2 mm Hg in the control eyes. Four weeks after the medication change, the mean IOP was 17.3 ± 3.9 mm Hg in the study eyes (P < .001) and 16.1 ± 4.1 mm Hg in the control eyes (P = .02). The difference between the mean IOP change of 2.1 mm Hg in the study eyes and 0.8 mm Hg in the control eyes was found to be statistically significant (P = .01). CONCLUSION: These findings suggest that the fixed combination dorzolamide-timolol therapy achieves additional lowering of the intraocular pressure compared with the concomitant administration of a beta-blocker and dorzolamide. Copyright (C) 2000 Elsevier Science Inc.
Keywords: beta adrenergic receptor blocking agent; betaxolol; dorzolamide; dorzolamide plus timolol; levobunolol; timolol; adult; aged; article; clinical trial; controlled clinical trial; controlled study; drug efficacy; female; glaucoma; human; intraocular pressure; major clinical study; male; patient compliance; priority journal; cosopt

Relevance of quality of life and treatment compliance measurement in patients with chronic open-angle glaucoma - Baudouin, C.; Béchetoille, A.; Bron, A.; Denis, P.; Nordmann, J.-P.; Renard, J.-P.; Rouland, J.-F.; Sellem, E.; Rigeade, M.-C.; Arnould, B. (Journal Francais d'Ophtalmologie, 2000)
Chronic glaucoma is a severe disease that can induce blindness. Early diagnosis and symptomatic treatment reduce the risk of blindness. Treatment that will be started before the onset of clinical signs and will remain lifelong thereafter is troublesome, and therapeutic compliance is usually poor. Thus, quality of life (QOL) measurement in patients with chronic glaucoma has a particular purpose: to measure patients' perception of the disease and treatment in order to maintain good treatment compliance to ensure therapeutic management efficacy and to preserve visual function. No glaucoma-specific instrument is available in the medical and QOL literature. Various generic (SF-36, SF-20 and SIP)1 and specific (VAQ, VF-14, NEI-VFQ)1 QOL questionnaires, one glaucoma-specific symptomatic scale (GSS)1, and one treatment preference scale (COMTol)1 have been used to measure QOL in glaucoma patients. These instruments do not sufficiently measure the psychosocial dimension of the disease and the QOL impact of treatment. An instrument able to measure all dimensions needs to be developed in order to help ophthalmologists in the therapeutic management of their patients and to mesure QOL in patients in the successive stages of the disease.
Keywords: blindness; early diagnosis; open angle glaucoma; palliative therapy; patient compliance; quality of life; questionnaire; rating scale; review; social psychology; vision

Topical dorzolamide 2%/timolol 0.5%: A review of its use in the treatment of open-angle glaucoma - Ormrod, D.; McClellan, K. (Drugs and Aging, 2000)
The nonselective β-blocker timolol and the carbonic anhydrase inhibitor dorzolamide both lower intraocular pressure (IOP). Timolol and dorzolamide have different mechanisms of action and their effects are additive when administered together. Therefore, the 2 drugs are frequently used concomitantly to treat patients with open-angle glaucoma who have not adequately responded to first-line therapy. A barrier to good compliance with concomitant therapy is the need to administer 5 or 6 drops of medication on 2 or 4 occasions during the day. Timolol 0.5% and dorzolamide 2.0% have therefore been combined in a single formulation, reducing the number of administrations required to 2 per day. Clinical trials in patients with glaucoma have demonstrated that dorzolamide 2%/timolol 0.5% (dorzolamide/timolol) is superior to monotherapy with the individual components. When dorzolamide/timolol administered twice daily was compared with concomitant treatment with dorzolamide 2% and timolol 0.5%, each administered twice daily for 90 days, both regimens resulted in marked lowering of trough IOP (measured just before the morning dose) compared with baseline (reduction in IOP = 4.2mm Hg). The effect of the 2 regimens on IOP at all time points, both before treatment and at peak effect (2 hours after treatment), were virtually indistinguishable. When the combined formulation was compared with a concomitant regimen that included dorzolamide 2% 3 times daily and timolol 0.5% twice daily the concomitant regimen was slightly more efficacious than the combined regimen at trough after 90 days: IOP was lowered by 3.6mm Hg in the combined group versus 4.1mm Hg in the concomitant group. Dorzolamide/timolol has been compared with concomitant administration of timolol 0.5% and the IOP lowering miotic drug, pilocarpine 2.0%. This non-blind patient-preference study found that both regimens reduced IOP. However, the dorzolamide/timolol combination was preferred by the patients because of reduced frequency and severity of adverse effects and less frequent administration. Dorzolamide/timolol was well tolerated in clinical trials, the adverse effects reflected those of the individual components, and no additional tolerability issues were identified. However, the potential for timolol to cause cardiorespiratory effects must be considered when prescribing this combination. Furthermore, dorzolamide is a sulfonamide and can cause allergic reactions in those who are hypersensitive to this class of drug. Conclusions: Dorzolamide/timolol is a well tolerated and effective fixed combination for lowering IOP in the treatment of open-angle glaucoma and is likely to be useful in those patients who do not respond adequately to first-line monotherapy. Compared with concomitant therapy with the same 2 drugs the primary advantage is convenience, which may lead to improved compliance. Studies of compliance and comparisons with other currently available combination therapies would be useful to fully define the value of the formulation. Nonetheless, dorzolamide combined with timolol in a single applicator system will be a useful addition to the treatment options for glaucoma, a leading cause of preventable blindness.
Keywords: beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; pilocarpine; timolol; allergic reaction; blindness; dose response; drug absorption; drug distribution; drug excretion; drug metabolism; drug mixture; drug tolerability; eye blood flow; headache; human; intraocular hypertension; intraocular pressure; monotherapy; nausea; open angle glaucoma; patient compliance; priority journal; review

Pediatric cataract (Survey of Ophthalmology, 2000)
There are over 1.5 million children blind worldwide. The prevalence of childhood cataract has been reported as 1-4 cases per 10,000 children in the developing world. Aphakic glasses and contact lenses are unsatisfactory for rehabilitation of aphakia because of various problems associated with their use. The development of improved and refined microsurgical techniques, the availability of suitable PMMA and foldable IOL designs, better methods of modern capsular surgery, and a better understanding of the growth and refractive development of eyes in children have all helped make pediatric intraocular lens implantation a most successful technique. There is presently a clear shift in favor of IOL implantation for pediatric cataract. The main advance in treatment of childhood cataract over the past decade has been with the transition from a specific form of surgery, namely varying forms of lensectomy with spectacle or contact lens correction, to a much more modern procedure based on the principles learned in adult cataract surgery. In particular, the use of modern hydrodissection and capsulorhexis techniques, better techniques for removal of lens substance, and placement of modern PC-IOL designs into the capsular bag, have brought this procedure into step with the established techniques applied in adult cataracts. As recently as the early 1990s, there was controversy as to whether or not to place implants in the eyes of children. There is no longer such a controversy; the age limit for receiving lens implants is rapidly decreasing, encroaching on the first week of life. One of the most important factors in the advancement of pediatric surgery has been the recent success in reducing the incidence of secondary cataract (chapter 7). This problem basically occurred in 100% of the cases and had been a major stumbling block in introducing successful pediatric implantation, for a half century. Primary posterior capsulotomy was almost always required. Now, with better cortical removal techniques and introduction of highly biocompatible IOL designs, such as the Alcon AcrySof design, which appears to help to retard PCO, the previously almost unavoidable problem of PCO can now be better contained. Performing primary posterior capsulotomy and anterior vitrectomy is very important in developing countries (Table 9.3). In most cases, it ensures a clear visual axis. This is very important, as follow-up PCO treatment is often limited or not possible. Early use of an IOL may be justified in selected cases in developing countries, where parental compliance and follow up may be particularly difficult to achieve and where regular spectacle or contact lens wear is difficult to maintain. However, of utmost importance, pediatric cataract surgery, as described here, especially in very young children is best performed in a referral center by ophthalmologists with advanced experience in this field. Visually significant cataracts may be successfully operated even in newborns in order to prevent amblyopia. In such cases, careful planning of the surgical procedure, selection of the IOL and use of appropriate IOL power is an obvious must.
Keywords: aphakia; capsulotomy; cataract; glaucoma; human; intraocular pressure; lens; lens implant; postoperative complication; priority journal; review; treatment outcome; uveitis; vitrectomy

Analysis of glaucoma therapy costs in Poland. I--population of the Mazovian District - Czechowicz-Janicka, K.; Orlewska, E.; Tobota, Z.; Anielska, E.; Dyczkowska, A. (Klinika oczna, 2000)
AIM OF THE STUDY: The purpose of this study was to estimate and evaluate costs of glaucoma therapy in Poland in 1998-2000 years. MATERIAL AND METHODS: 315 patients (591 eyes) including 364 POAG eyes and 227 PACG eyes were evaluated. Progression of the disease was measured in two modes: by changes in the optical nerve disc (c/d) and by IOP level. Duration of the study was 12 months. Total costs (e.g. number of visits, amount of medications used, surgical and laser procedures performed) were calculated on 100 eyes/12 months. RESULTS: Pharmacological therapy constitutes 40-50% of the total costs in both glaucoma types. Timolol was the mostly prescribed drug in POAG, while pilocarpine led in PACG group. Dorzolamide was on the third place, but it generated the biggest part of total costs. Patients with advanced forms of the disease more frequently saw doctor on visits (average 6 visits per year); patients with elevated IOP (> 21 mm Hg) underwent surgical procedures more commonly than these with optical nerve disc changes (c/d > 0.6). The total costs of the therapy of non-advanced cases amounted 70.243 PLN on the average, while in advanced cases it reached the average of 155.230 PLN. CONCLUSION: 1. The total cost of glaucoma therapy depends on progression of the disease. 2. The most cost-generating part is the pharmacological therapy of glaucoma.
Keywords: dorzolamide; pilocarpine; sulfonamide; thiophene derivative; timolol; adult; aged; ambulatory care; article; cost; disease course; economics; female; glaucoma; human; intraocular pressure; laser surgery; male; middle aged; Poland

Deep intramuscular methylprednisolone for the treatment of cystoid macular oedema in uveitis - Tehrani, N.N.; Saeed, T.; Murray, P.I. (Eye, 2000)
Purpose. To study the use of intramuscular methylprednisolone in the treatment of cystoid macular oedema in patients with uveitis. Methods. A total of 32 patients with various types of uveitis with unilateral cystoid macular oedema were recruited. Patients received 160 mg of intramuscular methylprednisolone into the thigh and were reassessed 6-8 weeks later. In 17 patients in whom there had been no significant improvement, a further injection of methylprednisolone was given; a total of 49 injections. Results. After a first injection a significant improvement in vision (an increase of ≥ 2 Snellen lines) was seen in 15 of 32 eyes (47%), and 17 of 32 eyes (53%) showed no significant change. After the second injection 7 of 17 eyes (41%) showed a significant improvement but there was no change in 9 of 17 eyes (53%). Only one eye deteriorated more than 2 lines of Snellen acuity. There were minimal ocular or systemic side effects associated with this form of treatment. Conclusions. Despite limited success, deep intramuscular methylprednisolone may have a role as an alternative mode of treatment in uveitis patients with unilateral cystoid macular oedema, thus avoiding the potential hazards of periocular injections. In comparison with orally administered systemic corticosteroids, an injection ensures patient compliance and is associated with fewer side effects.
Keywords: acetazolamide; azathioprine; corticosteroid; cyclosporine; dexamethasone; methylprednisolone; prednisolone; adult; aged; ankylosing spondylitis; article; body weight disorder; clinical article; clinical trial; comorbidity; controlled clinical trial; controlled study; corticosteroid therapy; dose response; drug efficacy; drug safety; female; glucosuria; human; hyperhidrosis; hypertension; intraocular hypertension; iridocyclitis; leg pain; lipoatrophy; male; paresthesia; patient compliance; psoriasis; retina macula cystoid edema; secondary glaucoma; subcutaneous fat; thigh; treatment outcome; uveitis; vision test; visual acuity; body weight gain

Compliance and viewpoint of glaucoma patients in Greece - Konstas, A.G.P.; Maskaleris, G.; Gratsonidis, S.; Sardelli, C. (Eye, 2000)
Purpose. To document the prevalence of non-compliance and to investigate patients' perceptions concerning glaucoma in a Greek cohort. Methods. We investigated 100 consecutive patients referred to our glaucoma clinic and already treated for chronic glaucoma. Compliance and patients' insight were ascertained by two independent observers by means of a predetermined questionnaire. All patients were subsequently assessed for their ability to instil their eyedrops accurately. Results. Fifty one per cent of our patients were not aware of the nature of glaucoma, but 80% were afraid it might lead to blindness. Clinically significant non-compliance (more than two doses missed per week) was established in 44% of our patients. Men and those using eyedrops more than 4 times a day were more likely to default. Non-compliant patients exhibited higher mean intraocular pressure (22.9 vs 18.5 mmHg; p > 0.001) and worse visual field loss (10.8 vs 7.0 dB; p = 0.008) compared with compliant patients. Involuntary non-compliance was also common in our group, with only 53% instilling their eye drops accurately. Conclusion. Non-compliance is a significant limiting factor in glaucoma therapy in Greece.
Keywords: beta adrenergic receptor blocking agent; dipivefrine; dorzolamide; eye drops; pilocarpine; adult; aged; article; blindness; chronic disease; cohort analysis; controlled study; eye irritation; fear; female; follow up; Greece; human; intraocular hypertension; intraocular pressure; major clinical study; male; observer variation; open angle glaucoma; patient attitude; patient compliance; patient monitoring; prevalence; sex difference; statistical analysis; visual impairment

Patients' acceptance of a switch from dorzolamide to brinzolamide for the treatment of glaucoma in a clinical practice setting - Barnebey, H.; Kwok, S.Y. (Clinical Therapeutics, 2000)
Background: The first topically active carbonic anhydrase inhibitor, dorzolamide, was developed to circumvent the adverse systemic effects of oral carbonic anhydrase inhibitors. However, its use has been associated with ocular discomfort. Objective: The present study examined the acceptability of brinzolamide, as measured by patients' ratings and stated preferences, in patients with glaucoma previously treated with dorzolamide in the clinical practice setting. Methods: This was a prospective, open-label, noncomparative study conducted shortly after the approval of brinzolamide. Ophthalmologists in private practice in the continental United States were asked to select patients currently using dorzolamide as their sole or combination therapy for glaucoma. Patients underwent a screening assessment in which they were asked to rate their ocular comfort with dorzolamide on a scale from 1 to 6. Brinzolamide was then substituted for dorzolamide, and patients returned for a follow-up visit ~1 to 3 months later. At this visit, patients were asked about ocular comfort, their preferred medication, and whether they thought ocular comfort influenced their adherence to treatment. Intraocular pressure (IOP) was measured at both visits. Results: Valid visit dates (ie, both baseline and follow-up dates) were available for 447 of 501 patients from 68 of 73 sites (range, 1-40 patients per site). Because not all measurements were available for all patients at each visit, the sample size varied for each measurement. Demographic data were not available. The switch to brinzolamide resulted in a mean decrease in IOP of ~0.8 mm Hg (P < 0.001, paired t test). Sixty-nine percent of patients (274/397) reported an improvement of ≥1 grade in their comfort rating with brinzolamide versus dorzolamide. The mean (± SD) improvement in comfort rating was 1.43 ± 1.48 grades (P < 0.001, Wilcoxon rank sum test). When patients were asked whether their adherence to treatment was affected by the occurrence of burning and stinging, 43% (173/399) answered affirmatively. Fifty-nine percent (251/424) preferred brinzolamide to dorzolamide. At the end of the study, based on patient preference, physician judgment, and other factors, 73% of responding patients (301/410) continued with brinzolamide therapy. Conclusions: In this study, the switch from dorzolamide to brinzolamide resulted in overall improvements in comfort and ocular hypotensive efficacy. However, studies using a more rigorous randomized, controlled, crossover design are needed to support these observations.
Keywords: brinzolamide; dorzolamide; adult; aged; article; clinical practice; drug efficacy; drug tolerability; female; glaucoma; human; intraocular pressure; major clinical study; male; osmolality; patient compliance; patient satisfaction; rating scale; screening

Glaucoma incidence in an unselected cohort of diabetic patients: Is diabetes mellitus a risk factor for glaucoma? - Ellis, J.D.; Evans, J.M.M.; Ruta, D.A.; Baines, P.S.; Leese, G.; MacDonald, T.M.; Morris, A.D. (British Journal of Ophthalmology, 2000)
Aims-To evaluate whether diabetes mellitus is a risk factor for the development of primary open angle glaucoma or ocular hypertension (OHT). Methods-A historical cohort study of an unselected population comprising all residents of the Tayside region of Scotland was performed using record linkage techniques followed by case note review. Ascertainment of prevalent diabetes was achieved using the Diabetes Audit and Research in Tayside Study (DARTS) validated regional diabetes register. Glaucoma and treated OHT were defined by encashment of community prescriptions and the statutory surgical procedure coding database. Results-The study population comprised 6631 diabetic subjects and 166 144 non-diabetic subjects aged > 40 years without glaucoma or OHT at study entry. 65 patients with diabetes and 958 without diabetes were identified as new cases of glaucoma or treated OHT during the 24 month study period, yielding a standardised morbidity ratio of 127 (95% CI, 96-158). Case note review demonstrated non-differential misclassification of prevalent glaucoma and OHT as incident disease (diabetic cohort 20%, non-diabetic cohort 24%; p=0.56) primarily as a result of non-compliance in medically treated disease. Removing misclassified cases and adjusting for age yielded an incidence of primary open angle glaucoma in diabetes of 1.1/1000 patient years (95% CI, 0.89-1.31) compared to 0.7/1000 patient years (95% CI, 0.54-0.86) in the non-diabetic cohort; RR 1.57 (95% CI, 0.99-2.48). Conclusions-This study failed to confirm an association between diabetes mellitus and primary open angle glaucoma and ocular hypertension. A non-significant increase in diagnosed and treated disease in the diabetic population was observed, but evidence was also found that detection bias contributes to this association.
Keywords: acetazolamide; epinephrine; adrenalin plus guanethidine; adrenergic receptor stimulating agent; agents acting on the eye; antiglaucoma agent; antihypertensive agent; beta adrenergic receptor blocking agent; betaxolol; carbachol; carbonate dehydratase inhibitor; carteolol; dipivefrine; dorzolamide; guanethidine; levobunalol; metipranolol; miotic agent; pilocarpine; timolol maleate; unclassified drug; adult; aged; article; clinical protocol; cohort analysis; controlled study; data base; diabetes mellitus; diagnostic procedure; disease association; disease classification; eye surgery; human; incidence; intraocular hypertension; major clinical study; clinical audit; morbidity; open angle glaucoma; patient compliance; population research; prescription; prevalence; priority journal; register; risk assessment; risk factor; statistical analysis; United Kingdom; diamox; ganda; propine; simplene; trusopt

Effect of health education on patients' beliefs about glaucoma and compliance - Rendell, J. (Insight - Journal of the American Society of Ophthalmic Registered Nurses, 2000)
A pretest-posttest control group experimental design (n = 100) was used to determine the effectiveness of an interactive patient education program compared with a didactic approach for persons with primary open angle glaucoma at a major specialist eye hospital in England. This study used a questionnaire with a knowledge test to explore patients' glaucoma knowledge, a series of vignettes to explore understanding of compliance and health motivation, and health locus of control scales to assess the effect of these variables. The improved posttest results (P = .000) suggest that patients benefit from education programs and that the ophthalmic nurse is an effective patient teacher. The interactive program had no statistically significant difference from the didactic presentation. Other types of interactive programs may prove to be more beneficial. (Insight 2000;25:1 12-8.).
Keywords: adult; aged; article; attitude to health; female; health education; human; male; methodology; middle aged; open angle glaucoma; patient compliance; psychological aspect; questionnaire

Current status of follow-up for diabetic retinopathy patients: The importance of periodic ophthalmologic care - Gotoh, Y.; Sugawara, T.; Sasaki, Y.; Sasaki, K.; Kobayashi, T.; Takahashi, N.; Tazawa, Y. (Folia Ophthalmologica Japonica, 2000)
We investigated the regularity with which patients with diabetic retinopathy (DR) visited the DR clinic and the relationship between stage of DR or visual acuity and regularity of visits. The subjects for this study were 1,023 outpatients who were seen in Iwate Medical University Hospital between January 1997 and December 1998. We found that 70% of patients who were scheduled for follow-up visits with us from before the start of the study period visited the clinic regularly during the study period, while only 18% of patients who were newly referred to our clinic during the study period visited the clinic regularly. About 70% of patients with DR of stages A-III to A-V visited regularly, while about 40% of patients with DR of stages B-I to B-V came irregularly or did not visit within 2 scheduled follow-up appointments. Forty percent of patients with severe ocular complications such as neovascular glaucoma, optic neuropathy, or severe proliferative retinopathy discontinued their visits. Patients whose retinopathy was treated by any means were more willing to make follow-up visits. The results suggest that it is important for patients to visit the clinic on a regular schedule and for doctors to educate patients with DR about the importance of follow-up visits in managing this complication of diabetes effectively.
Keywords: article; diabetic retinopathy; follow up; human; major clinical study; patient compliance; patient education; postoperative complication; visual acuity

Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy. - Mendicino, M.E.; Lynch, M.G.; Drack, A.; Beck, A.D.; Harbin, T.; Pollard, Z.; Vela, M.A.; Lynn, M.J. (Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 2000)
PURPOSE: To compare the visual outcome and refractive status of children with primary congenital glaucoma who underwent 360 degrees trabeculotomy or goniotomy as an initial surgical procedure. METHODS: This retrospective study describes 24 eyes (15 patients) with primary congenital glaucoma that underwent 360 degrees trabeculotomy as the initial procedure and 40 eyes (23 patients) that underwent goniotomy as the initial procedure. Inclusion criteria were: (1) diagnosis of primary congenital glaucoma and initial angle surgery before 1 year of age, (2) no other ocular or systemic diseases, (3) 360 degrees trabeculotomy or goniotomy as the first surgical procedure, and (4) ability to obtain an Allen or Snellen visual acuity. A postoperative vision of 20/50 or better was considered good. Surgical success was defined as an intraocular pressure (IOP) less than 22 mm Hg with or without medication and without evidence of a progressive optic neuropathy. RESULTS: The IOP was successfully controlled in 92% of eyes in the trabeculotomy group and in 58% of eyes in the goniotomy group (P =.004). Of eyes in the trabeculotomy group, 79% had vision of 20/50 or better compared with 53% in the goniotomy group (P =.03). High myopia was more prevalent in the goniotomy group, but this difference was not statistically significant (P =.16). A poor visual outcome was associated with failure of the angle surgery or poor compliance with follow-up and amblyopia therapy. CONCLUSION: For primary congenital glaucoma, 360 degrees trabeculotomy is a highly effective procedure that results in excellent pressure control and is at least as successful as multiple standard procedures. In this study, 360 degrees trabeculotomy resulted in better vision than what is reported in the literature for standard angle procedures.
Keywords: anterior eye chamber; article; comparative study; female; follow up; glaucoma; human; infant; intraocular pressure; male; methodology; newborn; pathology; retrospective study; trabeculectomy; treatment outcome; visual acuity

Telemedicine in the control of intra-ocular pressure. - Michelson, G.; Striebel, W.; Prihoda, W.; Schmidt, V. (Journal of telemedicine and telecare, 2000)
Glaucoma is one of the most common causes of blindness in the Western world and a major risk factor is increased intra-ocular pressure. We therefore used telemedicine in its control. Patients measured their intra-ocular pressure several times a day with a portable instrument and the values were then entered into a portable digital assistant. These data were transmitted by a modem to a central server. If the intra-ocular pressure was pathologically high, an email message was automatically sent to the ophthalmologist. The pressure curve, including a statistical analysis, was displayed in an easily readable chart format. Ten patients with glaucoma participated in a trial. Self-tonometry with telemedicine enabled continuous evaluation of the patient by the ophthalmologist. This approach offered the advantage of controlling the treatment remotely. Advantages for the patient were that the measurements were easily done at home under normal conditions, and the patient could control when the measurement and data transmission would be performed. Telemedicine is a cost-effective technique enabling the early diagnosis of pathologically increased intra-ocular pressure.
Keywords: ambulatory monitoring; article; glaucoma; human; intraocular pressure; methodology; physiology; self care; standard; telemedicine

The Bristol shared care glaucoma study: Outcome at follow up at 2 years - Gray, S.F.; Spry, P.G.D.; Brookes, S.T.; Peters, T.J.; Spencer, I.C.; Baker, I.A.; Sparrow, J.M.; Easty, D.L. (British Journal of Ophthalmology, 2000)
Aim - To examine the outcome of care for patients with glaucoma followed up by the hospital eye service compared with those followed up by community optometrists. Methods - A randomised study with patients allocated to follow up by the hospital eye service or community optometrists was carried out in the former county of Avon in south west England. 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria were studied. The mean number of missed points on visual field testing in the better eye (using a 'better/worse' eye analysis) in each group were measured. The visual field was measured using the Henson semiautomated central field analyser (CFA 3000). Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. The mean number of missed points on visual field testing in the worse eye, mean intraocular pressure (mm Hg), and cup disc ratio using a 'better/worse' eye analysis in each group at 2 years were also measured. Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. An analysis of covariance comparing method of follow up taking into account baseline measurements of outcome variables was carried out. Additional control was considered for age, sex, diagnostic group (glaucoma suspect/established primary open angle glaucoma), and treatment (any/none). Results - From examination of patient notes, 2780 patients with established or suspected glaucoma were identified. Of these, 752 (27.1%) fulfilled the entry criteria. For hospital and community follow up group respectively, mean number of missed points on visual field testing at 2 year follow up for better eye was 7.9 points and 6.8 points; for the worse eye 20.2 points and 18.4 points. Similarly, intraocular pressure was 19.3 mm Hg and 19.3 mm Hg (better eye), and 19.1 mm Hg and 19.0 mm Hg (worse eye); cup disc ratio at 2 year follow up was 0.72 and 0.72 (better eye), and 0.74 and 0.74 for hospital and community follow up group respectively. No significant differences in any of the key visual variables were found between the two groups before or after adjusting for baseline values and age, sex, treatment, and type of glaucoma. Conclusions - It is feasible to set and run shared care schemes for a proportion of patients with suspected and established glaucoma using community optometrists. After 2 years (a relatively short time in the life of a patient with glaucoma), there were no marked or statistically significant differences in outcome between patients followed up in the hospital eye service or by community optometrists. Decisions to implement such schemes need to be based on careful consideration of the costs of such schemes and local circumstances, including geographical access and the current organisation of glaucoma care within the hospital eye service.
Keywords: adult; aged; article; clinical trial; community care; controlled clinical trial; controlled study; female; follow up; glaucoma; health care access; health care delivery; human; intraocular pressure; major clinical study; male; measurement; outpatient care; priority journal; randomized controlled trial; treatment outcome; United Kingdom; visual field

The long-term safety and efficacy of brinzolamide 1.0% (Azopt) in patients with primary open-angle glaucoma or ocular hypertension - March, W.F.; Ochsner, K.I. (American Journal of Ophthalmology, 2000)
PURPOSE: Oral carbonic anhydrase inhibitors used to treat glaucoma have significant systemic side effects. Brinzolamide 1.0%, a new topical ocular carbonic anhydrase inhibitor, is effective apparently without significant systemic side effects. This study was performed to establish the long-term safety and efficacy of brinzolamide 1.0% two and three times daily for primary open-angle glaucoma and ocular hypertension. METHODS: An 18-month, multicenter, double-masked, parallel, controlled study was conducted. Patients were randomized to brinzolamide two or three times daily or timolol 0.5% twice daily in a 2:2:1 ratio (n = 150, 153, and 75, respectively). Intraocular pressure was measured at 8:00 AM at eligibility and months 1, 3, 6, 9, 12, 15, and 18. Efficacy was based on intraocular pressure reduction from baseline. Safety was also evaluated. RESULTS: All regimens produced clinically relevant and statistically significant (P < .05) intraocular pressure reductions from baseline. Mean changes in intraocular pressure trough measurements ranged from -2.7 to -3.9 mm Hg with brinzolamide twice- daily dosing and -2.8 to -3.8 mm Hg three times daily dosing compared with - 4.7 to -5.6 mm Hg with timolol. The intraocular pressure reductions with brinzolamide two and three times daily were clinically and statistically equivalent. One hundred forty-four patients were discontinued from the study after randomization with the most common reasons being the occurrence of an adverse event (46), inadequate intraocular pressure control (23), patient decision unrelated to study medication (11), lost to follow-up (16), and noncompliance (9). Adverse events were nonserious and resolved without sequelae. There were no clinically relevant changes in safety parameters. Brinzolamide produced less ocular discomfort (burning/stinging) than timolol, and total carbonic anhydrase inhibition levels remained below that known to cause systemic side effects. CONCLUSION: Brinzolamide produced significant and equivalent reductions in intraocular pressure when dosed two and three times daily for 18 months. Brinzolamide was safe and well tolerated by patients, with minimal ocular discomfort. (C) 2000 by Elsevier Science Inc.
Keywords: brinzolamide; carbonate dehydratase inhibitor; timolol; timolol maleate; adult; aged; article; clinical trial; controlled clinical trial; controlled study; dose response; drug efficacy; drug safety; female; human; human cell; human tissue; intraocular hypertension; intraocular pressure abnormality; long term exposure; major clinical study; male; multicenter study; open angle glaucoma; priority journal; randomized controlled trial; single blind procedure; taste disorder; visual impairment; azopt; timoptic

Initial medical management of open-angle glaucoma - Fechtner, R.D. (Journal of Glaucoma, 2000)
Keywords: beta adrenergic receptor blocking agent; brimonidine; latanoprost; adult; article; case report; clinical feature; depression; disease course; disease predisposition; drug choice; gonioscopy; human; intraocular pressure; male; open angle glaucoma; patient compliance; priority journal; risk assessment; risk factor; treatment indication; treatment outcome; treatment planning; visual acuity

Emerging perspectives on glaucoma: Highlights of a roundtable discussion - Lee, D.A.; Fechtner, R.D.; Fiscella, R.G.; Singh, K.; Stewart, W.C. (American Journal of Ophthalmology, 2000)
PURPOSE: To present emerging perspectives on open-angle glaucoma related to patient compliance, current drug therapy, and treatment options. METHODS: Roundtable discussion. RESULTS: The panel discussion identified the following issues about patient compliance: 1. It is a common problem in clinical practice and is often underappreciated by physicians. 2. It is difficult for clinicians to detect. 3. There are several risk factors that increase the probability of noncompliance. 4. Compliance can be improved through education, communication, improvement of the doctor-patient relationship, compliance aids, and simplifying the treatment regimen. CONCLUSION: Patients' compliance with the therapeutic regimen for open-angle glaucoma is very important to the eventual outcome of their disease treatment. Physicians can improve their patients' compliance by a few simple, cost-effective interventions in the clinical setting. When considering different agents as first-line therapies, once-a-day dosing would be optimal for enhancing compliance. (C) 2000 by Elsevier Science Inc.
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; betopic s; brimonidine; brinzolamide; carbachol; carbachol; carteolol; demecarium; dipivefrine; dorzolamide; dorzolamide plus timolol; ecothiopate iodide; latanoprost; latanoprost plus timolol; levobunolol; lopidine; mam; methazolamide; metipranolol; miotic agent; pilocarpine; prostaglandin; timolol; timolol maleate; unclassified drug; cost effectiveness analysis; doctor patient relationship; glaucoma; intraocular pressure; open angle glaucoma; patient compliance; patient education; priority journal; review; risk factor; treatment outcome; alphagan; azopt; betagan; betopic s; carbastat; cartrol; cosopt; diamox; epifrin; humorsol; lopidine; mam; optipranolol; pilocar; propine; timoptic; trusopt; xalatan; xalcom

A randomized, comparative open-label study on the efficacy of latanoprost and timolol in steroid induced ocular hypertension after photorefractive keratectomy - Vetrugno, M.; Maino, A.; Quaranta, G.M.; Cardia, L. (European Journal of Ophthalmology, 2000)
Purpose. To evaluate the effect of 0.005% latanoprost and 0.50% timolol for the treatment of steroid-induced ocular hypertension (SIOH) after excimer laser photorefractive keratectomy (PRK). Methods. In this comparative, open-label study we enrolled 29 patients who received steroid therapy after PRK and developed intraocular pressure (IOP) elevation within 30 days of treatment. Fifteen were randomized to 0.005% latanoprost (group A) and 14 to 0.50% timolol (group B). IOP measurements were scheduled at 1, 3, 7, 15, 30, 60, 90 and 120 days of therapy. Results. We did not find any real differences between latanoprost and timolol except at the 7-day and 15-day timepoints, when latanoprost reduced IOP significantly more than timolol (p = 0.033, 0.035, respectively). After 7 days of therapy two of the 14 timolol-treated patients had high IOP (24 and 26 mmHg) but these promptly returned to normal when latanoprost was added. No significant differences were observed in the ocular side effects considered. Conclusions. 0.005% latanoprost is as safe and effective as 0.50% timolol in the treatment of SIOH after PRK. Both drugs provide a significant and stable IOP reduction in the majority of patients after short-term treatment. These findings are encouraging for the use of latanoprost in the management of SIOH after PRK, although further trials are necessary to consider it as a primary treatment.
Keywords: dexamethasone; latanoprost; steroid; timolol; adult; aqueous humor flow; article; clinical article; clinical trial; controlled clinical trial; controlled study; eye toxicity; female; human; intraocular hypertension; intraocular pressure; keratectomy; male; myopia; patient compliance; priority journal; randomized controlled trial

Efficiency in the dispensary care and surgical treatment of glaucoma patients - Iunusova, G.D. (Vestnik oftalmologii, 2000)
The number of blind and poor-sighted patients with glaucoma remains high, which is due to improper organization of treatment of this patient population, among other things. Surgery is an important treatment modality; its effect is higher in patients with the initial stages of disease, which is seen from our observations. Normal intraocular pressure and high visual acuity are retained for 10 years and longer in patients operated on with stage I glaucoma. In patients with developed and far-advanced glaucoma administered complex treatment after surgery, including retrobulbar injections of trental (0.5 ml, 10 injections per course), cerebrolysin (0.5 ml, 10 injections per course), and electric stimulation of the visual analyzer, the glaucomatous process was arrested, visual acuity improved, and visual field extended. In patients with lens opacity, cataracts were extracted and intraocular lenses were implanted; this improved visual acuity without correction. Due to early diagnosis of glaucoma and properly organized regular check-ups of patients (including complex and timely surgery) vision improved and glaucomatous process stabilized in the majority of patients.
Keywords: ambulatory care; article; case report; classification; female; follow up; glaucoma; human; intraocular pressure; male; middle aged; Russian Federation; statistics; time; visual acuity; visual field

Glaucoma medical therapy: A comparison of timolol and latanoprost - Bonsanto, D. (Annali di Ottalmologia e Clinica Oculistica, 1999)
Latanoprost is a PGF2α analogue able to reduce intraocular pressure (IOP) in glaucomatous eyes. We valued many multicentric randomized, double- blind placebo studies in which latanoprost 0.005% was administered once a day while timolol 0.5% was administered twice a day. Both these drugs reduced effectively IOP but latanoprost 0.005% administered at 8 P.M. seems to be more effective than timolol 0.5%. At ocular level latanoprost caused a slight increase in conjunctival hyperemia well tolerable, and an iris increased pigmentation in mixed colour iris without clinical diseases. Consequently latanoprost can be considered a useful drug in the glaucoma therapy so as timolol, but with no contraindications and a better compliance of patients.
Keywords: latanoprost; timolol; article; clinical trial; conjunctivitis; controlled study; double blind procedure; drug efficacy; drug safety; drug tolerability; glaucoma; human; intraocular pressure; major clinical study; multicenter study; patient compliance; randomized controlled trial

Ethnic variation in attitudes toward hypertension in adults ages 75 and older - Ontiveros, J.A.; Black, S.A.; Jakobi, P.L.; Goodwin, J.S. (Preventive Medicine, 1999)
Background. Although critical to the management of hypertension the attitudes of geriatric patients and possible ethnic group differences in attitudes concerning the disease are poorly understood. Methods. Data from a 1995-1996 population-based survey of 507 Hispanic American, African American, and non-Hispanic white adults ages 75 and older were used to assess ethnic differences in perceptions regarding the cause, prevention, and treatment of hypertension, as well as associations between perceptions and use of preventive health services. Results. African Americans were more likely to attribute hypertension to health behaviors and stress. In contrast, Hispanic Americans were more likely consider the disease a normal part of aging, whereas non-Hispanic whites were more likely to attribute hypertension to heredity or mechanistic causes. Non-Hispanic whites were less likely to perceive hypertension as preventable, whereas Hispanic Americans were less likely to feel that hypertension was treatable. The odds of having a primary care physician, blood pressure checked, or glaucoma checked were lower among older African Americans and Hispanic Americans than older non-Hispanic whites. The odds of having had a recent physical and of emergency room use were higher among African Americans and lower among Hispanic Americans, in relation to non-Hispanic whites. Conclusion. Ethnic differences regarding hypertension were clearly evident in this sample of older adults. In addition, attitudes regarding the cause and treatment of hypertension were found to be associated with both the use and the underuse of preventive health services in all three ethnic groups.
Keywords: aged; article; Caucasian; controlled study; ethnic difference; female; health care utilization; human; hypertension; major clinical study; male; Black person; patient attitude; preventive health service; priority journal

Compliance and psychological conditions: A long-term investigation in 245 glaucomatous patients - Pecori Giraldi, J.; Liguori, A.; Mollicone, A.; Paone, E. (Acta Ophthalmologica Scandinavica, Supplement, 1999)
A long-term epidemiological investigation was made with 245 open-angle glaucoma patients classed in 3 age bands and by sex, with the aim of determining the prevalence of compliance and the psychological conditions induced by the extended time factor of the disease. It became clear that a good level of compliance can be obtained if patients understand the severity of the disease and its possible consequences and a good relationship exists between patient and doctor. The higher tendency towards depression in under-45-year-old women is, perhaps, due to the undesirability of having to accept a situation requiring an indefinite period of treatment.
Keywords: adult; aged; chronic patient; conference paper; depression; disease severity; female; human; major clinical study; male; open angle glaucoma; patient compliance; patient education; priority journal; psychological aspect; questionnaire; sex difference

The treatment of newly diagnosed patients with glaucoma or with ocular hypertension in the Netherlands: An observational study of costs and initial treatment success based on retrospective chart review - Oostenbrink, J.B.; Rutten-Van Mölken, M.P.M.H.; Opdenoordt, T.S. (Documenta Ophthalmologica, 1999)
To determine the health care resource use and costs of patients with glaucoma or ocular hypertension in the Netherlands during the first 2 years after primary diagnosis, we performed a study based on retrospective chart review. Data of 200 patients and their health care resource use were collected in five hospitals. Unit-prices were calculated using micro costing in two hospitals. The mean 2-year costs per patient were estimated to be US$ 877. Outpatient visits to the ophthalmologist and medications were the cost-driving factors, and were responsible for 40 and 30% of total costs, respectively. Total costs were considered to be low, when compared to the estimated costs per patient in Sweden and the USA. In multiple least-squares regression only baseline IOP-value, the change in IOP-value between baseline and the next visit and the hospital of treatment were significantly related with total costs. The variation in costs between patients largely depended on whether or not a patient had undergone surgery.
Keywords: adult; aged; argon laser; article; cataract extraction; consultation; controlled study; diagnostic test; economic evaluation; female; glaucoma; health care cost; health care utilization; human; intraocular hypertension; intraocular pressure; major clinical study; male; Netherlands; resource allocation; trabeculectomy

Use of eye care services by older Australians: The Blue Mountains Eye Study - Wang, J.J.; Mitchell, P.; Smith, W. (Australian and New Zealand Journal of Ophthalmology, 1999)
Purpose: To assess utilization of eye care services in an older Australian population. Methods: The Blue Mountains Eye Study examined 3654 permanent residents aged 49 years or older from two New South Wales postcode areas. At interview, we collected information about past attendance to eye care practitioners, demographic and socio-economic status variables and past medical and eye history. Full-time optometric and part-time ophthalmic services were available in this community. Results: Almost all participants (99%) had seen either an ophthalmologist or optometrist in the past, with 62, 27, 7 and 3% having last attended in the last 2, 2-5, 5-10 and > 10 years, respectively. Among those participants (2251) who had been seen in the last 2 years, 50.2% (1131) last saw an ophthalmologist, 48.6% (1094) last saw an optometrist and 26 (1.2%) could not state whom they saw. After adjusting for age and sex, factors statistically significantly associated with attending an ophthalmologist included older age, female gender, higher socio-economic status, moderate to high myopia and presence of systemic disease (diabetes, hypertension) or any significant eye pathology. Factors statistically significantly associated with attending an optometrist were younger age, living alone, not currently married, being able to go out alone, having better presenting visual acuity, hyperopia and absence of diabetes or significant eye pathology, including moderate to high myopia. Conclusions: Findings from this study indicate that whether people use eye care services and whom they visit is mainly driven by need factors. Although there was considerable overlap, this study found relatively appropriate utilization of eye care services by this population.
Keywords: adult; aged; article; Australia; diabetic retinopathy; factor analysis; female; health care utilization; human; hypertension; major clinical study; male; mass screening; myopia; open angle glaucoma; population research; age related macular degeneration; retina vein occlusion; socioeconomics

Ophthalmic nurse run services. - Gardner, R.F. (The British journal of theatre nursing : NATNews : the official journal of the National Association of Theatre Nurses, 1999)
Keywords: ambulatory care; article; cataract extraction; glaucoma; health care quality; human; nurse administrator; nurse practitioner; nursing; nursing evaluation research; ophthalmology; organization and management; work

Acute care hospital utilization by patients with visual impairment - Morse, A.R.; Yatzkan, E.; Berberich, B.; Arons, R.R. (Archives of Ophthalmology, 1999)
Objective: To assess whether visual impairment contributes to average length of stay (ALOS) within inpatient care facilities. Methods: We used the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) data for 1993, containing 1 principal diagnosis code and up to 8 secondary diagnosis codes for approximately 2.6 million hospital discharges. We evaluated ALOS differences in patients with and without visual impairment and in patients with eye pathologic conditions, including eye surgery. Visual impairment is not a primary admitting diagnosis, but may be coded as a secondary diagnosis. Eye pathology comprises a large variety of conditions, including corneal ulcers, abscesses, corneal deposits, edema, cataracts, vitreous hemorrhages, and many other eye disorders (ICD-9-CM codes 360-368.9 and 370-379). Results: The ALOS was 13.4 days for patients with visual impairment (N = 5764), 11.9 days for patients with either eye pathology or visual impairment (N = 60 085), and 8.2 days for patients with no visual impairment (N = 2 546 586). Using a series of multivariate models that controlled for the variables of age, sex, and payer source, as well as disease, disorders, and ophthalmology procedures, we found that the existence of visual impairment added 2.4 days to the ALOS (P<.001), while eye pathology combined with a secondary diagnosis of visual impairment added 1.8 days to the ALOS (P<.001). Conclusions: Visual impairment contributes significantly to hospital length of stay. A better understanding of the functional care needs of patients with visual impairment in an acute care setting and at the time of discharge from the hospital may contribute to reducing excess ALOS and its related costs while improving the quality of patient care.
Keywords: adult; aged; article; cornea ulcer; female; health care planning; health care quality; health care utilization; hospital discharge; human; human cell; human tissue; length of stay; major clinical study; male; priority journal; visual impairment

Penetration of topical ciprofloxacin by presoaked medicated soft contact lenses - Kalayci, D.; Basci, N.; Kortunay, S.; Hasiripi, H.; Bozkurt, A. (CLAO Journal, 1999)
Purpose: To assess the penetration of topical ciprofloxacin by a presoaked medicated disposable soft contact lens without topical drop administration. Methods: Disposable soft contact lenses were presoaked in 0.3 % topical ciprofloxacin (Ciloxan, Alcon Laboratories, Fort Worth, TX) for 10- 12 hours. Presoaked lenses were placed on the eyes of patients with senile cataracts for 3 hours in group A, 5-6 hours in group B, and 8-12 hours in group C prior to their scheduled lens extraction surgery. Aqueous humor samples were drawn by paracentesis during the operation. Ciprofloxacin concentrations were determined by high pressure liquid chromatography- fluorescence detection. Results: The mean ciprofloxacin concentration was 2.70 ±0.98 μg/mL in group A, 1.22±1.0 μg/mL in group B, and 0.5 ± 0.2μg/mL in group C. Conclusions: Penetration of topical ciprofloxacin is enhanced through a presoaked disposable soft contact lens, and at 3 hours therapeutic levels are obtained. Significant levels of ciprofloxacin are retained through 8-12 hours. This mode of treatment may increase patient compliance compared to frequent topical drop administration, and as a consequence, assure efficient treatment of keratitis, at least for the first 3 hours.
Keywords: ciprofloxacin; antibiotic therapy; aqueous humor; article; cataract extraction; controlled study; drug delivery system; drug penetration; high performance liquid chromatography; human; keratitis; patient compliance; senile cataract; soft contact lens; topical drug administration; ciloxan; Plano Focus

For your eyes: New ophthalmic agents offer convenience and other advantages over older drugs - Waldron, T. (Drug Topics, 1999)
Keywords: agents acting on the eye; benzoporphyrin derivative; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; ciprofloxacin; diclofenac; dorzolamide; dorzolamide plus timolol; hyaluronidase; interleukin 2 receptor antibody; loteprednol etabonate; mcx ra immunotoxin; memantine; prednisolone acetate; sv 205; thalidomide; timolol; timolol maleate; trifluridine; unclassified drug; allergic conjunctivitis; conjunctivitis; drug approval; drug choice; drug contraindication; drug cost; drug efficacy; drug marketing; eye inflammation; herpes simplex keratitis; human; intraocular hypertension; keratitis; open angle glaucoma; patient compliance; macular degeneration; short survey; topical drug administration; uveitis; visual impairment; vitreous hemorrhage; alrex; azopt; ciloxin; cosopt; lotemax; predforte; timoptic; trusopt; viroptic; vitrase; voltaren; zenapax

Topical therapies for glaucoma: What family physicians need to know - Lewis, P.R.; Phillips, T.G.; Sassani, J.W. (American Family Physician, 1999)
Medication classes historically used in the management of glaucoma include beta blockers, miotics, sympathomimetics and carbonic anhydrase inhibitors. Because topically applied medications are more site specific, they are preferred in the treatment of glaucoma. Compared with oral medications, topical agents are associated with a decreased incidence of systemic side effects. With topical administration, conjunctival and localized skin allergic reactions are relatively common, whereas severe reactions, including death, are rare. Recently introduced topical agents for glaucoma therapy include dorzolamide and brinzolamide, the first topical carbonic anhydrase inhibitors; brimonidine and apraclonidine, more ocular- specific alpha agonists; and latanoprost, a prostaglandin analog, which is a new class of glaucoma medication. Latanoprost has the unique side effect of increasing iris pigmentation. Like their predecessors, the newer agents lower intraocular pressure by a statistically significant degree. Preservation of visual field, the more substantial patient-oriented end point, continues to be studied.
Keywords: adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; brimonidine; brinzolamide; carbonate dehydratase inhibitor; carteolol; dipivefrine; dorzolamide; latanoprost; levobunolol; metipranolol; miotic agent; pilocarpine; timolol maleate; bradycardia; drug efficacy; drug safety; glaucoma; headache; human; hypertension; intraocular pressure; nausea; oral drug administration; patient compliance; review; topical drug administration; alphagan; azopt; betagan; betoptic; iopidine; isoptocarpine; ocupress; ocusert; optipranolol; propine; timoptic; trusopt; xalatan

Unmet needs in the pharmacological treatment of asthma - Demoly, P.; Chanez, P.; Godard, P. (Pulmonary Pharmacology and Therapeutics, 1999)
Keywords: beclometasone; beta 2 adrenergic receptor stimulating agent; corticosteroid; theophylline; antiinflammatory activity; asthma; behavior disorder; bone atrophy; cataract; conference paper; disease severity; forced expiratory volume; glaucoma; growth inhibition; human; inhalational drug administration; metabolic disorder; metered dose inhaler; oral drug administration; patient compliance; patient education; priority journal; skin disease

Patient preference, efficacy, and compliance with timolol maleate ophthalmic gel-forming solution versus timolol maleate ophthalmic solution in patients with ocular hypertension or open-angle glaucoma - Schenker, H.; Maloney, S.; Liss, C.; Gormley, G.; Hartenbaum, D. (Clinical Therapeutics, 1999)
This study was designed to compare timolol maleate ophthalmic gel- forming solution 0.5% (timolol gel) once daily with timolol maleate ophthalmic solution 0.5% (timolol solution) twice daily with respect to patient preference, intraocular pressure (IOP)-lowering effect, and tolerability. A total of 202 patients with ocular hypertension or open-angle glaucoma and an IOP ≥22 mm Hg were enrolled in this 12-week, randomized, observer-masked, two-period crossover study. Significantly more patients preferred timolol gel to timolol solution (P < 0.001). Ninety-two percent of patients preferring timolol gel strongly agreed or agreed that once-daily dosing was a reason for their preference. Those who preferred timolol solution did so because of fewer side effects. The mean IOP-lowering effects of the 2 treatments were similar at both morning trough and peak time points. The incidence of drug-related adverse experiences was similar (timolol gel 11.4% vs timolol solution 10.9%). Because both treatments were well tolerated and effective in lowering IOP, timolol gel, with its once-daily dosing regimen, should be considered in patients who are candidates for therapy with an ophthalmic beta-blocking agent.
Keywords: beta adrenergic receptor blocking agent; eye drops; gellan; timolol maleate; article; beta adrenergic receptor blocking; blood pressure; burn; clinical trial; controlled clinical trial; controlled study; crossover procedure; dose response; drug efficacy; drug formulation; drug tolerability; eye inflammation; gel; heart rate; human; intraocular hypertension; intraocular pressure abnormality; major clinical study; open angle glaucoma; patient compliance; patient satisfaction; questionnaire; randomized controlled trial; single blind procedure; topical drug administration; treatment outcome; upper respiratory tract infection; visual impairment; gelrite; timoptic

Effects of the rational use of corticosteroids eye drops for the prevention of ocular toxicity in high-dose cytosine arabinoside therapy - Itoh, M.; Aoyama, T.; Yamamura, Y.; Nakajima, K.; Nakamura, K.; Kotaki, H.; Matsuyama, T.; Saitoh, T.; Kami, M.; Chiba, S.; Hirai, H.; Yazaki, Y.; et al. (Yakugaku Zasshi, 1999)
Although the use of corticosteroid (cs) eye drops or the use of eye washing by artificial tears was effective for the prevention of ocular toxicity such as keratitis and photophobia in the high-dose cytosine arabinoside (Ara-C) therapy, the toxicity was not prevented perfectly. We studied the effects of the rational use of CS eye drops, and the combined use of CS eye drops and eye washing by physiological saline in order to prevent the ocular toxicity. Before the study, the instillation of 0.1% sodium bethamethazone phosphate (BM) eye drops was carried out at 4 - 6 times per day during the high-dose Ara-C therapy, and continued for several days after the high-dose Ara-C therapy. However, the rational use of 'eyelid closure' and 'naso-lacrimal occlusion' after the instillation was not performed Consequently, the ocular toxicity was observed in 3 (19%) of 16 cases of the patients. When the instillation of BM eye drops at 4 times per day was carried out rationally according to the consultation of pharmacist during the high-dose Ara-C therapy and for additional 10 days after the therapy, no ocular toxicity was observed in all cases (0 of 6 cases). Furthermore, the combined use of eye washing by physiological saline and instillation of BM eye drops was effective for the decrease of the risk of ocular toxicity, because no ocular toxicity was observed in the high-dose Ara-C therapy (0 of 34 cases). Our procedure in this study would be effective for the prevention of ocular toxicity in the high-dose Ara-C therapy.
Keywords: artificial tear; balanced salt solution; betamethasone sodium phosphate; cytarabine; eye drops; mitoxantrone; adolescent; adult; article; cancer chemotherapy; chemoprophylaxis; clinical article; clinical trial; controlled clinical trial; controlled study; corticosteroid therapy; dose response; drug efficacy; drug megadose; drug utilization; eye protection; eye toxicity; female; human; male; patient compliance; risk factor; topical drug administration

The glaucoma patient's perception of treatment - Naacke, H.; Baudouin, C. (Journal Francais d'Ophtalmologie, 1999)
Keywords: pilocarpine; timolol; environmental factor; glaucoma; patient care; patient compliance; patient satisfaction; personality; prescription; psychological aspect; review

Potential utility of electronic drug compliance monitoring in measures of adverse outcomes associated with immunosuppressive agents - Feldman, H.I.; Hackett, M.; Bilker, W.; Strom, B.L. (Pharmacoepidemiology and Drug Safety, 1999)
Poor compliance with prescribed medications limits the effectiveness of many pharmacologic therapies and enhances their potential toxicities. Traditional methods of measuring drug-taking behavior, including direct observation, patient self-report, pill counts, and therapeutic drug level monitoring, all have well-described limitations in validity and interpretability. Electronic medication event monitoring has been used to assess compliance with therapies for hypertension, glaucoma, anemia, and epilepsy, overcoming many problems of traditional approaches. However, no published reports describe the use of electronic monitoring with immunosuppressive agents, despite their increasing use for non-life-threatening conditions and their many dose-dependent toxicities. Transplant recipients are thought to be at particular risk from noncompliance. Therefore, we undertook this study to assess the feasibility of electronically monitoring compliance with immunosuppressive drugs among renal allograft recipients. Twenty-five kidney transplant patients receiving immunosuppressive medications from a single pharmacy were enrolled. Each subject received electronic monitors with their immunosuppressive serum drug refills for cyclosporine and azathioprine. Each subject returned their monitors after the first month of this 2-month study for downloading data. The frequency distribution of interdose intervals were described. Two measures of average non-compliance were calculated for both drugs: the proportion of monitored days that had missed doses, and the proportion of missed doses. Once daily and twice daily regimens of cyclosporine were compared. Concordance in drug compliance between the two drugs was calculated for each subject and averaged over the study population. Twenty-two of 25 subjects missed one or more doses of cyclosporine or azathioprine. Seventeen (68%) subjects never missed four or more consecutive doses. Subjects were non-compliant with cyclosporine on 8.7% of monitored days, and noncompliance with azathioprine on 9.8% of monitored days. Subjects were non-compliant with 6.8% of their cyclosporine doses and 9.8% of their azathioprine doses. Patients were compliant with both drugs on 86.6% of days and were non-compliant with both drugs on 5.1% of days. Subjects were noncompliant with cyclosporine during 5% and 13.2% of monitored days for once and twice daily dosing regimens, respectively. Concordance analysis demonstrated that for 91.7% of days of monitoring, compliance information was identical for both drugs. This study demonstrated the feasibility of electronic medication event monitoring among kidney transplant patients. This methodology represents an important tool for monitoring compliance of immunosuppressive agents essential to their safe and effective use, and should be considered for use in future studies of these drugs and others with substantial dose-dependent toxicity.
Keywords: antianemic agent; anticonvulsive agent; antiglaucoma agent; antihypertensive agent; azathioprine; cyclosporine; immunosuppressive agent; anemia; article; clinical article; drug efficacy; epilepsy; glaucoma; human; hypertension; kidney transplantation; patient compliance; patient monitoring; priority journal; self report; MEMS

A new device for ocular massage after trabeculectomy [1] - Quaranta, L. (Acta Ophthalmologica Scandinavica, 1999)
Keywords: mitomycin; aqueous humor flow; conjunctiva; finger; glaucoma; human; intraocular pressure; letter; massage; mechanical stimulation; medical device; ocular massage; patient compliance; postoperative care; priority journal; trabeculectomy

Clinical research of trabeculectomy on outpatients - Ao, J.; Liu, X. (Yan ke xue bao = Eye science / "Yan ke xue bao" bian ji bu, 1998)
PURPOSE: To investigate the feasibility of Trabeculectomy on outpatients. METHODS: Postspectively compared and discussed the surgery effect and complications of trabeculectomy on 38 eyes of 27 outpatients with those on 38 eyes of 30 inpatients. All the surgeries were performed by the same surgeon in the same period. RESULT: The IOP of outpatients' group after one week, one month, three months or more are respectively 1.4800 +/- 0.5977 kPa, 1.8379 +/- 0.5517 kPa, 1.9650 +/- 0.4879 kPa, while the inpatients' group are 1.3468 +/- 0.5994 kPa, 1.7737 +/- 0.5177 kPa, 2.0144 +/- 0.5447 kPa. t-test has shown that the differences of the IOP after the surgery, the surgery effect and complications of trabeculectomy between the outpatients and the inpatients had no significance. CONCLUSION: Trabeculectomy on outpatients in hospital with satisfied facility would be effective, safe and feasible.
Keywords: adolescent; adult; aged; ambulatory care; article; closed angle glaucoma; female; glaucoma; human; intraocular pressure; male; middle aged; prospective study; trabeculectomy; treatment outcome; visual acuity

Stroke and depression: Clinical features and treatment - Torta, R.; Cicolin, A.; Keller, R. (Italian Journal of Neurological Sciences, 1998)
Keywords: amfebutamone; amisulpride; amoxapine; citalopram; fluoxetine; nefazodone; ademetionine; serotonin; serotonin uptake inhibitor; sulpiride; trazodone; tricyclic antidepressant agent; affective neurosis; clinical feature; closed angle glaucoma; cognitive defect; conference paper; constipation; depression; dysthymia; functional assessment; human; human cell; human tissue; incidence; patient compliance; social status; cerebrovascular accident; treatment outcome; urine retention; visual impairment; xerostomia

Ambulatory blood pressure monitoring in glaucoma patients. The nocturnal systolic dip and its relationship with disease progression - Collignon, N.; Dewe, W.; Guillaume, S.; Collignon-Brach, J. (International Ophthalmology, 1998)
Purpose: This study was designed to uncover a new sensitive and specific factor for predicting the progression of glaucoma. Methods: The 24-hour ambulatory blood pressure and diurnal curve of intra-ocular pressure were recorded in seventy patients: 51 primary open angle glaucoma (POAG) and 19 normal tension glaucoma (NTG). The mean systolic, diastolic and average arterial blood pressure were calculated, along with the nocturnal dip of systolic pressure and diastolic blood pressure. Two-year disease progression was assessed for all patients by means of retrospective analysis of visual fields defects on repeated perimetries. Results: Abnormal (absence or increased) nocturnal dip of systolic blood pressure was found to be correlated with disease progression in POAG and NTG patients with a sensitivity of 86% and a specificity of 85%, whereas no significant correlation was found for the other risks factors envisaged. Furthermore, a significant relationship between stable visual field defects and the use of diuretics/laser procedure was evidenced. Conclusion: The nocturnal dip of systolic blood pressure should be considered as a predictive factor of disease progression in NTG and POAG. Further prospective studies are needed to ascertain whether dip normalization could help slow down the visual field loss in these patients.
Keywords: anticoagulant agent; antilipemic agent; antithrombocytic agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; diuretic agent; adult; aged; ambulatory monitoring; article; blood pressure monitoring; disease course; female; glaucoma; human; hypertension; major clinical study; male; visual field defect

Risk factors for noncompliance with glaucoma follow-up visits in a residents' eye clinic - Kosoko, O.; Quigley, H.A.; Vitale, S.; Enger, C.; Kerrigan, L.; Tielsch, J.M. (Ophthalmology, 1998)
Objective: This study aimed to identify factors associated with compliance with glaucoma follow-up visits. Design: Computer records of a university residents' eye clinic were reviewed to identify a random sample of all persons who had an examination with International Classification of Disease (ICD) 9 coding (ICD9) for glaucoma suspect or glaucoma during a 2- year period (1991-1993) to undergo telephone interview. Participants: Those who were seen at least every 6 months regardless of earlier return instructions were defined as compliant with follow-up (controls, n = 362). Those who had any lapse between visits of longer than 6 months were defined as noncompliant (cases, n = 362). Results: Interviews were completed for 196 cases and 242 controls. Noncompliant persons were significantly more likely to be suspects for glaucoma rather than to have definite glaucoma and to be dissatisfied with waiting time in the clinic (29.1% vs. 17.8%, P < 0.005) and to state that they did not take their glaucoma medications as prescribed (25.4% vs. 13.4%, P < 0.004). They also were less likely to have been prescribed eyedrop medication. A high percentage of both patients and controls knew that glaucoma can lead to blindness (85.2% and 88.4%, respectively). The most common reasons patients gave for not keeping follow- up visits were the perception that their eye problem was 'not serious enough,' the cost of examinations, and that the doctor did not tell them to come back. Conclusion: Compliance with follow-up visits for glaucoma is associated with markers for early disease attempts to improve compliance might focus on improved communication of the seriousness of the disease and improvements in clinic waiting time.
Keywords: adult; aged; article; controlled study; female; follow up; glaucoma; health care cost; human; major clinical study; male; patient care; patient compliance; priority journal; risk factor

Interview concerning knowledge of glaucoma - Takahashi, M.; Nakajima, M.; Azuma, L. (Folia Ophthalmologica Japonica, 1998)
General outpatients of Osaka Medical College Hospital, including glaucoma patients, were interviewed as to their knowledge of glaucoma. Results showed that most of the patients who first visited our eye clinic had little knowledge of the disease. A few patients with glaucoma had a little knowlege about their disease. The source of such knowledge, excepting that of the glaucoma patients, was near relatives or friends, family medical books and television. Of the glaucoma patients, 85% had good compliance, but 43% of those had some problems in the medical management of eyedrops. Nearly half the patients were not satisfied with their doctor's explanation about glaucoma.
Keywords: eye drops; adult; aged; doctor patient relationship; family; female; glaucoma; human; interview; Japan; major clinical study; male; medical information; medical literature; patient compliance; patient education; review; television

Acyclovir for the prevention of recurrent herpes simplex virus eye disease - Wilhelmus, K.R.; Beck, R.W.; Moke, P.S.; Dawson, C.R.; Barron, B.A.; Jones, D.B.; Kaufman, H.E.; Kurinij, N.; Stulting, R.D.; Sugar, J.; Cohen, E.J.; Hyndiuk, R.A.; et al. (New England Journal of Medicine, 1998)
Background: Long-term treatment with antiviral agents has been shown to prevent recurrences of genital and orofacial herpes simplex virus (HSV) disease, but it is uncertain whether prophylactic treatment can prevent recurrences of ocular HSV disease. Methods We randomly assigned 703 immunocompetent patients who had had ocular HSV disease within the preceding year to receive 400 mg of acyclovir or placebo orally twice daily. The study outcomes were the rates of development of ocular or nonocular HSV disease during a 12-month treatment period and a 6-month observation period. Results: The cumulative probability of a recurrence of any type of ocular HSV disease during the 12-month treatment period was 19 percent in the acyclovir group and 32 percent in the placebo group (P<0.001). Among the 337 patients with a history of stromal keratitis, the most common serious form of ocular HSV disease, the cumulative probability of recurrent stromal keratitis was 14 percent in the acyclovir group and 28 percent in the placebo group (P=0.005). The cumulative probability of a recurrence of nonocular (primarily orofacial) HSV disease was also lower in the acyclovir group than in the placebo group (19 percent vs. 36 percent, P<0.001). There was no rebound in the rate of HSV disease in the six months after treatment with acyclovir was stopped. Conclusions: After the resolution of ocular HSV disease, 12 months of treatment with acyclovir reduces the rate of recurrent ocular HSV disease and orofacial HSV disease. Long-term antiviral prophylaxis is most important for patients with a history of HSV stromal keratitis, since it can prevent additional episodes and potential loss of vision.
Keywords: aciclovir; antivirus agent; placebo; adolescent; adult; article; child; clinical trial; controlled clinical trial; controlled study; cornea disease; drug efficacy; erythema nodosum; herpes simplex keratitis; Herpes simplex virus; human; keratitis; major clinical study; oral drug administration; patient compliance; priority journal; randomized controlled trial; recurrent infection; treatment outcome; virus infection; zovirax

The glaucoma work group--an initiative of the Tübingen University Eye Clinic - Erb, C.; Stübiger, N.; Schüller, S.; Rassmann, K. (Klinische Monatsblätter für Augenheilkunde, 1998)
Keywords: adult; aged; article; curriculum; female; Germany; glaucoma; human; male; methodology; middle aged; open angle glaucoma; patient compliance; patient education; psychological aspect; university hospital

Intraocular pressure self-monitoring in glaucoma patients - Draeger, J. (Klinische Monatsblätter für Augenheilkunde, 1998)
Keywords: article; glaucoma; human; intraocular pressure; oculoplethysmography; patient compliance; psychological aspect; self care

Improving the care of glaucoma patients. - Wilson, R.P. (Journal of ophthalmic nursing & technology, 1998)
Keywords: aged; article; case report; female; glaucoma; health care quality; human; methodology; nursing; organization and management; patient compliance; patient education; psychological aspect

Effect on intraocular pressure after substitution of levobunolol for timolol in patients controlled on timolol or timolol and dipivefrin - Enzenauer, R.W.; Butler, P.J.; Weller, R.W.; George, R.K.; Dirks, M.S. (Annals of Ophthalmology - Glaucoma, 1998)
The purpose of this 'open-label' switch-over study was to evaluate the effect of substitution of levobunolol for timolol on intraocular pressure in patients with glaucoma or ocular hypertension. An appropriate baseline intraocular pressure was determined at the beginning of the study. The results show that intraocular pressure can be expected to be controlled at least as well when patients are switched to levobunolol 0.5% from timolol 0.5%.
Keywords: beta adrenergic receptor blocking agent; dipivefrine; levobunolol; timolol maleate; article; clinical article; controlled study; drug efficacy; human; intraocular hypertension; intraocular pressure; open angle glaucoma; patient compliance; priority journal; topical drug administration

Knowledge, attitudes, and self care practices associated with age related eye disease in Australia - Livingston, P.M.; McCarty, C.A.; Taylor, H.R. (British Journal of Ophthalmology, 1998)
Aim - To determine the level of correct knowledge about common eye disease and attitudes towards blindness prevention and treatment, and how these factors influence self care practices in a population based sample. Methods - A cluster random sample of the Victorian population was interviewed. The study population comprised residents aged 40 years of age or older living in five randomly selected Melbourne metropolitan suburbs and four randomly selected rural areas of Victoria. Questions were asked to ascertain each person's knowledge of common age related eye disease - that is, cataract, age related macular degeneration (AMD), and glaucoma. A subsample of the population was also asked questions to determine their attitudes to blindness prevention and treatment. All respondents were asked the year of their last visit to an eye practitioner. Results - A total of 3184 (89%) eligible residents were assessed. Sex (females), age (younger people), higher levels of education (secondary, trade, or tertiary education), recent visit to an eye practitioner (within the past 2 years) and English spoken at home appeared to be significant predictors of knowledge of common age related eye conditions. Younger people believed blindness prevention and blindness treatment were the highest priorities compared with other diseases; people who spoke English at home and people with knowledge of common age related eye disease also considered blindness treatment to be the highest priority compared with other diseases. People with a previous diagnosis of age related eye disease, older people, females, people with correct knowledge of common eye diseases, and those who spoke English at home were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices. Conclusion - These data show that there is a large gap in the public's knowledge and understanding of eye disease that will need to be understood for eye health promotion activities.
Keywords: adult; aged; aging; article; attitude; Australia; blindness; cataract; education; eye disease; female; glaucoma; health care utilization; health promotion; human; interview; language; male; normal human; ophthalmology; population research; priority journal; macular degeneration; rural area; self care; sex difference; urban area

Prevalence of serious eye disease and visual impairment in a north London population: Population based, cross sectional study - Reidy, A.; Minassian, D.C.; Vafidis, G.; Joseph, J.; Farrow, S.; Wu, J.; Desai, P.; Connolly, A. (British Medical Journal, 1998)
Objective: To estimate the magnitude of serious eye disorders and of visual impairment in a defined elderly population of a typical metropolitan area in England, and to assess the frequency they were in touch with, or known to, the eye care services. Design: Cross sectional survey using two stage cluster random sampling. Setting: General practices in north London. Subjects: Random sample of people aged 65 and older, drawn from a defined population of elderly people registered with 17 general practice groups. Main outcome measures: Proportions and population prevalence estimates were determined for visual acuity, assessed with the person's own spectacles (if any), classified into four categories: prevalence of cataract, age related macular degeneration, and refractive error causing visual impairment and of definite primary open angle glaucoma; and status of contact with eye services. Results: 1547 of 1840 (84%) eligible people were examined. The population prevalence of bilateral visual impairment (visual acuity < 6/12) was 30%, of which 72% was potentially remediable. 92 of these 448 cases (21%) had visual acuity < 6/60 ('blindness') in one or both eyes. Prevalence of cataract causing visual impairment was 30%; 88% of these people were not in touch with the eye services. The prevalence of vision impairing, age related macular degeneration was 8% and of glaucoma (definite cases) was 3%. Three quarters of the people with definite glaucoma were not known to the eye services. Conclusions: Untreated visual impairment and eye disorders affect a substantial proportion of people aged 65 years and older. These findings should contribute to the setting up of future strategies for presentation of sight and eye health services in general.
Keywords: aged; article; blindness; cataract; eye disease; general practice; health care utilization; health survey; human; major clinical study; open angle glaucoma; prevalence; priority journal; refraction error; macular degeneration; spectacles; United Kingdom; urban population; visual acuity; visual impairment

Glaucoma. - Gricar, J.A.; Wilson, P.R.; Cave, D.G. (Managed care interface, 1998)
The routine, easiest-to-treat adult patients with glaucoma utilize 1.80 office visits, 3.34 prescriptions, and 2.02 medical/surgical procedures during the course of a year. Based on data from the PTE-Registry database, this patient group did not receive any hospital admissions or professional inpatient services. Eye surgery was performed at an average rate of 0.08 times per PTE. About 53.5% of all PTEs were treated without the use of prescription drugs. When a drug was prescribed, beta blockers were used most often. In fact, 74.1% of all PTEs treated with a single drug group used a beta blocker.
Keywords: adolescent; adult; ambulatory care; article; clinical practice; cost of illness; economics; glaucoma; health service; hospitalization; human; middle aged; ophthalmology; patient care; statistics; United States; utilization review

Cost-effective pharmacotherapy for allergic rhinitis - Ferguson, B.J. (Otolaryngologic Clinics of North America, 1998)
This article provides guidelines for pharmacotherapy to maximize symptom relief from allergic rhinitis. Consideration of frequency, severity, and site of symptoms is important in directing pharmacotherapy efficacy and maximizing cost-effectiveness. The agents available include antihistamines, decongestants, steroids, mast cell stabilizers, anticholinergic agents, and mucolytics. Appropriate indications for each and combinations of various agents are discussed within the context of drug efficacy, side effects, affordability, and ease of compliance. The direct and indirect costs of allergic rhinitis are not well delineated but are explored to put the costs of therapy in perspective.
Keywords: antihistaminic agent; astemizole; cetirizine; cholinergic receptor blocking agent; clemastine; decongestive agent; diphenhydramine; ephedrine; fexofenadine; ipratropium bromide; levocabastine; loratadine; mucolytic agent; naphazoline; oxymetazoline; phenylephrine; phenylpropanolamine; promethazine; propylhexedrine; pseudoephedrine; steroid; terfenadine; tetryzoline; tripelennamine; unindexed drug; xylometazoline; allergic rhinitis; cost effectiveness analysis; drug cost; dry eye; epistaxis; glaucoma; headache; human; insomnia; patient compliance; review; sedation; tremor; vertigo

Make glaucoma screening a routine part of DM programs. (Healthcare demand & disease management, 1998)
Physicians who treat patients with glaucoma say there is a serious lack of attention to screening, a deficiency that can lead to blindness for many patients with asthma, diabetes, and heart disease. Here's what your DM program can do about it.
Keywords: article; diagnostic test; disease management; glaucoma; human; patient compliance; physical examination; risk factor; United States

Preoperative features of patients with exfoliation glaucoma and primary open-angle glaucoma. The AHEPA study - Konstas, A.G.P.; Tsatsos, I.; Kardasopoulos, A.; Bufidis, T.; Maskaleris, G. (Acta Ophthalmologica Scandinavica, 1998)
Purpose: To describe and compare the preoperative characteristics of Greek patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG). Methods: We prospectively investigated the preoperative features of 100 consecutive patients undergoing filtration surgery for either EXG, or POAG. We compared 74 patients with EXG and 26 with POAG. Results: EXG patients were older (68.2 vs 62.4 years; p < 0.05) and more often from the countryside (73%). Both glaucomas showed a preponderance for males, similar frequencies of positive family history and systemic disorders, with the exception of diabetes which was more common in POAG (19.2% vs 5.4%). The first IOP measurement, before treatment, was significantly higher in EXG (40.4 mm Hg) compared with POAG (33.9 mm Hg). Despite a shorter duration of medical therapy (25 vs 65 months) and more topical drugs EXG patients exhibited higher mean preoperative IOP (36 vs 27.8 mm Hg for POAG; p < 0.05). EXG patients had significantly worse visual acuity than POAG (0.4 vs 0.6; p < 0.05) and worse compliance to medical therapy (48%) compared to POAG (33%).
Keywords: antiglaucoma agent; adult; age; aged; article; clinical feature; controlled study; diabetes mellitus; pseudoexfoliation; family history; female; filtering operation; geographic distribution; human; intraocular pressure; major clinical study; male; open angle glaucoma; patient compliance; preoperative evaluation; priority journal; sex difference; topical drug administration; visual acuity

Compliance with timolol treatment in glaucoma - Rotchford, A.P.; Murphy, K.M. (Eye, 1998)
Purpose. To assess levels of compliance in elderly patients on timolol eyedrops for glaucoma. Methods. A postal questionnaire was sent from the general practitioner to 86 patients over 55 years of age on repeat prescriptions for timolol eyedrops. The questionnaire asked details about the duration of treatment, family history, the level of understanding of the disease and the importance of treatment, other regular medication, side-effects attributed to the drops and how often patients omitted their drops. A search of practice and local hospital dispensing data was carried out to assess how frequently monthly repeat prescriptions for timolol eyedrops were actually dispensed over a 12 month period. This allowed a total volume to be calculated for each patient. Results. Twenty-four per cent of patients admitted to omitting eyedrops either occasionally or frequently. Fifty-one per cent were found to have had insufficient drops dispensed to comply with treatment as prescribed. In non-compliant patients the mean period without drops was 85 days of the year, with a maximum of 165 days. Conclusion. Compliance with treatment is poor and patients underestimate their level of defaulting when questioned.
Keywords: timolol; adult; aged; article; comprehension; family history; female; general practitioner; geriatric patient; glaucoma; human; major clinical study; male; patient compliance; questionnaire; topical drug administration

The effect of deep posterior subtenon injection of corticosteroids on intraocular pressure - Mueller, A.J.; Jian, G.; Banker, A.S.; Rahhal, F.M.; Capparelli, E.; Freeman, W.R. (American Journal of Ophthalmology, 1998)
PURPOSE: To investigate the effect of posterior subtenon injections of corticosteroids on intraocular pressure in a variety of ocular diseases. METHODS: We retrospectively analyzed 202 consecutive posterior subtenon corticosteroid injections (148 of methylprednisolone acetate, 80 mg, and 54 of triamcinolone acetonide, 40 mg) in 63 eyes of 55 patients (26 male, 29 female; mean age ± SD, 60.17 ± 26.55 years). All patients had received topical or systemic corticosteroids before the injection, and no rise in intraocular pressure had been noted. Preinjection and postinjection intraocular pressure measurements were compared by two-tailed paired t test. Statistical analysis was performed separately by patient (first injection of first injected eye), by eye (first injection of each eye), and by all injections. To detect increase in intraocular pressure during follow-up, statistical analysis was performed separately 14 to 90 days, 91 to 150 days, and 151 to 270 days after injection. RESULTS: No statistically significant difference was found between preinjection and postinjection intraocular pressure measurements. A power calculation in the most stringent subanalysis (by patient) proved that there is only a 3.87% chance to statistically miss a clinically significant rise in intraocular pressure from 15 to 21 mm Hg. CONCLUSIONS: Posterior subtenon injection of corticosteroids does not cause an increase in intraocular pressure. All patients in our study had been treated previously with topical or systemic corticosteroids and did not react with an excessive increase in intraocular pressure. This safety of repository corticosteroids may therefore not apply to patients whose status in responding to corticosteroids is not known.
Keywords: corticosteroid; methylprednisolone; triamcinolone acetonide; adult; article; controlled study; dose response; female; follow up; glaucoma; human; injection site; intraocular drug administration; intraocular pressure abnormality; iridocyclitis; major clinical study; male; patient compliance; priority journal; retrospective study; statistical analysis; topical drug administration

Costs of glaucoma medications - Fiscella, R.G. (American Journal of Health-System Pharmacy, 1998)
Keywords: adrenergic receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin; article; cost benefit analysis; cost control; cost of illness; drug cost; drug marketing; glaucoma; health care cost; intraocular hypertension; patient compliance; priority journal

Geriatric low vision referrals by ophthalmologists in a Senior Health Center - Pankow, L.; Luchins, D. (Journal of Visual Impairment and Blindness, 1998)
A review of the records of 307 ophthalmology patients at a senior health center found that of the 47 patients who were deemed appropriate for referral to the low vision clinic, only 13 were actually referred. This finding indicates that ophthalmologists, as well as other physicians, were underutilizing the low vision services that are available to their patients at the center. This article describes the study and discusses the criteria to consider in referring geriatric patients for visual rehabilitation services.
Keywords: aged; clinical article; female; geriatric patient; glaucoma; health care utilization; health center; human; male; optic nerve atrophy; patient referral; macular degeneration; review; visual impairment

Maximal medical therapy for glaucoma - Zimmerman, T.J.; Fechtner, R.D. (Archives of Ophthalmology, 1997)
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin derivative; editorial; glaucoma; human; intraocular pressure; patient compliance; priority journal; treatment planning

Ocular tension and pupil diameter effects of timolol 0.50% and pilocarpine 2% or 4% in association - Taverniti, L.; Voccia, L.; Amoroso, L.; De Stefano, C.; Virno, M. (Acta Ophthalmologica Scandinavica, Supplement, 1997)
Keywords: antiglaucoma agent; beta adrenergic receptor blocking agent; pilocarpine; timolol; adult; aged; conference paper; female; headache; human; intraocular pressure; major clinical study; male; open angle glaucoma; patient compliance; priority journal; pupil; tonometry; topical drug administration; visual impairment

Eye care utilisation patterns in a rural county in Ireland: Implications for service delivery - Clendenin, C.; Coffey, M.; Marsh, M.; West, S. (British Journal of Ophthalmology, 1997)
Aims/background: This investigation determined eye care utilisation patterns in a rural county in Ireland. Population based estimates of visual impairment and glaucoma were available, so the two studies will optimise planning for eye care services for the county. Methods: Roscommon has a population of 55,000 served by one ophthalmologist and two optometrists. Data were collected on all outpatient visits for all providers for a 3 month period. Information was abstracted on demographics, presenting and final diagnoses. Expected number of visits for glaucoma were calculated using the population structure and rates of glaucoma, and assuming one visit per year per glaucoma patient. Results: 1398 patients had a total of 1442 visits in 3 months. A third of the visits were to optometrists, and all but 21 visits were for normal eye examinations or glasses. The majority of children aged less than 16 years, and people older than 60 years were seen by the ophthalmologist. Among children, 81% of all visits were to the ophthalmologist and 92% were classified as a normal examination. Only an estimated 188 visits per year for glaucoma were observed, compared with 1100 expected. Conclusion: In this rural county, many of the visits to the ophthalmologist were for normal eye examination, particularly among children. Screening algorithms which would free the ophthalmologist to see more complicated problems could be considered. There is an underutilisation of services by glaucoma patients. Reasons for this are described.
Keywords: adolescent; adult; aged; algorithm; article; child; demography; female; glaucoma; health care planning; health care utilization; human; information processing; Ireland; major clinical study; male; ophthalmology; optometry; priority journal; rural population; screening; spectacles; visual impairment

Patient compliance: The doctor's duty - Boeyink, S.J. (Clinical Eye and Vision Care, 1997)
Compliance with glaucoma treatment and treatment plans have been difficult to obtain since the initiation of the medical management of glaucoma. There have been many definitions of noncompliance put forth and multiple reasons for this noncompliance isolated. If doctors hope to improve compliance in their patients, they must take a more active role in educating their patients and modifying treatment plans to inspire greater compliance.
Keywords: dipivefrine; pilocarpine; timolol; eye disease; glaucoma; human; medical decision making; patient compliance; patient education; short survey; treatment planning

An unusual side effect of dorzolamide [1] - Zambarakji, H.J.; Spencer, A.F.; Vernon, S.A. (Eye, 1997)
Keywords: epinephrine; betaxolol; dipivefrine; dorzolamide; pilocarpine; timolol; adult; case report; conjunctivitis; drug formulation; drug granule; eye irritation; human; intraocular foreign body; intraocular pressure; letter; male; open angle glaucoma; patient compliance; topical drug administration; visual impairment; trusopt

Racial variations in treatment for glaucoma and cataract among Medicare recipients - Wang, F.; Javitt, J.C.; Tielsch, J.M. (Ophthalmic Epidemiology, 1997)
Purpose: To identify the location of barriers to treatment for glaucoma and cataract among African-American Medicare beneficiaries. Methods: We examined the receipt of eye care in general and care for glaucoma and cataract in particular among black and white Medicare beneficiaries using 1991 Medicare physician claims data. Racial differences in treatment for glaucoma and cataract were examined both for the Medicare population as a whole and for identified eye care users. The results were compared to the expected value of black-white difference based on population prevalence data for each specific condition. Results: Thirty percent of black beneficiaries and 45% of white Medicare beneficiaries used eye care services in 1991. After adjusting for the expected difference in prevalence, black beneficiaries were half as likely to be surgically treated for glaucoma compared to white beneficiaries, and 80% as likely for cataract. When the analysis was restricted to those using eye care services, blacks continued to have lower than expected rates of treatment for glaucoma (observed RR = 3.2, 95% confidence interval = 3.1-3.4 vs an expected RR of 4.3, 95% confidence interval = 3.5-5.4), but a higher rate of treatment for cataract (RR = 1.2, 95% confidence interval = 1.2-1.3). Among those with physician diagnosed glaucoma and cataract, blacks were more likely to undergo surgical treatment for these conditions than whites (RR = 1.5 for glaucoma, 95% confidence interval = 1.4-1.5; RR = 1.2 for cataract, 95% confidence interval = 1.2-1.3). Medicare population as a whole and for identified eye care users. The results were compared to the expected value of black-white difference based on population prevalence data for each specific condition. Conclusion: Barriers to treatment for glaucoma and cataract among black Medicare beneficiaries involve primarily limitations in access to the eye care system. The undertreatment for glaucoma among black beneficiaries was reduced, but not eliminated, after removing the effect of unequal access to the eye care system.
Keywords: aged; article; cataract; Caucasian; female; glaucoma; health care access; human; male; medicare; Black person; priority journal; race difference; statistical analysis

Extended wear in perspective - Brennan, N.A.; Chantal Coles, M.-L. (Optometry and Vision Science, 1997)
Background. Convenience and safety are major motivating factors in the choice of a mode of correction for refractive errors. Extended wear of contact lenses is associated with greater convenience than daily wear, but questions remain concerning the safety and risks associated with this modality. This paper investigates the hurdles that have rendered extended wear an unfavorable option thus far and seeks to identify strategies to overcome these obstacles. Method. We review the history of extended contact lens wear, focusing on soft extended wear for cosmetic use. Results of incidence and relative risk studies for the major complications are scrutinized. The factors that are associated with increased risk together with mechanisms which have been proposed on based on scientific research are analyzed to derive strategies for preventing adverse reactions in extended wear. Result. Infectious keratitis associated with extended wear of contact lenses has been identified by the community as a major issue, although the degree of concern may be disproportionate. Current perceptions of the relative risk of extended wear versus daily wear in the context of the risk for nonwearers may be misplaced, and the role of eye closure versus consistency and duration of wear remains open to debate. In the minds of practitioners and patients, other adverse reactions may be of greater significance in rejecting extended wear. Nonetheless, the potential extent of injury from infection demands attention. Studies collectively attest that corneal hypoxia during extended wear is a potential causative mechanism in infectious keratitis, suggesting that the provision of higher oxygen levels to the cornea will reduce morbidity rates from this unwanted complication. However, the issues of stagnation of the post-lens tear film during eye closure, mechanical properties of the lens, and lens movement remain unresolved and may prove to be contributing factors to adverse responses. Conclusions. Attention to oxygen permeability and mechanical properties of soft contact lenses should solve the remaining problems with extended wear. Materials currently under development promise to meet at least some of the desired properties and may lead to the long-awaited advent of safe extended wear.
Keywords: poly(methyl methacrylate); silastic; aphakia; contact lens; cornea; cornea ulcer; disposable equipment; extended wear contact lens; gas permeability; human; hydrogel; hygiene; hypoxia; keratitis; morbidity; oxygen transport; papillary conjunctivitis; patient compliance; priority journal; refraction error; review; risk benefit analysis; risk factor; smoking; tear film

Latanoprost: A new approach to the treatment of glaucoma - Khouri, A.S.; Fechtner, R.D.; Zimmerman, T.J.; Willman, M.R. (Today's Therapeutic Trends, 1997)
The therapeutic objective in treating glaucoma is achieving a reduction in intraocular pressure (IOP), the primary modifiable risk factor for this condition. Although prostaglandins have been shown to be effective in lowering IOP, frequent side effects have previously limited their utility. Latanoprost (Xalatan(TM)), a new topical prostaglandin F2α derivative with a significantly improved side-effect profile, reduces IOP through a unique mechanism of action. While other therapies inhibit production of aqueous humor or increase trabecular outflow, this agent appears to increase aqueous outflow by augmenting the natural uveoscleral outflow facility from the eye. Administered once a day, latanoprost is as effective in reducing IOP as therapy with timolol maleate twice daily while potentially improving patient compliance, a major concern in glaucoma treatment.
Keywords: latanoprost; pilocarpine; timolol maleate; drug efficacy; glaucoma; human; patient compliance; review; xalatan

Gel-like formulation in eye drops for glaucoma therapy - Olto, S. (Deutsche Apotheker Zeitung, 1997)
Keywords: antiglaucoma agent; timolol maleate; eye drops; timolol; unclassified drug; clinical trial; drug formulation; gel; glaucoma; human; intraocular drug administration; note; patient compliance; dispatim

Cardiovascular effects of topical carteolol hydrochloride and timolol maleate in patients with ocular hypertension and primary open-angle glaucoma - Netland, P.A.; Weiss, H.S.; Stewart, W.C.; Cohen, J.S.; Nussbaum, L.L.; Abrams, D.; Schwartz, G.; Hughes, P.; Adelson, A.; Brink, M.; Myers, M.; Bahr, R.; et al. (American Journal of Ophthalmology, 1997)
PURPOSE: To compare the effects of topical timolol maleate 0.5% and carteolol hydrochloride 1% on pulse rate and blood pressure. METHODS: In a randomized, double-masked, parallel-design, multicenter clinical trial, we compared the effects of timolol and carteolol on pulse rate and blood pressure measured by 24-hour ambulatory blood pressure monitoring in 169 adult patients with either ocular hypertension or primary open-angle glaucoma. RESULTS: From noon to 8 PM, baseline mean pulse rate of 82 to 83 beats per minute (bpm) had decreased by 4 to 6 bpm in both groups after 4 weeks of therapy with timolol or carteolol. From midnight to 4 AM, the pulse rate in the carteolol group was significantly above baseline (P = .005), while the timolol group was significantly below baseline (P < .001). Four times as many patients became bradycardic (heart rate, <60 bpm) on timolol (18.4%) as did patients on carteolol (4.5%) from midnight to 4 AM. More than twice as many patients exhibited a resolution of their bradycardia with carteolol (46.7%) as did patients treated with timolol (18.2%) from midnight to 4 AM. Overall cardiovascular adverse effects were reported significantly more frequently in the timolol than the carteolol group (P = .002).CONCLUSIONS: Timolol causes significantly lower mean heart rate during the nighttime and more nocturnal bradycardia than carteolol does in patients with ocular hypertension and primary open-angle glaucoma. These differences may be because of the intrinsic sympathomimetic activity of carteolol.
Keywords: carteolol; timolol maleate; adult; aged; ambulatory monitoring; article; beta adrenergic receptor blocking; blood pressure regulation; bradycardia; cardiovascular response; clinical trial; controlled clinical trial; controlled study; double blind procedure; female; heart rate; human; human cell; human tissue; intraocular hypertension; major clinical study; male; multicenter study; open angle glaucoma; priority journal; randomized controlled trial; topical drug administration

Contact lens-related microbial keratitis: Part II: Pathophysiology - Liesegang, T.J. (Cornea, 1997)
The literature is reviewed concerning the pathophysiologic effects of contact-lens wear, the microbiology of contact lens wear, the change in microflora with contact-lens wear. The contamination of contact lenses and contact-lens products, patient compliance, and corneal interaction with the contact lens. Hypoxia and hypercapnia are the most significant changes in the cornea as a result of contact-lens wear. Changes take place in the conjunctival flora in patients with contact lenses. Compliance of patients and contamination of contact lenses and contact-lens products are significant risk factors. The corneal interaction with the contact lens can overwhelm the protective mechanisms of the cornea, increasing the ability of microbes to adhere to the cornea and progress to microbial keratitis. Some of the factors associated with microbial keratitis are modifiable and should stimulate the contact-lens industry to develop better contact lenses and contact lens products and also permit ophthalmologists to obtain better informed consent from their patients.
Keywords: contact lens solution; bacterium contamination; conjunctiva; contact lens; cornea; human; keratitis; microbiology; microflora; patient compliance; priority journal; review; risk factor

Improvement of compliance and eyedrop administration in glaucoma patients with combined therapy - Busche, S.; Gramer, E. (Klinische Monatsblatter fur Augenheilkunde, 1997)
Background. Poor compliance can be dangerous to successful medical treatment of glaucoma. Among other things one reason for non-compliance represents the inability of the patients to place drops in the eye appropriately. Therefore information regarding the patients ability to administer an eyedrop safely are a prerequisite to determining a therapy scheme which ensures the compliance of glaucoma patients. Patients and methods. 100 glaucoma patients on medical therapy who first presented in the outpatient glaucoma clinic of the University Eye Hospital of Wurzburg were examined by standardised questionnaire and ability tests. We evaluated: 1. Can the eyedrop administration of glaucoma patients be improved by a standardised instruction? 2. Can the eyedrop administration be improved by the use of a drop aid (Autodrop®)? 3. Can the accuracy of aiming and the manual ability be evaluated with a target-test on a sheet of paper with a series of concentric circles? 4. How do patients on combined therapy distinguish between their different bottles and where is the dosage regimen noted? 5. What kind of distinguishing marks of eyedrop-bottles do the patients prefer? Results. 1. Before verbal instruction 76% of the patients applied the eyedrops appropriately, after instruction 94% (p < 0.001) were capable. Touching the eye with the tip of the dropper was reduced significantly. Touching the eye before instruction was found in 63% of the patients, after instruction it was found in 41% (p < 0.001). 2. When patients used the drop aid 81% were able to place a drop in the eye appropriately. Only by 46% of the patients the Autodrop® was welcomed. 3. 16% of the patients were not able to place a drop within 1.5 cm of the center of the target (according to the size of an eye). 4. 47% of the patients who use more than one eyedrop bottle admitted problems in distinguishing the bottles, only 38% of the patients read the labels. 5. 76% of the patients would prefer markable stickers of different colours for the bottom of the bottles to improve distinguishing the bottles in combined therapy. Conclusion. Instruction improves eyedrop administration in 18% of our patients. In combined therapy with several drugs new distinguishing marks are requested by the patients. To improve compliance combination preparations should be administered if available.
Keywords: beta adrenergic receptor blocking agent; carbachol; dipivefrine; eye drops; adult; aged; article; drug formulation; female; glaucoma; human; major clinical study; male; patient compliance

Packaging of ophthalmic solutions - Influence on stability, sterility, eye drop instillation and patient compliance - Van Santvliet, L.; Sam, T.; Ludwig, A. (European Journal of Pharmaceutics and Biopharmaceutics, 1996)
The properties and pharmacopoeial requirements of multidose and single-dose packaging used to deliver eye drops are discussed. Further, the biopharmaceutical importance of the drop volume instilled and the possibilities of drop size reduction are emphasized. Finally the problems of patient compliance and the development of compliance aids are described.
Keywords: cholinesterase inhibitor; clonidine; eye drops; glass; phenylephrine; pilocarpine; plastic; preservative; rubber; timolol; container; contamination; drug packaging; drug stability; drug sterility; drug tolerability; drug use; eye disease; glaucoma; patient compliance; review

The effect of a medication alarm device on patient compliance with topical pilocarpine. - Laster, S.F.; Martin, J.L.; Fleming, J.B. (Journal of the American Optometric Association, 1996)
BACKGROUND: This study was performed to investigate the use of an electronic medication alarm device (Prescript TimeCap) to enhance compliance in glaucoma patients taking pilocarpine. METHODS: Thirteen subjects were selected who had been diagnosed with open-angle glaucoma and were receiving 1 drop of pilocarpine solution 4 times a day in both eyes. For each subject, the study was divided into 2 30-day phases, one with the medication alarm device and the other without. Thus, each subject served as his or her own control. Compliance was measured based on the amount of pilocarpine used and by patient questionnaire. In addition, the subjects completed a post-study questionnaire regarding the ease of use of the TimeCap and whether it helped them remember to take their medication. RESULTS: When subjects used the TimeCap, they administered an average of 2.867 g (P < 0.0001) more pilocarpine over the 30 days than during the period without it. Subjects also estimated a significant difference in compliance level, 95.8 percent with the alarm device versus 83.1 percent without it (p < 0.01). All subjects reported no difficulty using the TimeCap, and all reported that it helped them remember to take their medication. CONCLUSIONS: These results are highly suggestive that the TimeCap is an effective compliance aid for glaucoma patients on pilocarpine.
Keywords: eye drops; muscarinic agent; pilocarpine; devices; article; clinical trial; controlled clinical trial; controlled study; drug administration; drug packaging; female; human; male; open angle glaucoma; patient compliance; phase 1 clinical trial; phase 2 clinical trial; questionnaire; randomized controlled trial; topical drug administration

Silent myocardial ischemia in glaucoma and cataract patients - Waldmann, E.; Gasser, P.; Dubler, B.; Huber, C.; Flammer, J. (Graefe's Archive for Clinical and Experimental Ophthalmology, 1996)
Background: Glaucoma and cataract are multifactorial diseases. They have been described to be associated with cardiovascular risk factors. Methods: Twenty-four-hour ECG monitoring was done in 22 normal-tension glaucoma patients, 27 open-angle glaucoma patients, 25 cataract patients, and 20 normal controls. The frequency of silent myocardial ischemia (SMI) as well as that of ventricular extrasystoles (VES) was evaluated. Results: At least one episode of significant asymptomatic ST-T segment depression occurred in 45% of the normal-tension glaucomas, in 25.9% of open-angle glaucomas, in 12% of cataract patients, and in 5% of normal controls. The frequency of VES was not significantly different among the groups. Conclusions: Glaucoma, especially normal-tension glaucoma, is significantly associated with the occurrence of episodic asymptomatic myocardial ischemias. Cataract patients, however, had only a slightly, statistically not significantly increased frequency of both SMI and VES compared with normals.
Keywords: adult; aged; ambulatory monitoring; article; cataract; controlled study; electrocardiography monitoring; female; glaucoma; heart muscle ischemia; heart ventricle extrasystole; human; major clinical study; male; priority journal; risk factor; ST segment depression

Will latanoprost be the 'wonder' drug of the '90s for the treatment of glaucoma? - Higginbotham, E.J. (Archives of Ophthalmology, 1996)
Keywords: epinephrine; antiglaucoma agent; carbonate dehydratase inhibitor; dorzolamide; latanoprost; pilocarpine; timolol maleate; clinical trial; drug efficacy; drug safety; editorial; eye color; glaucoma; human; hyperemia; intraocular hypertension; intraocular pressure; patient compliance; pigment disorder; priority journal; quality of life; trabeculoplasty; phxa41

Effect of topical anti-inflammatory treatment on the outcome of laser trabeculoplasty - Shin, D.H.; Frenkel, R.E.P.; David, R.; Cheetham, J.K.; Ahn, B.H.; Chan, R.Y.; Chen, K.; Hong, Y.J.; Lamping, K.A.; Latina, M.A.; Macy, J.; Rakofsky, S.; et al. (American Journal of Ophthalmology, 1996)
PURPOSE: We investigated the effect of antiinflammatory treatment on the outcome of argon laser trabeculoplasty. METHODS: In this multicenter, double- masked, randomized, placebo-controlled, parallel comparison study, 140 chronic open-angle glaucoma patients received either 0.25% fluorometholone or vehicle four times a day unilaterally, beginning 24 hours before and continuing one week after argon laser trabeculoplasty. The laser surgeon placed 50 to 60 burns over the inferior 180 degrees of the trabecular meshwork. The patients were followed up frequently for five weeks after the procedure. RESULTS: Following argon laser trabeculoplasty, signs of anterior chamber inflammation were significantly lower in the fluorometholone group. However, there was no significant difference between the fluorometholone and the vehicle groups in the incidence of increased intraocular pressure in the immediate post-argon laser trabeculoplasty period. Intraocular pressure decreased significantly in both groups from day 1 throughout the follow-up period. A significant between-group difference in intraocular pressure decrease was found only at week 5 (7.83 ± 6.27 [S.D.] mm Hg for the fluorometholone group vs 6.63 ± 5.79 mm Hg for the vehicle group, P = .046). No drug-related clinically significant adverse events were observed. CONCLUSIONS: Use of fluorometholone is effective in attenuating inflammation and has no clinically significant impact on the outcome of argon laser trabeculoplasty or on the incidence of intraocular pressure spikes during the immediate post-argon laser trabeculoplasty period.
Keywords: fluorometholone; adult; antiinflammatory activity; argon laser; article; clinical trial; controlled clinical trial; controlled study; double blind procedure; female; follow up; human; incidence; intraocular pressure; major clinical study; male; multicenter study; open angle glaucoma; patient compliance; patient monitoring; priority journal; randomized controlled trial; topical drug administration; trabeculoplasty; treatment planning

Twenty four hour blood pressure monitoring in normal tension glaucoma - Meyer, J.H.; Brandi-Dohrn, J.; Funk, J. (British Journal of Ophthalmology, 1996)
Background - The few investigations that used continuous 24 hour blood pressure monitoring to investigate whether blood pressure in patients with normal tension glaucoma is lower than in normal subjects yielded conflicting results. Therefore, a prospective controlled trial was carried out. Methods - Systemic blood pressure was recorded continuously over a 24 hour period in 20 patients with normal tension glaucoma (IOP ≤ 21 mm Hg). Eight of them showed a localised loss of the neuroretinal rim area and, in addition, optic disc haemorrhages-that is, focal ischaemic signs. Twenty healthy patients without glaucoma, who were hospitalised for cataract or retinal surgery, served as controls. Blood pressure was automatically measured every 20 minutes during the day and every 40 minutes at night. Results - Both groups showed a significant (physiological) blood pressure drop at night, which was significantly (p < 0.001, ANOVA) more pronounced in the group with normal tension glaucoma than in the control group. There was a weak trend towards lower blood pressure values in the normal tension glaucoma group. Minima, maxima, and mean values of the systolic, diastolic, and mean arterial pressures did not differ significantly between the group with normal tension glaucoma and the control group. The greatest differences occurred with nocturnal systolic and diurnal diastolic values. There were no significant differences between the subgroup with focal lesions and the other patients with normal tension glaucoma. Conclusions - Patients with normal tension glaucoma tend to have lower blood pressure values (p > 0.05, ANOVA) than normals; this difference is probably much smaller than formerly assumed. Patients with normal tension glaucoma, however, have significantly greater nocturnal blood pressure drops (p < 0.001, ANOVA) than normal controls. Nocturnal blood pressure drops (relative day-night differences) may play a more important role in the pathogenesis of normal tension glaucoma than the absolute height of the blood pressure.
Keywords: adult; aged; ambulatory monitoring; article; bleeding; blood pressure; blood pressure monitoring; circadian rhythm; clinical article; controlled study; diastolic blood pressure; female; glaucoma; human; male; mean arterial pressure; optic disk; pathogenesis; priority journal; systolic blood pressure

The efficient use of perimetry for neuro-ophthalmic diagnosis - Reitner, A.; Tittl, M.; Ergun, E.; Baradaran-Dilmaghani, R. (British Journal of Ophthalmology, 1996)
Aims/background - Automated perimetry is both one of the most important diagnostic procedures in ophthalmology and the most difficult for the patient who is required to comply with strict and tiring conditions. This paper examines the use of a moving fixation target and a strategy for full threshold determination only in those data points found to be abnormal. Methods - 142 eyes in 71 patients were subjected to two types of visual field tests: the Dicon TKS 4000 Autoperimeter program 5 and the Humphrey field analyser program 30/2. The first procedure was compared with a commonly used instrument and strategy that is usually employed for the management of glaucoma patients. Results - Such a strategy was used in patients presenting with neuro-ophthalmic problems taking an average testing time of 14.9 minutes. The alternative test described here took an average of 3.9 minutes, without loss of diagnostic value. Conclusion - The shorter testing time results in greater patient acceptance, fewer fatigue induced artefacts, and the possibility of completing a perimetry test with patients whose ability might seriously be challenged by a longer test. The reduced time required and the more natural condition of not having to fixate on an unmoving position were found not to reduce the diagnostic value of the data produced in patients presenting for various reasons at a neuro-ophthalmology clinic.
Keywords: adult; article; artifact; diagnostic procedure; diagnostic value; fatigue; female; glaucoma; human; major clinical study; male; neuroophthalmology; patient compliance; perimetry; priority journal; time; visual field

Causes of blindness in Irbid, Jordan - Al-Salem, M.; Arafat, A.F.; Ismail, L.; Jaradat, M. (Annals of Saudi Medicine, 1996)
To determine the most common causes of blindness and the age of onset of these conditions among Jordanians of Irbid, a study of all registered members in two societies for the care of the blind was carried out. Of all registered members, 185 individuals were blind according to the World Health Organization definition and satisfied our inclusion criteria. It was found that genetically determined causes made up 41% of the total causes. In 57% of the subjects, blindness occurred in the first two decades of life. The specific leading causes of blindness, in the order of their frequencies, were tapetoretinal degenerations as different variants of retinitis pigmentosa (17.6%), glaucomas (16%), diabetic retinopathy (13%), post-infection corneal scarring (11.5%), congenital cataract (8.8%) and uveitis (8%). The results reflect the satisfactory achievements in primary health care levels and the challenge to make specialized tertiary health care more accessible.
Keywords: adolescent; adult; aged; article; blindness; congenital cataract; diabetic retinopathy; female; genetic disorder; glaucoma; health care access; health care quality; human; Jordan; major clinical study; male; onset age; primary health care; priority journal; retinitis pigmentosa; scar formation; school child; retinitis pigmentosa; uveitis

To preserve or not to preserve, is that the question? - Wilson, L.A. (British Journal of Ophthalmology, 1996)
Keywords: eye drops; preservative; bacterium contamination; cornea ulcer; drug storage; editorial; intraocular foreign body; keratitis; occupational accident; patient compliance; priority journal; Pseudomonas aeruginosa; risk factor

Improving compliance with glaucoma eye-drop treatment. - Cooper, J. (Nursing times, 1996)
Many older patients attending ophthalmic out-patient clinics have been prescribed eye drops for long-term use to treat glaucoma but do not continue with their treatment. This review looks at chronic simple glaucoma, the problems of compliance with long-term medical treatment in older people and the current and future treatment of glaucoma. Recommendations are made on the nurses' role in supporting these patients.
Keywords: aged; human; nursing; open angle glaucoma; patient compliance; patient education; review

Current contact lens care systems: Proper use and problem prevention - Key, J.E.; Mobley, C.L. (Ophthalmology Clinics of North America, 1996)
As contact lenses have grown in popularity and complexity, so have the lens care systems for maintenance of a clean contact lens on a clean, wet eye. A great deal of care has gone into the development of solutions for removing deposits, conditioning the lenses before placing on the eye, and cushioning the lenses while on the eye. Effective and elaborate disinfection systems are readily available ranging from the simple concept of thermal disinfection to chemical preservatives to short-acting, one-step, chemically buffered hydrogen peroxide systems. The range in complexity of the lens care hygiene system has led to patient and practitioner confusion, resulting in misuse of products. At times, this misuse results only in ocular irritation or discolored or damaged lenses. More seriously, improper use of the disinfection systems or no use at all can lead to vision-threatening microbial keratitis. These problems can be prevented by proper patient usage of the available lens care systems and knowledgeable practitioner instructions as to which solutions are to be used and how they are to be used. Problems can be prevented if lens care hygiene is considered to be as important as the contact lens fit itself and if this importance is properly communicated to the patient.
Keywords: contact lens solution; hydrogen peroxide; article; contact lens; hygiene; patient compliance; priority journal

Asthma - Calverley, P.M.A. (Postgraduate Medical Journal, 1996)
Bronchial asthma is now recognised to be a major cause of morbidity and even mortality in people of all ages. Two important ideas have changed our approach to asthma management. The first is understanding that asthma is a chronic inflammatory disorder which needs regular treatment with anti-inflammatory drugs such as inhaled corticosteroids to prevent further attacks. The second development is the availability of prescribable peak flow meters, which allows both confident diagnosis and early prediction of relapse. Asthma management guidelines provide a logical treatment framework for most patients, but a few difficult cases still consume large amounts of medical time. The commonest problem is one of compliance with treatment which may respond to patient education, although this is not universally so. Other problems include misdiagnosis, acid reflux and, rarely, true corticosteroid-resistant asthma. Several potentially important new treatments have been developed. These include longer acting anticholinergic drugs, drugs with bronchodilator and some anti-inflammatory properties which antagonise or inhibit the production of leukotrienes, sub-types of phosphodiesterase inhibitor with anti-inflammatory properties and immunosuppressive drugs such as cyclosporin. Ultimately these new treatments must be rigorously tested and integrated into a care plan that remains centred on patient education.
Keywords: aminophylline; antiinflammatory agent; bronchodilating agent; cholinergic receptor blocking agent; corticosteroid; cyclosporine; immunosuppressive agent; leukotriene; phosphodiesterase inhibitor; theophylline; asthma; bone disease; convulsion; Cushing syndrome; diagnostic error; gastroesophageal reflux; glaucoma; headache; heart arrhythmia; hoarseness; human; hypokalemia; inhalational drug administration; intravenous drug administration; morbidity; mortality; nausea; oral drug administration; patient compliance; patient education; peak expiratory flow; practice guideline; relapse; review; skin disease; tachycardia; taste disorder; tremor; vomiting; xerostomia

Herpes zoster peripheral ulcerative keratitis in patients with the acquired immunodeficiency syndrome - Neves, R.A.; Rodriguez, A.; Power, W.J.; Muccioli, C.; Lane, L.; Belfort Jr., R.; Foster, C.S. (Cornea, 1996)
The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herpes varicella-zoster virus in patients with the acquired immunodeficiency syndrome (AIDS). Three AIDS patients with ocular herpes zoster infection (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral keratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy. Two of the patients responded well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis developed. The third patient had a recurrent episode of inflammation with PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella- zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct diagnosis and aggressive early long-term systemic antiviral treatment must be instituted to control inflammation, ulcer progression, and complications.
Keywords: aciclovir; acquired immune deficiency syndrome; adult; antiviral activity; article; case report; cornea neovascularization; cornea ulcer; diagnostic accuracy; disease association; dose response; early diagnosis; encephalitis; human; keratitis; Kirisawa uveitis; male; oral drug administration; patient compliance; priority journal; scar; topical drug administration; Varicella zoster virus; virus infection

Unoprostone (isopropyl unoprostone). A viewpoint by S. Naga Subramanian - Naga Subramanian, S. (Drugs and Aging, 1996)
Keywords: adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; latanoprost; pilocarpine; unoprostone isopropyl ester; aqueous humor outflow; epithelium; eye blood flow; glaucoma; human; hyperemia; intraocular hypertension; intraocular hypotension; intraocular pressure; Japan; long term care; nonhuman; note; patient compliance; permeability; pigment disorder; priority journal; quality of life; sclera; side effect; venous pressure; vision; uf 021

Large differences between prescribed and dispensed medicines could indicate undertreatment - Nilsson, J.L.G.; Johansson, H.; Wennberg, M. (Drug Information Journal, 1995)
The difference between prescribed and dispensed medicines in Sweden has been determined for the 20 most common diagnoses for all outpatients. For all diagnoses together, the value of dispensed medicines was 14% lower than for those prescribed. For some diagnoses a considerable number of the prescriptions never appeared at the pharmacies, for example, climactic symptoms-48%, allergic rhinitis-42%, glaucoma-41%, and diabetes-39%. If the doctors intended that the medicines prescribed should also be consumed by the patients in order to obtain appropriate treatment, these data indicate that considerable undertreatment occurs for patients with certain diagnoses.
Keywords: drug; allergic rhinitis; article; coma; diabetes mellitus; human; patient compliance; prescription; priority journal; statistical analysis; Sweden

Short-term efficacy of apraclonidine hydrochloride added to maximum- tolerated medical therapy for glaucoma - Robin, A.L.; Ritch, R.; Shin, D.H.; Smythe, B.; Mundorf, T.; Lehmann, R.P.; Brotherman, D.; Camras, C.; Derick, R.; Garrett, D.T.; Gross, R.; Kapetansky, F.; et al. (American Journal of Ophthalmology, 1995)
PURPOSE: We determined whether the addition of topical apraclonidine hydrochloride to eyes that are receiving maximal medical therapy but still have inadequate intraocular pressure control and that are scheduled to undergo surgery could adequately decrease intraocular pressure, postponing the need for further intervention. METHODS: We performed a prospective, 90- day, multicentered, placebo-controlled, double-masked parallel study. We enrolled one eye each of 174 glaucoma patients with inadequate intraocular pressure control who were on maximally tolerated medical therapy. We continued to administer maximum medical therapy for glaucoma. Study medications were either apraclonidine hydrochloride 0.5% or placebo (apraclonidine's vehicle). Patients were instructed to take the study medication every eight hours. We measured intraocular pressure, change in intraocular pressure from baseline, and the number of eyes requiring surgery after the addition of study medication. RESULTS: Fifty-two (60%) of 86 patients treated with apraclonidine maintained adequate intraocular pressure control throughout the study and avoided surgery, compared with 28 (32%) of 88 patients treated with placebo (P < .001). Apraclonidine treatment resulted in significantly more patients attaining an additional 20% reduction or more in intraocular pressure from baseline and an intraocular pressure less than or equal to 20 mm Hg (P < .05). The most common ocular complication was conjunctival hyperemia (11 of 86 patients, 12.8%). The most frequent nonocular problem was dry mouth (four patients, 4.7%). CONCLUSION: Apraclonidine appeared to be safe in all eyes and efficacious in some eyes. It significantly lowered intraocular pressure when used in combination with maximally tolerated medical therapy, which delayed or prevented further glaucoma surgery for at least 90 days in 52 (60%) of 86 treated patients.
Keywords: apraclonidine; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; miotic agent; adult; aged; article; clinical protocol; clinical trial; conjunctiva disease; controlled clinical trial; controlled study; double blind procedure; drug efficacy; eye color; eyelid edema; female; human; hyperemia; intraocular pressure; major clinical study; male; multicenter study; open angle glaucoma; patient compliance; priority journal; pruritus; randomized controlled trial; taste disorder; topical drug administration; visual acuity; xerostomia

Clinicians and patients with hypertension: Unsettled issues about compliance - Rudd, P. (American Heart Journal, 1995)
Ambulatory treatment of hypertension depends largely on long-term oral medications to lower blood pressure and delay or prevent cardiovascular morbidity and mortality. Failure to achieve the therapeutic goal may reflect biologic, pharmacologic, or behavioral factors. Ignoring behavioral factors may result in unnecessary or even dangerous regimen escalation. More than half of patients with insufficient reductions in blood pressure display suboptimal medication compliance as assessed by pill count or bioassay. Once-daily dosing may be an important part of enhancing compliance, patient convenience, and regimen simplification; however, drug concentrations may be subtherapeutic when dosing delays or omissions occur. Electronic monitoring data in hypertension, glaucoma, seizure disorders, and other diseases indicate that 50% to 60% of patients adhere well to prescribed regimens, that 5% to 10% adhere poorly, and that the 30% to 45% adhere to an intermediate but markedly variable degree. A growing body of literature offers empirical support for focused and personalized interventions.
Keywords: antihypertensive agent; calcium antagonist; debrisoquine; nifedipine; human; hypertension; outpatient care; patient compliance; priority journal; review

Do glaucoma patients use eye drops correctly? - Hosoda, M.; Yamabayashi, S.; Furuta, M.; Tsukahara, S. (Journal of Glaucoma, 1995)
Purpose: To assess how glaucoma patients use their topical medications. Methods: 142 subjects were tested before an examiner as to how they used their eyedrops. Results: Fifty-six patients (39.4%) used one drop. The number of drops instilled increased with age. The tip of the bottle touched the ocular surface in 78 (54.9%). The proportion of patients whose bottle came into contact with the eye or periocular tissues increased with age. Only four patients (2.8%) closed the treated eye and compressed the medial angle after applying the medication, Conclusions: It is important that ophthalmologists instruct their patients on the correct manner of applying topical medication so that the patients can themselves administer the medicine precisely. Such instruction will improve the patients' compliance and quality of life during therapy for glaucoma.
Keywords: eye drops; adult; age; aged; article; controlled study; female; glaucoma; human; major clinical study; male; methodology; patient compliance; patient counseling; priority journal; quality of life; topical drug administration

Compliance in patients prescribed eyedrops for glaucoma - Patel, S.C.; Spaeth, G.L. (Ophthalmic Surgery, 1995)
We studied the rate of failure to use eyedrops as prescribed for glaucoma and some of the factors possibly associated with that noncompliance by interviewing 100 patients being followed in a setting emphasizing correct usage. Fifty-nine reported they had not used their eyedrops precisely as prescribed. Factors significantly influencing compliance included daily dose frequency, forgetfulness, inconvenience, and unaffordability. Gender and race were marginally significant factors, with men and blacks reporting somewhat higher rates of missed doses than women and white. Side effects and age were not significant causes of noncompliance.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; drug cost; female; glaucoma; human; major clinical study; male; patient compliance; priority journal; race difference; risk factor; side effect; topical drug administration; treatment failure

Long-term treatment with MK-507 0.5% ophthalmic solution in primary open- angle glaucoma and ocular hypertension - Kitazawa, Y.; Tsukahara, S.; Iwata, K.; Mizogami, K.; Mishima, H. (Folia Ophthalmologica Japonica, 1995)
The purpose of this study was to examine the long-term efficacy and safety of MK-507 (generic name: dorzolamide hydrochloride), a novel topical carbonic anhydrase inhibitor, in patients with primary open-angle glaucoma and ocular hypertension. MK-507 0.5% ophthalmic solution (o/s) was instilled 3 times daily for 48 weeks. The 54 patients enrolled in the study were measured as to intraocular pressure in both eyes before morning instillation (Trough IOP) and 2 hours after dosing (Peak IOP) at every 4 weeks. Thirty-eight patients completed the study with 0.5% o/s monotherapy; 13 patients were dosed up to 1% o/s and 3 required topical β-blocker additionally. MK-507 significantly reduced IOP throughout the 48-week trial without diminishing effectiveness. The mean reduction in Trough IOP over 48 weeks was 2.9±2.4 mmHg; that of Peak IOP was 3.8±2.3 mmHg. The effect of dose escalation from 0.5% o/s to 1% o/s was clearly observed. Ocular adverse effects were observed in 10 patients. The main symptom was a temporary smarting sensation. No systemic adverse effects were observed throughout the study. Based on these results, MK-507 is deemed to be effective and safe as an ocular hypotensive agent.
Keywords: carbonate dehydratase inhibitor; dorzolamide; article; clinical trial; controlled study; dose response; drug efficacy; drug safety; human; hypotension; intraocular hypertension; intraocular pressure abnormality; long term care; major clinical study; open angle glaucoma; patient compliance

Latanoprost - a promising new glaucoma drug - Nagasubramanian, S. (British Journal of Ophthalmology, 1995)
Keywords: antiglaucoma agent; latanoprost; prostaglandin; prostaglandin F2 alpha; timolol; aqueous humor outflow; conjunctiva disease; drug efficacy; editorial; glaucoma; human; hyperemia; intraocular pressure; patient compliance; priority journal; topical drug administration; phxa41

Office visits for glaucoma: United States, 1991-92. - Schappert, S.M. (Advance data, 1995)
Keywords: adult; African American; age; aged; ambulatory care; article; Caucasian; female; glaucoma; health service; health survey; human; information processing; male; middle aged; ophthalmology; statistics; United States; utilization review

Chlorhexidine or polyhexamethylene biguanide for acanthamoeba keratitis [21] - Seal, D.V.; Hay, J.; Kirkness, C.M. (Lancet, 1995)
Keywords: biguanide; chlorhexidine; dibrompropamidine; disinfectant agent; propamidine isethionate; Acanthamoeba; cornea disease; drug efficacy; drug legislation; drug resistance; human; keratitis; letter; minimum inhibitory concentration; patient compliance; priority journal; topical drug administration; brolene

Laser glaucoma treatment under development - Ferrari, C. (Journal of Clinical Laser Medicine and Surgery, 1995)
Keywords: cataract; follow up; glaucoma; human; neodymium laser; patient compliance; sclerotomy; short survey; surgical drainage

Correlates of variable patient compliance in drug trials: Relevance in the new health care environment - Urquhart, J. (Advances in Drug Research, 1995)
Keywords: anticoagulant agent; antiglaucoma agent; beta adrenergic receptor blocking agent; colestyramine; gemfibrozil; nifedipine; oral contraceptive agent; phenobarbital; clinical trial; decision making; disease severity; dose response; drug efficacy; drug exposure; drug information; drug labeling; drug mechanism; drug overdose; glaucoma; health care; health care management; heart disease; human; methodology; migraine; patient care; patient compliance; priority journal; prognosis; review; statistical analysis

Outpatient management of small traumatic hyphaemas. - Jackson, H.; Bentley, C.; Thompson, G. (Eye (London, England), 1994)
Keywords: adolescent; ambulatory care; case report; ethnology; eye injury; Ghana; human; hyphema; intraocular hypertension; male; note; sickle cell trait

Traditional eye medicines - Good or bad news? - Foster, A.; Johnson, G.G. (British Journal of Ophthalmology, 1994)
Keywords: Africa; blindness; chemical injury; cornea disease; cornea ulcer; drug therapy; editorial; eye disease; eye infection; eye injury; health care access; hemorrhagic conjunctivitis; herbal medicine; human; Malawi; patient satisfaction; priority journal; traditional medicine; Zimbabwe

Editorial - Gilmartin, B. (Ophthalmic and Physiological Optics, 1994)
Keywords: contact lens; diabetic neuropathy; editorial; glaucoma; human; insulin dependent diabetes mellitus; patient compliance; priority journal; spectacles; visual acuity; visual aid; visual disorder; visual field

Effect of resisting tonometry on intraocular pressure. - Frantz, K.A.; Peters, R.J.; Maino, D.M.; Gunderson, G.G. (Journal of the American Optometric Association, 1994)
BACKGROUND: Children and patients with developmental delay frequently resist the procedure of tonometry. Intraocular pressure (IOP) readings, if obtained under stressful circumstances, may have questionable reliability because IOP is influenced by numerous factors characteristic of the uncooperative patient. These factors include possible increases in arterial blood pressure, intraocular vascular engorgement, and pressure on the globe. A study of the effect upon IOP of these factors occurring simultaneously has not been reported previously. METHODS: We measured IOP using the Tono-Pen on 40 cooperative adults under normal conditions and again under conditions simulating the resistant patient. RESULTS: Paired t-test revealed a statistically significant difference between IOP readings under the two conditions (p < 0.001), with IOP under "resistant" conditions showing more variability and averaging 6mmHg higher than under normal conditions. CONCLUSIONS: We conclude that IOP readings in resistant patients should be viewed with caution. The possibility of obtaining false high readings in these patients could lead to unnecessary glaucoma evaluations if based only on elevated IOP readings.
Keywords: adult; article; female; human; intraocular pressure; male; oculoplethysmography; patient compliance; physiology; reproducibility; standard; Valsalva maneuver

The role of laser trabeculoplasty as primary therapy for open-angle glaucoma - Smith, S.D.; Netland, P.A. (International Ophthalmology Clinics, 1994)
Keywords: acetazolamide; epinephrine; antiglaucoma agent; beta adrenergic receptor blocking agent; betaxolol; calcium channel blocking agent; carbachol; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; demecarium; dipivefrine; ecothiopate iodide; levobunolol; metipranolol; pilocarpine; timolol; timolol maleate; uric acid; aplastic anemia; bronchospasm; cardiovascular disease; drug cost; gastrointestinal symptom; human; intraocular hypertension; iritis; lacrimal duct occlusion; laser; laser surgery; open angle glaucoma; patient compliance; priority journal; retina detachment; retina macula cystoid edema; review; trabeculoplasty; visual field defect; visual impairment

Early trabeculectomy in the management of primary open-angle glaucoma - McHam, M.L.; Migdal, C.S.; Netland, P.A. (International Ophthalmology Clinics, 1994)
Keywords: epinephrine; antiglaucoma agent; antimetabolite; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; fluorouracil; mitomycin; timolol; aqueous humor outflow; bradycardia; bronchospasm; cataract; choroid hemorrhage; clinical trial; conjunctiva disease; controlled clinical trial; controlled study; cost; endophthalmitis; eye toxicity; filtration; gastrointestinal symptom; human; intraocular pressure; laser surgery; multicenter study; open angle glaucoma; oral drug administration; patient compliance; priority journal; quality of life; randomized controlled trial; review; topical drug administration; trabecular meshwork; trabeculectomy; trabeculoplasty; visual disorder

The sight test fee: Effect on ophthalmology referrals and rate of glaucoma detection - Laidlaw, D.A.H.; Bloom, P.A.; Hughes, A.O.; Sparrow, J.M.; Marmion, V.J. (British Medical Journal, 1994)
Objective - To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989. Design - Review of referral records and clinical notes. Setting - Referrals to the Bristol Eye Hospital. Subjects - 51919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail. Main outcome measures - Numbers of referrals; rate of adult true positive glaucoma referrals. Results - Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion. Conclusions - The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.
Keywords: article; glaucoma; health care delivery; health care utilization; hospital utilization; human; major clinical study; medical fee; patient referral; priority journal; United Kingdom; vision test

Editorial - Gilmartin, B. (Ophthalmic and Physiological Optics, 1994)
Keywords: accommodation; color discrimination; computer model; editorial; glaucoma; human; intraocular pressure; patient compliance; priority journal; vision test; visual field

Eye disease among ambulatory Jewish senior citizens in California - Dougherty, P.J.; Engelhardt, R.F.; Lee, D.A. (Journal of Community Health, 1994)
Knowledge of the epidemiology of eye disease among the elderly becomes increasingly important as our population ages. Leading causes of blindness in the elderly include age-related macular degeneration, open-angle glaucoma and cataract. Few studies have examined the prevalence of these blinding eye diseases among senior citizens. A retrospective review of vision screening examinations from 429 patients seen at the UCLA Mobile Eye Clinic in visits to a Jewish senior citizens' center was performed to examine the distribution of best recorded visual acuity and prevalence of eye disease in a group of ambulatory Jewish senior citizens. Best recorded visual acuity was ≥20/40 in the better eye for 83.9% of the patients. The prevalence of age-related macular degeneration was 20.7%, and increased with increasing age (p<.00005). The prevalence of open-angle glaucoma was 6.3%. The prevalence of senile cataract was 59.0% and increased with increasing age (p<.00005). Despite the limitations imposed by a retrospective review of charts, our study provides an indication of the prevalence of blinding eye disease and distribution of visual acuity among ambulatory Jewish senior citizens in southern California. Except for the high prevalence of senile cataract, the prevalence data derived from this study are similar to other epidemiologic studies of eye disease in the elderly.
Keywords: aged; ambulatory care; article; blindness; cataract; disease predisposition; elderly care; female; human; Jew; major clinical study; male; open angle glaucoma; prevalence; macular degeneration; retrospective study; risk factor; senile cataract; United States; visual acuity

Cumulative incidence of patients with disc hemorrhages in glaucoma and the effect of therapy - Hendrickx, K.H.; Van den Enden, A.; Rasker, M.T.; Hoyng, P.F.J. (Ophthalmology, 1994)
Purpose: In this longitudinal study, the cumulative incidence of patients with glaucoma and disc hemorrhages was investigated. A possible effect of glaucoma therapy on the incidence rate of disc hemorrhages was evaluated. Methods: A group consisting of 68 patients with primary open-angle glaucoma (POAG), 34 with normal-pressure glaucoma, and 125 with suspected glaucoma (mean follow-up, 7.3 ± 2.5 years; range 3-13 years) was observed closely with quarterly examinations. Results: In normal-pressure glaucoma, the cumulative incidence of patients with disc hemorrhages was 35.3%, which was significantly higher than for those with POAG (10.3%; P < 0.01) and for those with suspected glaucoma (10.4%; P < 0.001). The mean follow-up period before a first disc hemorrhage was detected was 2.5 ± 2.8 years. In the bleeders, recurrent disc hemorrhages were observed in 67% of the patients with normal- pressure glaucoma, 29% of those with POAG, and 54% of glaucoma suspects. In normal-pressure glaucoma, therapy had no effect on the incidence rate of disc hemorrhages. In glaucoma suspects, a significant reduction of the incidence rate of disc hemorrhages per year (0.11 ± 0.04) was observed during episodes with therapy compared with episodes without (0.43 ± 0.15; P < 0.05). A concept of two populations (i.e., one with disc hemorrhages and the other never having them) seems to be valid for normal-pressure glaucoma, but not for POAG and suspected glaucoma. Conclusion: The cumulative incidence of initial disc hemorrhages increases with time in POAG and suspected glaucoma, but reaches a limit in normal-pressure glaucoma. Glaucoma therapy may reduce the incidence rate of all, initial and recurrent, disc hemorrhages in patients with high pressures, but not in patients with normal-pressure glaucoma.
Keywords: adult; aged; article; bleeding; female; follow up; human; intraocular hypertension; intraocular pressure; major clinical study; male; open angle glaucoma; optic disk anomaly; patient compliance; priority journal; treatment planning

Evaluation of the Humphrey FASTPAC threshold program in glaucoma - O'Brien, C.; Poinoosawmy, D.; Wu, J.; Hitchings, R. (British Journal of Ophthalmology, 1994)
The makers of the Humphrey perimeter have developed a rapid thresholding program, FASTPAC, to address the problems of fatigue and poor test performance associated with. prolonged perimetry. The performance of FASTPAC was compared with the standard threshold program of the Humphrey visual field analyser (program 24-2) in 44 glaucoma patients. FASTPAC reduced the mean test time by 35% (from 12.6 to 8.2 minutes), owing to a reduction in the number of stimulus presentations. FASTPAC underestimated the mean deviation (MD) (Wilcoxon, p=0.007) and corrected pattern standard deviation (CPSD) (Wilcoxon, p=0.005). The sum of the differences between FASTPAC and the standard program was -1.19 (SD 2.37) dB for MD and 0.97 (2.14) dB for CPSD. The measured difference between the two methods was independent of the value of either MD or CPSD, indicating that the measurement error was just as likely to occur with either early or advanced visual field loss. No difference was noted in short term fluctuation or in the reliability indices of test performance. These results indicate that FASTPAC, while considerably faster, is not as accurate as the standard threshold program at measuring retinal sensitivity in glaucoma. This inaccuracy may be offset in practical terms by greater patient acceptability and by increasing the number of patients capable of performing reliable threshold perimetry because of the reduction in duration of the FASTPAC program.
Keywords: adult; aged; article; clinical article; clinical trial; controlled clinical trial; controlled study; diagnostic accuracy; diagnostic error; diagnostic test; female; glaucoma; human; intermethod comparison; male; patient compliance; perimetry; priority journal

Management of iridocorneal endothelial syndrome - Ritch, R.; Wilson, M.R.; Samples, J. (Journal of Glaucoma, 1994)
Keywords: apraclonidine; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; dipivefrine; mitomycin; pilocarpine; timolol; adult; article; case report; iridocorneal endothelial syndrome; clinical examination; cornea disease; cornea endothelium; differential diagnosis; drug efficacy; eye disease; glaucoma; gonioscopy; headache; human; intraocular pressure; iridocorneal endothelial syndrome; iris disease; laser surgery; male; muscle spasm; patient compliance; priority journal; trabeculectomy; visual field; ocusert

Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma - Immonen, I.J.R.; Puska, P.; Raitta, C. (Ophthalmology, 1994)
Purpose: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation. Methods: Transscleral contact krypton laser cyclophotocoagulation was performed in 62 eyes of 57 patients with therapy- resistant glaucoma. A minimum follow-up for 6 months was obtained for 59 eyes. The krypton laser was delivered via a fiberoptic probe with compression of the sclera by the probe. The energy used was 4 to 5 J per application at the tip of the probe with an exposure time of 10 seconds. Results: The intraocular pressure (IOP) decreased from the baseline mean of 34.8 ± 11.0 mmHg to 20.4 ± 8.3 mmHg within 10 days, to 22.6 ± 12.5 mmHg at 1 month, to 21.3 ± 11.3 mmHg at 3 months, and to 20.9 ± 9.1 mmHg at 6 months postoperatively. Intraocular pressures of 8 to 24 mmHg were obtained in 62% of the eyes at 1 month, 60% at 3 months, and 73% at 6 months postoperatively with one or more cyclophotocoagulations but no other hypotensive procedures. The corresponding success rates after 6 months were 82% for eyes in which the procedure was performed to preserve vision and 50% for eyes in which the procedure was performed to relieve pain. No clinical signs of scleral injury or cyclodestruction-related loss of vision were detected. Conclusions: Krypton laser cyclophotocoagulation appears to be an effective and well- tolerated means of lowering IOP in therapy-resistant glaucoma. An advantage of the method is that standard retinal krypton photocoagulators can be used for the procedure.
Keywords: article; clinical article; fiberoscope; follow up; glaucoma; human; intraocular pressure abnormality; krypton laser; laser coagulation; patient compliance; postoperative period; priority journal; sclera buckling procedure; visual acuity

Combined timolol and pilocarpine vs pilocarpine alone and timolol alone in the treatment of glaucoma - Zadok, D.; Geyer, O.; Zadok, J.; Lazar, M.; Krakowski, D.; Nemet, P. (American Journal of Ophthalmology, 1994)
We compared the effects of pilocarpine 4% alone, timolol 0.5% alone, and a combination of timolol 0.5% and pilocarpine 4% in the treatment of glaucoma. We treated 43 patients with glaucoma using each drug and then with the combination of drugs for four weeks each. Only patients with a morning intraocular pressure of at least 24 mm Hg without treatment were included. The patients were examined, after one and four weeks of treatment with pilocarpine, timolol, or combined timolol 0.5% and pilocarpine 4%, before the morning dose and at two and five hours after it. At the end of the study, the mean reduction in intraocular pressure from baseline was 9.2 ± 5.1 mm Hg (28.5% ± 12.7%) with combined timolol 0.5% and pilocarpine 4%, 5.6 ± 3.6 mm Hg (17.6% ± 9.7%) with pilocarpine, and 7.5 ± 5.0 mm Hg (21.2% ± 12.6%) with timolol. Intraocular pressure was consistently lower with the combination treatment than with timolol or pilocarpine alone. We believe that this combined solution of timolol-pilocarpine is a valuable contribution to the treatment of open-angle glaucoma.
Keywords: pilocarpine; timolol; adult; article; clinical article; dose response; drug efficacy; drug mixture; drug potentiation; female; human; intraocular hypertension; intraocular pressure; intraocular pressure abnormality; male; open angle glaucoma; patient compliance; priority journal; statistical analysis; topical drug administration; visual acuity

Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders - Hayreh, S.S.; Zimmerman, M.B.; Podhajsky, P.; Alward, W.L.M. (American Journal of Ophthalmology, 1994)
We measured 24-hour ambulatory blood pressure monitoring and diurnal curve of the intraocular pressure in 166 white patients with anterior ischemic optic neuropathy, normal-tension glaucoma, primary open-angle glaucoma, and other optic nerve head disorders. Hourly average blood pressure data analyses showed a significant (P < .0001) decrease in mean systolic (26%) and diastolic (33%) blood pressure measurements at night. A significantly (P = .0028) lower nighttime mean diastolic blood pressure and a significantly (P = .0044) greater mean percentage decrease in diastolic blood pressure were noted in normal-tension glaucoma than in anterior ischemic optic neuropathy. Patients with arterial hypertension taking oral hypotensive therapy showed a significant association between progressive visual field deterioration and nocturnal hypotension, particularly in anterior ischemic optic neuropathy. Intraocular pressure showed no significant correlation with visual field deterioration in any of these conditions. Our findings suggest that nocturnal hypotension, in the presence of other vascular risk factors, may reduce the optic nerve head blood flow below a critical level, and thereby may play a role in the pathogenesis of anterior ischemic optic neuropathy and glaucomatous optic neuropathy; that is, nocturnal hypotension may be the final insult in a multifactorial situation. The same mechanisms may be true of a number of other ocular ischemic disorders. This finding opens a new dimension in the understanding and management of these visually disabling diseases.
Keywords: antihypertensive agent; beta adrenergic receptor blocking agent; betaxolol; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; dipivefrine; hydrochlorothiazide; timolol; adult; aged; ambulatory monitoring; article; circadian rhythm; diastolic blood pressure; female; human; hypertension; hypotension; intraocular hypertension; low tension glaucoma; major clinical study; male; open angle glaucoma; optic nerve disease; optic nerve lesion; oral drug administration; primary glaucoma; priority journal; systolic blood pressure; topical drug administration; visual field defect

Universal coverage and preventable blindness - Javitt, J.C. (Archives of Ophthalmology, 1994)
Keywords: blindness; Caucasian; glaucoma; health care access; human; Black person; note; patient care; priority journal

Practice patterns of the office-based ophthalmologist - Sastry, S.M.; Chiang, Y.-P.; Javitt, J.C. (Ophthalmic Surgery, 1994)
Practice patterns of office-based ophthalmologists were characterized using data collected from the National Ambulatory Medical Care Survey (NAMCS) of 1989, a national probability sample survey conducted by the National Center for Health Statistics. The sample includes office visits made between 1989 and 1990 to nonfederally-employed physicians primarily engaged in office-based practice. Over 38 million office-based patient visits documented in the NAMCS were analyzed. Fifty-two percent of patients (20.4 million) were over 65 years old; 90% (34.9 million) were white, with blacks and Asians accounting for 5% (1.9 million) and 3% (1.1 million) of visits, respectively. The leading primary diagnoses and professional activity associated with the visits were cataract/cataract surgery 23% (8.9 million), disorders of refraction 19.5% (7.5 million), and glaucoma 13% (4.9 million). Over 40% (16.1 million) of visits were for visual dysfunction, abnormal appearance, or abnormal sensation. Nearly 33% (12.5 million) were related to either a diagnostic/screening session or some form of treatment. The duration of visits ranged from 6 to 10 minutes (22.9%), 11 to 15 minutes (29.8%), and 31 minutes or longer (6.7%); 74% (28.1 million) of the patients were asked to return for a follow-up visit at a specified time, and 13% to return if needed. The major sources of reimbursement for office visits were Medicare (41%, 15.6 million); Blue Cross/Blue Shield (13%, 5 million); and other commercial insurance (15.5%, 5.8 million).
Keywords: adolescent; adult; aged; ambulatory care; article; cataract extraction; child; diagnostic procedure; female; follow up; glaucoma; health insurance; health statistics; human; information processing; major clinical study; male; medical practice; medicare; national health insurance; priority journal; race difference; refraction error; reimbursement; surgical technique

New medications for the schizophrenias - Keks, N.A.; Burrows, G.D. (Medical Journal of Australia, 1994)
Keywords: carbamazepine; chlorpromazine; clozapine; dopamine 2 receptor; dopamine receptor blocking agent; fluphenazine; haloperidol; neuroleptic agent; pimozide; remoxipride; risperidone; thioridazine; trifluoperazine; valproic acid; agranulocytosis; akathisia; closed angle glaucoma; constipation; drug contraindication; drug efficacy; drug potency; editorial; extrapyramidal symptom; human; myoclonus epilepsy; orthostatic hypotension; parkinsonism; patient compliance; schizophrenia; sedation; tachycardia; tardive dyskinesia; urine retention; visual impairment; xerostomia; dopamine receptor antagonist

Herbis et orbis: The dangers of traditional eye medicines - Harries, A.D.; Cullinan, T. (Lancet, 1994)
Keywords: adverse drug reaction; blindness; cornea ulcer; drug therapy; eye disease; health care utilization; herbal medicine; human; note; priority journal; Tanzania; traditional medicine

Clinical pearls in optometric management of the geriatric patient. - Selvin, G.J.; Townsend, J.C. (Journal of the American Optometric Association, 1994)
BACKGROUND: Painstaking attention to detail is absolutely necessary for optometrists to provide the appropriate clinical management of the geriatric patient. METHODS: Clinical management techniques (pearls) are discussed which aid in the diagnosis and treatment of problems specific to geriatric patients. Factors noted in patient presentation are stressed and include physical appearance, ability to move about, and use of other senses. The most commonly occurring eye anomalies occurring in the geriatric population are discussed including iatrogenic drug side effects, pupillary anomalies, extraocular palsies, dry eye, corneal degenerations, refractive error changes, lenticular changes, glaucoma, age-related maculopathy, vitreoretinal disease, and ocular manifestations of systemic disease (vascular occlusive disease, diabetes, ischemic optic neuropathy, other neuro-ophthalmic disease). RESULTS: Conditions relatively rare in the young population occur with regularity in the elderly population and often must be assumed to be present in concert with some typical patient presentations in the geriatric population. CONCLUSIONS: Optometrists as primary health care providers often provide the only avenue individuals with blinding and sometimes life threatening conditions have in managing these conditions. Optometrists managing geriatric patients are required to know what happens to this population from an ocular disease as well as other function and dysfunction standpoint.
Keywords: aged; ambulatory care; elderly care; eye disease; eye fundus; human; optometry; primary health care; review

Special problems of people with diabetes and visual impairment - Rosenthal, J.L. (Journal of Visual Impairment and Blindness, 1993)
The treatment of diabetes mellitus is extending the life expectancy and improving the lives of people with this condition. However, since complications are more common as the duration of diabetes increases, more people are experiencing severe complications of diabetes, including visual impairment. This article discusses the type of visual impairment caused by diabetes and the unique problems that people with diabetes and visual impairment face.
Keywords: cataract; diabetes mellitus; diabetic neuropathy; diabetic retinopathy; diet restriction; glaucoma; human; life expectancy; patient compliance; patient monitoring; review; treatment planning; visual impairment

Systemic blood pressure in glaucoma patients - Kaiser, H.J.; Flammer, J.; Graf, T.; Stumpfig, D. (Graefe's Archive for Clinical and Experimental Ophthalmology, 1993)
Blood pressure was monitored for 24 h in 32 control patients, 38 open-angle glaucoma patients referred because of decompensated IOP despite maximum treatment, 40 patients with open-angle glaucoma referred because of progressive damage despite controlled IOP, and 39 normal-tension glaucoma patients. In the control group a physiological drop in blood pressure during the night was observed. The patients referred with uncontrolled IOP had blood pressure very similar to that of the control group during both day and night. However, the open-angle glaucoma patients with progression despite well-controlled IOP and also the patients with normal-tension glaucoma had markedly, and statistically significantly, lower systolic blood pressure during both day and night. The difference in diastolic blood pressure was smaller. Thus, blood pressure should be considered in diagnosis.
Keywords: antihypertensive agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; adult; aged; ambulatory monitoring; antihypertensive therapy; article; blood pressure; blood pressure monitoring; circadian rhythm; controlled study; diastolic blood pressure; female; glaucoma; human; hypertension; intraocular pressure; major clinical study; male; open angle glaucoma; priority journal; prognosis; systolic blood pressure

Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level - Freedman, S.F.; Freedman, N.J.; Shields, M.B.; Lobaugh, B.; Samsa, G.P.; Keates, E.U.; Ollie, A. (American Journal of Ophthalmology, 1993)
Fifty-eight healthy, normolipidemic adult men participated in a prospective, masked, randomized crossover study designed to compare the effects of two topical nonselective β-adrenergic antagonists, carteolol and timolol, on plasma high-density lipoprotein cholesterol levels. Two eight- week treatment periods were separated by an eight-week drug-free period. Carteolol 1.0% or timolol 0.5% was used, one drop twice daily, in both eyes without nasolacrimal occlusion. Fresh plasma was assayed for levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoproteins A-I and B-100. With indistinguishable effects on intraocular pressure, carteolol and timolol induced different (P = .013) decrements in high-density lipoprotein cholesterol levels. Carteolol treatment decreased high-density lipoprotein cholesterol levels by 3.3% (-0.04 mmol/l) and raised the ratio of total to high-density lipoprotein cholesterol levels by 4.0% (0.15 unit); timolol treatment decreased high-density lipoprotein cholesterol levels by 8.0% (- 0.10 mmol/l) and raised the ratio of total to high-density lipoprotein cholesterol levels by 10.0% (0.37 unit). There was no differential drug effect on the other lipid variables measured. Ocular nonselective β- adrenergic antagonist therapy can produce clinically relevant decrements in high-density lipoprotein cholesterol levels in healthy men.
Keywords: apolipoprotein A1; apolipoprotein B100; carteolol; cholesterol; high density lipoprotein cholesterol; low density lipoprotein cholesterol; timolol; triacylglycerol; adult; article; cholesterol blood level; controlled study; crossover procedure; drug efficacy; drug mechanism; glaucoma; human; human experiment; lipoprotein blood level; male; normal human; patient compliance; priority journal; statistical analysis; topical drug administration; triacylglycerol blood level

Predicted outcome from hypotensive therapy for glaucomatous optic neuropathy - Van Buskirk, E.M.; Cioffi, G.A. (American Journal of Ophthalmology, 1993)
Keywords: antihypertensive activity; disease predisposition; glaucoma; human; hypertension; intraocular pressure abnormality; optic nerve disease; patient compliance; prediction; priority journal; review; risk factor

Timolol-pilocarpine fixed-ratio combinations in the treatment of chronic open angle glaucoma [4] - Moriarty, A.P.; Dowd, T.C.; Puustjarvi, T.J.; Repo, L.P. (Archives of Ophthalmology, 1993)
Keywords: pilocarpine; timolol; dose response; drug mixture; human; intraocular pressure; letter; open angle glaucoma; patient compliance; priority journal

Central vein occlusion study of photocoagulation. Manual of operations. Central Vein Occlusion Study Group. (The Online journal of current clinical trials, 1993)
This paper is the complete protocol (Manual of Operations) used in the Central Vein Occlusion Study (CVOS). The CVOS is a randomized clinical trial and natural history study of central retinal vein occlusion supported by the National Eye Institute. The administrative structure includes a Data and Safety Monitoring Board, 9 clinical centers, a coordinating center, and a photograph reading center. The Manual of Operations describes study design, organization, policies, and procedures. Procedures described in detail include measurement of visual acuity, fundus and iris photography, fluorescein angiography, and quality control.
Keywords: adult; article; clinical protocol; clinical trial; controlled clinical trial; human; iris; ischemia; laser coagulation; methodology; multicenter study; neovascular glaucoma; neovascularization (pathology); patient compliance; prospective study; randomized controlled trial; retina artery occlusion; retina macula cystoid edema; vascularization; visual acuity

Issues in international ophthalmology - Egbert, P.R. (Seminars in Ophthalmology, 1993)
Keywords: blindness; cataract; cataract extraction; Ghana; glaucoma; health care availability; health care utilization; human; India; Nepal; onchocerciasis; Peru; priority journal; review; trachoma; xerophthalmia

Primary open-angle glaucoma: Compliance with treatment and repercussion of glaucoma on the patient's life. Concerning 341 cases in the department of Marne, France - Bour, T.; Blanchard, F.; Segal, A. (Journal Francais d'Ophtalmologie, 1993)
Patient compliance with treatment is an important factor in chronic diseases such as primary open-angle glaucoma (POAG). Among the 404 glaucoma patients included in our study in the department of Marne (France), 341 patients responded by completing an anonymous questionnaire at home in which the psychological effect of the illness, their knowledge about it, compliance with treatment and their relationships with the physician were explored. Sixty-eight per cent of these patients confirmed strict compliance with the treatment prescribed; this rate does not vary with respect to either the ophthalmologist (p = 0.57), or the duration of treatment (p = 0.42). Half of the remaining patients only alter the hours of their treatment and 6% forget to instil the eyedrops on certain days. According to our survey, the principal causes of poor compliance are forgetfulness, time constraints with other duties, poor doctor-patient relationship and lack of sufficient knowledge about the disease and its treatment. The majority of patients (59%) are minimally disturbed by the treatment; 2/3 of the subjects do not feel any change in their morale whereas 15% are more depressed or weakened since the time the illness was discovered. Fifty-six per cent of them observed little or no change in their vision; 32% believe to have a moderate or considerable repercussion and 6% claim a very severe visual deterioration. Generally, patients appear to have a positive attitude towards their illness and do not try to deny it. Thirty-eight per cent of them consider it as a handicap which they can overcome and 42% have either no particular opinion or take it as a minor event.
Keywords: acetazolamide; adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carteolol; pilocarpine; timolol; timolol maleate; adult; aged; article; controlled study; doctor patient relationship; France; human; major clinical study; open angle glaucoma; patient compliance; questionnaire; carteol; diamox; timoptol

Maintained intraocular pressure reduction with once-a-day application of a new prostaglandin F(2α) analogue (PhXA41): An in-hospital, placebo- controlled study - Racz, P.; Ruzsonyi, M.R.; Nagy, Z.T.; Bito, L.Z. (Archives of Ophthalmology, 1993)
To eliminate uncertainties about compliance, 15 patients with glaucoma (intraocular pressure [IOP] >22 mm Hg and <40 mm Hg) were hospitalized to participate in a clinical trial of the ocular hypotensive effectiveness of the new prostaglandin F(2α) analogue prodrug, PhXA41 (13,14-dihydro-17- phenyl-18, 19, 20-trinor-PGF(2α)-isopropyl ester; latanoprost [World Health Organization generic name]). At 9 PM on each of five consecutive days, one of the investigators applied one drop of a 0.006% solution of PhXA41 (representing approximately 2 μg of PhXA41 per treatment) to one eye of nine patients and one drop of placebo to one eye of six patients. This was followed by an evaluation of potential local side effects at 9:30 PM. Complete examinations, including tonometry (Goldmann), were also performed at 8 AM and 8 PM on days 1 to 6, as well as at noon and 4 PM on days 1, 2, and 6. Except for mild conjunctival hyperemia in two PhXA41-treated eyes (once each at 8 AM), no side effects were observed or reported by any patient. Starting with the first IOP measurement after the first treatment (8 AM on day 2), IOP was reduced by 20% to 30% in the eyes treated with PhXA41. This reduction was highly significant (P<.01 at 12 time points and P<.05 at the remaining two measurements) throughout the study. The IOP reduction did not become attenuated during the 23 hours after treatments. At 11 hours after the last treatment, the mean (±SD) IOP difference between PhXA41-treated and contralateral control eyes was -5.5±2.8 mm Hg, as compared with -6.1±1.8 mm Hg 12 hours later. PhXA41 must, therefore, be regarded as an excellent candidate for use as a once-a-day glaucoma medication.
Keywords: drug analog; eye drops; latanoprost; phxa 41; placebo; prodrug; timolol maleate; unclassified drug; adult; aged; aqueous humor flow; article; clinical article; controlled study; drug efficacy; drug potency; female; hospitalization; human; intraocular hypertension; intraocular pressure; male; open angle glaucoma; patient compliance; priority journal; slit lamp; tonometry; topical drug administration; phxa 41; timoptic

Treatment for glaucoma: Adherence by the elderly - Gurwitz, J.H.; Glynn, R.J.; Monane, M.; Everitt, D.E.; Gilden, D.; Smith, N.; Avorn, J. (American Journal of Public Health, 1993)
Objectives. The purpose of this study was to determine the extent of nonadherence to treatment for glaucoma among elderly patients. Methods. This was a retrospective cohort study of 2440 patients older than age 65 who were enrolled in the New Jersey Medicaid Program and who were newly initiated on a topical agent for the treatment of glaucoma. Two patient-specific measures of nonadherence were employed: (1) no filled prescription for any glaucoma medication over a 12-month period after the initiation of therapy and (2) number of days without therapy for glaucoma during this 12-month period. Results. By the first measure, 569 patients (23%) were found to be nonadherent. The mean number of days without therapy during the study year was 112. Factors associated with nonadherence included the use of glaucoma medication requiring more than 2 administrations per day and the presence of multiple other medications in the patient's drug regimen. Patients started on multiple glaucoma medications were more adherent than those started on a single agent. Age and sex were not found to be predictors of nonadherence. Conclusions. Substantial nonadherence was found to be common in this population. More attention to the issue of nonadherence could result in important benefits in the preservation of sight.
Keywords: adult; aged; article; cost effectiveness analysis; counseling; elderly care; eye protection; female; glaucoma; human; major clinical study; male; medicaid; patient compliance; priority journal; topical treatment; visual impairment

Systemic and local tolerability of ophthalmic drug formulations: An update - Hugues, F.-C.; Le Jeunne, C. (Drug Safety, 1993)
All eye drops raise problems of local tolerance, but with variable frequencies. They can induce pain on instillation, allergic reactions, delayed healing, punctate keratitis, disturbances of lacrimal secretion, disturbances of accommodation (especially the parasympathomimetics) and local pigmentation after prolonged use. Corticosteroids are associated with 2 major risks: chronic glaucoma and cataract, initially reversible if treatment is stopped. There is still a major risk of corneal herpes with corticosteroids. It is important to be aware of these local problems as they are responsible for poor patient compliance. The systemic effects essentially concern the agonists and antagonists of the autonomic nervous system. β-Blocker eye drops can cause bronchospasm, heart failure, syncope and psychiatric disorders, especially at high doses and with nonselective β-blockers. These consequences are usually related to failure to comply with the prescribing precautions. α-Adrenergic agonists, which exert dose-dependent effects, can induce hypertensive crises or angina attacks. Apart from patients at risk (children under the age of 30 months and the elderly), parasympathomimetics cause few systemic adverse effects; anticholinesterases, which have curare-like properties, are contraindicated for 6 weeks before general anaesthesia. In the very young and the very old, atropinic eye drops carry a risk of cardiovascular collapse and neuropsychiatric disturbances. Problems may also occur with other classes of drugs such as anti-infectives, antiseptics, anti-inflammatories and contact lens products. Nevertheless, it is clear that this form of treatment is generally very well tolerated in relation to the volume of eye drops prescribed by ophthalmologists each day.
Keywords: alpha adrenergic receptor stimulating agent; antibiotic agent; antivirus agent; atropine derivative; beta adrenergic receptor blocking agent; betaxolol; carteolol; cholinergic receptor blocking agent; cholinergic receptor stimulating agent; corticosteroid; eye drops; local anesthetic agent; metipranolol; timolol; accommodation; allergic reaction; angina pectoris; article; bronchospasm; cataract; drug tolerance; glaucoma; heart failure; herpes simplex keratitis; hypertension; lacrimation; mental disease; pain; patient compliance; punctate keratitis; respiratory tract disease; shock; faintness

Patient outcomes with co-managed post-operative care after cataract surgery - Revicki, D.A.; Brown, R.E.; Adler, M.A. (Journal of Clinical Epidemiology, 1993)
This study examined the practice of co-managed post-operative care and the visual acuity outcomes and complications associated with co-managed services. Data on service utilization and medical outcomes were collected for 2822 cataract surgery procedures performed in 5 ambulatory eye centers between January and July 1988. Average age of patients was 72.8 (SD=10.4) and 63% were female. Eighty-seven percent of eyes were co-managed. Average number of post-operative visits within 90 days was 4.7 and 6.2 for co-managed cases with and without complications, respectively. Successful visual acuity outcomes (<20/40) were experienced by 86% of all co-managed patients. There was evidence that patients with pre-existing ocular conditions (e.g. glaucoma, macular degeneration) and serious post-surgical complications were not referred for co-management. For co-managed patients without pre-existing medical or ocular conditions, 92% had successful vision outcomes, while 77-90% with these conditions had successful outcomes. Ninety-three percent of co-managed cases had no post-operative complications, and the rate of specific types of complications ranged from 0.04 to 2.0%. Using physician evaluations as the standard, sensitivity of optometrist detection of complications was 59% and specificity was 99.6%. Optometrists located in separate offices demonstrated 95.8% accuracy in assessing patients for post-operative complications.
Keywords: adult; aged; article; cataract; cataract extraction; controlled study; diagnostic accuracy; female; glaucoma; health care utilization; human; major clinical study; male; optometry; outpatient; postoperative care; postoperative complication; priority journal; prognosis; macular degeneration; surgical patient; visual acuity

Initial treatment of glaucoma: Surgery or medications - Sherwood, M.B.; Migdal, C.S.; Hitchings, R.A.; Sharir, M.; Zimmerman, T.J.; Schultz, J.S. (Survey of Ophthalmology, 1993)
Should surgery or medications be the initial therapy for primary open angle glaucoma? In this set of articles, Drs. Sherwood, Migdal, and Hitchings present evidence suggesting that filtration surgery provides better intraocular pressure control than does medical treatment, good (or better) visual field preservation, and visual acuity as good as that in medically treated fellow eyes. They also cite cost effectiveness, quality of life, and possible adverse effects of medical treatment on future surgery. Drs. Sharir and Zimmerman, on the other hand, favor initial medical therapy, questioning the validity of some reports on surgical results, citing the risks of complications, and noting recent and current progress in the development of antiglaucoma medications. Dr. Schultz' editorial evaluates both points of view, concluding that additional prospective randomized tests may be useful and that either approach may be a viable option, as long as it is individualized to each particular patient.
Keywords: acetazolamide; adrenergic receptor blocking agent; carbonate dehydratase inhibitor; dipivefrine; pilocarpine; timolol; aplastic anemia; cost benefit analysis; drug fatality; eye irritation; filtering operation; gastrointestinal toxicity; glaucoma; glaucoma surgery; human; intraocular pressure; long term care; patient compliance; priority journal; quality of life; review; surgical risk; topical drug administration

Glaucoma: Treatment and compliance - Gossel, T.A. (U.S. Pharmacist, 1992)
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; carbachol; carbonate dehydratase inhibitor; carteolol; demecarium; dipivefrine; dyflos; ecothiopate; ecothiopate iodide; glycerol; levobunolol; mannitol; metipranolol; miotic agent; mydriatic agent; physostigmine; pilocarpine; timolol; timolol maleate; urea; aqueous humor; article; closed angle glaucoma; cornea disease; cyst; drug mechanism; genetic predisposition; glaucoma; headache; human; hyperemia; intraocular pressure; iridectomy; myopia; open angle glaucoma; patient compliance; patient counseling; visual field defect; visual impairment; betagan; betoptic; humorsol; isopto carbachol; ocupress; ocusert pilo 20; optipranolol; phospholine iodide; timoptol

Should laser trabeculoplasty be the initial mode of treatment in open- angle glaucoma? - Savitt, M.L.; Wilensky, J.T. (Seminars in Ophthalmology, 1992)
Keywords: beta adrenergic receptor blocking agent; miotic agent; timolol; argon laser; dry eye; filtering operation; human; medical decision making; open angle glaucoma; patient compliance; priority journal; ptosis (eyelid); review; topical drug administration; trabeculoplasty; treatment planning; vision

Once-daily versus twice-daily levobunolol (0.5%) therapy: A crossover study - Derick, R.J.; Robin, A.L.; Tielsch, J.; Wexler, J.L.; Kelley, E.P.; Stoecker, J.F.; Novack, G.D.; Coleman, A.L. (Ophthalmology, 1992)
The authors executed a two-period, randomized, double-masked, crossover study comparing once-daily to twice-daily levobunolol hydrochloride (0.5%) in 20 patients with elevated intraocular pressure (IOP). Modified diurnal curves were performed at four times for each study arm: baseline, day 1, day 14, and day 28. The mean diurnal corrected decrease in IOP from baseline ranged from 16% ± 11% to 22% ± 9% when the subjects were treated twice daily, and from 14% ± 10% to 18% ± 8% when the same subjects were treated once daily. At day 1, patients had a significantly greater IOP lowering after twice-daily therapy than after once-daily therapy (P < 0.05). At 14 and 28 days, there was no clinically significant difference between the two treatment regimens. The results of our crossover study suggest that once-daily treatment with levobunolol (0.5%) is as effective as twice-daily treatment.
Keywords: levobunolol; timolol; adult; aged; circadian rhythm; clinical article; conference paper; demography; dose response; drug cost; drug efficacy; female; heart rate; human; intraocular hypertension; intraocular pressure; male; open angle glaucoma; patient compliance; phase 1 clinical trial; phase 2 clinical trial; priority journal; topical drug administration

A mechanical device for temporary nasolacrimal occlusion [3] - Hubbe, R.E.; Shields, M.B. (American Journal of Ophthalmology, 1992)
Keywords: controlled study; devices; drug absorption; drug blood level; drug metabolism; glaucoma; human; human experiment; devices; lacrimal duct occlusion; letter; normal human; nose mucosa; patient compliance; priority journal; topical treatment

Side effects of topical treatment in pigmentary glaucoma - Lehto, I. (Acta Ophthalmologica, 1992)
A series of 35 patients with pigmentary glaucoma were asked to report possible side effects of topical glaucoma medication using a multiple-choice questionnaire. Of the 31 patients (89%) returning the forms, 22 (71%) were men and 9 (29%) women with a mean age of 45.1 years, range 23 to 72 years. The mean follow-up time of their glaucoma was 10.7 years, range 2 to 30 years. A mild burning feeling (in 50% in all treatment groups) and redness of the eyes (in 42% treated with timolol alone and in 50% with timolol combined with dipivephrine, pilocarpine or both) were the main complaints, followed by a slight reduction of vision (in 17% in the timolol group and in 56% with combined treatment) and mild watering of the eyes (in 42% of the timolol and in 31% of the combined treatment groups). Twenty-three percent of the patients did not have any side effects from their topical medication. Patients who admitted defaulting their topical treatment once a month amounted to 43% and once a week to 17%. Patients who admitted to never having missed a drop amounted to 40% of the sample; forgetfulness and haste were the main reasons for not applying the drops.
Keywords: epinephrine; dipivefrine; pilocarpine; timolol; adult; aged; article; burn; clinical article; drug tolerance; dyspnea; eye inflammation; female; headache; human; male; muscle hypotonia; mydriasis; open angle glaucoma; patient compliance; pigment disorder; priority journal; questionnaire; topical drug administration; topical treatment; vertigo; visual impairment

Cataract surgery in Fuchs' heterochromic iridocyclitis - Sherwood, D.R.; Rosenthal, A.R. (British Journal of Ophthalmology, 1992)
Eighteen eyes in 17 patients with Fuchs' heterochromic iridocyclitis underwent cataract extraction with or without intraocular lens implantation (17 extracapsular and one intracapsular). Intraoperative complications included hyphaema, poor pupillary dilatations, and localised zonule dehiscence with vitreous loss. Only four eyes developed a marked anterior uveitus (two pseudophakic and two aphakic) which resolved within 2 weeks with topical steroids. Three eyes developed a rise in intraocular pressure (IOP) to more than 30 mm Hg on the first postoperative day. In all three eyes the IOP returned to normal off all therapy within 1 week. In one of three eyes preoperative glaucoma was made worse following surgery. Visual acuity testing revealed that 15 eyes (83.3%) achieved 6/12 vision or better. Lamellar macular hole, pre-existing macular scar, and pre-existing retinal detachment accounted for the poor visual result.
Keywords: steroid; adult; aged; article; cataract extraction; clinical article; contact lens; female; glaucoma; human; hyphema; intraocular hypertension; iridocyclitis; male; patient compliance; peroperative complication; postoperative complication; priority journal; pupil reflex; retina detachment; retina macula hole; scar; topical drug administration; uveitis; visual acuity; vitreous body; wound dehiscence

Glaucoma blindness in Denmark - Fuchs, J.; Nissen, K.R.; Goldschmidt, E. (Acta Ophthalmologica, 1992)
In order to evaluate the prevalence and the incidence of glaucoma blindness in Denmark, all registration forms of persons ≥ 50 years of age at admission, admitted to the Danish Association of the Blind (DAB) between 1955 and 1987 with glaucoma as main, cause of blindness, were examined. In 1987 6.7% of DAB members ≥ 50 years of age suffered from blindness caused at least partially by glaucoma, equivalent to an estimated prevalence of 45 per 100,000 of the Danish population ≥ 50 years. The estimated annual incidence of blindness due to glaucoma was 7 per 100,000 ≥ 65 years, and in an equal number of patients glaucoma was a contributory cause of blindness. The incidence of blindness due to glaucoma was decreasing in the young age groups (< 65 years) throughout the study period. Glaucoma blindness seems to occur at a later age now than earlier, leaving the patients blind for a shorter time. This pattern may be explained by improved health services but could also be due to a change in the spontaneous course of glaucoma. The proportion of glaucoma blindness in the glaucoma population was estimated to be 4-5%.
Keywords: adult; aged; article; blindness; Denmark; disease course; female; glaucoma; health care quality; human; major clinical study; male; morbidity; onset age; patient compliance; priority journal; prognosis; sex difference; visual acuity

Compliance aids--do they work? - Rivers, P.H. (Drugs & aging, 1992)
The decision to use a compliance aid will depend on the motivation of the patient, their specific medication regimen, and their physical and cognitive ability. The administration of oral medicines may be facilitated through the appropriate use of 'organisers' which act as aides memoire. 'Medidos' and 'Dosett' are the most frequently studied compliance aids and both have been shown to be beneficial to the elderly and to community-based psychiatric patients. Adherence to a medication regimen may be improved without the use of proprietary compliance aids by ensuring that the most appropriate traditional container is used and by paying attention to the highest standard of labelling on the medicine container. Gadgets that are designed to improve physical dexterity can be useful when applying topical preparations, administering insulin injections, operating pressurised inhalers or administering eyedrops. The accurate administration of eyedrops is particularly important when treating glaucoma and may be facilitated by using devices that are designed to help with aiming of the eyedrops ('Easidrop', 'Mumford Auto-drop,' 'Opticare'). If squeezing the eyedrop container is a problem the 'Opticare' device may be particularly suitable. There may be value in the use of the compliance aids to provide assistance to carers who become involved with preparing medication for patients. Selection of an appropriate compliance aid is not likely to be the total solution to inadequate adherence and most patients will require a combination of strategies to facilitate adherence to treatment with medicines.
Keywords: drug; eye drops; adolescent; adult; aged; drug packaging; female; human; male; middle aged; oral drug administration; patient compliance; patient education; review; self help

Drug treatment of depression in medically ill patients - Series, H.G. (Journal of Psychosomatic Research, 1992)
Depressive symptoms are common in medically ill patients although depressive disorders are considerably underdiagnosed and undertreated. Drug treatments for depression are reviewed in terms of a risk/benefit analysis. The main benefit is approximately to double the chance of recovery (from about 30 to 65%), with possible associated improvements in physical condition. The risks of treatment are considerable and include overdose, unwanted effects at therapeutic dose and interaction with other drugs. Among the risks associated with specific medical conditions are orthostatic hypotension, cardiotoxicity, deterioration of seizure control in epileptic patients and increased side effects in patients with renal and hepatic impairment. The available data suggest that there is relatively little to choose between antidepressants in terms of efficacy (although the quantity and quality of these data vary). It is therefore primarily the risks which should determine the choice or antidepressant, and these must be separately evaluated for each patient.
Keywords: antidepressant agent; imipramine; mianserin; nortriptyline; trazodone; agranulocytosis; anticholinergic effect; cardiotoxicity; closed angle glaucoma; constipation; cost; delirium; depression; digestive system function disorder; drug efficacy; drug mechanism; drug metabolism; drug overdose; epilepsy; headache; human; kidney disease; liver disease; morbidity; mouth disease; nausea; orthostatic hypotension; patient compliance; physical disease; priapism; review; risk; seizure; stomach emptying; tremor; urine retention; xerostomia

Undertreatment of glaucoma among black Americans - Javitt, J.C.; McBean, A.M.; Nicholson, G.A.; Babish, J.D.; Warren, J.L.; Krakauer, H. (New England Journal of Medicine, 1991)
Background. Cross-sectional studies and those using national data sets estimate that glaucoma-related blindness is between six and eight times more common among black Americans than among whites. Community-based studies have found that glaucoma is four to six times more prevalent among blacks. It is not known why blacks with glaucoma are more likely to become blind than whites with glaucoma. Methods. To investigate the possibility that undertreatment of glaucoma is an important factor contributing to this higher rate of blindness, we studied the population-based rates of incisional and laser surgery for open-angle glaucoma among blacks and whites in a 5 percent random sample of Medicare claims for 1986 through 1988. Results. For all U.S. census divisions combined, the rate of surgery for glaucoma among black Medicare beneficiaries was 2.2 times higher than the rate among white beneficiaries (95 percent confidence interval, 2.1 to 2.3). We calculated an expected rate of treatment among blacks on the basis of the rate of treatment among whites and the assumption that glaucoma is four times more prevalent among blacks - a conservative estimate. The observed rate of glaucoma surgery among blacks was 45 percent lower than the expected rate we calculated, which may in part account for the excess rate of blindness among blacks. The magnitude of this difference in treatment rates varied from 29 percent in the Middle Atlantic states to 50 percent in the South Atlantic states. Conclusions. Older black Americans are not receiving potentially sight-saving care for open-angle glaucoma at the same rate as older white Americans.
Keywords: aged; article; blindness; ethnic difference; health care utilization; human; Black person; open angle glaucoma; prevalence; priority journal; United States

Ophthalmology in the Oxford region: Analysis of time trends from linked statistics - Ferguson, J.A.; Goldacre, M.J.; Henderson, J.; Bron, A.J. (Eye, 1991)
Objectives: to report on trends in ophthalmology workload using linked statistical data; Design: analysis of linked abstracts of hospital inpatient and day case records for ophthalmology; Setting: six districts in Southern England covered by the Oxford record linkage study; Subjects: records for hospital admissions to ophthalmology from 1975 to 1985; Measurement and Main Results: Over the period of study, the number of episodes of inpatient and day case care increased by 16.3%. Notable increases in age-specific admission rates were seen among the elderly. An increase in the number of individuals treated contributed about 67% and an increase in multiple admissions per individual contributed about 33% to the increase in admission rates. Both average length of stay per episode and total time in hospital per individual decreased consistently during the 11 years; and there was no increase in emergency readmissions over time. No significant changes over time were found in admission rates for retinal detachments and defects or for glaucoma. There was a statistically significant increase averaging 4.8% per annum in admission rates for cataract, and a significant decrease averaging 5.2% per annum in admission rates for strabismus and other disorders of binocular eye movement between 1975 and 1985. Conclusions: Age-specific admission rates in ophthalmology are much higher in the very young and old than in other age groups. Patterns of work in the specialty are therefore particularly affected by variation in the age distribution of the population. The increase in cataract surgery reflected both the increase in numbers of old people in the population and an increase in age-specific operation rates for cataract. Attempts to alter attitudes and behaviour of the elderly regarding eye diseases, disability, and facilities for treatment may have had a positive impact on the use of services. The decrease in admissions for children probably reflects the impact made by child health surveillance programmes. As the child screening programme has expanded, the admission rates for strabismus have decreased.
Keywords: adolescent; adult; age; aged; ambulatory surgery; article; cataract; cataract extraction; child; child health; eye movement; glaucoma; health care utilization; hospital admission; hospital patient; human; infant; length of stay; ophthalmology; patient attitude; retina detachment; strabismus; United Kingdom; workload

Liability for extended-wear contact lenses. - Classé, J.G. (Optometry clinics : the official publication of the Prentice Society, 1991)
Because of the risk of serious complication that accompanies the extended wear of contact lenses, clinical management should emphasize adequate communication with the patient and a systematic program of examination and follow-up. Management should be in compliance with informed consent requirements, which obligate practitioners to document instructions, findings, warnings, and recall examinations. The most likely legal claim is one of negligence, and the most common causes of liability are inappropriate patient selection, improper wearing schedules, improper management of contact lens-related complications (especially corneal abrasions), and inadequate monitoring of ocular health. In determining the liability of optometrists, a medical standard of care may be applied.
Keywords: cornea ulcer; disposable equipment; extended wear contact lens; human; legal aspect; legal liability; malpractice; optometry; patient compliance; review; risk factor

The effect of a glaucoma medication reminder cap on patient compliance and intraocular pressure - Chang Jr., J.S.; Lee, D.A.; Petursson, G.; Spaeth, G.; Zimmerman, T.J.; Hoskins, H.D.; Mills, R.; Brown, R.; Kass, M.; Lue, J. (Journal of Ocular Pharmacology, 1991)
A multi-site, open-labeled clinical trial was conducted to evaluate the ease of use and acceptance of a newly developed medication cap with a memory aid (C Cap(TM) Compliance Cap, Allergan, Inc.) and its effect on patient compliance and intraocular pressure. One-hundred-twenty-two patients with glaucoma or ocular hypertension received their prescribed eye drops in bottles with the compliance cap. Overall, 83% of the patients found the compliance cap very easy to use. By the end of the study, significantly more patients (67%) claimed 100% compliance than prior to using the compliance cap (41%). An overall drop in intraocular pressure of 0.8 mm Hg was seen. However, in a subset of patients who reported an increase in compliance, mean intraocular pressure decreased from baseline by 1.7 mm Hg. The results of this study suggest that the compliance cap helps patients with glaucoma or ocular hypertension remember to take their medication as prescribed.
Keywords: dipivefrine; levobunolol; pilocarpine; adolescent; adult; article; clinical trial; female; glaucoma; human; intraocular pressure; major clinical study; male; patient compliance

The use of a new portable noncontact tonometer in home tonometry. - Stewart, W.C.; Cascairo, M.A.; Banta, R. (Annals of ophthalmology, 1991)
We used a new portable noncontact tonometer for home tonometry on 26 patients with chronic open-angle glaucoma or suspected low-tension glaucoma. In an outpatient setting, the mean difference and correlation coefficient between the family member's noncontact tonometry values and the nursing staff's applanation tonometry values used as a control was 1.0mmHg and 0.894mmHg, respectively. The difference between the means was not statistically significant (P greater than .05, by Student's t test). At home, the variances of four noncontact tonometric values obtained every other hour did not differ significantly from those obtained in the outpatient setting by the nursing staff (P greater than .05). Five of 26 patients had their medical regimen changed based on the results of home tonometry. This study suggests that many nonmedical personnel can do noncontact tonometric scanning reliably. At home, noncontact tonometry may help evaluate a patient's intraocular pressure control.
Keywords: adult; aged; ambulatory care; article; comparative study; female; human; devices; intraocular hypertension; intraocular pressure; male; middle aged; monitoring; oculoplethysmography; open angle glaucoma; pathophysiology

Effectiveness of the C Cap(TM) in promoting prescription refill compliance among patients with glaucoma - Sclar, D.A.; Skaer, T.L.; Chin, A.; Okamoto, M.P.; Nakahiro, R.K.; Gill, M.A. (Clinical Therapeutics, 1991)
In an attempt to increase patient compliance with a dosing regimen, prescriptions for topical solutions of glaucoma medication were refilled using the C Cap(TM), a memory aid designed to help patients to remember to instill the medication as prescribed. A comparison of the number of prescription refills requested by 121 patients with glaucoma showed that patients who received the C Cap requested significantly more refills in the six months after receiving the C Cap than before and requested significantly more refills than did patients who did not receive the C Cap.
Keywords: dipivefrine; levobunolol; timolol; timolol maleate; adult; article; drug delivery system; female; glaucoma; human; major clinical study; male; patient compliance; priority journal; topical drug administration; betagan; propine; timoptic

Real-time compliance data to help define optimal drug regimens - Urquhart, J. (Annals of the New York Academy of Sciences, 1991)
Patients dose in ways and at times other than they are supposed to in drug trials. The extent to which they deviate from instructions is sufficiently large that to ignore it is to underestimate the magnitude of drug effects or even sometimes to draw erroneous conclusions by use of primary analytical techniques meant to avoid bias. Intelligent use of secondary analyses, based on real-time regimen compliance data, opens a new window on the understanding of drug actions. These considerations are particularly important in attempt to learn whether drugs have clinically important time-of-day effects or other manifestations of biorhythmic phenomena. With about a third of patients taking only 40-80% of prescribed doses, and a substantial minority of doses being taken at times other than those requested, there is much potential for confusion if this dosing and dose-timing information is ignored or not taken advantage of in analysis of drug trials. It certainly seems clear that automatic drug-delivery systems capable of releasing drug according to a defined time schedule would obviate much of the 'dose-taking' and 'dose-timing' vagaries in outpatient drug therapy - especially to carry out chronotherapeutic regimens, if they can be defined. However, these vagaries in dosing can probably be turned to advantage to learn more from drug trials than is possible when one analyzes trial results on the usual assumption that all patients doses per protocol.
Keywords: colestyramine; pilocarpine; conference paper; drug dose; drug effect; drug monitoring; electronics; epilepsy; glaucoma; human; major clinical study; outpatient; patient compliance; priority journal; topical drug administration

New glaucoma drug may encourage compliance (Geriatrics, 1991)
Keywords: antiglaucoma agent; beta adrenergic receptor blocking agent; metipranolol; adult; aged; allergy; beta adrenergic receptor blocking; conjunctivitis; dermatitis; drug cost; human; intraocular hypertension; note; open angle glaucoma; patient compliance; priority journal; topical drug administration; optipranolol

Patient drug schedules and compliance. - Fingeret, M.; Schuettenberg, S.P. (Journal of the American Optometric Association, 1991)
Open-angle glaucoma is a chronic disease usually requiring a patient to take medications for the rest of his or her life. Because of the expense and side effects of the medications and due to a lack of understanding of the condition, many patients do not take their medications properly, often leading to progressive damage. A written instruction sheet completed for each patient covering their medication dosage schedule is an aid that may subtly remind individuals to use their medications, reducing the problems associated with noncompliance.
Keywords: adrenergic receptor blocking agent; article; drug administration; human; open angle glaucoma; patient compliance

New minitrephine makes lacrimal canalicular rehabilitation an office procedure - Sisler, H.A.; Allarakhia, L. (Ophthalmic Plastic and Reconstructive Surgery, 1990)
A new minitrephine, with a stainless steel tube of 0.81-mm outer diameter, 16-mm length, a plastic hub and handle assembly for manual rotation, Luer lock attachment to either standard or specially designed 3-ml syringe with spring-assisted plunger, and an intraluminal stylet - all disposable - has been designed by us principally for opening a distally occluded lacrimal canaliculus prior to stenting with any desired implant. Local anesthesia via a nasociliary nerve block makes this an office procedure. Other potential uses include transscleral globe biopsies of suspected malignancies, intraorbital biopsies, drainage of fluid-filled spaces wherein a beveled needle evacuation might undesirably pierce the far end of the cyst - all with possible ultrasonic monitoring - or the creation of a correctly sized, round, noncollapsible passage for a Molteno valve stenting of the anterior chamber, for intractable glaucoma.
Keywords: ambulatory care; clinical article; human; lacrimal duct; lacrimal duct occlusion; note; trephine

Screening for glaucomatous visual field loss. The effect of patient reliability - Katz, J.; Sommer, A. (Ophthalmology, 1990)
Eighty-eight glaucoma patients and 252 normal subjects underwent C-30-2 testing on the Humphrey Field Analyzer. The effect of fixation losses, high false-positive and false-negative response rates on visual field test results was assessed using the mirror image method of detecting asymmetry across the horizontal meridian, and the Humphrey STATPAC pattern standard deviation (PSD) and mean deviation (MD). Glaucoma patients with poor fixation (≥ 20%) had less depressed fields and fewer localized defects than those with good fixation. Fixation loss did not affect measures of localized defects or generalized depression among normal subjects. High false-positive rates (≥ 10%) were associated with less-depressed visual fields among glaucoma patients and normal subjects. Visual fields were depressed by an average of 9 dB for glaucoma patients and 7 dB for normal subjects with high false-negative rates (≥ 33%), when compared with those with low false-negative rates. Apparent localized defects were observed among normal subjects with high false-negative rates. Most of these defects were located in the superior nasal and adjacent arcuate area.
Keywords: article; computer analysis; computer assisted perimetry; eye fixation; glaucoma; human; major clinical study; methodology; patient compliance; priority journal

Aspects of glaucoma patient care and its impact on compliance - Amon, A.; Menapace, R.; Wedrich, A.; Radax, U. (Spektrum der Augenheilkunde, 1990)
Keywords: article; clinical article; education; glaucoma; human; methodology; patient care; patient compliance; patient education; psychological aspect

Maintaining a healthy eye. - Rakow, P.L. (Journal of ophthalmic nursing & technology, 1990)
Keywords: Acanthamoeba keratitis; allergic conjunctivitis; article; contact lens; human; patient compliance

Outcome of referrals by optometrists to general practitioners: an 18 month study in one practice. - Perkins, P. (The British journal of general practice : the journal of the Royal College of General Practitioners, 1990)
All general ophthalmic services forms (GOS18) received by one practice over an 18 month period were analysed and the patient outcome after two years noted from the practice records. Sixty one forms were collected. Fifty patients (82%) were referred by the general practitioners to the local eye hospital. Among the 45 patients that have so far been seen by an ophthalmologist, 22 (49%) were diagnosed as having cataracts, eight (18%) macular degeneration and two (4%) glaucoma. Thirteen patients (29%) were found to have normal eyes. Nine of the 61 patients (15%) were not referred to an ophthalmologist and two patients (3%) were already under review at the eye hospital. It is concluded that some referrals to ophthalmologists might be avoided if general practitioners received improved training in ophthalmology, However, general practitioners remain an effective filter in the referral system between optometrists and ophthalmologists.
Keywords: adolescent; adult; aged; ambulatory care; article; child; eye disease; female; general practice; human; infant; male; middle aged; optometry; patient attitude; patient referral; preschool child; prognosis; United Kingdom

Response properties of normal observers and patients during automated perimetry - Nelson-Quigg, J.M.; Twelker, J.D.; Johnson, C.A. (Archives of Ophthalmology, 1989)
Automated perimetry was performed on both eyes of 54 normal subjects, 36 patients with ocular hypertension and normal visual fields, and 20 patients with early glaucomatous visual field loss to evaluate false-positive errors, false-negative errors, fixation losses, consistency of double determinations, and testing time. For all subject groups and response measures, large interindividual variation was found. No meaningful age-related changes were obtained for false-negative errors, false-positive errors, fixation losses, or consistency of double determinations. Contrary to earlier reports, we found a low number of normal subjects and patients exceeding the 33% false-positive and false-negative limits established for the Humphrey Field Analyzer. A large number of normal subjects and patients, however, exceeded the 20% limits for fixation losses.
Keywords: clinical article; computer analysis; computer assisted perimetry; glaucoma; human; intraocular hypertension; patient compliance; priority journal; psychomotor performance; visual field defect

Glaucoma: Ignorance and apathy - Elliott, A.J. (Eye, 1989)
Keywords: clinical article; education; glaucoma; human; letter; methodology; patient compliance; patient education; patient information; psychological aspect

Personalities and chronic glaucoma - Demailly Ph.,; Zoute, C.; Castro, D. (Journal Francais d'Ophtalmologie, 1989)
Keywords: article; female; human; major clinical study; male; open angle glaucoma; patient compliance; personality

Dosage cost analysis in glaucoma management. - Gelvin, J.B.; Goen, T.M. (Journal of the American Optometric Association, 1989)
After the diagnosis of chronic open-angle glaucoma has been made, and the indications vs. contraindications of each of the potential first-line topical medications have been weighed, what medical therapy should be initiated if the most cost effective form of management is desired? We surveyed 40 pharmacies in four cities and found no statistical difference between the mean annual cost of therapy with timolol maleate (Timoptic), betaxolol (Betoptic), and pilocarpine. Statistically, both dipivefrin (Propine) and levobunolol (Betagan) were found to be more expensive. We also discovered that there are large variations in medication prices between various pharmacies. In order to enhance compliance, optometrists may want to know the pharmacies in their communities that offer antiglaucoma medications at reasonable prices.
Keywords: analysis of variance; article; cost; economics; human; open angle glaucoma; patient compliance; pharmacy (shop); randomization

The dynamics of the glaucoma process based on data from prolonged ambulatory care of patients - Bakurskaia, V.I.; Kunin, V.D. (Oftalmologicheskiǐ zhurnal, 1989)
On the basis of a prolonged dispensary observation (from 14 to 27 years) over 107 patients, the authors have studied timeliness of therapeutic and surgical treatment, dynamics of glaucomatous process after 3, 6, 9, 12, 15, 18, 21-27 years. In the beginning of the observation, initial and advanced stages (88.5%) with a moderate rise of intraocular pressure (69%) prevailed. With prolongation of observation, initial stages regularly turn into subsequent ones, sometimes in the presence of normal values of intraocular pressure. Stabilization of glaucomatous process was most frequently observed in patients who had underwent regular complex medicamentous therapy and timely surgical treatment. Glaucoma of stage I most frequently turns into more advanced stages with decreased visual functions within first three years. Therefore, it is in this period when patients should be subjected to thorough dispensary observation, timely refer to in-patient's treatment, and the question about surgical treatment be decided in early terms.
Keywords: aged; ambulatory care; article; female; glaucoma; human; male; middle aged; pathology; time

An analysis of the efficacy of ambulatory care of patients with glaucoma detected in the initial stages of the disease - Luchik, V.I.; Lovlia, G.D.; Astapova, N.N. (Oftalmologicheskiǐ zhurnal, 1989)
The study of effectivity of various terms of dispensary treatment of glaucomatous patients revealed at the initial stage of the disease was conducted by out-patient cards. The study covered 469 out-patient cards of glaucomatous patients aged from 35 to 85 years. The analysis of the results obtained has shown that normalization of intraocular pressure within the first year of dispensary treatment was achieved in 260 (55.4%) patients; surgical treatment was used in 144 (30.7%) patients. Dynamic observation in remote terms has shown stable normalization of intraocular pressure in 275 (58.6%) patients, its unstable normalization in the rest. Stabilization of visual functions took place in 338 (72.1%) patients. The most frequent turn of initial stage of glaucoma into subsequent ones is recorded to take place within 5 years of dispensary observation over the patients.
Keywords: adult; aged; ambulatory care; article; female; glaucoma; human; male; middle aged; time

Assessing the utility of reliability indices for automated visual fields. Testing ocular hypertensives - Bickler-Bluth, M.; Trick, G.L.; Kolker, A.E.; Cooper, D.G. (Ophthalmology, 1989)
Monocular (right eye) visual fields were recorded with the Humphrey Visual Field Analyzer (30-2 Program) at baseline as well as 6 and 12 months later in 120 patients with established ocular hypertension. Indices of field reliability (fixation loss, <20%; false-positives and false-negatives, <33%) and field sensitivity (mean deviation [MD] and pattern standard deviation [PSD]) were examined. At baseline, 35% of patients exhibited low reliability (LR) fields, a figure which decreased to approximately 25% at 6 and 12 months, respectively. During this period, over 50% of patients produced at least one LR field, whereas 8.3% were unable to produce even one reliable field. Exhibition of a LR field appeared to be independent of patient age. Fixation errors, the major cause of LR fields, decreased by approximately 10% over the 12-month period; most patients had between 20 and 32% fixation errors. The incidence of significant defects indentified by PSD was greater than that for MD; this was true for both reliable and LR fields. It is suggested that increasing the fixation loss criteria for assessing patient reliability to a 33% cutoff might substantially increase the percentage of fields graded reliable with minimal effect on the sensitivity or specificity of the test.
Keywords: computer analysis; computer assisted perimetry; human; intraocular hypertension; major clinical study; methodology; patient compliance; priority journal; reliability; visual field

An eyedrop medication monitor for the surveillance of patient non-compliance (III) - The examination of the evaluation method of the data (II) - Nakajima, S.; Kawano, K.; Mastunaga, A.; Tanzawa, I.; Tetzuka, H.; Tetzuka, M. (Japanese Journal of Hospital Pharmacy, 1988)
Keywords: pilocarpine; clinical article; glaucoma; human; patient compliance; prescription

Early diagnosis of initial glaucoma in a polyclinic - Korkhov, A.P. (Oftalmologicheskii zhurnal, 1988)
Keywords: ambulatory care; article; human; intraocular hypertension; time

Dispensary care of glaucoma patients - Kovaleva, T.V.; Vykhodtsev, V.P. (Meditsinskaia sestra, 1988)
Keywords: ambulatory care; article; glaucoma; human; intraocular pressure; Russian Federation

Moraxella corneal ulcer. - Parker, P. (Journal of ophthalmic nursing & technology, 1988)
Keywords: aged; article; bacterial infection; case report; cornea ulcer; human; male; middle aged; Moraxella; nursing; pathology; patient compliance

Glaucoma secondary to aphakia and its outpatient therapeutic management - Cânciu, G. (Revista de chirurgie, oncologie, radiologie, o. r. l., oftalmologie, stomatologie. Oftalmologie, 1988)
Keywords: aged; ambulatory care; aphakia; article; female; glaucoma; human; male; methodology; middle aged; multimodality cancer therapy

Effect of changing medication regimens in glaucoma patients - Novack, G.D.; David, R.; Lee, P.-F.; Freeman, M.I.; Duzman, E.; Batoosingh, A.L. (Ophthalmologica, 1988)
When glaucoma medication fails to adequately control intraocular pressure (IOP), a second medication is frequently added. Before adding a second drug to patients whose IOP was no longer controlled by 0.5% timolol, we tested the effect of switching to another beta blocker, levobunolol (0.5 or 1%). We also evaluated the effect of study participation on compliance in the control group continuing to receive 0.5% timolol. In each treatment group, the IOP of approximately 30-40% of the patients was successfully controlled for the 3-month study period. The remaining patients did not exhibit significant pressure reductions and were dropped from the study within 2 weeks. We concluded that (1) the results of 'switch' studies without a control group must be interpreted carefully, and (2) the initiation of a 'new regimen' with an equieffective beta blocker may be sufficient to increase compliance and thereby control IOP.
Keywords: levobunolol; timolol; clinical article; glaucoma; human; intraocular pressure; patient compliance; topical drug administration

Ambulatory care of patients with (surgically treated) glaucoma - Dobromyslov, A.N.; Panina, N.B. (Oftalmologicheskii zhurnal, 1987)
Keywords: aged; ambulatory care; article; female; glaucoma; human; male; middle aged; postoperative care

The economics of Ne-YAG laser treatment. - Rich, W. (Developments in ophthalmology, 1987)
Keywords: ambulatory care; article; cost; economics; glaucoma; hospitalization; human; iris; laser surgery; lens capsule; vitreous body

Data on the detection of glaucoma in polyclinics of Samarkand - Iusupov, A.I.; Saliev, M.S. (Vestnik oftalmologii, 1987)
Keywords: adult; ambulatory care; article; glaucoma; human; intraocular hypertension; middle aged; Uzbekistan

Dynamics of the glaucoma process (ambulatory care data) - Kolotkova, A.I.; Kamorina, T.I. (Vestnik oftalmologii, 1987)
Keywords: aged; ambulatory care; article; female; glaucoma; human; intraocular hypertension; male; middle aged

Management of open-angle glaucoma. - Stelmack, T.R. (Journal of the American Optometric Association, 1987)
Open-angle glaucoma is a non-curable, blinding disease which has its best prognosis when management begins at its earliest onset. Recent studies, such as those demonstrating axonal loss before functional or physical changes occur, will have an effect on the current standard of management. This includes indications for initiating treatment as well as what constitutes controlled intraocular pressure. Pharmacological management is often difficult due to drug tolerance and compliance problems. Some types of secondary open angle glaucomas respond very poorly to treatment. Hence, an accurate diagnosis is imperative to proper management. Principles underlying pharmacological management are discussed. When pharmacological management fails, laser and/or surgical intervention is required to prevent further vision loss.
Keywords: beta adrenergic receptor blocking agent; miotic agent; article; human; laser surgery; open angle glaucoma; pathophysiology; patient compliance; trabeculectomy

Effectiveness of ambulatory care and treatment of the early stages of open-angle glaucoma in elderly patients with atherosclerosis - Krivitskii, A.K. (Oftalmologicheskii zhurnal, 1987)
Keywords: aged; aging; ambulatory care; arteriosclerosis; article; human; middle aged; open angle glaucoma; pathology

Compliance with topical timolol treatment - Kass, M.A.; Gordon, M.; Morley Jr., R.E. (American Journal of Ophthalmology, 1987)
To determine if compliance with timolol treatment was better than compliance with pilocarpine treatment (as reported previously), we measured compliance with timolol treatment in a sample of 110 patients using an unobtrusive eyedrop medication monitor, which recorded electronically the date and time of each drug administration over a four- to six-week period. The patients administered a mean ± S.D. of 82.7% ± 19.0% of the prescribed timolol doses (range, 20% to 100%). Forty-five patients were treated concurrently with timolol and pilocarpine. These patients administered a mean ± S.D. of 84.3% ± 14.0% of the prescribed pilocarpine doses (P=.012, and van der Waerden test). Our results suggest that while compliance is influenced by the drug regimen, defaulting is not eliminated by prescribing a more convenient medication with fewer side effects.
Keywords: pilocarpine; timolol; timolol maleate; adverse drug reaction; compliance (physical); drug administration; drug comparison; drug dose; drug therapy; eye toxicity; glaucoma; human; intoxication; intraocular pressure; major clinical study; patient compliance; priority journal; self medication; therapy; visual system

A glaucoma medication time-table card. - Kooner, K.S.; Zimmerman, T.J. (Annals of ophthalmology, 1987)
Keywords: eye drops; drug administration; editorial; glaucoma; human; methodology; patient compliance; patient education

Acetazolamide and compliance in the preoperative glaucoma patient - Parrish II, R.K.; Davis, H.A. (Chibret International Journal of Ophthalmology, 1986)
Keywords: acetazolamide; carbonate dehydratase inhibitor; blood and hemopoietic system; carbon dioxide blood level; controlled study; drug efficacy; drug therapy; glaucoma; human; major clinical study; patient compliance; retrospective study; therapy; visual system

New drug therapy in open-angle glaucoma. - Patorgis, C.J.; Magnus, D. (Journal of the American Optometric Association, 1986)
Keywords: betaxolol; nadolol; propanolamine derivative; timolol; article; drug therapy; human; open angle glaucoma; patient compliance

Compliance with topical pilocarpine treatment - Kass, M.A.; Meltzer, D.W.; Gordon, M. (American Journal of Ophthalmology, 1986)
Using an unobtrusive eyedrop medication monitor, we measured compliance with topical pilocarpine treatment in a sample of 184 patients. The eyedrop monitor recorded electronically the date and time of each pilocarpine administration over a four- to six-week period. The subjects administered a mean ± S.D. of 76.0% ± 24.3% of the prescribed pilocarpine doses. Eleven patients (6%) took less than one quarter and 28 patients (15.2%) took less than one half of the prescribed administrations. In contrast, when the subjects were interviewed they reported taking a mean ± S.D. of 97.1% ± 5.9% of the prescribed pilocarpine doses. As determined by the monitor, 45 patients (24.5%) had at least one day per month with no administrations of pilocarpine; 56 subjects (30.4%) compressed the doses during the daytime hours, leaving an interval between the night dose and the morning dose the next day of 12 hours or more. The rate of compliance was significantly higher (P < .0001) in the 24-hour period preceding the return appointment than in the entire observation period.
Keywords: pilocarpine; clinical article; compliance (physical); drug administration; drug delivery system; drug formulation; drug therapy; glaucoma; human; intraocular pressure; patient compliance; priority journal; therapy; topical drug administration; visual system

Can ophthalmologists correctly identify patients defaulting from pilocarpine therapy? - Kass, M.A.; Gordon, M.; Meltzer, D.W. (American Journal of Ophthalmology, 1986)
We determined whether clinical measurements and assessments available to ophthalmologists could be used to identify patients who default from pilocarpine treatment. The measurements and assessments included intraocular pressure, pupillary diameter, pupillary reactivity to light, the patient's report of compliance, the physician's prediction of compliance, the patient's log of pilocarpine administration, and the weight of pilocarpine eyedrops utilized. Compliance with the pilocarpine regimen was measured with an unobtrusive eyedrop medication monitor. Intraocular pressure and pupillary diameter did not correlate with compliance to the regimen as measured by the eyedrop monitor. Pupillary reaction to light, the physician's prediction of compliance, a daily log of pilocarpine administration, the weight of pilocarpine utilized, and the patient's report of compliance correlated modestly with compliance as measured by the monitor (range of correlations, 0.19 to 0.24). However, none of these measures taken by itself or combined in any manner adequately distinguished patients with lower rates of compliance from those with higher rates of compliance. At present, the eyedrop monitor is the only reliable method for detecting patients who default from treatment.
Keywords: eye drops; pilocarpine; clinical article; drug delivery system; drug monitoring; drug therapy; glaucoma; human; intraocular pressure; patient compliance; priority journal; psychological aspect; pupil; therapy; topical drug administration; visual system

"Good morning: this is Mr. Cataract, and this is Mrs. Glaucoma". - Spaeth, G.L. (Ophthalmic surgery, 1986)
Keywords: ambulatory care; cataract extraction; cost benefit analysis; diagnosis related group; economics; editorial; glaucoma; health care delivery; human; legal aspect; length of stay

Improved outpatient care for patients in the initial stages of glaucoma - Dobromyslov, A.N.; Alekseev, V.N.; Kugleev, M.A. (Vestnik oftalmologii, 1986)
Keywords: ambulatory care; article; human; open angle glaucoma; Russian Federation

Principles of outpatient follow-up in ocular hypertension - Cherkasova, I.N. (Vestnik oftalmologii, 1986)
Keywords: ambulatory care; article; differential diagnosis; follow up; glaucoma; human; intraocular hypertension; risk

Experience in improving the effectiveness of the dispensarization of patients with primary glaucoma - Titenko, K.S.; Lovlia, G.D.; Luchik, V.I.; Mal'tseva, L.G. (Vrachebnoe delo, 1985)
Keywords: ambulatory care; article; glaucoma; health care quality; human; intraocular hypertension; mass screening; organization and management; Ukraine

Improved dispensary care for glaucoma patients in the polyclinic - Sporova, N.A.; Voitova, N.A.; Smirniagina, G.I.; Kozlova, L.P. (Vestnik oftalmologii, 1985)
Keywords: adult; aged; ambulatory care; article; female; glaucoma; health care quality; human; male; middle aged; Russian Federation; scotoma; standard

Combined conservative treatment in the system of dispensary observation of glaucoma patients - Titenko, K.S. (Oftalmologicheskii zhurnal, 1984)
Keywords: adult; aged; ambulatory care; article; comparative study; drug combination; female; glaucoma; human; male; middle aged

Early glaucoma detection in district health care facilities - Litvinenko, A.G. (Oftalmologicheskii zhurnal, 1984)
Keywords: adult; aged; ambulatory care; article; human; intraocular pressure; mass screening; middle aged; open angle glaucoma; Ukraine; vision test; visual field

Dispensary follow-up of patients with primary open-angle glaucoma - Sidorenko, S.A.; Sporova, N.A.; Voitova, R.N.; Kozlova, L.P. (Vestnik oftalmologii, 1984)
Keywords: adult; aged; ambulatory care; article; follow up; human; middle aged; open angle glaucoma

A reevaluation of glaucoma management. - Quigley, H.A. (International ophthalmology clinics, 1984)
Keywords: acetazolamide; epinephrine; pilocarpine; timolol; article; cataract; cost; drug effect; drug therapy; endophthalmitis; glaucoma; human; middle aged; patient compliance; postoperative complication; tachyphylaxis; time; trabecular meshwork; visual acuity

Combined procedures for cataract and glaucoma. - Hunsaker, J.; Kass, M.A. (International ophthalmology clinics, 1984)
Keywords: aged; anterior eye chamber; article; cataract; cataract extraction; follow up; human; open angle glaucoma; patient compliance; postoperative complication; procedures; time; trabecular meshwork

The office visit and the glaucoma patient. - Olander, K.W.; Zimmerman, T.J. (Annals of ophthalmology, 1984)
Keywords: ambulatory care; article; glaucoma; human

Trabeculo-retraction using an Argon laser in chronic open angle glaucoma - Malthieu, D.; Turut, P.; Sicard, C. (Bulletin des sociétés d'ophtalmologie de France, 1984)
Keywords: argon; adolescent; adult; aged; ambulatory care; article; child; chronic disease; female; human; laser; male; middle aged; open angle glaucoma; time; trabecular meshwork

Our experience in the out-patient treatment of glaucoma - Truşca, E.; Ionescu, M.; Niculescu, E. (Revista de chirurgie, oncologie, radiologie, o. r. l., oftalmologie, stomatologie. Oftalmologie, 1984)
Keywords: ambulatory care; article; glaucoma; human; outpatient department; Romania

Glaucoma screening. A cost-effectiveness analysis - Gottlieb, L.K.; Schwartz, B.; Pauker, S.G. (Survey of Ophthalmology, 1983)
We designed an intricate model of the process of glaucoma screening, diagnosis, and treatment in order to evaluate the medical care costs of such efforts in relation to the benefits in terms of quality-adjusted years of vision saved, utilizing the economic principles of cost-effectiveness analysis. Although a relatively limited data base and numerous assumptions concerning the accuracy of diagnostic tests, the natural history of ocular hypertension and glaucoma, and the effectiveness of available treatment modalities, limit our ability to draw definitive conclusions concerning the cost-effectiveness of various glaucoma screening options, our analysis indicates that glaucoma screening is probably cost-effective when targeted at certain subgroups of the population. Our analysis suggests that changes in several aspects of existing screening policies may be appropriate if cost-effectiveness is to be used as one of the criteria for the efficient allocation of resources to and within screening programs. Specifically, combinations of screening tests and screening targeted at high risk populations such as blacks, diabetics, and relatives of glaucoma patients are probably more cost-effective than screening of the general population with a single test. In younger populations, the importance of detecting ocular hypertension argues for the use of tonometry. Ophthalmoscopy may be more cost-effective in older age groups in whom the higher prevalence of glaucoma outweighs the need for identifying ocular hypertensives. In the very elderly, automated perimetry becomes cost-effective since the detection of established field loss will have greater yield. In addition, it is evident that diversion of resources away from actual screening efforts and towards efforts aimed at improving follow-up and compliance would be an additional cost-effective strategy.
Keywords: cost benefit analysis; diagnosis; economic aspect; glaucoma; human; prevention; screening test; social aspect; tonometry; visual field; visual search; visual system

The socioeconomic cost of glaucoma - Wolmark, (Revue internationale du trachome et de pathologie oculaire tropicale et subtropicale et de santé publique : organe de la Ligue contre le trachome avec la collaboration de l'International Organization against Trachoma et des organisations nationales et internationales de santé publique, 1983)
Keywords: adolescent; adult; aged; ambulatory care; article; blindness; child; cost; economics; female; France; glaucoma; health care cost; health service; hospitalization; human; infant; male; middle aged; newborn; preschool child; visual disorder

Therapeutic problems in ocular hypertension. - Sood, N.N.; Grover, A.K.; Agarwal, H.C. (Indian journal of ophthalmology, 1983)
Keywords: antihypertensive agent; article; economics; human; intraocular hypertension; patient compliance; psychology; tachyphylaxis

Metaphors of glaucoma. - Kugelmann, R.; Bensinger, R.E. (Culture, medicine and psychiatry, 1983)
In a phenomenological study of glaucoma as an illness, 31 patients were interviewed. The goal of the study was an explication of the meanings of the experience of glaucoma, in a twofold sense: (1) the face, the role, or the self of the patient that responds to the illness; (2) the visage that the illness presents to the patient. This twofold explication was achieved by generating a classification of the interviews in terms of the dominant metaphor that emerged in each interview. The following basic metaphors are presented through case material: glaucoma as an accompaniment of aging, as blindness, as pressure, as an abstraction (and a weapon), and as fate. Variations on these themes demonstrate the necessity, in such work and for enhanced communication with patients, of paying attention to both the face that the illness presents and to the self that responds.
Keywords: adaptive behavior; adult; aged; article; blindness; case report; doctor patient relationship; female; glaucoma; human; male; middle aged; patient attitude; patient compliance; psychological aspect; social isolation

Compliance with treatment of patients with chronic open-angle glaucoma - MacKean, J.M.; Elkington, A.R. (British Journal of Ophthalmology, 1983)
The compliance with treatment of 168 patients with chronic open-angle glaucoma was studied. 42% of the patients missed at least some of their medication. Patients were more likely to miss doses in the middle of the day than in the morning or evening. Two factors found to improve compliance were the knowledge of the name of their eye disease and the possible ill effects of having no treatment. Patients were more likely to be poor compliers if they had been prescribed medication to be used 3 or 4 times a day than if they had been told to use treatment only twice a day.
Keywords: acetazolamide; epinephrine; beta adrenergic receptor blocking agent; pilocarpine; case report; glaucoma; human; open angle glaucoma; patient compliance; therapy; visual system

The follow-up of patients with chronic open-angle glaucoma - Demailly Ph.,; Pittman, S.; Abadie, P. (Journal Francais d'Ophtalmologie, 1982)
Compliance to examinations performed in a specialised department was studied in patients with chronic open-angle glaucoma. A total of 429 case reports from patients treated from 1974 to 1977 were analyzed, follow-up being for a period of up to 7 years. Examinations were performed 2 or 3 times a year, and any patient who did not return for 2 consecutive years was considered as lost. The number of lost patients was very few, about 10% a year, and this did not increase during the whole follow-up period. Overall, compliance was not related to sex. However, a higher proportion of women were lost between the second and third year of follow-up. The distance between patient's homes and the medical center, near or far away, was not significant. As expected, a higher proportion of patients over 60 were lost after 1 year of follow-up.
Keywords: clinical article; glaucoma; human; open angle glaucoma; visual system

Pilocarpine T.I.D. -How is it taken? - Norell, S.E. (Pharmacy International, 1982)
Keywords: fluorescein; pilocarpine; glaucoma; methodology; patient compliance; self medication; short survey; therapy; topical drug administration; visual system